RU2480155C1 - Method of estimating state of vestibular-motor projection and system for its realisation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine. In method realisation, performed is videomonitoring of eyes, on which darkened glasses with accelerometer and video cameras are put on, head movements, on which headphones are put on and laser pointer is fixed, movements of body and extremities in performance of neurologic tests and study of neurologic reflexes. Two infrared light diodes are directed on each of tested person's eyes for eye illumination and creation of motion illusion when screens of virtual reality are switched on. Biological calibration of all device components is performed. Research is carried out with put on and taken off glasses on tested person and their placement on hard floor and on soft platform. Assessment of results is carried out by indices of head movements, taking into account difference of movements dispersion during performance of different tests, presence of spontaneous nystagmus or saccades or their appearance while performing research are also taken into account. System includes darkened glasses with video cameras, light diodes, headphones, laser pointer, accelerometer, fixed on dark glasses and connected with inlet of computer, which is provided with software. To perform biological calibration and task of direction of look of eyes, screens of virtual reality, whose inlets are connected to computer inlets, are directed at them.

EFFECT: method makes it possible to extend functional possibilities and increase diagnostics accuracy.

9 cl, 7 dwg, 3 ex

Description

The invention relates to medicine, in particular to neurology and neurosurgery, namely to diagnosis (instrumental documentation), monitoring, examination, treatment and rehabilitation of nervous structural and functional disorders, leading to the appearance of symptoms such as dizziness, headaches, impaired coordination of movements , and can also be used in military, aviation, marine, sports, family medicine.

According to Cochrane reports, dizziness occurs in 20% of the total population of the globe. It turns out to be the third most frequent cause of seeking medical attention in the United States (Desmond AL. 2004). In Germany, up to 22.9% of the total population suffers from it, and the quality of life of individuals with such complaints is significantly reduced (Neuhauser HK, et al., 2008). 90-95% of the total population periodically experiences bouts of headaches, among which 20% have pains of pronounced intensity (Ropper AN., Brown RH., 2005). In many cases, these pains are formed with the participation of the vestibular system. In 12% of the world's population, intense headaches are migraine in nature (Harker L.A., 1994). Recently, they began to pay attention to the fact that people suffering from migraine have a significantly increased risk of vascular accidents, including heart attacks and strokes (Mishchenko T.S., 2009). In Ukraine, the situation is even worse as a result of an unfavorable environmental situation, in particular, caused by the Chernobyl accident (Zdesenko I.V., 2001). To solve this problem in developed countries, Laboratories for the study of dizziness and headache were created (Claussen C.F., Franz V., 2006; Graybiel A., Fregly A.R., 1966).

A known method of ultrasonic cranio-corpography, according to which determine the movement of the neck of the subject. Head / shoulder movements are recorded using markers located on the shoulders and head, so that they move with the subject. The position curve of each marker in three space coordinates is then determined depending on time and stored as a data set. The neck movement is then isolated from head movements and torsion movements by determining the difference between the average of the two curves representing the movements of the shoulders and the head position curve. The motion pattern determined using cranio-corpography is evaluated and analyzed using a data processing device. The method is especially useful for determining the presence and degree of damage to the cervical spine due to a whiplash injury as a result of a car accident [6789044 Method and apparatus for determining a neck movement pattern Date Issued: September 7, 2004 Claussen; Claus-Frenz (Bad Kissingen, DE)].

The specified method is carried out using a device consisting of a set of markers located respectively on the shoulders and head of the subject, a data processing system attached to the configuration of the receiver to record the position of each of the markers. The processing system contains an analysis module and a subtracting unit configured in such a way as to use the recorded results to form the difference between the average value of the location of the shoulders and the location of the head and generate a neck movement profile extracted from at least one of the three space coordinates [6789044 Method and apparatus for determining a neck movement pattern Date Issued: September 7, 2004 Claussen; Claus-Frenz (Bad Kissingen, DE)].

The specified method is limited to registration of movements only in 4 points.

The device lacks technical means for recording eye movements, limb movements and their interaction with head movements, body movements - bending, bending, and the like.

