RU2289321C2 - Method for predicting the development of scoliosis - Google Patents

Abstract

FIELD: medicine, diagnostics.

SUBSTANCE: the present innovation deals with predicting the development of idiopathic scoliosis at applying more simplified techniques of investigation. It is necessary to test patients to detect their leading hand, leading eye and leading ear and calculate the coefficient of encephalic asymmetry C by the following formula: C=(Cr-Cl)/(Cr+Cl+Ca), where Cr - the quantity of tests at predominance of right hand, eye, ear; Cl - the quantity of tests at predominance of left hand, eye, ear; Ca - the quantity of tests at the absence of predominance of either right or left hand, eye, ear; and predict the probability of development of idiopathic scoliosis in patients at C being within 0.50-0.85 interval.

EFFECT: higher accuracy of prediction.

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Description

The invention relates to medicine, namely to methods for predicting the appearance of idiopathic scoliosis in children.

Idiopathic scoliosis - curvature of the spine with torsion curvature - is one of the types of degenerative diseases of the spine. The etiology of idiopathic scoliosis has not yet been established.

To date, methods are known aimed at differential diagnosis of the early stages of idiopathic scoliosis by biochemical analysis (1) or to identify the possibility of progression of scoliotic deformation based on color asymmetry between the concave and convex sides of each vertebra within the scoliotic arch (2).

A common drawback of these methods aimed at diagnosing an existing scoliosis is that with their help it is impossible to effectively predict the possibility of developing scoliosis, i.e. to predict the patient's propensity for scoliotic spinal deformity before it appears.

A known method for predicting the risk of developing dystrophic diseases of the spine by the concentration of glycosamines in the blood serum of patients (3). However, using this method, which allows obtaining information about the state of metabolism of connective tissue, it is impossible to establish a specific type of dystrophic disease of the spine, i.e. highlight the risk of directly idiopathic scoliosis.

As the closest technical solution to the claimed achieved result, a method for predicting spinal deformities in children is selected, consisting in clinical studies of children's feet - at an early age of three years, identifying the type of static foot failure and, in the presence of longitudinal flatfoot, predicting the development of static scoliosis in a child . To control and verify the prognosis, the child, after reaching the age of five, conducts additional studies using computer plantography and stabilization and with asymmetry of the static load in the frontal plane, the presence of asymmetric flexion systems in the knee and hip joints confirm the prognosis of the development of static scoliosis (4).

The disadvantage of this method is that it, in essence, is limited only to the establishment of the relationship between functional disorders of the feet of the child and his musculoskeletal system without identifying physiological causes, the consequence of which is the development of the disease, which essentially reduces the effectiveness of predicting the development of scoliosis. In addition, the known method is complicated, because is essentially two-stage and requires - for a reliable diagnosis of scoliosis - the use of computer plantography and stabilization, which is not always possible in medical institutions.

The etiology of idiopathic scoliosis has not been established; it is not clear which genetic (or other) factors are key in its occurrence in children of different ages. The term itself, indicating such scoliosis, is idiopathic, i.e. arising for no apparent reason. The presented invention is the result of a study, as a result of which a connection was established between the development of idiopathic scoliosis and certain characteristics of the functional asymmetry of the child’s brain.

The technical result solved by the invention is the establishment of certain specific parameters of the manifestations of functional asymmetry of the brain in a child, indicating a high likelihood of idiopathic scoliosis in him. The basis for the conclusion about the high probability of the occurrence of idiopathic scoliosis is the idea of the physiological dependence of specific individual manifestations of the functional asymmetry of the brain and disorders in the formation of a child’s muscle corset - the trunk, the tone of which is functionally related to the asymmetry of brain functions.

According to the invention, a method for predicting the development of scoliosis consists in testing patients to determine their leading arm, eye and ear, and calculate the asymmetry coefficient of the brain As _as by the formula

K _ac = (K _p -K _l ) / (K _p + K _l + K _o ),

where K _p - the number of tests with a predominance of the right hand, eye, ear;

K _l - the number of tests with a predominance of the left hand, eye, ear;

To _about - the number of tests in which there was no predominance of the right or left hand, eye, ear, and predicting the development of scoliosis in patients with K _as in the range of 0.50 -0.85.

The essence of the method lies in the correlation established by the authors of the appearance and development of idiopathic scoliosis with features of the nervous regulation of functions, in particular with interhemispheric asymmetry of the brain. Studies conducted by the authors led to the conclusion that the functional asymmetry of the brain is directly related to the formation of muscle tone of the trunk corset, which, in turn, determines the development of idiopathic scoliosis.

The inventive method is as follows. Patients — children aged 3 to 7 years — are tested to determine their leading arm, eye, and ear. At this age, children complete the formation of functional asymmetry of the cerebral hemispheres.

