Patent Publication Number: US-2019192949-A1

Title: Portable Physical and Occupational Therapy Systems and Methods

Description:
BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present invention relates generally to physical and occupational therapy tools and methods. The present invention relates more specifically to balance pole structures and methods for their use that assist with the rehabilitation of a patient through physical and cognitive therapies. 
     2. Description of the Related Art 
     Physical therapists and occupational therapists have a wide range of tools and methods available to them to facilitate the rehabilitation of patients that require such recovery therapies. Some of these tools and methods are designed to address both physical and cognitive limitations that the patient may be experiencing as a result of illness or injury. While a wide range of structures and tools have been developed to assist therapists in the rehabilitation of a patient, very few might be considered to be portable in nature. In addition, the tools and methods that provide rehabilitation are generally dedicated only to physical therapies or only to occupational or cognitive therapies. Those systems that attempt to address both physical and occupational therapies with a patient at the same time are generally not portable in nature and typically require the patient to visit a therapist&#39;s office or clinic in order to engage in the rehabilitation activities. The portable tools that therapists do have available to them (such as resistance bands, step platforms, and the like) are typically limited in the range of exercises or activities that they can be implemented with. 
     Balance poles of different heights and orientations can provide a variety of options for a physical therapist and occupational therapist in the process of rehabilitating a patient. Existing therapy systems that utilize balance poles, however, tend to be fixed or stationary structures that the therapy patient must visit the therapist&#39;s office or clinic to utilize. Therapies associated with the use of balance poles or post targets and the like, are generally not constructed in such a way that a therapist can transport one or more of the structures to the location of the therapy patient. In addition, such existing tools and structures as may be found in a rehabilitation clinic are generally adaptable to but one or two methods of use. At best, a therapy clinic might provide a number of stations with variously configured poles and posts, used as sitting and/or standing targets along with an assortment of manipulable objects for one or more therapy patients to engage with on a rotating basis. 
     There are a range of diagnoses that result in a patient being prescribed sitting and/or standing therapies in order to improve their dynamic balance. Sitting balance as an initial goal is highly important for performing activities such as bed mobility, transfers, and other activities of daily living (ADL&#39;s). Patients should be able to complete balance activities that a therapist might direct, from their own wheelchair, from a firm or soft seated surface such as a treatment table, from an adjustable treatment mat, or from a hospital bed. Patients should be able to engage in a range of motion exercises that gradually provide the sitting balance that is required by ADL&#39;s. Various sitting therapies should allow a patient to work their shoulders, elbows, and wrists through a range of motions that vary according to height and distance from the patient. Varying the distance that the patient is required to move through can greatly facilitate the overall rehabilitation process. It is also important to incorporate mid-line training in seated physical therapy activities, especially when the therapy is part of neural rehabilitation. Diagonal training is a key component of neural rehabilitation and requires the therapy patient to exercise through a wide range of directional motions for arms, elbows, wrists, and hands that will address a wide variety of motion dysfunctions. Seated activities with such motion therapies allow patients to perform the activities generally unattended with relative safety. 
     Dynamic standing balance also plays a key role in everyday human function. The primary focus for improving dynamic standing balance is to reduce the risk of falls and provide safety and independence with functional mobility such as gait (walking). Patients that are able to complete standing exercises should thereafter be able to work on a variety of dysfunctions to improve overall dynamic standing balance. The initial step of performing a sit-to-stand activity improves gluteal strength and focuses on independence with transfer training and the like. Once in a standing position, therapy patients should again be able to work with across mid-line training activities, especially if their diagnosis is in any way neurologically related. Therapy patients should also be able to work on functional endurance training in the standing position. Endurance training can be used with a goal of improving the patient&#39;s functional standing tolerance which carries over into day-to-day functions such as walking to a car, performing ADL&#39;s such as teeth brushing, grooming, dressing, preparing meals, etc. 
     As with sitting therapies, standing therapies should also vary with respect to distance and angular motion to allow for stretching to various heights and leaning to various angles without jeopardizing standing balance. Eventually in a rehabilitation process, dynamic standing balance can be further challenged by introducing an unstable surface to the therapy activities. Unstable surfaces improve core strength and dynamic standing balance while the patient performs functional movements of the upper extremities and torso carrying out the range of motion, and the cognitive aspects of the therapy. 
