RU2269330C1 - Method for restoring normal muscular tonicity in children at the age of up to 5 at hyperkinetic form of juvenile cerebral palsy - Google Patents

Abstract

FIELD: medicine, pediatrics, neurology.

SUBSTANCE: the innovation suggested deals with performing muscular manipulations along with conducting power impact upon muscles. For areas of tendinous-ligamentous apparatus fixation to periosteum successively in area of inferior limbs, back, neck, head, superior limbs it is necessary to detect points providing body position resetting when they are pressed with fingers towards the side of normal physiological position. They should be labeled with pellets out of freshly obtained fruit grains containing alpha-oxyacids. Then they should be subjected to point impact due to applying static pressure along a normal against body surface. Then one should conduct linear tangential power impact upon muscles being adjacent to pellets due to massaging and/or vibrational stroking with efforts not overcoming pain threshold. One should detect desired points at inferior limbs at plantar and rear surfaces of feet in area of toes' bottom at the side being opposite to that with pronounced pathological rotation. One should daily detect about 2-5 points to be then affected. Mechanical manipulations with juvenile muscles should be carried out due to stimulating child's active straightening his body himself. For this purpose a child should squat at physiologically normal position of his feet. Then it is necessary to press upon knee joints to make them to lift. Then it is necessary to press upon knee joints to make them to drop up to full squat position. Mechanical manipulations with juvenile muscles should be performed similarly due to keeping the body in horizontal position upon a rigid foundation. For this purpose, limbs and head should be fixed to the foundation with elastic bandages for 50-70 min, then the head should be unfixed followed by unfixing superior and inferior limbs successively at temporal delay for 5-10 min. Therapy course lasts for 20-25 seances. The innovation enables to detect more accurate sites for the impact.

EFFECT: higher efficiency.

3 cl, 2 ex

Description

The invention relates to medicine, namely to nursing in pediatrics, and can be used for the rehabilitation of impaired functions of the musculoskeletal system in children with various forms of cerebral palsy, requiring long-term corrective nursing patronage.

Cerebral palsy (cerebral palsy) refers to diseases of the brain and is manifested by severe pathologies of the musculoskeletal system. Known methods of treating various forms of cerebral palsy through massage and physical therapy (see, for example, application RU 99114734, Semenova and others, A 61 N 1/00, 04/27/2001; and others). So, a method for the treatment of spastic forms of cerebral palsy is described, in which the dominant muscle synergy is determined and, based on these characteristics, elastic traction is fixed, and then the body and extremities are given a physiological position for 3-8 hours (RU 2040923 C1, Tyachina, A 61 N 3 / 00, 1995). In another invention (RU 2113204 C1, Ternovskaya et al., A 61 H 7/00, 1998), a scheme for performing traditional massage manipulations — rubbing, stroking, and acupuncture for patients with cerebral palsy — is given, and the massage begins from the head in a certain sequence, which improves mental function in spastic forms.

It is known that with a hyperkinetic form in children with cerebral palsy, automatic movements are observed, often of a stereotypical nature, which can cover the limbs, trunk, face. They are a manifestation of striatum dysfunction. Hyperkinesis in nature can be athetoid and chorea-like. In the first case, these are involuntary slow worm-shaped movements randomly replacing each other. Typically over-extension of the middle and upper phalanges of the fingers. The extensor posture predominates more often. The intensity of hyperkinesis depends on voluntary movements, emotional background. Any arbitrary movement is accompanied by abnormal friendly movements. Due to the tension of the agonist, which, according to the law of Sherrington, inhibits the antagonist, the movement becomes intermittent slow loses smoothness. As a result of the loss of reciprocity, a limb or trunk cannot be fixed in a certain pose that is optimal for a given movement. Inadequate control of the overlying nerve structures causes an excessive nature of movements, and the proprioceptors excited in this case provoke new motor impulses. In the intervals when the movement stops, a decreased muscle tone is manifested. Adaptation and fixation reflexes are weakly expressed. Muscle tension is involuntarily replaced by their hypotension. Another type of extrapyramidal hyperkinesis is chorea-like. Choreatic movements are sweeping, unexpected, not stereotypical, they are quick, without tension. In contrast to the athetotic form, periods of relative rest are noted for various durations. Hyperkinesis makes it difficult to stand and walk (see Badalyan L.O., Pediatric Neurology, Moscow: MEDpress-inform, 2001). A great influence on hyperkinesis is exerted by the emotional background (see, for example, Kachesov V.A. Fundamentals of intensive rehabilitation of cerebral palsy, book 2. M., 2001). The data presented indicate the characteristic features of this form of pathology, which requires specific techniques for manual manipulation. In the invention (RU 2098073 C1, Samigullin et al., 10.12.1997) a method for the treatment of cerebral palsy is described in uniformly repeating cycles (12 procedures, a break of 14 days). In the supine position, the child is exposed to each part of the body (face, neck, arms, legs, chest and abdomen) in a consistent ratio of 1: 1.5 with classical therapeutic massage and acupressure. Then, similarly - in the supine position. Complete the procedure with passive exercises of physiotherapy for 4-5 minutes, the total duration of one procedure is 20-25 minutes. With a hyperkinetic and spastic form, calming, relaxing techniques of classical massage and inhibitory methods of acupressure are used.

