Method for electric stimulation of spinal cord

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely neurology, physiotherapy. A method involves exposure of a patient's spinal cord above thoracic spines T11-T12. The patient is laid on one side with his/her feet supported by rocking frames. An active electrode is applied on skin. The exposure length is 10-20 seconds. The patient is exposed to a square electric bipolar stimulus sequence. The exposure amplitude is 40-70 mA, frequency is 5-40 Hz, and length is 0.5 m seconds. The carrier frequency is 10 kHz.

EFFECT: method provides higher clinical effectiveness ensured by rhythmic alternating activity in flexor and extensor muscles.

1 tbl, 6 dwg

 

The invention relates to medicine, and physiology of movements and electrophysiology and can be used to develop treatment and rehabilitation of people with spinal injuries to a specific location.

Severe pathology occurs after damage to the spine and spinal cord, usually resulting in complete immobility. The number of such patients in the world increases every year.

Over the last 20 years established ways of calling samopodoben movements using electrical stimulation of the spinal cord. U.S. patent 1991 (US 5002053) describes a method of applying electrodes to the surface of the spinal cord, provides a device for placing the electrode on the surface of the spinal cord, results in the parameters of the electrical stimulus required to call locomotor movements, describes the results of a call to locomotion in animals and proposes to use this method to call the movements in humans. Domestic counterparts: a Method for the treatment of patients with spinal injuries (EN 96117107) and method for the treatment of patients with chronic lesions of the spinal cord (EN 2204423). In these methods, the proposed electrical stimulation of the lumbar enlargement of the spinal cord of man. The stimulation is performed by electrodes placed on the Dura mater of the spinal cord; this stimulation duration is characteristic of the movement of the legs in a light position of the patient, lying on your back or on your side with hanging in the Balkan frames legs. The difference between these inventions is that one of them (EN 2000121379/14) method independent stimulation of implanted electrodes for chronic stimulation. The method of simulation and training to the treatment of patients with chronic lesions of the spinal cord (EN 2008115819/14) consists in simultaneous electrical stimulation of the two segments of the spinal cord below the lesion, which not only causes locomotor movement of the lower extremities, but also leads to the support body weight.

However, all the ways analogous to the treatment of patients with chronic spinal injuries are invasive and are imposing stimulating electrodes on the surface of the Dura mater of the spinal cord (epidurally) with subsequent electrical stimulation of the spinal cord below the level of lesion. The implementation of these methods of treatment requires surgical intervention to implant the electrodes, as well as specific medical service for the entire period of operation of the stimulating electrodes to prevent infection of the site of implantation through the wire electrodes located cutaneous, and to prevent rejection reactions of the electrodes.

The method of stimulation of the spinal cord (U.S. Pat. EN 2393885), is selected for the prototype of the claimed solution, causes involuntary movements of the lower limbs, characteristic for a walk, electromagnetic effects on the spinal cord in the region of the thoracic vertebrae of a person when combined with the inductor on the skin above the vertebrae. The intensity of impact: 2-2 .5 Tesla. The method is non-invasive. The disadvantage of this method is its low efficiency, identified in practice as it causes involuntary locomotor movement less than 50% of stimulated.

The inventive method of electrical stimulation of the spinal cord allows you to get a new one compared to the prototype of the technical result consists in increasing the efficiency and effectiveness of spinal cord stimulation.

To achieve the specified result is the following set of essential features: a method of electrical stimulation of the spinal cord (including, as a prototype, the impact on the area above the thoracic vertebrae T11-T12 spinal cord of the patient is placed lying on his side, with his legs hanging in frames, swings, and the impact within 10-20 seconds), unlike the prototype, the exposure is performed via an active electrode placed on the patient's skin, a sequence of electrical rectangular bipolar incentives in the form of meanders with the amplitude of 40-70 mA, frequency 5-40 Hz, pulse duration of 0.5 msec and carrier frequency 10 kHz.

From recently the x publications known when electrical stimulation of the spinal cord for cutaneous location of active electrodes, the best place to call locomotor reflexes is the locus between the spinous processes of the vertebrae T11 and T12 [6, 7]. It is shown [8] that the frequency range of 25-50 Hz is effective to call the rhythmic movements of the legs of a person with an electrical epidural stimulation of the lumbar thickening. On the other hand, when the electromagnetic cutaneous stimulation effective for calling rhythmic samopodoben movements is the frequency range of 3-5 Hz [5, 9]. Stimulation with a frequency less than 2 Hz does not cause locomotion; on each of incentives arise reflex motor responses; train activity characterizing the locomotion, does not occur [10].

