RU2823491C1 - Method for functional diagnostics of biomechanics of motor disorders in human knee joint - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to methods for diagnosing biomechanics of movements. Method for diagnosing biomechanics of movements in a knee joint of a person, in which a person performs exercises of a complex of therapeutic gymnastics, which are shown on the screen of an electronic device; knee orthosis is put on patient’s knee joint with integrated transducers and sensors recording knee joint goniometry and biopotentials of biceps muscle of thigh, quadriceps muscle of thigh, anterior tibial muscle, triceps muscle of shin. Data from the orthosis transducers during the patient’s performance of exercises of a complex of therapeutic gymnastics are transmitted remotely to an electronic device and then to a doctor via the Internet. Therapeutic gymnastics complex includes exercises in which, first, a person in an initial position lying on his/her back performs breathing exercises, flexion-extension in the ankle joints simultaneously and alternately with each leg, flexion, extension of the leg in the knee joint, with the heel sliding along the surface, lifting the chest with support on the buttocks and shoulders, abduction of the straight leg to the side, tension of the posterior group of thigh muscles, straightening the leg in the knee joint, imitation of cycling, circular movements with a straight leg, writing numbers with a straight leg in the air, then, in the initial position, the person lying on his/her stomach, hands under the chin, abducts the straight leg to the side, bends the leg in the knee joint, lifts the straight leg up, then, in the initial sitting position, performs flexion-extension of the toes, adduction and extension of the feet, extension-flexion of the leg in the knee joint, walking in place with lifting the knee, leg abduction, imitation of cycling with one leg, then in the initial position he performs rolling from the heel to the toe, walking on the spot with raising the knee, abducting the straight leg, half-squatting, without taking the heels off the floor.

EFFECT: method enables to simultaneously record knee goniometry data and bioelectric activity of thigh and shin muscles when performing active and/or passive movements in the knee joint, according to a video reference set of exercises with remote transmission of said data to a mobile device and their further transmission to a doctor over the Internet, objective presentation of biomechanics of movements in the knee joint is a tool for telemonitoring of the rehabilitation process at home.

1 cl, 2 dwg

Description

The invention relates to medicine, namely to the field of medical rehabilitation. The method for functional diagnostics of the biomechanics of motor disorders in the human knee joint can be used in home rehabilitation, telemonitoring, and telepatronage for patients with diseases of the nervous and musculoskeletal systems.

In accordance with federal clinical recommendations, after knee or hip replacement, rehabilitation measures begin within 1 day in the intensive care unit or surgical department (the first stage of rehabilitation) and continue after discharge from the surgical department in the medical rehabilitation department for patients with impaired function peripheral nervous system and musculoskeletal system (second stage of rehabilitation) [1,2]. At the first stage, the patient receives rehabilitation measures for 4-7 days, at stage 2 - 10-14 days. Thus, the patient can stay in hospital for up to 21 days.

Currently, the use of accelerated rehabilitation technologies (fast-track) after hip and knee replacement is becoming increasingly popular. This technology is relevant both abroad and in our country, since it combines efficiency and cost-effectiveness [3]. When using this technology, the patient reaches the discharge criteria 3-4 days after surgery [4]. An important component that allows patients to avoid postoperative complications and be discharged from the hospital earlier is early rehabilitation. This prevents the development of the well-known adverse physiological consequences of prolonged bed rest, such as muscle wasting and atrophy, the formation of pressure ulcers, decreased lung function, impaired tissue oxygenation and an increased risk of thromboembolism.

The recommendations of the Society for Accelerated Recovery After Surgery (ERAS, fast-track) indicate that reducing the period of stay of a patient who has undergone hip or knee arthroplasty in the hospital limits the period for assessing the early postoperative prognosis, which requires the organization of structured follow-up such patients on an outpatient basis for a long time. Only dynamic observation in an outpatient setting allows a more accurate assessment of the result of surgical treatment (survival, surgical complications, complications of anticoagulant prophylaxis), the functional result of the operation and its impact on the quality of life of patients. Only an assessment of the long-term prognosis allows us to confirm that by reducing the duration of hospitalization, the key principle of accelerated recovery is observed - maintaining the quality of medical care.

In Russia, an organized system of medical patronage and social support has not yet been developed, allowing for proper monitoring of patients who have undergone knee or hip replacement after early discharge and carrying out rehabilitation measures on an outpatient basis [4]. Territorial separation between doctor and patient and shortage of medical personnel aggravate this problem. According to federal clinical recommendations, the patient must take control photographs annually and be seen at the clinic for a consultation, which does not allow for a timely assessment of the patient’s functional state and prevent developing complications.

