Therapeutic Gymnasium - Equipment & Objectives PDF

THERAPEUTI C GYMNASIUM DR. ARWA SINNARWALA (NEUROPHYSIOTHERAPY PT) OBJECTIVES: At the end of the lecture student should be able to –  Name the equipment's present in a therapeutic equipment.  Describe the construction of each equipment ...

THERAPEUTI C GYMNASIUM DR. ARWA SINNARWALA (NEUROPHYSIOTHERAPY PT) OBJECTIVES: At the end of the lecture student should be able to –  Name the equipment's present in a therapeutic equipment.  Describe the construction of each equipment  Describe the uses of each equipment  Differentiate between movable and non movable equipment's. Introduction  The word “ Therapeutic “ means “ contributing towards relief and cure” and the word “ gymnasium “ is a Greek origin meaning “ a fitness centre”  Definition - it can be defined as “ a fitness centre where a PT contributes towards relief of pain and cure of various ailment via exercises” or “ a covered location equipped for physical exercises “  Therapeutic gymnasium is a room or building equipped for indoor sports or a large room containing equipment such as bars weights and ropes for physical exercise  Rehabilitation oriented fitness program as designed to improve strength stamina stability flexibility functionality and/or mobility  Therapeutic gymnasium should have the following facilities 1. Private treatment rooms 2. Large windows that contribute to a bright environment and an ample and cosy atmosphere. 3. New state of the art equipment Gym based therapeutic is rehabilitation oriented fitness program that are designed to  Improve Muscle Strength  Increase Endurance  Increase Flexibility  Improve Stability  Functionality or mobility  Improve sleep patterns  Physical Disability or other problems  Improve overall health and fitness  Construction of the gymnasium  Location – Minimum traffic and corridor can be used for ambulation.  Roof – Ideally this should have all the supporting structures enclosed above a flat ceiling.  Walls – They should be smooth to prevent grazing injuries and free from unnecessary protruding structures eg mirrors clocks  Floor – This should be constructed of suitable wooden laths running across the room. This also help for slipperiness to be reduced.  Windows – Sufficient windows should be constructed to provide adequate lighting with opening elements to secure reasonable ventilation and minimize odour.  Lighting – Artificial lights should be adequate in number and spacing. They should not cast shadow and be protected by glass.  Heating – A stuff and sleepy atmosphere should be avoided by using a thermostat.  Classification of Equipment Equipment Based on Based on Use Type Therapeuti Strength Balance Fixed Movable c training training training equipment equipment  Therapeutic gym usually include  Tilt table  Medicine balls( various weights usually 1-11kg  Treadmill  Balance board  Static stationary bicycle  Weight Cuffs (of various weights )  Quadriceps table  Dumbbells( wights 1-5 kg)  Wall bar  Wrist roller  Shoulder wheel  Wands  Traction table  Ankle exerciser  Plinth  Jogger  Suspension bed and apparatus   Vestibular/physio/swiss/gym ball Parallel bars  Staircase/ training stairs/ ramp  Peg boards  Continuous passive motion apparatus(CPM)  Hand exerciser/ gripper/ Springs  Rowing machine  Bolster / Wedges  Finger ladder  TheraBand's/Thera tubes  Shoulder pulley  Trampoline  Walking Aids- wheelchair , walker, crutches, canes  Parallel bars Description of the equipment:  It is a fixed equipment.  It is 10 – 20 feet long and placed parallel to the wall at equal distance between the wall and bar for the therapist to stand.  It has a mirror at one or both ends for visual input and posture correction  Parallel bars are generally fixed to the floor and hence patients feel more secure.  Floor – uniform wooden platform, with no obstruction in between.  Handgrips- metal or wooden , ovoid or cylindrical in shape with a diameter of 1.5 to 2 inches for ideal and strong grip.  Height is adjustable – usual 20 to 38 inches ( at level of greater trochanter of the patient  Width – 15 to 25 inches  Uses  Sit to Stand  Standing with and without support  Balancing exercises  Gait training  Postural correction  Lower limb exercises  Treadmill  It is a device used for walking or running while staying at the same place.  The machine provides a moving platform with a wide conveyer belt driven by an electric motor.  Uses – Cardiorespiratory functioning Overall fitness of the body Endurance & gait training  Stationary cycle  It is a stable device with saddle , pedals and handle bars.  Resistance can be varied with a knob.  Uses – endurance exercise of lower limb.  Mobilitytraining of lower limb without weight bearing.  