2. Handling method: Move the discs from this column to an adjacent column, and only one disc can be moved at a time. Generally, the disk with large diameter is placed below and the disk with small diameter is placed above. Therapists use a stopwatch to evaluate the time spent by patients in each training session, so as to compare before and after treatment.
Step 3: Function
(1) Stretching the spine: Putting the cylindrical plate at the same height as the patient's eyes is helpful for the patient's spinal stretching training. Patients can take a standing posture or a sitting posture. For elderly patients with cervical spondylosis, it should be noted that the intensity of treatment should not be too high (Figure 10- 1- 1).
Figure 10- 1- 1 posture and balance
(2) Shoulder movement: Raise the position of the game board or increase the height of the wooden column (Figure 10- 1-2).
Figure 10- 1-2 Shoulder flexion exercise
ROM can improve shoulder flexion. When the game board is placed on the patient's side for treatment, the shoulder abduction function can be improved (Figure 10- 1-3). Figure 10- 1-3 shoulder abduction.
(3) Elbow joint movement: Raise the wooden column of the game board or increase the distance from the patient, and then operate it, which is beneficial to the elbow extension function of the patient. (4) Forearm movement: Operating the patient's forearm in pronation or supination position is beneficial to improve the forearm rotation function (Figure 10- 1-4).
(5) Wrist joint movement: Raising or lowering the position of the game board will be beneficial to wrist extension or wrist flexion training.
(6) Thumb movement: When the big disc is used, the carpometacarpal joint and metacarpophalangeal joint of the patient's thumb are straightened, and the flexion position of interphalangeal joint is operated. If a small intervertebral disc is used, the patient's thumb should be abduction to the palm position.
(7) Finger movement: When training with a small disc, the metacarpophalangeal joint and interphalangeal joint of the patient should be flexed. If a large intervertebral disc is used, the metacarpophalangeal joint and the proximal interphalangeal joint should be straight and the distal interphalangeal joint should be flexed. This treatment can also improve webbed contracture.
(8) Other therapeutic effects: including upper limb coordination training, muscle strength training and hand sensory training.
Figure 10- 1-4 Forearm Movement
(2) Fixed bicycles 1. The structure is composed of a fixed bicycle, and the cushion and distance can be adjusted as required, and the inclination of the cushion and the angle of the armrest can be adjusted.
2. Training methods
(1) Hip flexion: Put down the seat cushion and extend the pedal crank to face forward; (2) Hip extension: Raise the seat cushion and lengthen the pedal crank to make it face forward.
(3) Bend your knees: put down the seat cushion and stretch the pedal crank to face forward; (4) Knee extension: Raise the seat cushion and lengthen the pedal crank to face backward.
(5) ankle plantarflexion: raising the cushion and lengthening the pedal crank to grow backward; (6) Ankle flexion: lower the cushion and lengthen the pedal crank to grow forward.
3. The application of this device in training can improve the joint mobility of lower limbs, especially in the following situations.
(1) Orthopedic diseases such as fracture (such as after meniscectomy of knee joint): If the affected lower limb can bear part of the weight, the ROM and muscle strength of joint can be increased.
(2) Joint diseases (except rheumatoid arthritis): such as osteoarthritis, especially after artificial hip and knee joint replacement, help to maintain or improve joint ROM, prevent deformity and muscle contraction from stimulating exercise, and improve muscle strength.
(3) Spinal injury complicated with incomplete paralysis of lower limbs and trunk: ROM stimulation is helpful to maintain the full range of lower limb joints, enhance muscle strength, improve balance, stimulate coordination, train alternate gait, and is also suitable for some patients with low back injuries.
(4) Lower limb amputation: Prosthetics can help patients maintain ROM and muscle strength of amputated lower limb joints, prevent joint stiffness, promote coordinated and interactive gait and improve limb circulation.
(5) Progressive nervous system diseases: patients with multiple sclerosis, Parkinson's disease, generalized myasthenia, etc., are helpful to maintain the alternate gait of lower extremity joint ROM and muscle strength stimulation, or improve the balance function of lower extremity, improve proprioceptor afferent stimulation, and improve limb circulation.
(6) Soft tissue injury: For patients with tendon injury or burn, it is beneficial to improve and/or increase joint ROM and muscle strength to prevent contracture and improve the circulation after fixation. For patients with upper limb soft tissue injury, with the introduction of vibration stimulation, it is beneficial to the recovery of sensation.
(3) occupational therapy lathe 1. The structure is a traditional woodworking workshop lathe, which consists of a pedal conveyor flywheel and a workbench.
The workbench has devices for fixing working parts and various tools.
2. Just like a pedal sewing machine, the patient can use a knife to process the wood into the shape of a disc and a wooden cone by using a pedal to drive the wood to rotate through a flywheel. The lathe speed is low, and the flywheel resistance can be adjusted according to the needs of different treatments.
3. Through the functional training of this instrument, it is helpful to improve the patient's joint mobility, muscle strength, endurance, hand-eye coordination, tolerance to noise and tolerance to rotating objects. Training has the following different effects on different joints.
