RU2651100C1 - Orthoses for hydro-rehabilitation of children with spastic paralysis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medical technology, namely to prosthetic and orthopaedic appliances, and is intended for orthotics of children and adolescents with various pathologies of the distal segments of lower extremities with a predominant increased muscle tone. Orthosis for the hydro-rehabilitation of children with spastic paralysis contains polymeric sleeves for shin and foot, connected by polymeric elastic ankle joints, the elements of fastening the hinges with sleeves. Elements of fastening the ankle joints to the sleeves for shin and foot are made of polymeric materials. Inner surface of the sleeves is lined with an antibacterial film. In the back calcaneal region of the sleeves for shin and foot there are cavities, one above the other, in which quadrangular nuts are located, made of a polymer material, one of which is with a left thread and the other with a right thread. Nuts are connected together by a stud made of polymer material, which has threads at the ends corresponding to the nuts. In the middle part of the stud, a tetrahedron is made, by means of which an angle α is set, between the conditioned center of the elastic ankle joint and the edges of the sleeves. Change in the angle α leads to an adequate change in the angle β between a horizontal line passing through the center of the calcaneal bone and a line parallel to the instep bone. Nuts, the stud and the tetrahedron form an adjusting device that moves freely in the cavities of the sleeves for shin and foot. Contours of the cavities in the sleeves for shin and foot have ends curved inwards with the possibility of retaining the nuts, and a lower surface of the foot sleeve has a sole made of a polymeric material with hemispherical depressions, located in the heel and toe region, and equipped on the lower surface with wavy corrugations in the transverse and longitudinal directions. In the sole holes, along the frontal plane parallel to the lower surface,are made passing through the upper ends of the hemispherical depressions. All elements of the orthosis are made of materials with specific gravity less than or equal to the water specific gravity and their weight fraction is chosen taking into account that the orthosis was kept on the water surface. Inner surface of the foot sleeve is made with transverse and longitudinal coverings.

EFFECT: invention provides an opportunity to carry out hydro-rehabilitation with various elements of swimming, special exercises in the water environment for children with spastic paralysis of the distal segments of limbs, while providing the orthopedic correction of the foot position relative to the shin specified by therapeutic indications, movement with a specified amplitude in the corrected directions, hygienic and safety.

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Description

The invention relates to medical equipment, in particular to prosthetic and orthopedic products, and is intended for orthosis of children and adolescents with various pathologies of the distal lower extremities with a predominant increase in muscle tone, including those arising from cerebral palsy (cerebral palsy), the consequences of traumatic brain injuries (TBI), encyphalitis, an early organic lesion of the central nervous system (CNS), with congenital malformations of the brain.

Currently, in the field of theory and practice of rehabilitation of children with injuries of the musculoskeletal system, much attention is paid to hydrorehabilitation with swimming elements and the development of new exercises for teaching children motor movements in the aquatic environment [1]. In children, the distal parts of the lower extremities are most often affected, and for most children with such lesions of the musculoskeletal system, characterized by spastic paralysis, both mild and moderate forms of damage, hydrorehabilitation with swimming elements is, for medical reasons, one of the important components of a comprehensive rehabilitation.

There are a number of hydrorehabilitation techniques with therapeutic swimming elements for children with spastic paralysis. However, when they are applied, movements in the joints of the lower and upper extremities when a sick child is in water occur along trajectories and in ranges that do not coincide with the paths and ranges of movements in normal, but in such ranges and planes that are dictated by pathological settings, neuromuscular disorders and other manifestations of lesions of the musculoskeletal system. This is especially manifested in the distal extremities. Moreover, such movements can aggravate the manifestations of the pathological development of the patient’s neuromuscular-muscular system, especially in childhood, and lead to the appearance of secondary deformations.

Therefore, for patients with lesions of the distal parts of the lower extremities, it is advisable to carry out hydrorehabilitation with swimming elements in the orthoses that have joints at the ankle joint level that direct the movements of the limb along the necessary and corrected medical path and in a certain range.

In the event that there is a pathology of the distal parts of the upper extremities, with hydrorehabilitation, it is advisable to use orthoses on the wrist joint.

However, the currently existing orthoses have a number of disadvantages that impede their use in the process of hydrorehabilitation with swimming elements.

