Abstract:
A rotary rehabilitation apparatus is presented for rehabilitation of a person&#39;s extremity, including the joints and assorted muscles, tendons, ligaments, that can be tailored to the person&#39;s needs based upon their physical size, type of injury, and plan for recovery. The apparatus facilitates the adjustment of the range of motion of the user&#39;s extremity in a cycling action by offsetting a moveable lever from a fixed lever at a plurality of angles. As the user&#39;s extremity moves in a circular path, the extremity engages in extension and flexion to cause movements in the articulations formed at the user&#39;s joints.

Description:
RELATED APPLICATIONS 
     This application is a continuation-in-part application of U.S. patent application Ser. No. 10/687,207, filed Oct. 16, 2003 now U.S. Pat. No. 7,226,394. The aforementioned application is incorporated herein by reference. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     This invention relates generally to the field of exercise and rehabilitation, and more specifically, to an apparatus providing selective adjustment of the range of motion of a user&#39;s extremities, including either arms and legs, actively engaging in or passively participating in a cycling action. 
     2. Description of the Related Art 
     One of the most significant and the most common athletic injuries is to the knee, and published data continues to report at an incidence of between one-quarter and one-third of all men and women experience some type of knee injury annually. Approximately 10.8 million individuals visit a physician for knee injuries alone each year. Total estimated annual U.S. costs of all musculoskeletal conditions is $254 billion. Many injuries to the lower extremities of persons necessitate the use of rehabilitation exercises. Such injuries may include those to the joints of a person&#39;s leg (e.g., knee, hip ), replacement of one&#39;s joint (e.g., total hip or knee arthroplasty [THA, TKA]), ligaments or tendons associated with these joints (e.g., anterior cruciate or medial collateral ligament [ACL, MCL], or patella or quadriceps tendons), or muscles of the leg (e.g., Rectos or biceps femoris, etc). Rehabilitation exercises are also frequently prescribed after surgery and are performed to further repair an injured site on a user&#39;s extremity. 
     Major trunk injuries are also exceedingly common in the United States. Major trunk injuries include those injuries that affect the shoulders and back. The shoulder joint, being the most flexible joint in the human body, can be easily injured because of accidentally over-extending the range of motion. The U.S. Department of Labor estimates that thirty-five percent of all muscoskeletal injuries are major trunk injuries. Over four million visits are made to health care professionals each year because of shoulder injuries. Moreover, the U.S. Department of Labor estimates that the average time off-work for shoulder injuries is twelve days. This corresponds to an estimated $13-20 billion due to time lost from work. 
     One common rehabilitation exercise recommended to improve muscle, ligament and tendon strength, and endurance for extremities post-injury or post-surgically, is movement in a cycling motion. The movement of a person&#39;s upper or lower extremity in a circular path induces motion in the articulations that form the shoulder and elbow or hip and knee, respectively. However, for rehabilitation to be effective, it must be tailored to the specific needs of a given person based on their physical size, type of injury, and plan for recovery, among other factors. For example, if a surgical repair has been made to a torn ACL of a person&#39;s leg, it is often desirable at the beginning of a rehabilitation regimen to limit the flexion or extension of the knee, due not only to pain, but also to avoid damage to the repair. Likewise, for the shoulder, a physician may recommend limiting the motion of the shoulder to something far less than its full capability of 360 degrees until natural recovery and sufficient rehabilitation has occurred. Although cycle-type exercise machines are recommended for use in certain rehabilitation regimens, they generally do not facilitate the adjustment of the range of motion of one individual extremity. Further, these machines are limited to the standard pedal or handle arrangement where one lever (handle or pedal) is offset from the other by 180 degrees around a hub. There are, however, rehabilitation regimens where benefits to flexibility, strength, and/or endurance are achieved by offsetting levers or handles at another angles for passive, assisted active, and active range of motion. 
