RU2572550C1 - Method for forming vertical posture and walk in patients with para- or tetraparesis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: movements of exercises are performed slowly and accompany static voluntary muscle stretch; the stretched muscles are hold tensed for 5-7 seconds, and then relaxed; the exercises are repeated 3-5 times. The first training involves performing five exercises in accordance with the patent claim: standing with voluntary body stretch along a vertical axis; head rotations to the right and left; head inclinations sideways and forward; slow pulling and stretch of arms sideways, lifting up of arms alternately with the spinal columns as straight as possible. The second training provides doing the above exercises added with: body rotations and inclinations to the right and left; body weight transport from one leg to another, heel-to-toe, and full-circle to one and other sides; alternate knee flexions and extensions with feet tightly pressed to a support; alternate leg swings back and forth and sideways; waking with a stable additional support back and forth with cross-coordination; sidesteps sideways. Starting from the third training, the exercises are added with outward and side lunging, skip jumps, standing on an instable platform, and diaphragmal respiration. The first training lasts for 10 minutes, and the following ones - for 30 minutes.

EFFECT: method provides forming the vertical posture and walk in the patient with para- or tetraparesis by creating a feel of support when standing or walking, a feel of joint flexion and extension, posture improvement, sensitivity of paralysed parts of body, postural regulation, higher range of active joint motions, reduced pathological synkineses, flexion walk settings in spastic disorders, improved knee closure in walking of the patients with flaccid paralysis, improved function of patient's internal organs.

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Description

The invention relates to medicine, namely to rehabilitation medicine, can be used to treat patients with damage to the central nervous system, motor disorders.

A characteristic feature of such patients is a combination of motor and sensory disorders, which significantly complicates the process of restoring postural and motor activity. Meanwhile, the patient’s quality of life directly depends on his ability to maintain a posture and move independently. Each new movement, the development of each new pose open up new opportunities for him. Most patients after an injury to the central nervous system have biomechanical and neurophysiological capabilities to maintain a vertical posture, mastering walking with and without additional support. However, only a few realize this opportunity.

Methods for the formation of motor functions in people with disabilities with a pathology of the central nervous system, in particular for patients with spinal cord injury [Method for the formation of motor functions in people with disabilities with spinal cord injury / Konovalova NG, Leontyev MA, Frolenko S. YU. - Patent for invention No. 2392915, IPC А61Н 1/00, А61Р 25/00, А61К 31/4015, publ. 06/27/10 Bull No. 18]. The method involves medical gymnastics to strengthen the muscle corset in the supine position, sitting, verticalization, movement on the suspension, analytical gymnastics for key muscle groups, laying in a reducing position, manual development of contractures while taking nootropic drugs.

The advantage of this method is that physical effects aimed at stimulating the recovery and replacement processes in the central nervous system occur while taking pharmacological drugs that improve blood supply and trophic nerve tissue.

The disadvantage of this method is that its use does not provide fixation of the trunk and limbs in the correct position, does not affect the afferent flow from the organs of support and movement.

A known method of forming stability in a sitting position in patients with statodynamic disturbances [A method of forming stability in a sitting position in patients with statodynamic disturbances / N.G. Konovalova, M.A. Leontiev, E.V. Stepanova, I.V. Shupenko. - Patent for invention No. 2448670, IPC А61Н 1/00, publ. 04/27/2012, Bull No. 12]. In this case, the patient trains postural regulation using visual feedback through a stabilograph and a computer.

The disadvantage of this method is that it does not create an additional afferent flow to the central nervous system and does not provide for the fixation of the musculoskeletal system in a functionally advantageous position.

There is a method for the rehabilitation of neurological patients with motor disorders [The method of medical-conductive rehabilitation of neurological patients with motor disorders: RF patent for the invention No. 2242959, IPC A61H 1/00, Isanova V.A. from 10/30/2000. Application No. 2000127273/63]. The method is based on the organization of movement in the proximal-distal direction in diagonal samples. In this case, reciprocal relationships are formed, weakened muscles are activated.

The disadvantage of this method is that it does not affect the sensitivity of paralyzed parts of the body, does not provide for the formation of a feeling of reliance on the feet when standing and walking, and does not affect postural regulation.

