RU2803379C1 - Multifunctional exercise machine for rehabilitation and strengthening of arms and torso and method of its use - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention is related in particular to simulators for the rehabilitation of patients with disorders of the upper limbs, torso and central nervous system. The simulator contains a frame with the frames of the left and right seats fixed on it, including two pairs of handles, made with the possibility of raising the upper limbs in the frontal and sagittal planes in the sitting position of two patients at the same time. Each handle has a cable and block system in the form of a roller system with shock absorbers to create load or unload during exercise. Each handle has T-shaped connections with a lever with holes with a range of adjustment depending on the height, size, length of the patient's arms. The left and right parts of the simulator, containing the first and second sets of handles, are designed to work independently of each other, and are designed to be fastened together with fasteners with the possibility of separating and placing each half in a separate place from each other. The seats of the simulator are made with the possibility of height adjustment depending on the height of the patient. The simulator contains rollers adjustable in length for fixing the legs, and the cable block system with weight blocks is made with the possibility of adjusting the load on each arm separately. When performing exercises, the patient performs flexion-extension of straight arms by moving the handles of the first set or abduction-adduction of straight arms by moving the handles of the second set.

EFFECT: strengthening of the joints and muscles of the arms, trunk, treatment and rehabilitation of the musculoskeletal system, development of the patient's motor abilities and endurance by increasing the variability of changes in the load applied to various muscle groups of the trunk, arms and joints in the process of therapeutic measures or training, which is provided for by performing reciprocating movements of the shoulder girdle and upper limbs of the patient, with one and both hands simultaneously and alternately (flexion-extension and abduction-adduction of straight arms) in the frontal and sagittal planes in the sitting position.

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Description

Field of technology to which the invention relates

The group of inventions relates to the field of medicine and can be used for the treatment and rehabilitation of patients with muscle atrophy, contractures, spinal cord and brain injuries, cerebral palsy (CP), disorders of the musculoskeletal system, disorders of the central nervous system (including after strokes), with impaired motor functions of the upper extremities, and strengthening of the spine.

In addition, the multifunctional complex can be used for therapeutic exercises and sports training both in rehabilitation centers, gyms and fitness rooms, and at home for disabled people and people with disabilities, as well as people without disabilities.

State of the art

A multifunctional simulator is known for developing the muscles of the arms, legs, and torso. The technical result of the invention is to expand the functionality of the simulator. The simulator contains a base, a stand, a reclining seat, and a guide for collecting weights. In hollow racks with the possibility of movement, internal pipes are installed, connected at the top by a jumper. Platforms with handles are mounted on both sides of the lintel, and a Y-shaped handle is hingedly mounted in the center of the lintel. Rotary discs are installed under the seat, on which L-shaped levers with handles and holders are installed, with the possibility of reinstallation. On the rotary disks, in grooves made along their circumference, internal and external cables are laid, the ends of which are fixed at one point on the circumference of the disks. There are also horizontal blocks on the platform. A corner block is fixed to the lower crossbar of the rack at platform level. The cables from the disks, bending around the blocks on one side, are connected through the corner block to the fork of the lower pulley block. From the upper block of the pulley, the cable is connected through a block mounted on the handle shank to a set of weights (RF patent No. 2259221 dated 12/18/2003, published 08/27/2005).

The disadvantages of the known device are:

- the simulator is applicable to strengthen the muscles of people who can make certain movements with parts of the body, while in the claimed invention it is possible to develop the muscles and joints of practically immobile patients who cannot independently raise their arms;

- in the known simulator, its design allows the patient to do only abduction-adduction of the upper limbs during training, and in the claimed one both abduction-adduction and flexion-extension;

- the known device does not allow adjustment of the hand grips depending on the length of the patient’s arms, but the proposed one has such a possibility, and therefore it is suitable for both children and adults.

A multifunctional simulator is also known, containing a three-dimensional frame formed by vertical posts connected to each other in the upper and lower parts along the perimeter by horizontal beams, brackets mounted on the frame, load-bearing pulleys with cables connected to weights, benches connected by brackets to the frame, seats, stops for arms and legs and handles for arms, characterized in that it is made with equipment for training in seven positions, the frame is hexagonal, the horizontal upper beams are interconnected by a horizontal bracket laid along the diagonal of the hexagon and equipped at the protruding end with a crossbar with handles for training pulling up while standing, brackets with cable blocks are installed on the upper beams, the racks are equipped with vertical guides for loads connected to the cable pulleys, on two opposite sides of the frame, composite benches with soft seats and foot rests for training in a lying position are fixed with brackets to the lower horizontal beams , the first of which is made with a soft seat along most of the length of the bracket, between the vertical posts above the attachment point of the first bench there is a crossbar with two movable levers with handles at the free ends, and the second bench is made with an inclined soft seat installed at an angle to the bracket longer and with a soft seat of shorter length installed at a different angle to the bracket, and between the vertical posts above the attachment point of this bench there are two crossbars, one of which is connected to a soft seat of greater length, and the other is made with two installed with the ability to rotate and move along on the crossbar with levers with handles at the free ends for stretching training, on the other three sides of the frame to the lower horizontal beams in front of the mentioned guides with weights, composite benches with soft seats for training in a sitting position are fixed with brackets, one of these benches is equipped with a footrest, the other is equipped the support of the elbows of the hands, and the third - the support of the body, while the cable connected to one of the loads is equipped with handles suspended above the bench with a support for the body for training in pulling the cable, and the cables connected to the other two loads rest on pulleys installed above the benches and are equipped with handles located in front of the benches for training by pulling the cable, while on one side of the frame to the lower horizontal beam in front of the said guides with a load, a bracket and a pulley are attached, connected to the load by a cable, equipped at the upper and lower ends with handles for training by pulling the cable while standing ( RF patent No. 2304452 dated December 23, 2005, publ. 08/20/2007). The disadvantages of the known simulator are:

