RU2071758C1 - Method for rehabilitation of newborn infants affected with perinatal pathologies - Google Patents

Abstract

FIELD: medicine, pediatrics. SUBSTANCE: first predominant hemitype of affection is determined. Right-side hemitype is observed in case of pathologies in organs of abdominal cavity, pelvis, lower extremities, right-sided neurological disorders characterized by predominant turn of infant's head to right in position on back. Left-side hemitype is observed in case of pathologies of thorax and thoracic organs, disorders in psychic development, left-sided neurological disorders characterized by predominant turn of head to left in position on back. Infant is subjected to course of procedures by exerting externally applied pain-inflicting action by successively and alternately pressing with fingers with effort sufficient to cause responsible spontaneous strain of muscles in body zones selected depending on localization of pathologic process. Single procedure lasts 1-3 s repeated from 1 to 5 times. Procedures are repeated every other day in total number of 8-12 per treatment source. EFFECT: higher efficiency.

Description

 The invention relates to medicine, namely to pediatrics and non-drug therapy, and can be used as an auxiliary method in inpatient and outpatient settings for the rehabilitation of newborns with various forms of perinatal pathology (birth injuries of the spine and spinal cord, craniospinal birth injuries, perinatal encephalopathy, sepsis toxic intestinal paresis, cardiopathy, pneumopathy, defects in the development of the skeletal system), including premature infants.

 A study of the pathology of the neonatal period in recent decades has revealed a large proportion of perinatal injuries (see Ratner A. Yu. Birth injuries of the nervous system. Kazan University Press. 1985; as well as the article "Genital CNS Injuries" by N. N. Bely in Journal. "Questions protection of motherhood and childhood ", 1991, N 3, p. 41 44). An increase in the birth rate of premature babies, as well as patients with perinatal hypotrophy, is observed. All this puts forward in a number of urgent problems of modern medicine the issues of developing effective methods of rehabilitation and social adaptation, although by inertia they are considered as auxiliary drug therapy, their development in relation to newborns is extremely insufficient.

 Rehabilitation methods by means of electrotherapy are known, but their application to newborns is extremely difficult due to the lack of development of methods for determining individual dosages. Acupuncture is not recommended until the age of three (Gaava Luvsan. Traditional and modern aspects of oriental reflexology. M. Nauka, 1992, p. 412). In addition, during acupuncture there is a risk of infection (HIV, serum hepatitis), which excludes the use of the classical Zhen-Chiu techniques for gold and silver needles, but replacing them with single steel needles damages the technique itself (Reflexotherapy by the Zhen-Chiu method, Gorky, 1962. Proceedings of the Gorky Medical Institute. S. 4, 5).

 The closest known method of rehabilitation of perinatal pathology of the newborn in terms of methodological essence and the achieved result is massage. However, of all types of massage, only light superficial is considered acceptable for newborns. During the massage, hand movements should be soft, gentle, without jolting, especially in the area of the spine (see V. I. Dubrovsky. All types of massage. M. Young Guard, 1993, p. 216, 217). Massage in young children is contraindicated in congenital heart defects with severe cyanosis and decompensation of cardiac activity (ibid.).

 The problem to which the present invention is directed, is the creation of a drug-free method of rehabilitation of newborn children using hidden reserves of the body.

 This problem is solved by the fact that according to the method of rehabilitation of newborns with perinatal pathology, including the effect of massage on the zones selected depending on the localization of the pathological process, the predominant lesion hemi-type is preliminarily identified: right in the pathology of the abdominal cavity, pelvis, lower limbs, right-side neurological disorders, characterized by a predominant turn of the head to the right in a supine position, left with pathology of the chest and its organs, mental disorders about the development, left-sided neurological disorders, characterized by a predominant turn of the head to the left in a supine position and conduct a course of external lateral effects by successively alternating pressure with the fingers with an effort causing a response of spontaneous muscle tension, for 1-3 seconds from 1 to 5 times for the following zones: paravertebral on the side of the identified hemitype, interspinous shoulder-scapular and intercostal on the side of the hemitype, additionally on the zones of the left hand along the meridian of the heart with the left m hemitype, additionally along the anterior midline of the chest and abdomen, along the large intestine and inguinal regions with the right hemitype, then to the zones innervated by the occipital and trigeminal nerve (along the outer branches of the occipital and trigeminal nerve), and the area around the eye on the side of the hematotype , and with a mixed lesion, the number of exposure zones is accordingly expanded.

