Eye On Ergometers : Physical Therapy Products
October 2011 - If you put functionality, versatility, and low cost (at least for some models), and you have three good reasons to purchase an upper-body ergometer. The fact that most patients don't cringe when they see the upper-body cycle is one more plus. Call it physical therapy without the pain and torture, but a willingness to churn the pedals can go a long way toward fostering compliant patients.
Eleven-year therapy veteran Scott Hopkins, MS, PT, attributes the lack of patient moaning and groaning to the unit's relatively easy motion, particularly among the newer devices. "They love the machine, and the newer ones operate smoothly," says Hopkins, vice president of outpatient operations at Brooks Rehabilitation, Hudson, Fla. "People will grudgingly do knee-extension and hamstring machines, but ergometers garner the fewest complaints."
Hopkins' ergometer (an Endorphin E4 370), which features bidirectional resistance, combines both upper- and lower-body churning, and even among patients who are told only to work the upper body, Hopkins routinely finds them completing lower-body reps at the same time. Athletes who require a lot of lower-body strengthening can use the upper-body ergometer to get in a cardiovascular workout, a crucial component to help maintain athletic endurance while rehabilitating a lower-extremity injury.
Upper-body ergometers have come a long way since the belt-driven units of the past, with many devices now relying on magnets to fine-tune resistance. A butterfly's wings could seemingly advance the wheel on the lowest setting, while King Kong may have trouble with the highest resistance on some models.
With solid evidence-based research backing up the ergometer's efficacy, it's no wonder that an overwhelming number of therapy practices have at least one machine on hand. As to which machine you should pick, it all depends on how much money you are wanting to spend and how much room you have.
Better designs and sophisticated technology have made these machines a viable option even for practices tight on space and funds. Hopkins recommends a portable tabletop unit for those with already crowded floors. For those with room and money to spend, a larger commercial-style ergometer is the best way to go.
Whether the machines are large or small, chances are high they will feature many of the same digital readouts found on modern treadmills. With built-in programs for interval and hill training, therapists can choose the correct setting based on a patient's functional goals.
Nowadays, these goals frequently involve getting patients to move sooner and more often than ever before, a philosophical paradigm shift that fits perfectly with user-friendly ergometers. "With upper-body injuries and surgeries, such as shoulder sprains/strains, rotator cuff repairs, and shoulder fractures, the philosophy is to get patients moving as quickly as possible," Hopkins says. "That has been the biggest shift, and surgeons have obviously helped this evolve through new techniques. With rotator cuff repair, for example, things are certainly a lot less invasive than they used to be. Getting patients moving quicker is now recommended by many of the physician protocols."
Hopkins uses the upper-body ergometer for mostly shoulder, wrist, and elbow rehabilitation. With geriatric patients, he focuses primarily on regaining function for activities of daily living and house chores, usually following a surgery or a fracture. "We also use ergometers a lot on young athletes to regain their range of motion and after rotator cuff surgery or elbow surgery," says Hopkins, who oversees the Tampa and Orlando regions for Brooks Rehabilitation. "We want to get that joint moving and build(ing) strength, and we will even use it in the workers' compensation arena with injured workers."
FUNDS AND FLOOR SPACE
With versatility and practicality to spare, ergometers are the classic "good buy." With warranties usually covering the first year, chances are good that problems will be few. "This equipment is really built well, and it is probably going to last a good five to ten years," Hopkins says. "We are not finding any major issues."
On the rare occasion where something does go wrong, Hopkins is able to call on the manufacturer, which also happens to reside in his home town of Tampa. If the situation calls for it, the makers are out quickly to dissect the machine and get it fixed-a feature that providers should ask for regardless of geography.
For practitioners looking to purchase an ergometer, the number one issue resembles real estate-location, location, location. If you have a big enough location, spend the money on the dual machine, which features both upper- and lower-body options. Since the lower part serves as a recumbent bike, you may be able to avoid buying a recumbent cycle. For those medium-size spaces, an upright freestanding unit could also fit the bill.
Once you deal with space and cost, the next consideration is technology. You want enough sophistication to boost rehab results, with care to avoid the nonintuitive morass that will only drive you crazy. Hopkins reports that, like computers, some ergometers offer different operating systems. "The bottom line is to always look for functionality," Hopkins cautions. "The unit that we have in our clinic is an upright apparatus that is highly adjustable. If we have a workers' comp patient who is a post office worker that must be on his feet all day, we can have him stand and use this apparatus. We can raise the swing arm and lever arm to match height, and have him stand for 20 minutes while performing the exercises. And with an elderly patient, we can certainly have him or her sit down and be well supported. So versatility is that final option you really want to look for."
