The recovery period after a stroke can take many months or even years. But regardless of the degree of neurological deficit, concomitant disorders and how much the patient himself is motivated to recover, controlled physical activity is extremely necessary. In specialized rehabilitation centers for patients, exercise therapy and mechanotherapy programs are being developed, which significantly reduce the recovery time and have a general health effect. Used for this, it is possible to create loads on those muscle groups that are practically not involved in active or passive gymnastics or are not worked out well enough to eliminate contractures, prevent muscle atrophy and improve coordination of movements.

Appointment of rehabilitation simulators

To understand the need for simulators in post-stroke rehabilitation, it is enough to consider the most important problems that accompany this period.

Muscle tone disorders... Muscle hypertonicity that develops after a stroke makes it extremely difficult to carry out both passive and active exercises necessary to restore motor activity and coordination of movements of the patient. With the help of exercise therapy, massage and physiotherapy, it is not always possible to achieve the correct sequence of movements, the required level of load and other aspects that determine the correct implementation of rehabilitation measures. In addition, the patient is often worried about pain in muscles and joints, which can completely exclude the possibility of performing exercise therapy with him - he reflexively resists the instructor's movements in fear of pain. The simulators can reduce the load on muscles and joints due to additional suspension points, shock absorption systems and increase neuromuscular control through training with biofeedback. Thanks to this, the degree of pain is significantly reduced and the exercise becomes more comfortable.

Circulatory and trophic disorders... Innervation disorders and a deficiency in motor activity inevitably lead to a decrease in the supply of nutrients and oxygen to the tissues, which leads to negative consequences for tissue metabolism. As a result, stagnant, atrophic, necrotic and other processes may develop, which entail dysfunctions of all systems and organs. This further complicates the already difficult situation, and bedsores, muscle atrophy, intestinal atony, respiratory and heart failure, etc., can join the consequences of a stroke.

Psychological barrier... It is very difficult for a person who has kept bed rest for a long time and has difficulty maintaining balance, it is very difficult to overcome himself and try to return to his usual life. The main role in this is played by the psychological barrier: “I can’t,” “I will be in pain,” “I will fall and hurt myself,” etc. In such cases, the patient may experience an irrational distrust even of close people who offer their support and support. It is important for him to feel reliable support for his legs himself and to be able to independently control the strength of the grip of his hands, which saves him from falling.

With the help of work on simulators, the listed problems lose their acuteness. The patient is provided with optimal physical activity in his condition and psychological stress is reduced. He is able to independently carry out various actions (for example, hold on to the handrail tightly), which relieves him of fear.

Rehabilitation Equipment Requirements

A stroke rehabilitation machine must meet the following minimum requirements:

• have permits for its use in the field of medical rehabilitation;
• the design of the simulator should be designed in accordance with the requirements for ergonomics and technical aesthetics;
• the technical parameters of the simulator should provide for the possibility of adjusting the height / amplitude / load / frequency and other indicators within the framework of the exercises for which this simulator is designed;
• the base of the machine must be firmly fixed in the floor / on the wall / on the ceiling and must not move in any of the planes while working on it.

Simulators for rehabilitation of the group of companies "Madin"

GC "Madin" develops simulators for rehabilitation after a stroke, which are used to restore and maintain motor abilities, coordination of movements, normalization of muscle tone and other aspects of physical health.

Exercise machine "Balance-Master"... This allows you to work out the muscles that are responsible for the stable position of the lumbar spine and the trunk as a whole. It has a biofeedback training function that provides the required degree of stress without overstrain. With regular exercises on the "Balance-Master", there is a decrease in muscle tone and normalization of muscle reactions. The movements performed with the simulator help to restore intestinal functions, which in most cases are disturbed due to improper innervation and prolonged bed rest. Balance-Master also provides a physiological load on the joints, which allows them to prevent stiffness and increase the range of motion. Stimulation of blood circulation through active movements improves tissue trophism, prevents osteoporosis. The patient learns to safely transfer the general center of gravity of the body to the paralyzed leg and thus prepares himself for the first step.

