Suspension therapy

suspension therapy in details with the principles, indications, benefits, advantages and disadvantages, materials required for performing activities using suspension techniques.

1. Suspension Therapy Dr. PETETI SAIRAM MPT(NEURO)

2. Objectives : Introduction Principles of Suspension Therapy Indications/ Aims Advantages Disadvantages Materials used Types of Suspension Techniques

3. Suspension therapy is defined as suspending a part of the body or whole body with the support of the slings and pulleys to a suspension frame.

4. Principles of Suspension Therapy Friction Pendulum Eliminating gravity movement

5. Friction : Friction occurs during a particular surface moves on another, which restrict the movement of the object. If the surfaces are more smooth and slippery will have less friction & movement will be more and smooth. If the surfaces are hard and rough will have more friction & movements are opposed by frictional force. This principle in suspension therapy with less friction causes the smooth and easy movement.

6. Pendulum: Pendulum is a heavy material suspended by the weightless thread. The force applied in the pendulum results in TO & FRO movement (oscillations). The oscillations will continue until the forces come down, step by step by the resistance of air and gravity. Pendular movements are usually seen in shoulder and hip joints of human body. The simple muscular contraction is required to produce oscillation. This principle in suspension therapy helps in Maintain muscle properties. Increase range of motion. Strengthening of muscles.

7. Eliminating Gravity of Movement: If the person has muscle power 2 can go for the suspension exercises. It's difficult to perform suspension exercises (active contraction) if the muscle power is less than 2. Minimum of MMT 2 is required for performing suspension exercises. If MMT 3 then patient can go for against gravity exercises, instead of suspension therapy.

8. Indications: Aims : Spinal cord injury (Quadriplegia, Paraplegia) Hemiplegia Post-Operative muscle weakness To maintain muscle properties To increase range of motion To prevent muscle wasting To improve muscle strength

9. Advantages : Reduces the work load of the therapist. Limbs can be lifted easily Active movements can be performed with less friction. Easier to maintain the position of the limbs with slings and pulleys in required position.

10. Disadvantages: Quite complex and not always the first choice for beginners to resistance training. Required lot of materials like slings, ropes and pulleys.

11. Materials used/ Suspension Instruments: Suspension Frame Supporting Ropes Pulleys Slings S- Hook & Dog Clips Wooden Cleat

12. Suspension Frame it’s made of stainless steel or plastic coated steel. 5 cm metal mesh is placed over the top and head end of the frame, rest of the sides of frame is left open. The measurement of frame 1m or 2m width 2m length 2m height. * In the middle of the frame (2m length * 1m width * 1m height) couch is placed for the patient’s accommodation.

13. Supporting Ropes 1.5 meter and 3 ply hemp ropes are used to avoid slipping. One end of the rope is fixed and other end passes through the wooden cleat and knotted in half-hitched manner. The are 3 varieties of ROPES. Primary supporting ropes Secondary supporting ropes Vertical supporti g ropes Primary supporting rope: point of axis for suspension and support distal joint. Secondary supporting rope: its added with the primary to support proximal joint. Vertical supporting rope: used in supporting mid portion of the joint.

14. Pulley’s it’s provides mechanical advantage. It reduces the burden to lift the body parts or whole. 1 or 2 pulleys can be used depending on the situation. If the body part is big 2 pulleys are used.( trunk, thorax, thigh)

15. Slings slings are made of canvas There are 4 types Single sling Double sling Three ring sling Head sling

16. Single Sling: It is 68 cm length and 17 cm width. Both the ends are having the D-rings for the attachment with the dog clip or S-hook. These types of slings are used for the elbow and knee region. It is some- time folded in figure of 8 manner to support the wrist and ankle. Double Sling: It is bigger than the single sling, it will have more than two sides with the D-rings. It is more useful for supporting the bigger parts like thorax, trunk, and thigh. It has 68 cm length and 28 cm width. Three-ring Sling: It is 75 cm length and 3-4 cm width, it consists of three D-rings. Two at the both end of the sling and one in the middle kept moving. It is mainly used for wrist and ankle regions.

17. Head Sling: It is used for head support in the middle of the sling presents a slit for accommodation of occipital region while in supine or lower ear accommodation while inside lying.

18. S-hook and dog clips: The S-hook and dog clips are used: 1. To attach the supporting rope with the mesh. 2. To attach the sling with the supporting ropes

19. Wooden Cleat: It is made up of wood and is used for altering the length of the rope. It has two or three holes for the rope passage, the rope itself holds the cleat by friction resistance. Sometime the wooden cleat is placed horizontally, for adjusting the length of the rope and the oblique alignment of the cleat for friction resistance by the rope to avoid slippery.

20. Procedure One end of the supporting rope is attached by the S-hook with the mesh and another end is passes through the one hole of the wooden cleat, and taken out through another hole. The wooden cleat is used for adjusting the length of the rope, and another way of lengthening adjustment made by knotting the rope about the cleat. The one more S-hook attaches the sling with the supporting rope in-between the two holes of the wooden cleat. The knotting should be half-hitched, so that it can be removed easily while altering the support or movement. Sometime padding is needed mainly for elbow and knee joint to avoid flexion movement.

21. Types of suspension Axial suspension Vertical suspension Pendular suspension.

22. Joint axis is taken as the point of the suspension. The limb is supported by the slings above the axis of the joint. 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. Uses Relaxation. Maintain muscular property. Increase the blood circulation. Increase the venous drainage. Increase the lymphatic drainage. Axial suspension

23. The centre of gravity of the body part or the body is taken as the point of suspension. The body parts can be supported in these types of suspensions rather than strengthening or performing pendular movement of the limb. Uses 1. To support the body part 2. To reduce the pressure sore. Vertical Suspension

24. 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, anteriorly or posteriorly. 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. Uses To strengthen the muscles. To increase the muscle power. To increase the endurance. Pendular Suspension

25. Techniques Position of the patient Point of suspension Needed accessories Procedure/instructions to the patient.