     SUMMARY OF THE INVENTION 
     A rotary rehabilitation apparatus is presented that allows for the selection of a range of motion for upper and/or lower extremities of a person engaging in a cycling action. The adjustable lever assembly allows for safer, more immediate rehabilitation following hip, knee, shoulder, and/or elbow injuries and further provides for pain reduction, increasing the range of motion, strengthening soft tissue and general conditioning. The assembly comprises one movable lever and a flywheel rotatably mounted on a support and having a series of bores along a diameter thereof with which the movable lever or handle is releasably mounted. In an exemplary arrangement where the rotary rehabilitation apparatus is incorporated with a cycle-type exercise machine, for example a cycle ergometer, a user will sit on the seat and place their feet or hands on the levers to impart a force thereon. As the user&#39;s feet or hands move in a circular path, the extremities engage in extension and flexion to cause movement in the articulations formed at the user&#39;s hip and knee or shoulder and elbow joints. The amount of movement in the articulations of the extremity and consequently, the range of motion at these joints can be controlled by mounting the lever with the appropriate bore on the flywheel. If increased extension and flexion is desired, the lever can be mounted with a bore further away from the axis of rotation of the flywheel. Conversely, if a smaller degree of extension and flexion is preferred, the lever can be mounted with a bore closer to the flywheel axis of rotation. 
     In one configuration, the moveable lever is releasably mounted within a mounting bore of the flywheel and the other lever is left at full diameter. This configuration allows an adjustable range of motion for one extremity and a fixed range of motion for the other extremity, which allows for more limited, rehabilitative exercises for one extremity (e.g., an injured knee or shoulder) and more robust exercises for the other. 
     In another aspect, more than one series of bores extend across different diameters of the flywheel, so that the movable lever can be mounted at various angles with respect to the fixed lever around the axis of rotation. For example, while levers are typically aligned 180 degrees from one another around a hub on an cycle-type exercise machine, it may be desired in rehabilitation regimens to position the levers at a different angle to work on the passive range of motion (“PROM”), the assisted active range of motion (“AAROM”), and the active range of motion (“AROM”). 
     The rotary rehabilitation apparatus of the present invention provides improved options for rehabilitation regimes where a cycling or rotary action would be beneficial to recovery from injury of a person&#39;s extremities. As a user progresses in their injury recovery, such as by increasing strength and flexibility in their extremities, the movable lever or handle can be disengaged and remounted within another bore that provides a different range of motion for their extremity when rotating the assembly. 
     By rapidly affecting PROM, AAROM and AROM this invention will reduce the time required to recover from extremity injuries, increasing improvements in measurable outcomes such as range of motion, edema, proprioception, return to unassisted gait activities, initial functional independent measures, strength and conditioning; reduce overall inpatient and outpatient costs, accelerate return to vocational or avocational activities; and significantly improve quality of life by expediting a return to autonomy. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a right side elevation view of the rotary rehabilitation apparatus of the present invention incorporated with a cycle-type exercise machine; 
         FIG. 2  is perspective view of the rotary rehabilitation apparatus of the present invention incorporated with a cycle-type exercise machine; 
         FIG. 3  is a top plan view of the rotary rehabilitation apparatus of the present invention incorporated with a cycle-type exercise machine; 
         FIG. 4  is a front elevation view of the rotary rehabilitation apparatus of the present invention incorporated with a cycle-type exercise machine; 
         FIG. 5  is a side elevation view of an embodiment of the flywheel with a non-linear configuration of bore holes; 
         FIG. 6  is a side elevation view of an embodiment of the flywheel with a non-linear configuration of bore holes with a continuous ring of additional mass applied to the outer perimeter of the flywheel to increase the flywheel inertia; 
         FIG. 7  is a side elevation view of an embodiment of the flywheel with a non-linear configuration of bore holes with a non-continuous ring of additional mass applied to the outer perimeter of the flywheel to increase the flywheel inertia; 
         FIG. 8  is a left perspective view of the flywheel with a linear configuration of bore holes mounted with the hub; 
         FIG. 9  is a right perspective view of the flywheel of  FIG. 8 ; 
         FIG. 10  is an exploded view of the flywheel as mounted with the hub; 
         FIG. 11  is a front elevation view of the flywheel of  FIG. 8 ; 
         FIG. 12  is a right side elevation view of the flywheel of  FIG. 8 ; 
         FIG. 13  is a perspective view of an embodiment of a pedal lever assembly; 
         FIG. 14  is an exploded view of an embodiment of a pedal lever assembly; 
         FIG. 15  is a top plan view of an embodiment of a pedal lever assembly; 
