RU2797176C1 - Method of kinesiterapeutic treatment of diseases of the muscle-motor apparatus - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to methods of treatment of diseases of the human musculoskeletal system, and in particular to methods of kinesiotherapy treatment using machine vision and artificial intelligence. A method of kinesitherapeutic treatment of diseases of the musculoskeletal system is proposed, characterized by the following: initially an anamnesis of the patient's life and disease is collected, functional diagnostics of the patient's musculoskeletal system is conducted and the results of the collection of anamnesis and functional diagnostics are transmitted to a server, where a list of preliminary diagnoses is formed, based on which the selection of kinesitherapeutic exercises recommended for treatment is made in the form of complexes aimed at restoring a certain part of the human musculoskeletal system; the exercises that are contraindicated in concomitant diseases or in the current disease are excluded from the list, after which the formed sets of exercises with recommendations on technique and the frequency of their execution are transmitted to the patient's client application, then the patient performs the specified list of exercises, while the patient performs the exercises in front of the video camera associated with the client application, while in the client application a video sequence is formed in which the patient's image is selected and a skeletal 3D model is built in the form of an undirected graph with vertices at reference points located at the junction of the main bones of a person and also the face of a person, after that, the angular displacements of each reference point are evaluated during the performance of diagnostic exercises. and the resulting angular displacements are compared with the angular displacements of the reference exercise, while reporting errors to the patient or signaling the patient to stop exercising.

EFFECT: invention reduces the risk of injury or exacerbation of diseases of the musculoskeletal system when the patient independently performs kinesitherapeutic exercises, as well as monitoring the progress of treatment and the regularity of performing kinesitherapeutic exercises.

3 cl, 6 dwg

Description

The invention relates to methods for the treatment of diseases of the human musculoskeletal system, and in particular to methods of kinesiotherapy treatment using machine vision and artificial intelligence [IPC A63B21/00].

A METHOD OF THERAPEUTIC AND HEALTH IMPACT ON A HUMAN ZHDANOVA V.A. is known from the prior art. [RU2643403C1, publ. 02/01/2018], which includes performing physical therapy exercises, characterized in that, first, relaxation and / or toning of the corresponding pain zones of the patient's body is carried out, after which the patient's body is restored to the position of the body axis as close as possible to the gravity vector, for which the following are used postures and exercises:

- the patient stands with his back against a smooth vertical surface, pushing his feet forward, placing them parallel at a distance of twice the width of the foot, then bends his knees and presses the entire spine tightly against the vertical surface, pushing the pelvis forward and upward with the tension of the muscles of the lower abdominals, gluteus maximus muscles , the pelvic floor, the shoulder blades are pressed against the ribs, lowered down together with the shoulder girdle, the patient straightens the legs, at the same time trying to press the spine along the entire length, including the neck, to the vertical plane, sliding along it without pressure, do not hold your breath; repeat until stable fixation of new sensations in the body;

- the patient, while standing, mentally projects the highest point of the cranial vault - the top of the head to the middle of the distance between the inner ankles, and the doctor, with light pushes in the chest, back and side of the shoulder joints, helps the patient feel stability in a vertical position, in this stable position the patient fixes the horizontal position of the pelvis , in which the rear and front upper spines are at the same level relative to the floor;

- in the process of everyday life, the patient reinforces the feeling of this new physiological posture by checking his presence in it every half hour or hour;

- in the patient's sitting position: support only on the buttocks, the top of the head is projected to the middle of the distance between them, the legs are extended at the knees at an angle greater than 90 degrees, the hips are maximum in weight, the feet are on the floor; at the same time, the patient enhances his sense of the vertical by performing small oscillatory movements of the body around the spine with a static head, small, barely noticeable swaying back and forth and from side to side, slight displacement of the patient on the buttocks in all possible directions, the patient imagines that, sitting , rotates the gymnastic hoop and makes the corresponding movements of the body clockwise and counterclockwise, when performing these exercises, while sitting, the patient raises and holds his gaze at 45 degrees to the horizon, then closes his eyes, then with his eyes open, he ceases to fix the surrounding objects with his gaze - defocuses his gaze ;

