RU2799478C1 - Method for treatment of movement disorders and a vestibular carousel for its implementation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions can be used to treat movement disorders. The patient is placed on a bed and fixed. The point of rotation of the bed is determined so that the point of rotation of the bed coincides with the projection point of the vestibular analyzer at the level of the lower eyelid of the patient. Set up the footrest so that the entire foot of the patient rests evenly on the footrest. The distance from the pivot point to the foothold is measured. The patient is put an eye mask on and the vestibular carousel is started, first in one direction of rotation for 6 minutes, then in the other for 6 minutes. Rotational speed is 23–35 rpm. After a complete stop of the vestibular carousel, the mask is removed from the patient and the patient is lifted. The vestibular carousel includes a patient table, consisting of a bed, an engine, a support, patient fixators, and leg supports. The lounger moves on rollers fixed on its frame. Two stoppers are attached to the bed. A footrest, adjustable in length, is attached to the lounger with the help of pins. A counterweight is attached to the frame of the lounger from the side of the head of the lounger.

EFFECT: group of inventions provides increased efficiency of treatment of motor disorders, and increased reliability of the vestibular carousel device.

2 cl, 5 dwg, 1 tbl, 3 ex

Description

The invention relates to medicine and is intended to reduce the activity of pathological muscle tone, by influencing the vestibular apparatus of a patient with movement disorders that have arisen against the background of perinatal CNS damage, genetic diseases, post-traumatic and post-infectious complications.

An analogue is known in the description of the invention No. GR1009812 dated 13.09.19, IPC A61G 7/00, a training system for medical use and physical recovery, where the centrifuge consists of a support base (1) with movement and rotation mechanisms that include an engine (14 ), gearbox (15), drive gear (16) and rotation transmission (18), axle (19), two to four beds (2, 3) that rotate on wheels (11) connected to the central shaft with a square an iron plate connecting them (20), as well as a system of exercises at the ends of the bicycle (5) and a horizontal position (2), which are all connected to the Electrical Control Panel (dashboard) of the anthropocentric center with an inverter (7) and an electronic control system ( controller) (7b) and power supply (6) with its protector (8). The support base (1) is characterized by a tripod with three supported blades (12) firmly mounted on a square steel plate that is bolted to the floor for constant rotation (13) and is characterized by a tubular shaft (19). Center through through hole and away from central rotating ring with two bearings and double mounting guards for rotational safety. Power is supplied through the shaft to the motor (14) with gearbox (15) and drive (16). The drive device is connected by a toothed belt (17) to a rotating pinion (18) which is located at the bottom of the rotating shaft (19). The gears are arranged in such a way that there is balance and the rotation of the beds does not go away. In order to vary the speed according to the G level, the motor (14) was connected to the gearbox (15) to change the speed according to the desired level of gravitational force. In particular, depending on the speed of the gearbox and the radius of rotation, a gravitational force of 1 g is produced. It is also characterized by the connection with an inverter (7) to achieve an increase in gravity up to 3 g and an electronic control system (controller) (7b). The human centrifuge, in addition to increasing the weight for the implementation of the previous points, is also characterized by a system of horizontal movement (platform) on the bed for horizontal sliding on bearings, pushing the legs to the support at the end of the Bed (lib), with a protective railing (9) that we called horizontal rowing (2). It even has a set of rubber bands on both sides of the bed for limb training, as well as handles (9b), harnesses (10) and a head restraint system (4) to prevent nausea. The anthropocentric center is also characterized by a bed with a bicycle (5) at its end, in order to combine rotation with exercises in a horizontal position for higher physical strengthening. The bicycle is characterized by the possibility of changing its position in order to be able to adjust, on the one hand, the height of the person, on the other hand, to increase the radius of rotation and the gradation of the G level on the legs. The advantage of this design is that in a horizontal position, the person who is spinning does not feel nauseous.

