RU2550049C2 - Method for systemic rehabilitation of patients suffering from forearm and hand plegia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, systemic rehabilitation of the patients suffering from forearm and hand plegia. Successive discrete bracing of upper extremities is performed. What is used is a night-time brace made of an ergonomic, low-temperature thermoplastic material (HTTM) in the form of a forearm sleeve with the distal section at the level of nail phalanxes with the sleeve perforated along its full length and having a thumb opening and extension brace openings for the other fingers; there are also provided fastening elements to enable the spiral fixation of the night-time brace on the forearm and hand. A day-time HTTM brace is configured as a forearm sleeve perforated along its full length and having a thumb opening and the distal section at the level of heads of the metacarpals to release the fingers enabled to fulfil the hand function in the daytime with the fastening elements ensuring the straight or spiral fixation of the brace on the forearm. A dynamic HTTM brace is configured as a forearm sleeve having a thumb opening, perforated along the full length of the sleeve and provided with a distal section at the level of heads of the metacarpals with the distal section being detachably connected to a dynamic spring-loaded brace enabling functioning of extensor muscles of the fingers. Each finger has a loop connected to a spring rod with the dynamic spring-loaded brace; the fastening elements enable the straight or spiral fixation of the dynamic brace on the forearm. What is also used is a wrist joint fixation brace (WJFB) made of HTTM and configured as a sleeve perforated along its full length with electoneuromyostimulation electrodes mounted into the sleeve, for the simultaneous combined extension and fixation; the brace is also provided with the fastening elements ensuring the straight or spiral fixation of the WJFB. The fastening elements are presented by a zip fastener or a Velcro fastener providing the straight or spiral fixation of the brace sleeve junction.

EFFECT: method provides the complete elimination of flexion contracture in the wrist joint and fingers.

2 cl, 4 dwg, 1 tbl

Description

The invention relates to medicine, namely to traumatology, orthopedics and neurology, and allows for the rehabilitation of the full range of movements of all segments of the upper limb: forearm; the wrist joint and small joints of the hand, and also allows you to dose the effect of electroneuromyostimulation as a whole on the upper limb, and on its individual segments.

Known technical solutions for the rehabilitation of the upper limbs of patients, made in the form of tires, orthoses or devices for the rehabilitation of segments of the upper limb, such as the wrist or forearm (Copyright certificates No. 862938, No. 971315, No. 148202, No. 1621918, No. 16731107). A known method of rehabilitation of patients with central spastic paresis of the upper extremities through complex treatment, including pharmacotherapy, orthosis and physiotherapy, while physiotherapy (together with other procedures) includes electromyostimulation of extensors of the hand and fingers (RF Patent No. 2422167, IPC A61N 1/00, 2009 .). This method is used for the rehabilitation of the upper limb after a stroke.

Also known is a functional tire for the rehabilitation of patients with radial nerve damage, containing a forearm splint with straps mounted on a stand equipped with a circular mechanism with removable springs, hand grip, palm rest, rubber threads, stop for the first finger of the right and left hand located on the ends of the rubber threads of the cuff for 2-5 fingers, metal plates with grooves for the springs of the circular mechanism, as well as a support arc and a metal arc, the latter being fixed to supporting arc, and the metal arc has a base for attaching rubber threads and furrows for the passage of rubber threads. The considered technical solution allows for early rehabilitation of patients with damage to the radial nerve, taking into account the condition of the extensor muscles of the hand and fingers (RF Patent No. 2307626, IPC A61F 5/00, 2005 - prototype).

Common disadvantages of the known technical solutions are: the lack of continuous (round-the-clock) systemic rehabilitation of the upper limb, the duration of treatment, the complexity and volume of the devices.

The objective of the invention is to increase the effectiveness of treatment of both the upper limb as a whole, and its segments; reduction of treatment time by providing continuous systemic rehabilitation of the upper limb; maintaining patient mobility and self-care capabilities.

