RU2246329C1 - Method for applying active dynamic electric stimulation of extremity muscles - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves using Stimul-1 apparatus. Movements applied in manual muscular testing are administered concurrently with current passed through. Initial postures are selected with injured muscle force, measured as a result of manual muscular test, taken into account. 4 points estimation being obtained, movement in articulation is carried out with gravitation force and weighting collar load of 500 g being overcome in standing sitting and lying position. 3 points high estimation being the case, movements are carried out without gravitation force being overcome in sitting position to train lower extremity articulations. 2 points high estimation being obtained, movements are carried out under easier conditions without gravitation force loading in lying initial position. 1 point being the estimation, patient strains muscle in isometric mode in lying initial position.

EFFECT: enhanced effectiveness of rehabilitation treatment; involving earlier idle muscle fibers in work.

Description

The invention relates to medicine, namely, at the junction of two specialties of traumatology and orthopedics and physiotherapy.

It is generally recognized that electrical stimulation - the therapeutic use of pulsed currents to restore the activity of organs and tissues that have lost normal function, is widely used in the treatment of pathology of the musculoskeletal system, especially in diseases associated with hypotrophy of the rearticular muscles of large joints, such as the brachial, ulnar, wrist, and hip , knee and ankle joints.

Currently, in the practice of medical medical institutions, the method of passive electrical stimulation training of the muscle apparatus is mainly used (Technique and method of physiotherapeutic procedures (reference book) / Edited by V.M. Bogolyubov. - M .: Medicine, 1983, p. 85-107).

This method is accepted by us as a prototype. However, it has the following disadvantages:

- does not provide for the active participation of the patient, as a result of which it proceeds in conditions far from the actual functioning of the muscles;

- short time of the procedure;

- an undifferentiated approach to determining the parameters of electrical stimulation,

as a result of which the method of passive electrical stimulation does not fully affect the functional state of the rearticular muscles, thereby delaying the treatment time, does not sufficiently affect the prevention of further progression of joint diseases and the development of secondary functional disorders (muscle hypotrophy). An important place in the treatment of joint pathology is occupied by active dynamic exercises of physical therapy aimed at strengthening one muscle or another (S.P. Mironov, M.B. Tsykunov Fundamentals of rehabilitation of athletes and ballet dancers in case of injuries and diseases of the musculoskeletal system. - M .: GlavNIVTS Medical Center UD President of the Russian Federation, 1998, p.100). The choice of the type of exercise and the necessary starting points should be carried out, focusing on the results of preliminary manual testing of muscle strength according to a 6-point evaluation system. Based on the foregoing, we have proposed a method of active dynamic muscle electrostimulation for the treatment of joint pathology and the prevention of muscle hypotrophy.

Electrical stimulation of rearticular muscles in combination with simultaneous exercise of therapeutic exercises (active dynamics) from the initial positions selected according to the results of manual muscle testing compares it favorably with the prototype.

The method is as follows.

Before the beginning of dynamic dynamic electrical stimulation of one or another rearticular muscle, the procedure of manual muscle testing is performed. In this case, the strength of the affected muscle is determined, focusing on the strength of the patient's symmetrical normal muscle. In accordance with this, depending on the data obtained (point score), the initial position of the patient is selected for the procedure of active dynamic electrical stimulation.

When assessing 5 points (excellent - 100% of the norm) and 0 points (very bad - an attempt to make a muscle movement does not give an answer), active dynamic electrostimulation procedures are not used.

A score of 4 points (good - 75% of the norm) determines the strength of the muscle, capable of moving in the joint with full amplitude with moderate manual resistance. With this assessment, during the procedure of electrical stimulation, the patient performs movement in the joint with overcoming the force of gravity and with weight (weighting cuff - 500 g). Starting positions: standing, sitting, lying.

