RU2098149C1 - Method for treating diseases and consequences of locomotor system damages - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves carrying out electrostimulation of muscles in walking. Pairs of electrodes having one electrode active and the second one being indifferent, are applied to main and additional muscle groups. Treatment duration is equal to 20 min at the beginning and starts growing to 60 min beginning from the fifth-sixth treatment. Current voltage amplitude concurrently grows from 30 to 60 V, pulse duration periods being 20-200 mcs and frequency 30-80 Hz. Stimulating current is supplied to muscles at natural excitation and contraction phases, electrode size is to correspond to diameter of muscle or muscle group under stimulation and electrode is positioned in perpendicular to muscle fibers direction. EFFECT: wide range of functional applications. 13 cl

Description

 The invention relates to medicine, namely to traumatology, orthopedics and rehabilitation of patients after injuries and lesions of the musculoskeletal system of various origins.

 There is a method of artificial correction of movements through electrical stimulation of muscles, as a method of restructuring walking stimulation, which uses the amplitude program of the impact of electrical impulses on certain muscles ("Prosthetics and prosthetics." Sat Proceedings, issue 77, M. TsNIIPP, 1987, p.65 -75).

 The aim of the invention is to expand the scope of nosologies to be treated, improve the functional state of muscles, as well as increase the effectiveness of treatment and support ability of the extremities, the rapid development of a stereotype of walking close to normal.

 This goal is achieved by the fact that in the method of treating diseases and consequences of injuries of the musculoskeletal system, which consists in electrical stimulation of the muscles, electrical stimulation is performed while walking, pairs of electrodes: active and indifferent, are applied to the main and additional muscle groups, the session starts from 20 min, and 5-6 sessions, its duration is brought to 60 minutes, with increasing voltage amplitude from 30 to 60 V, the pulse duration is 20-200 μs and their frequency is 30-60 Hz, a stimulating current is supplied to the muscles in the phases of natural excitation and muscle growth, the size of the electrodes corresponds to the diameter of the stimulated muscle or muscle group, and the electrode is placed perpendicular to the course of muscle fibers, and with residual effects after poliomyelitis, the consequences of a compression fracture of the spine and damage to the spinal cord, acute cerebrovascular accident accompanied by paresis of the lower extremities, pairs of electrodes are placed on the main muscle group: large and medium gluteal, biceps and semi-tendon, and an additional muscle group: calf and b tibial, with the consequences of cerebral palsy, electrodes are applied to the main muscle group: the gluteus maximus, calf and quadriceps, and the additional muscle group: tibia and sacral, with injuries: in post-traumatic flexion-extensor contracture of the knee joint, false joint of the leg bones, electrodes to the main muscle group: the quadriceps, gastrocnemius, soleus, and the large and middle gluteus, and the extra muscle: tibial, with closed fracture IU leg bones electrodes are placed on the main group of muscles: the gastrocnemius, quadriceps and biceps femoris, and more muscle - the gluteus maximus; with deforming arthrosis of the knee joint, electrodes are applied to the main muscle group: the quadriceps and biceps femoris, semitendinosus and additional gastrocnemius; with the consequences of an Achilles tendon rupture, electrodes are placed on the main muscle group: the calf and biceps femoris and the extra gluteus maximus muscle, with the consequences of a compression fracture of the vertebral body, electrodes are placed on the sacro-spinous and gluteal muscles on both sides; with a traumatic dislocation of the shoulder and shoulder-scapular periarthritis, the electrodes are applied to the main muscle group: the deltoid and triceps muscles of the shoulder, as well as the trapezoid and rhomboid muscles, with osteochondrosis of the lumbosacral and thoracic spine, electrodes are applied to the sacrospinal muscles on both sides of the spine; during hip replacement, electrodes are applied to the main muscle: gluteus maximus and secondary gluteus maximus; when prosthetics of the lower leg, electrodes are placed on the main muscle group: a truncated calf muscle; the quadriceps femoris, gluteus maximus muscle, with kyphoscoliosis, the electrodes are located on the rhomboid and sacral-spinous muscles on both sides of the spine.

 The main features of the proposed method is: conducting electrical stimulation of muscles in walking, which functionally helps to restore muscle, contributes to the rapid development of a stereotype of walking close to normal, the duration of the session is gradually increased from 20 to 60 minutes, because conducting a session over 60 minutes is difficult for the patient. The increase in the amplitude of the voltage from 30 to 60 V, the pulse duration of 20-200 μs and the frequency of 30-80 Hz were determined experimentally and correspond to the physiological properties of the muscles in walking. It is very important to apply current to the muscles in the phase of natural arousal and muscle contraction, as only in this case, the stimulating current acts as if in resonance with the movements of the patient. This is achieved by using a synchronization sensor of an angular knee angle sensor located in the area of the knee joint, or an angular hip sensor located in the area of the hip joint. Correspondence of the electrode size to the diameter of the stimulated muscle and its placement perpendicular to the course of muscle fibers is necessary for the most effective stimulating effect on the muscle.

 Clinical example 1. Patient K., age 49 years. Diagnosis: residual after polio. Flaccid paresis of the muscles of the lower extremities.

 Ill at the age of 9 months. After suffering polio, a flaccid paresis of the muscles of the lower extremities developed. Repeatedly treated for this disease. It uses an orthopedic locking device on the left lower limb.

Objective status: the patient moves independently in the castle orthopedic apparatus to the left leg with the help of an additional support on 2 crutches. Atrophy of the soft tissues of the lower extremities is noted, more pronounced on the left. The muscle strength of the right leg 2-4 points, (on average 2.65 points), the left leg 0-2 points (on average 1.4 points). The range of motion in the knee joint is 20 ^o , in TBS is 7 ^o .

 The patient conducted 25 sessions (everywhere ESM while walking) of artificial correction of movements by electrical stimulation of the muscles of both lower extremities. The following muscles were stimulated while walking: on the left, the major and middle gluteal muscles (the main muscle group), the extra muscle straining the broad fascia of the thigh, the semitendinosus muscle, the biceps femoris, quadriceps femoris, calf muscle; on the right, the main gluteus maximus and gluteus maximus, additional biceps femoris, quadriceps femoris.

 For all muscle groups, the active electrode was proximal, and the passive (indifferent) electrode was distal. The distance between the electrodes depended on the volume of the muscle group and ranged from 12 cm for the large and middle gluteal muscles to 3 cm for the calf muscle. The size of the electrodes for stimulation of each of the listed muscle groups also depended on muscle volume.

 To stimulate the muscles, unipolar rectangular electrical signals with an amplitude of 30-60 V, a duration of 20-120 μs and a repetition rate of 40-60 Hz were used, which were generated by an 8-channel stationary corrector of movements.

 The temporary ES program was set using the knee and hip synchronization sensors.

 During the first 5 sessions, the patient’s traveled distance was increased from 200 m to 1.5 km in order to gradually adapt paretic muscles to new conditions.

