JP7016097B2 - Magnetic stimulator and its excitation method - Google Patents

Description

In the present invention, the affected area (for example, the suprahyoid muscle group and the infrahyoid muscle group that control swallowing movement, and the rectus abdominis muscle, trapezius muscle, and latissimus dorsi muscle) that exist symmetrically with respect to the center of the body (midline). , A magnetic stimulator that individually magnetically stimulates a CPG (central pattern generator) localized in the spinal cord, and a motor nerve connecting the CPG and each muscle.

There are various disorders that can be treated with magnetic therapy, but here we will focus on dysphagia.
The number of dysphagia cases in Japan is enormous, and of the approximately 400,000 strokes that occur annually, about 5% of patients have damage to the neural mechanisms that control dysphagia. Other diseases that cause dysphagia other than stroke include traumatic brain injury, cerebral palsy, dementia, Parkinson's disease, Huntington's disease, Wilson's disease, amyotrophic lateral sclerosis (ALS), multiple sclerosis, and brain tumors. , There are many such as severely injured amyotrophic disease. In addition to the above diseases, there are also dysphagia due to aging, and it is expected that the number of patients with dysphagia will increase in the future.

Dysphagia refers to a condition in which oral intake of food and beverages is difficult, and the majority of pneumonia, which is the third leading cause of death in Japan, is called aspiration pneumonia caused by dysphagia in the elderly. In addition, dysphagia can cause suffocation.
As mentioned above, dysphagia is plagued not only by the elderly but also by many cerebrovascular accidents and other patients, and more than 20,000 new dysphagia patients occur annually. Therefore, improving this dysphagia is very important for maintaining good health of the elderly and cerebrovascular accidents. Therefore, the following dysphagia treatment devices have been proposed (Patent Document 1 and Non-Patent Document 1).

Japanese Unexamined Patent Publication No. 2012-250588

Internet <URL: http://www.djoglobal.com/vitalstim>

In the case of a healthy person, when food or liquid is taken in, the food or liquid mechanically stimulates the pharynx to induce swallowing. Animal experiments have demonstrated that the swallowing center can be activated by directly electrical stimulation of the nasopharyngeal nerve or pharyngeal nerve pharyngeal branch distributed in the pharyngeal mucosa, or by electrical stimulation of the pharyngeal mucosa.
Also, anatomically, more nerve distribution is observed on the side wall of the pharynx. Using this as a hint, the invention described in Patent Document 1 provides effective swallowing training and treatment to a swallowing patient by electrically stimulating this portion instead of food or liquid to induce swallowing.

In the invention described in Patent Document 1, a stimulating electrode is brought into close contact with the mucous membrane of the pharynx via the nasal cavity, and an appropriate value of current is supplied to the stimulating electrode to apply electrical stimulation to the portion, thereby training swallowing. However, the adhesion of the stimulating electrode to the pharyngeal mucosa via the nasal cavity imposes a heavy burden on the patient and cannot be easily treated.

On the other hand, the invention described in Non-Patent Document 1 is to attach a stimulating electrode to the epidermis of a patient from the lower jaw to the neck and energize the stimulating electrode to electrically stimulate the internal pharyngeal mucosa. There is a problem that sometimes it causes pain due to electric shock to the patient, and if there is hair such as a jaw beard, it cannot be attached to the part (throat) where the stimulation electrode is required.

Furthermore, various suprahyoid muscle groups that control the swallowing action are present symmetrically with respect to the center of the mandible (median line) as shown in FIG. In addition, the position of the muscle group varies from patient to patient, and in order to stimulate the entire muscle group widely present in the lower jaw, a large treatment device capable of covering this is required, and the amount of electric power corresponding to the muscle group is required. Will increase.

The present invention is much easier to use than Patent Document 1, does not cause pain during electrical stimulation as in Non-Patent Document 1, is not restricted by the site of use due to body hair, etc., and the lower jaw on both sides of the midline. The muscles that are widely present in the area and control the swallowing action (or the above-mentioned rectus abdominis muscles and other muscles that are not directly related to the swallowing action but are the targets of magnetic treatment, and motor nerves: The main task is to provide a new magnetic stimulator capable of individually magnetically stimulating.

The present inventors have studied a continuous magnetic pulse generator (Japanese Patent Laid-Open No. 2015-107176) for stimulating peripheral nerves of large muscles of limbs with continuous magnetic pulses to cause continuous large contractions in these large muscles. Has been advanced.
By applying this device to magnetic stimulators such as swallowing disorders, for example, small muscles related to swallowing of patients, the suprahyoid muscles and the infrahyoid muscles existing to the left and right of the midline of the jaw. We have completed a device that can individually apply magnetic stimulation to the group (or muscles and nerves related to other disorders) to effectively swallow and other training and treatment of the patient.

The invention according to claim 1 (magnetic stimulator A: FIGS. 15 and 16 )
A pair of left and right U-shaped cores 50L / 50R,
Conductors 65x / 65y (or 65Lx / 65Ly / 65Rx / 65Ry) wound around the front and rear legs 51Lx / 51Ly / 51Rx / 51Ry of the U-shaped core 50L / 50R and exciting the U-shaped core 50L / 50R.
The pair of U-shaped cores 50L / 50R around which the conductors 65x / 65y (or 65Lx / 65Ly / 65Rx / 65Ry) are wound are arranged side by side, and their legs 51Lx / 51Ly / 51Rx / 51Ry are oriented in the same direction. In the magnetic stimulator A composed of the case 1 to be stored toward
The case 1 is composed of a left side case portion 1L, a right side case portion 1R, and a connection portion 40 separated from the left / right side case portions 1L and 1R.
The connection portion 40 is composed of a holding arm portion 41L / 41R that extends laterally from the main body and holds the left side case portion 1L and the right side case portion 1R in a position close to or away from the connection portion 40. Be done,
The one U-shaped core 50L is housed in the left case portion 1L, and the other U-shaped core 50R is housed in the right side case portion 1R.
The surface including the tip surface (52Lx / 52Ly) of the leg portion 51Lx / 51Ly of the one U-shaped core 50L is defined as a magnetic flux generating surface (FL).
The surface including the tip surface (52Rx / 52Ry) of the leg portion (51Rx / 51Ry) of the other U-shaped core (50R) is defined as a magnetic flux generating surface (FR).
The connection portion 40 is characterized in that an internal angle adjusting mechanism 44 for adjusting the internal angle θ of the magnetic flux generating surface FL / FR is provided.

