According to the Register of Russia, only 44% of sanatorium-resort institutions are state-owned, only 3% belong to municipalities. The remaining 53% are private institutions.

Today, sanatorium-resort organizations are experiencing an acute shortage of highly qualified personnel. The staffing of such institutions with medical personnel averages 87 percent, which also indicates not only a shortage of doctors and instructors, but also a shortage of secondary medical personnel. In addition, an increase in the flow of patients becomes impossible due to an increase in the load on the staff, which is already lacking. Thus, the institution is experiencing an acute problem of the impossibility of financial growth due to problems with personnel.

The decision to use automatic multifunctional systems in the spa industry is logical in view of the above-mentioned problem. An excellent example of such a multifunctional system is a set of automated couches for mechanotherapy “Newtonic”. The set consists of 8 couches of different orientation, which are designed for active-passive gymnastics in outpatient or inpatient conditions, for the restoration and implementation of physical therapy programs, for the restoration and treatment of a number of major diseases of the musculoskeletal system. The set of automated couches is also aimed at restoring motor activity after a Covid-19 infection and solving some problems in the older age group who have problems with movement and posture, as well as with motor functions that are altered or impaired.

Firstly, such a system is multifunctional. This means that the complex allows you to provide almost the entire range of possible movements: passive, passive with accompaniment or recall, passino-active, active with resistance, active with accompaniment.

Secondly, the complex of 8 couches is safe. Practicing on them, the patient does not have the opportunity to fall and injure himself. This quality distinguishes automatic multifunctional systems from, for example, classical physical therapy. Especially for people from the older age group, for whom any injury can be serious in view of age. In addition, a number of patients from the older age group, who have limitations in the form of reduced motor activity, do not have the opportunity to fully exercise physical therapy standing. Working with couches, all of the above will be done in a comfortable position (lying or sitting), which does not have the possibility of additional risks of falling, stability disorders, balance disorders. All exercises are performed safely.

Thirdly, Newtonic allows you to automate the rehabilitation process by increasing the throughput and flow of patients. This means that a specialist in the field of physical therapy, rehabilitation treatment or in the field of preventive treatment has a tool that allows him to effortlessly carry out rehabilitation, rehabilitation, preventive processes with a greater degree of intensity and with greater throughput. For example, the institution uses 8 automated couches, on which 8 people simultaneously undergo the wellness process in automatic mode. Thus, during the working shift, the system can provide a rehabilitation process for 64 – 70 people who undergo a full cycle. And this is about working in one shift.

Fourth, leveling difficulties with the staff. An automated system that works according to programmed programs from simple programs to therapeutic and restorative ones can undoubtedly alleviate (solve) the problem with the shortage of highly qualified personnel. It can reduce the dependence of the management of the sanatorium complexes on the staff itself. That is, the requirements for personnel are relatively less, and at the same time the throughput increases. In addition, many patients, many visitors, sanatoriums can receive these procedures in a collective automatic system. Thus, an element of additional socialization is included here, when people work in a small group, they quickly master these simulators. Moreover, the passive exposure system does not involve any complex physical exertion, which again unloads the cardiovascular system, especially in older people.

In addition to the above, a set of couches solves another important problem – the diversification of services. Mikhail Kochiashvili, an expert in the beauty and health industry, anti-crisis manager, creator of the management system, technology and promotion system, director of the National Association of Beauty Industry Enterprises (NAPIK), at the forum “SANKUR-Evolution 2022”, which took place on September 13-14, 2022, said that the diversification of services is one of the most important factors, which contributes to the survival of the institution and revenue growth in 2022. The range of services should be quite extensive and contain a solution for any direction of the sanatorium industry. A set of automated “Newtonic” couches for mechanotherapy is suitable for the above-mentioned task. This is a full-fledged service that can work in combination with related services provided by the institution.

Safety, versatility, automation, comfort, additional impact on both passive and active muscular actions, optimization of personnel, the possibility of diversification in the form of a full-fledged service, suggests that the complex of 8 Newtonic couches is necessary and in demand in the spa industry.

The set of automated couches for mechanotherapy “Newtonic” is a system of 8 couches of different orientation, which are designed for active-passive gymnastics in outpatient or inpatient conditions, for the restoration and implementation of physical therapy programs, for the restoration and treatment of a number of major diseases of the musculoskeletal system. The set of automated couches is also aimed at restoring motor activity after a Covid-19 infection and solving some problems in the older age group who have problems with movement and posture, as well as with motor functions that are altered or impaired.

