Suspension therapy_111333.pptx physiotherapy

Suspension Therapy

1. Suspension therapy Dr.Kaushik Patel (MPT)

2. Introduction The word suspension means suspending part/parts of the body using supports to free the body from friction and allowing free movement without any resistance. In suspension therapy, parts of the body are supported in slings and elevated by the use of variable length ropes fixed to a point above the body.

3. Suspension frees the body from the friction of the material upon which body components may be resting and it permits free movement without resistance when the fixation is suitably arranged relative to the supported part. All that is needed for the suspension to be effected is a fixed point (hook) above the relevant part of the body and a suspensory unit which consists of a sling and an adjustable rope .

4. A suspensory unit consisting of a rope and a sling.

5. PRINCIPLES It is working under the principles of Friction Pendulum Eliminating gravity movement.

6. FRICTION It occurs during a particular surface moves on another. It is the force, which restrict the movement of an object. If the surfaces are more smooth and slippery will have less friction, in that surface the movement will be more.

7. If the surfaces are hard or rough results in more friction and the movements are opposed by the friction force. The same principle is used in the suspension which has less friction causes the smooth and easy movement.

8. PENDULUM A simple pendulum is a heavy particle , suspended by a weightless thread and free to move to and fro. One complete swing is called as oscillation. During the oscillation, the area of movement of pendulum forms a segment of base of the cone. The oscillation will be continued until the force comes down. The oscillation distance may come down step by step, by the resistance of the air and gravity.

9. In the human body the pendular motion occurs. Mainly in the shoulder and hip joints , forward leg movement and the arm swing movement while walking, is the simplest example.

10. The simple muscular contraction is necessary to the initiate the oscillation. The same mechanism is used in the suspension therapy to maintain the muscle property , increase the range of movement and strengthening the muscles.

11. ELIMINATING GRAVITY MOVEMENT If the person has the muscle power 2(gravity eliminated movement), can go for the suspension exercises. If the muscle power is less than 2, it is difficult to perform the suspension therapy exercise by the patient himself.

12. So, the patient should have minimal muscle power of 2 to undergo for suspension therapy exercise. If the muscle power is above 3, the patient can go for against the gravity exercise instead of suspension therapy exercise.

13. ADVANTAGES: It reduces the burden for the therapist Easy to lift the limbs. Active movement can be performed easily with minimum friction.

14. DISADVANTAGES: Not useful for the muscles of “0” grade. Put lot of neuromuscular demand. Increase the chance of trick movement. Constant supervision should be required to avoid trick movement.

15. Not use for small joint Time consuming. Required more space. Decrease attention of therapist over the patient.

16. Suspension Instruments Suspension Frame/ Grothus Apparatus Fixed point Supporting ropes Slings Hook and Clips Wooden cleat Dog clip and S hook Storage trolley

17. Grothus apparatus: Late Mrs. Guthrie Smith has invented the suspension apparatus. It consists of a standard couch with mesh around four areas. Head end. Right side. Left side. Overhead mesh.

18. FIXED POINT : • It is made of stainless steel or plastic coated steel. In the top and head end side presents the 5cm metal mesh and remaining side kept open.

19. Supporting ropes : There are different types of ropes: Single rope. Double rope. Pulley rope

20. Single rope : It has a ring fixed at one end, by which it is hung up. The other end of the rope passes through one end of the wooden cleat , through the ring of a dog clip and through the other end of cleat and is then knotted with a half-hitch.

21. The cleat is used for alternating the length of rope. The cleat should be kept horizontal to adjust the length and pulled oblique when supporting.

22. Further shortening of the rope may be brought about by knotting it about the cleat, as in Fig, so that the supporting end is firm but the free end can be pulled out with no permanent knots made.

23. A - The cleat in the horizontal position for changing the length of the rope; B - The cleat in the oblique position in which frictional resistance causes it to 'hold' its own position. Two alternative methods (A and B) of shortening a rope with the free end held in such a manner that a tug on it enables quick release.

24. Pulley rope : A pulley rope has a dog clip attached to one end of the rope which then passes over the wheel of a pulley. The rope then passes through the cleat and a second dog clip. This arrangement is used for reciprocal pulley circuits, it is used for three-dimensional movements of a limb, that is abduction or adduction with flexion or extension and medial or lateral rotation.

25. A - A dog clip; B - A karabiner clip.

26. Double rope : A double rope consists of a ring and clip from which the rope is hung to create a compensating the device permitting a certain amount of swivel on the rope.

