RU2648876C1 - Method of treatment of children with spastic paralysis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to restorative medicine, and can be used in the treatment of children with spastic paralysis, including the consequences of infantile cerebral palsy (ICP) and perinatal affection of the nervous system. For the purpose, the patient is determined by the required movement direction and amplitude of the segments of the feet and hands relative to the shin and forearm in the joints in the frontal, sagittal and horizontal planes. Set the feet and hands to the desired position. Gypsum negatives are made, then gypsum positives are made based on gypsum negatives. After that, orthopedic devices are made for the distal sections of the lower and upper limbs with hinges at the level of the ankle and wrist joints, respectively. During the manufacture of the apparatus, the patient is given a massage and exercise therapy, then the orthopedic devices are put on the limbs and placed in an aqueous medium, hydrotherapy is performed including elements of various methods of swimming.

EFFECT: method provides an effective complex recovery of movement functions in children with spastic paralysis at the level of distal limbs, reduction of stiffness in the joints, correction of the movement functions of the distal sections of the upper and lower limbs, and also provides the necessary ranges and expedient directions of movements in the ankles and wrist joints in the process of hydro-rehabilitation.

1 cl, 2 ex, 1 dwg

Description

The invention relates to medicine, namely to reconstructive medicine - a method for treating children with the consequences of cerebral palsy (cerebral palsy) and perinatal damage to the nervous system, characterized by multiple paresis, paralysis of limb muscles, pathological settings, contractures in the joints of the limbs. The most commonly affected are the distal upper and lower extremities.

Known conservative, surgical, medical methods of treating children with the consequences of cerebral palsy and some other lesions, characterized by the occurrence of increased muscle tone. Among conservative methods, the most widespread methods are those involving physiotherapeutic procedures, massage and physiotherapy exercises (exercise therapy) [1, 2, 3, 4].

These methods contribute to some restorative development of normal postures and movements, proprioceptive neuromuscular relief.

The disadvantages of the known methods of treatment are low efficiency, the inability to achieve sufficiently intensive proprioceptive stimulation and reflex relaxation of skeletal muscles.

Also known is a conservative method such as orthosis [5], which allows for the correction of the amplitude and direction of movements in the joints. However, it is often not used in combination with other methods, which reduces their effect on the child's body.

A known method of treating children with spastic paralysis, including with cerebral palsy and perinatal lesions of the nervous system [5]. The method is based on the fact that, along with massage and exercise therapy, the child conducts therapeutic swimming lessons with the child. The method allows to reduce stiffness in joints, increase volumes of active movements and range of motion in joints, increase hemodynamics in muscles and ligaments, strengthen musculoskeletal, respiratory systems of a child. However, this method does not allow for therapeutic swimming to carry out movements of the affected limbs in planes and ranges, as normal, and not in the pathology that is present in sick children. In addition, this method is designed only for the treatment of children in the first two years of life.

There is a method of treating children with spastic paralysis of various ages using massage, exercise therapy and hydrotherapy - performing motor exercises in water, including swimming, which is selected as a prototype [6]. It allows a greater degree of improvement in the effectiveness of rehabilitation and habilitation, reduces stiffness in joints, increases the volume of active movements and range of motion in joints, increases hemodynamics in muscles and ligaments in children of both nursery, preschool and school age. The disadvantages of this method is that when performing various exercises in water, such as walking, arm movements, exercises with movement elements of different swimming methods, a child having affected distal segments of the limbs, accompanied by pathological settings in the ankle and wrist joints, performs movements in planes corresponding not to norm, but pathology. Moreover, the amplitude of movements in the joints is not regulated and often exceeds the amplitude of the corresponding movements in the child is normal. And the more actively the exercises are carried out, the sooner the positions are fixed, the vicious positions of the feet and hands are increased. In this case, the pathological development of the musculoskeletal and muscular apparatus of the extremities occurs, leading to secondary deformations in the joints and a violation of the entire musculoskeletal system.

The technical task of the invention is to ensure the effectiveness of the comprehensive restoration of motor functions in children with the consequences of cerebral palsy at the level of the distal extremities, to reduce stiffness in the joints in cases of their limitedness, to correct the motor functions of the distal upper and lower extremities, to provide the necessary ranges and appropriate directions of movements in the ankle and wrist joints during hydrorehabilitation, as well as magnify hemodynamics in the muscles and ligaments, strengthen the musculoskeletal and respiratory system of the child, and thus improve the child's well-being, increase its activity in the universal life, reduce disability.

The stated technical tasks are achieved due to the fact that first (at the beginning) the specific patient determines the required directions and amplitudes of movements in the frontal, sagittal and horizontal planes, which should be carried out according to medical indications by segments of the feet and hands relative to the lower leg and forearm in the ankle and wrist joints, respectively , set feet and hands in the required position, make gypsum negatives, then make gypsum positives on them, and then make ortho pedagogical devices to the distal parts of the lower and upper extremities with hinges at the level of the ankle and wrist joints, respectively, verify the position of the hinges in the planes in which the movements in the hinges will occur, and the range of movements in them in accordance with the previously defined required directions and appropriate ranges, and after massage and exercise therapy put orthopedic devices on the limbs, place the child in the aquatic environment and carry out hydrorehabilitation, including elements of various swimming methods.