The magnetic stimulator A has a pair of independent U-shaped cores 50L / 50R prepared on the left and right, and the magnetic stimulator A is used instead of the electrode attached to the center of the lower jaw of Non-Patent Document 1. In the treatment, one motor point MpL (affected part to which magnetic stimulation is to be given) of the patient is located between one leg 51Lx / 51Ly of the magnetic stimulator A, and the other is located between the other legs 51Rx / 51Ry. By installing the magnetic stimulator A so that the motor point MpR of the above is located, a more local stimulus can be given to the vicinity of the left and right motor points MpL / MpR as compared with the electrical stimulus of Non-Patent Document 1. Can be done.
The content of the above "same direction" does not mean "exactly the same direction", and the internal angle θ with the magnetic flux generating surface FR including the tip surface 52Rx / 52Ry of the leg portion 51Rx / 51Ry described below is 180 °. Including cases less than.

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With the internal angle adjusting mechanism 44, the internal angle θ of the surfaces FL / FR can be easily adjusted to the shape of the patient's lower jaw (or affected portion).

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In this case, since the left side case portion 1L and the right side case portion 1R are installed so as to be close to and separated from the connection portion 40, various patients having motor points MpL / MpR having different positions (angles and intervals). The magnetic stimulator A can be adjusted so that the center of the U-shaped core 50L / 50R can always be aligned with the motor point MpL / MpR.

The invention according to claim 2 (FIGS. 4 to 7) is the magnetic stimulator A according to claim 1 .
One conductor 65x is wound so as to integrally surround the circumference of one leg portion 51Lx / 51Rx of the U-shaped cores 50L / 50R arranged side by side.
The other conductor 65y is characterized in that it is wound so as to integrally surround the other leg portion 51Ly / 51Ry of the U-shaped core 50L / 50R.

The invention according to claim 3 (FIGS. 8 and 9) is the magnetic stimulator A according to claim 1 .
One conductor 65Lx / 65Ly is individually wound so as to surround each leg portion 51Lx / 51Ly of one U-shaped core 50L.
The other conductor 65Rx / 65Ry is characterized in that it is individually wound so as to surround each leg portion 51Rx / 51Ry of the other U-shaped core 50R.

When the magnetic flux generating surface F is a flat surface as shown in FIG. 3, the leg portion 51 of the U-shaped core 50 and the conductor 65 are arranged at right angles in the winding method shown in FIG. 4, but in other cases. Then, since an angle is generated at the internal angle θ of the magnetic flux generation surface FL / FR, an angle of half of the internal angle θ is generated between the leg portion 51 of the U-shaped core 50 and the conductor 65. This angle is small and is within the range that does not hinder practical use.

The invention according to claim 4 is characterized in that, in the magnetic stimulator A according to any one of claims 1 to 3 , all the conductors 65 are connected in series.

The invention according to claim 5 (FIG. 10) is the excitation method for the magnetic stimulator A according to any one of claims 1 to 4 .
An exciting current is intermittently passed through the conductor 65 that excites the U-shaped core 50L / 50R, and in a pair of U-shaped cores 50L / 50R arranged side by side, one leg portion 51Lx (51Ly) of one U-shaped core 50L is formed. One leg portion 51Rx (51Ry) of the other U-shaped core 50R adjacent to each other is excited to the same pole.

That is, when the adjacent leg portions 51Lx / 51Rx are excited to the same N pole (or S pole), the adjacent leg portions 51Ly / 51Ry on the opposite side inevitably become the opposite polar S pole (or N pole). Be excited. By adopting such an excitation method, the eddy currents ULx / ULy / URx / URy merge at the motor point MpL / MpR and cross the eddy current, so that the intensity can be locally doubled. In addition, according to this excitation method, the change in the magnetic flux generated from one core tip surface 52L acts in the direction of strengthening the eddy current at the motor point MpR, and similarly, the change in the magnetic flux generated from the other core tip surface 52R also changes. Since it works in the direction of increasing the eddy current at the motor point MpL, it is possible to induce a larger eddy current to the motor point MpL / MpR than when the magnetic flux is generated by a single core.

The invention according to claim 6 (FIG. 11) is another example.
The excitation method of the magnetic stimulator A according to any one of claims 1 to 4 .
An exciting current is intermittently passed through the conductor 65 that excites the U-shaped core 50L / 50R, and the pair of U-shaped cores 50L / 50R arranged side by side with one leg 51Lx (51Ly) of one U-shaped core 50L. It is characterized in that one leg portion 51Rx (51Ry) of the other U-shaped core 50R adjacent to each other is excited to a different pole .

That is, the leg 51Lx is excited to the N pole (or S pole), and the adjacent leg 51Rx is excited to the opposite S pole (or N pole).
At this time, the other leg 51Ly of the pair of U-shaped cores 50L naturally becomes the S pole (or N pole), and the other leg 51Ly of the other U-shaped core 50R naturally becomes the N pole (or S pole). become.