A known method of using the pneumatic suit "Atlant" for the rehabilitation of patients [Isanova V.A. New innovative technologies of medical and social rehabilitation in the conditions of rehabilitation institutions: a methodological manual. - Kazan: MRZ RT, 2007. - 4-6 p.]. The advantage of the method proposed in the methodological manual is that motor activity improves, muscle contractures and spasticity decrease, the range of movements increases, and blood circulation improves.

The methodological manual contains a description of the modes of using the Atlant suit for patients, taking into account the possibilities of movement and holding the posture, and a separate regimen for patients with hemiparesis. The mode 2 is described, intended for patients with motor impairment, able to move with the help of technical means over short distances. The mode includes: putting on a suit, sitting-standing adaptation, walking with additional support on crutches (walkers) for 15-20 minutes, performing movements for the distal parts of the upper limbs using the PNF method in the initial position, standing with support on the upper limbs and speaking out complex sentences when speech impairment.

Patients with para- and tetraparesis have their neurophysiological and clinical features, which determines the need to create a separate way to restore the vertical posture and walking, based on the safe rehabilitation potential of these patients and the capabilities of the Atlant suit.

The disadvantages of the method:

1. Does not use vestibulotonic and ceynotonic reflexes.

2. Does not use arbitrary traction of the body and limbs along the axis, which allows you to include deep muscles, normally responsible for maintaining the posture.

3. Does not use smooth, slow movements that allow you to include the maximum number of muscle fibers in your work.

4. Does not use exercises in a standing position on an unstable support, which allows you to effectively mobilize the patient's sensory and motor potential.

5. When practicing with patients with flaccid paraplegia, he does not use objects to change the mass-inertial characteristics of the patient’s body and to achieve a facilitating, complicating or corrective effect when learning to walk.

The objective of the invention is the formation of a vertical posture and walking in patients with para- or tetraparesis.

The task is achieved by the method of forming a vertical posture and walking in patients with para- and tetraparesis by performing a complex of physical exercises in a Atlas pneumosuit.

The movements of the exercises are performed slowly, against the background of a static strong-willed muscle tension, hold tension for 5-7 s, followed by relaxation, the exercises are repeated 3-5 times. At the same time, in the first lesson, the first five exercises are performed: standing with an arbitrary stretching of the body along the vertical axis: the feet are pressed to the floor, the crown extends upward, the physiological curves of the spine are maximally straightened; turning the head to the right and left; tilting the head to the sides and forward; slow removal of the arms, stretching them to the sides to the tips of the fingers, alternately raising the arms, while the raised arm stretches up, the other down, the spine is straightened as much as possible.

In the second lesson, the exercises are added to the first five exercises: turns and tilts of the body to the right and left; transfer of body weight from one leg to another, from heels to socks, in a circle in one and the other direction; alternating bending and extension of the legs without taking off the feet from the support; alternate swings with legs back and forth and to the sides; walking with a stable additional support forward and backward, observing cross coordination: the right hand - the left leg and vice versa; walking by step in one direction and the other.

Starting from the third lesson, exercises are added to the listed exercises: lunges forward and to the sides, jumps, standing on an unstable support, diaphragmatic breathing.

The duration of the first lesson is 10 minutes, the next 30 minutes.

In patients with lower flaccid paraparesis, in the last three lessons of the treatment course, when doing walking exercises, weights and / or skis are put on the lower third of the leg.

As an unstable support, a paperweight type support is used.

Exercises are performed using additional support depending on the condition of the patient.

The novelty of the method:

- The movements of exercises are performed slowly, against the background of a static strong-willed muscle tension, hold tension for 5-7 s, followed by relaxation, the exercises are repeated 3-5 times. This allows you to include deep muscles, normally responsible for maintaining the posture, as well as to include the maximum number of muscle fibers in the work.

- In the first lesson, perform the first five exercises, and then add. At the same time, in the first lesson they perform: standing with an arbitrary stretching of the body along the vertical axis: the feet are pressed to the floor, the crown extends upward, the physiological curves of the spine are straightened to the maximum; turning the head to the right and left; tilting the head to the sides and forward; slow removal of the arms, stretching them to the sides to the tips of the fingers, alternately raising the arms, while the raised arm stretches up, the other down, the spine is straightened as much as possible.

