RU195236U1 - DEVICE FOR DETERMINING THE EXPRESSION OF VESTIBULAR ATAXIA - Google Patents

Abstract

The utility model relates to medical equipment and can be used in otorhinolaryngology to determine the severity of vestibular ataxia. The technical result of the utility model is to increase the accuracy of determining the severity of vestibular ataxia. This is achieved by the fact that the device for determining the severity of vestibular ataxia is made of a polymer material in the form of a truncated cone. On the inner surface of the base, whose diameter is 28.0 cm, a strip 0.5 cm wide is shown passing through its center. The device is equipped with an electronic level located on the outer surface of the base of the device.

Description

The utility model relates to medical equipment and can be used in otorhinolaryngology to determine the severity of vestibular ataxia.

Peripheral (vestibular) ataxia occurs with damage to the peripheral vestibular apparatus, cochleovestibular nerve and vestibular nuclei and pathways of the brain stem. It is manifested by dizziness (often a sensation of rotation of surrounding objects), imbalance when walking, in a standing position (Romberg test) and sitting. Nausea and vomiting, increased dizziness and instability during head movements are characteristic. There is no ataxia in the limbs; the joint-muscle feeling is preserved.

Disruption of the equilibrium function is a very serious problem, since patients are often unable to move without assistance even within their own homes. This disorder makes up about 10% of the reasons for visiting otorhinolaryngologists and neurologists. The coordination of movements depends not only on the correctness of the coordinated work of the vestibular nuclei, cerebellum, cerebral cortex with the peripheral vestibular receptor, organ of vision and proprioceptors.

In assessing the state of vestibular function, much attention is paid to the study of a person's ability to maintain a vertical position of the body - the equilibrium function, which is carried out by means of installation reflexes that hold the center of gravity of the body within the projection of its support area. In turn, the body balance maintaining system, which operates with the participation of vestibular reception, proprioception, cerebellum and muscle effectors, together with spatial orientation systems and locomotion form a statokinetic system that provides the following functions: orientation of the person in space (sensory); maintaining body balance in statics and dynamics (motility); energy supply of motor acts.

The methods of studying the vestibular apparatus, allowing to judge its function, include such methods as Romberg, Barani, Oppenheim, Uemura tests, step test, Fukuda's written test, etc. The listed methods are very subjective, since they give a qualitative characteristic and not quantitative, therefore it is difficult to evaluate the dynamics of the process during treatment [http://meteopathy.ru/zdorovye-i-bolezn/rukovodstvo-po-golovokruzheniyam-i-narusheniyam-prostranstvennoj-orientacii/11/].

One way to detect vestibular ataxia is stabilization. The previously used methods of conducting stabilographic studies involved conducting tests, often painful for the patient: examination on an apparatus whose design provided for oscillating movements in the horizontal and sagittal planes by tensi and mechanical sensors and registration on computers, control of spontaneous and rotational deviations using the “writing rod” and scales [Khilov K.L. The function of the organ of balance and the disease of movement. L .: Medicine, 1969.278 s].

The use of modern equipment significantly expanded the diagnostic capabilities of statokinetic studies, and allowed for an informative qualitative and quantitative assessment of the equilibrium function.

A modern scientific version of Romberg's posture is to conduct research on a stabilometric platform, which is the center of the device that evaluates the equilibrium function in quantitative terms [Monsell EM, Furman J.M., Herdman S.J. et al. Computerized dynamic platform posturography // Otolaryngol-Head-Neck-Surg. 1997, Oct, No. 117 (4), p. 394-398].

The deviation of the body of the subject is recorded by four sensor sensors located at the corners of the platform, the total signal from which is displayed on a two-coordinate display, the recorded range of movements being a statokinesigram, additional diagnostic information is provided by graphical images of the frequency and amplitude of the deviations of the center of gravity of the subject (histogram and stabilogram). Computer processing of the survey results allowed us to obtain a simple, accurate and highly informative method for the diagnosis of statokinetic disorders.

In combination with a set of functional tests, computer stabilometry is a highly sensitive objective method and is used to detect vestibular disorders at the earliest stage when they are not subjectively manifested [V.T. Palchun, M.M. Magomedov, L.A. Luchikhin Otorhinolaryngology Moscow “Medicine” 2002, 53-54 pp.].

Unfortunately, computer stabilometry has a number of negative aspects, which include the high cost of the design, the need for a separate room and a specially trained specialist, as well as the discomfort that patients may experience during the study.

