Method for reconstructing motor functions in patients after ischemic insult

FIELD: medicine.

SUBSTANCE: the present innovation deals with treating ischemic insult, especially at rehabilitation of patients at its acute phase. Along with medicinal therapy it is necessary to fulfill nervous-muscular electrostimulation (NES) of paretic extensors of fingers and wrist followed by evaluation of motor function. NES of paretic extensors of fingers and wrist should be started from the moment of establishing the fact of ischemic insult to be continued during 3-4 wk. Duration of 1 seance lasts for about 20-30 min twice daily. Impulses should be supplied every 4 sec at 2-sec-long duration. The innovation increases the quality of motor and functional reconstruction in post-insult patients due to changing the terms for the onset of NES technique towards its decreasing.

EFFECT: higher efficiency of reconstruction.

1 ex, 1 tbl

 

The invention relates to medicine and can be used in the treatment of ischemic stroke, namely in the rehabilitation of patients in the acute phase.

One type of rehabilitation is its motor rehabilitation. There is a method of recovery of motor function post-stroke patients, which is to perform passive movements in paretic extremities and treatment regulations (Stolyarova L.G., Tkachev BORN in Rehabilitation of patients with post-stroke movement disorders. M: Medicine. 1978, p.34).

These movements serve to prevent the development of bedsores, statistical pneumonia, development of improper installation of the extremities, leading to contractures, as well as the so-called distress that may occur after long-term immobilization of patients.

The basis of all methods of motor recovery is the provision of afferent flow with the paretic limb, whereby activated neuroplasticity processes in the cerebral cortex.

Motor rehabilitation of patients with ischemic stroke. conduct and use of neuromuscular electrical stimulation (NES). The R / V induces muscle contraction, the force of which exceeds arbitrary.

Closest to the invention is a method of recovery of motor function post-stroke patients, who who is conducting, along with drug therapy, neuromuscular electrical stimulation of the paretic extensors of the fingers and wrist (John Chae, Francois Bethoux, Theresa Bohinc, et al. Neuromuscular Stimulation for Upper Extremity Motor and Functional Recovery in Acute Hemiplegia. The Stroke. 1998; 29: 975-979). Electrical stimulation begins after 4 weeks of stroke onset. Date of stimulation due to the stabilization of the patient in these terms. Stimulation was carried out for 60 minutes 1 time per day every day for 15 days. Produced submaximal extension of the wrist and fingers. The impulse was applied cyclically - 10 on and off, while he was a two phase, symmetric, wavy, with individual amplitude to stimulate a certain amount of movement and the frequency of 25-50 Hz.

Motor deficit was assessed using internationally accepted scale of the Fugl-Meyer evaluation and self - FIM.

However, the most significant motor recovery occurs in the first few weeks after the onset of infarction that is not accounted for in this way. Since the R / V was started after 4 weeks from the beginning of the stroke, prophylaxis flexion installation hands and pain in the joints of the paretic limb was provided is not enough. In addition, a relatively late conduct of the R / V may not be sufficiently influenced neurodynamic processes in the head m is the ZGA. The latter arise after his ischemic damage and are of great importance in the restoration of disturbed functions.

In the described method of applying each pulse lasted 10 seconds, and the maximum extension in the wrist joint and joints of the fingers continued for hours. This mode can lead to fatigue of the muscles and most likely negative patient response to the procedure.

One of the most important tasks is the early start of rehabilitation measures in post-stroke patients, which contributes to a more pronounced functional recovery, enabling self-service patients. Rehabilitation after a stroke should begin as soon as possible. Since the most significant motor recovery occurs in the first few weeks after injury, the rehabilitation of motor function should be started immediately in patients achieving clinical stability. On the need for early initiation of rehabilitation measures and indicates the possible existence of a critical period for cortical plasticity, which leads to the recovery of motor abilities of the upper extremity.

The technical result of the invention is to improve the quality of motor and link the data with him functional recovery post-stroke patients due to changes in the timing of the start of the R / V in the direction of their reduction: R / V is in the acute period, i.e. from the first hours.

This result is achieved by a method for the recovery of motor functions of patients with ischemic stroke, namely, that along with the drug therapy of neuromuscular electrical stimulation of the paretic extensors of the fingers and wrist with further assessment of motor function, neuromuscular electrical stimulation of the paretic extensors of the fingers and wrist start since the establishment of the fact of ischemic stroke and continued for 3-4 weeks, the duration of a single session of 20-30 minutes twice a day, and pulses every 4 seconds with a duration of 2 seconds.

The mechanism of positive action on the R / V motor recovery is the increase in muscle strength, prevention of forced position of the limbs, which prevents the formation in the Central nervous system of stagnant pockets of excitation. Electrical stimulation of the neuromuscular system can be considered as one of the physiologically adequate methods for selectively activating the motor function of the paretic muscles in the early stages of the disease by promoting the true restoration of disturbed motor functions, and in later periods - compensatory reorganization involving new safe links. Rehabilitation in need with the Oka leads to increased muscle strength and reorganization of neuronal activity. Connection and activation of the supplementary motor ways that facilitate violated as a result of stroke impulse conduction, especially expressed during early rehabilitation. This is indicated by theory of sensorimotor integration, which argues that the touch flow arising from the movements of the paretic limb, directly affects subsequent motor output. Ultimately, NPG provides quantitative and qualitative changes in proprioceptive activity, contributing to the recovery of motor function impaired as a result of stroke (Chernikova L.A. Modern state of the problem of physical neurorehabilitation and prospects of its development // Physiotherapy, balneology and rehabilitation. - 2003. No. 1. P.3-6)shows that, when the stroke is recommended for the stimulation of those muscles, which are usually not rising tone: a stimulating signal applied to the extensor of the fingers and wrist, the extensor of the forearm and peroneal muscle group. This provides the optimum balance of tone different muscle groups, which improves the functionality of the sick.