- In the second lesson, the exercises are added to the first five exercises: turns and tilts of the body to the right and left; transfer of body weight from one leg to another, from heels to socks, in a circle in one and the other direction; alternating bending and extension of the legs without taking off the feet from the support; alternate swings with legs back and forth and to the sides; walking with a stable additional support forward and backward, observing cross coordination: the right hand - the left leg and vice versa; walking by step in one direction and the other.

- Starting from the third lesson, exercises are added to the listed exercises: lunges forward and to the sides, jumps, standing on an unstable support, diaphragmatic breathing. Exercises on an unstable support effectively mobilize the patient's sensory and motor potential.

- The duration of the first lesson is 10 minutes, the next 30 minutes. In patients with lower flaccid paraparesis, in the last three lessons of the treatment course, when doing walking exercises, weights and / or skis are put on the lower third of the leg.

- As an unstable support use support type paperweight.

- Exercises are performed using additional support, depending on the condition of the patient.

The method allows to obtain a new technical result, which consists in the formation of a vertical posture and walking in patients with para- or tetraparesis due to the formation of a feeling of support on the feet while standing and walking, a feeling of flexion and extension in the joints of the limbs, improved posture, sensitivity of paralyzed parts of the body, postural regulation, increase the volume of active movements in the joints of the limbs, reduce pathological synkinesia, flexion settings when walking with spastic disorders and improve the closure Nia in the knee joint during walking in patients with flaccid paresis, improvement of the internal organs of the patient.

The Atlant suit creates additional stimulation of proprioceptors, provides soft external fixation of the joints of the limbs and spine. In combination with gymnastics, including slow movements with arbitrary traction along the axis of the body and limbs, the use of additional devices to facilitate, correct and complicate the conditions for maintaining a vertical posture and walking, the use of the Atlant suit opens up opportunities for restoring or improving a vertical posture and mastering or correcting a biped locomotion in patients with para- and tetraparesis.

The method is as follows.

To perform physical exercises, a Atlas pneumatic suit is put on the patient. Neuro-orthopedic rehabilitation pneumosuit “Atlant”, which is produced by the company “NPO“ Dinafors ”Law Firm CJSC Address: 1/28, Moscow, Atlant.dynaforce.ru, Old Petrovsko-Razumovsky pr-d. The suit is a jumpsuit with sleeves. Pneumatic chambers are located in the jumpsuit of the tight-fitting silhouette, located along the muscles of the antagonists of the trunk and limbs. After injection into the air chambers, the suit tightly compresses the patient’s body, which activates tactile, baro- and proprioceptors and forms a powerful afferent flow into the central nervous system. This stimulates the α-γ-motor neuron system and creates neurophysiological conditions for maintaining the posture, with subsequent restructuring of the supraspinal motor control systems to a physiological state closer to normal. The suit provides soft external fixation and correction of the vertical posture due to the dilution of the shoulder joints, straightening the spine.

The suit helps to extinguish pathological reflexes and allows you to give a measured load on the muscles. By creating compression in the trunk and extremities, it stimulates tactile and baroreceptors, enhances the proprioceptive flow into the central nervous system. As a result, the muscular-articular feeling is formed, the reaction of motor neurons is ordered. All this creates neurophysiological conditions for maintaining posture and performing movements, with the restructuring of supraspinal motor control systems to a physiological state closer to normal. Physical exercises that activate vestibulo-and cervicotonic reflexes, slow movements with arbitrary traction of the body and limbs along the axis allow using the generated proprioceptive flow to restore (form) postural and locomotor stereotypes. Directional changes in the mass-inertial parameters of the human body, facilitating and complicating the conditions for performing exercises, expand the patient's motor capabilities. As a result, postural and locomotor stereotypes improve.

By creating external pressure in the chest and abdominal region, the suit creates resistance to the expansion of the chest on inspiration, stimulating the diaphragmatic component of breathing, and helps to normalize intra-abdominal pressure. As a result, the best conditions for the work of internal organs are created, the normal ratio of the tone of the parasympathetic and sympathetic parts of the autonomic nervous system is restored, the function of external respiration, the work of the cardiovascular system and the gastrointestinal tract are improved.

