Method and device for carrying out programmed muscle electrostimulation

FIELD: medicine.

SUBSTANCE: method involves applying muscle electrostimulation in various periodic locomotions concurrently using two transducer types, performing locomotor-oriented stimulation with no motion. Goniometric transducers are set in the vicinity of large articulations. Podometric transducers are set under heel and forefoot and for treating fingers. Any of at least eight concurrently used transducers could be used as synchronizing one allowing proper synchronization moment to be determined. Data taken from all transducers are recorded and analyzed in course of stimulation using special purpose software to produce diagnostic information. To specify rhythm of any movement type, acoustic signal source is used.

EFFECT: high accuracy of muscle electrostimulation and movement correction in various periodic locomotions; enhanced effectiveness of locomotor-oriented stimulation of immovable patients.

13 cl, 1 dwg

 

The scope of the invention

The invention relates to medicine, in particular of traumatology, orthopedics and neuropathology, prosthetics, angiology, rehabilitation and can be used for rehabilitation treatment of patients with different diseases of the musculoskeletal, nervous and vascular systems, such as osteochondrosis, peripheral and Central paralysis and paresis, limb defects, spinal disorders, for the treatment of children with cerebral palsy and other comorbidity.

Background of invention

In Russia and abroad in recent decades have been developed various types of functional electrical stimulators.

A device for correction of movements when walking, containing the sensor information about the phases of the step, the electrodes and the electronic site, which includes the power supply unit, synchronization unit, the unit set the pace of stimulation, the unit job duration stimulating effects, unit assignments and time parameters and the power amplifier. This device contains all the main functional parts of devices of this type. The device operates in accordance with the parameters laid down in its electronic structure, the main of which can be regulated within certain limits (as the USSR №740255, 1980). However, this device has significant is nedostatki, because it is adapted for a limited number of muscles and allows you to work only in a narrow range of walking speed, and requires a complex installation timing sensors (sensor phase information of the step).

Subsequently, these developments all the necessary adjustments were assigned to the control computer program that is not only much easier, but also allows the flexibility to modify the program of stimulation (RF patent No. 2082452, 1997). In order to avoid the use of long cable connecting the patient and the control computer, we developed a device where the cable is replaced by a radio frequency (RF patent №2126276, 1999). The use of the radio channel makes the patient's Autonomous, but, on the other hand, independent movement of the patient can lead to the fact that he will be out of range of transceiver devices. This option has another significant disadvantage that is not associated cable, the patient can walk along an arbitrary trajectory that ultimately alters the rhythmic structure of the step, which is the base for stimulation. This device has the option to install the goniometric sensors on the knee or hip joint, however, the use of sensors on both joints at the same time is not possible Besides the technical implementation does not allow the stimulator unit in one housing, adapted for wearing his patient, so the block was divided into stationary and portable.

Company "Spark", Moscow, developed the device Multisystem - Akord-08". This device is designed for electrical stimulation of muscles during walking, has eight channels of muscle stimulation and goniometric sensor for the knee joint and is a standalone device that connects to the computer just to download the program of stimulation. Autonomous operation of the device is one of its attractive qualities. However, the real conditions of use may require frequent intervention in the rehabilitation process, adjusting channels, the adaptation of the synchronization mode and other actions. In such conditions, this advantage turns into a disadvantage. In addition, this device has a coarse tuning of the stimulation modes and the main drawback is inaccurate installation of the temporary program of stimulation. Cycle step in the program of this device is divided only into 16 parts. Therefore, the maximum theoretically possible accuracy of installation of the temporary work program muscle is significantly below an acceptable level. A significant drawback of this device is that it allows synchronization from only one sensor movements of the knee joint, i.e. both sides (right and left) sinhroniziruete is from the sensor, located on one of the sides. The specified design feature severely limits the ability to use this device, which can only be used for almost periodic walk provided intact knee.

Any of the above devices has claimed device characteristics: the presence in the construction of the actual unit stimulator, electrodes placed on the muscles, sensors, computer control program, connecting lines and additional devices.

These analogues, in addition have a number of common the following limitations that significantly affect the possibility of using the method of functional electrical stimulation for different categories of patients.

1. The inability to use the same device for different types of sensors depending on the patient's pathology, as all equivalents are composed of only one type of sensor. Cannot use for synchronization or obtain control of functional information of other joints and bearing areas of the foot and hand.