The technique for determining the leading hand includes nine tests. Applause test - is to determine the hand that makes punches in the palm of the other hand (the leading hand is more active). The test for the establishment of a watch is to determine the hand that makes the watch (a non-knowing hand captures the watch). The test for crossing arms (Napoleon's pose) is to determine the hand, which is faster sent to the forearm of the other hand and lies on top. In the test for interlacing fingers, the hand is considered the leading hand, the thumb of which rests on top. The test for the simultaneous action of the hands is that the patient draws a circle with one hand and a square with the other. Then the order of the hands changes. The lead is considered to be a hand whose drawings are more accurate and complete. The tapping test is carried out as follows. A rectangle divided into 6 squares is drawn on a piece of paper. For a certain time, the patient puts dots in each square with one hand. The total number of points is calculated and the average number of points in one square is calculated. Then, on another sheet of paper, a similar rectangle is drawn, divided into 6 squares, and the procedure is repeated for the other hand. A hand is considered to be leading, which corresponds to a larger average number of points in one square. Test for measuring the size of the thumb bed. A hand is considered to be leading, which corresponds to a large size of the nail bed. Test for lifting the item from the floor. A hand is considered to be leading, with the help of which the patient raises an object from the floor. Target accuracy test. The patient throws, for example, a dart at a target hanging on the wall. Leading is considered to be the hand that provided the most hits on the target.

When determining the leading eye, three tests are used. One eye blink test. In the process of blinking, the patient closes the ignorant eye. The test “viewing through a telescope” consists in the fact that the patient is guided by the guiding eye through a paper sheet folded into a “telescope”. The last test - Rosenbach's test - is that the patient fixes the tip of the pencil with his eyes and combines the latter with any point. The leading eye is considered to be the eye, when closed, the pencil is shifted in his direction.

Determination of the leading ear is made using dichotic listening, when various combinations of monosyllabic words are delivered to the patient's right and left ears through headphones. Then the patient is asked to write the words that he remembered. The essence of the test is that the patient reproduces a larger number of words filed in the leading ear.

The duration of the whole complex of tests is no more than 30 minutes. After the completion of the testing procedure, the patient’s brain asymmetry coefficient K _{ac is} calculated (both in the motor sphere — hands, and in the sensory sphere — vision, hearing) by the formula

K _ac = (K _p -K _l ) / (K _p + K _l + K _o ),

where K _p - the number of tests with a predominance of the right hand, eye, ear;

K _l - the number of tests with a predominance of the left hand, eye, ear;

To _about - the number of tests in which there was no predominance of the right or left hand, eye, ear.

From the entire group of patients, those are selected in whom K _ac is in the range 0.50-0.85 and they predict the likelihood of developing idiopathic scoliosis. The value of K _as means that the patient is “right-” or “left-hemispheric”, i.e. it is dominated by functions of the right or left hemisphere. The sign of K _ac does not affect the prognosis of scoliosis, only its absolute value is important.

The proposed method was tested on two groups of children aged three to seven years. The first group (80 people) included children with scoliosis, the second (60 people) - children with no such diagnosis. In the group of children with scoliosis, the majority had K _ac in the range of 0.50-0.85, in the group of healthy children K _ac in the range of 0.50-0.85 had a minority of children.

As a result of the study (and comparative analysis) of _As in the groups of sick and healthy children, the following results were obtained (Tables 1 and 2).

The results of determining the asymmetry of the leading leg,%
Table 1 Peripheral Asymmetry Type / Lead Leg Children with scoliosis (80 people) Children without scoliosis (60 people) Girls The boys Total Girls The boys Total Left 3.70 3.70 7.40 ** 13.40 10.00 23.40 ** Right 46.30 36.30 82.60 ** 33.30 23.30 56.60 ** "Isopods" 6.30 3.70 10.00 * 11.70 8.30 20.00 ** * The differences are significant at p <0.05.
** At p <0.01

Average values of the coefficient of general asymmetry of the examined children
Table 2 Values K _ac Children with scoliosis Children without scoliosis 55.14 * 32.05 * * The differences are significant at p <0.05

LITERATURE

1. RF patent No. 2188426, cl. G 01 N 33/52, 2002

2. RF patent No. 2195870, class. A 61 B 6/02, 2003

3. RF patent No. 2204138, cl. G 01N 33/52, 2003

4. RF patent №2147829, cl. A 61 B 5/00, 2000 (prototype).

Claims (1)

A method for predicting the development of scoliosis, including testing a patient, characterized in that when testing the patient determine his leading arm, leading the eye and ear, calculate the asymmetry coefficient of the brain CAS by the formula Cas = (Kn-Cl) \ (Kn + Cl + Co), where Kp - the number of tests with a predominance of the right hand, eye, ear; Cl - the number of tests with a predominance of the left hand, eye, ear; To - the number of tests in which there was no predominance of the right or left hand, eye, ear, and with Cas in the range of 0.50-0.85, the likelihood of developing idiopathic scoliosis is predicted.