RU2721824C1 - Method of muscular tonus normalization in infantile cerebral paralysis and device for implementation thereof - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to neurology, and can be used for treating infantile cerebral paralysis (ICP). Proposed method is implemented by magnetic-pulse therapy by means of action on motor neurons of spinal cord, through application on joints of electrode in form of magnetic inductor - magnetic loop of soft multicore wire in vinyl sheath, or plastic pins with metal inserts. Anti-spyx procedure is performed for 23 minutes at 1 minute per 1 frequency, with frequency of 10 to 100 hertz, followed by procedure - balance of microelements during 18 minutes, at rate of 1 minute of action for each microelement. In order to implement this method, a device is proposed, which includes: power supply unit, ATmega 328 microprocessor, with programmed characteristics of selected exposure modes, output signal amplifier, electrodes, a liquid crystal indicator and exposure intensity control buttons are connected to the microprocessor, program on/off buttons, indicators for selection of pulse shape with switching button, microprocessor on one side is connected to power supply, and on the other side to amplifier of output signal, to which is connected audio signal speaker and its volume control, output signal amplifier is connected to outputs for connection of electrodes.EFFECT: proposed method allows to achieve muscular fibers relaxing effect in muscle hypertension.2 cl, 1 dwg

Description

The invention relates to medicine, namely to neurology, and can be used to treat cerebral palsy (cerebral palsy).

Cerebral palsy is a collective term that unites a group of non-progressive neurological disorders. Movement disorders can be combined with changes in the psyche, speech, vision, hearing, seizures, and sensitivity disorders. But, basically, the most pronounced motor disorders (paresis, paralysis, impaired coordination, violent movements, muscle spasticity), expressed in the inability to maintain a normal posture and perform voluntary movements. Muscle spasticity in injuries and diseases of the spinal cord develops as a result of the appearance of a complex set of neurophysiological disorders in the segmental apparatus of the spinal cord (below the level of its damage), manifested by impaired pre and postsynaptic inhibition, as well as hyper excitability of motor neurons. Excessive spasticity of the muscles, as a rule, is accompanied by pain, as well as impaired bladder function.

Therapy for cerebral palsy is mainly symptomatic. The generally accepted tactics of conducting therapeutic actions is a combination of drug therapy and a combination of physiotherapy exercises, massage, mechanotherapy, a method of biological feedback, physiotherapeutic procedures and stimulation of mental and speech development.

In convulsive conditions of cerebral palsy, various anticonvulsants are prescribed, with dystonic hyperkinetic manifestations, anticholinergics, L-dopa drugs, anticonvulsants, benzodiazepines, and combinations thereof.

With an increase in muscle tone, the following groups of drugs are used: benzodiazepine derivatives, muscle relaxants; dopaminergic drugs; central anticholinergics; botulinum toxin-based drugs (botox, dysport).

With a sufficiently long-term use of these drugs, tissue trophism is impaired and the patient’s general well-being worsens, and after a while the drugs cease to have the proper therapeutic effect, in addition, medications aimed at reducing spasticity lead to a decrease in the patient’s limited motor capabilities.

Physiotherapy methods have a normalizing effect on the state of the central nervous system, improve blood circulation and metabolism in organs and tissues, reduce muscle tone, stimulate weakened muscles, and reduce the severity of hyperkinesis. As a rule, various types of massage (classical, segmental, acupressure, canning, etc.) are used to treat motor disorders, aimed at relaxing spastic muscles and stimulating the function of weakened muscles. However, physiotherapeutic methods have a large number of contraindications and the likelihood of harmful side effects (for example, increased convulsive readiness, etc.), but most importantly,

In all cases of the manifestation of the disease, rehabilitation is extremely time-consuming, and in the late residual (delayed, after 3 years) stage, physiotherapeutic methods of treatment, as well as massage, are not effective enough. The methods used make it possible to partially rebuild the pathological motor stereotype and form a new one.

