Medical Training and Muscle Rehab Therapy

It was recognised in the 1980s that top-level athletes who had suffered locomotor injuries could be rehabilitated and thus return to competitive sport considerably more quickly if the physiotherapy programme was supported by a regimen of intensive muscle strengthening treatment.
The Employer's Liability Insurance Associations in Germany (initially that for the clerical and administrative sector) soon recognised the benefits of this approach for the "non-sporting" population as well. Using this type of approach "normal patients" could generally return to work much more rapidly, which meant a huge saving in cost (shorter period of illness, lower invalidity rate).

The key features of this type of rehabilitation are:

1. Interdisciplinary
cooperation between doctors, physiotherapists, masseurs and graduate sports teachers.

2. Intensity
of the training program. Training sessions last between 3 and 5 hours per day.

3. Complexity:
the entire body is trained, not just the injured part. Training makes use of the main elements of modern training theory.

4. Prevention
of renewed injury. Situations or conditions that could cause injury (e.g. muscular dysbalance, but also sport-specific external factors that can trigger injury) can be controlled under the training conditions.

Objectives of Medical Training and Muscle Rehab Therapy:

Complete freedom from pain:
  • Restoration of the best possible muscular function: strength, stamina and co-ordination.
  • Restoration of the best possible articular functions and component structures (ligaments, tendons, cartilage).
  • Re-learning of kinetic patterns specific to everyday life and sporting activities.
  • Prevention of renewed injury.
Phases of the muscle rehab training:
  • Phase 1 – mobilisation: early functional therapy
  • Phase 2 – stabilisation: functional therapy
  • Phase 3 – functional muscle strengthening: full functionality
  • Phase 4 – muscle-loading training: full stress resistance
The duration of the various phases depends on the following factors:
  • type of injury
  • surgical procedures
  • post-operative recovery process
  • individual condition of patient
  • clinic's own guidelines on after-treatment.
Medical Training and Muscle Rehab Therapy is used not only as a support therapy in the orthopaedic and traumatological areas, but is also an indispensable rehabilitation method in medical and neurological fields.

BPM computer-aided diagnostics and therapy

The BPM computer-aided diagnostics system is used to generate data on the patient's ability to balance and his or her proprioceptive functions. The data is used as part of a daily cognitive rehabilitation programme to support and promote continuous therapeutic progress. The data can be generated and fed back to the patient during a training session, used to assess and diagnose the patient's current status, or used to evaluate the overall success of a rehabilitation program. The cognitive co-ordination training permitted by the BPM computer provides invaluable support in the treatment of patients with balance dysfunction or proprioceptive deficits. The system continuously monitors force and weight distribution and feeds this information back to the patient in the form of visual and acoustic signals, motivating the patient in his or her attempts to improve balance, proprioception and locomotor function.

Biofeedback:
patients receive immediate and continuous feedback on their progress. This promotes independence and gives patients a feeling of control over their therapy. As a result, patient compliance and therapy success are improved.

Communication:
the easily-comprehendible, visual and acoustic messages transmitted by the BPM computer-based co-ordination system creates a very important communication channel between patient and therapist. Therapeutic instructions can be both seen and heard. Patient movements and responses are registered and reported back to the patient during the training session.

Additional incentive:
continuous feedback supports the therapist in that the patient receives a continual update from the system on how accurately he or she is following the therapist's instructions. This motivates the patient and accelerates the locomotor learning process as the patient has an objective measure of what is expected.

Audio signal:
by using acoustic feedback in addition to the visual signals provided by the system, even badly injured patients are able to receive feedback support during therapy.

Sensitivity:
the BPM system can be used in the treatment of all neurological and neuromuscular disorders, as cognitive-coordinative therapy can be performed when the patient is in either a sitting or standing position, and the sensitivity of the system can be adjusted by the therapist to match the patient's abilities. Progress is achieved by encouraging the patient to undertake exercises of gradually increasing difficulty.

Objective measurement:
The system provides the therapist with a means of objectively measuring patient performance. As improvements in locomotor function can be recorded over a long period, the ability to assess therapeutic progress is greatly enhanced, which in turn increases the effectiveness of a treatment programme

Other cognitive-coordinative techniques
are available to train balance and spatial positioning and to re-educate gross and fine motor skills (balls, ropes, rollers, rocker and wobble boards), and these form an integral part of the daily therapy repertoire. A personal therapy programme incorporating all or some of the above techniques is compiled for each patient based on the patient's clinical state.