The development of telemedicine technologies makes it possible to solve the issue of remote monitoring of the patient by questioning using audio and video communication according to a developed checklist, but this is a subjective assessment of the condition. Video instructions on a computer monitor or smartphone allow the patient to perform therapeutic exercises in accordance with the rehabilitation period, but do not monitor the quality of its execution.

In modern conditions, technologies related to methods for assessing the quality and effectiveness of rehabilitation are acquiring practical significance. Particular attention is paid to the objective assessment of rehabilitation outcome indicators [5]. In this regard, the development of methods for assessing the dynamics of motor disorders during medical rehabilitation is of great importance [6, 7]. New methods for assessing effectiveness make it possible to timely change therapeutic approaches, reorient drug treatment and make changes to the set of non-drug rehabilitation methods [8]. The growing medical demand for precise methods of recording human movements has led to significant progress in the field of biomechanics [9].

Comprehensive registration of biological and mechanical characteristics of movement is a necessary condition for studying the patterns of human movement control. It is possible with the simultaneous recording of electrophysiological and biomechanical indicators of movement, when the electrical activity of the muscles and the external picture of movement are recorded (kinogram, cyclogram, tensodynamogram, goniogram, mechanogram). When recording these processes on different media, there is a need for special devices for recording synchronization [10].

Goniometry (angulometry) is the measurement of angles in human body joints. The joint angle is an important biomechanical characteristic. The traction force of the muscle (that is, its length and its shoulder relative to the axis of the joint) depends on the joint angle [10].

There is a known method of goniometry using a protractor-goniometer according to the classical method described by Marx V.O. [eleven]. The disadvantage of this method is: the need to know the technique of this measurement. Measurement is possible by a doctor or a specially trained exercise therapy instructor.

The goniometry method is known as an application for smartphones using accelerometer technology to estimate angles (Goniometer pro application) [12]. The disadvantage of this method is: rapid development and changes in both hardware and software, which leads to measurement errors. Using any other brand of hardware or software may also result in errors. Using a smartphone solely as a goniometer is a high cost for this diagnosis.

A well-known digital goniometer is Halo (Halo Medical Devices, Sydney, Australia) [13]. The portable device takes measurements using a laser, without direct contact with the patient. The manufacturer of this device claims that its device is accurate to within 1°.

A common drawback of all of the above goniometric methods is that this study does not provide insight into the biomechanics of movement in the joint.

Electromyography is a method of recording the electrical activity of muscles. Allows you to receive information directly while performing physical exercise. Three main areas of using electromyography to study human motor activity can be distinguished: characterizing the activity of individual motor units of muscles, determining the activity of individual muscles in various motor acts, and characterizing the coordination of the activity of muscles united by common participation in movement. To solve biomechanical problems, mainly the second and third directions are used. When electromyography is used to study movement, cutaneous electrodes are typically used. Skin electrodes can be mono- or bipolar. The electromyogram can reflect the electrical activity of those muscles over which the electrodes are located [10].

A device for recording electromyographic signals of human muscles is known, consisting of several wireless sensors (Neurorobotics Trigno, Delsys Trigno Research+). The device allows you to record the activity of individual human muscles by installing sensors on adhesive tape to the area of the muscle being studied.

The disadvantage of using this device is the need for knowledge and skills to correctly install the sensors, which makes measurements possible only by specially trained personnel.

The proposed method allows you to simultaneously record goniometry data of the knee joint and bioelectrical activity of the muscles of the thigh and lower leg when performing active and/or passive movements in the knee joint, according to a reference set of exercises demonstrated on video with remote transfer of this data to a mobile device and their further transfer to the doctor via the network The Internet, which gives an objective idea of the biomechanics of movements in the knee joint and is a tool for telemonitoring the rehabilitation process at home.

This result is achieved by using a device - a rigid brace-type orthosis for the knee joint, on which position sensors (accelerometers) are fixed, collecting data on the flexion and extension of the knee joint and electromyographic (EMG) sensors that record muscle biopotentials.

Position sensors are located on the part of the orthosis adjacent to the thigh and on the part of the orthosis adjacent to the lower leg.

Registration of muscle biopotentials is carried out using bipolar cutaneous electrodes (EMG sensors) located in the projections of the following muscles: biceps femoris, quadriceps femoris, tibialis anterior, triceps surae (musculus triceps surae). Electrical activity of muscles is recorded at rest and during active and/or passive movement. Electromyography and goniometry are recorded simultaneously.

