RU2816785C1 - Method for post-flight rehabilitation and recovery of functional state of muscular apparatus of knee joint of astronauts by means of bio-controlled mechanotherapy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to aviation, space and restorative medicine and can be used to restore the functional state of the muscular apparatus of the knee joint of astronauts in the post-flight medical rehabilitation program, in particular, at the sanatorium-and-spa stage (second stage) of rehabilitation. Musculo-ligamentous apparatus of the knee joint is trained in a ballistic mode, the training profile is rectangular, the astronaut position is sitting. Speed limitation is 45 degrees per second, the type of mobilization of the knee joint in the frontal plane is flexion and extension of the shin. Movement angle does not exceed 80 degrees. Sequence of application of modes of motor activity—passive flexion and extension in knee joint, active resistance during flexion in knee joint, active resistance in knee extension. Torque limits—200 Nm, number of repetitions—15 times, pause between successive application of motion resistance modes is 30 seconds, total training time of knee joint muscles is 25 minutes, course is 14 procedures.

EFFECT: method provides higher effectiveness of therapeutic measures in the recovery period, as well as optimization of balance of musculo-ligamentous apparatus of knee joint, formation of correct motor skills in recovery post-flight period.

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Description

The invention relates to the field of medicine, in particular aviation, space and rehabilitation medicine, and can be used to restore the muscular system of the knee joint of astronauts in a post-flight medical rehabilitation program. The invention can be used in the practice of doctors of aviation and space medicine, physical therapy, orthopedic traumatologists, therapists, physiotherapists, specialists involved in medical activities, prevention and/or issues of recovery and rehabilitation in the field of aviation, space and rehabilitation medicine.

Restoring the functional state of the musculoskeletal system of astronauts after a long stay in hypogravity conditions is one of the urgent tasks of aviation and space medicine [1]. It is known that during their stay on the international space station, when cosmonauts live for a long time in conditions of weightlessness, the speed and strength qualities of the muscular system are significantly reduced. These changes are especially pronounced in groups of antigravity muscles [2]. The degree of functional impairment may vary and can be most accurately assessed in the post-flight period. A number of studies have shown that at the first stage of stay at the Yu.A. Gagarin mainly corrects gross disorders in the functioning of the neuromuscular system [3, 4]. However, during the cosmonauts’ stay at the second stage of rehabilitation, a number of functional disorders were identified, among which were an imbalance in the strength of the muscle antagonists of the knee joint, decentralization of the axes of motion in the large joints of the lower extremities, and dysfunction in the weak links of the kinematic chain. The consequence of these disorders is an excessive uneven load on the cartilaginous surface of the knee joint, and as a consequence, a high risk of developing destructive and degenerative changes in it [5, 6].

To restore the balance of astronauts’ muscles, methods such as exercise therapy and physiotherapeutic procedures are actively used. When staying at the sanatorium-resort stage of rehabilitation, methods such as balneotherapy and peloid therapy are added to the complex of rehabilitation methods. The scientific literature describes the use of a biomechanical training complex to restore the strength and endurance of an astronaut’s leg muscles after a long space flight [7, 8, 9]. The formation of muscle tension adequate to the actions performed is a task, the solution of which will allow the formation of not only correct motor skills, but also increase the coordination capabilities of the cosmonauts’ muscular system both in post-flight rehabilitation and in pre-flight preparation.

State of the art

Currently, there are known methods for restoring the functional state of the neuromuscular system and preventing physical inactivity in astronauts under conditions of hypogravity exposure, as well as in the post-flight period.

There is a known method (SU 208192 A1) for the prevention of physical inactivity in cosmonauts during their stay in hypogravity conditions, which involves influencing the cosmonaut’s musculoskeletal system with a load adequate in strength and direction of earth’s gravity using, for example, bands made of elastic materials.

However, the method does not provide a solution to the problem of muscle asymmetries and optimization of the balance of the muscles of the knee joint, which are formed in conditions of confined space and reduced motor activity.