- the exercise machine does not have back supports, and therefore disabled people who cannot support their backs cannot train on it, whereas in the claimed invention there are such supports;

- the known model of the simulator does not contain adjustment of the length of the hand handles, while the claimed simulator does contain them.

- the known simulator allows the patient to do only flexion-extension of the arms during exercise, while the claimed one allows both flexion-extension and abduction-adduction of straight arms during training,

- in the known simulator, the handles for the hands contain handles made in one horizontal plane, while in the inventive simulator there are L-shaped handles located horizontally and vertically, and, therefore, this allows you to change the location of the hands when working with your hands, which consequently allows you to work out more the number of muscles sitting in one place.

Disclosure of the invention

The technical result of the group of inventions is the strengthening of the joints and muscles of the arms, torso, treatment and rehabilitation of the musculoskeletal system, the development of the patient’s motor capabilities and endurance by increasing the variability of changes in the load applied to different muscle groups of the torso, arms and joints during treatment or training , which is ensured by performing back-and-forth movements of the patient’s shoulder girdle and upper limbs, with one and two hands simultaneously and alternately (flexion-extension and abduction-adduction of straight arms) in the frontal and sagittal planes in a sitting position.

The essence of the invention is expressed in a set of essential features, in which:

a simulator for the rehabilitation of patients with various disorders of the upper extremities and torso, containing a simulator frame with frames of the left and right seats attached to it, incorporating two pairs of handles for hands rotating up and down, with the ability to raise the upper extremities in the frontal and sagittal planes ( flexion-extension and abduction-adduction of straight arms) in a sitting position for two patients at the same time,

each hand handle has its own cable block system to create load or unload during exercise, and contains pulley-drums with grooves with one end of the cable fixed by a spindle on it, attached to rotation units for moving the handles up and down, the other end of the cable secured with a fastening bolt to the load blocks,

cable block systems are roller systems consisting of six rollers in the upper part of the frame, four rollers of the beam of the left frame of the seat, two rollers of the beam of the right frame of the seat, as well as eight vertical guides for moving cargo blocks and contains bumpers-shock absorbers,

each hand grip has T-shaped connections with a lever with holes with a range of adjustment depending on the height, size, length of the patient's arms, and contains an L-shaped handle for grasping the hands in different positions (back of the hand from above, below and from the inside) to work more muscles of the patient,

the pulley-drums of the simulator regulate the initial upper and lower position (angle of location) of the hand handles through the holes on them, using locking pins,

the angle of rotation (movement) of the hand handles up and down is adjusted by bump stops,

the left and right parts of the simulator, containing the 1st and 2nd set of handles, work independently of each other (for the work of two patients), and are attached to each other with fasteners with the ability to separate and place each half in a separate place from each other,

in this case, the seat of the simulator is adjustable in height depending on the height of the patient,

in this case, the simulator contains length-adjustable rollers for fixing the legs depending on the functional limitations of the patients,

Moreover, each handle contains an eyelet for attaching additional weights when raising the arms up,

at the same time, the load on each hand can be adjusted separately through a cable-block system with weight blocks,

The method of patient rehabilitation, carried out using the simulator described above, consists of performing two types of exercises:

When performing the first type of exercise, the patient, sitting on the seat, holding L-shaped handles with both hands or one, rotating through rotation units containing pulley-drums, alternately or simultaneously performs reciprocating movements of the upper limbs up and down (flexion- extension of straight arms), moving the hand handles of the 1st set in the sagittal plane,

when performing an exercise of the second type, the patient, sitting on a seat, holding with two hands or one on L-shaped handles rotating through rotation units containing pulley-drums, alternately or simultaneously performs reciprocating movements of the upper limbs up and down (abduction-adduction of straight lines hands), moving the hand handles of the 2nd set in the frontal plane.

The cause-and-effect relationship of the characteristics of the group of inventions with the provided technical result is that the frame of the simulator, consisting of two parts, and attached to the left and right seat frames and having left and right, rear and front rotating handles adjustable in length with L-shaped handles when grasping different positions of the hands to perform reciprocating movements (up and down) through rotation units with a pulley-drum, fixed to the left and right beams with fasteners. Adjustment of the angle of rotation of the hand handles when moving up and down is carried out by rubber bumpers-clamps mounted on the pulley-drums of the simulator with holes with pins-fixers for adjusting the angle of these handles. In order to create unloading assistance when lifting the handles, or additional load during training, the simulator has cable-block systems for redistributing loads with the ability to adjust, and there are also special lugs on the handles for attaching additional weights. To prevent bruises on the hands when coming into contact with the handles, there are special soft cuffs for the forearms.