Alter Step... This simulator is a rehabilitation complex consisting of a ladder and bars. The adjustable position of the simulator allows you to adjust the height of the elements individually, for each patient. An important feature of Alter Step is its motivational ability. It provides a secure wrist rest while walking, and the steps are anti-slip to keep your feet stable. In combination, this allows you to overcome the psychological barrier, which is often found in those who have suffered a stroke and are on prolonged bed rest. In addition, on this simulator, the patient can conduct independent exercises, developing the muscles and joints of the lower and upper extremities and the shoulder girdle. The Alter Step can be adjusted to the needs of the patient - the steps vary in height up to 15 cm and can be transformed into a platform. The angle of inclination of the handrails changes in accordance with the angle of inclination of the steps, the height and width of the handrails can be adjusted individually. The wheelchair ramp makes it easier to operate the machine. The patient can independently climb onto the simulator and there, using the handrails, get up from it and start exercising. With the help of Alter Step, it is convenient to track the dynamics of recovery, increase or decrease the level of exercise difficulty, depending on the objective indicators of a given patient. In addition to restoring muscle tone and mobility of the joints of the arms and legs, the simulator provides an optimal level of cardio load, which generally promotes oxygen saturation of tissues, restores blood circulation intensity and improves overall health indicators.

"Exarta Mini"... This simulator is designed for exercise therapy for patients with limited mobility who are unable to independently engage in physiotherapy exercises due to contracture of joints and muscles, severe pain syndrome, muscle atrophy and other conditions that often accompany the rehabilitation period after a stroke. The main advantage of "Exart Mini" is the ability to use in almost any conditions, including when recovering at home. The design of the simulator provides for the facilitation of active and passive movements of the patient due to additional suspension points. This simultaneously reduces the manifestations of discomfort and painful sensations and allows you to reduce the load on insufficiently developed muscles and joints, which prevents their injury. Trainings can be carried out both in two planes (movements left-right, up-down), and in 3D. In the latter case, a physiological load on the joints of the articulated type is provided, the range of motion increases and an additional load is created, which is necessary for progress. Also, exercises in the so-called closed kinematic chains train the muscles to work in a friendly way, as it happens in life, for example, when standing up and walking.

"Imitron"... This machine is designed for mechanotherapy and performs movements that simulate walking. The "Imitron" design provides for the possibility of training even in patients with adynamic lower extremities - the mechanism is set in motion by moving the levers by hands (or even one lever with one hand). Thanks to exercises on the simulator, the prevention of congestive pulmonary and cardiac phenomena is carried out, which is especially important for patients who remain motionless for a long time. Exercising in an upright position relieves constipation and also prevents urinary tract infections. By stimulating blood circulation, the risk of osteoporosis and trophic disorders is reduced, and passive movements allow maintaining the mobility of the joints of the arms and legs, preventing their contracture and preventing degenerative changes. In addition, the simulator allows you to gently and gradually eliminate the already developed stiffness of the joints, and regular exercises on it have a positive effect on the psychoemotional state of the patient.

"Equos"... This trainer is designed to restore vestibular function, develop correct walking skills, improve the ability to maintain a stable body position, and to treat other disorders caused by vestibular dysfunction (ataxia). Its feature is biofeedback, which creates an additional channel that informs the patient about the position of his body in space. The effectiveness of "Equos" is based on physiological, non-traumatic stimulation of the vestibular nuclei of the brain. After 20 minutes of exercising, the ability to maintain body balance improves for 4-5 hours. After working with Ekvos, other rehabilitation measures may be carried out that are difficult or unsafe for a patient who is unable to maintain balance. As a result, patients with vestibular dysfunction and ataxia have access to a wider range of treatment and rehabilitation procedures. According to the studies conducted, in 100% of patients who underwent rehabilitation with this simulator, coordination of movements and the ability to maintain body position significantly improved, and a partial improvement in speech and cognitive abilities was observed.

Rehabilitation glove "Anika"... This one is designed to improve fine motor skills - one of the main abilities that make self-care possible, completely or partially lost after a stroke. This is a unique design that uses biofeedback and allows you to adjust the rehabilitation program based on the individual characteristics of the clinical situation and the patient's objective capabilities.

All simulators developed by the Madin Group of Companies are included in the standards for equipping medical rehabilitation centers and have the appropriate documentation allowing their use in rehabilitation departments and specialized institutions.

What types of medical rehabilitation equipment are there?