However, the presence of such a violation of muscle tone, as spasticity, makes it difficult, and often makes it practically impossible to carry out rehabilitation measures in this category of patients.

Therefore, the development of methods to reduce pathologically increased muscle tone remains an important task of modern rehabilitation medicine.

A known method of treating muscle spasticity using electrical stimulation of the spinal cord, patent RU 2038099, from 06.27.1992., A61N 1/32, A61R 31/33, A61M 5/14 (Melamud E.E .; Ninel V.G .; Suvorov A .V. A method of stopping spastic syndrome caused by a violation of the segmental apparatus of the spinal cord.)

Electrodes are injected into the epidural or subdural space of the spinal cord above the lumbar bulge in a patient through a puncture or open path at a hundred, and then they are exposed to the posterior columns of the spinal cord by a pulsed current of parameters determined in advance with the simultaneous introduction of a drug mixture into the epidural space (clonidine, opioid preparation).

The disadvantage of this method: The method does not give a complete and sufficiently long clinical effect, since the action of only one pulse current relieves pain, but does not normalize the inhibition processes in the motor neuron apparatus of the spinal cord. The method is quite traumatic, it can not be carried out at home, but only under the supervision of qualified personnel in a clinic.

A known method for the treatment of cerebral palsy, see patent UA No. 63921, A61N 2/00, A61N 5/067 dated 02/15/2004, "Method for the treatment of cerebral palsy", including the pulse-magnetic therapy of the vertebral line on each side with a frequency 30 pulses / min with a magnetic induction value of 0.7 T, scanning of He-Ne by laser radiation with a power of 10 mW in the cervical-alveolar zone for 10-15 minutes paravertebrally for a course of treatment of 4-6 sessions, intravenous laser exposure by introducing the distal end of the fiber into a 2-3 cm vein with a He-Ne laser with a power of 1.5-2 mW for 10-20 minutes, microwave therapy of biological active points - 31 points for 10-20 minutes with a power of 10 mW, auriculopuncture of biologically active points of the auricle - 11 points up to 20-30 minutes, a course of treatment spend 10-15 sessions.

Disadvantage: this method is both traumatic and difficult to conduct, both in a hospital and inability to conduct it at home.

The well-known "Method of reducing increased muscle tone in cerebral palsy" - patent RU No. 2262357 from 12.23.2003 g A61N 1/20, A61N 2/04

In this method, the treatment is carried out by combining transspinal micropolarization and magnetic pulse stimulation. Transspinal micropolarization (TSMP) is carried out with a direct current of 100-300 μA by applying cutaneous electrodes with an area of 20-35 cm. TSMP is performed for 30-40 minutes, while the anode is located laterally from the spinous process of the seventh cervical vertebra C7, and the cathode is contralateral to the cathode in lumbosacral area at the level of the spinous processes of L5-S1. Magnetic-pulse stimulation is carried out by short pulses, two in each message, and the amplitude of magnetic induction of the first pulse is 1400 mT, and the second one is at least 55%, alternating 3-4 messages to each segment of the spinal cord along the spinal column on the right and left. Each time, stimulation begins with the cervical spine, the course of treatment is 6-7 procedures with an interval of at least one and no more than two days.

The disadvantage of this method are: the relative complexity of the procedure. The patient must be placed on a couch or horizontal surface, which additionally causes pain and muscle tension, which in itself leads to an increase in spasticity.

The procedure must be carried out in stationary conditions, every day, breaks should not be more than two days, the number of procedures is not more than 6-7. An increase in the number of procedures does not lead to a decrease, but rather to an increase in muscle tone.

All the proposed and described methods are most effective for children with cerebral palsy in the age of 3 to 7 years; the method was less effective in children 8-12 years old (1.5 times lower); and even lower (almost 2 times) - in patients older than 13 years. (D.Yu. Pinchuk, G.V. Sidorenko, M.V. Katysheva et al. Transcranial micropolarization in the rehabilitation treatment of spastic forms of cerebral palsy // Journal of Neurology and Psychiatry named after S. S. Korsakov - 200 iti 01. No. 7 . - S. 58-59.)

