RU2734406C1 - Method for rehabilitation of functional disorders of locomotor apparatus in hemiparesis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to methods of rehabilitation of functional disorders of locomotor apparatus in hemiparesis. Method is based on the fact that the muscles of the patient's diseased leg are synchronously synchronized with phases of the motor act in phases of their natural excitation and contraction, for which electrodes mounted on a diseased leg are used. Simultaneously, electric synchronization of muscles of the patient's hand in synchronization with motor act phases is performed in phases of their natural excitation and contraction, for which electrodes are installed on the patient's hand. Synchronized with motor act phases electric muscle stimulation of a patient's leg muscles and synchronous with phases of motor act electric stimulation of muscles of a patient's healthy hand is performed in accordance with trajectories of a healthy leg and patient's healthy arm. Trajectories of motion of healthy leg and healthy hand of patient are fixed with angular motion sensors arranged on them.

EFFECT: higher efficiency and reduced length of leg rehabilitation in hemiparesis.

1 cl, 2 dwg

Description

The invention relates to medicine and can be used in traumatology, orthopedics and neurology in the rehabilitation of patients with hemiparesis.

A known method of rehabilitation of functional disorders of the musculoskeletal system [Prosthetics Guide. Edited by N.I. Kondrashin. M .: Medicine, 1988, p. 277-308], which consists in the fact that if the patient has the ability to perform an independent motor act, electrostimulation of muscles is performed simultaneously with the patient performing a motor act. For electrical muscle stimulation, electrodes are used, namely, a pair of electrodes; an independent motor act performed by the patient during electrical muscle stimulation is walking; the amplitude of the stimulating pulse is up to 60 V, the duration of the stimulating impulses varies from 20 μs to 200 μs, and the repetition rate of the stimulating pulses is 40-80 Hz.

The disadvantages include the lack of a systematic locomotor cycle, which does not contribute to the development of correct motor stereotypes, and the limitation in the number of movements also leads to this. As a result, the rehabilitation period is lengthened, its effectiveness decreases, and a positive result is not always achieved. Until the patient becomes able to independently perform a motor act, i.e. walk, contractures of a different nature (muscle, articular) may develop, limiting further rehabilitation or making it almost impossible.

There is also known a method of treating diseases and consequences of damage to the musculoskeletal system [RU 2098149 C1, A61N 1/32, 6 A61B 17/56, 10.12.1997], which consists in multichannel electrical muscle stimulation when walking by applying a pair of electrodes (active and indifferent) on muscle groups and setting the parameters of electrical stimulation with step phases using angle sensors located in the knee or hip joint. In this case, the electrodes are applied to the main and auxiliary muscle groups, the duration of electrical stimulation in the first session is 20 minutes, and from sessions 5-6, its duration is increased to 60 minutes, then the voltage amplitude is increased from 30 to 60 V, the pulse duration is from 20 to 200 μs and repetition rate from 30 to 60 Hz. Electrical stimulation is carried out by supplying an electrical impulse in the phases of natural excitation and retraction of muscles, while the size of the electrode is chosen equal to the diameter of the stimulated muscle or muscle group, and the electrode itself is positioned perpendicular to the course of muscle fibers.

This method has the following disadvantages: it is necessary to have the patient's ability to stand and walk, which immediately limits the circle of those rehabilitated, since often this ability appears quite late from the onset of the disease or does not appear at all, and therefore, the real effective time for physiological recovery will be lost. Moreover, during this period of time, before the patient becomes able to independently perform a motor act, contractures of a different nature may develop, excluding the possibility of rehabilitation for almost all categories of patients with pathologies of the musculoskeletal system.

The disadvantages also include the lack of a systematic locomotor cycle, a restriction in the number of movements, which interferes with the high-quality and intensive development of correct motor stereotypes.

In addition, there is a known method for the rehabilitation of functional disorders of the musculoskeletal system [RU 2126276 C1, A61N 1/18, 02/20/1999], which consists in electrical muscle stimulation while walking by installing a pair of electrodes, and in it muscle electrical stimulation is carried out in the phases of natural excitement and muscle contraction, synchronizing electrical muscle stimulation with the phases of the step. Additionally, a corrective, unloading, fixing, and support-ability-increasing effect on the affected part of the musculoskeletal system is carried out by installing a rigid orthosis on the patient.