Classification of simulators

Considering the classification of rehabilitation simulators, we note the following points:

• The main classification is which sites will be affected. An example is exercise equipment designed for the arms, body, or back. On sale there are options for the execution of simulators designed to work out several muscle groups at once.
• Manufacturers also carry out an unspoken classification of simulators on the basis of which diseases they can be used for. An example is a large group of equipment designed to work after a stroke.
• Most exercise machines are compact and can be installed at home.

There are quite a large number of different types of rehabilitation simulators, all of which have their own specific advantages and disadvantages. The classification is carried out according to several criteria, which we will discuss in more detail below.

• Walking simulators.

In addition to this, there are fairly simple rehabilitation simulators, for example, wall bars or parallel bars. They allow you to do basic exercises for general development. Knee, foot, or ankle workouts are also on sale.

Conditions. There are also large versions that can support the body or are designed for walking distance.

In general, we can say that most of the characteristics by which the classification is carried out are conditional.

The most common rehabilitation simulators

There are several simulators that are most widespread:

• Vertical mill. It is used to create a natural load on the human shoulder girdle. The exercise when using this device often consists in moving the wheel forward, but other movements can be performed as well.
• Wrist. To work out this part of the body, an exercise machine is used that simulates the natural movement of the wrist. The peculiarity lies in the fact that it is possible to regulate the magnitude of the load.
• The horizontal mill is very popular when there is a need to develop a shoulder joint. Many experts point out that this simulator is better than others as a warm-up.
• The multifunction minibike is a complex type device. Can be used to work out the thighs, thighs or shoulders. The design is able to mimic the natural movement of the joints, thereby ensuring their development.
• Bicycle simulators are very widespread. They are intended for rehabilitation, as they allow you to load the legs, but at the same time there is no load on other parts of the body.
• Walking simulators.
• Bubnovsky rehabilitation simulator. This type of simulator is in great demand today, since one can replace many others.

In addition, there are fairly simple rehabilitation simulators, for example, wall bars or parallel bars. They allow you to do basic exercises for general development. Knee, foot, or ankle workouts are also on sale.

Any serious illness for a person, especially when he is bedridden, is an ordeal. Even a short stay in an immobilized state (3-5 days) reduces muscle strength and joint mobility, impairs blood circulation, and reduces intestinal motility. Exercise machines for bedridden patients are used to restore physical activity, strengthen muscles, and improve the general condition of the patient.

Functions of rehabilitation simulators

Many reasons can contribute to the supine state: spinal injuries, articular pathologies, Parkinson's disease, stroke, paralysis, chronic diseases, side effects of drugs. Prolonged static position of the body causes dystrophic changes in muscle and articular tissues, therefore, as soon as possible, you need to start restorative gymnastics and use simulators for bedridden patients.

Devices that provide a load of individual muscles and joints for therapeutic purposes are called rehabilitation simulators. They contribute to the restoration of lost human abilities after illness and injury. Depending on functional disorders, each model is designed for a specific muscle group and has its own design features.

According to GOST, rehabilitation devices are divided into several types:

• to restore the functions of the spinal column;
• restoring the functionality of the hands;
• restoring the working capacity of the lower extremities;
• models of the universal range.

The first ones are designed for patients with diseases of the intervertebral discs and various articular deformities. Products of the second group provide metered loads on the muscles of the upper torso. Leg trainers strengthen the smooth muscles of the limbs and develop joints. Universal adaptations act simultaneously on the upper and lower body.

Exercise machines for bedridden patients have a sparing effect on the muscles, taking into account the weakened state of the body. In most cases, they are equipped with electric motors and hydraulics. They can be divided into 2 groups: mechanotherapy devices and robotic technology.

Mechanotherapy devices

This group includes special devices that locally affect a specific muscle group, by means of physical efforts of the patient himself, inertia, or due to a mechanical engine.

To increase the effect of mechanotherapy, it is necessary to exercise systematically. The duration of actions and the level of stress are determined by the attending physician, depending on the nature of the injury and disease.

Exercise machines for bedridden patients, aimed at restoring lost functions, strengthening joints and smooth muscles, differ from the usual sports equipment by the presence of special sensors, control panels and monitors that allow you to adjust to the patient's condition, read and memorize information. Mechanotherapy devices work out joints, lower and upper limbs, fine motor skills of the hands.