Closest to the patented method is a method for the treatment of cerebral palsy through massage and physiotherapy exercises described in the invention (RU 2214209 C1, Rybakova, 10.20.2003), aimed at treating the spastic form of cerebral palsy in children under 5 years of age. For each muscle with a pronounced high tone, the presence of its response to the force impact by the hands of a rehabilitologist is diagnosed, which manifests itself in the appearance of a sharp mechanical resistance with a certain amount of impact, and felt tactile. The set value is taken as the upper limit of the impact, and then in the process of carrying out the manipulations, multiple, random in the direction of force impacts are carried out that do not exceed the previously established upper limit of the impact. This method is intended for the treatment of spastic forms of cerebral palsy and does not take into account the specific features of the hyperkinetic form, which are described above.

The technical result of the invention is to increase the effectiveness and specificity of treatment due to a more accurate determination of the places of application of force in patients with a hyperkinetic form of cerebral palsy. An additional technical result is the absence of skin irritation under the place of attachment of the grains.

The technical result is achieved by the fact that a method of restoring muscle tone in children under the age of 5 years with a hyperkinetic form of cerebral palsy includes mechanical manipulations with the muscles of the child and the implementation of force on them. For the areas of attachment of the tendon-ligamentous apparatus to the periosteum, successively in the region of the lower extremities, back, neck, head, and upper extremities, points are identified that provide, with the force of the fingers, the body position to the normal physiological position, mark them with pelots from freshly extracted fruit grains, containing alpha hydroxy acids, and they carry out a point force action by applying static pressure normal to the surface of the body and a linear tangential force effect the muscles adjacent to the pelots by rubbing and / or vibrational stroking with an effort not exceeding the pain threshold, while 2-5 points are exposed daily and affect them, the course of treatment is 20-25 sessions

The method can be characterized in that the detection of points on the lower extremities is carried out on the plantar and dorsal surfaces of the foot in the area of the base of the fingers on the side opposite to the side of the foot with pronounced pathological rotation.

The method can also be characterized by the fact that mechanical manipulations with the child’s muscles are performed by stimulating the child to actively straighten his body, for which the child is squatted with the physiologically normal setting of the feet, and then they are pressed on the knee joints, forcing him to rise, and then pressed on the knee joints, prompting him to sink to a deep squat position.

The method can be characterized, in addition, by the fact that mechanical manipulations with the muscles of the child are carried out by holding the body in a horizontal position on a rigid base, while the limbs and head are fixed to the base with elastic bandages for 50-70 minutes, then the head is released, then sequentially, with a time delay of 5-10 minutes, release the upper and lower limbs.

The method is implemented as follows.