 The method is as follows. Before starting treatment, all methods of objective examination are carried out, including instrumental ones, the volume of which is determined depending on the type or nature of the lesion and usually includes radiographic, electrographic, rheoencephalographic, and biochemical studies. If necessary, an ultrasound examination is performed.

 The treatment program is determined in accordance with the type of primary lesion.

 As our observations have shown, in newborn children, three main types of lesions can be identified: right-sided, left-sided, and mixed.

 The so-called right or lower type is characterized by the predominant position of the head to the right when lying on the back and the following types of pathology: pathology from the gastrointestinal tract (toxicosis, toxic intestinal paresis, staphylococcal infections, intestinal dyskinesia, hernia); pathology of the development of the lower extremities (dysplasia of the hip joints); urogenital system pathology (formation and development); neurological manifestations on the right side.

 The left (upper) type is characterized by the predominant position of the head to the left when lying on the back, it is accompanied by pathology of the cardiovascular system (heart failure, heart defects, cardiopathy); pathology of the respiratory system (pneumopathy, atelectasis, shortness of breath); defects in the formation of the chest (funnel-shaped, keeled sternum); impaired mental development; neurological manifestations on the left side.

 The mixed type has certain signs of a right or left type of defeat with the advantage of one or the other. Usually, the predominant left-side or right-side position of the head is not characteristic when lying on the back. Neurological manifestations of a mixed type of lesion are tetraplegia (paresis) with a primary lesion of either side.

 Thus, the type of lesion is detected during a detailed examination of the child. It is noticed and confirmed in practice that the type of lesion affects the position of the child’s head. Identification of the type of lesion is necessary to select the preferred side of the impact.

 So, for example, with the left type of lesion, pressure is applied to the paravertebral zones on the left along the entire spine, the interspinous zones of the spine and intercostal areas of the back on the left, then on the shoulder-scapular zones and areas of the left hand along the meridian of the heart, then along the front surface of the chest and intercostal spaces on the left, the impact continues on the occipital, temporal region, on biologically active zones and points around the left eye. With the right type of lesion, a similar effect is performed, but paravertebrally on the right, then along the intercostal spaces on the right and on the front surface of the chest and front wall of the abdomen, along the outer edge of the abdominal muscles on the right and left, along the large intestine and further to the occipital, temporal region, biologically active zones and points around the right eye. With a mixed type of lesion, a universal program of exposure is carried out, including programs of the right-sided and left-sided type of lesion or their elements in accordance with the existing pathology.

 The following are examples of the treatment of specific sick newborns and premature babies according to the proposed method from the department of the second stage of nursing of the premature infant hospital of the Moscow region N 1 VAZ with central nervous system damage and sepsis.

 Example 1. Patient R. M. on November 20, 1992 Born from 1 pregnancy, 1 birth at 37 weeks. Birth weight 3700 g, height 52 cm, head circumference 34 cm, chest circumference 33 cm. Apgar score 7 points.

 He was admitted to the neonatal pathology department No. 5 of VAZ VAS on 12/11/92 with a diagnosis of natal injury of the cervical spine, right-sided focal-drainage pneumonia. DN II Art. perinatal malnutrition I Art. prematurity I Art. hip dysplasia, dysbiosis, staphylococcal infection, umbilical vein phlebitis.