For example, orthoses are known that are formed by manufacturing a metal frame consisting of strips, while metal joints are located at the level of the joints, and inside the frame there are leather sleeves connected to the frame with metal rivets [2]. When immersed in water, the liners of such orthoses are saturated with moisture and lose their properties, and the metal parts rust. Therefore, such orthoses cannot be used for hydrorehabilitation with elements of swimming or bathing.

Known orthoses with sleeves made of sheet polymer materials [3]. Such sleeves do not absorb moisture, but they also have metal joints with the above disadvantages. In addition, metal joints in the aquatic environment, even with the slightest oxidation of the metal, become stiff and interfere with movements in the joint. It should be borne in mind that in pools there is a rather aggressive environment accelerating the processes of oxidation. The execution of plastic sleeves due to the reduced coefficient of friction creates a situation in which the patient may fall, for example, when approaching the pool on the tile. In addition, the used ankle joints (metal) create movements in only one sagittal plane, which in the case of spastic paralysis prevents some necessary movements in the horizontal and frontal planes. These movements must be carried out with a subsequent return to the starting position, otherwise the patient will feel uncomfortable and he may experience an exacerbation of spastic processes.

Known orthosis [4] with shin and foot sleeves made of a polymer material, elastic polymer joints, fastening elements. This orthosis makes it possible to carry out spatial movements relative to the ankle joint in the necessary ranges. However, the attachment of the polymeric hinges to the sleeves in the known orthosis is metal, which does not allow the apparatus to be used in an aqueous medium during hydrorehabilitation, for example, in a pool. In addition, when in the aquatic environment, fungal and salt deposits may appear, including on the inner surface of the polymer sleeve, which violates the hygiene requirements of the product. Another disadvantage is the very low coefficient of friction at the foot sleeve in contact with the floor surface when approaching the pool and in the pool itself. The design of the well-known orthosis does not allow translating, if necessary, the sleeve of the foot into the equinus position, which may be required when swimming with the "crawl" style or vice versa, bringing the foot into a bent position - both for medical reasons and if it is possible to swim with the "breaststroke" style. In addition, in the known orthosis, the adjustment of the range of motion in the ankle joint is not provided.

The implementation of the lower inner surface of the sleeve of the foot without laying does not contribute to a reasonable, from the point of view of medical indications, unloading of the foot and the formation of the arch of the foot.

The technical task of this invention was to develop an orthosis in which hydrorehabilitation with various swimming elements can be carried out, special exercises in the aquatic environment for children with spastic paralysis of the distal extremities, while ensuring, according to medical indications, orthopedic correction of the position of the foot relative to the lower leg, movement with a given amplitude in adjusted directions, increased hygiene and safety.

This object is achieved in that the fastening elements of the ankle joints to the shin and foot sleeves are made of polymer materials, and the inner surface of the sleeves is lined with an antibacterial film, while in the back calcaneal region of the shin and foot sleeves there are cavities, one above the other, in which the tetrahedral nuts are located made of polymeric material, one of which is left-handed and the other is right-handed, the nuts are interconnected by a stud made of polymeric material having ends corresponding to the nuts a flange, and in the middle part of the hairpin a tetrahedron is made, with the help of which the angle α is established between the conditional center of the elastic ankle joint and the edges of the sleeves, and the change in the angle a leads to an adequate change in the angle β located between the horizontal line passing through the center of the calcaneus, and with a line parallel to the metatarsal bone, while the nuts, stud and tetrahedron form an adjusting device that moves freely in the cavities of the calf shafts and feet, while the contours of the cavities in the shin sleeves and the feet have sides, bent inward with the possibility of holding nuts, and the lower surface of the foot sleeve has a sole made of a polymer material with vacuum hemispherical recesses located in the heel and toe areas, and provided on the lower surface with undulations in the transverse and longitudinal directions, with corrugations this in the sole are made along the frontal plane parallel to the lower surface of the hole, passing through the upper ends of the hemispherical recesses, and all the elements of the orthosis Execute from materials with a specific weight less than or equal to the specific gravity of water and the weight fraction is selected in view of the fact that the brace is held on the water surface and the inner surface of the foot sleeve is provided with transverse and longitudinal calculations. At the same time, the color range of materials is selected that does not increase the irritability of sick-blue, green tones.

In FIG. Figure 1 shows an orthosis for the rehabilitation of children with spastic paralysis.

