What is a verticalizer. Verticalizer for the disabled: why is such a complex device needed? Indications for the use of verticalizers

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

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

Selection of the necessary device

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

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

For patients with enhanced physical abilities, mechanical chairs-verticalizers are purchased, with limited ones - completely electric.

For a constantly moving person, it is advisable to purchase a special stroller. For children with cerebral palsy, they are made in mixed versions - an electric drive and a mechanical stander.

Fixture size

The main criterion for choosing a device is size. The main overall parameters of the verticalizer, as well as any mechanical device, are height, length and width. It is necessary to estimate the dimensions of the room in advance in order to choose the correct dimensions, because the person in the device should not feel squeezed.

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

During measurements, the patient should be dressed in the same way as he will be dressed in the future when using the stander.

Correct measurements:

hip width - from the ilium;
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 patella to the ilium;
from the feet to the chest - from the soles to the nipples.

Choosing a device for children

Children get up on their feet from 10 months, so you should not buy 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 verticalizers - especially at first - up to 20 minutes a day. But walkers are designed so that the patient can rely on himself. Therefore, it all depends on the individual condition.

When selecting walkers, certain measurements are also taken.

In the verticalizer, which will be used in the future for the prevention of contractures, a table with a limited rim must be provided. 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 inconvenience.

When a 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

In children with cerebral palsy, asymmetry of the pelvis may be observed - in this case, a rigid device should be provided in the stander to fix this area.

Due to the different lengths of the legs or when eversion of the feet, the patient has to be put on orthopedic shoes. In this case, the foot cups should 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 latch 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 he will be uncomfortable.

Correction should occur gradually - especially the pelvis and lower extremities. First, the child must stand a little, then, depending on the position that he takes, his position is corrected. Again they wait for the tension in the muscles to weaken, and correct again. You can not immediately fix in the desired position. In this case, muscle tension will increase the tone, and muscle injury may occur.

Choosing a stander for adults

Standers for adults have to be purchased if there are spinal injuries. They can also improve the quality of life in people with disabilities with dysfunction of the cardiovascular system.

It should be borne in mind that adults will have to use the device without outside help, so they will have to switch from a stroller to a verticalizer according to the following algorithm:

drive close to him;
put the front wheels on the brake;
move the legs to the supply;
fix the feet;
knees should rest firmly on the knee pads;
then the buttocks are fixed.

If the unit is equipped with a seat, the height of the seat must be adjusted. When landing, the knees should be at a right angle, only one finger of an adult should pass from them to the inside of the edge of the seat.

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

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

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

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

Adults and children start training from 5 minutes, constantly increasing the time. Their duration is further brought up to 5 hours. The exception is children under one year old, the maximum time for classes for them is up to 30 minutes a day.

Convenient model

One of the most convenient verticalizers for children is the verticalizer brand.

This stand is designed for a child from 2 to 6 years old, adjusted for height - height, designed for a disabled person who is not able to independently stand in an upright position.

The length in the verticalizer is regulated by the length of the lower frame, the chassis is extended, the inclination of the rack changes.

The child can play and eat in the device, as a table is built into it.

The verticalizer wheels rotate, and - which is very convenient - they are equipped with brakes that work almost instantly.

Bicycle for children with cerebral palsy

It is advisable for a child whose physical capabilities are expanded to purchase a special tricycle.

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

Standing devices are designed for passive or active-passive holding of a vertical posture with complete or partial fixation of the patient, for training the balance function when standing and moving, for safe training of individual self-service skills, individual motor functions. The design of the verticalizers provides for 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, which have sufficient strength, meet aesthetic and sanitary and hygienic requirements.

As a rule, standers are designed according to a modular principle and can be easily assembled taking into account the individual needs of the patient, his neurological status, and motor activity. In the designs of standers, the main modular elements are torso and pelvis fixators, knee stops, stop fixators. Calling a doctor at home and consulting with him will alleviate the problem of choosing a suitable stander for a patient with cerebral palsy.

Indications for the 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 a condition after operations on the hip joints;
cognitive impairment, lack of motivation of the child to a vertical position;
spasticity and violations of the muscle tone of the lower extremities, which do not allow the child to stand independently without making pathological movements and taking pathological postures.

Verticalizers contribute to maintaining a vertical posture during the habilitation of children with cerebral palsy, as well as mastering motor actions and developing the functions of the upper limbs. These devices are used from an early age (from 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 departments) is stimulated or normalized, the activation of which helps to maintain a vertical posture, 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 increase, motor-visceral reflex connections are normalized, muscle tone decreases, and coordination of movements improves.

Standers 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, special treatment and rehabilitation tasks.

Many foreign and domestic firms specializing in the production of rehabilitation equipment have proposed and are producing a fairly large range of verticalizers designed for children of different ages, with different levels of motor activity, locomotor disorders etc.

In most cases, issued static standers, 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 stand (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 provides for a foot stop adjustable in width, an emphasis for knee joints adjustable in height, a belt for fixing the chest or lumbar spine, an anti-slip rubber mat, and a table adjustable in height.

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 affected. Depending on the volume of brain damage, the severity of cerebral palsy is determined. When a child has a disease, various motor abnormalities are observed. In the most severe forms of leakage, muscle structures are involved. In addition to a partial loss of motor activity during the disease, pathology of the visual and auditory apparatus, as well as a violation of speech activity, can be detected.