 Upon receipt, the condition is serious. The skin is grayish, perioral cyanosis, bloating of the wings of the nose, retraction of the intercostal spaces, breathing is weakened on the right, miscellaneous rales, respiratory rate of 76 per min, the stomach is swollen, soft, the liver is + 2 cm, the spleen is not palpated.

 Neurological status: inhibited, hypotension of the flexors of the arms and legs (more pronounced on the right), head position mainly to the right. Reflexes of the knee and biceps are caused by Robinson. Moreau, Galant, protection is weakened, support and stepping there. Reflexes of Babinsky, Pusen, Rossolimo are more pronounced on the right.

 X-ray of the cervical spine from 12/14/92: moderate thickening of paravertebral fiber at level I-V, body C IV is shifted forward by 1 mm.

 X-ray of the chest from 12/14/94: on the right are the areas of focal-drainal infiltration of the lung tissue, the heart is shifted to the right.

Clinical blood test from 12/11/92:
red blood cells 3 million

hemoglobin 103
color indicator 1
white blood cells 10700
ESR 16
Sowing from the trachea from 12/14/92: Pseudomonas aeruginosa was seeded.

 Medical treatment was carried out: calcium chloride, dibazole, bifidum-bacterin, prednisolone, lasix. aminophylline, B vitamins, penicillin, physiotherapeutic treatment. In parallel, treatment sessions were carried out according to the proposed method every other day.

 Before the start of the procedure, an integral assessment of the condition, data of an objective examination was carried out, and an exposure program was determined.

 On examination: in the position on the back, the head is turned mainly to the right, the leading pathology is lung pathology (right-sided focal-drainage pneumonia), as well as the intestines (dysbiosis, staphylococcal infection, umbilical vein phlebitis), the pathology of the musculoskeletal system (hip dysplasia) right-sided type of lesion.

 The child was placed on his stomach and began to act paravertebrally to the right of the 2 cervical vertebra to the end of the spine, including the sacral region, then the exposure was performed along the interspinous spaces of the entire spine to the same level, then the exposure continued along the 2 back line (a conditional line running in the middle between the line corresponding to the middle of the spine, it corresponds to the course of the posterior median meridian, and the line passing along the medial edge of the scapula), then along the intercostal spaces to the right. Then the child was turned on his back and the exposure was carried out along the front-median meridian, then along the front wall of the abdomen along the outer edge of the rectus muscles of the abdomen on the right and left and further along the large intestine. Each impact was carried out with the fingers of the hands in succession with alternating pressure with an effort of not less than the force causing a response of spontaneous muscle tension for 1-3 seconds from 1 to 5 times and repeated every other day for 10 sessions. We call this effect external pain exposure (VBV).

 After the treatment, positive dynamics were observed. The disappearance of auscultatory signs of pneumonia (wheezing) and respiratory failure after 3 sessions. Improvement in general condition was observed from session to session (after 7 sessions, the condition is satisfactory). After 9 sessions, active sucking, improvement of stool appeared. At discharge, January 10, 1993, the condition is satisfactory. Weight 3110 g, height 53 cm, head circumference 35 cm, chest circumference 33 cm. The skin is clean. Active Tendon reflexes are live, step and support positive. Pueryl breathing, frequency 40 min, no wheezing. Nasal breathing is free. Heart sounds are clear, rhythmic, heart rate of 120 per minute. The abdomen is calm, normal in shape, stool 2-3 times a day of yellow-brown color. Upon recovery, he was discharged under the supervision of a local therapist and neuropathologist.

 Example 2. Patient P. V. 11/15/91 He was admitted for treatment to the Department of Premature N 5 TMT VAZ 11/22/91 with a diagnosis of natal trauma to the cervical spine, perinatal malnutrition, II stage. pneumopathy, drug allergy, cardiopathy.

 The child was born from 1 pregnancy, 1 childbirth with a period of 38 weeks with a body weight of 2600 g, height 50 cm, head circumference 32 cm, chest circumference 31 cm. Condition of the child after moderate birth.

