RU2572751C2 - Method for assessing hip proprioception deficiency - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: examined hip joint (HJ) is positioned under visual control at an angle equal to a half of potential range of motion in the plane (A). The patient reproduced this position that is the angle in the examined plane (B) only using proprioception without visual control. The angles are measured by means of a biological feedback unit of Trust-M BOS rehabilitation-diagnostic apparatus; the number of reproduction attempts is preset. A rate of reproduction errors (C) in modulus in each attempt is calculated by formula: (A-B)/A×100% = /C/. An average rate of errors of all the attempts reflexes a degree of the examined HJ proprioception deficiency in this plane.

EFFECT: method provides the simple non-invasive quantitative assessment of proprioception deficiency in any joint and plane in patients of different ages.

2 ex, 10 tbl

Description

The invention relates to medicine, namely to traumatology and orthopedics.

Proprioreception allows the body to perceive and evaluate the change in the relative position of body parts and their movement. Therefore, this sensitivity will be impaired in patients with damage to the musculoskeletal system.

From the literature, methods for evaluating this type of sensitivity are known.

To assess somatosensory sensitivity, a fully relaxed finger, the researcher should passively move it from the lateral surfaces with minimal pressure. The test finger should be separated from other fingers. In this case, the patient is not allowed to make any active movements with his fingers. If the sense of movement or position in the fingers is lost, you need to explore more proximal parts of the body. Normally, the subject should determine the movement in the interphalangeal joints with a range of 1-2 ° (Neuropathology / Badalyan L.O. Textbook for students of higher educational institutions - 7th edition corrected - M .: Publishing Center "Academy", 2012. - 400 from.). The disadvantage of this method was the inability to quantify the sensitivity violation. Muscular-articular sensation can be checked in another way: the patient’s hand or fingers are given a certain position, and the patient’s eyes should be closed; then the patient is asked to describe the position of the hand or simulate this position with the other hand. Next technique: arms extended forward; in case of violation of the muscular-articular feeling, the affected arm makes wave-like movements, falls or does not reach the level of the other arm (Neurology and Neurosurgery / edited by A.N. Konovalov, A.V. Kozlov; E.I. Gusev, A.N. Konovalov, V.I. Skvortsova: Textbook: - vol. 1. - 2009. - 624 p.). As in the previous case, there is no way to quantify the impaired sensitivity, this technique is difficult when studying violations in the lower extremities.

There is a method of objective evaluation of the proprioreceptive function of capsule-ligamentous structures in patients with injuries of the knee joint in a closed kinematic circuit using the stabilometric method (Vetrile VS, Kosov I.S., Orletsky A.K. Stabilometry as a method for evaluating proprioception in case of damage to the capsule-ligamentous apparatus of the knee joint // Bulletin of Traumatology and Orthopedics named after N.N. Priorov. - 2002. - No. 2. - P. 38-41). However, this method evaluates the entire complex involved in maintaining the balance of the body, including, in addition to the somato-sensory receptors, also visual, vestibular analyzers, not allowing an isolated study of muscular-articular reception.

The technical result of the proposed method lies in the fact that the hip joint under visual control is given a position equal to half the possible amplitude of movement in the studied plane, after which the patient reproduces this position using only proprioreception, without the control of the visual analyzer, while the entire study is fixed using the module biological feedback of the rehabilitation and diagnostic complex Trust-M BOS; spend several attempts, and then calculate in each attempt the percentage of playback errors by the formula:

(A-B) / A × 100% = / B /,

where A is the angle in the investigated plane, equal to half the possible amplitude of movement of the joint in the patient;

B - the angle in the investigated plane, which the patient could reproduce in this attempt;

/ B / - percentage of error reproducing angle A in this attempt, without taking into account the sign, which is compared with the values of the percentage of errors in the contralateral joint.

The essence of the proposed method is as follows.

The patient reveals the range of motion in the examined joint. For accurate estimation of the initial amplitude of movements in the hip joint and data recording, the Trust-M complex is used for the diagnosis, treatment, and rehabilitation of patients with motor pathology, since it allows recording angles in joints in three planes simultaneously. In the module with biological feedback of the Trust-M rehabilitation and diagnostic complex, half of the detected amplitude of movement is set. A patient under control of vision must reproduce a given angle, while the patient can control the accuracy of reproduction on the monitor screen. Next, the patient should, with his eyes closed, perform the installation of the joint to the desired angle, using only proprioreception.

The percentage of errors is calculated by the formula

(A-B) / A × 100% = / B /,

where A is the angle in the investigated plane, equal to half the possible amplitude of movement of the joint in the patient;

B - the angle in the investigated plane, which the patient could reproduce in this attempt;

/ B / - percentage of error reproducing angle A in this attempt, without taking into account the sign (modulo).

The patient makes several attempts. The average value of the errors of all attempts will reflect the degree of insufficiency of proprioception of the studied hip joint. To take into account individual characteristics, a similar study is carried out in the contralateral joint (angles A should be the same as those of the studied joint) and the results are compared.

This method allows quantitatively (in percent) to reflect the lack of reception in any joint and any plane, which allows the use of this method in rehabilitation in patients with orthopedic, traumatological and neurological profiles. It does not take much time and does not extend the examination time when registering biomechanical parameters. It is not invasive and allows the assessment of changes in the sensitivity of the capsule-ligamentous apparatus in both adults and children.

