RU2197215C1 - Method for treating patients with pathological neurological lesions of muscular tonicity and postural regulation in case of the diseases of central nervous system, vestibular and motor apparatus - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: available deformations are affected with a physical loading. The latter is first imitated at "shouldersfeet" section in an axial direction due to initiating the tension of correcting elastic pulls. Tension value corresponds to 60% against body weight, not more. Then tension degree is changed in deformation-bearing area by maximally adjusting initial deformed posture to physiological three-dimensional position. Moreover, the angles between axial loadings along thigh and shin in a knee joint and along vertebral column and thigh in a hip joint should correspond to 125-140 deg. Then come correcting physical exercises without removing axial loading. The method enables to destroy a pathological stereotype of movement appeared as a result of the disease. EFFECT: higher efficiency of therapy. 4 cl, 2 ex

Description

 The invention relates to medicine, namely to methods and means of treating neurological disorders of the musculoskeletal system.

 Known from the patent of the Russian Federation 2054907, class. A 61 F 5/00, 1992, a method for the treatment of neurological disorders of motor function of various etiologies by acting on the spine and upper and lower extremities of the patient’s body.

 The disadvantages of this method are the insufficient increase in the range of motor activity and a decrease in pathological synergy in antagonist muscles.

 The closest in essence to the proposed method for the treatment of patients with pathological neurological disorders of muscle tone and postural regulation in diseases of the central nervous system, vestibular and musculoskeletal systems is the treatment method known from the patent of the Russian Federation 2040923, MKI6 A 61 H 3/00, 1992 patients with pathological neurological disorders of muscle tone and postural regulation in diseases of the central nervous system, vestibular and musculoskeletal systems by Actions available to twisting or misalignment of the spatial position of the body exercise initiated tension corrective elastic braces for daily sessions.

 The disadvantages of this method are the long duration of the patient’s treatment course, the impossibility of conducting treatment sessions at home and the inability to create a “force field” that causes the patient’s body to have a complex of adaptive reactions that destroys the pathological stereotype of movement resulting from the disease.

 The aim of the invention is to provide the possibility of creating a "force field" that causes a complex of adaptive reactions in the patient’s body, destroying the pathological stereotype of movement resulting from the disease and affecting the sensitivity threshold of the receptors and mechanisms of the central system as a result of the disease, regulating the adequate functioning of antigravity muscles, fixing normal physiological characteristics of movement that occur during daily sessions tviya available on twisting or misalignment of the spatial position of the body, and reduce the time of treatment.

This goal is achieved by the fact that when implementing a method of treating patients with pathological neurological disorders of muscle tone and postural regulation in diseases of the central nervous system, vestibular and musculoskeletal systems by acting on existing deformations or disturbances in the spatial position of a part of the body by physical stress, initiated by elastic corrective tension cravings during daily sessions, the cycle of exposure to a patient with physical activity is carried out daily and sessions for 2-5 weeks, and the treatment session itself is carried out continuously, sequentially simulating physical activity first on the shoulder-foot section in the axial direction on the diseased and healthy sides of the body, by initiating the tension of corrective elastic rods, the magnitude of which is regulated depending on the patient’s condition, equal to not more than 60% of his body weight, then the degree of tension of the corrective elastic rods in the zone with deformation or violation of the spatial position of the parts of the body is changed, as close as possible and Khodnev deformed posture to physiological spatial position of the torso and limbs, asking if the angles between the axial loads along the femur and tibia and along the spine and femur at the knee and hip joints, which are respectively 125 - 140 ^o, after which operate without removal axial exercise corrective physical exercise.

 In addition, in the method of treating patients with pathological neurological disorders of muscle tone and postural regulation in diseases of the central nervous system, vestibular and musculoskeletal system, for each specific patient, corrective exercises from the complex can be selected: body verticalization, walking, flexion, extension, rotation of the arms and legs, flexion and extension of the feet, small movements with the fingers of the hand, exercises for coordination and accuracy of movements, working out speech and then removing physical activity ki, and if the positive elements of a new stereotype retained in movements that arose during a session of loading with elastic rods, after removing it, the exercises shown for this particular patient can be continued under the control of the patient’s vision and tactile sensitivity for an hour, and the duration each session can be at least 1 hour.

 The method is as follows.

