CN109288512B - Electrocardio trigger device for spinal rehabilitation system - Google Patents

Electrocardio trigger device for spinal rehabilitation system Download PDF

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CN109288512B
CN109288512B CN201811077737.8A CN201811077737A CN109288512B CN 109288512 B CN109288512 B CN 109288512B CN 201811077737 A CN201811077737 A CN 201811077737A CN 109288512 B CN109288512 B CN 109288512B
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magnetic
mode
muscle
signal
control module
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CN109288512A (en
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张岩
阚泉
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North China University of Science and Technology
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Abstract

An electrocardio trigger device used in a spinal rehabilitation system. The spinal rehabilitation system treats the slight muscular contracture and muscular tension caused by bad living habits, diseases and the like of modern people. It contains various medicines for promoting bone formation and preventing ectopic bone formation, which are selectively released in the interstitial space of the tissue through a special coating layer and concentrated at the affected part by magnetic field arrangement. In order to improve the activity of the medicine, the invention also adds a device for forming ganglion interference, artificial alkalescent environment and the like. The invention induces discharge through the muscle tension related ganglia of the human body, effectively improves the health indexes of muscles and nerves and promotes the healing of injury; meanwhile, the myoelectricity detection is combined to carry out self-adaptive adjustment in real time so as to obtain better treatment effect. In order to realize better cut-in time in the electromagnetic therapy process, the indicating device prompts the patient to carry out abdominal respiration under the management of the control device so as to cooperate with the magnetic therapy, and avoid excessive interference of evoked potential and normal human electrocardio.

Description

Electrocardio trigger device for spinal rehabilitation system
Technical Field
The application relates to bone fracture rehabilitation, in particular to the field of spinal rehabilitation, and specifically relates to a spinal column and a rehabilitation device for related nerves and muscles.
Background
Modern people have a certain part of their body in a fixed posture for a long time and muscles in a low-load continuous contraction state for a long time due to sitting work, bad life habits, diseases or some reason. This results in a decrease in water in the fibrous tissue matrix, such as ligaments, decreased viscoelasticity, and decreased interfibrillar lubrication. At the same time, the distance between the fibers is shortened and the contact period is prolonged, which may cause chemical cross-bonding between the fibers, thereby causing adhesion between the fibers. The people of the type often cause new fibers due to chronic inflammation of muscle tissues, the new fibers are disorderly arranged and form adhesion with the original fibers again, and the slippage among the fibers is further limited. For a long time, this "vicious circle" will cause the muscles to develop slight contractures, causing muscle tension. Modern lifestyles dictate that such muscle tensions occur mostly in the spine attachment or related large and small muscle groups, which over time can lead to spinal fatigue, overload, and even irreversible injury. Of particular concern is that most muscle fatigue or injury is accompanied by related bone strain or hyperplasia.
The application of spinal traction and fixation and the relief of muscle tension through the application of mechanical and electrical fields has proven to be an effective treatment in the field of spinal rehabilitation. However, this procedure inevitably results in unnecessary damage to the spine and even injury to the Spinal Cord (SCI), and medical practitioners are often reluctant to adopt aggressive treatment regimens to avoid SCI; accidental massage injuries also often occur during active treatment procedures such as massage of non-spinal injuries. There is a need to provide effective real-time electrophysiological monitoring when spinal therapy is involved. It is a promising direction in the art to combine electrophysiological testing with a variety of spinal rehabilitation modalities. It is also the focus of research in the field to obtain effective and representative data from a variety of electrophysiological indicators and to guide the subsequent spinal rehabilitation.
Neuroelectrophysiology is a technique that relies on various forms of energy stimulation to measure, record and analyze bioelectrical and electrical properties of an organism that are produced by the peripheral nerves of the organism, according to neuroanatomical principles. Evoked Potentials (EPs) refer to specific stimuli (acoustic, optical, or somatosensory stimuli) given to the nervous system (from receptors to the cerebral cortex), or information on the stimuli (positive or negative) processed by the brain, which produce detectable bioelectrical responses at specific locations and at fixed time intervals (time-locked relationship) relative to the stimuli in the system and in the corresponding areas of the brain. It reflects the integrity of the structure and function of the synaptic transmission and axonal conduction cells and molecular systems, and is an effective functional index.
An electromyographic signal (EMG) is a bioelectric signal that is generated in conjunction with muscle movement. When the limbs of a human body move, neurons in the cerebral cortex which control the movement area excite and generate electric pulses with certain frequency, the electric pulses accurately conduct specific muscle fibers through a nervous system, when the electric pulses reach nerve-muscle synapses, endplate potentials are generated in the muscle fibers, and depolarization of the endplate potentials generates a string of action potentials in the muscle fibers to cause muscle contraction, so that the limbs complete the actions set by the brain. The surface EMG is a comprehensive physiological electrical phenomenon generated by each part of muscle activity in limb movement, and the analysis and research on the surface EMG can find the corresponding relation between the surface EMG and the physiological state of the muscle and the limb movement mode, and can be widely applied to the fields of clinical medicine, sports medicine, medical rehabilitation and the like. The concept of the presence of a trigger point (MTrP) in the muscle tonus zone of human skeletal muscle has been widely recognized. Spontaneous electrical activity was recorded in the MTrP zone of the muscle tone, which was further manifested and detected in the form of myoelectricity. Simply speaking, a muscle expresses its physiological state (statement of the physiological state of the lateral muscle tension in the present invention) by an electrophysiological signal; in turn, the muscle tone can be appropriately adjusted by influencing the myoelectricity by means of an applied field.
Methods and devices exist in the prior art for improving muscle tone by electrically stimulating a patient and receiving myoelectric/biofeedback signals from the patient. However, these devices use simple electrode stimulation, with frequencies approximately between 5Hz and 100Hz, and electrical signals including waveforms that are simple. The stimulation effect on the human body is single, the fatigue of peripheral nerves is easily caused, and a large amount of unnecessary electrode heat is generated. The insertion of an electrode or patch electrode may lead to skin keratoses and unnecessary damage. The patient may have an unwanted view of the visually observable electrode stimulation, and this mind may also lead to a deterioration in the therapeutic effect. Most importantly, peripheral nerves may respond well to short-term stimulation, but long-term treatment can lead to nerve fatigue, and the effect can be quite dramatic. The reason is that human nerves have an adaptation process to the injury stress reflex generated by external stimulation in the evolution process, and the innervated nerves and muscles can easily reach the refractory period for the purpose of self-protection; the body's own nerve electricity including the ganglia is not prone to such fatigue, or has a longer fatigue endurance.
The ganglia are nodular structures in which the same functional neuronal cell bodies are gathered at peripheral sites other than the center. The surface of the membrane is coated with a connective tissue membrane containing blood vessels, nerves and fat cells. The capsule is connected to the adventitia of the peripheral nerve, the perineurium, and penetrates deep into the ganglia to form the reticular scaffold in the ganglia. The fibers emanating from the nerve cells within the ganglion are distributed to the relevant parts of the body, called postganglionic fibers. The ganglia can be both dorsal ganglia (sensory ganglia) and vegetative ganglia, depending on physiology and morphology. The vegetative ganglia include sympathetic and parasympathetic ganglia. The sympathetic ganglia are located on both sides of the spine. The parasympathetic ganglia are located in the vicinity of the innervated organ or within the organ wall. Within the ganglia, the axons of the preganglionic neurons synapse with postganglionic neurons. The ganglia are connected with the brain and spinal cord through nerve fibers, and in the past, people often have more functions as the transfer station of central nerve to peripheral conduction. But actually the inventors found through physiological tests conducted in the laboratory: bioelectricity produced by the human body by stimulation of the nervous system, including the ganglia, is inaccurately controllable in amplitude, frequency, and helps to promote rhythmic relaxation and contraction of the nerve-controlled muscles and connective tissues, and blood circulation in peripheral capillaries. Meanwhile, stimulation to the ganglia also causes the effect of the ascending nerve fibers on the brain, has the effect of relieving the tension and anxiety of a patient in practice, and has a certain treatment effect on the muscular tension caused by the nerves. But also to selectively excite or inhibit specific ganglia in various ways to achieve effects that mimic the effects of human own neuroelectricity generation, which are often incomparable in the field of neuromedicine. For example, stellate ganglion blockade, which is now widely used, helps to restore sympathetic-vagal balance, relieve pain, and the like. In the research on the condition that craniocerebral injury patients are combined with fracture healing of limbs, the absence of nerve caused by craniocerebral injury can promote the expression increase of callus collagen in the early stage of fracture healing, and the clinical manifestation is that the fracture local stress causes spasm, and then the delayed paralysis is converted. A large amount of cartilage callus can repair injury rapidly in the early stage of healing, and recover nerve and bone structure. This state of absence is positive for fracture healing, but at the present time animal models of absence are made in the field by damaging the cranium and clinically blocking certain specific ganglia of the patient by surgery. The method has great operation risk and is irreversible, and irrecoverable loss is caused to the mind and body of a patient.
Taking the stellate ganglion block as an example, the prior art is limited to paranodal injection of drugs, which is both risky and easily causes other side effects caused by the drugs. The invention provides a magnetoelectric stimulation mode for carrying out specific induction work on corresponding ganglia. However, the situation of mutual interference with the electrocardiosignals inevitably occurs in the stimulation process, and the interference can be improved by adopting the way of triggering the magnetic stimulation circuit by the electrocardio while shielding, which is a technical problem to be solved by the technical personnel in the field. Meanwhile, how to accurately locate the stimulation position easily, quickly and non-invasively is a problem that is not overcome by the technical personnel in the field. The former physiotherapy practitioner often performs positioning through experience pressing and patient feedback, which is inaccurate and can cause accidental injury; although it is also proposed to add electrodes for measurement, the laboratory environment and clinic are very different, the detection cost is high, and the requirement for operators is high.
