RU2830420C1 - Interactive trainer for arm motor function rehabilitation after neurological injury - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to neurology and medical rehabilitation, and can be used for rehabilitation of patients with impaired motor function. Exercise machine contains a table, the tabletop of which is made in the form of two rectangular panels with a smooth surface. One of panels is 80×40×5 cm, second size 80×20×5 cm is configured to move relative to the first in the vertical plane at a distance of up to 60 cm with pitch of 1 cm and fixation at any level, as well as in the horizontal plane forward and backward at a distance of up to 18 cm. Movable panel has 5 cm high sides along the left, right and rear edges to prevent rolling of the objects installed on it. Interactive panels are attached to table legs. Legs are placed on the stand, equipped with a height adjustment mechanism and wheels, which enables to use the training apparatus while sitting, standing, as well as lying in a functional bed. Inside the panels there are built-in colour sensors connected by a microcontroller for each sensor. On the fixed panel there are 16 pieces arranged in two rows parallel to the front edge of the panel, on the movable panel there are 8 pieces arranged in one row, parallel to the front edge of the panel. Openings (windows) are made in the panels above the sensors so that the colour sensor picks up the colour of an object located on the surface of the panel directly above it. Separate LED strip-illumination in the form of a square is built around each colour sensor in the panel so that the panel preserves an even surface. Microcontrollers and LED strips are connected to the computer. Each of the sensors is a microchip with a microcircuit which converts intensity of the colour spectrum into a signal of different frequency, which is inversely proportional to the frequency of the output signal. Colour sensors and LED strips are connected to microcontrollers and then to a computer which controls the operation of the device through a built-in program.

EFFECT: simplification and improvement of efficiency of trainings.

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Description

The invention relates to medicine, namely to neurology and medical rehabilitation, and can be used for the rehabilitation of patients with hand motor function disorders (central and peripheral paresis) due to the consequences of diseases such as stroke, traumatic brain injury, spinal cord injury, multiple sclerosis, Parkinson's disease and other diseases that cause damage to the motor structures of the nervous system.

In Russia, the incidence of stroke is 2-3 per 1000 population, of which 70% have upper limb dysfunction [Machinsky P.A., Plotnikova N.A., Ulyankin V.E., Rybakov A.G., Makeev D.A. Comparative characteristics of the incidence of ischemic and hemorrhagic stroke in Russia // News of universities. Volga region. Medical sciences. 2019. No. 2 (50). URL: https://cyberleninka.ru/article/n/sravnitelnaya-harakteristika-pokazateley-zabolevaemosti-ishemicheskim-i-gemorragicheskim-insultom-v-rossii (date of access: 30.03.2023; Kalinina S. Ya., Semenova T. N., Grigorieva V. N. Impaired hand function in the clinical picture of stroke // PM. 2017. No. 1 (102). URL: https://cyberleninka.ru/article/n/narushenie-funktsii-ruki-v-klinicheskoy-kartine-insulta (date of access: 30.03.2023].

Traumatic brain injury affects 600 thousand people per year in Russia, 18% of whom have impaired hand function [Akulov M.A., Khatkova S.E., Mokienko O.A., Orlova O.R., Usachev D.Yu., Zakharov V.O., Orlova A.S., Tomsky A.A. Efficiency of botulinum therapy in the treatment of upper limb spasticity in patients with traumatic brain injury. Korsakov Journal of Neurology and Psychiatry. 2016; 116(8): 30-35.].

In Russia, Parkinson's disease occurs in 19-51 cases per 1000 population, the exact % of upper limb involvement is unknown [Razdorskaya V.V., Voskresenskaya O.N., Yudina G.K. Parkinson's disease in Russia: prevalence and incidence // Saratov Scientific Medical Journal. 2016. No. 3. URL: https://cyberleninka.ru/article/n/bolezn-parkinsona-v-rossii-rasprostranennost-i-zabolevaemost].

According to modern theories of motor control and the network theory of brain structure, the ability to perform movements depends on how well the network of neurons in the brain responsible for a particular motor skill functions. The thicker it is, the more neurons and synapses it involves, the better the movement. With neurolesion, the motor chain of neurons is destroyed completely or partially (becomes thinner, there are fewer neurons) [Guggisberg AG, Koch PJ, Hummel FC, Buetefisch CM. Brain networks and their relevance for stroke rehabilitation. Clin Neurophysiol. 2019 Jul; 130(7): 1098-1124. doi: 10.1016/j.clinph.2019.04.004. Epub 2019 Apr 15. PMD: 31082786; PMCID: PMC6603430.]. To successfully restore a motor skill in the hand after a neurological lesion, it is not enough to simply pump up the necessary muscle, but it is necessary to increase the functional connection of neurons in the brain responsible for movements in the hand, to increase the number of neurons involved in this area and the number of synapses connecting them with each other [Boccuni L, Marinelli L, Trompetto C, Pascual-Leone A, Time to reconcile research findings and clinical practice on upper limb neurorehabilitation. Front Neurol. 2022 Jul 19; 13: 939748. doi: 10.3389/fheur.2022.939748. PMID: 35928130; PMCID: PMC9343948.]. Studies have shown the existence of laws according to which neural networks and connections between neurons in the brain are restored. These laws are called "principles of neuroplasticity", and the ability of the brain to change under the influence of experience, environment or disease is neuroplasticity. Compliance with the principles of neuroplasticity and the principles of motor learning during training in neurorehabilitation helps to create conditions for faster, easier for the patient and complete restoration of neurological functions [Levin MF, Demers M. Motor learning in neurological rehabilitation. Disabil Rehabil. 2021 Dec; 43(24): 3445-3453. doi: 10.1080/09638288.2020.1752317. Epub 2020 Apr 22. PMID: 32320305.].

Over the past five years, there has been intense research into the principles of neuroplasticity. The previously existing list of 6 principles has been expanded to include new principles, and this list will likely expand over time.

The following principles of neuroplasticity are distinguished [Maier M, Ballester BR, Verschure PFMJ. Principles of Neurorehabilitation After Stroke Based on Motor Learning and Brain Plasticity Mechanisms. Front Syst Neurosci. 2019 Dec 17; 13: 74. doi: 10.3389/fhsys.2019.00074. PMID: 31920570; PMCID: PMC6928101.]:

1. Multiple repetitions - in order for a particular motor skill to be well developed, it must be practiced many times, i.e. the required movement must be repeated many times.