As a result of the course of ES muscles in walking, the functional state of the muscles of the lower extremities sharply improved: the strength of the muscles of the left leg increased 2.2 times (from 1.4 to 3.08 points), the range of movements in the left CS increases to 41 ^o , in the left TEC from 7 ^o to 15 ^o . The strength of the muscles of the right leg from 2.6 to 3.9 points (1.5 times), the support ability of the lower extremities significantly increased. As a result, the patient was able to abandon the lock in the knee joint of the orthopedic apparatus, switch to an additional support, by 1 cane.

 Thus, the result of a 25-day course of treatment exceeded the results of many years of rehabilitation treatment carried out by this patient in various orthopedic clinics.

Clinical example 2. Patient S. 37 years. Diagnosis: consequences of a compression fracture of the spine at the level of L _I. Condition after decompressive laminectomy. Lower flaccid deep paraparesis. Dysfunction of the pelvic organs.

 Injury in 1990. After 3 months after the injury, a laminectomy was performed, after which flaccid paraparesis of the muscles of the lower extremities developed. Reconstructive treatment in CITO clinics for 5 months without success.

At admission, the following was objectively noted: the patient cannot move independently, lies on a gurney. Marked atrophy of the muscles of the lower extremities is noted. Sensory impairment from level L ₂ . Urinary incontinence. Stool delay up to 5 days. The strength of the muscles of the lower extremities on both sides is 0-1.5 points (1.2 points on average). There are no active movements in the joints of the legs, passive in full.

 A course of ES muscles in walking (30 sessions). The following muscles were stimulated (right and left): large and middle gluteal muscles, the main muscle group; biceps and semi-tendon muscles, the main muscle group, quadriceps muscle, extra muscle, calf muscle, additional muscle, tibia muscle, and additional muscle, sacrospinous muscle, additional muscle.

 The principle of choosing the size of the electrodes and the distance between the active and indifferent electrodes for each muscle group did not differ from the previous clinical example 1. The parameters of the electric signal were as follows: amplitude 40-60 V; pulse duration 50-200 μs, repetition rate 30-60 Hz, depending on the stimulated muscle.

 The time program was set using knee angle synchronization sensors. Given the severity of motor disorders, the patient had 30 sessions of mouse ES in walking.

 During the first 5 sessions, the patient was trained in standing and basic walking skills on crutches and was able to move independently with the help of additional support on crutches up to 150 m.Then, for another 5 sessions, the walkable distance was increased to 2 km.

 As a result of the course of ES muscles in walking, the patient walks independently with the help of an additional support on a cane. In the Center’s archive there is a video recording of the walk of this patient before and after completion of the treatment course.

 The strength of the muscles of the lower extremities increased to 3-4 points (an average of 3.4 points).

 Clinical example 3. Patient S. 25 years. Diagnosis: consequences of acute cerebrovascular accident. Right hemiparesis.

 In 1990, during childbirth, the patient developed stroke, followed by complication in the form of right-sided hemiparesis, speech impairment. As a result of the rehabilitation treatment, it was possible to return the speech within 1.5 years, but the violation of walking was not eliminated.

Objectively: the patient moved independently with the help of additional support on the crutch. The gait is shaky, there is no activity of movement of the right upper limb, the range of active movements in the CS does not exceed 10 ^o C, in TBS 5 ^o , there are no active movements in the GSS (dragging the right leg), pronounced torso to the left.

 The strength of the muscles of the right leg is 1-3 points (an average of 1.75 points), the right arm an average of 1.8 points.

 The patient received a course of ES muscles during walking, consisting of 20 sessions. Conducted ES of the following muscle groups: main muscle groups: large and middle gluteal muscles on the right to increase the support ability of the paretic limb; semi-tendon and biceps muscles of the right thigh to increase the volume of extensor movements in TBS, increase the support ability of the paretic limb. Stimulation of these muscles was carried out in the phase of support. Additional muscle groups: the right tibial muscle for lifting the foot in the phase of transfer; the right gastrocnemius muscle to increase the range of motion in the COP in the phase of transfer, the rectus femoris muscle to increase the range of motion in the CS in the phase of transfer, sacrospinal muscles on both sides to reduce torso to the left; deltoid muscle on the right to lead the right arm behind. The selection of electrodes and their location did not fundamentally differ from the two previous clinical examples 1, 2.

 The selection of the parameters of the electric signal was carried out individually and amounted to the following values: amplitude 40-50 V, pulse duration 60 μs, repetition rate 50 Hz. The signal was synchronized with the phases of the step using the knee sensor on the left (unaffected limb). For the first 3 sessions, the distance traveled by the patient was increased from 500 to 2500 m. In subsequent sessions, she walked about 2.5 km per session (about 1 hour walk).

As a result of the course of treatment with ES muscles during walking, the following results were obtained: the patient walks independently with support on 1 cane, the active abduction of the right arm at the back was 20 ^o , the torso to the left sharply decreased, the range of movements in TBS increased to 17 ^o , in the CS to 38 ^o , there was an active back flexion in the right GSS in the portable phase. The strength of the muscles of the right leg increased from 1.7 points to 3.6 points, the right arm from 1.8 to 2.9 points. Walking speed increased 3.5 times.

 These results indicate the high efficiency of ES muscle in walking in this category of patients.

 Altogether, 12 patients were treated with ESM in walking with the consequence of stroke with similar or very similar results.

 Clinical example 4. Patient K., 20 years old. Diagnosis: cerebral palsy. Spastic paraparesis of the muscles of the lower extremities.

 Sick from 1.5 months of age, when violations of the musculoskeletal system were first detected.

 Repeatedly conducted courses of rehabilitation treatment in various medical institutions in Moscow without a visible effect.

Objectively: walks independently with the help of additional support on 2 crutches, there is a flexion installation in the CS and TBS on both sides, significant (up to 15-20 ^o ) body sway in the frontal plane, walks on toes due to the lack of active back flexion in the GSS. Active extension in TBS is limited to 165 ^o (normal 180 ^o ), in KS to 148 ^o (normal 180 ^o ).

 The patient underwent a 20-day course of ES of the following muscle groups: the main muscle groups of the gluteus maximus muscle in the first 2/3 phases of support to increase stability when walking, the quadriceps femoris muscle on both sides to increase the range of extensor movements in the CS and increase leg supportability in the first half phases of support; additional muscle groups of the tibial muscles on both sides; in order to increase the amount of back flexion in the ankle joint in the first half of the transfer phase; Sacro-spinous muscles on both sides to reduce the sway of the trunk in the frontal plane in the first half of the transfer phase.

 The parameters of the electric pulse were as follows: amplitude 30-50 V, pulse duration 40-100 μs, repetition rate 55 Hz. The synchronization of the electrical impulse during walking with the required step phase was carried out using two knee angle sensors.

 The patient underwent 20 sessions of ESM while walking, during each of which he walked 1800 m (during the first session this distance was 1000 m due to fatigue of the patient).