Disclosure of Invention
The invention provides a rehabilitation system for relieving and treating spinal injuries, spinal fatigue and related muscular tension of a patient. The intelligent treatment device overcomes the defect that the conventional rehabilitation device can only aim at the problem of a single spine, integrates various treatment means, and realizes intelligent treatment under the monitoring of a preset detection program. Meanwhile, due to the fact that multiple possible pathogenic mechanisms of the same representation of the user are considered, detection and judgment logics combined by multiple detection means are adopted, and the device can automatically make proper physical therapy according to specific conditions of the user. Thereby realizing effective and safe spinal rehabilitation and avoiding unnecessary secondary injury or delay.
The rehabilitation device comprises a myoelectricity detection module 1, a magnetic therapy module 2, a massage module 3, a control module 4, a display module 5, an electrocardio module 6, a bone fracture module 7 and the like.
The present invention relates to the fields of electrophysiology and electromagnetic medicine. The amplitude and frequency spectrum of the well-known Electromyographic (EMG) signal have their own characteristics: the surface EMG signals measured from the body surface of a human body are usually weak, and the amplitude is generally not more than 5 mV; the frequency is also lower, the frequency spectrum range is generally 0.02-1000 Hz, and the frequency spectrum energy is mainly concentrated between 0.25-350 Hz. There is a good linear relationship between the degree of relaxation and tension of the muscle and the magnitude of the generated surface myoelectric voltage. The method for measuring the electromyographic voltage amplitude uses a root mean square method, can reflect the change characteristics of the EMG signal amplitude on a time dimension, and depends on the internal relation between muscle load factors and the physiological and biochemical processes of muscles, so that the time domain analysis index is often used for reflecting the muscle activity state in real time and without damage, and has better real-time performance. Meanwhile, the impedance of the muscle part of the human body can effectively express the relaxation degree of the human body, and generally, the more relaxed the human body is, the smaller the impedance is. Therefore, the method can accurately acquire the muscle tension degree of the human body in real time and grade the muscle tension degree.
The degree of muscle tone obtained may contain various information such as bone damage caused by spinal strain, hyperplasia, etc., nerve damage, pain caused by disturbance of lactate metabolism and muscle spasm, and muscle tension caused by external force or psychology, etc. If the different causes of muscle tone cannot be effectively distinguished, targeted therapy cannot be effectively performed. The invention obtains real-time myoelectricity and impedance signals of human body by arranging the myoelectricity signal collector in a specific area of the body surface, realizes the identification and classification of the myoelectricity signal abnormal inducement by a preset program in a gate control logic circuit which can be programmed in real time on site, and combines different treatment means according to different judgment results.
First, Transcranial Magnetic Stimulation (TMS) is applied to the user, with the selected stimulation area located outside the dura mater and detected by magnetic field evoked potentials. The simple magnetic stimulator consists of DC power supply, charging circuit, energy storing element, discharging switch, charge and discharge control circuit, coil and other parts. Various transcranial magnetic stimulators and control modules including software, well known to those skilled in the art, are incorporated by reference into the present invention, such as the DTMS transcranial magnetic stimulation circuit arrangement described in US2008200749A or the commercially available US Medtronic Mag Pro type magnetic stimulator.
The excitation generated by the magnetic stimulation cortex motor area is applied, the anterior horn cells of the spinal cord or the motor fibers of the peripheral nerves are depolarized through a descending conduction path, and the potential change recorded in corresponding muscles, nerves and spinal cords is the motor evoked potential detection stimulation. SRPs can be classified into Sensory Evoked Potentials (SEPs) and Motion Evoked Potentials (MEPs) according to different stimulation patterns. SEPs mainly reflect the functional status of sensory pathways for dorsal ascending conduction in the spinal cord, while transcranial stimulated MEPs reflect the integrity of conduction pathways for ventral descending movement in the spinal cord. The MEP is helpful for detecting whether the spine has substantial damage, and particularly has a better flaw detection effect on potential damage which does not show obvious limb obstacle. The study by Maerten, Dvorak et al indicated that in spondylopathy and disc herniation, the sensitivity of MEP was 84%, significantly higher than 36% of SEP, and that MEP was slightly more sensitive to cervical canal stenosis than lumbar canal stenosis. Presumably, the volume of the cervical canal is small, so that the spinal cord is more easily compressed after the stenosis. Machida reported 85% sensitivity of transcranially induced MEPs in patients with traumatic spinal cord injury. In order to reach the stimulation site through the skull, scalp, etc., the magnetic field peak value cannot be less than 1 tesla (T), and should generally be between 1-2T, by selecting the number of coil turns and the current value. A flat circular coil (with a larger stimulation range and more suitable for peripheral nerves) is arranged at the top of the skull of the user in a tangential relationship with the skull, and can be an iron core coil or a combined coil, the diameter of the coil is 12-20 cm, and the distance from the center of the coil to the top of the head of the user is less than 3.5 cm. Because the device is only used for physiological detection, the action time is short, and a natural cooling or air cooling mode is adopted. The coil is used for realizing fast frequency TMS at the depth of 1-3 cm in the skull of a user, namely the frequency of a time-varying magnetic field generated by time-varying current is more than 1 Hz. The detection of the transcranial magnetic stimulation MEP signal can be realized by using a common motor potential detector, and the flaw detection is carried out on the spinal conduction path by analyzing the conventional indexes such as the conduction time, the signal magnitude and the like. In this case, mechanical massage of the affected part or the relevant part should be strictly prohibited to avoid secondary damage to the spine caused by the subsequent massage step.
Second, peripheral nerve conduction pathways can also be detected by MEPs. The acquisition method of MEP (also called MEPs) of peripheral nerves is similar to the prior SEP technology, and the anode of a patch guide electrode is arranged on the abdomen of the targeted muscle to be tested, and the cathode is arranged on the descending muscle tendon segment of the nerve, so that the distance between the electrodes is ensured to be more than 35 mm. If necessary, the subcutaneous microneedle electrode can be used instead to improve the signal pickup effect and avoid noise interference. Meanwhile, MEP signals can be picked up at a specific limb nerve path or ganglion according to the subject of a patient, so that the muscle electric wave conducted through a specific vertebral segment is focused in a targeted manner, and qualitative measurement can be carried out on the damage of the specific nerve path. The selection of the targeted muscle is based on the conventional selection standard of transcranial magnetic stimulation signal detection in the field, and the muscle is preferably, but not limited to, the major muscles of the limbs far away from the trunk.
In the waveform signal obtained by MEP detection, the first single-phase positive-phase wave which arrives quickly is called a direct wave (D wave), and the conduction of the wave is not transmitted through synapses, so the wave is also called a direct wave; a group of positive waves (I waves) appear after the D wave, which are caused by the fact that the connecting fibers indirectly excite the pyramidal cells and are called indirect waves. The MEP waveform is led out by electrical stimulation to prompt that the function of the spinal conduction tract is normal, and the disappearance of the waveform indicates that the conduction function is blocked, namely the judgment principle of 'full or no' or 80% reduction of the amplitude, and the monitoring sensitivity can reach 100%. If D wave conduction block exists, the D wave conduction block is classified by a gate control circuit, and mechanical massage is strictly forbidden for possible spinal cord injury, so that treatment injury is prevented. And when the D wave conduction is normal, the I wave latency is prolonged (the judgment standard is approximately more than 1.5 times of the normal time), which indicates that peripheral nerve inflammation or injury, such as demyelination caused by overstrain, and the like, exists, and then the operation mode 2-3 of the nerve bone injury rehabilitation is switched. Clinical experiments show that the transcranial magnetic stimulation for more than two times can effectively simulate and stimulate normal induction signals under the condition that a patient is not anesthetized and awake. Moderate mechanical massage is supplemented with magnetic field-induced myoelectrical stimulation to assist in the activation of neurons and conduction pathways.
Finally, the electromyography detection module also comprises pickup means for electromyography (for example surface electromyography) to detect neuroelectrical conduction capabilities. After MEP detection is finished and it is judged that the patient does not have diseases such as serious spinal cord and nerve injury which are not suitable for mechanical massage, the myoelectric pickup device detects myoelectric signals of a specific massage part of the patient in real time. When the muscle has pain, spasm or simple fatigue, the conduction speed of peripheral nerve fibers at the problem points (including pain points, spasm points, fatigue areas, and the like, the same shall apply hereinafter) is reduced, and the blood circulation is not smooth. Which can be confirmed by detection of the electromyographic signals and further detailed differentiation can be made.
Recent sports medicine studies have shown that: the more the slow muscle fibers of the skeletal muscles of the human body are, the larger the area percentage is, and the slower the MPF descending slope in the frequency domain analysis index of the electromyographic signals is. Further, pain, particularly chronic long-term pain, can result in an increase in local muscle fast muscle fiber proportion and volume and a corresponding decrease in slow muscle fibers, resulting in a significant increase in the slope of the decrease in MPF value. For example, it has been clinically found that pathological inflammation or non-pathological spasm of the small myxomyelis can lead to an increase in the spontaneous firing frequency of dorsal root ganglia of the spinal cord, with the result that radial pain may occur in the corresponding lateral root pain as well as in the upper extremities. Problem-related nerve tissues around the pain part have high-frequency electric signals, which are reflected by sharp decrease of median frequency, that is, obvious increase of median frequency Slope (MPs). The inventor considers that the high-frequency rapid interruption phenomenon in the nerve fiber conduction process is an adaptive phenomenon of an organism under incomplete block. The high frequency discontinuity of the electrical signal at the point of interest causes the electrical charge of the cells surrounding the organ tissue to rapidly change between increasing and decreasing.
