RU2487739C1 - Method of treating locomotor disorders accompanying acute ischemic stroke - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely neurology, reflexotherapy. The method comprises the magnetic-laser therapy (MLT), acupuncture and therapeutic exercises (TE) with underlying pharmacotherapy. The MLT involves a paravertebral exposure at wave length 0.88 m, power 10 mW, magnetic field strength 40 mT, 4 minutes on each side alternately. The acupuncture represents another embodiment of the method of inhibition. At first, the acupuncture exposure is contralateral, and starting from the 3rd-5th procedure, the exposure also covers the involved side. All the exercises of each following session are conducted with rate load gain, an increase of the number and extent of the exercises. If observing paresis of the upper extremity, the MLT covers a collar region at the level of interosseus processes of the 5th-6th cervical and thoracic 1st-2nd vertebrae. At first, the acupuncture covers the point (TA) Lan-wei at a healthy ankle of the lower extremity. Starting from the 3rd-5th procedure, the exposure also involves the point Er-jian at a hand of the affected upper extremity. If observing paresis of the lower extremity, the MLT involves the lumbar-sacral region at the level of interosseus processes of the 2nd-3rd lumbar and 1st-2nd sacral vertebrae. Originally, the exposure covers the point Shou-san-li in a forearm of the healthy upper extremity. Starting from the 3rd-5th procedure, another version of the method of excitation is included on the affected side whereat the acupuncture needle is inserted into the point Tsu-syui within a foot of the affected lower extremity. If observing hemiparesis, the MLT includes the collar region at interosseus processes of the 5-6th cervical and 1rd-2nd thoracic vertebrae, then on the lumbosacral region. The exposure includes the point Lan-wei at the healthy ankle of the lower extremity and simultaneously the point Shou-san-li in the forearm of the healthy upper extremity. Starting from the 3rd-5th procedure, the exposure is added with a simultaneous effect on the point Er-jian at the hand of the affected upper extremity and on the point Tsyu-syui at the foot of the affected lower extremity. The physical exercises are combined with the correction of the hand and foot positions. For the purpose of the correction, a trainer extends the fingers and positions them properly in a combination with active-passive flexion and extension of the ankle joint. Treating the locomotor disorders starts 1-7 days after the ischemic stroke has been verified. The therapeutic course consists of 12-15 daily procedures.

EFFECT: method provides higher clinical effectiveness, reduces the length of staying in hospital and the disability rate in the patients.

3 ex, 5 tbl

Description

The invention relates to medicine and is intended for the treatment of motor disorders in ischemic stroke in the acute period by the integrated use of magnetic laser therapy, acupuncture and physiotherapy exercises (exercise therapy).

One of the most common and disabling injuries in ischemic stroke (II) is movement disorders (paralysis, paresis, coordination disorders and statics), which, according to the Register of the Research Institute of Neurology of the Russian Academy of Medical Sciences, are observed in 81.2% of cases. Not more than 15% of patients can return to work, the rest remain disabled. The phenomenology of central paresis largely depends on the location of the lesion (Rehabilitation of neurological patients. / A.S. Kadykov, L.A. Chernikova, N.V. Shakhparonova. - M.: MEDpress-inform, 2008. - 560 pp., Ill. P.272) and is accompanied by the development of various functional disorders, such as impaired ability to move independently (especially with gross hemiparesis and lower spastic paraparesis), impaired self-care, domestic and labor skills, contractures and arthropathies.

Typical for post-stroke motor disorders is the formation of the Wernicke-Mann posture, characterized in that the shoulder is brought (pressed) to the body, the hand and forearm are bent, the hand is turned with the palm down, and the leg is bent at the hip and knee joints and bent in the foot.

The time during which the progression of motor disorders is noted is extremely variable and depends on etiopathogenetic factors (embolism, thrombosis, cerebrovascular insufficiency), the volume and localization of the ischemic zone, the state of central hemodynamics, age, professional and psychological characteristics of the patient, as well from the presence of concomitant diseases, the volume and effectiveness of the measures taken, the technical equipment of the medical institution and the experience of the medical staff. More than 1,200 publications are devoted to this problem in the world every year, most of which reflect changes in previous views on various private issues.

There are currently no specific pharmacological preparations with a reliable therapeutic effect in case of motor disorders. The main objectives of the medical treatment of AI are to maintain effective cerebral blood flow, brain metabolism, normalization of heart activity, blood pressure and integrative activity of cerebral structures, however, this is not a pharmacological standard and this type of treatment is characterized by the variability of therapeutic approaches.

In the acute period of stroke in the treatment of motor disorders, posture treatment (special antispastic laying of limbs), passive physical exercises are used, massage is used for both healthy and paretic limbs (Rehabilitation of neurological patients. / A.S. Kadykov, L.A. Chernikova, N.V. Shakhparonova. - M .: MEDpress-inform, 2008 .-- 560 p .: ill. S.276). There are separate guidelines for the restoration of motor functions (Guidelines for the restoration of motor functions after a stroke. / Sarah Tyson, Ann Ashburn, Jacqueline Jackson; Translated from English. Edited by L. A. Gurkina. - St. Petersburg: Polytechnic, 2001. - 87 s: ill.). Numerous experimental and clinical studies have shown that new technologies in the field of motor rehabilitation and new approaches in kinesitherapy, which differ from traditional ones in that they are aimed at training, restoring and solving a specific narrow motor problem, play an important role in activating the mechanisms of neuroplasticity.

Walking on treadmills with support systems that facilitate body weight is considered more effective for hemiparesis than traditional walking training methods. It should be noted that the data on the use and effectiveness in the acute period of stroke of robot therapy, as one of the latest technologies in rehabilitation, are too contradictory. The Lokomat system proposed in 1996 by G.Colombo for training walking in patients with spinal cord injury and subsequently used in patients with post-stroke hemiparesis also made certain adjustments to simulate physical training similar to a physiological pattern. An important positive result of this direction is to facilitate the work of physical therapy instructors, but at the same time, reliable data are not obtained in comparison with traditional physical therapy approaches.

In the literature, the technique of restoring the function of the hand is widely discussed, according to which intensive training of the paretic arm is carried out while fixing a healthy one. This technique was first proposed by E. Taub et al. in 2003 for patients with mild hemiparesis and disease duration more than 1 year. The essence of the proposed method is that a healthy arm is fixed with the help of special adaptations to the body so that the patient cannot use it. A number of studies have shown that fixing a healthy hand with simultaneous intensive training in the period from 4 to 14 days after AI requires careful selection of patients, great physical effort, both on the part of patients and the instructor of exercise therapy. The use of such a technique in the acute period remains controversial in connection with the obtained experimental data, in which it was shown that the use of strength training in rats within 7 days after brain damage leads to a significant increase in the size of the lesion focus. In practice, the work of the neurological departments after the early onset of physical activity, especially with the use of simulators, have cases of deterioration and even repeated strokes.

Of interest is the use of robotic orthoses fixed on the patient’s paretic arm, which are programmed in such a way that prevents the appearance of flexion synergy in the arm during voluntary movements. Training with this robot is necessary for 8 weeks (3 times a week), then it leads to a significant decrease in the severity of synergy and increases the functionality of the arm. This technique is used for gross paresis, but when movements appear in a paretic hand. This technique requires a long course of procedures.

Recently, research at the Research Institute of Neurology of the Russian Academy of Medical Sciences has been conducting studies to study the possibilities of neuromuscular electrical stimulation in the acute period of a stroke (in the first hours after the development of a disease) for a paretic arm (Chernikova L.A. New technologies in the rehabilitation of stroke patients. // Atmosphere. Nervous diseases. - 2005. - No. 2. - P.32-35). The course of treatment is 20 minutes 2 times a day, lasting 3 weeks, it has a very positive effect on the motor and functional recovery of patients and does not worsen the state of cerebral blood flow (according to perfusion-weighted magnetic resonance imaging (MRI)), without increasing the infarction zone (by diffusion-weighted MRI data). The most common equipment options for this technique are: Amplipulse, Amplidin, Stimulus. Using the technique causes a targeted afferent flow and leads to foci of activation of the cerebral cortex on the side of the lesion in the peri-infarction zone (Umarova R.M., Chernikova L.A., Tanashyan M.M., Krotenkova M.V. Neuromuscular electrical stimulation in acute period of ischemic stroke. // Issues of balneology, physiotherapy and physiotherapy. - 2005. - No. 4. - P.6-8). This procedure requires careful selection, as it is not effective in all patients (Worthinton JA, De Sousa LH The use of clinical measures in the evaluation of neuromuscular stimulfttion in multiple sclerosis patients / In: "Current consepts in multiple sclerosis". H / Wientholter, J. Dihgans, J. Mertin (eds.) - London: Elsevier, 1990. - P.213-218). The results on the use in the acute period of neuromuscular electrical stimulation are represented by small groups, the applied methods are aimed at improving motor function, especially the forearm. A positive and important factor in electrical stimulation is selectivity (contraction of certain muscles), adequacy of stimulation, accessibility (can be performed at the patient’s bedside, does not require active participation, does not limit the treatment regimen). But this technique has limitations in the form of contraindications: the patient’s presence of a pacemaker, metal structures, etc. The technique has not yet been widely used in the treatment of motor disorders in the acute period of a stroke either among neurologists or among physiotherapists.