2. The impossibility of carrying out a preliminary biomechanical diagnostics using the sensors used.

The process of functional electrical stimulation based on direct IP is the use of biomechanical information about the patient, the resulting diagnostic tests. However, in real conditions of obtaining the necessary diagnostic data is problematic. This is because the instruments themselves do not have the necessary set of sensors, and institutions, as a rule, do not have the laboratory of biomechanics.

3. The impossibility of stimulation in the case of gross pathological walk.

Existing designs of electrical stimulation based on the work from one type of sensor is only applicable in the case of periodic walk. In the case of severe pathology, the use of such an algorithm is impossible, and other data devices do not possess.

4. Failure to make fine tunings time program of stimulation and adaptation program for the phases of the cycle step of the particular patient.

The setting time of the stimulation program in the known devices operate on the basis of the included variables temporary stimulation, and in some cases the program may be changed by the doctor. However, there is no ability to configure using the individual parameters of the walk given patient.

5. The inability wide adaptation stimulating pulse to a specific patient.

Adjust the amplitude, duration and frequency of the stimulating pulse when working with the patient, neobhodimo wide limits, including directly during stimulation. Most devices are not thin, and stepped adjustment, which is actually hard mode.

6. The inability to set the pace of walking or other periodic action for the patient.

To conduct the stimulation session, especially for patients with complex musculoskeletal disorders, the importance of setting a certain rhythm produced movements and the change of rhythm in accordance with the current biomechanical parameters during stimulation. This is due to the fact that the method of functional stimulation it focuses on rhythmic movement.

7. The inability to adapt to the stimulation program for use in various periodic locomotion other than walk, including an exercise bike, walking up the stairs, rhythmic locomotion of the lower extremities that are not related to walking, including lying, rhythmic locomotion of the upper extremities and trunk, other locomotion.

Tight-binding parameters and stimulation algorithm to the process of walking is not possible to use the described device for stimulation in conditions other periodic locomotion.

8. The impossibility of carrying out a cyclic stimulation, and focused on a specific locomotion in the absence of the POC is mochi.

Analyzed counterparts do not possess the ability to conduct oriented locomotor stimulation in the absence of movement from the side of the stimulated limb, because they do not have modes of stimulation in the absence of a signal from the timing sensor.

9. In the described devices, there is no possibility of saving all the data for the time during which stimulation was carried out (operation modes of stimulation channels, work the clock and recording sensors, changing modes of operation).

Analysis of this information is of considerable value to the physician, as adequately characterizes the process of stimulation and functional response of the patient.

To overcome the above limitations was developed proposed complex "NMG-STIMULUS".

The invention

The present invention is to provide an accurate programmable electrical stimulation of muscles and motion correction in various periodic locomotion and conduct oriented locomotor stimulation for immobilized patients.

This problem is solved due to the fact that in the present invention include the ability of electrical stimulation of muscles during walking and at different periodic locomotion other than walk, including locomotion of the upper extremities and tolove is a, using simultaneously used by different types of sensors, and depending on the patient's pathology sensors installed in the major joints, including the knee, hip, ankle, shoulder, elbow, wrist joints, as well as in the heel area of the foot, the toe of the foot and fingers.

There is the possibility of using simultaneously at least eight sensors, and any of these sensors can be assigned to the clock. In accordance with the invention use at least four goniometric sensor, detecting motion in the major joints, and at least four photometrically (reference) sensor under the heel and toe of each foot and fingers of each hand. In the stimulation process data from all sensors are recorded and analyzed by the software. Thus, both in the period of stimulation and in the absence of stimulation, and you can get all the essential diagnostic information from the sensors. The software has the appropriate processing algorithms and present the results of the Desk in the form of diagnostic data.

To implement stimulation in cases of gross pathological walk the proposed complex has the following features, namely, that the can is about to use any of the, at least four for each side of the body of the registration sensors as the synchronizing sensor that gives a wide choice to install as the clock master, the most stable sensor. On the other hand has the ability to set not only any sensor as synchronization, but also to determine for him the actual moment of synchronization, i.e. some event in the cycle of movement. So for photometrically sensors can determine the moment of synchronization associated with the early reliance on the sensor or its termination. In turn, the sensor registers movement in the joint, it is possible to determine the time synchronization not only in phase but also in amplitude. This takes into account the time difference between the given event and the actual start of the driving cycle in a given patient. In the case where movement of the patient have gross pathology, there is a possibility to set the rhythmic work of the channels; stimulation and the duration of the cycle, which will be followed regardless of the actions of the patient, while oriented locomotor stimulation carried out without purpose of synchronizing the sensor. This mode can be used, for example, for spinal patients, or patients who currently are not capable of arbitrary movements.