         FIG. 16  is a left side elevation view of an embodiment of a pedal lever assembly; 
         FIG. 17  is an front elevation view of an embodiment of a pedal lever assembly; 
         FIG. 18  is an exploded view of the slotted bushing including the locking lever and a standard bicycle pedal; 
         FIG. 19  is a perspective view of the slotted bushing with the locking lever in position; 
         FIG. 20  is a sectional view of the beveled front of the slotted bushing including the locking pad and locking face; 
         FIG. 21  is a side view of the slotted bushing with phantom threads for connecting to the pedal; 
         FIG. 22  is a side view of the quick release adaptor inserted through the flywheel with the locking face positioned against the planar surface of the flywheel; 
         FIG. 23  is a left perspective view of the rotary rehabilitation apparatus showing one lever approaching engagement with one of the bores of the flywheel and the flywheel rotatably mounted with a hub; 
         FIG. 24  is a right perspective view of the rotary rehabilitation apparatus showing the lever mounted with the flywheel and the hub with which the flywheel is mounted; 
         FIG. 25  is a top view of the rotary rehabilitation apparatus showing the lever mounted with the flywheel, and the flywheel mounted with the hub; 
         FIG. 26  is a front elevation view of the rotary rehabilitation apparatus of  FIG. 25 ; 
         FIG. 27  is a right elevation view of the rotary rehabilitation apparatus of  FIG. 25 ; 
         FIG. 28  is a side elevation view of one embodiment of the disk of the flywheel showing a linear configuration of bores along two diameters thereof; 
         FIG. 29  is a side elevation view of another embodiment of the disk of the flywheel showing a linear configuration of bores along four diameters thereof; 
         FIG. 30  is a side elevation view of one brace member of the flywheel; 
         FIG. 31  is a front elevation view of the brace member of  FIG. 30 ; 
         FIG. 32  is a rear elevation view of the coupling for mounting the hub with the flywheel; 
         FIG. 33  is a side elevation view of the coupling of  FIG. 32 ; 
         FIG. 34  is a front elevation view of the coupling of  FIG. 32 ; 
         FIGS. 35 and 36  schematically show leg members having feet positioned on the levers of the rotary rehabilitation apparatus at a first position of rotation and at a second position of rotation; 
         FIGS. 37 and 38  schematically show leg members having feet positioned on the levers of the rotary rehabilitation apparatus with one of the levers mounted at a different position on the flywheel than the levers of  FIGS. 35 and 36  and the levers being at a first position of rotation and at a second position of rotation; 
         FIG. 39  is a right side elevation view of a rotary rehabilitation apparatus configured for upper extremity movement of the shoulder and/or elbow; and 
         FIGS. 40-44  show various views (perspective view, exploded perspective view, right side elevation view, top plan view and front elevation view) of the lever assembly of a rotary rehabilitation apparatus of the present invention. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     One rotary rehabilitation apparatus  10  providing for the selection of a range of motion for one or both legs  200  of a person is shown in  FIGS. 1-4 . An embodiment of the rotary rehabilitation apparatus for rehabilitating a person&#39;s upper extremities will be discussed in detail below. The rotary rehabilitation apparatus  10  is shown incorporated in a cycle-type exercise machine  100  having a support  102  upon which the apparatus  10  is rotatably mounted and a seat  104  positioned at a distance from the support  102 . In this arrangement, the person can sit in the seat  104 , place their feet  204  on the levers  12   a  and  12   b  and impart a pushing force thereto with their legs  200  to rotate a flywheel  14  at a center point  15  thereof around an axis extending in the horizontal plane. 
     The adjustable range of motion for each leg  200  is achieved by having the movable lever  12   a  be repositionable along one or more diameters of the flywheel  14 . The flywheel  14  has a series of bores  16  extending laterally there through parallel to the flywheel rotational axis and formed in a row along the flywheel diameter so that the lever  12   a  can be removably mounted with one of the bores  16 . In the embodiment of the rotary rehabilitation apparatus  10  shown in  FIGS. 1-4 , the flywheel  14  has two separate series of bores  16  each aligned along one flywheel diameter and orthogonal to one another.  FIGS. 5-7  show an embodiment of the flywheel  14  that utilizes a non-linear configuration of two series of bores. This non-linear configuration provides separate options for ranges of motion and can be highly beneficial with certain patients who have experienced difficulty in achieving improvements with their range of motion utilizing the linearly arranged bore holes.  FIG. 6  reveals an embodiment of the flywheel  14  that utilizes a continuous ring  19  at the outer perimeter wall of the flywheel.  FIG. 7  conversely utilizes a non-continuous outer ring  17 . Both embodiments include additional mass at the outer ring of the flywheel  14  to increase the inertia of the flywheel and enhance the benefits associated with passive rotation. By increasing the mass of the flywheel at the perimeter wall of the flywheel, the desired rotation speed can be maintained with reduced energy input from the extremity of the user. 
