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The Development of Devices for the MOTIVATIVE Exercise of Impaired Extremities



ShigeoTakizawa
Rehabiliad Corporation
Fujisawa-shi, Japan

Authors:

Takizawa, Shigeo BA1. Tetsuhiko Kimura, M. D. Ph. D2. Hideo Kijima, M. D. Ph. D3.

Yuzou Okamoto, M. D. Ph. D4. Kentaro Nagaoka, M. D5. Kyoko Takizawa, RPT. 6

1 Rehabiliaid Corporation, Fujisawa-shi 251-0871 Japan. rehabiliaid@civilnet.org

2 Department of health services administration, Nippon Medical School, Tokyo 113-8602.

3 Kijima orthopaedics doctor's office, Fujisawa-shi 251-0054 Japan.

4 Kigankai Medical Corporation Okamoto hospital, Mie-cho 879-7131 Japan.

5 Shonankenyuukai Medical Corporation Nagaoka hospital, Chigasaki-shi 253-0008 Japan.

6 Roujinhokensisetu Shonannooka, Chigasaki-shi 253-0001 Japan.


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Key words: bedridden - accompanied movement - acquisition of walking - painless

Abstract. 1) The cushion, the upper extremity function training device, the simple ankle plantar flexion and knee extension and flexion training devices, the flexible leg brace, the RAKU walker and the shower chair combination raku walker with stoppers what got over a step with the slides were developed and used. By the using the devices developed, the movement of the functional extremity had accompanied the movement of the impaired extremity, so that the painless motivative exercise have improved the impaired extremity with continuing to extend the range of motion or ROM instead of the passive exercise. 2) Disabled bedridden patients who were adapted for ROM exercise depending on own general condition were taken out to the training room by using the wheelchair advances. The passive exercise on mats as ROM exercise in the training room has been never done for them. 3) The motivative exercise to the reinforcement of the muscle force of trunk and extremities and extending ROM of the knee and foot can be extended gradually by ones own pace without pain. 59 people in 193 inpatients have acquired walking from bedridden by the rehabilitation that was based on the motivative exercise.


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Introduction

Disabled people being due to the hemiplegia by cerebrovascular disease and lower extremity fracture try to improve physical conditions by the passive exercise of a physical therapist until today. A lot of them got the contracture and became bedridden by the difficulty of walking, because there is a limit in the human resources of physical therapists.

We report the devices were developed and used, of which disabled people can be rehabilitated to the acquisition of walking from bedridden.

The movement of own functional extremity can accompany the movement of own impaired extremity by help of the devices. We name the movement of the impaired extremity accompanied that is an exercise for the impaired extremity the motivative exercise. Because both of own motivation of the patients to acquire walking from bedridden and the physical therapist motivates the patients to do are important and necessarily. The rehabilitation based on the motivative exercise has realized for disabled patients to acquire walking from bedridden.


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Devices and Usage.

Rehabiliaid Corporation developed devices following.

Fig. 1 is a cushion for the positioning, the prevention of bedsore and the physique change. It is easy to use for anyone, rich in the flexibility and also good in the stability. By inserting a fig. 1 into each location, the prevention of contracture and bedsore has been done and the bedsore has improved. And also it helps disabled patients to keep the wheelchair sitting position, then they can do the motivative exercise.

Fig. 2 is a light and convenience device for training that can be used when the upper limbs function training vessel have not been set in the training room. The device is possible to carry and has been already used at some special nursing home for the aged and the health service facilities for the elderly for more than a year.

The rehabilitation by the motivative exercise was realized by using Fig. 3 and 4. Both of them are used in the sitting posture on which both feet set. Disabled patients move Fig. 3 or 4 by the both feet and legs.1) The accompanied movement by Fig. 3 or 4 was realized the motivative exercise. The movement range of the extremities by using of these devices is announced by Endos 2) and the result was shown in the table 1.

