RU2102962C1 - Method to restore peripheral nerves at remote terms after traumas - Google Patents

Abstract

FIELD: medicine, neurology. SUBSTANCE: method deals with electrostimulation impact by impulses of rectangular form for 15-20 minutes successively upon distal and proximal points of peripheral and central sections of injured nerves and mobile points of innervated muscles with discrete increase of frequency for each area at 1-15 hertz by conducting vibromassage for 5-10 minutes with discrete increase of frequencies per one procedure 9-11 hertz, 29-31 hertz and 74-76 hertz for the course of 18-20 procedures daily. To increase therapeutic efficiency curative gymnastics is recommended at morning hours before the onset of procedure. EFFECT: higher efficiency to restore conductivity of peripheral nerves. 2 cl, 6 tbl

Description

 The invention relates to medicine, namely to physiotherapy.

 A known method of restoring the conductivity of peripheral nerves by vibration massage with a fixed frequency [1].

 Its disadvantages include a low percentage of recovery of peripheral nerve conduction, impaired due to injuries, especially in the long term, as well as long recovery periods.

 There are also known methods of restoring the conductivity of peripheral nerves by electrical stimulation [2].

 The disadvantage of these methods is also a low percentage of recovery of peripheral nerve conduction, especially in the long term and low treatment efficiency.

 Closest to the technical nature of the claimed is a method of restoring the conductivity of the peripheral nerves of the extremities by exposure to an injured limb and its corresponding reflexogenic zone by vibration massage. The impact on these zones alternate every other day, on the course - 20-25 procedures [4].

 The disadvantage of this method is the low percentage of recovery of peripheral nerve conduction, impaired due to injuries, especially in the long term.

 Common features of the proposed method and prototype are: conducting a vibration massage sequentially at frequencies of 9-11 Hz, 34-36 Hz and 74-76 Hz with a duration of exposure of each frequency along the damaged nerve to the limb - 2-4 minutes, to the reflexogenic zone - 1- 2 minutes, and the effects on these zones alternate every other day, on a course of 10-15 procedures.

 Distinctive features of the proposed method are: conducting electrical stimulation by paired current pulses for 15-20 minutes sequentially at the distal and proximal points of the peripheral and central segments of the injured nerves and motor points of the muscles innervated by them with a discrete increase in frequency in each region from 1 to 15 Hz in one procedure and exposure at each frequency for 5-10 seconds, as well as conducting in the morning, 4-6 hours before electrical stimulation of physiotherapy exercises.

 The essence of the proposed method is as follows. The patient is electrostimulated with paired current pulses with a delay between them of 5 ms rectangular for 15-20 minutes sequentially to the distal and proximal points of the peripheral and central segments of the injured nerves and the motor points of the muscles innervated by them with a discrete increase in frequency in each region from 1 to 15 Hz and exposure at each frequency for 5-10 seconds. 5-10 minutes after electrostimulation, a vibration massage is performed with a discrete increase in frequencies in one procedure, 9-11 Hz, 29-31 Hz and 74-76 Hz with an exposure of each frequency for 2-4 minutes along the injured nerve for 1-2 minutes - to the collar zone and 3-5 minutes - the lumbosacral zone. In the morning hours, 4-6 hours before electrical stimulation, the patient is given physiotherapy exercises with individually selected complexes that do not cause muscle fatigue. On the course - 18-20 procedures daily.

Justification of the hallmarks
The claimed physiotherapy exercises, carried out in the morning 4-6 hours before electrical stimulation, activates recovery and compensatory processes, increases the tone of skeletal muscles, promotes the formation of the dominant movement. The interval of 4-6 hours is due to the need to restore the neuro-muscular apparatus before electrical stimulation, which is also a kind of gymnastics. The claimed parameter of electrostimulation - pair pulses were studied by us in 48 patients with neuropathies of traumatic origin in the long term after the injury. The effect of paired pulses with a discrete increase in frequency during the procedure compared to electrical stimulation with a discrete increase in frequency during the procedure with single pulses has a more pronounced therapeutic effect, due to the fact that the second pulse, next with an interval of 5 ms after the first, falls into the supernormal period for excited fibers and causes excitation of part of the fibers that did not respond to the first pulse. This leads to the fact that in remote periods, when exposure to other physiotherapeutic factors, including electrical stimulation with single impulses, does not already restore peripheral nerve conduction, the use of paired impulses during electrical stimulation allows in a significant number of cases to restore peripheral nerve conduction.

 Vibro massage, performed daily, 5-10 minutes after electrical stimulation along the injured nerve and to the corresponding reflexogenic zone, accelerates the recovery processes activated in the injured limb by previous physiotherapy exercises and electrical stimulation.