Information from these sensors and sensors enters a signal collection and transmission unit fixed on the orthosis, which in real time transmits it wirelessly (for example, via Bluetooth) to an external digital device (smartphone, tablet, personal computer), where incoming data is stored and processed. data. The data can be transferred wirelessly to the doctor's (nurse's) digital device. In this case, to directly monitor and obtain target data from sensors, the patient needs to perform a series of physical exercises, which are demonstrated on the same digital device in the form of a video recording.

Integration of a “standard” rigid orthosis of the “brace” type with electronic sensors makes it possible to fully preserve the functionality of the first, while providing the ability to monitor the dynamics of the work of antagonist muscles and obtain a comprehensive understanding of the biomechanics of movements in the knee joint. The use of a standard orthosis provides the advantage of requiring only a one-time installation and fixation of the sensors with the help of a specialist; further use of the device is possible for the patient independently without any difficulties, incl. at home, similar to a “regular” orthosis. The ability to wirelessly transfer data to an external digital device allows you to collect information and analyze it in real time, as well as store or remotely transmit it to a doctor, which allows you to objectively assess the patient’s rehabilitation process and prevent the development of complications. Demonstration on a digital device of video recordings of exercises that the user of the orthosis must repeat, firstly, eliminates the need for the direct presence of a specialist and simplifies the process of medical rehabilitation, and secondly, significantly increases the quality of monitoring on a digital device, since the time and sequence of exercises become known. Registration of data during the performance of the demonstrated standard complex of therapeutic exercises allows for feedback from the patient and creates an objective idea of the functional capabilities of the lower limb. Using a smartphone, tablet or personal computer as an external digital device eliminates the need for specialized equipment and allows the patient to independently carry out rehabilitation using, for example, a personal smartphone.

The use of a rigid orthosis with integrated sensors will solve the issue of outpatient monitoring of patients at home after knee or hip replacement using fast-track technology through telemonitoring.

The method is implemented as follows.

A rigid orthosis for the knee joint (brace type) with integrated sensors and sensors is installed on the lower limb in accordance with the length of the limb.

The location of the EMG sensors is corrected using fixing screws in the projections of the biceps femoris muscle, quadriceps femoris muscle, tibialis anterior muscle, and triceps surae muscle.

Using standard fasteners, the orthosis is fixed on the lower limb.

The device turns on.

The signal collection and transmission unit wirelessly connects to an external digital device, collects data from sensors (biopotentials and angulometry data) in real time and transmits them to the digital device. At the same time, a video recording of the exercises that the user of the orthosis must repeat is shown on a digital device.

At the end of the exercises, the device turns off.

The orthosis is removed from the limb.

The orthosis with sensors is put on again by the patient independently and does not require additional settings.

Information about the dynamics of leg activity in the orthosis, in the form of digital values demonstrating signals of muscle activity, as well as the angle of flexion and extension of the knee joint, can be displayed, stored on an external digital device and transmitted to the doctor via the Internet.

The method is illustrated by a clinical example.

Patient N., 24 years old, was undergoing outpatient treatment in the medical rehabilitation department of the SamSMU Clinic since July 17, 2023. until July 28, 2023 with a diagnosis of “flexion-extension contracture of the right knee joint, condition after autoplasty of the anterior cruciate ligament on the right.” In the process of performing therapeutic exercises using an individual method, the patient used an orthosis to record data on bioelectrical muscle activity and goniometry. Goniometry and electromyography sensors were fixed on the orthosis in the area of the anterior and posterior muscle groups of the thigh and lower leg. Data registration was carried out remotely using a smartphone, then the data was remotely transmitted to the attending physician. Data from the sensors was displayed in the form of graphs. The necessary exercises were demonstrated to the patient on a smartphone, while the doctor remotely (without personal presence next to the patient) monitored the dynamics of restoration of range of motion in the knee joint based on incoming data. The patient did not notice any discomfort during the exercises in the orthosis and removed it independently. Based on the data obtained, the doctor gave feedback to the patient.

Demonstrated reference complex of therapeutic gymnastics:

Starting position lying on your back.

1. Breathing exercises. One hand is placed on the stomach, the other on the chest. When performing the exercises, take a deep breath through the nose and exhale through the mouth. The exercise should be repeated 3 times.

2. Flexion-extension at the ankle joints simultaneously and alternately with each leg. Repeat the exercise 10 times.

3. Flexion and extension of the leg at the knee joint, sliding the heel along the surface. Perform alternately with each leg 5 times.

4. Raising the chest with support on the buttocks and shoulders. Legs straight, arms bent at elbows, emphasis on elbows and shoulders. Raise your chest a few centimeters from the surface and lower it. Repeat the exercise 5 times.