The DigiMax® diagnostics system

enables isometric and dynamic/auxotonic muscle actions to be precisely measured, evaluated and compared. This information is used to carefully adjust the training devices used in Medical Training and Muscle Rehab Therapy and guarantees reproducible and objectively comparable measurements and reliable documentation of muscular and arthrokinematic data.

Isometric measurements of:
  • force
  • torque
Auxotonic measurements of:
  • force
  • torque
  • acceleration
  • speed
  • power
  • impulsive force
  • work
  • overview

Bar chart and the presentation of several training units:

Force:
a) peak force
b) mean force

Torque:
a) peak torque
b) mean torque

In dynamic training:
a) work
b) mean power

B I O D E X – isokinetic dynamometer:

a diagnostics and training system for the spinal column and limb joints. Measures parameters of the locomotor system such as torque, power and energy of acceleration. Dynamic ramping: special mode used in isokinetic training. The angular velocity adjusts automatically to match the individual (initial) speed of the patient. The angular velocity is kept slightly lower than the patient's speed so that the patient can be guided by the resulting resistance. This ensures that the patient works up smoothly to the specified training speed. As a result, patients experience a degree of resistance that they themselves generate on the device.

Diagnostic techniques for measuring and improving cardiovascular efficiency Therapeutic equipment and training options:
  • computer-controlled cycle ergometer with pulse-frequency display/control unit
  • computer-controlled upper-body ergometer with pulse-frequency display/control unit
  • treadmills with pulse-frequency display/control unit
  • suspended walking device (treadmill with locomotion system) for cardiovascular training under conditions of reduced bodyweight
  • group therapy: aquajogging with buoyancy aids in the therapy pool
Diagnostics:
  • treadmill diagnostics with measurement of: speed, acceleration, heart rate, blood pressure, lactate concentration, oxygen saturation, tidal volume.
  • cycle ergometer and upper-body ergometer with computer-controlled recording of: cardiac stress in watts, heart rate, blood pressure, lactate concentration, oxygen saturation, tidal volume.

General Applications:
cardiovascular diagnostics in rehabilitation, as well as in general and competitive sport:
  • determining general/specific aerobic stamina;
  • determining lactate threshold;
  • determining the initial requirements before commencing a therapy program.

Applications in competitive sport:
performance testing in high-performance sport (e.g. the CONCONI test involving gradually increasing cardiac stress levels) are carried out under medical supervision. Measurement of peak cardiovascular stress and determination of the lactate threshold.

Objectives:
Development of a specific training plan to increase performance levels in the aerobic stamina region. Monitoring of training: recognition of overtraining states. Comparison of actual and target levels after injury. Talent recognition and development.

Applications in rehab diagnostics:
determination of cardiovascular capacity by determining the physical working capacity per kilogram bodyweight at a heart rate of 130/150/170 beats per minute (PWC 130/150/170). Used in both rehabilitation and post-convalescence care. Special test programs are used that can be varied to meet specific patient needs (choice of level/time).

Objectives:
computer-controlled stamina training, monitored by the therapist, to improve cardiovascular capacity. Training on different pieces of equipment with continuous monitoring of pulse, blood pressure, breathing and patient's general state. Regular testing enables course of therapy to be checked and revised as required.

Indications:
  • heart disease (e.g. coronary heart disease, coronary insufficiency);
  • pulmonary disorders (with added oxygen supply during stress phase);
  • vascular disease (e.g. peripheral vascular disease);
  • other internal disorders (e.g. diabetes);
  • metabolic diseases (e.g. obesity therapy for children and youth);
  • stamina training using a suspended walking apparatus (treadmill with weight-compensation harness) for patients with existing locomotor limitations or for severely overweight patients.

SMS computer for measurement of the spinal column

Measuring principle:
  • lateral weight displacement
  • anterior-posterior shift
  • tracking the centre of balance
The measurement of the vertebral column may be carried out with the patient sitting or standing. The graphical images recorded are analysed to yield numerical values. The SMS method provides very useful data that complements other techniques such as digital photopodoscopy of the sole of the foot, functional diagnostics of the foot's rolling motion when analysing a patient's walking and running gaits, and other comparative diagnostic techniques in orthopaedics and accident surgery.


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