PAJĄK Rehabilitation – SPIDER THERAPY

Post-traumatic and post-operative paresis presents a clinical picture similar to post-stroke conditions, the only difference being that the underlying causes differ. Essentially, the therapy proceeds in a very similar way. It should be added, something not mentioned above, that alongside purely physical therapy, speech therapy must be carried out in parallel to address speech disorders and sensory aphasia. Being fastened into the "Spider" and given a sense of stability and security means the patient does not have to devote a great deal of attention to holding a safe position. As a result, such patients can direct more of their attention to the process of speech re-education. Time and again we have observed that carrying out speech therapy in the "Spider" is far more effective. Plaster casts are also sometimes used, applied for example to the healthy upper limb in order to "force" the impaired limb to function. We also successfully carry out therapy for other neurological conditions. These include multiple sclerosis, myasthenia gravis, Alzheimer's disease and many others.

Ligament and tendon reconstruction, both primary and secondary, is another very extensive subject. The reconstruction of the cruciate ligaments of the knee, currently the most commonly performed at various ages, makes up a large group of mostly physically active young people. The frequently reconstructed Achilles tendon or the flexor tendons of the fingers cause functional problems that require professional therapy as an essential factor complementing surgical treatment. In such cases, even the most perfectly performed reconstruction of the anterior cruciate ligament (ACL) or the Achilles tendon cannot lead to a proper return of function without subsequent professional rehabilitation.

A very important factor is the presence of proprioceptive receptors within the ligament structures, without which a joint or muscle cannot function properly. Working on sensation and coordinating movement patterns, taking into account the synergistic and antagonistic action of the muscles, is a fundamental requirement here. The same applies to rehabilitation following knee arthroscopy where damage to the menisci and cartilage surfaces has been diagnosed. A knowledge of the pathophysiology of both the injuries and the regenerative processes is indispensable here.

Exercises performed in the "Spider" need not be limited to static exercises based on the synergistic or antagonistic action of particular muscle groups. It is possible, for example, to learn the gait pattern thanks to the treadmill built into the "Spider". Thanks to the system of elastic cable attachments, the gait pattern can be precisely controlled, and by adjusting these attachments or working "through the elastic cables" it is possible to improve its correctness. This is the most important matter, because moving with an incorrect gait pattern has a negative effect on other parts of the musculoskeletal system that were not damaged during the injury.

In other words, therapy cannot focus solely on the "damaged element" of the musculoskeletal system, knowing that its dysfunction will cause a functional problem in another area.

This part of the paper briefly discusses the most common conditions requiring therapy. This applies both to congenital dysfunctions of the central nervous system (CNS) and to acquired conditions. Just as with "peripheral conditions" we can speak of treating their cause (for example, a fractured limb), in the case of CNS conditions causal treatment essentially does not exist. Every CNS disorder, regardless of its aetiology, causes dysfunctions within the musculoskeletal system, which are the reason for the patient's loss of independence and their need for help from others. These may also lead to secondary complications in the form of contractures or bone and joint deformities, which compounds the functional problem. A further aspect of this issue is the presence of significant sensory disturbances, including deep sensation. This is precisely why proper, multidirectional therapeutic action that takes into account the complexity of CNS injuries is so important.

Joint injuries of the upper limbs are a major problem when it comes to self-care. Injuries to the shoulder, elbow or wrist joint cause considerable difficulty in everyday activities such as dressing, eating and so on, and in effect create dependence on others. All intra-articular fractures, by their very nature, cause a reduction in joint mobility (particularly of the shoulder and elbow). This means that proper orthopaedic management of the injury must be followed by professional therapy aimed not only at regaining the full range of motion of these joints but, above all, at restoring the function of the limb. The therapeutic possibilities in this area are practically unlimited and are based on movement patterns which, in a coordinated way, can also be shaped in the "Spider" device.

Extra-articular injuries of both the upper and lower limbs do not pose a major rehabilitation problem. Therapeutic efforts come down to regaining proper muscle strength and limb function. In the era of stable osteosynthesis, immobilisation in plaster casts is very rarely used, and it was precisely this that used to be the most common cause of patients' problems, causing "stiffening" of the joints and muscles. Proper orthopaedic management of these injuries is a fundamental prerequisite for regaining function and, before that, for achieving bone union. Therapy is useful in helping to restore the appropriate movement patterns that guarantee function. And here again the "Spider" renders invaluable service.

Spinal pain syndromes, regardless of their location, are quite simply a "plague of civilisation". They are one of the most common reasons why patients present at medical and rehabilitation clinics. The problem usually concerns the lumbar spine, but it is often accompanied by complaints in the cervical region, which may present as so-called "brachial neuralgia". Because of the "contents" of the spine (the spinal cord and nerve roots), the management of such cases must be interdisciplinary, and proper clinical and imaging diagnostics are the basis for an accurate diagnosis and, consequently, for effective therapy.

Treatment that is purely orthopaedic or purely neurological, not combined with modern physiotherapy, addresses only part of the problem the patient presents with and does so incompletely. A skilful combination of pharmacotherapy and physiotherapy can, and most often does, produce satisfactory treatment results. It should be emphasised that one must always strive for causal treatment, as only this can produce the maximum therapeutic effect.

And so, in the case of instability in a given section of the spine - which is the "primary" cause of all other spinal problems (disc disease, spinal canal stenosis, root syndromes and so on) - it is necessary, using appropriate rehabilitation techniques, to work first towards improving the stability and then the mobility of the spine. Such an approach relieves the pain, improves function and, most importantly, prevents the development of the consequences of instability described above.

The PNF method renders quite simply invaluable service in the work on dynamic stabilisation. If, however, the patient presents too late and we diagnose, for example, disc disease, then after bringing them out of the acute pain phase we should combine PNF methods with McKenzie therapy and manual therapy. Thanks to this, the herniated intervertebral discs can be brought back "into place" and the complaints subside.

