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Methodology

Methodical variety of specific training (table 1) allows you to create a personalized program of rehabilitation therapy.

Areas of application for Kinidex exercise machine:
  1. Neurorehabilitation.
  2. Traumatology and orthopedics.
  3. Rheumatology.
  4. Pediatrics (cerebral palsy).
  5. Sports medicine and fitness - joint exercises.
Indications for adaptive kinesitherapy:
  1. Cerebrovascular diseases, strokes with motor and coordination disorders.
  2. Neurodegenerative diseases.
  3. Demyelinating diseases of the central nervous system and peripheral nervous system.
  4. Vertebrogenic and discogenic lesions of the peripheral nervous system (osteochondrosis, osteoarthritis, spondylarthrosis, intervertebral hernias).
  5. Spinal trauma.
  6. Muscles injury, ligaments damage, bones and joints diseases.
  7. Traumatic and compression-ischemic lesions of peripheral nerves (peripheral neuropathies).
  8. Contractures.
  9. Arthrosis (coxarthrosis, gonarthrosis), legamentoses, periarthritis.
  10. Children's cerebral palsy.
  11. Congenital diseases of the musculoskeletal system (myopathy, osteochondropathy).
  12. Posture disorders.

Table 1. Basic methods of adaptive kinesitherapy

Methodology Type Execution number 1 Execution number 2
verticalization static without stop fixing with stop fixing
dynamic without stop fixing with stop fixing
mechanotherapy mechanotherapy horizontal vertical
with slip ventral dorsal
with displacement ventral dorsal
coordination training support function training tempo-rhythm correction
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General requirements (for the implementation of adaptive kinesitherapy):
  1. The patient is delivered sitting in a stroller and placed inside the contour of the simulator, facing forward. The patient can be delivered on a gurney and be in a horizontal position. In this case, the suspension system is located under the patient (on a stroller or gurney). The patient can be placed in a suspended system directly on the spot without the additional items for his delivery.
  2. Method of placing the patient in the suspension system:
    1. the pelvis is located on the seat;
    2. the front straps come out in front between the patient's legs and lie on the front surface of the abdomen and chest area;
    3. the side straps adjoin the outer surfaces of the hips and pelvis and run from the front of the shoulder joints;
    4. the back straps run along the back, behind the shoulder joints;
    5. for additional fixation of the patient the chest strap is used;
    6. in case of using lower and upper limbs cuffs, they are additionally fixed to suspension system their upper straps:
      1. lower limb cuff: the outer is fixed to the side strap of the harness, the inner is fixed to the front strap of the harness;
      2. upper limb cuff: the front strap is fixed to the front strap of the suspension system, the rear upper strap is fixed to the rear strap of the suspension system;
    7. At the same time, cuffs must be tightly tightened with upper and intermediate tension straps, so that the cuff locking modules are in their specific positions:
      1. lower limb cuff:
        1. upper locking module - located on the border of the middle and upper third of the shin (it is possible to place it directly in the upper third);
        2. lower locking module - is located in the region of the lower third of the shin above the ankle joint;
        3. foot locking module is located in the metatarsal area of the foot.
        4. additional foot extension is provided by 2 straps, located on one side of foot locking module;
      2. upper limb cuff:
        1. upper locking module - located in the upper third of the forearm (its location in the lower third of the shoulder is allowed);
        2. lower locking module is located in the lower third of the forearm (its location in the region of the wrist joint is allowed);
        3. palm locking module is located in the metacarpal region (one or several fingers of the hand could be fixed in the loop of palm locking module).
  3. The patient is lifted automatically with the control of his position in the harness system.
  4. To perform dorsal displacement, the patient is placed face-to-back.
  5. An inactive lower limb can be fixed to the supporting surface by additional cuffs.
    1. To exclude excessive deviations of the pelvic region, the suspension system is fixed, for this purpose, to the rear beams of the anti-gravity frame on the one hand, and to the rear hinges of the suspension system, on the other hand by elastic fasteners.
    2. To exclude excessive deviations, as well as the formation of a passive return of the limb to the starting point of the spatial position, cuffs fixated by elastic ropes.
  6. The required settings of the control program are set, and the mechanical drive process is started.
  7. After the required time has elapsed, the patient is released into the stroller.
  8. After the patient descends, it is necessary to make sure of its safe position in the stroller and, only after that, unfasten the carbines of the front free ends from the loops of the lifting cables. Suspension system is extracted from the patient by means of hardware lifting.
Dynamic verticalization:
  1. Items 1-3 of the general requirements are met.
  2. After lifting the patient to the front seat loop of the suspension system, the cable of the drive is attached with the intermediate roller fixed in the "0" position.
  3. For the passive version: items 6-8 are performed.
  4. For the active version: limb cuff connected to the drive cable. By means of the program setting, the starting point of the movement is set. After that, the patient performs active body movements due to active muscle contractions of the limb, on which the cuff is fixed.
  5. Items 6-8 of the general requirements are met.
Gravitational mechanotherapy:
  1. The patient is delivered for a horizontally oriented technique - lying on a gurney (or the simulator is located next to the bed on which the patient is lying), while the leg end of the gurney is facing forward and parallel to the simulator, or inwardly perpendicular to it. For a vertically oriented technique - sitting in a stroller and placed inside the contour of the simulator face-to-face forward.
  2. The cuff is fixed to the selected segment. Attach the cable to the cuff.
  3. Items 6-8 of the general requirements are met.
Mechanotherapy with slip:
  1. Items 1-5 of the general requirements are met.
  2. The cuff is fixed to lower locking module. Attach the cable to the cuff.
  3. Items 6-8 of the general requirements are met.
Mechanotherapy with displacement:
  1. Items 1-5 of the general requirements are met.
  2. The cuff is fixed to upper locking module. Attach the cable to the cuff.
  3. Items 6-8 of the general requirements are met.
Tempo-rhythm correction:
  1. Items 1-4 of the general requirements are met.
  2. Attach the cable to the upper locking module of the lower limb cuff.
  3. Item 6 of the general requirements is being implemented.
  4. When performing a training exercise in the static phase, the contralateral limb performs an actively similar locomotion.
  5. Items 7-8 of the general requirements are met.
Support function training:
  1. Items 1-2 of the general requirements are met.
  2. Items 3-5 of the general requirements are met. Note: the patient's liftig is incomplete and is insurable.
  3. Attach the cable to the upper locking module of the lower limb cuff.
  4. Item 6 of the general requirements is being implemented. When performing a training exercise in a dynamic phase, the contralateral limb retains a static equilibrium.
  5. Items 7-8 of the general requirements are met.
Active support of the passive drive