- imitation of walking in the starting position: sitting, the seat surface is hard, the support is only on the buttocks, the hips are in weight, the angle at the knee joint is more than 90 degrees, the legs are off the support, the muscles of the lower abdominal and interscapular region are in good shape, the shoulder girdle is in the plane the horizon, the shoulder blades are brought together and lowered, the hands are on the hips, the head and neck are in the pre-nodding position - as when throwing a hood over the head, then the patient shifts the knee of one leg forward, while the feet remain in place, on the same line, while the translational movement of the thigh is accompanied by movement pelvis on the same side, the hand of the same hand moves along the upper surface of the thigh to the groin, the other thigh goes back, accompanied by the movement of the pelvis from its side, and the hand on this side lies on the shin below the knee joint, the shoulder girdle makes counter movements with opposite knee joints, and the head occupies a fixed position due to the gaze holding the imaginary goal of the route, the patient remembers a sense of symmetry and the same sensations from the contralateral, oncoming movement of the halves of the body;

- exercise "stopped step": both legs are placed on the support, and the leg extended forward touches the support with the heel, where the foot and toes produce maximum dorsiflexion, and the foot left behind is in the state of stopped repulsion from the support - stopped plantar flexion, while the patient remembers the feeling of lightness for both halves of the body;

- double crossing movement forward - right leg and left shoulder girdle, then vice versa, eyes look in the direction of movement, the head is motionless,

- walking with a wide step, in which the patient should feel the tension of the lower third of the gluteus maximus muscle on the side of the leg that is behind; they first put the heel on the support, then the outer surface of the foot, begin to touch the support with the pads of the toes from the little finger to the big toe, then they push and take the leg forward, while raising the toes towards themselves, and put the leg back on the heel, all movement is accompanied by a rise in the pelvis on the same side, the feet with the inner edge go in one line or at a distance of 5-10 cm from each other, do not allow swinging from side to side;

- when performing exercises, the patient uses affirmations of a healing nature;

- exercises are performed during wakefulness for 0.5-2 minutes every 0.5-2 hours until a stable sensation of a new physiological position of the body and its automatic use;

- additionally 3-4 times a day, half an hour before meals, the patient lies with the navel area on an elastic elevation in the form of a roller 15-20 cm wide, 25-30 cm high, then shifts the roller 5-7 cm lower, then - above the navel, not allowing severe pain, and guided by a feeling of discomfort, while using the implementation of small movements - bends in the lumbar spine and breathing to change the direction of the roller, the duration of the procedure - as long as the patient wants to perform it;

- breathing during exercises: the patient imagines that his chest is a cap or cone, and his stomach is a ball, and while inhaling, the patient lowers this “cone” or “cap” of the chest onto the “ball” of the abdomen, the patient exhales through closed lips , with resistance.

The main disadvantages of this method is the lack of exercise variability depending on the individual characteristics of the patient, the presence of concomitant diseases, as well as the course of the disease of the musculoskeletal system. In addition, in this method there is no control over the exercise and adjustment of the treatment program.