     Speech therapists may also use a number of different physical and occupational therapy tools to improve cognitive function and to address neurological processing dysfunctions. 
     Patients can be required, for example, to perform activities that involve duplication of viewed patterns. Errors by the patient in duplicating such patterns can be recorded by the therapist and goals can be set to reduce the number of errors. Patients can be given a variety of patterns and be required to complete a wide range of tasks associated with the patterns using two-dimensional or three-dimensional tools and structures. Very detailed procedures maybe communicated to the patient orally or visually to direct the therapy patient to utilize various therapy tools to carry out range of motion, cognitive identification, and balance stability activities. 
     Once again, while a number of therapy tools and methods have been developed that address the activities and issues described above, few if any such tools and systems might be considered portable in nature, such that the physical or occupational therapist could bring the tools to the patient as opposed to requiring the patient to visit a fully outfitted rehabilitation clinic. Even among those tools and systems that are in use in rehabilitation clinics and the like that do provide these activities, most are narrowly focused on a single type of activity, rarely combining both physical and cognitive actions into a single activity, such that a therapy patient might engage in the activities without significant supervision. 
     There is, therefore, a need for portable physical and occupational therapy systems and methods that a therapist may use alone or in combination with other similar systems to provide a wide range of rehabilitation activities to therapy patients, especially those that are not able to utilize a centralized rehabilitation clinic or the like. It would be desirable if such a portable therapy tool system could be utilized alone or in combination with other similar systems to provide a wide range of sitting or standing, physical or occupational, therapies for the rehabilitation of the patient. 
     SUMMARY OF THE INVENTION 
     The present invention therefore provides portable physical and occupational therapy systems and methods with a uniquely adjustable balance pole assembly utilized as a target in combination with a number of manipulable objects, such as rings, that engage the target, all for the purpose of exercising patients through a range of motions and through a range of cognitive actions. The present invention provides a basic therapy tool set that incorporates a target pole of variable height utilizing a number of shorter pole sections connectable together. The target pole is pivotally positioned on a target base that provides stability to the pole when oriented vertically or at an angle. Each therapy tool set preferably includes a number of therapy rings sized and structured to be placed over the target pole top end and thereby be positioned on the target pole in either a random or patterned order. The height of the target pole may be varied by utilizing one or more pole sections at a time. The angle of the target pole with respect to the vertical (and therefore with respect to a horizontal platform on which the therapy tool set is placed) may be varied by releasing a pole angle lock on the target base to allow the pole to pivot and move to a new locking engagement point at a preset angle. Alternate pole height and pivot structures are anticipated that allow for variability in the height and angle of the target pole. 
     While the basic therapy tool set of the present invention may be utilized alone, it finds its best use in combination with additional therapy tool sets structured the same or similarly, and arranged in positions around the therapy patient in a manner that requires a variety of different motions be carried out according to the therapy regimen specified. A basic kit utilized by a therapist would preferably involve three complete therapy tool sets that may each be assembled and positioned in an array around a therapy patient for implementation of a wide range of physical and cognitive therapy routines. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a perspective view of the basic unit of the therapy tool set of the present invention shown in an assembled condition ready for use. 
         FIG. 2  is a top plan view of a kit making up the basic unit of the therapy tool set of the present invention shown in an unassembled condition. 
         FIG. 3  is an elevational side view of the basic unit of the therapy tool set of the present invention shown in an assembled condition ready for use, demonstrating the tilting angle feature of the invention. 
         FIG. 4A  is a top plan view of a group of three therapy tool sets of the present invention shown in a linear arrangement with two of the target poles angled outward. 
         FIG. 4B  is a top plan view of a group of three therapy tool sets of the present invention shown in a right angle arrangement with each of the target poles positioned vertically. 
         FIG. 5A  is an elevational side view of a group of three therapy tool sets of the present invention with varying heights and of different colors, shown in a linear arrangement with two of the target poles angled inward. 
         FIG. 5B  is an elevational side view of two therapy tool sets of the present invention shown with a pattern of rings on the first set to be emulated on the second set. 
         FIG. 6A  is a top plan view of an alternate structure for the target base of a therapy tool set of the present invention. 