The orthosis for hydrorehabilitation consists of shin sleeves 1 and foot 2, the inner surfaces of which are covered with an antibacterial film 3, shin and foot sleeves are interconnected by polymer hinges 4. Hinges are attached to the shin and foot sleeves using fasteners 5. In the back calcaneal region between the sleeves adjusting device 6 is located in the lower leg and foot. The foot sleeve has a sole 7 with hemispherical recesses 8 and holes 9. The lower surface of the sole 7 is made with wave-shaped corrugations 10 in the longitudinal and transverse m directions.

The orthopedic apparatus is mounted on the patient by attaching 11 the lower leg 1 mounted on the sleeve using a polymer rivet 12. The inner surface of the foot sleeve is made with longitudinal and transverse laying of the foot arch 13, which leads to uniform unloading and the formation of the foot arch.

In FIG. 2 shows a back section of an orthosis. In the sleeves of the lower leg 1 and foot 2, in their posterior calcaneal region, cavities 14 and 15 are located, respectively, for installing the adjusting device 6, which consists of two tetrahedral nuts of polymer material - the upper 16 and lower 17, one of which is on the left, and another with right-hand thread. The nuts are interconnected by a stud made of polymer material 18, having a thread corresponding to the nuts at the ends, and a tetrahedron 19 is made in the middle part of the stud, while the contours of the sleeves of both the lower leg and the feet forming the cavities have bumps 20 and 21 bent inward, which gives the ability to hold nuts. To protect the impact of nuts on the rear inner surface of the shin and foot sleeves in the respective cavities, a tongue 22 is provided, which is fastened with waterproof glue to the lower back of the foot sleeve in its cavity 15. The adjusting device 6 in the sleeve cavities is held by the sides 20, 21 in the orthosis. Under the nuts 16 and 17, washers 23 are made of an elastic polymeric material, for example, polyurethane, to mitigate the impact.

Due to movement - by turning the tetrahedron located on the hairpin, the necessary initial position of the foot relative to the lower leg and the range of motion in the ankle joint, which is determined by the angle α, are established. It is located between the center of the elastic ankle joint and the edges of the sleeves, and a change in the angle α leads to an adequate change in the angle β, located between the horizontal line passing through the center of the calcaneus and the line of the parallel metatarsal bone, as shown in FIG. 2.

In FIG. Figure 3 shows an orthosis fragment - view A from the side of the bottom surface of the sole 7, with the arrangement of hemispherical recesses 8, holes 9 and corrugations 10 on it.

Ankle joints 3 are made of a polymer composition and have an original shape in the form of a four-petal figure. Moreover, they are made of various stiffness and various sizes, which allows you to set them depending on the need to achieve certain parameters of movement in the ankle joint. This design of the ankle joint allows you to reliably connect the sleeve of the leg and foot and, at the same time, makes it possible to move the ankle joint to the required size in three-dimensional space. The adjustment device is used to set the required range of motion in the ankle joint, as well as to create the necessary position of the foot relative to the lower leg when using the orthosis.

The cavities in the shin and foot sleeves have a volume in which the nuts, when using the orthosis, move somewhat freely in the space of the cavity and, at the same time, cannot completely rotate around the axis of the pin, holding onto the internal walls of the cavities.

The use of polymeric elastic joints in the orthosis, as well as the proposed adjusting device, which controls the angle of flexion in the ankle joint, allows you to act on the equine installation, carry out movements in predetermined directions, move the foot to the position necessary to perform swimming exercises during hydrorehabilitation.

Thus, in the process of swimming, the patient’s foot will be able to move in the ranges and directions of motion specified by the orthopedic surgeon.

The adjusting device, consisting of lower and upper nuts, studs with a tetrahedron are made of a polymer material, for example, caprolon, which ensures the absence of a reaction to the aquatic environment, strength and reliability.

The use of hemispherical depressions in the plantar of the foot improves the adhesion of the orthosis to the wet surface of the pool floor or shower room, and the openings improve the evacuation of hemispherical depressions when rolling the foot when walking or when the center of gravity changes when the patient is in a static position.

The sole design is made of lightweight polymer, for example, foamed polyethylene, which on the one hand has a certain strength and, on the other hand, sufficient flexibility and elasticity, which allows rolling the foot from the heel to the toe and damping when walking.

At the same time, holes in the frontal plane are made parallel to the lower surface and passing through the upper ends of the hemispherical recesses, which regulates the process of evacuation with hemispherical recesses when standing and walking.