At this time, the directions of the eddy currents ULx / ULy / URx / Ury flow antisymmetrically with the median plane CL as the center line. As a result, the eddy currents ULx, ULy / URx, and URy that merge at the left and right motor points MpL / MpR that coincide with the center of the left and right U-shaped cores 50L / 50R flow in the same direction and strengthen each other. Double.

In addition, the symmetry of the evoked reaction (muscle movement, etc.) of the living body induced by the magnetic stimulus is increased by the eddy current ULx / ULy / URx / Ury that flows symmetrically with the median plane CL as the center line. For example, taking the stimulation to the suprahyoid muscle group as an example, even muscle contraction of the left and right geniohyoid muscles and the digastric muscle can be obtained at the same time, and along the midline of the hyoid bone connected to these muscles. You can get a proper lift. It is very important to obtain symmetrical muscle contraction in the reconstruction of swallowing motion.

The invention according to claim 7 is the excitation method of the magnetic stimulator A according to claim 5 or 6 .
It is characterized in that an exciting current is intermittently passed through a conductor 65 that excites the U-shaped core 50L / 50R, and the current direction of the intermittently flowing exciting current is intermittently reversed for each excitation cycle.

Nerves have different stimulus sensitivities depending on the direction of the eddy current U. Therefore, by intermittently reversing the current direction of the exciting current, the current direction of the eddy current U is also intermittently reversed. This makes it possible to appropriately stimulate nerves, albeit intermittently.

According to the present invention, the muscles that control the swallowing action that are widely present in the lower jaw, the rectus abdominis muscle and other muscles that are symmetrically present on both sides of the median plane, the motor nerves (motor points), etc. are simply and individually. Can be magnetically stimulated.

It is a side sectional view which shows the state which applied the magnetic stimulator of this invention to the lower jaw of a patient. FIG. 1 is a front view of FIG. 1 as viewed from below. It is a perspective view of the 1st Example of the magnetic stimulator of this invention. It is a perspective view which looked at the outline of the internal structure of FIG. 3 from the bottom side. It is a vertical sectional view of FIG. FIG. 5 is a vertical cross-sectional view taken along the display cross section (CP plane) in a right-angled direction. FIG. 3 is a plan view of FIG. 3 with the lid removed. It is a perspective view which looked at the outline of the internal structure of the modification of FIG. 3 from the bottom side. 8 is a plan view of FIG. 8 with the lid removed. It is a schematic diagram of the eddy current generated in the lower jaw at the time of the treatment by the magnetic method of this invention. It is a schematic diagram of the eddy current generated in the mandible at the time of the treatment by the other magnetic method of this invention. It is a perspective view of the 2nd Embodiment of the magnetic stimulator of this invention. It is a perspective view of the 3rd Example of the magnetic stimulator of this invention. FIG. 13 is a plan view showing a state in which a part of the lid portion is cut off. It is a perspective view of the 4th Example of the magnetic stimulator of this invention. FIG. 15 is a plan view with the lid removed.

Hereinafter, the present invention will be described with reference to the illustrated examples. First, the application site of the magnetic stimulator A of the present invention is an affected area that is symmetrical with respect to the center of the body (midline) {for example, the suprahyoid muscle group, the infrahyoid muscle group, and others that control swallowing motion. The rectus abdominis muscle, trapezius muscle, latissimus dorsi muscle, other CPG (central pattern generator) localized in the spinal cord, and the motor nerve connecting the CPG and each muscle}.
Hereinafter, dysphagia will be described as a representative example, and first, a normal swallowing motion will be described (see FIGS. 1 and 2).
The nasal cavity 77 and the oral cavity 78 are connected to the upper entrance of the pharynx 76, and the lower exit of the pharynx 76 is connected to the larynx 79 and the esophagus 90.
At the time of breathing, the air entering from the nasal cavity 77 is sent to the larynx 79 via the pharynx 76, and is sent to the lungs through the trachea 88.

On the other hand, at the time of swallowing, the bolus such as food, water or liquid nutrient chewed in the oral cavity 78 is sent to the pharynx 76, and is sent to the stomach via the esophagus 90 as described later.
Since the air and the bolus pass through the pharynx 76 in this way, if the muscle that separates breathing and swallowing cannot be controlled, the bolus erroneously enters the trachea 88 and causes aspiration. This point will be described in more detail.

When food is chewed and the bolus is swallowed, the bolus mechanically stimulates the pharynx 76 as described above to induce a swallowing action. Then, the esophageal mass enters the epiglottis valley 81 from the oral cavity 78, and the muscle 83 connected to the epiglottis cartilage 82 immediately below is inverted by the induced swallowing action, and the epiglottis 84 closes the entrance of the trachea 88 at the same time. The passage is switched from the oral cavity 78 to the esophagus 90 via the pharynx 76, whereby the bolus smoothly flows down from the oral cavity 78 to the esophagus 90.

In order to prevent the bolus from entering the trachea 88, the entrance of the larynx 79 that is instantly connected to the trachea 88 by the swallowing reflex needs to be covered with the epiglottis 84 in a timely manner. Such a swallowing action is performed by the above-mentioned suprahyoid muscle group 70, the infrahyoid muscle group (not shown), the superior pharyngeal constrictor muscle, and various other muscles operating in a very short time and in a timely manner.
It is controlled by the swallowing center in the medulla oblongata of the brain. Therefore, due to various diseases such as aftereffects of stroke, aging, neurological diseases, and morphological abnormalities of the oral cavity and pharynx, the nervous system from the pharyngeal branch or pharyngeal branch to the swallowing center, and the muscle group that controls swallowing from the swallowing center (particularly, the suprahyoid muscles). When a disorder occurs in the neural system leading to the suprahyoid muscle group70) including the bone muscle, the jaw bi-abdominal muscle (anterior abdomen), and the suprahyoid muscle, swallowing disorder occurs. The suprahyoid muscle group 70 exists on both sides of the median plane CL, which is the center line of the body, and the suprahyoid muscle group on the left side is represented by 70L and the suprahyoid muscle group on the right side is represented by 70R.