5. Abduction of the straight leg to the side. As you exhale, pull the sock towards you, lift your leg 10 cm, move your straight leg to the side 30 degrees, return to i. p., Perform the exercise alternately with each leg 5 times.

6. Tension in the posterior thigh muscles. Bend your leg 60 degrees at the knee joint, sliding your foot along the couch, in a bent state, press on the surface with your heel for 2-3 seconds, return to the starting position. Perform the exercise alternately with each leg 4 times.

7. Straightening the leg at the knee joint. Raise your leg up, bend at the knee joint, straighten, return to the starting position. Perform the exercise alternately with each leg 4 times.

8. Simulation of cycling. Raise your leg and perform circular movements in the knee joint, imitating riding a bicycle. Repeat 5 movements with each leg in turn.

9. Circular movements with a straight leg. As you exhale, raise your straight leg, perform circular movements, alternately, 5 “circles” with each leg.

10. “Write numbers with a straight leg.” Place your hands under your lower back. As you exhale, raise your straight leg up, extend your toes, “write” numbers from 1 to 5 in the air with your leg, repeat the same with the other leg.

Starting position: lying on your stomach, hands under your chin

11. Abduction of the straight leg to the side. Move your straight leg to the side 40 degrees and return to the starting position. Repeat the exercise with each leg alternately 5 times.

12. Bending the leg at the knee joint. Bend your leg at the knee joint and return to its original position. Bend each leg 8 times in turn.

13. Raising the straight leg up. Raise your straight leg up 20-30 cm and return to the starting position. Perform the exercise alternately with each leg, 5 times.

Starting position - sitting

14. Flexion and extension of the toes. Bend - straighten your toes, moving forward, then back, imitating the movements of a caterpillar. Perform for 1 minute.

15. Bringing and spreading the feet. From the starting position - feet together, spread your toes apart, then your heels, repeat the movements until there is a distance of 50 cm between the feet. Bring your feet back together in the same way. Repeat 5 times.

16. Extension-flexion of the leg at the knee joint. Perform alternately 5 times with each leg.

17. Walking in place with high knees. Perform alternately 5 times with each leg.

18. Leg abduction to the side. Extend the leg at the knee joint, move it to the side, bring it down, return it to its original position. Repeat alternately 5 times with each leg.

19. Imitation of riding a bicycle with one leg. Raise your leg and perform circular movements in the knee joint with each leg 5 times.

Starting position - standing

20. Rolling from heel to toe. Stand on your toes - inhale, lower on your heels - exhale. When performing, monitor your posture (body straight, gaze forward). Repeat 6-8 times.

21. Walk in place with high knees for 1-2 minutes.

22. Straight leg abduction. Without lifting your foot from the floor, place it forward on your toes, move it to the side, back, and return to the starting position. Repeat with the other leg. Perform 4 times with each leg.

23. Half squats without lifting your heels off the floor. When performing, watch your posture (back straight). Squat, creating an angle at the knee joint of no more than 90 degrees. Do it 6 times.

Figures 1 and 2 show graphs for recording muscle biopotentials and goniometry in accordance with the exercises performed in different starting positions (the numbering of the captions under the graph along the X axis corresponds to the description number of the exercise in the presented complex and its photo under the graph). Fig. 1 - Graphic registration of muscle biopotentials and goniometry when performing therapeutic exercises in the initial position lying on the back and lying on the stomach; fig. 2 - Graphic registration of muscle biopotentials and goniometry when performing therapeutic exercises in the initial sitting and standing position.

During the exercises the following graphs were recorded:

emg1 - biceps femoris muscle (musculus biceps femoris)

emg2 - quadriceps femoris muscle

emg3 - tibialis anterior muscle (musculus tibialis anterior)

emg4 - triceps surae muscle (musculus triceps surae)

angl - angle of flexion of the knee joint

Information sources:

1. Builova T.V., Tsykunov M.B. Rehabilitation during knee replacement. Federal clinical guidelines. Ministry of Health of the Russian Federation. FSBI "Privolzhsky Federal Medical Research Center" of the Ministry of Health of the Russian Federation. FSBI Central Research Institute of Traumatology and Orthopedics named after. N. N. Priorov" of the Ministry of Health of the Russian Federation, Nizhny Novgorod National Research University named after. N.I. Lobachevsky. Union of Rehabilitologists of Russia. - 2015 20 p. https://rehabrus.ru/Docs/kl_rek_endoproteze_kolen%20site_srr.doc.