In the muscular soreness caused by sports fatigue, the synchronism of the excitation of the sports unit is strengthened for maintaining the muscle tension during the fatigue; and the decrease of muscle fiber conduction velocity (muscle fiber conduction velocity) caused by the blood flow resistance due to the increase of the intramuscular pressure and the hyperexcitability of the muscular membrane due to the accumulation of lactic acid, which can be used as a dominant indicator in fatigue after exercise. The myoelectric amplitude can be slowly increased through massage and physical therapy, the Mean Power Frequency (MPF) of the myoelectric signals is also increased at the same time, and fast muscle fibers can be understood to have a rest, and the lactic acid metabolism and the blood circulation at a problem point are recovered to be normal.
The electrode sampling frequency for detecting pain signals is 300Hz-500Hz, preferably 450 Hz; the fatigue signal detection electrode is set to have a sampling frequency of 8 to 300Hz, preferably 20 to 100Hz, and more preferably 50 Hz. The common mode rejection ratio is larger than 120dB, and the sensitivity is 1 muV. The pick-up electrode measures the electrical activity of the muscle surface by using an active surface electrode, and the diameter of a conductive area is between 6 and 12 mm. The graphite electrode or the titanium electrode is selected as the electrode, so that accidents of the electrode in a magnetic field are prevented.
Before the electrodes of the myoelectricity pickup device are placed, the skin temperature color-changing paint is smeared on the affected part of a patient and extends to the side of the spine, the skin temperature color-changing paint can effectively mark the temperature difference of the body surface, and the bright contrast is formed at the positions, the periphery and the healthy side of muscles which influence the blood circulation, such as tension, spasm and the like. The skin temperature color-changing coating adopts a binary mixture of two organic matters of palm alcohol and myristyl alcohol as a solvent, and the color-changing range is approximately 30-44 ℃ and further is 33-40 ℃ by adjusting the proportion of the palm alcohol and the myristyl alcohol and the processing technology. Marking the low-temperature points which are obviously lower than the healthy side and the peripheral parts in the area coated with the color-changing paint.
Each group of three electrodes is arranged around the mark point as a center, the connecting line of the active electrode and the measuring electrode is parallel to the main muscle fiber trend at the mark point, the long axis of the electrode is in the same direction with the muscle fiber, the distance between the long axis of the electrode and the muscle fiber is 2-2.5cm, the electrode is prevented from being placed on the tendon as far as possible, and the neutral electrode is placed at an electric neutral position near the mark point. And selecting healthy side symmetry, and arranging a group of electrodes.
An electromyographic signal field processing device is connected behind the electromyographic signal pickup device, and is used for carrying out logic judgment after filtering and amplification, and if a signal obtained in a low-frequency sampling time sequence enters a fatigue signal judgment process; and if the signals obtained in the high-frequency sampling time sequence enter a pain signal judgment process. In the process of judging the electromyographic signals, fast Fourier transform is realized to obtain the MPF value of the electromyographic signals so as to carry out frequency domain analysis. In the frequency domain analysis process, a Matalab analyzer is adopted to monitor whether the MPF value meets a preset index, for example, if a rapid decline or even a flash (similar to cliff decline) phenomenon occurs, the MPF value is indicated to enter a release mode 2-1, otherwise, the MPF value enters a release mode 2-2; the self-adaptive neural network learning mode can also be adopted to make a judgment, myoelectricity distribution maps at two sides of the normal spine are obtained by combining laboratory data, a human body region myoelectricity weighting coefficient table is set according to different heights, ages, weights and even body fat parameters, and the judgment is made after the myoelectricity data/healthy side data at the affected side exceed the weighting coefficient.
The working procedure of the control module in the signal picking process is carried out according to the following logic: detecting MEP signals generated by transcranial magnetic stimulation in targeted muscles, and judging whether a nerve downlink conduction link has damage, specifically, whether D waves are correctly detected; strictly forbidding any form of mechanical massage if there is a link conduction obstacle; if the D wave signal is normal, the real-time surface electromyography monitoring process is carried out, wherein the massage mode is determined by monitoring whether the MPF value in the signal is rapidly reduced or even is subjected to flash-off phenomenon, and the latency time of the MPs signal and the electromyography signal can be further combined.
In the relieving mode 2-1, a static magnetic field with the size of 0.6-0.9T is applied and is arranged in the up-down (or left-right) direction of the massage bed; applying ultrasonic waves to the side of the vertebral column on the skin temperature indicating position, wherein the ultrasonic waves have the ultrasonic convergence depth of 0.8-2.5cm, the frequency of 0.2-1.0MHz and the power of 1mW/cm2(ii) a The ultrasonic transducer is tightly attached to the skin, the effective area of the transducer probe is 10mm multiplied by 8mm, and the longitudinal direction is vertical to the direction of the spine of the human body. The ultrasound forms a 1 cm square convergence point in the subcutaneous tissue corresponding to approximately the ganglion where the cell walls in the nerve tissue vibrate with charged particles in the cytoplasm, causing depolarization of the cell membrane according to the hall effect. The action potential will be transmitted to the corresponding skeletal muscle, resulting in a slight twitch or tremor. The action potential is sent out by the patient self-nerve node, has high simulation and adaptability, and the size of the action potential obtained by induction is in nonlinear correlation with the ultrasonic frequency. Meanwhile, the ultrasonic frequency is adaptively changed along with the electromyographic signals obtained by the pickup electrodes, and the MPF drop value of the electromyographic signals is reduced by the feedback mode. Because of the "on or off" nature of depolarization of multiple nerve cell membranes, the above-mentioned non-linear increase in evoked potential, i.e., the phenomenon that it may change linearly without following ultrasound frequency modulation, is clinically observed. The control module adjusts the ultrasonic frequency by taking 0.1KHz as a unit, the ultrasonic frequency adjusted each time keeps more than at least one period, and the MPF value is detected at periodic intervals.
In the relaxation mode 2-2, a static magnetic field (avoiding acting on the head of the user) is applied, the size is 2.5T, and the static magnetic field can be arranged in the vertical (or horizontal) direction of the massage bed; then, according to the skin temperature indication, the position with the most obvious temperature change is selected as the center of the action zone of the gradient magnetic field, the gradient magnetic field is applied, the size of the gradient magnetic field is 100mT, and the switching rate is 10-15mT/m.s (y circle). Under the action of the magnetic field gradient, the action zone generates bioelectricity effect on tissues including nerves and muscle receptors, so that irregular muscular abdominal vibration which is difficult to be detected by naked eyes occurs, the bioelectricity effect is helpful for blood circulation and lactic acid metabolism, and more or less heat is generated according to the switching rate of the magnetic field gradient. The generated heat can cause the temperature of the part coated with the skin temperature allochroic paint to change, and the phase-change material can absorb heat to be liquefied after the threshold value of the phase-change material contained in the part is reached, so that the skin can be prevented from being thermally damaged. Meanwhile, the operator can monitor the skin temperature through the color of the skin temperature color-changing paint. In the stop period of the gradient magnetic field and when the myoelectricity acquisition module starts to work, the phase-change material also acts to avoid the over-low temperature of the coating part and prevent the myoelectricity signal error caused by the muscle tension of skin and muscle due to the cold and heat change.
The analysis result of the large samples of the electrocardiogram of different typing cervical spondylosis patients shows that the cervical spondylosis and the abnormal electrocardiogram have greater correlation and identity, so the cervical spondylosis and the abnormal electrocardiogram are also called as cervical syndrome. The bioelectricity generated in the process of magnetic field stimulation to the peripheral nerve is inevitably partially overlapped or even collided with the electrocardiosignal. Clinical data show that the condition is particularly obvious in cervical spondylosis patients, and the error interval of the ultrasonic magnetic field treatment effect is obviously increased. If real-time electrocardio detection can be further added in the working process of the magnetic therapy module, better time indication can be provided for ultrasonic magnetic therapy incision.
Hotten (Holden) in 2004 showed that The vessel wall generates a potential difference in The static magnetic field at The body surface, and that The induced electric field may affect The propagation of The cardiac electrical action potential (The sensitivity of The heart to static magnetic fields J. Progress in Biophysics & Molecular Biology, 2005, 87 (2-3): 289-320.). Particularly for the conventional three-lead, five-lead, twelve-lead and other electrocardiographic detection results, the influence of the magnetostatic field induction potential is mainly reflected on T-wave deformation or delay. Static magnetic field therapy, such as in the alleviation mode 2-1 of the present invention, is insufficient to have a significant effect on electrocardio because the magnetic field strength is small, but similar interference of the adverse potential difference with the therapeutic effect can still be seen through detection and comparison of experimental results. Reliable grounding, filters, metal covers and the like can be added to the electrocardiograph to avoid interference. Further, the electrocardiosignal can be made to realize the ultrasound in the S-wave trigger mode 2-1 through the circuit.