There is also a known method (RU 2306960 C2) of increasing the resistance to fatigue of human muscles while maintaining maximum voluntary strength, carried out by exposure to long-term low-frequency electrical stimulation of the muscular system while simultaneously stretching them. The method makes it possible to increase muscle resistance to fatigue in an isokinetic mode in the absence of a significant decrease in the maximum voluntary strength of the stimulated muscles.

Considering that the method allows you to increase muscle performance, which is undoubtedly important in the rehabilitation and training of astronauts, the disadvantage of this method is the lack of data on the use of this method in astronauts while in hypogravity conditions and during the period of post-hypogravity readaptation.

There is a known method (RU 2227048 C1) for restoring and/or preserving the functionality of human muscles in conditions of microgravity and/or hypokinesia, which involves applying dry electrodes to the surface of the skin, training the muscular system by electrical stimulation of the muscles by applying low-frequency pulses of electric current to the electrodes.

However, the method does not provide a solution to the problem of muscle asymmetries and optimization of the balance of the muscles of the knee joint, which are formed in conditions of confined space and reduced motor activity.

There is a known method (RU 2657852 C2) of step-by-step rehabilitation for injuries of the knee joint, which consists in the sequential use of a complex of physical therapeutic effects: massage, pharmacopuncture, magnetic therapy, transcutaneous electrical neurostimulation (TENS), acupuncture, physical therapy (physical therapy), then mechanotherapy is carried out using a multi-joint a programmable mechanotherapeutic complex with biofeedback, which involves flexion and extension of the knee joint in active and passive modes; at the second stage, a complex of physical therapeutic effects is carried out, including pharmacopuncture, mechanotherapy using a multi-joint programmable mechanotherapeutic complex with biofeedback, exercise therapy and exercises on a pneumatic simulator, which is based on the principle of “natural load transfer”, then a pulsed effect on the knee joint is carried out with low-power light in the visible and near infrared range.

The author noted the possibility of using the developed method in cosmonauts, however, the disadvantage of the method is the lack of data on the use of this method in cosmonauts while in hypogravity conditions and during the period of post-hypogravity readaptation. In addition, the disadvantage of the proposed method of mechanotherapy is its effectiveness only when used in combination with other rehabilitation methods.

The technical result to which this invention is aimed is to optimize the work of the antagonist and synergist muscles of the knee joint, to form the correct conditioned reflex motor reactions both in the post-flight recovery period and in everyday life.

The technical result is achieved in that the method for optimizing the balance of the flexor and extensor muscles of the knee joint of astronauts using robotic mechanotherapy includes active and passive mobilization of the joint with a given speed and adjustable resistance.

What is new is that:

- training of the muscular apparatus of the knee joint occurs in a ballistic mode, the training profile is rectangular, the astronaut’s position is sitting, the speed limit of mobilization is 45 degrees per second, the type of mobilization of the knee joint in the frontal plane is flexion and extension of the lower leg, the angle of movement does not exceed 80 degrees, sequence of application of motor activity modes - passive flexion and extension at the knee joint, active resistance during flexion at the knee joint, active resistance during extension at the knee joint, torque limits - 200 Nm, number of repetitions - 15 times, break between successive application of motion resistance modes - 30 seconds, total training time for the muscles of the knee joint - 25 minutes.

To achieve the most pronounced effect, the course must be at least 14 procedures.

Efficiency lies in:

- optimization of muscle balance - strengthening weak muscle groups, leveling out areas of muscle tissue;

- prevention of injuries and damage to the musculoskeletal system while restoring motor activity and biomechanics of movement;

- normalization of blood flow and neuromuscular transmission, and as a result, acceleration of recovery of the functional state in the post-flight period.

A method for optimizing the balance of the flexor and extensor muscles of the knee joint of astronauts using robotic mechanotherapy is implemented on a robotic biomechanical complex with biofeedback Con-trex, the main tasks of which are diagnosis and objective functional assessment of the condition of the patient’s musculoskeletal and neuromuscular systems based on volume the movement being performed, the patient’s recorded effort and determining the optimal speed characteristics of his movement. These technologies are implemented through special modules; in our method, the MJ module was used - for training and diagnosing the joints of the lower extremities, which has the following characteristics: modes - isokinetic, isotonic, isometric, ballistic, passive mobilization; profile - sinusoidal, rectangular; resistance - eccentric, concentric, torque limits - from 0 to 300 Nm, speed of movement from 0 to 180 degrees per second, amplitude of movement from 0 to 180 degrees, type of movement in the joint - flexion, extension, abduction, adduction, rotation.

