RU2242959C2 - Method for carrying out medical conductive rehabilitation of neurological patients suffering from motor disorders - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves applying principles for organizing movement in proximal-distal direction depending on extremities ontogenesis. This rehabilitation method involves performing approximation techniques in diagonal movement samples, that is under dynamic conditions with alternating action from making articulation compressed in one movement sample phase to its becoming expanded in the other movement phase.

EFFECT: achieving differentiated activity of antagonist muscles in given movement pattern; training reciprocal movements; stimulating trunk muscle activity for making irradiation in feeble extremity muscle groups.

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Description

The invention relates to medicine, namely to neurology with conductive therapy, in particular kinesiotherapy, and is intended for use in the rehabilitation of neurological patients with motor disorders (tetraparesis, lower paresis, hemiparesis) resulting from various diseases related to clinical manifestations, prognosis and pathogenesis such as traumatic brain injury, spinal cord injury, acute circulatory failure, cerebral palsy.

A wide arsenal of rehabilitation tools for these patients is known, which include mineral baths, medications, and primarily physical exercises (see Physiotherapy. Edited by M. Weiss, A. Zembatoi, translated from Polish. M: Medicine, 1986. [1] related to kinesiotherapy techniques. These methods include, first of all, the method of G. Kabat and the Bobbath spouses, one of the basic principles of which is the use of a complex movement, in which the rotation element in combination with the movement the axis of the plane, since in life most of the movements requiring amplification are performed along a diagonal path (discus, chopping wood, etc.). These movements more effectively affect the activation of the affected muscles and their maximum gain in a given movement pattern through participation in the movement of more muscles, joints, ligaments during the restoration of impaired motor functions (see [1], p. 359).

The closest analogue is the exercise pattern and motion patterns for various parts of the body (see [1], p. 366) aimed at restoring impaired motor functions in neurological patients through increased muscle response using central nervous system mechanisms by altering the excitability of alpha motor neurons leading to an improvement in the condition of the peripheral neuromotor apparatus. All exercises require a certain starting position, manual contact of the methodologist, elements of movement.

These exercises for the upper limbs in the lead-to-lead pattern (exercise 1) include the starting position: the limb is straightened, retracted and turned inward in the shoulder joint, straightened in the elbow joint, pronounced forearm, fingers and hand straightened, the brush is brought in the elbow direction; capture: the methodologist’s hand of the same name on the patient’s hand, the opposite hand - above the wrist joint on the inside; elements of movement: flexion of fingers and hand, bringing the hand in the radial direction, supination of the forearm, flexion, adduction and external rotation in the shoulder joint. In this movement pattern, the working muscles are as follows: a group of flexors of the fingers and hand, arch support, coracorachumeral, deltoid (front part), pectoralis major, infraspinatus, small round, trapezoid (lower part), front dentate.

In the diagram from abduction to reduction, exercise 13, for the lower extremities - the starting position: the leg is straightened, brought and rotated inward in the hip joint, the knee joint is straightened, fingers and foot are bent, pronation of the foot; movement elements: straightening of the fingers and feet, supination of the foot, flexion, adduction and external rotation in the hip joint; capture: the methodologist’s hand of the same name on the back and inner surface of the foot, the opposite hand - on the calcaneal tuber from the lower and inner sides. In this model of movement, the working muscles are as follows: a group of flexors of the fingers and foot, quadriceps femoris, iliac-lumbar, large adductor, long adductor, short adductor, scallop, pear-shaped, internal obstructive, external obturator, upper twin, lower twin.

These exercises give the best results in restoring the patient's motor activity in comparison with other known methods, but their essence is in the movement with emphasis on the distal muscle activity, i.e. those muscles that are most weak. The movements begin with the indicated muscles, in the distal-proximal direction, they are passive, performed by the hand of the methodologist, therefore their recovery by this method is very long and not effective enough.

The objective of the invention is to increase the efficiency of the rehabilitation method by using the principles of organizing movement in the proximal-distal direction, due to ontogenesis in the limbs.

The problem is solved in the known method of rehabilitation for the upper extremities with exercises in the scheme from abduction to adduction with elements of movement: flexion of the fingers and hand, adduction of the hand in the radial direction, supination of the forearm, flexion, adduction and rotation in the shoulder joint; in this method, the methodologist’s hand is grabbed on the elbow joint (in the lower third of the proximal upper limb).

The need for capture in the proximal limbs in this sample of movement is due to the fact that when the central nervous system is damaged, the proximal muscles suffer less, have a reserve potential for their active contraction by pulses from the synergist muscles of the shoulder girdle, the trunk, which are active muscles. Said grip provides support and the creation of lightening to reduce muscle fibers m. biceps brachii through tactile stimulation of the extensor muscles of the shoulder. The proposed method for the rehabilitation of a patient with affected upper limbs creates the conditions for connecting working muscles to the affected muscles of the shoulder: m. supraspinatus-synergist deltoid muscles that deflect and raise the shoulder, m ,. serratus anterior, which raise the arm above a horizontal plane. In this case, the capture is carried out with approximation and movement from the bottom up to cause the myotatic reflex, to enhance the tensile reflex.