One of the noteworthy physical methods, which is the most pathogenetically substantiated and the effectiveness of which doctors in many countries of the world have seen, is low-intensity magnetic laser therapy (MLT). This is due to the fact that fundamental works appeared that showed the possibility of the influence of a magnetic field (MP) and laser radiation (LI) on the structural elements of an atom, the membranes of living cells with a change in their permeability for the most significant ions (calcium, potassium, sodium, etc.). ), the activating effect of laser therapy on the biosynthesis of proteins, DNA, RNA, tissue regeneration and regulation of the microcirculation system (Moskvin S.V. Efficiency of laser therapy. - M., 2003; Moskvin S.V., Builina V.A. Low-intensity laser therapy. - M., 2000). This interaction is based on the principle of resonance, i.e. at the corresponding frequency of the external MF and LI, an active influence of these two factors on certain atomic structures is observed, which is called "resonant cyclotron frequencies", and the method itself is called "ion-parametric MLT" (Samosyuk I.Z., Golovchenko Yu.I., Samosyuk NI Magnetolaser therapy in the complex treatment of patients in the acute period of ischemic stroke. // Photobiology and photomedicine. International scientific and practical journal 1, 2; 2007, p-43).

The effectiveness of reflexology (RT) in AI is shown in many works. The method is mainly used after an acute period (from 1 to 3 months). There is no unified tactics, justification criteria, direction of TA application and their quantity to obtain the expected effect.

As a prototype for the closest technical essence, we have chosen a method for the treatment of motor disorders in ischemic stroke in the acute period, which consists in using MLT in a stable method against the background of drug exposure (Datsenko I.V.The effect of magnetic laser therapy on the functional state of the central nervous system in patients having undergone a hemispheric ischemic stroke. // Medical business. - 2006. - No. 3 - S.-51-54). The impact is carried out on 4 zones:

- transcranial to the projection of the ischemic focus (magnetic field up to 30 mT, laser radiation up to 50 mW, wavelength 0.78 μm, frequency modulation 37.5 Hz);

- on the projection of the carotid artery bifurcation on the affected side (magnetic field up to 30 mT, laser radiation up to 40 mW, wavelength 0.67 μm, frequency modulation 37.5 Hz);

- to the eye region through a closed eyelid on the affected side (magnetic field up to 30 mT, laser radiation up to 40 mW, wavelength 0.67 μm, frequency modulation 10 Hz);

- on the projection of C8-Th3 segments of the spinal cord (magnetic field up to 30 mT, laser power 50 mW, wavelength 0.78 μm, frequency modulation 10 Hz).

The exposure is carried out using two frequency modulations of 10 Hz and 37.5 Hz. The total duration of the procedure is up to 30 minutes. In the first days of the disease, the procedures were carried out 2 times a day, after 5-7 days from the time of the occurrence of a stroke, the effect was 1 time per day.

The disadvantages of the method we have chosen as a prototype include the following:

1. Insufficiently effective recovery or improvement of the motor function of the patient.

2. High risk of contractures and pathological posture Wernicke-Mann. During expert assessment and dynamic observation of 18 patients who underwent AI (results of clinical follow-up, case histories) of the city multi-profile hospital No. 2 of St. Petersburg in 7 (38.8%) cases, after 6 months, the patients formed the Wernicke-Mann posture, 2 (11.1%) patients had spasticity in the affected hand, and 4 (22.2%) patients had contractures in the foot.

3. There is no effect on the psychoemotional status against the background of the treatment, despite the improvement of hemodynamic parameters.

4. The duration of inpatient treatment is 20-25 days. The late start of rehabilitation is on day 8-12.

5. High disability of patients after 6 months and a year after treatment - 61.6% and 77.8%, respectively.

The technical result of the invention is to increase the efficiency of recovery or improve the motor function of the patient, increase the psycho-emotional status of patients; prevention of contractures and pathological posture of Wernicke-Mann, reducing the length of hospital stay, and, accordingly, earlier starting rehabilitation, as well as reducing disability after 6 months and a year after treatment.

The technical result of the invention is achieved by the fact that against the background of drug exposure, magneto-laser therapy (MLT) is carried out using a stable method, acupuncture exposure and physical therapy classes. Initially, an MLT procedure is carried out, starting with exercise on the healthy side. Immediately after completion of physiotherapy exercises, an acupuncture effect is performed on the healthy side, adding acupuncture effect on the affected side with 3-5 procedures. When using the second variant of the inhibitory method, the exposure is 35 minutes, and the second variant of the exciting method is 10 minutes. Physical therapy classes on the affected side are carried out after the acupuncture procedure. MLT is carried out paravertebrally with a power of 10 mW, a magnetic field of 40 mT, a radiation wavelength of 0.88 μm, for 4 minutes in automatic mode alternately on each side. In physiotherapy exercises, consisting of 12-15 passively active exercises, first on a healthy limb, then on the affected one, initially include free movements with the help of an instructor, and then movements with increasing resistance with light, medium and pronounced resistance until the patient is comfortable tired. All types of exercises in each subsequent lesson are carried out with an increase in the temporal load, as well as with an increase in the number and volume of exercises performed. When performing physiotherapy exercises, the patient's attention is focused on the affected limb by verbal installation. Initially, exercises for raising and lowering the limbs are performed, and when signs of movement in the affected limb appear no earlier than the next lesson, they include flexion and extension exercises in the elbow and wrist joint of the upper limb, knee and ankle - lower, when performing exercises to raise and lower limbs, as well as flexion and extension in full no less than 3 times no earlier than the next lesson include exercises consisting in abduction of the limb to the side. In the presence of paresis of the upper limb, MLT is performed on the collar zone at the level of the interspinous processes of the 5-6 cervical and 1-2 thoracic vertebrae. Acupuncture is performed by the second version of the inhibitory method, initially to the acupuncture point (TA) of Lan-wei (PC 142) in the lower leg area on the healthy side of the lower limb, and with 3-5 procedures, the effect is added to the TA Er-jian (GJ II 2) in the area brushes on the affected upper limb are also the second option of the inhibitory method. In the presence of paresis of the lower extremity, MLT is performed on the lumbosacral region at the level of the interspinous processes of 2-3 lumbar and 1-2 sacral vertebrae. Acupuncture treatment is carried out by the second version of the inhibitory method in TA Shou-san-li (GI II 10) in the region of the forearm of a healthy upper limb, and with 3-5 procedures, the second variant of the exciting method is added on the affected side, introducing an acupuncture needle into TA tsu-shu ( VB XI 40) in the foot area of the affected lower limb. With hemiparesis, MLT is performed on the collar zone at the level of the interspinous processes of the 5-6 cervical and 1-2 thoracic vertebrae, then on the lumbosacral spine. Acupuncture is performed by the second inhibitory method in TA Lan-wei (PC 142) in the lower leg of a healthy lower limb and simultaneously in TA Shaw-san-li (GI II 10) in the forearm of a healthy upper limb. With 3-5 procedures, a simultaneous effect is added to TA Er-jian (CI II 2) in the area of the hand on the affected side of the upper limb by the second variant of the inhibitory method and to TA Qiu-xu (VB XI 40) in the foot region of the affected lower limb by the second variant of the exciting method. During physical exercises, an additional correction of the position of the hand and foot is carried out, which consists in the extension of the fingers of the upper limb and hand by the instructor of exercise therapy and its correct location, as well as in passively active flexion and extension of the foot in the ankle joint. The treatment of motor disorders begins from 1-7 days after verification of ischemic stroke, the course of treatment is 12-15 procedures, carried out according to 1 procedure daily.

The method is as follows.

The main indications for the application of the invention:

1) an established diagnosis of AI with the presence of motor disorders without limiting the age, area of ischemia and the size of the lesion;

2) stable hemodynamic parameters (blood pressure max. 180 \ 100 mm Hg, min. 100 \ 60 mm Hg, heart rate min. 50 v1 min, max. 110), the absence of complex cardiac arrhythmias (ventricular extrasystole, severe tachyarrhythmia) and coronary insufficiency on the ECG;

3) lack of depression of consciousness and convulsive syndrome;

4) preservation of visual function and understanding of inverted speech;

5) the optimal time for applying the methodology is 1-7 days after the onset of AI (motor impairment is aggravated with an increase in the limitation of the pathological process);

6) lack of decompensation from the main physiological systems;

7) hyperthermia no higher than 38 degrees, clinical and biochemical parameters within the proper values.