Fig. 5 is used for the patients who have improved of the disturbance in gait that had been caused by the drop fold of hemiplegia, contracture of equino-varus and peroneal nerve paralysis. The benefit from the official department was carried out in 1998 so that the reality of the use will be announced in the Scientific Meeting of the Japanese Society of Prosthetics and Orthotics on November in 1999.


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Fig. 1 Cushion.

Fig. 1 is a cushion for the positioning, the prevention of bedsore and the physique change. It is easy to use for anyone, rich in the flexibility and also good in the stability. By inserting a fig. 1 into each location, the prevention of contracture and bedsore has been done and the bedsore has improved. And also it helps disabled patients to keep the wheelchair sitting position, then they can do the motivative exercise. 

Fig. 2 Training device.

Fig. 2 is a light and convenience device for training that can be used when the upper limbs function training vessel have not been set in the training room. The device is possible to carry and has been already used at some special nursing home for the aged and the health service facilities for the elderly for more than a year.

Fig. 3. & Fig. 4. The simple ankle plantar flexion and knee extension and flexion training devices.

Fig 3. The simple ankle plantar flexion and knee extension and flexion training devices.The rehabilitation by the motivative exercise was realized by using Fig. 3 and 4. Both of them are used in the sitting posture on which both feet set. Disabled patients move Fig. 3 or 4 by the both feet and legs.(1) The accompanied movement by Fig. 3 or 4 was realized the motivative exercise. The movement range of the extremities by using of these devices is announced by Endos (2) and the result was shown in the table 1.

Fig 4. The simple ankle plantar flexion and knee extension and flexion training devices.The rehabilitation by the motivative exercise was realized by using Fig. 3 and 4. Both of them are used in the sitting posture on which both feet set. Disabled patients move Fig. 3 or 4 by the both feet and legs.(1) The accompanied movement by Fig. 3 or 4 was realized the motivative exercise. The movement range of the extremities by using of these devices is announced by Endos(2) and the result was shown in the table 1. 

Fig. 5 Flexible leg brace.

Fig. 5 Flexible leg brace.

Fig. 6 Raku walker, the shower chair combination.

Fig. 6 is a walker. We named this walker which has casters composed with the slide and wheels the raku walker. Because RAKU means easy and comfortable in Japanese and also this walker is easy and comfortable to use. It is not always but may be dangerous to use the usual four wheels pattern walker for the patient who can walk in the parallel bars. Because it seems to run too much and walking of patient may not follow it. It was reported that the adaptation for the patient, the adapted diseases and the predominance of the at-home use to the others depending on the report after the notification of clinical trial plan finished by Takizawas(3)and Nagasawas(4) The performance and the way of using were reported by Takizawa(5). And also the good influence of profit to give to the establishment and the public society were reported by Makita<SUP>6)</SUP> and Takizawa(7). All the results of those reports were shown in table 2.

Fig. 6 is a walker. We named this walker which has casters composed with the slide and wheels the raku walker. Because RAKU means easy and comfortable in Japanese and also this walker is easy and comfortable to use. It is not always but may be dangerous to use the usual four wheels pattern walker for the patient who can walk in the parallel bars. Because it seems to run too much and walking of patient may not follow it. It was reported that the adaptation for the patient, the adapted diseases and the predominance of the at-home use to the others depending on the report after the notification of clinical trial plan finished by Takizawas3) and Nagasawas4). The performance and the way of using were reported by Takizawa5). And also the good influence of profit to give to the establishment and the public society were reported by Makita6) and Takizawa7). All the results of those reports were shown in table 2.


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The program and Characteristic Points

The characteristic points of the Takizawa Method rehabilitation and the program schedule are reported and shown in the table 3 according to the staging for the apoplectic ictus.

1) At the time of rehabilitation training, the patients do not feel pain and the training is painless. And also pain and strong fatigue should not be left to them. Because some chronic term patients have improved even who had been hospitalized for five years8). So that the rehabilitation must be done with patience having the patient keep the confidence of improvement and motivation. The rehabilitation is begun as early as possible.