Professional therapeutic simulators include devices from the following manufacturers:

• Artromot;
• Kinetec;
• Ortorent and others.

Thanks to the action of the devices, lost functions are restored, muscle tone rises, the musculoskeletal system is strengthened for further rehabilitation.

Leg trainers

The exercise bike for bedridden patients is designed for cyclic rotations of the lower extremities. The device is equipped with a remote control that controls specific programs. The monitor allows you to monitor the progress of your workouts. Sliding function and clips allow the model to be installed on the headboard.

Indications for use:

• postoperative rehabilitation;
• paralysis;
• recovery from coma;
• complications after a stroke;
• prolonged immobilization of the limbs.

The leg trainer for bedridden patients improves blood circulation in soft tissues, maintains elasticity of joints, prevents the formation of blood clots, bedsores, and congestion in tissues.

Note. The rehabilitation device simplifies the care of bedridden patients, since during its operation it is not necessary to change the position of the body.

Joint devices provide control of flexion and extension movements, adductions, abductions and rotations. The control panel adjusts the angle of the hip and knee. Such procedures prevent stiffness of the joint and promote early rehabilitation of the patient.

Indications for use:

• hip fractures;
• knee osteotomy;
• installation of a hip prosthesis;
• excision of the articular membrane.

Manufacturers produce exercise equipment for bedridden patients after a stroke that imitate walking. This prevents muscle and tendon atrophy and maintains motor abilities until the connection between the brain and the limb is restored.

Hand devices

Shoulder rehabilitation machines can be used by both supine and sedentary patients. The remote control allows you to set the range of motion, the angle of adduction, abduction and rotation.Indications for use are shoulder replacement, trauma and dislocation with complications.

Universal models

Manufacturers produce active-passive simulators for the simultaneous development of the upper and lower extremities. The combined apparatus is equipped with special devices, clamps, the ability to control the heart rate, analysis and display of results on the monitor. Thanks to this, rehabilitation after various diseases is faster and more efficient.

The device is used for patients with the following pathologies:

• traumatic brain injury;
• stroke;
• rehabilitation period after prosthetics and amputation;
• decreased movement in elderly patients;
• spinal injury.

Mechanotherapy rehabilitation is prescribed by the attending physician after a complete diagnosis. The simulator for bedridden patients is selected taking into account the area of ​​immobility and the patient's physical condition.

The latest innovative development for the rehabilitation of bedridden patients is robotics, which affects all problem areas. The use of such systems allows the patient to get to his feet faster, prevent complications associated with immobility, and adapt the heart to future loads.

The essence of the system is a mechanical movement identical to a healthy body. The person is attached to the robot, the patient looks at the screen and the pictures prompt him to an action, which the technician performs for him. In the process of manipulation, the atrophied muscles "remember" the lost movements.

Contraindications to the use of simulators

In many cases, exercise equipment is of great benefit in helping a person with rehabilitation and facilitating the care of a bedridden patient. However, there are states where using the hardware method can cause complications. These include:

• Ankylosis (joint immobility due to fusion of articular surfaces);
• Infectious diseases;
• Thrombophlebitis;
• Cholelithiasis;
• Tumors and hernias in the area that will be stressed during training.

Apparatus for bedridden patients can improve the general condition of a person, restore muscle tone, maintain elasticity of joints, and restore lost abilities. In a complex composition with medications, physiotherapy and massages, they contribute to high rehabilitation of the body. You can buy an exercise machine for bedridden patients in orthopedic centers, online stores, and from manufacturers of specialized equipment. Each small victory moves the bedridden patient to a new stage of the rehabilitation path, leaving the negative consequences of the disease behind.

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The first and most important rule of using rehabilitation simulators is that only a rehabilitation doctor can choose the right simulator or set of simulators and draw up an individual training program for the patient. Neither the patient nor his caregivers can and should not determine the level of the required load, choose the type of simulator and begin training. Self-activity in this matter can lead to very serious consequences!