(1) Hip joint: Make the patient stand with healthy legs, adjust the flexion and extension angle of hip joint by adjusting the height of pedal, and strengthen the hip joint extensor training by increasing the load.
(2) Knee joint: If the patient suffers from knee extensor relaxation, when the patient sits on the chair seat, the affected leg is suspended by a sling and pedaled by the healthy lower limb, so that the affected leg will generate static contraction when pedaled without load, and the knee joint can be flexed by extending the length of the pedal.
(3) Ankle joint: Fix the knee joint, put your feet on the pedal, and train the flexion and extension range of the ankle joint of the affected leg while pedaling hard. Adding wedge-shaped pads on the inside and outside of the sole is helpful to train the ankle varus function.
(4) Universal workbench 1. The base structure of the workbench is pulley type, which can be easily moved, and the height and inclination of the workbench can be adjusted according to the treatment needs.
2. Patients can use the workbench for ROM and muscle strength training of upper and lower limbs and trunk joints in various postures without affecting the tissue healing of injured parts of the body.
(5) Upper limb suspension frame 1. Usage The therapist suspends the patient's forearm at an appropriate height with a sling, adjusts the position of the arm to fix or limit the range of motion of the shoulder joint, and adjusts the weight on the weight support to reduce the weight of the arm to facilitate the patient's activities. The hanger can be used for personal care activities, such as eating, washing face and combing hair, writing communication activities, such as writing and keystroke, comprehensive exercise of upper limb functions, such as sanding therapy games, and entertainment activities, such as reading and painting skills (Figure 650).
2. When the fracture and dislocation of the upper limb are affected, the weight of the limb and plaster can be reduced by hanging the upper arm, which is beneficial to the early activity of the movable joint. When the upper limbs are weak, such as spinal cord injury, multiple sclerosis, neuronal diseases, etc., the weight of the limbs can be reduced by suspension, which is beneficial to the early training of muscle strength and coordination ability. When the peripheral nerve is injured, it can reduce the weight of the arm, make the limbs move early, effectively prevent joint contracture, and carry out muscle strength training early.
Figure 10- 1-5 Upper limb suspension frame
(6) Suspension system
Active joint movement is carried out by fixed axis suspension. The rope is fixed above the joint, and the movement ground of the limb is parallel.
1. abduction and adduction of shoulder joint (fig. 10- 1-6)
Fig. 10- 1-6 abduction and adduction axial fixation of shoulder joint.
2. Hip flexion and extension. Flexion and extension of hip joint under axial fixation.
(7) skateboarding; Powerboard) This device is mostly used in the exercise after hip surgery to increase the range of motion of the joint, so that patients can learn to use it, which can not only prevent patients from making wrong actions, but also improve the enthusiasm of patients for exercise. The method is to put a skateboard under the affected limb, and it is best to tie roller skates on your feet; If there is no pulley, you can sprinkle talcum powder on the skateboard to reduce the friction of the limbs on the skateboard.
1. Patients with abduction and adduction of hip joint lie on their backs, with their toes facing upwards, so as to keep the hip joint in the middle position to avoid external rotation during abduction and adduction of hip joint.
2. Patients with flexion and extension of hip joint lie on their backs, and their feet slide up and down on the skateboard, as does the knee joint. The hip joint cannot rotate for abduction and adduction. The alternative posture is to put the skateboard above the patient's side between the two lower limbs, and the skateboard can also be placed on a higher platform. Note: If the patient is in lateral position after operation, adduction of the affected hip joint should be avoided.
(8) nailing operation 1. Structure This operation is one of the classic occupational therapy projects, which consists of hammer nails and wood.
(1) Hammer: Hammer has different characteristics due to the size and weight of the hammer head and the shape and length of the hammer handle. It should be analyzed, designed and selected according to the needs of patients' occupational therapy. For example, when the hammer handle is long, due to inertia and leverage, a strong knocking force can be generated. But to lift this hammer, it needs a strong grip and swing force. The hammer head is small and light, and the hammer handle is short, although it does not have a strong knocking force.
Therefore, it is necessary to prepare different materials that can be freely replaced, such as hammer handles and sponge elastic bandages, for adjustment. Wrapping sponge and bandage on the hammer handle helps to adjust the grip strength.
(2) Nail: The bigger and longer the nail, the more it needs to be struck with strong muscle strength. The smaller the nail, the shorter it is, and the weaker the driving force can be. But at this time, dexterity is very demanding, especially the dexterity of both hands and the coordination of hand and eye.
(3) Wood: The harder and thicker the wood texture, the greater the resistance, which requires a strong knocking force. The wood is soft and thin, which can be completed by tapping.
2. Motion (1) is beneficial to improve or enhance the muscle strength and joint mobility of upper limb joints, especially elbow joint, forearm wrist joint and hand.
(2) It is beneficial to improve or enhance the dexterity of upper limbs and hand-eye coordination.