This method has the same disadvantages. It is necessary to have the patient's ability to stand and walk, which immediately limits the circle of the rehabilitated, since in most cases this ability may appear very late or not at all, and therefore the real effective time for physiological recovery will be lost. Moreover, during this period of time, before the patient becomes able to independently perform a motor act, contractures of a different nature may develop, limiting further rehabilitation or making it practically impossible. The disadvantages also include the lack of a systematic locomotor cycle, a restriction in the number of movements, which interferes with the high-quality and intensive development of correct motor stereotypes.

The well-known method for the rehabilitation of functional disorders of the musculoskeletal system [RU 2235566 C2, A61N 1/16, 10.09.2004], which consists in the fact that if the patient has the ability to an independent motor act, muscle stimulation is performed simultaneously with the patient's motor act, moreover, electrical muscle stimulation is carried out in the phases of natural excitement and muscle contraction and synchronization of electrical muscle stimulation with the phases of the motor act performed by the patient, which is carried out using angular sensors, and, for electrical muscle stimulation, electrodes are used, and the motor act performed by the patient during electrostimulation of muscles, is a repeatedly repeated systemic movement along a given trajectory.

A feature of this technical solution is that a simulator is used as a source of repeated systemic motion along a given trajectory. As motor stereotypes are formed and the neuromuscular apparatus is restored, the volume of physical activity is increased by increasing the number of repeated systemic movements along the trajectory set by the simulator. With a longer electrostimulation session, either an exercise bike, or a walking simulator with an ellipsoidal characteristic of the support pedals movement, or a stair walking simulator is used as a simulator. In addition, angular sensors are installed on the rotation axes of the simulator elements. Apply from one to several pairs of electrodes corresponding to the transverse size of the stimulated muscle and located perpendicular to the course of muscle fibers, which are applied to certain muscle groups, depending on the nature of the lesion. At the beginning of the rehabilitation cycle, the duration of the muscle electrical stimulation session is 30-40 minutes, and then the duration of the muscle electrical stimulation session is adjusted to 60-90 minutes. In the patient's conditions not accompanied by impaired neuromuscular conduction, the amplitude of the stimulating impulse is 30-80 V, the duration of the stimulating impulses is 20-200 μs, the repetition rate of the stimulating impulses is 25-150 Hz, and in the conditions of the patient, accompanied by impaired neuromuscular conduction, the amplitude of the stimulating pulse is 30-80 V, the duration of the stimulating impulses varies from 20-200 μs, the repetition rate of the stimulating impulses is 25-150 Hz.

The disadvantage of the closest technical solution is the relatively low efficiency of rehabilitation, caused by the fact that in a large number of cases, one of the patient's limbs (for example, a leg) is healthy, but for the rehabilitation of the second limb, not information about the movement of a healthy leg is used, but a repeated systemic movement along a given trajectory, the source of which is the simulator. This reduces the effectiveness of rehabilitation and increases its duration; moreover, the trajectories of movement of the patient's healthy leg and healthy arm are recorded by angular motion sensors placed on them.

The closest in technical essence to the proposed one is the method of rehabilitation of functional disorders of the musculoskeletal system [RU 2645928, C1, A61N 1/36, 02.28.2018], based on the fact that electrical stimulation of the muscles of the patient's diseased leg is carried out synchronously with the phases of the motor act in the phases their natural excitation and contraction, for which electrodes installed on the diseased leg are used, and the synchronization of electrical stimulation of the muscles of the diseased leg with the phases of the motor act is carried out in accordance with the systemic movement along a given trajectory, and the trajectory of movement of the healthy leg is taken as the systemic movement along a given trajectory , fixed by the angular motion sensors placed on it, while the movement of the sick leg along a given trajectory is corrected at each step of the patient, taking into account the fixed spatial position of the sick leg using the motion sensors installed on it.

The disadvantage of the closest technical solution is the relatively low efficiency of rehabilitation, caused by the fact that there are no additional effects on the human body, which in a large number of cases increase the effectiveness of rehabilitation and reduce its duration.