2. From simple to complex - the exercise or task for the patient must be feasible, you cannot give the patient a task that is too complex, which he will not be able to cope with. At the same time, each time the exercise should be made more complex, as soon as the patient has begun to cope with it well. Always maintain the tasks at a complex, but feasible level. The complexity of the exercises can be ensured by various parameters: giving a greater power progressive load, greater amplitude, height, speed, accuracy, duration, etc.

3. The principle of specificity (specificity of exercises for each restored area of the brain). This principle says that in order to effectively restore the neural network responsible for a particular skill, you need an exercise that trains this particular skill. That is, to restore movement in the elbow - the patient needs to move the elbow during the exercises; to restore the pinch grip - grab using the pinch method; suitcase grip - grab using the suitcase method; to restore pronation-supination - pronate / supinate the forearm, etc. Thus, the exercise must be problem-oriented and task-specific (oriented to a very specific task and motor problem in the hand).

4. Interval training. Research shows that the most effective for stimulating neuroplasticity are training in short sets - 45-60 seconds, followed by a short rest. This is explained by the fact that after a certain time, neurons stop perceiving the stimulus presented during training (stop assimilating information), and their depolarization and inhibition occurs. A short rest between sets allows motor neurons to rest and be ready to perceive information again. With interval training, a new motor skill is better assimilated.

5. Intensity and dose. It is difficult to measure the dose of training. It is usually calculated in hours spent on exercises, the more of them, the more effective the rehabilitation course. Exercises should be performed at the maximum possible speed and intensity for the patient to stimulate neuroplasticity (it should be noted that this type of exercise performance differs from musculoskeletal, cardio, pulmonary rehabilitation, where the principles of exercise performance are moderate loads at an intensity lower than the maximum possible).

6. Targeted exercise (throwing a ball into a basket, putting a book on a shelf) - the fulfillment of specific goals and movement patterns stimulates the processes of forming hand movement networks better than classical exercises.

7. Variety of tasks and exercises. The more varied the tasks and exercises performed by the hand, the wider the cortical representations responsible for hand movements, and therefore the better, more precise, stronger, faster the motor skills of the hand.

8. Explicit feedback (visibility of the result/success and the ability to see the error/incorrect action - the ability to see the result of the movement immediately after its completion: carried three cubes without dropping them; managed to turn the domino over; biofeedback; neurofeedback. Feedback immediately indicates the success or failure of the action. The movement pattern that led to the erroneous result will be “forgotten” by the brain, while the brain will most likely try to automatically remember the successful result [Loriette C, Ziane C, Ben Hamed S. Neurofeedback for cognitive enhancement and intervention and brain plasticity. Rev Neurol (Paris). 2021 Nov; 177(9): 1133-1144. doi: 10.1016/j.neurol.2021.08.004. Epub 2021 Oct 19. PMID: 34674879.].

9. Implicit feedback - delayed, progress graphs, videos comparing results over several days, increase patient motivation and promote better acquisition of motor skills [Loriette C, Ziane C, Ben Hamed S. Neurofeedback for cognitive enhancement and intervention and brain plasticity. Rev Neurol (Paris). 2021 Nov; 177(9): 1133-1144. doi: 10.1016/j.neurol.2021.08.004. Epub 2021 Oct 19. PMID: 34674879.].

10. Motivation, game, reward - contributes to better skill acquisition compared to classical exercises [Ali A S, Arumugam A, Gururaj S, Kumaran D S. Effects of game-based rehabilitation on upper limb function in adults within the first six months following stroke: protocol for a systematic review and meta-analysis. JBI Evid Synth. 2021 Aug; 19(8): 1954-1963. doi: 10.11124/JBIES-20-00349. PMID: 33720108.].

11. Modulation of the weaker hand (modulation of choice) - an obstacle to acting with the uninvolved limb during training (fixation of the “healthy” hand, “send the healthy hand on vacation”), helps to normalize interhemispheric interactions, makes the skill automatic, contributes to the inhibition of convergent neuroplasticity (unnecessary, in the healthy hemisphere) [Mattson MP, Leak RK. The hormesis principle of neuroplasticity and neuroprotection. Cell Metab. 2024 Feb 6; 36(2): 315-337. doi: 10.1016/j.cmet.2023.12.022. Epub 2024 Jan 10. PMID: 38211591.].

Research shows that using at least the 6 principles of neuroplasticity during physical therapy makes it not just effective, but highly effective.

Practical medicine must adapt to scientific data, introducing them into everyday use. Hand rehabilitation simulators must be designed so that they allow training in compliance with modern principles of neuroplasticity.

Failure to comply with the principles of neuroplasticity in medical rehabilitation simulators makes the process of forming a functional network of neurons, and therefore the restoration of the skill, slower and less complete. The creation of new simulators for the rehabilitation of hand function after neurolesions, working on the principles of neuroplasticity, will accelerate the recovery of patients and increase the degree of recovery, will make active training available to patients with low functional capabilities of the hand.

The Manualex M12 hand therapy table is known - a table for developing fine motor skills of the hands [Brand Technomex, country of origin Poland https://medpribor.pro/product/manualex-m12/] The Manualex M12 simulator is designed to improve joint mobility, muscle strength and endurance after injuries and surgeries. It has 12 separate simulators (handles) located on the table for training various muscle groups and practicing individual movements: finger flexion; grip of cylindrical surfaces; thumb opposition exercises; "pincer" exercises; "pull to yourself"; "upward pull"; finger flexion exercise; dorsal flexion exercise of the wrist; multifunctional grip exercise (ball); finger straightening exercise; forearm pronation-supination exercise; ulnar and radial abduction exercise of the hand. The resistance force of each handle is regulated from 250 to 2750 g, thus creating the possibility to simplify or complicate the exercises by gravity. The disadvantages include the fact that during the training, the movement is performed at a time (and therefore trained) only in one separate muscle / muscle group (only elbow extension or only finger flexion), while when using the claimed invention, patterns of complex movements are trained, which does not simply pump up some separate muscle, increasing its volume and strength, but restores complex motor skills. Manualex M12 complies with the principle of multiple repetitions of the declared movements, but it is impossible to complicate the exercise by the accuracy of the grip, the accuracy of movements, stimulate the speed of completing tasks. During work with the simulator, the patient grabs the handle and does not release it until the end of the exercise, that is, there are no repetitions of grips - the principle of specificity of grip training is not observed. In the claimed invention, the principle of specificity of grip training is observed. The disadvantage of Manualex M12 is that training on it does not comply with the principle of task focus - there is no specific goal of the exercise (abducting the thumb - adducting the thumb - is not a goal on which the patient could focus, except for the mechanics of his body, which is a minus for neurorehabilitation). The success of the task is measured not by anatomical movement, but by achieving the goal - manipulation of the object. The principle of diversity of tasks and exercises in Manualex M12 is achieved by twelve exercises. Using the claimed simulator allows you to diversify exercises every day, every training session, selecting objects of any shape, size, weight (cylinders, cones, cubes, balls, dominoes, cards, putting on a colored glove, etc.). The disadvantage of Manualex M12 is also that it does not contain an interactive component, does not provide explicit feedback (no signals about the correctness of the exercise, points, no game moment), there is no implicit feedback (training success graphics).