They introduce the patient to the technical and physiological properties of the suit. Measure the patient’s pulse, blood pressure, put on a suit, in the initial position, standing or lying down, depending on the patient's motor capabilities. The initial heart rate and blood pressure before training in a suit should be within the physiological norm for the patient. They pump air into the chamber of the suit with a pneumatic compressor. Adaptation to the costume 1 min.

The patient is asked to perform all movements slowly, against the background of static volitional muscle strain. Each exercise is repeated 3-5 times. Hold tension for 5-7 seconds, followed by relaxation, the exercises are repeated 3-5 times. Classes begin with exercises aimed at maintaining a vertical posture. Then they proceed to the exercises that prepare the patient for walking, perform various types of walking, lunges, and jumps. End the lesson with exercises on balance and exercises in diaphragmatic breathing.

In the first lesson, the first five exercises are performed.

1. Standing with an arbitrary stretching of the body along the vertical axis: the feet are pressed to the floor, the crown extends upward. The physiological curves of the spine are maximally straightened.

2. Turning the head to the right and left.

3. Tilts the head to the sides and forward.

4. Slow abduction of the arms, stretching them to the sides to the tips of the fingers.

5. Alternate raising of the hands. In this case, the raised hand stretches up, the other down. The spine is as straight as possible.

In the second lesson, the exercises are added to the first five exercises:

6. Turns and tilts the body to the right and left.

7. Transfer of body weight from one leg to another, from heels to socks, in a circle in one and the other direction.

8. Alternate bending and extension of the legs without taking off the feet from the support.

9. Alternate swings of legs back and forth and to the sides.

10. Walking with a stable additional support forward and backward, observing cross-coordination: the right arm is the left leg and vice versa.

11. Walking with a step in one direction and the other. In the third lesson, add the remaining exercises.

12. Lunges forward and sideways.

13. Hops.

14. Standing on an unstable paperweight support.

15. Diaphragmatic breathing.

The first lesson lasting 10 minutes aims at adapting the patient to a pneumosuit, mastering the correct posture and static volitional muscle tension.

The duration of the second lesson is increased to half an hour. During this lesson, patients perform the first 9-11 exercises. At each subsequent lesson, the amplitude of movements is increased, attention is paid to posture correction in the frontal and sagittal planes, the elimination of excess synkinesias, the additional support is reduced, up to the complete elimination, if the patient's condition allows it.

Patients with lower flaccid paraparesis in the last three lessons of the treatment course, when performing walking exercises, use the weights in the lower third of the lower leg to facilitate the removal of the lower leg when walking and / or skiing to stimulate the back flexion of the feet in the phase of transfer.

Next, air is released from the chambers, and gradually, over a period of 10-15 s, adaptation takes 1-3 minutes. Repeatedly measured blood pressure, pulse, an assessment of overall health.

Example 1. Patient U-va O.I., 50 years old. Diagnosis: traumatic disease of the spinal cord, late period (trauma in 2011), as a result of dislocation of the C ₅ vertebra. Partial conduction disturbance syndrome in the spinal cord from level C ₅ segments. Type "D". Before starting classes in the Atlant pneumatic suit, the patient could sit without additional support on her back and arms, but could not perform turns and inclinations from a sitting position. She could stand and move with the help of unstable additional support, the movements were uncertain, slow. Spasticity on the Ashfort scale - 3 points. O-va O.I. within 10 days I was engaged in medical gymnastics in a pneumosuit “Atlant” according to the method described above. During the first lesson, the patient was trained to breathe correctly and strain the necessary muscle groups while standing in the uneven bars for 10 minutes; she completed 5 exercises. During the second lesson, she performed 9 exercises. Then, starting from the third lesson, the patient performed a full range of physical exercises in the uneven bars. In each subsequent lesson, the amplitude of movements was increased, paying attention to posture correction in the frontal and sagittal planes, conducted exercises to improve walking skills, and completed exercises with equilibrium exercises. The exercise was repeated 3-5 times, the duration of the second and subsequent classes was 30 minutes.