         FIG. 6B  is a top plan view of a further alternate structure for the target base of a therapy tool set of the present invention. 
         FIG. 7  is a high level flowchart showing the basic therapy planning steps associated with a typical manner of utilizing the therapy tool sets of the present invention for both physical therapy and cognitive therapy. 
         FIG. 8  is a flowchart showing the basic therapy process steps associated with a primarily physical therapy regimen carried out in a sitting position utilizing the therapy tool sets of the present invention. 
         FIG. 9  is a flowchart showing the basic therapy process steps associated with a primarily physical therapy regimen carried out in a standing position utilizing the therapy tool sets of the present invention. 
         FIG. 10  is a flowchart showing the basic therapy process steps associated with a combined physical and cognitive therapy regimen carried out in a sitting or standing position utilizing the therapy tool sets of the present invention. 
         FIG. 11  is a flowchart showing the basic therapy process steps associated with a primarily cognitive therapy regimen carried out in a sitting or standing position utilizing the therapy tool sets of the present invention. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     Reference is made first to  FIG. 1  for a perspective view of a first structural embodiment of the basic unit for the therapy tool set of the present invention. Therapy tool set  10 , shown in  FIG. 1  fully assembled and ready for use, incorporates two primary structural components. Target pole  12  is fixed in an upright position on top of and extending from target base  14 . Target pole  12  is preferably constructed of target poles sections  11   a - 11   c . Breaking target pole  12  down into sections  11   a - 11   c  facilitates not only the storage and transport of therapy tool set  10 , but also the use of the therapy tool with target poles of different heights. Pole sections  11   a - 11   c  may be press fit one into the other or may include threaded connectors and/or spring pin connector locks. However the pole sections are connected together, they should present a smooth overall exterior surface such that therapy rings and the like may be easily placed on the target pole top end  24  and slide down to the target pole bottom end  26 . 
     Target pole  12  is secured to target base  14  by insertion of target pole bottom end  26  into pole socket  20 . Target base  14  (generally square in this first embodiment) incorporates base cross beams  16   a  &amp;  16   b  that extend from the perimeter of target base  14  to pole pivot  22  which pivotally supports pole socket  20 . In a preferred embodiment, pole pivot  22  comprises an inverted tee connector that rotates inside base cross beams  16   a  &amp;  16   b  and extends upward to where it is fixed with pole socket  20 . This structure provides a pivot point whereby target pole  12  may be fixed in a vertical upright position, or may be pivoted at an angle by releasing pole angle locks  18   a  &amp;  18   b  and rotating target pole  12  on pole pivot  22  to a predetermined offset angle, whereby pole angle locks  18   a  &amp;  18   b  reengage with alternate apertures. Although the present invention as shown in  FIG. 1  utilizes a specific type of spring loaded pin-in-aperture lock, with an inner cylinder rotating in the outer cylinder of base cross beam  16   a  &amp;  16   b , various alternate structures for establishing a variable angle pivot point on target base  14  are anticipated. 
     Once assembled as shown in  FIG. 1 , therapy tool set  10  may be oriented and positioned alone or in combination with additional tool sets to provide a versatile therapy system offering a wide range of methods of use. In general, the purpose of the therapy tool set is to provide a target and a number of manipulable objects (therapy rings in the described embodiment) that are directed toward and are intended to engage the target. In  FIG. 1 , two sets of therapy rings are provided, a first set  32   a - 32   n  preferably having a first color, along with a second set of therapy rings  39   a - 30   n  preferably of a second and distinct color. Different therapy ring colors, of course, allow for various cognitive therapy methods to be implemented. 
     Therapy tool set  10  shown in  FIG. 1  may be constructed from a range of different materials. While it is preferable that the tool set be compact and lightweight, it is also desirable that it be rugged and inexpensive to manufacture. Components made of PVC plastic tubular structures, including the therapy rings, are suitable for the present invention. Other lightweight plastic or metal components may likewise serve adequately for the structural materials that make up the parts and pieces of the therapy tool set. 