The Fitlight trainer is known - a system of wireless programmable sensors for training speed and reflexes [Brand XMSJ, China, https://aliexpress.ru/item/1005004683252839.html?ysclid=lvg9h9xalq546200112&sku_id=12000030087681583]. It consists of separate modules containing motion and vibration sensors that are attached to the surface (wall, table, floor). Also, backlight bulbs light up on the modules at the moment when you need to bring your hand closer to them, in the sequence specified by the program. The sensors react to the approach of any object to them, and impact on them. Allows you to train large motor skills. Disadvantages of this device: react to any object approaching them, regardless of whether it approaches the right side or not, does not allow for control of pronation-supination exercises, abduction of the thumb. Unlike the Fitlight simulator, the claimed simulator contains color sensors that react differently to the red or blue surface of an object (hands in a glove, the palm of which is one color, and the back of another color), which expands the technical capabilities of the device and allows for control of such exercises as turning over an object lying on the surface, during which pronation/supination of the forearm is performed, abduction of the thumb, dexterity of the fingers is required (gloves with fingers of different colors, which according to a given program must be brought to the sensors of the simulator). Another disadvantage of the Fitlight trainer is that the system modules are located on the surface, protrude above it, not allowing objects to be moved above them on a flat surface, which does not allow training in which the patient needs to move objects on the surface (for patients with low functional capabilities of the hand). In contrast, the sensors of the proposed trainer are built into the tabletop, which is a flat surface and allows patients even with low functional capabilities of the hand to move objects on the surface. Another disadvantage is that training on the Fitlight trainer does not comply with the principle of specificity of grip training - the sensor will react even to a hand without an object brought to it. In contrast, the sensors in the claimed trainer react to the color of the brought object and will not react if the object was not captured and not brought (they do not react to an empty hand if it is not in a colored glove) or the object was brought on the wrong side. Another disadvantage of the Fitlight simulator is the lack of modulation of the desired hand (the principle of stimulation of the modulation of choice is not observed). The Fitlight simulator does not control whether the exercise has been performed by the desired hand or not, which creates the possibility for the patient to "cheat" by helping himself with a hand that is not subject to training. In contrast, different training modes in the claimed simulator allow you to control manipulations with only one trained hand (a colored glove is put on it).

A simulator - a rehabilitation complex for functional therapy of the upper limbs with extended feedback ArmeoSpring is known [Manufacturer - Hocoma (Switzerland) https://beka.ru/katalog/mekhano-i-robotizirovannaya-terapiya/vosstanovlenie-funktsiy-verkhnikh-konechnostey/armeo-spring/]. The complex is designed to rehabilitate the motor functions of the upper limbs for patients with strokes, brain and spinal cord injuries and other neurological pathologies of the upper limbs. An ergonomic orthosis-exoskeleton with an integrated weight support system compensates for the weight of the upper limb, allowing the patient, even with small residual functional capabilities (muscle strength from 2 points according to MRC), to perform training tasks in 3D simulation mode of real life situations. The exoskeleton is attached to the injured arm, allowing the following movements to be performed: flexion/extension, abduction/adduction, horizontal abduction/adduction, internal/external rotation, circular movements in the shoulder joint; flexion/extension in the elbow joint; pronation/supination of the forearm; grasping movements of the hand (the pressure-sensitive joystick detects even a slight compression of the hand, facilitating the performance of exercises to develop the grasping function of the hand). It has an interactive interface, explicit and implicit feedback, a game component, and is good at increasing motivation. The disadvantage of ArmeoSpring is that the patient's hand is fixed to the exoskeleton during training, and the palm grasps the joystick, which is not completely released until the end of the training, only being able to press on it with varying force. Thus, the principle of specificity of grip training is not observed (there is no multiple repetition of the movement during training: grab and release an object). The joystick also has a cylindrical shape, so there is no possibility to train other types of grip: pinch, suitcase, key, spherical, or their diversity is limited by the shape and size of the joystick. There is no possibility to train the abduction of the thumb, extension of the fingers, and to conduct training with patients with high functional capabilities of the hand - to complicate the exercises by gravity, resistance. These capabilities are provided in the declared simulator.

A rehabilitation device is known that contains n sensors (n is natural) for fixation on a person's upper limb, a tracking unit, a control unit, the input of which is connected via a signal to the tracking unit, and the output is configured to be connected to a computer interacting with the visualization unit. The visualization unit is configured to display the position and spatial orientation of each of the sensors on the computer monitor screen. The sensors are configured to be placed and fixed, respectively, on the distal phalanges of the fingers, on the middle part of the hand, on the forearm. Each sensor is an orientation sensor and contains an accelerometer, a magnetometer, and a gyroscope. The tracking unit is configured to record and transmit data on the position and spatial orientation of each of the sensors [patent RU 198065 U1, 2020]. A disadvantage of the device is the placement of the sensors on the patient; the hand itself is visualized, without the object held in it, which does not provide the opportunity to receive indirect feedback on the success of achieving the goal during training (it does not provide information on whether the object has been brought to the target by the hand or not). Another disadvantage is that training on this device involves the use of virtual objects, which does not allow for strength exercises with a progressive increase in the gravity of the objects being grasped.

The limb rehabilitation system RehabKit is known [developed by Evolv, Russia, https://www.medicalexpo.ru/prod/evolv/product-84105-1005903.html], consisting of a built-in sensory 3D camera Azure Kinect, for tracking the position of the body in space and displaying its virtual avatar on the computer screen. The disadvantage of the system is the impossibility of conducting training on fine motor skills, pronation / supination, complicating exercises by the gravity of the objects being grasped (grasping an object during training is not provided), there is no specificity of grip training.