For exact adjustment and the display time of the stimulation program provides the following features:

- definition of cycle time step or cycle other movement of the patient,

- constant current analysis cycle time step or cycle of another movement with adjustment of stimulation parameters according to the last cycle,

- definition of rhythm, pitch or rhythm other cyclic movement (changing rhythm step stimulation stops and resumes when restoring the rhythm of movement, including when changing time driving cycle).

To adapt a stimulating pulse to the individual patient includes installation of all four stimulation parameters (amplitude, frequency, duration, start and end of the pulse packet) from zero to the maximum value in increments of one unit.

To set the rhythm or rhythm any other movement in the block stimulator set the audio source to be managed package desktop software. Using sound signals specify the desired walking pattern of the patient or his changes. The audio signal is also used for an audible indication of the time and duration of stimulation. From the software you can create an audio signal to any stimulated muscle (a muscle on one side of the body left or right). The beginning and end of the audio signal will be sootwetstwu shall be the beginning and end of the stimulus pulse.

In order to adapt the stimulation program to work on the bike, to walk the stairs for rhythmic locomotion of the lower extremities, not related to walking, including lying, to rhythmic locomotion of the upper extremities and trunk, in the proposed complex, there is no need to make special settings or to use additional tools, because the algorithm of the software is versatile and can be used directly for any periodic motions. An additional possibility is the use of different types of sensors and binding time synchronization to any set event (circuit-opening sensor, the amplitude attributable to a given point in time).

For subsequent clinical data analysis the operation of the sensors and modes of stimulation of the muscles remain in the database for the entire period of each stimulation session.

The proposed set of "NMG-STIMULUS" is a device programmed electrical stimulation of muscles and consists of equipment installed in the patient, and equipment mounted separately.

Directly on the patient record:

goniometric sensors for large joints, including the hip, knee, ankle, shoulder, elbow, wrist,

odometric the ski sensors for the heel of the foot, the toe of the foot, the fingers of the hand,

stimulating electrodes

the stimulator unit (belt or backpack sling),

connecting lines.

Depending on the condition of the patient session of electrical stimulation is done, usually, every day, with a duration of 20-60 minutes Total number of procedures up to 10 to achieve the desired effect.

Separately from the patient set the computer with the control program, the power supply unit stimulator and a connecting line. The complex operates from AC mains voltage of 220 V±10%, 50 Hz±1%. The maximum power consumption, depending on the type of computer equipment is not more than 400 VA.

In more detail, the present invention will be described with reference to the accompanying drawing, which shows a General block diagram of a complex programmable functional electrical stimulation "NMG-STIMULUS",

The block diagram of the system comprises a computer 1, the external unit 2 power connection line 3, block 4 stimulator (stimulation-biomechanical unit), goniometric sensors 5, photometrische sensors 6, the stimulating electrodes 7.

Through a special software available in the computer 1, make adjustment and coordinated functioning of all components of the complex. In the qu is authorized vicinity of the computer 1 is an external unit 2 power supply for operation of unit 4 of the stimulator. The power supply is realized by means of the connecting line 3. In this same connection line 3 is line two-way communication between the computer 1 and block 4 of the stimulator. This line loads the program operation of the stimulator unit 4 of the computer 1, the adjustment program for stimulation and receiving data from unit 4 of the stimulator.

The actual unit 4 stimulator is a plastic housing, the outside of which are the connectors for the eight pairs (active and earth) stimulating electrodes 7 and eight sensors 5, 6, and inside the electronic circuit of the device. Overall dimensions of the block 4 stimulator 150×100×50 mm

The internal circuit block 4 of the stimulator consists of a Central processor 8 with its own software and 9 peripheral devices, internal block 9 power, eight channels 10 stimulation, eight channels 11 for input clock signals (four channels for goniometric sensors and four channels for photometrically sensors) and source 12 audio signals. Channels 10 stimulation form a unipolar P-shaped pulses of stimulation. The pulses of each channel have a temporal offset with respect to the pulses in neighboring channels. The repetition frequency of the stimulating pulses from 0 to 120 Hz (working 40-80 Hz). The duration of the positive half-wave impul the owls from 20 to 300 μs. The amplitude of the positive half wave from 0 to 150 C. Digital angle sensors (goniometry) have an accuracy of not less than ±1 degree. Registration accuracy ptogramme (time driving cycle) is not less than 0.01 C.

