Adeli suit

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Adeli suit
ADELI suit.jpg
ADELI suit in ADELI Medical Center
TypeSuit
MaterialElastic bands

The ADELI Suit is derived from a suit originally designed for the Soviet space program in the late 1960s [1] that was first tested in 1971. [2] The purpose then was to give the cosmonauts in space a way to counter the effects of long-term weightlessness on the body. The ADELI Suit is currently used to treat children with physical disabilities resulting from cerebral palsy, other neurological conditions originating from brain damage or spinal cord injury.[ citation needed ]

Contents

Historical background – Space race

The Cold War and the Space Race between United States and the Soviet Union was taken to another level in the 1960s and 1970s – succeeding over one another in space travelling. Several efforts to bring a life form – before sending a human to space - were undertaken by both, particularly with some dogs by the Soviets and chimps by the US (dogs Laika in November 1957 and then Belka and Strelka on Russian Sputnik 5 in August 1960 and the chimpanzees Ham or Enos in January and November 1961, respectively, on US Mercury capsules. The Soviets were generally ahead of the US until the late 1960s (first satellite, first animal in space, first lunar flyby, first human object to reach lunar surface, first pictures of the far side of the Moon, first human in space, first woman in space), [3] having a gigantic military complex and investing enormous amounts in R&D of space traveling.[ citation needed ]

The first crewed space trips counted only for hours, maybe days. Large problem the industry was facing, was that no matter how well prepared physically the cosmonauts (USSR) and the astronauts (USA) for the trip, even a short stay in space had a massive negative influence on their health. [4] The conditions of weightlessness (antigravity) and hypokinesia (lack of movement) caused immediate retardation of the whole body and motor system of the space traveler – muscles, bones, peripheral and Central Nervous Systems degenerated within several hours to a large extent. [5] Upon return to Earth, the astronauts had to readjust to Earth's gravity and experienced problems standing up, stabilizing their gaze, walking and turning. These disturbances are more profound as the length of microgravity exposure increases. [6] These symptoms are very similar to those experienced by people with a mechanic damage of the brain and motor system. Often, astronauts needed a long-term intensive rehabilitation to get back in shape. The Soviets, however, did find a solution for cosmonauts to stay fit for months in space, contrary to the US, which had to return their astronauts after just a couple of days.[ citation needed ]

Invention of the suit

The breakthrough in support for crewed space traveling was a special elastic suit, invented by the Russian Center for Aeronautical and Space Medicine in the late 1960s. [1] The Soviet space scientists designed and developed a fully functional prototype of the dynamic correction clothing - called the "Penguin Suit". By wearing this "Penguin Suit", it provided deep compression force on the skin, muscle, and bone even in weightlessness. Thus the astronauts would not suffer from the effects of extended staying in a gravity-free environment. Also the scientists and the rehabilitation medicine team developed a set of intensive training program to restore and build up the astronauts' physical and sensor-motor function. [7] The construction of the Suit was rather simple – shoes, knee-pads, shorts and shoulder-pads, all connected between each other with elastic elements. The location of the elastic bands is similar to the position of antagonistic muscle pairs. Two main functions were achieved – an axial load of up to 40 kg and resistance for every movement made. [8] In total, the device has quite well imitated the Earth gravitation force, not allowing the brain and body of the cosmonaut to degenerate in space. Before the Russian suit was copied by the Americans, the USSR had an advantage of its cosmonauts staying in space for months and returning to Earth in a better condition than the US astronauts.[ citation needed ]

Space suit in Medicine

For many years, the Penguin suit was used successfully with astronauts to help them prevent disability. As Russia became more open, the technology for this early "therapy suit" was shared with those who work in rehabilitation. Reasoning that the effects of weightlessness were very similar to the physical problems seen in motor disorder patients, they decided to modify the suits for use with patients with cerebral palsy. At the Pediatric Institute of the Russian Academy of Medical Sciences, a team developed the first therapeutic suit in the early 1990s. [9] Two major co-inventors of the suit - Professor Inessa Kozlovskaya and Professor Xenia Semenova - have decided to transfer the advantages of their device to treatment of patients with severe neurologic conditions, especially children. In 1994, the "loading and training device" was patented all over the world through World Intellectual Property Organization with its application in medicine – mainly in rehabilitation of cerebral palsy and similar neurologic conditions. [10]

