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Rehabilitation Programs

Neuromuscular Education

For Superior Motion Training and Injury Prevention

With Quick Effective Results

    Patient Training Techniques

 

Getting the “feel” of Inertial Exercise is essential in maximizing patient progress. This feel is the result of smooth coordinated repetitious acceleration and deceleration of weight on the travel sled.  A transition from one phase to another can be easily learned with little practice if the concept of smooth motion is adhered to. The velocity of the travel sled is not important; the smooth control of travel repetition is.  While training a patient, if any anxiety begins to manifest, simply add weight to the sled regardless of the technique of motion involved.  This assists in reinforcing the smooth flow “feel”. 

Patient precautions

Prior to using this equipment for injury rehabilitation, inflammation and pain should be controlled.

 

The patient should experience no pain during the exercise.

 

A physical therapist, physician, or professional trainer should supervise the patient while using equipment.

 

Use of the Impulse increases the core temperature of muscle holistically.  Cooling processes of the body can cause dehydration.  The patient should consume a cup of water prior to exercise if dehydration is a concern.

 

All of the exercise techniques incorporated in the use of the Impulse consist of reciprocally pulling on a line, causing a sled to accelerate and decelerate in a horizontal plane along a track.  The motion is restricted to a predetermined ROM.  Both the start of acceleration and end of deceleration occur at the Initial Position (IP) of ROM.  The End Position (EP) of ROM is the end of the acceleration portion of the exercise.  The exercise technique determines when the eccentric component of deceleration begins, at the ROM EP or ROM IP.  Selection of IP is determined by the biomechanical deficiency of the user.  The IP should be in the area of ROM at which the user would need to expend maximal available energy related to conditions in the biomechanical area being developed.  Three basic exercise techniques may be incorporated in the use of the Impulse.  They are:

 

Passive Phasic (catch waiting) The user pulls the line through the ROM accelerating the sled.  At the EP, (which is just prior to the sled reaching the center of the track) the user returns to the IP quickly, producing slack in the line, allowing the sled to coast along the track.  At the IP, the user waits until the slack comes out of the line, producing a slight jerk, catching the momentum of the sled and bringing it to a halt. Thus ends one repetition and the next begins. This technique develops a sense of catch anticipation.  When employed with 20 or more pounds, it can be beneficial in training ballistic inhibition and developing gait.

 

Active Phasic (catch anticipation) The user pulls the line through the ROM accelerating the sled.  At EP, the user returns to the IP quickly, producing slack in the line.  While the sled coasts, the user anticipates the catch and accelerates the limb into the momentum of the sled.  This anticipatory act will halt the sled and create a prestretch condition in the biomechanical components.  The result is an automatic transition into an acceleration phase initiating the next repetition.  This technique develops motor skills where instantaneous muscle synergism is needed.  It is beneficial in developing functional eccentric reflex actions fundamental in protecting injured areas; furthermore, it develops high proprioceptive skills typically called for in sport or industrial activity.  By varying the activation technique, one may produce extremely low or extremely high forces.   It is an excellent exercise technique for joints that are typically tight.

 

Tonic     The user pulls the line through the ROM to the EP, accelerating the sled.  At the EP, the user continues to attempt acceleration of the sled. When the user feels the momentum of the sled pulling on the line, he decelerates the sled proprioceptive tracking it throughout the return to the IP.  At IP, deceleration forces are converted to acceleration forces for the next repetition.    This technique develops motor program skills where continuous muscle coactivation through out ROM is needed.  It is beneficial in developing protective motor programs that will maximize the efficient cocontractive use of an injured area.  Applied properly it can increase ROM and reduce pain.   It is an excellent exercise technique for joints that are typically loose or prone to sublux.