As a result of the course of treatment with ESM in walking, the following positive changes were noted: resistance to walking increased significantly, fatigue and spasticity of muscles of the lower extremities decreased, the volume of extensor movements in TBS increased to 175 ^o , in CS to 169 ^o , active back movements of the foot appeared in phase transfer, the patient begins a new step with support on the heel (as it should be normal). Swing of the body decreased by 8 ^o . In addition, an average of 1.5 times increased muscle strength of the limbs from 2.3 to 3.5 points.

 Thus, as a result of the use of ESM in walking in patients with cerebral palsy, it was possible in a short time to achieve such positive shifts that significantly exceed the results of the traditional rehabilitation treatment of such patients, which in most cases is multi-year.

 Clinical example 5. Patient M. 30 years. Diagnosis: post-traumatic flexor-extensor contracture of the right knee joint.

 A road injury, in 1990 received a fracture of both thighs and the right lower leg. In April 1990, the Ilizarov apparatus was placed on the right lower limb, in which the patient was more than 1.5 years old. As a result, contracture arose in the Constitutional Court.

Objectively: walks independently with the help of an additional support on a cane; there are no active movements in the CS when walking. In the supine position, the volume of active movements in the cop does not exceed 7 ^o . Forced installation of a limb in the COP at an angle of 160 ^o . With passive movements, the range of movements in the CS does not increase. The patient underwent surgical elimination of contracture in the CS due to lengthening of the tendon of the rectus muscle and dissection of numerous adhesions. 5 days after surgery, the patient started a course of ES mouse while walking. The stimulation mode was changed gradually over 10 sessions: the amplitude of the electric signal was increased from 30 to 60 V; duration from 20 to 200 μs, repetition rate of about 40 to 60 Hz: the traveled distance increased from 150 to 3500 m.

 Conducted ES of the following muscles: main muscle groups: the quadriceps muscle for extension in the CS in the support phase, the calf muscle for flexion in the CS in the transfer phase.

As a result of the ES course of these two muscles (20 sessions), the following results were obtained: the patient was able to walk without additional support, there were active movements in the CS while walking to 35 ^o . The volume of passive movements in the COP increased from 7 ^o to 50 ^o . Thus, in 30 days, the patient was able to return the lost function of movements in the CS.

 According to the literature, the rehabilitation treatment of such patients after such surgical interventions is from 3-4 to 10-12 months. This indicates the extremely high efficiency of ES muscles when walking in such patients.

 Clinical example 6. Patient U. 29 years. Diagnosis: false joint of the bones of the left leg in the middle third. Flexion contracture in the cop.

 From the anamnesis it is known that 1.5 years ago in a car accident, he received an open fracture of the bones of the left leg in the middle third. He was treated in a number of clinics in Moscow. The patient developed a false joint of the bones of the left lower leg in the middle third. Half a year ago, in the City Clinical Hospital N 59, the Ilizarov apparatus was superimposed with the aim of fusion of the false joint. However, no signs of consolidation were observed.

Objectively: the patient walks with support on crutches, does not rest on his left leg, there is an Ilizarov apparatus on the left lower leg of 4 knees and 4 pairs of cross-spokes. Shortening of the left leg due to the bones of the lower leg by 8 cm, pronounced atrophy of the muscles of the lower leg and thigh on the left is determined. On the R-gram: left lower leg there is a false joint of the lower leg bones with a bone defect. The flexion contracture in the left COP at an angle of 160 ^o .

 The patient underwent a course of ES of the muscles of the left extremity in walking, consisting of 32 sessions. The following muscle groups were subjected to ES: the main muscle groups: the large and middle gluteus muscles on the left to restore leg support; quadriceps femoris muscle to eliminate CS contracture; gastrocnemius and soleus muscles for influencing the pseudoarthrosis zone and enhancing the posterior push of the left grave an additional group of muscles of the tibial muscle on the left - to influence the zone of the pseudoarthrosis in order to activate the regenerative processes of the bone.

 The principle of the selection of electrodes is identical to that presented in clinical example 5. The electrodes on the patient’s body were fixed using special cuffs, and in the area of the pseudoarthrosis with an adhesive patch.

The stimulating signal parameters for this patient were as follows: amplitude 40-60 V, duration 60-100 μs, repetition rate 50 Hz. The stimulus signal was synchronized with the phases of the step using a knee sensor fixed in the CS region of the intact leg (i.e., to the right). In total, the patient underwent 32 sessions of ES in walking. During the first 5 sessions of ESM in walking, the traveled distance was increased from 500 to 2500 m. At the same time, compression and then distraction of bone fragments in the Ilizarov apparatus was performed at the speed of 1 mm per day in the first 2 weeks. The total duration of the patient’s stay in the clinic was 64 days. As a result of the course of ES muscles, while walking in the Ilizarov apparatus on the left shin, signs of bone regeneration and the formation of bone marrow appeared after 3 weeks. Upon completion of distraction in the apparatus and the ESM course, it was possible to achieve full compensation of the bone defect along the length and consolidation of bone fragments. The patient began to walk with support on 1 cane, loading the left leg. The flexion contracture extension was eliminated after a course of treatment was 180 ^o . After 1.5 months. after discharge to the outpatient, the Ilizarov apparatus was removed. A month later, the patient again began his work.

 Thus, as a result of the course of ES muscle in walking, this patient was completely cured in 4.5 months, whereas before that he had been unsuccessfully treated for more than 1.5 years. This indicates the extremely high efficiency of the proposed method of treatment in patients with non-healing fractures and false joints of long tubular bones.

 Clinical example 7. Patient I. 34 years. Diagnosis: closed fracture of the right lower leg bones in the lower third. Extensor contracture in the right cop. Road injury 1 month ago. He was treated in the clinic of the Institute. Sklifosovsky, where a plaster cast was applied.

Objectively: the right lower limb in a plaster cast from the foot to the inguinal fold. The patient walks on crutches, not leaning on his right leg. Active extension in the COP after removal of gypsum does not exceed 160 ^o . The patient was changed to a plaster cast for a functional one, i.e. from the foot to the knee. In a plaster cast on the back surface, 2 windows 4 x 6 cm in size were made for the subsequent application of electrodes to the calf muscle.

 The patient received an ESM course in walking, consisting of 30 sessions. The following main muscles were subjected to electrical stimulation: calf muscle to accelerate bone regeneration, improve blood circulation in the fracture zone in the middle third of the support phase; the rectus femoris muscle to increase the stability of the right leg and complete extension in the CS in the first 1/3 of the supporting phase; gluteus maximus muscle to restore support of the right leg in the first 2/3 of the supporting phase. The sizes of the electrodes for muscle stimulation were selected in accordance with the volume sizes of the latter. The distance between the active and indifferent electrodes for each muscle was chosen taking into account the possibility of obtaining the maximum painless muscle contraction using a special electron-optical technique. The electrodes were mounted with special cuffs. By measuring the moment of forces, depending on the parameters of the stimulating signal, the optimal values of the signal parameters were determined: amplitude 50-60 V, pulse duration 60-120 μs, repetition rate 50 Hz.

 The temporary program of ESM in walking was carried out using a knee angle sensor located in the region of the right knee joint.