A course of procedures in order to optimize the balance of the muscular system of the knee joint, normalize blood flow and neuromuscular transmission is carried out using the Con-trex MJ module complex in ballistic mode, rectangular training profile, in a sitting astronaut position, with a speed limit of mobilization - 45 degrees. second, type of mobilization of the knee joint in the frontal plane, flexion and extension of the lower leg, angle of movement does not exceed 80 degrees, sequence of application of motor activity modes - passive flexion and extension of the knee joint, active resistance when flexing the knee joint, active resistance when extending the knee joint , torque limits 200 Nm, number of repetitions 15 times, break between successive application of movement resistance modes - 30 seconds, total training time for the muscles of the knee joint - 25 minutes.

Achieving a technical result is also ensured by the fact that the course of procedures for optimizing the balance of the muscles of the knee joint is at least 14 procedures.

The physiological effect is ensured by the fact that in the area of influence the imbalance in the strength parameters of the antagonist muscles is eliminated, muscle fatigue is reduced, microcirculation is improved, arterial inflow and venous outflow are normalized, the bioelectrical activity of the neuromuscular system is improved, the speed of propagation of electrical impulses along the motor fibers of the nervous tissue increases, as well as along axon terminals that do not have a myelin sheath.

Indications for using the method:

- restoration of motor activity during the post-flight rehabilitation period;

- conditions of overstrain and overtraining of the musculoskeletal system and their prevention;

- the need to increase the functionality of the musculoskeletal system of astronauts;

- muscle imbalance, insufficient level of development of individual muscle groups.

Contraindications to using this method:

- acute injuries;

- painful conditions accompanied by acute pain syndrome, feverish conditions.

The inventive method was tested to optimize the balance of the muscles of the knee joint in 5 astronauts. A dynamometer study after a course of robotic mechanotherapy (14 procedures) made it possible to identify optimization of the balance of the muscular system of the knee joints, which occurred due to changes in the power parameters of muscle tension for movement. It was noted that the difference between the parameters of the maximum and average application of force during the exercise was leveled, which indicates that the astronaut applied the same uniform force during prolonged physical activity. At the same time, the load during the mechanotherapy sessions, although it was dynamic, however, active compensation was carried out for the effort exerted by the astronaut, as a result of which control was exercised over the strengthening of weak muscle groups and the relaxation of the grooved areas of the muscles. As a result of such a load, the correct dynamic stereotype of movements was formed, while the conscious control of muscle tension contributed to the formation of correct motor skills in everyday life. The data obtained from the results of electromyographic and rheovasographic studies indicate the consolidation of the positive effect of mechanotherapy on the functional state of the neuromuscular system (increased amplitude (P<0.01), motor response area (P<0.03), decreased latency (P<0, 01), increasing the speed of propagation of excitation along nerve fibers (P<0.05)) and peripheral hemodynamics of astronauts (improving indicators: rheographic index on the left foot (P<0.04), elastic modulus on the right (P<0.02) and left leg (P<0.05) and venous outflow on the right leg (P<0.04).

Consequently, by comparing the indicators of electroneuromyography, rheovasography, dynamometry, before and after application of the claimed method, one can conclude that there is a significant statistically significant improvement in the indicators, and, consequently, a positive effect of its use for optimizing the balance of the muscles of the knee joint of astronauts. As a result of a course of robotic mechanotherapy, the functional state of the neuromuscular system, as well as the peripheral hemodynamics of the lower extremities of astronauts, improves.

It is obvious that the combination of physical characteristics of the effects, the duration of individual procedures and courses in this invention ensure the achievement of the stated technical result. The use of this method shows the effectiveness and high potential of this invention. Thus, the proposed method for optimizing the balance of the muscles of the knee joint of astronauts using robotic mechanotherapy has new properties that provide a positive effect.