 At the time of admission to the ward premature baby condition is serious. Reduced motor-reflex activity: sucks sluggishly, regurgitation, decreases in weight. The skin is dry, flaky. Oral cyanosis. In the lungs, puerile breathing. Heart rhythm is correct, tones are sonorous. The stomach is soft. The chair is decorated, urination is normal. Reflexes of support and stepping are weak. X-ray of the cervical spine: thickening of fiber C IV-VI. On the ECG, there are signs of an increase in the load on the right ventricle, in the posterior wall of the left ventricle changes in the type of focal, myocardial hypoxia, heart rate of 187 beats per minute.

 Against the background of drug treatment (calcium chloride, dibazole, oxacillin, hydrocortisone, aminophylline, gentamicin, lysozyme, gamma globulin), physiotherapeutic treatment (UHF, electrophoresis, etc.), the child's condition did not improve. On the seventh day of stay in the clinic, treatment was started with the proposed method of external pain exposure (VBV).

 The condition of the child is serious, sucks sluggishly, does not put on weight. The skin is dry, oral cyanosis persists. Easy retraction of intercostal space during breathing. Weight 2500g.

 Before the beginning of the VBV procedure, an integral assessment of the condition, data of an objective examination was carried out and the program of exposure was determined.

 On examination: in the position on the back, the head is turned mainly to the left, the leading pathology is the pathology of the cardiovascular system (ECG signs of an increase in the load on the right ventricle, changes in the type of focal in the back wall of the left ventricle, myocardial hypoxia, heart rate 187 beats per minute), oral cyanosis, the chest is slightly deformed (predisposition to the development of a keeled sternum) is a left-sided type of lesion.

 The therapeutic effect was carried out successively by alternating pressure with an effort of not less than the force causing the appearance of the pain syndrome, and not more than the level of maximum pain tolerance, and each effort was carried out for 1-3 seconds from 1 to 5 times.

 The child was placed on the stomach and began to act paravertebrally to the left of the 2 cervical vertebra to the end of the spine, including the sacral spine, then the inter-spinal intervals of the entire spine were exposed to the same level, then the exposure continued along the 2 back line (conditional line running in the middle between the line corresponding to the middle of the spine, it corresponds to the course of the posterior median meridian, and the line passing along the medial edge of the scapula) to the level 4 of the thoracic vertebra, then air acted on the intercostal spaces on the left. The exposure continued on the left hand along the channel of the heart. Then the child was turned on his back and the exposure was carried out along the anteromedian meridian on the sternum and further along the intercostal spaces in the direction from the sternum to the spine. Each action was carried out with the fingers of the hand in succession with alternating pressure with an effort of at least an effort causing a response of spontaneous muscle tension for 1-3 seconds from 1 to 5 times and was repeated every other day for 9 sessions.

 After the treatment, the child's condition is satisfactory. Active Sucks well, gaining weight, clean skin. Newborn reflexes are satisfactorily triggered. The rhythm of the heart is correct, the tones are sonorous. In the lungs, puerile breathing, percussion pulmonary sound. The abdomen is soft, the chair is regular, decorated. The liver and spleen are not palpable. ECG: without signs of focal changes, heart rate of 120 per min. Weight 3680 g. The child was discharged under the supervision of a local pediatrician.

 Example 3. In A. 18.03.93 p. Received on the fifth day with a diagnosis of natal trauma to the cervical spine, mixed tetraparesis, prematurity III tbsp. malnutrition III art. pneumopathy, cardiopathy, pyoderma, umbilical vein phlebitis, dysbiosis, dysplasia of the hip joints.

 She was born from 1 pregnancy, 1 birth, in a period of 30 weeks. Birth weight 1400 g. Height 46 cm. Apgar score 5-6.