Also known from the prior art is a METHOD FOR THE TREATMENT OF LUMBAR OSTEOCHONDROSIS WITH HERNIATED DISC [RU2142771C1, publ. 20.12.1999] characterized by the performance of dosed physical activity, physiotherapeutic procedures and additional therapeutic effects, characterized in that as a dosed physical activity, various types of exercises are performed for 12 - 36 sessions, 2 - 5 series of each type of at least 2 - 20 repetitions per series with overcoming pain by pronouncing the sound "HA" on the exhale, while starting exercises from hanging on the horizontal bar with lifting the legs bent at a right angle at the knee joints to chest level, then on the "Hyperextension" or "Roman chair" simulator they lift and lower the torso without bending it, then perform the exercise lying on the "Leg Wave" simulator, bending and unbending the legs at the knees, after which the legs are flexed and extended at the knees on the "Leg extension" simulator, then the straight line is removed on the "Standing gluteus" simulator. leg back, bend it in the hip joint and return to its original state, proceed to the exercises on the Crossover simulator, performing torso bends, kneeling in different planes until the body touches the floor, complete the set of articular gymnastics exercises for the lumbar and abdominal sections, and also hip joints, performed in the prone position by swinging one or two legs, rotating the legs in the hip joints bent or straight at the knees, as physiotherapy after exercise

the patient is exposed to water with a temperature of 4 - 6oC in the form of a shower or a stream of water, or a bath for 10 - 120 s; , and between sessions carry out protein nutrition.

The main disadvantages of the technical solution are that in the proposed method there is no preliminary diagnosis and anamnesis, the results of which are formed and prescribed sets of exercises, and there is no control over the exercise and adjustment of the treatment method.

The closest in its technical essence is a SYSTEM FOR DIAGNOSIS AND TREATMENT OF DISEASES OF THE MUSCLE-MOTOR APPARATUS [RU23106U1, publ. 05/20/2002], containing a database block on the etiology and pathogenesis of diseases of the musculoskeletal system, means and methods of their treatment, a diagnostic block, a block for analyzing and developing an individual treatment plan, a block for monitoring treatment results, while the diagnostic block contains information carriers of an anamnesis of life and anamnesis of the patient’s illness, the first of which contains information about the patient’s age, bad habits, occupation, information about past diseases, and the carrier of information about the anamnesis of the disease includes information about the patient’s complaints, X-ray data, MRI, CT, duration of the existing disease, characteristics of the musculoskeletal system, the presence or absence of scoliosis, lordosis, hyperlordosis, hyperkyphosis, kyphosis, hypertonicity of the paravertebral muscles, stiffness of the interspinous ligaments, as well as information about the condition of the shoulder, knee, ankle joints in the prone position, information about the condition of the hip joints in the "lying on the back" position, information about the presence or absence of the "tension" symptom, information about the body flexion test from the position "sitting, legs bent", "sitting with straight legs", while the output of the diagnostic database unit is connected to the possibility feedback to the input of the diagnostic unit, and the output of the diagnostic unit is connected to the input of the analysis unit and the development of an individual treatment plan, which gives specific recommendations on the number, duration and types of training on specific simulators, the output of the treatment unit is connected with the possibility of feedback to the output of the control unit results of treatment and the release of a database block on the etiology and pathogenesis of diseases of the musculoskeletal system, means and methods of their treatment.

The main technical problem of the prototype is the lack of exercise control, resulting in a high risk of comorbid injuries or exacerbation of the disease by the patient, and there is no adjustment in the treatment methodology.

The objective of the invention is to eliminate the shortcomings of the prototype and analogues.

The technical result of the invention is to reduce the risk of injury or exacerbation of diseases of the musculoskeletal system when the patient independently performs kinesitherapeutic exercises, as well as ensuring control of the progress of treatment and the regularity of performing kinesitherapeutic exercises.

The specified technical result is achieved due to the fact that the method of kinesitherapeutic treatment of diseases of the musculoskeletal system is characterized by the fact that the anamnesis of the patient's life and disease is initially collected, functional diagnostics of the patient's musculoskeletal system is carried out and the results of the anamnesis and functional diagnostics are transmitted to the server, where a list of preliminary diagnoses is formed on the basis of which the selection of kinesitherapeutic exercises recommended for treatment in the form of complexes is made, aimed at restoring a certain part of the human musculoskeletal system, those exercises that are contraindicated in concomitant diseases or in the current disease are excluded from the list of these exercises, after which formed sets of exercises with recommendations on the technique and frequency of their implementation are transferred to the patient's client application, then the patient performs the specified list of exercises, while the patient performs the exercises in front of a video camera associated with the client application, while in the client application a video sequence is formed in which the patient's image is selected and a skeletal 3D model is constructed in the form of an undirected graph with vertices at reference points located at the joint of the main human bones and also the human face, after which the angular displacements of each reference point are evaluated during diagnostic exercises. and the resulting angular displacements are compared with the angular displacements of the reference exercise, while reporting errors to the patient or signaling the patient to stop exercising.