 As a result of the ESM course in walking, the following results were obtained: already after the 10th session, the patient began to lean on his right leg, by the end of the ESM course the patient used additional support on 1 cane. Completely eliminated contracture in the COP. When conducting dynamographic studies, an almost complete restoration of the shape of the curve of the support reaction of the right leg is noted. On the R-grams of the bones of the right lower leg there are pronounced signs of consolidation. 1 month after the completion of the ESM course in walking, the patient was examined again: he walks without additional support. On the R-gram of the bones of the knees there is a complete consolidation of the fracture zone. The patient started to work. Thus, the use of ESM in walking has reduced the treatment time by about 1-1.5 months. (according to the literature, a complete fusion of such fractures occurs but earlier than 4-4.5 months), which indicates the extremely high efficiency of such treatment in patients with fresh diaphyseal fractures of long tubular bones.

 Clinical example 8. Patient F. 38 years. Diagnosis: closed fracture of both bones of the right lower leg in the middle third. Flexion contracture in the right hip joint. Complaints of pain in the fracture area, inability to step on the right leg.

 Medical history: personal injury when falling from a height of 1.5 m. He was taken to the trauma unit 81 of the City Clinical Hospital in Moscow, where the debris was repositioned and a gypsum dressing was applied. After 1 month after the injury was transferred to the clinic TsNIIPP.

 Objectively: walks independently with additional support on crutches, not leaning on the right leg. On examination, the right lower limb in a plaster cast.

On the R-gram of the right lower leg there is a fracture of the lower leg bones in sr / 3 with no signs of consolidation. Limit extension in TBS up to 170 ^o . The patient was given a functional gypsum dressing up to the knee joint with stirrups, 2 rectangular holes 4 x 6 cm in size were made along the back surface of the gypsum dressing in the calf muscle for subsequent electrical stimulation of this muscle while walking. The patient was given a four-channel ESM course in walking, consisting of 30 sessions. The following main muscles were stimulated: the calf muscle in the middle of the transfer phase in order to influence the fracture zone, accelerate osteoreparative processes, improve blood circulation, increase muscle function, the quadriceps femoris muscle in order to improve muscle function, increase leg supportability in the first half of the support phase, biceps muscle hips in order to increase the support ability of the legs, improve the functional state of the muscles in the first half of the support phase. The gluteus maximus muscle was additionally stimulated to increase the amount of extensor movements in the hip joint in the first half of the support phase.

 To conduct ESM sessions while walking, 2 electrodes (active and indifferent) were applied to each of the above muscles, which were attached to the patient's body using special cuffs.

 Using a series of special studies, the optimal parameters of the electric signal were determined: amplitude 30-60 V, pulse duration 80-120 μs, repetition rate 60 Hz. The synchronization of the electric pulse supply with the phases of the step was carried out using knee angle sensors mounted in the area of both knee joints.

 As a result of the ESM course in walking, the following results were obtained: the patient began to walk with additional support on 1 cane. On the R-grams of the right lower leg after the ESM course in walking, there are all signs of consolidation. At the control examination after 1 month. after the course of treatment, the patient walks without additional support, the fracture is fully consolidated.

 Clinical example 9. Patient C. 49 years. Diagnosis: deforming arthrosis of the right knee joint of the II degree, deforming arthrosis of the left knee joint of the I degree. Complaints about the restriction of movements in the knee joints, more on the right, pain when walking, difficulty moving, especially when descending stairs.

 From the anamnesis: considers himself ill for 3 years, when the above complaints first appeared. Over the past year, the patient notes a significant deterioration. During the year 2 times passed a course of conservative treatment without effect.

Objectively: the patient walks on her own with the help of an additional support on a cane, moderate swelling of soft tissues in the region of both knee joints, palpation of the knee joints is painful. Active movements in the knee joints are limited: on the right, flexion is limited to 90 ^o , extension to 160 ^o , left flexion to 100 ^o , extension to 170 ^o . Passive movements in the joints in full, however sharply painful.

 In the clinic of TsNIIPP, the patient underwent a course of electrical stimulation of the muscles of the lower extremities during walking, consisting of 25 sessions. The following main muscles were stimulated: the quadriceps muscle on both sides in order to improve blood circulation and metabolic processes, increase extension in the CS at the end of the transfer phase and the first 1/4 phase of the support, semi-tendon and biceps femoris (their distal portion) to improve blood circulation in the region KS, an increase in the bending angle in the KS in the first 1/2 phase of the transfer. An additional (corrective) effect was applied to the gastrocnemius muscle on both sides to enhance the posterior shock in the middle third of the support phase.

 The distance between each pair of electrodes active (+) and indifferent (-) was determined by the volume of the stimulated muscle and the maximum painless contraction of the latter.

A series of special studies established the optimal parameters of the stimulating signal: amplitude 40 V, pulse duration 60-100 μs, repetition rate 50-60 Hz. The synchronization of the electric pulse supply with the phases of the step was carried out using sensors installed in the area of both column joints. During the first 5 sessions, the traveled distance was increased from 500 to 2000 m. In subsequent ESM sessions, the patient passed 2000 m for each session. As a result of the course of treatment according to the proposed methodology, the patient began to move independently without additional support, the pain syndrome was eliminated, difficulties in walking practically disappeared. An objective examination shows a significant increase in range of motion in the knee joints. On the right, the bending increased to 115 ^o , extension to 170 ^o C, on the left, bending to 120 ^o , extension to 180 ^o . Passive movements in full, painless.

 The patient was again examined after 3 and 6 months. objective status unchanged. Thus, the use of ESM in walking in such patients allows you to get a quick effect from treatment, to create a long-term remission, which indicates a significantly white high efficiency of the proposed treatment methods than all existing ones.

 Clinical example 19. Patient K., 20 years old. Diagnosis: chronic Achilles tendon rupture on the left. Condition after achilloplasty. Extensor contracture of the left knee joint. Complaints about the absence of plantar flexion, the inability to walk without additional support, the absence of a jerk function of the left leg.

 Anamnesis: injury about 2 years ago during sports. She was treated in CITO, was operated twice, and repeated rehabilitation was carried out without a satisfactory effect.

Objectively: upon examination, marked atrophy of the calf muscle is noted, the patient moves independently with additional support on 1 crutch, support on the left leg only on the toe. Plantar flexion is absent completely. There is a limitation of flexion in the left knee joint to 70 ^o .

 On October 12, 2011, an autoplasty of the Achilles tendon was performed. After 10 days, the sutures were removed, the healing of the postoperative wound by primary intention. 2 weeks after removal of the sutures, the patient took a three-channel ESM course in walking, which amounted to 20 sessions. The following muscles were stimulated: the main gastrocnemius muscle in the middle third of the support phase to restore plantar flexion to strengthen the posterior shock, to reduce atrophy of this muscle; biceps femoris muscle in the first half of the transfer form to increase the amount of flexion in the knee joint, additional stimulation acted on the gluteus maximus muscle to restore the left leg support ability in general.

