RU2299002C1 - Method for predicting functional disorders of motor system in children - Google Patents

Abstract

FIELD: medicine, orthopedics.

SUBSTANCE: a child should be inspected at early age, moreover, one should detect the state of muscular tonicity and reflexes and, if muscular tonicity is increased and reflexes are either regenerated or normal it is possible to predict the development of kyphosis; if muscular tonicity is decreased and reflexes are regenerated one should predict the development of kyphoscoliosis. The innovation enables to predict possible development of functional disorders of motor system in children at earlier terms and carry out prophylactic procedures in due time.

EFFECT: higher accuracy of prediction.

4 ex, 1 tbl

Description

The invention relates to medicine, and can be used to prevent the possible development of functional disorders of the musculoskeletal system (OA) in young children with concomitant neurological pathology.

A known method for predicting spinal deformities in children (Pat. RF No. 2147829, 2000), including a clinical study of a child under the age of 3 years, determining the type of static foot failure with a podoscope and predicting the possible development of spinal deformities in the presence of foot deformity.

The method is modern, technologically advanced, but its use in clinical practice is limited by the need for a qualified orthopedic doctor and the availability of equipment that is not available in clinics, therefore, timely identification of children at risk for spinal deformities is difficult, especially for young children (from a month to a year) .

The technical problem - early prediction of the development of functional disorders of ODE and prevention of organic changes in the musculoskeletal system in children with concomitant neurological pathology - is solved as follows.

In a method for predicting functional disorders of the musculoskeletal system in young children, including a clinical study of a child, according to a technical solution, a neurophysiological study is carried out and the state of neurological symptoms is determined - muscle tone and reflexes, and if muscle tone is increased and reflexes are enlivened or normal, they predict development kyphosis, if muscle tone is reduced and reflexes are reduced or normal, scoliosis is predicted to develop if muscle tone is reduced and reflexes are revitalized, rognoziruyut development of kyphoscoliosis.

It is known that the central nervous system (CNS) is the main dominant system that affects motor functions. The study examined children without gross neurological and orthopedic pathology. The most informative neurological symptoms that affect the motor sphere were selected - revitalization or decrease in muscle tone and reflexes, which are signs of the functioning of the child’s central nervous system.

For an objective assessment of the correspondence of these neurological symptoms to functional disorders of the child’s musculoskeletal system, the authors used clinical signs that most objectively reflect the functional state of the OA and which are the precursors of such structural disorders of the spine as scoliosis, kyphosis, kyphoscoliosis (see table). 201 children were examined at an early age: from one year to five years. Children were divided into 4 groups: without neurological pathology - 37 children, 21 children - with increased muscle tone, lively or normal reflexes, 25 children - with reduced muscle tone and reduced or normal reflexes, 17 children - with reduced muscle tone and lively reflexes, the remaining children - 101 people were a control sample group.

Clinical features were assigned a numerical code and mathematically processed data. Processing of the results was carried out in the STATISTICA 6.0 package, a discriminant analysis unit (pattern recognition model). The discriminant functions were calculated and a decisive rule was compiled, according to which the correspondence of neurological symptoms to the clinical signs of the functional state of the OA was determined.

Table No. p / p Spinal structural changes Clinical signs of functional disorders of the ODA type of waste SHOP violations posture type knee joint installation lower limb length lower leg deformity degree of joint mobility deformation of the feet one Kyphosis "Heavy" traumatic kyphotic or round concave flexion normal varusnaya hypomobility neurogenic anterior adduction of the feet and their varus installation in walking 2 Scoliosis "naval" dysplastic asymmetric or flat extensor (recruitment) functional impairment hallux valgus hypermobility reduction of the arches of the feet, valgus installation of them in walking 3 Kyphoscoliosis mixed "laden-naval" traumatic and dysplastic combined type extensor norm or shortening varus or valgus hypo- or hypermobility front cast / lead, non-fixed OHL / BP stop setting

The reliability of the analysis was verified by two parameters: the Wilks' Lambda parameter, which characterizes the power of object discrimination and the F-criterion, which shows the reliability of the separation. The obtained parameters showed good discrimination of objects: wilks' Lambda = 0,063 (with wilks' Lambda = 1, the resulting model cannot divide the mixture according to this set of attributes, with wilks' Lambda = 0 - the absolute division of the mixture into the required number of groups); F-criterion = 36.384 (with F - criterion <24.548, the separation of the mixture according to this set of features is not significant).

Thus, the use of neurological symptoms - an increase or decrease in muscle tone and reflexes in a neurophysiological study of a child at an early age - allows predicting possible deviations in the development of the functional state of ODE in the early stages, even before the development of clinical manifestations, and in time to begin active preventive measures.

