Therasuit is a breathable, supportive dynamic device that is composed of cap, vest, shorts, and kneepads, which are interconnected by a series of elastic bands 1. This unique approach helps accelerate progress in motor skills and enhance the functional skills in children who suffer from Cerebral Palsy, Developmental Delay, Traumatic Brain Injuries and other neurological and sensory disorders 2,3. This new treatment tool is inspired by the technology developed to help Russian astronauts counteract the negative effects of weightlessness, such as, muscle atrophy, loss of bone density, and lack of ability to ambulate 3. Therasuit aligns the body, normalizes the muscle tone, improves proprioception and reduces pathological reflexes. Intensive Therasuit therapy can provide strengthening, flexibility, increased endurance, and help the patients to acquired skills such as rolling, crawling, sitting, and walking, which they have never able to do before 2.
Therasuit is a soft dynamic proprioceptive orthotic constructed of a breathable but highly durable fabric 3. Therasuit consists of cap, vest, shorts, kneepads, and shoe attachments, which are connected to each other through a system of elastic bands. It comes in five sizes:
Small (yellow) 3-5 yrs, 34”- 44″ tall
Medium (red) 5-8 yrs, 44″ – 51″ tall
Large (green) 8-12 yrs, 51″ – 56″ tall
x- Large (blue) 12-adulthood, 56″- 66″ tall
xx- Large ( blue/yellow) adults
Therasuit is the most recent design that does not require lengthy training and skills. It can be used by both therapists and parents, during a variety of functional activity 1.
The idea of designing the suit therapy began in the 1960’s, when the Russian cosmonauts started suffering from the negative effects of the weightlessness, such as, loss of bone density, muscle atrophy, and altered integration of sensory and motor responses, as a result of being on the space for a long time. So in order to regain muscle strength, bone density, and sensory integration, the ”Penguin Suit”, which was a special light weight garment to be worn during space flight, was developed. And this was the earliest form of Therasuit. . After several years, the Russian scientists shared this early ”Therapy Suit” with those who work in the rehabilitation throughout Europe. Due to the similarities in the effect of weightlessness between the cosmonauts and people with cerebral palsy (CP), the Pediatric Institute of the Russian Academy of Science, took the idea and created a special suit for patients’ use, which was known as ”LK Adeli 92”. The positive results increase the belief of the effectiveness of ” Suit Therapy” with the Adeli suit in treating patients with CP and other neurological disorders.
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A rehabilitative therapy clinic in Poland, Euromed, took the idea one-step further, by designing an intensive physical therapy program with the use of the LK Adeli 92 suit as an essential part of their program. As a result of their huge success, people traveled to Euromed to try the ”Suit Therapy” with Adeli Suit 3. In 2001, Richard and Izabela Koscielny ,American physical therapists, designed and patented the ”Therasuit”, after they traveled to Europe to try the Suit Therapy with Adeli Suit and at the end of the first session, Kaya their 6 yrs old daughter with CP took her first steps, and that was a turning point in their life. This suit was the first suit available in United States to rehabilitate neurological and sensory disorders 4.
Therasuit is used to treat patients who diagnosed with CP, hemiplegia, stroke, developmental delays, ataxia, athetosis, traumatic brain injuries, spinal cord injuries (spina bifida), Down Syndrome, and many other neurological disorders 3 4 . It is also helpful for patients suffering from sensory integration problems and autism 4.
Therasuit helps the patient to maintain proper alignment, by the use of the elastic rubber bands that keeps the body in upright position with the center of gravity falling between the feet. This position helps the patient to acquire the proper pattern of movements. On the other hand, this position is hard to maintain, required huge energy, and may cause fatigue and lack of endurance. Studies show that a CP patient would use 3 times more energy performing the same activity as a non-affected person5.
These postural changes occurred immediately after wearing the Therasuit and it normalize the muscle tone. Therasuit allows the patient to have more fluent and coordinated movement for both upper and lower limbs, by providing external stabilization to the trunk, and this could help patients with ataxia and athetosis.
Therasuit help restoring deep proprioception from muscles, joints, and ligaments, and allows the nervous system to develop properly, by applying pressure to the patient’s body and that will help in sensory integration problems. Many infants and children with cerebral palsy experience difficulty in processing sensory input and therefore have even greater difficulty producing a desired motor output, and its important to obtain an optimal state of arousal and affecting the child’s motivation, initiation, and purposeful interaction with the environment 6.