27. The rope then passes through one side of a cleat, round a pulley wheel at the lower end, to the case of which is attached a dog clip, through the other end of the cleat and over the wheel of an upper pulley which is attached to the compensating device. The rope then passes down again through a centre hole in the cleat where it is knotted.

28. The rope is shortened by pushing the cleat down, allowing the lifter to move with gravity , at the same time as it offers a mechanical advantage. Such a rope is used to suspend the heavy parts of the body- the pelvis, thorax or heavy thighs when these are to be supported together.

29. Slings There are following four types of slings: Single Sling Double Sling Three Ring Sling Head Sling

30. A - A single sling; B- A double sling; C- A head sling; D -A three-ring sling ready for use; E - A three-ring sling ready for storage.

31. Single Slings: Single slings are made of canvas bound with soft webbing and with a D ring at each end . They are used open to support the limbs , or folded in two and as a figure of eight to support the hand or foot. They measure 68 cm long by 17 cm wide .

32. A and B- A single sling folded and being made into a figure of eight for use on the foot and ankle;

33. Double Slings : Double slings are broad slings measuring 68 cm long and 29 cm wide with D rings at each end and are used to support the pelvis or thorax or the thighs together, especially when the knees are to be kept straight

34. Three-ring Slings: Three ring slings are webbing slings 71 cm long by 3–4 cm wide with three D rings, one fastened at each end and one free in the middle. The centre ring is for attachment to the dog clip and the webbing is slipped through the end D rings to make two loops These slings are used to support the wrist and hand or ankle and foot

35. Head Sling : A head sling is a short, split sling with its two halves stitched together at an angle to create a central slit And it allows the head to be supported.

36. WOODEN CLEAT : It is made of wood and is used for altering of the rope. It has two or three holes for the rope passage. The rope itself hold the cleat by friction resistance.

37. S-HOOK AND DOG CLIPS : S-hook and dog clips are used: 1. To attached the supporting rope with the mesh. 2. To attach the sling with supporting ropes.

38. STORAGE TROLLEY : Storage of slings and ropes is done with the help of hooks.

39. TYPES OF SUSPENSION Axial suspension. Vertical suspension. Pendular suspension.

40. Axial suspension This occurs when all the ropes supporting a part are attached to one ‘S’ hook which is fixed to a point immediately above the centre of the joint which is to be moved, e.g. if the lower limb is to be moved at the hip joint, two ropes, one to the foot and one to the area of the knee , will be used and fixed at a point immediately over the axis of the hip joint.

41. If the movement is initiated the limb moves both sides and the base of the swings shows the segment of the base of the cone shape. The part moves parallel to the floor

42. A- The pencil pushed through a circle of paper demonstrates that when the pencil is pivoted the paper moves in a plane parallel with the floor, thus demonstrating the principle of axial fixation; B - Axial fixation for adduction and abduction of the hip

43. Uses: Relaxation Maintain muscle property Increase the blood circulation Increase venous drainage Increase lymphatic drainage

44. VERTICAL SUSPENSION In using vertical suspension the rope is fixed so that it hangs vertically above the centre of gravity of the part to be suspended. The centre of gravity of each part of the body is, on the whole, at the junction of the upper and middle third.

45. Vertical suspension is used for support as it tends to limit the movement rather than strengthening or performing pendulum movements of the limb. Uses: To support the body part To reduce the pressure sore.

46. PENDULAR SUSPENSION Here at first the axis of the joint is taken as the point of suspension then depends on the strengthening of the muscle group , the axis is changing towards medially or laterally.

47. The muscles will be getting resistance while movement if the axis is shifted opposite to that movement. For example , if the axis is shifted towards the abductor side the adductor muscles will be getting resistance during movement.

48. USES To strengthen the muscles . To increase the muscle power . To increase the endurance.

49. Suspension for the Lower Extremity The Hip Abduction and Adduction The starting position is lying with the opposite leg abducted to its limit, even if the knee has to be bent over the side of the plinth and the foot supported on a footstool. The fixation point is immediately above the hip joint. One sling is put under the lower thigh and one three-ring sling on the foot and ankle; each is attached to a rope hung from the fixation point.