Our preliminary studies have shown that cutaneous electrical stimulation of the spinal cord with a frequency of 5-40 Hz stimuli rectangular shape, the same as used in epidural electrical stimulation of the spinal cord, causing rhythmic movement of the feet. However, such stimulation is ineffective and poorly reproducible due to pain stimuli: the threshold value of the amplitude of the stimulus to call movements more or coincide with thresholds of cutaneous pain sensitivity.

The essence of the invention lies in the fact that saving up is const prototype to stimulate involuntary shagadelic movements of the patient, the inventive method unlike the prototype allows to obtain more positive results - higher efficiency of stimulation.

EXAMPLE

The experimental set-up [11] provides the optimal conditions for running involuntary shagadelic movements. Subjects were placed on the couch lying on your left side, both feet were placed on separate boards, fastened with ropes by type of swing to hook in the ceiling of the experimental room. Right (top) leg supported directly in the leg region, and the left lower leg was placed on a rotating tire is attached to a horizontally oriented boards. In this situation the subjects movement of the legs had no limitations, as it happens when the legs are hung in the Balkan frame, and had a maximum amplitude of movements. The statement prescribed subjects to lie still and not to impede the movement caused by electric stimulation of the spinal cord.

Cutaneous electrical stimulation of the spinal cord was performed stimulator [12]. An active electrode in the form of a disk with a diameter of 2.5 cm, made from conductive plastic [13], was positioned on the midline of the spine at the level of thoracic vertebrae T11 and T12 between the spinous process method : automatic shape the AMI. The passive electrode is a rectangular plate 510.2 cm2[14] disposed symmetrically on the skin above the crests of the Ilium. To call samopodoben motions filed rectangular bipolar incentives in the form of meanders, with a duration of 0.5 MS with a carrier frequency of 10 kHz (figure 1), the amplitude of 0-70 mA, incentives followed with a frequency of 5-40 Hz, duration of stimulation was 10-20 sec.

Electromyogram (EMG) of muscles of the legs gave bipolar surface electrodes placed bilaterally on m. rectus femoris., m.biceps femoris, m.tibialis anterior and m.soleus. EMG signals were recorded using a telemetric 16-channel NCS system [15].

Movement of the legs in the knee joint were recorded using goniometers; the sensors were mounted on both legs.

Kinematic characteristics of leg movements were recorded by a video system [16]. Reflective markers were attached to the points of the body coinciding with the axes of motion in the shoulder, hip, knee and ankle joints. Angular movement in the hip joint was calculated based on the position of the markers on the lateral myselt shoulder, greater trochanter and lateral myselt hips. Markers attached to the great trochanter, lateral maselko hip and ankle, used for evaluation of knee motion. Movement in the ankle joint, smartlipo markers, localized on the lateral myselt hip, ankle and big toe. The reconstruction of the movements of one sagatelova cycle produced by the original program.

Check EMG and kinematic parameters shahania was synchronized. The average period sagatelova cycle and the amplitude of the angular movements of the joints of the feet was determined for 10-12 cycles. The period of the cycle shahania was calculated based on the duration of the interval between the two maximum values of the angular displacements of the hip, knee and ankle joints. The phase shift between movements in the knee and hip joints was determined by the interval between the maximum values of the angles (angular movements in these joints).

Results

When electrical cutaneous stimulation of the spinal cord with a frequency of 5-40 Hz in four of the five subjects were called involuntary movements of the legs.

The intensity of the stimulus that causes movement was 40-70 mA. The threshold intensity of the stimulus that causes movement, were below the threshold of pain sensitivity. The amplitude caused by movements depended on the amplitude of stimulation is gradually increasing the intensity of the stimulus, increased the amplitude of the movement of the legs in all the joints, when the intensity of the stimulus threshold cutaneous pain sensitivity amplitude motion the feet was the maximum.

Registered features such involuntary movements of the legs, caused by cutaneous electrical stimulation of the spinal cord, which prove that it siteline movement.

Figure 2 presents the electromyograms of the muscles of the femur and tibia of both legs, registered under arbitrary shagadelic movement, electrical cutaneous stimulation of the spinal cord with frequencies of 5 and 30 Hz. Recording time is 10 seconds. Used the following abbreviations: Prsv - random motion, 5 Hz and 30 Hz stimulation with frequent 5 and 30 Hz, respectively, Etc. - the right leg, LV - left leg, RF - m. rectus femoris (knee extensor), BF - m.biceps femoris (knee flexor), TA - m.tibialis anterior (extensor of the foot), S - m.soleus (flexor of the foot). Muscle contraction-antagonistas alternate with electrical stimulation, and during voluntary movements.

Figure 3 presents genogram characterizing the motion of both legs at the knee. Recording time is 10 seconds. Used the same abbreviations as in the previous figure. The deviation of the line-up corresponds to the forward movement, the deviation of the bottom line corresponds to the backward motion. The right and left legs move in the knee joint with electrical stimulation as reciprocal, as during voluntary movements.