A device is known presented in the patent for a utility model of the Russian Federation No. 112630, class. A61N 36 publ. 01/20/2012, - "Electrical stimulator."

The device includes a power supply, a microprocessor, with programmable characteristics of exposure modes, an output signal amplifier, device operation indicators, electrodes and protection in the form of a metal mesh screen along the contour of the device inside the case.

The effect obtained by the implementation of an electric stimulator consists in influencing the frequencies of brain rhythms to achieve effects of activity or passivity.

The action of the electric stimulator is based on the effect on the frequencies of the brain through the connected electrodes and does not allow affecting the motor neurons of the spinal cord.

There is no way to set individual intensity of exposure.

There is no possibility of exposure to unipolar positive impulses, negative impulses or bipolar impulses, which are necessary for sedation or stimulation of neurons.

There is no soundtrack that is necessary to track the end of the procedure.

The technical solution of the proposed method and device is to reduce increased muscle tone during cerebral palsy and create a compact, lightweight, easy to use, self-powered device that allows you to carry out procedures at home, eliminating the need to shift the patient from the stroller to the couch, or turn it over.

This problem is solved by normalizing muscle tone during cerebral palsy by the influence of magnetic pulse therapy with a given frequency and amplitude on the motor neurons of the spinal cord, by applying an electrode in the form of a magnetic inductor to the joints and performing the Antispastic procedure for 23 minutes, at the rate of 1 minute per frequency with a frequency of exposure from 10 to 100 Hertz; followed by the procedure - Balance of trace elements, for 18 minutes, 1 minute for each frequency of the trace element, and the electrodes are made in the form of an electromagnetic loop made of soft stranded wire in a vinyl braid or in the form of plastic clothespins with metal inserts.

The implementation of this method is carried out on a device including a power supply unit, an ATmega 328 microprocessor with programmable characteristics of the selected exposure modes, an output signal amplifier, electrodes connected to the amplifier output. An ATmega 328 microprocessor is connected with a liquid crystal indicator, exposure intensity control buttons, program on / off buttons, pulse shape selection indicators with a switch button, the microprocessor is connected to the power supply on one side, and the output amplifier to which the speaker is connected, on the other sound signal and its volume control, the amplifier of the output signal is connected to the terminals for connecting the electrodes.

The method of normalizing increased muscle tone in cerebral palsy with the Antispastic program is carried out by exposing the motor neurons of the spinal cord with specially selected frequencies - 23 frequencies from 10 to 100 hertz.

The second procedure is the Balance of trace elements (Calcium, Sodium, Potassium, Magnesium, Cobalt, Zinc), in this procedure, the known frequencies of the hert range inherent in each trace element are used for 18 minutes at the rate of 1 minute per trace element frequency.

According to the literature data of the researchers, an increase in the concentration of copper and a significant decrease in the concentration of zinc in blood serum in children with severe cerebral palsy, especially with convulsive syndrome (Zhukovskaya ED and others, “The content of certain trace elements in hair and red blood cells in cerebral palsy,” Pediatrics , 1992, No. 7-9, pp. 76-77), and also a decrease in the concentration of a trace element such as cobalt in the blood serum is determined.

This procedure - the balance of trace elements, allows you to configure the body to produce the missing trace elements and normalize their balance.

In Fig. 1 shows a diagram of the device, where 1 is a programmable microprocessor "ATmega 328"; 2 - battery power supply, 9 volt battery; 3 - output signal amplifier; 4 - on / off button; 5 - indicator for turning on the device; 6 - a liquid crystal indicator that reflects the intensity of the intended impact, which is connected to the microprocessor - 1; 7 - buttons to decrease or increase the intensity of exposure; 8 - indicators of pulse shapes (selection of positive unipolar pulses, selection of negative unipolar pulses, selection of bipolar pulses) that are connected to the microprocessor - 1; 9 - button for switching pulse indicators; 10 - speaker and volume control of the sound signal; 11 - the button that starts the therapy mode - 2 and its indicator - "Balance of trace elements", (green); 12 - button that starts the procedure mode 1 - "Antispastic" and its operation indicator (Red), 13 - connectors for connecting electrodes, 14 - connector for connecting an external power supply unit with 9 volts.

