Transcript Pneumex

The Pneu-Back™ Program
Level I
The Pneu-Back ™ Program
Seven Steps to a Healthy Back
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Assessment
Measure Analyze Posture
Pneu-Weight Pain Free Warm Up
Back System III
Pneu-Weight and Pneu-Back Chair
Pneu-Back Chair Specific Recruitment
Home Maintenance Program
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The Pneu-Map™
 Quantitate posture curves
 AP and Lateral
 Measure Spinous Process
 Measure lean
 Show patient progress
Computer Generated
Documentation and
Protocols
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 Patient understanding and
compliance
 Documentation
 Computer generated
protocols
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Using The Pneu-M.A.P.™
 Level M.A.P
 Patients in a gown so wheel can run
on the spinae process.
 Stand patient in front of MAP heels
against base.
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 Adjust height so wheel
reaches the sacrum.
 Line patient up with
wheel on spinae process
at lumbar apex.
 Run wheel down
patients lumbar apex to
make sure you are on
spinae process.
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 Patient--hands at sides, relax, stand
normally and focus on point at eye
level.
 Tell patient you will put a finger on
their forehead to prevent movement.
 Move wheel from the lumbar to
patient’s cranial apex.
Note:If wheel is off center of head, check the
patient for Scoliosis or lateral shift.
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 With thumb and index finger on
wheel, run wheel with constant
pressure down center of spine.
 Start at cranial apex, run down to
the sacrum.
 The pen on the bar will trace
contours of spine.
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How to Read a Screening
Locate 6 points:
Cranial Apex
 cranial apex
 cervical apex (approx.. C4)
 4 lines down from
cervical apex (approx. C7)
 thoracic apex
 lumbar apex
 sacral apex
Cervical Apex
4 Down
Thoracic Apex
Lumbar Apex
Sacrum
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 Apex is furthest point out on
curve.
 If apex covers more than one
point, pick center point.
 If you have two points the
same, choose lower of the two
Exception: If cervical apex covers more than one point,
choose points 4 lines up from C7 transition point.
Palpate to find the sacrum before letting
patient move. Place the wheel on that point.
Make a mark on M.A.P. grid.
Each point will have a
Horizontal (x value)
Vertical (y value)
When reading points:
 Stand directly in front
of tracing.
 Put mark on left side of
the line
 Read from right of line
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Enter Patient
First Name
Last Name
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Enter Screening
Be sure to select
Posture
Enter Points
Use Tab Key to
move
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Exercise Display
The computer
evaluates data
and calculates
curves and
lean.
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View Protocols
To view the
exercise
protocols click on
the radio button
at the top right of
the Posture
Analysis box
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New Sessions
 Select Visit
 Select Billing
 Select Screening
 Enter New Points
 Select Graph
 Select Post
Screening
New protocols will be generated based on values entered into initial screening
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The Pneu-Weight™
Buoyancy Without Water
Unweighting is defined as applying
vertical support to a patient in order to
lessen weight bearing stress.
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Benefits
Balance mode
prevents falling.
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Patients can exercise
without fear.
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Lumbar & cervical
spine Unweighting.
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Using the Pneu-Weight
Key Benefits
 Orthopedic Patients
 Knee, Hip, & Ankle Injury
 Back Problems
 Gait Training
 Cardiovascular
 Overweight Patients
 Respiratory Ailments
 Neurological Patients
 Assist in lifting wheelchair Patients
 Cervical/Upper Thoracic
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Pneu-Weight Components
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The Pneu-Weight™ Unweighting system uses
pneumatic power and the Pneu-Vest™ to
support the patient.
The Pneu-Weight’s™ 1 to 360 lb. Unweighting
range allows the patient to perform low-impact
kinetic exercises in an upright, functional
position
The center of the Unweighting system is the
Pneu-Vest ™. This Unweighting harness fits
the patient like a snug vest with leg straps.
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The Pneu-Vest ™
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Fits all sizes
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Supports
comfortably
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Allows
confidence
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Unweighting
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Exercise Mode
Neurological or spinal
cord injury
Post surgical
Sciatica
Balance Mode
Show the patient they
cannot fall
Treadmill activities will
be done in the balance
mode.
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Treadmill Walking
 Forward
 Lateral
 Retro
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Gait Analysis & Enhancement
In working with patients in various stages we
discover many of them have in common
various strength imbalances, range of motion
restrictions, and incorrect firing and
recruitment patterns.
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First Test
 The
first of these tests is
forward walking on the treadmill
while unweighted.
 We are looking for any irregular
stride patterns.
 Our speed will be at a normal
to challenging level.
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Observation
The most common things we
will observe:
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Toe In
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Toe Out
Poor Pelvic
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A tendency to toe in (internally
rotate)
Toe out (externally rotate)
Poor pelvic stability
Circular gait pattern
Lack of coordination and
support between upper and
lower extremities. (Minimal arm
swing, having to hold treadmill
etc.)
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Second Test
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The second test we utilize is lateral side
stepping at a normal to challenging level
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Subject beginning facing to one side and
then rotating 180° and doing the same
thing facing the opposite side.
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Observations
The most common things we see:
 A marked contrast in ability between
one side and the other.
Toe Out
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Toeing out
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Inability to maintain balance at set
speed. (The patient should maintain
parallelity between the foot and the treadmill).