     The size of each therapy tool set  10  as shown in  FIG. 1  is dependent upon the range of motion exercises and therapies that it is intended to be used with. Because the tool set may be used with a therapy patient in either a sitting or standing position, some variability in the height is required. Once again, the pole sections as shown in  FIG. 1  facilitate the use of tool sets of varying height. The various methods of use described herein below are facilitated best by therapy tool sets that can vary in height from as low as two feet to as high as four feet, although the use of higher structures may be anticipated. Although the example in  FIG. 1  incorporates two therapy ring sets, each containing three rings, the number of rings appropriate for use with a single therapy tool set is not so limited. Again, as can be seen from the various methods of use described below, a large number of rings can be provided for implementation of a wide range of therapy methods. 
     Although each of the components of the present invention may be manufactured from the same type of material and retain the same basic color in appearance, it is preferable for the therapy ring sets to be of distinct colors for the purpose of implementing a range of cognitive therapies in addition to the physical therapies associated with simple ring and target placement. It is also preferable with some therapies to have target poles of distinct colors (described in more detail below) which color may be imparted to the components either at the manufacturing stage where colors are incorporated into the plastic material (for example) or later in the manufacturing process where components may be coated with particular colors. Additionally, color sleeves (not shown) may be used in connection with different target poles in order to vary the color of a specific target pole for use in a grouping of therapy tool sets. 
       FIG. 2  describes a preferred embodiment for a therapy kit  40  that incorporates one complete therapy tool set such as therapy tool set  10  shown in  FIG. 1  along with a wider array and number of therapy rings. Therapy kit  40  is structured to be collapsible and easily portable to allow a therapist to bring one or more such kits to a therapy session. The entire kit preferably includes the target pole, here broken down into pole sections  11   a - 11   c , as well as target base  14  shown separated from target pole sections  11   a - 11   c . Target base  14  in  FIG. 2  is shown in this top plan view to include base cross beams  16   a  &amp;  16   b  which extend towards the center and support pole socket  20 . The pole pivot structure described generally in  FIG. 1  is seen to be made up of the inverted t-shaped section  17  that rotates within the cylindrical interior of base cross beams  16   a  &amp;  16   b  and is rotationally fixed into position the using pole angle locks as described above. 
     A larger selection of therapy rings are shown in  FIG. 2  as preferably being included in therapy kit  40 , with therapy rings of a first color  42  provided, therapy rings of a second color  44  provided, and therapy rings of a third color  46  provided. These therapy ring sets are preferably stored and transported in ring bags  48   a - 48   c . As indicated above, a therapist may have one or more therapy kits  40  as shown in  FIG. 2  which may be used alone or in connection with other kits in various arrangements that are shown in and described with  FIGS. 4A &amp; 4B  (for example). 
       FIG. 3  shows the basic use of therapy tool set  10  over a range of angles provided by pole pivot  22  configured on target base  14 . Target pole  12  as shown in  FIG. 3  is again constructed preferably in pole sections (three in the embodiment shown) and is secured into pole socket  20  preferably with pole socket lock  23 . The therapist chooses not only the height of target pole  12  by selecting one, two, or three pole sections, but also selects the angle at which target pole  12  is to be positioned for the specific therapy session. Target pole  12  may be positioned directly upright, or may be angled at one or more preset angles to either side to alter (increase or decrease) the range of motion that the therapy patient is to utilize. Although a wide range of angles are possible, altering target pole  12  by 15 degrees, 30 degrees, or 45 degrees from the vertical provides an adequate range of different distances or angles for the physical therapy to be carried out. At the various preset angles, and with target base  14  stationary on the floor or other support surface, target pole top end  24  can be positioned in a wide range of locations to direct the therapy patient&#39;s engagement of the therapy rings onto the target pole. 
     In the example shown in  FIG. 3 , the therapy patient is in the process of placing therapy rings  50  onto target pole  12  in a specific ordered manner based upon the color of the rings. In the example shown, one of the therapy rings of a third color is placed first on target pole  12 , followed by a therapy ring of a second color, and thereafter a therapy ring of a first color. These therapy rings, for example, may be placed by the therapist with instructions to the patient to duplicate the pattern of the rings on the target pole  12 . Thereafter, the therapy patient may place ring  46   b  of the third color, followed by ring  44   b  of the second color, followed by ring  42   b  of a first color to duplicate the pattern established by the therapist. Additional sets of three different colored rings may then follow as shown with ring set  50  in  FIG. 3 . This basic cognitive exercise may be carried out on the single therapy tool set  10  in a range of angled positions to provide physical motion therapy at the same time as the cognitive activities occur. 