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At early stages, Therasuit is used as a supportive tool for weak muscles, but after a period of time the elastic band are tighten up , resulting in increasing muscle’s strength by applying a resistance to the body. Therasuit improves the bone density as well as helping diminishing the subluxation of the hip joint by loading the skeletal system with mechanical forces. Therasuit has the ability to provide the dynamic correction of the movement or position. It can also help in normalizing the gait pattern, decreasing contractions, improving spatial awareness, improving balance, and providing vestibular inputs. Therasuit improves head control and trunk support, resulting in better speech production 3,4.
It is contraindicated to use the Therasuit with children who had hip subluxation greater than 50%, or severe scoliosis7.
The following medical condition may hinder the child’s use of the Therasuit: hip subluxation less than 50%, heart conditions, uncontrolled seizure activities, hydrocephalus (VP Shunt), diabetes, kidney problems, and high blood pressure 3.
The Therasuit method is an intensive and specific therapeutic exercise program for children and adolescent with neurological disorders. This program consists of three hours session, five days per week for three weeks, and it may vary depending on the child needs and the therapist recommendations 8,9. Therasuit method refers to two types of treatment which can be used in isolation or combination: – Therasuit, and the Universal Exercise Unit [UEU], which is multifunctional device that is used for balance, equilibrium, and strengthening training 1. UEU, also known as the cage, divided into two types: Monkey cage, and Spider cage. Monkey cage consists of pulleys, straps, and splints that enables the patient to perform independent movement while gravitational forces are eliminated through the suspension of the body part that is being exercised. Monkey cage helps in preventing muscle atrophy, improve muscle strength, increase active and passive ROM, prevent joint contracture, and normalize the muscle tone. In contrast, the Spider cage, which is a dynamic system of elastic cords that allows independent movement while the body is supported, helps in improving muscle strength, stabilization, balance, and coordination, and sensory integration. The Spider cage also promotes developmental milestones, functional independence, and provides the right amount of support and resistance to develop and improve isolated movement for functional skills 9,10.
Therasuit in Kuwait
In Kuwait, Therasuit is available only in Yiacco Apollo Medical Center (Dr. Aisha AL-Ragm). Therasuit is applied in combined with intensive physical therapy program for 3 days per week with a course of 10 sessions. One of the therapists in Yiacco Apollo Center reported that Therasuit with the intensive physical therapy program had helped in improving the posture, the muscle tone and regaining the functional abilities of the child with cerebral palsy. This treatment is expensive compared with the total number of sessions given. In Arab World, Therasuit is also found in Bahrain (Step Rehab Center), KSA (Advanced Pediatric Physical Therapy), and Egypt (Al-Hamd Center, Al-Rahma Center, and Hope Center).
On a study designed by Richard K. and Izabela K. to investigate the efficiency of the Therasuit in combination with the intensive exercise program in treating patients with cerebral palsy. The study took place at the Pediatric Fitness Center from July 2003 – May 2004. Twenty children (12 females 8 males) participated in this study with a mean age of 6.3 (range of 2.5 to 13). The subjects were evaluated twice, pre and post treatment sessions. The Gross Motor Functional Measurement form [GMFM] was used. The intensive program lasted for 3 weeks (3 hours/ 5 times a week), and the treatment sessions composed of different exercises that depends on the child’s need with or without the Therasuit. Ninety-two percent of all participants showed functional improvements. Coordination improved by 56%, strength and range of motion by 100%, balance by 62%, and movement control by 64%. Ninety percent of the subjects learned to roll independently, 75% were able to sit without assistance, 49% started to crawl. Also 39% of the patients stand independently, 33% walk with assistive devices, and 21% walk independently 11.
On a study done by Amy F. Kelly G., and Laura S, to investigate the effects of the intensive suit therapy on gait, functional skills, caregiver assistance, and gross motor ability in children with CP, 2 children with Spastic Diaplegia classified at level III on the Gross Motor Function Classification System [GMFCS] were participated . Each child participated in the Therasuit method, 4 hrs a day 5 days a week for 3 weeks and the outcomes were assessed using dimensions D (standing) and E (walking, running, and jumping) of the GMFM, the Pediatric Evaluation of Disability Inventory and Instrumental gait analysis. The study showed small improvement in function and significant improvement in walking speed, cadence, symmetry, joint motion, and posture were found with gait analysis 12.