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Parallelity
Important-the stabilizing leg is usually
the one to look at in the case of
improper recruitment, strength or
fatigue.
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Third Test
The third test we will utilize is retro
walking again at a normal to
challenging level..
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Observations
Retro
Observing this test we typically
see:
 Minimal hip extensions one side
or the other or both
 Poor pelvic stability when
attempting additional extension
 Poor coordination and support
between upper and lower
extremities while conducting test
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Recommendations
 Aggressive ankle mobilization and
strengthening program where indicated
 Use the gait straps in various fashions
 Utilize the treadmill in conjunction with the
Unweighting system, the stretching
program and the gait straps to get the
subject to desired strength, endurance
recruitment and flexibility levels.
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Primary Gait Conditions
External Rotation –
With external/internal rotation each leg
is independent and needs to be
evaluated that way. Opposite leg may
be externally rotated, straight or
internally rotated.
In externally rotated or internally rotated
each leg may be treated concurrently. Often
times with external rotation circumduction
will also be present. The strap placement
works for circumduction.
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Internal Rotation –With
external/internal rotation each
leg is independent and needs to
be evaluated that way. Opposite
leg may be externally rotated,
straight or internally rotated. In
externally rotated or internally
rotated each leg may be treated
concurrently.
Varus & Valgus
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With both varus & valgus both sides will be done
concurrently. The effect of the tensioning will be
to bring the person out and begin establishing a
new neuromuscular recruitment and gait pattern.
Over-striding With
excessive forward foot strike
usually both sides will be
done concurrently. The effect
of the tensioning will be to
reduce flexion and begin
establishing a new
neuromuscular recruitment
and gait pattern.
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Unweighting on Treadmill
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Testing
Balance
Neurological
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 Warm-up Acute & Chronic
 Retrain Neuro patterns
 Post Orthopaedic
Obesity
Spondylolsis
Stenosis
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Warm up
The most effective program in working with and
acute and chronic low back patient begins with a
10-12 min treadmill session while unweighted.
We will employ the same steps as discussed in the
unweighted assessment section:
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6 min forward walking
2 min right lateral
2 min retro
2 min left lateral
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Stretching Program
At the conclusion of the warm up we will
employ a self or assisted stretching
program
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Hamstring
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Psoas
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Piriformis
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Indicators for Unweighting
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Break muscle spasms
leading to acute / chronic
discomfort
Limited Range of Motion
Changing lean patterns more
aggressive than normal
Bulge / Herniation
Scoliosis
Spondylolysis
Post Surgery
Osteoporosis
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Treatment Protocol
Treating a patient with an acute or chronic low
back problem
 Put the patient in a vest and stabilize them in a
Pneu-back chair
 Unweighted position, whether in extension,
neutral, or flexion, will be determined by:
• Patient tolerance
• Initial evaluation
• What you are trying to accomplish
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NOTE: A general rule of thumb on this is
that you will take the patient opposite to
what they are presenting.
 Impingement with referral and anterior
lean, normally distract in extension with
thoracic pad all the way down.
 Distraction in extension over pad will
tend to maximize lumbar vertebral
spacing.
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Results
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By distracting in a certain postural attitude with a
stabilized pelvis, a very effective lumbar distraction
technique is accomplished and the erectors begin
loosening up.
By firing the abdominals to accomplish mobilization,
further messages are being sent to the antagonist
muscles to relax.
By accomplishing active mobilization through the region
with muscles in a distracted and relaxed state, a
compression and decompression activity is initiated and
a normal balance and circulation through the affected
region is facilitated.
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Lumbar Unweighting
 Unweight 50% of body weight for 6-8 minutes,
then begin active recruitment
 For anterior (forward) lean, Unweight in
extension approximately 6 - 10” forward
 For posterior (backward) lean, Unweight in
flexion approximately 0 – 4” back
If patient does not tolerate extension or flexion unweight in
neutral position
Active Recruitment in
Unweighting
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Be very specific on what you are trying to accomplish
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Acute - place pad at affected area approximately
20-25 psi 10-15 times, one set maximum range of
motion
Chronic - same as acute
Excessive anterior (forward) lean if acute /chronic may help to do all exercises Unweighted/in
extension
Negative lean - same as excessive w/ positioning in
flexion.
Limited range of motion unweight in extension - do
protocols Unweighted
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Scoliosis - Unweight in extension
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Use scoliosis pad on convex side to get unilateral recruitment.
Work multiple levels as necessary on convex side.
Spondylolysis - Unweight in flexion
Herniation/Rupture - Unweighting based on
patient tolerance and specific area of herniation
Post surgical - same as acute
Osteoporosis - repetitions at therapist’s
discretion
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Cervical/Thoracic Unweighting
Unweight 6-8 lbs for 6-8 minutes, then begin active recruitment. Early
stage resistance is often done by hand.
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Excessive kyphosis (extension)
Limited range of motion (extension)
Forward lean when upper thoracic in balance
(extension)
Further down on thoracic column (flexion or
neutral position)
Shoulder mobilization
Specific stabilized mobilization
Muscle Energy Techniques
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Pneu-Angle Adjuster
It provides the ability to
unweight in any vertical
direction. e.g. neutral,
flexion, extension, in
combination with neutral,
right or left.