This simulator provides the opportunity to rehabilitate and restore a large number of muscle groups and joints of the upper extremities, shoulder girdle, and spine. Length-adjustable hand handles allow you to perform alternately or simultaneously reciprocating movements with straight arms up and down (flexion-extension and abduction-adduction), and a special cable-block system for redistributing loads helps with this, which is especially important for people with disabilities whose joints are inactive and severely limited in movements. The simulator allows two patients to train simultaneously and perform reciprocating movements of the shoulder area and upper limbs up and down with one or both hands simultaneously and alternately in the frontal and sagittal planes, being a multifunctional complex that replaces several simulators. This simulator makes it possible to rehabilitate both disabled people and people with disabilities who have significant physical functional limitations, as well as healthy people and athletes, creating various types of loads - by using different options for the position of the girth of the hands (the back of the hand above and below, inside and outside ) on the L-shaped handles, and creating a load when raising the arms both up and down through the load-block system and the load securing lugs. And the presence of adjustment of the seat and fixing rollers for the legs in height and length, can cover a group of people of different ages, thereby increasing the functionality of the simulator.

Brief description of drawings

The essence of the group of inventions is illustrated by drawings, where in Fig. 1, 2 show diagrams of a simulator for the rehabilitation of patients and use the following notations:

1 - left seat frame;

2 - right seat frame;

3, 4 - simulator frame;

5, 6 - upper horizontal racks of the simulator frame;

7, 8 - rear vertical posts of the simulator frame;

9 - front vertical posts of the simulator frame;

11 - left vertical post of the simulator frame;

12 - right vertical post of the simulator frame;

13 - upper left U-shaped platform of the simulator frame;

14 - upper right U-shaped platform of the simulator frame;

15 - left beam for attaching the length-adjustable 1st set of hand handles;

16 - right beam for attaching the 2nd set of hand handles, adjustable in length;

17, 18 - rear and front T-shaped strips of the left beam for attaching the 1st set of hand handles, adjustable in length;

19, 20 - rear and front handles, adjustable in length, from 1 set of L-shaped hand grips;

21, 22 - rear and front handles, adjustable in length, from the 2nd set of L-shaped hand grips;

23 - left height-adjustable seat;

24 - right height-adjustable seat;

25 - side back of the left height-adjustable seat;

26 - side back of the right height-adjustable seat;

27 - length-adjustable left leg clamp;

28 - right leg clamp adjustable in length;

29, 30 - adjustable rear and front drum pulleys with cable fixation of the left beam of the shoulders of the 1st set of hand handles;

31, 32 - adjustable rear and front drum pulleys with cable fixation of the right shoulder beam of the 2nd set of hand handles;

33, 34 - rotation units of the 1st set of handles for the hands of the rear and front levers of the left shoulder beam;

35, 36 - rotation units of the 2nd set of handles for the hands of the rear and front levers of the right shoulder beam;

37, 38 - rear and front hand grips of the 1st set,

39, 40 - rear and front hand grips of the 2nd set;

41, 42 - rear and front T-shaped connections of levers and hand grips;

45, 46 - rear and front levers that regulate the length of the 1st set of hand grips;

47, 48 - rear and front levers that regulate the length of the 2nd set of hand grips;

49, 50 - back and front soft cuffs for the forearm of the hand grips;

53, 54 - rear and front locking pins adjusting the angle of the 1st set of hand grips;

55, 56 - rear and front locking pins adjusting the angle of the 2nd set of hand grips;

57, 58 - rear and front lever clamps adjusting the length of the 1st set of hand grips,

59, 60 - rear and front lever clamps adjusting the length of the 2nd set of hand grips;

61, 62 - wing clamps of the rear and front T-shaped connections of the levers and hand grips,

65, 66 - lugs for attaching additional load when lifting the rear and front hand handles of the 1st set;

67, 68 - lugs for attaching additional load when lifting the rear and front handles for the hands of the 2nd set;

69, 70 - spindle for fixing the cable on the adjustable rear and front pulley-drums of the beams of the arms of the hand handles;

72, 73 - holes on the adjustable rear and front pulley-drums on the beam of the arms of the hand handles;

74, 75, 76, 77 - rotation rollers of the frame beam of the left seat for moving the cables of the 1st set of hand handles adjustable in length;

76a, 77a - rotation rollers of the frame beam of the right seat for moving the cables of the 2nd set of hand handles, adjustable in length;

78, 79, 80, 81, 82, 83 - rotation rollers for moving cables adjustable in length for the 1st and 2nd set of hand handles;

84, 85, 86, 87, 88, 89, 90, 91 - guides for moving load blocks up and down;

92, 93 - upper and lower fasteners of the rear part of the simulator frame;

94, 95 - upper and lower fasteners of the front part of the simulator frame;

96, 97 - front and rear fasteners of the upper part of the simulator frame to the left beam of the 1st set of hand handles;

98, 99 - holes on the adjustable rear and front pulley-drums on the right beam of the arms of the 2nd set of hand handles;

100, 101 - rubber bumpers-clamps adjusting the height of the angle of raising and lowering the rear and front pulley-drums of the handle beams;

102 - fastening bolt for fastening the second end of the cable to a set of load blocks;

103 - pin for fixing load blocks;

104, 104b, 104v, 104g - cargo blocks;

105 - rubber bumpers-shock absorbers for silent lowering of load blocks;

106 - holes in the load blocks for placing the locking pin;

107 - fixing bottom plate for fastening the exercise machine frame to the seat frame;

108 - adjustable foot bolsters for fixing the feet;

109 - wing-lock seat;

110 - seat height adjuster;

111 - thumb-latch for adjustable leg bolsters;

112 - length regulator for leg bolsters;

In fig. Figure 1 shows a diagram of the simulator in an operating mode that allows for alternating or simultaneous execution of reciprocating movements (up and down) of handles with L-shaped handles in the sagittal plane.