A hand rehabilitation system is known in which the patient holds a joystick with his hand during training to manipulate it in virtual reality [Hand rehabilitation system CUREO® CUREosity Germany https://www.medicalexpo.ru/prod/cureosity/product-303086-1045473.html]. The disadvantage of the system is that during training there is no multiple repetition of the grip (there are no movements released-grabbed-released-grabbed, and the patient constantly holds the joystick) - i.e. there is no specific training. There is also no way to increase / decrease the force load on the muscles involved in the grip (the shape and weight of the held joystick do not change).

There are rehabilitation gloves with motion sensors placed on the fingers that transmit information to the computer: SENSO REHAB TRAINING GLOVE manufactured by SensoMed LLC, Russia https://sensorehab.com/ru; Anika rehabilitation glove [manufactured by Madin, Russia https://colibri.group/product/аника-реабилитакция-перчатка/?ysclid=lv13erypjw577827б24]. Training in the glove follows the principles of multiple training, specificity, provides feedback, motivation, and a game form. The disadvantage of gloves is the need to select the right size and the right side of the glove (have a full size range of left and right gloves), placing the glove on the patient, exercises do not provide for manipulation of real objects, which does not allow for strength exercises with a progressive increase in the gravity of the objects being grasped, to control the accuracy of the grip, there is no tactile feedback. The claimed simulator allows for training in grasping objects, forms patterns of complex movements, rather than individual movements, with a gradual increase in their gravity, precision, and provides tactile feedback, which more effectively restores the skill of grasping objects.

The Ergo Plus arm rehabilitation table [manufacturer Integro https://integro.site/tovar/stol-dlya-terapii-ruk-ehrgo-plyus/?ysclid=lv15fsycgc781687588] and the rehabilitation table for ergotherapy [manufacturer Reatech https://kalina-sm.ru/catalog/reabilitacionnyi-kompleks-dlja-jergoterapii/?ysclid=lv164zg0v1225553524] are known. They are tables with horizontal surfaces that contain objects for gripping and manipulation: pegs and holes for them, cylinders of various sizes, beads, locks, and nuts for unscrewing. The disadvantages of these tables are the lack of the ability to change the height of the objects, an interactive component, implicit feedback, no control over the speed of the exercises, and a game component that increases motivation.

The closest analogue of the invention is the arm rehabilitation training table [manufactured by TOPMED Physio Rehab Co, China; Access mode: https://www.czrehab.com/ru/product/medical-hand-exercise-rehabilitation-table/. Access date: 08.05.2024], which is a table with randomly lit colored buttons located on the surface of the tabletop, equipped with a display showing the speed of completing tasks. The patient's task during training is to press the lit button (the simulator contains pressure sensors). The surface of the table can be rotated at an angle, moving from a horizontal to a vertical position. The device allows you to control the training of exercises in the shoulder, elbow and the skill of pressing buttons. The disadvantage of the prototype is the limited number of exercises performed on the simulator (the principle of diversity is not observed): there is no possibility to train pronation/supination, abduction/adduction of the thumb, finger extension, it is impossible to train the ability to grasp objects (i.e. the principle of specificity is not observed). The disadvantages of the prototype are also the impossibility to change the distance between the buttons, which does not allow to complicate or simplify the exercise in terms of the amplitude of movements, the absence of implicit feedback (success graphs during training).

The proposed simulator allows placing objects on the table surface, training their grip, movement and release (adherence to the principle of grip training specificity), training pronation/supination, and controlling the modulation of the choice to act with the right hand. The simulator has two panels, the distance between which can be increased or decreased, which makes it possible to complicate/simplify the exercise in terms of the amplitude of movements, the gravity of the object, and the accuracy of the movements. Our simulator has the ability to provide the patient with explicit and implicit feedback from the exercises.

The objective of the invention is to develop a simulator that ensures the performance of rehabilitation exercises in compliance with 11 principles of neuroplasticity, which will make training easier for the patient and more effective.

The technical result of using the invention is the expansion of the technical capabilities of the device due to the possibility of placing objects on the surface of the table, training their grip, movement and release (adherence to the principle of grip training specificity), the possibility of training pronation / supination, controlling the modulation of the choice to act with the desired hand, the possibility of complicating / simplifying the exercise in terms of the amplitude of movements in height by moving the level of the movable panel and depth by moving the movable panel back and forth, in terms of the gravity of the object, the accuracy of the execution of movements, the possibility for the patient to receive explicit and implicit feedback from the exercises, a reduction in the recovery period due to stimulation of the process of functional cortical-subcortical reorganization of the motor cortex by training that adheres to the principles of neuroplasticity.

The proposed invention is illustrated by the following figures: Fig. 1 shows a general view of the exercise machine in its original form (before changing the position of the panels), where: 1 - the first panel with dimensions (length x width x thickness) of 80 x 40x5 cm; 2 - the second panel 80 x 20x5 cm; 3 - sides 5 cm high along the left, right and rear edges of the second panel to prevent objects placed on it from rolling off; 4 - a fastening for the possibility of moving the second panel vertically upwards up to 60 cm in 1 cm increments, with the possibility of fixing at any step/level; 5 - a fastening for moving the second panel horizontally - forward by 18 cm and backward by 18 cm in 1 cm increments, with the possibility of fixing at any step/level; 6 - color sensors built into the panel; 7 - openings/windows above the color sensors, providing access to the sensor of light reflected from an object placed on the panel. 8 - LED strip lighting on the panel around each sensor; 9 - computer; 10 - stand on which 11 - table legs are placed, having 12 - a height adjustment mechanism, 13 - wheels; 14 - a pull-out drawer under the panel 1 for storing objects. In Fig. 2 - the simulator in operation, where: 15 - objects to be grasped, one side of which is red, the other blue, 8 - LED illumination of the field, glowing blue, on which the object must be placed with the blue side to the surface of the panel; 8 - LED illumination of the field, glowing red, on which the object must be placed with the red side to the surface of the panel; 16 - display of timing and feedback on the computer screen during the exercise.