Additional materials for the description of the method of post-flight rehabilitation and restoration of the functional state of the muscular system of the knee joint of astronauts using biocontrolled mechanotherapy

Implementation of the claimed method for optimizing the balance of the muscles of the knee joint and increasing the functionality of the musculoskeletal system of astronauts at the second stage of the post-flight rehabilitation program.

Example 1

Cosmonaut S., 53 years old, was sent to the international space station three times as part of the main crew, the total flight time was more than 530 days, the total time in outer space was more than 16 hours. At the second stage (sanatorium-resort stage) of rehabilitation, he was observed in the city of Pyatigorsk.

A dynamometric study of the muscles of the knee joint showed that the parameters of the maximum torque of the muscles of the extensors of the knee joint on the right were 88.2 Nm, flexors 62.1 Nm; on the left, the maximum torque of the extensor muscles is 86.1 Nm, the flexor muscles are 58.4 Nm. The average torque of the knee extensor muscles on the right is 69.1 Nm, the flexor muscles are 50.3 Nm; on the left, extensors - 79.2 Nm, flexors - 42.4 Nm. The electromyographic study revealed an increase in the residual latency of the motor response on the right to 4.12 ms and on the left to 4.05 ms. Parameters of the amplitude of the motor response on the right at the points of stimulation of the deep peroneal nerve “head of the fibula” - 4.86 mV and “popliteal fossa” - 4.65 mV. On the left, the amplitude of the motor response at the stimulation point “head of the fibula” was 4.92 mV, and at the stimulation point “popliteal fossa” - 4.54 mV. On the right, the speed of propagation of excitation along the nerve fiber in the area “tarsus” - “head of the fibula” - 49.2 m/s, “head of the fibula” - “popliteal fossa” - 44.6 m/s. Speed of propagation of the electrical impulse along the motor fibers of the peroneal nerve on the left in the area “tarsus” - “head of the fibula” was 48.6 m/s, “head of the fibula” - “popliteal fossa” - 48.2 m/s. A study of peripheral circulation using the method of rheovasography of the lower extremities (shin abduction, foot abduction) showed that the astronaut had an increased rheographic index on the left foot to 2.18 c.u. (norm 0.9-1.3 c.u.).

After cosmonaut S. underwent a course of 14 procedures of biocontrolled mechanotherapy of the muscles of the knee joints (in ballistic mode, training profile

- rectangular, astronaut position - sitting, speed limitation of mobilization - 45 degrees per second, type of mobilization of the knee joint in the frontal plane - flexion and extension of the lower leg, angle of movement does not exceed 80 degrees, sequence of application of motor activity modes - passive flexion and extension of the knee joint, active resistance when flexing the knee joint, active resistance when extending the knee joint, torque limits 200 Nm, number of repetitions 15 times, break between successive application of movement resistance modes - 30 seconds, total training time for the muscles of the knee joint - 25 minutes) , the dynamometry indicators changed as follows: the maximum torque of the knee joint extensor muscles on the right was 63.9 Nm, the flexor muscles 62.6 Nm; on the left extensors 61.5 Nm, flexors 62.6 Nm. The average torque of the knee extensor muscles on the right was 58.6 Nm, flexor muscle torque was 58.5 Nm; on the left, extensors 59.4 Nm, flexors 58.1 Nm. A repeated study of muscle bioelectrical activity revealed a decrease in residual latency to normative values - 3.04 ms on the right, 2.99 ms on the left. A rheovasographic study of the lower extremities of cosmonaut S. after a course of mechanotherapy revealed a decrease and normalization of the rheographic index on the right foot to 1.03 c.u. These changes indicate optimization of muscle balance, normalization of peripheral blood flow and bioelectrical activity of muscles.

Example 2

Cosmonaut Sh., 51 years old, went to the international space station four times as part of the main crew, the total flight time was more than 709 days, the total time in outer space was more than 21 hours. At the second stage (sanatorium-resort stage) of rehabilitation, he was observed in the city of Pyatigorsk.

