RU2711429C1 - Method for overcoming hyperactivity in children and device for its implementation - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to the field of medicine, namely neurology. What is presented is a method for overcoming hyperactivity in children characterized by demonstrating a video sequence which is emotionally positively perceived by a child. Then the child's body displacement is measured in three spatial axes, the current value of the body displacement is compared to a pre-set individual threshold, and the video sequence is stopped in periods when the value of movement of the body of the threshold is exceeded.EFFECT: invention provides solving the problem of minimizing spontaneous hyperactive movements of a child not related by consciousness or purpose of movements.11 cl, 2 ex, 8 dwg

Description

Technical field

The invention relates to medicine, specifically to neurology, and relates to a method for improving the treatment of children with attention deficit hyperactivity disorder (ADHD) by developing a new, stable form of motor behavior using the conditioned reflex method (operant conditioning). The proposed method is implemented using hardware.

State of the art

Hyperactivity is described as unorganized, unregulated, and excessive motor activity (ICD 10 - International Classification of Diseases of the 10th Revision. WHO, Geneva, 1995). Hyperactivity is either an independent symptom, or manifested in combination with attention deficit disorder in children. A neurophysiological mechanism that provokes hyperactivity is a deficiency of inhibitory effects, mainly of a dopaminergic nature, in the medial and precentral parts of the prefrontal cortex (Shaw P, Lerch J, Greenstein D, et al. Longitudinal Mapping of Cortical Thickness and Clinical Outcome in Children and Adolescents With Attention-Deficiency / Hyperactivity Disorder. Arch General Psychiatry. 2006; 63: 540-9). It is these brain structures that provide attention control and organization of behavior.

There are two main ways to overcome the pathogenetic mechanisms of hyperactivity: pharmacological and neurocorrection. Among the pharmacological preparations with proven effectiveness, Stratter (amotoxylin hydrochloride), Ritalin (methylphenidate) and amphetamine group preparations (Adderall and others) are distinguished. However, these and other drugs have side effects, and their effect is not prolonged, that is, it is limited only by the duration of the drug, which is several hours. Methods of psychological correction, methods of physical action on the brain (electrical and magnetic stimulation), and methods of biological feedback (neurofeedback) are referred to neurocorrection methods of overcoming hyperactivity. The latter are not associated with direct physical effects on the brain and are aimed at optimizing bioelectric processes in the brain of a child: increasing the severity of the alpha rhythm and reducing the severity of beta and theta ranges (Fedorenko E.V. Application of the method with biological feedback in primary school children with the syndrome attention deficit hyperactivity disorder // Successes in modern natural sciences. - 2013. - No. 8. - p. 30-32). These hardware methods require a long course of therapy, their effectiveness in the long term is comparable to pharmacological effects (Kropotov JD, Grin-Yatsenko VA, Ponomarev VA, Chutko LS, Yakovenko EA, Nikishina I. ERPs correlates of EEG relative Beta training in ADHD children // Int. J. Psychophysiology. 2005. No. 55. P. 23-34). The advantage of neurocorrection methods is the absence of side effects, as well as the long-term manifestation of the effect after stopping the course of therapy. In general, the effectiveness of existing methods aimed at overcoming childhood hyperactivity remains insufficiently high, which stimulates the development of new ways to correct this condition. For example, in the patent application of the Republic of Korea No. 1020140095763, a video sequence with game content was used to test children with attention deficit hyperactivity disorder. In the method for correcting attention deficit hyperactivity disorder according to the patent of the Russian Federation No. 2395313, correction is carried out by means of a pulsed color effect with a changing frequency. A known method and system for the diagnosis and treatment of attention deficit hyperactivity disorder (application PCT / IL2003 / 000173), providing for the impact on the patient of many gradually increasing visual computer stimuli to which he must physically respond, and the patient is promptly informed by auditory and visual messages (feedback) regarding the speed and accuracy of their reactions. Feedback messages are addressed to the patient’s consciousness and are stimulating in nature, forming his desire to improve his reactions, bringing them closer to the age norm. The treatment method described in the application is implemented exclusively in the conscious sphere of perception.