Therefore, using the magnetic stimulator A according to the present invention, for example, in the case of dysphagia, the suprahyoid muscles 70L / 70R (here, this portion is referred to as a motor point MpL / MpR) that controls the swallowing action are pulsed. By intermittently giving a stimulus and contracting the motor point MpL / MpR intermittently, it stimulates the damaged nervous system and the pharyngeal phase to which these are connected to activate the swallowing function. Is.
The left and right motor points MpL / MpR are spread to the left and right with respect to the center (median) line CL of the patient's jaw as shown in FIG. These positions are likely to vary from person to person and are not constant. In order to give magnetic stimulation to the left and right motor points MpL / MpR, it is preferable that the center of the left and right U-shaped cores 50L / 50R comes directly below the left and right motor points MpL / MpR. In addition, in this case, it is preferable that the magnetic flux generating surface F (or FL / FR) including the tip surface 52Lx / 52Ly / 52Rx / 52Ry faces the epidermis directly above the motor point MpL / MpR as much as possible.

Next, a magnetic stimulator A for local magnetic stimulus such as the treatment of dysphagia according to the present invention will be described with reference to the illustrated examples. Hereinafter, examples of the present invention will be described in more detail, but these examples are merely examples for explanation, and the present invention is not limited to these examples. In the description of the embodiments of the present invention, those having the same function are designated by the same reference numerals (Arabic numerals and alphabets) for the sake of simplicity, and the description thereof will be omitted. And in the case of a pair of left and right with the same code (Arabic numeral), if it is necessary to distinguish this for explanation, add L (meaning left) and R (mean right) to the code. .. Further, in the pair of left and right parts, if there are parts having the same function in the front and back and it is necessary to distinguish them, add x (front) and y (rear) after L and R.

In the treatment of dysphagia, the magnetic generation surface F of the magnetic stimulator A is held along the mandibular epidermis as shown in FIGS. 1 and 2. At this time, it is necessary to be able to stimulate only the left and right motor points MpL / MpR, which control the swallowing operation without stimulating the inferior alveolar nerve 72 and the like. For that purpose, the U-shaped cores 50L / 50R are respectively placed directly under the motor points MpL / MpR as described above. Further, it is preferable to make them face each other as described above.

3 to 9 are the first embodiments of the magnetic stimulator A of the present invention, in which the surface along the lower jaw of the magnetic stimulator A, that is, the surface where the magnetic flux generation surface F is flat, is shown in FIG. When the magnetic flux generating surface F is formed in a shallow V shape so that the second embodiment) follows the shape of the lower jaw, FIGS. 13 and 14 (third embodiment) make the internal angle θ of the magnetic flux generating surface F variable. In this case, FIGS. 15 and 16 (4th embodiment) show a case where the spacing between the U-shaped cores 50L / 50R can be changed in addition to this. The above example is just an example.
Hereinafter, the first embodiment will be described. Regarding the second and subsequent embodiments, the same reference numerals are given to the portions having the same functions as those of the first embodiment, and the description of the first embodiment shall be incorporated.

(First Example)
The main parts of the magnetic stimulator A are a pair of left and right U-shaped cores 50 having the same shape and a conductor 65 wound around the legs 51 of the U-shaped core 50, which are made of non-metal such as resin or ceramic. It is stored in the case 1.

The U-shaped core 50 is a stack of a large number of magnetic materials such as a U-shaped rolled silicon steel plate with a thin insulating film or an amorphous foil body, or a stack of a large number of U-shaped bent cores. The rolled silicon steel sheet used in this embodiment has a thickness of 0.35 mm. In this U-shaped core 50, the parallel portions around which the conductor 65 is wound are each the leg portion 51, and the tip surface thereof is represented by 52. One surface passing through the center of the pair of legs 51 of the U-shaped core 50 is referred to as a display cross section (CP surface). The magnetic flux generation surface F (FL / FR) is orthogonal to the display cross section (CP surface). It is preferable that the displayed cross section (CP surface) coincides with the motor point MpL / MpR in terms of enhancing the therapeutic effect.
In the present invention, the U-shaped cores 50 are used as a pair on the left and right. Therefore, when it is necessary to distinguish them, one is a U-shaped core 50L and the other is a U-shaped core 50R, as described above. Since the legs 51 of the U-shaped core 50 are located at two locations in the front and rear, when it is necessary to distinguish them, they are set to 51Lx / 51Ly / 51Rx / 51Ry, respectively. When it is necessary to individually represent the tip surface 52 of the leg portion 51 of the U-shaped core 50, it is set to 52Lx / 52Ly / 52Rx / 52Ry, respectively.

The pair of U-shaped cores 50 are arranged side by side and housed in the case 1. However, as shown in FIGS. 4 to 6, the pair of U-shaped cores 50 have the tip surfaces 52 of the legs 51 in the same direction. They are stored side by side in the case 1 so as to be parallel to each other and located at the corners of a quadrangle.
The content of the above "same direction" does not mean "exactly the same direction", and the internal angle θ with the magnetic flux generating surface FR including the tip surface 52Rx / 52Ry of the leg portion 51Rx / 51Ry described below is 180 °. Including cases less than.
In the arrangement relationship of these legs 51Lx / 51Ly / 51Rx / 51Ry, the front leg 51Lx / 51Rx indicated by the reference numeral x and the rear leg 51Ly / 51Ry indicated by the reference y are adjacent to each other, and the legs 51Lx / 51Ry and the legs are adjacent to each other. It is assumed that the portions 51Ly and 51Rx are diagonally located. The tip surfaces 52Lx / 52Ly / 52Rx / 52Ry are formed flat. These tip surfaces 52Lx / 52Ly / 52Rx / 52Ry are included in one surface, and this surface is referred to as the above-mentioned magnetic flux generation surface F (FIG. 5).