In particular, the collection of anamnesis and functional diagnostics is carried out using a client application installed on a personal portable or stationary computer.

In particular, the list of sets of recommended exercises is divided into stages by days, weeks, months.

In particular, after each stage is completed, a second diagnosis is made, after which the treatment method is adjusted.

Brief description of the drawings.

In FIG. 1 shows an example of a client application interface installed on a patient's personal computer.

In FIG. Figure 2 shows an example of building a skeletal 3D model of a patient.

In FIG. Figures 3 and 4 show the algorithm for assessing the quality of exercise performance and deviations in the ODA.

In FIG. Figure 5 shows an example of the data structure on the server and the interaction of the client application with it.

Implementation of the invention.

The method of kinesiotherapeutic treatment of the musculoskeletal system (ODA) is characterized by the fact that for its implementation, the patient is initially diagnosed, including the collection of anamnesis by questioning and functional diagnostics. In this case, the survey is carried out by means of a software product (client application) installed on the patient's personal computer (see Fig. 1). As a personal computer, a mobile device (smartphone), portable or stationary personal computer with extended multimedia capabilities, namely, the ability to record and play video images and sound, can be used. During the questionnaire, patients answer a series of questions aimed at collecting an anamnesis of life and an anamnesis of the disease, as well as identifying comorbidities. After that, the results of the questionnaire are sent to the server, where preliminary diagnoses are formed in the questionnaire module on the server.

After the survey, a functional diagnosis of the mobility of the patient's musculoskeletal system is performed. In which the patient consistently performs a series of diagnostic physical exercises in various positions (standing, sitting, lying on the floor). At the same time, video recording is made and a video sequence of the specified exercises is formed.

The obtained results of the survey, as well as the generated video sequence of performing diagnostic exercises, are transferred to the server, to the patient's personal account, where they evaluate the quality of the exercises and deviations in the MDA and form a list of kinesitherapeutic exercises recommended for treatment.

To assess the quality of the exercises and deviations in the ODA, the patient’s image is captured in the video sequence and a digital 3D skeletal model of the patient is built with the formation of the following reference points:

- point 0 at the tip of the nose

- points at the beginning 1, middle 2 and end 3 of the left eye;

- points at the beginning 4, middle 5 and end 6 of the right eye;

- points on the left 7 and right 8 ear;

- points of the left 9 and right 10 corners of the mouth;

- points of the left shoulder 11 and right shoulder 12;

- points of the left 13 and right 14 cubits;

- points of the left 15 and right 16 wrists;

- points of the tips of the left 17th and right 18th little fingers of the hands;

- points of the tips of the left 19th and right 20th index fingers;

- points of the tips of the left 21 and right 22 thumbs;

- points of the left 23 and right 24 hip joints;

- points of the left 25 and right 26 knee joint;

- points of the left 27 and right 28 ankle joint;

- points of the left 29th and right 30th calcaneal bones;

- points of the left 31 and right 32 index toe;

In addition to the mentioned reference points 0-32, auxiliary points 33 and 34 are distinguished, which, when connected, form the central vertical axis of the skeletal model and are located in the middle of the segment connecting the reference points 11 and 12 for the reference point 33 and in the middle of the segment connecting the reference points 23 and 24 for the reference points 34 (see Fig. 2).

In the general case, the process of assessing the quality of exercise performance and deviations in the ODA is explained by algorithms (see Fig. 3, 4).