After 10 lessons, the patient became more confident to sit without additional support, was able to perform simple movements in a sitting position. Stiffness in the spine decreased, active movements in the joints became more free. The patient began to feel better support on the feet. Improving walking was manifested by an increase in speed, walking became more cosmetic. Coordination of movements improved: the patient began to easily change stride length, direction and walking speed. It became easier for the patient to breathe, breathing rate decreased by 3 per minute, heart rate - by 12 per minute.

Output. As a result of performing a set of physical exercises in the Atlant pneumatic suit according to the proposed method, the patient formed a more effective sitting stereotype for 10 days, improved posture, improved motor stereotypes, and it became possible to change walking parameters.

Example 2. Patient With about OS, 20 years. Diagnosis: traumatic brain disease, an intermediate period, as a result of severe brain contusion. Spastic tetraparesis, coarser on the left, cerebellar disturbances. Post-traumatic encephalopathy.

Before starting classes in the “Atlant” pneumosuit, the patient was uncertainly sitting without resting on her arms and back, she could not perform any actions in this position. She could stand on her own with a wide support base, periodically falling back and to the left. Moved independently, adhering to the caregiver. The gait was spastic-paretic, discoordinated, there was always a fear that it would fall. Stiffness while walking was noted.

S-o.S. within 10 days I was engaged in medical gymnastics in a pneumosuit “Atlant” according to the method described above. At the beginning of the course, classes were held in uneven bars, the patient was trained to breathe correctly and to strain the necessary muscle groups simultaneously with the arbitrary stretching of the body along the vertical axis. In the first lesson, she performed 5 exercises lasting 10 minutes. In the second lesson, the patient performed physical exercises in the uneven bars, she was added 6 subsequent exercises and began to form the correct walk, observing cross-coordination. From the third lesson, the patient performed a full range of exercises. At each subsequent lesson, the amplitude of movements was increased, attention was paid to the formation of correct posture, improvement of walking skills, and classes were completed with balance exercises. The exercise was repeated 3-5 times, the duration of the session did not exceed 30 minutes.

After 10 lessons, the patient's severity of coordinating disorders decreased, she became more confident in standing and sitting without support. Walking improved by increasing speed, reducing the asymmetry of steps and stiffness. Cross movements of arms and legs appeared while walking. In the last lesson, the patient was able to move along the corridor without additional support.

Output. As a result of classes in therapeutic gymnastics in the Atlant suit according to the proposed method, during 10 days the patient’s movements became more coordinated, focused, postural regulation in sitting, standing, walking, and cross coordination of upper and lower extremities was restored. The degree of paresis in the lower extremities decreased.

Example 3. Patient F-va Yu.V., 38 years old. Diagnosis: traumatic disease of the spinal cord, late period (trauma in 2011), as a result of a fracture of L ₁ vertebra. Partial spinal conduction disorder syndrome from level L _{3 of the} segment. Type "D". Before starting classes in the “Atlant” pneumosuit, the patient could confidently sit without additional support, could perform turns and inclinations from a sitting position. She could stand and move with the help of unstable additional support. The movements are not coordinated, not rhythmic, slow, periodically the opening of the left knee joint occurred. When standing and walking, the patient strongly involved the shoulder girdle and upper limbs.

The patient spent 10 days doing therapeutic exercises in a pneumatic suit “Atlant” according to the method described above. At the beginning of the course, the patient was trained to breathe and strain the right muscle groups, stretching the body along the vertical axis. Exercises were performed while standing in the uneven bars. In the first lesson, she performed 5 exercises lasting 10 minutes. Then the patient performed exercises that prepared for proper walking, various types of walking, lunges, and jumps. In the second lesson, the number of exercises was increased by 5. From the third lesson, the patient performed a full range of exercises. At each subsequent lesson, the amplitude of movements was increased, attention was paid to posture correction in the frontal and sagittal planes. The last three classes for performing exercises in walking the patient put weighting on the lower third of the legs and skis. We finished classes with exercises on an unstable support such as a paperweight. The duration of the lesson did not exceed 30 minutes.

