CC BY
22
DOI 10.14526/01_1111_168
TRAINING SIMULATOR FOR CORRECT WALKING FORMATION AND VESTIBULAR APPARATUS TRAINING
Nicholas M. Belokrylov - doctor of medical sciences, professor of adaptive and therapeutic
physical training department, Perm State Humanitarian-Pedagogical University, 24, Str. Siberian, Perm, 614990, Russia Ludmila V. Sharova - doctor of biological sciences, professor Perm State Humanitarian-Pedagogical University, 24, Str. Siberian, Perm, 614990, Russia Alexsey V. Shepalov - Regional Children's Clinical Hospital, 22, Str. Bauman, Perm, 614066, Russia Svetlana V. Annenkova - post-graduate Perm National Research Polytechnic University, 29, Komsomolsky prospect, Perm, 614990, Russia
E-mail: sharovalv@bk.ru
Annotation. One of the most urgent problems in teenage orthopedy is a correct formation of torsion mindsets during lower extremities development among children with a norm and with pathology. Torsion formation of the lower extremities depends on the peculiarities of anatomical structure of hip, knee, ankle joints and the form of a foot. An original training simulator is offered in order to improve walking, develop the functions of feet support, create the possibilities of correct torsion formation of the lower extremities, improve the skills of walking and balancing. Materials. The apparatus consists from a wooden shield in the basis of which there are cylinder-like holes- niches, on the right and the left sides with "imitation of steps". Spring units in a form ofplugs are set into these holes, connected with the platforms in a form of a footprint of a child, covered with anti-slip material. Plugs can move in a niche, they are placed and set with a screw depending on given torsion parameters of "imitation steps". Research methods: Spring device helps to balance in case of one-supporting step at each footprint owing to the possibility of minimal oscillatory movements, shield itself can be at an angle 10-15° with imitation of moving up the mountain. The training simulator helps to form the skills of walking and balancing. Results. The system of trainings at the created training simulator is offered, preliminary clinic results are received. Preliminary clinical effectiveness estimation of the training simulator is positive. After three courses of two-week lessons with the interval of a month 90% of children with different orthopedic pathology have a correct skill of walking formation, self-control improvement, disappear the cases of loss of balance during a walk, children stop stumpling, their feet are correctly turned during a walk. Conclusion. Offered by the authors training simulator is effective in case of wide spectrum of pathology of the lower extremities, it is simple in structure, helps children to improve walking within several courses, make it more confident, helps to improve balance during the support, improve balancing abilities of children. Preliminary estimation of the training simulator showed its high level of effectiveness. Keywords: rehabilitation, walking function improvement, torsion formation of the lower extremities, balancing function, vestibular apparatus.
Introduction: Walking in a norm is a difficult cyclic locomotor act, which is fulfilled with the help of many kinematic pairs and owing to the work of many muscles of a shoulder and pelvic girdles and lower extremities.
Lower extremities fulfill supporting, spring and motional functions of a person's body. Owing to joints, muscles and ligaments lower extremities amortize body movements and weaken all pushes, vibrations influence on the body during walking, running, jumping. Healthy lower extremities have functionally expedient anatomic structure that is why on their state depends the work of muscles in order to decrease energy expenditure during the walk and a correct development of locomotor apparatus in general [1,2].
Locomotor system disorders take the 1st place among all defect, at the same time, three fourth of them form defects of extremities development. It is known that the amount of children with inborn anomalies and the variants of locomotor system hypoplasia is not going down, the number of new-born children with the disorders in skeleton development is 2,5%.
One of the most urgent problems in children and teenage orthopedy is a correct formation of torsion mindsets during lower extremities development among children with a norm and with pathology. Torsion is a structural characteristic of a bone, which is presented as its curling along a longitudinal axis, and is determined according to positional relationship of the opposite joint ends of a bone. It is connected directly with the bone and can be determined irrelative of the position of an extremity or body in space for each long cortical bone.
Torsion formation of the lower extremities depends on the peculiarities of anatomical structure of hip, knee, ankle joints and the form of a foot, functions of the surrounding muscles, ergonomics of their work.
Torsion of a bone structure of the lower extremities influences not only
manner of walking, but also the function of all its segments, including its supporting part - foot itself, and the hip joint is the key anatomic element, which starts torsion mechanism of a hip formation at different levels in the horizontal plane. The volume of rotation depends on the angle of inclination forward (anteversion) of femoral neck, which is sufficiently big among children. Inner rotation increase in 1,5 is the sign of antetorsion, twice more increase is dysplasia of a hip joint.
The process of physiological torsion development of a lower extremity segments happens only in case of a normally developed musculoskeletal system and is conditioned by the activity of muscles in dynamics and statics. In case of system diseases and inborn disorders of development of the lower extremities, as a rule, their torsion development also violated [3].
The aim of the training simulator
invention is the opportunity creation for the skills of walking and balancing formation and improvement.
Research methods and research organization: The research was held by the group of the authors. We fulfilled the observation over the children during the process of teaching correct feet position during a walk and the reflex of walking formation in complicated conditions. Methodologists directed their efforts to a child's pelvis turn forward in one-supporting period of a step, and it conditioned the rhythm of a walk, corrected formed rotational skills during foot placing. At the same time, there was spasticity decrease among children with neurologic disorders of different level and also the function improvement of a vestibular apparatus. For the created special balancing device a priority certificate for a useful model is received.