Disadvantages: it is impossible to place the pivot point at the level of the projection point of the vestibular analyzer, the lack of effectiveness in the treatment of movement disorders. The design is designed for use by healthy people and athletes.

The closest analogue of the method for the treatment of cochleovestibular disorders in patients with osteochondrosis of the cervical spine is known in the description of the invention to patent No. 2475223, dated 06.07.2011, IPC A61H 1/00, publ. 02/20/2013, by injecting the patient with drugs that improve the blood circulation of the brain, characterized in that after daily injections of drugs, centrifugal forces are applied to the patient in the direction of the head - lower limbs in three stages:

at the first stage, for 3 days, one session is performed every day, exposure to centrifugal forces for 5 minutes at a rotation speed of 28 rpm;

at the second stage, for 3 days, one session is performed every day, exposure to centrifugal forces for 8 minutes at a speed of 30 rpm;

at the third stage, for 4 days, one session is performed every day, exposure to centrifugal forces for 10 minutes at a rotation speed of 30 rpm.

Disadvantages: insufficient effectiveness in the treatment of movement disorders, only centrifugal physical effect is applied.

EFFECT: increased efficiency of treatment of movement disorders with increased reliability of the device.

The technical result in 1. Method for the treatment of movement disorders, which consists in the fact that the patient is laid on the bed 1, the patient is fixed, the vestibular carousel is rotated, the vestibular carousel is stopped, is achieved by determining the rotation point of the bed 1, laying the patient on his back on the bed 1, so that the rotation point of the bed 1 coincides with the projection point of the vestibular analyzer, at the level of the lower eyelid of the patient, then the leg support 8 is set so that the patient's entire foot rests evenly on the leg support 8, the distance from the pivot point to the leg supports 8, put on the patient an eye mask, start the vestibular carousel in one direction of rotation, set the rotation frequency to no more than 35 rpm, while the duration of rotation in one direction is 6 minutes, then after the rotation time has elapsed, reduce the frequency rotation to 0 and rotate in the other direction, set the rotation frequency to no more than 35 rpm, while the duration of rotation in the other direction is 6 minutes, then after the rotation time has elapsed, reduce the rotation frequency to 0, and after the vestibular carousel has completely stopped remove the mask from the patient, lift the patient.

The technical result according to claim 2. The vestibular carousel, which includes a patient table 5, consisting of a sunbed 1, an engine 12, a support 15, patient fixators, leg supports 8, is achieved due to the fact that the patient table 5 consists of a sunbed 1 , which moves on rollers 4 fixed on the frame of the lounger 2, while two stoppers 3 are attached to the lounger 1, a leg support 8, adjustable in length, is attached to the lounger 1 with the help of pins, and to the frame of the lounger 2, from the side of the head of the lounger 1 , counterweight 6 is attached.

The basis of motor disorders is damage to the central nervous system, leading to the activation of pathological motor reflexes: labyrinth-tonic reflex, neck-tonic reflex, asymmetric-tonic reflex, tonic support reflex, step automatism, etc. They do not allow to verticalize and move correctly. When trying to force verticalization, pathological reflexes are exacerbated and lead to an increase in pathological muscle tone.

Thus, the presence of the vestibular carousel, which affects the reflex formation of healthy muscle tone, can significantly affect the rehabilitation potential of many patients with movement disorders. Carrying out the procedure in a horizontal position avoids provocative irritation of pathological reflexes.

The vestibular apparatus provides us with orientation in space. Its main organ is the vestibular analyzer. Thanks to the vestibular analyzer, we have an idea about our movement in three-dimensional space: in the horizontal, frontal and sagittal planes, about the reaction to linear and non-linear acceleration.

The nervous system receives information about turning in a certain direction. For example: when the head is tilted, the nervous system receives this information and in response sends a command to the muscles in order to adjust the center of gravity and maintain balance when moving or at rest.

