From Big Medical Encyclopedia

MECHANOTHERAPY (grech, mechane tool, machine + therapeia treatment; outdated synonym kinesitherapy) — the physical exercises made with the medical purpose on special devices; component of LFK. The m is used during the performing recovery treatment when long, intensive local influences for development of mobility in joints of extremities and increases in force of muscles are required. Exercises on mechanotherapeutic devices accelerate process of recovery of the broken motive function. The nature of the movements which are carried out on these devices is defined by anatomic features of this or that joint. On sick M.'s organism it is reasonable to apply to rendering more versatile action in a complex with exercises of remedial gymnastics.

Indications and Contraindications

Indications: permanent motive disturbances in joints — contractures because of cicatricial processes of a posttraumatic origin, restriction of movements in joints after the postponed arthritis of various etiology, paresis of various origin, and also unsharply expressed decrease in force of muscles of extremities as a result of a long bed rest, the postponed disease, etc.

Contraindications: acute inflammatory processes in joints, small terms after the postponed injuries of a musculoskeletal system (fractures of bones before their strong consolidation, damage of soft tissues before their scarring). Sharply expressed decrease in an animal force (impossibility to overcome the weight of a segment of an extremity), the deformation of joints caused by the expressed disturbance of congruence of joint surfaces or shift of axes of joints, emergence in the course of performance of exercises of synergies (consensual movements), the general serious condition of the patient.

A technique

in practice of recovery treatment use three main types of mechanotherapeutic devices: 1) the devices of pendular type based on the principle of the balancing pendulum; 2) devices, designs to-rykh the principle of the block and draft of a load is the cornerstone; 3) mechanotherapeutic devices, in to-rykh the principle of the lever in combination with the inertia arising at the movement is used.

Fig. 1. The leg of the patient is fixed by cuffs to the mechanotherapeutic device of pendular type: the patient, making the movements in a knee joint, causes swing of a pendulum; owing to the arising inertia amplitude of movements increases in a joint.

Devices of pendular type. Operation of these devices is based on increase in amplitude of the movements made by the patient with force of the inertia developing at the movement of the balancing pendulum (fig. 1). As the main indication to use of devices of this type serves existence of a contracture. The device of pendular type is supplied a set of removable loads from 1 to 5 kg, belts for fixing of an extremity, the porolonovy small pillows placed on basic platforms.

The medical industry of the USSR makes the set consisting of devices for all joints of top and bottom extremities; devices are mounted on a special rack or fasten to a wall. Pendular devices M. can be used in the conditions of a special office (stationary devices) or to be applied in chamber (bedside devices).

During the use of the device of the patient seat on a chair, the segment of an extremity located proksimalny a joint, in Krom the movements are developed, place on a support little table, and fix the mobile segment of an extremity located distalny a joint to the special bar established under the corresponding corner (depending on character of a contracture); on a bar at the necessary height fix a load. The patient, making the active movements in a joint, sets a pendulum in motion and owing to rychagovy action and the inertia arising at the same time amplitude of movements gradually increases in the affected joint.

The dosage of loading is reached by change of a corner, under the Crimea establish a bar of the device with the segment of an extremity fixed to it, and also change of situation and size of a load, speed and duration of performance of exercises. Duration of the procedure 10 — 20 min., for day of the procedure 2 — 3 times can be carried out.

The number of procedures (lasting 1 — 2 month and more) is defined on a course individually and depends on the nature of disturbance of motive function.

The devices based on the principle of the block and draft of a load, include: stationary block installations, special functional «mechanotherapeutic tables» and figurative block installations. As indications to use of mechanotherapeutic devices of this type serve preferential decrease in an animal force and restriction of movements in joints.

Stationary block mechanotherapeutic installation consists of the mobile self-orientating block, two guides of bars, on the Crimea the metal platform with loads, a set of disks weighing 1 kg, a cord with a carbine and the replaced nozzles moves (the handle or a belt for fastening to a leg). During the use of the patient of the device captures the handle of the device and depending on a task (simplification of movements or increase in force of muscles) makes active exercises, during the performance to-rykh the weight of a load counterbalances the weight of an extremity or renders counteraction to the movement.

The functional mechanotherapeutic table consists of the following parts: panels, about a cut are movably connected two arches; the couplings moving on bars of arches; the blocks suspended to arches; a cord with a carbine, a set of bags with sand (from 1 to 5 kg are powerful) and nozzles for fastening of a cord to an extremity. During the use of the patient of the device lays down on a table and makes the active movements by the extremity which is movably fixed to the device. Depending on a pose of the patient (on a back, a stomach, a side), and also the provision of arches of the device strengthening of various muscular groups can be reached. The average duration of the procedure is 15 min. The number of procedures is defined by extent of functional disturbances and, in particular, decrease in force of muscles.

Figurative block installations, the principle of action to-rykh it is similar described above, attach to wall bars, a lintel of a door, etc.

Mechanotherapeutic devices, in to-rykh it is used the principle of the lever and the inertia arising at the movement, turn on roller «cart», «coil», «rocking chairs» for hands and legs and other devices. Such devices apply in medical institutions and in house conditions for simplification of active movements and recovery of mobility in joints.

Fig. 2. The brush of the patient lies on roller «cart»: the active movements in a radiocarpal joint (assignment and reduction) made by the patient amplify thanks to rotation of rollers.

The roller cart represents the metal platform, on the basis a cut there are two axes with the roller bearings strengthened on them. The patient places an extremity on the roller cart and makes the active movements facilitated by rotation of rollers (fig. 2). This device is used for simplification of movements in humeral, elbow, radiocarpal, coxofemoral, knee joints.

The mechanotherapeutic coil intends for development of movements in metacarpophalangeal and radiocarpal joints and consists of the metal cylinder connected to two disks and a clamping level. During the use of the patient of this adaptation captures fingers the cylinder, fixes it a clamping level and makes rotary motion by the coil.

Fig. 3. Foot of the patient is fixed to mechanotherapeutic «rocking chair»: by means of the lever of the patient increases amplitude of movements in an ankle joint.

Mechanotherapeutic rocking chairs of various design intend preferential for recovery of movements in radiocarpal and talocrural joints. During the use of the patient of the device places a brush or foot on the basic platform and makes by means of the lever smooth rockings in a joint (fig. 3). The dosage during the use of similar devices is defined by the volume of the made movements (their amplitude), speed and duration of the procedure. Duration of the procedure averages 10 — 15 min., for day of the procedure can repeat. The number of procedures is defined on a course of treatment individually.

See also Physiotherapy exercises as method .

Bibliography: Kaptelin A. F. Recovery treatment (physiotherapy exercises, massage and work therapy) at injuries and * deformations of a musculoskeletal system, page 53, M., 1969; about N e, Mekhanote-rapevtichesky devices for recovery of movements in joints, Ortop, and travmat., No. 9, page 73, 1978; The Guide to physical methods of treatment, under the editorship of S. A. Brustein, t. 1, p.1, page 75, L., 1927.

A. F. Kaptelin.