The main contraindications are the active phase of rheumatism, ischemic disease with coronary insufficiency on the ECG and frequent angina attacks, heart attack six months before the stroke, decompensation from the main physiological systems.

The method can be combined with the use of cardiac drugs, vitamins, with drugs that improve metabolic processes. It is not recommended to combine with sleeping pills, drugs acting at the synaptic level (proserin, midocalm), ganglion blockers, tranquilizers and hormonal drugs.

Conducting a comprehensive course use of the proposed method can begin in the intensive care unit and end in the specialized department (neurological, vascular-neurological).

The MLT procedure, acupuncture and exercise therapy at the beginning of the course should be performed in patients in a prone position. Before the procedure and after the end, it is necessary to measure blood pressure, heart rate, heart rate and monitor the patient's condition during treatment (mood, assessment of the dynamics of motor disorders, stool, diuresis, fatigue). In order to achieve maximum effect after the procedures, the most comfortable position is necessary. When carrying out acupuncture, special rollers are used. Do not change the position of the arm or leg before inserting the needles. Changing the location of the brush (in the presence of spasticity) and the foot is carried out after the introduction of the needle on the affected limb. In the presence of sensory disturbances, it is not always possible to obtain clear, intended sensations when the needle is inserted into the acupuncture point (TA), and in these cases it can be judged by a slight contraction of the muscles in the foot and relaxation on the hand. The appearance and intensification of the sensations provided during the treatment process is a positive trend. An increase in range of motion and muscle strength in assessing motor function during treatment is an objective indicator of positive dynamics.

As a rule, during the course of the course, side effects are not noted. The use of disposable steel acupuncture needles in connection with the presence of increased muscle excitability and the nature of the sensations provided when using the second variant of the inhibitory method is a feature.

It is necessary to limit the motor load on the third day after a stroke, when hemodynamic parameters may be unstable, during this period in the presence of subjective complaints of a decrease in mood, or a fluctuation in blood pressure in the direction of lowering or increasing more than usual for the patient, it is advisable to refrain from the planned load when using exercise therapy.

The installation character of the planned MLT, acupuncture and exercise therapy should be carried out with the patient after a thorough familiarization with the medical history (medical history, bad habits, concomitant pathology, character traits, patient profession), recommendations of the attending physician and drug treatment plan. Orientation of the patient to a favorable prognosis, despite the severity of the condition, should be taken carefully, the emphasis on each achieved positive regression of motor deficiency should be clearly explained to the patient.

MLT is carried out paravertebrally with a power of 10 mW, a magnetic field strength of 40 mT, a radiation wavelength of 0.88 μm, for 4 minutes in automatic mode alternately on each side. An apparatus for magneto-laser therapy AMLT-01 with a rectangular radiating head was used. In the apparatus there are 3 semiconductor laser diodes of the ILPN-203 type with an indication of the presence of radiation from each laser and a magnetic nozzle.

The device was recommended by the Committee on New Medical Technology of the Ministry of Health of the USSR (Minutes No. 6 of July 13, 1987).

One-time acupuncture needles made of steel are used, domestic or imported.

In physiotherapy exercises, consisting of 12-15 passively active exercises, initially on a healthy limb, then on a temporarily affected, initially include free movements with the help of an instructor, and then movements with increasing resistance with easy, medium and pronounced resistance until the patient is comfortable tired. All types of exercises in each subsequent lesson are carried out with an increase in the temporal load, as well as with an increase in the number and volume of exercises performed.

For example, in the first lesson, the patient is not able to perform the exercises to raise and lower the limbs in full, only when signs of movement in the affected limb appear no earlier than the next lesson include flexion and extension exercises in the elbow and wrist joint of the upper limb and the knee and ankle - lower . And when performing exercises for raising and lowering the limbs, as well as for flexion and extension in full no less than 3 times no earlier than the next lesson, include exercises that involve limbs to the side, while at each lesson they increase the angle of limb abduction.

When performing physiotherapy exercises, the patient's attention is focused on the affected limb by verbal installation.

For example, with hemiparesis, without emphasizing the duration over time (usually 2-3 minutes), it is recommended to consider first the affected naked arm, then the leg, offering to focus on the hand, then on the foot. It is also possible to make slow breathing movements through the nose, fixing attention on the affected arm and leg alternately (2-3 minutes). The task is explained in an understandable form for the patient. In the presence of paresis of the upper limb, MLT is performed on the collar zone at the level of the interspinous processes of the 5-6 cervical and 1-2 thoracic vertebrae. Acupuncture is performed by the second version of the inhibitory method, initially in TA Lan-wei (PC 142) in the lower leg area on the healthy side of the lower limb. With 3-5 procedures, the effect is added to TA Er-jian (GJ II 2) in the area of the hand on the affected upper limb is also the second option of the inhibitory method. In the presence of paresis of the lower extremity, MLT is performed on the lumbosacral region at the level of the interspinous processes of 2-3 lumbar and 1-2 sacral vertebrae. Acupuncture exposure is carried out by the second version of the inhibitory method in TA Show-san-li (GI II 10) in the forearm region of a healthy upper limb. With 3-5 procedures, the second variant of the exciting method is attached on the affected side, introducing an acupuncture needle into TA Qiu-xu (VB XI 40) in the foot area of the affected lower limb. With hemiparesis, MLT is performed on the collar zone at the level of the interspinous processes of the 5-6 cervical and 1-2 thoracic vertebrae, then on the lumbosacral spine. Acupuncture is performed by the second inhibitory method in TA Lan-wei (PC 142) in the lower leg of a healthy lower limb and simultaneously in TA Shaw-san-li (GI II 10) in the forearm of a healthy upper limb. With 3-5 procedures, a simultaneous effect is added to TA Er-jian (GI II 2) in the area of the brush on the affected side of the upper limb by the second variant of the inhibitory method and to TA Qiu-xu (VB XI 40) in the foot region of the affected lower limb by the second variant of the exciting method. During physical exercises, an additional correction of the position of the hand and foot is carried out, which consists in the extension of the fingers of the upper limb and hand by the instructor of exercise therapy and its correct location, as well as in passively active flexion and extension of the foot in the ankle joint. The treatment of motor disorders begins from 1-7 days after verification of ischemic stroke, the course of treatment is 12-15 procedures, carried out according to 1 procedure daily.

Distinctive essential features of the proposed method and a causal relationship between them and the achieved technical result:

- Carry out magneto-laser therapy (MLT) with a stable method, acupuncture exposure and physical therapy classes.

The complex use of MLT, acupuncture, exercise therapy is etiopathogenetic in nature and affects, through peripheral, segmental and central mechanisms, the recovery processes of neuroplasticity in the affected area and the compensatory function of the central nervous system due to the healthy side.

Magnetic laser therapy, by regulating the mechanisms of the autonomic nervous system when exposed to the collar zone and lumbosacral, helps to potentiate the effect of acupuncture through the optimization of energy exchange. During exercise therapy and RTI, metabolic processes are strengthened, which leads from the first lesson to an increase in the volume and strength of movement in the limbs.

- MLT is performed paravertebrally.

Paravertebral exposure by a physical factor, namely, MLT, improves the regulation of the mechanisms of the autonomic nervous system and vascular tone by enhancing the metabolism of this reflexogenic zone, since this area is the zone of representation, primarily of the sympathetic part of the autonomic nervous system.

- MLT is carried out alternately on each side.

Alternate exposure on each side i.e. paravertebral to the collar zone is based on the reflex regulation mechanism due to the autonomic nervous system, and directly its sympathetic department. Sympathetic innervation carries vasomotor functions and its effect on the coronary, brain vessels, vessels of the upper extremities is known. The impact on the lumbosacral region alternately i.e. paravertebral when using MLT has a therapeutic focus in lesions of the lower extremities, due to the lumbosacral plexus and vasomotor centers of this department.

- Laser radiation power of 10 mW, magnetic field strength of 40 mT, radiation wavelength of 0.88 μm, 4 min continuously in automatic mode.

The selected parameters of the MLT were selected by us empirically to achieve maximum efficiency.

- The temporary exposure during acupuncture with the second inhibitory method of acupuncture is 35 minutes, and the second exciting method is 10 minutes.

