RU2336857C1 - Method for rehabilitation treatment of immobilised patient - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: influence on locomotor apparatus is implemented by way of segmental positioning with the help of a surgical bed, that is capable of preserving a segment position for the set time and turning back to initial position. Manipulation is conducted in cycles as folows: rise of back at 60 degrees for 50 seconds and retention up to the end of the cycle, coxofemoral and knee joints bending at 45 degrees for 50 seconds, dorsal bending of footsteps at 20 degrees for 15 seconds, extention of the knee joint at 45 degrees for 50 seconds - straight leg is raised at 45 degrees, extention of the footsteps to initial position for 90 seconds, the knee joint bending at 45 degrees for 90 seconds, extention of the coxofemoral and the knee joints and turning back to initial position for 90 seconds, returning the trunk to initial position for 120 seconds, turning to the right side at 20 degrees for 60 seconds, returning to initial position for 90 seconds, turning to the left side at 20 degrees for 60 seconds and returning to initial position for 90 seconds. The manipulation is implemented round-the-clock up to beginning of motor performance.

EFFECT: reduction of treatment time and simplification of personnel's work at patient's treatment.

2 cl, 1 tbl

Description

The invention relates to medicine, namely to neurosurgery, neurology and traumatology, and can be used for the rehabilitation of patients with damage to the central nervous system and musculoskeletal system.

The restoration of motor activity is of fundamental importance for the treatment of immobilized patients. Known methods of restoring motor activity of a person using massage or physiotherapy exercises, which the patient performs independently, with the help of medical personnel or using various types of devices for motor rehabilitation and training (see, for example, RU 2283677, IPC А63В 23/00, publ. September 20, 2006. RU 2155571, IPC А61Н 1/00, publ. 10.12.2000. RU 2142737 C1, IPC 6 А61В 5/16, publ. 20.12.1999). Known methods in the implementation of the impact on the musculoskeletal system of the patient with hands require large physical costs of medical personnel, and in the methods using simulators, the effects are carried out on individual segments for a limited time.

Closest to the claimed one is the method (RU 2290242 C1, IPC А63В 23/04, published on December 27, 2006), according to which the spinal locomotor generator is stimulated with vigorous rhythmic movements of the hands with lightened legs. Optimal for calling locomotor movements is the patient's horizontal position on his back or side with his legs bent half-bent on the Balkan frames or vertical on a parachute suspension. In this case, the patient causes activation of the spinal locomotor generator by himself with vigorous alternate arm movements that imitate arm movements while running. The method allows to develop the skill of spinal automatic walking in paralyzed patients for the subsequent restoration of motor functions of the lower extremities.

The disadvantage of the prototype method is the impact on only one segment of the musculoskeletal system - the patient’s hands for a limited time, which does not provide quick rehabilitation.

The problem to which this invention is directed is to create a method that provides rehabilitation treatment of an immobilized patient through targeted continuous round-the-clock exposure to his musculoskeletal system.

The technical result achieved by using the present invention is to facilitate the work of personnel to treat the patient and reduce the time to normalize his motor functions.

The problem is achieved with the achievement of the aforementioned technical result is achieved by the fact that in the method of rehabilitation treatment of an immobilized patient, based on the impact on his musculoskeletal system, the effect is carried out by segmental positioning of the back and / or thighs, and / or legs, and / or feet, and / or torso in a predetermined sequence, time intervals and force using a functional bed, made with the possibility of lifting to a given angle of the selected segment of the bed, saving this position for a given time and the segment returns to its original position after a specified time interval.

The technical result is also achieved by the fact that the effect is carried out in cycles in the following sequence: raising the back at an angle of 60 degrees in 50 seconds with holding it until the end of the entire cycle time, bending the hip and knee joints at an angle of 45 degrees in 50 seconds, back bending of the feet by 20 degrees in 15 seconds, extension of the knee joint by 45 degrees (straight leg raised upward by 45 degrees) in 50 seconds, extension of the feet to their original position in 90 seconds, flexion of the knee by 45 degrees in 90 seconds, extension hip and knee joint and limbs returning to their original position in 90 seconds, torso returning to their original position in 120 seconds, turning to the right side by 20 degrees in 60 seconds, returning to their original position in 90 seconds, turning to their left side by 20 degrees in 60 seconds, returning to its original position in 90 seconds.

The exposure is carried out around the clock until the appearance of motor activity.

The claimed method implements the main tasks of rehabilitation: creating the most favorable conditions for the course of regenerative processes in the spinal cord; prevention and treatment of pressure sores and contractures, deformations of the osteoarticular apparatus, relief of pain, restoration of the function of the pelvic organs, stabilization of the labile respiratory and cardiovascular systems, prevention of muscle atrophy. The method is aimed at constant exposure to peripheral receptors and segmental apparatus of the brain. This is achieved by periodically creating irritation of the efferent and afferent paths that close the reflex arc, including the operation of the segmental-reflex apparatus of the brain after the same period of time, with the same strength, in the same sequence around the clock. At the same time, more comfortable conditions for recovery in the affected area are created due to improved cerebrospinal circulation in this area due to a change in the position of the body and segments of the patient. With a combination of reversible and irreversible functional changes, restoration is based on both restitution mechanisms and compensation for lost functions, therefore, along with the tasks of active afferentation and stimulation of the motor centers, the tasks of restructuring the motor innervation programs of muscle groups involved in the formation of replacement movements are included. The method ensures the preservation of the musculoskeletal system in a functional state, stimulation of the segmental apparatus of the spinal cord, the development of new associative connections in damaged areas of the brain.