     As can also be seen in  FIGS. 1-4 , the movable lever  12   a  is mounted with the flywheel  14  and the fixed lever  12   b  is mounted with a crank  18  extending radially from a hub  20  with which the flywheel  14  is rotatably mounted at the center point  15 . This configuration allows for lever adjustment both along the flywheel  14  diameter towards or away from the center point  15 , and concentrically on the flywheel  14  around the center point  15  such that the lever  12   a  may be at an offset angle relative to the fixed lever  12   b  about the flywheel axis of rotation of 90, 180 or 270 degrees. 
       FIGS. 8-12  show more detail of the flywheel  14  and mounting with the hub  20 . The flywheel  14  comprises a circular disk  22  having opposing first and second planar surfaces  24 ,  26  and a perimeter wall  28 , and a circumferential ring  30  fixed around the perimeter wall  28 . The ring  30  may be press fit onto the disk perimeter wall  28  or may be mounted thereto with fasteners or adhesives. A first set of notches  32  are formed along an inner edge  34  of the ring  30  adjacent to the disk first planar surface  24  and in alignment with each row of the series of bores  16 . These notches  32  facilitate the extension of brace members  36  across the disk planar surface  26  on a diameter of the ring  30  to matingly fit with the notches  32 . A second set of notches  38  having a curved profile are formed along the ring inner edge  34  adjacent to the disk second planar surface  26 . When the movable lever  12   a  is mounted with the bore  16  furthest from the center point  15 , the notches  38  provide extra clearance such that the lever  12  fits properly adjacent to the second planar surface  26 . 
     Depending on the functionality desired in the cycle-type exercise machine  100 , the flywheel  14  can be designed to have a relatively large or small moment of inertia. A large moment of inertia flywheel  14  requires more peddling force to accelerate the same to a given speed, but also causes the flywheel  14  to better resist changes in speed, resulting in smoother “steady-state” cycling, which may be preferred in certain rehabilitation exercises. The higher moment of inertia is created by making the flywheel  14  heavier and/or moving more of the flywheel weight out to the circumferential ring  30 . 
     The flywheel  14  is mounted with the hub  20  by insertion of a fastener  39  through the bore  16  of the disk  22  forming the center point  15  of the flywheel  14  and through a coupling  40  for securing with the hub  20 . Specifically, the fastener  39  extends into a receiving bore  42  formed in a stem  44  rotatably mounted within a body  46  of the hub  20 . In this arrangement, the hub body  46  is stationary on the support  102  while the hub stem and the mounted flywheel  14  rotate relative to the hub body  46 . The hub  20  is preferably mounted adjacent to the first planar surface  24  on a side of the flywheel  14  opposite of the movable lever  12   a.    
     In addition to controlling the moment of inertia in the flywheel  14 , the overall resistance to turning of the flywheel  14  may be controlled to increase the amount of work a user must perform in peddling, as those of skill in the art appreciate with respect to known cycle-type exercise machines. For example, frictional resistance may be incorporated in to the design of the hub  20 , such that the rotation of the stem  44  relative to the hub body  46  requires a certain amount of force to overcome the static and dynamic friction within the hub  20 . Alternatively, a frictional surface (not shown), for example, a brake, may selectively engage the circumferential ring  30  to create static and dynamic friction. 
