The correction method of psycho-autonomic imbalance in patients with injuries and diseases of musculoskeletal system


(57) Abstract:

The invention relates to medicine, physiotherapy. Pre-determine the index of the voltage of the autonomic nervous system by R. M. Baevsky. Affected by pulsed electric current. If normotone spend twice the rate of electrotherapy. The course consists of 5 sessions. Act signals a triangular shape. If vagotonia spend a single course. The course consists of 10-12 sessions. Affect the signals of rectangular shape. If sympathicotonia spend a single course. The course includes 5-7 sessions. Affect the signals of rectangular shape. The method prevents the development of complications.

The invention relates to medicine, namely to traumatology and orthopedics, and physical therapy, and can be used for the treatment of trauma and orthopedic patients with psychovegetative imbalance.

There is a method of correction of psycho-autonomic imbalance in patients with injuries and diseases of musculoskeletal system (ODS) by using the complex pharmacological preparations (Training method. manual for doctors cadets, "the Syndrome of vegetative-vascular dystonia and evaluation of vegetative state in children R. R. Shilyaev, I. C. P is face-to-face action. Any pharmacological drug has a significant number of contraindications and purpose of complex drugs chronic patient often leads to aggravation of existing violations.

There is a method of correction of psycho-autonomic imbalance in patients with injuries and diseases of the UDF by transcranial electrical stimulation (C. C. Rychkov, V. A. Alexandrov. Transcranial electrical stimulation (TES) /mechanism of action, analgesic and associated effects/ Issues balneology, 1994, No. 6, S. 23-27), which combine the use of mode TPP rectangular pulses with a frequency of 77 Hz and duration 3,750,25 MS galvanic component, 2 to 5 times greater than its average pulse current with a threshold value of the total current 3-4 mA with fronto-mastoidal location of the electrodes (cathode - the forehead, the anode - head).

However, this method, although information on analgesic, membrane, reparative, sedative, immunomodulating and antitumor effects, provides a therapeutic effect (e.g., reduction in the incidence of septic complications) in only 50-70% of cases. The lack of therapeutic effect 50-30% of those explained under the next analog accepted method of correction of psycho-autonomic imbalance in patients with injuries and diseases of musculoskeletal system (Century. G. Golubev, N. N. Korableva. Transcranial electrotherapy suffered from mechanical damage and their consequences. Mat. scientific session of RMAPO "Success theory. and the wedge. medicine M., 1995, 123 - 124.). The method involves performing in patients with trauma and effects of transcranial electrotherapy pulse current of a rectangular or triangular shape low frequency in a narrow range of 60 to 90 Hz with a maximum of 77 Hz and the predominant influence on subcortical stem the brain, duration 3,0 - 5,0 MS, amplitude 0.5 to 4.0 mA. The value of the current to 10 mA. The treatment is depending on the clinical picture or the severity of the patient from 5 to 15 sessions. Break if this is allowed only after 4 - 5 session. If necessary, repeat a course two weeks.

However, in the known method the selection of parameters of physical therapy effects (number of sessions and their duration) provide empirically based on the severity of the clinical picture. Such selection is not appropriate and does not allow to achieve the maximum effect. 20 - 40 % of cases patients "do not respond" to treatment, the method does not allow to obtain the desired clinical effect. 5 - 6% ) (MDM) indirectly can also be considered those with ineffective therapy.

Present method aims to correct these deficiencies.

The objective of the invention is to provide a highly effective method of correction of psycho-autonomic imbalance in patients with injuries and diseases of musculoskeletal system, designed to prevent possible complications, to get a more pronounced therapeutic effect.

The essence of the invention is that the method of correction of psycho-autonomic imbalance in patients with injuries and diseases of the musculoskeletal system, including transcranial electrotherapy (TCET) pulsed current, rectangular or triangular in shape, with a frequency of 60 to 90 Hz, with a duration of 3.0 to 5.0 MS and an amplitude of 0.5 - 4.0 mA pre-patient determine the index of the voltage of the autonomic nervous system by R. M. Baevsky and the establishment of the state of normotone spend twice the rate of electrotherapy using triangular waveforms 5 sessions per course of one week, sympathicotonia - single course using rectangular waveforms from 5 - 7 sessions with a break of not less than four months, vagotonia, with a single course using rectangular waveforms from 10 to 12 sessions with a repeat signal is reduced to 0.1 mA.

The use of the invention allows to obtain the following technical result.

The method is highly effective. It allows in 94.8% of cases to prevent the development of complications in complex treatment and monotherapy can be used for the prevention of complications in patients with injuries and recurrence or deterioration of patients with diseases of the UDF. The proposed method can improve the circulation, arrest the purulent wound processes, contributes to the closure of osteomyelitis fistula. The method allows to correct the psychosomatic condition of patients with trauma and orthopaedic diseases of the UDF. Positive impact on the mental state in accordance with the subjective feelings of the patients and psychometric data monitoring noted in 98.8% of cases.

The method has practically no contraindications.