Next, the angular displacements of each reference point are evaluated during the diagnostic exercises. To do this, local coordinate systems are constructed, while these coordinate systems are built on the basis of the Gram-Schmidt algorithm, according to which each coordinate system depends on the position of the parent bone of the human skeletal model, taking into account its spatial rotation.

Next, the obtained angular displacements are compared with the angular displacements of the reference exercise performance and the percentage of deviation of the current exercise performance metric from the reference metric is calculated:

deviation <15%, which means the norm;

deviation 15 - 25%, which means small deviations;

deviation 25 - 50%, which means pathology;

deviation >50%, which means a critical disease of ODA or a period of its acute course.

Further, taking into account the questionnaire, the formation of preliminary diagnoses, as well as taking into account the functional diagnosis of ODA in the module for selecting recommended exercises to restore the normal functionality of the musculoskeletal system, kinesitherapeutic exercises recommended for the treatment of ODA are selected.

At the same time, the recommended exercises are formed from an array of exercises grouped into complexes and aimed at restoring the functionality of one or another part of the ODA. In the presented embodiment, these complexes include exercises affecting the cervical region, shoulder girdle, upper, middle and lower back, abs and lower limbs. In addition, these complexes also include exercises performed in various positions: standing, sitting on a chair or on the floor, lying on the stomach, lying on the side, lying on the back, on all fours. These complexes are stored in the exercise module in the form of a description of the exercises and files with the metrics of the reference performance of each exercise (see Fig. 5).

The formation of complexes of recommended exercises is carried out taking into account deviations when comparing the performance metrics of diagnostic exercises with the reference exercise performance according to the following algorithm:

We take the latest diagnostic history DiagnosticHistory. Create an array programExercises

Iterates over all history of ExercisePoseConditionHistory exercises from the history field.

Loop through history metrics history (AngleConditionHistory)

If score == 1 (no deviations) - choose any block of exercises

Find an entry in the MetricExercise table where (AngleCondition.id == kind).

conditionExercises = any block of exercises from the exercises list.

Otherwise, we calculate a block of exercises for the user depending on the points.

Find all scores for all previous DiagnosticHistory by field conditionId = scores

Loop over found scores, i = 0, blockIndex = 0, blockIndex < 4 (maximum 4 exercise blocks):

If score > scores[i]

blockIndex += 1

i += 1

conditionExercises = block of exercises from the MetricExercise table by the kind field by the index blockIndex.

Add selected exercises to programExercises

In addition, exercises that can lead to an exacerbation of the disease itself, as well as concomitant diseases, are excluded from the complexes of recommended exercises. To do this, in the exercise selection module, an exercise ban block is formed, in which, on the basis of preliminary diagnoses, prohibited exercises are removed from the formed complexes of recommended exercises.

After that, the generated set of exercises is distributed by day (for 3 days, taking into account the exercise every other day) and sent by the UserProgramDay file to the patient's client application.

Next, the patient on his client application launches the rehabilitation program recommended to the user, in accordance with which he performs kinesitherapeutic exercises (see Fig. 6). At the same time, the patient performs these exercises in front of a video camera connected to a personal computer or built into it. In the process of performing exercises, a video stream is continuously formed, according to which, by analogy with the stage of functional diagnostics, a skeletal 3D model of the patient is constructed with the formation of reference points and the calculation of their spatial displacement. According to the indicated calculations of spatial movement, the correctness of the exercises is controlled, and deviations from the reference exercises are recorded.

Further, after the completion of the complex of exercises distributed over the days, a repeated functional diagnostics is performed. According to the results of the repeated diagnosis and the results of the quality of the performance of kinesitherapeutic exercises, the complexes of exercises are adjusted, namely, the decrease or increase in the load, the exclusion or inclusion of exercises, and the recommended complex of kinesiotherapeutic exercises is re-formed. This cycle is repeated until the required acceptable level of the functional state of the ODA.

