RU2372886C1 - Inphyta-therapeutic approach in children suffering from infantile cerebral paralysis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine and concerns therapy of the patients with infantile cerebral paralysis. The approach is implemented as follows: a child is made sit down set with contact longitudinally applied external plates 9x6 cm in parallel to spine on cervical. On a panel of the device "INPHYTA" modulation frequency 52 Hz is set up. At the first procedure exposure time is 1 minute, 2 minutes - at the 2^nd, 3 minutes - at the 3^rd, 5 minutes - at the 4^th, 5 minutes - at the 5^th, 3 minutes - at the 6^th, 2 minutes - at the 7^th and 1 minute at the 8^th procedure. Therapeutic course is 8 daily procedures. The approach ensures more evident positive effect on clinical values (in the patients, original muscular tonus is decreased, range of motions is enlarged, attention and memory are improved). Said frequency of pulse low-frequency electromagnetic field possesses more biotropic action on metabolic processes, neuromuscular transmission, regional blood circulation and cerebral bioelectrogenesis.

EFFECT: performed therapeutic course considerably improves functional condition of the patient, and improvement is stated in 88,5% of patients.

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Description

The invention relates to medicine and relates to the treatment of children with cerebral palsy.

The frequency of perinatal pathology in the structure of diseases of newborns and children of the first year of life is 60-80%. This pathology is the main reason for the development of cerebral palsy, hydrocephalus, as well as diseases of the internal organs, leading to the development of minimal cerebral dysfunction (Losinskaya N.E., Kiryanova V.V., 2007). According to various statistics, in 6-10% or more of children who have had perinatal encephalopathy, later, by 6-10 months, a clear picture of cerebral palsy is formed (Semenova K.A., 2001). According to the UN, cerebral palsy takes the first place in the structure of child disability according to the neurological profile (Strukova G.M., Duberman T.M., Zinovieva S.E., 2007) and makes up 24% (Skvortsova I.A., Osipenko T.N., 1993). The prevalence of cerebral palsy in various regions of Russia is from 2.5-5.6 to 8.9 per 1000 children (Zykov V.P., Shadrin V.N., Komarova IB, 2003).

There is information in the literature on the use of physical methods of treatment (magnetotherapy, micropolarization, EHF puncture, electrical stimulation) for perinatal brain damage in children of the first year of life and cerebral palsy with positive results.

In the last decade, scientists have been attracting great attention to studies of weak electromagnetic fields of non-thermal intensity, their effect on the human body is being studied. The basis of this effect is the specific effect of small doses of physical factors.

A pulsed low-frequency electromagnetic field affects neurohemodynamics, general hemodynamics, microcirculation and immunity. The effect is based on the high sensitivity of the body to certain frequencies of weak electromagnetic fields, acting as a soft threshold stimulator. Correcting the functional state of the hypothalamic-pituitary system, as well as the bioelectric activity of the cerebral cortex, the electromagnetic field affects the entire body (Makarov G.S., 1992).

Under the influence of a pulsed low-frequency electromagnetic field, the inhibitory systems of the central nervous system are activated, its excitability is reduced, and the balance of the main nervous processes in it is normalized. All this, in turn, leads to the normalization of the process of voluntary relaxation of skeletal muscles, increase its speed and, accordingly, to improve the functional state of the body (Denisenko Yu.P., Vysochin Yu.V., 2006).

A known method of treating children with cerebral palsy using pulsed low-frequency electromagnetic field from the apparatus "INFITA" with a modulation frequency of 20 Hz (Ponomareva CO., Babina L.M. Clinical and electrophysiological parameters under the influence of infatherapy in patients with cerebral palsy. / / Abstracts of the scientific-practical conference “Physiotherapy - an actual direction of modern medicine.” - St. Petersburg, 2007, p. 263-265). The procedures were prescribed from the 9 × 6 cm extension plates contactally, stably to the cervical spine paravertebrally, modulation frequency of 20 Hz, lasting 1 min on the 1st day, 2 min on the 2nd day, 3 min on the 3rd day, 5 min on the 4th day, 5 min on the 5th day, 3 min on the 6th day, 2 min on the 7th day and 1 min on the 8th day, daily. The course has 8 procedures.

Under the influence of the therapy, a positive dynamics was observed in the general condition of children and an improvement in cerebral hemodynamics according to a rheoencephalographic study.

Given that a pulsed low-frequency electromagnetic field has a regulatory effect on neuro- and hemodynamics, microcirculation based on the biomedical resonance effects of weak electromagnetic fields, to which the human body exhibits particularly high individual sensitivity, the authors considered it advisable to use these properties for the treatment of patients with central perinatal lesions nervous system and cerebral palsy.