 Vibration massage with a frequency of 9-11 Hz causes the most pronounced analgesic effect, normalizes tendon and periosteal reflexes, and has a predominant effect on the regeneration of the intra-stem vascular bed, which helps to accelerate the growth of nerve fibers. Vibration massage with a frequency of 34-36 Hz increases the amount of muscle strength and normalizes the volume of active movements to a greater extent, as well as accelerates the growth and myelination of regenerating nerve fibers. The frequency of vibration exposure of 74-76 Hz contributes to the disappearance of trophic disorders and the restoration of skin pain sensitivity, has a beneficial effect on the state of the autonomic nervous system, and stimulates the formation of loose fine-fibrous connective tissue with a small fraction of the cellular component in the area of the injury. Considering the paraclinical data on reduced functional lability at the beginning of the vibration massage procedure, the use of mechanical vibrations with a reduced frequency and with a discrete increase in frequency during the procedure to 35 and 75 Hz is quite justified, which contributes to the imposition of a higher level of functional lability of the neuro-muscular apparatus and has a training effect . The total time of exposure to vibration massage up to 15 min during the procedure was selected on the basis of long-term observations, which showed that its decrease does not give the desired results, and the increase causes pathological reactions in the body.

 The method is as follows. Every day, in the morning, the patient is given physiotherapy exercises. Patients perform exercises that contribute to the development of contractures and increase the tone of skeletal muscle. After 4-6 hours after physiotherapy exercises, electrical stimulation is carried out for 15-20 minutes by paired pulses of successively distal and proximal points of the peripheral and central segments of injured nerves, motor points of the muscles innervated by them. Stimulation of each region is carried out by the current block of the MG-42 ectromyograph using cutaneous bipolar electrodes with a discrete increase in frequency from 1 to 15 Hz in one procedure and with an exposure at each frequency of 5-10 seconds. 5-10 minutes after electrostimulation by a labile technique, vibromassage is performed on the injured limb and the corresponding reflexogenic zone during one procedure. Vibro massage for each area is carried out sequentially at frequencies of 9-11 Hz, 29-31 Hz and 74-76 Hz with an exposure of each frequency along the nerve for 2-4 minutes, and for the reflexogenic zone from 1-2 (collar zone) to 3- 5 min (lumbosacral area), for a course of 18-20 procedures, daily.

 Example 1. Patient V., 32 years old, was admitted to the neurological clinic of the Tomsk Research Institute of Balneology and Physiotherapy with a diagnosis of traumatic damage to the radial, median and ulnar nerves on the right, a syndrome of partial conduction disturbance. Condition after surgical treatment of fracture-dislocation of the radial head in the elbow joint. The injury is 8 months old. Prior to admission to the clinic, the patient received massive physiotherapeutic and drug treatment: ultrasound N 10, acupuncture N 10, DDT prozerin, UHF N 10, paraffin N 10, massage N 20, exercise therapy, injections of proserin N 30, vitamin B, N 15 and B1 N 15, which turned out to be practically ineffectual.

 A patient in the clinic of the Tomsk Research Institute of Balneology and Physiotherapy was treated in accordance with the claimed method, namely physiotherapy exercises daily in the morning; 5 hours after physiotherapy exercises, electrical stimulation was performed by paired pulses of successively distal and proximal points of the peripheral and central segments of injured nerves and motor points of the muscles innervated by them. Each region was stimulated with a discrete increase in frequency from 1 to 15 Hz in one procedure (with exposure at each frequency of 7 seconds). 15 minutes after electrostimulation by a labile technique, the patient underwent vibration massage on the injured limb and the corresponding reflexogenic zone. Vibration exposure in each area was carried out sequentially at frequencies of 1 Hz, 35 and 75 Hz with an exposure of each frequency along the nerve for 3 minutes, for a reflexogenic zone 2 minutes. The course has 18 procedures.

 After the treatment, the patient normalized flexion and extension in the elbow joint, extension appeared and bone flexion increased, brush strength increased from 4 to 18 kg according to dynamometry data (Table 1), muscle tone of the affected limb increased according to myoelectrotonometry, tendon and periosteal muscles normalized reflexes, disorders of skin pain sensitivity decreased. After treatment, the parameters of evoked potentials obtained from muscles innervated by the ulnar, median, and radial nerves were normalized (Table 2). So, with the stimulation of all motor points, an increase in the amplitudes of M-responses was observed, an increase in the reduced rate of excitation in the distal regions, more pronounced for the radial nerve, occurred.