Also known is a system and device for testing vestibular and oculomotor functions. The device includes a beam guiding device supported by several bearings, an engine configured to selectively displace the beam, and a component that matches head movements with beam movements and serves to transmit motor-generated movements to the patient’s head along one or more axis of stimulation [US 2011/0152711 A1, A61B 5/0496, A61B 5/11, 2011].

The method provides testing of the vestibular and oculomotor functions, not taking into account the state of the vestibulo-spinal function, evaluating the movements of the eyes and head in response to the movement of a simple light stimulus, preventing the ability to evaluate eye movements in response to complex pictures or video presentations. There is no possibility of assessing the movements and movements of the body, recording the movements of the limbs and their interaction with the body. Nor is it envisaged to study the interaction of sensory systems: visual, vestibular, somatosensory, auditory, olfactory and magnetic.

Closest to the claimed invention are a device and method for performing selective stimulation of oculomotor reflexes involved in the stabilization of the visual image on the retina.

According to the method, in real time, auditory and visual stimuli are modified in accordance with the patient’s head movements and stimuli are generated that integrate vestibular and visual reflexes based on the patient’s response. The use of additional components allows you to modify somatosensory stimuli to enhance the selective ability of the device.

The device with which the indicated method is carried out comprises a helmet, including darkened glasses and headphones, a vestibular rehabilitation unit (VVR) and a remote training unit (OTB), strain gauges for measuring the center of gravity, a computer. An accelerometer or other device, including inertial, electromagnetic, infrared, ultrasound, is provided for recording head movements. Additional accessories can be used, such as a webcam mounted on glasses, or elsewhere, similar to the case in which a television screen is used. It is also proposed to introduce posturography (PG) and video histogram (VNG) into the device to record eye movements generated by visual stimulation [US 2009/0240172 A1, A61B 5/11, A61M 21/00, 2009].

These devices and methods relate to vestibular rehabilitation systems and methods for treating only vestibular neuronitis, dizziness, and sensations of subsequent instability. The authors consider the mechanism of the described deficiency of the vestibulo-oculomotor reflex. Use selective stimulation of oculomotor reflexes involved in image stabilization on the retina due to a combination of visual vestibular and somatosensory functions. The main parameter is the movement of the patient’s head. Individual selection of visual stimuli does not have standardization of parameters. Head movements are intended to be calculated using an accelerometer or any other device for recording head movements. Measurements can be carried out using additional components. The center of gravity is considered as a function of the positions and masses that make up the body. This does not explain the specific strategy for the patient’s behavior when the center of gravity moves, for example, forward. The following options are possible: step forward, tilt in the joints of the feet of the tibia forward, tilt forward in the lumbar portion of the body and move the arms forward or arms forward in the opposite direction diagonally, the same legs, squat. Therefore, vestibulo-spinal information, such as the center of pressure of the sole of the foot on the platform, recorded using the power platform, is well known, and the center of gravity is measured using strain gauges, its measurements with the help of video will be expensive, the accuracy will be insufficient.

In the patent, the body is considered as a system having three main inputs - visual, vestibular and somatosensory, and with the help of PG and VNG they suggest performing an assessment or functional diagnosis of the equilibrium system, stimulating the visual, auditory, somatosensory or vestibular systems. Firstly, neither GHG nor VNG use auditory stimuli. Secondly, auditory synthetic stimuli are used that do not affect the function of perception of space. Thirdly, these devices do not allow to evaluate the state of the locomotion function. Finally, these systems do not allow the study of the interaction function with space.

Following the principles of vestibular rehabilitation of a patient, the authors successfully stimulate sensory information, which is a trigger for an imbalance - this is not a fact that the patient will feel better. It all depends on how the patient has the disease. With the progressive course of the disease, constant stimulation of equilibrium disorders will lead to disability of the patient.