       FIGS. 13-17  show the components of the movable lever  12   a . The lever body  48  has opposing surfaces  49  onto which the user&#39;s foot is placed and a bore  50  extending through the body  48  from a lateral side face  52  to a medial side face  54 . A chamfer  56  is also formed at the bore entrance of the lateral side face  52 . A sleeve  58  has a first end  60  and a second end  62 , and is configured for insertion into the bore  50  such that the second end  62  extends out of the lever medial side face  54  as shown in  FIG. 15 . A pin  64  is inserted into the sleeve  58  and has a shank  66  extending out of second end  62  thereof, and a collar  68  having a concentric base  70  configured to abut the first end  60  and a beveled region  72  mateably fitting within the chamfer  56 . A protrusion  74  is formed on the shank  66  near an end distal to the collar  68  such that the pin  64  frictionally fits within one bore  16  of the flywheel  14  to secure the lever body  48  thereto. If enough of a pulling force is applied to the lever body  48  away from the flywheel  14 , the protrusion  74  is removed from the frictional fit in the bore  16  and may be repositioned as desired in another bore  16 . The lever body  48  and sleeve  58  are also rotatable about the pin  64  such that as the flywheel  14  rotates, one of the peddling surfaces  49  is maintained in alignment such that the user can continue to apply a force thereto with their feet  204  through the cycling motion. 
     In an alternative embodiment as shown in  FIG. 18 , a standard bicycle pedal  330  can be employed with a quick release adaptor  332 . The utilization of a standard bicycle pedal  330 , a bicycle pedal with clips or a hand grip, with the quick release adaptor  332  is highly desirable in this application because if the pedal is damaged or simply wears out it can be quickly and inexpensively replaced by purchasing it at a wide array of commercial retail establishments. Moreover, it is critical in rehabilitation settings that the levers be easily removed and repositioned because many patients have reduced strength because of injuries or debilitating illnesses that limit the amount of force they can apply in these situations. While the application of a bicycle pedal in this invention is addressed in more detail below it should be understood that other apparatus for application of force from the extremities of a user are also contemplated. For example, hand grips for utilization by the hands of a user in-lieu of pedals for the feet are also contemplated by this invention. 
     In  FIG. 18  a standard bicycle pedal  330  is shown approaching engagement with the quick release adaptor  332 . In this embodiment, the combination of a pedal and the quick release adaptor is defined as a lever. The quick release adaptor  332  is comprised of a machined bushing  336  with a beveled edge  338 , a first shaft  340  of diameter D 1  and a second shaft  342  of diameter D 2 . A slot  344  is machined into the bushing  336  wherein a spring loaded locking lever  346  resides. The portion of the locking lever  346  proximate the beveled edge  338  is biased upward away from the center of the shafts  340 ,  342  through the force of a spring  348 . The locking lever  346  is held in position in the slot  344  with the assistance of a roll pin  350  that is inserted through holes  352 ,  354  in the second shaft  342  and through a hole  353  in the locking lever  346  itself. The roll pin  350  serves as a pivot point about which the locking lever  346  can rotate a sufficient amount to facilitate detachment of the quick release adaptor  332  from the flywheel  14 . 
     As shown in  FIG. 19 , the locking lever  346 , in its preferred embodiment, utilizes a push pad  356  wherein finger or hand pressure P is applied forward of the roll pin  350  to overcome the force of the spring  348  (not shown), which is also located forward of the roll pin and beneath the locking lever  346  in the slot  344 . Pressure P rotates the locking lever  346  downward about the roll pin  350 . As seen in  FIG. 18  and extending from the push pad  356  is a locking lever shaft  358  such that when the locking lever  346  is positioned within the slot  344  the surface  360  of the locking lever shaft  358  is flush with, or slightly below, the outer diameter D 1  of the first shaft  340 . Maintaining the locking lever shaft  358  flush with the outer shaft diameter D 1  allows the quick release adaptor  332  to be inserted into a bore  16  of the flywheel  14  without interference. As shown in  FIG. 18  adjacent to the shaft  358 , and opposite the push pad  356 , is the locking pad  362 . The locking pad  362  utilizes a locking face  364  that upon insertion into and once passing through the bore  16  secures the quick release adapter  332  in position and prevents inadvertent extraction of the quick release adapter  332 . The upper surface  366  of the locking pad  364  is beveled at the same slope as the beveled edge  338  to further facilitate insertion of the quick release adapter  332  into position through the bore  16 . Once the locking pad  362  is inserted entirely through the bore the spring  348  forces the entire locking pad  362  upward including the locking face  364 . 
     As shown in  FIG. 21 , second shaft  342  with diameter D 2  includes internal threads  370  for installation of a standard bicycle pedal  330 . The preferred threads are standard 9/16 inch with 20 threads per inch; however, it should be understood that other thread configurations are also contemplated. 