 Example 2. Patient L., 35 years old, was admitted to the neurological clinic of the Tomsk Scientific Research Institute of Balneology and Physiotherapy with a diagnosis of traumatic damage to the peroneal and tibial nerves on the left side of the leg. Trophic ulcer of the left sole. Condition after amputation of 1 and 4 fingers of the left foot. Restriction of severe injuries 1.5 years. The trophic ulcer did not heal from the moment of the injury, skin plastic was performed for its treatment, but the necessary effect was not achieved. Prior to admission to the clinic, inconclusive treatment of DDT, paraffin, exercise therapy, application of Vishnevsky ointment and solcoseryl was performed. Massive edema of the foot, hyperkeratosis of the rear of the foot and an extensive (3x4 cm) stanza ulcer of the sole have survived.

 The patient was treated in accordance with the claimed method. After the treatment, the patient had flexion and increased extension of the foot (Table 3), the patient began to walk on heels and toes, strength in the foot increased, tendon reflexes normalized, and the zone of sensitive disorders decreased. Swelling of the foot significantly decreased, cyanosis, hyperkeratosis decreased, and the trophic ulcer of the sole, which did not heal for 1.5 years, completely disappeared. After treatment, an improvement in the functional parameters of the neuromuscular apparatus was also noted (Table 4).

 The table shows that there was a normalization of the rate of excitation along the peroneal nerve. The amplitude of the evoked potentials from the muscles innervated by the peroneal nerve increased 2.5 times. The latency values of the evoked potentials during stimulation of the tibial nerve at the distal and proximal points decreased, and the rate of conduction of excitation along the tibial nerve increased.

 When analyzing the average values of the studied parameters (tab. 5, 6), it turned out that in patients treated with the claimed method, the advantage of the proposed method was confirmed in comparison with the prototype.

 From table 5 it is seen that in the groups treated by the claimed method, in comparison with the prototype, a decrease in pain (1.5 times), a decrease in edema in the injured limb (1.2 times), an increase in strength (1.8 times) , an increase in the volume of active movements (1.5 times), which was clinical confirmation of the restoration of peripheral nerve conduction in this group of patients.

 The table shows that in the groups of patients (table 6) treated by the claimed method (compared with the prototype), there is an increase in the amplitudes of the evoked potentials (more than 1.5 times) and the normalization of the values of SPVe reduced before treatment in cases with combined damage nerves of limbs. In addition, there were positive changes in the parameters of peripheral blood circulation (estimated by rheovasography), normalization of muscle tone and temperature of the damaged limb.

 Thus, clinical trials have shown that the inventive method provides a higher therapeutic effect due to the synergistic effect of the modified electrical stimulation and vibration massage, which has a more active effect on metabolic processes and activates recovery processes in the injured nerve. This leads to the fact that in the long term (6 months or more), when exposure to other physiotherapeutic factors, including electrical stimulation with single pulses, no longer leads to the restoration of peripheral nerve conduction, the combined use of paired stimulating pulses and vibration massage allows restoration of peripheral conduction nerves. The method is well tolerated by patients, its adverse reactions have not been identified, contraindications are common for physiotherapy.

 Sources of information.

 1. A.Ya. Cramer Guide to hardware massage. Tomsk, 1994. P.240.

 2. A. V. Zavyalov, V. B. Laskov. The technique and neurophysiological substantiation of combined multichannel electroneuromyography with peripheral paresis and paralysis. Questions of balneology and physiotherapy. 1984, N 3. S.11-16.

 3. A.S. N 1569013 (USSR), MKI A 61 H 23/00. A method for the treatment of injuries of nerve trunks of limbs / A. Ya. Kreimer, L.P. Strelis, E.V. Mikhailova. Publ. 06/07/90, Bull. N 21.

Claims (2)

 1. A method of restoring peripheral nerve conduction in the long term after an injury by exposure to a massager with a discrete increase in frequencies in one procedure of 9 11, 29 31 and 74 76 Hz with an exposure of each frequency of 2 4 min along the injured nerve, 1 2 min to the collar zone and 3 5 min on the lumbosacral zone, characterized in that they produce electrostimulation by paired pulses of rectangular current for 15 20 min sequentially on the distal and proximal points of the peripheral and central segments t avmirovannyh nerves and motor points of muscles innervated with discrete frequency increases for each region of 1 to 15 Hz and an exposure at each frequency of 5 10 seconds, and then at 5 for 10 minutes to conduct said vibratory, a course of 18 daily 20 treatments.  2. The method according to p. 1, characterized in that in the morning 4-6 hours before electrical stimulation exercise physiotherapy is carried out.

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