Variants of inhibitory and stimulating methods in the theory and practice of acupuncture are one of the basic principles and rules for using acupuncture in the treatment of individual symptoms or syndromes of various diseases. The second inhibitory method has a relaxing effect, improves microcirculation, while removing spasticity and pain. The second exciting method - on the contrary, has a tonic effect on reduced muscle tone, increases peristalsis, motor function of the intestine or gall bladder. Thus, when exposed to the second inhibitory method, a greater temporary exposure is required than when exposed to the second excitation method. Specific quantitative values of temporary exposures are selected empirically to achieve maximum efficiency.

- Physiotherapy exercises consists of passively active exercises. Initially, free movements with the help of an instructor are included, and then movements with increasing resistance with light, medium and pronounced resistance until the patient is comfortable tired, and all types of exercises in each subsequent lesson are performed with increasing temperature load, as well as with an increase in the number and volume of exercises performed. Initially, exercises for raising and lowering the limbs are carried out, and when signs of movement in the affected limb appear no earlier than the next lesson, they include flexion and extension exercises in the elbow, wrist, knee and ankle joints. When the exercises are performed in full at least 3 times and no earlier than the next lesson include exercises consisting in the abduction of the limb to the side.

When performing physical exercises, the principle of step loading is used, that is, from simple to more complex, while not only the complexity of the exercises increases, but the tempo load also increases and the number and volume of exercises performed increases. If you initially perform passive exercises, that is, free movements with the help of an instructor, and then movements with increasing resistance with light, medium and pronounced resistance until the patient is comfortable tired, that is, with the participation of both the patient and the instructor, then they perform active exercises, then eat without the help of an instructor.

Exercise for raising and lowering the limbs is the simplest and most basic exercise, which helps to add further exercises for flexion and extension in the joints, complicating exercises to take the limbs to the side.

The principle of step loading is necessary to obtain a rapid regression of motor deficiency.

- Initially perform exercises on a healthy limb, then on the affected.

Performing exercises initially on a healthy limb forms the correct motor skills in the patient, which helps to eliminate neurological deficits and consolidate motor skills as a reflex.

- Therapeutic exercise on a healthy limb is performed with simultaneous MLT, after which acupuncture is performed on a healthy limb.

The effectiveness of this technique was noted in a comparative assessment during the joint work of neurologists, reflexologists and exercise therapy physicians. This technique helps to motivate the patient to the correct movements on the affected side, control over the execution of movements and the rapid assimilation of motor skills.

- Therapeutic exercise on the affected limb is carried out after the extraction of acupuncture needles, since the movements after the procedure become, as shown by clinical practice, the most controlled by the patient himself. The effectiveness of this approach is marked by clinical observations.

- When performing physiotherapy exercises, the patient's attention is focused on the affected limb by verbal installation. Focusing the patient on the affected limb during exercise enhances the reflex activity of the central mechanisms of motor function.

- In the presence of paresis of the upper extremity, MLT is performed on the collar zone at the level of the interspinous processes of the 5-6 cervical and 1-2 thoracic vertebrae, and acupuncture is performed by the second version of the inhibitory method, initially to the acupuncture point (TA) of Lan-wei (PC 142) in the area lower legs on the healthy side of the lower extremity, and from 3-5 procedures add an effect to TA Er-jian (GJ II 2) in the area of the hand on the affected upper limb is also the second variant of the inhibitory method;

The area of the collar zone is a reflexogenic zone and affects the basic mechanisms of regulation of the autonomic nervous system and, when exposed to MLT, the processes of sympathetic and parasympathetic influence and their ratio improve.

The influence of the second variant of the inhibitory method on the affected side due to feedback has an effect on the recovery processes of the ischemic zone, and the neuroplasticity of the border areas and the compensatory functions of the healthy side. The initial exposure to the second variant of the inhibitory method on the healthy side, and from the 3-5th procedure, the addition of exposure to the affected method by the same method includes adaptation mechanisms due to the reflex effect of acupuncture.

- In the presence of paresis of the lower limb, MLT is performed on the lumbosacral region at the level of the interspinous processes of 2-3 lumbar and 1-2 sacral vertebrae, acupuncture is performed by the second variant of the inhibitory method in TA Show-san-li (GI II 10) in the forearm a healthy upper limb, and from 3-5 procedures attach the second variant of the exciting method on the affected side, introducing an acupuncture needle into TA tsu-xiu (VB XI 40) in the foot area of the affected lower limb;

The effect of MLT on the lumbosacral region at the level of the interspinous processes of 2-3 lumbar and 1-2 sacral vertebrae has a trophicostimulating effect due to the predominant effect on the parasympathetic part of the autonomic nervous system.

The second variant of the inhibitory method when using a healthy upper limb in the forearm due to the acupuncture's general reflex mechanism contributes to the restoration of the damaged connections of the affected area and the adaptation of the compensatory relationships of the healthy side.

Joining procedure 3-5 of the second variant of the exciting method when using TA on the affected foot by stimulating feedback and neuroplasticity processes helps to restore the disturbed processes of the affected area, and also leads to the formation of a focus of excitation on the healthy side and activation of compensatory mechanisms in the symmetric zone.

It was noted that when using other TAs located both on the affected limbs and on healthy ones, such as Qu-chi (GI II 11), Zu-sanli (E IX 36) and others, this effect did not occur or was absent .

The positive effect when using these points is established empirically. During the observation, it turned out that during the course of treatment and as a result of observations in the distant period, patients do not form contracture in the foot and the pathological Wernicke-Mann posture.

- With hemiparesis, MLT is performed on the collar zone at the level of the interspinous processes of the 5-6 cervical and 1-2 thoracic vertebrae, then on the lumbosacral spine. Acupuncture is performed by the second inhibitory method in TA Lan-wei (PC 142) in the lower leg of a healthy lower limb and simultaneously in TA Shaw-san-li (GI II 10) in the forearm of a healthy upper limb. With 3-5 procedures, a simultaneous effect is added to TA Er-jian (GI II 2) in the area of the brush on the affected side of the upper limb by the second variant of the inhibitory method and to TA Qiu-xu (VB XI 40) in the foot region of the affected lower limb by the second variant of the exciting method. During physical exercises, an additional correction of the position of the hand and foot is carried out, which consists in the extension of the fingers of the upper limb and hand by the instructor of exercise therapy and its correct location, as well as in passively active flexion and extension of the foot in the ankle joint.

The use of MLT on the collar zone at the level of the interspinous processes of the 5-6 cervical and 1-2 thoracic vertebrae and on the lumbosacral spine helps restore the regulatory mechanisms of the autonomic nervous system of both the sympathetic and parasympathetic sections.

Due to the feedbacks when using acupuncture (a general reflex mechanism) and exercise therapy, an effect on the affected area and regression of pathological symptoms occurs. The manifestation of the therapeutic effect with the integrated use of MLT, acupuncture with the use of TA on the healthy side and the affected side (the second variant of the inhibitory method on the hand and the second variant of the excitatory method on the foot) helps to optimize energy exchange and metabolic processes. Acting on the healthy side when using acupuncture, a focus of excitation is created, which, through switching mechanisms, activates the processes of neuroplasticity and restoration of the ischemic focus.

Addition of the simultaneous effects of acupuncture on the affected side of the upper limb and on the affected lower limb with the 3-5 procedure (on the affected side of the upper limbs using the second method of the inhibitory method, and on the affected lower limb the second option - the exciting method) enhances the reflex effect on the central mechanisms of the affected area , in order to restore both affected nerve cells and increase the functional activity of neighbors in the area of the ischemic focus.

An additional correction of the position of the hand and foot, consisting in the extension of the fingers of the upper limb and hand by the instructor of exercise therapy and its correct location, as well as in passively active flexion and extension of the foot in the ankle joint, is necessary in order to restore the correct motor skill, due to the normalization of muscle tone and constant fixation of the patient's attention during movements.

- Treatment of all types of motor disorders begin on the 1st - 7th day after verification of ischemic stroke.

Regression of motor deficiency at an early start of treatment compared to treatment in a more delayed period occurs earlier and more pronounced compared with those patients in whom acupuncture was used at a later stage. Movement disorders are exacerbated with an increase in the limitation of the pathological process. Treatment of all types of motor disorders at this stage, that is, on the 1st - 7th day after verification of ischemic stroke, contributes to a more effective rehabilitation measures.

The set of essential distinguishing features allows you to:

- increase the efficiency of restoration or improvement of motor functions of patients;

- increase the efficiency of restoration of the psycho-emotional status of patients;

- to carry out the prevention of contractures and pathological posture Wernicke-Mann;

- reduce the length of stay in the hospital, and, accordingly, start rehabilitation at an earlier date;

- reduce disability after 6 months and a year after treatment.

