What is a verticalizer? Verticalizer for disabled people: why is such a complex device necessary? Indications for use of verticalizers

Verticalizers are special devices made specifically for children with cerebral palsy and other diseases that limit the ability to independently take a vertical position - myopathies, spina bifida, etc.

These devices can be selected according to height: children, teenagers, adults. Verticalizers are used in the rehabilitation process; for children with severe conditions, ordinary strollers are used.

Selection of the required device

Without examining the patient and consulting a doctor, selecting the required model is impossible. When choosing, the disease is assessed in relation to physical capabilities, and only then the required type of device is selected.

The patient must take part in the selection - especially if he is already in adolescence, since he knows his needs and correctly assesses the possibilities.

For patients with advanced physical capabilities, mechanical upright chairs are purchased, while for those with limited physical capabilities, fully electric chairs are purchased.

For those who constantly move, it is advisable to purchase a special stroller. For children with cerebral palsy, they are manufactured in mixed versions - an electric drive and a mechanical verticalizer.

Fixture size

The main criterion for choosing a device is size. The main dimensional parameters of a verticalizer, like any mechanical device, are height, length and width. You need to assess the size of the room in advance in order to choose the right dimensions, because a person in the device should not feel squeezed.

The patient is also measured; to select a device, you need to know the weight, height, width of the hips, foot size, volume and width of the chest, the distance from the feet to the knees, hips and chest.

When taking measurements, the patient should be dressed the way he will be dressed in the future when using the verticalizer.

Proper measurement:

hip width – from the iliac bones;
chest - from one edge to the other in the widest part;
from the feet to the knees - from the sole of the shoe to the middle of the kneecap;
from the knees to the hips - from the middle of the kneecap to the ilium;
from the feet to the chest - from the sole to the nipples.

Choosing a device for children

Children start standing on their feet at 10 months, so it is not worth purchasing a verticalizer earlier.

It may be better to purchase special walkers for children with cerebral palsy - you should definitely consult a doctor.

Children can stay in walkers for a longer period of time; in stand-up beds - especially at first - up to 20 minutes a day. But walkers are designed so that the patient can support himself. Therefore, it all depends on the individual condition.

When selecting a walker, certain measurements are also taken.

The verticalizer, which will be used in the future for the prevention of contractures, must have a table with a limited side. The angle of the table should change. The child will have to spend a significant amount of time in the device in the future, and he should not experience any inconvenience.

When the history of a child with cerebral palsy indicates epilepsy or convulsive readiness as a concomitant disease, all hard parts of the device are upholstered with soft material.

The nuances of fitting the device

Children with cerebral palsy may experience asymmetry of the pelvis - in this case, the verticalizer should be equipped with a rigid device that fixes this area.

Due to different leg lengths or when the feet are everted, the patient has to be put on orthopedic shoes. In this case, the foot cups must be enlarged.

The patient himself is not able to control the position of the body - it is imperative to choose a device with a rigid clamp that secures the body in the desired position, and the belts are located in several areas - at the level of the chest, waist, pelvis. Otherwise, the baby will just hang and feel uncomfortable.

Correction should occur gradually - especially in the pelvis and lower extremities. First, the child must stand for a while, then, depending on the position he takes, his position is adjusted. Again, they wait for the tension in the muscles to ease, and adjust again. You cannot immediately fix it in the required position. In this case, muscle tension will increase tone, and muscle injury may occur.

Choosing a verticalizer for adults

Standing machines for adults have to be purchased if there are spinal injuries. They can also improve the quality of life in people with disabilities with impaired cardiovascular function.

It should be taken into account that adults will have to use the device without assistance, so they will have to move from the stroller to the stander according to the following algorithm:

drive close to him;
put the front wheels on the brakes;
move the legs to the delivery;
fix your feet;
your knees should rest tightly against the knee pads;
then the buttocks are fixed.

If the device is equipped with a seat, its height must be adjusted. When sitting, the knees should be at a right angle; only one adult finger should extend from them to the inside edge of the seat.

