EQUIPMENT FOR LB THERAPY

Suspension systems

Summary: For patients not capable of independent standing the "static system" is needed. This system can basically be used for all patients, and it is by far the simplest system in terms of handling and price. For finer tuning and endurance training of already ambulating patients, the dynamic systems have advantages
Only the "static system" and the "weight adjustable" system allow unsymmetrical body weight support which some find helpful for training of severe hemiplegic patients.

2.3.1 "Static system"("the original"):
This was our first and is still our most used system. Regularly equipped with a pair of spring balances, a pair of pulleys and the harness, this set up theoretically might be a static system but practically is not. A static system in the true sense would not allow for the vertical and lateral movements our body performs during normal gait. In our system, the little yield of the spring balances under load as well as the movement of the body within the harness give sufficient freedom to allow the necessary vertical movements. There are three enormous advantages of this so-called "static system": It is its unbeatable simplicity in handling, allowing - as the only system up to now - to adjust body weight support during walking (by simply pulling the rope/s even with one hand so that the other hand of the therapist is still free to handle the patient's limb). The second superb feature of the system is in fact its inherent stiffness with little displacement when under load . This gives additional support to maintain up-right position of the rump in most severely paralyzed patients. Thisway, the system is most useful and actually necessary for patients not capable of standing or walking by themselves. Last not least there is an inherently low price which should not be higher than some 250 - 300 Euro including a metal mounting plate for fixation to the ceiling. In this setting the suspension can be mounted to the ceiling with about 290 cm as the minimum height of the room.

As with the other systems, the non-ambulating patients enter the treadmill with the wheel chair via a ramp, the harness is mounted and fixed and the patient is pulled into upright standing position with help of the pulleys (see accompanying film HARNESS on CD).

2.3.2 Dynamic systems: "Adjustable weights".
Physiotherapists in Basel had the idea to increase the vertical yield by loosening but basically maintaining the ropes of the static system and perform the actual body weight support with help of defined weights (e.g. bags filled with sand). The vertical yield is limited by the ropes of the static system and thisway a high degree of security is achieved; patients can first be mounted under the static system, subsequently weights are applied and the ropes loosened. However, patients who cannot stand and brain damaged patients might feel unsecured by the yield of the suspension. In such cases the static system should be used. At least theoretically inertia of the moved weights introduces some abrupt movements especially with fast stepping; apart from this, smooth walking is achieved. Change in body weight support needs loading or removing of sand bags which is less comfortable than pulling a rope in the static system (see above). Woodway company has built a system based on these ideas using an array of weights and metal springs.

2.3.3 Dynamic system: Pneumatic.
We have so far tested a German made pneumatic system which bears a considerable amount of sophistication (CONNEX). Body weight support is pre-adjustable as percentage of body weight (which can be measured by the system). Also adjustable is the amount of allowable yield i.e. the distance a patient can sack before he is automatically pulled up again (which, of course, would interrupt walking). Thus the system is of little use for patients who cannot stand, but it has shown optimal for learning finer corrections and for endurance training under BWS of patients who can already walk independently. There are US American systems which have a similar principle but are somewhat less comfortable in handling. The price of such systems is relatively high.