The method does not take into account all 20 types of dizziness and nosological units associated with them, does not take into account the concept of sensory notebooks, where the perception of space occurs due to four systems: visual, auditory, vestibular and somatosensory. In order to stabilize the image on the retina, you must first find the localization of the lesion of the systems that form the perception of space, movement and interacting with space (opening doors) in order to individually select the optimal treatment. The device does not make it possible to simultaneously record the movements of the eyes, body, limbs and their interaction. The mechanisms of how the hearing takes part in the orientation and movement in space are not taken into account - we feel the direction from where the sound comes. The orientation in space is also affected by the smell. Magnetic radiation affects the state of coordination of movements. Posturography is limited to performing the Romberg test. The device does not allow to perform locomotor tests, such as Unterberger or Fukudi. It is customary to develop rehabilitation programs taking into account the clinical course of the disease: restitution, adaptation of suppression, habituation or compensation.

The basis of the invention is the task of expanding the functionality of the method for assessing the condition of the vestibulomotor projection and improving the accuracy of diagnosis.

The second task, which is the basis of the invention, is the improvement of the system for assessing the condition of the vestibulomotor projection to expand its functionality and improve the accuracy of diagnosis.

The problem is solved by the fact that in the method of assessing the state of the vestibulomotor projection, which consists in video monitoring of eye movements, on which dark glasses are put on, on which the accelerometer is fixed, head movements, on which headphones are put on, body movements and limbs when performing neurological tests and research neurological reflexes, physiological and pathological, according to the invention, video cameras are placed in the darkened glasses, a laser pointer is additionally fixed on the head, we examine the eyes two infrared LEDs are sent to illuminate the eyes and create the illusion of movement when the virtual reality screens are turned on, turn on the software, receive images from all cameras and a signal from the accelerometer on the computer screen, carry out biological calibration of all components of the device, for which standard metrologically verified units are recorded - distances, angles, accelerations, then conduct research when wearing and removed glasses on the subject, when placing it on a hard floor and and on a soft platform, the results are evaluated first by indicators of head movements, which are recorded using a laser pointer, taking into account the difference in the spread of movements when performing different tests, they also assess the presence of spontaneous nystagmus or saccades or their appearance during studies, and each of the tests includes video recording, and video files recorded in the computer’s memory are stored as documents and analyzed according to the relevant parameters.

The method may additionally use an odor emitter.

The method may additionally use a magnetic emitter.

The second task is solved by the fact that in the system for assessing the condition of the vestibulomotor projection, including darkened glasses, headphones fixed on the head of the subject and connected to the player or the audio output of the computer, an accelerometer fixed on dark glasses and connected to the input of a computer that has software according to the invention, on the darkened glasses placed cameras, the outputs of which are connected to a video capture card, the output of which is connected to the input of the computer's video card, on the head researched fixed laser pointer, coupled with a computer for calibration and reference biological view directions are directed to the eye of a virtual reality displays, inputs of which are connected to the computer outputs a darkened glasses on eyes of the subject are directed as two infrared LEDs for illuminating the eye.

When using four cameras, three of them are mounted on the case of darkened glasses, and the fourth on a tripod in front, behind or to the side of the subject, most often at the back above.

When using six or more cameras, they are placed so that the subject is at the starting point of the Cartesian three-dimensional coordinate system.

The device may include an odor emitter located next to the subject.

The device may contain a magnetic emitter located next to the subject.

The device further comprises a soft platform placed on the floor where the subject is located during the tests.

The claimed system combines equipment for computer video histogram, video posturography and video cranio-corpography, which makes it possible to use a wide arsenal of neurological tests in the method: Romberg, Uemuri (standing on one leg with eyes closed), Unterberger-fukudi, diadochokinesis, Garcia (protective reflex) and the like. At the same time, it is possible to evaluate eye movements during the tests of Babinsky, Barani, and finger-bearing test. The system makes it possible to evaluate the subtle interaction during the movements of the eyes, limbs and individual parts of the limbs, different parts of the body, head and eyes, in real time, in turn, allows you to detect not only pathological movements of these components of the body, but imperfect physiological movements that occur when the study of new operations (the development of a new route by racers), to develop on the basis of the received diagnostics special training and rehabilitation procedures and significant improvements operator activities.