There is a method of correcting motor and mental functions in children with attention deficit hyperactivity disorder (patent RU 2457783, the closest analogue), which consists in setting the patient on a stable platform, with which the body movements are recorded when the child performs arbitrary movements determined by the game situation. Thus, the correction method in the cited patent is aimed at including an increasing volume of motor activity in the sphere of consciousness, through consciously controlled hand-eye coordination. The method has limited effectiveness, since the effect is aimed at the consciousness-related sphere of the patient's motor behavior, while the main problem of children with hyperactivity is excessive consciousness-uncontrolled, spontaneous, non-purposeful movements that require minimization. At the same time, conscious purposeful movements in children with hyperactivity are not an object requiring correction, because quite accurate and coordinated. In addition, the method of recording the movements of a child using a stable platform used in the method according to patent RU 2457783 determines the movement of body parts only in the sagittal horizontal plane, and does not display movement along the vertical axis. Therefore, the stable platform does not allow to register a number of typical spontaneous movements in children with hyperactivity, namely the rotation of the head along the axis of the spine and the rotation of the hands along the axis of the forearm, if they are lowered down along the body. During these movements, there is no significant shift in the projection of the center of mass, and the stabilized platform does not register this kind of movement. In the context of the method claimed in the cited patent, these properties of the stabilized platform are not of great importance. However, in relation to the claimed solution, the method of analyzing the movements of the child described in the cited patent cannot be used, since the latter excludes from the analysis a significant part of spontaneous movements due to the structural features of the stable platform, which is unacceptable.

The claimed invention is aimed at solving the problem of minimizing spontaneous hyperactive movements of the child, not associated with the consciousness or purpose of the movements. Minimization of precisely these movements can overcome the pathogenetic mechanism of the disease.

Disclosure of the invention

To solve this problem, the claimed method of overcoming hyperactivity in children is characterized by the fact that they demonstrate a video sequence that is emotionally positively perceived by the child, measure the amount of movement of the child’s body along three spatial axes, compare the current amount of movement of the body with a predetermined threshold and stop demonstrating the video sequence in periods of exceeding the magnitude of the displacement of the body of the set threshold.

Implementation of the proposed method ensures the achievement of a technical result - the reduction of spontaneous hyperactive movements of the child.

Moreover, the measurement of the amount of movement of the child’s body along the three spatial axes is more accurate compared to the measurement of the movement of the center of pressure of the feet of the child, as in the invention of the Russian Federation No. 2457783, and allows a complete assessment of the movements of the child in space. Performing measurements of the movements of the human body along three spatial axes, for example, using a three-axis accelerometer, is known and described, for example, in RF patents No. 2593983 and No. 2546407.

The use of demonstration of a video sequence, such as a film or a computer game, and its termination as positive and negative reinforcement, as unconditional incentives for encouragement and “punishment,” has been used in clinical practice for a relatively long time, in particular, to restore visual acuity in amblyopia (USSR copyright certificate No. 1688867, patent US 6033073), for training the muscles of the nasopharynx in order to get rid of snoring (patent US 8460159). It is also known to use the start and stop of a computer game as incentives for the correction of physiological functions, for example, according to RF patents No. 2061508 and No. 2457783.

A causal relationship between the set of essential features and the technical result provided by the invention is manifested in the fact that the implementation of the impact in accordance with the proposed method leads to the emergence of a new form of motor behavior due to the development of a stable reflex mechanism, which externally manifests itself in minimizing spontaneous hyperactive movements.

In the particular case, the threshold value is set individually and equal to 20% of the values of body movements measured during one minute.

In another particular case, the measurement of the magnitude of the movements of the body is carried out using a device based on a three-axis accelerometer and made with the possibility of fixing on the body of a child.

In another particular case, to measure the magnitude of the movements of the body, a smartphone or tablet is used that contains the displacement sensor, which is in the hands of the child.