     Reference is next made to  FIGS. 4A &amp; 4B  for a description of alternate arrangements of multiple therapy tool sets of the present invention. In each of  FIGS. 4A &amp; 4B  three therapy tool sets  10   a - 10   c  are utilized in an arrangement that allows for variability in the therapy regimen. In  FIG. 4A , therapy tools sets  10   a - 10   c  are positioned in a linear arrangement to provide three target poles at spaced distances from each other. In addition to varying the distance between each therapy tool set  10   a - 10   c , the angle of each target pole  12   a - 12   c  may be varied so as to increase or decrease the distance between the respective target pole top ends. In the example shown in  FIG. 4A , a distance D 1  is established between a center therapy tool set target pole  12   b  and a left therapy tool set target pole  12   a . This orientation places the therapy patient (either seated or standing) in front of the linear array of therapy tool sets  10   a - 10   c  with tool set  10   a  positioned on their left and tool set  10   c  positioned on their right. D 1  therefore represents a range of motion distance between a center line and the angled extreme point of placement for the target pole top end for tool set  10   a . Distance D 2  represents a right range of motion from the same center point to the right of the therapy patient. These distances, of course, may be independently varied if, for example, the therapy patient&#39;s right or left side requires greater range of motion rehabilitation. While cognitive therapies could be used with the arrangement shown in  FIG. 4A , this linear arrangement of multiple therapy tool sets lends itself most readily to modifying and varying range of motion by increasing distances D 1  &amp; D 2  from very small (where  12   a  &amp;  12   c  may be angled inward toward target pole  12   b ) or very large as is shown in the example of  FIG. 4A . 
       FIG. 4B  provides a similar structural arrangement to the linear arrangement of  FIG. 4A  except that the left and right tool sets  10   a  &amp;  10   c  are positioned closer in to the patient. This arrangement of tool sets  10   a - 10   c  may be of benefit for therapies that involve radial motion in a clockwise or counter-clockwise progression as is suggested by the broken line in  FIG. 4B . Although not shown in  FIG. 4B , target poles  12   a - 12   c  could likewise be angled either away from the therapy patient or towards the therapy patient to provide a small diameter radial range of motion process or a larger diameter radial range of motion. It will be recognized, for example, that therapy tool set  10   a  might be turned 90 degrees so that target pole  12   a  may be angled outward rather than to the side. Similar reorientations of therapy tool sets  10   b  &amp;  10   c  may accommodate larger or smaller range of motion therapies. 
     Although the square base configuration of the present invention shown in  FIGS. 4A &amp; 4B  lends itself to the linear and angled arrangements shown, alternate embodiments with circular or S-shaped bases (described in more detail below) could likewise be implemented in the same types of groups and arrangements. The essential features of the base structure include stability over a range of angles (for the target pole); collapsibility for transport; and some facilitation of the placement of therapy tool sets next to each other. Additionally, simple clips snapped over the base structures of two adjacent therapy tool sets may be used to improve stability and maintain the arrangement of multiple therapy tool sets established by the therapist. 
     Reference is next made to  FIGS. 5A &amp; 5B  which are elevational views of groups of therapy tool sets used in additional types of therapy regimens.  FIG. 5A  shows, as an example, the same alignment shown in  FIG. 4A  with a group of three therapy tool sets  10   a - 10   c , but with the target poles angled in different directions and configured with different lengths. In this arrangement, a first therapy tool set  10   a  is configured with a single target pole section forming target pole  12   a  angled inward towards a second therapy tool set  10   b . The second therapy tool set  10   b  is configured with a long target pole  12   b , in this case made up of three target pole sections. Finally, a third therapy tool set  10   c  is positioned to the right of the center therapy tool set  10   b  and is configured with two target pole sections forming target pole  12   c  and angled inward toward the center pole. Again, the arrangement shown is merely representative of a wide variety of arrangements and configurations that one or more of the therapy tool sets may be set up in. 