Since 2000, using the described system and method, more than 500 patients have been examined, in which other neurological methods practically no pathological changes were detected, which indicates a significant increase in the accuracy of diagnosis of the claimed method and system.

The invention is illustrated by drawings.

Figure 1 shows a diagram of a system for assessing the state of the vestibulomotor projection;

figure 2 - glasses with video cameras, front view;

figure 3 - glasses with video cameras, rear view;

figure 4-6 are examples of studies of the vestibulomotor projection of patients;

Fig.7 - oculomotor core.

The system for assessing the state of the vestibulo-motor projection (Fig. 1) contains darkened glasses 1 (Fig. 2, Fig. 3), on which video cameras are placed (Fig. 1 shows four video cameras). When using four cameras, three of them 2, 3, 4 are mounted on the case of darkened glasses 1 (Figure 2, Figure 3), and the fourth camera 5 (Figure 1) is mounted on a tripod in front, behind or on the side of the subject, most often back upstairs. Video cameras 2, 4 (FIG. 2) are directed to the eyes of the subject, and video camera 3 is in the direction of the eye of the subject (FIG. 3). When using six or more cameras (not shown) they are placed so that the subject was at the starting point of the Cartesian three-dimensional coordinate system. The outputs of the video cameras 2, 3, 4, 5 are connected to the video capture card 6, the output of which is connected to the input of the video card of a computer 7 having software (FIG. 1). On glasses 1 (Fig. 3), an accelerometer 8 is fixed, connected to the input of computer 7. On the head of the subject, a laser pointer 9. is connected to computer 7, and surround or stereo headphones 10 connected to the player or audio output of computer 7. In darkened glasses 1 two infrared LEDs 11 are also directed at the eyes of the subject to illuminate the eyes. For biological calibration and setting the direction of gaze, the virtual reality screens 12 are directed at them, the inputs of which are connected to the video outputs of computer 7.

Odor emitter 13, as well as a magnetic emitter, 14 connected to computer 7 can be placed next to the subject. On the floor, where the subject is located during the tests, an additional soft platform 15 can be placed.

The method is as follows.

Shaded glasses 1 with video cameras 2, 3, 4 are put on the eyes of the subject, stereo headphones 10 and a laser pointer 9 on the head. Two infrared LEDs 11 are sent to the eyes of the subject to illuminate the eyes and create the illusion of movement when the virtual reality screens 12 are turned on. The software is turned on, receiving on the computer screen 7 an image from all cameras 2, 3, 4, 5 and a signal from the accelerometer 8. A biological calibration of all components of the device is carried out, for which standard metrologically verified units are recorded - distances, angles, accelerations.

Additionally, odor emitter 13 and magnetic emitter 14 may also be used.

In the future, depending on the tasks, the following studies are performed.

1. According to Romberg: hard floor, eyes looking forward (glasses 1 removed).

2. According to Romberg: hard floor, eyes look forward (glasses 1 put on).

3. According to Romberg: hard floor, the eyes are looking forward (in glasses 1, due to the alternate activation of infrared LEDs 11, an illusion of movement is created).

4. According to Romberg: soft platform 15 on the floor, eyes looking forward (glasses 1 removed).

5. According to Romberg: soft platform 15 on the floor, eyes look forward (glasses 1 are worn).

6. According to Romberg: a soft platform 15 on the floor, the eyes look forward (in glasses, due to the successive inclusion of infrared LEDs 11, an illusion of movement is created).

7. The same is repeated with the supply of music from one stereo earphone 10 to the second.

8. The same set of tests is performed with the head tilted forward, backward, sideways, by turning the head to detect positional dizziness or vertebrobasilar insufficiency.

9. The same set of tests is performed with eye movements to the sides, up, down.

Evaluation of the results is carried out first according to the head movement indices recorded by the laser pointer 9, taking into account the difference in the spread of movements when performing different tests (regulatory data published: Claussen C.-F. Cranio-Corpo-Graphy (CCG) - 30 years of equilibriometric measurements of spatial and Temporal head, neck and trunk movements. In: Equilibrium Research, Clinical Equilibriometry and Modem Treatment. (Eds.) Claussen C.-F., Haid CT, Hofferberth B., Exerpta Medica, International Congress Series 1201, Elsevier Science BV, Amsterdam Netherland. 2000, 245-259; Nashner LM, Black FO, Wall C. III. Adaptation to altered support and visual conditions during stance: patients with vestibular deficits. J. Neurosci, 1982, 2, 536-544). The presence of spontaneous nystagmus or saccade or their appearance during studies is also assessed.