The proposed interactive trainer for rehabilitation of the hand motor function after neurological damage contains a table, the tabletop of which is made in the form of two rectangular panels with a smooth surface. One of the panels is made with dimensions of 80x40x5 cm, the second one with dimensions of 80x20x5 cm is made with the possibility of moving relative to the first one in the vertical plane at a distance of up to 60 cm with a step of 1 cm and fixation at any level, as well as in the horizontal plane forward and backward at a distance of up to 18 cm. The movable panel has a side 5 cm high along the side edge and end sides with an arched upper edge with a complete decrease in its height from the upper edge of the side rim along the side edge of the movable panel to the opposite side edge of this panel to prevent rolling of objects placed on it. The interactive panels are attached to the table leg holders. The legs are placed on a stand, equipped with a height adjustment mechanism and wheels, which allows using the trainer while sitting, standing, and lying in a functional bed. The panels have built-in color sensors connected to a microcontroller for each sensor. There are 16 of them inside the fixed panel, arranged in two rows parallel to the front edge of the panel, and 8 inside the movable panel, arranged in one row parallel to the front edge of the panel. There are openings (windows) above the sensors in the panels that let in light in such a way that the color sensor detects the color of an object located on the surface of the panel directly above it. Around each color sensor, a separate LED backlight strip in the form of a square is built into the panel in such a way that the panel maintains a flat surface. The microcontrollers and LED strips are connected to the computer (Fig. 1). Each of the sensors is a microchip with a microcircuit that converts the intensity of the color spectrum into a signal of different frequencies, inversely proportional to the frequency of the output signal. The sensors can be implemented, for example, on the basis of the Tcs3200 color recognition sensor microcircuit manufactured by Kuongshun Electronic Limited, China [https://ru.made-in-china.com/co_kuongshun/product_Color-Sensor-Tcs230-Tcs3200-Color-Recognition-Sensor-Detector-Module-DC-3-5V_rhnguisvg.html?ysclid=lvfirc54ah816081148], which allows recognizing the red, blue, green color spectra of an object at a distance of 1 cm under any lighting. Color sensors and LED strips are connected to microcontrollers and then to a computer that controls the operation of the device through a built-in program. The table can have a pull-out drawer under the panel for storing items. The device is powered by a household electrical power supply.

The proposed device operates as follows.

The exercise table for rehabilitation of the motor function of the hand after neurological damage is switched on by connecting to the power supply, then the computer is switched on, the exercise machine application is launched on it, which controls the operation of the exercise machine, turns on / off the backlight of the required fields, sound signals, counts the number of sensor triggering cases, displays the results on the screen. The patient sits on a chair at the exercise table, stands next to it or is in the bed to which the device is moved. Depending on the selected training mode, the necessary objects for manipulation in the initial position are placed on the first panel of the device or next to it.

As an example of items that can be used for training, the following can be given in quantities from 2 to 24 pieces:

1. Wooden cubes measuring 3x3x3 cm with one red and one blue side.

2. Wooden cubes measuring 10x10x10 cm with one red and one blue side.

3. Hollow cylinders 7 cm in diameter and 20 cm high, with a red base and a blue top - a lid and the ability to fill them with sand (to change the weight from 250 to 2500 g).

4. Wooden checkers with red and blue sides, 6 cm in diameter, 6 cm in height.

5. Dominoes 7x3x1 cm with red and blue sides.

6. Cardboard cards 9x6x0.05 cm with red and blue sides.

7. Thin fabric napkins, one side of which is red, the back is blue - size 17x17 cm.

8. Thick cloth napkins (made of flannel fabric), one side of which is red, the back is blue, size 10x10 cm.

9. Fabric glove, back side red, palm side blue (or vice versa).

10. Red and blue fabric finger cots

and other objects with red and/or blue sides.

The objects for manipulation have red and blue sides, for example, wooden blocks or cylinders (Fig. 2). The second panel is fixed in the desired position, depending on the required exercise. During one training session, 3 to 5 exercises are selected for the patient (in the exercise program selection menu on the computer). Then the computer program is started, after which the backlight of those fields of the panel on which the objects need to be placed lights up. As soon as one object is placed on the desired field, a sound signal is heard and +1 game point for the completed task is added to the monitor. When the objects are placed correctly above all the highlighted fields, they go out and the following fields light up, to which the same objects need to be moved. Training takes place in a continuous mode lasting 600 seconds or in approaches, each approach lasting from 30 to 90 seconds (configured in the program) with a rest period of 20 seconds or until the command to start the next approach is pressed (configured). After each approach, the total score is indicated. After 10 approaches, you can see the graph of the results in each approach. After 10 approaches of the same exercise, it is changed to another, if necessary, the position of the second panel is changed and the objects for gripping and manipulation are replaced.

The backlight on the panels can light up in different modes - with different speeds, different numbers of illuminated fields, different sequences, positions and color modes. Examples of operating modes can be:

1. The backlight of the entire row (8 fields) lights up in red. It stays on until objects are placed on all fields with the red side facing the panel. As soon as all objects are placed correctly, the same fields light up in blue. To complete this task, the same objects should be turned over with the blue side facing the panel. After this task is completed, the backlight color changes again. This task forces the patient to perform an exercise on pronation/supination of the forearm (if cubes, cylinders, napkins are selected for manipulation) or work with the thumb (if the patient works with dominoes, cards, tiles). The mode can be interval: 20 seconds rest after each approach lasting from 30 to 90 seconds, a total of 10 approaches for one exercise, or continuous with an exercise duration of 600 seconds.

2. The backlight of the entire row (8 fields) lights up in red. It stays on until objects are placed on all fields with the red side facing the panel. As soon as all objects are placed in the correct order, all fields of the next row light up in the same color. After this task is completed, all fields of the next row light up, etc. This task forces the patient to perform an exercise to train the grasping of objects, moving and releasing them, and also trains control of movements in the shoulder, elbow, and hand. The mode can be interval: 20 seconds of rest after each approach lasting from 30 to 90 seconds, a total of 10 approaches for one exercise, or continuous with an exercise duration of 600 seconds.

3. One field lights up (randomly) in a random color, as soon as an object of the desired color (a hand in a red-blue glove) is placed on it, the next field lights up in random order, etc. The exercise trains speed, movements in the elbow joint. The mode can be interval: 20 seconds rest after each approach lasting from 30 to 90 seconds, a total of 10 approaches for one exercise.

4. Position of panels: the second panel is raised up relative to the first panel to the maximum height achievable by the patient's hand. The backlight on the field of the first panel lights up in a random order in a random color as soon as an object of the desired color (a hand in a red and blue glove) has been placed on it, the backlight of a random field from the second panel lights up in a random order. As soon as an object of the desired color (a hand in a red and blue glove) has been placed on it, the random field of the first panel lights up again, etc. Control of movements in the shoulder joint is trained. Interval mode: 20-second rest after each approach lasting from 30 to 90 seconds, a total of 10 approaches per exercise. 5. The backlight lights up simultaneously for any two adjacent fields. Points are awarded only when the sensors of both fields are triggered. Fields light up for 4 seconds, then the backlight of two other adjacent fields lights up for 5 seconds, etc. It is possible to increase the time for completing the task. The exercises train finger extension, increase grip width, and speed of movement. Interval mode: 20-second rest after each approach lasting from 30 to 90 seconds, a total of 10 approaches per exercise.

