RU2813057C1 - Simulator for rehabilitation treatment of patients with gunshot wounds of spine and spinal cord, as well as spinal cord injury - Google Patents

Abstract

FIELD: restorative medicine.

SUBSTANCE: invention can be used in neurosurgery for the rehabilitation of patients with gunshot wounds of the spine and spinal cord injury in the immediate postoperative period. The simulator includes a rectangular frame placed longitudinally and perpendicular to the bed. Two pairs of parallel blocks are attached to the horizontal frame post, located above the middle of the bed, on which sling-shaped garters are placed for suspending the patient’s lower extremities in the area of the foot and popliteal fossa. Garters for suspending the patient's lower extremities in the area of the popliteal fossa are equipped with cords with handles for the patient to grasp. On the vertical post closest to the foot there is a hook for fixing rubber expanders that prevent bending of the limbs at the knee and hip joints.

EFFECT: improvement in the formation of movements in patients is achieved starting from the immediate postoperative period.

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Description

The invention relates to restorative medicine and can be used in neurosurgery for the rehabilitation of patients with gunshot wounds of the spine and spinal cord injury in the immediate postoperative period, with the aim of restoring movement disorders in victims with spinal cord contusion and improving the quality of life in patients with complete anatomical spinal injury brain

The proposed device makes it possible to begin rehabilitation of victims in bed in the immediate postoperative period after stabilization of the general condition. In this case, both the shoulder girdle and upper limbs, as well as the torso and lower limbs, are included in the work. An important feature of this simulator is the independent restoration of neurological deficits under the guidance of a physical therapy methodologist.

A characteristic feature of such patients is the symmetry of the lesion with varying degrees of spinal cord damage due to injuries and wounds of different levels.

According to the nature of the lesion, the most severe are patients with a complete anatomical break of the spinal cord (type A on the ASIA scale). The goal of rehabilitation in this group is to strengthen the muscles of the trunk and shoulder girdle above the level of the spinal cord injury. Restoring self-care skills, turning in bed to avoid bedsores, as well as moving into a wheelchair independently. For the lower extremities, the use of the system is aimed at restoring range of motion in the joints, reducing muscle spasticity, as well as improving blood circulation in the lower extremities and pelvis. Preparing the patient for further rehabilitation in an exoskeleton.

More favorable in terms of rehabilitation and outcome are victims with partial spinal cord injury (cervical and thoracic spine) (type B and C on the ASIA scale).

For this group, in addition to the above-mentioned goals of rehabilitation, it is to increase strength and range of motion in the limbs with partially preserved movements and sensitivity up to 3 points or more. With verticalization and learning to walk at the beginning, in a walker, and then on crutches. It is important to restore the function of the pelvic organs within the limits of self-care. Carry out passive and subsequently active development of the joints of the upper and lower extremities.

A method of forming motor functions in disabled people with spinal cord injury is described [Method of forming motor functions in disabled people with spinal cord injury / Konovalova N.G., Leontiev M.A., Frolenko S.Yu. - Patent for invention No. 2392915 dated 06.27.10. Application No. 2009114189 dated 04/14/09. publ. 06.27.10. Bulletin No. 18]. The method involves doing therapeutic exercises to strengthen the muscle corset, in a lying position, sitting, verticalization, suspension movements, analytical gymnastics for key muscle groups, placing in a retraining position, manual development of contractures while taking nootropic drugs.

The advantage of the method is that physical effects aimed at stimulating restorative and replacement processes in the central nervous system occur while taking pharmacological drugs that improve blood supply and trophism of nervous tissue.

The disadvantages of the method are the inability to use this method in the immediate postoperative period. The ability to independently conduct therapeutic exercises for patients under the guidance of a physical therapy methodologist. As well as simultaneous training of the torso, upper and lower extremities.

There is a known method for developing stability in a sitting position in patients with statodynamic disorders [Method for developing stability in a sitting position in patients with statodynamic disorders / N.G. Konovalova, M.A. Leontyev, E.V. Stepanova, I.V. Shupenko. - Patent for invention No. 2448670 dated April 27, 2012 according to application No. 2010152118 dated December 20, 2010. publ. Bulletin No. 12]. In this case, the patient trains postural regulation using visual feedback through a stabilograph and a computer.

The disadvantage of this method is that it does not involve mastering targeted movements of the limbs, active conscious work of the muscles of the torso, and does not target the patient to awareness of position and conscious control of the movement of individual parts of the body, the work of muscle groups.

As a prototype, a method was chosen for the formation of postures and movements in patients with spinal cord injury, in particular a method for the formation of motor functions in patients with tetraparesis [Method of restorative treatment of patients with spinal cord injury N.G. Konovalova, V.V. Lyakhovetskaya, I.V. Deeva, E.V. Filatov – patent for invention - RU2539164C1 dated January 10, 2015]

The method of restorative treatment of patients with spinal cord injury is carried out by performing a set of physical exercises, placing the patient on the Exarta kinesiotherapeutic installation, for which the patient’s body or parts of the body are fixed in suspensions, and he performs the exercises while lying down, sitting on a support - a couch or a wheelchair .

The advantage of this method is its versatility in the treatment of patients with osteochondrosis, as well as the consequences of injuries to the spine and spinal cord.

The disadvantage of this method is the impossibility of its use in the immediate postoperative period, and there is also no possibility of simultaneously restoring movement in the upper and lower extremities, which can be performed by the patient himself under the guidance of a physical therapy methodologist. In addition, it requires a separate office because... the installation is very complex and cumbersome; it cannot be used in a ward for several patients at the same time.