10. The same tests are used with the Uemuri pose (standing on one leg, alternately on the left and right) (regulatory data published: Trinus K.F. Chornobyl vertigo. 10 years of monitoring. Neurootology Newsletter, 1996, Suppl. 1, 140 p.).

11. The same tests are used with a sample of Uemuri after listening to a mobile phone for 4-5 minutes with and without a magnetic filter.

12. Rehabilitation: glasses 1 are removed, the patient looks at the figure in front of him and moves the body so as to touch the components of the figure, register the data of the movements of the laser pointer 9.

13. Rehabilitation: glasses 1 are removed, the patient looks at the figure in front of him and moves the case so as to touch the components of the figure, register the data of the movements of the laser pointer 9, performed to the music.

14. Autorotation test, vestibulo-ocular reflex, frequency 0.01 Hz.

15. Autorotation test, vestibulo-ocular reflex, frequency 0.02 Hz.

16. Autorotation test, vestibulo-ocular reflex, frequency 0.04 Hz.

17. Autorotation test, vestibulo-ocular reflex, frequency 0.08 Hz.

18. Autorotation test, vestibulo-ocular reflex, frequency 0.16 Hz.

19. Autorotation test, vestibulo-ocular reflex, frequency 0.32 Hz.

20. Autorotation test, vestibulo-ocular reflex, frequency 0.64 Hz.

21. Autorotation test, vestibulo-ocular reflex, frequency 1 Hz.

22. Autorotation test, vestibulo-ocular reflex, frequency 2 Hz.

23. Autorotation test, vestibulo-ocular reflex, frequency 3 Hz.

24. Autorotation test, vestibulo-ocular reflex, frequency 4 Hz.

25. Autorotation test, vestibulo-ocular reflex, maximum frequency.

26. Test 16 is repeated with the upper infrared LED 11 turned on to fix the gaze. Tests 14-25 are evaluated by parameters published by Claussen C.F., Franz B. Contemporary & practical neurootology. Solvay, Hannover, 2006, 410 p and Desmond A.L. Vestibular function: evaluation and treatment. Thieme, New York, Stuttgart, 2004, 228 p.

27. Pupillometry with neurological tests (5-10 tests): record the appearance of anisocoria and wave-like dilations / contractions of the pupils (Trinus K.F. Migraine - a synoptic (vestibular) disorder: evidence-based approach. International Neurological Journal, 2011 No. 2 (40)) .

28. Dix-Hallpike test left.

29. Dicks-Hallpike test right.

30. Tilts of the head.

31. Head positioning.

32. Body positioning. Tests 28-32 are considered positive if nystagmus occurs in any of the head positions.

33. Caloric test: left ear irrigation with water 30 ° C.

34. Caloric test: left ear irrigation with water 44 ° C.

35. Caloric test: right ear irrigation with water 30 ° C.

36. Caloric test: right ear irrigation with water 44 ° C. The evaluation is carried out by frequency, "Claussen butterfly" Claussen C.F., Franz B. Contemporary & practical neurootology. Solvay, Hannover, 2006, 410 p. or slow phase velocity Bojrab D.L., Stockwell C.W. Electronystagmography and rotation tests. In: Neurotology. Jackler R.K., Brackmann DE. (Eds.). Mosby. St. Louis, Baltimore, Boston. 1994, 219-228.

37. Sample Unterberger-Fukudi.

38. A written test of Fukudi.

39. Indicative test.

40. A sample of diadochokinesis.

41. Samples for the smoothness of the movements of the limbs and their parts.

42. Video documentation of tremor of the eyelids, limbs.

43. Samples for completeness of movements of the trunk, neck, limbs and their parts.

44. Video documentation of the features of pathological and physiological neurological reflexes.

During each of the tests, they include recording video, recorded in the computer's memory 7 video files can then be stored for a long time as documents and be analyzed according to the relevant parameters.