The proposed design of the sole of the orthosis and its corrugated surface in the longitudinal and transverse directions increase the child's safety in the process of hydro rehabilitation. The presence of washers under the stud nuts softens the blows, and laying out the arches in the sleeve of the foot improves their comfort and ensures the formation of the arches of the foot.

An antibacterial film that is applied by sintering on the inner surface of the shin and foot liners protects the patient's skin from the possibility of diaper rash, redness and the acquisition of various fungal diseases in the pool.

For the manufacture of an orthosis for hydrorehabilitation of children with spastic paralysis, materials were selected so that their specific gravity was less than or equal to the specific gravity of water and their weight fraction was selected taking into account that the orthosis was held on the surface of the water.

The use of the proposed orthopedic product increases the efficiency of comfort and ease of use in the rehabilitation of children with spastic paralysis.

A similar design, but without a sole and sleeves on the forearm and hand, has an orthosis on the wrist joint in case of damage to the distal parts of the upper limb.

To enhance the therapeutic effect and increase the functional load on the lower extremities, the orthoses are equipped with swimming devices, for example, fins. First, the orthoses are put on the patient, and then the fins are put on the orthoses. Flippers dress immediately before the child is immersed in water.

In order to confirm the advantages of the present invention - an orthosis for hydrorehabilitation of children with spastic paralysis, they were tested.

For this purpose, in accordance with medical indications, an experimental batch of individual orthoses was made (5 pieces) and transferred to the experimental group (4 people aged 2 to 14 years). The tests were carried out in the pool under the supervision of attending physicians, orthopedic surgeons of the enterprise LLC PROP MP ORTEZ and a doctor-instructor for hydrorehabilitation.

Testing of orthopedic devices took place from November 2016 to May 2017. Patients were advised to visit the pool 4 times a week. Hydro rehabilitation of children was carried out using the existing technique involving swimming exercises.

Clinical example

R-va Anna 10 years old with a diagnosis of cerebral palsy, right-sided paraparesis of the distal extremities, equinus installation of the foot. The patient made orthoses for the ankle and wrist joints. Moreover, according to medical indications, ankle polymer joints of medium stiffness with predominant movement in the sagittal plane were selected. The patient underwent a course of hydrorehabilitation with swimming elements of the "crawl" style. The patient in the process of hydrorehabilitation was in orthoses on the ankle and wrist joints.

As a result of observations, it was established that the orthoses make it possible to provide movements in the corrected position. All movements have become closer to normal. At the same time, the comfort of using the orthoses, the convenience of their removal and dressing were noted. Good adhesion to the floor was noted when approaching the water, as well as with the bottom of the pool. Design failures, abrasions of the skin, naminas during examination were not noted.

During the inspection and walking tests after the course of hydrorehabilitation with the use of orthoses, its more effective effect on the main characteristics of the patient’s movements was noted than according to the results of a previous course of hydro rehabilitation without the use of orthoses.

Testing of all applied orthoses has shown their high functionality in the process of hydro rehabilitation. It is noted that when using orthoses, it is possible to provide the range of movements necessary for medical indications in the ankle joint, moreover, in the directions and ranges corrected for medical indications. This significantly increases the effectiveness of rehabilitation, prevents the development of secondary deformities. When performing swimming exercises individually, using the rotation of the tetrahedron, the angle a in the ankle joint was established, in accordance with the requirements of the doctor.

In the absence of the need to provide a hard-set definite angle in the ankle joint in one of the children, the orthosis for this child was made without an adjusting device, and the initial angle was set by installing an elastic polymer ankle joint.

The comfort and safety of using orthoses was confirmed. The sleeve of the foot of the orthosis on the ankle joint did not slip on the floor in the pool and when approaching it. Patients noted the convenience and ease of orthoses and ankle joint.

Inspection of children after testing showed that the use of orthoses made it possible to expand the indications for the use of orthoses, due to the ability not only to use orthoses in everyday life, but also to effectively use them during hydrorehabilitation, when swimming, to expand the number of components of comprehensive rehabilitation, thereby speeding up the healing process . No signs of abrasion, diaper rash and other violations of the skin in children after a visit to the pool were observed.

In the process of testing the prototypes of devices, breakdowns, failures in the work was not observed. There were no complaints from sick children and their parents.

The results of clinical examinations showed that the tested orthoses provide high efficiency of their use in the rehabilitation process. Using orthosis of children in the process of hydrorehabilitation with a mild and moderate form of pathology of the distal lower extremities, it is possible to significantly reduce pathological manifestations.