 Electrodes were applied to each of the listed muscles: active (+) and indifferent (-), the distance between the electrodes depended on the size of the stimulated muscle. Using the special technique, the most effective parameters of the stimulating signal were determined: amplitude 60 V, pulse duration 100-120 μs, repetition rate 60 Hz.

 A signal was fed to the stimulated muscles in the necessary phases of the step using a synchronization sensor installed in the region of the left knee joint.

 During the first five sessions, the traveled distance was increased from 150 m to 2 km.

After a course of electrical stimulation of muscles during walking, the following results were obtained: the patient began to walk without additional support, i.e. fully supported and jerk function of the leg. Atrophy of the gastrocnemius muscle on the left sharply decreased, the difference in the perimeter of the right and left lower legs in symmetrical areas did not exceed 1 cm (up to a course of 4 cm). Plantar flexion was almost completely restored. Flexion in the left knee joint increased to 135 ^o . Therefore, the use of ESM in walking in such patients allows at least 2–2.5 times reduction in the duration of rehabilitation treatment (according to the literature, the working capacity of patients with chronic Achilles tendon rupture after surgical treatment is restored after 2.5-3.5 months.) , dramatically improve its results, which indicates an extremely high degree of effectiveness of such treatment in this category of patients.

Clinical example 11. Patient K., 35 years old. Diagnosis: compression fracture of the body of L ₁ vertebra. Injury industrial fall from a height of 3 m one month ago. He was treated in the clinic of the Institute. Sklifosovsky. Transferred for treatment and prosthetics to the clinic TsNIIPP.

 Objectively: the patient was delivered on a stretcher. On examination, atrophy of the muscles of the back is noted. Sharp pain in the lumbar region during palpation and percussion. Body movements in bed are painful. Active movements in the lower extremities saved. On the 5th day, the patient was made a fixation-unloading corset made of thermoplastic, on the 5th day it was allowed to walk in a corset with additional support on crutches. An ESM course in walking has begun. In total, 30 ESM sessions were performed. During the first 5 sessions, the load was dosed increased from 200 to 1,500 m. All subsequent sessions the patient walked 2,000 m.

 The following muscles were stimulated: the main effect was directed to the sacro-ostisi muscles and gluteal muscles on both sides. Sacrospinous muscles were stimulated to create a muscle corset, improve blood circulation in the lumbar spine, and accelerate regenerative-proliferative processes in the damaged vertebral body in the first half of the transfer phase. Gluteal muscle ES was performed to restore the correct stereotype of movements in the first 2/3 of the supporting phase. The sizes of the electrodes for muscle stimulation corresponded to the sizes of the latter. The electrodes were mounted using special elastic cuffs.

 The distance between the electrodes was selected similarly to the previous clinical example 10.

 Using special studies, the optimal parameters of the stimulating signal were selected: amplitude 60 V, duration 100-120 μs, pulse repetition rate 40-60 Hz. The stimulus signal was synchronized with the phases of the step by using knee angle sensors on both sides.

 After the course of ESM while walking, the following results were obtained: the patient began to move independently in a corset without additional support, the pain in the fracture area stopped, the functional state of the back muscles improved, which is confirmed by clinical and instrumental studies. Eliminated atrophy of the muscles of the lumbar region. On the R-gram of the lumbar spine there are signs of consolidation of the fracture. After 2 months after discharge, the patient began to carry out his main work, i.e. the total duration of treatment was 4 months.

 Thus, the use of ICD through ESM in this category can dramatically improve the results of rehabilitation treatment, accelerate the rehabilitation process. According to the literature, with uncomplicated vertebral fractures, disability is restored no earlier than 5-6 months.

 Clinical example 12. Patient O. 22 years. Diagnosis: condition after traumatic dislocation of the right shoulder. Flexion-extensor-abduction-adduction supination-pronational contracture of the shoulder joint.

 From the anamnesis it is known that 6 months ago, as a result of a fall on his right arm, the patient received a dislocation of his right shoulder. In the emergency room N 116 in Moscow, the dislocation was corrected, and a headscarf was applied. Then, outpatient rehabilitation was carried out for three weeks with no visible effect. Subsequently, rehabilitation treatment was carried out twice in a hospital setting (including the ESM course at rest), the range of movements increased slightly.

Objectively: a moderate atrophy of the triceps of the right shoulder, deltoid, trapezius and rhomboid muscles is noted during examination. The strength of the muscles of the shoulder and forearm is reduced compared to the left upper limb by 30-50. The range of motion in the shoulder joint is sharply limited: flexion 30 ^o , extension 17 ^o , leads 36 ^o internal rotation 30 ^o , external rotation 15 ^o . Movement in the joint is sharply painful.

 The patient was given an ESM course in walking, consisting of 15 sessions lasting 45 minutes each. The following muscles were electrostimulated: the main muscles were the deltoid muscle to restore extension, abduction and external rotation in the shoulder joint in the last 1/3 phase of the support and the first 1/3 phase of the triceps transfer of the shoulder muscle to restore extension in the shoulder joint in the same phase. Trapezius and rhomboid muscles to restore the rise of the scapula in the first 1/3 phase of the transfer.

 The size of the electrodes exactly corresponded to the sizes of the indicated muscles, the distance between the electrodes for each of the stimulated muscles was 4 cm for the deltoid muscle, 3 cm for the triceps muscle of the shoulder, 5.5 cm for the trapezius, rhomboid muscles. The parameters of the stimulating signal were selected individually taking into account the electromyography data and obtaining the maximum contraction of the stimulated muscle: the pulse amplitude was 40 V, the duration was 100-120 μs, and the pulse repetition rate was 60 Hz.

A temporary program of ES muscles during a locomotor act (walking) was carried out using a knee angle sensor located on the columnar joint from the side of the shoulder joint damage. As a result of the course of ES of the muscles of the right upper limb in walking, it was completely possible to eliminate the pain syndrome when moving in the shoulder joint. Muscle atrophy is completely eliminated. The strength of the muscles of the right shoulder and forearm increased by an average of 1.7 times and almost completely equaled the strength of similar muscles on the strained side. The range of motion in the joint was restored almost completely: extension 36 ^o , abduction 85 ^o , internal rotation 57 ^o , external rotation 35 ^o , flexion 64 ^o .

 Immediately after completing the course of treatment, the patient began to perform his main profession, while for 6 months. after an injury, the patient spent on the sick leave for more than 5 months. due to the inability to do their job.

 The patient is re-examined after 3 and 6 months. and in all respects recognized as completely healthy.

 Consequently, the ICD course through ESM in patients with the consequences of a traumatic dislocation of the shoulder can dramatically accelerate the rehabilitation of patients, completely restore movement in the damaged joint and muscle function, eliminate the atrophy of the latter and is an effective means of rehabilitation treatment in this category of patients.

 Clinical example 13. Patient U. 25 years. Diagnosis: consequences of traumatic dislocation of the left forearm. Flexion-extension contracture of the left elbow joint. Complaints: history of injury 7 months ago. In the emergency room, a dislocation was reduced, a plaster cast was applied. After 3 weeks, the development of joint movements was started. I took outpatient treatment courses three times without dynamics.