Here are examples of clinical use of the method:

Example 1. (paresis of the upper limb)

Patient I., 65 years old, a profession as a pediatrician, was treated at the State Medical Hospital No. 2 from 11.16.08 to 12.3.08.08 at the Neurology Department No. 1 for the treatment of patients with cerebrovascular accident. Received on an emergency basis.

The diagnosis of the main: CVB. Ischemic stroke in the LSMA basin on 11/16/2008 GB III Art. Atherosclerosis of cerebral arteries. Paresis of the right upper limb.

Concomitant: III stage obesity, gout without exacerbation.

Complaints upon admission of weakness, dizziness, lack of movement in the right upper limb, headaches in the occipital region.

Anamnesis of the disease: he became ill sharply, on November 16, 08, at 18 o’clock dizziness, a noise in the head, general weakness, headaches in the occipital region suddenly developed, then weakness and numbness in the right upper limb and lack of movement joined.

Neurological status at admission: Clear consciousness. There is no dysarthria. The movements of the eyeballs in full. Nystagmus horizontal installation when looking to the left. Ptosis on the right. Central paresis of facial muscles on the right. Language deviates to the right. Pronounced right-sided paresis of the upper limb. There are no meningeal signs. Independently with difficulty turns in bed. Numbers of blood pressure at admission 195 \ 110 mm. Hg.

Blood test November 16, 2008: hemoglobin 131 g / l, red blood cells 4.82 million / l, white blood cells 7.21 thousand / l, platelets 244000 / l, lymphocytes 29, monocytes 11, neutrophils 69, eosinophils 1, basophils 2, ESR 11 mm / hour.

Biochem. blood test 11.16.2008: ALT41 U / l; ACT 35 U / L; total protein 68.3 g / l; prothrombin 106%; MHO 1.04; fibrinogen 3.8 g / l; urea 4.6 mmol / l; creatinine 79 μmol / L; uric acid 358 μmol / l; cholesterol 4.12 mmol / l; total bilirubin 13.5 μmol / l; glucose 5.73 mmol / l;

General analysis of urine 11/16/2008: color of urine of St. yellow; specific gravity 1019; acid reaction White blood cells 0-1 in the s / s; The epithelium is flat 0-1 in the s / s.

BCS Triplex Scan 11/18/2008:

Carotid arteries: Hemodynamically significant stenoses, occlusion in the OSA, NSA and ICA were not detected. Pathological tortuosities, aneurysms, angio-dysplasias and significant stenosing lesions were not detected. The main type of blood flow without significant asymmetry.

Vertebral arteries: located in the V1 and V2 segments, left: D - 2.9 mm, right: D - 2.8 mm. Speed indicators are reduced. Vertebral veins are not dilated. The jugular vein flows are not changed. Left and right main bloodstream D = S. Conclusion: BCA without pathology at an extracranial level.

Spiral computed tomography of the brain

November 16, 2008: data for acute cerebrovascular accident in the LSMA basin by ischemic type.

ECG 16.11.08 g: sinus rhythm 88 in 1 min; normal position of EOS; interatrial block I st., incomplete blockade of the left leg of the bundle of His; hypertrophy of the left ventricle with systolic load.

Consultation with an ophthalmologist November 17, 2008: optic nerve discs of satisfactory nutrition on the fundus, veins dilated, narrow arteries; retinal angiopathy.

Treatment: In the department received infusion, antihypertensive, disaggregant, antiarrhythmic therapy. Acupuncture, MLT and exercise therapy according to the above methodology has been used since November 21, 2008, after hemodynamics stabilized on the 5th day after hospitalization. Before the start of the course, the patient was informed about the possibilities of this technique and the features of his participation in further treatment. At the time of starting treatment, dizziness disturbed when getting up in bed. Initially, the psychoemotional status and mood were assessed on the Robson scale (SR), which amounted to 4 points, the severity of paresis was assessed on a 6-point scale (SH) - 1 point, the assessment of rehabilitation assistance - on the Barthel index (IS) - 12 points, the rating of social participation on the Renkin scale (SHRE) was 4 points. HELL before the procedure 155 \ 90 mm. Hg, pulse 82 min. rhythmic.

MLT was performed with a power of 10 mW, a magnetic field of 40 mT, a radiation wavelength of 0.88 μm, for 4 minutes in an automatic mode, using the stable method, paravertebrally alternately on each side of the collar zone at the level of the interspinous processes of the 5-6 cervical and 1-2 thoracic vertebrae. Against the background of the procedure on a healthy left hand, physical therapy classes began - passive-active movements with raising and lowering the arm. Initially, free movements were performed with the help of an instructor. Then, movements with increasing resistance with light, medium and pronounced resistance were performed until the patient was comfortably tired. 15 passively active exercises were carried out when raising and lowering the arm. During the exercise, the patient was explained that after that he needed to correctly perform movements on the affected arm as much as possible, fixing attention first on the entire limb, then on the hand.

At the end of the MLT and exercise therapy exercises, an acupuncture needle was inserted into TA Lan-wei (PC 142) in the lower leg area on the opposite side of the affected arm, that is, on the left leg with an exposure of 35 minutes, the second variant of the braking method. In the first lesson, the patient could independently put a paretic arm straightened in the elbow joint parallel to the body and raise it by 30 degrees, holding for 5 seconds. After performing 15 movements with raising behind the head and lowering parallel to the torso of the arm and three independent lifting of the affected arm straightened in the elbow joint by 30 degrees, the lesson was completed. All types of exercises in each subsequent lesson were carried out with an increase in the temporal load, as well as with an increase in the number and volume of exercises performed. During classes, the psychoemotional state, pulse, blood pressure were monitored.

When evaluating the initial criteria at the end of the first procedure, the following results were obtained: assessment of the psychoemotional status and mood by SR - 6 points; the assessment of the degree of paresis in SH was 1-2 points, the assessment of rehabilitation assistance in IS - 12 points (remained the same), the assessment of social participation in ShRE - 4 points, blood pressure 130 \ 80 mm. Hg, pulse 74 beats per minute, when lifting to a vertical position disturbed by dizziness. The positive dynamics noted by the patient himself motivated further treatment.

In the third procedure, to the second variant of the inhibitory effect in TA Lan-wei (PC 142) on a healthy lower limb in the left leg region with an exposure of 30 minutes, the introduction of the TA Er-jian acupuncture needle (GJ II 2) on the affected right arm was added in the area of the brush, the second variant of the inhibitory method with an exposure of 35 min. During the procedure, the fingers were straightened. Physical therapy classes on the affected right arm were carried out after the acupuncture procedure. When performing movements in the left hand, the patient controlled the correctness of movements, performed bending of the arm in the elbow joint.

This approach with acupuncture was used before the end of the course. After the 6th procedure, the patient could independently raise his right arm, which was straightened and bent at the elbow, while lying down and sitting abduction to the side, he moved in the room, dizziness was not disturbed. When assessing the initial criteria, the results were as follows: assessment of the psycho-emotional status and mood by SR - 8 points; assessment of the degree of paresis according to ШШ - 4 points; assessment of rehabilitation assistance in information security - 19 points; assessment of social participation by ShRE - 1 point; HELL 130 \ 85 mm. Hg, pulse 74 beats per minute, moved independently, dizziness was not disturbed.

The course of treatment in the complex of MLT, exercise therapy, acupuncture was carried out in the amount of 12 procedures. As a result of treatment, improvement was achieved: strength was restored in the right limb, blood pressure and psycho-emotional status returned to normal.

The initial data after the course of treatment are presented by the following indicators: assessment of the psychoemotional status and mood by SR - 8 points; assessment of the degree of paresis according to Sh – 5 points; assessment of rehabilitation assistance in information security - 20 points; Evaluation of social participation by ShRE - 0 points; HELL 130 \ 75 mm. Hg, heart rate of 78 beats per minute. Discharged in satisfactory condition at the urgent request of the patient December 3, 2008

Recommended by:

1. Observation of a neurologist, therapist of the clinic.

2. Daily monitoring of blood pressure, heart rate.

3. Curantyl 75 mg × 3 p / d.

4. Egiloc 100 mg × 2 p / d.

5. Diet with the restriction of animal fats.

6. Observation in the Department of Angiurology.

7. Conducting a course of acupuncture, MLT, exercise therapy on an outpatient basis once every six months.

Example 2. (Paresis of the left lower limb).

Patient D., 53 years old, a driver profession, was treated at the State Medical Hospital No. 2 from 10/16/07 to 10/30/2007 at the Neurology Department No. 1 for the treatment of patients with cerebrovascular accident.

The diagnosis of the main: CVB. Ischemic stroke in the PSMA basin, left-sided deep paresis of the lower extremity of 10/17/07, GB III art., Risk ССО-4. Atherosclerosis of cerebral arteries. Ischemic heart disease. Angina pectoris II fcl Atherosclerotic cardiosclerosis.