The CPU 8 receives information from the goniometric and photometrically sensors 5, 6 and channel 10 stimulation and sends it to the computer 1. In accordance with the obtained from the computer team produce the operating modes of the channels 10 stimulation.

The device operates as follows. The CPU 8 of block 4 of the stimulator in real-time, performs the steps:

- receiving information from sensors

- receive information about the work of the channels of stimulation,

- receive control commands of the computer

- send information about the operation of the stimulator unit to the computer

- send control commands to the channels of stimulation,

- define the necessary rhythm of the movement of the patient with a sound or audible indication of stimulation.

From the computer 1 sets the mode of operation of the stimulator unit 4, which includes the programme of work of the channels 10 stimulation, task synchronization mode with the working clock of the sensor and recording sensors, setting the rhythm of the movement through sound or audible indication of stimulation.

The complex provides electrical stimulation of muscles lie in the cyclic movements of the patient, for example, if you walk, bike, other mentioned periodic locomotion limbs and torso in a set phase of this movement by a custom program stimulation or oriented locomotor stimulation events outside the patient's movements.

Installation operation modes of the sensors to synchronize the stimulation produced from the main control program of the computer. Are set to the following basic settings: kind and type of the sensor and, in fact, the moment, which is the beginning point of the cycle of movement. In the software package make the selection of the appropriate type of sensor is increasing and its type - hip, knee, ankle, shoulder, elbow, wrist, or photometrische and its type under the heel or toe of the foot, or finger of the hand. For goniometric sensors determine the amplitude or phase of the movement as a point of reference or define both parameters together. For photometrically sensors that time may be short circuit or disconnection of contacts of a sensor. For each side of the body (right or left) can be used only one synchronization sensor, the synchronization carried out independently for each side of the body with any type of sensor that is located on each side. Any sensors that are not used to is the synchronization, can be used to check the current settings.

Set sound stimulation involves the task of the program the necessary rhythm of movement and the indication of stimulation pulses on any muscle for each side using the source 12 audio signals.

Functionally works as follows. The patient uses the stimulating electrodes 7 in accordance with the selected methodology stimulation and wear a belt or backpack suspension unit 4 stimulator. Choose for each side (left and right) sensor, which is fixed on the lower or upper limb, foot or hand of the patient, or for the diagnosis install all the sensors. Stimulating electrodes 7 and the sensors 5, 6 include respective connectors of the unit 4 of the stimulator. The stimulator unit 4 is connected to the computer 1 via the connecting line 3. The computer 1 includes a control program. After the start of operation of the software will download the selected method of stimulation or the physician determines the operating modes of the channels 10 stimulation and sensors 5, 6. Checks the channels 10 stimulation and proper installation of the mode of stimulation. To do this, for each channel 10 sequentially doctor gives trial stimulating pulse. Thus determine the efficiency is simulatie and valid pain threshold stimulus pulse. After this surgery, the patient goes into a mode of self-movement (walk, bike, other periodic movement or stimulation outside of motor activity (locomotion oriented)). The doctor starts the registration parameters of the sensors and stimulation. On the monitor of the computer 1 are displayed in graphical form the channels 10 stimulation and sensors 5, 6, as well as other service information. During the session the practitioner can, guided by the available options, change the mode of stimulation, to specify a different rhythm of movement and to perform other necessary actions.

General algorithm of working with primary patient following:

diagnosis,

the purpose of the stimulated muscles,

- the purpose of synchronizing sensors

- conduction stimulation.

For diagnostics after installing sensors, load the appropriate diagnostic technique, and the patient at the command of the doctor begins to move, they will be made within 1-2 minutes. After the movement, the physician analyzes the information received from the sensors through the use of existing software tools package. On the basis of the received diagnostic information specify the synchronization mode for each of the sides of the body (which sensor and what mode will be used), specify the choice of thinking is to stimulate and determine what kind of locomotion will use (walk, bike, other periodic motion of the upper and lower limbs). If necessary, reinstall or install additional electrodes on the stimulated muscles. Based on the diagnostic data and individual patient's feelings install mode and stimulation for each muscle. The mode of stimulation is checked by applying a test stimulus for each muscle, if necessary, and make the adjustment. As can be dismantled (optional) sensors that do not use for synchronization.