The method is as follows. During preventive examinations, the neurologist visually determines the state of muscle tone and reflexes of the child. If abnormalities are detected, it predicts the possibility of the development of functional disorders of the musculoskeletal system and sends to the orthopedic surgeon:

- muscle tone is increased, and reflexes are lively or normal, they predict the development of kyphosis,

- muscle tone is reduced, and reflexes are reduced or normal, predict the development of scoliosis,

- muscle tone is reduced, and reflexes are revitalized, the development of kyphoscoliosis is predicted.

The orthopedist prescribes active preventive measures, including the correction of the most significant "controlled" risk factors for spinal deformity and recommends periodic (1-2 times a year) examinations by an orthopedic surgeon.

Example 1. Child N. 12 years old - medical examination by an orthopedic doctor.

From the anamnesis it was found that in the first year of life, the child was registered with a neurologist with a diagnosis of “Perinatal damage to the central nervous system (CNS central nervous system). Syndrome of motor disorders in the form of 2-sided pyramidal insufficiency ”(clinically revealed increase in muscle tone in the lower extremities and revitalization of reflexes).

The orthopedist revealed impaired gait in the form of anterior adduction of the feet, their varus installation, flexion installations of the knee joints, joint hyomobility and varus deformity of the legs. The axis of the spine in the slope is straight, sharply enhanced thoracic kyphosis. On the roentgenogram, no structural changes in the tissues were detected, but there was an increase in thoracic kyphosis.

Diagnosed with Kyphosis of the thoracic spine. Impaired gait.

Example 2. Child B. 5 years old - examination by an orthopedic surgeon. From the anamnesis - up to a year the child was observed by a neurologist with a diagnosis: “PP of the central nervous system. Syndrome of motor disorders in the form of myatonic syndrome ”(clinically - decreased muscle tone and reflexes).

The orthopedist revealed: asymmetry of the shoulders, shoulder blades, and triangles of the waist, naval type of gait, hypermobility of all joints, recurrence of knee joints. On the podoscope - all the arches of the feet are reduced, the eversion of the calcaneus is 12 °. Diagnosis: asymmetric posture. Flat valgus deformity of the feet.

The child is at risk for the formation of scoliosis in adolescence.

Example 3. Child M. 7 years old - examination by an orthopedic surgeon.

From the anamnesis - up to a year was observed by a neurologist with a diagnosis: “Central nervous system PP. Syndrome of motor disorders in the form of mixed lower paraparesis ”(clinically, a decrease in muscle tone and revitalization of reflexes in the lower extremities.

An orthopedist clinically revealed impaired gait in the form of anterior adduction of the feet while walking, impaired posture in the frontal and sagittal planes, varus deformity of the leg bones. On the podoscope, all arches of the feet are reduced, the angle of the calcaneus is normal. Diagnosis: "Kyphoscoliotic posture. Varus deformation of the legs. Longitudinally transverse flat feet. "

The child is at risk for the formation of kyphoscoliosis in adolescence.

Example 4. Child C. Observed by a neurologist and orthopedist from one month.

The diagnosis of a neurologist: "Central nervous system impairment of spinal circulation at the level of the cervical spine (SHOP). Bilateral pyramidal insufficiency ”(clinically muscular tone and reflexes are increased).

Diagnosis of an orthopedic surgeon: Traumatic changes in SHOP (rotational subluxation of C _1. Unfixed equinovarus stop installation. "

The child is at risk for the formation of kyphosis.

Up to a year old, a child underwent 3 courses of physiological and medical treatment. When examining a child in a year together with an orthopedist and a neurologist, it was noted: normalization of muscle tone and reflexes. Support on the entire foot with the correct turn of the feet outwards. The range of motion in the cervical spine is full. The axis of the spine is straight. On the podoscope, the inner longitudinal arch of the feet is contoured. Recommendations - observation of an orthopedist at maternity age.

Thus, the proposed method makes it possible to predict the occurrence of functional disorders of OA in young children (from one month) even before the development of their clinical manifestations. This allows timely conduct of preventive measures for children who are at risk for the formation of spinal deformities.

Claims (1)

A method for predicting functional disorders of the musculoskeletal system in children, including a study of a child at an early age, characterized in that they determine the state of muscle tone and reflexes of the child and, if muscle tone is increased, and reflexes are lively or normal, they predict the development of kyphosis if muscle tone is lowered and reflexes are reduced or normally predict the development of scoliosis, if muscle tone is reduced, and reflexes are animated predict the development of kyphoscoliosis.