In another particular case, a movie, a slide show or a computer game is used as a video sequence.

In another particular case, sessions to overcome hyperactivity are carried out for a duration of 15 to 30 minutes daily, with a total number of at least 15.

A device for implementing a method of overcoming hyperactivity in children comprises a video display device and a device for measuring the amount of movement of the child’s body, including a sensor that determines the amount of movement of the child’s body along three spatial axes, a computing device connected to the output of the sensor, and means for transmitting measurement data to footage display device.

As a sensor that determines the magnitude of body movements, a three-axis accelerometer can be used, which generates continuous signals in time that characterize the movement of the body along three spatial axes.

The computing device can be a microcontroller, with the ability to receive signals from the device for measuring the magnitude of the body’s movement, converting the analog signal to digital form, filtering the signal to select frequencies characteristic of the child’s overall motor activity, summing the signals along three separate spatial axes, integrating the signal with a constant time 1 sec., calculating the threshold of hyperactivity and constant comparison of the signal from the device for measuring the amount of displacement bodies with a threshold of hyperactivity.

In a particular case, as a means for transmitting measurement data, use means operating via the Bluetooth, WiFi, ZigBee network protocols or using USB, COM-port, or RJ-45 to exchange information.

As a video display device, a computer, smartphone, tablet or television set-top box can be used, characterized by the ability to install a software application that allows you to select a video sequence, receive data from a device for measuring body movement, interrupt and resume demonstration of a video sequence, and evaluate the effectiveness of a session to overcome hyperactivity and save the result.

Brief Description of the Drawings

FIG. 1 is a graph illustrating an example of the overall motor activity of a healthy child.

FIG. 2 is a graph illustrating an example of the general motor activity of a child with a diagnosis of "hyperactivity"

FIG. 3 is a histogram of the distribution of total motor activity

FIG. 4 is a structural diagram of the inventive device to overcome hyperactivity

FIG. 5 - diagram of the installation of a compact body on the patient’s head

FIG. 6 is a graphical diagram of controlling the demonstration of footage.

FIG. 7 is a graph of changes in the total motor activity of the patient according to Example 1

FIG. 8 is a graph of changes in the total motor activity of the patient according to Example 2

The implementation of the invention

The proposed method is based on the transformation of previously indifferent forms of motor behavior into actual ones, that is, into those forms of behavior that are related to the motivational-emotional sphere, and, therefore, can be subject to correction by the operant conditioning method (a special case of the conditioned-reflex method). Actualization is achieved by isolating certain forms of motor activity according to specified criteria from general motor activity, and associating them with positive and negative motivational stimuli.

In relation to child hyperactivity, the term motor behavior refers to the general motor activity of a child in a state of active calm wakefulness, an example of which is watching a movie, slide show or playing on a monitor screen (TV, computer, smartphone or other similar device). A positive motivational incentive is the ability to watch an interesting film for a child, a slide show, or the possibility of playing a game. In contrast, a negative motivational incentive is to stop showing a child an interesting film, slide show, or to stop managing the game. The general motor activity (OA) of a healthy child in a state of active calm wakefulness is characterized by a sharp dominance of conditions with minimal energy of movement.

In FIG. Figure 1 shows an example of a 25-minute record of the ODE of a healthy child of 8 years old when he watches an independently selected animated film. Registration of the ODE was performed by a three-axis accelerometer sensor (model LIS3DHTR of the company STMicroelectronics), mounted above the ear on the child's head, with the summation of accelerations along three axes and the integration of the signal with a time constant of 1 second. As you can see, more than 80% of the registration time, the ODA is close to "0". This is a typical example of OA for healthy children in an active, calm, awake state. In FIG. Figure 2 shows an example of a 8.5-year-old child diagnosed with "hyperactivity" under similar conditions for registering ODE. Obviously, the dominant state is the ODE with a significantly higher energy of movements, only occasionally interrupted by periods of relative rest.