The technical result of the proposed method is to improve the central blood supply, oxygen saturation of the blood, increase the redox processes and, as a result, improve the neurodynamic and hemoliquorodynamic processes in the central parts of the nervous system.

The technical result is achieved by the fact that the method, including the influence of a pulsed low-frequency electromagnetic field from the INFITA apparatus, is characterized in that they use the influence of an electromagnetic field with a modulation frequency of 52 Hz, with the arrangement of paired emitters in the form of extension plates on the cervical spine, paravertebrally, 1 min in the first procedure, 2 min in the 2nd, 3 min in the 3rd, 5 min in the 4th, 5 min in the 5th, 3 min in the 6th, 2 min - at the 7th and 1 min - with the 8th procedure, daily, 8% per treatment course edur.

Under the influence of a pulsed low-frequency electromagnetic field with a modulation frequency of 52 Hz, the most pronounced reaction is expected from the regulatory substances of the central nervous system (hypothalamus - cerebral cortex - hippocampus - reticular formation of the midbrain), which determines the information-modulating nature of the effect on the nervous system, which is significant for this pathology in the context of complex rehabilitation therapy, requiring an adequate regulatory factor.

The method is as follows: the child is seated, the extension plates 9 × 6 cm are longitudinally contacted, parallel to the spine on the cervical spine. On the panel of the apparatus "INFITA" set the modulation frequency of 52 Hz. The exposure time is 1 minute with the first procedure, 2 minutes with the 2nd, 3 minutes with the 3rd, 5 minutes with the 4th, 5 minutes with the 5th, 3 minutes with the 6th, 2 minutes - at the 7th and 1 min. - with the 8th procedure, daily. There are 8 procedures per treatment course.

The method is illustrated by the following example.

Patient Denis S., 2 g. 10 months. (medical history No. 927), he was admitted to the neuropsychiatric department of the clinic of the Federal State Institution Pyatigorsk State Research Institute of Health and Health of the Russian Federation on 05/20/2007 complaining of the inability to stand and move independently.

A child from the 1st pregnancy proceeding against the background of toxicosis in the 1st and 2nd half, anemia and the threat of termination in the early stages. Childbirth at 28 weeks. Chronic fetal hypoxia. The baby was born with a mass of 1780.0. Applied obstetric benefits in childbirth. Within 1 month was in the intensive care unit. Early neuropsychic development was delayed: he began to hold his head confidently at 3 months, and sit at 9 months. At present, she doesn’t stand on her own, does not walk, does not speak. The diagnosis of cerebral palsy was made at 11 months. He was treated 2 times a year on an outpatient basis and once in a hospital.

When viewed from the internal organs there are no changes.

Neurological status

Study of craniocerebral innervation: moderate convergent strabismus, no other disorders were detected. Do not stand alone, do not walk. Reliance on socks, with a cross in the lower third of the legs. Limitation of the range of active movements in the lower extremities and dilutions in the hip joints, unfixed flat-valgus deformity of the feet. Manipulative function is reduced, but to a lesser extent. Tendon reflexes of the upper limbs are enlivened, D = S, lower limbs - high, D = S. Babinsky's pathological reflex on both sides. Sensitivity (tactile) is not broken. Understands addressed speech. Pronounces individual syllables. On the electroencephalogram - slow-wave (delta) activity dominates. Sharp waves. With photostimulation, paroxysmal activity is recorded. On the electromyogram, a decrease in the bioelectrogenesis of paretic muscles is determined: the amplitude of oscillations of the extensors of the hand is 167 μV, flexors - 122 μV, the anterior tibial muscle - 158 μV, and the calf - 125 μV. Indicators of rheoencephalographic studies indicate the presence of obstructed venous outflow, increased peripheral pulse vascular resistance and indirect signs of intracranial hypertension.

Clinical diagnosis: cerebral palsy, spastic diplegia of moderate severity. Delay in psycho-speech development.

Comprehensive treatment was carried out, including massage, exercise therapy, a speech therapist and a physiotherapy course - “INFITA” therapy from 9 × 6 cm extension plates, contact, stable paravertebral to the cervical spine, modulation frequency 52 Hz, 1 min duration in 1- 2nd day, 2 minutes on the 2nd day, 3 minutes on the 3rd day, 5 minutes on the 4th day, 5 minutes on the 5th day, 3 minutes on the 6th day, 2 minutes on the 7th day and 1 min on the 8th day, daily. The course has 8 procedures.

