CERVIM (Rehabilitation and Equitherapy Center), is a national reference when it comes to Habilitation and Rehabilitation Centers for people with disabilities/special needs, being the pioneer in introducing Adapted and Paralympic Sports, in the area of therapy and the use of new treatment techniques. Also participating in promoting postgraduate and extension courses, as well as professional training in the areas of Health, Education and Equitation.
For the CERVIM staff, bringing the functionality back to their patients is not enough. Our primary focus is to reintegrate them in the social sphere, strengthening their sense of identity and self-esteem through a simple formula: rehabilitation + integration = conquering the functional barrier.
The aim of the center is to create a platform for the patients, students, athletes, professionals, partners and the institution itself, to reach their full potential, thereby emerging to overcome any obstacle thus allowing the achievement of goals and dreams of each and every person involved.
"We do not believe in limits. We overcome them ... " CERVIM Team.
The history of CERVIM begins in 1991, when new treatments for people with disabilities/special needs were still unknown in Brazil. It was back then, that a pioneering interdisciplinary group formed by Dr. Tania Frazão (Physiotherapist), Prof. Frederick Frazão (Equestrian Professor and Physiotherapist), Dr. Simone de Miranda (Psychologist and Educator) and Prof. Jorge Roberto de Miranda (Physical Education Professor), all of them, technical advisers by ANDE-BRAZIL (Equitherapy National Association: www.equoterapia.org.br), initiated the work habilitation and rehabilitation of patients through Equitherapy (Therapeutic Riding / Hippotherapy), counting on the support of the School of Riding Army (Military Horsemanship) in the city of Rio de Janeiro, and since then has been promoting this activity as a new option for the treatment of several disorders.
Said this, before the group founded the AETERJ (Equitherapy Association of the State of Rio de Janeiro) in 1996. CERVIM Equitation Therapy Center of Rehabilitation of the Military Village, created in 2006, is the groundbreaking work of this group, as it offers a wide variety of treatment programs and monitoring to these special people, thus becoming a reference in Habilitation and Rehabilitation Centers in Brazil.
ENABLING AND REHABILITATION:
It is a method of global treatment that has the horse as a therapeutic tool using the interdisciplinary team to promote the bio psycho-social development of its practitioners. CERVIM Equitherapy Therapy is divided into four treatment programs:
- Hippotherapy: Therapy utilizing a horse as a kinesiotherapeutic tool to rehabilitate motor disorders.
- Pedagogical: suitable for practitioners with cognitive dysfunction, behavioral, etc..
- Pre-Sports and Sports: recommended for practitioners indicated to inset sports.
MOTOR AND RESPIRATORY PHYSIOTHERAPY
The physiotherapy aims to evaluate motor function and establish strategies to maintain and enable the functionality of the patient by maintaining and / or improving joint mobility, muscle strength, prevent shortening, decreases in muscle and bone deformities, as well as sensory regular function. At our center, we use several therapeutic methods and concepts according to the needs of our patients, among them M. Bobath, PNF (Proprioceptive Neuromuscular Facilitation), Sensory Integration (SI), M. RTA (Reeducation Thoracic-abdominal), M. Cuevas Medek Exercises (CME), M. TheraSuit, all very useful for neurological disorders.
The respiratory therapy evaluates lung function and prevents pulmonary issues. It involves the application of techniques that will be improving the maximum inflation and the effectiveness of cough, promoting a higher quality of life for patients.
Intensive Therapy Programs:
The basis for the TheraSuit method was inspired by a garment created for the purpose of interposing the negative effects experienced by astronauts (muscle atrophy, osteoporosis) when they were exposed to weightlessness on their long journeys through space. The method differs from traditional therapy in several aspects. The first step for the accomplishment of a good treatment program is the specific evaluation to identify the actual deficits of the patient. Then, based on the evaluation results, an intensive program designed and specific is elaborated to last 3 or 4 weeks, as indicated, being held for 5 days a week, with 3 hours daily. The training is always individual and it aims, among others aspects, to gaining strength, cardiorespiratory fitness, coordination, balance and to enhance one’s functionability. See more information downpage.
