RU2281790C2 - Method of neuromuscular electrical stimulation and neuromuscular electrical stimulator - Google Patents

Abstract

FIELD: medicine; prophylactic physical therapy.

SUBSTANCE: neuromuscular electrical stimulators act on part of human body, submerged in water, with electric current through electrodes connected with current supply. Dielectric layer separates electrodes. Electrodes are submerged into water close to part of human body to be stimulated; there is no direct contact between body and electrodes. Level of influence is adjusted due to changing distance between body and electrodes and/or orientation of electrodes relatively body. In general case electrical stimulator has stimulation pulse oscillator placed inside air-proof dielectric case, onto surface of which case the electrodes are mounted. Electrodes are connected to oscillator. In particular, electrodes can be made in form of plates or rings to embrace the case. High physical-therapeutic effect is achieved due to larger area of influence being subject to effect of stimulation pulses.

EFFECT: high therapeutic effect.

11 cl, 10 dwg

Description

The inventive group of inventions relates to medicine, in particular to physiotherapeutic methods and means, and can be used to create means of preventive physiotherapy, including those used at home.

A well-known means of physiotherapeutic effects on the human body is neuromuscular electrical stimulation by exposure to electric current using electrodes applied to the body [1]. In neuromuscular electrical stimulation, (synonyms: electromyostimulation, galvanization or stimulation with low voltage and low frequency currents), electrodes are applied to the patient’s body area, most often metal plates with conductive electrolyte spacers facing the body surface, with which they are passed from the electric generator through the stimulated body area electric current with specified parameters.

It is known to use in physiotherapeutic practice the so-called hydroelectric single-chamber and two-chamber baths [2], which allow electrical stimulation of individual parts of the body. The method of electromyostimulation implemented in two-chamber baths is the closest to the claimed one and is selected as its prototype.

Circuit solutions of known electrical stimulators are very diverse. Stationary devices have great potential in terms of installing and adjusting the parameters of the stimulating current, including computer-controlled electrical stimulators [3–9]. Such devices are used as means for physiotherapeutic procedures in special rooms under the supervision of a physician.

Known portable devices, mainly designed for electromyostimulation in the process of daily human activity in order to relieve pain [10] or as a means of correcting his movements [11]. The mentioned electric stimulator [11] is equipped with special sensors sensitive to human movements and controlling the parameters of the stimulating current. An electrical stimulator [10], which provides an analgesic effect, also has the means to adjust the level of stimulating current.

The inventive electrical stimulator also belongs to the group of portable devices and has characteristics similar to the known electrical stimulators [10, 11] for controlling the parameters of the stimulating current. However, the only means known to the applicant for neuromuscular electrical stimulation carried out in an aqueous medium are the galvanic baths described in [2]. In this regard, a two-chamber galvanic bath, as closest to the claimed device, is selected as the prototype of the claimed neuromuscular electrical stimulator.

The prototype method [2] lies in the fact that the limbs of the patient (arms or legs) are immersed in the corresponding two containers filled with water (baths), in each of which one metal electrode is placed. The electrodes are connected to the opposite output poles of the stimulating current source. After immersion of the limbs of the patient in these containers with water include a current generator. The stimulating current passes from one pole of the current source to the other along a circuit formed by series-connected: the first electrode, a layer of water in the first container, a part of the patient’s first limb immersed in water, a stimulated area of the patient’s body, a part of the patient’s second limb immersed in water, a layer of water in second capacitance and a second electrode. The parameters of the stimulating current (current strength, frequency, pulse shape, etc.) are set depending on the goals of electrical stimulation: the achievement of the analgesic effect, tetanic muscle contractions, etc.

However, the known method of electrical stimulation, being a means of therapeutic or corrective physiotherapy, is focused on working with limited muscle groups of human limbs and cannot be used as an effective means of electrical stimulation of all muscle groups presented on the surface of a human body.

The disadvantages of the prototype device are due to the mentioned disadvantages of the method.