The child's treatment tolerance was good.

After the course of treatment, the condition improved. Muscle tone in the lower extremities decreased, began to lower the foot to the heel, the support improved. Strength in the hands increased, manipulative function improved, began to hold a spoon. The vocabulary has increased.

On the electromyogram, the amplitude of oscillations in the flexors of the hand increased by 50 μV (122-172 μV), in the extensors - 55 μV (167-222 μV), in the calf - 38 μV (125-163 μV), in the anterior tibial muscles - 62 μV (158-220 uV).

The electroencephalogram is dominated by slow-wave delta activity, with pointed waves. Betta activity has appeared. Paroxysmal activity during photostimulation is maintained.

At rheoencephalogram, spasm of peripheral vessels decreased slightly, venous outflow from the cranial cavity improved.

Based on clinical and electrophysiological parameters, treatment results were evaluated as a significant improvement.

The proposed method of treatment was tested on a group of children: the main group - 26 people, 26 children - a control group.

Both groups of patients were quantitatively equivalent, but not according to the severity of the lesion (table 1).

Among the patients of the main group, three did not hold their heads in an upright position, and two - held uncertainly, 5 - did not sit without support, 15 - did not stand and did not walk. Manipulative function was severely impaired in 10 and partially in 8, delayed psycho-speech development in 20, with no speech in four, gross dysarthria revealed in 9, dyslalia in 7 children. The history of epiparoxysms is in 2 people.

Of the observed patients in the control group, 5 people did not hold their head steady, 9 did not sit and did not stand on their own, 10 children could not walk on their own. Manual motor skills were impaired in 16 children. Delay in psycho-speech development was observed in 18 children, speech was absent in 8, severe dysarthria was observed in 6, dyslalia in four children.

All patients underwent treatment, including a sanatorium regime, a balanced diet, physiotherapy exercises, massage, and a speech therapist.

In addition, the children of the main group received physiotherapeutic procedures according to the proposed method, i.e. "INFITA" therapy for the cervical spine with a frequency of 52 Hz, duration 1 min - 2 min - 3 min - 5 min - 5 min - 3 min - 2 min - 1 min, and in the control - "INFITA" therapy of the same localization and duration, but with a frequency of 20 Hz. The number of procedures is 8 per course in both study groups.

Under the influence of treatment, changes in the clinical status were noted in the main group (see table 2): both children (100%) began to confidently hold their heads in an upright position, and one of the three not holding muscles of the neck became stronger, and he began to hold his head more confidently ( 33.3%). Two out of five (40%) began to sit with little support, 6 children were able to stand up while holding on to a support (40%), 1 - on their own (50%), 3 (20%) learned to walk, holding on to one hand. Manipulative function improved in 11 children (42.3%), vocabulary expanded in 8 people (40%).

The emergence of new functional capabilities was facilitated by a decrease in the initially increased muscle tone and an increase in muscle strength. In patients of the control group, the positive changes were slightly lower. Only one (11.1%) was able to stand, holding on to the support (40%). Two (66.7%) children began to sit with little support. One child (14.2%) out of 7 learned to walk, holding one hand. Only 10 children (38.5%) improved manual motility. Speech improved in 5 (27.8%) patients. Comparative dynamics are presented in table 2.

table 2 The dynamics of clinical indicators Clinical sign Patient groups Main Group Control group quantity percent quantity percent Began to hold his head 3 out of 5 60 2 out of 5 40 Steel with support: sit 2 out of 5 40 2 out of 9 22.2 to stand 6 from 15 40 1 from 9 11.1 to walk 3 from 15 twenty 1 from 9 11.1 Independently: sit 8 from 9 88.9 2 out of 3 66.7 to stand 1 from 2 fifty 1 from 7 14.2 to walk 1 from 2 fifty 1 from 7 14.2 Improvement: hand motility 11 from 26 42.3 10 from 26 38.5 Speeches 8 from 20 40 5 from 18 27.8

The data in the table indicate that according to the main clinical signs, namely motor capabilities, which are most important for children with cerebral palsy, improvement among patients of the main group was observed 2-3 times more.

The study of electromyographic indicators revealed a significant increase in the amplitude of the oscillations during movement of the muscles of the hand and lower leg.

By the end of the course of treatment, the oscillation amplitude in the main group significantly increased, compared with the initial value, in the muscles of the hand - by 64.5 μV, in the calf muscle - by 33 μV, in the anterior tibial - by 30 μV.

