3.
Efficiency of the locomotor system.
Frequent dysfunction of the locomotor system accompanying the underlying
disease prompt to analyse thoroughly the possible need of passive or dynamic correction, compensation, alleviation or
stabilisation of the particular elements of the system by means of appropriate orthoses (collars, etc.), e.g. the cranio-
cervical or thoracic segment of the vertebral column in the cases of subluxation symptoms or instability by means of
corsets or belts applied for the cases of scoliosis or muscular insufficiency, orthoses for the upper extremities in the
cases of contractures or special shoes or insoles – according to the individual needs of the patient. A very important
element of preparation, or even prerequisite, for the rehabilitation programme is taking into consideration the necessity
of massage and mobilisation in contractures, as well as increasing the muscular strength in the upper extremities.
4.
Possibility of autonomic dysreflexia
(sudden episodes of considerable elevation of arterial blond pressure which may
be life-threatening if not controlled immediately). Preventing of disturbances involves the elimination of potentially
harmful stimulation by
5.
voiding the bladder
immediately before exertion and during longer periods of exertion, as well as blood pressure
monitoring during the first sessions of exercise. In case of the episode, exercise should be discontinued and upright
position should be maintained until blood pressure returns to normal values.
6.
Presence, or predisposition to, the formation of bedsores
, which constitutes a common and important problem.
Prevention involves continuous control of body regions anatomically exposed to compression and application of
decompression measures (localisation, decompression and protection). The management of patients with bedsores
should not exclude rehabilitation by means of the Dynamic Parapodium.
7.
Muscular spasms
(due to hyperactivity resulting from loss of inhibitory control of motoneurons). Prevention is training,
which makes it possible to reduce both the frequency and magnitude of spasms. Pharmacological treatment is not
recommended, because it limits the possibility of training and may cause unfavourable side effects – depression,
vertigo, ataxia. In case of spasms the patient should be protected against injury to the lower extremities due to strong
contractions and rapid movements.
8.
Thermoregulation problems.
Limited ability to control body temperature may occur due to reduced perspiration and
inappropriate distribution of blood which leads in high temperature of the environment to the earlier occurrence of the
over-warming effect than in healthy subjects, associated with the risk of dehydration, elevation of body temperature,
heat stroke, or even circulatory collapse, whereas in cold environment it leads to excessive heat loss impairing the
cardiovascular control. Prevention involves optimal adjustment of the existing needs of rehabilitation to the efficiency of
the organism, with emphasis on regularity of training. In the cases of hypo- or hyperthermia, the exercise should be
discontinued and the environmental conditions (air temperature, relative air humidity), as well as the patient’s clothes,
intensity of the exercise and duration of the session adjusted according to the existing needs and possibilities.
Warning
Absolute contraindications for use of the Dynamic Parapodium
:
•
Deep mental impairment ( unable to be controlled),
•
Conditions preceding cerebral stroke,
•
Conditions preceding myocardial infarction,
•
Advanced osteoporosis with lower limb deformation (considerable deviation from the long axes of
the extremities),
•
Disturbances of body balance (of a high degree),
•
Articular contractures (knees, hip joints) over 30’,
•
Very strong muscular spasticity in lower extremities,
1.5
Exemplary Preliminary Rehabilitation Programme For The Period Of Adaptation Of The
Organism To The Device.
The period of adaptation, which should last approximately seven weeks, has been divided into stages. The
principle is to go on to the next stages after mastering the skills required in the previous stage, providing the patient’s
condition is good enough to progress to more intensive exercise.
The exercise should always be done in the presence of an accompanying person!
The first stage
Daily training: up to 3 repetitions daily (the presence of an accompanying person
mandatory
during the exercises).
The aim of the exercise is to familiarise the patient with the device, making him feel safe while using the
parapodium, preliminary adaptation to maintaining upright position.
1.
Changing the position from sitting to standing in the parapodium directly from a chair or bed, (the help of a
physiotherapist during the exercise is
mandatory
).
2.
Maintaining upright position in the parapodium for the following periods of time: 30 sec.– first session, 1 min. – second
session in the parapodium. The duration of staying in the upright position is prolonged by one minute per day until the
period of 20 minutes. The proposed durations of the exercise on subsequent days of training are dependent on the
condition of the patient. If the basic duration has been successfully completed (without the episodes of fainting, vertigo,
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