RU2192897C2 - Method for treating cases of postinsult pareses - Google Patents
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- RU2192897C2 RU2192897C2 RU99124339A RU99124339A RU2192897C2 RU 2192897 C2 RU2192897 C2 RU 2192897C2 RU 99124339 A RU99124339 A RU 99124339A RU 99124339 A RU99124339 A RU 99124339A RU 2192897 C2 RU2192897 C2 RU 2192897C2
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- 238000000034 method Methods 0.000 title claims abstract description 16
- 208000007542 Paresis Diseases 0.000 title claims description 3
- 208000012318 pareses Diseases 0.000 title 1
- 210000000278 spinal cord Anatomy 0.000 claims abstract description 5
- 230000000694 effects Effects 0.000 claims abstract description 4
- 230000035945 sensitivity Effects 0.000 claims abstract description 4
- 230000007794 irritation Effects 0.000 claims description 4
- 230000002232 neuromuscular Effects 0.000 claims description 4
- 230000000638 stimulation Effects 0.000 abstract description 12
- 239000003814 drug Substances 0.000 abstract description 2
- 239000000126 substance Substances 0.000 abstract 1
- 210000003414 extremity Anatomy 0.000 description 8
- 230000017531 blood circulation Effects 0.000 description 4
- 210000004369 blood Anatomy 0.000 description 3
- 239000008280 blood Substances 0.000 description 3
- 230000032630 lymph circulation Effects 0.000 description 3
- 238000011084 recovery Methods 0.000 description 3
- 210000001519 tissue Anatomy 0.000 description 3
- 210000003710 cerebral cortex Anatomy 0.000 description 2
- 230000007659 motor function Effects 0.000 description 2
- 210000003205 muscle Anatomy 0.000 description 2
- 210000002569 neuron Anatomy 0.000 description 2
- 230000008569 process Effects 0.000 description 2
- 230000004936 stimulating effect Effects 0.000 description 2
- 208000023516 stroke disease Diseases 0.000 description 2
- 206010013142 Disinhibition Diseases 0.000 description 1
- 206010033799 Paralysis Diseases 0.000 description 1
- 208000006011 Stroke Diseases 0.000 description 1
- 230000001154 acute effect Effects 0.000 description 1
- 230000036772 blood pressure Effects 0.000 description 1
- 238000010835 comparative analysis Methods 0.000 description 1
- 125000004122 cyclic group Chemical group 0.000 description 1
- 201000010099 disease Diseases 0.000 description 1
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 1
- 230000006870 function Effects 0.000 description 1
- 230000006872 improvement Effects 0.000 description 1
- 230000002045 lasting effect Effects 0.000 description 1
- 210000003141 lower extremity Anatomy 0.000 description 1
- 210000005036 nerve Anatomy 0.000 description 1
- 210000000653 nervous system Anatomy 0.000 description 1
- 210000005259 peripheral blood Anatomy 0.000 description 1
- 239000011886 peripheral blood Substances 0.000 description 1
- 230000035807 sensation Effects 0.000 description 1
- 230000035909 sensory irritation Effects 0.000 description 1
- 239000008399 tap water Substances 0.000 description 1
- 235000020679 tap water Nutrition 0.000 description 1
- 230000001225 therapeutic effect Effects 0.000 description 1
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Abstract
Description
Изобретение относится к медицине, а именно к неврологии. The invention relates to medicine, namely to neurology.
Известен способ лечения парезов электростимуляцией нервов и мышц импульсным током с помощью многоканального устройства "Миотон" [1]. Однако известный способ направлен, в основном, на раздражение нервно-мышечных структур и лишь косвенно влияет на проприо- и экстерорецепторы и периферическое кровообращение, в то время как восстановление функций нервно-мышечного аппарата требует достаточного сенсорного раздражения в коре головного мозга, активного увеличения крово- и лимфообращения в области стимулируемых тканей. A known method of treating paresis by electrical stimulation of nerves and muscles by pulsed current using a multi-channel device "Myoton" [1]. However, the known method is aimed mainly at irritating the neuromuscular structures and only indirectly affects the proprio- and exteroreceptors and peripheral blood circulation, while the restoration of the functions of the neuromuscular apparatus requires sufficient sensory irritation in the cerebral cortex, an active increase in blood and lymph circulation in the area of stimulated tissues.