The indicated technical result is to reduce the risk of injury or exacerbation of diseases of the musculoskeletal system when the patient independently performs kinesitherapeutic exercises, as well as monitoring the progress of treatment and the regularity of performing kinesitherapeutic exercises is achieved due to the fact that when performing the formation of a list of recommended exercises, based on the information obtained at the stage of collecting anamnesis this list excludes exercises that are incompatible with concomitant diseases or exercises that can cause exacerbations of the current disease. Also, the specified technical result is achieved due to the fact that in the process of performing the exercises, a video sequence of performing exercises is formed, according to which a skeletal 3D model is constructed in the form of an undirected graph with vertices at reference points located at the joint of the main human bones and also the human face, after which an assessment is made angular displacements of each reference point during diagnostic exercises. and the resulting angular displacements are compared with the angular displacements of the reference exercise, while reporting errors to the patient or stopping the exercise.

Claims (26)

1. A method for kinesitherapeutic treatment of diseases of the musculoskeletal system, characterized in that initially they collect an anamnesis of the patient's life and disease, conduct functional diagnostics of the patient's musculoskeletal system and transmit the results of the collection of anamnesis and functional diagnostics to a server, where a list of preliminary diagnoses is formed, to on the basis of which the selection of kinesitherapeutic exercises recommended for treatment in the form of complexes aimed at restoring a certain part of the human musculoskeletal system is made, those exercises that are contraindicated in concomitant diseases or in the current disease are excluded from the list of these exercises, after which the formed sets of exercises with recommendations for the technique and the frequency of their implementation are transmitted to the patient's client application, then the patient performs the specified list of exercises, while the patient performs the exercises in front of the video camera associated with the client application, while in the client application a video sequence is formed in which the patient's image is selected and a skeletal 3D is constructed models in the form of an undirected graph with vertices at reference points located at the junction of the main human bones, as well as the human face, namely: - point 0 in the area of the tip of the nose; - points at the beginning 1, middle 2 and end 3 of the left eye; - points at the beginning 4, middle 5 and end 6 of the right eye; - points on the left 7 and right 8 ear; - points of the left 9 and right 10 corners of the mouth; - points of the left shoulder 11 and right shoulder 12; - points of the left 13 and right 14 cubits; - points of the left 15 and right 16 wrists; - points of the tips of the left 17th and right 18th little fingers of the hands; - points of the tips of the left 19th and right 20th index fingers; - points of the tips of the left 21 and right 22 thumbs; - points of the left 23 and right 24 hip joints; - points of the left 25 and right 26 knee joint; - points of the left 27 and right 28 ankle joint; - points of the left 29th and right 30th calcaneal bones; - points of the left 31 and right 32 index toe; in addition to the mentioned reference points 0-32, auxiliary points 33 and 34 are distinguished, which, when connected, form the central vertical axis of the skeletal model and are located in the middle of the segment connecting the reference points 11 and 12 for the reference point 33, and in the middle of the segment connecting the reference points 23 and 24 for the reference point 34, after that, the angular displacements of each reference point are evaluated during the performance of diagnostic exercises, the resulting angular displacements are compared with the angular displacements of the reference exercise, while a) deviation <15%, which means the norm; b) a deviation of 15-25%, which means small deviations; c) deviation of 25-50%, which means pathology; d) a deviation of >50%, which means a critical disease of the musculoskeletal system or a period of its acute course, further inform the patient about errors or give a signal to the patient about the need to stop the exercise. 2. The method according to p. 1, characterized in that the collection of anamnesis and functional diagnostics are performed using a client application installed on a personal portable or stationary computer. 3. The method according to claim 1, characterized in that the list of recommended exercise complexes is divided into stages by days, weeks, months. 4. The method according to claim 3, characterized in that after each stage, a second diagnosis is made, after which the treatment method is adjusted.

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