A device for studying ataxia is known [SU 1287845, 1987]. The device is designed to assess the state of the vestibular apparatus and allows you to determine the side of the predominant deviation and to quantify the degree of ataxia. The device contains a dielectric base, conductive plates, conductive probe, voltage source, indicator, latch, track switch. The plates are installed with the possibility of adjusting the gap between them, which is fixed by a latch. The tracks installed on the base can have a different configuration. Set the gap between the plates, the test subject is asked to draw a probe line along the axis of the plate with open and closed eyes. When you touch the side plates with the probe, the corresponding indicators light up. The number of touches determines the side of the primary deviation and the measure of the prevalence of the side of the deviation. Unfortunately, the description of the copyright certificate does not indicate the duration of the study using this device. According to the authors of the claimed utility model, the study may take at least 20 minutes.

As a prototype, we selected a device for determining the severity of vestibular ataxia, made of a polymer material in the form of a truncated cone, on the outer surface of the base of which a bilateral degree scale is attached, and in the center of the base, whose diameter is at least 28.0 cm, a hole is made in which a plumb with the possibility of finding it on the outside of the device, a strip with a width of at least 0.5 cm passing through its center is shown on the inner surface of the base.

The patient takes the device with two hands and places it in front of the person with the subsequent approach of the device to the face and its immersion in the device so that the peripheral fields of view of the patient are closed. After immersing the patient’s face in the device, the strip depicted on the inner surface of the base is located in front of the patient’s eyes. Since the peripheral fields of view of the patient are covered by the device, the patient’s gaze is not fixed, and the light, due to the implementation of the device in the form of a truncated cone, penetrates the inside of the device. Thus, even minimal external illumination is sufficient for the patient to see the strip depicted on the inner surface of the base. The doctor suggests the patient to place the strip parallel to the floor. The patient feels sex due to the work of the stabilization system of the body. The patient holds with his hands a device that can tilt left or right. On a two-sided degree scale, the deflection angle of the plumb line is determined, which is fixed in the hole made in the center of the base of the device. The degree of deflection of the plumb line assesses the severity of ataxia of peripheral origin.

Moreover, the determination on a bilateral degree scale is possible with a plumb line deviation angle of more than 1 degree, since the degree scale is graduated from 0 degrees in increments of 1 degree. If the plummet deviation angle corresponds to from 0 to 1 degree, then determine the zero degree of vestibular ataxia, from 1 to 3 degrees - the first degree of severity of vestibular ataxia, 4-5 degrees - the second degree, more than 5 degrees - determine the third degree of severity of vestibular ataxia. A two-sided degree scale also makes it possible to determine the direction of deviation of the body of the subject when the plummet deviates to the right or left relative to the degree scale. In that case, if the reading of the degree scale is 0, then the presence of latent ataxia and the direction of deviation of the body of the subject are determined using the hydraulic level. At the same time, the balloon of the hydrolevel leaves in the opposite direction from the deviation of the body of the subject, which indicates the presence of activation of the vestibular system from the direction of deviation of the body of the examined side.

The study takes 2-3 minutes. [Patent RU 161471, 2016].

The disadvantage of the device that we have chosen as a prototype is the lack of high accuracy in determining the severity of vestibular ataxia.

The technical result of the utility model is to increase the accuracy of determining the severity of vestibular ataxia.

The technical result of the utility model is achieved in that the device for determining the severity of vestibular ataxia is made of a polymer material in the form of a truncated cone. On the inner surface of the base is a strip 0.5 cm wide, passing through its center. The device is equipped with an electronic level located on the outer surface of the base of the device.

In FIG. 1, 2, 3 schematically presents the claimed device for determining the severity of vestibular ataxia, where:

1. a device in the form of a truncated cone;

2. strip;

3. the base of the device;

4. electronic level.

