RU2719655C1 - Method for assessing clinical effectiveness of children 3-6 months of age with consequences of perinatal central nervous system affection in form of motor development disorder - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to paediatric neurology, and enables assessing the clinical effectiveness of children 3–6 months of age with the consequences of perinatal CNS involvement in the form of motor development disorder. Method involves functional examination of a child's balance system before and after the treatment. Computer-based stabilometry is used on a stabiloplatform with high sensitivity for low weight. Stabilized platform is installed on solid even horizontal surface. Child of 3–6 months of life is placed on the above platform in the supine position. Time interval is maintained for the child to adopt a stable position; a statokinesiogram index is determined, which is a difference in the length and width of the ellipse of the statokinesiogram. If the value of the post-treatment value is more than 31 %, the treatment is considered to be effective, and if the value is reduced by less than 31 % or higher, the treatment is considered to be ineffective.

EFFECT: technical result is reduced to objective assessment of clinical effectiveness in children 3–6 months of life with consequences of perinatal CNS involvement in the form of motor development disorder.

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Description

The invention relates to medicine, namely to children's neurology and allows to evaluate the effectiveness of treatment of children 3-6 months of life with the consequences of perinatal damage to the central nervous system in the form of impaired motor development.

The relevance of the proposed method is determined by the high frequency of damage to the central nervous system in the perinatal period (80% of the pathology of the nervous system in childhood) and their severe consequences. Movement disorders are the most common consequences of these lesions (68.5%) in children 1 year old (L. Khachatryan. Early and long-term manifestations of perinatal nervous system lesions in young children: abstract of dissertation ... Dr. med. Sciences. - M., 2003 .-- 49 p.). Children with this pathology are at high risk for the formation of cerebral palsy (cerebral palsy), leading to disability of the child. In this situation, it is very important to start treatment for motor development disorders on time and to objectively evaluate its effectiveness (Barashnev Yu.A. Clinical and morphological characteristics and outcomes of cerebral disorders in hypoxic-ischemic encephalopathies // Obstetrics and gynecology. - 2007. - No. 5. - S. 39-42.).

Our proposed method allows us to evaluate the effectiveness of treatment of motor development disorders in children at the stage of formation of the first anti-gravity postures, which are of fundamental importance for the further development of the motor functions of the child, which will allow timely correction of habits and prevent the formation of disabling consequences.

Earlier, the evaluation of the effectiveness of the treatment of motor development disorders in children in the first half of life was carried out by dynamic neurological examination with the definition of muscle tone, tendon reflexes, unconditioned reflexes, an asymmetric neck-tonic reflex, symmetrical chain reactions, and sensory-motor behavior. In this case, only a qualitative assessment of the dynamics of the determined indicators was carried out. (Badalyan L.O. Pediatric Neurology / L.O. Badalyan. - 4th ed. - M .: MEDpress inform, 2016 - 608 p.).

According to the literature, there are known methods for assessing the psychomotor development of young children, which are based on the use of psychomotor development scales developed at different times: “Development Tables” by A. Gesell, 1925; scale of N. Bailey, 1969; Denver scale, 1973; Munich functional diagnostics, 1985; scale proposed by L.T. Zhurboy and E.M. Mastyukova, 1981; scale developed by O.V. Bazhenova, 1986. When applied in dynamics, in the process of rehabilitation treatment of children, they can be used to evaluate its effectiveness. The disadvantage of these methods is the subjectivity of the assessment.

There is a method of evaluating the effectiveness of non-drug rehabilitation of children with perinatal CNS lesions aged 1 to 9 months by quantifying the neuropsychiatric status using point tests according to Zhurba L.T., Mastyukova E.M., 1981 in the dynamics before and after the course of rehabilitation (Gorelikova EA, Kornyushin MA Evaluation of the effectiveness of non-drug rehabilitation of children with perinatal damage to the central nervous system // Pediatrics. - 2002. - No. 1. - P. 41-44.). With an increase in the quantitative assessment of neuropsychiatric status due to the normalization of motor development, the symmetrical formation of physiological muscle tone, the symmetrical development of muscle strength, the formation of the correct installation of the feet when supporting, the correct capture of the subject, the treatment is evaluated as effective.

