MECHANOTHERAPY: CONDITIONS FOR WHICH IT IS INDICATED AND DEVICES - MEDICINE - 2025

The mecanoterapia can be defined as a branch of physical therapy that uses mechanical devices to treat various diseases or injuries, in order to direct and induce performing movements, controlling the force with running, amplitude and trajectory of themselves.

Mechanotherapy was developed by the Swedish orthopedic physician Dr. Jonas Gustav Vilhelm Zander. This doctor is known for inventing exercise therapy using special devices in his design. He began his work in 1860 and the use of his techniques spread from 1910.

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The first devices developed were very complex and expensive. Currently these have been simplified, being very simple, functional and low cost devices that allow solving most of the problems due to injuries or diseases that require regional or segmental mobilization.

Among the mechanical instruments used we can name: shoulder wheels, pedal boards, hand tables, Swedish bench, stairs and ramps, trellises, pulleys, weights and tractions, among others.

The exercises must be indicated and planned by a physiotherapy specialist and the only absolute contraindications are recent fractures, ankylosis, the patient's mental inability to execute active movement, and musculoskeletal processes of infectious origin.

For what conditions is it indicated?

Mechanotherapy can be used to increase or decrease muscular endurance, for passive mobilizations, to increase the range of certain joint movements, to reduce muscle atrophies, etc.

The list of pathologies for which it is used is very extensive. The main objective is to improve all those functions that have to do with the quality of life of the patient.

The indications can be grouped into three areas: pathologies of the nervous system, the muscular system and the skeletal system.

Diseases

Diseases that are treated with mechanotherapy and that affect the nervous system include poliomyelitis, the recovery process of hemiplegia, plaque sclerosis, neuritis, polyneuritis, root compressions, amyotrophic lateral sclerosis and paraplegia.

These areas also include cerebral palsy, congenital malformations of the nervous system, lesions of the peripheral nervous system, the skeleton or the skull that occur during childbirth, sequelae of cerebrovascular diseases, autism and attention problems, back pain, mild to moderate scoliosis, among others.

Among the diseases that affect skeletal muscle and that can be treated with mechanotherapy are myositis, muscular dystrophies, spasticity, postural alterations, immobilization syndrome, muscular atrophies and stiffness, among others.

The bone pathologies that can be treated with mechanotherapy are arthritis, periarthritis and osteoarthritis.

Conditions that a therapeutic gym must have

Physical rehabilitation gym (Image by aldineiderios in www.pixabay.com)

The mechanotherapy area is part of the therapeutic gymnasium, however this includes other physiotherapy areas such as electrotherapy, hydrotherapy, occupational therapy, speech therapy and others. This environment must have certain characteristics in order to fulfill its function properly.

The minimum conditions are as follows:

- It must be located on the ground floor of the building to facilitate the mobilization of patients.

- It must have good lighting and adequate ventilation.

- The accesses must be wide to allow the entry of beds and wheelchairs and must have at least two access doors to facilitate the mobilization of patients in cases of emergency.

- Light and relaxing colors should be used to paint the walls. Mirrors should be placed to observe and self-correct movements and to give a feeling of spaciousness to the space.

- The floor must be non-slip.

Devices used in mechanotherapy

Mechanotherapy currently has many and varied devices, some fixed and others mobile, each with specific indications. Some will be mentioned below and the most frequently used ones will be described.

Fixed appliances include pedal board, shoulder wheel, Swedish bench, hand table, trellis, stairs and ramps, parallel walking bars, Rocher cage with pulleys, weights and tractions, the finger ladder, cervical and lumbar tractions, wrist wheels, wall pulleys, isokinetic bench, among others.

Mobile equipment includes walkers, canes and crutches, wheelchairs, isokinetic bicycles, weight sets, mats, arches, rotators, hand tables, stretchers and inclined planes, among others.

- Parallel bars

They are used to improve gait, lower limb strength, step width, balance, and independence.

Its use is indicated for patients with disabilities, for those who need to learn to use prostheses for walking, elderly patients, children with prostheses and for other diseases of cardiovascular origin that cause weakness and require rehabilitation.

- Stairs and ramps

There are basically two types, some built with two sets of five or six steps, each set with different heights, or a ramp that continues with a short staircase. In each case there are bilateral rails or handrails at a height of 90 cm.

In order to use this device, the patient must first train on the parallel bars for gait, so that they already have more strength and balance. In this apparatus the difficulty is increased when introducing steps and slopes. This prepares the patient for his independent daily life.

- Finger ladder

This device is built with a wooden board in which a few notches are made every 25 or 40 mm as steps. The board is about 130 cm long and is fixed to the wall with its lower end about 75 cm from the floor.

The exercise consists of going up and down the steps with the fingers of the hand, with the elbow extended. It is an exercise that is used to increase the mobility of the shoulder.

- Shoulder wheel

As its name indicates, it is a wheel that is on a structure attached to the wall and that can adjust its height to adapt it to each patient. The wheel has a crank that allows it to be rotated. With it, a series of exercises are indicated to improve the strength and mobility of the shoulder.

- Rocher's cage

The Rocher cage, also called the pole therapy cage, consists of a trellis with three lateral grilles and a ceiling grille that allows the suspension of pulleys and weights to treat a patient who is located on a stretcher within the grille space. It allows you to do various resistance exercises with pulleys and weights.

References

1. Chillier, M. (1974). US Patent No. 3,807,728. Washington, DC: US ​​Patent and Trademark Office.
2. Huang, C., Holfeld, J., Schaden, W., Orgill, D., & Ogawa, R. (2013). Mechanotherapy: revisiting physical therapy and recruiting mechanobiology for a new era in medicine. Trends in molecular medicine, 19 (9), 555-564.
3. Khan, KM, & Scott, A. (2009). Mechanotherapy: how physical therapists' prescription of exercise promotes tissue repair. British journal of sports medicine, 43 (4), 247-252.
4. Martínez, JM, Collados, FT, Llona, ​​MJ, Esparducer, MC, & Ferrández, AS (2001). Clinical profile of geriatric patients treated in a Rehabilitation Service. Rehabilitation, 35 (4), 229-234.
5. Vindell-Sánchez, B., & Pérez-Flores, E. (2014). Post-surgical rehabilitation protocol in cerebral palsy: Management experience at the Teletón Baja California Sur Children's Rehabilitation Center. Research in Disability., 162-7.