Elizabeth C. (2003) did a study on twelve yrs old boy who diagnosed with CP, to describe how the Therasuit combined with an Intensive Therapy Program can help improving the functional ability. Prior to participating in the intensive therapy program with Therasuit, the subject was classified using the GMFCS as level IV and his gross motor abilities were measured with the GMFM. The subject participated in intensive therapy with Therasuit for 3 weeks, Monday – Friday, 8:30am – 12:30 pm. In addition to the program, the boy also received a half an hour of aquatherapy and hippotherapy each of the weeks. After the 3 weeks, and after 6 months post intervention, the subject’s gross motor abilities were measured again. The study reported that the subject demonstrated improvements at the conclusion of the 3 weeks in all categories of the GMFM. The overall improvement from the baseline score was 8.66% without the use of assistive devices and 9.53% with assistive devices. The subject maintained these improvements when re-tested six months post intervention. This study suggested that the Therasuit with the Intensive Therapy Program, including aquatherapy and hippotherapy, helps improve a patient’s functional abilities 13.
Blundell SW, et al, designed a study to evaluate the effectiveness of the intensive task-specific strength training on lower limb strength and functional performance in children with cerebral palsy. The study done on 8 children, their ages ranged between 4-8 years, and diagnosed with cerebral palsy (7 with spastic diplegia +1 with spastic /ataxic quadriplegia). The training program was done for one hour twice a week for 4 weeks. The group circuit training consists of four stations, treadmill walking, sit-to stands, step-ups, and leg presses. The participants were evaluated three times. First, 2 weeks before the training. Then, they were evaluated immediately before the training session, and finally, after the training, with follow-up eight weeks later. The dynamometry and the Lateral Step-up Test were used to measure and evaluate the lower limb’s muscle strength while the Motor Assessment Scale[(Sit-to-Stand), minimum chair height test, timed 10-m test, and 2-minute walk Test] was used to assess the functional performance. The study showed improvement in the Isometric strength by a mean of 47%. And the functional strength, on Lateral Step-up Test, improved by 150%. The strength training improved the gait also with 22% improvement in speed and 38% in stride length. The seat height changes from 27 to 17 because of the improvement in the sit to stand activity. The subjects revaluated after 8weeks and the improvements were maintained14.
Another study designed by Jan F Morton et al, to evaluate the efficiency of the progressive resistance training of quadriceps and hamstrings muscles in children ,who are diagnosed with cerebral palsy (CP). Eight children with Spastic CP were participated in this study, and their ages ranged from (6 – 12) yrs. The progressive resistance training program lasted for 6 weeks (3sessions/week). The hand-held myometer was used to measure the strength, while the (GMFM) was used to evaluate the functional ability of the children. The gait was also evaluated by using the 10 meter timed walking test. The study reported increase in muscle strength and the muscle tone decreased and these results were maintained at the follow up. The standing, walking, running and jumping items in the (GMFM) were significantly improved with maintenance at follow up. Also the gait was improved, as the walking speed and step rate increased 15.
On a study prepared by Bar-Haim S et al, to investigate the differences between the Adeli suit (AST) and neurodevelopmental treatments (NDT) in treating 24 children with CP. The subjects were classified as level II to IV according to the (GMFCS), and assigned randomly to either treatment groups. The treatment sessions were done for 2 hours daily 5 times /week for a 4 weeks. The mechanical efficiency index (EIHB) during stair-climbing and the (GMFM-66) were used as measurement tools, and they were measured at the beginning, after 1 months, and finally after 10 months of treatment. After one month from the treatment, subjects from both groups showed faster improvement than other children with CP at their age. No significant different was reported between AST and NDT in enhancing the motor skills. On the other hand, the EIHB was increased in the AST groups more than the NDT group. The study showed that the AST could cause improvement in the mechanical efficiency in patients with cerebral palsy16.
Therasuit is a safe and effective therapeutic and exercise tool, based on the studied done to evaluate its efficiency and quality. Therasuit has the power to help children and adults with Cerebral Palsy and other neuromuscular disorders to achieve greater independence. I believe that Therasuit should be provided to all Kuwaiti patients who are in need and to be available in the rehabilitative centers and all general hospitals that have a Physical Therapy Department for free in order to improve the quality of life for Kuwaiti people who are not able to offered the Therasuit costs. Therasuit in combination with other therapies like the intensive therapy program, the UEU, aquatherapy, and hippotherapy can help in optimizing the patient’s best ability to make functional improvements.
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