RU2301622C1 - Computer method of taking preventive measures and correcting unfavorable perceptive and sensomotor reactions - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method is based upon inducing insubstantial reactions and vestibulo-opto-oculomotor nystagmus at patient followed by subsequent correction to arrest them due to training patient to be able to fix and keep real target in central direct vision to develop fixation reflex. Induction of substantial and nystagmus reactions is realized by using computer programs due to realization of opto-kinetic stimuli on background of retinal ones in form of diffusion spheres and ellipsoids of total screen size. Patient is trained additionally to be able of fixing and keeping as real and imagined target in central direct vision. After patient is able to correct and arrest substantial reactions and nystagmus, developed fixation reflex is used under conditions of showing only visual stimulus to patient, then under conditions of vestibular stimulation, then under conditions of combined showing of vision and vestibular stimuli to patient. Efficiency of training is judged from ability of patient to arrest substantial and vestibulo-opto-oculomotor reactions at high-speed movements off head at background of retinal opto-kinetic errors. Method allows to form and to consolidate sensor-motor skills stereotype under conditions of distorted vestibular, vision, proprio-support and other mechanic-receptor afferent ability, producing unfavorable perceptual-oculomotor reactions.

EFFECT: improved efficiency.

6 cl, 2 dwg, 2 ex, 1 tbl

Description

The present invention relates to medicine and can be used for the prevention, correction and relief of adverse perceptual (illusory) and sensorimotor reactions, in particular sensoroculomotor reactions, both in individuals suffering from dizziness and imbalance, and in persons for whom these reactions are undesirable in the process of professional activity.

For many types of sports and professional activities, high accuracy and speed of perception of the minimum change in the position of the head and other parts of the body is important both against the background of the body’s own movements and against the background of the movement of the surrounding space. To do this, it is desirable to have low vestibular thresholds (high sensitivity of the vestibular apparatus), but normal or even low vestibular reactivity, since high vestibular reactivity can lead to undesirable reactions from sensory systems during active activity: vestibulo-perceptive (dizziness, illusion of a false position body), vestibulo-oculomotor (nystagmus, violation of the accuracy of perception of visual spatial coordinates), vestibulomotor (imbalance and rdinatsii body).

The invention can be used by persons of the following professions:

- astronauts, whose professional activity during the initial adaptation to zero gravity and in the initial period of readaptation to gravity (Earth or Mars) is accompanied by the development of a complex of abnormal perceptual and motor reactions;

- by pilots, whose professional activity takes place in complex dynamic and visual conditions, leading to the development of illusory reactions and spatial disturbances;

- dancers who must perform subtle coordination movements and maintain balance against the background of high-speed movements and large accelerations;

- athletes in whom training and performances may be accompanied by adverse reactions from the sensory systems: vestibulo-perceptive (dizziness, illusion of a false position of the body), vestibulo-oculomotor (nystagmus, impaired perception of visual spatial coordinates), vestibulomotor (imbalance in landing, violation of body coordination in midair);

- medical specialists in the clinic for the treatment of patients suffering from dizziness and imbalance.

A change in the intensity of vestibular reactions under the influence of a fixation reflex and other visual factors has long been known [G. S. Tsimmerman, 1952; N.S. Blagoveshchenskaya, 1967; V.G. Bazarov, 1988]. This principle is the basis for the clinical use of Fresnel and Bartels glasses, which reduce the fixation reflex. At the same time, vestibular reactions become more distinct. However, the diagnostic significance of varying degrees of suppression of vestibular reactions by the fixation reflex began to be given after Ito [1972], who most fully described the physiological basis of these phenomena when tracking moving objects.