The frame of the simulator 3, 4, consisting of the frames of the left and right seats 1, 2, is secured to each other with fasteners 92, 93, 94, 95, 96, 97. Sitting on the seat 23, resting your feet on the fixing feet of the pillow 108, and your back on the side back 25, holding the L-shaped handles 19, 20 with both hands or one, the patient performs back-and-forth movements with the shoulder area and upper parts of the body, moving up and down (flexion-extension of straight arms) the hand handles of the 1st set 37, 38 in the sagittal plane, through rotation units 33.3 4 with pulley-drums 29, 30, mounted on the left beam 15 of the frame of the left seat 1.

In fig. 1, 2 shows a diagram of the simulator in an operating mode that allows for alternating or simultaneous execution of reciprocating movements (up and down) of handles with L-shaped handles in the frontal plane.

The frame of the simulator 3, 4, consisting of the frames of the left and right seats 1, 2, is secured to each other with fasteners 92, 93, 94, 95, 96, 97. Sitting on the seat 24, resting your feet on the fixing feet of the pillow 108, and your back on the side back 26, holding the L-shaped handles 21, 22 with both hands or one, the patient performs back-and-forth movements with the shoulder region and upper parts of the body, moving up and down (abduction-adduction of straight arms) the hand handles of the 2nd set 39, 40 in the frontal plane, through rotation units 35, 36 with pulley-drums 31, 32, mounted on the left beam 16 of the frame of the right seat 2.

Each hand handle of the 1st and 2nd sets 37, 38, 39, 40 contains pulley-drums 29, 30, 31, 32 for fixing one end of the cable with spindles 69, 70 on it, attached to rotation units 33, 34, 35, 36 for moving the handles up and down, and the other end of the cable is fixed with fastening bolts 102 to the load blocks 104, 104b, 104c, 104d to create unloading when lifting and load when lowering during training.

When moving the 1st and 2nd set of handles 37, 38, 39.4 0, cable block systems are used, consisting of six rollers in the upper part of the frame 78, 79, 80, 81, 82, 83, four rollers on the frame beam of the left seat 74, 75, 76, 77, two rollers on the frame beam of the right seat 76a, 77a, through which cables 113, 114, 115, 116 pass. Load adjustment occurs through load blocks 104, 104b, 104c, 104d, which move along eight guides 84 , 85, 86, 87, 88, 89, 90, 91.

Adjustment of the angle of rotation (movement) of the 1st and 2nd set of hand handles 37, 38, 39, 40 when moving up and down is carried out by rubber bumpers-clamps 100, 101, mounted on the pulley-drums of the simulator 29, 30, 31, 32 with holes 72, 73, and the initial position of these handles is adjusted using locking pins 53, 54, 55, 56.

For the rehabilitation of patients with various functional physical limitations (joint mobility), as well as training for people of different ages, the simulator provides various adjustments depending on height, the left and right seats 23, 24 are adjusted in height by a height adjuster 109 and a thumb lock 110, while the simulator contains length-adjustable rollers 108 and clamps 27, 28 for fixing the legs through regulators 112. Depending on the size and length of the patient’s arms, each hand handle 37, 38, 39, 40 has T-shaped connections 41, 42 with levers 45 , 46, 47, 48 with holes with a range of adjustment, and contains an L-shaped handle 19, 20, 21, 22 for grasping the hands in different positions (back of the hand from above, below and from the inside) to work more muscles of the patient.

To create additional load when raising the arms up, each handle 37, 38, 39, 40 contains ears 65, 66, 67, 68 for attaching additional weights.

This simulator is intended for the rehabilitation, recovery and development of people of various nosological groups with and without disabilities: with musculoskeletal disorders (MSD), with brain disorders and trauma, with disorders of the central nervous system (CNS), including after strokes , as well as healthy people and athletes.

The operation of the MULTIFUNCTIONAL simulator is described in the methods of training with it.

The method of training using the inventive MULTIFUNCTIONAL simulator consists of performing the following exercises:

1) Alternate or simultaneous performance of reciprocating movements of the hand handles of the 1st set in the sagittal plane. Sitting on the seat, holding the L-shaped handles with both hands or one, the patient simultaneously or alternately performs back-and-forth movements with the upper limbs up and down (flexion-extension of straight arms), moving the hand handles of the 1st set in the sagittal plane. To work out a larger number of muscles and joints - various options for the position of the girth of the hands (the back of the hand from above, below and from the inside) on L-shaped handles.