The technical result of the task is achieved by the fact that the method of systemic rehabilitation of patients with plegia in the forearm and hand includes: sequential, discrete orthosis of the upper limbs through the use of the following orthoses: night orthosis made of ergonomic, low-temperature thermoplastics, in the form of a sleeve on the forearm with distal a cut at the level of the nail phalanges with perforation along the entire length of the sleeve with a hole for the thumb and orthoses - “rectifiers” on other palms tzu; with fastening elements, providing the possibility of spiral fastening of the night orthosis on the forearm and hand; a day orthosis made of ergonomic, low-temperature thermoplastic, in the form of a sleeve on the forearm with perforations along the entire length of the sleeve with a hole for the thumb and with a distal cut at the level of the heads of the metacarpal bones, which provides the release of the fingers for the function of the hand in the daytime with fastening elements, providing the possibility of rectilinear or spiral-shaped fastening of the daytime orthosis on the forearm; a dynamic orthosis made of ergonomic, low-temperature thermoplastics, in the form of a sleeve on the forearm with an opening for the thumb with perforations along the entire length of the sleeve and with a distal section at the level of the heads of the metacarpal bones, detachably connected to a dynamic spring orthosis that provides the muscles of the extensors of the fingers, each finger of the hand is equipped with a loop connected to the spring rod with a dynamic spring orthosis; with fastening elements providing the possibility of rectilinear or spiral-shaped fastening of the dynamic orthosis on the forearm; an orthosis is a wrist joint retainer made of ergonomic, low-temperature thermoplastics, in the form of a sleeve with perforations along the entire length of the sleeve with electrodes of the device for electroneuromyostimulation mounted in the sleeve, providing the possibility of simultaneous joint straightening and fixing effects, and equipped with straight-line mounting elements providing fixing the orthosis - fixative of the wrist joint. As fasteners, a zipper lock or Velcro tape fastener can be used.

In fig. 1 presents a night orthosis, where: pos. 1 - sleeve on the forearm with a hole for the thumb and a distal section at the level of the tips of the nail phalanges; pos. 2 - perforation; pos. 3 - lock "lightning" - a fastening element - located in a spiral sleeve 1 orthosis; pos. 4 - orthoses (shells) “rectifiers” on the fingers.

In fig. 2 presents a daily orthosis, where: pos. 1 - sleeve with a hole for the thumb and a distal section at the level of the heads of the metacarpal bones; pos. 2 - perforation; pos. 3 - lock "lightning" - a fastener located in a spiral sleeve 1 of the orthosis.

In fig. Figure 3 shows a dynamic orthosis made of an ergonomic, low-temperature thermoplastic, in the form of a sleeve 1 on the forearm with a hole for the thumb with perforations 2 along the entire length of the sleeve 1 and with a distal cut at the level of the heads of the metacarpal bones, detachably connected to a dynamic spring orthosis 5, which provides the work of the muscles of the extensors of the fingers of the hand, while each finger of the hand is equipped with a loop connected by a spring rod with a dynamic spring orthosis; with fasteners 3, providing the possibility of a rectilinear or spiral-shaped fastening of a dynamic orthosis on the forearm.

In fig. Figure 4 shows an orthosis - a wrist joint retainer made of ergonomic, low-temperature thermoplastics, in the form of a sleeve 1 with perforations 2 along the entire length of the sleeve 1 with electrodes 6 mounted in the sleeve 6 for electroneuromyostimulation, which provide the possibility of simultaneous joint rectifying and fixing elements, and providing fastenings 3, providing the possibility of rectilinear or spiral-shaped fastening of an orthosis - wrist joint fixator.

Table 1 presents a graph of the use of the method of systemic rehabilitation of patients with plegia in the forearm and hand.

The method of systemic rehabilitation of patients with plegia in the forearm and hand is as follows

Upon admission and examination of the patient, a diagnosis of plegia of the forearm and hand is established, for example, accompanied by spasticity. The patient is prescribed complex treatment: pharmacotherapy, physiotherapy, for example physiotherapy, massage. To increase the effectiveness of treatment and reduce the time of hospitalization, an orthosis support is used, which is a kind of "hospital on the arm." For each patient, an individual set of orthoses is made directly on the patient segment. For this, the workpiece is heated to obtain the necessary plasticity, applied to the forearm and hand and is formed with high accuracy directly on the patient's body. The fastening elements 3 are the “lightning” lock or the Velcro fastener tape can be fixed on the orthosis blanks in advance or in the manufacturing process.

Clinical example. A 15-year-old patient with plegia of the forearm and hand, accompanied by spasticity after a brain injury, in whom a rehabilitation scheme has been prescribed. A feature of this method of systemic rehabilitation of patients with plegia in the forearm and hand is the possibility of rehabilitation in a place convenient for the patient (at home, on vacation, in a sanatorium, in a clinic and other conditions).

Together with pharmacotherapy with botulinum toxins, a systemic rehabilitation of the orthosis support “hospital on the arm” was used.