Due to the neurophysiological organization of the vestibular system and its morphofunctional connections [Leigh R., Zee D., The Neurology of Eye Movements, 1999; Dicks M., Hood J., Dizziness, 1987] it is possible to suppress the adverse vestibulo-proprioceptive and vestibulo-oculomotor reactions that occur with active movements of the head (or body) using a fixation reflex. In the works of Cawthorne T.E. and Cooksey F.S. [Rehabilitation in Vestibular injuries, 1945], Norre M.E. and de Weerdt W. [Treatment of vertigo, 1980] describes a method for suppressing paroxysmal dizziness in patients and in patients with congenital vestibulopathy using eye fixative ability. The technique involves the gradual complication of a set of exercises. Initially, they are performed in the supine and sitting position, while the patient makes eye movements up, down and to the side, traces the approach of the finger to the eyes. The second stage is the movement of the head and eyes in the sitting position of the patient; the third - the movement of the head and body in a sitting position and, finally, the fourth and fifth stages involve performing exercises while standing and in motion. After a training cycle, dizziness almost disappeared in patients and balance was restored when standing and walking.

The disadvantage of this method is that it does not provide the formation and consolidation of the stereotype of sensorimotor skills in conditions of distorted vestibular, visual, proprio-support and other mechanoreceptor afferentation, producing adverse perceptual-oculomotor reactions.

Known methods of suppressing the vestibulo-ocular reflex in the clinic in patients with unilateral lesions of the peripheral part of the vestibular system [Skljut IA, Likhachev SA, Bulletin of otorhinolaryngology, 3, 1990; S. A. Likhachev, I. A. Sklut, Bulletin of Otorhinolaryngology, 4, 2000]. The technique consists in stimulating the labyrinths with the help of the undamped sinosoidal rotation of the patient in the chair to the right and left of the initial position with speeds of 10 degrees / sec, 30 degrees / sec and 60 degrees / sec and fixing the gaze on the object, fixed by means of a holder-bar and moving together with a chair in front of the subject at the level of direct gaze.

This method is selected by us as a prototype of the claimed method.

The disadvantage of this method is that it does not provide the formation and consolidation of the stereotype of sensorimotor skills in conditions of distorted vestibular, visual, proprio-support and other mechanoreceptor afferentation, producing adverse perceptual-oculomotor reactions.

The technical result of the invention consists in the formation and consolidation of the stereotype of sensorimotor skills in conditions of distorted vestibular, visual, proprio-support and other mechanoreceptor afferentation, producing adverse perceptual-oculomotor reactions.

The problem is achieved in that in the known method for the prevention, correction and relief of adverse perceptual and sensorimotor reactions, which includes inducing illusion reactions in the test subject (patient) and vestibulo-optoculomotor nystagmus with their subsequent correction and stopping by teaching the test subject the ability to fix and hold in foveal vision a real target for the development of a fixation reflex, in addition, all the steps of the method are implemented by using computer programs in a dialogue m mode, the induction of illusory and nystagmal reactions is carried out against the background of retinal optokinetic stimuli (ROCKs) in the form of diffuse balls and ellipses on the entire screen, they additionally teach the test subject the ability to fix and hold in foveal vision both a real and an imaginary target, and then when teaching the test subject correction and stopping of illusory reactions and nystagmus use the worked out fixation reflex in conditions of presentation of only visual stimuli, then in conditions of only vestibular stimulation, then, under conditions of combined presentation of visual and vestibular stimuli to the subject, and the effect of training is judged by the subject’s ability to stop illusory and vestibulo-optoculomotor reactions during high-speed head movements against the background of retinal optokinetic interference.

When teaching correction and stopping of illusory and vestibulo-optocoulomotor (nystagmus) reactions of a test subject, they teach them how to fix and hold in foveal vision a real and imaginary target moving across the screen in the absence of visual and vestibular stimuli.

Eye nystagmus is recorded by electrooculography or video oculography.

Information about nystagmus is displayed on-screen in real time and in an accessible form for visualization by subjects.

The foveal stimulus is a point target moving on the monitor screen according to a given law.

Training in correction and stopping of illusory and vestibulo-optocoulomotor (nystagmus) reactions is carried out by fixing and holding in foveal vision real and imaginary targets against the background of multidirectional retinal optokinetic stimuli moving around the monitor screen at a speed of 10-25 deg / s.

Computer programs provide strictly dosed and multidirectional vestibular and visual stimulation, separately and combined in various modifications.