Belts should not squeeze the body, otherwise blood circulation will be impaired.

The first 2-3 classes are conducted only under the supervision of a specialist, with constant monitoring of blood pressure.

The indicator is measured first before being placed in a verticalizer, and then during classes.

It is especially important to monitor the training of patients with lower extremity joint contractures and skeletal deformities. For them, the elevation angle is determined individually; complete verticalization is excluded.

Adults and children begin training with 5 minutes, constantly increasing the time. Their duration is subsequently increased to 5 hours. The exception is children under one year old; the maximum lesson time for them is up to 30 minutes a day.

Convenient model

One of the most convenient verticalizers for children is the “Vertical mash” brand.

This stand is designed for a child from 2 to 6 years old, is adjusted according to height and height, and is intended for a disabled person who is unable to independently stand in an upright position.

The length in the verticalizer is adjusted by the length of the lower frame, the chassis is extended, and the tilt of the stand changes.

The child can play and eat in the device, since it has a built-in table.

The wheels of the verticalizer rotate and, which is very convenient, are equipped with brakes that operate almost instantly.

Bicycle for children with cerebral palsy

For a child whose physical capabilities have expanded, it is advisable to purchase a special tricycle.

Verticalizers(standers) are used to fix the child in a standing position, forming reflex connections and the image of a vertical body position through kinesthetic influence. These devices limit the influence of pathological motor stereotypes in an upright position and facilitate control of the position of the head, torso and movements of the upper limbs.

Verticalizers are designed for passive or active-passive holding of a vertical posture with full or partial fixation of the patient, for training the balance function when standing and moving, for the safe training of individual self-care skills and individual motor functions. The design of verticalizers includes various auxiliary elements or devices that facilitate their use, ensure the natural position of the child, etc. For their production, a wide variety of materials are used, in particular wood, metal, various polymers that have sufficient strength and meet aesthetic and sanitary-hygienic requirements.

The designs of verticalizers, as a rule, are made according to a modular principle and can be easily configured taking into account the individual needs of the patient, his neurological status, and motor activity. In the designs of verticalizers, the main modular elements are torso and pelvis clamps, knee supports, and foot clamps. Calling a doctor to your home and consulting with him will ease the problem of choosing a suitable verticalizer for a patient with cerebral palsy.

Indications for use of verticalizers

a tendency to form flexion contractures in the hip and knee joints in children who walk little or do not walk at all, moving by crawling;
the presence of hip dysplasia or conditions after hip surgery;
cognitive impairment, lack of child motivation to remain upright;
spasticity and disturbances in muscle tone of the lower extremities, which do not allow the child to stand independently without making pathological movements and adopting pathological poses.

Verticalizers help maintain a vertical posture during the process of habilitation of children with cerebral palsy, as well as the development of motor actions and the development of functions of the upper limbs. These devices are used from an early age (9-12 months).

With the systematic use of training devices, there is a passive and active effect on the musculoskeletal system (muscles, joints), the activity of brain structures (hypothalamus, motor centers of the cerebral cortex and other parts) is stimulated or normalized, the activation of which helps maintain a vertical posture and locomotor acts , manipulation of objects, etc.

With the correct and systematic use of verticalizers, the balance and mobility of the processes of inhibition and excitation in the central nervous system increases, motor-visceral reflex connections are normalized, muscle tone decreases, and coordination of movements improves.

Verticalizers are indicated for any form of cerebral palsy, and the choice of design, dosage and method of application is dictated by the child’s condition and special treatment and rehabilitation objectives.

Many foreign and domestic companies specializing in the production of rehabilitation equipment have proposed and produced a fairly large assortment of verticalizers designed for children of different ages, with different levels of physical activity, locomotor disorders etc.

In most cases they are issued static verticalizers, which provide only a passive position and movement of the child by an accompanying person or parents, however, some companies offer designs (mainly for adolescents or adults) that provide independent movement and are equipped with an electric drive.