In the magnetic field variation process of the relaxation mode 2-2, the detection of the electrocardiosignals is often seriously distorted, so how to realize better magnetic therapy cut-in time further needs to be solved. Data obtained from experiments conducted at north-river university of profession that influence abdominal breathing on heart rate indicate that subjectively controlling the rhythm of abdominal breathing helps to control the heart rate at a relatively low and steady level. Related research of the western society of transportation also shows that the heart rate and the breath can interact, and the coupling relationship is not described in detail herein. In the present invention, a lower heart rate is significantly beneficial for avoiding interference with peripheral nerve bioelectricity; at the same time, a relatively distinct relaxation phase of the respiratory muscles occurs at the end of expiration of the abdominal breath, which phase can be extended by the user consciously for 6-8 seconds. At this time, the gradient magnetic field switching rate in the 2-2 massage mode is controlled to be the peak value, and a better effect is achieved. Therefore, the invention is further provided with a breathing indicating device which can adopt any prompting means of sound, light, electricity and the like in the prior art, such as a buzzer or LED flashing lamp decoration. The magnetic field switching device is used for indicating the frequency of abdominal respiration of a user, and simultaneously, the magnetic field switching frequency and the expiration phase of the abdominal respiration are kept synchronous by matching the change of the gradient magnetic field after the user enters a stable respiration state. Clinical trials have shown that most adults are able to maintain a respiratory rate of 5-7 breaths per minute when they are abdominal breathing in conjunction with a breath indication device, while the heart rate will drop to a lower heart rate level within their normal range. The therapeutic effect is obviously improved by combining the magnetic field, and the measured MPF value can relatively rise by 1-10% under the condition of equal treatment time.
Still further, in the course of working of the rehabilitation system, the auxiliary therapeutic effect of the medicine is added, which is realized by the medication module, and the aim is to promote the blood flow at the local position and improve the relief effect of muscle tension. The medicine adopts proved formulas for supplementing bones and promoting blood circulation, which are well known by technicians in the field, and after the medicine is steamed and purified, effective components are further ground and mixed into the skin temperature color-changing coating to be coated on the part receiving magnetic therapy. The medicine can be heated and permeated into skin to achieve drug effect.
When the D wave conduction is normal and the I wave latency of the indirect wave is increased (when the determination criterion is approximately 1.5 times longer than the normal time, the control module waits until the MEP signal is relatively stable to perform calculation comparison after the MEP signal is changed in amplitude and latency between single times), nerve injuries such as nerve contusion and sheath removal can be predicted. Dominant nerve damage is often predictive of damage to the skeletal muscles innervating it and to the corresponding bones, with occult fractures being particularly the most dangerous. Recessive fracture, also called as recessive fracture, is often caused by fatigue, recessive trauma, etc., and is not easy to be found under normal X-ray, thereby delaying the disease condition and even causing secondary damage to the related nerve. In order to accelerate the healing of fractures, particularly recessive fractures, the invention designs and provides nerve bone fracture working modes 2-3.
Specifically, when the I wave latency reaches 1.5 times of the normal time length of the same sex adult resting and muscle relaxing state, the control module switches the device into a nerve and bone injury rehabilitation mode 2-3. Further, magnetic stimulation of the same intensity may be performed continuously for improved accuracy. When the difference between the I wave peak amplitude (peak-to-peak voltage in millivolts) and the latency (defined as the time from the beginning of stimulation to the appearance of muscle action potential in milliseconds) in the MEP signal generated by three continuous magnetic stimulations obtained by the targeted muscle position electrode does not exceed 20%, the data of the three MEP wave peak amplitude h1 and the latency t1 are respectively recorded and weighted and averaged to obtain the average value of the wave peak amplitudeh1Andt1. The reason is that MEP is subject to fluctuations due to various factors, such as muscle activity, respiration, and heartbeat, at the patient's measurementThe influence of psychological factors may cause the value to change.
The average value is respectively corresponding to the peak amplitude of the I wave at the healthy sideh2And incubation periodt2Comparing to obtain the healthy side positionh2Andt2again, the average values obtained according to the above method. The average calculation, the comparison of healthy side and affected side and the logic analysis are performed by a real-time field programming gating logic circuit. At this time, if the comparison result meets the condition one:h1is thath2Less than 85% (including 85%) and meets condition two:t1is thatt2Above 150%, the control module switches the whole device into a nerve and bone injury rehabilitation working mode 2-3. Under laboratory conditionsh1Is thath2Under 90%, damage can be considered to occur in the nerve path upstream of the position of the marker point, and the environment and operator factors are considered when the standard is strictly 85%.
In the above-described operation modes 2 to 3, the hollow microneedles for the electric needles of the skin electrodes (the electric needles may be made of a material similar to that described above and may be used for commercially available electrode electric needles that operate in a magnetic field) are arranged in the same manner as described above. Before the electrode is placed, the skin temperature color-changing paint is smeared on the affected part of a patient and extends to the side of the spine, the skin temperature color-changing paint can effectively mark the body surface temperature difference, and the bright contrast is formed at the positions, the periphery and the healthy side of muscle tension, spasm and the like which influence the blood circulation. The skin temperature color-changing coating adopts a binary mixture of two organic matters of palm alcohol and myristyl alcohol as a solvent, and the color-changing range is approximately 30-44 ℃ and further is 33-40 ℃ by adjusting the proportion of the palm alcohol and the myristyl alcohol and the processing technology. Marking points which are obviously different from the healthy side and the peripheral parts in the area coated with the color-changing paint, wherein the points comprise high-temperature points and low-temperature points. Each group of three electrodes is arranged around the mark point as a center, the connecting line of the active electrode and the measuring electrode is parallel to the main muscle fiber trend at the mark point, the long axis of the electrode is in the same direction with the muscle fiber, the distance between the long axis of the electrode and the muscle fiber is 2-2.5cm, the electrode is prevented from being placed on the tendon as far as possible, and the neutral electrode is placed at an electric neutral position near the mark point. And selecting healthy side symmetry, and arranging a group of electrodes.
The sampling frequency of the electrodes is likewise 300Hz to 500Hz, preferably 450 Hz. The common mode rejection ratio is larger than 120dB, and the sensitivity is 1 muV. The pick-up electrode measures the electrical activity of the muscle surface by using an active surface electrode, and the diameter of a conductive area is between 6 and 12 mm. The graphite electrode or the titanium electrode is selected as the electrode, so that accidents of the electrode in a magnetic field are prevented.
The electromyographic signal pickup device is connected with an electromyographic signal field processing device, and the electromyographic signal field processing device is used for filtering and amplifying the electromyographic signal and then realizing fast Fourier transform to obtain an MPF value of the electromyographic signal so as to carry out frequency domain analysis. At this point the MPF will flash similar to that described in mitigation mode 2-1 and will behave more aggressively, with multiple successive flashes occurring and the signal disappearing in practice.
The content of the hollow microneedle is a magnetic nanoparticle ball mixture with magnetic compliance. In the mixture, ferroferric oxide is used as a magnetic core to coat biodegradable organic materials, such as magnetic lipid substances adopted by Lopera, and the contained effective medicinal components are bone morphogenetic protein BMP2 (which is prepared by adopting commercially available recombinant human bone morphogenetic protein freeze-dried powder), osteoprotegerin OPG and prostaglandin PGe2, wherein the three components are called osteogenin the invention, and the preparation process is the prior art; the second one is temperature responsive thermosensitive magnetic nanoparticle sphere, the particle is composed of magnetic ferroferric oxide nanoparticles and a poly-isopropyl acrylamide shell layer coated outside the magnetic nanoparticles, the contained medicines are ligand RANKL of receptor activating factor RANK of nuclear factor KB and insulin growth factor 1, and the two are jointly called as the osteoclastin in. Research shows that the OPG and the RANKL have similar structures and occupy space, and can successfully inhibit the combination of the RANKL and a receptor thereof through competition, thereby inhibiting the activity of osteoclasts and indirectly promoting osteogenesis; prostaglandin PGe2 promotes osteocyte differentiation and osteogenesis at lower concentrations or in combination with glucocorticoids (e.g., cortisone), while stimulating bone resorption and bone metabolism at higher concentrations or in combination with insulin growth factor 1 (IGF) (Nakamura H, et. localization of OPG on the bone surface and disruption lines in tissue. histoche Cyto-chem, 200250 (7):945 953). The tail end of the hollow microneedle is connected with a pressure valve through an infusion tube to form a drug infusion system which is managed by a control module.
Setting the low-temperature and high-temperature color-changing areas as target fields, and realizing directional administration by adopting a mode of externally adding a permanent magnet magnetic field, wherein the magnetic induction intensity is 0.5-0.9T, and the time is more than 30 minutes. After 30 minutes the permanent magnet was removed and the control module controlled the drug infusion system to release the magnetic nanoparticle sphere mixture. At this point, the control module manages the respiratory indication device to prompt the patient to take high frequency shallow breaths, above 15 per minute, to achieve the effect of simulating hyperventilation, if necessary to provide a short oxygen supply to the patient. The BMP2 and OPG released in the environment of body fluid like weak alkalosis exert the best effect (the experimental result proves that the action mechanism is still to be studied further), and promote the growth of nerves and blood vessels at the corresponding positions and the healing of bone injury, especially recessive bone injury.