The principle of operation of the couch is based on smooth and repetitive movements of one or two parts, which allows you to perform the exercises correctly. The fixed part is the support. Stretching exercises, strength exercises, passive exercises and massage can be performed on a set of 8 couches. Each couch is designed to perform a special type of exercise. The patient exercises sequentially on each of the 8 couches for 1 hour, while receiving a complex load on all parts of the body.:

Multifunctionality of a set of couches for mechanotherapy “Newtonic”

One of the features of this kit is that it is a whole complex that combines 8 multidirectional functional systems. Since they are multidirectional and united into a single kinematic chain, passing from one couch to another, the complex is able to provide various types of recovery in various muscle groups, as well as provide a whole training process for people with impaired motor activity, as well as for a number of weakened patients who, after a long period of rehabilitation, move weakly or do not they have the ability to carry out the rehabilitation process in a standing or sitting position. In addition, a complex of 8 automated couches finds its place in health resorts, where 80% of visitors are the older age group, which has a number of restrictions in standing movements when using classical methods of physical therapy. The risks of falling, instability in posture, balance disorder, gait disorder – all this can actively lead to the fact that the complex of 8 Newtonic couches is most indicated for these groups of patients, since the rehabilitation process will be performed in a lying or sitting position, which do not have the above risks.  

Automation of medical and preventive processes

Another feature of this set of automated couches for mechanotherapy is the automation of therapeutic and preventive processes. When using the complex, it becomes possible to increase the flow of patients and reduce the amount of workload on existing staff without increasing the staff of the institution. Thus, a specialist in the field of physical therapy, rehabilitation treatment or in the field of preventive treatment has a tool that allows him to effortlessly carry out rehabilitation, rehabilitation, preventive processes with a greater degree of intensity and with greater throughput. For example, a complex of 8 automated couches simultaneously automatically undergo the wellness process of 8 patients. Thus, during the working shift, the system can provide a rehabilitation process for 64-70 people who undergo a full cycle.

Solving the problem of shortage of qualified personnel

In addition to automating medical and preventive processes, a set of automated Newtonic couches makes it possible to alleviate (solve) an acute problem – the lack of qualified personnel. A highly qualified instructor is often unavailable due to the increase in the number of sanatoriums. The complex works according to programmed programs from simple programs to therapeutic and restorative. Thus, it can reduce the dependence of the management of the sanatorium complexes on the staff itself. That is, the tasks for the staff and the requirements for it are relatively less, and at the same time, the throughput of the rehabilitation process increases. It is important to note that when using a set of Newtonic couches, an element of additional socialization is included when patients work in small groups and quickly master the mechanized system.

Barashkov G.N., Leading researcher; Silaev A.S., physiotherapist, FSBI “National Medical Research Center for Rehabilitation and Balneology” of the Ministry of Health of Russia, Moscow

Methods of passive-active mechanotherapy have proven themselves well in the treatment of various forms of dorsopathy, chronic diseases of the ligamentous-articular apparatus, the treatment of patients with pelvic dysfunctions, as well as forms of active prevention of osteoporosis and muscular atrophy in the older age group. Since the mid-90s of the twentieth century, methods of automated mechanotherapy using “tonus tables” complexes have been introduced into a number of clinical institutions and resort centers in Russia.
Developed at one time in the USA, then transformed in England, the Stauffer technique (Dr. Stauffer) was effectively used not only for rehabilitation and treatment, but also received its development in the sports industry. The complex, consisting of 8 or 6 couches or tone tables, allows you to provide almost the entire range of possible movements: passive, passive with accompaniment or recollection, passive-active, active with resistance, active with accompaniment.

Couches or tone tables are formed according to the basic principles of automated mechanotherapy with the possibility of regulating the strength, speed and volume of movements of various muscle groups. The ability to provide a wide range of different movements of the lower and upper extremities, as well as the lumbar and pelvic regions, make these systems almost universal. An important feature of these rehabilitation systems is that the patient is lying or sitting on the couch.

This makes it possible to start rehabilitation activities as early as possible – immediately after the patient has started to sit on the bed. And even if he can’t move on his own yet, classes in passive mode with various elements of movements accelerate his verticalization and the ability to start moving independently. This was shown by our studies in patients after a stroke.

In the context of a pandemic, COVID-19 has set tasks for healthcare professionals of various profiles related not only to rapid diagnosis and treatment, but also to the provision of high-quality medical care, including rehabilitation measures both during and after a new coronavirus infection.