A device including elastic traction is worn on the patient. Then, by tensioning the elastic rods, an axial load is created on the shoulder-foot section in the axial direction on the sick and healthy sides of the body. The magnitude of the tension of the corrective elastic rods is regulated depending on the physical condition of the patient, and the magnitude of the load can reach 60% of the body weight, then the degree of tension of the corrective elastic rods in the zone with deformation or violation of the spatial position of the body parts is changed, bringing the initial deformed posture as close as possible to the physiological spatial position of the trunk and limbs, while setting the angles between axial loads along the thigh and lower leg and along the spine and core in the knee and hip joints, which are respectively 125-140 ^o, then perform corrective exercise without removing axial exercise. The duration of each session may be at least one hour.

 For each patient, they can choose corrective physical exercises from the following complex: body verticalization, walking, flexion, extension, rotation of the arms and legs, flexion and extension of the feet, small movements of the fingers, coordination exercises and accuracy of movements, working out speech and then removing physical activity. If the positive elements of the new stereotype are preserved in the movements that occurred during the load application session with elastic rods after removing it, the exercises shown for this particular patient can be continued under the control of the patient’s vision and tactile sensitivity for an hour.

 The degree of fixation of the body (body parts) depends on the tension level of the rods, but due to their elasticity, the fixation is never rigid, the possibility of movement always remains.

 Clinical example 1: Patient K, 62 years old. He was admitted to the clinic of nervous diseases of the Russian State Medical University with a diagnosis of Parkinson's disease, mainly rigid form, 3 tbsp. Sick since 1992, when after emotional overstrain there was a feeling of awkwardness, stiffness, and then soon and trembling in the right hand. Gradually, the trembling increased, spread to the left hand; general stiffness appeared, it became difficult to walk, handwriting significantly deteriorated, speech became quiet, monotonous. It was treated on an outpatient basis, took tsarcopan 4 mg / day until 1994, since 1994 - 375 mg / day, and since 1996 the dose of nacoma has increased to 750 mg / day.

 The general condition of the patient upon admission to the clinic of nervous diseases of the Russian State Medical University in 1999: the patient's condition is satisfactory. Harsh breathing in the lungs. The borders of the heart are not changed, heart sounds are muffled. Blood pressure 120/80 mm Hg Pulse 74, rhythmic.

 Neurological status: consciousness is clear, comes into speech contact willingly. Pupils D = S, rounded, photoreaction preserved, weak convergence, hypomimia, rare blinking, speech is quiet, monotonous. Tendon and periosteal reflexes D = S, are revitalized, without a clear difference of sides. There are no pathological stop signs. Reflexes of oral automatism. General hypo- and oligokinesia; a significant increase in muscle tone in the limbs according to the plastic type, more on the right; in any position of the hands appears small-amplitude rhythmic tremor of the hands; walks in small steps, the symptom of “legs sticking to the floor” is pronounced, the head is lowered to the chest when walking, arms are extended along the body. Axeirokinesis. The start of movement is significantly hindered when the patient stomps on the spot for several seconds, turns when walking are difficult. Pathology from the sensitive sphere has not been identified. In the Romberg sample, it is stable; the coordinating sample performs satisfactorily. Vegetative disturbances in the form of moderate hypersalivation, frequent constipation is noted. No sheath symptoms.

 The severity of neurological impairment on the UPDRS scale was 64 points, which corresponds to the stage 3 Hoehn & Yahr scale. When performing a functional test on the move 20 meters, the patient passes for 38 s, making 42 steps.

 Ophthalmologist examination: no pathology found in the fundus.

 ECG - sinus rhythm, heart rate - 74. Horizontal position e.o.s.

 The craniogram is normal. Blood and urine tests without pathology.

 Conducted: transcranial magnetic stimulation of the motor zones of the cerebral cortex (TMS), VSWP on the AS.

 TMS: during stimulation of the left hemisphere, the central conduction time (HCV) at rest is 7.60 ms. At a force of 6.55 ms, the amplitude at rest is 2170.5 μV, the amplitude in the test for facilitation is 4760.0 μV, the total duration is 17.0 ms, the number of phases is 4. During stimulation of the right hemisphere, VSWR on Ac: latent the period of the 1st component during stimulation of the left hemisphere is 1.69 ms, the 2nd - 2.69 ms, the 3rd - 3.74 ms, the 5th - 5.82 ms; the amplitude of the 1st component is 0.34 μV, the second is 0.24 μV, the third is 0.32 μV, and the fifth is 0.52 μV; on the right side of the hemisphere, the latent period of the 1st component is 1.62 ms, the second is 2.71 ms, the third is 3.84 ms, and the 5th is 5.74 ms; the amplitude of the first component is 0.28 μV, the second is 0.21 μV, the third is 0.34 μV, and the fifth is 0.45 μV. Which does not significantly differ from the normal indicators of this age group.