A dynamometric study of the muscles of the lower extremities showed that the parameters of the maximum torque of the muscles of the extensors of the knee joint on the right were 88.4 Nm, flexors - 79.3 Nm; on the left, the maximum torque of the extensor muscles is 85.2 Nm, the flexor muscles are 74.4 Nm. The average torque of the muscles of the knee joint extensors on the right is 62.5 Nm, flexors 50.2 Nm; on the left, extensors - 66.3 Nm, flexors - 48.1 Nm. The electromyographic study revealed a decrease in the amplitude of the motor response at the points of stimulation of the deep peroneal nerve “head of the fibula” - 3.44 mV and “popliteal fossa” - 3.52 mV on the right. On the left, the amplitude of the motor response at the stimulation point “head of the fibula” was 4.13 mV, and at the stimulation point “popliteal fossa” - 4.21 mV. On the right, the speed of excitation propagation along the nerve fiber in the area “tarsus” - “head of the fibula” is 52.3 m/s, “head of the fibula” - “popliteal fossa” - 48.6 m/s. The speed of propagation of the electrical impulse along the motor fibers of the peroneal nerve on the left in the area “tarsus” - “head of the fibula” was 49.3 m/s, “head of the fibula” - “popliteal fossa” - 49.8 m/s. Residual latency on the right is 2.45 ms, on the left - 2.34 ms. A study of peripheral circulation using the method of rheovasography of the lower extremities (shin abduction, foot abduction) showed that the cosmonaut had an increased rheographic index on the right foot to 1.98 c.u. (norm 0.9-1.3 c.u.).

After cosmonaut Sh. underwent a course of 14 procedures of biocontrolled mechanotherapy of the muscles of the knee joints (in ballistic mode, rectangular training profile, sitting cosmonaut position, speed limit of mobilization - 45 degrees per second, type of mobilization of the knee joint in the frontal plane - flexion and extension of the lower leg , angle of movement - does not exceed 80 degrees, sequence of application of motor activity modes - passive flexion and extension in the knee joint, active resistance when flexing in the knee joint, active resistance when extending the knee joint, torque limits 200 Nm, number of repetitions 15 times, the break between successive application of movement resistance modes is 30 seconds, the total training time for the muscles of the knee joint is 25 minutes), the dynamometry indicators changed as follows: the maximum torque of the knee joint extensor muscles on the right was 54 Nm, the flexor muscles were 53.2 Nm; on the left, extensors 53.6 Nm, flexors 52.1 Nm. The average torque of the muscles of the extensors of the knee joint on the right was 49.2 Nm, flexors 48.9 Nm; on the left extensors 48.8 Nm, flexors 49.4 Nm. A repeated study of the bioelectrical activity of the muscles revealed an increase in the amplitude of the motor response at the stimulation points “head of the fibula” on the right up to 5.8 mV, on the left up to 5.4 mV, “popliteal fossa” on the right up to 5.6 mV, on the left - 5.9 mV . The peripheral blood circulation parameters of cosmonaut Sh. changed as follows: the rheographic index on the right foot returned to normal and amounted to 0.98 c.u. These changes indicate optimization of muscle balance, peripheral circulation in the lower extremities and increased functionality of the neuromuscular system of the astronaut’s lower extremities.

Literature

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Claims (1)

A method of post-flight rehabilitation of the functional state of the muscular system of the knee joint of astronauts using biocontrolled mechanotherapy, including active and passive mobilization of the lower extremities, characterized in that the training of the musculo-ligamentous apparatus of the knee joint occurs using the Con-trex apparatus with an MJ module in ballistic mode, training profile – rectangular, the astronaut’s position is sitting, the speed limitation of mobilization is 45 degrees per second, the type of mobilization of the knee joint in the frontal plane is flexion and extension of the lower leg, the angle of movement does not exceed 80 degrees, the sequence of application of motor activity modes is passive flexion and extension in knee joint, active resistance when flexing the knee joint, active resistance when extending the knee joint, torque limits - 200 Nm, number of repetitions - 15 times, break between successive application of movement resistance modes - 30 seconds, total training time for the muscles of the knee joint - 25 minutes, course – 14 procedures.