The conductor 65 is made of a band material of a non-magnetic metal such as copper or aluminum, or a litz wire (a twisted enamel wire). When the band material was used, the thickness was 0.4 to 1.5 mm, the width was 5.0 to 15.0 mm, the number of turns was 5 to 15, respectively, and a long copper band was wound in a coil shape. When the band material was used, the insulating film was made of polyamide-imide resin and thinned so as not to interfere with heat dissipation on the surface of the conductor 65. In this example, the thickness of the insulating coating was 20 μm. In this embodiment, the conductor 65 is formed by winding a long copper band in a coil shape, but the conductor 65 is not limited to this, and although not shown, the conductor 65 may be wound with the above-mentioned litz wire.

The method of winding the conductor 65 around the leg portion 51 of the U-shaped core 50 takes various forms as described below.
As shown in FIG. 7, in the first winding method, as shown in FIG. 7, the adjacent leg portions 51Lx / 51Rx are integrated with each other on the front side of a pair of U-shaped cores 50L / 50R provided in parallel adjacent to each other, and a conductor is formed around the core. This is a case where the 65x is wound, and the conductors 65y are wound around the rear legs 51Ly / 51Ry as a unit.
In this case, the conductors 65x and 65y may be wound around the portion of the U-shaped core 50 using a separate member and then connected in series, but one strip (or litz wire) may be continuous. You may wrap it around. According to this winding method, when the distance between the U-shaped core 50L and 50R is short, the conductor length used can be minimized, so that the total weight is reduced, and in addition, the calorific value and the calorific value are reduced. It has the advantage of reducing power consumption.

As shown in FIGS. 8 and 9, in the second winding method, the conductor 65L is wound around the front leg 51Lx of one U-shaped core 50L, and then independently wound around the rear leg 51Ly. .. The same applies to the other U-shaped core 50R, in which the conductor 65R is wound around the front leg portion 51Rx, and then independently wound around the rear leg portion 51Ry. In this case as well, the conductors 65L / 65R may be independently wound around the relevant portion of the U-shaped core 50L / 50R using a separate member, and then connected in series, but may be a single strip (or one strip). The litz wire) may be wound continuously. According to this winding method, since the conductor 65L and the conductor 65R are separated, they can be moved independently, and in addition, the directions and timings of excitation of the U-shaped cores 50L and 50R are independently set. It is possible to control.

The winding direction and connection method of the conductor 65 to the leg 51 are wound and connected in the direction in which the eddy current ULx · ULy / URx · Ury is generated in the affected part as shown in FIG. 10 or 11.

Since the magnetic stimulator A takes various forms as described above, the case 1 has a shape adapted to it.
The case 1 of the first embodiment is made of resin (here, made of ABS), and is composed of a case body 3 having an open upper surface and a lid portion 5 for closing the upper surface opening. The case body 3 is divided into a left side storage part 3L and a right side storage part 3R, and a pair of U-shaped cores 50 around which a conductor 65 is wound are stored in a parallel state.

The lid portion 5 in contact with the affected portion has four quadrangular (square or rectangular) convex portions 6 projected on the inside of the four corners of the lid portion 5. Then, the conductor 65 is fitted and fixed in the lid portion 5 so as to surround the four convex portions 6 so as to maintain the two winding states with respect to the leg portion 51 as described above. When the lid portion 5 is attached to the case body 3, the upper end portion of the leg portion 51Lx / 51Ly / 51Rx / 51Ry of the U-shaped core 50L / 50R housed in the left and right storage portions 3L / 3R, respectively, is the lower surface of the convex portion 6. It is fitted in line with the recess and the conductor 65 surrounds it.
In the above case, the conductor 65 is attached to the lid portion 5, but the conductor 65 may be wound around the U-shaped core 50 first and fitted into the case 1.
The method of holding the conductor 65 is based on a fixing member (or adhesive) (not shown).

As already mentioned, the tip surfaces 52Lx / 52Ly / 52Rx / 52Ry of the U-shaped core 50L / 50R housed in the left and right storage portions 3L / 3R, respectively, are included in one surface (magnetic flux generation surface F). It is held in. A thermostat (not shown) is installed in the case 1 so that the energization of the conductor 65 is stopped when the internal temperature becomes equal to or higher than the set temperature.
Since the surface including the upper surfaces of the four convex portions 6 of the lid portion 5 in common and the upper surface of the lid portion 5 are also parallel to the magnetic flux generating surface F, these surfaces are also referred to as magnetic flux generating surfaces F for convenience. There is.

Next, as shown in FIGS. 1 and 2, the lid 5 side of the magnetic stimulator A is placed along the lower jaw of the patient to explain a method for treating dysphagia using the magnetic stimulator A (first embodiment). Set so that the center of the left and right U-shaped cores 50L / 50R coincides with the left and right motor points MpL / MpR. In other words, the legs 51, 51Lx, 51Ly / 51Rx, 51Ry of the left and right U-shaped cores 50L / 50R are set so as to straddle the left and right motor points MpL / MpR, respectively.