It is worth noting that BMP2 has a close relationship with vascular calcification, especially arterial vascular calcification, and experiments at home and abroad prove that BMP has a certain causal relationship with ectopic ossification (also called ectopic osteogenesis HO). HO often occurs around large joints, such as the hip, elbow, lumbar, cervical, etc., and between muscles. HO causes joint limitation and pain, and the skin temperature of an affected part is obviously increased and may be related to blood flow abnormality and stromal cell differentiation at a focus; meanwhile, clinical observation shows that patients with craniocerebral injury and limb fracture have multiple early HO symptoms at the position near the focus where the blood flow is fast, and the skin temperature abnormal rise phenomenon also appears at similar positions, and the HO range easy to occur can be roughly calibrated by combining with bioelectricity detection. According to the Japanese-Union hospital experiment in Jilin, the reasons for the obvious increase of the incidence rate of HO of patients in the process of craniocerebral trauma and limb fracture healing include: the increase of transforming growth factor TGF, the massive maturation of BMP2 and the inhibition of osteoclast differentiation, etc. In order to avoid the occurrence of similar ectopic osteogenesis and undesirable vascular calcification, a thermosensitive magnetic particle ball containing the osteoclastin is mixed in the hollow microneedle, when the temperature rises to be close to 40 ℃, a poly (isopropyl acrylamide) shell layer coated outside the hollow microneedle starts to disintegrate, and the medicine is released into a tissue gap and enters blood through subcutaneous tissue. Said increase in temperature is mainly achieved by the bone fracture module 7, in particular: the bone fracture module comprises a plurality of sets of interference current electrodes and interference current machines. Each set of the electrodes can comprise commercially available quadruple electrodes (the interference position of the quadruple electrodes is positioned below the center of the geometric center of the electrodes) or common electrodes (the interference position of the common electrodes is positioned below the cross connecting line point of the two groups of electrodes), and the electrodes are selected according to the area of an implementation part; arranging electrodes at the high-temperature calibration position of skin temperature discoloration, wherein the crossing depth is about 2-5 cm, and the electrodes are specifically selected according to different positions of limbs or trunk; by using the intermediate frequency current, the current of 4.5kHz is selected specifically, and the interference current with the difference frequency of 10Hz and 9-22mA is generated at the interference position. The current not only promotes vasodilatation, lymphatic return and local temperature rise near the affected part, but also is beneficial to the fixed-point release of the osteopontin in the thermosensitive magnetic particle ball. The osteogenic substance and the osteoclastic substance are released in blood and tissue fluid near a high-temperature position marked by the skin temperature discoloration coating, and ectopic ossification and intravascular calcification at a focus are avoided due to ligand competition, the combined action of PGe2 and IGF1 and the like; and promote osteoblast differentiation and action at sites where nerve and bone damage may exist.
The interference current machine additionally introduces a multi-channel interference circuit for interfering with specific sympathetic ganglia, such as stellate ganglia, thoracic ganglia, lumbar ganglia, sacral ganglia, and the like. The interference electrode is arranged in the same way as before, common electrodes are adopted, and the ordinary physiological position and the approximate depth of the ganglion are known by the technical personnel in the field, the difference frequency of the interference current is set to be about 100Hz, and the intensity is 10 mA. At present, studies on stellate ganglia are more, and the treatment of various nervous diseases by blocking the stellate ganglia through injection is well known to medical workers. However, this procedure involves a certain risk and also requires a high level of skill on the part of the operator. Experiments of the inventor and a plurality of cooperative departments in the present school prove that the nerve loss similar state is simulated by adopting a mode of disturbing the ganglion by the interference current, and the weakening state of the central nervous system to the sympathetic nerve control in cranial trauma can be simulated as far as possible without damage although the effects of injecting and blocking the ganglion and operating the sympathetic nerve innervation cannot be achieved. The positive effects of these states of impaired control on bone healing and angiogenesis have been demonstrated in clinical trials (Yasuhara T, Shingo T, Date I. The functional roll of vascular endothelial growth factor in The central nervous system [ J ] Rev Neurosci 2004; 15(4): 293-307.). Under the condition of simulated absence of nerve, the effect of the neurotrophic factors on target cells in bone tissues and the expression of callus collagen are obviously improved. The research at present considers that the action mechanism is high expression of local catecholamine and adrenaline at the bone injury part, increase of the activity of chondrocytes and the like.
The interference on the ganglia can selectively interfere and shield the injury innervations and ascending nerves so as to induce craniocerebral reflex, thereby realizing that: on one hand, the activity and the binding capacity of cell-targeted receptors in nerve, muscle and skeletal tissues at the injury are directly improved, and the activity of chondrocytes at the injury is increased, on the other hand, the nerve loss state is simulated to induce the craniocerebral to secrete more autologous nerve growth factors, calcitonin gene peptides and the like, and the promotion effect of the nerve growth factors on bone healing is stronger than that of the existing rat-derived nerve growth factors for injection.
Detailed Description
The spinal rehabilitation system includes a physiotherapy table 31 as a carrying user, which is provided with an opening corresponding to the head and face of the person so that the user can breathe on his stomach. The rack adopts non-metallic material, avoids influencing electromagnetic therapy and treats the effect, and the below is equipped with four support posts of taking the gyro wheel. The periphery of the rack 31 is provided with an annular rail 32, the rail corresponding to the foot of the user is provided with a movable rail, and the whole rail is in a mouth shape with one end capable of being opened and closed. The rail 32 is provided with a support arm 321 corresponding to the head of the user, and the side surface of the rail is provided with a plurality of or more support arms 322 corresponding to the trunk of the user. The support arm can be multi-angled, curved and can slide on the fence to accommodate different positions. The support arm is made of nonmetal, and the end part of the support arm is provided with a fixed seat 323. The fixed seat of the supporting arm is detachably connected with an ultrasonic probe, an infrared probe, a gradient magnetic field coil, a permanent magnet, an electrode and the like. On the left side of the enclosure is a static magnetic field generator 324 which is implemented to provide a static magnetic field to the torso region of the user on the gantry 31. The size is 0.6-0.9T, and the method is realized by stable and constant controllable current and can adopt various common technologies in the field. A magnetic shield 325 is provided at the rail corresponding to the head of the user, and is made of ferromagnetic material with high magnetic permeability, such as silicon steel, and is slidably adjustable along the rail, and the thickness of the shield is 1-5 mm. After sliding to a proper position, the foldable cover can cover the head of a user so as to effectively prevent the head of the user from being stimulated by unnecessary magnetic fields.
A flat circular or figure-eight coil 21, which may be an iron core coil or a combined coil, is detachably fixed on the fixing seat of the supporting arm 321. The coil diameter is 9-20cm, preferably 12-15cm, and the peak value of generated magnetic field is not less than 1T. The distance between the center of the coil and the top of the head of the user is less than 3.5cm by adjusting the supporting arm during the transcranial magnetic stimulation. The frequency of the magnetic field generated by the time-varying current is greater than 1Hz, and the coil wire is connected to the control module through the fixing seat on the supporting arm 321. An anode electrode 11 is arranged at the targeted muscle belly of the back or the four limbs of a user in the transcranial magnetic stimulation stage, and a cathode electrode 12 is arranged at the position close to the tendon of the nerve descending which innervates the targeted muscle. The electrodes are graphite electrodes, and the distance between the two electrodes is more than 35 mm. The selected muscles include, but are not limited to, deltoid, biceps brachii, triceps brachii, biceps femoris, etc., and the current condition of the fine hand muscles can be monitored even by using smaller sized electrodes. A transcranial magnetic stimulation cycle can be set artificially by the control module, and is generally between 120s and 600 s. The signals collected by the two electrodes are transmitted to a control module, and are analyzed after being filtered, shaped and amplified as follows: 1. when the received first single-phase normal-phase D wave is blocked, the control module gives an alarm prompt to remind an operator that the user cannot perform any type of mechanical massage and stops further transcranial magnetic stimulation; 2. when the D wave conduction is normal and the I wave latency does not reach 1.5 times of the normal time, automatically entering a working mode 2-1 or 2-2; 3. when the D wave conduction is normal and the latency of the indirect wave I wave is prolonged to be 1.5 times of the normal time, the control module controls the whole device to enter a working mode 2-3.
After entering any working mode, the control module stops the continuous operation of transcranial magnetic stimulation and drives the electromyographic detection module 1 to pick up surface electromyographic signals. The picking position of the surface electromyographic signals is a mark point, and the mark point can be selected according to the self-description of a user, so that the skin temperature color-changing coating is further used for accurate positioning. The specific method comprises the following steps: the raw materials are selected from palmityl alcohol, myristyl alcohol, a leuco agent and a color developing agent, wherein the leuco agent can be selected from a thermosensitive dye Crystal Violet Lactone (CVL), the color developing agent is selected from diphenol propane (BPA), and the two alcohols exist as a solvent and a mixture. The solvent and solute were poured into a water bath heated vessel and stirred for a sufficient period of one hour to obtain a formulation. The color change performance of the composite material depends on the mass ratio of four substances, when CVL: BPA: myristyl alcohol: the mass ratio of the palm alcohol is 1: 3.3: 41: at 22 deg.C, the compound has the lowest melting point and good color-changing property at 33-40 deg.C. The complex is uniformly mixed with common phase-change materials, paraffin and the like can be selected as the phase-change materials, and the phase-change temperature is about 40 ℃ through simple proportioning processing. The mixed phase-change material and the compound are coated on the affected part and the corresponding position of the healthy side of a user. After the skin is stopped for 3 minutes, the skin is observed whether obvious skin temperature discoloration phenomenon exists or not, and the mark is carried out at the position which is obviously different from the peripheral skin or the healthy side.