 Upon admission to the department: very serious condition, hypotension, cyanosis, hyporeflexia, shortness of breath, retraction of the intercostal spaces, stiff neck, the head is thrown back. Large fontanel 1x1 cm, bulges. Reflexes Robinson. Moreau, Galanta, the protection is weakened, stepper and support are absent. Tremor of the chin and pens. Head circumference 28 cm. Chest circumference 25 cm. Dysplasia of the hip joints. Multiple pustular eruptions on the skin with a diameter of 3 mm. Heart sounds are deaf, rhythmic, heart rate 160 per minute. Breathing is weakened, diffuse creaking rales, BH 46 per min. The abdomen is swollen, the stool is liquid 5-6 times a day, green with a fetid odor.

 ECG from 23. 03. 93: sinus rhythm 156 per min, signs of dystrophic changes in the posterior wall of the left ventricle and overload of the right heart.

 X-ray of the cervical spine from 03/23/93: a significant thickening of paravertebral fiber at level I-V.

 Chest x-ray from 03.24.93: sinuses are free, a large number of lobular atelectasis along the pulmonary fields.

Clinical blood test from 03/23/93:
red blood cells 4.4 million

hemoglobin 142
color indicator 0.9
white blood cells 6.6 thousand

ESR 25
Urinalysis dated 03/23/93: light yellow, cloudy,
protein footprints
white blood cells 10-12 in n / a
flat epithelium 10 in p / sp
Analysis of feces for dys. group from 03.23.93: Staphylococcus aureus is seeded.

 The child is placed in the intensive care unit. Medical treatment was carried out (penicillin, gentamicin, oxacillin, aminophylline, bifidum-bacterin, calcium chloride, dibazole, hydrocortisone, glucose, measles gamma globulin), physiotherapeutic treatment (UHF, electrophoresis).

 Against the background of the treatment, after 10 days: the child’s condition is severe, the skin is pale, acrocyanosis, the head is thrown back, stiff neck, bulging fontanelle, tendon reflexes are sluggish, there are no reflexes of support, stepping, heart sounds are muffled, rhythmic, heart rate 166 per min, respiratory rate 48 min, respiration weakened, scattered dry and wet rales, retraction of intercostal spaces. The chair is mushy 3-4 times yellow-green. Purulent discharge from the navel.

Clinical blood test from 04/02/93:
white blood cells 4 thousand

ESR 24
In stool, Staphylococcus aureus is preserved.

 ECG: sinus rhythm, heart rate of 166 per min, dystrophic changes in the posterior wall of the left ventricle.

 On the 11th day of stay in the department, treatment with the method of VVB was started.

 Before the beginning of the VBV procedure, an integral assessment of the condition, data of an objective examination was carried out and the program of exposure was determined.

 On examination: the head is thrown back, signs of a right-sided type of lesion (phlebitis of the umbilical vein, dysbacteriosis, dysplasia of the hip joints) and signs of a left-sided type of lesion (pneumopathy, cardiopathy, chin tremor, arms) are revealed, thus, a mixed type of lesion is revealed.

 The therapeutic effect was carried out according to the universal program with successively alternating pressure with an effort of not less than the effort causing the appearance of the pain syndrome and not more than the level of maximum pain tolerance, and each effort was carried out for 1-3 seconds from 1 to 5 times.

 The child was placed on his stomach and began to act paravertebrally to the right of the 2 cervical vertebra to the end of the spine, including the sacral part of the spine, then the interstitial spaces of the entire spine were exposed to the same level, then the exposure continued along the 2 back lines, then along the intercostal spaces to the right, further, exposure continued paravertebrally to the left of level 2 of the cervical vertebra to level 4 of the thoracic vertebra, then along the 2 backlines of the left to the same level and then along the intercostal spaces left, then acted on the left hand along the channel of the heart. Then the child was turned over on his back and continued exposure along the front median meridian, then on the front wall of the abdomen along the outer edge of the rectus abdominis muscles on the right and left and further along the large intestine. Each action was carried out with the fingers of the hand in succession with alternating pressure with an effort of at least the force causing the appearance of the pain syndrome and not more than the maximum pain tolerance of the patient for 1-3 seconds from 1 to 5 times and was repeated every other day for 10 sessions.