Method Cuevas Medek Exercises (CME)
The method Cuevas Medek Exercises (CME) is a physical therapy approach used for children who have abnormal motor development caused by degenerative syndrome that affects the central nervous system. This therapy can be applied to children from 3 months old until they reach the control of independent walking. As the therapists that use the method CME need to expose the child to the influence of gravity through the progressive distal support, the use of this therapy can be limited by the height and weight of the child.
The CME method was created and developed by Ramon Cuevas, Chilean physical therapist, during the 70s, in Caracas, Venezuela. The basic principle of CME is based on the fact that children, who are committed to their development, need to reinforce their potential for natural recovery.
Hydrotherapy or aquatic rehabilitation is a therapeutic intervention that is based on the use of exercises linked to the physiological effects of immersion. It is suitable for people of all ages and it offers benefits such as improved muscle strength and cardiovascular function, stress reduction, pain reduction, decreased edema, increased circulation, increased range of motion, and to promote the acquisition of gait/walking.
Occupational therapy deals with the organization and planning of the daily life of the patient, which allows the person to be more functional and a better quality of life. Its purpose is to give the patient's autonomy and independence to their social participation through several activities implemented by qualified therapists. One of these activities is Sensory Integration Therapy, most used to treat patients with sensory disorders that affect learning, behavior, or movement. The method uses different sensory approaches to activate the adaptive responses of these patients.
The speech therapist is responsible for the involvement, evaluation, diagnosis, guidance and improvement of auditory peripheral central function. It works with feeding disorders such as dysphagia and other nourishment issues. It is about the study, research, prevention, evaluation and speech therapy in the area of oral and written communication, voice, audition/nervous system and facial muscles. Its activities will assemble the promotion, protection and restoration of health in the aspects related to patient communication throughout the cycle of life. This kind of treatment is intended to solve not only the language disorders, but also promote healthy and effective communication.
The psychological aspects involve not only the formation of many illnesses and conditions but also have a role in treatment of several disorders. The monitoring of patients and their families are performed by our therapists who use clinical psychology as a way to benefit: developing the capacity for self-observation, self-reflection and communication.
Psychomotricity is based on the holistic view of a balanced body and mind. It is a clinical and therapeutical approach to the patient as a whole; integrating cognitive, emotional and physical aspects, enhancing physical and mental well-being.
The Psycho-pedagogical approach aims to contribute to children, teenagers and adult integration. Because of their disabilities, whether physical or mental, are disconnected from the regular school system and educational institutions.
Having psychological principles, the goal of this kind of treatment is to overcome and also prevent learning problems through programs aimed to integrate, as well as providing guidelines for the development of the patient and their process of psychic organization. These parameters indicate directions for planning activities to be accomplished with patients, in the same line, they indicate possible difficulties that might be presented by these patients.
Suitable for all ages, Music Therapy uses music and its elements to facilitate and promote communication, learning, mobilization, expression and organization (physical, emotional, mental, social and cognitive) for the patient.
It aims to develop the potential of the individual and restore functions, exploring physical, emotional, mental, social and cognitive needs for the patient.
The Wii Sports Videogame has already been presented in the major rehabilitation centers in Canada, United States and Europe. The CERVIM staff uses this new tool for treating a variety of disorders such as paralysis, stroke and musculoskeletal injuries. With proper monitoring of a physical therapist, this resource has been used in rehabilitation programs, because it requires the players to perform a specific movement along with biofeedback helping with balance, coordination, endurance and muscle strength.
The physical activity and/or sport provide the opportunity for our patients to test their limits and potentials, preventing illnesses given by their disability, and promote social integration and improving self-esteem.