A healthy vestibular apparatus has a stable connection with the oculomotor apparatus. During a movement of any complexity, the vestibular apparatus reacts to it instantly. Processes information about changing the position of the head in space. These signals allow the brain to adjust the muscle tone of the entire body.

The claimed method for the treatment of movement disorders and the vestibular carousel for its implementation will increase the effectiveness of the treatment of movement disorders with increased reliability of the vestibular carousel.

The invention is illustrated by drawings, where

Fig. 1 shows a vestibular carousel;

Fig. 2 shows glass 7 in section;

Fig. 3 shows the vestibular carousel, side view;

Fig. 4 shows the table of the patient 5;

Fig. 5 shows the support of the vestibular carousel.

Description.

The method of treatment of movement disorders is carried out as follows:

Considering that the axis of rotation of the lounger is an eccentric, a counterweight is used. On the counterweight pin 6, put on standard pancakes for the barbell, weighing from 500 grams to 10 kilograms. Before using the carousel, put on a counterweight of 6.18 kilograms in order to compensate for the weight of the lounger. Before the session, add weight corresponding to the weight of the patient.

The surface of the movable bed 1 of the vestibular carousel is disinfected. Turn the mains switch on the side of the control unit to position 1, connecting the device to the mains. The handrails 18 are folded down, located along the long side of the fixed part of the frame 2. To do this, both handrails 18 are slightly lifted and folded to the side and down. The patient is seated, with the help of an instructor, in the center of the bed 1. If the bed 1 is located high, then a stand, a stable stool or a chair are used for convenience.

The rotation point of the bed 1 is determined. The patient is placed on his back on the bed 1, which is displaced with the help of seven pairs of rollers 4 located on the frame 2 of the bed 1, so that the rotation point of the bed 1 coincides as accurately as possible with the projection point of the vestibular analyzer, at the level of the lower century of the patient. The patient is fixed with seat belts 9. The patient's hands are placed along the body under the seat belts 9. The leg support 8 is set so that the entire foot of the patient evenly rests on the leg support 8. To do this, move the leg support 8, insert it into the holes in the stationary parts of the frame 2 of the lounger 1. If the reflex defect of the support (equinus) of the patient does not allow the installation of the entire foot on the leg support 8, then the moving part of the lounger 1 with the patient is displaced towards the head by a distance equal to the difference between the support on the full foot and the support on the extended sock. In the course of the session, with centrifugal action and a reflex effect on the equinus, a full foot is supported, the movable part of the lounger 1 returns to its original position and abuts with the help of two stoppers 3 against the frame of the lounger 2.

Wear an eye mask on the patient, which is the prevention of dizziness. Return the handrails 18 to the vertical position. On the control unit, press the start button in one of the directions of rotation. Slowly rotate the speed controller on the control panel clockwise until it matches the "speed versus height" table.

Rotation mode provides minimal irritation of the vestibular analyzer. After setting the individual speed, mark the start time of the session. Duration of rotation in one direction - 6 minutes. After the rotation time has elapsed, slowly rotate the speed control counterclockwise to the “O” position. Press the button to stop the rotation of the vestibular carousel and wait for the complete stop of rotation.

Then they rotate in the other direction. To do this, on the control unit, press the start button in the other direction of rotation. Slowly turn the speed control on the control panel clockwise until it matches the speed versus height table.

Correspondence table for the dependence of rotational speed on height (height in this case means the distance from the point of rotation to the support under the legs).

After setting the individual speed, mark the start time of the session. Duration of rotation - 6 minutes. After the rotation time has elapsed, slowly rotate the speed control counterclockwise to the “O” position. Press the button to stop the rotation of the vestibular carousel and wait for the complete stop of rotation.

After a complete stop of the vestibular carousel, the mask is removed from the patient, the handrails 18 are lowered, the seat belts 9 are unfastened, and the patient is helped down to the floor. Turn the mains switch on the side surface of the control unit to position 0. After the session, the counterweight 6 is released from the load.