In particular, it is known that, depending on the volume of damage to the brain tissue, complete (paralysis) or partial (paresis) loss of muscle control can occur. As a rule, in the most common case, it is paresis, which captures both the arm and leg on one side of the body (hemiparesis).

If the paretic (i.e., paresisized) limbs are moved, especially forcibly, then gradually some bypass paths for the conduction of nerve impulses are established in the brain and muscle control is restored. In the closest technical solution, a method of such forced movement is proposed, when the muscles of the legs are forced to contract coordinated electrical impulses, controlled by measuring the trajectories of the skeletal links of a healthy leg.

It was found that the restoration of the ability to walk after a stroke occurs much faster if the paretic arm is simultaneously set in motion along with the leg.

In the most general form, this is explained by the fact that the area of the brain that controls the movement of the limbs is very extensive, and most of it is responsible for the control of the forelimbs (hands).

It is believed that this happened historically, because originally, human ancestors moved on 4 limbs, while the upper ones developed to a much greater extent and, accordingly, have a much larger volume of connections with other neurons, in particular, with those that control the hind limbs.

Therefore, in order to increase the effectiveness of rehabilitation of the musculoskeletal system, it is advisable to set in motion the paretic arm along with the leg, while the restoration of the natural, physiological gait will go much faster.

The task, which is solved in the proposed invention, is to create a method that allows for more effective rehabilitation and reduce its time.

The required technical result is to increase the efficiency and shorten the rehabilitation period for a sore leg with hemiparesis.

The problem is solved, and the required technical result is achieved by the fact that in the method based on the fact that in the method of rehabilitation of functional disorders of the musculoskeletal system in hemiparesis, based on the fact that electrical stimulation of the muscles of the patient's diseased leg is carried out synchronously with the phases of the motor act in phases their natural excitation and contraction, for which electrodes installed on the diseased leg are used, at the same time, electrical stimulation of the muscles of the patient's diseased arm is carried out synchronously with the phases of the motor act in the phases of their natural excitation and contraction, for which electrodes installed on the diseased arm are used, while , synchronous with the phases of the motor act, the electrical stimulation of the muscles of the patient's diseased leg and synchronous with the phases of the motor act, the electrical stimulation of the muscles of the patient's diseased arm is carried out in accordance with the trajectories of movement, respectively, of the healthy leg and the healthy arm of the patient, moreover, the trajectories of the healthy the patient's legs and healthy hands are fixed by angular motion sensors placed on them. The drawing shows:

in fig. 1 - design of a device for the rehabilitation of patients with hemiparesis;

in fig. 2 - an example of using a device for the rehabilitation of patients with hemiparesis when placing electrodes and motion sensors on the patient's legs and arms, and the control module and the moistimulation module on the patient's belt.

The device for the rehabilitation of patients with hemiparesis contains a frame 1 with devices for adjusting the structure to the patient's size, swivel wheels 2 (including brakes), adjustable suspensions 3 for the patient's belt 4, support 5 for hands, 6 poles for Nordic walking, electrodes and motion sensors 7 on the patient's legs and arms, control module 8 and myostimulation module 9 on the patient's belt, cables 10.

The proposed method for the rehabilitation of functional disorders of the musculoskeletal system is implemented as follows.

An example of its implementation is the use of the presented device for the rehabilitation of patients with hemiparesis when placing electrodes and motion sensors on the patient's legs and arms, and the control module and myostimulation module on the patient's belt.

The device is a folding U-shaped tubular device made using welded, bolted, collet and pin joints on swivel wheels (while the front pair of wheels is equipped with brakes controlled by pressing the foot). Inside the device, a wide, durable fabric belt with a wrap, equipped with textile fasteners of the "burdock" type and additional belts with buckles, is suspended on adjustable chain braces and carabiners. The belt is attached to the patient's waist, fixing it in the center of the device. Buckled waistbands attach sturdy fabric leg loops that pass from the back between the thighs to prevent the patient from slipping down.

The patient is placed in the device from the open side, then with the help of an assistant, he is fixed in it with a belt and begins training.