If you are looking to purchase a piece of equipment from one of the big manufacturers, Hopkins says the factory-direct option is usually nonexistent. Instead, it is more typical to go through one of the distributors, such as Sammons Preston Rolyan. Distributors will help in the first year, and then outside the warranty, some manufacturers will work with you to find somebody who can service the equipment.
Good support could come in handy, because this is a machine that will not gather dust. As an active machine (as opposed to passive), patients need at least one good arm to make a successful crank. Fortunately, many machines allow different grips that help many different patients adjust. "Our machine has multiple hand positionings where you grip the crank itself and adjust those handles in three different positions-horizontal, 45 angle, or vertical grip-which does play a role in the patient's comfort level, especially after surgery," Hopkins emphasizes. "When you think of some of the arthritic geriatric patients, it is really convenient to have different grip angles. You can also work with the patient's hand position and isolate some musculature."
With ever more conscientious patients, the absence of an ergometer may very well trouble some potential clients. While physician referrals are still the life blood for Brooks Rehabilitation, there is a growing subset of patients who rely on other sources. "Patients often have insurance plans that are accepted in a lot of places. As a result, there is a growing trend in that they are shopping around and they are looking for value," Hopkins says. "And when they are dealing with a $30 to $60 copayment, they are looking for value even more. They are looking for clinics that really pay attention to them. They want the most bang for their buck, which means good equipment and good-quality treatment."
For most patients, value sometimes comes down to finding things at the clinic that can't be found at home. Seeking to go beyond the easily attainable hot packs, Hopkins likes to use the upper-body ergometer for its dynamic warm-up. A "passive" warm-up involving a 10-minute moist hot pack doesn't beat a good low-resistance ergometer workout, because the heat pack can only penetrate so far into the muscle.
Used in conjunction with shoulder-stability exercises and shoulder strengthening, resistance band exercises are an excellent complement to ergometer training. Fortunately, all of these modalities typically receive a warm welcome from payors. "The upper-body ergometer is well accepted by the reimbursement community," Hopkins says with the confidence borne of experience, "and we have never had any issues."
Eleven-year therapy veteran Scott Hopkins, MS, PT, attributes the lack of patient moaning and groaning to the unit's relatively easy motion, particularly among the newer devices. "They love the machine, and the newer ones operate smoothly," says Hopkins, vice president of outpatient operations at Brooks Rehabilitation, Hudson, Fla. "People will grudgingly do knee-extension and hamstring machines, but ergometers garner the fewest complaints."
Hopkins' ergometer (an Endorphin E4 370), which features bidirectional resistance, combines both upper- and lower-body churning, and even among patients who are told only to work the upper body, Hopkins routinely finds them completing lower-body reps at the same time. Athletes who require a lot of lower-body strengthening can use the upper-body ergometer to get in a cardiovascular workout, a crucial component to help maintain athletic endurance while rehabilitating a lower-extremity injury.
Upper-body ergometers have come a long way since the belt-driven units of the past, with many devices now relying on magnets to fine-tune resistance. A butterfly's wings could seemingly advance the wheel on the lowest setting, while King Kong may have trouble with the highest resistance on some models.
With solid evidence-based research backing up the ergometer's efficacy, it's no wonder that an overwhelming number of therapy practices have at least one machine on hand. As to which machine you should pick, it all depends on how much money you are wanting to spend and how much room you have.
Better designs and sophisticated technology have made these machines a viable option even for practices tight on space and funds. Hopkins recommends a portable tabletop unit for those with already crowded floors. For those with room and money to spend, a larger commercial-style ergometer is the best way to go.
Whether the machines are large or small, chances are high they will feature many of the same digital readouts found on modern treadmills. With built-in programs for interval and hill training, therapists can choose the correct setting based on a patient's functional goals.
Nowadays, these goals frequently involve getting patients to move sooner and more often than ever before, a philosophical paradigm shift that fits perfectly with user-friendly ergometers. "With upper-body injuries and surgeries, such as shoulder sprains/strains, rotator cuff repairs, and shoulder fractures, the philosophy is to get patients moving as quickly as possible," Hopkins says. "That has been the biggest shift, and surgeons have obviously helped this evolve through new techniques. With rotator cuff repair, for example, things are certainly a lot less invasive than they used to be. Getting patients moving quicker is now recommended by many of the physician protocols."