 

Initially, in the orientation process, train an uninvolved area of the body before treating the involved area.  Remember to use a hands on approach.  As an example, train the left arm in external rotation at an intensity of operation which you estimate the injured right arm can comply with. Allow the left arm to exercise independent of your hands on assistance giving verbal correction to insure the learning of the intensity required of the injury.  Once control is obvious, switch to the injured area and continue exercise.  It is not absolutely necessary to train an uninvolved upper extremity before treating the upper extremity.  The user will find a substantial neurological overflow to all the areas of the body after training in only one area.  The emphasis should always be on training control.

 

Training 

 

The most successful method in training a user is manual therapy - the hands on approach.  Remember, train an uninvolved area of the body in both the technique and intensity of exercise you expect the involved area to do.  For example, the injured area may be a knee; so start by training the shoulder in external rotation.  This training technique works with all three exercise methods.  The post pulley should be positioned at the height of the user’s elbow, user standing.  The shoulder is in the neutral position, elbow in a flexion of 90° with the maximal eccentric component (initial position) of the exercise beginning at a forearm perpendicular to the chest position.  The user should be placed such that in EP the line is pulled tight with the sled centered and the hips and feet parallel to the line.  ROM should be from 30° to 45° of external rotation.  

 

Progress in the training method as follows:

1. Place 17 ½ pounds or more on the Impulse sled.

2. Demonstrate the exercise.

3. Place the user in the appropriate starting position.

4. Instruct the user to watch your eyes or some object behind you.  Caution the user not to watch the sled or the line handle during the exercise.

5. Place the line handle in the user’s hand.

6. Grasp the hand of the user and instruct complete relaxation of the limb.   Do not progress until you have gained the confidence of the user, and your assessment of the limb's motor activity is that of complete relaxation.  You must be in complete control.  Like the lead in a dance couple.

7. Begin the exercise with what you consider an easy comfortable intensity being aware that all motor activity is performed by you.  If, through sensory feedback between hands, motor activity is performed by the user, caution the user to relax and let you do all the motor activities.  Be sure the user is not watching the sled or line handle motion.

8. After about ten relaxed and instructor controlled repetitions, ask the user to initiate input into the exercise by tracking your motions with his hands. If the user seems uncoordinated, continue exercising by over powering the uncoordinated condition.  Ask the user to relax while exercising and just track your motions. Tracking should occur in about ten reps.

9. When accompanied tracking is easy, ask the user to take control of the exercise.  Make motion corrections through instructor motion tracking when required.

10. When sensory feedback indicates user control of the exercise, remove your hand  while asking the user to continue the exercise.

11. Place close attention to the exercise motion being performed.  Look for:

     11.1 Improper range of motion

     11.2 Improper EP positioning in ROM

     11.3 Abnormal muscle tension

     11.4 Retarded return motion

     11.5 User observance of sled or line handle.  Make the appropriate verbal corrections.

     11.6 Improper motion technique (slack or no slack application)

     12. If the user’s coordination begins to "fall apart" grasp his hand and begin tracking assistance.  When proper motor control returns, release your hand.

     13. Ask the user to perform 30 repetitions without assistance.

 

After the user gains coordination with the device, select any motion for the trained extremity that does not require the use of the already fatigued muscles (example - a curl motion at 90° flexion).  Ask the user to exercise.  Increase the intensity of the exercise.  After a few reps, do the exercise with the smallest intensity possible.  If in performing this, the user has difficulty controlling the sled, add five pounds to the sled and continue the exercise.  When the control of motion is regained, reduce weight in five-pound increments each time allowing the control of motion to "set in".

When proficient in low intensity motion, adjust the Impulse for exercises of the involved area.  Exercise the involved area.  Initial exercise bouts should be 30 reps for each needed plane of motion of the involved area including the exercise specific to the injury.  For subsequent exercise sessions, when the user can perform 2 or more reps per second, change the exercise bouts to 30 seconds.

               Utilization in Rehabilitation

 

The examples described below are specific to the area of the body in question   They are offered as examples of how and what to do but are not written in stone.   Your imagination is your only limitation in the utility of Inertial Exercise.   To see sample programs click this

sample programs link.