Figure 4 shows the recording of movements of the joints of the right leg received in the district is the result of the processing cinematogram. Recording time is 10 seconds. Indicate in the figure: TSB - hip, KLN - knee, GLn - ankle, the other designations are the same as in figure 2. On the y - axis angular degrees. Movement of the joints of the foot during electrical stimulation have the same character as that of movement of joints during voluntary movements: registered alternating flexor and extensor motion in all joints. Differences induced motions from arbitrary consist in the fact that the amplitude of the displacements of the joints is smaller, the duration of step more. Numerical characteristics of movements of joints are presented in table 1.

Prsv
Table 1.
Characteristics of the movements of the joints of the right leg of the subjects in a random shagadelic movements and cutaneous electrical stimulation of the spinal cord.
Prsv: random motion, ES, 5 Hz and ES, 30 Hz electrical stimulation of the spinal cord with a frequency of 5 and 30 Hz, respectively.
JointMovement typeThe amplitude of the motion (CH. grad)Step duration (msec)
17.21.83173492.73
HipES, 5 Hz7.50.582273146.62
ES, 30 Hz1212225.3157.28
Prsv65.8(2.71175837.01
KneeES, 5 Hz26.510,342306.511.7
ES, 30 Hz28.66.512242186.58
Prsv5.20.971769.674.78
AnkleES, 5 Hz2.750,52282.5212.87
ES, 30 Hz2.30.582236.7219.09

Figure 5 shows the coordination of movements in the hip and knee joints, and knee and ankle the statutes of the right leg during one step. Designations are the same as in figure 4. When electrical stimulation of the spinal cord is observed correlation of movements in the hip and knee joints, although it is different from the relation between the movements of these joints during voluntary movements.

Figure 6 shows the reconstruction of one cycle of movements of the right leg at the maximum amplitude obtained after analysis cinematogram movements of the joints of the right leg. First poluchil - motion foot forward, the second poluchil - moving legs back. Designations are the same as in the previous drawings. Movement of the feet, caused by cutaneous electrical stimulation of the spinal cord, in General, similar to siteline arbitrary motion.

Movement in the hip joint of the left leg were not recorded, because the subjects were lying on their left side, therefore, the reconstruction presented in figures 4-6, the left leg is impossible.

Proposed electrical cutaneous stimulation of the spinal cord of the test causes involuntary movements of the lower limbs, characteristic for a walk, 80% of subjects. Thresholds call of movements is less than the threshold cutaneous pain sensitivity. When electrical cutaneous stimulation observed rhythmic alternating activity in the muscles of the flexor and extensor leg, registered movement in opposite knee su is cave right and left foot there are serial flexor and extensor movements in the joints of the right leg, the kind caused by movements similar to arbitrary siteline movement. Thus, cutaneous electrical stimulation of the spinal cord of a person by a series of rectangular bipolar incentives in the form of meanders, following with a frequency of 5-30 Hz, with a light position of the examinee, can cause involuntary typical walk natural locomotor movement of the lower extremities.

Cutaneous electrical stimulation of the spinal cord, in terms of external support legs suspended in the swing, you can initiate locomotor movements, involuntary specific to walk in humans. Appointment in physiology movements for modeling locomotor behavior, to study mechanisms of control of locomotor behavior, as well as in medicine to create non-invasive methods of treatment and rehabilitation of people with vertebrospinal pathology.

LITERATURE

[1]. Method of and device for inducing locomotion by electrical stimulation of the spinal cord. US 5002053. 1991.

[2]. A method of treating patients with chronic lesions of the spinal cord. The application for the invention: EN 96117107/14, 20.08.1996.

[3]. A method of treating patients with chronic lesions of the spinal cord. Patent RU 2204423.

[4]. The method of simulation and training to the treatment of patients with chronic lesions with the other brain. The application for the invention: EN 2008115819; date of publication of application: 27.10.2009; data on 11.02.2011 examination is completed.

[5]. The method of stimulation of the spinal cord. Patent RU 2393885.

[6]. Courtine, G., S.J.Harkema, C.J.Dy, Y.P.Gerasimenko, P.Dyhre-Now. Modulation of multisegmental monosynaptic responses in a variety of leg muscles during walking and running in humans. 2007; 582; 1125-1139 J. Physiol.

[7]. Dy C.J., Y.P.Gerasimenko, V.R.Edgerton, P.Dyhre-now, G.Courtine, S.J. Harkema. Phase-Dependent Modulation of Percutaneously Elicited Multisegmental Muscle Responses After Spinal Cord Injury. J. Neurophysiol 103: 2808-2820, 2010.