The child is laid on the couch. The first three points are diagnosed by means of a probe in the region of the base of the fingers on the side of the plantar surface of the foot of one lower limb opposite to the marked pathological rotation. With a static effect on each of these points, the foot takes a position that is as close as possible to its correct physiological position. Identified points are fixed with pelots using a band-aid. Fresh pellets of fruit grains are used as pelots, mainly apples, the pulp of which is rich in native alpha hydroxy acids. It is noticed that these grains, being on the skin of a child for about 2 days, do not cause any irritation. Next, they carry out a point effect on each pelot: with the thumb of the hand, the rehabilitologist exerts static pressure with an effort below the pain threshold, its magnitude is about 0.4 kg. The duration of exposure at each point is 10-20 seconds, a repeat of 2-3 times, a break between repetitions - 2-3 seconds.

Next, a linear effect is carried out on the opposite side of the back surface of the foot of the same limb with respect to the pronounced pathological rotation. Spend by rubbing the pads of the index and middle fingers.

The position of the points on the arch of the foot and on the sole of the foot, on the toe of the thumb and on the toe of the little finger, reflexively leading to the normalization of the initially sagging and rotated inside or outside of the foot, is successively diagnosed. These points are identified in turn by 2-3 for each procedure. The pelot is maintained until the next procedure. While maintaining the effect achieved in the previous procedure, the pelot is removed and go to the localization of the next 2-3 points. Similar points are detected at opposite ends of these muscles in the area of the knee joint and similar effects are performed with pelots.

Other points are identified in a similar way, marked with pelots and act on them sequentially: on the back, points are diagnosed that reflexively lead to normalization of the tone of the back muscles. For this, grains are applied, for example, paravertebrally in the back from the 2-3rd lumbar to 4-5th thoracic vertebrae.

In the neck area, points are diagnosed reflexively leading to a state of head retention. In the area of the pectoralis major muscle - points reflexively leading to normalization of the tone of the proximal arm muscles. In the area of the elbow joint, the presence of points is diagnosed, reflexively leading to normalization of the tone of the distal muscles of the hands and extension of the hands in the elbow joints. For an initially squeezed hand into a fist in the wrist, back of the hand and elbow joint - points that reflexively lead to normalization of the tone of the muscles of the hand and to the opening of the fingers of the hand.

Impacts are performed by the rehabilitologist’s forefinger or thumb pillow (the force normal to the body is 8-12 N) at the points of attachment of the muscle tendon heads to the bones. About 50-60 such reflex stimulating points localized with the help of pelots, massage and detection of these points is carried out in a predetermined sequence (in the region of the lower extremities, back, neck, head, upper limbs) during the course of treatment. A linear tangential force on the muscle is carried out by rubbing and / or vibration stroking with an effort not exceeding the pain threshold.

An exemplary scheme for conducting impacts has the following order. In the first sessions, the points located on the feet are determined and acted upon to normalize the sagging foot originally rotated inward or outward to a normal physiological position. Next, determine and act on the points on the back to restore the initially sharply weakened tone of the muscles of the back, then on the points in the neck to restore the tone of the muscles of the neck. Next, determine and act on the points in the places of attachment of the tendon heads of the muscles of the chest and proximal sections of the muscles of the hands to restore normal muscle tone of these muscle groups.

In the last sessions, they determine and act on the points in the places of attachment of the tendon heads of the distal muscles of the hands and hands to restore normal muscle tone of the hands.

Power action is carried out for one to two days several times (4-5 times) for each pilot from the number installed on the child’s body, every two hours, in the daytime. The number of repetitions of the effect on the pelots is determined until the pronounced effect is preserved.

In combination with the above effects, they additionally stimulate the child's active springy straightening of his body. For this child, passively squatting with a physiologically normal installation of the feet, and then press on the knee joints, causing him to rise. The same pressure on the knee joints is carried out from the upper position, prompting him to lower to a deep squat position. Such an exercise allows you to establish the effectiveness of the therapeutic effects on the feet. To increase the effectiveness of treatment, an exercise can be additionally conducted to stimulate the auditory and visual analyzers while holding the child's body in an upright position. Pictures are hung in front of the child, and during the previous exercise, at the time of straightening, the child is asked a question related to the objects depicted in the pictures. The purpose of this exercise is to change the pattern that has formed in the child’s brain, which prevents the development of two types of auto-magical reactions: straightening and balance.