In truth, the only element over which we, as the treating team, have any influence are the muscles, and therefore it is only through working on the muscles that we can approach the therapy of spinal complaints in a causal way. The other elements of the spine (ligaments, discs, bony structures), not being contractile, do not respond to "active work". It should be added that any neuralgia with no obvious "spinal" cause can and should be rehabilitated comprehensively, using neuromobilisation techniques alongside those mentioned above. This is applied to excellent effect in shoulder pain syndromes, ulnar and median nerve neuropathies and others. The ability to dose loading and rotation precisely through the "Spider" cables is a truly irreplaceable feature.

Joint arthroplasty is the next most frequent therapeutic issue in the field of orthopaedics. Most often it is the hip, knee, shoulder and metacarpophalangeal joints that are "replaced". Less frequently (for example, in rheumatic disease) arthroplasty of the elbow, wrist or ankle joint is performed. The reason for performing primary arthroplasty is osteoarthritis, which slowly but steadily limits a person's functioning through pain.

It is not just a single joint that becomes dysfunctional, because as the pattern of movement changes, other joints become overloaded, which accelerates the process of their degeneration. Thus the challenge in therapy is not simply to deal with the one (diseased) joint that has been "replaced" with an artificial one. It is essentially a matter of developing proper movement patterns thanks to which the "artificial" joint will function like the patient's own. This is just as important as perfect surgical technique and ensures the maximum longevity of the prosthesis.

Therapeutic management must be adjusted to suit the needs and abilities of the patient, taking into account the parameters of the implanted endoprosthesis. This is precisely why the process must be individualised and cannot follow a set routine. The "Spider" makes it possible to individualise the therapy in terms of dosing the load and reducing asymmetry (transferring body weight onto the operated limb). A knowledge of this field and close cooperation with the surgeon is a guarantee of achieving the best possible results. This is particularly important in the case of young, professionally active people. A patient with an artificial joint can be a fully productive employee, which has not only a positive aspect for the patient but is also economically measurable.

Joint injuries of the lower limbs are a problem of no small significance. On the one hand, they require perfect surgical management in the form of stable osteosynthesis, and on the other, the early introduction of joint movement and skilful loading, appropriate to the problem and the method of surgical treatment. This is extremely important not only because of the need to regain the full range of joint motion quickly, but also with regard to proprioception and the prevention of osteoarthritis, which is in a sense a natural consequence of such injuries.

Prolonged external immobilisation, which fortunately is now a rarity in the era of modern trauma surgery, as well as improper rehabilitation or its absence, significantly contribute to the development of post-traumatic osteoarthritis of the joint. In the case of large joints such as the knee and hip, as well as the ankle joint, which bear very high compressive forces, the development of osteoarthritis leads to permanent disability that often disqualifies the patient from "normal" everyday and professional life.

Such a condition often makes it necessary to decide on surgical treatment in the form of joint arthroplasty, which, particularly in young people, means having to give up work or retrain. Therapeutic management must be individualised and carried out in accordance with the latest knowledge of the pathophysiology of joint injuries. This is only possible within a medical and rehabilitation team with extensive clinical experience. Skilfully dosing loading and unloading through the "Spider" elastic cable system is a very precise task and makes it possible to conduct therapy in a controlled way in specific cases of joint injury.

Injuries of the thoracic and lumbar spine are less drastic in their consequences and are most often limited to "simple fractures" not burdened by neurological complications. Therapy consists of strengthening the muscular corset to improve dynamic stabilisation, but it must be based on modern rehabilitation methods. The best of these appears to be the PNF method, which alone is able to engage the muscles of key importance to the process of dynamic stabilisation. It is used not only in the case of recent injuries, but also for their consequences, such as instability, degenerative changes or disc disease.

Applying this method with the aid of equipment such as the "Spider" opens up entirely unlimited therapeutic possibilities, allowing work to be carried out without pain not only on improving stabilisation, but also on complete movement schemes and patterns, while ensuring the correct alignment of the individual sections of the musculoskeletal system, including the injured section of the spine.

Pelvic injuries can most broadly be divided into extra-articular injuries and those affecting the hip and sacroiliac joints. While extra-articular injuries do not present major therapeutic difficulties, joint injuries are a serious problem that has a negative effect on the patient's functioning. The rehabilitation of joint injuries of the pelvis cannot consist merely of restoring a sufficiently good range of motion in the hip joints. It must involve restoring the function of locomotion, and this goal is served by the skilful dosing of loading and the development of a proper gait pattern. All these functions can be shaped in an absolutely fully controlled way with the help of the "Spider", in combination, for example, with the PNF method.

Injuries of the cervical spine are a major rehabilitation problem because of the unfortunately frequent complication of spinal cord damage, which is prone to injury owing to the considerable physiological mobility of this section of the spine. Paresis or complete paralysis requires very early rehabilitation, regardless of whether or not the patient has undergone surgery. This is not just about limb dysfunction, but also about the fact that such patients, "condemned" to lie in bed, have problems with basic physiological functions (such as passing urine) and with pressure sores that develop despite proper preventive care.

Applying proper therapy not only prevents the development of limb deformities, but also helps to reduce the risk of general complications such as cardiorespiratory failure, which is not without significance in the case of older patients. The possibility of dynamic verticalisation, which we can achieve in the "Spider", allows such patients to maintain not only the proper functioning of the internal organs but also, by stimulating the periphery of the body, to promote the conduction of afferent stimuli.

Although injuries of this kind are most often permanent, one must not forget the emotional side of the patient, for whom professional therapy is an incredibly important and positively experienced emotional stimulus, one that helps these patients regain their belief in the meaning of life.