     In operation, the bicycle pedal  330  is threaded into the internal threads  370  of the quick release adaptor  332 . The user then inserts the end of the quick release adaptor  332  with the beveled edge  338  into the desired flywheel bore  16  to the point where the locking face  364  of the locking pad  362  reaches the opposite side of the flywheel  14 . As shown in  FIGS. 20 and 22  once the locking face  364  reaches the opposite side of the flywheel  14  the force of the spring  348  pushes the locking face  364  upward to a point where the tip  372  of the locking face  364 , measured from the centerline CL of the shaft  340  exceeds the dimension D 1 . Once the tip  372  of the locking face  364  extends beyond D 1  the quick release adaptor  332  cannot be withdrawn through the bore  16  without the tip  372  of the locking face being lowered to at least D 1  because the tip  372  interferes with the opposite face of the flywheel  14  when attempting to withdraw the quick release adapted  332 . In order to withdraw the quick release adaptor  332 , the user must apply pressure P to the push pad  356  forward of the roll pin  350  thereby causing the locking lever  346  to rotate downward forward of the roll pin  350 . Once the tip  372  of the locking face  364  is lowered to a point where it less than D 1  from the centerline CL the entire assembly comprised of the quick release adaptor and the bicycle pedal  330  can be withdrawn from the bore  16  of the flywheel  14  and repositioned as desired by the user by repeating the steps outlined above. 
       FIGS. 23-27  show an exemplary orientation for the rotary rehabilitation apparatus  10  where the movable lever  12   a  is shown mounting with one of the radially outermost bores  16  of the flywheel  14 . In  FIG. 28 , an embodiment of the flywheel  14  having two series of linear bores  16  is shown. Each concentric dotted line on the flywheel disk  22  connecting bores  16  on different rows represents a certain distance from the center point  15  (i.e., point of rotation) of then flywheel  14 , for example, one inch. Thus, one can quickly determine the degree of adjustment achieved by mounting a movable lever  12   a  with one particular bore  16 .  FIG. 29  shows another flywheel  14  embodiment having four series of bores  16  with each row rotated 45 degrees with respect to one another. Other bore arrangements of 30 and 60 degrees, for example, are also contemplated as required by the needs of the user&#39;s extremities. This arrangement allows for more fine-tuning of the angle offset between the movable lever  12   a  and the fixed lever  12   b , which may be desired in certain rehabilitation regimens. 
       FIGS. 30 and 31  show one brace member  36  having a curved edge  76  for abutting the coupling  40  on an end opposite of the notches  32  of the circumferential ring  30 , and beveled edges  78  on either side of the curved edges  76 . Each beveled edge  78  of one brace member  36  abuts a beveled edge  78  of another brace member  36  extending along an adjacent row of the series of bores  16 .  FIGS. 32-34  also show the coupler  40  in detail. A cavity  80  is formed in the cylindrical coupler  40  and is shaped to receive the stem  44  of the hub  20 . Also as seen in  FIG. 10  along with  FIGS. 32-34 , a bore extends from the cavity  80  through the coupler  40  with a length sufficient to allow the fastener  39  to extend there through to reach the stem  44 . In this way, the coupler  40  provides the interface to more securely mount the flywheel  14  for rotation about the hub body  46 . 
     The motion of a person&#39;s legs  200  utilizing the rotary rehabilitation apparatus  10  of the present invention is simulated in  FIGS. 35-36  showing the hip joint  206 , the upper leg  208  (e.g., the femur), the knee joint  210  and the lower leg  212  (e.g., the tibia). In  FIGS. 35 and 36 , the fixed lever  12   b  is at a radial distance (e.g., 6 inches) from the flywheel  14  axis of rotation that is much greater that the radial distance of the movable lever  12   a  (e.g., 1 inch) from such axis of rotation. This provides a relatively large range of motion for the user&#39;s leg peddling the fixed lever  12   b  while providing a relatively small range of motion for the leg rotating the movable lever  12   a . In this configuration, the movable lever  12   a  limits the change in angle formed between the lower leg  212  and a tangent extension of the upper leg  208  to 11 degrees, with the angles remaining between 67 degrees and 56 degrees. 