 The observation illustrates how in a patient suffering mainly from a rigid form of Parkinson’s disease with a disease duration of more than 7 years, with pronounced motor impairment during rehabilitation treatment using the proposed method, it was possible to achieve a significant improvement in the general condition. When conducting magnetic stimulation of the parameters of the MS response and the total duration of the MS response, which indicates the normalization of supraspinal effects on the segmental apparatus of the spinal cord. This effect is due to the action of a powerful proprioceptive stream when using the described method. The frequency and severity of tremor with a decrease in muscle rigidity has not changed.

 Clinical example 2: Patient N., 66 years old. He was delivered to the clinic of nervous diseases of the Russian State Medical University for emergency medical care with a diagnosis of acute ischemic cerebrovascular accident in the system of the right internal carotid artery. Hypertension of the III stage. He became acutely ill on the day of hospitalization, when against the background of a rise in blood pressure to 199/100 mm Hg. suddenly appeared weakness and numbness in the left limbs. Previously, he periodically noted blood pressure rises to 170/90 mmHg, he did not take antihypertensive therapy constantly, and was adapted to blood pressure of 140/90 mmHg.

 The general condition of the patient upon admission to the clinic of nervous diseases of the Russian State Medical University: the condition of the patient of moderate severity. Harsh breathing in the lungs. The borders of the heart are not changed, heart sounds are muffled. Blood pressure 170/90 mm Hg, pulse 76, rhythmic.

 Neurological status: clear consciousness, speech with elements of dysarthria. Oriented in place, time and self. There are no cerebral and meningial symptoms. Palpebral fissures D = S, restriction of movement of the eyeballs to the left. Pupils D = S, rounded, photoreaction preserved, left nasolabial fold smoothed. Tongue deviation to the left. Left-side hemiparesis with a decrease in muscle strength in the arm to 3 points, in the leg to 4 points. The muscle tone on the left is elevated in spastic type. Moves within the chamber with outside help. Tendon and periosteal reflexes S> D, animated. A pathological symptom of a babinski on the left. Reflexes of oral automatism. Left-side hemigipalgesia. The degree of neurological deficit on the Lindmark scale was 383 points, which corresponds to the moderate severity of ischemic stroke. The functions of the pelvic organs are controlled.

 Ophthalmologist examination: on the fundus - optic nerve discs are pale pink, the boundaries are clear. Arteries are moderately narrowed, veins are not dilated.

 ECG - sinus rhythm, heart rate - 80. The horizontal position of the electrical axis of the heart. Moderate left ventricular myocardial hypertrophy.

 The craniogram is normal. Blood and urine tests without pathology.

 Conducted: transcranial magnetic stimulation of the motor zones of the cerebral cortex (TMS), VSWP on the AS, KG, EchoEG.

 VSWR on Ac: the latent period of the 1st component during stimulation of the affected hemisphere is 1.58 ms, the 2nd - 2.82 ms, the 3rd - 3.63 ms, the 5th - 5.87 ms; the amplitude of the 1st component is 0.18 μV, the second is 0.21 μV, the third is 0.25 μV, and the fifth is 0.30 μV; on the side of the clinically intact hemisphere, the latent period of the 1st component is 1.62 ms, the second is 2.63 ms, the third is 3.66 ms, and the 5th is 5.83 ms; the amplitude of the 1st component is 0.18 μV, the second is 0.16 μV, the third is 0.20 μV, and the fifth is 0.35 μV. Which corresponds to moderately pronounced changes on the part of mesodiencephalic structures.

 ECHO-EG: Tr = Ms = Md = 67 mm. There is no displacement of the median structures and signs of intracranial hypertension.

 CT: foci of reduced density of cortical-subcortical localization in the right frontal and parietal lobes. The consequences of an extensive ischemic stroke in the system of the right internal carotid artery.