These examples are provided to explain the criteria for identifying hyperactivity manifestations in the child’s ODE. In particular, any increase in the sensor signal mounted on the patient’s body is considered as a criterion for the increase in motor activity. At the same time, in order to differentiate and exclude from the analysis the mechanical vibrations of the body associated with natural processes in the body at rest (breathing, palpitations, small movements of the limbs and head associated with reflex balance), a threshold value is introduced - the threshold of hyperactivity, the excess of which is considered as a high-energy movement characteristic of hyperactivity. The numerical value of the hyperactivity threshold is individual, and is calculated after every 1 min. registration. The threshold value is equal to the value of the sensor signal, which is 20% of all measured values of the sensor signal during the previous one minute. FIG. 3 illustrates the rule of calculating the hyperactivity threshold. The vertical dashed line divides the histogram into two parts so that the area of the histogram on the left is 20% of its total area. The projection of the vertical line on the abscissa axis indicates the numerical value of the hyperactivity threshold for a particular patient (in the above example, the hyperactivity threshold is 1.5 units). In FIG. 2, the hyperactivity threshold is indicated as a horizontal dashed line; any excess thereof is identified as a manifestation of hyperactivity. So, as a criterion for classifying the individual components of ODEs as manifestations of hyperactivity, there is an increase in the value of the sensor signal that exceeds the individual threshold of hyperactivity in magnitude.

The device (Fig. 4) for implementing the proposed method for overcoming hyperactivity in children comprises a smartphone (104) as a video display device and providing motivational stimuli to the patient, as well as a three-axis accelerometer sensor (101) that measures the amount of body movements and is connected to the microcontroller (102) . In the microcontroller (102), the analog signal received from the sensor (101) is converted into digital form by means of an ADC, filtered to select frequencies (0.2 to 10 Hz) that are characteristic of the child’s overall motor activity, and the signals along three separate spatial axes are summed and integrated with a time constant of 1 sec. The integrated signal is constantly compared with a pre-calculated and set threshold for hyperactivity (GH). Measurement data was transmitted to a smartphone (104) using Bluetooth tools (103). The software application (105) installed in the smartphone (104) controls the motivational incentives depending on the measurement data of the current state of the patient's ODE. The software application (105) performs the following functions:

- allows you to choose the source of motivational stimulation (film, slide show or game) to demonstrate the video to the patient;

- receives data from a device for measuring the magnitude of the movement of the body through the Bluetooth communication channel;

- modulates the brightness of the screen (turning on and off) in the information display device upon receipt of the relevant information;

- ends the session when it reaches a predetermined duration;

- evaluates the effectiveness of the session according to the developed algorithm and remembers its value.

Structurally, the electronic parts of the sensor (101), the microcontroller (102) and the batteries are combined in a compact housing (201), which is mounted on the patient’s head and fixed with an elastic tape (202), variable length (Fig. 5).

It should be noted that the use of a three-axis accelerometer sensor for measuring the magnitude of body movements is not necessary. This can be done using other types of sensors, the operation of which is based on the gyroscopic effect, measurement of capacitance, induction, photostream (ultraviolet, visible or infrared ranges), ultrasound, electromagnetic field or Hall effect. It is also possible to use video data as provided for in PCT / US2010 / 056805, if real-time processing of these video data is provided.

The invention can be implemented as follows.