5. The backlight lights up simultaneously for any two adjacent fields. Points are awarded only when the sensors of both fields are triggered. The fields light up for 4 seconds, then the backlight of two other adjacent fields lights up for 5 seconds, etc. It is possible to increase the time to complete the task. Finger extension, increasing the width of the grip, and speed of movement are trained. Interval mode: 20-second rest after each approach lasting from 30 to 90 seconds, a total of 10 approaches per exercise.

The above training program examples can be expanded with different combinations, sequence, number of fields involved in the task, speed, time and panel arrangement.

Indications: active rehabilitation of the hand motor function in central and peripheral diseases of the nervous system in patients with minimal, medium and high functional capabilities of the hand. Indications for training on the claimed simulator are general indications for ergotherapy, namely: the patient can actively move 10 degrees or more in three joints of the hand - abduction of the thumb and any two fingers, extension at the wrist / shoulder and elbow (rule of three tens); the patient can grab a piece of cloth in any way, lift it into the air and release it.

Contraindications (the same as contraindications for hand occupational therapy): inability to independently perform minimal movements in the hand (complete plegia in the hand, shoulder and elbow); lack of anatomically determined rehabilitation potential; general contraindications to active therapeutic exercise (including fever, hyperglycemia, acute period of ischemia, altered consciousness, inability to follow instructions, hyperkalemia, uncontrolled arrhythmia, blood pressure above 180 mm Hg, etc.).

The proposed simulator was used in the rehabilitation of 8 patients aged from 20 to 62 years with central paresis of the hand after a stroke (6 people) and a brain injury (2 people) in the early neurorehabilitation department of the Kuvatov Republican Clinical Hospital in Ufa.

The essence of the invention is illustrated by the following clinical examples.

Example 1.

Patient A., 73 years old, was hospitalized in the early neurorehabilitation department three weeks after the onset of the disease. Diagnosis: early recovery period of acute cerebrovascular accident of the ischemic (thromboembolic type) in the basin of the right middle cerebral artery. Right-sided hemiparesis of moderate severity.

Neurologically, the patient had spastic left-sided hemiparesis. Muscle strength was 3.5 points in the distal and 3.5 in the proximal parts of the left arm, finger extension and thumb abduction was 3 points, and finger flexion was 4 points. Muscle tone in the forearm flexors was 3 points according to Ashworth. The range of passive movements was unchanged, active movements were slow in the left arm, shoulder elevation and abduction were limited to 60 degrees. The patient's arm capabilities were assessed as low functional. The patient trained for 10 days on the proposed interactive simulator. Before treatment, the Fugl-Mayer scale score for the upper limb was 80 points (the maximum possible score was 126) and increased to 96 points after treatment. Active shoulder lift increased to 90 degrees, strength in the forearm and fingers of the left hand to 4-4.5 points. The "2 boxes and 150 cubes" test was 3 cubes/min before treatment, 15 cubes/min after treatment. Self-assessment of hand function, according to the visual analogue scale (where 0 is the hand does not work at all, 100 is working "excellently, you can't dream of better") before treatment was 0 points, after - 45 points. Frenchay test before treatment 0 points, after treatment 3 points.

The patient's arm functionality was assessed as low; the patient was easily fatigued. The patient trained for 10 days on the proposed interactive trainer. She performed four exercises per day. Each exercise was divided into 30-second sets with 20-second rest intervals between sets. 10 sets were performed.

The main goals of the training were: 1. training of shoulder control and elevation, grasping and holding objects; 2. training of thumb abduction; 3. training of cylinder grip, holding an object and pronation/supination of the forearm; 4. training of speed, shoulder control and forearm work.

A training session of four exercises was conducted over ten days.

Exercise 1.

Objective: training shoulder control, grasping and holding objects

Task: to install checkers 6 cm in diameter and 6 cm high on illuminated fields. 8 checkers were used.

Mode: the backlight of all fields of one first row of the second panel lights up, as soon as the objects are placed on the required fields on the entire row, one row of fields on the first panel lights up. As soon as the objects are placed on this row, a row of fields on the second panel lights up, etc. Duration of the approach is 30 seconds / rest 20 seconds. 10 approaches are completed. For each correctly placed object, +1 point is added.

Initial position of the panels: The second panel is raised by 5 cm in the horizontal plane and extended forward as much as possible: by 18 cm relative to its initial position. The patient is in a functional bed, the headrest is raised by 60 degrees, the exercise machine is moved to the bed so that its base is under the bed, and the panels are above the bed and the patient's knees.

A way to make the task more difficult: raise the second panel 6-14 cm higher than the initial state.

The results are presented in Table 1.

Exercise 2.

Task: training the abduction of the thumb

Task: you need to turn the dominoes side down, we used 16 wooden dominoes 7x3x1 cm with red and blue sides.

Initial position of the panels: on the same vertical level, the edges of the panels are closed. The patient is in a functional bed, the headrest is raised by 60 degrees, the exercise machine is moved to the bed so that its base is under the bed, and the panels are above the bed and the patient's knees.

Complication: the exercise is made more difficult by changing the thickness of the object, the smaller it is, the more difficult it is (objects in order of increasing complexity: thick dominoes, small dominoes, cardboard, cards).

Mode: the backlight of all fields of one/two rows lights up, as soon as objects are placed on the entire row, the same row lights up in a different color, etc. Duration of the approach is 30 seconds / rest is 20 seconds. For each correctly placed object, +1 point is added. 10 approaches are completed.

The results are presented in Table 2.

Exercise 3.

Objective: to train the cylinder grip, object holding and forearm pronation/supination

Task: turn the cylinders side down, use 8 cylinders for the first 5 days and 16 cylinders for the next 5 days with red and blue sides weighing 250 g.

Initial position of the panels: on the same vertical level, the edges of the panels are closed. The patient is in a functional bed, the headrest is raised by 60 degrees, the exercise machine is moved to the bed so that its base is under the bed, and the panels are above the bed and the patient's knees.

Mode: the backlight of all fields of the first row lights up, as soon as objects are placed on the entire row, the same row lights up in a different color, etc. Duration of the approach is 30 seconds / rest is 20 seconds. 10 approaches are completed.

A way to make the task more difficult is to increase the mass of the cylinders, using several rows located further from the front edge.

The results are presented in Table 3.

Exercise 4.