50. The limb is lifted just clear of the plinth. Using this method of support the movements of abduction and adduction may be mobilized or the abductor or adductor muscles may be especially worked with or without manual resistance

51. Abduction and adduction of the hip joint in axial fixation (·–·–·–· axial line)

52. Flexion and Extension The starting position is side lying with the underneath leg flexed as far as possible. The fixation point and sling arrangements are as above, with the limb lifted until it is horizontal. If the movement of flexion is to be mobilized the knee and hip must be flexed together to overcome the passive insufficiency of the hamstrings. Equally, when mobilizing extension the knee should be extended to overcome active insufficiency of the hamstrings

53. Flexion and extension of the hip joint in axial fixation (·–·–·–· axial line).

54. The Knee Flexion and Extension. The starting position is side lying with one or two pillows between the slightly flexed thighs. One three-ring sling is applied to the foot and ankle and one rope attached to a fixation point above the knee joint. By keeping the hip slightly flexed on the trunk the foot can be seen each time the knee is extended and part of the arc of movement is thus observed by the patient. This position may be used to mobilize the knee joint or to work the flexors or extensors of the knee

55. A pillow is placed between the thighs for flexion and extension of the knee in axial fixation (·–·–·–· axial line)

56. Suspension for the Upper Extremity The Shoulder Joint Abduction and Adduction The starting position is lying, quarter turned towards the arm which is to be moved This allows the normal anatomical movement to be performed in the plane of the scapula. Alternatively, the starting position is prone lying, quarter turned towards side lying with a pillow under the trunk on the side of the arm which is to be moved (Fig. 8.21B). The advantage of prone lying is that the therapist can see the movements of the scapula as well as those of the arm.

57. Two single ropes are required, one attached to a single sling under the elbow and one to a three-ring sling applied to the wrist and hand. The fixation point is over the shoulder joint. If the movement is to be only of the glenohumeral joint, the therapist must stand on the opposite side with one hand on the point of the shoulder depressing the scapula. In this form of support either abduction and adduction of the glenohumeral joint, or movements of the shoulder girdle, may be mobilized. Glenohumeral rhythm may be re-educated and all the muscles performing shoulder girdle movements may be worked.

58. Shoulder abduction and adduction in axial fixation. A, Quarter 15° turned from lying; B, Quarter 15° turned from prone lying. This position may also be used for protraction and retraction of the scapula (·–·–·–· axial line)

59. Flexion and Extension The starting position is side lying on pillows and quarter turned to the back. Female patients need two pillows under the head and one under the shoulder to allow the forearm to clear their wider pelvis. The slings and ropes are arranged as described above and again the movement may be limited to the glenohumeral joint and the muscles working over it, or movements of the shoulder girdle may be included.

60. If in addition to the angular movements it is desired to perform rotation of the glenohumeral joint, then only one sling should be used at the level of the elbow and a single pulley rope should be attached to the fixed point above the shoulder. The ends of the sling are attached to each end of the pulley circuit and it will then be possible to perform medial or lateral rotation with two angular movements

61. It will be necessary to turn the patient further towards the side or more prone. It is then possible to perform flexion, adduction and lateral rotation alternately with extension, abduction and medial rotation, or flexion, abduction and lateral rotation alternately with extension, adduction and medial rotation.

62. Using axial fixation over the right glenohumeral joint and a single pulley rope the movements of extension/adduction/medial rotation and flexion/abduction/lateral rotation can be performed with the patient quarter 15° turned to the right (·–·–·–· axial line)

63. Using axial fixation over the right glenohumeral joint and a single pulley rope the movements of extension/abduction/medial rotation and flexion/adduction/lateral rotation can be performed with the patient quarter 15° turned to the left (·–·–·–· axial line).

64. Elbow Joint Flexion and Extension Because of the carrying angle of the forearm it is easier to perform these movements when the arm is suspended in abduction. The starting position is sitting on a low-backed chair. A single sling and rope supports the arm in vertical fixation, and a three-ring sling and single rope are fixed to a point above the elbow joint. The therapist should stand behind as she may need to give additional support by holding the arm with a grasp inside the sling, which will allow palpation of the flexors and extensors which are covered by the supporting sling Alternatively, a folded single sling under the palm, attached to a single pulley rope, will allow pronation and supination to occur with extension and flexion of the elbow joint.

65. Vertical fixation by rope V for the arm. Axial fixation by rope A for the forearm. ·–·–·–· is the axis from the suspension point of rope A immediately above the elbow joint (x)

66. Flexion and Extension of the Whole Arm. As a functional movement this may be performed with the patient in the sitting position, e.g. practising taking the hand to the mouth may be done by using two single slings attached to two single pulley rope circuits. One sling is placed round the arm and one round the forearm. If the ropes are sufficiently tightened the patient can grasp, supinate and flex the elbow and shoulder while adducting and laterally rotating. This sort of support is used for patients who have difficulty in performing personal facial toilet, feeding, turning the pages of a book fixed at eye level, or working in front of themselves

67. Thank you..