The effectiveness of the methods used directly depends on the early start of rehabilitation actions in the hospital, continuation in polyclinic conditions and then at the stage of sanatorium treatment.
As you know, the first place in the rehabilitation of patients with COVID-19 is the restoration of respiratory function and the elimination of muscle dysfunction.

In these areas, the use of multifunctional mechanotherapeutic couches (tone tables) is particularly relevant.

• the process of rehabilitation and restoration of motor function can be started at an early stage;
• the rehabilitation process can be started with passive movements, which the mechanical trainers carry out in the patient automatically in a given speed mode;
• the process of restoring and maintaining motor function, initiated at an early stage, helps to prevent the development of muscular atrophy, maintain the mobility of the articular apparatus, improve trophic by activating venous and lymphatic outflow, prevents and reduces the risks of thrombosis in the vessels of the lower extremities;
• reduces the level of cognitive and depressive reactions by working in a small group of patients united by common goals and objectives;
• patients with limited mobility move to couches (tone tables) in a wheelchair and with the help of an instructor can quickly master and restore the functional state of the muscle groups of the lower extremities. This is especially true in patients who have been on bed rest for a long time.

What is especially important, in patients with impaired lung function, classes in passive mode can be carried out simultaneously, or without interrupting inhalation therapy (oxygen, singlet oxygen or other inhalation mixtures).

The next stage of rehabilitation takes place in a polyclinic or in a rehabilitation center. Here the complex of tone tables can be installed either in the general hall of therapeutic physical culture (physical therapy), or in a separate office. Along with patients after a coronavirus infection, other groups of patients can be rehabilitated on these complexes: patients after a stroke or myocardial infarction, patients after reconstructive operations on large joints (knee, hip), patients recovering from injuries, patients of the older age group with pathologies such as diabetes mellitus, osteoporosis, sarcopenia, and a number of others.

One of the most important features of this complex is the possibility of personalizing the rehabilitation program, a gradual transition and combination of different types of movements, their dosage by speed and time, a combination of different groups of exercises.
A special advantage is the ability to combine classes on mechanotherapy couches (tone tables) with other physiotherapy procedures at the same time. This undoubtedly gives a faster result on the one hand, and on the other – reduces the burden on the medical staff. Examples of the possibilities of combined application can be the following: a combination of classes on tone tables with simultaneous exposure to low-frequency electric currents (DDT, faradic currents, Kotz currents, CHANCE). This allows you to reduce the pain syndrome during exercises, activate the microcirculation of muscles and ligamentous-articular apparatus.

To reduce spastic conditions, improve the function of the articular and tendon-ligamentous apparatus, such methods of heat treatment can be used as local application of heat carriers – paraffin, parafango, ozokerite, exposure to infrared, including polarized light sources (infrared emitters, Bioptron lamp, etc.).

Sanatorium-resort stage. At the sanatorium-resort stage, the complex of automated mechanotherapeutic simulators (tone tables) has the widest possible application possibilities. One of the main problems of the sanatorium industry today is the shortage of medical personnel. As it is known, various forms of physical therapy are particularly popular with patients, however, the lack of personnel or their lack significantly inhibit and limit the use of various methods of physical therapy in the sanatorium-resort industry.

Automated systems “tone tables” allow not only to facilitate the work of a physical therapy instructor, but also to increase the flow of rehabilitated patients several times. With group classes and the presence of a full set of 8 tone tables, the continuous rehabilitation process in groups of 6 people makes it possible to carry out rehabilitation complex procedures for at least 48 patients in one work shift, and with two shifts, this possibility is doubled. Taking into account the increasing need for rehabilitation of the musculoskeletal system and locomotion systems after a coronavirus infection, this is very relevant.

Using a modern system of multifunctional automated mechanical trainers (tone tables), we achieve the following results:

• eliminate weakness and dysfunction of the musculoskeletal system and locomotion systems;
• improve microcirculation of muscle tissue, enhance venous and lymphatic outflow,
  ensure activation of tissue metabolism, reduce interstitial edema of the lower extremities;
• activate proprioception systems and improve patient mobility and stability;
• combining passive and active movements, we quickly restore the strength and speed characteristics of the most important muscle groups;
• combining active resistance movements with breathing exercises, we contribute to the active restoration of the functions of the respiratory muscles and, above all, the diaphragm and external intercostal muscles;
• active exercises in comfortable and safe lying and sitting positions allow performing exercises in a wide group of patients, expanding indications and ensuring safety in people with chronic diseases of the cardiovascular or central nervous systems.

Safety, efficiency, versatility are the qualities that make the modern complex “tonus tables” necessary and in demand at all stages of medical and sports rehabilitation.