The invention is illustrated by examples.

Example 1 (Figure 4)

Patient P., 30 years old, complaints of dizziness, weakness, fatigue. In FIGS. 3-5, the right eye is on the top left, the left eye is on the right, the video from the video camera aimed at the patient is on the bottom left, the video on the patient’s glasses is on the right. The recording was carried out in a darkened room, the picture is blurred at the bottom right due to the active movement of the head. An autorotation test with a frequency of 1 Hz revealed convergence of the eyes.

Example 2 (Figure 5)

Patient N., 27 years old, complaints of headache, weakness, loss of initiative. During the test of diadochokinesis, anisocoria and atypical multidirectional eye movements arose.

Example 3 (Fig.6)

Patient B., 33 years old, complaints of chronic fatigue, meteorological dependence. When performing the Uemuri test (standing on one leg), a nasal adduction of the right eye was noted. The obtained result is explained in Fig.7. A slice of the upper part of the Varoliev bridge is presented. Activation of the pyramidal tract leads to elevation of the leg, due to the cortico-rubro-spinal tract, the patient's posture is fixed, in this case, the excitation passed to the oculomotor core. In a patient, the violation is localized in the area of transition of excitation from the red nucleus to the oculomotor nucleus.

Specially selected physical education in combination with drug treatment allowed to correct this movement defect. After 1 month, such a movement was no longer recorded.

Claims (9)

1. A method for assessing the state of the vestibulomotor projection, which consists in video monitoring of eye movements, on which tinted glasses are fixed, on which the accelerometer is fixed, head movements, on which headphones are put on, body and limb movements when performing neurological tests and studying neurological reflexes, physiological and pathological, characterized in that cameras are placed in the darkened glasses, a laser pointer is additionally fixed on the head, two infrared light are sent to the eyes of the subject Methods for illuminating the eyes and creating the illusion of movement when virtual reality screens are turned on, include software, receiving images from all video cameras and a signal from the accelerometer on a computer screen, carry out biological calibration of all components of the device, for which standard metrologically verified units are recorded - distances, angles, acceleration, then conduct research when wearing and removing glasses on the subject, when placing it on a hard floor and on a soft platform, assessing the result c, they first perform the indicators of head movements, which are recorded using a laser pointer, taking into account the difference in the spread of movements when performing different tests, they also assess the presence of spontaneous nystagmus or saccades or their appearance during studies, and during each test they include video recording, and the recorded video files are stored in computer memory as documents and analyzed according to relevant parameters. 2. The method according to claim 1, characterized in that the odor emitter is additionally used. 3. The method according to claim 1, characterized in that it additionally use a magnetic emitter. 4. A system for assessing the condition of the vestibulomotor projection, including darkened glasses, headphones fixed on the subject’s head and connected to the player or audio output of the computer, an accelerometer fixed on darkened glasses and connected to the input of a computer having software, characterized in that on darkened glasses contain video cameras, the outputs of which are connected to a video capture card, the output of which is connected to the input of a computer video card, a laser pointer is fixed on the head of the subject For biological calibration and specifying the direction of eye gaze, virtual reality screens are directed at them, the inputs of which are connected to the computer outputs, and two infrared LEDs are also directed at the eyes of the subject in darkened glasses for the eyes of the subject. 5. The system according to claim 4, characterized in that when using four cameras, three of them are mounted on the case of darkened glasses, and the fourth - on a tripod in front, behind or on the side of the subject, most often from behind from above. 6. The system according to claim 4, characterized in that when using six or more cameras, they are placed so that the subject was at the starting point of the Cartesian three-dimensional coordinate system. 7. The system according to claim 4, characterized in that it further comprises an odor emitter located next to the subject. 8. The system according to claim 4, characterized in that it further comprises a magnetic emitter located next to the subject. 9. The system according to claim 4, characterized in that it further comprises a soft platform located on the floor where the subject is located during the tests.

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