2) Alternate or simultaneous performance of reciprocating movements of the hand handles of the 2nd set in the frontal plane. Sitting on the seat, holding the L-shaped handles with both hands or one, the patient simultaneously or alternately performs reciprocating movements of the upper limbs up and down (abduction-adduction of straight arms), moving the handles for the hands of the 2nd set in the frontal plane. To work out a larger number of muscles and joints - various options for the position of the girth of the hands (the back of the hand from above, below, from the inside and from the outside) on L-shaped handles.

Example 1. Training while sitting on seat 23 - alternating or simultaneous performance of reciprocating movements (up and down) of handles with L-shaped handles in the sagittal plane (Fig.). The patient, sitting on seat 23, resting his feet on the fixing pillows 108, and his back on the side backrest 25, holding the L-shaped handles 19, 20 with two hands or one, performs reciprocating movements with the shoulder region and upper parts of the body, moving upward -down (flexion-extension of straight arms) hand handles of the 1st set 37, 38 in the sagittal plane, through rotation units 33.3 4 with pulley-drums 29, 30, attached to the left beam 15 of the frame of the left seat 1.

To work on more muscles and joints, the patient changes the position of the hands (the back of the hands is above, or below, or from the inside - perpendicular to the floor (thumb at the top)), holding the L-shaped handles 19, 20, and performs reciprocating movements shoulder area and upper body, moving the hand handles of the 1st set 37, 38 up and down.

To increase the amplitude of movement of the arm joints, the simulator provides for adjustment of the angle of rotation (movement) of the 1st set of hand handles 37, 38 when moving up and down, which is carried out by rubber bumpers-clamps 100, 101, mounted on the pulley-drums of the simulator 29, 30 with holes 72, 73, and the initial position of these handles is adjusted using locking pins 53, 54.

To create additional load during training when moving the 1st set of handles 37, 38 up and down, cable-block systems are used. Load adjustment occurs through load blocks 104, 104b, which move along four guides 84, 85, 86, 87.

To create additional load when raising the arms up, each handle 37, 38 contains an eyelet 65, 66 for attaching additional weights depending on the functional limitations of the patient, which also increases the number of muscle groups worked.

Performing reciprocating movements of the handles 37, 38 alternately or simultaneously, in which the patient moves (flexion-extension of straight arms) the hand handles of the 1st set in the sagittal plane up and down, holding the L-shaped handles with both hands or one hand 19, 20 (back of the hand BOTTOM), provides elaboration of:

- arm joints: shoulder, elbow, wrist;

- arm muscles: brachialis, biceps brachii, coracobrachialis,

- back muscles: levator scapulae muscles, rhomboid muscles, supraspinatus muscles, latissimus dorsi muscles;

- chest and abdominal muscles: external oblique abdominal muscle, rectus abdominis muscle;

- shoulder region and thoracic spine.

Performing reciprocating movements of the handles 37, 38 alternately or simultaneously, in which the patient moves (flexion-extension of straight arms) the hand handles of the 1st set in the sagittal plane up and down, holding the L-shaped handles with both hands or one hand 19, 20 (back of the hand TOP), provides elaboration of:

- arm joints: shoulder, elbow, wrist;

- arm muscles: triceps brachii, deltoids, brachialis, biceps brachii, coracobrachialis,

- back muscles: trapezius muscles; levator scapulae, rhomboids, supraspinatus, latissimus dorsi;

- chest and abdominal muscles: external oblique abdominal muscle, rectus abdominis muscle, latissimus dorsi muscle, thoracolumbar fascia, lumbar triangle;

- shoulder region and thoracic spine.

Performing reciprocating movements of the handles 37, 38 alternately or simultaneously, in which the patient moves (flexion-extension of straight arms) the hand handles of the 1st set in the sagittal plane up and down, holding the L-shaped handles with both hands or one hand 19, 20 (the back of the hand from the INSIDE - perpendicular to the floor (thumb at the top)), provides the following:

- arm joints: shoulder, elbow, wrist;

- arm muscles: brachialis, biceps brachii, triceps brachii, deltoids, flexor digitorum profundus, flexor carpi ulnaris, pronator teres, extensor carpi radialis longus, supinator, coracobrachialis;

- back muscles: levator scapulae muscles, rhomboid muscles, supraspinatus muscles, latissimus dorsi muscles;

- chest and abdominal muscles: external oblique abdominal muscle, rectus abdominis muscle.

- shoulder region and thoracic spine.

Example 2. Training while sitting on seat 24 - alternating or simultaneous performance of reciprocating movements (up and down) of handles with L-shaped handles in the frontal plane (Fig. 1, 2). The patient, sitting on seat 24, resting his feet on the fixing pillows 108, and his back on the side backrest 26, holding the L-shaped handles 21, 22 with both hands or one, performs reciprocating movements with the shoulder region and upper parts of the body, moving upwards down (abduction-adduction of straight arms) hand handles of the 2nd set 39, 40 in the frontal plane, through rotation units 35, 36 with pulley-drums 31, 32, mounted on the right beam 16 of the frame of the right seat 2.

To work out more muscles and joints, the patient changes the position of the hands (the back side is on top or bottom, or from the inside or outside - perpendicular to the floor (thumb on top or bottom)) holding the L-shaped handles 21, 22 and performs the forward movements of the shoulder area and upper parts of the body, moving the hand handles of the 2nd set up and down 39, 40.