[8]. Minassian K., B. Jilge, F. Rattay, M.M. Pinter, H. Binder, F. Gerstenbrand, M.R. Dimitrijevic Stepping-like movements in humans with complete spinal cord injury induced by epidural stimulation of the lumbar cord: electromyographic study of compound muscle action potentials. Spinal Cord (2004) 42, 401-416.

[9]. Gerasimenko y, Gorodnichev R., Machueva E., Pivovarova E., Semyenov D., Savochin A., Roy, R.R. and Edgerton V.R. Novel and direct access to the human spinal locomotor circuitry. J. Neuroscience 30(10): 3700-3708 March 2010.

[10]. Uperation, Youvraj, Innnovative, Nasarbekova, Vigicer, Pesavento. Peculiarities of formation of locomotor patterns in decerebrated cats with epidural stimulation of the spinal cord. Russian physiological journal. Sechenov. 2003. T. No. 9. S-1057.

[11]. Gurfinkel V.S., levick US, Kazennikov O.V., Selyanov VA is There a generator shagadelic movements in humans? // Human physiology. 1998. So 24. No. 3. P.42.

[12]. Brand, manufacturer: PENDANT. SPb., Russia.

[13]. Brand, manufacturer: Lead-Lok, Sand point, United States.

[14]. Brand, manufacturer: Ambu, Ballerup, Germany.

[15]. MA is ka, manufacturer: ME 6000, MegaWin, Finland.

[16]. Brand, manufacturer: Qualisys, Sweden.

The method of electrical stimulation of the spinal cord, including the impact on the area above the thoracic vertebrae T11-T12 spinal cord of the patient is placed lying on his side, with his legs hanging in frames, swings, while the impact in the 10-20, characterized in that the exposure is performed via an active electrode placed on the patient's skin, a sequence of electrical rectangular bipolar incentives in the form of meanders with the amplitude of 40-70 mA, frequency 5-40 Hz, pulse duration of 0.5 MS and carrier frequency 10 kHz.



 

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FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to gastroenterology, paediatrics. The method involves exposure to alternating current. The exposure is performed by pulse alternating current of carrier frequency 2500 Hz and stimulating frequency 50 Hz. Pulse duration is 20 seconds; pause length is 20 seconds. The exposure is enabled by two electrodes. One electrode is introduced through rectum at depth to 1.5 - 2.0 cm. Another bifurcated electrode is fixed on a reflex-segmental region within S2-S5. The current intensity is adjusted by patient's sensations to achieve an evident painless vibration. Duration of the exposure is 12-20 minutes. The procedures are performed daily. The therapeutic course is 10-12 procedures.

EFFECT: method normalises a regular defecation rate, improves stool consistence, prolongs remission to 6-8 months.

2 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely - to physiotherapy. Method includes two stages. At the first stage short course of nestitherapy is carried out. The second stage includes 10-12 procedures of peloid therapy and 12-14 procedures of impact with currents of hyperacoustic frequency. In carrying out peloid therapy impact is performed on two fields, alternating them each second day. One day application of peat or sapropel is made on the back with temperature of peloid 38C. On the second day - applications are performed in form of short socks and gloves with peloid temperature 40-42C. Impact time is 20-30 minutes. Impact with currents of hyperacoustic frequency is performed on two fields, alternating them every second day. One day impact is performed on collar area and lateral surfaces of neck. Impact is performed with power 2-3 W for 10-15 minutes. On the second day impact is performed on palm surfaces of hands and feet soles. Impact is performed with power 4-6 W for 3-5 minutes on each zone. The course includes 12-14 procedures.

EFFECT: method increases treatment efficiency due to impact on inflammatory process both in lower and upper parts of respiratory tract by impact on blood and lymph circulation, bronchi tone and indirectly on reflexogenic zones.

2 ex, 9 tbl

FIELD: medicine.

SUBSTANCE: through puncture opening in proximal and distal directions one should perform osseous tunnels being coaxial to osseous log to connect, thus, the cavity of osseous cyst with medullary canal. Through the parts of healthy bone at the distance of 1-2 cm against cyst's edge in oblique direction one should implant rigid electrodes at the angle of 45 deg. against its center by applying beck's needles with dielectric covering. Subcutaneously one should implant elastic electrodes in projection of lesion focus and connect an electrostimulating unit to cutaneous ends of electrodes. Onto intraosseous electrodes one should supply impulse current of negative polarity, and onto elastic ones - of positive polarity at 10-20 mcA power and frequency of 0.5 Hz, of total duration and front of rectangular impulses cut being 200 mcsec, not more.. One should affect with impulse electric currents on the 24-h basis till complete covering the osseous defect observed.

EFFECT: higher efficiency of therapy.

2 ex

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