The technical problem to which the claimed group of inventions is directed is to create a method of neuromuscular electrical stimulation as an electromassage physiotherapeutic procedure carried out by a person in an aqueous medium without assistance and providing the possibility of exposure to any muscle groups present on the surface of the human body. The inventive electrical stimulator is designed to implement this method.

The essence of the proposed method of neuromuscular electrical stimulation is that a part of the human body immersed in water is exposed to electric current through electrodes connected to a current source, separated by a dielectric layer and immersed in water in close proximity to the stimulated part of the body without direct contact with it.

When implementing the method in the indicated set of signs, the lines of the electric current flowing between the electrodes are closed not only through the water into which the human body is immersed, but partially through its body. As a result, an electric current passes through a part of the human body immersed in water, which causes a stimulating effect.

To control the level of stimulating effect, the magnitude of the current flowing through the part of the human body immersed in water is changed by changing the distance between the surface of the stimulated part of the body and the electrodes and / or the angular position of the electrodes — orientation relative to the surface of the stimulated part of the body. This can be done by the person himself according to his own feelings, which is extremely convenient.

The inventive method can be implemented in various modifications by forming various patterns of distribution of streamlines in the water column. Depending on the implemented modification, various stimuli of different locality can be achieved: from simultaneous exposure to a large group of muscles to a narrowly targeted effect on a particular muscle.

The authors have created various designs of devices designed to implement the proposed method. These devices differ from each other in the form of execution of the housing and the electrodes, as well as the relative position of the electrodes.

In general, for all structural varieties of the case, the claimed neuromuscular pacemaker contains a stimulating pulse generator located inside a sealed dielectric housing, on the outer surface of which electrodes isolated from each other are connected, connected to the said generator.

The electrodes can be made in the form of plates, in particular flat, mounted on the surface of the housing.

The electrodes can be made in the form of rings covering the body and placed mainly in parallel planes. The simplest form of the body will be cylindrical. In this case, the electrodes can be installed with the possibility of their axial movement, i.e. changes in the distance between them, which allows you to adjust the locality of the stimulating effect.

To achieve an even more local effect of the stimulating current, an open cavity can be made in the housing, and electrodes are installed in this cavity. In particular, the housing may be cylindrical, and said cavity is made in one of the ends of the cylinder.

Two open cavities can be made in the housing, in each of which one of the mentioned electrodes is installed. In this case, a variant is possible when the body is made cylindrical, and both cavities are made in one of the ends of the cylinder. It is also possible that the body is cylindrical and the cavities are made one at a time at both ends of the cylinder.

To ensure automatic on / off stimulator on the outer surface of the housing an additional electrode is installed, included in the power supply circuit of the generator so that when the electric stimulator is immersed in water, the generator power circuit is closed.

For ease of use and to prevent possible contact of the hand with the electrodes, the electrostimulator is equipped with a corresponding handle.

Also, for the convenience of using an electric stimulator, it can be performed with zero or positive buoyancy.

The essence of the claimed group of inventions is illustrated by graphic materials, which depict:

figure 1 - illustration of the method using a pair of flat electrodes located parallel to the surface of the human body;

figure 2 - the same, with the orthogonal arrangement of the planes of the electrodes to the surface of the human body;

figure 3 is an example of the design of the inventive electrical stimulator with flat electrodes;

4 is an example of the application of the inventive electrical stimulator to perform the procedure of neuromuscular electrical stimulation in the bath;

5 is an example of an electric stimulator with a cylindrical body and ring electrodes;

6 is an example of an electric stimulator with electrodes placed in one cavity of a cylindrical body;

7 is an example of an electric stimulator with electrodes placed in different cavities, made in one end of the cylindrical body;

Fig - an example of an electric stimulator with electrodes placed in cavities made in opposite ends of the cylindrical body;

Fig.9 is an example of a design of an electric stimulator with an additional electrode;

10 is an example of an electrical circuit of an electric stimulator with a generator power control circuit through an additional electrode.