2) The prevention of bedsore and the contracture and deformation of the joints should be the important purpose for the rehabilitation on the bed. Functional positioning and a physique changing with Fig. 1 will be done easily. The passive exercise for ROM exercise on the bed in the hospital room will be done for the purpose of the muscle power reinforcement and ROM keeping.

3) To keep a sitting position, the gatch bed must be done gradually.

4) After the bedridden patients could keep a sitting position, they can be taken out to the training room with using the wheelchair advances. By using the devices developed, the motivative exercise will be done with the assistance of own functional extremity without taking pain and also with considering own condition. But ROM exercise by the passive exercise on mats is never done in the training room.

5) The devices are used for the training from the early stage of the training. The motivative exercise for the reinforcement the muscle force of trunk and extremities and ROM of the knee and ankle will be extended gradually. Then standing position may become possible.

6) After the disabled patients becomes possible to keep the standing position, the training will be done with using parallel bars or wall bars and both of them. The orthosis like Fig. 5 and 6 are used for compensating the irreversible function.

7) The exercise is extended and continued with observing a muscle power test, a ROM test, the general conditions and the training conditions attentively by the indication of doctors.


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Table 1 The movement range of the extremities (Fig.3 and Fig.4)

Fig 3.

The plantar flexion angle

About to 37 degrees from 0 degrees.

By the passive exercise of a PT

About to 37 degrees from minus 12 degrees

Fig.4

A knee joint extension and flexion angle

About to 118 degrees from 10 degrees

By the movement of a PT

About to 140 degrees from 0 degrees

Table 2 the adaptation for the patient, the adapted diseases and the predominance of the at-home use for the raku walker.

 

3),

4)

Adaptation for patients

The parallel bars walking.

3) and 4) had been reported after the notification of clinical trial plan finished.

The posture of patients

Keeping out of the frame.

The adapted diseases

The postoperative patient for the femoral neck fracture and coxarthrosis, the patient for the chronic rheumatism of joints and the apoplectic ictus whose function of arms is kept.

A distinguishing characteristic

It doesn't run too much by the function of the slides` friction

The patient can walk at relieved.

5)

The advantage convenience of the use

The patients can get over the step that height is up to 2.7cm high when they do not have any lifting force in their arms.

6)

An effect

Saving labor of the care person in the Health Service Facilities for the Elderly to use.

7)

An effect

The official financial expenditure can be reduced because the independence of ADL for the postoperative femoral neck fracture patient has been realized.


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Table 3

The Takizawa program.

About the stage and the adaptation for physique position for each training devices.

Stage

Super acute/ acute

convalescence

chronic

Early

middle

late

physique position

bed rest, sitting

sitting

standing

gait

Home

Developed

Fig 1

*

*

*

*

*

Fig. 3/ 4

 

*

*

*

*

Fig. 5

 

 

*

*

*

Fig. 6

 

 

 

*

*

Both

Fig. 2

 

*

*

*

*

Market

goods

Spindle band

 

*

*

*

*


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Result.

There is a specialized bedridden elderly-disabled patients' hospital5, for one care staff member toward four patients. There are 226 hospital beds in it. When patients were hospitalized, all of them were apraxia of gait. Only10 people could walk at that time in 1988. At the end of 1994 training was done to 193 inpatient in the training room and at the bed. The rehabilitation was done to 127 people in the training room among them by one physical therapist and four helper everyday. The result of rehabilitation and the items of inpatients' diseases are shown in the table 4, what were reported by Takizawa 9) and Kijimas10) .