The technical result is ensured by the fact that the proposed method includes:

- biological feedback provided by the computer implementation of this method in an interactive mode, the effectiveness of which is higher compared to conventional rehabilitation exercises;

- A conscious perception of information simultaneously from various sensory sources, which allows faster formation of new sensorimotor patterns, which, as a result of repeated repetition, are fixed and performed automatically;

- preventive training in the ability to suppress adverse perceptual (illusory) and sensorimotor reactions induced by the experimentally stimulating part of computer tests;

- Prevention, correction and relief of abnormal perceptual and sensory-oculomotor reactions using computer stimulation programs that provide strictly dosed and multidirectional vestibular and visual stimulation, separately and simultaneously combined in various modifications;

- computer programs that ensure the objectification of subjective reactions and increase efficiency by increasing information content due to the appeal to a greater number of reflex links that realize perceptual and oculomotor reactions. The use of a complex of computer tests makes it possible to objectify the participation of different levels of the central nervous system (CNS) in the implementation of adverse subjective reactions, as well as to characterize their participation in the organization of tracking and fixation eye movements and their connection with the state of various sensory inputs.

The method is as follows.

They create computer programs that provide both separate, selective, and combined, multimodal, strictly dosed stimulation of various sensory inputs, both in the absence and against the background of additional sensory stimuli (visual stimulation - retinal optokinetic stimulation and vestibular stimulation - active head rotations). Visual stimulation induces illusory reactions in the form of centuries (illusions of the movement of one’s own body or surrounding space) and optokinetic nystagmus. Vestibular stimuli also induce illusory reactions (dizziness), vestibular and vestibular opto-ocular nystagmus. Vestibular training is aimed, on the one hand, at maintaining low thresholds of the vestibular apparatus (maintaining the significance of the vestibular afferent signal for the central nervous system), and on the other, at reducing vestibular reactivity (inhibiting the generalization of the vestibular signal to various structures of the central nervous system). The goal of all stimulation tests is to train the subject to develop a visual reflex (fixative ability of the eyes) that suppresses the abnormal oculomotor and illusory reactions that occur during visual and vestibular stimulation (complex visual and dynamic environments).

Next, conduct test procedures on the computer in interactive mode. Procedures are chosen by the doctor or experimenter, depending on the goals and objectives of the examination. The registration of eye movements can be carried out by electrooculography (EOG) (or videooculography - VOG) and hardware-software complex "SENSOR". The basis of this complex is a personal computer with the Windows 2000 operating system (98) and mathematical software for stimulation, registration and analysis of eye movements. The registration of eye movements by the EOG method can be carried out by a portable autonomous four-channel "Digital EOG signal recording device" (SDG). The SDG provides full automation of measurements, has its own ADC, operates on direct current. The LRC allows you to artifactlessly record both fast, rhythmic oculomotor activity (saccades, nystagmus) and slow aperiodic eye movements, as well as automatically return the EOG signal to the isoline before and after each stimulation program. The remote principle of transmitting information using the infrared port is used. To obtain information about eye movements, EOG electrodes in horizontal and vertical leads are attached to the subject. Registration of eye movements can also be carried out by videooculography (VOG).

The visual stimulus used in the program is a point target up to 1 ° in size (foveal stimulus), moving according to a given law both on the non-reference field of the screen and on the background of the ROCS, which is made in the form of balls and ellipses of different diameters and shapes against the background of the screen monitors moving according to a certain law of motion (Fig. 1.)

The vestibular stimuli used in the program are active head rotations with open eyes in the longitudinal, frontal and sagittal planes with a frequency of 0.125 Hz (Fig. 2.)

Method cycle Background testing 20 minutes 1st cycle of training. Learning the fixative ability of the eyes at rest on an unoriented screen background 15 minutes 2nd cycle of training. Learning the fixative ability of the eyes on the background of induced optokinetic nystagmus and vectorial illusory reactions 15 minutes 3rd cycle of training. Learning the fixative ability of the eyes on the background of induced vestibular nystagmus and dizziness 15 minutes 4th cycle of training. Training of eye fixative ability against the background of induced vestibulo-optokinetic nystagmus and dizziness 15 minutes Control testing 20 minutes

Each cycle is carried out at least 6 times with an interval of 1-2 days. The first 3 sessions are carried out in a sitting position, the next three - in a standing position. The number of sessions can be increased either at the request of the subject, or at the insistence of the specialist conducting the training.