It is established that the differences in the state of source of the autonomic tone and response ANS require individualized approaches to transcranial electrotherapy. The ANS imbalance with a predominance of one or another link leads to a different response to any stimuli, including lecheng impact. The assumption of different responses to specific electrical impulses of individuals with different tone of the ANS. Using a simple available non-invasive methods of imaging type of autonomic tone was the basis of the method of correction of psycho-autonomic imbalance. Select three groups of individuals with different tone ANS: normotonic, somatotonic and vagotonic allowed to choose the parameters MDM specific to each of these groups, allowing in turn significantly increase the efficiency of transcranial electromodulation.

The specificity of the selected parameters (waveform, number, session length and course of treatment, and so on) confirmed a highly sensitive method to investigate cardiointervalometry (KIM). As a diagnostic test to identify the belonging of the examined person to one group or another on the tone and response of the ANS were applied questionnaire A. M. Wayne and method of determining the index R. M. Baevsky. It is noted that the indicators KIM may change after the first session MDM, at the end of the course MDM formed the new state of the autonomic response of the cardiovascular system, while the overall tone of the ANS more conservative the nature of the response of the ANS.

The state of normotone of sympathetic - and vagotonia, identified in the evaluation of CCC on rhythm and vegetative homeostasis (index R. M. Baevsky), correlate with the types of nonspecific adaptive reactions (R. E. Filipchenko. I. A. Privalov, K. I. The Liubarskaya, G., Alekseev. Problems of organization of mass preventive examinations in an industrial plant. Novosibirsk, 1980, 25-32). It was a match is found groups of tension on both criteria. As to the higher centers of the ANS include the limbic-reticular complex, hypothalamic area, stem structure, the results of transcranial electrotherapy (MDM), pulse currents which directly stimulating effect on the basic nucleus of the hypothalamus, have an impact on all of the above parts of the brain. Thus, we can say that with the help of MDM therapy is a direct impact on the higher centers of the ANS.

The state of sympathicotonia characterizes the activation ergotropic processes - acute stress, the stress under tension, i.e., acute or subacute condition. To correlate this state, and stimulation of adaptive reactions effective there is a short in the deterioration of the condition of the patient, possible chronic pathological process, the growth of asthenia.

The state of vagotonia is called activation trophotropic processes and is characterized by the stress in the stage of exhaustion. In this state, effective for transfer of adaptive reactions to other "lower" level of response more stable) long course of MDM, but the first three sessions are conducted in the form of a "review" of subcortical structures with electrical signals: the patient does not feel the impact, but the vegetative centers of these signals are received, according to KIM and experimental data in laboratory animals.

Normotone, despite its outward appearance, within the group has extreme boundary condition, the greater the heterogeneity, which may be a state of preactivation, or condition characterized as prestissimo. The presence of clinical manifestations of pathology normotonikov is an indication for electrotherapy. However, because these patients have a very inadequate compensation, and any abrupt intervention can change this state of fragile balance, we used a triangle (pointed) unidirectional electrical signals, the PC in this group is like fixing the results of therapy. One week break is necessary to fix what is happening in the body changes, since it is known that any factor causing non-specific reaction occurring within 7 to 8 days, after which the formed individual outcome of this action.

Correlate of tone and response of the ANS are the psychological characteristics (both personal and reactive). Psychometric monitoring before treatment, immediately after and long-term showed persistent positive changes, especially in relation to the reactive features of mentality of the person. We used computerized versions of Russian versions of the test is MMPI and Spilberger Hanina, adapted to our social conditions with reliability, validity and own an adequate standard. When choosing a methodology took into account that the tests have been successfully used in patients in the acute period of pathological diseases (I. A. Melentiev, 1994).

The method is as follows.

By inspection and survey questionnaire A. M. Wayne (disorders of the autonomic nervous system. /Edited by A. M. Wayne. - M.: Medicine, 1991, 624 S.) the patient determine the initial tone of the ANS. According to the results of kardiointervalografii (KIT) adlernest patient to the group norm, car or sympathicotonia, in accordance with than spend electrotherapy. For this purpose, the apparatus MDM-1, MDM-C, Transair-2, etc. providing the above-mentioned parameters. Devices approved for use in medical practice, produced by the domestic industry. The patient explain the essence of electrotherapy and get consent to treatment. The session is conducted in the morning (9 - 12 hours) sitting in a comfortable chair with fixed on the seat back and head. On the head of the patient is put on the electrodes with fronto - occipital their location, and in the forehead area include the anode, and in the neck is the cathode. In the forehead electrode should be placed at the junction of the upper and middle thirds of the forehead. Electrodes are put on top of the hydrophilic strips, soaked in warm water or in particularly sensitive individuals) solution of novocaine. Electrical stimulation exercise frequency pulse current 70 - 90 Hz. In accordance with the technical requirements of the machine to the work set the time duration of the procedure, switch on the device with the launch of the countdown timer. The control knob output current slowly rotate clockwise on the threshold of sensation portability of the electrical signals. Depending on which group the patient belongs: normotonic, vagotonia or sympathicotonia chosen a particular course of treatment, and the shape of the signals. During the session the sensitivity electrosignals can rise and in this case it is permissible to increase the amperage. Upon completion of the control knob of the output current returns to the left, counterclockwise, to the initial current value is 0 mA. Turn off the machine, remove the electrodes from the scalp.