Example 1. Patient V., 56 years old. Pain in the right inguinal region has been disturbing for about 5 years. It was treated on an outpatient basis for about 3 years. In the last 2 years noted an increase in pain, an increase in the severity of contracture. According to the clinical X-ray examination, the patient revealed right-sided coxarthrosis of the third art. (according to the classification of N.S. Kosinskaya), flexion-leading contracture of the right hip joint (movements according to the SFTR method (through zero) S: 0-10-110; F: 30-0-10; R: 30-0-30) . Pain syndrome, measured on a visual analogue scale - 8 points. Patient prepare for arthroplasty of the hip joint. Referral to the Biomechanics laboratory in Ivanovo is associated with the need to assess a violation of proprioception to form a rehabilitation program in the postoperative period.

The revealed data on the assessment of somatosensory sensitivity are presented in the appendix (tables 1, 2, 3, 4, 5). There were 5 attempts to reproduce the angle. The calculation of the percentage of execution errors of each attempt was carried out according to the formula: (A-B) / A × 100% = / B /, where

A - angle in the studied plane, equal to half the possible amplitude of movement of the joint in the patient;

B - the angle in the investigated plane, which the patient could reproduce in this attempt;

/ B / - percentage of error reproducing angle A in this attempt, without taking into account the sign (modulo).

The average value of five attempts was compared with the values of a healthy contralateral joint.

During the examination, the volume of the bending amplitude (sagittal plane) is 100 °, therefore A was determined as 50 ° (50% of the amplitude of movement). This angle will be set for the right (patient) and for the left joints. Since extension is not possible in the joint under study, this study was not conducted. The values of A were calculated similarly for other planes of motion in the joint. So, the volume of the amplitude of the leads (frontal plane) is 30 °, therefore A is 15 °, the reductions are 10 °, therefore A is 5 °, the amplitude of the external rotation (horizontal plane) is 30 °, therefore A is 15 °, the internal rotation is 30 °, therefore A - 15 °.

After evaluating the somatosensory sensitivity by the above method, a deficiency of propriosensitivity in the sagittal plane in flexion was 21.6% ± 4, frontal in the abduction position - 37% ± 5, adduction - 28% ± 4, horizontal - 14% ± 2.4 in position of both external and internal rotation. The revealed data indicate a violation of sensitivity in all planes (more pronounced in the frontal). This shows a higher proprioreceptive instability of the hip joint in this plane.

Example 2. Patient S., 34 years old. In childhood, she was treated in the children's orthopedic department for dysplasia of the left hip joint. Joint pain worries about 4 years, appeared after the birth of a child. Treated conservatively. In the last year, she noted an increase in pain, an increase in the severity of restriction of movements. According to the clinical X-ray examination in a patient - left-sided dysplastic coxarthrosis of the III stage. (according to the classification of N.S. Kosinskaya), flexion-reducing contracture of the left hip joint (movements according to the SFTR method S: 0-0-80; F: 20-0-10; R: 25-0-25). Pain syndrome, measured on a visual analogue scale - 7 points. Patient prepare for arthroplasty of the hip joint. Referral to the Biomechanics laboratory is associated with the need to assess proprioreception disorders to form a rehabilitation program in the postoperative period.

The revealed data on the assessment of somatosensory sensitivity are presented in the appendix (tables 6, 7, 8, 9, 10). The calculation of the percentage of execution errors of each attempt was carried out according to the formula (A-B) / A × 100% = / B /, where A is the angle in the studied plane, equal to half the possible amplitude of the joint movement in the patient; B - the angle in the investigated plane, which the patient could reproduce in this attempt; / B / - percentage of error reproducing angle A in this attempt, without taking into account the sign (modulo). The average value of five attempts was compared with the values of a healthy contralateral joint.

During the examination, the volume of the bending amplitude (sagittal plane) is 80 °; therefore, A was determined as 40 ° (50% of the amplitude of motion). This angle will be set for the right (patient) and for the left joints. Since extension is not possible in the joint under study, this study was not conducted. The values of A were calculated similarly for other planes of motion in the joint. So, the volume of the amplitude of the leads (frontal plane) is 20 °, therefore A is 10 °, the reductions are 10 °, therefore A is 5 °, the amplitude of the external rotation (horizontal plane) is 25 °, therefore A is 12 °, the internal rotation is 25 °, so A is 12 °.

After evaluating the somatosensory sensitivity by the above-described method, a deficit of propriosensitivity in the sagittal plane in flexion was 16.5% ± 1, frontal in the abduction position - 36% ± 2, adduction - 36% ± 4, horizontal in the position of internal rotation 18% ± 1, 5, external rotation - 20 ± 1.5. The revealed data indicate a violation of sensitivity in all planes (more pronounced in the frontal). This shows a higher proprioreceptive instability of the hip joint in this plane.

Thus, the proposed method provides the following features:

1. quantitative assessment of the lack of proprioreception;

2. assessment of somatosensory sensitivity in any plane;

3. allows you to conduct research in both adults and children, is not invasive;

4. use in patients with neurological and orthopedic-traumatological profile in the treatment and rehabilitation.

application

Claims (1)

A method for assessing the insufficiency of the proprioceptor apparatus of the hip joint, including giving the studied joint a certain position, characterized in that at first the joint under control of vision is given a position at an angle equal to half the possible amplitude of movement in this plane (A), after which the patient reproduces this position - angle in of the studied plane (B), using only proprioreception without vision control, the angles are fixed using the biofeedback module of the Trust-M BOS complex, perform a given number of playback attempts, the percentage of playback errors (B), modulo, in each attempt, calculated by the formula: (A-B) / A × 100% = / B /, with the average the value of the percentage of errors of all attempts reflects the degree of insufficiency of proprioception of the studied hip joint in this plane.