Training is carried out until the disappearance (in extreme cases, to a significant reduction) of nystagmus and dizziness with high-speed head movements in the absence and against the background of visual interference (ROCK).

Before training, the ability of the fixation reflex to suppress abnormal oculomotor and illusory reactions caused by experimental conditions is assessed. To do this, at the time of the development of illusions and nystagmus reactions during stimulation, a target appears in the form of a dot on the monitor screen and the subject must fix it with a look. The absence or presence of the effectiveness of the fixation reflex is judged by the change in the intensity of the illusory and nystagmine reactions at this moment.

1st training cycle includes:

- Long-term fixation and retention of the gaze on the target in the central and peripheral positions during the entire time it is on the screen. The target jumps from the central position to the right, left, up and down. The time of fixing the gaze on the target in each position is 10 seconds;

- Fixing and holding the gaze on the visible target, for 2 seconds in the central position, then moving left, right, up and down, then disappearing and further fixing the gaze in the current position on the imaginary target for 5 seconds;

The 2nd training cycle includes:

- Long-term fixation and retention of the gaze on the target in the central and peripheral positions against the background of visual interference (ROCK). The target jumps from the central position to the right, left, up and down against the background of the ROCS. The time of fixing the gaze on the target in each position is 10 seconds. The speed of the ROKS is 10-25 degrees / second;

- Fixing and holding the gaze against the background of the ROCS (horizontal, vertical, diagonal) on the visible target, for 2 seconds in the central position and moving left, right, up and down, then disappearing and further fixing the gaze in the current position on imaginary target for 5 sec. The speed of the ROKS is 10-25 degrees / second;

- Fixation and retention of the gaze on an imaginary target against the background of movement (linear, pendulum-like, circular) ROCKS. The linear velocity of the ROCKS horizontally, vertically and diagonally is 10-25 degrees / second. The frequency of circular and pendulum-like (sinusoidal) motion of the ROCK is 0.1-0.6 Hz, the amplitude is 10-20 degrees;

3rd cycle of training includes:

- Long-term fixation and retention of the gaze on the target in central and peripheral positions against the background of vestibular stimulation (active swinging and rotational movements of the head in the sagittal, frontal and horizontal planes). The target jumps from the central position to the right, left, up and down against the background of the ROCS. The time of fixing the gaze on the target in each position is 10 seconds. Head frequency 0.125 Hz;

- Fixing and holding the gaze against the background of vestibular stimulation on the visible target for 2 seconds, located in the central position and moving left, right, up and down, then disappearing, and further fixing the gaze in the current position on the imaginary target for 5- t seconds Head frequency 0.125 Hz;

- Fixation and retention of the gaze on an imaginary target against the background of vestibular stimulation. Head frequency 0.125 Hz;

4th cycle of training includes:

- Long-term fixation and retention of the gaze on the visible (10 sec.) And imaginary (5 sec.) Targets against the background of vestibulo-optokinetic stimulation (linear motion of the ROCK along the horizontal, vertical and diagonal). Head movement occurs around the longitudinal, sagittal and frontal axes of the body with a frequency of 0.125 Hz. The speed of the ROKS is 10-25 degrees / second;

- Long-term fixation and retention of the gaze on the visible (10 sec) and imaginary (5 sec) targets against the background of vestibulo-optokinetic stimulation (pendulum-like and circular motion of the ROCK). Head movement occurs around the longitudinal, sagittal and frontal axes of the body with a frequency of 0.125 Hz. The frequency of circular and pendulum-like (sinusoidal) motion of the ROCK is 0.1-0.6 Hz, the amplitude is 10-20 degrees.