The method for treating movement disorders is carried out using a vestibular carousel, which consists of a patient table 5, an engine 12 with a gearbox 11, a glass 7, a support 15. The vestibular carousel is controlled using a control panel.

The patient table 5 consists of a movable part of the bed 1, which moves on seven pairs of rollers 4 attached to the frame 2 of the bed 1 with handrails 18 attached to it from both sides using movable brackets. Seat belts 9 or patient clamps are attached to the patient table 5.

On the upper side, the lounger 1 is upholstered with soft upholstery, on the lower side, two stoppers 3 are attached to the lounger 1 with the help of self-tapping screws, which ensure the control of the mobility of the lounger 1. On the outer part of the lounger 1, with the help of pins inserted into the holes of the lounger 1, a leg support 8 is attached, height adjustable.

To the frame of the lounger 2, from the side of the head of the lounger 1, a counterweight 6 is attached by a collapsible bolted connection. A plate 17 is welded to the frame of the lounger 2 from the bottom side with a continuous seam, attached to the shaft 10, placed inside the cup 7 with the help of a coupling. A reducer 11 and an electric motor 12 are attached to the plate 17 in the lower part.

Glass 7 is fixed on the upper frame support 13, which is supported by 4 posts 14 on supports 15 connected by jumpers 16. Example 1.

Treatment of a patient, age 5 years, GMFCS (Global Motor Skills Assessment System) - level 2 up to 6 years, diagnosis - cerebral palsy (infantile cerebral palsy), spastic left-sided hemiplegia, unsteady walking with hands on handrails or walkers. Severe pathological muscular synkinesis and synergy on the left.

Put on the counterweight 6 pancakes for the barbell, weighing 32 kilograms.

The surface of the movable bed 1 of the vestibular carousel is disinfected. Turn the mains switch on the side of the control unit to position 1, connecting the device to the mains. Fold down the handrails 18, located on the long side of the fixed part of the lounger. To do this, both handrails 18 are slightly raised and folded to the side and down. The patient is seated, with the help of an instructor, in the center of the bed 1. For convenience, a stable stool is used.

The rotation point of the bed 1 is determined. The patient is placed on his back on the bed 1, which is displaced with the help of seven pairs of rollers 4 located on the frame of the bed 2, so that the point of rotation of the bed coincides as accurately as possible with the projection point of the vestibular analyzer, at the level of the lower eyelid of the patient. . The patient is fixed with seat belts 9. The patient's hands are placed along the body under the seat belts 9. The leg support 8 is set so that the entire foot of the patient evenly rests on the leg support 8. To do this, move the leg support 8, insert it into the holes in the stationary parts of the frame 2 loungers 1. Measure the distance from the pivot point to the leg support 8-92 cm with a tape measure. Put on an eye mask on the patient. Return the handrails 18 to the vertical position. On the control unit, press the start button in the left direction of rotation. The vestibular carousel begins to rotate. Slowly turn the speed control on the control panel clockwise until 31 rpm is reached.

Note the start time of the session. Duration of rotation - 6 minutes. After the rotation time has elapsed, slowly rotate the speed control counterclockwise to the “O” position. Press the button to stop the rotation of the vestibular carousel and wait for the complete stop of rotation.

Then they rotate to the right. To do this, on the control unit, press the start button in the right direction of rotation. The vestibular carousel begins to rotate. Slowly turn the speed control on the control panel clockwise until 31 rpm is reached.

After setting the rotation frequency, mark the start time of the session. Duration of rotation - 6 minutes. After the rotation time has elapsed, slowly rotate the speed control counterclockwise to the “O” position. Press the button to stop the rotation of the vestibular carousel and wait for the complete stop of rotation. After a complete stop of the vestibular carousel, the mask is removed from the patient, the handrails 18 are lowered, the seat belts 9 are unfastened. The patient is helped to sink to the floor. Turn the power switch on the side of the control box to position 0.

Session ended.

After the session, the counterweight 6 is released from the load.