The basis of the proposed method is the establishment of a direct time relationship between the manifestation of hyperactivity in a child’s spontaneous ODE and the ability to view a video sequence (film, slide show or game play) on the smartphone’s screen (104), which is emotionally positively perceived by the child and is a motivational stimulus. A compact case (201) is mounted on the child’s head, containing a three-axis accelerometer sensor (101), which measures the amount of movement of the child’s body along three spatial axes, sensor measurements (101) are transmitted to the microcontroller (102), in which the current value of the body’s movements is real-time It is compared with a predetermined threshold equal to 20% of the values of body movements measured during the previous minute. The comparison results by means of (103) Bluetooth are transmitted to the smartphone (104). The demonstration of the footage continues only in the absence of signs of hyperactivity in the ODE, which are identified by these comparison results. The screen brightness control algorithm is illustrated in FIG. 6. Above is a graph of the ODE change over time (rectangular bars). When the ODE value is below the hyperactivity threshold (GH) (dashed horizontal line), the smartphone screen remains on, which allows the patient to observe the video sequence (Part I - the left part of the figure). When the ODE exceeds the GH value, the smartphone screen goes blank, depriving the patient of the pleasure of watching a movie or controlling the game (part II - the middle part of the figure). The video sequence can be resumed only when the ODE value returns to values lower than the GHG (part III - the right side of the figure). A session with a demonstration of a film (slides) or a game lasts at least 15 minutes. This is due to the need to achieve the minimum required number of combinations of the components of ODE, attributable to manifestations of hyperactivity, with negative motivational incentives, the number of which should be at least 100 in one session. In this case, the session should not last more than 30 minutes, since by this time signs of fatigue begin to appear, which can provoke frustration in the child and his refusal to continue working. The total number of sessions that is necessary to overcome hyperactivity is at least 15, and is determined by the sum of the necessary repeats for the brain to form a new sustainable skill to suppress the child’s excess motor activity. The intervals between sessions should not exceed 2 days, since such a time is critical for maintaining the skill acquired in the previous session.

When using the proposed method, if you adhere to the terms adopted in the methodology of the conditioned reflex (or, more precisely, operant conditioning), hyperactive movements of the child are a conditional stimulus. This property acquires a part of the motions from the continuum of ODEs after their artificial selection according to a given criterion and direct synchronous association with an unconditional stimulus, which is a motivationally colored event: the termination of a film demonstration or the stopping of a game. Outside the procedure, any components of the child’s ODA are indifferent, not directly related to motivational stimuli, and only reflect the balance of activation and inhibitory processes in the brain structures associated with movements. During the procedure, when unconditional stimuli (“punishment”) are associated with conditioned (with high-energy movements) conditions arise under which a conditioned reflex begins to form. In relation to a specific situation, the action of the reflex mechanism will be aimed at minimizing the hyperactive movements associated with “punishment”. Probably, the formation of such a mechanism is associated with the selective suppression (inhibition) of certain internal states of the brain, represented by functional dynamic interneuronal associations that “produce” hyperactive movements at the output. At the same time, due to the association with “encouraging” stimuli, those internal states of the brain that form relatively normal, non-hyperactive movements will be maintained, preserved and gradually become dominant. The current level of knowledge in this field of neurophysiology is too fragmented and insufficient for a more accurate description of the processes that underlie the achieved result.

The effectiveness of the proposed method and device is confirmed by statistical data on changes in the ODA and the results of testing the attention function in patients diagnosed with attention deficit hyperactivity disorder who have undergone a training course using the described method using the described device. The following are two typical examples.

Example 1. Patient F.G. 6.5 years old, diagnosis: attention deficit with a predominance of hyperactivity - attention-deficit / hyperactivity disorder: predominantly hyperactive / impulsive presentation (code in ICD-11 - 314.01 / F90.1). In FIG. Figure 7 shows a graph reflecting the average (per session) value of the child's ODE (bars), measured during 18 twenty-minute training sessions with a demonstration of a film chosen by the patient on his own. The first column is the average ODE value, measured a few days before the start of the training. The vertical line at the top of each column is the standard deviation of the ODA values. The dashed line connects the points that display the results of the Schulte proofreading test (the average time the object was among similar ones), which is standardly used to measure the level of attention. The test was carried out before the training session. During the first 9 sessions, the level of ODE, although slightly decreased relative to the first session, was consistently high. After the 10th session, the ODE became significantly lower (p <0.05), with some fluctuations. The test result showed an improvement in the concentration of attention (significant, p <0.05, decrease in the time spent by the object).