Research methods and research organization: a training simulator is created for a correct rotational placing of
footprints are placed in a form of a "herringbone" with the opportunity to turn feet at a different angle facing outer and inner rotations depending on the set aim.
feet formation during a walk in order to train vestibular apparatus and prevent the relapses of foot deformation among preschool children. Picture 1 presents a platform in a form of a child's footprint. 10
Picture 1 - the picture presents a "footprint" with a spring device
given torsion parameters recommended by a doctor. A spring device itself is presented as a spring, which is pressed into couplings from a firm plastic and it helps to balance during one-supporting step at each footprint, in this case support stays sufficiently stable for a walk on a platform. Minimal vibrating movements of a spring during a walk give a child an opportunity to balance while moving forward, footprints, in case of a supporting load, are able to fulfill vibrating movements and leans relative to a horizontal plane within several grades and a board itself can increase the lean to 10-15° with the imitation of moving up the hill. The invention concerns medicine, in particular the devices of forming the skills of walking and balancing.
Placed on a shield platforms in a form of a child's footprint (picture 2) help to fulfill the exercises, which train a child's ability to hold the balance, keep vertical position of a body, walk with a correct foot placing, with a correct turn.
The device consists of a furniture shield from joint wood of soft kinds, in the basis of which there are cylinder-like holes-niches, on the right and the left sides with imitation of the left and the right steps. Longitudinal distance between the holes corresponds to the length of a child's step and can be changed depending on a child's age (from 3 to 7). Spring units in a form of plugs are set into these holes, connected with the platforms in a form of a footprint of a child, made of a wood or plastic, covered with anti-slip material.
A plug can move in a niche, they are placed and set with a screw depending on
Picture 2 - Location of the platforms-footprints on a shield with an opportunity to turn them in a horizontal plane.
A foot turn can be different depending on a set aim and is regulated by a doctor by means of a simple device. This procedure is the following: a child stands on a platform-footprint and walks standing on "footprints", his weight and oppositely directed force of spring elasticity influence a platform. The vibrations of a footprint are minimal, during the support they make a child balance and fix a foot steadily involving proprioceptive mechanism of muscular-joint apparatus. A child starts to wiggle from side to side (like during
pitching on board a ship) trying to hold the balance, not to fall. A balancing device for the skills of walking formation and improvement can be used in medical rehabilitation as the means for a correct step placing and balancing on one leg during the phase of rolling while moving.
The work at a training simulator is fulfilled after the main remedial gymnastics lesson (RG) individually. The duration of the lessons is 5-15 minutes depending on the age of a child, the lessons can be repeated till 5 times a day. A child overcomes all the way along the training simulator, the length of a training simulator is one and a half meters.
The training lessons are repeated during several days or one month and it
helps to form the skill of walking on an unsteady surface and has a positive influence on training muscles of the lower extremities and a vestibular apparatus. The lessons are held in an easy form of a game, which is interesting for children. For children with neurological disorders, in particular with infantile cerebral paralysis (ICP), after the position of feet correction, such kind of rehabilitation is very useful as the opportunity to balance causes activation of the additional reflexes, covering the mechanisms of spasticity. Depending on the set aim the device helps a child to walk independently, balancing with hands if it is necessary, or walk holding the hand of a helper or the handrail (picture 3).
Picture 3 - A child holds the handrail while using the training simulator
Results and their discussion. At the
initial stages of the research we studied the peculiarities of feet setting during a walk with the help of footprints visualization on paper, estimated the angle of foot turn, equitability of the steps, vibrations in the turn of the feet. We clinically estimated the groups of people with orthopedic disorders and people with somatic pathology with different deviations in lower extremities torsion formation. Preliminary study had the character of clinical estimations and had the aim to reveal additional opportunities of
the device. One of the results of such kind of preliminary estimations became the following observations. The device can be used not only in case of feet pathology and not correct character of their setting during a walk, but also in case of the walking function rehabilitation among children with damage of other big joints, in particular hip, knee and ankle joints and also after serious surgical treatment and long-term immobilization [4].
Conclusion. The offered training simulator for a correct walking formation is
widely used during remedial gymnastics lessons (RG). This training simulator is safe in use, children use it easily and it increases their motivation to go in for remedial gymnastics lessons. Preliminary clinical effectiveness estimation of the training simulator is positive. After three courses of two-week lessons with the interval of a month 90% of children with different orthopedic pathology have a correct skill of walking formation, self-control improvement, disappear the cases of loss of balance during a walk, children stop stumpling, their feet are correctly turned during a walk. Clinical observations continue and are systematized.
Offered by the authors training simulator is effective in case of wide spectrum of pathology of the lower extremities, it is simple in structure, helps children to improve walking within several courses, make it more confident, helps to improve balance during the support, improve balancing abilities of children. Preliminary estimation of the training simulator showed its high level of effectiveness.
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10.14526/29_2015_29.
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Submitted: 07.11.2016 Received: 11.11.2016
Nicholas M. Belokrylov - doctor of medical sciences, professor of adaptive and the rapeutic physical training department, Perm State Humanitarian-Pedagogical University, 24, Str. Siberian, Perm, 614990, Russia
Ludmila V. Sharova - doctor of biological sciences, professor Perm State Humanitarian-Pedagogical University, 24, Str. Siberian, Perm, 614990, Russia, E-mail: sharovalv@bk.ru Alexsey V. Shepalov - Regional Children's Clinical Hospital, 22, Str. Bauman, Perm, 614066, Russia
Svetlana V. Annenkova - post-graduate, Perm National Research Polytechnic University, 29, Komsomolsky prospect, Perm, 614990, Russia