The Dynamic verticalizer (Fig. 148) is designed to develop the function of balance, coordination and limited motor activity.

Rice. 148.

Available in three sizes: small, medium and large (Fig. 149). The design includes a width-adjustable foot clamp, a height-adjustable support for the knee joints, a belt for fixing the chest or lumbar spine, an anti-slip rubber mat, and a height-adjustable table.

Rice. 149.

Physical rehabilitation of disabled people with lesions of the musculoskeletal system / Ed. S. P. Evseeva, S. F. Kurdybaylo. - M.: Soviet sport, 2010. - 488 p. Part II. Physical rehabilitation of children suffering from cerebral palsy. Chapter 4. Clinical and functional characteristics of cerebral palsy. 7.2. Verticalizers. pp. 394-397.

Cerebral palsy is a chronic congenital neurological disease characterized by damage to the central nervous system. Occurs when one or more areas of the brain are damaged. Depending on the volume of brain damage, the severity of cerebral palsy is determined. When the child is ill, various motor abnormalities are observed. In the most severe forms of the disease, muscle structures are involved. In addition to partial loss of motor activity, the disease can reveal pathology of the visual and auditory apparatus, as well as impaired speech activity.

Cerebral palsy is often accompanied by epileptic seizures and dementia. The disease is chronic and cannot be fully recovered. But with control, treatment, and most importantly with long and proper rehabilitation, the symptoms and course of the disease are much easier to bear. Currently, during the rehabilitation of such patients, a verticalizer for children with cerebral palsy is widely used. It is convenient because the child can stand independently and contributes to the child’s social adaptation.

Treatment of this disease will be primarily aimed at the rehabilitation of the patient’s motor functions, correction of the speech apparatus and restoration of the psycho-emotional state. Motor functions are restored by changing and strengthening certain postures. In addition to concomitant disorders, it is also necessary to focus on treating the immediate cause of the disease. To do this, a thorough diagnosis of the patient is carried out.

If traditional methods of treatment are not effective, then they resort to radical therapy - surgery. Surgical methods affect tendons and muscles. This brings them to a more natural state. If it is possible to correct any disorders affecting the brain, then they resort to neurosurgery. Treatment should be started as early as possible. Since as the child develops, orthopedic changes occur, which will need to be corrected later.

All patients with cerebral palsy require mandatory rehabilitation. It, like treatment, needs to be started as early as possible. Rehabilitation activities include swimming in the pool, a dosed increase in physical activity (only with the permission of a specialist), exercises to develop the functions of the cerebral hemispheres, and the development of fine motor skills. At home, it is imperative to support the work on the child’s rehabilitation. Now there are special installations for giving the patient a fixed vertical position. These installations are called verticalizers. They are very convenient to use; depending on the model, they can change the patient’s position, train the muscular corset and help the patient adapt to the world around him. At the same time, a person gains some freedom of movement and can feed himself using a table.

This is special equipment with the help of which a patient with limited mobility can independently take a vertical position. The verticalizer for children with cerebral palsy cannot be replaced because the child spends quite a long time in a lying or sitting position. Thus, there is a risk of complications in the form of bedsores, osteoporosis or muscle atrophy.

The verticalizer may be different depending on the condition of the child. They can be either a separate independent structure or part of some equipment. They also differ in function, size, shape and how the patient fits in it. Therefore, before purchasing such equipment, you should definitely consult your doctor. It is worth noting that children with this disease often experience epileptic seizures.

To avoid injury to the child, the structure must be stable, and all its parts must be covered with protective soft upholstery.

Types of verticalizers

There are about six types of verticalizers. Each type has its own specific list of criteria and characteristics. With the help of this, the most suitable device is selected for a particular patient, taking into account all the features of the course of the disease. You can rent the drug for a while to evaluate all the characteristics.