Objectively: moderate atrophy of the biceps and triceps muscles of the shoulder, active and passive movements in the left elbow joint are sharply limited, the total range of flexion-extension is 20 ^o .

 A 15-day walking ESM course was given to the patient. Two main muscles were stimulated: the biceps of the shoulder in the middle of the support phase to increase the amount of flexion in the joint, the triceps muscle at the end of the support phase and the beginning of the transfer phase to increase extension in the joint. The principle of selection of electrodes by size and the distance between two pairs of electrodes for each stimulated muscle was similar to the previous clinical examples.

The parameters of the stimulating signal were also selected in a special way: amplitude 40 V, pulse duration 40-60 μs, frequency 50 Hz. The stimulus signal was synchronized with the phases of the step using a sensor, a knee angle installed in the region of the left foot CS. For each session, the patient walked 2.5 km. The treatment results are as follows: shoulder muscle atrophy was completely eliminated (the perimeter of the shoulder sections on both sides after the course was 32 cm, before the course on the right shoulder 32 cm, on the left shoulder 27 cm), the range of movements in the elbow joint was almost completely restored after the course of the ESM in walking he was 110 ^o . Consequently, as a result of the 15-day course of treatment of ESM in walking, it was possible to fully restore the function of the shoulder muscles, the range of motion in the elbow joint, which confirms the high efficiency of the proposed method, which significantly exceeds all existing methods of rehabilitation treatment of such patients.

 Clinical example 14. Patient P. 36 years. Diagnosis: left-sided shoulder-scapular periarthritis. Complaints of constant pain in the shoulder joint, aggravated by abduction and extension of the shoulder, raising the shoulder blade, limiting movement in the joint.

 From the anamnesis of diseases, it is known that the patient suffers from this disease for about 8 years, when the pain in the joint first appeared, arising for no apparent reason. Repeatedly treated in various clinics in Moscow. In the next 2 years, all of the above complaints intensified, periods of remission were reduced to 1-2 months.

Objectively: upon examination, pronounced atrophy of the deltoid, trapezius, and rhomboid muscles on the left. The strength of the muscles of the shoulder and forearm is reduced by an average of 48. The range of motion in the joint is limited in the following examples: flexion 25 ^o , extension 16 ^o , lead 32 ^o , internal rotation 26 ^o , external rotation 16 ^o . Active and passive movements in the joint are painful.

 The patient was given a course of 4-channel ESM while walking from 25 sessions, the duration of the first five sessions consistently increased from 5 to 50 minutes. All subsequent sessions were 50 minutes each and were performed daily. The following muscles were subjected to electrical stimulation: the main triceps muscle of the shoulder to restore extension in the shoulder joint in the last 1/3 phase of the support and the first 1/3 phase of the transfer, deltoid to increase the abduction of the shoulder in the same phase; trapezoid and rhomboid muscles in the first 1/3 phase of the transfer to restore the lift and reduce the scapula from the affected side: the biceps of the shoulder to increase flexion in the shoulder joint in the first half of the support phase.

 The sizes of the pairs of electrodes for stimulation of each of the listed muscles were selected in accordance with the size of the latter, the distance between the two electrodes was determined using special studies of the contractility of these muscles. For the deltoid muscle, this distance was 4 cm, for the trapezius and rhomboid muscles 6 cm, for the triceps and biceps muscles of the shoulder 3.5 cm Using the special technique, the parameters of the most effective signal were established: amplitude 45-55 V, duration 50-120 μs, frequency pulse repetition of 40-60 Hz. The stimulus impulse was synchronized with the phases of the step using two knee angle sensors installed in the region of the right and left knee joints.

After a course of 4-channel ESM while walking, this patient obtained the following results: pain was completely eliminated, atrophy of the muscles of the shoulder girdle, muscle strength increased by an average of 39 Significantly increased the range of motion in the joint: extension to 28 ^o , flexion to 53 ^o , abduction up to 65 ^o , internal rotation up to 44 ^o , external rotation up to 20 ^o . The patient was re-examined after 8 months, the clinical picture did not change. For preventive purposes, a supportive course of ESM in walking with a positive effect was carried out. A total of 6 such patients with a similar effect were treated. Thus, the use of ICD by means of a multi-channel ESM allows one to achieve a significant improvement in the function of the muscles of the shoulder and shoulder girdle, increase the range of motion in the joint, and sharply extend the period of stable remission (up to 1 year or more), which is possible using traditional methods of rehabilitation of such patients.

Clinical example 15. Patient S., 46 years old. Diagnosis: osteochondrosis of the lumbosacral and thoracic spine, okreshkovy syndrome. Instability of the ligamentous apparatus. Complaints of persistent pain in the area of Th _8-10 , L _1-2 and L ₅ -S _{I of a} radiating nature. From the history of the disease it was found that the patient suffers from this disease for about 5 years. In the last 2 years, the pain has intensified significantly. Repeatedly treated in a hospital. Over the past year, she has undergone manual therapy courses three times without a significant effect.

Objectively: with palpation and percussion, pain is noted at the level of Th _8-10 , L _I-2 , L ₅ -S _I vertebrae. Sacrospinous muscles are tense, more on the left. Spinal column mobility is limited. Curvature of the lower thoracic and lumbosacral spine is noted. Focal neurological symptoms but detected. In the study of support reactions, a decrease in the maxima was noted below the level of body weight (96-99).

 The patient was made an unloading corset (orthosis) from light thermoplastic for 3 days. After that, a course of 6-channel walking ESM was held, consisting of 25 sessions. In order to adapt the muscles to the conditions of electrical stimulation, the duration of the sessions increased during the first 5 sessions from 20 to 45 minutes. All subsequent sessions were 45 minutes long, during which time the patient passed 3 km per session. The following main muscle groups were stimulated: sacrospinous muscles on both sides throughout the lumbar and lower thoracic spine to create a muscle corset, relieve pain and improve blood circulation in this part of the spinal column in the first half of the transfer phase for each of these muscles ; external and internal oblique muscles of the abdomen on both sides in order to strengthen the muscles of the lateral and anterior abdominal walls and increase intra-abdominal pressure, increase unloading of the lumbar and lower thoracic spine (in the first half of the transfer phase). Additional stimulation of the gluteus maximus muscle was also performed on both sides in order to increase leg support in the first 2/3 phases of support. The sizes of the electrodes were selected strictly in accordance with the size of the stimulated muscles, the attachment to the patient's body was carried out using special elastic cuffs. The distance between the active and indifferent electrodes for each of the groups of stimulated muscles depended on the possibility of obtaining the maximum painless muscle contraction using electron diffraction studies. By measuring the moment of force, depending on the parameters of the stimulating signal, the optimal parameters were determined: amplitude 40-60 V, duration 100-200 μs, pulse repetition rate 50-60 Hz. The temporary program of ESM in walking was carried out using knee angle sensors installed on both knee joints.