The objective of the invention is to improve the formation of movements in patients with gunshot wounds of the spine and spinal cord, as well as in patients with spinal cord injury, on the original simulator, starting from the immediate postoperative period.

The solution to this problem is ensured by the fact that the simulator for the rehabilitation treatment of patients with gunshot wounds of the spine and spinal cord, as well as with spinal cord injury, includes a rectangular frame placed perpendicular to the bed; two blocks are attached to the horizontal stand of the frame, on which sling-like garters are placed, equipped with cords with handles; on the vertical stand there is a hook for fixing rubber expanders.

The invention is illustrated by the following figures.

Fig. 1. 1 - U-shaped frame with rectangular posts; 2 - parallel blocks; 3 - sling-shaped leg garters with loops for the cord, 4 - handles on the cord, 5 - rubber expander bands; 6 - hook on a vertical stand for fixing rubber expanders.

Fig. 2. 7 - Fastening the structure with parallel blocks, 2 - blocks.

Fig. 3. Flannel sling leg garters with cord loops;

8 - loops for the cord.

Fig. 4. 1 - Vertical stand; 6 - hook for attaching a rubber expander.

Fig. 5. Appearance of the patient after three weeks of rehabilitation:

a) in a sitting position; b) in a standing position in a walker.

The goal is achieved using the original simulator (Fig. 1). The patient lies on a bed to which a U-shaped frame 1 is attached, the posts of which are rectangular in shape. On the horizontal part of the frame, structures with parallel blocks 7 are placed on which sling-shaped garters 3 are attached to suspend the lower extremities in order to facilitate movements, with the help of which the patient can independently perform movements in the joints of the legs with the help of the hands, if there are no active movements in the legs. Both lower limbs are hung in parallel on sling-shaped garters 3, the cord with handles 4 from which is located on blocks 2, which are located on a structure with parallel blocks of the horizontal part of the frame 1, and their location can be changed depending on the size of the patient. To the sling-shaped garters 3 supporting the legs with loops for the cord 8 in the lower part (ankle joint area), rubber bands are fixed - expanders 5, which with the other end are put on a metal hook 6, which is located on the vertical post of the frame 1. Expanders 5 contribute to the resistance to flexion of the limbs in knee and hip joints, and also return the limbs to their original position (IP). Thanks to expanders 6, the upper shoulder girdle is loaded and when moving the legs independently, the load on the muscles increases and thus, by training, the patient increases the strength of the muscles of the lower extremities. As a result of active movements with the arms and simultaneously with the legs, movements occur in the joints of the limbs, respiratory movements of the chest increase and the possibility of congestion in the lungs and vessels of the limbs, as well as in the pelvis, decreases. In the area of the upper third of the legs, a second device for hanging limbs is put on (sling garter 3), to which a cord with handles 4 is fixed, the free end of which is passed through parallel blocks 2. The patient, being in the supine position (SP), after hanging the limbs, begins to pull one by one The handles of the cord 4 are pulled towards you, while flexion and extension of the limbs occur at the knee and hip joints. In addition, when active movements appear in the legs, the patient can additionally independently perform abduction and adduction of the limbs. The proposed simulator allows not only restoration of movements in the lower extremities, but also training of the muscles of the shoulder girdle and upper extremities. The method allows you to maintain movement in large joints, prevents the development of ankylosis, and performing these exercises with the unification of the body into a single biokinematic chain ensures the restoration of muscle tone. In addition, movements in the torso and limbs improve blood circulation in all tissues and organs, promote the restoration of nerve tissue, improve the processes of general metabolism and energy in the body, stimulate the functioning of the urination and defecation organs, reduce pain, and activate the immune system.

Example

The wounded man received a mine explosion wound and was admitted to us with a diagnosis of “Combined wounds of the chest, abdomen, pelvis, and limbs. Multiple fragmentation non-penetrating wounds of the thoracic and lumbar spine with a bruise, partial disruption of spinal cord conduction, multiple gunshot fractures of the ThXI-LV vertebrae. Lower paraplegia with dysfunction of the pelvic organs.” After operations on the chest and abdominal cavity, the patient's condition improved, and he was transferred to the neurosurgery clinic. For multiple shrapnel wounds of the spine, the patient underwent operations aimed at decompressing the spinal cord and removing a metal fragment, as well as percutaneous transpedicular fixation of the spine at the L1-L2 level. After the operations, the patient's neurological status showed positive dynamics in the form of a sensation of the presence of lower extremities, and barely noticeable active movements in individual muscles of both hips. Since the start of rehabilitation on the simulator, the wounded man began to develop and increase movements in his legs. The range of motion in the joints of the lower extremities increased, and sensory disorders began to regress. Three weeks have passed since we started using our simulator. The patient learned to sit up in bed independently, as well as stand in a walker, transferring the main load to his arms, and also take the first steps on the spot (Fig. 4 a, b). Thus, the muscle strength of the lower extremities was restored to 3-4 points.

Claims (1)

A simulator for the rehabilitation treatment of patients with spinal cord injury associated with gunshot wounds, including a rectangular frame placed longitudinally and perpendicular to the bed, two pairs of parallel blocks are attached to the horizontal frame stand located above the middle of the bed, on which sling-shaped garters are placed for hanging the lower limbs of the patient in the area of the foot and popliteal fossa, and garters for hanging the lower extremities of the patient in the area of the popliteal fossa are equipped with cords with handles for the patient to grip; on the vertical stand closest to the foot, there is a hook for fixing rubber expanders that counteract flexion of the limbs at the knee and hip joints.