Helps giving exercise in closed kinematic chain.  Other variation are elliptical trainers Quadriceps table  Parts – Foot rest at distal end Other end is provided with weight Table with or without back rest Patient supported to sit in high sitting position and knee extension is performed.  Uses – increase power and endurance of Quadriceps muscle Wall Bars  It is a single section hardwood constructed sturdy frame.  Use – support for sit to stand  Balance problems  Coordination Stairs  It is placed at the corner of the gym. There a 2 series of steps of different heights which are placed at right angle to each other.  At the top it is separated by a square platform. These are known as corner stairs.  The standard dimensions are - 4 steps of 4 inches each OR  3 steps of 6 inches and 2 steps of 9 inches  Individuals steps should be atleast 3 feet wide so that there is enough room for the patient as well as the crutches if prescribed.  The handrail on each side is 35 inches above the steps. A second rail can be present for children  Uses- Training for ascending and descending stair climbing Weight transfers. Shoulder wheel  It is a wheel mounted on the wall made of either wood or metal.  Consists of fulcrum, handle and handpiece  On one spoke of the wheel there is a movable 6 inch handle  It allows a full arc of shoulder range of motion.  At the fulcrum there is a friction screw which can be used to provide a wide range of resistance.  Height- it is adjustable according Uses- To improve mobility and flexibility of the shoulder joint. Strengthening of shoulder joint. Used in patients with shoulder joints.  Finger ladder  The finger ladder is a simple piece wood equipment which consists of notches that are cut onto a wooden board which is 4 feet long.  Each notch is 1 and a half inches apart with 30 numbered steps.  The ladder is secured onto the wall with it lower end 30 inches from the floor.  It gives good visual feedback to the patient during exercise and hence motivates the patient to perform better  Use – helps in progressive improvement in shoulder ROM  Improving overhead ROM  improving neuromuscular coordination of UL  frozen shoulder  weakness of shoulder muscles. Plinth  It is a treatment table which is usually 30 inches tall, 30-32 inches wide and 70 inches long.  The height of the plinth should be adjustable such that it comes upto the waist of the therapist and is convenient for the therapist to work with.  It may be wrapped with a mattress of foam or rubber.  Some plinths are built with hinges at the level of the hips which allows the patient to perform exercises in sitting or semi reclined position.  It may sometimes be desirable to have a plinth that is lower and wider for those patients who are wheelchair users. This allows the patient to be independent in getting on and off the wheelchair by themselves.  Uses : Active and passive exercises can be given tot he patient on the plinth. Shoulder pulley  Consists of pulley attached to the ceiling.  The rope is wound around the pulley.  It also has a hand piece.  Uses – perform assistive and resistive shoulder exercises. Decrease shoulder stiffness. Tilt table  It is a table which can be tilted to standing  Angle of tilt can be changed from below for up to 180 deg  Patient is asked to lie down on the table and is secured by straps around pelvis and thoracic region.  Uses – bring patient in standing  Provide proprioceptive sensation  Reduce spasticity Wrist roller  It is a wooden rod mounted on the wall  Consists of varying diameter for different grips of patient  Fulcrum- at centre, effort through hand and resistance through knob.  Uses- for wrist flexion and extension exercises  To increase gripping power Balance boards  A Wobble board is used for the proprioceptive training in the upper or lower extremities.  It can be used for unidirectional rocking or multidirectional.  Uses – Balance training Proprioceptive training Ankle Movements. Ankle exerciser  The foot is mounted on a wooden base with two adjusting springs for ankle exercises.  Tightening spring's nuts can increase resistance further.  Uses:- To Increase strength for ankle  Medicine Ball  These are weighted ball made out of fine leather  Weight ranges from 1 kg to 6 kg  Uses – improve core, UL, LL strength. Vestibular or Swiss Ball  These made out of soft elastic with a diameter of 35 to 85 centimetres and are filled with air.  Used for core muscle strengthening  Back stretching and strengthening  Sitting balance training Free weights.  