Наиболее близким, принятым за прототип, является способ лечения постинсультных нарушений, включающий электростимуляцию путем последовательного циклического нанесения раздражения на двигательную точку разгибателя кисти здоровой руки и симметричный участок паретической руки; двигательную точку тыльного сгибателя стопы здоровой ноги и соответствующую зону пострадавшей нижней конечности с повторением цикла в течение 10 мин и дополнительной одновременной световой стимуляцией [2]. The closest adopted for the prototype is a method of treating post-stroke disorders, including electrical stimulation by sequential cyclic application of irritation to the motor point of the extensor of the hand of a healthy hand and a symmetrical section of the paretic hand; the motor point of the back flexor of the foot of a healthy leg and the corresponding zone of the affected lower limb with a cycle of 10 minutes and additional simultaneous light stimulation [2].
Недостатком данного способа являются отсутствие максимальной приближенности стимулирующих импульсов к физиологическим параметрам тканей рецепторного аппарата и вовлечение в процесс саногенеза не всей афферентной системы, а лишь некоторых ее звеньев. Это обусловливает медленное восстановление утраченных двигательных функций. The disadvantage of this method is the lack of maximum proximity of stimulating pulses to the physiological parameters of the tissues of the receptor apparatus and the involvement in the process of sanogenesis of not the whole afferent system, but only some of its links. This leads to a slow recovery of lost motor functions.
Цель изобретения - сокращение срока восстановления постинсультных нарушений двигательных функций за счет растормаживания и стимуляции временно инактивированных и перифокально расположенных нервных клеток. The purpose of the invention is to reduce the recovery period of post-stroke disorders of motor functions due to disinhibition and stimulation of temporarily inactivated and perifocal nerve cells.
Поставленную цель достигают за счет того, что воздействуют прямоугольными импульсными токами на рецепторный аппарат глубокой и поверхностной чувствительности дистальных отделов конечностей и соответствующий сегментарный аппарат спинного мозга. This goal is achieved due to the fact that they act with rectangular impulse currents on the receptor apparatus of deep and surface sensitivity of the distal extremities and the corresponding segmental apparatus of the spinal cord.
Сопоставленный анализ предлагаемого решения с прототипом показывает, что все ранее описанные методы базировались на стимуляции только двигательных точек. В предлагаемом способе в процесс стимуляции вовлекают рецепторный аппарат паретичных конечностей и соответствующий сегментарный аппарат спинного мозга, что позволяет восстановить утраченные и формировать новые функциональные взаимосвязи корково-подкорковых структур, улучшить крово- и лимфообращение в паретичных конечностях, а также, рефлекторно воздействуя на весь организм, оказывает положительный психотерапевтический эффект. A comparative analysis of the proposed solution with the prototype shows that all the previously described methods were based on stimulation of only motor points. In the proposed method, the receptor apparatus of the paretic limbs and the corresponding segmental apparatus of the spinal cord are involved in the stimulation process, which makes it possible to restore the lost and form new functional relationships of the cortical-subcortical structures, improve blood and lymph circulation in the paretic limbs, and also, reflexively affecting the whole body, It has a positive psychotherapeutic effect.
Способ осуществляют следующим образом. Лечение начинают в положении больного лежа на спине. Для электростимуляции применяют аппарат "УЭИ-1", генерирующий прямоугольные импульсные токи длительностью 5 мс и частотой 70 Гц. Сила тока 3-4 мА, смена полярности через 2 мин, время экспозиции 30 мин. The method is as follows. Treatment begins with the patient lying on his back. For electrical stimulation, the UEI-1 apparatus is used, generating rectangular pulse currents of 5 ms duration and 70 Hz frequency. Current strength 3-4 mA, polarity reversal after 2 minutes, exposure time 30 minutes.