A surface electromyographic signal pickup electrode is arranged around the mark point as a center, a neutral electrode in a group of three electrodes 13 is arranged at an electrically neutral position closest to the mark point, and an active measuring electrode ensures that a connecting line of the active measuring electrode is parallel to the trend of main muscle fibers at the mark point; the electrodes themselves have their long axis in the same direction as the major muscle fibers, and are spaced 2-2.5cm apart, so that they are not placed as far above the tendon as possible. A set of electrodes 14 is also placed symmetrically on the healthy side. The electrode sampling frequency for detecting pain signals is 300Hz-500Hz, preferably 450 Hz; the fatigue signal detection electrode is set to have a sampling frequency of 8 to 300Hz, preferably 20 to 100Hz, and more preferably 50 Hz. The common mode rejection ratio is larger than 120dB, and the sensitivity is 1 muV. The pick-up electrode measures the electrical activity of the muscle surface by using an active surface electrode, and the diameter of a conductive area is between 6 and 12 mm. The electrode is graphite electrode or titanium electrode. The electrode sampling frequency in modes 2-3 of operation is the same as that used to detect pain signals.
The following description takes one marked point as an example: the MPF value of the lead wires led out from the marking point on the affected side and the two groups of electrodes arranged on the corresponding healthy side are obtained by realizing fast Fourier transform after filtering and amplifying respectively. The two groups of data enter the logic judgment unit 41 of the control module respectively. The affected side signal obtained in the high frequency sampling timing sequence enters a pain signal judgment process, and the affected side signal obtained in the low frequency sampling timing sequence enters a low frequency judgment process. The Matalab analyzer 42 of the control module performs frequency domain analysis on the MPF in each judgment process, firstly, whether the MPF value obtained in the high-frequency sampling time sequence has rapid decline or flash phenomenon is judged, the judgment standard is to measure whether the corresponding middle frequency Slope (MPs) has obvious rise, the normal range of the slope value is preset by referring to the age, the body fat, the weight and the corresponding signal of the healthy side of the user, and the MPF can also be obtained by performing self-adaptive learning on a plurality of experiments of the user. Generally, if the MPs value is more than or equal to 60%, the affected part muscles of the user need physical therapy relief, and the process enters the process 2-1. If the MPF value obtained in the high frequency sampling sequence does not have the above-mentioned rapid drop, the analyzer 42 further analyzes the MPF value obtained in the low frequency sampling of the affected part, and performs analysis and comparison according to the above-mentioned steps. At the moment, the MPs value is larger than 45%, and the user can be judged to need physical therapy relaxation by combining the latency time of the collected electromyographic signals, and the process 2-2 is entered.
In mode 2-1, the control module activates the static magnetic field generator 324 to apply a static magnetic field of a size of 0.6-0.9T to the torso, particularly the spine, of the user; setting an ultrasonic action area 5-10cm from the side of the retrospinal column on the mark point; applying ultrasound with ultrasonic probe to obtain ultrasound with depth of 0.8-2.5cm, frequency of 0.3-1.0MHz and power of 1mW/cm2(ii) a The transducer of the ultrasonic probe is tightly attached to the skin, the effective area of the transducer is 10mm multiplied by 8mm, and the longitudinal direction of the transducer is vertical to the direction of the spine of a human body. The ultrasound forms a 1 cm square convergence point in the subcutaneous tissue corresponding to approximately the ganglion where the cell walls in the nerve tissue vibrate with charged particles in the cytoplasm, causing depolarization of the cell membrane according to the hall effect. The action potential will be transmitted to the corresponding skeletal muscle, resulting in a slight twitch or tremor. Meanwhile, the ultrasonic frequency and intensity pick up electricity along with the surface myoelectricityThe electromyographic signals obtained at the poles are adapted in such a way that the MPF fall value of the electromyography is reduced or in other words the MPs value is "raised". And stopping the magnetic field function by the control module every working period, and entering a surface electromyogram signal acquisition time sequence. And (4) entering a high-frequency sampling time sequence after the working mode 2-1, and repeating the steps again by using the picked skin surface electromyographic signals. Until the measured value of MPF or MPs reaches a preset standard or reaches a predetermined time.
In mode 2-2, a static magnetic field (avoiding acting on the head of the user) is applied, the size is 2.5T, and the magnetic field can be arranged in the left and right directions of the massage couch; then, according to the skin temperature indication, the position with the most obvious temperature change is selected as the center of the action zone of the gradient magnetic field, and the gradient field with the size of 100mT and the switching rate of 10-15mT/m.s (y circle) is applied. The gradient coil is disposed on one of the support arms.
Under the action of the gradient magnetic field, the action zone generates bioelectricity effect on tissues including nerves and muscle receptors so as to realize the shaking of the muscle belly in an indiscriminate form which is difficult to be detected by naked eyes. Clinical experiments show that the medicine can promote blood circulation and lactic acid metabolism, and is also helpful for fatigue recovery of corresponding nerve pathways, and more or less heat is generated according to different gradient magnetic field switching rates. The generated heat can cause the temperature of the part coated with the skin temperature allochroic paint to change, and the phase-change material can absorb heat to be liquefied after the threshold value of the phase-change material contained in the part is reached, so that the skin can be prevented from being thermally damaged. Meanwhile, the operator can monitor the skin temperature through the color of the skin temperature color-changing paint. In the stop period of the gradient magnetic field and when the myoelectricity acquisition module starts the working period, the phase-change material also generates phase change to release heat so as to avoid the over-low temperature of the coating part and prevent the myoelectricity signal error caused by the muscle tension of skin and muscle due to the cold and heat change. The gradient magnetic field switching rate is adaptively changed along with the electromyographic signals obtained by the pickup electrodes, and the feedback mode reduces the MPF drop value of the electromyography or in other words increases the MPs value. And stopping the magnetic field function by the control module every working period, and entering a surface electromyogram signal acquisition time sequence. The difference is that the low-frequency sampling time sequence is carried out after the working mode 2-2, and the steps are repeated again for the picked signals until the MPF or MPs value reaches the preset standard.
The gradient magnetic field coil is characterized in that an 8-shaped coil is arranged on the supporting arm fixing seat, the upper half 0 of the coil is fixed on the fixing seat, and the lower half O of the coil is arranged below the rack. The upper coil and the lower coil are formed oppositely, and the whole coil can move back and forth along with the supporting arm to adapt to the change of different positions.
Furthermore, an infrared skin temperature monitoring probe can be additionally arranged to prevent scalding. The infrared thermometer can be realized by adopting common technology in the field, and the monitoring range is 30-45 ℃. The probe is arranged on the supporting arm fixing seat and is electrically connected with the control module. The early warning temperature is preset in the control module, for example, 41 degrees centigrade (the specific selection of the phase-change material needs to be considered), so that the temperature early warning of the monitored area is realized, and scalding or accidents are prevented.
Further, in order to avoid the mutual influence between the potential field generated by the static magnetic field in the blood vessel wall and the electrocardiac action potential in the mode 2-1, the lead-in electrocardiograph 61 may be used. The electrocardio-detecting device adopts common three-lead, five-lead or twelve-lead modes and the like to detect the electrocardio of a user. To avoid interference, the electrocardiograph 61 is protected by reliable grounding, a filter, a metal outer cover of the outer cover and the like. The detection trigger circuit can also be adopted to realize the starting of the electrocardio S-wave trigger ultrasound. That is, a corresponding circuit is additionally arranged on the electrocardiogram detector: the electrocardiosignal detection circuit 62 realizes the amplification of electrocardiosignals, the frequency band of the signals is 1-2KHz, and the amplification factor can be adjusted; the S-wave detection circuit 63 is composed of a follower, a QRS filter, a wave shaping circuit, a peak value holder, and a comparator. The electrocardiogram output signal is converted into a voltage signal, is rectified and then is input into a monostable trigger to detect S waves, and an S wave synchronous pulse signal is obtained. And triggering the driving circuit at the rising edge of the S wave to realize the starting of the ultrasonic signal. The trigger circuit avoids the R wave action of the open heart action potential, thereby reducing the mutual influence of the two. Furthermore, the trigger circuit is not directly connected with the starting circuit but is connected with the starting circuit through the control module. After a rising edge trigger signal is obtained, the control module temporarily stores the signal, and starts the ultrasonic signal after the next trigger signal is obtained; the temporary storage behavior can effectively reduce the refractory period reaction of peripheral nerves and prolong the effective treatment time. And two or more trigger signals can be further temporarily stored according to the actual effect, and then the ultrasonic circuit is driven to work at a waiting time.
And further to achieve better timing of magnetotherapy cut-in mode 2-2. A buzzer or similar warning means is additionally arranged at the position of the fence close to the head of the user. The buzzer is electrically connected with and managed by the control module and used for guiding the frequency of abdominal respiration of a user, and meanwhile, the magnetic field switching frequency and the expiration phase of the abdominal respiration are kept synchronous by matching with the change of the gradient magnetic field after the user enters a stable respiration state. Specifically, the buzzer sounds to prompt a user to inhale, and the control module controls the switching rate of the gradient magnetic field coil to be at least kept above 80% of the peak value of the gradient magnetic field coil between 3s and 6s of the sounding of the buzzer. Clinical trials have shown that most adults are able to maintain a respiratory rate of 5-7 breaths per minute when they are abdominal breathing in conjunction with a breath indication device, while the heart rate will drop to a lower heart rate level within their normal range. The therapeutic effect is obviously improved by combining the magnetic field, and the measured MPF value can relatively rise by 1-10% under the condition of equal treatment time.