 

General Shoulder Program

 

This program can be used to initiate rehabilitation associated with most shoulder problems.  It can be modified for specific problems; for example, a chronic dislocation shoulder may want to focus more on shoulder internal rotation and adduction than external rotation and abduction, or a rotator cuff tendonitis may need to back off external rotation exercises until pain diminishes, but should be able to perform most other motions.

 

Position -Neutral

Sled Weight- 10 pounds

Line Attachment - Line Handle

Motions-  Extension,  Flexion,  Internal rotation,  External rotation (in 200 - 300 abduction),  Adduction (450 to 100),  Abduction (100 to 450)

 

If the patient has difficulty coordinating the movement, increase or decrease the weight until he can perform it in a coordinated fashion.  This may be different for each of the shoulder patterns, again depending upon pathology.  The frequency should be a comfortable rate for the patient.  He will usually choose the frequency rate most appropriate for the shoulder pattern.  For example, shoulder adduction will be easier in most cases than external rotation and most patients will automatically increase the frequency on this exercise, thereby increasing the resultant force.

 

Begin the first day with one set of 30 at a tolerable frequency.  Then progress to 3 sets of 30 reps or to 3 sets of 30 seconds, again at a tolerable frequency.  As the patient progresses, increase the force by increasing the frequency of the exercise, or increase the weight (1¼ pounds to 2½ pounds increments) if for any reason the frequency should not increase.

 

Specific Problems Upper Extremities

 

Chronic Shoulder Dislocation/Post Reconstruction

 

You can work through a very small ROM on the Impulse by utilizing only 10" to 18" of sled travel from either side of the central pulleys.  This makes it possible to achieve relatively high forces while working through a very small ROM as in a dislocating shoulder. Working shoulder adduction and internal rotation can be done quite successfully early on in the rehabilitation of an anterior inferior dislocation or ER and abduction in a posterior dislocation.  Using short quick tonic movements on the Impulse causes reflexive co-contraction about the shoulder and works quite well in multi-directional instabilities. As he progresses, the patient can be moved into more functional positions depending upon lifestyle and goals.

 

Impingement/Rotator Cuff Tendonitis  Attachment - Line Handle

 

These work quite well with the general program.  The patient will more than likely need to drop down on weight or frequency in external rotation depending upon the stage of inflammation.  He may also be progressed to the "Empty Can" position for isolation of the supraspinatus.

 

Adhesive Capsulitus   Attachment - Line Handle

 

The Impulse works quite well as an adjunct to heat, mobilization, and other therapies for frozen shoulder.  Generally the condition will respond to high weights (25 pounds) and slow movements for extension, using the full length of the track performing repetitions until fatigue.  Other motions follow the general protocol with caution to underlying pathology (i.e. tendonitis, bursitis, fracture, etc.)

 

Arthritis - OA - RA   Attachment - Line Handle (upper extremities) ankle strap (lower extremities)

 

Arthritis patients do particularly well in post-acute phases because no weights are being lifted against gravity causing joint compression for long periods of time.  Five pounds of weight at a frequency rate comfortable for the patient is usually adequate although, occasionally ER and abduction need to be reduced to 2½ pounds.  A frequency rate of one set of 30 reps is most appropriate.

 

Tennis Elbow Medial or Lateral  Line Attachment - Line Handle

Elbow Extension - 10 Pounds

Elbow Flexion - 10 Pounds

Wrist Extension - 10 Pounds (Male); 5 to 7½ pounds (Female)

Wrist Flexion - 10 Pounds (male); 5 to 7½ pounds (Female)

 

Line Attachment - Sport Handle


Pronation - 10 Pounds (Male); 5 to 7½ pounds (Female)

Supination - 10 Pounds (Male); 5 to 7½ pounds (Female)

Ulnar Deviation - 10 Pounds (Male); 5 to 7½ pounds (Female)

Radial Deviation - 10 Pounds (Male); 5 to 7½ pounds (Female)

 

Begin with one set of 30 reps and progress to 3 sets of 30 seconds.  If these patterns are difficult to isolate or are painful, they can be incorporated into part of a shoulder pattern, such as shoulder extension with wrist extension or internal rotation with wrist flexion or pronation.