In the proposed method utilizes proprietary mode of stimulation, which does not cause discomfort and fatigue stimulated muscles of the patient and not having a negative impact on Central hemodynamics. N is To produce 2 times a day for 20-30 min for 3-4 weeks with periods of pulse 2 and pauses 4 C. The advantage of a longer assignment procedure in comparison with the known method is "fixing" the optimum ratio of muscle tone extensor and flexor tendons of the hand and fingers, which prevents the formation of stagnant pockets of excitation that generates, in turn, poor movement pattern. Double use of the R / V provides the necessary timing of stimulation, without causing fatigue of the muscles. And for a short period of the pulse (2) provides a more physiologic muscle contraction.

An example implementation of the method

We examined 14 patients (mean age 66±8 years) within the first 48 hours of ischemic stroke (AI) in the basin of the middle cerebral artery. All patients had motor deficits in the hand of varying severity. At admission, at 5 and 21 days and 3 months AI all patients were additionally evaluated on standardized international scales: assessment of neurological deficit was made by the European Stroke Scale (ESS) and National Institute of Health Stroke Scale (NIHSS), self-help skills by Barthel Index (BI), motor deficit Fugl-Meyer Scale, which made it possible to assess separately the function of the muscles of the shoulder and forearm.

The control group of patients was carried out conventional treatment. The primary group in addition has carried out the R / V extensor finger and brush paretic hand.

The electrodes were superimposed on the extensors of the hand and fingers paretic hand: proximal - below the elbow, distal is on the border between the lower and middle third of the forearm. The effect was found to be two times a day for 20-30 minutes every 3-4 weeks. Ensured supply of two-phase intermittent alternating current, amplitude modulated, frequency of 50 Hz by the "biorhythm". The current intensity was adjusted individually so as to provide a submaximal amount of extension of the hand and wrist, which does not cause discomfort to the patient.

Data processing was performed using the software package STATISTICA 6.0. Data are presented as median.

The average start time of stimulation was 22 h from the beginning of AI. The main and control groups were matched for age and severity of neurological deficit at all scales. Neurological deficit ESS totaled 53 points at the rate of 100 points; NIHSS 8 points at the rate of 0. Motor deficit in the hand in the whole Fugl-Meyer Scale amounted to 14 points at the rate of 60 points. All the patients showed good tolerance conducted by the R / V: effects on systemic hemodynamics were noted (some patients were conducted Holter ECG monitoring in the first day).

Patients of the main group was not observed flexion installation hands that have improved their functional POS of the property. So, any of the patients of the main group there was an increase in tone in the flexors of the hand and fingers. In addition, in the study group identified the best recovery of motor function of the hand (see table).

Table

Dynamics of recovery of motor function of the hand.
ScaleWhen receivingAfter 3 weeks
The main groupThe control groupThe main groupThe control group
European Stroke Scale,
in points49.558.088.572
National Institute of
Health Stroke Scale, in8.552.51
points
Shoulder on the Fugl-Meyer,
in points42529.528
Prepl is whose on the Fugl-
Meyer, in points2.53106
Brush on Fugl-Meyer,
in points2511.511
In General, the hand on the Fugl-
Meyer, in points9355049
Data are presented as median.

As shown in the table, the R / V paretic limb, which was launched simultaneously with drug therapy has a positive effect on its motor recovery and function. The increased muscle tone of the flexors of the fingers and hands, taking place at the Central paresis of the hand, significantly limits its functionality. Therefore, the normal ratio of muscle tone in the extensor and flexor tendons of the hand and fingers, which is provided by the proposed method extends the functionality of patients, improving self-service capabilities.

The method leads to passive muscle contraction only certain what ysz - extensors of the hand and fingers, and it provides the selectivity and the adequacy of the stimulation of the respective zones of the cerebral cortex.

Low cost of use of the present invention is an additional factor that indicates the need for wider distribution.

At the same time, the proposed method provides adequate, metered flow afferention with a specific group of muscles. In view of the physiology of exposure, no effect on Central hemodynamics this method can be used in the early rehabilitation period.

The proposed method, the timing of the R / V hands in the acute period of ischemic stroke improves recovery of her motor functions.

Method for the recovery of motor functions of patients with ischemic stroke, namely, that along with the drug therapy of neuromuscular electrical stimulation of the paretic extensors of the fingers and wrist with further assessment of motor function, characterized in that neuromuscular electrical stimulation of the paretic extensors of the fingers and wrist start since the establishment of the fact of ischemic stroke and continued for 3-4 weeks, the duration of a single session of 20-30 minutes, spend a day in 2 sessions, with the pulses serves deletelines is followed in 2 to every 4 C.



 

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