After an ESM course in walking, the following results were obtained in this patient: the pain syndrome was completely canceled, the function of the sacrospinous muscles was normalized, which was confirmed both clinically and by electron diffraction. More than 2-fold increased mobility of the spine, decreased by 7 ^o arc curvature of the spine 13 ^o to 6 ^o. Supporting reactions after a course of treatment additionally exceeded the level of body weight (106-110).

 The patient was examined after 6 and 12 months. After the course of treatment, the preservation of positive changes after the first course of ESM was ascertained. For preventive purposes after 12 months. repeated ESM course in walking. After which the patient was able to refuse to wear an unloading corset. Therefore, the use of ICD through multichannel ESM allows you to effectively treat osteochondrosis of the spine even in fairly advanced conditions, as evidenced by the above clinical example.

 Clinical example 16. Patient B. 45 years. Diagnosis: right-sided coxarthrosis of the IV degree. Condition after arthroplasty of the right hip joint. From the anamnesis it is known that he considers himself sick for 15 years, when the pain in the right TBS first appeared. In 1988, due to sharp changes in the joint and severe pain syndrome, joint replacement was performed by Sivash endoprosthesis. After 6 months after the operation, pain in the joint, instability when walking, the inability to move on uneven surfaces, on stairs without resting on crutches appeared. Conservative treatment carried out in CITO did not give effect. Received for treatment at the clinic TsNIIPP.

Objectively: walks independently with additional support on a cane at home, with additional support on crutches outside the house. No more than 1 km passes per day. Marked atrophy of the muscles of the pelvic girdle on the right and proximal right thigh is noted. The strength of these muscles is an average of 2 points. Active movements in the right TBS are sharply limited due to pain (flexion by 3-4 ^o , extension not more than 5 ^o , reduction 2-3 ^o , abduction 6 ^o ).

 The patient had 25 sessions of ES muscles when walking. The following muscle groups were subjected to ES: the main muscle group is the gluteus maximus muscle to increase the support of the right leg in the first 2/3 phases of support. Auxiliary muscle group is the gluteus maximus muscle to reduce left torso swelling, increase the volume of abduction in the TBC, the biceps femoris and the semitendinosus muscle to increase the extension in TBS in the first 1/2 phases of the support, the muscle straining the broad fascia of the thigh to increase flexion in TBS in the first 1/2 phase of the transfer; large and long adductors to increase adduction in TBS in the first 1/2 phase of support.

 The size of the electrodes for each of the stimulated muscles was equal to their diameter, the distance between the electrodes ranged from 10 cm for the gluteus maximus muscle to 3 cm for the muscle straining the wide fascia. The electrodes were attached to the patient’s body using specific cuffs. The optimal parameters of the electric pulse were individually selected: amplitude 60 V, duration 100 μs, repetition rate 50 Hz.

 A temporary program of ES muscles in walking was carried out using a knee angle sensor located in the region of the right knee joint. In total, the patient underwent 25 sessions of ESM in walking. During the first 4 sessions, the traveled distance was increased from 600 m to 3,000 m.

 As a result of the course of rehabilitation treatment, the patient disappeared pain in TBS both with movements and at rest. The patient began to move independently without additional support. The travel distance in one day increased from 1 km to 10 km. Moves freely on stairs.

Objectively: the atrophy of the muscles of the thigh and pelvic girdle on the right decreased, muscle strength increased from 2 to 4.2 points. The volume of active movements in TBS sharply increased: flexion from 3-4 ^o to 16 ^o , extension from 5 ^o to 18 ^o , reductions from 2-3 ^o to 8 ^o , abduction to 15 ^o . The patient was re-examined after 6 and 12 months after the course of treatment, no significant changes in the patient's status were detected. The results of treatment of this patient indicate a high efficiency of ESM in walking in this category of patients.

 Clinical example 17. Patient K., 29 years old. Diagnosis: post-traumatic stump of the left tibia in the middle third. Flexion contracture in the left knee joint. Phantom pain syndrome.

 Case history: road injury 3 years ago. 2.5 years prosthetics. In the design of the leg prosthesis there is a sleeve on the thigh. In the last 7 months, walking on the lower leg prosthesis was significantly limited due to the development of flexion contracture and increased phantom-pain syndrome.

Objectively: upon examination, atrophy of the left gastrocnemius and quadriceps muscles is pronounced, the soft tissues of the stump and left thigh are flabby. The strength of the muscles of the stump of the leg was reduced on average by 65 muscles of the thigh by 39 muscles of the pelvic girdle - by 17 (compared with the preserved limb). The movements in the left CS are painful, active and passive extension in the CS is limited to 165 ^o . The patient walks on the prosthesis of the lower leg independently with the help of additional support on the cane. When studying the biomechanical parameters of the patient’s walking on the prosthesis, a decrease in the tempo, locomotion speed, a decrease in the step length and a number of other pathological signs, as well as asymmetry of the kinematic, dynamic walking parameters (on the side of the prosthetic limb they were less than on the remaining limb), transfer rhythm coefficient amounted to 0.37 (normal 1.0). The patient underwent an ESM course in walking on the lower leg prosthesis, consisting of 20 sessions. The following major muscles were electrically stimulated: truncated calf muscle to reduce soft tissue atrophy of the stump, improve blood circulation, as well as strengthen the posterior thrust of the prosthetic limb in the middle third of the support phase, the quadriceps femoris muscle to increase extension in CS, eliminate soft tissue atrophy of the thigh in the first 1 / 2 phases of support, gluteus maximus muscle to increase support ability and brace resistance of the prosthetic limb, strengthen the front push in the first 2/3 phases of support.

 In total, the patient underwent 20 sessions of ESM while walking on the prosthesis. After the first 10 sessions, the patient was able to abandon the additional support on the cane, as well as from the sleeve on the thigh.

 For ES of the stump, thigh, and pelvic girdle, flexible patch multilayer electrodes were used. The electrodes were attached to the stump of the lower leg by either suturing the latter to the inner surface of the cover worn on the stump, or using an adhesive patch. Electrodes were attached to the quadriceps and gluteus maximus muscles using special cuffs. The electrodes were pre-wetted with warm boiled water. The size of the electrodes was determined by the size of the stimulated muscle. The distance between the electrodes (+) and (-) for each muscle was determined by a series of special studies (muscle contractility) and amounted to 8 cm for the gluteus maximus muscle, 5 cm quadriceps muscle, 2 cm calf muscle. Electrical impulse parameters for walking ESM After a series of studies, the dependence of muscle contractility on various parameters of the electric pulse was selected: the signal amplitude was 60 V, the duration was 100-200 μs, and the frequency was 50 Hz. As a result of the course of ES muscles when walking on the shank prosthesis, the following results were obtained: the functional state of the soft tissues of the stump, hip and pelvic girdle improved sharply, the perimeter of the stump increased by 1.5 cm, the atrophy of the quadriceps muscle was completely eliminated. Muscle strength increased by an average of 54 compared to baseline. As a result of increased support ability and brace resistance of the prosthetic limb, the patient got rid of the need to use a sleeve on the thigh and additional support on a cane. When studying the biomechanical parameters of walking, it was found that the pace increased, the walking speed increased by more than 2.5 times, the step length increased, the kinematic and dynamic asymmetry decreased, and the transfer rhythm coefficient increased to 0.96.