Still further, in the course of working of the rehabilitation system, the auxiliary therapeutic effect of the medicine is added, which is realized by the medication module, and the aim is to promote the blood flow at the local position and improve the relief effect of muscle tension. The medicine adopts proved formulas for supplementing bones and promoting blood circulation, which are well known by technicians in the field, and after the medicine is steamed and purified, effective components are further ground and mixed into the skin temperature color-changing coating to be coated on the part receiving magnetic therapy. The medicine can be heated and permeated into skin to achieve drug effect. The specific medicinal components are as follows (mass ratio): herba Epimedii 5, rhizoma Drynariae 21, Achyranthis radix 6, Carthami flos 1, radix Saposhnikoviae 9, Moschus 1, SHANQI 2, sanguis Draxonis 11, fructus Psoraleae 3, Succinum 4, rhizoma Ligustici Chuanxiong 10, and Notopterygii rhizoma 2. The medicinal components can be independently coated on the affected part after the skin temperature discoloration coating is removed, and the temperature monitoring is completely completed by the infrared probe. The hydrogel dressing can be added in the using process; uniformly coating the drug coating in the medical sterile transparent hydrogel dressing layer; the tailored dressing layer is in a specific shape, is laid on main muscle groups on two sides of the spine, such as erector spinae, multifidus muscles and the like, and is not limited to a specific magnetic therapy position; meanwhile, the mechanical traction effect of the corresponding muscle group is matched after coating, and the mechanical traction effect is realized by additionally arranging an upper limb mechanical traction rod; the traction rod is arranged on one side of the head of a user of the massage platform, and the height of the traction rod is slightly higher than the back of the user in a prone position; the traction direction is parallel to the platform, and the acting force direction is far away from the human body so as to realize the traction on the upper limbs of the user; the drawing is controlled by a control module, and the frequency is between 5 and 15 times per minute. Further, the pulling may be coordinated with the abdominal breathing rate. Specifically, the buzzer sounds to prompt a user to pull after breathing, and the user releases after pulling lasts for 4-8 seconds; the user uses the disappearance of the pulling force as an indication of exhalation.
In the nerve bone injury rehabilitation working mode 2-3, an interference current machine 71 is accommodated under the physiotherapy table frame 31 and is connected with a plurality of interference electrodes 711 through leads; the interferential electrodes 711 may be arranged on the support arm 322, facilitating movement to correspond to different ganglia; a pressurizing valve 72 is also accommodated below the physiotherapy table frame and is connected with a plurality of hollow microneedle electrodes 722 serving as surface electromyogram signal pickup electrodes through infusion tubes 721; the hollow micro-needle electrodes are in a group of three, a neutral electrode is arranged at an electric neutral position closest to the marking point, and the connecting line of the two active measuring electrodes is parallel to the main muscle fiber trend at the marking point; the long axis of the electrode is in the same direction with the main muscle fiber, and the distance between the two active electrodes is 2-2.5 cm. A group of hollow microneedle electrodes are also symmetrically arranged on the healthy side. The sampling frequency is 300Hz-500Hz, preferably 450Hz, the common mode rejection ratio is more than 120dB, and the sensitivity is 1 muV. The pick-up electrode measures the electrical activity of the muscle surface by using an active surface electrode, and the diameter of a conductive area is between 6 and 10 mm. The electrode is graphite electrode or titanium electrode.
Furthermore, the tail end of the hollow microneedle is connected with a pressurizing valve mechanism through an infusion tube to realize controllable infusion of the drug, and the healthy side does not carry out drug infusion. The pressurizing valve and the micro-needle contain a magnetic nanoparticle ball mixture with magnetic compliance. In the mixture, ferroferric oxide is used as a magnetic core to coat biodegradable organic materials, such as magnetic lipid substances adopted by Lopera, and the contained effective medicinal ingredients are bone morphogenetic protein BMP2 (adopting commercially available recombinant human bone morphogenetic protein freeze-dried powder), osteoprotegerin OPG and prostaglandin PGe 2; the second one is temperature responsive thermosensitive magnetic nanoparticle sphere, the particle is composed of magnetic ferroferric oxide nanoparticles and a poly-isopropyl acrylamide shell layer coated outside the magnetic nanoparticles, the contained medicines are ligand RANKL of receptor activating factor RANK of nuclear factor KB and insulin growth factor 1, and the two are called as osteoclastin together in the invention. Setting the mark point area as a target field, and realizing the magnetic field setting of the mark point by adopting a mode of adding a permanent magnet, wherein the magnetic induction intensity is 0.5-0.9T, and the time is more than 30 minutes. The permanent magnet is selected from the prior art, has a unipolar cylindrical shape, and has a section circle radius of 1.5-4 cm. Which is arranged on the support arm 322 and is positioned 3-8cm above the marking point by means of an adjustable support arm. This permanent magnet 326 not only provides a targeted magnetic field environment, but the prior art also demonstrates its benefits in healing of occult bone injuries. The control module controls drug infusion to release the magnetic nanoparticle sphere mixture 30 minutes after applying the targeting magnetic field to the marker site. At this point, the control module manages the breathing instruction device to prompt the patient to perform high frequency shallow breathing, above 15 breaths per minute, to achieve the effect of simulating over-ventilation, and to provide the patient with a short-time oxygen supply if necessary. The indication mode can also adopt a buzzer or LED flashing lamp decoration and the like.
The control module controls the operation of the bone fracture module 7 while the patient breathes as instructed. The bone fracture module comprises an interference current electrode and an interference current machine; the electrodes comprise commercially available quadruple electrodes (the interference position of the quadruple electrodes is positioned below the center) or common electrodes (the interference position of the common electrodes is positioned below the cross connecting line point of the two groups of electrodes), and the electrodes are selected according to the area of the implementation part; calibrating electrodes at a high-temperature calibration position of skin temperature discoloration, avoiding the surface electromyographic signal pickup electrodes from the space as much as possible, wherein the crossing depth is about 2-5 cm, and the electrodes are specifically selected according to different positions of limbs or trunk; an intermediate frequency current, specifically a 4.5kHz current, is used to generate a differential frequency of 10Hz, 9-22mA interference current at the interference location. The current not only promotes vasodilatation, lymphatic return and local temperature rise near the affected part, but also is beneficial to the fixed-point release of the osteopontin in the thermosensitive magnetic particle ball. When the temperature rises to approximately 40 ℃, the poly (isopropyl acrylamide) shell coated outside the drug release capsule begins to disintegrate, and the drug is released into the interstitial space of the tissue and enters the blood through the subcutaneous space. Because ligand competition and PGe2 combined action with IGF1, etc. avoid focal ectopic ossification and intravascular calcification; and promote osteoblast differentiation and action at sites where nerve and bone damage may exist. And when the temperature reaches nearly 40 ℃, the skin temperature allochroic paint begins to generate phase change, so that the overhigh temperature and the excessive release of the bone breaking element are avoided.
The interferential current machine additionally leads to a multi-path interference circuit for interfering with a particular sympathetic ganglion, such as, but not limited to, a stellate ganglion, a thoracic ganglion, a lumbar ganglion, a sacral ganglion, etc. The interference electrodes are arranged in the same manner as before, common electrodes are adopted, electrode connecting lines are crossed, the crossing points correspond to the positions of the ganglia, and the proper depth of the ganglia is known to those skilled in the art. The difference frequency of the interference current generated by the medium-frequency current at the interference position is about 100Hz, and the intensity is 10 mA. The interference current inhibits the excitation of corresponding ganglia, has the effect similar to the blocking of the ganglia, and can effectively promote the activity of the osteoclasts and osteoblasts. When the effective ganglion is blocked, the MPF signal obtained by the myoelectric electrode at the high-temperature mark point obviously rises, and the rising amplitude can generally reach more than 12 percent of the initially measured MPF value, which is also the method for defining the effective ganglion in the invention. The so-called effective ganglia may in the present invention include the ganglia that innervate the muscle where the site is marked, such as the directly innervating ganglia and other ganglia that may be present on the path of the central to the directly innervating ganglia. Rapid and accurate ganglion interference blocking for different target muscles requires that an operator has rich experience and anatomy knowledge; also, because of the complexity and susceptibility to disturbance of the nervous system, the effective ganglia may be subject to deterioration of the blocking effect due to overstimulation or muscle tone in the patient, also known as facilitation of ganglia. The invention designs a wheel ganglion interference mode based on the method, and takes the preset interference electrodes of n ganglia as an example (n is generally between 3 and 6, and the total time of the interference period is too long easily caused by excessive interference electrodes, thereby influencing the final rehabilitation effect): starting preset n ganglion interference electrodes in turn in each period from 1 st to nth interference periods; while only the interfering electrodes of the active ganglia (possibly more than one) are activated during the (n + 1) th interfering cycle; sequentially starting preset n ganglion interference electrodes in turn in each period from the (n + 2) th period to the (2 n + 1) th period; and so on, ending the preset time. And inserting an electromyographic signal pickup period after the end of each ganglion interference period, and determining whether the ganglion interference electrode is the effective ganglion according to the rising amplitude of the MPF at the end of the electromyographic signal pickup period. If none of the valid ganglia can be determined in a round, then the valid ganglia interference period for that round will not interfere with any ganglia, preventing over-facilitation. The start of the disturbance period is based on the moment of removing the permanent magnet, and the total duration is generally set to be not more than 30 minutes. If necessary, the permanent magnet may be applied again at the marking point after 30 minutes for 30 minutes, and the interference period duration is set to 30 minutes as the next cycle. The interference current machine can control the synchronous work of the affected part interference electrode and the ganglion interference electrode so as to achieve the synchronization of releasing osteogenic element, broken bone element and absence of nerve at the affected part.