If the sore leg is twisted or twisted, the patient will not fall - he will be held by a belt with leg loops. In addition, in case of severe fatigue, the patient can rest by slightly bending his legs and leaning his back on the belt, and his legs on the belts. If the patient is completely suspended in the air, his center of gravity will move slightly forward, the knees will rest against the crossed tubes of the structure, so the body will be hung inside the device and will not fall.

While moving, the patient from all sides feels contact with the details of the device, which quickly turns into an unconscious but familiar feeling of security. Using the device gives the patient the confidence that in the event of a sudden problem with the injured leg, a fall will not occur. He gradually learns not to be afraid to move in a natural upright posture and the conducted myostimulation becomes more effective.

For more complete control over balance, the patient is encouraged to use Nordic walking poles. These two sticks in the hands of the patient, although not very firmly on their feet, nevertheless, instead of one-sided support, provide symmetrical two-sided support. With deviations of the body from the vertical during the execution of walking movements, they allow the patient to better maintain balance. In addition, the participation of the hands in the walking process contributes to a faster recovery of coordination of movements.

Since one of the arms of a patient with hemiparesis usually hangs limply along the body and is not able to keep itself bent, the device is equipped with special supports for the arms. The patient inserts the forearms into adjustable annular cuffs made of elastic fabric, which are suspended on special brackets installed at the desired height on the frame. After that, he puts his hands into the lanyards (gloves) of the sticks, fixing them securely. Now, even in the event of an accidental release of the hands or loss of coordination by the patient, the sticks will not fall out of his hands and he will not have to bend over them, especially since this is impossible while inside the device.

The load from the weight of the paretic arm in this design is eliminated, which makes it easier for the patient to move the sick limb and makes it possible to involve it in the rehabilitation process.

Such a device allows the simultaneous use of active electromyostimulation of the paretic arm using the electrodes of the myostimulation module when training a sore leg. This significantly speeds up the recovery of physiological walking skills compared to training only the legs.

The device and the proposed method of rehabilitation were tested in a clinic. With the medical staff, we discussed in detail all the details of attaching the patient, adjusting the various links of the device to the patient's size, the features of the postures that the body can take under certain circumstances. As advantages, a greater degree of patient safety when walking, a more physiological posture, etc. were noted.

Patient B.A.P., 59 years old, in July 2019 was operated on for a spinal disease. The regimen was semi-recumbent, the diagnosis was made - hemiparesis. Training using the prototype method RU 2645928 is recommended.

Patient SH.E.M., 64 years old. The diagnosis is hemiparesis. Training according to the proposed method is recommended. FIG. 2, the patient walks along the sidewalk in the device of FIG. 1, leaning on Nordic walking poles and equipped with a control module and a myostimulation module. Motion sensors are installed over the patient's outerwear. The myostimulation electrodes are installed on the skin, then the cables are brought out from under the trousers and connected to the myostimulation module using connectors.

In the second example of rehabilitation, an approximately 20-30% reduction in the duration of rehabilitation was achieved.

Thus, due to the introduction of an additional operation, according to which, along with the electrical stimulation of the sore leg, it is possible to simultaneously conduct electrical stimulation and set the paretic arm in motion, the restoration of a natural, physiological gait is much faster, and the required technical result is achieved, which consists in increasing the efficiency and shortening the rehabilitation period. sore leg with hemiparesis.

Claims (1)

A method for the rehabilitation of functional disorders of the musculoskeletal system in hemiparesis, based on the fact that electrical stimulation of the muscles of the patient's diseased leg is carried out synchronously with the phases of the motor act in the phases of their natural excitement and contraction, for which electrodes installed on the diseased leg are used, simultaneously with this synchronous with phases of a motor act electrostimulation of the muscles of the patient's diseased arm in the phases of their natural excitation and contraction, for which electrodes installed on the diseased arm are used, while electrical stimulation of the muscles of the patient's diseased arm is synchronous with the phases of the motor act and electrical stimulation of the muscles of the patient's diseased arm synchronous with the phases of the motor act are carried out in accordance with the trajectories of movement of the healthy leg and healthy arm of the patient, respectively, and the trajectories of movement of the healthy leg and healthy arm of the patient are recorded by angular motion sensors placed on them.

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