After three out of ten daily sessions, the patient showed a decrease in the activity of pathological reflexes during the patient's verticalization. After eight sessions, the patient's stability improved markedly. The severity of synkinesis and synergies decreased. A month later, after the course, the patient can walk steadily up to 10 m without support.

Example 2

Treatment of the patient, age 10 years, GMFCS - level 4 up to 12 years, diagnosis - cerebral palsy, double spastic diplegia. The patient has severe vestibulopathy, aggravated spasticity with any change in body position in space. Motor skills are poorly expressed, slow paretic movements during rollovers and crawling on the stomach. Feet in forced equinus.

Put on the counterweight 6 pancakes for the bar, weighing 45 kilograms.

The surface of the movable bed 1 of the vestibular carousel is disinfected. Turn the mains switch on the side of the control unit to position 1, connecting the device to the mains.

The handrails 18 are folded down, located along the long side of the fixed part of the frame 2 of the lounger 1. To do this, both handrails 18 are slightly lifted and folded to the side and down. The patient is seated, with the help of an instructor, in the center of the bed 1. For convenience, a stable stool is used.

The rotation point of the bed 1 is determined. The patient is placed on his back on the bed 1, which is displaced with the help of seven pairs of rollers 4 located on the frame 2 of the bed 1, so that the rotation point of the bed 1 coincides as accurately as possible with the projection point of the vestibular analyzer, at the level of the lower century of the patient. The patient is fixed with seat belts 9. The patient's hands are placed along the body under the seat belts 9. The leg support 8 is set so that the entire foot of the patient evenly rests on the leg support 8. To do this, move the leg support 8, insert it into the holes in the stationary parts of the frame 2 loungers 1. Measure the distance from the pivot point to the leg support 8-112 cm with a tape measure. Put on an eye mask on the patient. Return the handrails 18 to the vertical position. On the control unit, press the start button in the left direction of rotation. The vestibular carousel begins to rotate. Slowly turn the speed control on the control panel clockwise until 28 rpm is reached.

Note the start time of the session. Duration of rotation - 6 minutes. After the rotation time has elapsed, slowly rotate the speed control counterclockwise to the “O” position. Press the button to stop the vestibular rotation of the carousel and wait for the complete stop of rotation.

Then they rotate to the right. To do this, on the control unit, press the start button in the right direction of rotation. The vestibular carousel begins to rotate. Slowly turn the speed control on the control panel clockwise until 28 rpm is reached. After setting the rotation frequency, mark the start time of the session. Duration of rotation - 6 minutes. After the rotation time has elapsed, slowly rotate the speed control counterclockwise to the “O” position.

Press the button to stop the rotation of the vestibular carousel and wait for the complete stop of rotation. After the vestibular carousel has completely stopped, the mask is removed from the patient, the handrails 18 are lowered, the seat belts 9 are unfastened. Turn the power supply switch on the side surface of the control unit to position 0.

Session ended.

After the session, the counterweight 6 is released from the load.

After 6 out of 12 daily sessions, the patient's manifestations of vestibulopathy significantly decreased, and spasticity decreased. After 12 sessions, the quality and speed of movements improved. The patient was able to get on all fours, after 3 weeks he began to walk on his knees in a walker. Significantly decreased spasticity in the ankle.

Example 3

A 10-year-old patient, a disabled child. Diagnosis: cerebral palsy, left-sided spastic, hemiparesis. GMFCS: Level 1 up to 12 years old.

The patient has severe lameness when walking independently on the left leg. Reliance on the left on a high toe. The left hand with active vertical movements is pulled up by spastic tension.

Put on the counterweight 6 pancakes for the bar, weighing 46 kilograms.

The surface of the movable bed 1 of the vestibular carousel is disinfected. Turn the mains switch on the side of the control unit to position 1, connecting the device to the mains. The handrails 18 are folded down, located along the long side of the fixed part of the frame 2 of the lounger 1. To do this, both handrails 18 are slightly lifted and folded to the side and down. The patient is seated, with the help of an instructor, in the center of the bed 1. For convenience, a stable stool is used.