Hopkins uses the upper-body ergometer for mostly shoulder, wrist, and elbow rehabilitation. With geriatric patients, he focuses primarily on regaining function for activities of daily living and house chores, usually following a surgery or a fracture. "We also use ergometers a lot on young athletes to regain their range of motion and after rotator cuff surgery or elbow surgery," says Hopkins, who oversees the Tampa and Orlando regions for Brooks Rehabilitation. "We want to get that joint moving and build(ing) strength, and we will even use it in the workers' compensation arena with injured workers."
FUNDS AND FLOOR SPACE
With versatility and practicality to spare, ergometers are the classic "good buy." With warranties usually covering the first year, chances are good that problems will be few. "This equipment is really built well, and it is probably going to last a good five to ten years," Hopkins says. "We are not finding any major issues."
On the rare occasion where something does go wrong, Hopkins is able to call on the manufacturer, which also happens to reside in his home town of Tampa. If the situation calls for it, the makers are out quickly to dissect the machine and get it fixed-a feature that providers should ask for regardless of geography.
For practitioners looking to purchase an ergometer, the number one issue resembles real estate-location, location, location. If you have a big enough location, spend the money on the dual machine, which features both upper- and lower-body options. Since the lower part serves as a recumbent bike, you may be able to avoid buying a recumbent cycle. For those medium-size spaces, an upright freestanding unit could also fit the bill.
Once you deal with space and cost, the next consideration is technology. You want enough sophistication to boost rehab results, with care to avoid the nonintuitive morass that will only drive you crazy. Hopkins reports that, like computers, some ergometers offer different operating systems. "The bottom line is to always look for functionality," Hopkins cautions. "The unit that we have in our clinic is an upright apparatus that is highly adjustable. If we have a workers' comp patient who is a post office worker that must be on his feet all day, we can have him stand and use this apparatus. We can raise the swing arm and lever arm to match height, and have him stand for 20 minutes while performing the exercises. And with an elderly patient, we can certainly have him or her sit down and be well supported. So versatility is that final option you really want to look for."
If you are looking to purchase a piece of equipment from one of the big manufacturers, Hopkins says the factory-direct option is usually nonexistent. Instead, it is more typical to go through one of the distributors, such as Sammons Preston Rolyan. Distributors will help in the first year, and then outside the warranty, some manufacturers will work with you to find somebody who can service the equipment.
Good support could come in handy, because this is a machine that will not gather dust. As an active machine (as opposed to passive), patients need at least one good arm to make a successful crank. Fortunately, many machines allow different grips that help many different patients adjust. "Our machine has multiple hand positionings where you grip the crank itself and adjust those handles in three different positions-horizontal, 45 angle, or vertical grip-which does play a role in the patient's comfort level, especially after surgery," Hopkins emphasizes. "When you think of some of the arthritic geriatric patients, it is really convenient to have different grip angles. You can also work with the patient's hand position and isolate some musculature."
With ever more conscientious patients, the absence of an ergometer may very well trouble some potential clients. While physician referrals are still the life blood for Brooks Rehabilitation, there is a growing subset of patients who rely on other sources. "Patients often have insurance plans that are accepted in a lot of places. As a result, there is a growing trend in that they are shopping around and they are looking for value," Hopkins says. "And when they are dealing with a $30 to $60 copayment, they are looking for value even more. They are looking for clinics that really pay attention to them. They want the most bang for their buck, which means good equipment and good-quality treatment."
For most patients, value sometimes comes down to finding things at the clinic that can't be found at home. Seeking to go beyond the easily attainable hot packs, Hopkins likes to use the upper-body ergometer for its dynamic warm-up. A "passive" warm-up involving a 10-minute moist hot pack doesn't beat a good low-resistance ergometer workout, because the heat pack can only penetrate so far into the muscle.
Used in conjunction with shoulder-stability exercises and shoulder strengthening, resistance band exercises are an excellent complement to ergometer training. Fortunately, all of these modalities typically receive a warm welcome from payors. "The upper-body ergometer is well accepted by the reimbursement community," Hopkins says with the confidence borne of experience, "and we have never had any issues."