Thus, the presented invention, an orthosis for hydrorehabilitation of children with spastic paralysis, is an effective, functional, high-quality tool that can improve the quality and speed up the rehabilitation of children with disabilities, and the rehabilitation period passes for a child with positive emotions.

The advantages of this invention over the prototype are:

1. All elements of the orthosis, including ankle joints, fasteners, adjusting device, are made of polymer material.

2. The inner surface of the sleeve of the lower leg and foot is covered with an antibacterial film.

3. The sleeve of the foot is made with the laying of the inner surface, which leads to the unloading of the foot and the formation of the arch of the foot.

4. Designed adjusting device, which makes it possible to move the foot to the desired position and move in a certain range. The use in the orthosis of polymer elastic ankle joints, as well as a designed adjustment device that adjusts the angle of flexion in the ankle joint, allows you to act on the equinus installation, move the foot to the position necessary to perform swimming exercises during hydrorehabilitation.

5. When using the proposed orthosis in the process of hydrorehabilitation, the range of movements required in the ankle joint, medically necessary, is provided, moreover, in planes and ranges corrected for medical indications.

6. The foot sleeve has a sole having hemispherical recesses and openings, as well as a corrugated lower surface, which improves the safety of use.

7. The use of materials for the manufacture of an orthosis with a specific gravity less than or equal to the specific gravity of water increases the comfort and convenience of using the orthosis during the hydro-rehabilitation of children with spastic paralysis.

8. The use of orthosis in children during hydrorehabilitation with a mild to moderate form of pathology of the distal parts of the lower extremities makes it possible to significantly reduce pathological manifestations, eliminate secondary deformations of the musculoskeletal system, and also expand the indications for the appointment of orthoses, the number of components of complex rehabilitation, thereby speed up the healing process.

9. The use of orthosis of children in the process of hydrorehabilitation provides an increase in the socio-economic effect by reducing the duration of the rehabilitation period.

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. Orthopedic apparatus for ankle joint ANO-01. Handbook of prosthetics. Leningrad, Medicine, 1978, p. 209.

3. Orthopedic and orthopedic center, "Ankle joint device for patients with cerebral palsy, Voronezh, http://ortosom.ru/bez-rabriki/apparat-na-golenostopnyj-sustav/

4. An cut on the ankle joint for children with the consequences of cerebral palsy. Patent of the Russian Federation No. 2320299, 03/27/2008 Bull. No. 9.

Claims (2)

1. An orthosis for the rehabilitation of children with spastic paralysis, comprising polymeric shin and foot sleeves connected by polymer elastic ankle joints, hinge fastening elements with sleeves, characterized in that the ankle hinge fastening elements to the shin and foot sleeves are made of polymeric materials, and the inner surface the sleeves are lined with an antibacterial film, while in the posterior calcaneal region of the shin and foot sleeves there are cavities, one above the other, in which tetrahedral nuts are located, made of a polymeric material, one of which is left-handed and the other is right-handed, the nuts are interconnected by a polymer material stud having a thread corresponding to the nuts at the ends, and a tetrahedron is made in the middle part of the stud, with the help of which the angle α between the conditional center is established elastic ankle joint and the edges of the sleeves, and a change in the angle α leads to an adequate change in the angle β, located between the horizontal line passing through the center of the calcaneus and the line parallel to the metatarsal th bone, while the nuts, stud and tetrahedron form an adjusting device that moves freely in the cavities of the calf and foot sleeves, while the contours of the cavities in the calf and foot sleeves have sides that are bent inward to hold the nuts, and the lower surface of the foot sleeve has a sole made of a polymeric material with hemispherical recesses located in the heel and toe areas, and provided on the bottom surface with undulations in the transverse and longitudinal directions of the corrugations, while in p the soles are made along the frontal plane parallel to the lower surface of the hole, passing through the upper ends of the hemispherical recesses, and all the elements of the orthosis are made of materials with a specific gravity less than or equal to the specific gravity of the water and their weight fraction is selected taking into account that the orthosis is held on the water surface, and the inner surface of the sleeve of the foot is made with transverse and longitudinal calculations. 2. An orthosis for hydrorehabilitation of children with spastic paralysis according to claim 1, characterized in that for strengthening the therapeutic effect and increasing the functional load on the lower limbs of the patient, the orthoses are equipped with swimming devices-flippers.

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