When a DC pulse current is continuously applied to the conductor 65 in a constant cycle in this state, the left and right U-shaped cores 50L / 50R are continuously excited in a pulse shape in a constant cycle. G indicates a magnetic force line.
In the case of FIG. 10, the adjacent front legs 51Lx / 51Rx have the same N pole, and the other posterior adjacent legs 51Ly / 51Ry are excited to the opposite S poles.
The eddy current ULx / URx generated around the former leg 51Lx / 51Rx flows in the same direction (clockwise), and the eddy current ULy / generated around the adjacent legs 51Ly / 51Ry on the other rear side. The URy flows in the opposite direction (counterclockwise direction) to the former. Therefore, the eddy currents ULx, ULy / URx, and URy merge between the legs 51Lx, 51Ly, 51Rx, and 51Ry of the U-shaped core 50L / 50R, and the eddy current is doubled. In addition, the change in the magnetic flux generated from one core tip surface 52L acts in the direction of strengthening the eddy current at the motor point MpR, and similarly, the change in the magnetic flux generated from the other core tip surface 52R also causes the eddy current at the motor point MpL. Since it works in the direction of strengthening, it is possible to induce a larger eddy current to the motor point MpL / MpR than when the magnetic flux is generated by a single core. This merging eddy current crosses the affected muscle (in this case, the motor point MpL / MpR) at a right angle, and concentrates a magnetic stimulus of twice the intensity to apply to the left and right motor points MpL / MpR. The eddy currents in other parts are much weaker than this.

If this confluence PL / PR is matched with the motor points MpL / MpR divided into the left and right of the jaw, one core is used and mainly between the motor points MpL / MpR divided into the left and right (on the midline). The motor point MpL / MpR can be directly stimulated with a strong eddy current as compared with the case of stimulation, and can be stimulated more effectively.

FIG. 11 shows another method of generating an eddy current U, in which the adjacent front legs 51Lx / 51Rx are excited so as to have different poles. (Of course, the legs 51Ly / 51Ry on the rear side of each other are also different poles.)
That is, when the front leg 51Lx / 51Rx is the N (S) pole, the rear leg 51Ly / 51Ry is the S (N) pole.

Eddy currents ULx · URy in the same direction (clockwise) flow around the front leg 51Lx of one U-shaped core 50L and the rear leg 51Ry of the other U-shaped core 50R, and the remaining U-shaped core 50L. An eddy current URx · ULy flows in the direction opposite to the eddy current ULx · URy (clockwise) around the leg portion 51Ly on the rear side of the core 50L and the leg portion 51Rx on the front side of the other U-shaped core 50R.
Therefore, the eddy current ULx / ULy of the confluence PL in one U-shaped core 50L and the eddy current URx / URy of the confluence PR in the other U-shaped core 50R both flow in the same direction, and the eddy current is the same as in FIG. The strength of the current U is doubled.
In addition, the symmetry of the evoked reaction (muscle movement, etc.) of the living body induced by the magnetic stimulus is increased by the eddy current ULx / ULy / URx / Ury that flows symmetrically with the median plane CL as the center line. Due to this symmetry, for example, in the case of stimulation to the suprahyoid muscle group, even muscle contraction of the left and right geniohyoid muscle and digastric muscle can be obtained at the same time, and the hyoid bone connected to these can be obtained at the same time. A proper elevation along the midline can be obtained. It is very important to obtain symmetrical muscle contraction in the reconstruction of swallowing motion.

In this case, unlike the case of FIG. 10, the adjacent eddy currents ULx / URx on the front side and the adjacent eddy currents ULy / URy on the rear side flow in the same direction on the midline. When the distance is short, a strong magnetic stimulus can be applied to the part on the midline.

If the confluence points PL / PR are matched with the motor points MpL / MpR divided into the left and right sides of the jaw, stimulation can be performed more effectively than in the case of one as described above.
In the above, the eddy current U may cross the muscle of the affected area at a right angle (motor point MpL / MpR) or may flow in parallel, but the eddy current may flow to the muscle of the affected area. When flowing across at right angles, it contracts more than when flowing in parallel.

The above-mentioned excitation method is such that an exciting pulse current is passed through the conductor 65 in a fixed cycle, but the present invention is not limited to this, and the flow of the exciting pulse current may be inverted for each cycle. As a result, the direction of the eddy current U flowing around the leg portion 51 is reversed. Depending on the motor point, the sensitivity may differ depending on the direction of the eddy current U across the motor point. In such a case, the cycle-by-cycle inversion of the exciting pulse current is optimal for obtaining a uniform magnetic stimulation effect.

Next, a second embodiment (FIG. 12) of Case 1 will be described. Generally, the lower surface of the mandible often has a loose V shape centered on the median CL. Therefore, the motor point MpL / MpR to be stimulated is also gently and symmetrically inclined in a V shape about the median plane along the lower surface of the jaw.
In order to generate the eddy current U so as to cross the motor point MpL / MpR as described above, the magnetic flux generation surface including the tip surface 52 of the left and right U-shaped cores 50) should face the motor point MpL / MpR, respectively. It is preferable that it is.

The lid portion 5 of the case 1 is formed in a loose V shape from the center, one of which is the left lid portion 5L and the other of which is the right lid portion 5R. The internal angle θ on the surface side of the left side lid portion 5L and the right side lid portion 5R is formed to be less than 140 to 180 ° (preferably 150 to 165 °). The internal angle θ is adjusted to the average value of the angles of the lower surface of the jaw of a general person.

The case body 3 of the case 1 is also divided into a left side storage part 3L and a right side storage part 3R according to the lid part 5, and is formed in a V shape according to the internal angle θ. Therefore, the magnetic flux generating surface FL including the tip surfaces 52Lx and 52Rx of one U-shaped core 50L housed in the left side storage portion 3L and the right side storage portion 3R, respectively, and the tip surface 52Rx and 52Ry of one U-shaped core 50R. The internal angle θ with the magnetic flux generating surface FR included is also equal to the internal angle θ of the lid portion 5, resulting in a loose V shape.