Often cerebral palsy is accompanied by epileptic seizures and dementia. The disease is chronic and not subject to full recovery. But with control, treatment, and most importantly with a long and proper rehabilitation, the symptoms and course of the disease are much easier to tolerate. At present, in the rehabilitation of such patients, a verticalizer for children with cerebral palsy is widely used. It is convenient because the child can stand on his own, contribute to the social adaptation of the child.

The treatment of this disease will be primarily aimed at the rehabilitation of the patient's motor functions, the correction of the speech apparatus and the restoration of the psycho-emotional state. Motor functions are restored by changing and fixing certain postures. In addition to concomitant disorders, it is also necessary to focus on the treatment of 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 the tendons and muscles. This brings them to a more natural state. If it is possible to correct any disorders related to the brain, then they resort to neurosurgery. You need to start treatment as early as possible. Since with the development of the child, orthopedic changes occur, which will need to be adjusted later.

All patients with cerebral palsy need mandatory rehabilitation. Start it, like treatment, you need as early as possible. Rehabilitation measures 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 rehabilitation of the child. 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 position of the patient, train the muscle corset and help the patient adapt to the outside world. At the same time, a person acquires some freedom in movement, can eat independently using a table.

This is a special equipment with the help of which the patient, limited in motor activity, can independently assume a vertical position. The verticalizer for children with cerebral palsy is not replaceable for the reason that the child spends quite a long time in a lying or sitting position. Thus, there is a risk of getting complications in the form of bedsores, osteoporosis or muscle atrophy.

The verticalizer may be different depending on the condition of the child. They are either a separate independent design, or part of any equipment. They also differ in function, size, shape and fixation of the patient in it. Therefore, before purchasing such equipment, be sure to consult a doctor. It is worth noting that children with this disease often undergo epileptic seizures.

In order to avoid injury to the child, the design must be stable, and all its parts are 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 for a particular patient is selected, 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 is almost entirely on the patient's abdominal region.
Rear - such a device fixes the back and, using a special mechanism, helps the patient to rise from a prone position. This is the best option for patients who cannot hold their head or have severe musculoskeletal problems.
Multilevel - the most important thing in 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 position, the body adapts to a new state. The stand 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 inclination of the central rack, which allows you to increase the load on the lower limb belt.
Active - the main feature of this type is that it allows you to train the lower limb girdle.

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

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

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

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

Verticalizer at home

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

The most affordable option would be a wooden structure (plywood can be the base). But if there are skills in working with iron and a welding device, then the design 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 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 models of devices and stop at a more suitable model. If any mechanism is used in the manufacture of the verticalizer, then you also need the advice and help of an electrician (auto electrician). The undercutting of parts according to the drawing and the assembly of parts is carried out either on their own and by skills, or by a carpenter. You can contact the furniture assemblers. In any case, this option will be more budgetary than the factory one. The final step will be the soft upholstery of the equipment to prevent injury. A do-it-yourself verticalizer will ideally fit the parameters of a small patient, so all the details will be calculated individually.

I will 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 in moving and independently rising from a bed or chair. This device allows a person to stay in a standing position for a long time, supporting him and preparing him for this important human ability, which characterizes us as “upright walking”.

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 not surprising and finding a device that meets a wide range of human needs is often only a matter of price and time.

Let's return to the verticalizer - what experience I had with it I will now tell you. When working in the rehabilitation department, we used and use a verticalizer in people after a spinal cord injury, after undergoing surgery on the spinal cord - it was mainly the cervical spine, they were used in people in the recovery period after a traumatic brain injury, after. Often the verticalizer is used as a means.

These were classes that began with a physiotherapist, when a person in a lying position was transferred to a stand of a verticalizer in a horizontal position. Then they strengthened it with straps, put fixators of the knee joints to stabilize and secure the legs in a straightened position, ready for the appearance of a vertical load on them and gradually transferred to a vertical position increasing the time spent in this position, and on the days of the first classes and gradually increasing the angle of inclination, tending to 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, in which its outflow from the brain is possible; blood pressure. Therefore, in the days of the first classes, try not to immediately give a vertical position - this is especially true for people who are at the stage of early rehabilitation - for the first time weeks and months after the disease, when the transition to a sitting or standing position is just beginning.

When using a stander, 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 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 weight of the patient is placed on the legs. It is especially important to keep this in mind when using standers for children with cerebral palsy.

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

Standers for children with cerebral palsy

On average, children stand on their feet at about 10 months, so at this time (in no case before) you should start accustoming 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 stander, the child practically does not move (especially with a high level of fixation), therefore stay in the standing device should be limited to 20-30 minutes per day(unless there are special recommendations of the doctor in this regard).

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

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

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

Standers for adults

When using the stander to rise from a sitting position without a seat, you must firstly drive as close as possible to the stander. Then put the front wheels of the wheelchair on the brake and place the feet on the stander footrest (in the so-called sandals) and fix 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 for safe lifting.

When using a stander with a seat, you need to properly adjust the settings of the seat, since the effectiveness of verticalization and the safety of the patient depend on it. The distance from the patient's knees on the inside to the edge of the seat should be such that one finger (but no more!) passes freely. The seat height and position of the sandals should be adjusted so that the patient's knees are at the same level as the hips and the legs are at a right angle.

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

During the first 2-3 sessions of verticalization, 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 lying down. Particular care should be taken in the verticalization of patients with contractures of the joints of the lower extremities and skeletal deformities. Full verticalization in this case is excluded, and the angle of permissible inclination of the stand of the verticalizer (always with a back support) is determined by doctors individually. The time spent in an upright position is also determined on an individual basis. In general, doctors do not recommend staying in the verticalizer for more than 4 hours a day, and verticalization sessions should start from 3-5 minutes.