To increase the amplitude of movement of the arm joints, the simulator provides for adjustment of the angle of rotation (movement) of the 2nd set of hand handles 39, 40 when moving up and down, which is carried out by rubber bumpers-clamps 100, 101, mounted on the pulley-drums of the simulator 31, 32 with holes 72, 73, and the initial position of these handles is adjusted using locking pins 55, 56.

To create additional load during training when moving the 2nd set of handles 39.40 up and down, cable-block systems are used. Load adjustment occurs through weight blocks 104v, 104g, which move along four guides 88, 89, 90, 91.

To create additional load when raising the arms up, each handle 39, 40 contains an eyelet 67, 68 for attaching additional weights depending on the functional limitations of the patient, which also increases the number of muscle groups worked.

Performing reciprocating movements of the handles 39, 40 alternately or simultaneously, in which the patient moves (abduction-adduction of straight arms) the hand handles of the 2nd set in the frontal plane, holding with both hands or one hand the L-shaped handles 21, 22 (back of the hand BOTTOM), provides elaboration:

- hand joints. shoulder, elbow, wrist,

- arm muscles: triceps brachii, deltoids, brachialis, biceps brachii, palmaris brevis, flexor carpi radialis, brachioradialis, coracobrachialis;

- back muscles: trapezius muscles; levator scapulae, rhomboids, supraspinatus, latissimus dorsi;

- chest and abdominal muscles: pectoralis major, pectoralis minor, external intercostal muscles;

- shoulder region and thoracic spine.

Performing reciprocating movements of the handles 39, 40 alternately or simultaneously, in which the patient moves (abduction-adduction of straight arms) the hand handles of the 2nd set in the frontal plane, holding with both hands or one hand the L-shaped handles 21, 22 (back of the hand TOP), provides elaboration of:

- arm joints: shoulder, elbow, wrist;

- arm muscles: triceps brachii, deltoids, brachialis, biceps brachii, coracobrachialis, palmaris brevis, flexor digitorum profundus, flexor carpi ulnaris, pronator teres, extensor carpi radialis longus, supinator, brachioradialis, brachialis ;

- back muscles: trapezius muscles; levator scapulae, rhomboids, supraspinatus, latissimus dorsi;

- chest and abdominal muscles: external oblique abdominal muscle, rectus abdominis muscle, latissimus dorsi muscle, thoracolumbar fascia, lumbar triangle;

- shoulder region and thoracic spine.

Performing reciprocating movements of the handles 39, 40 alternately or simultaneously, in which the patient moves (abduction-adduction of straight arms) the hand handles of the 2nd set in the frontal plane, holding with both hands or one hand the L-shaped handles 21, 2 (the back of the hand from the INSIDE - perpendicular to the floor (thumb at the top)), provides the following:

- arm joints: shoulder, elbow, wrist;

- arm muscles: triceps brachii, deltoid muscles, brachialis, biceps brachii, coracobrachialis, coracobrachialis, palmaris brevis, flexor carpi radialis, brachioradialis, brachialis muscles;

- chest and abdominal muscles: pectoralis major, pectoralis minor, external intercostal muscles, external oblique, rectus abdominis, transverse abdominis, internal oblique, pyramidal muscle,

- back muscles: teres major muscle, muscle, external intercostal muscle, trapezius muscles; levator scapulae muscles, rhomboid muscles, supraspinatus muscles, latissimus dorsi muscles, thoracolumbar fascia, lumbar triangle;

- shoulder region and thoracic spine.

Performing reciprocating movements of the handles 39, 40 alternately or simultaneously, in which the patient moves (abduction-adduction of straight arms) the hand handles of the 2nd set in the frontal plane, holding with both hands or one hand the L-shaped handles 21, 22 (the back of the hand is OUTSIDE - perpendicular to the floor (thumb below)), provides the following:

- arm joints: shoulder, elbow, wrist;

- arm muscles. triceps brachii, deltoids, brachialis, biceps brachii, coracobrachialis, palmaris brevis, flexor digitorum profundus, flexor carpi ulnaris, pronator teres, extensor carpi radialis longus, supinator, brachioradialis, brachialis;

- back muscles: teres major muscle, erector spinae muscle, serratus inferior posterior muscle, external intercostal muscle, trapezius muscles; levator scapulae muscles, rhomboid muscles, supraspinatus muscles, latissimus dorsi muscles, thoracolumbar fascia, lumbar triangle;

- chest and abdominal muscles: pectoralis major muscle, pectoralis minor muscle, external intercostal muscles, external oblique abdominal muscle, rectus abdominis muscle, transverse abdominal muscle, internal oblique abdominal muscle, pyramidal muscle;

- shoulder region and thoracic spine.

Clinical example 1. Gr-M., 33 years old. Diagnosis: Combined injury. CCI. Severe brain contusion. Walks with Canadian canes. While walking, the right hand was secured to a cane with an elastic band. He cannot raise his arms straight in the frontal plane. I did the squat while holding onto a support. After a long period of time and following injury, significant muscle atrophy was observed. Significant reduction in the functional work of the right hand up to 50%. Right arm: 1) shoulder joint: flexion 130° and extension 15°; abduction was 100° and adduction 10°; external rotation was 35° and internal rotation was 60°; 2) elbow joint: flexion 50° and extension 170°; pronation 40°, supination 40°; 3) wrist joint: flexion 35° and extension 30°; abduction: radial 15°, ulnar 25°.