Objective: Training for speed, shoulder control and forearm work

Task: bring your hand in a red and blue glove to the illuminated field with the side facing up.

Mode: the backlight of one field lights up randomly for 5 seconds, alternately on one panel and then on the other. If after 5 seconds the hand has not been placed on the required field, the backlight lights up on another field, the point is not counted. If the patient manages to bring his hand to the required field within 5 seconds, the next field lights up, the point is added.

Duration of the approach is 30 seconds / rest 20 seconds. 10 approaches were completed.

Initial position of the panels: The second panel is raised 10 cm in the horizontal plane and every day its position is set 5 cm higher than the previous day. The patient is in a functional bed, the headrest is raised 60 degrees, the exercise machine is moved to the bed so that its base is under the bed, and the panels are above the bed and the patient's knees.

A way to make the task more difficult: raise the second panel 15-55 cm higher than the initial position.

The results are presented in Table 4.

Example 2.

Patient V., 24 years old, admitted to inpatient treatment with a diagnosis of a consequence of severe TBI in the form of right-sided hemiparesis from 2022. 28 months have passed since the onset of the disease. Neurologically, the patient had spastic right-sided hemiparesis. Muscle strength is 4 points in the distal and 3 in the proximal parts of the right arm. Muscle tone in the flexors of the forearm on the right is 3 points according to Ashworth. The range of passive movements is unchanged, active movements are limited: flexion of the right shoulder up to 80 degrees, flexion of the shoulder 160, pronation / supination with a flexed forearm 70/60 degrees. Limitation of active extension of the right elbow to 100 degrees, extension / dorsiflexion of the wrist 30/25 degrees, mild dysmetria in the right hand. The strength of the muscles of the left arm is 5 points, the range of active and passive movements on the left is full.

The patient's hand capabilities were assessed as average. The patient trained for 10 days on the proposed interactive trainer. He performed four exercises per day. Each exercise was divided into 60-second sets with 20-second rest intervals between sets. The main goals were to train 1. elbow movements, 2. shoulder 3. gripping large objects 4. pronation supination

Before treatment, the Fugl-Meyer scale score for the upper limb was 98 points (the maximum possible score is 126) and increased to 108 points after treatment. The values for the "upper extremity" subscale changed from 21 to 25 points, active elbow extension increased to 180 degrees. The "2 boxes and 150 cubes" test was 11 cubes/min before treatment, and 27 cubes/min after treatment. The Motor Activity Log test before treatment was 14 points on the "frequency of hand use" scale and 9 points on the "how well the action is performed" scale (out of a maximum possible 150 points). The FIM functional independence measure before treatment was 85 points. Self-assessment of hand function, on a visual analogue scale (where 0 is the hand does not work at all, 100 is it works “perfectly, you can’t even dream of better”) before treatment was 0 points, after - 50 points. Frenchay test before treatment was 4 points, after treatment - 5 points.

A training session of four exercises was conducted over ten days.

Exercise 1.

Objective: to train pinch grip, shoulder control and elevation

Task: put napkins on the burning cells. The first five days, eight flannel napkins were used, one side of which was red, the back was blue, size 10x10 cm; the second five days - four fabric napkins 17x17 cm.

Mode: the backlight of all fields of one row lights up, as soon as objects are placed on the entire row, the next row lights up, etc. Duration of the approach is 60 seconds / rest 20 seconds. For each correctly placed object, +1 point is added. 10 approaches were completed.

Initial position of the panels: the second panel is 2 cm higher than the first; the patient sits on a chair behind the exercise machine.

A way to make the task more difficult is to raise the second panel higher than its initial state.

The results in points are presented in Table 5.

Exercise 2.

Task: abduction of the thumb

Task: turn the dominoes side down (the first five days we used 8 dominoes measuring 7x3x1 cm with red and blue sides; the last five days we used dominoes measuring 5x3x0.5 cm with red and blue sides).

Mode: the backlight of all fields of one row lights up, as soon as objects are placed on the entire row, the same row lights up in a different color, etc. Duration of the approach is 60 seconds / rest 20 seconds. For each correctly placed object, +1 point is added. 10 approaches were completed.

Initial position of the panels: the second panel is at the level of the first, their edges are closed; the patient sits on a chair behind the exercise machine.

Method of making the task more difficult: changing the fields involved in the training, reducing the thickness of the objects used.

The results are presented in Table 6.

Exercise 3.

Objective: training of palm and fist grip; training of elbow control.

Task: place objects in the right rows, the first five days used 8 pieces of 3x3 cm cubes; the last five days used checkers with a diameter of 6 cm.

Mode: the backlight of all fields of one row lights up, as soon as objects are placed on the entire row, another row lights up, to which objects need to be moved, etc. Duration of the approach is 60 seconds / rest 20 seconds. 10 approaches were completed.

Initial position of the panels: the second panel is at the level of the first, their edges are closed; the patient sits on a chair behind the exercise machine.

Method of making the task more difficult: increase the size of the objects used; increase the distance between the rows: move the second panel back relative to the first by 2 cm per day.

The results are presented in Table 7.

Exercise 4.

Objective: training pronation-supination of the forearm; control of movements in the wrist

Task: turn the cylinders over with the right side down, used 8 cylinders for the first 5 days and 16 cylinders for the next 5 days with red and blue sides weighing 250 g.

Initial position of the panels: on the same vertical level, the edges of the panels are closed.

A way to make the task more difficult is to increase the mass of the cylinders, using several rows located further from the front edge.

Mode: the backlight of all fields of one row lights up, as soon as objects are placed on the entire row, the same row lights up in a different color, etc. Duration of the approach is 60 seconds / rest 20 seconds. 10 approaches are completed.

The results are presented in Table 8.

Example 3.

Patient D., 52 years old, diagnosed with sequelae of dissection of the left posterior cerebral artery with ischemic stroke, mild left-sided hemiparesis, right ataxia. 75 months have passed since the onset of the disease. Neurologically: muscle strength is 4.5 points in the distal and 4 points in the proximal parts of the arm. Muscle tone in the forearm flexors is 2 points according to Ashworth. The range of passive movements is unchanged, active movements are not limited, dysmetria, misses the finger-nose test in the right hand.