The device operates as follows:

The patient takes the device (1) with two hands and places it in front of the person with the subsequent approach of the device to the face and its immersion in the device so that the peripheral fields of view of the patient are closed. After immersing the patient’s face in the device, the strip (2) depicted on the inner surface of the base (3) is located in front of the patient’s eyes. Since the peripheral fields of view of the patient are covered by the device, the patient’s gaze is not fixed, and the light, due to the implementation of the device in the form of a truncated cone, penetrates the inside of the device. Thus, even minimal external illumination is sufficient for the patient to see the strip (2) depicted on the inner surface of the base (3). The doctor suggests the patient to place the strip parallel to the floor. The patient feels sex due to the work of the stabilization system of the body. The patient holds with his hands a device that can tilt left or right. Using the electronic level (4) determine the angle of deviation

Moreover, the determination by the readings of the electronic level is possible with an accuracy of tenths, with an angle of more than 0.1 degrees, since the electronic scale of the device is calibrated from 0 degrees in increments of 0.1 degrees. If the values of the electronic level correspond to 0 to 1 degree, then determine the zero degree of severity of vestibular ataxia, from 1 to 3 degrees - the first degree of severity of vestibular ataxia, 4-5 degrees - the second degree, more than 5 degrees - determine the third degree of severity of vestibular ataxia. The electronic level indicates the direction of deviation and, accordingly, makes it possible to determine the direction of deviation of the body of the subject, which is an important diagnostic element for determining activation or inhibition of the vestibular system. The study takes 2-3 minutes.

A distinctive essential feature of the utility model and a causal relationship between it and the achieved result: the device for determining the severity of vestibular ataxia is equipped with an electronic level located on the outer surface of the base of the device.

On the basis of the ENT department, SZGMU im. I.I. We examined Mechnikov 7 patients using 2 devices - using the claimed utility model and prototype device.

Table 1 shows the results of determining the severity of vestibular ataxia in degrees and its severity using the prototype device and the claimed utility model.

As can be seen from the data presented in the table, only in 2 patients out of 7, the severity of vestibular ataxia are the same, in 5 patients the severity of vestibular ataxia is different. The difference in the indications for determining the degree of ataxia is crucial in the choice of the patient’s treatment tactics by the doctor, as well as in the prognosis of his condition.

The distinctive essential feature is new and allowed to increase the accuracy of determining the severity of vestibular ataxia.

We give examples from clinical practice:

Example 1

Patient S., 28 years old, was admitted to the ENT department with a diagnosis of vestibular neuronitis stage of excitation on day 2 of the disease.

Determined expressed nystagmus to the left II.

When examined using a device for determining the severity of vestibular ataxia, which is the prototype, a deviation to the right of 3 degrees was determined, which corresponds to 1 degree of ataxia. In the study using the claimed utility model (with an electronic level), a deviation of 4.2 degrees was determined, which corresponds to 2 degrees of ataxia, which significantly changes the approach to further treatment of this patient.

For the treatment of grade 1 ataxia, a standard dosage of betagistin 24 mg is used 2 times a day (i.e. 48 mg per day), in case of grade 2 ataxia, the daily dosage rises from 72-96 mg per day, with grade 3 ataxia, the daily dosage reaches 144 mg betahistine.

In addition, in the first degree of ataxia, rehabilitation is applied according to the principle of habituation, and in the case of 2 and 3 degrees, according to the principle of sensory replacement.

Thus, the testing of the claimed utility model made it possible to reveal that the treatment of this patient was chosen incorrectly and corrected it.

Example 2

Patient M., 56 years old, underwent an outpatient treatment by a neurologist about the presence of positional dizziness. Spontaneous nystagmus to the right 2 degrees. At the initial examination using the device for determining the severity of vestibular ataxia, which is the prototype, the ataxia was 2 degrees, and using the claimed utility model with an electronic level of 2.8 degrees. Both values correspond to 1 degree of ataxia. When examined after 2 weeks, there is no spontaneous nystagmus. The ataxia detected using the prototype was 2 degrees, which corresponds to 1 degree of ataxia, and using the claimed utility model with an electronic level - 3.2, which corresponds to 2 degrees of ataxia.

Thus, the testing of the claimed utility model revealed that the treatment of this patient was incorrectly selected and adjusted, that is, the dosage of Betaserk from 16 mg 2 times a day was increased to 24 mg 2 times a day. We did not reveal the spontaneous nystagmus, which neurologists usually focus on, since we believe that the vestibulo-ocular reflex was suppressed by the central nervous system, which is quite natural, but in no case is a sign of recovery.

The device is made of polyvinyl chloride.

Thus, a device was developed to determine the severity of vestibular ataxia, which allows to increase the accuracy of determining the severity of vestibular ataxia, compared with the prototype.

Claims (1)

A device for determining the severity of vestibular ataxia, made of a polymeric material in the form of a truncated cone, on the inner surface of the base of the device, the diameter of which is 28.0 cm, shows a strip 0.5 cm wide passing through its center, characterized in that it is additionally equipped with an electronic level located on the outer surface of the base of the device.

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