Because of the nature of occult fractures, patients are often clinically without typical symptoms of injury, but manifest as local muscle tension, spasticity, and are often not known by the patient at first instance. Unlike rehabilitation treatments for typical bone injuries, occult fractures, especially old occult fractures, often already present large amounts of callus and fibrous scarring at the affected site, possibly even with muscular atrophy. Because the muscles have insufficient feedback to the nerve, the ganglia that innervate the affected muscles tend to be overdischarged. At this time, bone formation cannot be promoted at all, but rather, blood circulation at the affected part should be promoted, muscle tension should be improved, and normal biological level and physiological environment at the affected part should be restored first, while interference necessary for the administration of over-discharged ganglia and the injection of magnetic nanoparticle sphere mixture at the affected part should be given. Therefore, further, after the execution of the aforementioned working modes 2-3 completes one period of time, the control module controls the whole system to enter a new working cycle again: transcranial magnetic stimulation is executed, and the myoelectric detection module detects the movement evoked potential MEP and the surface myoelectric signals.
When the I wave delay obtained by the induction of the round does not reach more than 1.2 times of the normal time length of the rest and muscle relaxation state of the same-sex adult, the MPF value does not need to be judged whether to rapidly decline or flash, and the following working mode is directly entered: in the working mode, the working time interval is set to be not less than 30 minutes and the abdominal respiration of the patient is guided through the whole process of the respiration indicating device; the control module activates the static magnetic field generator 324 to apply a static magnetic field of a size of 0.6-0.9T to the torso of the user; setting an ultrasonic action area 5-10cm from the side of the retrospinal column on the mark point; the control module controls the ultrasonic probe to apply ultrasonic waves, the ultrasonic waves have the ultrasonic convergence depth of 0.8-2.5cm, the frequency of 0.3-1.0MHz and the power of 1mW/cm2(ii) a The transducer of the ultrasonic probe is tightly attached to the skin, the effective area of the transducer is 10mm multiplied by 8mm, and the longitudinal direction of the transducer is vertical to the direction of the spine of a human body; the ultrasonic frequency and intensity are adaptively adjusted along with the electromyographic signals obtained by the surface electromyographic pickup electrode, and the feedback mode reduces the MPF (maximum pulse width) value of the electromyography or in other words increases the MPs value; the control module simultaneously controls the interference current machine to start interference of the ganglion interference electrode on a plurality of specific ganglia, and the pressurizing valve conveys the magnetic nanoparticle ball mixture to the hollow microneedle electrode while the interference is carried out; interference to ganglia may also be selected from rotational ganglion interference patterns, where ganglia are selected from, but not limited to, stellate, thoracic, lumbar, sacral ganglia, and the like. For convenience of description, the above operation mode is named as the concealed fracture rehabilitation mode 2-4.
Furthermore, in the concealed fracture rehabilitation mode 2-4, an electrocardiograph 61 is used to avoid the mutual influence of the potential field generated by the static magnetic field in the blood vessel wall and the electrocardiographic action potential. The electrocardio-detecting device adopts common three-lead, five-lead or twelve-lead modes and the like to detect the electrocardio of a user. To avoid interference, the electrocardiograph 61 is protected by reliable grounding, a filter, a metal outer cover of the outer cover and the like. The detection trigger circuit can also be adopted to realize the starting of the electrocardio S-wave trigger ultrasound. That is, a corresponding circuit is additionally arranged on the electrocardiogram detector: the electrocardiosignal detection circuit 62 realizes the amplification of electrocardiosignals, the frequency band of the signals is 1-2KHz, and the amplification factor can be adjusted; the S-wave detection circuit 63 is composed of a follower, a QRS filter, a wave shaping circuit, a peak value holder, and a comparator. The electrocardiogram output signal is converted into a voltage signal, is rectified and then is input into a monostable trigger to detect S waves, and an S wave synchronous pulse signal is obtained. And triggering the driving circuit at the rising edge of the S wave to realize the starting of the ultrasonic signal. The trigger circuit avoids the R wave action of the open heart action potential, thereby reducing the mutual influence of the two. Furthermore, the trigger circuit is not directly connected with the starting circuit but is connected with the starting circuit through the control module. After a rising edge trigger signal is obtained, the control module temporarily stores the signal, and starts the ultrasonic signal after the next trigger signal is obtained; the temporary storage behavior can effectively reduce the refractory period reaction of peripheral nerves and prolong the effective treatment time. And two or more trigger signals can be further temporarily stored according to the actual effect, and then the ultrasonic circuit is driven to work at a waiting time.
Furthermore, an infrared skin temperature monitoring probe can be additionally arranged to prevent scalding. The infrared thermometer can be realized by adopting common technology in the field, and the monitoring range is 30-45 ℃. The probe is arranged on the supporting arm fixing seat and is electrically connected with the control module. The early warning temperature is preset in the control module, for example, 41 degrees centigrade (the specific selection of the phase-change material needs to be considered), so that the temperature early warning of the monitored area is realized, and scalding or accidents are prevented.
The control module can be realized by a common singlechip, a field programmable gate control circuit or a microcomputer in the field, and a small keyboard or a conventional keyboard is used as an input device in a matching way.
The above examples are only for the purpose of illustrating the technical solutions of the present invention, and should not be construed as limiting the scope of protection. Those skilled in the art can make various changes and modifications to the invention without departing from the spirit and scope of the invention.

Claims (2)

1. An electrocardiographic triggering device for use in a spinal rehabilitation system, the spinal rehabilitation system comprising:
the device comprises a myoelectricity detection module, a magnetic therapy module, a massage module, a control module, a display module, an electrocardio module and a bone fracture module; the myoelectricity detection module detects myoelectricity on the surface of a human body in real time and classifies the myoelectricity according to myoelectricity level and characteristics; the control module judges whether to enter a preset relieving massage mode 2-1, a relaxing massage mode 2-2 or a nerve bone injury rehabilitation mode 2-3 according to the classification result sent by the myoelectricity detection module; in the nerve bone injury rehabilitation mode 2-3, a magnetic nanoparticle ball mixture with magnetic compliance is adopted, and the magnetic nanoparticle ball mixture contains osteogenin and osteoclastin; the magnetic nanoparticle ball mixture is placed in a pressurizing valve, and the pressurizing valve is connected with the tail end of a microneedle of the hollow microneedle electrode and is managed by a control module; injecting the magnetic nanoparticle ball mixture under pressure after adding 0.5-0.9T permanent magnet in the targeting field for more than 30 minutes; then the control module manages the breath indicating device to prompt the patient to perform high-frequency shallow breathing for more than 15 times per minute;
the device is characterized in that after the execution of the nerve bone injury rehabilitation mode 2-3 is finished for a period of time, the control module controls the whole system to enter a new round of working cycle again, wherein transcranial magnetic stimulation is executed, and the myoelectric detection module detects a Movement Evoked Potential (MEP) and a surface myoelectric signal; when the I wave delay induced by the round does not reach more than 1.5 times of the normal time length of the rest and muscle relaxation state of the same-sex adult, the MPF value is directly entered into a preset relieving massage mode 2-1 without judging whether the MPF value is rapidly reduced or flashed; in the preset relieving massage mode 2-1, the electrocardio detector 61 is used for detecting the electrocardio of the user by adopting a common three-lead, five-lead or twelve-lead mode; the electrocardio detector is protected by adopting a reliable grounding mode, a filter mode and an outer cover metal jacket mode, and the detection trigger circuit is adopted to realize the starting of electrocardio S-wave trigger ultrasound; and one of the magnetic nanoparticle ball mixture takes ferroferric oxide as a magnetic core and is coated with a biodegradable organic material, the medicine components of the magnetic nanoparticle ball mixture are bone morphogenetic protein BMP2, osteoprotegerin OPG and prostaglandin PGe2, the other medicine components of the magnetic nanoparticle ball mixture are temperature-responsive thermosensitive magnetic nanoparticle balls, the magnetic nanoparticle ball mixture consists of magnetic ferroferric oxide nanoparticles and a layer of polyisopropylacrylamide shell layer coated outside the magnetic nanoparticles, and the medicine components of the magnetic nanoparticle ball mixture are ligand RANKL of receptor activating factor RANK of nuclear factor KB and insulin growth factor 1.
2. The cardiac trigger device of claim 1, wherein: the detection trigger circuit is connected with the ultrasonic starting circuit through the control module; after a rising edge trigger signal is obtained, the control module temporarily stores the signal, and starts an ultrasonic signal after the next trigger signal is obtained; in the preset relieving massage mode 2-1, a static magnetic field is applied in the upper and lower directions of a platform where a patient is positioned, and the size is 0.6-0.9T; ultrasonic is applied to the indicating point on the indication position of the color-changing skin temperature coating along the side of the spinal column and vertical to the indicating point, the ultrasonic convergence depth is 0.8-1.5cm, the frequency is 0.2-1MHz, and the power is 1mW/cm2The effective area of the transducer probe is 10mm multiplied by 8mm, the transducer probe is tightly attached to the skin, and a convergence area of about 1 square centimeter is formed by a convergence point at a corresponding nerve node under the skin; the convergence region causes depolarization of cell membranes in corresponding nervous tissues, and the generated action potential causes slight jitter of dominant skeletal muscles; in the time of the ultrasonic action interval, the myoelectricity detection module continuously picks up the myoelectricity near the mark point; the ultrasonic frequency is adaptively adjusted through a feedback signal, and the MPF value of the electromyogram is adjusted to be in a rising trend relative to the recorded value obtained by the electromyogram signal detection module in the previous working cycle.
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