In the position of flexion of the wrist joint on the fingers of the spastic hand, orthoses 4 (sheaths) “rectifiers” are put on the fingers.

The straightened fingers are placed in the distal part of the sleeve 1 of the night orthosis, the spiral location of the junction of which allows the brush and fingers to be held in a practically circularly enclosed space of the distal part of the sleeve. Then the wrist joint extends with the fingers and hand straightened fixed by the distal part of the night orthosis. At the moment the fingers and forearm are located on the same axis, the proximal part of the sleeve of the orthosis is put on the forearm. Then the lock is fastened ("lightning" or Velcro tape fasteners) located in a spiral. Since the sleeve 1 of the night orthosis is made with perforations 2, the upper limb of the patient feels quite comfortable. All night the orthosis provides a predetermined position of the patient's upper limb.

The sleeve of a 1-day orthosis is also worn in two steps starting from the level of the heads of the metacarpal bones, and finger straighteners may not be used. In this way, the fingers remain free for daytime function and rehabilitation. The patient can self-care and attend botulinum therapy or physiotherapy. Night and day orthoses are used continuously throughout, for example, a year.

For the successful use of a dynamic orthosis with a spring orthosis 5, the "hospital on the arm" system is immediately supplemented with physiotherapy and massage immediately before use. Then the fingers of the hand are fixed in loops to the arches of the spring orthosis 5, while the fingers are unbent by the springs, and bent by the patient himself. To train your fingers is recommended 3-5 times a day for 30 minutes. Thus, the function of the muscles of the extensors of the hand is replenished, and the space under the palmar surface remains free, for example, to work on a computer keyboard.

Next, you should use an orthosis - a wrist joint retainer with electrodes mounted in the sleeve 1 6 of the device 7 of the electroneuromyostimulator. An orthosis - a wrist joint fixator serves as a stencil of the fixation points of electrodes 6 on the patient's forearm in the projection of the trunks of peripheral nerves or muscles in need of rehabilitation.

The result of systemic rehabilitation during the year of the patient in the above example was an improvement in the function of the hand, improved self-care.

The positive effect of the claimed invention is to increase the effectiveness of treatment of both the upper limb as a whole, and its segments; reduction of treatment time by providing systemic rehabilitation of the upper limb; maintaining patient mobility and self-care capabilities. The inventive method of systemic rehabilitation of patients "hospital on the arm" with plegia in the forearm and hand eliminates flexion contracture in the wrist joint and fingers completely.

Claims (2)

1. A method of systemic rehabilitation of patients with plegia in the forearm and hand, including: sequential, discrete orthosis of the upper extremities by using the following orthosis designs: night orthosis made of ergonomic, low-temperature thermoplastics, in the form of a sleeve on the forearm with a distal section at the level of the nail phalanges with perforation along the entire length of the sleeve with an opening for the thumb and orthoses - “rectifiers” on the other fingers, with fastening elements providing the possibility of joint ralevidnogo fixing Night orthosis on forearm and hand; a day orthosis made of ergonomic, low-temperature thermoplastic, in the form of a sleeve on the forearm with perforations along the entire length of the sleeve with a hole for the thumb and with a distal cut at the level of the heads of the metacarpal bones, which provides the release of the fingers for the function of the hand in the daytime with fastening elements, providing the possibility of rectilinear or spiral-shaped fastening of the daytime orthosis on the forearm; a dynamic orthosis made of ergonomic, low-temperature thermoplastics, in the form of a sleeve on the forearm with an opening for the thumb with perforations along the entire length of the sleeve and with a distal section at the level of the heads of the metacarpal bones, detachably connected to a dynamic spring orthosis that provides the muscles of the extensors of the fingers, each finger of the hand is equipped with a loop connected to the spring rod with a dynamic spring orthosis; with fastening elements providing the possibility of rectilinear or spiral-shaped fastening of the dynamic orthosis on the forearm; an orthosis is a wrist joint retainer made of ergonomic, low-temperature thermoplastic, in the form of a sleeve with perforations along the entire length of the sleeve with electro-neuromyostimulation electrodes mounted in the sleeve, providing the possibility of simultaneous joint straightening and fixing effects, and equipped with straight fastening elements that provide the possibility of fastening an orthosis - a fixative of a wrist joint. 2. The method according to p. 1, characterized in that the fasteners used are a “lightning” lock or Velcro fastener, which fixes the joint of the sleeve of the orthosis in a straight line or in a spiral.

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