When the index Baevsky, comprising from 30 to 90.E., state the state of normotone and spend twice the rate of electrotherapy using a triangular waveform frequency 70-90 Hz to 5 sessions per course with a week break between sessions.

When the index having up to 30 in.E., corresponding to the state of vagotonia, the patient navigate the course of 10 to 12 treatments, the severity of vagotonia (up to 15 in.E.) after a month I repeat a similar course.

During the first three procedures after determining the threshold of individual sensitivity to electric signals, the control knob reduce the value of the output current of 0.1 mA, in subsequent procedures performed on the level of individualmente, spend a single rate of no more than 5 to 7 treatments. If necessary, repeat the course, but not earlier than 4 months.

The method applied in 114 patients with injuries and diseases of the musculoskeletal system with impaired psycho-vegetative balance in basic clinics of the Department of traumatology of RMAPO: CCH N 36 N 15. Of them in age from 16 to 68 years were 54 women and 60 men. Period effects ranged from five to 12 sessions per course and up to 3 identical courses. In 76 patients (66,7%) using MDM by the proposed method provided a clinical effect on the first three procedures: disappeared ischemic pain in osteochondrosis, decreased pain in the affected segments after injury and surgery, 98 (86,0%) improved circulation in the affected segments were stopped lymphovenous oedema. 112 patients (98,3%) improved blood counts, data PSMR, psychometry, etc.,

Example 1. Patient K., 43 years of the hospital treatment of osteochondrosis of the cervical spine with ischemic pain in the left upper extremity, weakness of the hands. The patient complained of headaches, especially after emotional stress, sleep disturbance, restriction of motion in the neck. In E. compression of the vessels of the left shoulder. Clinically had impaired sensation in the area of the wrist and forearm. Patient estensione, easily excitable, emotionally labile. Held: a survey A. M. Wayne, cardiointervals. Identified vagotonic (JN = 17.E.). Conducted two courses transcranial electrotherapy rectangular signals with a frequency of 70 to 90 Hz on the above methodology. As a result, second-third session, the patient felt a subjective improvement. Upon completion of the full course of treatment is controlled completely ischemic pain in his hand, appeared the possibility of physical therapy aimed at increasing range of motion in the neck, decreased contraction of the neck muscles on the back-side surface. It was noted stabilization of blood pressure during the initial sharp its variations. The patient noted a feeling of relaxation after a dream, the possibility of a more complete and easy to perform job responsibilities. To control KIM - IN= 24 in.E. There was marked clinical effect, not noted when previously held medical interventions.

Example 2. Patient Century. 54 years was in outpatient treatment at CDC regarding non-consolidation of the fracture of the left tibia. During examination: TG, PSMR, Plotnikov (JN= 180.E.), observed phenomena of depression, alienation, the tendency to aggression, attempts to shift the responsibility for their failures on others, etc., Conducted a single course of TCAT by the proposed method using rectangular waveforms of the 5 sessions. The inclusion of MDM in the complex treatment of the patient was provided to reduce the voltage of the adrenergic system (JN= 96 in. E.), the mitigation of negative psychological traits, reducing the level of reactive anxiety. 4 months course MDM repeated through * months marked the fracture fracture basementboy bones.

Example 3. Patient M 27 years after surgery, about incorrectly fused fracture of the condyles of the left shoulder was noted hysteroid reaction expressed by aggressive colouring, disturbance of sleep and wakefulness, pronounced swelling of the arm (+8 cm compared with the healthy limb), reducing the pulsation of the arteries of the forearm, redness in the area of the postoperative scar, extreme pain, not allowing it to start early movement in the elbow joint. When the survey questionnaire A. M. Wayne and determination IN the results KEITH patient referred to a group of normotonic (JN= 82.E.). Held twice the rate of electrotherapy with usage decreased cropped pain in his hand, improved segmental blood flow. Initiated therapy. At the end of the second year of MDM improved psychological status, the tendency to increase range of motion in the operated joint.

The correction method of psycho-autonomic imbalance in patients with injuries and diseases of the musculoskeletal system, including transcranial electrotherapy pulse current of a rectangular or triangular in shape with a frequency of 60-90 Hz, duration 3,0-5,0 MS and an amplitude of 0.5-4.0 mA with determining individual sensitivity to electrosignals, wherein the pre-patient determine the index of the voltage of the autonomic nervous system by R. M. Baevsky and the establishment of the state of normotone spend twice the rate of electrotherapy using a triangular waveform 5 sessions per course of one week, sympathicotonia-single course using rectangular waveforms from 5-7 sessions with a break between them not less than four months, vagotonia, with a single course using the rectangular waveforms of 10-12 sessions with a repetition of them in a month, during the first three sessions in this group is


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