The presence of distinctive essential features allows us to conclude that the invention meets the patentability criterion of "novelty."

The claimed technical solution is not obvious to a specialist, which allows us to conclude that the claimed invention meets the criterion of "inventive step".

The claimed invention can be made of known materials using known means, which allows us to conclude that the claimed invention meets the patentability criterion of "industrial applicability".

In FIG. 1 shows a child in the process of performing exercises in an aqueous environment. To increase the effectiveness of classes in the process of hydro rehabilitation, the child is equipped with orthopedic devices on the lower 1 and upper 2 limbs. In FIG. 1 in the region of the lower and upper extremities, the planes A (sagittal), B (horizontal), B (frontal), and also the angles α and β are the ranges of movements of the lower and upper limbs, respectively. The child in the aquatic environment with arm 3 is supported by an assistant coach. The ability to move limbs in the shown planes and angles is due to the use of elastic polymer joints in orthopedic devices, since they provide limb movement in three-dimensional space.

The orthopedic apparatus is made individually from materials that, in their specific gravity, are less than or equal to the specific gravity of water, that is, the apparatus itself should not sink in water. The child, wearing the apparatus, does not feel its severity, the apparatus does not interfere with the performance of any exercises in the aquatic environment, but, on the contrary, contributes to the correct setting of the limbs during the exercises. The assistant coach does not need to monitor the position of the limbs, the device adjusts the range of their movements. Constant exercises in the aquatic environment with the use of orthopedic devices on the lower and upper limbs help to consolidate the movements of the limbs of the child, bringing them closer to the normal position. At the same time, the attention of the assistant coach is focused on ensuring that the child correctly holds his head and back so that the movements of the limbs are synchronous.

The claimed method can be carried out as follows.

A child with pathologies of the musculoskeletal system at the level of the distal parts of the lower extremities is located on an orthopedic couch, where the required directions and ranges of movement in the ankle joints of one or two limbs, traditional for the child, are determined, then a negative is made using plaster bandages giving each foot the necessary position, then using the negatives, they get the positives and after processing them make an orthop -periodic machines using elastic polymer hinges with certain ranges of flexion in them, and the direction in which the bending can be carried out, setting them at the level of the ankle. During the manufacturing time of the apparatus, the child is given massage and exercise therapy. Then, if necessary, and the testimony of an orthopedic surgeon, one or two orthopedic devices are put on and the child is placed in the aquatic environment, where hydrorehabilitation is carried out, including elements of various swimming methods, taking into account the particularities of the child’s disease. It should be noted that these orthopedic devices should be made specifically for swimming, that is, in the manufacture of devices should be used the main and auxiliary elements that do not change their characteristics when the device is in the aquatic environment.

In a similar manner, a method of treatment is carried out in a child with lesions of the distal upper limbs. In this case, to remove the negative, the child sits on a chair in front of the orthopedic couch, puts his hand or hands (in case of a pair of lesions) on the couch, and the orthopedist, using plaster bandages, removes the negative from one or two hands of the child.

With combined lesions of the upper and lower extremities, operations to remove the negative are carried out sequentially, starting with the lower extremities.

As the child undergoes treatment or physiological growth, when there are changes in the initial parameters, medical indications regarding changes in the required directions and ranges of movements in the joints of the child's limbs, the necessary correction is introduced into the orthopedic devices or, if significant changes are made, new devices are made.

The following are specific examples of testing the claimed method for the treatment of diseases of the musculoskeletal system in children with spastic paralysis.

Example 1

Diagnosis: perinatal damage to the central nervous system of mixed origin, recovery period, mild cerebral palsy, spastic diplegia, equinovarus installation of both feet. The child was admitted for treatment at the age of 4 years. Previously, doctors recommended only massage and exercise therapy for treatment.

From the anamnesis: second child from twins of the first pregnancy, reduced weight at birth.

The doctor’s recommendation is that after a massage and exercise therapy, classes on hydrorehabilitation with swimming elements in individually made orthopedic devices on the lower limbs. The removal of gypsum negatives and the manufacture of positives.

During the massage and exercise therapy, the child was made orthopedic devices on both lower limbs. During the swimming process, the trainer's special attention was paid to the work of the lower extremities in the orthoses. Swimming was carried out using the elements of the crawl method. After 10 swimming sessions, a decrease in the installation deformation of both the varus and equinus of both feet was observed. When examining a child, it was found that movements in the ankle joints are carried out in directions significantly shifted closer to normal, pathological settings of the feet decreased. In addition, a good stability of the sick child was noted both when approaching the pool and when walking along the bottom of the pool.