Facilitation of the staff’s labor during the treatment of the patient is achieved due to the automatic impact on their musculoskeletal system without physical participation of the staff.

The reduction of treatment time is achieved by round-the-clock comprehensive multi-purpose segmental effects on the musculoskeletal system of the patient.

The method is carried out using a functional bed (RU 2231348, IPC 7 A61G 7/002, A61G 7/057, publ. 06/27/2004). The functional bed contains a base in the form of a frame on wheels with brakes, end backs and a bed in the form of movable sections with drives for raising and lowering them. The bed is equipped with a panel for the body, which is located between the frame and the bed. The bed is composed of a dorsal panel, a head panel, a femoral panel, a shin panel and a foot panel. Each panel is made in the form of drop-down wings with a pneumatic drive for raising and lowering them. The bed provides a program-controlled change in the position of the trunk, back, head, hips, legs and feet of the patient in a continuous round-the-clock mode of operation.

The patient lies on a bed, which starts in a predetermined mode, depending on the pathology and the task set by the attending physician for this patient. The patient’s musculoskeletal system is affected by segmental positioning of the back and / or thighs, and / or legs, and / or feet, and / or torso in a predetermined sequence, time intervals and strength of action, depending on the specific pathology.

We will consider the implementation of the method as an example of a spinal cord lesion with a precipitated C ₄ -C ₅ intervertebral disc at the cervical level in the form of tetraplegia and impairment of all types of sensitivity according to the conductor type. After the surgery, the patient could not independently make a single movement in the limbs. The best therapeutic effect was achieved when the cycles were performed in the following sequence: raising the back at an angle of 60 degrees in 50 seconds and holding it until the end of the entire cycle, bending the hip and knee joints at an angle of 45 degrees in 50 seconds, back bending of the feet by 20 degrees in 15 seconds, extension of the knee joint by 45 degrees (straight leg raised upwards by 45 degrees) in 50 seconds, extension of the feet to their original position in 90 seconds, flexion of the knee by 45 degrees in 90 seconds, pa bending the hip joint and knee joint and returning the limbs to their original position in 90 seconds, returning the body to their original position in 120 seconds, turning to the right side by 20 degrees in 60 seconds, returning to their original position in 90 seconds, turning to their left side by 20 degrees in 60 seconds and return to starting position in 90 seconds. The cycle is completed. The continuous repetition of this cycle for 75 days against the background of drug therapy allowed the patient to restore self-urination, get on his feet, serve himself 70%.

The method can be used to treat patients with hip fracture who have contraindications for surgical treatment, after acute cerebrovascular accident (stroke) and other immobilized patients.

The table shows examples of rehabilitation treatment of patients with various spinal cord injuries or pathologies by the present method, confirming its practical applicability. The treatment was carried out on the basis of the neurosurgical department of the 1st Naval Clinical Hospital in St. Petersburg. For each type of lesion or pathology, cycles with different parameters were selected and used depending on the type of pathology and the objectives for treatment. Treatment of patients ended with positive results with a reduction in the duration of treatment by 30-40%.

Thus, the use of the present invention eliminates the physical labor of personnel in the treatment of the patient and reduces the time to achieve a positive therapeutic effect. The technique of exposure is painless, non-traumatic, has a comprehensive multi-purpose effect on the human body.

Table The results of rehabilitation treatment of patients with impaired motor function Name of pathology The number of days of treatment The number of exposure cycles Continuous work time (hour) Result Vertebral spinal injury with spinal cord injury 240 34560 5760 + Head injury 27 1440 240 + Osteochondrosis of the lumbosacral spine with pain 10 1440 240 + Condition after removal of a spinal cord tumor eleven 1584 264 + Condition after ONMK 10 1440 240 + Closed femoral neck fracture 7 1008 168 + Condition after surgery: posterior fusion of L4-S1 vertebrae 31 4464 744 +

Claims (2)

1. The method of rehabilitation treatment of an immobilized patient, including the impact on his musculoskeletal system by segmental positioning of the back, and / or thighs, or legs, and / or feet, and / or body in a predetermined sequence, time intervals and force of exposure using functional bed, made with the possibility of maintaining the position of the segment for a given time and returning it to its original position after a predetermined time interval, characterized in that the bed is made with the possibility of lifting this angle of the selected segment of the bed, and the effect is carried out in cycles in the following sequence: raising the back at an angle of 60 ° for 50 s with holding it until the end of the entire cycle time, bending the hip and knee joints at an angle of 45 ° for 50 s, rear bending of the feet by 20 ° in 15 s, extension of the knee joint by 45 ° in 50 s - the straight leg is raised upward by 45 °, extension of the feet to the initial position in 90 s, flexion of the knee by 45 ° in 90 s, extension of the hip joint and knee joint and limb return in ref one position in 90 s, returning the body to its original position in 120 s, turning on its right side by 20 ° in 60 s, returning to its original position in 90 s, turning on its left side by 20 ° in 60 s and returning to its original position 90 sec 2. The method according to claim 1, characterized in that the effect is carried out around the clock until the appearance of motor activity.