Concomitant: Dyslipidemia. Chr. bronchitis, calming exacerbation.

Complaints upon admission of weakness and numbness in the left lower limb, instability when walking, nervousness, irritability, disturbed sleep.

The clinical picture is represented by: central paresis of the facial muscles of the left, left-sided rough paresis of the lower limb.

assessment of rehabilitation assistance in information security - 10 points; assessment of the degree of paresis on a six-point scale (SH) - 1 point; assessment of the psychoemotional status and mood according to SR - 4 points; assessment of social participation by ShRE - 4 points. HELL at admission 185 \ 100 mm. Hg, heart rate at 95 per minute, rhythmic.

Clinical blood test 10/16/2007: ESR 4 mm / h., Lake. 7.0 thousand \ l, Er. 5.8 million \ l, Hemoglobin 138 g / l. platelets 356 thousand, lymphocytes 22%, monocytes 11%, neutrophils 61%.

Biochem. blood test 10/16/07: ALT 30 U / l; AST 28 U / L; total protein 69.9 g / l; creatinine 56 μmol / l; cholesterol 4.68 mmol / l; triglycerides 1.53 mmol / l; total bilirubin 7.9 μmol / l; potassium 3.8 mmol / l; creatine phosphokinase 67 U / L; glucose 5.31 mmol / L, prothrombin 95.2%; MHO1.1; fibrinogen 3.5 g \ l.

General analysis of urine 76.70.07 g.: Color of urine St. yellow; transparent specific gravity 1020; acid reaction; white blood cells 0-1 in the s / s epithelium flat 0-1 in the s / s.

Ultrasound of the thyroid gland of 10/20/2007. Conclusion: diffuse change in the tissue of the thyroid gland.

The conclusion of the x-ray examination of 10.25.07: on the x-ray. chest clearly distinct infiltrative opacities in the lungs were not detected. The diaphragm is located correctly, its left contour is fuzzy due to pleural layers. The heart is enlarged due to the left ventricle. The aorta is elongated, deployed, its shadow is intense.

Spiral CT scan of the brain October 16, 2007. Conclusion: data on the ONMK type of AI caused by thrombosis of the proximal part of the middle cerebral artery or one of its deep penetrating branches.

BCS Triplex Scan 10/17/2007. Conclusion: the vascular wall is atherosclerotically altered. In the area of beef. OCA and the mouths of the ICA and ICA are dense atherosclerotic plaques located on the right, stenosing the lumen of the ICA at the mouth up to 65% in diameter, on the left there is little stenotic lumen of the vessels. In both PA, the blood flow is altered-main. PA on the right - diameter in V1-V2 segments = 3.5-4.0 mm, there is a deficit in blood flow, signs of hemodynamically insignificant stenosing lesion from the mouth are detected. PA on the left - there are signs of a hemodynamically insignificant stenosing lesion from the mouth. The walls are atherosclerotically altered. Diameter in V1-V2 segment = 3.0 mm. Speed indicators are reduced.

ECG dated 10/16/2007: sinus rhythm with a heart rate of 98 in 1 minute, left ventricular hypertrophy, incomplete blockade of the left leg of P. gisa.

Consultation with an ophthalmologist 10/16/2007: hypertensive retinal angiopathy.

Treatment: antihypertensive, antiplatelet therapy, nitro drugs, potassium and magnesium preparations in combination with acupuncture, MLT and exercise therapy in the amount of 15 procedures.

The use of acupuncture, MLT and exercise therapy in the complex began on October 17, 2007, after the diagnosis was established and hemodynamic parameters were stable. Before the proposed methodology was carried out, a reassessment of the basic initial indicators of the patient’s condition was carried out, which are presented by the following results: assessment of the psychoemotional status and mood by SR was 3 points; the severity of paresis on a six point scale (SH) was 1 point; assessment of rehabilitation assistance in information security - 10 points; HELL 160 \ 100 mm. Hg and heart rate with a heart rate of 92 per minute.

A course of treatment has been started with the use of 10 mW MLT, a magnetic field strength of 40 mT, a radiation wavelength of 0.88 μm, 4 min each with a stable method in automatic mode, para-vertebral alternately on each side of the lumbosacral region at the level of 2-3 interspinous processes lumbar and 1-2 sacral vertebrae. Against the background of the procedure, exercise therapy was performed in the form of 15 passively active exercises on a healthy, right leg with light, moderate and pronounced resistance when raising and lowering the lower limb straightened in the knee joint with an emphasis of attention first on the entire leg, and then on the foot without time fixation (usually 2–3 min), accompanied by slow breathing through the nose. All types of exercises in each subsequent lesson were carried out with an increase in the temporal load, as well as with an increase in the number and volume of exercises performed.

After conducting exercise therapy, a needle was introduced on the right forearm in TA Shaw-san-li (GI II 10) as the second version of the inhibitory method with an exposure of 35 minutes. Then the patient was informed that he should repeat the most correctly performed exercises with the affected left foot after removing the acupuncture needle from TA Shou-san-li (GI II 10). When performing passive-active exercises, an increase in muscle strength in the leg was noted and the patient was able to slowly raise three times by 30 degrees and hold for 5 seconds the left leg straightened in the knee joint parallel to the right (healthy) leg. The first lesson was over. First of all, an improvement in the psycho-emotional status and mood was noted: the evaluation after the procedure was 6 points for SR; there were movements in the paretic leg up to 2 points in Sh, the assessment of rehabilitation assistance in information security and the assessment of social participation in ShRE remained the same, blood pressure decreased to 145 \ 90 mm Hg, heart rate 78 per minute.

Due to the positive dynamics in the following procedure and subsequent classes, the raising and lowering of the left leg was carried out with abduction, flexion and extension in the knee joint.

From the 4th procedure, in addition to introducing a needle on the right forearm into TA Shaw-san-li (GI II 10) as the second variant of the inhibitory method with an exposure of 35 minutes, the introduction of the acupuncture needle by the second variant of the excitation method with an exposure of 10 minutes on the affected left leg was added in the area of the foot in TA Qiu-syu (VB XI 40). Exercise therapy on the affected left leg was performed after removing the needle. After the 6th procedure, the patient without outside help independently moved in the ward. The course of treatment was carried out in the amount of 12 procedures with the subsequent assessment of baseline indicators, which are presented as follows: assessment of psychoemotional status and mood in the SR - 8 points, assessment of the degree of paresis in ШШ - 4 points, assessment of rehabilitation assistance in IB -19 points, assessment of social participation in SHRE - 1 point, HELL 135 \ 80 mm Hg, pulse with a heart rate of 74 per min. After the course, the patient could move around without assistance, go down and climb the stairs.

It is discharged in satisfactory condition with improvement, a slight neurological deficit while walking remains.

Recommended by:

1. Observation of a neurologist and therapist at the clinic.

2. Thrombo-ass 100 mg per day.

3. Efox Long 50 mg. 1 t. Per day.

4. A second course of reflexology, MLT in the exercise therapy complex after 6 months, subsequent treatment 1 time per year in the clinic.

Example No. 3. (hemiparesis).

Patient A., 45 years old, fixed-route taxi driver, was treated at the hospital No. 2 from 11/14/07 to 11/18/07 in the intensive care unit N 1 (general intensive care unit), from 11/18/07 to 5/12/07 in the neurological department No. 1 for the treatment of patients with cerebrovascular accident.

The diagnosis of the main: CVB. Ischemic stroke in the basin of the left middle cerebral artery of 11/14/2007 GB III art. Atherosclerosis of cerebral arteries.

Companion: Chr. gastritis, without exacerbation.

He acted on an emergency basis, with complaints of weakness in the right limbs, anxiety, anxiety, dizziness, general weakness, decreased psychoemotional status, depressed mood.

Anamnesis of the disease: Acutely ill, 11/14/07, at about 09:00 o’clock. severe headaches, dizziness, general weakness suddenly developed, then weakness in the right limbs joined.

Neurological status at admission: Clear consciousness. Speech saved. The movements of the eyeballs in full. Nystagmus horizontal installation when looking to the left. Ptosis on the right. Central paresis of facial muscles on the right. Language deviates to the right. The severity of right-sided hemiparesis corresponds to 1 point on a six-point scale (SH) according to L. Mc.Peak, 1996, M. Weiss, 1986. There are no meningeal signs. Independently with difficulty turns in bed. Assessment of rehabilitation assistance in information security - 12 points, assessment of social participation according to SRE - 4 points, mood and psycho-emotional status were reduced on a 10 point scale F. Robsona (SR) to 2 points, blood pressure 195 \ 110 mm Hg, pulse 68 per min .