A score of 3 points (satisfactory - 50% of the norm) determines the strength of the muscle, capable of moving in the joint with full amplitude and overcoming the weight of the moved segment without external manual resistance. With such muscle strength during electrical stimulation, movement is performed with overcoming the force of gravity, but without burdening. Starting positions: sitting for joints of the upper limb, lying for joints of the lower limb.

A score of 2 points (poor - 25-30% of the norm) determines the strength of the muscle, capable of performing movements in the joint with full amplitude only in light conditions (muscle strength is not enough to overcome the weight of the moved segment). With this assessment, during electrical stimulation, movement is performed under lightened conditions (gravity is excluded) along a plane on a wooden roller carriage. Starting positions: lying.

A score of 1 point (very poor - 5-10% of the norm) corresponds to such muscle strength that it is impossible to perform a given movement in the joint (when trying to perform a test task, muscle contraction is determined only visually and by palpation). During electrical stimulation, the patient only strains the muscle in isometric mode. Starting position: lying.

In the process of active dynamic electrical stimulation during the passage of current, the patient actively carries out the specified movement in the trained segment, corresponding to the movement during manual muscle testing, straining the stimulated muscle; muscle tension is held until the end of the current flow.

A current intensity is selected that is tolerated by the patient and which is sufficient for movement. During the entire time of electrical stimulation, the performer of the procedure monitors the correct position of the patient's torso. The duration of the procedure is 15-30 minutes, 2 times a day. The course of electrical stimulation is 15-30 procedures.

Technical characteristics of electrical stimulation. To influence the rearticular muscles, we apply the method of electrical stimulation on the Stimul-1 apparatus, which is a source of alternating sinusoidal current with a frequency of 1-2.5 kHz, which creates amplitude modulation by pulses with a frequency of 50 Hz with a modulation depth of 100%, used in pulsed mode “sending - pause ”- 5-10 seconds.

For electrical stimulation, we use skin elastic electrodes based on rectangular carbon fiber materials of size 3 × 6 cm (GOST R 15.013-94). The electrodes moistened with water are fixed on the surface of the patient's body in the area of the motor points of the stimulated muscle using rubber cuffs (bandages). Two electrodes are used according to the bipolar technique. The active electrode (+) is located on the motor point of the muscle (determined by the Erb table), indifferent (-) - at the point of transition of the muscle into the tendon.

Results: In the clinic for the period from 2000 to 2003. 27 patients were treated using this technique at the age of 12-46, with various pathologies of large joints (shoulder, ulnar, wrist, hip, knee, ankle joints) - congenital hip dislocation (7), traumatic shoulder dislocation (6), deforming arthrosis different localization (14). The treatment results were evaluated according to x-ray examination, computed tomography, thermography, dynamography sonography, goniometry, functional-motor tests. Excellent results - 29.6% (8), good - 37% (10), satisfactory - 25.9% (7), unsatisfactory - 7.4% (2). In our experience, with passive muscle stimulation for 27 patients, excellent results - 22.2% (6), good - 33.4% (9), satisfactory - 29.6% (8), unsatisfactory - 14.8% (4) .

Thus, we have shown the advantages of the proposed method of active dynamic electrical stimulation training of muscles, its practical feasibility and clinical usefulness.

Claims (1)

The method of active dynamic electrical stimulation in the treatment of pathology of large joints, which consists in using the electrotherapeutic effect on the Stimul-1 apparatus, characterized in that, simultaneously with the passage of current, they perform motor tasks corresponding to the movements used in manual muscle testing, the initial positions are selected taking into account the strength the affected muscle, determined according to the results of manual muscle testing, while when assessing 4 points, movement in the joint is performed with overcoming deer of gravitational force and with a weighting weighting cuff of 500 g, the initial position while standing, sitting and lying down; when assessing 3 points, the movement is performed with overcoming the force of gravity without weight, the initial position is sitting for the joints of the upper limbs, lying for the joints of the lower extremities; when evaluating 2 points, they perform movements in lightened conditions with the exception of gravity, the initial position is lying down, the rating is 1 point - the patient strains the muscle in isometric mode, the initial position is lying.