 The patient was examined twice to study individual results after 6 and 12 months, and the preservation of all the positive aspects of the ESM course in walking was observed. Thus, an ESM course in walking on the shank prosthesis allows normalizing walking of the disabled person, dramatically improving the functional state of soft tissues of the stump and other segments of the prosthetic limb, weakening the processes of atrophy in the muscles of the stump, eliminating the atrophy of the thigh muscles, and sharply increasing the supportability of the prosthetic limb.

 In total, 30 disabled people with unilateral and 12 disabled people with bilateral stumps of the lower leg with similar or similar results were treated using this technique.

Clinical example 18. Patient S. 40 years. Diagnosis: aseptic necrosis of the apophyses of the vertebral bodies (Scheurmann-Mau disease). Kyphoscoliosis II Art. Complaints of pain when walking and sitting, the presence of curvature of the spinal column, fatigue, weakness of the back muscles:
Objectively: kyphotic deformity of the thoracic spine is pronounced, scoliosis of the lumbar spine with an apex of deformity at the level of Th _VII , with an angle open to the right.

 Anamnesis of the disease: considers himself ill for 2-2.5 years, when pain in the thoracic spine first appeared. Gradually the pain intensified. About a year later, deformation of the spinal column began to increase sharply. Four times underwent a course of conservative treatment in various clinics in Moscow, however, it was not possible to stop the development of spinal deformity.

Objectively: there is kyphotic deformity of the thoracic spine with the apex of the arch at the level of VII-VIII thoracic vertebrae, left-sided scoliosis in the lower thoracic and lumbar spine. The left shoulder girdle is 3 cm higher than the right. According to the R-gram: the angle of kyphosis was 132 ^o , the magnitude of scoliotic deformation 22 ^o . The patient received a 6-channel ESM course of 25 sessions. The following main muscles were stimulated: rhomboid on both sides in the first half of the transfer phase in order to reduce kyphotic deformation, increase the strength of these muscles, sacrospinous muscles on both sides in the first half of the transfer phase (a stronger contraction of this muscle was achieved from the convex side of the curvature) with the goal of reducing scoliotic deformation, normalizing the function of these muscles. Large gluteal muscles were subjected to additional stimulation in the first half of the support phase in order to increase the support function of both legs. To stimulate the muscles in walking, 2 electrodes were applied to each of the stimulated muscles: active and indifferent, which were attached to the patient's body using special cuffs. The distance between the electrodes depended on the volume of stimulated muscles and the possibility of obtaining the maximum painless muscle contraction.

In a series of special studies of the dependence of the force on the parameters of the electric signal, its optimal values were established: amplitude 40-60 V, pulse duration 100-120 μs, repetition rate 60 Hz. The synchronization of the supply of an electrical impulse to the stimulated muscles was carried out using knee angle sensors. During the session, the patient walked 2.5 km. Results of the ESM course in walking: the value of kyphotic deformation decreased by 2 times to 157 ^o , scoliotic deformation by 8 ^o (14). The strength of the back muscles increased on average 46 cm to the left of the shoulder girdle above the right one cm. The pain syndrome sharply decreased, muscle fatigue became less.

 This clinical example indicates the high efficiency of ESM in walking in patients with severe spinal deformities, including with Scheurmann-Mau disease.

 Thus, from the above examples it is clear that the proposed method is highly effective in the treatment of various nosologies.

Claims (13)

 1. A method of treating diseases and consequences of injuries of the musculoskeletal system, which consists in multichannel electrical stimulation of muscles when walking by applying a pair of electrodes (active and indifferent) to muscle groups and setting parameters of electrical stimulation with step phases using angle sensors located in the knee or of the hip joint, characterized in that the electrodes are applied to the main and auxiliary muscle groups, the duration of electrical stimulation in the first session is 20 minutes, and from 5 to 6 seconds its duration is brought to 60 min, then the voltage amplitude is increased from 30 to 60 V, the pulse duration is from 20 to 200 μs and the repetition rate is from 30 to 60 Hz, and electrical stimulation is carried out by applying an electric pulse in the phases of natural excitation and muscle retraction, while the size of the electrode is chosen equal to the diameter of the stimulated muscle or muscle group, and the electrode itself is placed perpendicular to the course of the muscle fibers.  2. The method according to p. 1, characterized in that with the residual effects of poliomyelitis, the consequences of spinal fractures and spinal cord injuries, the consequences of acute cerebrovascular accident, accompanied by paresis of the muscles of the lower extremities, pairs of electrodes are applied to the main muscle group, large and middle gluteal, biceps and semi-tendon and additional muscle group, calf and anterior tibial.  3. The method according to p. 1, characterized in that in the aftermath of cerebral palsy, electrodes are applied to the main muscle group, the gluteus maximus, calf and quadriceps, and the additional muscle group, tibial and sacral-spinous.  4. The method according to p. 1, characterized in that in the case of a false joint of the lower leg bones and post-traumatic contracture of the knee joint, the electrodes are placed on the main muscle group, the quadriceps, gastrocnemius and soleus, the large and middle gluteal and additional muscle groups, the tibia.  5. The method according to p. 1, characterized in that when the leg fracture is closed, the electrodes are placed on the main muscle group, gastrocnemius, quadriceps and biceps femoris and additional gluteus maximus muscle.  6. The method according to p. 1, characterized in that with deforming arthrosis of the knee joint, electrodes are applied to the main muscle group, the quadriceps and biceps femoris, the semitendinosus and the extra muscle - the calf.  7. The method according to p. 1, characterized in that when the Achilles tendon rupture after restoration of the integrity of the latter, the electrodes are placed on the main muscle group, gastrocnemius and biceps and additional gluteus maximus muscle.  8. The method according to p. 1, characterized in that with the consequences of a compression fracture of the body of the spine, the electrodes are applied symmetrically on the sacral-spinous and gluteal muscles on both sides.  9. The method according to p. 1, characterized in that in case of a traumatic dislocation of the shoulder and shoulder-shoulder perriatritis, electrodes are applied to the main muscle group, the deltoid and triceps muscles of the shoulder and the additional muscle group - trapezoid and rhomboid.  10. The method according to p. 1, characterized in that in case of osteochondrosis of the lumbosacral and thoracic spine, electrodes are placed on the sacro-spinous muscles on both sides paravertebrally.  11. The method according to p. 1, characterized in that after the endoprosthesis replacement of the hip joint, the electrodes are applied to the main muscle of the gluteus maximus and additional gluteus maximus muscle.  12. The method according to p. 1, characterized in that during prosthetics of the stump of the leg, the electrodes are placed on the main muscle group, truncated calf muscle, quadriceps femoris, gluteus maximus.  13. The method according to p. 1, characterized in that with kyphoscoliosis, the electrodes are placed symmetrically on both sides of the spine on the rhomboid and sacral-spinous muscles.