Blood test 11/14/2007: hemoglobin 150 g / l, red blood cells 5.00X10 (12) / l,

leukocytes 11.2X10 (9) / l, platelets 254X10 (9) / l, lymphocytes 30, monocytes 10, neutrophils 50 stab 7, eosinophils 1, basophils 2, ESR 9 mm / hour.

Biochem. blood test 11.16.07: ALT45 U / l; ACT 45 U / l; Total protein 65.3 g / l; fibrinogen 3.8 g / l; prothrombin 106%; MHO 1.04; Creatinine 79 μmol / L; cholesterol 4.12 mmol / l; total bilirubin 13.5 μmol / l; glucose 5.73 mmol / l;

General urine analysis: 07/16/07. St. color yellow; transparent specific gravity 1010; weak acid reaction .; white blood cells 0-1 in the s / s; flat epithelium 0-0-1 in s / s;

BCS duplex scanning 11/14/2007

Carotid arteries: Hemodynamically significant stenoses, no occlusion detected. Pathological tortuosities, aneurysms, angiodysplasias were not detected. CMM up to 0.7 mm in OCA. According to ICA, the bloodstream of the main type without significant asymmetry.

Vertebral arteries: located in the V2 and v1 segments, left: D - 2.8 mm in the V2 segment. LSC - 29 cm / s, right: D -2.8 mm in the V2 segment of LSC - 27 cm / s, the blood flow of the main type, symmetrical. Stenosis, tortuosity, angiodysplasia were not detected.

Subclavian arteries: left and right main bloodstream D = S. Conclusion: BCA without pathology at an extracranial level. MRI tomography dated 11/14/07. Acute cerebrovascular accident in the pool of the left middle cerebral artery (LSMA).

ECG 11/14/07: Sinus rhythm 85 in 1 min. The normal position of the EOS. Atrial blockade of the I st. Incomplete blockade of the left leg of a ventriculonector. Left ventricular hypertrophy.

Consultation with an oculist. 11/15/07. Fundus: optic nerve discs of satisfactory nutrition, veins dilated, narrow arteries. Zakl: retinal angiopathy (hypertonic).

Treatment: In the department received infusion, antihypertensive, disaggregant therapy. The use of acupuncture, MLT, and exercise therapy in the complex treatment in the amount of 15 procedures was started in the intensive care unit after verification of ischemic stroke (II) on the second day after hospitalization on November 15, 2007. The patient was interviewed and acquainted with the main provisions of the proposed method of course treatment.

Before using the proposed method, an assessment was made of the patient’s condition and baseline for the dynamics of treatment: blood pressure 160/95 mm Hg, pulse rate of 94 strokes per 1 min, diuresis 4 times a day, stools are normal, mood is reduced on a 10-point Robson scale - (SR) up to 2 points, the degree of paresis on a six-point scale (SH) was 1 point (movements in the wrist and foot on the right were noted, there were no active movements), the assessment of rehabilitation assistance in information security was 12 points, the assessment of violations of social participation was ShRE - 4 points, disturbing sleep with awakenings, appetite with izhen.

MLT was performed with a power of 10 mW, a magnetic field of 40 mT, a radiation wavelength of 0.88 μm, for 4 min each using a stable method paravertebrally alternately on both sides of the collar zone at the level of the interspinous processes of the 5-6 cervical and 1-2 thoracic vertebrae -sacral department. During MLT, physical therapy classes on the healthy, left side were started. Fifteen passively active exercises were performed in the form of raising and lowering the left arm straightened in the elbow joint with light, moderate, pronounced resistance, abduction and flexion in the elbow joint, then 15 passively active exercises with raising and lowering the left leg straightened in the knee joint with light, moderate and pronounced resistance, and with a gradual increase in temperature load. After three independent lifting of a leg straightened in the knee joint by 30 degrees and holding for 5 seconds, the session was completed. After the exercise exercises were performed acupuncture.

Acupuncture was performed as a second inhibitory method in TA Lan-wei (PC 142) in the lower leg region of a healthy left lower limb and simultaneously in TA Shou-san-li (GI II 10) in the area of a healthy left forearm. After acupuncture, that is, after removing the needles, the patient was recommended to perform exercises on the affected right hand with the focus first on the entire extremity, then on the hand without time fixation (usually 2-3 minutes) After three times lifting the right arm straightened in the elbow joint 35 degrees, the occupation for the affected arm was completed and went on to occupations on the affected leg. After triple lifting of the right affected leg straightened in the knee joint by 30 degrees and holding it for 5 seconds, the session ended.

After the first procedure, an assessment was made of the initial indicators of the patient's condition, which were used to reflect the dynamics of treatment: an assessment of the psychoemotional status and mood according to SR - 4 points, the severity of paresis in the leg and arm according to ШШ - 2 points, assessment of rehabilitation assistance according to IB - 12 points; assessment of violations of social participation by the ShRE - 4 points. HELL 130/85 mm Hg, heart rate with an emergency of 78 in min. The results were regarded as a positive effect and the patient was motivated by a favorable treatment outcome. With 4 procedures, acupuncture was added on the lesion side, that is, on the right side, in addition to TA Lan-wei (PC 142) and Shaw-san-li (GI II 10) and needles were inserted into TA Er-jian (GI on the affected side) II 2) the second version of the inhibitory method in the area of the hand with an exposure of 35 minutes and in the foot area; the second version of the inhibitory method in TA Qiu-xu (VB XI 40) with an exposure of 10 min in the area of the foot.

When conducting physiotherapy exercises, the LFK instructor recommended first examining the affected right, naked arm, then the affected right leg, suggesting that you focus on the hand, then on the foot. Slow respiratory movements through the nose were also performed, while the patient's attention was fixed on the affected, that is, right, arm and leg alternately (2-3 minutes). Initially, free, that is, passive, movements with the help of an instructor were performed on a healthy left arm and leg, and then on the affected, that is, right, limbs, with a slowed uplift of the arm straightened in the elbow joint and lowering along the trunk in the supine position, as well as lifting and lowering the legs straightened in the knee joint. Tempo loading gradually increased. As a result, an increase in muscle strength and range of motion was noted when raising and lowering the arms and legs during the procedure.

In the 5th lesson, the patient was able to perform exercises on raising and lowering the limbs to 45 degrees, as well as on flexion and extension in full in the knee joint 3 times after classes.

At the 6th lesson, exercises were included, which consisted of leading the affected limbs to the side, flexion and extension in the elbow and knee joints.

During physical exercises, an additional correction of the position of the hand and foot was carried out, which consisted in the extension of the fingers of the upper limb and hand by the instructor of exercise therapy and its correct location, as well as in passively active flexion and extension of the foot in the ankle joint. After the 6th lesson, the patient with the help of an instructor moved in the ward.

The course treatment in the amount of 15 procedures is completed with a positive effect in the form of a significant regression of motor deficiency: the patient without assistance helps to move independently in the room, on the stairs, and serves himself. Mood and psychoemotional tone on the Robson scale — 9 points, the assessment of the degree of paresis in SH was 4 points, the assessment of rehabilitation assistance in IS — 19 points, the assessment of social participation in SHRE — 1 point, blood pressure 135/90 mm Hg, pulse with a heart rate of 78 per minute . Until 2011, he underwent course treatment on an outpatient basis once every six months.

MRI 12/08/2011: The consequences of an ischemic stroke in the LSMA basin, compared with the data from 11/14/2007, is a positive trend. Ecg, Uzdg, clinical and biochemical parameters without features. Assessment of key indicators, vital functions and ongoing treatment and rehabilitation measures: assessment of social participation by SRW - 9 points, assessment of rehabilitation assistance by IS - 19 points, assessment of social participation by SR - 1 point. With significant physical exertion, fatigue is noted on the right hand faster than on the left. There were no transient ischemic attacks and repeated strokes. Remained to work in his profession without limiting the load and shortening the time of work.

Recommended: 1. Observation of a neurologist and therapist of the clinic; 2. Daily monitoring of blood pressure, heart rate; 3. Curantyl 75 mg × 3 p / d; 4. Thrombo-ass 100 mg 1 time per day; 5. Diet with limited animal fats; 6. Observation in the Department of Angiurology; 7. Conducting a course of acupuncture, MLT, exercise therapy on an outpatient basis once every six months.

A comparative expert evaluation of the treatment results was carried out in two groups - according to the claimed method and the prototype method. In both groups, 18 patients were examined. In the prototype group are patients who underwent treatment in the city multidisciplinary hospital No. 2 of St. Petersburg, in which the prototype method has been used for more than 10 years. A comparative assessment of the effectiveness of treatment is presented in tables No. 1-5.