 Immediately upon connecting the VBV method, a positive dynamics was observed in the state of the child: active sucking after one session, disappearance of wheezing in the lungs and shortness of breath (decrease after one session and disappearance after the third), activation of tendon reflexes from the second session, decrease in stiff neck from the second session, disappearance after the seventh session.

 Upon recovery, he was discharged under the supervision of a local pediatrician and neurologist.

 The invention is based on the theoretical developments of the author V. A. Kopylov, set forth by him in the work Functional abilities of the nervous system and its role in physiological processes. SCST USSR, VINITI, N 1953-85, dep. Moscow, 1985; in the work of Uglov F. G. Kopylov V. A. Pain as a stimulator of protective and reparative processes. "Herald of Surgery", 1985, N 6, p. 17, and was named by the author the method of external pain and stress (VBV).

An analysis of the results allows us to draw the following conclusions about the high effectiveness of treatment with the method of external pain and tension of newborns with perinatal pathology:
Significant improvements, and then normalization of muscle tone during spastic tetraparesis were noted in 82.4% with mixed tetraplegia in 88.5% and the absence of effect in only 2.8% of cases;
complete restoration of the sucking reflex, which was absent or strongly inhibited before treatment with the method of VVB in 37 children, occurred in 33 (89.3%), improvement in 3 (8), and there was no effect in one (2.7);
a complete restoration of motor automatism reflexes in treating 80 newborns was obtained in 57 children (71.2%), improvement in 22 (27.5%) and did not produce an effect in one (1.3%);
in 14 deeply premature babies with a funnel-shaped sternum and shortness of breath of the “swing” type, in all cases it was possible to quickly eliminate shortness of breath and achieve either a complete correction of the defect or its significant correction, which could not be achieved by any other methods;
when treating 14 newborns with cardiopathy, all received significant improvement up to the full normalization of the condition, while 3 cases of elimination of gross systolodiastolic murmur were noted;
of 13 newborns treated for septic toxicosis, complete cure was obtained in 12 (92.3%), and in one, when 4 newborns with toxic intestinal paresis were treated, all of them managed to eliminate the latter, all 5 newborns treated in connection with with disruption of the intestines (loose stools), achieved stool normalization;
in 32 newborns admitted for treatment with shortness of breath, normalization of respiration was obtained in all, a case of spreading atelectasis of the upper lobe of the left lung was documented;
in no case was there a worsening of the condition or complications with the use of the course of VVV, moreover, the reaction to its administration in newborns is calmer than to electrophoresis, which allows us to recommend this technique in the complex treatment of sick newborns, especially after prolonged mechanical ventilation (artificial ventilation) lungs) and with damage to the central nervous system.

Claims (1)

 A method of rehabilitation of newborn children with perinatal pathology, including the effect of massage on the zones selected depending on the localization of the pathological process, characterized in that the pre-determined primary hemitipy of the lesion: right in the pathology of the abdominal cavity, pelvis, lower limbs, right-sided neurological disorders characterized by predominant turning the head to the right in the supine position, left with pathology of the chest and its organs, mental development disorders, left-sided neurological disorders, characterized by a predominant turn of the head to the left in a supine position, and conduct a course of external pain treatment by successively alternating pressure with the fingers with an effort that causes a response of spontaneous muscle tension for 1 3 s from 1 to 5 times in the following zones: paravertebral on the side of the identified hemi-type, interspinous shoulder-shoulders and intercostal on the side of the hemi-type, additionally on the areas of the left hand along the meridian of the heart with the left hemi-type, additionally then along the anterior midline of the chest and abdomen, along the large intestine and inguinal regions with the right hemi-type, then to the zones innervated by the occipital and trigeminal nerves (along the outer branches of the occipital and trigeminal nerve), and the areas around the eye on the side of the hematotype, and when mixed lesions, respectively, expand the number of exposure zones, the procedure is repeated every other day to 8 12 per course.