After 10 lessons, the patient experienced an increase in muscle strength in the distal and proximal parts of the lower extremities, which led to an increase in the motor score by 6. An increase in the locomotor score was 1. The patient learned to close the left knee joint when walking, which led to an improvement in the biomechanics of standing and walking . The patient mastered standing without additional support and was able to perform simple exercises in a standing position. Improving walking skills was manifested by an increase in the speed of movement and the confident closure of both knee joints in the support phase. It became easier for the patient to tolerate the lower legs and appeared dorsiflexion of the feet in the phase of transfer.

Output. As a result of performing a set of physical exercises in the Atlant pneumatic suit according to the proposed method, the patient improved postural standing stereotype and walking walking stereotype for 10 days, the movements became more balanced, the amplitude of movements and walking speed increased.

In this way, 68 patients were treated. Similar results were obtained in the treatment of other patients with traumatic disease of the spinal cord and brain, para- or tetraparesis. According to a neurological examination, motor score increased in 67% of patients, locomotor score in 25%.

After a course of therapeutic exercises in the Atlant suit, all patients developed a feeling of support on the feet while standing and walking, and there were feelings of flexion and extension in the joints of the lower extremities. All showed an improvement in posture due to a more symmetrical distribution of muscle tone in the right and left halves of the body, a decrease in excess chest kyphosis and lumbar lordosis, a pelvic angle, and formation of cervical lordosis. In patients with motor disorders of the spastic type, there was a decrease in flexion settings in the joints of the limbs. Patients with sluggish type disorders noted an improvement in biomechanical closure in the knee joints.

All patients improved locomotor skills: walking became more cosmetic, confident, cross movements of arms and legs formed, the position of the body and head straightened. Pathological synkinesia was significantly less pronounced than before the start of classes. In particular, patients with a cervical level of damage to the spinal cord stopped performing excessive movements of the same shoulder girdles to initiate step movements. All examined learned to change the pace and direction of movement.

Comparison of stabilograms before and after treatment of patients (table) showed a statistically significant decrease in the area (S) and length (L) of the statokinesiogram after a course of training in a pneumosuit.

The proposed method is used at the Federal State Institution Novokuznetsk Scientific and Practical Center for Medical and Social Expertise and Rehabilitation of Persons with Disabilities to restore the postural and locomotor functions of people with disabilities with traumatic disease of the spinal cord and brain, para- or tetraparesis.

Claims (5)

1. A method of forming a vertical posture and walking in patients with para- or tetraparesis by the patient performing a set of physical exercises in an Atlant pneumatic suit, characterized in that the movements of the exercises are performed slowly, against the background of a static strong-willed muscle tension, hold tension for 5-7 c, followed by relaxation, the exercises are repeated 3-5 times,
at the same time, in the first lesson, five exercises are performed:
standing with an arbitrary stretching of the body along the vertical axis: the feet are pressed to the floor, the crown extends upward, the physiological curves of the spine are maximally straightened; turning the head to the right and left; tilting the head to the sides and forward; slow abduction of the arms, stretching them to the sides to the tips of the fingers, alternately raising the arms, while the raised arm stretches up, the other down, the spine is maximally straightened;
in the second lesson, the exercises are added to the first five exercises: turns and tilts of the body to the right and left; transfer of body weight from one leg to another, from heels to socks, in a circle in one and the other direction; alternating bending and extension of the legs without taking off the feet from the support; alternate swings with legs back and forth and to the sides; walking with a stable additional support forward and backward, observing cross coordination: the right hand - the left leg and vice versa; walking by step in one direction and the other;
starting from the third lesson, the exercises are added to the listed exercises: lunges forward and to the side, jumps, standing on an unstable support, diaphragmatic breathing. 2. The method according to p. 1, characterized in that the duration of the first lesson is 10 minutes, the next 30 minutes. 3. The method according to p. 1, characterized in that patients with lower flaccid paraparesis in the last three lessons of the course of treatment when performing exercises in walking, put on the lower third of the leg lower weight and / or ski. 4. The method according to p. 1, characterized in that as an unstable support use support type paperweight. 5. The method according to p. 1, characterized in that the exercises are performed using additional support, depending on the condition of the patient.