Contraindications to the use of rehabilitation simulators

Rehabilitation simulators are absolutely contraindicated for the following diseases and conditions:

• severe coronary heart failure
• acute thrombophlebitis, cerebrovascular accident
• cardiac or aortic aneurysm, acute myocardial infarction
• pre-stroke condition
• diabetes mellitus (severe form) with complications
• acute infections, hemorrhages
• myopia with the threat of retinal detachment
• malignant tumor

Rehabilitation simulators should be treated with great care for the following diseases and conditions:

• heart disease
• respiratory diseases with the threat of transition to the stage of acute failure
• hemorrhoids and anal fissures
• acute hypertension, hypertensive crises

Principles of using rehabilitation simulators

Everything related to special, rehabilitation simulators cannot be generalized. In this issue, as nowhere else, an individual approach is important, therefore it is impossible to generalize the features of the use of all rehabilitation simulators - in each category of simulators, in each age group, in each case, the features will be different.

However, there are general principles for the use of rehabilitation simulators, general approaches, general theoretical provisions that must be taken into account when using certain devices to restore body functions.

Rehabilitation simulators should only be used as part of an individually tailored program. for a specific patient, and only under the systematic supervision of a physician. The program is drawn up by a rehabilitation doctor together with an orthopedist and other specialists, whose opinion is important in this particular case.

The rehabilitation simulator should provide the amount of assistance that is absolutely necessary. It is necessary to regularly check whether this or that fixation or support device is required, or it can be discarded, since the patient copes on his own.

The rehabilitation simulator should provide a feasible load. If the load is too light, the workout will not work (it's like trying to pump up your biceps, lifting a 100 grams dumbbell day after day). If the load is unbearable, the patient's condition will only worsen (it's like trying to pump up the biceps in one day, lifting a barbell weighing 200 kg). In this case, the load level must be regularly checked and gradually increased (see point 1).

The rehabilitation simulator must be precisely tailored to the patient's anatomical parameters. Exercising on a simulator that is not properly adjusted can cause orthopedic complications (dislocation of the hip, sprains, scoliosis, etc.) and interfere with the natural physiological activity of a person.

The rehabilitation simulator should be used in combination with other treatment and rehabilitation measures. These activities include exercise therapy, massage, physical and magnetic therapy, occupational therapy, hydrotherapy, art therapy, clinical psychology, etc. Rehabilitation of children with cerebral palsy also includes the development of speech and social contact, snoezelen, hippotherapy, music therapy, and the use of orthopedic products.

The rehabilitation simulator should not cause emotional dislike and fear. The aesthetic aspect is especially important when working with children. If a child is intimidated by a new device, you need to give him time to get used to it before starting to exercise.

Neither child nor adult should be left alone in the rehabilitation simulator. Even if the patient can independently perform exercises on the simulator, you need to be in the same room with him and observe the process.

Rehabilitation simulators are specially designed both for the prevention of various diseases and for the healing and recovery of the human body as a whole after surgery or injuries of any severity. They are an indispensable part of an effective course of physiotherapy exercises, since they carry out physiotherapeutic effects.

Simulators are used for rehabilitation, mainly for disorders of the musculoskeletal system. In addition, they are simply irreplaceable for people who need to restore muscle tone, improve the functioning of the cardiovascular and respiratory systems, rehabilitation after the most complex operations, myocardial infarction, etc.

The design of such simulators allows you to take into account any peculiarities and possibilities in the movement of a person whose functions of the musculoskeletal system are impaired for some reason. That is why all rehabilitation simulators include special limiters of power load and range of motion. In addition, they have a number of additional parameters, the use of which makes it possible to significantly facilitate exercises to the required and maximally safe level during training.

Types of exercise equipment for rehabilitation

Rehabilitation simulators are of two types: active and passive exposure. In addition, there are models that include the function of choosing a training option. This feature allows people with different physical abilities to use the simulators.

There are also models designed specifically for children, adolescents and young men. In other words, rehabilitation simulators can be designed for users of a certain age, or they can be of all ages. The latter are composed of a variety of tunable regulators, with which you can adjust the simulator to your anatomical features.

You can purchase simulators aimed at working out individual parts of the human body: back, lower or upper limbs, etc. Rehabilitation training equipment can also be complex, allowing, after certain manipulations with the settings, to train any part of the body.

Whichever one you choose for rehabilitation, in any case, its use at home, in specialized clinics or in rehabilitation centers will allow you to achieve high physiotherapeutic results, as well as significantly improve your health.