The sensors needed to obtain diagnostic information can be left.

Next is the actual process of stimulation. During stimulation, the physician observes the work of the channels of stimulation and produce movement effect of the stimulation on the available diagnostic information from the sensors. If necessary, make additional adjustments synchronization modes or stimulation.

1. The method of electrical stimulation of muscles in the periodic locomotion of the patient, namely, that electrical stimulation of muscles perform stimulating pulses from electrodes installed on the muscles, stimulating pulses simultaneously synchronize using goniometric and photometrically Dutch the Cove, moreover, the installation location of each goniometric sensor selected from a group including a knee, hip, ankle, shoulder, elbow and wrist joints, and the installation location of each photometrical sensor selected from the group including the heel area of the foot, the toe of the foot and fingers.

2. The method according to claim 1, characterized in that for the goniometric sensors determine the moment of synchronization and phase and amplitude.

3. The method according to claim 1, characterized in that for photometrically sensors detect when synchronization is associated with the beginning or termination of support on the sensor.

4. The method according to claim 1, characterized in that the electrical stimulation is carried out at a walk, rhythmic locomotion of the lower extremities, rhythmic locomotion of the upper extremities and torso.

5. The method according to claim 1, characterized in that conduct electrical stimulation of the muscles of the lower extremities, upper extremities and trunk.

6. The method according to claim 1, characterized in that the set stimulation parameters from zero to the maximum value in increments of one unit.

7. The method according to claim 1, characterized in that the rhythm of movement, change and audible indication of the stimulation process using a source of audio signals.

8. The unit of electrical stimulation of the muscles of the patient containing the stimulator unit with channels tis is ulali and channels for input clock signals from the sensors, the electrodes placed on the patient's muscles, computer, power supply, connectors, at least four goniometric sensor made with the possibility of registration of motion in the major joints, and at least four photometrically sensor made with the possibility of registration bearing the patient's heel or toe of the foot, or press the fingers of the hand, and the device is made with independent timing for each side of the body with any type of sensor that is located on this side.

9. The device according to claim 8, wherein the stimulator unit is made in a single housing which can be worn by the patient.

10. The device according to claim 8, characterized in that it is made with the possibility of registration data to obtain diagnostic information from all sensors simultaneously.

11. The device according to claim 8, characterized in that at least one of the four for each side of the body the most stable sensor is clock.

12. The device according to claim 8, characterized in that it contains a source of audio signals to set the pace of the movement, its changes and for an audible indication of the stimulation process.

13. The device according to claim 8, characterized in that the repetition frequency of the stimulating pulses 0-120 Hz (working 40-80 Hz), duration put the additional half-wave pulse of 20-300 ISS, the amplitude of the positive half wave of 0-150, precision goniometric sensors not less than ±1 degree, the accuracy of registration ptogramme not less than 0.01 C.



 

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Electrode device // 2252793

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2 dwg

FIELD: medicine; medical engineering.

SUBSTANCE: method involves placing negative and positive electrode on skin surface in the innervation area of the second and the third trigeminus branch. An additional negative electrode is applied in the innervation area of auriculotemporal trigeminus branch. The electrodes are fed with pulsating electric current in predefined sequence. Current intensity is controlled in stimulation process in a way that patient feels intensive sensation with no pain. Device has DC supply source connected to unit for generating pulsating electric current having three outlet leads for connecting electrodes, modulator having regulator unit, transformer, switch and microprocessor.

EFFECT: enhanced effectiveness of anesthesia in treating teeth.

15 cl, 7 dwg

FIELD: medicine, therapy, cardiology.

SUBSTANCE: at hypertension I stage a patient should be prescribed several courses of transcranial electrostimulation at interval of 1-2 mo per 5-7 seanses , current power being 0.5-0.8 mA. At hypertension II and III stages one should prescribe transcranial eletrostimulation along medicinal therapy, and, also, several courses at interval of 2-3 mo and current power being 0.8-1.2 mA. The innovation enables to remove side effects, shorten the period of in-patient therapy and reduce the dosage of hypotensive preparation.

EFFECT: higher efficiency of therapy.

2 cl, 2 ex, 4 tbl

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