Training on the simulator. First, exercises were performed according to example 1, training while sitting on seat 23 (Fig. 1) (see description above), moving up and down (flexion-extension of straight arms) the handles for the hands of the 1st set 37, 38 in the sagittal plane, holding with hands on L-shaped handles 19, 20, alternately performs back-and-forth movements with the shoulder region and upper parts of the body. To work out more muscles and joints, the patient changes the position of the girth of the hands, holding the L-shaped handles: 1) the back side is on top; 2) back side from below; 3) the back side from the inside - perpendicular to the floor (thumb at the top). Next, we do the same exercises only with both hands at the same time. Then we added exercises according to example 2, training while sitting on seat 24 (Fig. 1, 2) (see description above), moving up and down (flexion and extension of straight arms) the handles for the hands of the 2nd set 39, 40 in the frontal plane , holding the L-shaped handles 21, 22 with his hands, alternately performs back-and-forth movements with the shoulder region and upper parts of the body. To work out more muscles and joints, the patient changes the position of the girth of the hands, holding the L-shaped handles: 1) the back side is on top; 2) back side from below; 3) back side from the inside - perpendicular to the floor (thumb at the top); 4) the back side is outside - perpendicular to the floor (thumb from below). Next, we do the same exercises only with both hands at the same time. The load is zero, that is, the weight of the handles is balanced by the weight of the loads. For the patient, the main task at this stage is to learn to raise and lower straight arms. During the training, the patient fixed his hand with special rehabilitation gloves, since he could not hold his fingers. 5 repetitions of each exercise for two weeks. This is the maximum number of repetitions per workout. Training duration is 30 minutes, three times a week for one month. A week later they added one load, and a week later another one. The weight of one cargo block is 5 kg. Passing through the roller system, the weight of the load block is halved. After a month, 4 loads, also increased the number of repetitions to 10.

Results in two months. While walking, I stopped using an elastic band to secure my hand to the cane. Started squatting on his own without support. Raising straight arms in the frontal plane. Increased mobility of the joints of the right hand up to 65%, left hand up to 40%. Right arm: 1) shoulder joint: flexion 130° and extension 25°; abduction was 100° and adduction 20°; external rotation was 35° and internal rotation was 60°; 2) elbow joint: flexion 50° and extension 180°; pronation 50°, supination 50°; 3) wrist joint: flexion 45° and extension 35°; abduction: radial 35°, ulnar 25°.

Clinical example 2. Gr-M., 34 years old. Clinical diagnosis: Consequence of severe vertebral spinal cord injury. Lower paraplegia, anesthesia. Violation of physical fitness according to the type of incontinence. Moves with the support of the caregiver's hand. Cannot raise his arms while standing on his own without support.

Training on the simulator. First, exercises were performed according to example 1, training while sitting on seat 23 (Fig. 1) (see description above), moving up and down (flexion-extension of straight arms) the handles for the hands of the 1st set 37, 38 in the sagittal plane, holding with hands on L-shaped handles 19, 20, alternately and simultaneously performs back-and-forth movements with the shoulder region and upper parts of the body. To work out more muscles and joints, the patient changes the position of the girth of the hands, holding the L-shaped handles: 1) the back side is on top; 2) back side from below; 3) the back side from the inside - perpendicular to the floor (thumb at the top). Next, we added exercises according to example 2, training while sitting on seat 24 (Fig. 1, 2) (see description above), moving up and down (flexion and extension of straight arms) the hand handles of the 2nd set 39, 40 in the frontal plane , holding the L-shaped handles 21, 22 with his hands, alternately and simultaneously performs back-and-forth movements with the shoulder region and upper parts of the body. To work out more muscles and joints, the patient changes the position of the girth of the hands, holding the L-shaped handles: 1) the back side is on top; 2) back side from below; 3) back side from the inside - perpendicular to the floor (thumb at the top); 4) the back side is outside - perpendicular to the floor (thumb from below). Load with 2 load blocks. 5 repetitions of each exercise for two weeks. This is the maximum number of repetitions per workout. Training duration is 30 minutes, twice a week for one month. Two weeks later they increased it by one more load block. A month later, they increased to 4 weight blocks, and also increased the number of repetitions to 10.

Result after 16 workouts. Moves without the help of a caregiver, but with safety nets. Can walk indoors with hands behind head.

Clinical example 3. Gr-M. 20 years old. Diagnosis: Cerebral palsy, spastic diplegia.

Moves with the support of the caregiver's hand. The right hand works fine. During training, he constantly lowers his head. Raises his left hand to the shoulder. While walking with a walker, the left hand is tied with an elastic bandage. Left arm: 1) shoulder joint: flexion 20°, extension 5°; abduction was 30° and adduction 5°; external rotation was 10° and internal rotation was 5°; 2) elbow joint: flexion 90° and extension 130°; pronation 10°, supination 50°; 3) wrist joint: flexion 10° and extension 10°; abduction: radial 5°, ulnar 5°.