Example 2. Patient A.M. 8 years, attention deficit with hyperactivity mixed type - attention-deficit / hyperactivity disorder: combined presentation (code 314.01 / F90.2). This patient underwent 23 training sessions using the described method using the described device. As a motivational reinforcement (incentives for encouragement and punishment), we used a computer game, turning it on and off. Designations in the graph of FIG. 8 are the same as in FIG. 7. The patient completed the first course using the described device in March - April 2017. (Fig. 8A). A noticeable distinct and stable decrease in the ODE value between 6 and 8 sessions, with the subsequent maintenance of the ODE level at a relatively low level. For the patient A.M. a repeated course of 12 training sessions was conducted with the described device, 8 months after the end of the first training course (Fig. 8B). The initial value of the ODE before the start of the second course of training was significantly lower than before the first course, which indicates the preservation of the result achieved in the first course of training. During the second course, the ODE gradually decreased by 28 - 42% relative to the value of the ODE before the start of the second course of training. Assessment of the level of attention (Schulte test) in a patient A.M. demonstrated its significant (p <0.01) growth during the first course of the training. In the course of the second course, an even higher quality of attention was noted, but not exceeding the bounds of reliability, which characterizes the achievement of an individual stable level for this indicator.

Thus, the use of the described method and device leads to the achievement of a result, namely, to a significant decrease in hyperactivity in children. The effect of using the described method and device has a long after-effect in the form of a low level of manifestations of hyperactivity observed over several months. The consequence of a decrease in hyperactivity is an improvement in the parameters of attention, the most important clinical manifestation of the disease, affecting social adaptation and learning ability.

Claims (11)

1. A method of overcoming hyperactivity in children, characterized in that they demonstrate a video sequence that is emotionally positively perceived by the child, measure the amount of movement of the child’s body in total along three spatial axes, compare the current amount of movement of the body with a predetermined individually threshold and stop displaying the video sequence in periods of exceeding the value moving the body of the set threshold. 2. The method according to p. 1, characterized in that the threshold value is set equal to 20% of the values measured for one minute of the movements of the body. 3. The method according to p. 1, characterized in that the measurement of the displacement of the body is carried out using a device based on a three-axis accelerometer and made with the possibility of fixing on the body of the child. 4. The method according to p. 1, characterized in that to measure the magnitude of the movements of the body using a motion sensor containing a smartphone or tablet, which is in the hands of the child. 5. The method according to p. 1, characterized in that the quality of the video use a film, a slide show or a computer game. 6. The method according to p. 1, characterized in that the sessions to overcome hyperactivity spend a duration of 15 to 30 minutes daily, with a total number of at least 15. 7. A device for overcoming hyperactivity in children according to the method according to claim 1, comprising a video display device and a device for measuring the amount of movement of the child’s body, including a sensor that determines the amount of movement of the child’s body along three spatial axes, a computing device connected to the output of the sensor, and means for transmitting measurement data to a video display device. 8. The device according to p. 7, characterized in that as a sensor that determines the magnitude of the movements of the body, use a three-axis accelerometer, which generates continuous in time signals characterizing the movement of the body along three spatial axes. 9. The device according to claim 7, characterized in that the computing device is a microcontroller, with the ability to receive signals from the device for measuring the magnitude of the body’s movement, converting the analog signal to digital form, filtering the signal to highlight frequencies characteristic of the child’s overall motor activity, summing signals along three separate spatial axes, integrating the signal with a time constant of 1 s, calculating a pre-set threshold and constantly comparing the signal from the device -keeping for measuring the displacement of the body with a predetermined threshold. 10. The device according to p. 7, characterized in that as a means for transmitting measurement data using means operating on the network protocols Bluetooth, WiFi, ZigBee or using USB ports, a COM port or RJ-45 to exchange information. 11. The device according to claim 7, characterized in that a computer, smartphone, tablet or television set-top box is used as the display device for the video sequence, characterized by the ability to install a software application that allows you to select the video sequence, receive data from the device for measuring the amount of body movement, interrupt and resume video demonstration, evaluate the effectiveness of the session to overcome hyperactivity and save the result.

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