Методика стимуляции заключается в следующем: активные подковообразные электроды накладываются на дистальные отделы паретичных конечностей (кончики пальцев и два конечных межфаланговых сустава) и, объединенные одним проводом, подключаются к отрицательному полюсу. Гидрофильную прокладку из фланели смачивают теплой водопроводной водой. Индифферентный электрод накладывают на шейно-грудной отдел позвоночника, те проецируют на соответствующий сегментарный аппарат. Процедуры продолжительностью 30 мин проводят ежедневно, курс лечения состоит из 10 сеансов. The stimulation technique is as follows: active horseshoe-shaped electrodes are superimposed on the distal parts of the paretic extremities (fingertips and two final interphalangeal joints) and connected by one wire are connected to the negative pole. The hydrophilic gasket from the flannel is moistened with warm tap water. An indifferent electrode is applied to the cervico-thoracic spine, they project onto the corresponding segmental apparatus. Procedures lasting 30 minutes are carried out daily, the course of treatment consists of 10 sessions.
При данной методике электростимуляции достигают комплексное воздействие на нервно-мышечные структуры, при котором восстанавливают их утраченные функциональные взаимосвязи, снимают парабиотические состояния, что в конечном итоге способствует восстановлению движения паретических конечностей. With this method of electrical stimulation, a complex effect on neuromuscular structures is achieved, in which they restore their lost functional relationships, relieve parabiotic conditions, which ultimately helps restore the movement of paretic limbs.
В результате проведенной неспецифической электростимуляции в остром и раннем восстановительном периодах у больных с мозговым инсультом появляются активные движения в парализованных конечностях и нарастает мышечная сила, происходят заметные положительные изменения в эмоционально-волевой сфере: взгляд становится более осмысленным, больные проявляют интерес к окружающему, возникает ощущение внутреннего комфорта, улучшается сон. У пациентов с исходно высокими цифрами артериального давления наблюдается снижение его на 10-25 мм рт. ст. As a result of nonspecific electrical stimulation in the acute and early recovery periods, patients with cerebral stroke exhibit active movements in paralyzed limbs and increase muscle strength, noticeable positive changes occur in the emotional-volitional sphere: the look becomes more meaningful, patients show interest in the environment, a sensation arises inner comfort, improving sleep. In patients with initially high numbers of blood pressure, a decrease of 10-25 mm Hg is observed. Art.
Преимущества предлагаемого способа заключаются в следующем:
стимулирующие импульсы по характеристикам максимально приближены к физиологическим параметрам тканей рецепторного аппарата;
стимуляция прямоугольными импульсными токами рецепторного аппарата глубоких и поверхностных видов чувствительности дистальных отделов паретичных конечностей оказывает выраженное сенсомоторное раздражение в коре головного мозга, что стимулирует временно инактивированные нейроны и заставляет их формировать новые функциональные связи, во-вторых, имеет мощный контроль над моторными единицами в спинальных сегментах;
активно замыкаясь на собственные сегменты спинного мозга, ток при переключении полярности на входе и выходе вызывает дополнительное раздражение, что усиливает лечебный эффект;
происходит улучшение крово- и лимфообращения в паретичных конечностях.The advantages of the proposed method are as follows:
stimulating impulses in their characteristics are as close as possible to the physiological parameters of the tissues of the receptor apparatus;
stimulation of deep and superficial sensitivity types of distal parts of paretic extremities with rectangular pulsed currents of the receptor apparatus produces pronounced sensorimotor irritation in the cerebral cortex, which stimulates temporarily inactivated neurons and forces them to form new functional connections, and secondly, it has powerful control over motor units in the spinal segments ;
actively closing on its own segments of the spinal cord, the current when switching polarity at the input and output causes additional irritation, which enhances the therapeutic effect;
there is an improvement in blood and lymph circulation in the paretic limbs.