In the control group, changes in bioelectrogenesis were slightly lower: in the muscles of the hand, the oscillation amplitude improved by 16 μV, in the muscles of the lower leg - by 33 μV, in the anterior tibial - by 23 μV. The results are presented in table 3.

Table 3 EMG Oscillation Amplitude Dynamics Dynamics of indicators Main group Control group Indicators Before treatment, M ± m ₁ After treatment, M ± m ₂ R Before treatment, M ± m ₁ After treatment, M ± m ₂ R m. flexor carpi 76.3 ± 16.5 120.9 ± 18.6 <0.005 67.9 ± 11.7 84.2 ± 11.7 <0.1 m. extensor carpi 166.5 ± 17.7 183.0 ± 12.9 = 0.09 74.2 ± 16.3 80.8 ± 13.6 <0.2 m.gastrocnemius 134.3 ± 12.1 167.0 ± 15.3 = 0.006 140.9 ± 11 174.6 ± 12.4 ≥0.05 m.tibialis 149.2 ± 13.4 179.9 ± 17.0 <0.005 141.9 ± 7.5 164.6 ± 7.5 <0.05

Analyzing the main parameters of the bioelectric activity of the brain, the authors revealed a decrease in the number of electroencephalograms with the presence of pathological elements. In the main group of patients, slow wave paroxysms before treatment were recorded on an EEG in 15 (55.6%) patients; after treatment, the number of such patients decreased to 9 (33.3%). A significant positive trend in the differentiation of the leading rhythm: before treatment, the leading betta rhythm was on the electroencephalogram in 2 children (7.4%), after treatment - in 10 (37%).

The following dynamics of indicators was observed in the control group: paroxysmal activity was recorded on the electroencephalogram before treatment in 6 (23.1%) patients, after treatment the number of such patients decreased to 3 (11.5%), while there was no clear positive dynamics in the differentiation of the leading rhythm noted.

Changes in cerebral hemodynamics are as follows:

the venous outflow index increased by 32.1%, which is 7.6% more than in the control group, the initially reduced pulse wave propagation time characterizing the elastic properties of blood vessels increased by 32.5% in the main group and by 8.85 % - in the control, and initially increased decreased by 36.04% - in the main and 9.8% - in the control group. The initially increased peripheral pulse vascular resistance in the main group decreased by 21.1%, while in the control group it decreased by 14.3%.

Thus, in the compared groups, significant positive dynamics are noted: there is an increase in blood flow to the brain against the background of an improvement in the elastic properties of blood vessels, an improvement in venous outflow due to a decrease in spasm and normalization of vascular tone is also recorded, the latter being more pronounced in the main group. Comparative dynamics of rheographic indicators are presented in table 4.

After analyzing the clinical and functional state of patients after treatment in both groups, the authors stated the following results (table 5).

Table 5 The results of treatment of patients with cerebral palsy under the influence of treatment Indicators Patient groups Main Control n % n % Significant improvement 12 46.2 5 19.7 Improvement eleven 42.3 12 46.2 Slight improvement 3 11.5 9 34.1

The data obtained indicate a more pronounced positive effect of "INFITA" therapy with a modulation frequency of 52 Hz according to the proposed method in complex treatment with physiotherapy, massage and a speech therapist on clinical, neurophysiological and hemodynamic parameters in children with perinatal damage to the central nervous system and children's cerebral palsy, which the authors attribute to the more biotropic effect of a given frequency of a pulsed low-frequency electromagnetic field on metabolic processes, neuromuscular th transmission, regional circulation and brain bioelectrogenesis. Apparently, the proposed modulation frequency (52 Hz) is adequate for this pathology, compared with the previously known (20 Hz), as indicated by a high percentage of significant improvement in the condition of patients (46.2%).

The proposed method, being more effective in the treatment of patients with cerebral palsy, can be recommended for use in the complex spa treatment of this category of patients both in sanatorium-resort conditions and in the inpatient phase of rehabilitation therapy.

Claims (1)

A method of treating children with cerebral palsy, including exposure to a pulsed low-frequency electromagnetic field from the INFITA apparatus, characterized in that they use the influence of an electromagnetic field with a modulation frequency of 52 Hz, with the arrangement of paired emitters in the form of extension plates on the cervical spine, paravertebrally, 1 min in the first procedure, 2 min in the 2nd, 3 min in the 3rd, 5 min in the 4th, 5 min in the 5th, 3 min in the 6th, 2 min - at the 7th and 1 min with the 8th procedure daily for a course of treatment 8 procedures.