The Pneu-Back™ Program

Level I

The Pneu-Back ™ ProgramSeven Steps to a Healthy Back

1 Assessment

2 Measure Analyze Posture

3 Pneu-Weight Pain Free Warm Up

4 Back System III

5 Pneu-Weight and Pneu-Back Chair

6 Pneu-Back Chair Specific Recruitment

7 Home Maintenance Program

The Pneu-Map™

Quantitate posture curves AP and Lateral

Measure Spinous Process

Measure lean

Show patient progress

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Patient understanding and compliance

Documentation

Computer generated protocols

Computer GeneratedDocumentation and 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 cervical apex (approx.. C4) 4 lines down from

cervical apex (approx. C7) thoracic apex lumbar apex sacral apex

Cranial Apex

Cervical Apex 4 Down

Thoracic Apex

Lumbar Apex

Sacrum

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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.

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

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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 ScreeningBe 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

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New protocols will be generated based on values entered into initial screening

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.

Patients can exercise without fear.

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

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 ™

Fits all sizes

Supports comfortably

Allows confidence

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Unweighting 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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ObservationThe most common things we

will observe: 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.)

Toe In

Toe Out

Poor Pelvic

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Second Test

The second test we utilize is lateral side stepping at a normal to challenging level

Subject beginning facing to one side and then rotating 180° and doing the same thing facing the opposite side.

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ObservationsThe most common things we see: A marked contrast in ability between one

side and the other.

Toeing out

Inability to maintain balance at set speed. (The patient should maintain parallelity between the foot and the treadmill).

Important-the stabilizing leg is usually the one to look at in the case of improper recruitment, strength or fatigue.

Toe Out

Parallelity

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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

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 testRetro

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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.

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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.

Varus & Valgus

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 Testing Balance Neurological

Obesity Spondylolsis Stenosis

Warm-up Acute & Chronic Retrain Neuro patterns Post Orthopaedic

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Warm upThe 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:

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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HamstringPg 57

PsoasPg 57

PiriformisPg 57

Indicators for Unweighting 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 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

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Active Recruitment in Unweighting

Be very specific on what you are trying to accomplish

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 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 UnweightingUnweight 6-8 lbs for 6-8 minutes, then begin active recruitment. Early stage

resistance is often done by hand.

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.

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