Method for applying active dynamic electric stimulation of extremity muscles

FIELD: medicine.

SUBSTANCE: method involves using Stimul-1 apparatus. Movements applied in manual muscular testing are administered concurrently with current passed through. Initial postures are selected with injured muscle force, measured as a result of manual muscular test, taken into account. 4 points estimation being obtained, movement in articulation is carried out with gravitation force and weighting collar load of 500 g being overcome in standing sitting and lying position. 3 points high estimation being the case, movements are carried out without gravitation force being overcome in sitting position to train lower extremity articulations. 2 points high estimation being obtained, movements are carried out under easier conditions without gravitation force loading in lying initial position. 1 point being the estimation, patient strains muscle in isometric mode in lying initial position.

EFFECT: enhanced effectiveness of rehabilitation treatment; involving earlier idle muscle fibers in work.

 

The invention relates to medicine, namely located at the junction of the two specialties of traumatology and orthopedics and physiotherapy.

It is recognized that electrical stimulation is a therapeutic use of pulsed currents to restore the activity of organs and tissues that have lost normal function, widely used in the treatment of diseases of musculoskeletal system, especially in diseases associated with malnutrition periarticular muscles of large joints, such as shoulder, elbow, wrist, hip, knee and ankle joints.

Currently in the practice of medical institutions is mostly used technique passive electrostimulation workout muscle apparatus (equipment and Technique physiotherapeutic procedures (Handbook), Ed. Vmmolotova. - M.: Medicine, 1983, p.85-107).

This method adopted by us for the prototype. However, it has the following disadvantages:

- does not provide for active participation of the patient, resulting in proceeds in conditions far removed from the real functioning of muscles;

- short duration of the procedure;

- undifferentiated approach to the determination of the parameters of electrical stimulation,

which way passive stimulation does not fully affect the functional state of paraurti olyarnik muscles, thereby prolonging the duration of treatment, not affect the prevention of further progression of diseases of the joints and the development of secondary functional impairments (muscle hypotrophy). An important place in the treatment of diseases of the joints take an active dynamic exercises of medical physical culture, aimed at the strengthening of a particular muscle (Spironol, Mbique Basis rehabilitation of athletes and ballet dancers with injuries and diseases of the musculoskeletal system. - M.: Glasnews Medical center of administration of the President of the Russian Federation, 1998, p.100). The choice of the type of exercises and the necessary starting positions should be based on the results of the preliminary manual testing of muscle strength and 6-point evaluation system. From the above, the us for treatment of diseases of the joints and prevent muscle hypotrophy method active dynamic electrostimulation of muscles.

Electrostimulation periarticular muscles in combination with simultaneous exercises therapeutic exercises (active speaker) from initial positions, elected according to the results of manual muscle testing, distinguishes it from the prototype.

The method is as follows.

Before beginning active dynamic electrostimulation varying periarticular thinking what s the procedure manual muscle testing. This determines the strength of the affected muscles, focusing on the strength of the symmetric normal muscles of the patient. In line with this, depending on the received data (scoring) is elected by the initial position of the patient for the procedure active dynamic electrostimulation.

When assessing 5 points (excellent - 100% of normal) and 0 points (very bad - trying to move a muscle does not answer) procedures for active dynamic electrostimulation not used.

Score 4 points (good - 75% of normal) determines the strength of the muscles, capable of movement in the joint with a full amplitude at moderate manual resistance. In this assessment during the procedure, the stimulation of the patient is movement in the joint to overcome the gravitational force and weight (weight-cuff - 500 g). Starting position: standing, sitting, lying.

Score 3 points (satisfactory - 50% of normal) determines the strength of the muscles, capable of movement in the joint with full amplitude and overcoming the weight of the roaming segment without external manual resistance. When such a force muscles by stimulation of the movement is performed by overcoming the force of gravity, but without the heaviness. Starting position: sitting for the joints of the upper limbs, lying for the joints of the lower limb.

Score 2 points (bad 25-30% of normal) what determines the strength of the muscles, capable of movement in the joint with a full amplitude only in favourable conditions (muscle power is insufficient to overcome the weight of the floating segment). In this assessment in the process of stimulation, movement is facilitated conditions (excluded the force of gravity) on a plane, on a wooden roller cart. Starting position: lying.

Score 1 point (very bad - 5-10% of normal) equates the power of the muscles, which perform a given movement in the joint is not possible (when you try to perform a test task, the contraction of muscle is only determined visually and by palpation). During electrical stimulation, the patient only strains the muscle in isometric mode. Starting position: lying.

In the process of active dynamic electrostimulation when current passes through the patient is actively implementing a given movement in the trained segment corresponding to the movement during manual muscle testing, straining stimulated muscle; muscle tension is held until the end of the make current.

Adjusts the intensity of the current that is carried by the patient and which is sufficient to effect the movement. During the whole time electrical contractor procedures control the correct position of the patient's torso. The procedure lasts 15-30 minutes, 2 times the day. The rate of stimulation is 15-30 procedures.

Specifications electrical stimulation. To influence periarticular muscles we use the technique of electrical stimulation on the “Stimulus 1”, which is the source of alternating sinusoidal current with a frequency of 1-2 .5 kHz, creating the amplitude modulation of the pulse frequency of 50 Hz with a modulation depth of 100%, used in the pulse mode “make - break” - 5-10 sec.

For electrostimulation use cutaneous elastic electrodes based on carbon fibrous materials rectangular in shape, size 3×6 cm (GOST R 15.013-94). Water-soaked electrodes are fixed on the body surface of the patient in the field of motor points stimulated muscle using rubber manzhetok (bandages). Uses two electrodes in a bipolar technique. The active electrode (+) placed on the motor point of the muscle (as determined by table Erba), indifferent (-) - at the junction of the muscle tendon.

Results: In the clinic for the period from 2000 to 2003, were treated 27 patients according to this method, at the age of 12-46 years, with various pathologies of the large joints (shoulder, elbow, wrist, hip, knee, and ankle joints) - congenital dislocation of the hip (7), traumatic dislocation of the shoulder (6), deforming arthrosis of different type (14). Rez is ltati treatment was evaluated according to x-ray examination, computed tomography, thermography, sonography of dynamometry, goniometry, functional-motor tests. Excellent results and 29.6% (8), good - 37% (10), satisfactory for 25.9% (7), unsatisfactory to 7.4% (2). In our experience with passive stimulation of muscles of 27 patients with excellent results is 22.2% (6), good and 33.4% (9), satisfactory and 29.6% (8), unsatisfactory or 14.8% (4).

Thus, we have shown the advantages of the proposed method active dynamic electrostimulation its muscles, its practical feasibility and clinical utility.

How active dynamic electrostimulation in the treatment of pathologies of large joints, which consists in the use of electrotherapeutic impact on the “Stimulus 1”, characterized in that simultaneously with the flow of current to perform motor tasks, corresponding to the movements used in manual muscle testing, the initial position is chosen taking into account the strength of the affected muscles, defined by the results of manual muscle testing, if the score of 4 points is movement in the joint to overcome the force of gravity and weight weight cuff 500 g, the initial position of standing, sitting and lying; the assessment 3 credits the movement is performed by overcoming the force of gravity without from is gewane, the original sitting position for the joints of the upper limbs, lying to the joints of the lower extremities; the assessment score of 2 if the movements are performed under simplified conditions with the exception of gravity, initial position - lying, score 1 point - the patient stretches the muscle in isometric mode, the initial position - lying down.



 

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