The discovery behind was the so-called "Functional Antigravitation System" – a special "software", integrated into the Central nervous system. This program/software allows a healthy human to easily cope with Earth gravity in every movement he makes – sitting, standing up, walking, using arms and so on. In case of brain-injured people, their life in a wheel chair or even in bed, this software is damaged or not developed in the first place. Professors Kozlovskaya and Semenova, after some month of research, modifications and ultimately – with a successful application – came up with "therapeutic suit" LK ADELI-92. The name ADELI / АДЕЛИ is a tribute to the prototype – the Penguin suit – as it originates from a penguin kind called the Adélie penguin. [11]

After more fundamental studies by Professor Semenova [12] and development of special application methods described on over thousand pages manual, the suit was acknowledged by conventional medicine and has found immediate wide-range application in Russia, within the state rehabilitation and re-integration programme for cerebral palsy children. The programme was called "Disabled Children" and introduced by Boris Yeltsin.[ citation needed ]

Construction

The suit is designed to create a normal framework of forces on the body, stabilizing the torso to allow more fluent and coordinated movement for all the limbs. The suit uses a system of elastic bands and pulleys that create artificial forces against which the body can work, to prevent muscular atrophy and reduce osteoporosis.[ citation needed ] It consists of a vest, shorts, knee pads, shoes and sometimes a head piece, all connected in a prescribed pattern with bungees of appropriate tension. The theory behind the ADELI Suit is that through active movement therapy the brain is stimulated and thus retrained to recognize, and eventually initiate, correct movement of the muscles. [13]

Claimed benefits

The ADELI Medical Center states that the effect of the suit is that the established pathological synaptic pathways are rewritten with the new normal reflex pathways, which exercises therapeutic effects on the structures of the Central Nervous System responsible for motor activity. [13] Claimed benefits include external stabilization, restoration of muscle tone, re-alignment of the body towards the normal, normalization of gait, provision of tactile stimulation, improved balance, support of weakened muscles, strengthening of functional muscles, relaxation of contracted muscles, and improvement of coordination. [13] [14] [15] [16] Suit therapy has been proposed as a treatment for cerebral palsy, however, the suit manufacturers also recommend the treatment for other neuromuscular disorders, including developmental delays, traumatic brain injury, post-stroke, ataxia, athetosis, spasticity and hypotonia. The suit is, however, contraindicated in patients with hip subluxation greater than 50% or severe scoliosis and used with precautions in patients with heart conditions uncontrolled seizure activities, hip subluxation, hydrocephalus, diabetes, kidney problems and hypertension. [17]

Long-term effects

Rehabilitative gains in motor control through treatment with the ADELI Suit are typically retained after the intensive course is completed. Research on groups of children with the ADELI Suit therapy has shown long-term retention of skills once their therapy program ceased. However, further research is still needed into all the long-term effects.[ citation needed ]

Related Research Articles

Hemiparesis, or unilateral paresis, is weakness of one entire side of the body. Hemiplegia is, in its most severe form, complete paralysis of half of the body. Hemiparesis and hemiplegia can be caused by different medical conditions, including congenital causes, trauma, tumors, or stroke.

<span class="mw-page-title-main">Cerebral palsy</span> Group of movement disorders that appear in early childhood

Cerebral palsy (CP) is a group of movement disorders that appear in early childhood. Signs and symptoms vary among people and over time, but include poor coordination, stiff muscles, weak muscles, and tremors. There may be problems with sensation, vision, hearing, and speaking. Often, babies with cerebral palsy do not roll over, sit, crawl or walk as early as other children of their age. Other symptoms include seizures and problems with thinking or reasoning, each of which occur in about one-third of people with CP. While symptoms may get more noticeable over the first few years of life, underlying problems do not worsen over time.

Spasticity is a feature of altered skeletal muscle performance with a combination of paralysis, increased tendon reflex activity, and hypertonia. It is also colloquially referred to as an unusual "tightness", stiffness, or "pull" of muscles.

Hereditary spastic paraplegia (HSP) is a group of inherited diseases whose main feature is a progressive gait disorder. The disease presents with progressive stiffness (spasticity) and contraction in the lower limbs. HSP is also known as hereditary spastic paraparesis, familial spastic paraplegia, French settlement disease, Strumpell disease, or Strumpell-Lorrain disease. The symptoms are a result of dysfunction of long axons in the spinal cord. The affected cells are the primary motor neurons; therefore, the disease is an upper motor neuron disease. HSP is not a form of cerebral palsy even though it physically may appear and behave much the same as spastic diplegia. The origin of HSP is different from cerebral palsy. Despite this, some of the same anti-spasticity medications used in spastic cerebral palsy are sometimes used to treat HSP symptoms.