The disadvantages of the method:

1. The subjectivity of the assessment.

2. There are no clear boundaries for changes in the quantitative assessment of neuropsychiatric status, indicating the effectiveness of the treatment.

3. The accuracy of the method is not indicated.

Closest to the technical solution to the claimed method is a method for evaluating the effectiveness of treatment of children with severe motor impairment from the age of 6 months to 3 years by determining the dynamics of general motor activity, coordination of movements, psychomotor skills and electromyographic indicators: modulation depth, ratio average amplitudes of the signal in the phases of rest and movement (Features of electromyographic activity in young children with motor impairments / E.S. Zhvansky et al. // Phys. Human Biology. - 2016. - No. 1. - S. 49-56). Treatment is assessed as effective in improving the coordination of movements in the form of a longer possibility of verticalization, the appearance of support on the full foot, reducing the unsteadiness of the gait, improving muscle tone, the appearance of a desire for game and exercise therapy, and increasing the depth of modulation (approaching a value of 0.7), a decrease in the ratio of average signal amplitudes in the phases of rest and movement (approaching a value of 0.7) during electromyography.

The disadvantages of the method:

1. It takes a lot of time to spend.

2. It is labor intensive.

3. The implementation of the method involves technical difficulties.

4. Requires the application of electrodes to the child's body (an allergic reaction is possible when in contact with disinfectants and gels to enhance electrical conductivity).

5. There are no clear boundaries for changing clinical indicators and indicators of electromyography, indicating the effectiveness of the treatment.

6. The accuracy of the method is not indicated.

The technical result of the proposed method is an objective assessment of the effectiveness of treatment of children 3-6 months of life with the consequences of perinatal damage to the central nervous system in the form of impaired motor development.

The technical result is achieved by the fact that for children 3-6 months of life in the dynamics (before and after treatment), computer stabilometry is performed on a stable platform with high sensitivity for low weight, with the determination of a derivative parameter: the difference in the length and width of the statokinesiogram ellipse and with a decrease in this indicator is more than 31%, the treatment is evaluated as effective, and if it is reduced by less than 31% or increased, the treatment is evaluated as ineffective with an accuracy of 84.05%.

The novelty of the method lies in the fact that for the first time to assess the effectiveness of treatment of children 3-6 months of life with the consequences of perinatal damage to the central nervous system in the form of impaired motor development, it is proposed to use a quantitative assessment of indicators of computer stabilometry, in particular, determining the indicator - the difference in the length and width of the ellipse of the statokinesiogram.

Previously, the method of computer stabilometry was used in children over the age of 5 years for the diagnosis of imbalances, pathologies of the musculoskeletal system and the habilitation of children with cerebral palsy using the principle of biological feedback. All studies were carried out in a standing position and were aimed at identifying a pathological stereotype of support in the main stance (Kiselev D.A. Stabilometry in the diagnosis and treatment of children with a hemiparetic form of cerebral palsy: auto-ref. Diss., Candidate of medical science. - M ., 2007. - 28 p .; IA Poghosyan. System for the diagnosis and comprehensive treatment of musculoskeletal disorders in children with multifactorial pathology: abstract of thesis ... of a doctor of medical sciences. Perm, 2007. - 39 p. ; Savelyev M.Yu. Physiological substantiation of stabilometry in static assessment who equilibrium of children of primary school age in norm and at disturbances of motor function: Abstract of a thesis ... Candidate of Medical Science - Arkhangelsk, 2005. - 19 c)...... However, in children of the first half of life, the maintenance of this posture has not yet been formed.

Previously, we proposed a method for using the quantitative characteristics of computer stabilometry: the velocity of the center of pressure, the width of the ellipse of the statokinesiogram, the difference in length and width of the ellipse of the statokinesiogram for diagnosing the formation of motor development disorders in children 3-6 months of life (Pat. 2598960 Russian Federation. Method for diagnosing the formation of disorders motor development in children aged 3-6 months of life / Samsonova T.V., Nazarov SB, Zemlyanikin K.O. // Inventions. Useful models. - 2016. - No. 28).