To increase the effectiveness of treatment and additional normalization of muscle tone, the child’s body lying on his back is fixed for a period of at least 1 hour to a narrow board with a length exceeding the height of the child. The purpose of the manipulation is to preserve in the child’s memory an image of the normal physiological position of the body. Fixation is carried out with the help of soft elastic bandages in a position that ensures straightening of the limbs, the location of the hands along the body, with the head fixed with a bandage through the forehead. After the retention time, the head, arms, legs are released alternately while the child is maintaining the proposed position.

The actual determination and actions on points can be preceded by deep force actions throughout the child’s body towards the head by vigorous grinding and kneading at an angle of 20-40 degrees with a force of 4-8 N.

The course of treatment includes 20-25 sessions of 90-120 minutes with daily localization and fixation of the next 2-5 points, makes it possible to form motor skills, stabilize acquired motor functions and maintain the child’s vital muscle tone.

Example 1. Child D.Sh., 4 years old. Diagnosis at admission: posthypoxic encephalopathy, hyperbilirubin jaundice, cerebral palsy, hyperkinetic form.

Upon admission revealed: a significant violation of all motor functions of the ODE: the girl does not stand, does not walk, there are chaotic movements of the arms, legs, head. With verbal communication, there is an increase in impaired motor functions.

As a result of five courses (20 sessions each) according to the claimed method, the child began to maintain a steady vertical position, confident walking was restored, and the chaotic movements of the limbs and head decreased. The child confidently performs various game movements with arms and legs (performs exercises on sports equipment - on the gymnastic wall of the crossbar, rings; plays the ball, rides in-line skates; in the winter goes skiing; starts to skate). The tone is restored by 70%. The connection between verbal communication with motor functions has ceased to be revealed.

Example 2. Child A.P., 4.5 years. Diagnosis at admission: posthypoxic encephalopathy, chorea-like hyperkinetic form of cerebral palsy with identified hyperkinesis.

Upon admission, it was revealed that the child is standing, but walking with staggering, often falls when walking, does not rest on a full foot, but applies emphasis on “tiptoes”.

As a result of one course conducted by the claimed method; consisting of 20 sessions, the child began to walk stably (without staggering), in 50-60% of the time he relies on a full foot. Confidently holds small objects with his hands, willingly performs game manipulations with large objects.

Using the patented method, five lengthy (course) corrective nursing patronages of children aged 3.5-5 years were carried out. In all cases, as a result of rehabilitation measures, an improvement in the condition of patients was obtained, the tone was restored by at least 50 percent.

The duration of remission in all cases is at least a year.

Claims (4)

1. A method of restoring muscle tone in children under 5 years of age with a hyperkinetic form of cerebral palsy by mechanical manipulation of the child’s muscles and the exercise of force on them, characterized in that for the zones of attachment of the tendon-ligamentous apparatus to the periosteum sequentially in the lower limbs, back, neck, head, upper extremities identify points that provide, with the force of the fingers, the alignment of the body position towards normal physiologists of their position, they are labeled with pelots from freshly extracted fruit grains containing alpha hydroxy acids, and they are subjected to a point force action by applying static pressure normal to the surface of the body and a linear tangential force effect on the muscles adjacent to the pellets by rubbing and / or vibrational stroking with an effort not exceeding the pain threshold, while 2-5 points are detected daily and affect them, the course of treatment is 20-25 sessions. 2. The method according to claim 1, characterized in that the identification of points on the lower extremities is carried out on the plantar and dorsum of the foot in the area of the base of the fingers on the side opposite to the side of the foot with pronounced pathological rotation. 3. The method according to claim 1, characterized in that the mechanical manipulations with the muscles of the child are carried out by stimulating the child to actively straighten his body, for which the child is squatted with the physiologically normal setting of the feet, and then press on the knee joints, forcing him to rise, after which press on the knee joints, causing him to lower to a deep squat position. 4. The method according to claim 1, characterized in that the mechanical manipulations with the muscles of the child are carried out by holding the body in a horizontal position on a rigid base, while the limbs and head are fixed to the base with elastic bandages for 50-70 minutes, then the head is released, then successively, with a time delay of 5-10 minutes - the upper and lower limbs.