CERVIM in partnership with AETERJ (Equitation therapy Association of the State of Rio de Janeiro), with ANDE - National Association of Sports for the Disabled (www.ande.org.br) and with CPB - Brazilian Paralympic Committee (www.cpb .org.br), promotes sports activities as treatment and/or training. Being a patient or an athlete, here the person will have the opportunity to get to know and play sports. The CERVIM/AETERJ offers trainings in the following sports:
• Boccia Paralympic,
• Football 7 a side,
• Equestrian Adapted,
• Petra (Race Running - www.racerunning.dk)
The AETERJ (Equitherapy Association of the State of Rio de Janeiro) in association with ANDE (National Association of Sports for the Disabled) organized and promoted the latest editions of the Carioca Championship of Adapted Bocce. The CERVIM/ AETERJ Adapted Bocce Team was presented in the last 4 editions of Paralympic School Championships and over the last 4 Adapted Bocce Brazilian Championships.
In 2009, CERVIM / AETERJ center was responsible for the deployment of a new sport for people with cerebral palsy named in Brazil as Petra and internationally called RaceRunning. This modality is part of athletics practice and it consists of a speed event using a tricycle without pedals. This equipment consists of a frame with three wheels attached to a support for the body that allows wheelchair athletes to be able to run propelled by the feet. The athlete has the support of a seat and a handlebar stem that is used to give direction. RaceRunning/Petra was primarily founded in 1989 in Denmark and it is currently practiced in Brazil thanks to a partnership between AETERJ, ANDE and CPB. This modality allows the athlete to strengthen muscles, improve coordination and ability to walk independently, plus a big boost to ones self-esteem.
After having it as a sport, the Brazilian team of Petra was presented in 2009 at the 3rd World Championship in RaceRunning in Kopenhagen, Denmark, there, the results were very impressive: 3 gold medals and a world record breaker.
Photos on the official website of RaceRunning:
It is part of the CERVIM team: The physiotherapist Tania Frazão (National Qualifier/ANDE/ www.ande.gov.br), Ana Cecilia Frazão and Frederico Frazão, International Sports Classifiers for Cerebral Palsy for the International Association (CPISRA / www.cpisra.org). The Brazilian classifiers team took part for the last 4 Paralympic Games as well as responsibility for the classification held at the National level.
Through these initiatives, CERVIM provides all the opportunities to have their patients as athletes enabling them to reach a high level in the Paralympic Games.
TheraSuit Method was created in Michigan/USA, by physical therapists Richard and Izabella Koscielny. This new treatment method was developed to rehabilitate their daughter with cerebral palsy. The base of the technique comes from a suit created by Russian researchers, looking to decrease the negative effects the astronauts have after long periods of time in space (muscular atrophy and osteoporosis).
After some adaptations, in 2002, a device called TheraSuit was created to improve and change proprioception (pressure from the joints, ligaments, and muscle), reduce pathological reflexes, restore physiological muscle synergies (proper patterns of movement) and load the entire body with weight (process similar to a reaction of our muscles to the gravitational forces acting upon us for 24 hours). All of the above normalizes afferent vestibulo-proprioceptive input (information arriving to the vestibular system). The vestibular system is a very important center. It processes, integrates and sends back all the information that arrives from muscles, joints, tendons etc. It influences muscle tone, balance and the position of the body in space.
The more correct proprioception from the joints, ligaments, muscles, tendons, joint's capsule etc., the more correct alignment. The vicious cycle (picture 1) can be interrupted and incorrect information is replaced by " new" correct information (picture 2). A patient (child) diagnosed with Cerebral Palsy and other neuro-motor disorders requires hundreds of repetitions of any particular movement. We believe that as individuals, we all have a "magic" number. For example: a baby that is trying to push-off the floor will need to repeat this movement a few hundred times in order to master it. Another one may need either more or less repetitions to learn the same skill. For the Cerebral Palsy child however, this fairly low "magic" number grows to a thousand or more repetitions to learn and master new skills. TheraSuit worn over a prolonged time will correct proprioception and accelerate the progress. Thanks to the TheraSuit and physical movement (therapy) the skills practiced will become more fluent and require less and less effort. Therefore, TheraSuit facilitates the development of new gross and fine motor skills like sitting, standing, walking.