During testing, the subject must note the appearance and direction of the vectorial illusions of movement and fix his gaze on the target against the background of the appearing illusions.

The speed of movement of the ROCK is selected by the researcher individually for each subject according to the intensity of the illusion of rotation. The choice of direction of movement of the ROCK is determined taking into account the characteristics of professional activity and complaints of dizziness.

The effectiveness of training is judged by the ability of the test person (patient) to stop the illusory and vestibulo-optoculomotor (nystagmus) reactions during high-speed head movements against the background of visual disturbances (ROX).

Example 1:

Patient Pedalko Irina Viktorovna, 46 years old. Over the past 2 years, she complains of headaches, tinnitus, staggering when walking, and occasional dizziness ("rotation of objects in front of the eyes"), especially with sudden head movements. Clinical examination revealed: osteochondrosis of the cervical spine, vertebro-basilar insufficiency. After a comprehensive assessment of the state of the oculomotor system using computer stimulation programs, an increase in vestibular reactivity of central peripheral genesis and a violation of the vestibulo-cerebellar synergies were diagnosed. After a training cycle of the fixation reflex (to fix the gaze on the point), upon presentation of optokinetic (movement of balls around the monitor screen) and vestibular stimuli (active rotation of the head), the patient disappeared with dizziness and resistance to walking.

Conclusion: due to the development of a fixation reflex in the patient P.I.V. when turning the head, dizziness is not observed and increased vestibular reactivity is not diagnosed. Optokinetic stimulation is not accompanied by optokinetic nystagmus and the development of age-related illusions when fixing the gaze on an imaginary target.

Example 2

Test subject Ivan Ivanovich, 21 years old, student of MIPT. No complaints. During the initial examination of the functional state of the oculomotor system using computer stimulation programs, upon presentation of optokinetic stimuli and rotation of the head, nystagmus and illusions of rotation of the body appeared. After a cycle of training the fixation reflex during the period of experimentally induced illusions of rotation and nystagmus reactions, the subject developed a steady fixation reflex that allows him to suppress (stop) experimentally induced illusions and nystagmus reactions under the influence of vestibular, optokinetic and vestibulo-optokinetic stimuli.

Claims (6)

1. A method for the prevention, correction and stopping of adverse perceptual and sensorimotor reactions, including the induction of an illusion in the test subject (patient) and vestibulo-optoculomotor nystagmus with their subsequent correction and stopping by teaching the test subject the ability to fix and hold in foveal vision a real target for developing a fixation reflex , characterized in that the induction of illusory and nystagmus reactions is implemented using computer programs by implementing on the background of retin Optical-kinetic stimuli in the form of diffuse balls and ellipses on the entire screen additionally teach the test subject the ability to fix and hold both real and imaginary targets in foveal vision, after which, when teaching the test subject how to correct and stop illusory reactions and nystagmus, the developed fixation reflex is used under presentation conditions only visual stimuli, then in conditions of only vestibular stimulation, then in conditions of combined presentation of visual and vestibular stimuli to the subject And on the training effect is judged by the ability of a test to stop the illusory and vestibular-optookulomotornye reaction at high-speed movement of the head on a background of retinal Optokinetic interference. 2. The method according to claim 1, characterized in that when teaching correction and stopping of illusory and vestibulo-optoculomotor (nystagmus) reactions of a test subject, they teach them how to fix and hold in foveal vision a real and imaginary target moving around the screen in the absence of visual and vestibular stimuli. 3. The method according to claim 1, characterized in that the eye nystagmus is recorded by electrooculography or videooculography. 4. The method according to claim 1, characterized in that the information about nystagmus is displayed on-screen in real time and in an accessible form for its visualization by subjects. 5. The method according to claim 1, characterized in that the foveal stimulus is a point target that moves on the monitor screen according to a given law. 6. The method according to claim 1, characterized in that the training in the correction and stopping of illusory and vestibulo-optoculomotor (nystagmus) reactions is carried out by fixing and holding in foveal vision real and imaginary targets against the background of multidirectional retinal optokinetic stimuli moving across the monitor screen at a speed 10-25 degrees / s.

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