The way to normalize muscle tone during cerebral palsy on the proposed device is as follows: the device is turned on by pressing the button (4), after which the red indicator lights up, next to the device’s power button - (5). The LCD indicator (6) for the passage of frequencies lights up, the number 1 appears on the indicator, which indicates the readiness for procedure No. 1 - “Antispastic”. Connectors - (13) are connected to electrodes - clips, plastic with metal inserts for connecting connecting wires to the device, or an electromagnetic loop - a stranded wire, in a vinyl braid with inductance - 0.59 mH. The volume control of the sound signal (10), adjusts the microphone volume, the frequencies involved, during the procedure.

Using the button (9) we set the necessary unipolar or bipolar pulses, the red indicator of the selected pulses (8) lights up. We turn on the button (12) - the red indicator of the beginning of the procedure - 1 “Antispastic” lights up; Next to the LCD indicator (6), the buttons (7) - a triangle down and up, you can adjust the intensity of exposure, according to the sensitive perception of the patient. When connecting an electrode in the form of a loop, the intensity, with the button with the triangle up, is set to 100 units, and when connecting the electrodes in the form of clothespins, the intensity of exposure using the triangular buttons is set according to the sensitivity of the patient.

The duration of each frequency is set to 1 minute. The passage of frequencies, and their change is automatic from the first frequency to the twenty-third, with procedure 1 “Antispastic” or up to 18 frequencies, with procedure 2 - “Balance of trace elements”. At the end of the procedure, the sound signal is turned off and the red indicator (8) of the selected pulses stops flashing.

After the device is turned off, the frequency is automatically set at the beginning of the procedure, per unit.

Such procedures, with a break of 2-3 hours, can be performed up to 3 per day.

The proposed method on this device allows you to achieve the effect of relaxation of muscle fibers with muscle hypertonicity.

Procedures for the elimination of muscle hypertonicity were performed in 15 patients undergoing rehabilitation in the clinic; all showed good positive dynamics.

The following are examples of the treatment of patients of the clinic with the proposed device:

Patient D.I., 26 years old.

Diagnosis: cerebral palsy. Spastic diplegia.

For measurements of general well-being, a 10-point scale was used.

10 procedures were performed to reduce the spastic state in the muscles.

1. The beginning of the procedure on 10.10.18 - muscle hypertonicity - 8 b., 10.23.18 g. - the end of the procedures on 10.23.18 g. - 5b.

2. Pain at the beginning of the procedures - 10/9/18, 7, 10/23/18, 1B;

3. Cramps in the muscles - 10.10.18, 10b .; 10.23.18 g. - 1b .;

4. Unpleasant sensations in the body and muscles - 10.10.18 g. - 8b .; 10.23.18 g. - 1b .;

5. Anxiety - 10/9/18, 10b .; 10.23.18 g. - 6b .;

6. Reduced mood - 10.10.18 g. - 8b.; 10/23/18 - 5b .;

7. Irritability - 10.10.18 g. - 6b .; 10/23/18 g. - 3b .;

8. Sleep disturbance - 10.10.18 g. - 10b .; 10/23/18 g. - 7b .;

9. Night spasticity - 10.10.18 g. - 9b .; 10.23.18 g. - 0b .;

10. Daily spasticity - 10.10.18 g. - 6b .; 10.23.18 g. - 1b .;

Patient E.L., 21 years old

Diagnosis: cerebral palsy. Spastic diplegia. Multiple contractures of the joints of the lower extremities.