Dumbbells/weight cuffs  These are graduated weights that are handheld or applied to the upper and lower extremities or trunk  Weight cuffs contain sand and have a Velcro strap to tie it over the distal part of the segment. Therabands  A theraband or resistance bands are latex bands or tubes that are used for light strength training exercises.  Elastic bands are available in assortment or grades or thickness  Tubing comes in graduated diameters and wall thickness that provide progressive levels of resistance.  Colour coding denotes the   Uses –  Used for strengthening exercises  For coordination training, sports specific training. Colour coding: Resistance Tan Extra extra light Yellow Extra light Red Light Green Light medium Blue Medium Black Medium heavy Silver Heavy Gold Extra heavy Wand  Used to perform self assisted shoulder exercises  Movements like flexion extension abduction adduction combination and MR and LR Peg board  It is a wooden board with holes in which pegs are placed  Are of different types based on their colour weight , shape, texture etc  Used for coordination exercises and gripping exercises,  Finger flexor strengthening  Fine grip and prehension training  Used for game like activities Wedges and bolsters Wedges Bolsters  The wedge is a most  Long narrow pillow filled versatile shape. with cotton  Wedges Board for such  Provides an unstable gross-motor activities as rolling tumbling, walking surface that helps up or downhill or just achieve greater lying down to read or activation of core study. musculature  Excellent for positioning  Used for paediatric severely disabled patients. children Finger grip exercise  A rectangular frame as 6 springs for finger strengthening.  The springs are detachable does making progressive resisted exercise possible. Removing the springs decrease the resistance level and inserting increases the resistance level.  It has been provided with an extra Bass for gripper so that it can kept on the table platform for those patient whose hands are very weak. Finger exercise ring  Exercise ring It consists of a metallic ring with 5 springs for each of four fingers and thumb fitted to the ring.  The spring ends Leather Looks for inserting the fingers Used for flexion exercises of all fingers development of forearm muscles and paraplegic rehabilitation. Theraputty  These are used for hand therapy  uses – prevent future hand and wrist problems  Used to increase strength on tendons joints of hand.  They are available in different colours depending on their resistance. Walking aids  Wheelchair  Canes - Single / Tripod / Quadripod.  Crutches – Axillary / Gutter / Elbow  Walkers – Basic /Rollator Canes  These are appliances which are used to transfer weight from the upper limb to the ground or may be used to assist with maintain balance.  Material – made up of wood or light metal like aluminium.  Can be Single point or Multipoint- tripod or quadripod  Can be adjustable or non adjustable  Parts –handle , single upright, ferrule  Handle - this is the top of the stick  Can be 3 different design.  1) crook top -used to hand up the stick  2) Flat top – good grip and control.  3) Swan neck top – more balanced  Ferrule - Made of rubber  Covering at the end point or tips , high coefficient of friction and fits well.  Multiring and depressed to form a vacuum.  Uses –  Provide balance support in standing and walking  Take some pressure off one or both legs  Improve feeling of safety and security when walking Crutches  Crutches are a type of Walking Aids that serve to increase the size of an individual's Base of support.  It transfers weight from the legs to the upper body and is often used by people who cannot use their legs to support their weight.  They can be adjusted both in hand grip length and total height  Types - Axillary ,Gutter, Forearm/ elbow  Axillary - it includes an axillary pad, hand grip single distal end.  The axillary pad is to be held between the upper arm and the chest wall, it should not be pushed into the axilla.  Uses – total weight bearing on both legs or partial weight bearing on one leg  Gutter - metal adjustable crutch legs with gutter splint mounted on top  Parts – Vertical Handgrip, forearm support, forearm strap, notches for length, ferrule,  The forearm is placed on this splint and secured.  Uses – Rheumatoid arthritis  Forearm/elbow –  Sticks of adjustable length with horizontal handgrip  They are not as stable as axillary crutches.  Walkers – normal , rollators  They are large based having 3 or 4 point of contact  They have a light weight frame with 4 feet & adjustable length. Wheelchair  Types- manual, powered.  Any chair on wheels that can be propelled either manually or by power  Parts : WC frame Seat & cushion Arm rests Leg rests Foot rests Restraints  Uses - amputee  paralysis  recent surgeries THANK YOU !!!