We also proposed the use of quantitative characteristics of computer stabilometry: the difference between the length and width of the statokinesiogram ellipse, the levels of 60% of the spectrum power in the frontal and sagittal planes, to predict the formation of cerebral palsy in children 3-6 months of life (Application for a patent for invention No. 2018121169 from 06/09/2018. A method for predicting the formation of cerebral palsy in children 3-6 months of life / Samsonova TV, Nazarov SB, Nikolaeva SV).

As a criterion for evaluating the effectiveness of treatment of children 3-6 months of life with perinatal CNS lesions in the form of impaired motor development, we chose a quantitative indicator of the statokinesiogram - the difference in the length and width of the ellipse, since the state of muscle tone (hypotension, hypertension or dystonia) and its ability to hold the first anti-gravity postures, and pronounced changes in muscle tone violate this ability. With the effectiveness of rehabilitation treatment, normalization of muscle tone and a pronounced decrease in the difference in length and width of the statokinesiogram ellipse occur.

The method is as follows: the study is carried out in accordance with the methodology developed by the Ivanovo Research Institute of Motherhood and Childhood (Pat. 2585142 Russian Federation. A method for studying the equilibrium function in children aged 3-6 months of life / Samsonova T.V., Nazarov S .B., Zemlyanikin K.O. // Inventions. Utility Models. - 2016. - No. 15) on a stabilometric computerized complex consisting of a personal computer and a stabilometric platform (Complex stabilometric computerized this “STABILO-MBN": operating manual. - M., 2004.) and the additional use of the weighting platform of the company "MBN" (stabilometric platform with high sensitivity for low weight), which allows computer stabilometry in children 3-6 months of life.

The child is laid in a supine position on a stabilometric platform with high sensitivity for low weight. The stable platform should be on a solid, level, horizontal surface, then the time period must be maintained until the child takes a stable position. Next, the recording command is activated on the computer, and the registration time of 20 seconds begins. Then, processing of the registered data is carried out, with the determination of the difference between the length and width of the ellipse of the statokinesiogram (measured in millimeters). If this indicator decreases by more than 31%, the treatment is assessed as effective, and if it decreases by less than 31% or increase, the treatment is assessed as ineffective with an accuracy of 84.05%.

Distinctive features of the method. Parameters for evaluating the effectiveness of treatment of children 3-6 months of life with the consequences of perinatal CNS damage in the form of impaired motor development are proposed. Children undergo computer stabilometry on a stable platform with high sensitivity for low weight, install the stabiloplast on a solid, level, horizontal surface, put the child 3-6 months of age on the said platform in a supine position, maintain a time period for the child to adopt a stable position, determine the indicator statokinesiogram, which is the difference between the length and width of the ellipse of the statokinesiogram, and with a decrease in the value of this indicator after treatment by more than 31 % treatment is assessed as effective, and if it is reduced by less than 31% or increased, it is considered ineffective.

To objectify the data, in parallel with the application of the proposed method, a clinical examination of children was carried out, their motor development was evaluated in dynamics.

The essence of the method is illustrated by the following examples:

Example 1

Child R., 4 months old, born from 4 pregnancies, 1 birth in a period of 30-31 weeks with an Apgar score of 5/6 points in serious condition. Neurological status: hydrocephalic head, head circumference 41.0 cm, craniotabes sections, pliable cranial sutures, large fontanel 2.5 × 2.5 cm. Cranial nerves without pathology. Muscle tone is dystonic. Weakness of the shoulder girdle. Tendon reflexes are living, symmetrical, no pathological reflexes. Installation labyrinth reflex with a delay. With horizontal suspension, the head holds weakly. When traction for hands is practically not grouped. Psychomotor development: the gaze captures, traces, attention is unstable, quickly exhausted, auditory concentration, smiles, walks. In the position on the stomach, he raises his head for a short time. Reliance is weak, on tiptoe. Based on clinical data, motor disorders were identified. Diagnosis: The consequences of perinatal damage to the central nervous system, impaired and delayed motor development. According to the proposed method, the following values of stabilometric data were obtained: the difference in the length and width of the ellipse of the statokinesiogram at admission is 7.02 mm, after the course of treatment - 4.89 mm. A decrease of this indicator by 30% was noted, which indicated the lack of effectiveness of the treatment. After the course of treatment: with horizontal suspension, the head holds weakly, with traction by the hands it is not grouped enough, in the supine position it holds the head uncertainly. Conclusion: treatment was assessed as ineffective, which was confirmed by clinical data and the absence of positive dynamics of the revealed changes according to computer stabilometry.