Each of the adaptive kinesitherapy techniques, launched in the passive drive mode, can be supplemented by active support of the training exercise. The method of active support is that with the passive movement of the limb the patient independently, actively, moves the limb in the prescribed direction. In this case, the passive movement of the trained limb by a kinezisimulator performs the function of an external factor (augmentator), which sets the template for the direction, pace and speed that the patient must adhere to.

This technique is aimed at forming:

  1. complex coordination-motor adaptive reactions;
  2. an effective strategy for moving the common center of mass at the boundary of the reference contour-the formation of a dynamic support function;
  3. Tempo-rhythmic pattern of cyclic locomotion.

An important condition is the safety of the drive cable tension. If the active movement does not correspond to the speed of passive movement, the level of difficulty of the training mode is corrected. It should be remembered that correct active support at slow speed is more difficult

Active movement technique
  1. Items 1-4 of the general requirements are met. In this case, the patient's lifting is carried out with a vertical unloading of 10-40%, which ensures the patient's movement in the frontal direction.
  2. In order to form a supporting function, items 5 of the general requirements is implemented if it is necessary.
  3. The patient is given the task to perform active stepping forward and, further, back, to the starting position. The exercise is repeated for 3-5 minutes.
  4. Items 7-8 of the general requirements are met.
Active movement with the pelvis support
  1. Items 1-4 of the general requirements are met. In this case, the patient's lifting is carried out with a vertical unloading of 10-40%, which ensures the patient's movement in the frontal direction.
  2. After lifting the patient to the front seat belt of the suspension system, the cable of the drive is attached. Intermediate roller fixed on "5" or "6" position.
  3. In order to form a supporting function, items 5 of the general requirements is implemented if it is necessary.
  4. Item 6 of the general requirements is being implemented.
  5. The patient is given the task to perform active stepping forward and, further, back, to the starting position. The exercise is repeated for 3-5 minutes.
  6. Items 7-8 of the general requirements are met.