<span class="mw-page-title-main">Dystonia</span> Neurological movement disorder

Dystonia is a neurological hyperkinetic movement disorder in which sustained or repetitive muscle contractions result in twisting and repetitive movements or abnormal fixed postures. The movements may resemble a tremor. Dystonia is often intensified or exacerbated by physical activity, and symptoms may progress into adjacent muscles.

Hypotonia is a state of low muscle tone, often involving reduced muscle strength. Hypotonia is not a specific medical disorder, but a potential manifestation of many different diseases and disorders that affect motor nerve control by the brain or muscle strength. Hypotonia is a lack of resistance to passive movement, whereas muscle weakness results in impaired active movement. Central hypotonia originates from the central nervous system, while peripheral hypotonia is related to problems within the spinal cord, peripheral nerves and/or skeletal muscles. Severe hypotonia in infancy is commonly known as floppy baby syndrome. Recognizing hypotonia, even in early infancy, is usually relatively straightforward, but diagnosing the underlying cause can be difficult and often unsuccessful. The long-term effects of hypotonia on a child's development and later life depend primarily on the severity of the muscle weakness and the nature of the cause. Some disorders have a specific treatment but the principal treatment for most hypotonia of idiopathic or neurologic cause is physical therapy and/or occupational therapy for remediation.

The Bobath concept is an approach to neurological rehabilitation that is applied in patient assessment and treatment. The goal of applying the Bobath concept is to promote motor learning for efficient motor control in various environments, thereby improving participation and function. This is done through specific patient handling skills to guide patients through the initiation and completing of intended tasks. This approach to neurological rehabilitation is multidisciplinary, primarily involving physiotherapists, occupational therapists, and speech and language therapists. In the United States, the Bobath concept is also known as 'neuro-developmental treatment' (NDT).

Monoplegia is paralysis of a single limb, usually an arm. Common symptoms associated with monoplegic patients are weakness, numbness, and pain in the affected limb. Monoplegia is a type of paralysis that falls under hemiplegia. While hemiplegia is paralysis of half of the body, monoplegia is localized to a single limb or to a specific region of the body. Monoplegia of the upper limb is sometimes referred to as brachial monoplegia, and that of the lower limb is called crural monoplegia. Monoplegia in the lower extremities is not as common of an occurrence as in the upper extremities. Monoparesis is a similar, but less severe, condition because one limb is very weak, not paralyzed. For more information, see paresis.

Hypertonia is a term sometimes used synonymously with spasticity and rigidity in the literature surrounding damage to the central nervous system, namely upper motor neuron lesions. Impaired ability of damaged motor neurons to regulate descending pathways gives rise to disordered spinal reflexes, increased excitability of muscle spindles, and decreased synaptic inhibition. These consequences result in abnormally increased muscle tone of symptomatic muscles. Some authors suggest that the current definition for spasticity, the velocity-dependent over-activity of the stretch reflex, is not sufficient as it fails to take into account patients exhibiting increased muscle tone in the absence of stretch reflex over-activity. They instead suggest that "reversible hypertonia" is more appropriate and represents a treatable condition that is responsive to various therapy modalities like drug or physical therapy.

Diplegia, when used singularly, refers to paralysis affecting symmetrical parts of the body. This is different from hemiplegia which refers to spasticity restricted to one side of the body, paraplegia which refers to paralysis restricted to the legs and hip, and quadriplegia which requires the involvement of all four limbs but not necessarily symmetrical. Diplegia is the most common cause of crippling in children, specifically in children with cerebral palsy. Other causes may be due to injury of the spinal cord. There is no set course of progression for people with diplegia. Symptoms may get worse but the neurological part does not change. The primary parts of the brain that are affected by diplegia are the ventricles, fluid filled compartments in the brain, and the wiring from the center of the brain to the cerebral cortex. There is also usually some degeneration of the cerebral neurons, as well as problems in the upper motor neuron system. The term diplegia can refer to any bodily area, such as the face, arms, or legs.