The rotation point of the bed 1 is determined. The patient is placed on his back on the bed 1, which is moved using seven pairs of rollers 4 located on the frame 2 of the bed 1, so that the rotation point of the bed 1 coincides as accurately as possible with the projection point of the vestibular analyzer, at the level of the lower century of the patient. The patient is fixed with seat belts 9. The patient's hands are placed along the body under the seat belts 9. The leg support 8 is set so that the entire foot of the patient evenly rests on the leg support 8. To do this, move the leg support 8, insert it into the holes in the stationary parts of the frame 2 loungers 1. Measure the distance from the point of rotation to the leg support 8-113 cm with a tape measure. Put on an eye mask on the patient. Return the handrails 18 to the vertical position.

On the control unit, press the start button in the left direction of rotation. The vestibular carousel begins to rotate. Slowly turn the speed control on the control panel clockwise until 28 rpm is reached.

Note the start time of the session. Duration of rotation - 6 minutes. After the rotation time has elapsed, slowly rotate the speed control counterclockwise to the “O” position. Press the button to stop the rotation of the vestibular carousel and wait for the complete stop of rotation.

Then they rotate to the right. To do this, on the control unit, press the start button in the right direction of rotation. The vestibular carousel begins to rotate. Slowly turn the speed control on the control panel clockwise until 28 rpm is reached.

After setting the rotation frequency, mark the start time of the session. Duration of rotation - 6 minutes. After the rotation time has elapsed, slowly rotate the speed control counterclockwise to the “O” position. Press the button to stop the rotation of the vestibular carousel and wait for the complete stop of rotation. After a complete stop of the vestibular carousel, the mask is removed from the patient, the handrails 18 are lowered, the seat belts 9 are unfastened. We help the patient to lower himself to the floor. Turn the power switch on the side of the control box to position 0.

Session ended.

After the session, the counterweight 6 is released from the load.

After 4 out of 12 sessions, the patient showed a decrease in lameness and an increase in lateral stability. After 12 sessions, the patient noticeably dropped the heel on the left. When walking and running, spasticity in the left hand decreased. After 2 weeks, the quality of movements improved, the volume of active movements on the left increased.

Claims (2)

1. A method for the treatment of motor disorders, which consists in the fact that the patient is laid on a bed, the patient is fixed, the vestibular carousel is rotated, the vestibular carousel is stopped, characterized in that the vestibular carousel according to claim 2 is used, while determining the point of rotation of the bed, laying the patient on back on the bed in such a way that the point of rotation of the bed coincides with the projection point of the vestibular analyzer at the level of the lower eyelid of the patient, then the leg support is set so that the entire foot of the patient evenly rests on the leg support, the distance from the pivot point to the leg support is measured put on the patient an eye mask, start the vestibular carousel in one direction of rotation, set the rotation frequency from 23 to 35 rpm, depending on the measured distance from the rotation point to the leg support in accordance with the table contained in the description, while the duration of rotation in one direction is 6 minutes, then after the expiration of the rotation time, the rotation frequency is reduced to 0 and rotation is performed in the other direction with the same rotation frequency, while the duration of rotation in the other direction is 6 minutes, then after the rotation time has elapsed, the rotation frequency is reduced to 0, and after a complete stop of the vestibular carousel, the mask is removed from the patient, the patient is lifted. 2. The vestibular carousel for the treatment of motor disorders according to claim 1, which includes a patient table consisting of a lounger, an engine, a support, patient fixators, leg supports, characterized in that the patient table consists of a lounger that moves on rollers fixed on the frame of the lounger, while two stoppers are attached to the lounger, a leg support, adjustable in length, is attached to the lounger with the help of pins, and a counterweight is attached to the frame of the lounger, from the side of the head of the lounger.

Images