If the magnetic stimulator A of the second embodiment is placed under the patient's jaw, the median plane of the jaw is inevitably on the intersection of FL and FR due to the loose V-shape formed by the magnetic flux generating surface FL and FR. It will be positioned, and it will be possible to guide the patient's jaw to the optimum position. When energized, the motor points MpL / MpR are stimulated by the left and right U-shaped cores 50L / 50R facing the epidermis directly above the motor points MpL / MpR as described above. At that time, since the magnetic flux generating surfaces FL / FR and the epidermis directly above the motor point MpL / MpR are in close contact with each other, the magnetic flux generated from the tip surface 52 can be completely transmitted into the living body.

In Examples 1 and 2 above, the shape of the magnetic stimulator A is determined by averaging the shape of the patient's lower jaw to some extent. The shape of the patient's jaw varies widely, and the angle of the jaw is not uniform. The third embodiment of Case 1 corresponds to such a case, and will be described below.
In this case, the angle θ of the magnetic flux generating surface FL / MR of the lid portion 5 of the case 1 can be made variable. Thereby, the angle θ of the lid portion 5 can be changed according to the shape of the patient's lower jaw.
An example of Case 1 of the third embodiment is shown in FIG. FIG. 13 is merely an example, and all of the cases having a structure in which the angle θ of the magnetic flux generating surface FL / FR of the lid portion 5 of the case 1 can be changed (for example, the one in which the angle deformation portion is connected by a hinge) are applicable. ..
In the case of FIG. 13, the case 1 is divided into two parts on the left and right, the left side portion is referred to as the left side case portion 1L, and the right side portion is referred to as the right side case portion 1R. The left and right case portions 1L / 1R are divided into two left and right lid portions, which are the left lid portion 5L and the right lid portion 5R, respectively.
The opposite sides of the left and right lid portions 5L / 5R are joined in a hinge shape. This portion is referred to as a left-right connecting portion 30.

Fastening bolts 36 are inserted through the left and right sides of the left and right connecting portions 30, and the left and right case portions 1L / 1R can move in the rotational direction around the fastening bolts 36, and the internal angle θ thereof can be changed. The fastening bolt 36 can be tightened and loosened between the left side and the right side by means of a nut.
At the time of use, the angle can be adjusted by loosening the fastening bolt 36, and in that state, the fastening bolt 36 is tightened along the lower jaw of the patient to fix the angle of the internal angle θ.
In this case, the internal angle adjusting mechanism 34 is configured by the facing sides of the left and right lid portions 5L / 5R connected in a hinge shape and the fastening bolt 46.

The fourth embodiment of Case 1 will be described. As described above, the shape of the patient's jaw varies widely, the angle of the jaw is not uniform, and the positions of the suprahyoid muscle groups 70L and 70R are not uniform. Further, as already mentioned, there is also a request to make it applicable to stimulation to a part (motor point) other than the suprahyoid muscle group 70L / 70R.
Therefore, in this case, the angle θ of the lid portion 5 of the case 1 can be made variable, and the spacing between the U-shaped cores 50L / 50R can be changed. As a result, the angle θ of the internal angle of the magnetic flux generating surface FL / FR of the lid 5 and the distance between the tip surface 52 of the U-shaped core 50 can be changed according to the shape of the patient's jaw and the position of the motor point MpL / MpR. can.

15 and 16 show an example of Case 1 of the fourth embodiment. In this case, the case 1 is composed of a left side case portion 1L divided into left and right, a right side case portion 1R, and a connection portion 40 separated from the left / right side case portion 1L / 1R. A U-shaped core 50L / 50R with a conductor is housed in the left case portion 1L and the right case portion 1R, respectively, in the same manner as in the above embodiment.

Similar to the left and right connection portions 30 of the third embodiment, the connection portion 40 is a fastening in which the connection portion divisions 40L / 40R divided into two left and right are connected in a hinge shape and inserted into the connection portion division 40L / 40R. These are connected by a bolt 46 with a variable angle. When the fastening bolt 46 is screwed in and tightened, both are fixed, and when the fastening bolt 46 is loosened, the connecting portion 40 moves relatively in the rotation direction, and the angle θ can be adjusted.
Also in this case, the connecting portion divided body 40L / 40R and the fastening bolt 46 divided into two on the left and right serve as the internal angle adjusting mechanism 44.

Further, the connection portion 40 is provided with a holding arm portion 41L / 41R that holds the left side case portion 1L and the right side case portion 1R in a position close to or away from the connection portion 40. The holding arm portion 41L / 41R is composed of a rail 42 extending to the left and right sides, a groove 43 formed horizontally on the front and back surfaces of the right side case portion 1R, and a fixing screw 48 provided on the rail 42. ..
The rail 42 is slidably attached to a groove 43 formed horizontally on the front surface and the back surface of the left side case portion 1L and the right side case portion 1R. As a result, the left side case portion 1L and the right side case portion 1R can be brought close to each other and separated from each other along the rail 42. The left case portion 1L and the right case portion 1R are fixed by the fixing screw 48 provided on the rail 42.

Then, the angle θ and the separation distance of the left case portion 1L and the right case portion 1R of the magnetic stimulator A of the fourth embodiment are adjusted to match the motor points MpL / MpR of the patient. After that, when the magnetic stimulator A is placed under the patient's jaw and energized, the left and right U-shaped cores 50L / 50R stimulate the motor points MpL and MpR in the above states, respectively. Become.