Front - most devices belong to this type. The patient's support rests almost entirely on the patient's abdomen.
Rear – this device fixes the back and, using a special mechanism, helps the patient rise from a lying position. This is the best option for patients who cannot hold their head up or have serious abnormalities in the functions of the musculoskeletal system.
Multi-level - the most important thing about this type is that the child can independently change his position in this device. For example, stand or half-stand, sit, lie down.
Static – designed for passive adoption of a vertical position. In this situation, the body adapts to the new state. The verticalizer has wheels, so the patient can be transported without difficulty.
Mobile – used mainly for children from one year to adulthood. It has large wheels at the back, which allows the child to move independently. You can change the angle of the central pillar, which allows you to increase the load on the lower girdle of the limbs.
Active - the main feature of this type is that it allows you to train the lower girdle of the limbs.

Vertical columns are a very important application in the rehabilitation of children. The main functions include:

allow the patient to take a vertical position, even when it is impossible to do this on their own;
stimulate the muscle corset;
affect the musculoskeletal system.

The main advantage of this rehabilitation is the opportunity to avoid complications and maximize the physical and social development of the child. Such equipment significantly improves the patient’s quality of life and simplifies his care.

A prerequisite when choosing a verticalizer is age. According to this characteristic, there are three groups: 3-6 years old, 6-12 years old and 13-16 years old. The equipment is not used until 2 years of age.

Verticalizer at home

Despite all the positive aspects of rehabilitation equipment, not everyone can purchase it for their child. And all this is due to the fairly high cost of such an installation. But don’t be upset, the verticalizer can be made with your own hands. This installation is done quite simply. But in any case, before doing it, you should definitely consult a doctor.

The most affordable option would be a wooden structure (the base could be plywood). But if you have the skills to work with iron and a welding device, then the structure can be metal.

In order to make such equipment with your own hands, you need to start with a drawing; it is best to involve a person with experience or certain knowledge in this field. Then the drawing must be agreed upon with the attending physician to clarify the characteristics and parameters. It is also worth turning to the literature and reviews to see and compare different device models and settle on a more suitable model. If any mechanism is used in the manufacture of the verticalizer, then consultation and assistance from an electrician (auto electrician) is also needed. The turning of parts according to the drawing and the assembly of parts is carried out either with one’s own strength and skills, or by a carpenter. You can contact furniture assemblers. In any case, this option will be cheaper than the factory one. The final stage will be soft upholstery of the equipment to prevent injuries. A do-it-yourself verticalizer will ideally fit the parameters of a small patient, so all the details will be calculated individually.

I’ll tell you about the verticalizer, a means of rehabilitation for people with movement disorders. The verticalizer is designed to give a vertical position to the body of a person who has difficulty moving and getting out of bed or a chair independently. This device allows a person to remain in a standing position for a long time, supporting him and preparing him for this important human ability that characterizes us as “upright walkers.”

The verticalizer itself, as a device, is divided into several types - those that hold a person in front, those that hold a person from behind, and there are even those that move on wheels with a person in an upright position. Surely there are some other types of verticalizers, because in our age of technological progress it is no wonder and finding a device that meets a wide range of human needs is often just a matter of price and time.

Let's return to the verticalizer - I'll tell you what experience I had working with it. When working in the rehabilitation department, we used and still use a verticalizer in people who have suffered a spinal cord injury, after undergoing spinal cord surgery - mainly in the cervical spine, we have used it in people in the recovery period after a traumatic brain injury, after. The verticalizer is often used as a means.

These were classes that began with a physical therapy doctor, when a person in a supine position was transferred to the stand of a verticalizer in a horizontal position. Then they strengthened it with straps, placed knee joint clamps to stabilize and secure the legs in a straightened position, ready for a vertical load to appear on them, and gradually transferred them to a vertical position, increasing the time spent in this position, and in the days of the first lessons, gradually increasing the angle of inclination, tending to a vertical position.