The inventive method (see figure 1) is as follows. In water 1 immerse the body or part of the human body. Close to the surface 2 of the body (skin) separating body tissue 3 and water 1, a pair of electrodes 4 and 5 are separated by a dielectric layer 6 and an electric current is passed through them from a stimulating current generator (not shown in FIG. 1). Since the electrodes 4 and 5 are separated by a dielectric layer 6 having an electrical conductivity value close to zero, the electric current lines 7 flowing between the electrodes 4 and 5 are closed through water 1, the electrical conductivity of which is nonzero. In this case, part of the electric current lines 7 is closed through tissues 3 of the human body, which causes the effect of neuromuscular stimulation. The closer the electrodes 4 and 5 are located to the surface 2 of the body, the greater part of the lines of electric current 7 passes through the tissues 3 of the body and, therefore, the stronger the effect of neuromuscular stimulation. Since the distribution pattern of the current lines 7 has circular symmetry relative to the normal to the surface of the electrodes 4 and 5, this relative orientation of the body surface 2 and the electrodes 4 and 5 corresponds to the maximum level of the stimulating current (for the accepted distance between the body surface 2 and the electrodes 4 and 5).

Changing the orientation of the electrodes 4 and 5 with respect to the surface 2 of the body leads to the fact that an ever smaller part of the total electric current flowing through the electrodes 4 and 5 is closed through the tissues 3 of the body. Figure 2 shows the case when the surfaces of the electrodes 4 and 5 are orthogonal to the surface 2 of the body. The shortest distance between the surface 2 of the body and the electrodes 4 and 5 is determined by the minimum length of the perimeter section of the electrodes 4 and 5. As a result, the level of the stimulating current reaches its minimum value for a given distance between the surface 2 of the body and the electrodes 4 and 5.

Thus, by changing the distance between the surface 2 of the body and the electrodes 4 and 5 and / or the angular position — the orientation of the electrodes 4 and 5 relative to the surface 2 of the stimulated part of the body, you can change the strength of the stimulating current flowing through the tissues 3 of the body, thereby regulating the level of stimulating effect. These actions are carried out by the person himself on the basis of his sensations.

The above description of the essence of the proposed method is made on the example of the use of flat electrodes. A similar effect of a stimulating effect on the human body can be obtained by using electrodes of a different shape, for example, made in the form of cylindrical rings. By changing the shape of the electrodes, their location relative to each other and relative to the patient’s body, it is possible to form various patterns of the distribution of streamlines in the aquatic environment and in the stimulated area of the body. At the same time, the essence of the proposed method remains as it is described above on the example of the use of flat electrodes.

There are various constructive solutions of an electric stimulator designed to implement the proposed method. Basically, the differences in the designs of the electrostimulator relate to the shape of the electrodes and their installation location on its body and are primarily associated with the formation of a certain configuration of electric current lines, ease of use and manufacturability of the device.

In the general case (see Fig. 3), the inventive electric stimulator 8 comprises a sealed housing 9 made of dielectric material, inside which a stimulating current generator 10 is placed. The generator 10 is electrically connected to two metal electrodes 4 and 5 located on the outer surface of the housing 9. The use of plate electrodes 4 and 5 in this case determines the presence of flat surfaces of the housing 9 for placement of the mentioned electrodes 4 and 5. In the particular case, they can be mounted on two opposite flat walls of the housing 9, as shown in Fig.3. The housing 9 is also equipped with a handle 11 for holding the electric stimulator 8 in the hand by the patient (user) during the stimulation procedure and to prevent contact of the hand with the electrodes 4 and 5.

The stimulator 8 operates as follows. When you turn on the device, the generator 10 begins to generate an electric current of a fixed size and shape. In this case, the current can take any necessary shape, in particular, for physiological reasons, it is preferable to consider a sequence of amplitude-modulated pulses. Formed by the generator 10, an electric current is supplied to the electrodes 4, 5 and through them enters the water 1 surrounding the electric stimulator 8 (see Fig. 1). Since the casing 9 of the stimulator 8 is made of dielectric, and the conductivity of the water 1 is nonzero, the water 1 surrounding the electric stimulator 8 is the electric current-conducting section through which the electric current circuit of the generator 10 is closed and in which the electric power developed by the generator 10 is released. When the electrostimulator 8 is located near the surface of a human body immersed in water (see Fig. 4), part of the streamlines passes not only through water, but also through body tissues (see Figs. 1 and 2). This is especially pronounced when the body is immersed in fresh water, when the electrical conductivity of body tissues is greater than the electrical conductivity of water. In this case, the current density in the lines that are closed through the body tissues is sufficient for the manifestation of the effect of muscle contraction, i.e., electromyostimulation. The degree of manifestation of this effect (the level of electric current flowing through the body) a person regulates independently, holding the pacemaker 8 in his hand by the handle 11 and removing or bringing the pacemaker 8 closer to the body surface, or changing the orientation of the body 9 relative to the body surface.