A selective dorsal rhizotomy (SDR), also known as a rhizotomy, dorsal rhizotomy, or a selective posterior rhizotomy, is a neurosurgical procedure that selectively cut problematic nerve roots of the spinal cord. This procedure has been well-established in the literature as a surgical intervention and is used to relieve negative symptoms of neuromuscular conditions such as spastic diplegia and other forms of spastic cerebral palsy. The specific sensory nerves inducing spasticity are identified using electromyographic (EMG) stimulation and graded on a scale of 1 (mild) to 4. Abnormal nerve responses are isolated and cut, thereby reducing symptoms of spasticity.

<span class="mw-page-title-main">Management of cerebral palsy</span>

Over time, the approach to cerebral palsy management has shifted away from narrow attempts to fix individual physical problems – such as spasticity in a particular limb – to making such treatments part of a larger goal of maximizing the person's independence and community engagement. Much of childhood therapy is aimed at improving gait and walking. Approximately 60% of people with CP are able to walk independently or with aids at adulthood. However, the evidence base for the effectiveness of intervention programs reflecting the philosophy of independence has not yet caught up: effective interventions for body structures and functions have a strong evidence base, but evidence is lacking for effective interventions targeted toward participation, environment, or personal factors. There is also no good evidence to show that an intervention that is effective at the body-specific level will result in an improvement at the activity level, or vice versa. Although such cross-over benefit might happen, not enough high-quality studies have been done to demonstrate it.

Dyskinetic cerebral palsy (DCP) is a subtype of cerebral palsy (CP) and is characterized by impaired muscle tone regulation, coordination and movement control. Dystonia and choreoathetosis are the two most dominant movement disorders in patients with DCP.

<span class="mw-page-title-main">Athetoid cerebral palsy</span> Type of cerebral palsy associated with basal ganglia damage

Athetoid cerebral palsy, or dyskinetic cerebral palsy, is a type of cerebral palsy primarily associated with damage, like other forms of CP, to the basal ganglia in the form of lesions that occur during brain development due to bilirubin encephalopathy and hypoxic–ischemic brain injury. Unlike spastic or ataxic cerebral palsies, ADCP is characterized by both hypertonia and hypotonia, due to the affected individual's inability to control muscle tone. Clinical diagnosis of ADCP typically occurs within 18 months of birth and is primarily based upon motor function and neuroimaging techniques. While there are no cures for ADCP, some drug therapies as well as speech, occupational therapy, and physical therapy have shown capacity for treating the symptoms.

Upper motor neuron syndrome (UMNS) is the motor control changes that can occur in skeletal muscle after an upper motor neuron lesion.

<span class="mw-page-title-main">Ataxic cerebral palsy</span> Medical condition

Ataxic cerebral palsy is clinically in approximately 5–10% of all cases of cerebral palsy, making it the least frequent form of cerebral palsy diagnosed. Ataxic cerebral palsy is caused by damage to cerebellar structures, differentiating it from the other two forms of cerebral palsy, which are spastic cerebral palsy and dyskinetic cerebral palsy.

<span class="mw-page-title-main">Spastic cerebral palsy</span> Cerebral palsy characterized by high muscle tone

Spastic cerebral palsy is the type of cerebral palsy characterized by spasticity or high muscle tone often resulting in stiff, jerky movements. Cases of spastic CP are further classified according to the part or parts of the body that are most affected. Such classifications include spastic diplegia, spastic hemiplegia, spastic quadriplegia, and in cases of single limb involvement, spastic monoplegia.

<span class="mw-page-title-main">Spastic hemiplegia</span> Medical condition

Spastic hemiplegia is a neuromuscular condition of spasticity that results in the muscles on one side of the body being in a constant state of contraction. It is the "one-sided version" of spastic diplegia. It falls under the mobility impairment umbrella of cerebral palsy. About 20–30% of people with cerebral palsy have spastic hemiplegia. Due to brain or nerve damage, the brain is constantly sending action potentials to the neuromuscular junctions on the affected side of the body. Similar to strokes, damage on the left side of the brain affects the right side of the body and damage on the right side of the brain affects the left side of the body. Other side can be effected for lesser extent. The affected side of the body is rigid, weak and has low functional abilities. In most cases, the upper extremity is much more affected than the lower extremity. This could be due to preference of hand usage during early development. If both arms are affected, the condition is referred to as double hemiplegia. Some patients with spastic hemiplegia only experience minor impairments, where in severe cases one side of the body could be completely paralyzed. The severity of spastic hemiplegia is dependent upon the degree of the brain or nerve damage.