The fact is that the transition to a vertical position for the human body is, first of all, a redistribution of blood, during which its outflow from the brain is possible; in such situations, a deterioration in general well-being, a feeling of “faintness”, even fainting, which are possible due to a decrease in blood pressure. Therefore, in the days of the first classes, try not to immediately give a vertical position - this especially applies to people who are at the stage of early rehabilitation - for the first weeks and months after the disease, when the transition to a sitting or standing position is just beginning.

When using a verticalizer, it is important, first of all, to remember the general principle of distributing the load on the body. The load on the spine and hip joint is directly dependent on the angle of inclination of the verticalizer stand. The more the angle of inclination approaches 90 degrees, the greater the load level. In an absolutely vertical position, maximum stretching of the spinal column is achieved, and a load equal to the patient’s weight is placed on the legs. It is especially important to remember this when using verticalizers for children with cerebral palsy.

Any type of verticalizer must be located on a strictly horizontal surface. The parking brake of the verticalizer must always be locked - the verticalizer can only be removed from the brake to move it. All fixing belts provided by the verticalizer design must be fastened. Before each use, the verticalizer should be checked for damage.

Standing machines for children with cerebral palsy

On average, children stand on their feet at about 10 months, so at this time (in no case earlier) you should begin to accustom a child with cerebral palsy to an upright position. However, before using the verticalizer, parents should definitely consult with their doctor. It is important to remember that while in the verticalizer, the child practically does not move (especially with a high level of fixation), therefore the period of stay in the verticalizing device must be limited to 20-30 minutes per day(unless there are specific doctor’s recommendations on this matter).

If the verticalizer is used to prevent contractures, and the child has to spend a lot of time in it every day, in this case the verticalizer must be portable and must be equipped with a table with the ability to change the height and angle of inclination and with a limiting edge. If a child suffers from epilepsy, all hard parts of the verticalizer should be upholstered with soft material.

If there is asymmetry of the pelvis, it is necessary to equip the verticalizer with an additional rigid device that fixes this area. If there is a need to put a child in orthopedic shoes, then the verticalizer should have wider cups for the feet. If a child has an insufficient level of control over body position, then it is necessary to equip the verticalizer with a torso clamp, a head restraint and devices for fixing the hands on the table.

Correction of the position of the pelvis and lower extremities should occur gradually. First, let the child stand for a while in the verticalizer, then after a short amount of time the tension in his muscles will weaken a little, and everything can be corrected again. If the child is immediately fixed in the position of maximum correction, this can lead to muscle stretching and increased muscle tone.

Standers for adults

When using a verticalizer to rise from a sitting position without a seat, you first need to get as close to the verticalizer as possible. Then put the front wheels of the wheelchair on the brakes and place your feet on the footrest of the verticalizer (in the so-called sandals) and secure them with straps. In this case, the knees should rest against the knee pads. The lifting belt is located under the buttocks and is attached to the verticalizer. It is important that the belt is not placed too high or too low to ensure safe lifting.

When using a verticalizer with a seat, you need to properly adjust the seat parameters, since the effectiveness of verticalization and patient safety depend on this. The distance from the patient’s knees on the inside to the edge of the seat should be such that one finger can fit freely (but no more!). The height of the seat and the position of the sandals should be adjusted so that the patient's knees are level with his hips and his legs are at right angles.

If the knees are too high or too low, the knee pads will be either above or below the knees when moving to a vertical position, and they must completely surround the kneecap to effectively support the patient. In this case, the knee pads should fit tightly to the leg, but not squeeze it, so as not to disrupt blood circulation.

During the first 2-3 verticalization sessions, the patient must constantly be in someone’s presence. He needs to measure the pressure and, at the slightest dizziness, bring him first to a sitting position, then to a lying position. Particular care should be taken when verticalizing patients with contractures of the joints of the lower extremities and skeletal deformities. In this case, complete verticalization is excluded, and the angle of permissible inclination of the verticalizer stand (necessarily with reverse support) is determined by doctors individually. The time spent in a vertical position is determined individually. In general, doctors do not recommend staying in a verticalizer for more than 4 hours a day, and verticalization sessions should begin with 3-5 minutes.