Figure 5 presents an example embodiment of an electric stimulator with a cylindrical body 12, on the surface of which ring electrodes 13 and 14 are mounted.

Figure 6 shows another example of the design of an electric stimulator, in the case 15 of which a cavity 16 is made on the side of one of its ends, on the inner surface of which two electrodes 17 and 18 are placed isolated from each other, for example, in the form of flat metal plates. This embodiment of the housing 15 with the cavity 16 and the placement of the electrodes 17 and 18 in it provide a narrowly distributed distribution of the current lines 7 and, therefore, allow to localize the zone of the stimulating effect. This can find application when using the stimulant for medicinal purposes. When using this design option, the stimulator should be oriented so that the cavity 16 is directed towards the stimulated area.

A similar effect can be obtained if two cavities 19, 20 are made in a cylindrical body 15 (see Fig. 7) from the side of one of its ends and placed in each of them along the electrode 21 and 22, respectively. Figure 7 shows an example of such a design in which the cavities 19 and 20 are cylindrical recesses, at the bottom of which the electrodes 21 and 22 are installed in the form of flat round plates. In the General case, the shape of the housing 15, the cavities 19 and 20, as well as the electrodes 21 and 22 installed in them, does not matter. The above example shows one of the simplest manufacturing options for the device.

Among the electrical stimulators providing a more local (compared to FIG. 3) stimulating effect is the design shown in FIG. 8 with a cylindrical body 15, in which cavities 23 and 24 are made on the side of both ends, each of which has one electrode 25 and 26, respectively.

For the purpose of experimental verification of the claimed group of inventions, various samples of electrical stimulants were made (Fig. 3, Figs. 5-8), tests of which confirmed their operability, and the result achieved by the implementation of the claimed method is the effect of neuromuscular electrical stimulation.

One of the tested samples is presented in Fig.9. The housing 9 of the electric stimulator was made of plastic, and on the opposite sides of the housing 9 there were installed stainless steel electrodes 4 and 5 with an area of about 80 cm ² (the electrode 5 in FIG. 9 is not visible, and the electrode 4 is made of two plates). The stimulating current generator 10 is equipped with a circuit for automatically switching on when the electric stimulator is lowered into water. To this end, an additional plate electrode 27 was made on one of the external surfaces of the housing 9, connected to a power source 28 of the generator 10, for example, through a relay 29, as shown in FIG. 10. When the body 9 of the electric stimulator is in the air, the electric current between the electrode 5 and the electrode 27 is zero, and the contact 30 of the relay 29 is open. When lowering the electric stimulator into the water between the electrodes 5 and 27 and, accordingly, through the winding 31 of the relay 29, current flows. The relay 29 is activated, its contact 30 is closed and the power from the source 28 is supplied to the generator 10, which starts to generate current flowing between the electrodes 4 and 5.

The stimulating current generator 10 is configured to generate an amplitude-modulated pulse train of 0.5 ms duration with a repetition period of 10 ms. The modulation frequency was regulated within 0.3–2 Hz, the maximum pulse amplitude in idle mode was 30 V, and the internal resistance of the generator was about 150 Ohms.

Tests of the stimulator sample, which were carried out in a freshwater pool on a large number of patients of different ages and different levels of physical fitness, confirmed the operability of the proposed method of neuromuscular electrical stimulation and implementing this method of electrical stimulator, as well as achieving this result. At the same time, a very high physiotherapeutic effect of neuromuscular electrical stimulation carried out in water was noted. All patients felt a significant increase in the tone of the muscle groups subjected to electrical stimulation, as well as the extremely positive psycho-emotional effect of the underwater electric massage procedure.