     Additionally shown in  FIG. 5A  is the use of distinct target pole colors, established either with color manufactured into the material of the target pole sections (such as colored plastic molded material), using colored coatings on the pole material, or through the use of colored sleeves (not shown) that extend over a neutral colored pole material. In any case, the arrangement shown in  FIG. 5A  lends itself to not only physical therapies addressing range of motion and the like, but also cognitive therapies where color matching might be required between a first color set of therapy rings  42  that are positioned on the center therapy tool set  10   b  with a second color set of therapy rings  44  positioned on a similarly colored therapy tool set  10   a . Finally, a third color set of therapy rings  46  is positioned on a like colored therapy tool set  10   c . Once again, a wide range of therapy methods may be implemented in conjunction with the basic grouping of three variable height, different colored, therapy tool sets. 
       FIG. 5B  provides an example of the use of two therapy tool sets  10   a  &amp;  10   b , one of which ( 10   a ) is established with a reference pattern  49  of therapy rings already in place on target pole  12   a . The therapist may, for example, create an orderly or random sequence of therapy ring colors in the reference pattern  49  and direct the therapy patient to duplicate the pattern on a second therapy tool set  10   b . In this case, the placement and angle of the target pole  12   b  is less important than the matching of the reference pattern established by the therapist.  FIG. 5B  shows the therapy patient establishing the initial pattern of rings  52  on therapy tool set  10   b  and in the process of adding additional rings  54  copying the pattern to the top end of target pole  12   b  in an effort to recreate the overall reference pattern  49  established by the therapist. Once again, the pattern matching process shown generally in  FIG. 5B  may be combined with any of a range of motion exercises and therapies suggested by the arrangements of  FIGS. 4A &amp; 4B . 
     As indicated above, the present invention anticipates the use of various types of target bases to provide stability to the target pole in both an upright position and at an angle. The size and shape of the target base must be adequate to maintain stability for the therapy tool set, even when an extreme angle (45 degrees, for example) might be implemented on the particular target pole extending from the target base. Two alternate base structures are shown in  FIGS. 6A &amp; 6B .  FIG. 6A  shows a circular target base  64  for therapy tool set  60  that is similar in many respects to the square or rectangular base shown in the above described embodiments. Target base  64  includes base beam  66  preferably with pole pivot  62  structured in a manner identical to that shown above with the square or rectangular base. One advantage of the circular base shown in  FIG. 6A  is the ability to rotate the orientation of base beam  66  in any direction without concern for contact between the edges or corners of the base as would be of concern with a square or rectangular base. In this manner, the angle of the target pole configured with therapy tool set  60  may be less restricted in its orientation as compared to the more limited orientations shown in  FIGS. 4A &amp; 4B  utilizing square bases. 
       FIG. 6B  provides a therapy tool set  70  with an even more versatile S-shaped or C-shaped base. In the versatile embodiment shown in  FIG. 6B  the base is made up of first base arm  74   a  and second base arm  74   b . Each of these semi-circular arms are connected to a residual base cross beam that supports an inverted tee connector that serves as pole pivot  72 . The versatility of the design shown in  FIG. 6B  lies in being able to position the base arms  74   a  &amp;  74   b  independent of each other. In one configuration, an S-shaped base is established (solid lines shown in  FIG. 6B ) or in an alternate arrangement first base arm  74   a  maybe flipped over on the same side of the target pole as shown in broken line  74   a  position. 
     The S-shaped or C-shaped base shown in  FIG. 6   B lends  itself to interlacing of multiple therapy tool sets with the base arms of each extending into a base arm of an adjacent therapy tool set. In this manner, a compact arrangement of target poles may be established. In any case, the independently movable base arms  74   a  &amp;  74   b  continue to provide the required stability and versatility with regard to the use of a long target pole vertically oriented, or shorter target poles, each of which may be angled as described above. Other geometries for the target base are anticipated and as long as the primary requirement of maintaining stability through a range of target pole angles is met, alternate geometries may allow for an even greater range of therapies by positioning the target pole top ends of a number of therapy tool sets in an almost infinite range of positions. 
     Reference is next made to  FIGS. 7-11  for detailed descriptions of representative methods associated with the use of the therapy systems described above. These methods for using the structures and devices of the present invention provide a wide range of both physical and occupational therapies. That is, the systems of the present invention are designed to provide therapies for both physical rehabilitation and cognitive rehabilitation. The methods described below may be carried out with one or many of the standard therapy tool sets described above. The various embodiments of the tool sets described lend themselves to a wide range of therapy methods that are generally categorized and outlined by the specific method procedures described. 