2. Builova T.V., Tsykunov M.B., Kareva O.V., Kochetova N.V. Rehabilitation during hip replacement in a specialized hospital department. Federal clinical guidelines. Ministry of Health of the Russian Federation. Ministry of Education and Science of the Russian Federation. Federal State Autonomous Educational Institution of Higher Education "National Research University of Nizhny Novgorod named after. N.I. Lobachevsky." FSBI Central Research Institute of Traumatology and Orthopedics named after. N. N. Priorov" of the Ministry of Health of the Russian Federation, Federal State Budgetary Institution "Volga Federal Medical Research Center" of the Ministry of Health of the Russian Federation. Union of Rehabilitologists of Russia. - 2014. 32 p. https://rehabrus.ru/Docs/2020/Endoprotezirovanie.pdf.

3. Ageenko A.M., Sadovaya M.A., Shelyakina O.V., Ovtin M.A. Technology of accelerated rehabilitation after hip and knee replacement (literature review). Traumatology and orthopedics of Russia. 2017;23(4):146-155. DOI: 10.21823/2311-2905-2017-23-4-146-155.

4. Manevsky A.A., Sviridov S.V., Melekhov A.V., Barmotin G.V., Demin A.K., Nikitin I.G. Accelerated recovery during knee and hip arthroplasty: the need for national recommendations // Bulletin of Anesthesiology and Reanimatology. - 2022. - T. 19, No. 6. - P. 86-96. DOI: 10.21292/2078-5658-2022-19-6-86-96.

5. Klyachkin L.M. Medical rehabilitation of patients with diseases of internal organs: Director. for doctors / L.M. Klyachkin, A.M. Shchegolkov. - Moscow: Medicine, 2000. - 325. ISBN 5-225-04428-X.

6. Sheiko G.E., Belova A.N., Rukina N.N., Korotkova N.L. Possibilities of using biomechanical human motion capture systems in medical rehabilitation (review) // Physical and rehabilitation medicine, medical rehabilitation. 2022; 4(3): 181-196. DOI: https://doi.org/10.36425/rehab109488.

7. Lutsky L, Treger I. Quality Assessment in Medical Rehabilitation. Physical and rehabilitation medicine, medical rehabilitation. 2020; 2(1):38-48. DOI: https://doi.org/10.17816/rehab19266.

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9. Roggio F., Ravalli S., Maugeri G., et al. Technological advancements in the analysis of human motion and posture management through digital devices // World J Orthop. 2021. Vol. 12, N 7. R. 467-484. doi: 10.5312/wjo.v12.i7.467.

10. Kapilevich L.V. Biomechanics of motor activity: textbook / L.V. Kapilevich, V.I. Andreev, E.V. Koshelskaya - Tomsk: Tomsk Polytechnic University Publishing House, 2012 - 146 p.

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12. Jones A, Sealey R, Crowe M, Gordon S (2014) Concurrent validity and reliability of the simple goniometer iPhone app compared with the universal goniometer. 30:512-516.

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Claims (1)

A method for diagnosing the biomechanics of movements in the human knee joint, which consists in the fact that the person performs exercises of a complex of therapeutic gymnastics, demonstrated on the screen of an electronic device; The patient's knee joint is wearing a knee joint orthosis with integrated sensors and sensors that simultaneously record goniometry of the knee joint and the biopotentials of the biceps femoris, quadriceps femoris, tibialis anterior, triceps surae muscles, data from the orthosis sensors during the patient's performance of a complex of therapeutic exercises remotely transmitted to an electronic device and then to a doctor via the Internet; the complex of therapeutic gymnastics includes exercises in which first a person, in the initial position lying on his back, performs breathing exercises, flexion-extension at the ankle joints simultaneously and alternately with each leg, flexion, extension of the leg at the knee joint, with the heel sliding along the surface, raising the chest with resting on the buttocks and shoulders, moving the straight leg to the side, tensing the posterior thigh muscles, straightening the leg at the knee joint, imitation of riding a bicycle, circular movements with a straight leg, writing numbers in the air with a straight leg, then in the starting position the person is lying on his stomach, hands under the chin, abducts the straight leg to the side, bends the leg at the knee joint, lifts the straight leg up, then, in the initial sitting position, performs flexion-extension of the toes, abduction and spread of the feet, extension-bending of the leg at the knee joint, walking in place with raising the knee, abducting the leg to the side, imitating riding a bicycle with one leg, then in the initial standing position performs heel-to-toe rolls, walking in place with raising the knee, abducting the straight leg, half-squats, without lifting the heels from the floor.