Thus, the claimed group of inventions solves the problem of ensuring the possibility of using electrical stimulation as an electromassage physiotherapeutic procedure.

An additional advantage of the claimed invention should be considered the integrated nature of the procedures. This is manifested in the combined effect on the human body of the effects of the water procedure associated with the immersion of the whole body in water (bathing), and neuromuscular electrical stimulation. It is also important that neuromuscular stimulation can be performed under conditions of hydrostatic weightlessness of the human body, i.e. in conditions of almost completely relaxed muscles. This dramatically increases the physiological effectiveness of stimulation.

Important features of the claimed inventions are also the complete exclusion of the danger of a person getting thermal skin burns, which usually accompanies traditional electrical stimulation using patch electrodes, and the danger of an overdose of electrical stimulating effects, which is ensured by effective feedback due to self-regulation by the person of the level of stimulating effect based on their feelings.

INFORMATION SOURCES

1. Electrical stimulation - new opportunities / M.Yu. Gerasimenko, E.F. Filatova, N.N. Lazarenko // Conference "Biomedpribor - 2000".

2. Handbook of physiotherapy. - M., 1976, p. 54-55 (prototype method).

3. US patent No. 5922012, CL. A 61 N 1/04, A 61 N 1/32, 07/13/99.

4. US patent No. 5961542, cl. A 61 N 1/36, 10/05/99.

5. US patent No. 5974342, CL. A 61 N 1/36, 10.26.99.

6. A.S. USSR No. 1678388, class A 61 N 1/36, 09/23/91, bull.

7. RF patent No. 2062125, A 61 N 1/36, 06/20/96, bull. No. 17.

8. RF patent №2121380, A 61 N 1/36, 11/10/98, bull. No. 31.

9. RF patent №2128529, A 61 N 1/36, 04/10/99, bull. No. 10.

10. Application EPO No. 0377057, A 61 N 1/34, 11.07.90.

11. Method and device for programmed muscle electrical stimulation during pathological walking / A.S. Vitenson, A.M. Burova // Conference "Biomedpribor - 2000" (prototype electric stimulator).

Claims (11)

1. A neuromuscular pacemaker containing a stimulating pulse generator located inside a sealed dielectric housing that is capable of being held in the hand and on the external surface of which are connected electrodes isolated from each other and stimulating pulse generator, characterized in that the dielectric housing is cylindrical and the electrodes are made in the form of rings covering the body, placed mainly in parallel planes. 2. The pacemaker according to claim 1, characterized in that the electrodes are mounted with the possibility of their axial movement. 3. The pacemaker according to claim 1, characterized in that on the outer surface of the housing an additional electrode is installed, which is included in the power circuit of the stimulating pulse generator via an automatic switch-on circuit when the electric stimulator is lowered into water. 4. The electrical stimulator according to claim 1, characterized in that it has zero or positive buoyancy. 5. A neuromuscular pacemaker containing a stimulating pulse generator located inside a sealed dielectric housing that is held in a hand and connected to the stimulating pulse generator electrodes isolated from each other, characterized in that the electrodes are installed in at least one cavity corps. 6. The pacemaker according to claim 5, characterized in that an additional electrode is installed on the outer surface of the housing, which is included in the power supply circuit of the stimulating pulse generator through an automatic switch-on circuit when the electric stimulator is lowered into water. 7. The electrical stimulator according to claim 5, characterized in that the housing is cylindrical and the cavity is made in at least one of the ends of the cylindrical housing. 8. The electrical stimulator according to claim 7, characterized in that in the cylindrical body there are two cavities for installation in each respective electrode. 9. The electrical stimulator according to claim 8, characterized in that both cavities are made in one of the ends of the cylindrical body. 10. Electrical stimulator according to claim 8, characterized in that the cavity is made one at a time in both ends of the cylindrical body. 11. The electrical stimulator according to claim 5, characterized in that it has zero or positive buoyancy.

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