     This rehabilitation regimen may be recommended when the user is not to bend their leg to a certain degree, for example, to limit stresses on the hip  206  or knee  210 . Conversely, in  FIGS. 37 and 38 , the movable lever  12   a  and fixed lever  12   b  are at the same radial distance (e.g., 6 inches) from the flywheel  14  axis of rotation. Thus, both of the user&#39;s legs will participate in a large range of motion when peddling with the apparatus  10 . The movable lever  12   a , in the embodiment of  FIGS. 37 and 38 , allows for the angle formed between the lower leg  212  and a tangent extension of the upper leg  208  to cycle between 6 degrees and 88 degrees. This large range of motion rehabilitation regimen brings about much more flexion and extension than the configuration of  FIGS. 35 and 36 , and consequently more movement of the hip and knee articulations. Thus, the embodiment of  FIGS. 37 and 38  may be preferred during a later stage of injury or post-surgery rehabilitation when the flexibility and strength of the affected joint, for example, a user&#39;s ACL or total knee arthroplasty (TKA) has increased. 
     In the embodiment of the rotary rehabilitation apparatus  218  shown in  FIG. 39 , for upper extremities including the shoulder, wrist and elbow, the adjustable range of motion for each arm  220  is achieved by having the movable hand lever  222  be repositionable along one or more diameters of the flywheel  224 . The flywheel  224  has a series of bores  226 , either linear or non-linear as discussed above and depending upon the needs of the user&#39;s extremities, extending laterally there through parallel to the flywheel rotational axis and formed in a row along the flywheel diameter so that the hand lever  222  can be removably mounted with one of the bores  226 . In the embodiment of the rotary rehabilitation apparatus  218  shown in  FIG. 39 , the flywheel  224  has two separate series of bores  226  each aligned along one flywheel diameter. As previously discussed and as shown in  FIGS. 5-7  is an embodiment revealing a series of non-linearly arranged bores in the flywheel which is also contemplated by this invention. 
     Shown in  FIGS. 40-44 , is a fixed hand lever for use on the flywheel  224  seen in  FIG. 39 . The fixed hand lever is mounted to the flywheel  224  which is rotatably mounted at the center point  228 . This configuration allows for lever adjustment both along the flywheel  224  diameter towards or away from the center point  228 , and concentrically on the flywheel  224  around the center point  228  such that the hand lever  222  may be at an offset angle relative to the fixed hand lever about the flywheel axis of rotation of 30, 45 and 90 degrees or multiples thereof. 
       FIGS. 40-44  show the components of the movable hand lever  222 . The hand lever body  248  may be tubular in shape or have other configurations that readily accommodate gripping by the human hand. The hand lever has a bore  250  extending through the body  248  from a lateral side face  252  to a medial side face  254 . A chamfer  256  is also formed at the bore entrance of the lateral side face  252 . A sleeve  258  has a first end  260  and a second end  262 , and is configured for insertion into the bore  250  such that the second end  262  extends out of the lever medial side face  254 . A pin  264  is inserted into the sleeve  258  and has a shank  266  extending out of second end  262  thereof, and a collar  268  having a concentric base  270  configured to abut the first end  260  and a beveled region  272  mateably fitting within the chamfer  256 . A protrusion  274  is formed on the shank  266  near an end distal to the collar  268  such that the pin  264  frictionally fits within one bore  226  of the flywheel  224  to secure the hand lever body  248  thereto. If enough of a pulling force is applied to the hand lever body  248  away from the flywheel  224 , the protrusion  274  is removed from the frictional fit in the bore  226  and may be repositioned as desired in another bore  226 . The lever body  248  and sleeve  258  are also rotatable about the pin  264  such that as the flywheel  224  rotates, the lever body and sleeve also rotate such that the user can continue to apply a force thereto with their hands and arms through the rotary motion. 
     Similarly contemplated for the embodiment directed to the upper extremities is the use of the quick release adaptor  332  that is referenced above. In place of the bicycle pedal that is depicted in  FIG. 18  would be a hand grip or other comparable device for gripping by the upper extremities. 
     Many alterations and modifications may be made by those having ordinary skill in the art without departing from the spirit and scope of the invention. Therefore, it must be expressly understood that the illustrated embodiment has been shown only for the purposes of example and should not be taken as limiting the invention which is defined by the following claims. The following claims are thus be read as not only literally including what is set forth by the claims but also to include all equivalent elements for performing substantially the same function in substantially the same way to obtain substantially the same result even though not identical in other respects to what is shown and described in the above illustration.