Example 2

Examination of the child by an orthopedic surgeon.

The child was admitted for treatment at the age of 5 years.

Diagnosis: right-sided paroparesis.

Recommendations: massage, exercise therapy and swimming with orthopedic devices on the wrist joint of the right hand and the ankle joint of the right leg.

Negatives and positives were produced. During the massage and exercise therapy, the child was individually made orthopedic devices for the wrist joint of the right hand and the ankle joint of the right leg.

Swimming was carried out by the "crawl" method.

As a result of treatment using hydrorehabilitation in orthopedic devices, stiffness in the wrist and ankle joints of the affected extremities decreased, perverse installations in them decreased.

Testing examples have shown the effectiveness of using the proposed method of treatment using orthopedic devices.

The proposed method for the treatment of lesions of the distal extremities in children with spastic paralysis, paresis, which includes the stages of massage, exercise therapy and hydrorehabilitation using individual orthopedic devices, has shown the greatest treatment effectiveness.

On the basis of testing, recommendations were issued on the use of orthopedic devices in the swimming process and the sequence of the proposed method for the treatment of lesions of the distal extremities in children with spastic paralysis, in particular with the effects of cerebral palsy.

The use of an orthopedic apparatus in the treatment process using swimming techniques allows orthopedic correction in the ankles and wrist joints of the limbs and does not allow an excessive increase in the range of movements, deviations of the amplitude from the amplitude characteristic of normal movements, and regulate the correct directions of movement of the limbs and trunk as a whole.

The greatest effectiveness in treating lesions of the distal extremities in children with spastic paralysis, including the consequences of cerebral palsy, is achieved with the following sequence: massage, exercise therapy, hydrorehabilitation with swimming elements in orthopedic devices.

The proposed method of complex conservative treatment of children with the use of orthopedic devices in the process of hydrorehabilitation provided an improvement in the condition of patients, an increase in their activity in everyday life, a decrease in vicious attitudes, normalization of the upper and lower extremities, and approximation of the amplitudes of movements in the child's ankle and wrist joints to normal, ensuring movements in these joints on medically required planes.

After the rehabilitation using the proposed method, proprioceptive stimulation, reflex relaxation improved, and disability indicators decreased.

Thus, the advantages of the invention - a method for the treatment of children with spastic paralysis - compared with the prototype is:

- complex conservative treatment, including the stages: massage, exercise therapy, hydrorehabilitation with swimming elements in orthopedic devices;

- the possibility of using the proposed method for children and adolescents of different ages from 1 year to 18 years;

- the use in the process of hydrorehabilitation of individually manufactured orthopedic devices, which leads to an increase in patient activity in everyday life, a decrease in vicious attitudes, normalization of the upper and lower extremities and approximation of amplitudes in the child’s ankle and wrist joints, to ensure movements in these joints in the medical conditions required indications of planes;

- obtaining a socio-economic effect by reducing the patient’s disability as a result of improved proprioceptive stimulation, reflex relaxation, and also by reducing the time period of treatment or rehabilitation in medical institutions.

Information sources

1. Gallyanova I.A. The effect of medical swimming on the physical health of children with cerebral palsy // Scientific community of students of the XXI century. Humanities: Sat. Art. based on the materials of the XI international student scientific-practical conference, No. 11. URL sibac / info / archive / humanites / 11 / pdf.

2. Comprehensive rehabilitation of children with cerebral palsy (guidelines). - St. Petersburg: Peter, 2005, 285 p.

3. RF patent 2113204. A method for the treatment of cerebral palsy. Priority from 03/17/1997.

4. RF patent 2582873 C1. A method for the treatment of cerebral palsy in children. Priority of March 25, 2015.

5. Semenova K.A. Reconstructive treatment of children with perinatal damage to the nervous system and cerebral palsy. / Semenova K.A. - M .: LAW AND ORDER, series Great Russia, Heritage, 2007, 616 pp., Ill., P. 128-137.

6. www.prodetey.ru/9164-metodika-reabilitatsii-dtsp-plavanie.

Claims (1)

A method of treating children with spastic paralysis by means of massage, exercise therapy and hydrorehabilitation, which includes elements of different swimming methods, characterized in that first, first, a particular patient is determined the required directions and amplitudes of movements in the frontal, sagittal and horizontal planes, which should be carried out on medical indications of segments of the feet and hands relative to the lower leg and forearm in the ankle and wrist joints, respectively, establish the feet and hands in the required position, make gypsum negatives, then make gypsum positives on them, and then make orthopedic devices for the distal parts of the lower and upper extremities with polymer joints at the level of the ankle and wrist joints, respectively, align the positions of the joints in the planes in which movements will occur in the joints , and the range of motion in them in accordance with the previously defined required directions and appropriate ranges and, after massage and exercise therapy, put on orthopedic devices on the limbs, place the child in the aquatic environment and carry out hydrorehabilitation, including elements of various swimming methods.

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