Training on the simulator. First, exercises were performed according to example 1, training while sitting on seat 23 (Fig. 1) (see description above), moving up and down (flexion-extension of straight arms) the handles for the hands of the 1st set 37, 38 in the sagittal plane, holding with hands on L-shaped handles 19, 20, alternately performs back-and-forth movements with the shoulder region and upper parts of the body. To work out more muscles and joints, the patient changes the position of the girth of the hands, holding the L-shaped handles: 1) the back side is on top; 2) the back side from the inside - perpendicular to the floor (thumb at the top). 10 repetitions of each exercise for two weeks. This is the maximum number of repetitions per workout. Training duration is 20 minutes, three times a week for one month. The load is zero.

After two weeks, we added the position of grasping the hands, holding the L-shaped handles: 2) the back side from below, performing exercises according to example 1. Training while sitting on seat 23 (Fig. 1) (see description above), moving up and down ( flexion-extension of straight arms) handles for the hands of the 1st set 37, 38 in the sagittal plane, holding the L-shaped handles 19, 20 with hands, alternately performs reciprocating movements of the shoulder region and the upper parts of the body. We also added one weight block, performing exercises on the 1st set of handles. Then we added exercises according to example 2, training while sitting on seat 24 (Fig. 1, 2) (see description above), moving up and down (flexion and extension of straight arms) the handles for the hands of the 2nd set 39, 40 in the frontal plane , holding the L-shaped handles 21, 22 with his hands, alternately performs back-and-forth movements with the shoulder region and upper parts of the body. To work out more muscles and joints, the patient changes the position of the girth of the hands, holding the L-shaped handles: 1) the back side is on top; 2) the back side from the inside - perpendicular to the floor (thumb at the top). The load is zero, that is, the weight of the handles is balanced by the weight of the loads. For the patient, the main task at this stage is to learn to raise and lower straight arms. During the training, the patient fixed his hand with special rehabilitation gloves, since he could not hold his fingers. 10 repetitions of each exercise for two weeks. This is the maximum number of repetitions per workout. Training duration is 30 minutes, three times a week for one month.

A month later they added a load on one load, and two weeks later another load block.

Result after 24 workouts. While training at home on the treadmill and while walking, I stopped using an elastic band to secure my wrist. Moving around the house without the help of a caregiver. Raises the left arm all the way up, yet without full straightening at the elbow. Increased mobility of the joints of the left hand: 1) shoulder joint: flexion 70° and extension 25°; abduction was 120° and adduction 20°; external rotation was 40° and internal rotation was 20°; 2) elbow joint: flexion 70° and extension 150°; pronation 30°, supination 60°; 3) wrist joint: flexion 20° and extension 20°; abduction: radial 8°, ulnar 7°.

Claims (14)

1. A simulator for the rehabilitation of patients with disorders of the upper limbs and torso, containing a simulator frame with the frames of the left and right seats attached to it, including two pairs of handles, made with the ability to move up and down through rotation nodes and with the ability to raise the upper limbs in the front and sagittal planes in a sitting position of two patients at the same time, each handle has a cable-block system to create load or unload during exercise, and includes pulley-drums with grooves with the possibility of fixing one end of the cable on it with a spindle, attached to rotation units for moving the handles up and down, the other end of the cable is fixed with a fastening bolt to the load blocks, cable block systems are made in the form of roller systems consisting of six rollers in the upper part of the frame, four rollers of the left frame beam, two rollers of the right frame beam, as well as eight vertical guides for moving cargo blocks, and contain bumpers-shock absorbers, each handle has T-shaped connections with a lever with holes with a range of adjustment depending on the height, size, length of the patient's arms, and contains an L-shaped handle for clasping the hands in positions in which the back of the hand is located above, below and inside for working out patient's muscles the pulley-drums of the simulator are made with the ability to adjust the initial upper and lower positions of the handles through the holes on them using locking pins, the bumpers-clamps are made with the ability to adjust the angle of rotation of the handles when moving up and down, the left and right parts of the simulator, containing the first and second sets of handles, are designed to operate independently of each other, and are designed to be attached to each other with fasteners with the ability to separate and place each half in a separate place from each other, Moreover, the seats of the simulator are made with the possibility of height adjustment depending on the height of the patient, the simulator contains length-adjustable rollers for fixing the legs depending on the functional limitations of the patients, each handle contains an eyelet for attaching additional weights when raising your arms up, and the cable-block system with weight blocks is designed to regulate the load on each hand separately. 2. A method of rehabilitation of patients, carried out using a simulator according to claim 1, consisting in performing exercises of two types, in this case: when performing the first type of exercise, the patient, sitting on a seat and holding L-shaped handles with one or two hands, rotating through rotation units containing pulley-drums, alternately or simultaneously performs reciprocating movements of the upper limbs up and down - performs flexion and extension straight arms, moving the handles of the first set, when performing an exercise of the second type, the patient, sitting on a seat and holding L-shaped handles with one or two hands, rotating through rotation units containing pulley-drums, alternately or simultaneously performs reciprocating movements of the upper limbs up and down - performs abduction and adduction straight arms, moving the handles of the second set.