The Pingvin exercise suit is a Russian anti-zero-G suit to be worn during spaceflight, designed to mimic the effects of gravity on the body, thus counteracting the loss of bone and muscle in weightlessness. The suit has elastic bands connected to a waistband that create tension between the waist and the feet and between the shoulders and the waist, thus creating a force for the body to work against. Cosmonauts reported the suit to be uncomfortable and prone to overheating. After ground tests in 1971 at Baikonur and in-orbit tests in 1975 on the Salyut 3, it was in use on the Mir, and routinely during long Soviet spaceflights from 1978 on. Variants were developed for therapeutic use in people with movement problems.

<span class="mw-page-title-main">Diane Damiano</span> American biomedical scientist and physical therapist

Diane Louise Damiano is an American biomedical scientist and physical therapist specializing in physical medicine and rehabilitation approaches in children with cerebral palsy. She is chief of the functional and applied biomechanics section at the National Institutes of Health Clinical Center. Damiano has served as president of the Clinical Gait and Movement Analysis Society and the American Academy for Cerebral Palsy and Developmental Medicine.

References

  1. 1 2 "Space Suit History". sunrise therapy. Archived from the original on 2013-08-28. Retrieved 2013-12-18.
  2. ↑ "Penguin". Encyclopedia Astronautica. Archived from the original on 2016-03-23. Retrieved 2016-04-04.
  3. ↑ "TheSpaceRace.com - Timeline of Space Exploration". Archived from the original on 2013-09-24. Retrieved 2013-12-18.
  4. ↑ "Biological and Psychological Effects of Human Space Flight". 2012-04-24.
  5. ↑ "Effect of space on Human body". Archived from the original on 2012-04-28. Retrieved 2013-12-18.
  6. ↑ "Impact".
  7. ↑ "TheraSuit Orthosis" (PDF). Retrieved November 12, 2022.
  8. ↑ "Space Suit Helps Rehabilitate Stroke Victims". 27 August 2014.
  9. ↑ "Index".
  10. ↑ "About this file - European Patent Register".
  11. ↑ "DEVICE FOR TREATING PATIENTS WITH DISTURBANCES OF POSE AND MOTOR ACTIVITY". Archived from the original on 2013-12-20. Retrieved 2013-12-18.
  12. ↑ Semenova, K. A. (1997). "Basis for a method of dynamic proprioceptive correction in the restorative treatment of patients with residual-stage infantile cerebral palsy". Neuroscience and Behavioral Physiology. 27 (6): 639–643. doi:10.1007/BF02461920. PMID   9406213. S2CID   21471974. Archived from the original on 2013-12-19.
  13. 1 2 3 "Space Neurology | ADELI Medical Center". Adeli-center.com. Archived from the original on 2013-04-24. Retrieved 2013-03-02.
  14. ↑ Bailes, A. F.; Greve, K.; Burch, C. K.; Reder, R.; Lin, L.; Huth, M. M. (Summer 2011). "The effect of suit wear during an intensive therapy program in children with cerebral palsy". Pediatric Physical Therapy. 23 (2): 136–142. doi: 10.1097/PEP.0b013e318218ef58 . PMID   21552073. S2CID   23126577.
  15. ↑ Alagesan, Jagatheesan; Shetty, Angelina (Oct–Dec 2010). "Effect of Modified Suit Therapy in Spastic Diplegic Cerebral Palsy - A Single Blinded Randomized Controlled Trial". Online Journal of Health and Allied Sciences. 9 (4). ISSN   0972-5997.
  16. ↑ Bar-Haim, S.; Harries, N.; Belokopytov, M.; Frank, A.; Copeliovitch, L.; Kaplanski, J.; Lahat, E. (May 2006). "Comparison of efficacy of Adeli suit and neurodevelopmental treatments in children with cerebral palsy". Developmental Medicine & Child Neurology. 48 (5): 325–330. doi: 10.1017/S0012162206000727 . PMID   16608538.
  17. ↑ "Healthnet National Medical Policy - Suit Therapy for Cerebral Palsy" (PDF). Archived from the original (PDF) on 2013-12-19. Retrieved 2013-01-03.
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