The presented groups included patients of working age from 41 to 60 years with the presence of paresis of the upper limb, paresis of the lower limb, hemiparesis. Corresponding to the obtained results, the restoration of motor function was determined: for the absence of recovery, the arithmetic average number of points scored by the patient on all 3 scales and equal to 19 points or less was taken; minimum degree of recovery - 20-24 points; the average degree of recovery is 25-29 points; a significant degree of recovery - 30 points or more.

Table number 1. The dynamics of the regression of motor disorders during the procedure of the claimed method and the prototype method. The characteristic dynamics of the effectiveness of treatment Compare groups The inventive method Prototype method Lack of Positive Dynamics 0 5 (27.8%) Slight positive dynamics 2 (11,%) 9 (50%) Significant positive dynamics 16 (88.8%) 4 (22.2%) Total eighteen eighteen

The reaction to the first procedure is a favorable factor and a positive prognosis of course treatment. Significant positive dynamics in the first procedure in patients during testing of the proposed method was noted in 16 cases (88.8%), which exceeds the response of patients treated using the prototype method, which was observed only in 4 patients (22.2%). Thus, the positive dynamics in the first procedure in patients with testing the proposed method is 66.6% more effective compared to the prototype method.

Table number 2. A comparative assessment of the effectiveness of the treatment of motor disorders according to the claimed method and the prototype method after a course of treatment The nature of the restoration of motor function Compare groups The inventive method Prototype method Lack of recovery of motor function after treatment 2 (11.1%) 6 (33.5%) The minimum degree of recovery of motor function after a course of treatment 0 2 (11.1%) The average degree of recovery of motor function after a course of treatment 7 (38.9%) 8 (44.4%) A significant degree of recovery of motor function after a course of treatment 9 (50%) 2 (11.1%) Total: 18 (100%) 18 (100%)

The efficiency of restoration of motor function when using the prototype method was 66.6%, and when testing the proposed method - 88.9%. Thus, the claimed method by 22.3% increases the efficiency of restoration of motor function in patients compared with the prototype method.

Table number 3 A comparative assessment of the effectiveness of the treatment of motor disorders according to the claimed method and the prototype method 6 months after treatment Motor Disorders Compare groups The claimed method Prototype method Wernicke Mann Pose 0 7 (38.8%) Spasticity in the brush 0 2 (11.1%) Foot contracture 0 4 (22.2%)

Minor motor deficit 8 (44.4%) 1 (5.5%)

None of the 18 patients when testing the proposed method showed pronounced motor impairment (Wernicke-Mann posture, spasticity in the hand and contracture in the foot), while when using the prototype method, pronounced motor impairment was observed in 14 of 18 patients (72.2% )

Table No. 4. A comparative assessment of the effectiveness of the restoration of psychoemotional status on a 10-point scale (SR) according to the claimed method and the prototype method after the 1st procedure and after the course of treatment Assessment of the dynamics of psychoemotional status Compare groups The inventive method Prototype Total score Average score (in group) Total score Average mark Before treatment 57 3,1 59 3.2 After 1 procedure 83 4.6 64 3,5 After a course of treatment 146.5 8.1 103 5.7

The dynamics of the restoration of psychoemotional status is much more effective in patients using the proposed method, which is clearly presented in the table in terms of total and average score after the first procedure and after the end of the course in SR. The total and average scores for SR in the group of patients with the claimed method exceeds the positive dynamics of the correction of the psycho-emotional status of the prototype after the first procedure by 22.9% - the total score and 24% - the average score, after the course of treatment - by - 29.5% and 29 , 6%, respectively.

Table No. 5. A comparative assessment of disability and disability according to the claimed method and the prototype method. MSEC Survey and Disability Compare groups The inventive method Prototype method In 6 months 2 (11.1%) 7 (38.4%) After 1 year 2 (11.1%) 4 (22.2%) Refused to determine disability after 6 months 14 (77.7%) 7 (38.4%) Remained to work in their profession 12 (66.6%) 5 (27.8%) Changed jobs to less skilled 6 (33.4%) 13 (72.2% 0)

During the examination at MSEC 6 months after treatment, 14 patients (77.7%) refused disability, and a year later, 2 patients (11.1%) who tested the inventive method, respectively, 7 patients in the prototype group (38, 4%) and 4 patients (22.2%), that is, the effectiveness of the proposed method for reducing disability is 50%.

The beginning of rehabilitation according to the claimed method is on the 3-5th day, and according to the prototype method - on the 8-12th day. Reducing the start of rehabilitation is an average of 5-7 days. The period of inpatient treatment by the present method is 15-17 days, and by the prototype method - 20-25 days. Inpatient treatment is reduced by an average of 5-8 days.

The inventive method was tested in the city multidisciplinary hospital No. 2 of St. Petersburg.

Thus, the claimed method for the treatment of motor disorders in ischemic stroke in the acute period, compared with the prototype method, increases the efficiency of restoring the motor function and psycho-emotional status of patients, eliminates the risk of contractures and pathological Wernicke-Mann posture, reduces the length of hospital stay of patients , allows you to start rehabilitation at an earlier date. The effectiveness of the proposed method to reduce disability is 50%, which, of course, is a socio-economic significant factor.

Claims (1)

A method for the treatment of motor disorders in ischemic stroke in the acute period, which consists in the use of magnetolaser therapy (MLT) with a stable method against the background of drug exposure, characterized in that they additionally carry out acupuncture and conduct physical therapy classes, and initially carry out the MLT procedure, starting with this treatment physical education on the healthy side, immediately after the completion of physiotherapy exercises carry out acupuncture effects on health oic side attaching procedures with 3-5 acupuncture effects on the affected side, while when using the second embodiment of the braking exposure method is 35 minutes, and the excitation of the second embodiment of the method - 10 min; physical therapy classes on the affected side are carried out after the acupuncture procedure; MLT is performed paravertebrally, alternately on each side, with a power of 10 mW, a magnetic field strength of 40 mT, a radiation wavelength of 0.88 μm, for 4 minutes in automatic mode; physical therapy, consisting of 12-15 passively active exercises, first on a healthy limb, then on the affected limb, initially includes free movements with the help of an instructor, and then movements with increasing resistance, with light, medium and pronounced resistance until the patient is comfortable tired moreover, all types of exercises at each subsequent lesson are carried out with an increase in the temporal load, as well as with an increase in the number and volume of exercises performed, moreover, when performing physiotherapy exercises they emphasize manie patient on the affected limb by verbal installation; initially carry out exercises for raising and lowering the limbs, and when signs of movement in the affected limb appear, not earlier than the next lesson, include flexion and extension exercises in the elbow and wrist joint of the upper limb, knee and ankle - lower; when performing exercises for raising and lowering the limbs, as well as for flexion and extension in full, at least 3 times, not earlier than the next lesson, include exercises consisting in leading the limb to the side; in the presence of paresis of the upper extremity, MLT is performed on the collar zone at the level of the interspinous processes of the 5-6 cervical and 1-2 thoracic vertebrae, and acupuncture is performed by the second variant of the braking method, initially to the point of acupuncture (TA) doe-wee (PC 142) in the lower leg on the healthy side of the lower limb, and from 3-5 procedures add an effect to TA er-jian (GJ II 2) in the area of the hand on the affected upper limb, also the second variant of the inhibitory method; in the presence of paresis of the lower limb of MLT, the effect is performed on the lumbosacral region at the level of the interspinous processes of 2-3 lumbar and 1-2 sacral vertebrae, acupuncture is performed by the second variant of the inhibitory method in TA show-san-li (GI II 10) in the forearm a healthy upper limb, and from 3-5 procedures they attach the second variant of the exciting method on the affected side, introducing an acupuncture needle into TA tsu-xiu (VB XI 40) in the foot area of the affected lower limb; with hemiparesis, MLT is performed on the collar zone, at the level of the interspinous processes of the 5-6 cervical and 1-2 thoracic vertebrae, then on the lumbosacral spine, acupuncture is performed as the second braking method in TA doe-wee (PC 142) in the healthy shin area lower limb and simultaneously in TA show-san-li (GI II 10), in the region of the forearm of a healthy upper limb, with 3-5 procedures add simultaneous exposure to TA er-jian (CI II 2) in the area of the brush on the affected side of the upper limb the second version of the inhibitory method and in TA tsiu-xu (VB XI 40) in the area of the foot of the affected lower limb by the second variant of the exciting method, while during physical exercises, an additional correction of the position of the hand and foot is carried out, which consists in the extension of the fingers of the upper limb and hand by the exercise therapy instructor, and its correct location, as well as passively active flexion and extension of the foot in the ankle joint; treatment of motor disorders begins from 1-7 days after verification of ischemic stroke, the course of treatment is 12-15 procedures carried out according to 1 procedure daily.