Example 2

Baby M., 6 months old, born from 4 pregnancies, 2 preterm births in a period of 30 weeks with an Apgar score of 4/6 points in serious condition. Neurological status: head circumference 40 cm, large fontanel 1.5 × 1.5 cm, does not swell, is not tense, diffuse craniotabes. Cranial nerves without pathology. Moderate diffuse muscle hypotension, poorly rolls over to the stomach. Tendon reflexes are lively, symmetrical. When traction for hands is not grouped enough. Based on clinical data, motor disorders were identified. Diagnosis: consequences of perinatal damage to the central nervous system, impaired and delayed motor development. According to the proposed method, the following stabilometric data were obtained: the difference in length and width upon admission was 1.58 mm, after a course of treatment - 2.47 mm. An increase of this indicator by 56% was noted, which indicated the lack of effectiveness of the treatment. After the course of treatment: diffuse muscle hypotension persists, with traction by the hands it is weakly grouped, it is poorly turned over. Conclusion: treatment was assessed as ineffective, which was confirmed by clinical data and the absence of positive dynamics of the revealed changes according to computer stabilometry.

Example 3

Baby B., 3 months old, born from 1 pregnancy, 1 birth in a period of 39-40 weeks with an Apgar score of 8/9 points in satisfactory condition. Neurological status: head circumference 39.0 cm, large fontanel 1.5x1.5 cm, calm. Cranial nerves without pathology. Muscle tone is diffusely elevated, especially at the height of emotions. Tendon reflexes are lively. When traction is grouped, in a position on the stomach it tries to hold its head, the handles are often clamped into cams, the optical support is in the formation stage. A grasping reflex, Moro's reflexes are positive. The emotional tone is positive. Bearing with a tendency to toe. Based on clinical data, motor disorders were identified. Diagnosis: consequences of perinatal damage to the central nervous system, impaired and delayed motor development. According to the proposed method, the following values of stabilometric data were obtained: the difference in length and width upon admission is 17.2 mm, after a course of treatment - 11 mm. A decrease of this indicator by 36% was noted, which testified to the effectiveness of the treatment. After the course of treatment, positive clinical dynamics were noted: the emotional tone improved - it became calmer; muscle tone normalized, more often it opens up the palms, is better grouped by traction by the hands, reaches for toys, confidently holds its head, lying on its stomach. Conclusion: the treatment was rated as effective, which was confirmed by clinical data and the positive dynamics of the revealed changes according to computer stabilometry.

The accuracy of the proposed method is 84.05%.

The sensitivity of the proposed method is 86.00%.

The specificity of the proposed method is 78.95%.

The advantages of this method:

1. High accuracy - 84.05%, sensitivity - 86.00%, specificity - 78.95%.

2. Quantitative parameters are used, which excludes subjective assessment.

3. It is proposed to use a quantitative indicator to assess the effectiveness of treatment, reflecting a violation of the equilibrium function.

4. Does not require special preparation of the child for research.

5. The non-invasiveness of the method, its non-invasiveness.

6. Requires a small amount of time (20 seconds) for its conduct.

7. Allows you to evaluate the effectiveness of treatment of children 3-6 months of life with the consequences of perinatal damage to the central nervous system in the form of impaired motor development.

8. Allows timely correction of therapeutic measures to reduce the disabling consequences.

Claims (1)

A method for evaluating the effectiveness of treatment of children with the consequences of perinatal damage to the central nervous system in the form of impaired motor development, including a functional study of the child's equilibrium system before and after the treatment, characterized in that for the functional study, computer stabilometry is used on a stable platform with high sensitivity for low weight, establish stable platform on a solid, even horizontal surface, the child 3-6 months of life is laid on the aforementioned the platform in a supine position, withstand the time period for the child to adopt a stable position, determine the statokinesiogram indicator, which is the difference in the length and width of the statokinesiogram ellipse, and if the indicator value decreases after treatment by more than 31%, the treatment is evaluated as effective, and if it decreases less than 31% or increase - as ineffective.