 Table 4 Result of rehabilitation

Inpatients who acquired walking

Result of rehabilitation

The items of inpatients' diseases

Year

Numbers

Numbers/1993

1994

Numbers/1993

1994

1988

10

person walking oneself

9

cerebrovascular disease

92

143

1993

51

crutch walking

2

7

bone and articular diseases

22

63

1994

59

walker walking with raku/93

12

3

visceral disorder

14

74

ruku walker walking

11

dementia

9

14

walking in the parallel bars

37

29

others

5

28

standing position

10

15

apraxia of gait

33

53


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Discussion

The rehabilitation program with the motivative exercise, which was named Takizawa Method, is based on the experience of Takizawa6 who is on the physical therapist list registration number 566 in Japan. Though we will introduce the same developed devices and the program to Okamoto hospital4 of 70 beds for inpatients from now on as the field test, it is most important that we can get the same effect without the guidance of Takizawa6 in it.

At the same time, nowadays and until now, it is important that who acquired walking again by the rehabilitation continue it and get the chance of doing it after the discharge from the hospital. So it is important to instruct the care persons in the easy and painless Takizawa program.


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Acknowledgements

1) The devices that Rehabiliaid Corporation developed and the usage of those were introduced, by what the motivative exercise is realized.

2) The rehabilitation by the motivative exercise by using the devices and the Takizawa program improved in ADL to the acquisition of walking, so that it is sufficient to expect that patients acquire walking even in the bedridden elderly hospital.

3) The characteristic points are, FACE="MS 明朝" LANG="JA">① the exercise will be fitted to the physical condition and the ability of the patients, FACE="MS 明朝" LANG="JA">② patients do not feel pain by the exercise and FACE="MS 明朝" LANG="JA">③ the exercise is done in the sitting or standing position without using a mat and with using the devices in the training room.

4) Though it is predicted that 2300000 people in 5200000 disabled elderly people will be bedridden in 2025 in Japan, the fact we reported that 30% of bedridden inpatients had stood on their own feet and acquired walking shows the possibility of the daily life independence for 690000 people being due to the diffusion of the motivative exercise by the devices developed and the Takizawa program.


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References

1) Takizawa K. the 1st report of Used Experiment of Devices for impaired extremities. The 10th Conference lectures thesis collection. Rehabilitation Engineering Society of Japan. Osaka. 1995: 119-122.

2) Endo S, Makita M, Nagasawa H, Takizawa K, Kobayashi K, Shoji J. et all. Rehabilitation training with two simple training machines. 13th Int. Congress of the World Confederation for Physical Therapy. Yokohama. Japan. 1999.

3) Takizawa K, Mochizuki K, Jinnai H Makita M. Used experiences the 1st report of the new four wheels pattern walker with slide. Journal of the Japanese Physical Therapy Association. Vol. 23, Supplement NO. 2, 1996: 131.

4) Hiroshi Nagasawa, Aoki M, Maeda S, et all. The clinic experience report of the new four wheels pattern walker with slide. Proceedings of the 12th Scientific Meeting. the Japanese Society of Prosthetics and Orthotics. 1996: 336-337.

5) Takizawa S. The experiences report of the new four wheels pattern walker with slide. the 13th Conference lectures thesis collection. Rehabilitation Engineering Society of Japan. Ogaki-shi. 1998: 373-378.

6) Makita M. Used experience of the four wheels pattern walker with slide. Journal of Physical Therapy, monthly. The 15th roll No. 14, 1997: 46-47.

7) Takizawa S. Expect the establishment of the new life culture. The 4678 Kouseihukusi (Welfare). Jiji press. September, 1998: 20-22.

8)Endo S, Nagasawa H, Makita M, Takizawa K, et all. The acquisition of walking from bedridden. Civil Publishing Inc. Fujisawa. 1996: 76-98.

9) Takizawa K. The Rehabilitation for the bedridden elderly hospital. The Kanagawa Physical Therapy Association. Fujisawa. 1993.

10) Kijima H, Kanai S, et al. The Rehabilitation Trial for the acquisition of walking form bedridden at the bedridden elderly hospital. The Journal of the Japanese Clinical Orthopaedic Association. Vol. 23. NO. 2 JUNE. 1998: 186-191.


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