     Reference is made first to  FIG. 7  for a flowchart showing the method for setting up the therapy activity and carrying out performance of the process. Therapy setup and performance routine is initiated at Step  200  and begins with the therapist initially determining at Step  210  whether the therapy is to be primarily directed to physical rehabilitation or a combination of physical and cognitive rehabilitation. If there is a cognitive component, determined at decision Step  212 , then the therapist determines at decision Step  216  whether there should also be a physical component to the therapy. If there should also be a physical component to the therapy, then the process proceeds to therapy routine Step  222  (Connector C) shown in detail in  FIG. 10 . If there is a cognitive component but not a significant physical component, then the process proceeds to therapy routine Step  224  (Connector D) shown in detail in  FIG. 11 . 
     If there is not a primary cognitive component (i.e. the primary objective of the therapy is physical rehabilitation) then the decision process moves to decision Step  214  to determine whether the therapy patient should be sitting or standing. If standing, the process continues to therapy routine Step  220  (Connector B) shown in detail in  FIG. 9 . If the therapy patient is to be sitting during the therapy, then the process proceeds to therapy routine Step  218  (Connector A) shown in detail in  FIG. 8 . 
       FIG. 8  provides, beginning with Step  300 , a therapy that is directed primarily to physical rehabilitation with the therapy patient in a sitting position. Step  310  involves the therapist confirming the seating structure and height appropriate for use with the particular therapy patient. This step involves determining whether the patient is in a wheelchair, a folding chair, a therapy bench, or another type of seating arrangement. The nature of the sitting position is determinative of both the number of therapy tool sets utilized, as well as their height and angular orientation. 
     At Step  312 , the therapist selects one to three (or more) balance pole assemblies to be used in this primarily physical therapy setting. Step  314  involves the process of structuring the therapy environment, including positioning balance poles in proximity to the therapy patient&#39;s seating structure at Step  316 ; adjusting the height of each balance pole by, for example, assembling one to three pole sections for each of the balance pole assemblies at Step  318 ; and adjusting the angle of each balance pole by some orientation from the vertical at Step  320 . 
     Next in the process, the therapist determines whether to incorporate across mid-line or diagonal training at Step  322  before beginning the preparation of the step by step therapy regimen. The therapist then prepares the therapy regimen order and procedure at Step  324  and communicates this in writing or orally to the therapy patient. Finally, at Step  326  the therapy patient carries out the therapy regimen according to the directions received from the therapist. 
       FIG. 9  discloses a second general category of therapy, comprising a primarily physical therapy process, with the therapy patient in a standing position. Initiated at Step  400 , the primarily physical standing routine begins in much the same manner as the primarily physical sitting routine. At Step  410  the therapist establishes the specific standing position that the therapy patient will take. Because part of many physical therapy routines involve the therapy patient standing on an unstable surface the therapist decides at Step  410  whether or not to implement the therapy system of the present invention on a stable or unstable surface. At Step  412  the therapist selects one to three (or more) balance pole assemblies to be utilized in the therapy. 
     Again, the therapist structures the therapy environment at Step  414  which includes positioning the balance poles in proximity to the standing position of the therapy patient at Step  416 ; adjusting the height of each balance pole by assembling one to three balance pole sections for each balance pole assembly at Step  418 ; and adjusting the angle of each balance pole at Step  420 . 
     At Step  422  the therapist confirms the basic standing balance position by determining the pre-activity stability of the therapy patient. Modifications to the stable or unstable surface on which the therapy patient is standing may be made. The therapist determines whether to incorporate across mid-line or diagonal training at Step  424 . An additional parameter included in the standing therapy regimen involves an endurance element associated with activity timing. The therapist determines at Step  426  whether to incorporate such an endurance element in the therapy session by establishing timing parameters for either intermittent activity completions or total activity completion times. Finally, the therapist prepares the overall therapy regimen order and process at Step  428  and communicates this to the therapy patient. At Step  430  the therapy patient carries out the therapy involving the primarily physical standing regimen. 