The patient's hand capabilities were assessed as high functional capabilities. The patient trained on an outpatient basis (she specifically visited the clinic for the purpose of training, without other procedures) for 10 days on the proposed interactive trainer. She performed four exercises per day. Each exercise was divided into 90-second sets with 20-second rest intervals between sets. The main goals were to train 1. elbow movements, 2. shoulder 3. gripping large objects 4. pronation supination

Before the training course, the Fugl-Meyer scale score for the upper limb was 115 points (the maximum possible score is 126) and increased to 119 points after the treatment. The "2 boxes and 150 cubes" test was 24 cubes/min before the treatment, and 56 cubes/min after the treatment. The Motor Activity Log test before the treatment was 6 points on the "frequency of hand use" scale and 6 points on the "how well the action is performed" scale (out of a maximum possible 150 points), and after the training course, the Motor Activity Log test scores increased on both scales to 54 and 63 points, respectively. The FIM functional independence measure before the treatment was 104 points. Self-assessment of hand function, on the visual analogue scale (where 0 means the hand does not work at all, 100 means it works "excellently, you can't dream of better") before the treatment was 45 points, after - 70 points. Frenchay test before treatment 4 points, after treatment 5 points.

A training session of four exercises was conducted over ten days.

Exercise 1.

Objective: training palm grip; control of shoulder movements

Task: move objects to the given fields; 8 cylinders weighing from 250 to 500 g; 8 wooden cubes 10 cm by 10 cm.

Initial position of the panels: the movable panel is 40 cm higher than the front panel.

Method of making the task more difficult: changing the mass of objects, increasing the height of the second panel, changing the size of objects. Each day the task was made more difficult by only one parameter (mass of the object, size or height of its movement).

Mode: the backlight of all fields of one row of the first panel lights up, as soon as objects are placed on the entire row, the entire row of fields on the second panel lights up, etc. Duration of the approach is 90 seconds / rest 20 seconds. For each correctly placed object, +1 point is added. 10 approaches are completed.

The results are presented in Table 9.

Exercise 2.

Objective: training palmar grip; forearm pronation/supination

Task: place objects on the given fields with the correct side; 24 cylinders weighing from 250 g with one red and one blue side; 24 wooden cubes 10 cm by 10 cm with one red and one blue side;

24 wooden cubes measuring 3x3x3 cm with one red and one blue side; 24 wooden checkers with red and blue sides, 6 cm in diameter, 6 cm high.

Initial position of the panels: the second panel is on the same level as the first panel, the patient stands at the simulator

Method of making the task more difficult: changing the mass and size of objects

Mode: the backlight of all 24 fields of the simulator lights up in red, as soon as objects are placed on all fields, with the side down, all fields light up in blue, etc. Duration of the approach is 90 seconds / rest 20 seconds. For each correctly placed object, +1 point is added. 10 approaches are completed.

The results are presented in Table 10.

Exercise 3.

Objective: training finger dexterity; finger extension; wrist control

Task: place fingers, wearing colored finger cots, on the given fields.

Initial position of the panels: the second panel is on the same level as the first panel, the patient stands at the simulator

Method of making the task more difficult: changing the speed of changing fields

Mode: the backlight of two adjacent fields of the simulator lights up red or blue, or one field blue, the other red, in random order for 5 seconds, alternately on one panel, then on the other. If after 5 seconds the hand has not been placed on the required fields, the backlight on another field lights up, the point is not counted. If the patient managed to bring the fingers of the hand within 5 seconds to the required fields, the next one lights up, a point is added. The duration of the approach is 90 seconds / rest 20 seconds. For each two correctly placed fingers, +1 point is added. 10 approaches were performed.

The results are presented in Table 11.

Exercise 4.

Objective: training thumb abduction; finger dexterity

Task: turn objects from the red side to the blue side and back at the signal; use objects 24 pieces each, with blue and red sides: napkins; dominoes, thick cardboard, cards.

Initial position of the panels: the second panel is on the same level as the first panel, the patient stands at the simulator

Method of complicating the task: changing the size of objects, distance and height of the objects

Mode: the backlight of all fields of the simulator lights up in red. As soon as objects are placed on all fields, with the side of the desired color down, all fields light up in blue, etc. Duration of the approach is 90 seconds / rest 20 seconds. For each correctly placed object, +1 point is added. 10 approaches are completed.

The results are presented in Table 12.

During the therapy, all patients improved the motor skills of the trained hand, no one left the study early, two patients continued training on the simulator for more than 10 days. Thus, the possibility of training on the simulator of patients with different functional capabilities of the hand, in different body positions is shown. The simulator has proven itself as a device that can get a wide range of tasks (movements in the shoulder, elbow, wrist, fingers), which can be diversified, complicated or simplified in terms of range of movement, height, speed, gravity; provide extended feedback and make the effect of training very visual, thanks to the scoring and the ability to count the number of successfully completed movements. Training on the simulator complies with the principles of neuroplasticity, successfully forms the skill of grasping, the skill of manipulating objects, patterns of movements and improves the indicators in patients not only in physiological parameters, but also in scales of everyday activity and everyday skills.

Claims (3)

1. An interactive trainer for rehabilitation of the motor function of the hand after neurological damage, comprising a table with two legs on a stand and a screen, characterized in that the table top is made in the form of two rectangular panels with a smooth surface, wherein one panel is made with dimensions of 80 × 40 × 5 cm, the second with dimensions of 80 × 20 × 5 cm is fixed above the first and is made with the possibility of moving relative to the first in the vertical plane upward by a distance of up to 60 cm in increments of 1 cm and fixation at any level, as well as with the possibility of moving in the horizontal plane forward and backward by a distance of up to 18 cm, wherein on the movable panel there is a side 5 cm high along the side edge and end sides with an arched upper edge with a complete decrease in its height from the upper edge of the side rim along the side edge of the movable panel to the opposite side edge of this panel, on the fixed panel from above inward there are 16 color sensors located in two rows of 8 parallel to the side edge of the panel, on the movable panel from above inward there are 8 color sensors, located in one row parallel to the side edge of the panel, with each sensor connected to a microcontroller, a separate LED strip in the form of a square is built into the tabletop around each color sensor, holes are made in the panels above the sensors that transmit light in such a way that the color sensor detects the color of an object located on the surface of the panel directly above it, the microcontrollers and LED strips are connected to the computer, and the table legs are equipped with a height adjustment mechanism and wheels, placed on one of the sides of the stand. 2. The training device according to item 1, characterized in that each of the sensors, which is a microchip with a microcircuit that converts the intensity of the color spectrum into a signal of different frequencies, inversely proportional to the frequency of the output signal, is made on the basis of a Tcs3200 color detection sensor microcircuit. 3. The exercise machine according to item 1 or 2, characterized in that the fixed table panel is equipped with a pull-out drawer for storing items.