 TMS: during left hemisphere stimulation, the central conduction time (ICP) was 7.65 ms, the amplitude of the MS response was 3820.0 μV, the total duration of the MS response was 12.9 ms, and the number of phases was 3. During the right hemisphere stimulation (VCP) was 12.45 ms, the amplitude of the MS response was 1125.0 μV, the total duration of the MS response was 13.1 ms, and the number of phases was 3.

 After 3 weeks from the onset of the disease, the patient was prescribed a course of rehabilitation treatment using the proposed method. The first two sessions were carried out for 25 minutes with a moderate load of 5-20 kg. Subsequently, the load gradually increased to 40 kg, and the duration of the sessions increased to 50-60 minutes, the course of treatment was 12 sessions. Monitoring of blood pressure, heart rate, NPV was carried out before and after each session. When assessing neurological status, the most significant change was a decrease in muscle tone in paretic limbs with an increase in muscle strength in them (severity of paresis in the arm - up to 4.0 points and in the leg - 4.5-5 points) and an increase in motor activity of the patient. The severity of motor disorders according to the Lindmark scale after a course of application of the proposed method of treatment was 408 points.

 TMS (after a course of treatment): during left hemisphere stimulation, the central conduction time (VCP) was 7.45 ms, the amplitude of the MS response was 3870.5 μV, the total duration of the MS response was 13.4 ms, and the number of phases was 3. When stimulation of the right hemisphere, the time of central conduction (ICP) was 10.0 ms, the amplitude of the MS response was 1810.5 μV, the total duration of the MS response was 13.3 ms, and the number of phases was 3.

 Thus, in this clinical example, it is shown that against the background of treatment using the proposed method in a patient with ischemic stroke in the absence of a deep neurological deficit, positive dynamics are observed in the form of a decrease in tone, an increase in muscle strength and range of motion. When conducting magnetic stimulation, changes in the functional state of the motor pathway are detected, primarily from the side of the ICP and amplitude parameters, which may be associated with a change in the afferent influx into the structure of the central nervous system, as well as a change in the neurotransmitter systems.

 The effects of using the new method of treatment are immediately apparent and are expressed in improving the stability of the vertical position (confirmed by studies on a stabilograph), changes in the biomechanics of walking (increasing the stride length, shortening the phase of leg transfer, changing the characteristics of the foot roll due to the involvement of a larger sole surface in the support), the appearance of new movements of the hand, improved coordination of movements, changes in posture and posture. There is an effect on the psychological state of the patient - the emergence of faith in their motor capabilities, the rejection of support, sticks, etc.

 Thus, the proposed method of treatment destroys the pathological stereotype of motor functions and helps to restore normal physiological regulation of movements, quickly enough restoring the coordination of motor acts, especially those important as human walking and coordinated hand movement, as a result of which patients treat themselves (strokes, Parkinson's disease )

Claims (4)

1. A method of treating patients with pathological neurological disorders of muscle tone and postural regulation in diseases of the central nervous system, vestibular and musculoskeletal system by acting on existing deformations or disturbing the spatial position of parts of the body with physical stress, initiated by stretching corrective elastic rods during daily sessions, characterized in that the cycle of exposure to the patient with physical activity is carried out daily treatment sessions for 2-5 not del, and the treatment session itself is carried out continuously, sequentially simulating physical activity first on the shoulder-foot section in the axial direction on the sick and healthy sides of the body, by initiating the tension of corrective elastic rods, the value of which is regulated, depending on the condition of the patient, not more than 60 % of the weight of his body, then the degree of tension of the corrective elastic rods in the zone with deformation or violation of the spatial position of the parts of the body is changed, as close as possible to the initial deformed ozu to the physiological spatial position of the trunk and limbs, while setting the angles between the axial loads along the thigh and lower leg in the knee joint and along the spine and thigh in the hip joint, which are 125-140 ^o , after which they perform corrective physical exercises without removing the axial physical load .  2. The method according to p. 1, characterized in that for each specific patient, corrective exercises are selected from the complex: body verticalization, walking, flexion, extension, rotation of the arms and legs, flexion and extension of the feet, small movements of the fingers, coordination exercises and accuracy of movements, working out speech, and then subsequent removal of physical activity.  3. The method according to p. 1, characterized in that if the positive elements of a new stereotype that have arisen during the session of loading a patient with elastic cords are maintained in the patient’s movements, after removing the exercise, the exercises shown for this particular patient are continued, under the control of vision and tactile sensitivity patient for 1 hour  4. The method according to p. 1 or 2, characterized in that the duration of each session is at least 1 hour