For measurements of general well-being, a 10-point scale was used.

10 procedures were performed to reduce the spastic state in the muscles.

1. The beginning of the procedure 09/21/18, the hypertonicity of the muscles - 8b., 04.10.18, the end of the procedures - 2b.

2. Pain at the beginning of the procedures - 09/21/18, - 8b .; 10/04/18 - 2b;

3. Cramps in the muscles - 09/21/18, - 0b .; 10/04/18 - 0b .;

4. Unpleasant sensations in the body and muscles - 09/21/18, - 8b .; 10/04/18 - 2b .;

5. Anxiety - 09.21.18 g. - 7b .; 10/04/18 - 2b .;

6. Reduced mood - 09/21/18, 5b .; 10/04/18 - 2b .;

7. Irritability - 09/21/18, 2b .; 10/04/18 g. - 1b .;

8. Sleep disturbance - 09/21/18, - 8b .; 10/04/18, 4b .;

9. Night spasticity - 09/21/18, 10b .; 10/04/18 - 2b .;

10. Daily spasticity - 09/21/18, 6b .; 10/04/18 - 1b.

Patient E.S., 19 years old

Diagnosis: cerebral palsy. Spastic diplegia with a hyperkinetic component. For measurements of general well-being, a 10-point scale was used. 10 procedures were performed to reduce the spastic state in the muscles.

1. The beginning of the procedure on September 24, 18 - muscle hypertonicity - 10b., 03.10.18 - the end of the procedures - 6b.

2. Pain at the beginning of the procedures - 09.24.18, 3b .; 10/03/18, 2b;

3. Cramps in the muscles - 09.24.18, - 0b .; 10/03/18 - 0b .;

4. Unpleasant sensations in the body and muscles - 09.24.18, 7b .; 10/03/18 - 4b;

5. Anxiety - 09.24.18 g. - 10b .; 10/03/18 - 4b;

6. Reduced mood - September 24, 18 - 7b .; 10/03/18 g. - 5b .;

7. Irritability - 09.24.18 g. - 7b .; 10/03/18 g. - 5b .;

8. Sleep disturbance - 09.24.18 g. - 7b .; 10/03/18 g. - 5b .;

9. Night spasticity - September 24, 18 - 0b .; 10/03/18 - 0b .;

10. Daily spasticity - 09.24.18 g. - 7b .; 10/04/18 - 3b.

As can be seen from the clinical examples given, all patients experienced an improvement in condition after a course of procedures.

Sleep improved, anxiety and irritability decreased. Pain syndrome decreased.

Night spasticity decreased to 1-2 points. Daily spasticity decreased to 1-3 points.

Claims (4)

1. A method of normalizing muscle tone in cerebral palsy, including magnetic pulse therapy with a given frequency and amplitude, characterized in that it affects the motor neurons of the spinal cord by applying an electrode in the form of a magnetic inductor to the joints, and performing the procedure - Antispastic, within 23 minutes, at the rate of 1 minute at 1 frequency, with an exposure frequency of 10 to 100 hertz, followed by the procedure - Balance of trace elements, for 18 minutes, based on 1 minute of exposure to each frequency of a trace element. 2. A device for implementing this method, including a power supply unit, a microprocessor with programmable characteristics of the selected exposure modes, an output signal amplifier, electrodes, characterized in that a liquid crystal indicator and exposure intensity control buttons, program on / off buttons, shape selection indicators are connected to the microprocessor pulses with a switch button, the microprocessor is connected to the power supply on the one hand, and on the other hand to the output signal amplifier, to which the audio signal speaker and its volume control are connected, the output signal amplifier is connected to the terminals for connecting electrodes. 3. The device according to p. 2, characterized in that the electrodes are made in the form of a “magnetic loop” of soft stranded wire in a vinyl braid or in the form of plastic clothespins with metal inserts. 4. The device according to claim 2, containing an electronic programmable microprocessor of the type "ATmega 328".

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