A: Magnetic stimulator, CL: Center line (midline), CP: Display cross section, F: Magnetic flux generation surface, FL / FR: Left and right magnetic flux generation surface, MpL / MpR: Motor point, U: Vortex current, ULx / ULy / URx / URy: Vortex current generated in the legs of the left and right U-shaped cores, θ: Inner angle of the left and right magnetic flux generation surfaces 1: Case, 1L / 1R: Left / right case part 3: Case body, 3L: Left side storage part, 3R: Right side storage part, 5: Lid part, 5L: Left side lid part, 5R: Right side lid part, 6: Convex part, 30: Left and right connection part, 34: Inner angle adjustment mechanism, 36: Fastening bolt, 40 : Connection part, 40L / 40R: Connection part split body, 41L / 41R: Holding arm part, 42: Rail, 43: Groove, 44: Internal angle adjustment mechanism, 46: Fastening bolt, 48: Fixing screw, 50, 50L / 50R : U-shaped core, 51, 51Lx / 51Ly / 51Rx / 51Ry: Leg, 52, 52Lx / 52Ly / 52Rx / 52Ry: Tip surface, 65 / 65x / 65y (or 65L / 65R): Conductor, 70 / 70L / 70R : Supralingual muscle group, 72: Lower alveolar nerve, 74: Lower jaw, 75: Tongue bone, 76: Physopharynx, 77: Nasal cavity, 78: Oral cavity, 79: Epiglottis, 81: Epiglottis valley, 82: Epiglottis cartilage, 83: Muscles connecting to the epiglottis, 84: epiglottis, 88: trachea, 90: esophagus.

Claims (7)

A conductor 65x / 65y ( 65x / 65y) wound around a pair of left and right U-shaped cores 50L / 50R and the front and rear legs 51Lx / 51Ly / 51Rx / 51Ry of the U-shaped core 50L / 50R to excite the U-shaped core 50L / 50R. 65Lx / 65Ly / 65Rx / 65Ry) and the pair of U-shaped cores 50L / 50R around which the conductor 65x / 65y (65Lx / 65Ly / 65Rx / 65Ry) are wound are arranged side by side, and their legs 51Lx. In the magnetic stimulator A composed of the case 1 for storing 51Ly / 51Rx and 51Ry in the same direction.
The case 1 is composed of a left side case portion 1L, a right side case portion 1R, and a connection portion 40 separated from the left / right side case portion 1L / 1R.
The connection portion 40 is composed of a holding arm portion 41L / 41R that extends laterally from the main body and holds the left side case portion 1L and the right side case portion 1R in a position close to or away from the connection portion 40. Be done,
The one U-shaped core 50L is housed in the left case portion 1L, and the other U-shaped core 50R is housed in the right side case portion 1R.
The surface including the tip surface 52Lx / 52Ly of the leg portion 51Lx / 51Ly of the one U-shaped core 50L is designated as the magnetic flux generating surface FL.
The surface including the tip surfaces 52Rx / 52Ry of the legs 51Rx / 51Ry of the other U-shaped core 50R is designated as the magnetic flux generating surface FR.
The magnetic stimulator 40 is characterized in that the connection portion 40 is provided with an internal angle adjusting mechanism 44 for adjusting the internal angle θ of the magnetic flux generating surface FL / FR . One conductor 65x is wound so as to integrally surround the circumference of one leg portion 51Lx / 51Rx of the U-shaped cores 50L / 50R arranged side by side.
The magnetic stimulator according to claim 1, wherein the other conductor 65y is wound so as to integrally surround the other leg portion 51Ly / 51Ry of the U-shaped core 50L / 50R . One conductor 65Lx / 65Ly is individually wound so as to surround each leg portion 51Lx / 51Ly of one U-shaped core 50L.
The magnetic stimulator according to claim 1, wherein the other conductors 65Rx and 65Ry are individually wound so as to surround the respective legs 51Rx and 51Ry of the other U-shaped core 50R . The magnetic stimulator A according to any one of claims 1 to 3, wherein all the conductors 65x / 65y and 65Lx / 65Rx / 65Ly / 65Ry are connected in series . The excitation method of the magnetic stimulator A according to any one of claims 1 to 4.
An exciting current is intermittently passed through the conductor 65x / 65y (65Lx / 65Rx / 65Ly / 65Ry) that excites the U-shaped core 50L / 50R.
In a pair of U-shaped cores 50L / 50R arranged side by side, one leg 51Lx (51Ly) of one U-shaped core 50L and one leg 51Rx (51Ry) of the other U-shaped core 50R adjacent to the one leg 51Lx (51Ly). A method of exciting a magnetic stimulator, characterized in that is excited to the same pole . The excitation method of the magnetic stimulator A according to any one of claims 1 to 4.
An exciting current is intermittently passed through the conductor 65x / 65y (65Lx / 65Rx / 65Ly / 65Ry) that excites the U-shaped core 50L / 50R.
One leg 51Lx (51Ly) of one U-shaped core 50L and one leg 51Rx (50R) of the other U-shaped core (50R) adjacent to the one leg 51Lx (51Ly) of a pair of U-shaped cores 50L / 50R arranged side by side ( A method for exciting a magnetic stimulator, characterized in that 51Ry) is excited to a different pole . In the excitation method of the magnetic stimulator A according to claim 5 or 6.
An exciting current is intermittently passed through the conductors 65x / 65y and 65Lx / 65Rx / 65Ly / 65Ry that excite the U-shaped core 50L / 50R, and the current direction of the intermittently flowing exciting current is intermittently reversed for each excitation cycle. A method of exciting a magnetic stimulator, which is characterized in that the electric current is stimulated .

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