Литература
1. Гольдельман М.Г., Креймер А.Я. Лечение заболеваний нервной системы. - Томск, 1974. С. 174-175.Literature
1. Goldelman MG, Kramer A.Ya. Treatment of diseases of the nervous system. - Tomsk, 1974.P. 174-175.
2. Патент 2040282, A 61 N 1/18. 2. Patent 2040282, A 61 N 1/18.
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| RU99124339A RU2192897C2 (en) | 1999-11-17 | 1999-11-17 | Method for treating cases of postinsult pareses |
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| RU99124339A RU2192897C2 (en) | 1999-11-17 | 1999-11-17 | Method for treating cases of postinsult pareses |
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US9101769B2 (en) | 2011-01-03 | 2015-08-11 | The Regents Of The University Of California | High density epidural stimulation for facilitation of locomotion, posture, voluntary movement, and recovery of autonomic, sexual, vasomotor, and cognitive function after neurological injury |
| US9393409B2 (en) | 2011-11-11 | 2016-07-19 | Neuroenabling Technologies, Inc. | Non invasive neuromodulation device for enabling recovery of motor, sensory, autonomic, sexual, vasomotor and cognitive function |
| US9409011B2 (en) | 2011-01-21 | 2016-08-09 | California Institute Of Technology | Method of constructing an implantable microelectrode array |
| US9409023B2 (en) | 2011-03-24 | 2016-08-09 | California Institute Of Technology | Spinal stimulator systems for restoration of function |
| US9415218B2 (en) | 2011-11-11 | 2016-08-16 | The Regents Of The University Of California | Transcutaneous spinal cord stimulation: noninvasive tool for activation of locomotor circuitry |
| US9993642B2 (en) | 2013-03-15 | 2018-06-12 | The Regents Of The University Of California | Multi-site transcutaneous electrical stimulation of the spinal cord for facilitation of locomotion |
| US10092750B2 (en) | 2011-11-11 | 2018-10-09 | Neuroenabling Technologies, Inc. | Transcutaneous neuromodulation system and methods of using same |
| US10137299B2 (en) | 2013-09-27 | 2018-11-27 | The Regents Of The University Of California | Engaging the cervical spinal cord circuitry to re-enable volitional control of hand function in tetraplegic subjects |
| US10751533B2 (en) | 2014-08-21 | 2020-08-25 | The Regents Of The University Of California | Regulation of autonomic control of bladder voiding after a complete spinal cord injury |
| US10773074B2 (en) | 2014-08-27 | 2020-09-15 | The Regents Of The University Of California | Multi-electrode array for spinal cord epidural stimulation |
| US10786673B2 (en) | 2014-01-13 | 2020-09-29 | California Institute Of Technology | Neuromodulation systems and methods of using same |
| US11097122B2 (en) | 2015-11-04 | 2021-08-24 | The Regents Of The University Of California | Magnetic stimulation of the spinal cord to restore control of bladder and/or bowel |
| US11298533B2 (en) | 2015-08-26 | 2022-04-12 | The Regents Of The University Of California | Concerted use of noninvasive neuromodulation device with exoskeleton to enable voluntary movement and greater muscle activation when stepping in a chronically paralyzed subject |
| US11672983B2 (en) | 2018-11-13 | 2023-06-13 | Onward Medical N.V. | Sensor in clothing of limbs or footwear |
| US11691015B2 (en) | 2017-06-30 | 2023-07-04 | Onward Medical N.V. | System for neuromodulation |
| US11752342B2 (en) | 2019-02-12 | 2023-09-12 | Onward Medical N.V. | System for neuromodulation |
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| US11992684B2 (en) | 2017-12-05 | 2024-05-28 | Ecole Polytechnique Federale De Lausanne (Epfl) | System for planning and/or providing neuromodulation |
-
1999
- 1999-11-17 RU RU99124339A patent/RU2192897C2/en active
Non-Patent Citations (1)
| Title |
|---|
| ПОКРОВСКИЙ В.И. Малая медицинская энциклопедия. - М.: Медицина, 1996, т.4, с.244-246. * |
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