The problem is also solved in the known method of rehabilitation for the lower extremities with exercises in the scheme from abduction to reduction with elements of movement: straightening the fingers and feet, supination of the foot, flexion, adduction and external rotation in the hip joint; capture: the methodologist’s hand of the same name on the back and inner surface of the foot; in the specified method, the methodologist grabs with the opposite hand on the lower third of the thigh from the lower side.

Manual contact on the lower third of the thigh in this sample of movement is carried out in order to activate the rectus thigh muscle through the applied tactile stimulation of the proprioceptors of the biceps femoris muscle from the standpoint of the effect on its stretching and its antagonistic effect on the activity of the thigh muscle, which is the main one in this model. In this case, the capture is carried out with approximation and movement from the bottom up to cause the myotatic reflex, to enhance the tensile reflex.

The indicated captures of the proximal limbs with approximation are considered by the author as additional sensory input and afferentation to enhance activity to reduce the main muscles of this movement pattern. At the same time, the number of motor units of muscles involved in contraction increases, the number of active muscles increases due to the activity of muscle fibers of all the muscles involved in the exercise, which leads to the restoration of motor functions in a shorter time. The nucleation of nerve excitation in all paretic muscles and its conduction to the centers of the nervous system responsible for movement, in turn, activates alpha-gamma-motor neurons in the anterior horns of the spinal cord by impulses from the superior nervous formations of the central nervous system. All this helps to strengthen the contractility of muscle fibers of the lower extremities, dramatically reduces the recovery time of motor activity of paretic muscles. Working in a complex (system), all the muscles involved in the exercise, including the distal ones, begin to intensify their activity and restore the ability to make complex diagonal vital movements.

Exercises are as follows. The initial supine position at the initial stage of treatment is optimal.

The basic principles of kinesiotherapy involve controlling the hands of a methodologist (manual contact) with all movements with the spheres of motion control and posture, to improve the stability of the trained muscles. For these exercises, the area of manual contact is the proximal sections of the affected limbs, namely the elbow joint (lower third of the proximal upper limb), lower third of the thigh from the lower side. Capture in these areas can be supplemented by capture in the wrist and ankle areas.

The exercises are carried out slowly and in coordination, i.e. movements must occur simultaneously in several planes in which its successive elements overlap each other. The methodologist measures the impact on the muscles depending on their condition and functional activity, avoiding the stretching regime for weak muscles (for example, by maintaining them with a change in the angle of flexion and rotation), giving long-term stretching to strong muscles (both in time of stretching and in the angle of flexion in the hip joint; the greater the angle, the greater the extension). Exercises are carried out with sufficient counter resistance provided by manual contact and gravity of the limbs. Exercises are carried out with repeated repetition on the principle of establishing temporary connections, while re-excitation along the pathway of the nervous system facilitates neuromuscular conduction, as its synaptic resistance decreases.

The results of the examination of patients with various forms of neurological movement disorders indicate the effectiveness of the rehabilitation. Muscle tone significantly changed in all treated patients according to the proposed method (124 patients). At the same time, in most patients with a diplegic form of cerebral palsy (38 patients), a significant decrease in installation muscle hypertonicity was determined in the quadriceps muscle (30 patients) and in the calf muscle (18 patients). According to dynamometry data (Table 1), a significant increase in muscle strength of the upper extremities was noted:

2.33 + 0.22 kg on the right (control 0.89 + 0.28, p <0.001),

left 2.19 + 0.18 kg (control 1.16 + 0.33, p> 0.01).

The range of motion (table 2) in the hip joints increased significantly (flexion): according to angularity data, it amounted to

on the right 8.22 + 0.85 (control 4.56 + 0.97, p <0.01),

left 7.87 + 0.76 (control 3.00 + 0.83, p> 0.01).

Significant improvement in motor activity was observed in other patients of the observed group.

References.

1. Physiotherapy. Ed. M. Weiss, A.Zembatoi, translation from Polish. M .: Medicine, 1996 (analogues and prototype).

Claims (1)

A method of medico-conductive rehabilitation of neurological patients with motor disorders in the upper and / or lower extremities, including carrying out exercises of diagonal motion patterns in the circuit from the lead to the lead, characterized in that the methodologist’s hand is used for upper extremities on the elbow joint or in the lower third of the proximal department of the upper limb and / or for the lower extremities on the knee joint or in the lower third of the thigh, and the capture is carried out with approximation.