 

Specific Problems Lower Extremities

 

Quadriceps Strain    Line Attachment - Ankle Strap Around Ankle


Knee Extension - Seated - 17½ Pounds - catch at 90°

Knee Flexion - Seated - 17½ Pounds - catch at 90°

Hip Flexion - Standing - 17½ Pounds- catch at 0°

Hip Adduction - Standing - 15 Pounds - catch at 0°

Hip Abduction - Standing - 15 Pounds - catch at 0°

Hip Flexion with Knee Extension (kicking motion) - Standing - 15   Pounds catch at less the 30°

 

Progress to 3 sets of 30 reps or 30 seconds, decreasing weight by 5 pounds increments until there is no weight on the sled.

 

 

Hamstring Strain   Line Attachment - Ankle Strap Around Ankle

 

Knee Extension - Seated - 17½ Pounds

Knee Flexion - Seated - 17½ Pounds

Knee Flexion - Standing - 15 Pounds

Hip Adduction - Standing - 15 Pounds

Hip Abduction - Standing - 15 Pounds

Hip Extension with Knee Extension - Standing - 15

 

Progress to 3 sets of 30 reps or 30 seconds, decreasing weight by 5 pound increments until there is no weight on the sled. Hamstrings are primarily fast twitch fiber and need to be rehabilitated at a high performance rate for best results.  Patients will usually progress down in weight quickly on this one.

 

Post-Surgical Cases   Line Attachment - Ankle Strap Around Ankle

 

Protocol will depend on what was done in surgery and the current  stability/state of the knee joint.  Any of the above patterns may be done depending upon the surgery, etc.  One additional activity that can usually be done early on is to work on coordination and balance by attaching the ankle strap to the uninvolved leg, weight bearing on the involved leg (a partial support such as a walker or chair may be necessary), and performing leg and hip activities on the involved leg. This forces balance on the involved extremity.

 

Ankle Sprains    Line Attachment - Ankle Strap Around Foot per Specification.

 

Ankle Dorsi-flexion - Seated, knee at 45° ankle level with hip (use stool for foot) - 7½ to 10 pounds.  Link at bottom of foot with rope going away from body (facing post).

 

Ankle Plantars-flexion - Seated, knee at 45° ankle level with hip (use stool for foot) - 10 to 15 pounds.  Link at top of foot with rope going towards body (back to post).

 

Ankle Inversion - Seated, knee at 45 to 90°, ankle at floor level - 7½ to 10 pounds.  Link at instep (abductor halluces) with rope going under foot to post, foot at 90° to rope.  Hip internal rotation may be useful as the acceleration motivator.

 

Ankle Eversion - Seated, knee at 45 to 90° ankle at floor level - 7½ to 10 pounds.  Link at outstep (abductor minim digiti) with rope going under foot to post, foot at 90° to rope.  Hip external rotation may be useful as the acceleration motivator.

 

Combination hip abduction with eversion - Standing - 7½ to 10 pounds.  Link at outstep (abductor minim digiti) with rope going under foot to post, foot at 90° to rope.

 

Combination hip adduction with inversion - Standing - 7½ to 10 pounds.  Ling at instep (abductor halluces) with rope going under foot to post, foot at 90° to rope.

 

Ankle sprains respond quite well to the Impulse because it retrains the peroneals to react quickly when the ankle is challenged.  Progress to 3 sets of 30 reps or 30 seconds. Progress down in weight and up in frequency rate as quickly as possible.

 

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