     Reference is next made to  FIG. 10  for a description of the process of implementing the system of the present invention in connection with a therapy session that it both cognitive and physical, with both aspects being significant for the rehabilitation. Therapy cognitive and physical routine is initiated at Step  500 . At Step  510  the therapist establishes the sitting or standing, physical positioning parameters as described above. These include the balance pole assembly positions, heights, and angles. At Step  512  the therapist selects two or more different colored balance pole assemblies for use in the particular therapy session. 
     As before, the therapist structures the therapy environment at Step  514 . This structuring of the environment includes positioning the balance poles (in various colors) in proximity to the therapy patient at Step  516 . The therapist further provides various ring sets of two to three or more different colors introduced into the therapy environment at Step  518 . Finally, the therapist may optionally provide visual pattern matching charts or images, or may provide pre-constructed patterns on balance pole assemblies for the therapy environment at Step  520 . 
     As before, the therapist determines whether to incorporate across mid-line or diagonal training at Step  522 . In this combined cognitive and physical therapy regimen, the therapist may optionally provide at Step  524  an initial ring pattern to be duplicated on a balance pole assembly by the therapy patient. This Step  524  pre-constructed pattern process is demonstrated in a general manner by the assemblies shown in  FIG. 5B  and described above. The therapist then determines at Step  526  whether to incorporate a speed element into the activity by timing the therapy patient through all or part of the process. At Step  528  the therapist prepares the overall therapy regimen order and process and communicates this to the therapy patient. The therapy patient carries out the cognitive and physical regimen at Step  530 . 
     Reference is finally made to  FIG. 11  for a description of the process of implementing a combination cognitive and physical therapy regimen that minimizes the physical component and focuses instead on the cognitive elements of therapy, in association with the systems of the present invention. The therapy primarily cognitive routine is initiated at Step  600 . At Step  610  the therapist establishes the basic sitting or standing physical positioning parameters as before to generally place all objects involved in the therapy within reach of the therapy patient. Again, the emphasis in this routine is less on the physical range of motion and more on the therapy patient&#39;s recognition of colors, patterns, and hand-eye coordination. At Step  612  the therapist selects two to three or more, different colored balance pole assemblies for use in the therapy session. 
     Once again, at Step  614  the therapist structures the overall therapy environment utilizing the systems and components of the present invention. The balance poles in various colors are positioned in proximity to the therapy patient at Step  616 . The therapist then provides assorted ring sets, preferably two to three rings sets or more, in different colors, to the therapy environment at Step  616 . The therapist may provide a visual pattern matching chart or image that may simply be spoken to the therapy patient, or may be printed on paper or poster within view of the therapy patient. As described above, other methods for presenting a visual pattern to be matched are anticipated. One such option for providing a visual pattern is described at Step  622  in  FIG. 11  where the therapist may provide an initial ring pattern structured on a first balance pole assembly (established by the therapist) to be duplicated on a second balance pole assembly by the therapy patient. 
     Once again, the therapist decides whether to provide a speed element at Step  624 . This may involve an intermediate timing of a portion of the overall activity or timing of the completion of the overall activity by the therapy patient. The therapist prepares the therapy regimen order and process at Step  626  and communicates the same to the therapy patient. At Step  628  the therapy patient carries out the primarily cognitive therapy regimen. 
     Although the present invention has been described in connection with a number of preferred embodiments, for both the structures of the system and the steps in the methods, these embodiments are not considered to be limiting of the invention as further embodiments should be evident to those skilled in the art. These further embodiments still fall within the spirit and scope of the invention as set forth in the claims that follow. Where specific component sizes are mentioned in the above descriptions, these dimensions are representative of the spatial dimensions associated with the ranges of motion for the average person in a sitting or standing position. Although the preferred embodiments generally describe hollow tubular frame structures for the target poles and target bases, solid components are capable of carrying out the same or similar functions under the limitations of the claimed invention. The methods of use described in the preferred embodiments are intended to be representative of categories of rehabilitation regimens that might implement the systems of the present invention. As indicated, the therapy tool set of the present invention provides a versatile device that encourages the therapist to develop ever more innovative activities and exercises to provide physical and cognitive rehabilitation. The methods described and claimed herein therefore lend themselves to extension and refinement based upon the needs of a particular therapy patient and the rate of rehabilitation progress experienced.