• Cerebral Palsy
• Developmental delays
• Traumatic Brain Injury
• Post stroke (CVA)
• Spasticity (increased muscle tone)
• Hypotonia (low muscle tone) Contraindications:
• hip subluxation greater than 50%
• severe scoliosis Precautions:
• heart conditions
• uncontrolled seizure activities
• hip subluxation
• hydrocephalus (VP shunt)
• kidney problems
• high blood pressure
• Re-trains central nervous system
• Restores ontogenic development
• Provides external stabilization
• Normalizes muscle tone
• Aligns the body to as close to normal as possible
• Provides dynamic correction
• Normalizes (corrects) gait pattern
• Provides tactile stimulation
• Influences the vestibular system
• Improves balance
• Improves coordination
• Decreases uncontrolled movements in ataxia and athetosis
• Improves body and spatial awareness
• Supports weak muscles
• Provides resistance to strong muscles to further enhance strengthening
• Improves speech production and its fluency through head control and trunk support
• Promotes development of both fine and gross motor skills
• Improves bone density
• Helps to decrease contractures
• Helps improve hip alignment through vertical loading over the hip joint
References: www.suittherapy.com (International U.S. Patent US 7,153,246, PCT/US2008/051458.)
The Intensive Therapy Method:
Intensive therapy is different from other traditional therapies. The first step, is to make a specific assessment to identify the underlying cause. The next step, combining the results of the assessment with family/patient goals, to build an individualized program for a 3-4 week, 3 hour-per day session to achieve the goals.
The treatment is always individualized. The main goals are to improve strength, endurance, coordination, and balance together making overall functional gains. The main tools used during this session consist of Suit therapy and UEU (Universal exercise Unit - cage): Pulley system and Spider.
1) Suit therapy:
• knee pads
• shoe attachments
All the mentioned above elements of the suit are connected with each other through a system of elastic bands.
2) Universal Exercise Unit: Pulley system and Spider
When CERVIM team began the activities using the Intensive TheraSuit method, they were cautious enough to perform the measurement of the results of all programs conducted in order to evaluate and compare the results. Scales have been used and will be used to measure the results in the Therapeutic Programs of this method using the scientific world standards tests related to neurological disorders.
The conclusion after analyzing the results, is that patients who were submitted to intensive therapy (3-4 weeks) in CERVIM had an evolution in their frame of functionality, which is equaled to the gaining of a 6 to 12 month program with conventional therapies performed with the periodicity of 2 to 3 times per week, with variations depending on the condition, age, and family involvement. Nowadays, our patients (and their families) carry out regular intensive programs and they are able to monitor and see their gains and progress, as well as being able to predict exactly how often it is necessary to conduct their programs without losing their achievements.
All Cervim’s therapists that work with this technique have been trained and certificated in Michigan / USA and CERVIM/ RJ – BRA.
INTERNATIONAL TEAM: METHOD THERASUIT
CERVIM offers a team of therapists who work internationally, with over 7 years experience in the method and the fluency of English language. It was carefully made to comfort the families and patients who live abroad, providing the accomplishment of this intensive program.
The CERVIM team will be responsible for:
• Offering the majority of the equipment to be used during the programs;
• Personal and specific evaluation, using scales, measurements, photos and videos comparison;
• Organizing a personal program with functional goals, always related to the need and the desire of the patient or the patient’s family.
• Guidance and training of therapists and parents to promote the retention and increase of gains through a home program that should be happening during the breaks of the intensive programs.
• Evaluation and adaptation of the equipment used by patients and the role of indicating new or different equipment when it is necessary.
• Functional Classification (not official) for adapted sports and Paralympics, which allows the display of the ideal sport to be practiced / trained.