RU2214209C1 - Method of restoration of normal muscular tension in children up to 8 years of age with infantile spastic cerebral paralysis - Google Patents

Abstract

FIELD: medicine, particularly, pediatrics, concerning treatment of infantile cerebral paralysis. SUBSTANCE: method includes diagnosis for every muscle with pronounced high tension for presence of its response to force action by hands of rehabilitologist, expressed in arising of sharp mechanical resistance at definite value of action and sensed by touch of rehabilitologist; establishing of value of upper limit of force action; performance of manipulation including multiple random in direction force actions not exceeding the established value of force action upper limit. Method allows removal of spasm with effect preservation for nearest 30 min with gradual increase of duration of healing effect up to restoration of normal muscular tension. EFFECT: higher efficiency of treatment. 8 cl

Description

 The invention relates to medicine, namely to pediatrics, and can be used to treat children with various forms of cerebral palsy.

 Cerebral palsy (cerebral palsy) refers to diseases of the brain and is manifested by severe pathologies of the musculoskeletal system.

 There are various methods of treating cerebral palsy through massage and physical therapy (see, for example, application RU 99114734, Semenova et al., A 61 H 1/00, 04/27/2001; application RU 95120966, Samigullin, A 61 H 39/04 publ. 02/10/1998). It is known that spastic forms of cerebral palsy have common characteristics that differ in the place of localization of their manifestation. These include: sharply increased muscle tone, persisting pathological postures, convulsive readiness, as well as psychomotor disorders. With spastic forms in children with cerebral palsy, muscle contractions inadequate in energy costs are observed. Distorted amplified continuous signal from the periphery is recorded in various parts of the brain and gives incorrect information about the environment. Such distorted information leads to the improper development of the cerebral cortex as an intermediate in the cyclic process of perception, analysis and implementation of the information received and the violation of posotonic reflexes, which are manifested by a violation of coordination of movement. Violations of coordinated movements in cerebral palsy are due to many reasons, one of which is a violation of the mechanism of reciprocal innervation. The essence of reciprocal innervation is that reflex excitation in the group of nerve cells that innervate certain muscles is accompanied by reciprocal (conjugate) inhibition of activity in other cells that are functionally associated with antagonists. Such inhibition involving the intermediate Renshaw neuron, which acts as a relay switch, leads to relaxation of the muscles of the antagonists. Thus, the nerve centers of the antagonist muscles are in antiphases when performing many motor acts. The distortion of incoming information occurs at the level of nerve conductors. The reason for this violation is the occurrence of a mechanical blockade before the nerve conductor enters the spinal canal, as well as by constantly acting non-specific stimuli, i.e. compression by the body’s own tissues, sprains or contractions of the nerve roots and nerve conductors. The distortion of the incoming information leads to a violation of the mechanisms of reciprocal innervation, spastic manifestations and a violation of posotonic reflexes (see, for example, Kachesov VA Fundamentals of intensive rehabilitation of cerebral palsy. Book 2. M., 2001, 200 pp.).

 The closest in essential features to the patented method is a method of treating cerebral palsy by restoring normal muscle tone in children, based on manipulations by predominantly stroking, rubbing, kneading (see application RU 9710403, Ternovskaya et al., A 61 H 7 / 00, 09/20/1998).

 However, this method is difficult to implement with a high muscle tone of the patient, since the specific pose of the patient does not allow him to give his body a pose in which it is possible to effectively perform manipulations.

 The objective of the invention is to develop a method of restoring normal muscle tone in children under the age of 5 years with a spastic form of cerebral palsy.

 The technical result of the invention is to achieve a sustainable result of rehabilitation.

 The technical result is achieved by the fact that the method of restoring normal muscle tone in children is based on mechanical manipulations with the muscles of the child. Initially, for each muscle with a pronounced high tone, the presence of its response to the force impact by the hands of a rehabilitologist is diagnosed, which manifests itself in the appearance of a sharp mechanical resistance at a certain value of the effect and tactilely felt by the rehabilitologist. Take the set value as the upper limit of exposure, then in the process of carrying out manipulations carry out multiple, random in the direction of the force impact, the magnitude of not exceeding the previously established mentioned upper limit of exposure.

 The method may be characterized in that stretching and / or twisting and / or rotation and / or bending or extension and / or abduction or reduction are used as force actions.

 The method may be characterized in that the stretching is carried out at a speed of 0.4-0.6 millimeters per second, and rotation, bending, extension, abduction or reduction is carried out at a speed of 0.5-1.0 degrees per second.

 The method can be characterized by the fact that they perform manipulations with the muscles of the upper shoulder girdle, neck, upper and lower extremities.

 The method can also be characterized by the fact that before the start of the manipulations, a surface massage is performed to relax the tissues, including lightly stroking the child’s head, back and affected limbs and pointly randomly touching the child’s body with the fingers of the rehabilitologist.

 The method can also be characterized by the fact that manipulations are carried out with sessions lasting 90-120 minutes each, while acting for 3-5 minutes alternately for each affected muscle.

 The method may also be characterized in that the manipulations are carried out with the eyes of the child closed, if necessary by a bandage, in a supine position.

 The method can also be characterized by the fact that manipulations are carried out with relaxing musical accompaniment.

 The patented method is based on the following provisions.

 For the first time, we found that using low-amplitude force effects in the recommended ranges of linear and angular movements, it is possible to reduce muscle tone and eliminate the false brain pattern that is characteristic of patients with cerebral palsy under the age of 5 years. Until five years of age, the reversibility of pathological processes resulting from brain damage is observed, which makes the rehabilitation of children of this age group promising. As an information feature that allows you to determine the limit of force impact on the affected muscle, is the occurrence of sharp mechanical resistance of the affected muscle to the hands of a rehabilitologist with a certain amount of exposure. Muscle resistance is tactilely felt by a rehabilitologist and can be described as a “protest” of a spasmodic muscle to participate in the process of restoring normal muscle tone, and hence a normal brain pattern. This phenomenon was noticed for the first time and underlies the rehabilitation technique used. In the process of carrying out the actual manipulations, multiple, random in the direction force actions are carried out, not exceeding in magnitude the established upper limit of the force effect. The alternation of these movements should not be natural — it should be chaotic, that is, multidirectional, randomly selected. We noticed that carrying out such manipulations in the patented mode allows you to destroy the formed habitual installation in the child’s brain as a center for the formation of habitual pathological postures and attitudes. This makes it possible to gradually change pathological poses and attitudes to the correct ones and influence the formation of the correct brain patterns.

 The method is implemented as follows.

With the eyes of the child closed, if necessary, with the help of a tight bandage, when the child is lying on his back (a roller d = 10-15 cm is placed under the knee joints) with a relaxing musical accompaniment, the rehabilitologist performs the following manipulations:
carries out superficial massage for tissue relaxation, including light stroking of the head, back and affected limbs;
at a slow pace i.e. approximately one touch per second, conducts for 3-5 minutes chaotic point contacts with fingers in various parts of the body, with the aim of further deeper relaxation of subcutaneous tissues, superficial muscle fascia, muscle tendon heads.

 Further, the actual manipulations are carried out.

 For each muscle with a pronounced high tone, the presence of its response to the force impact by the hands of a rehabilitologist is diagnosed, which is manifested in the occurrence of a sharp mechanical resistance at a certain amount of impact and tactilely felt by the rehabilitologist (hereinafter referred to as the "emphasis state"). Take the set value as the upper limit of exposure. Further, in the process of carrying out the manipulations, repeated, random in the direction force actions are carried out, not exceeding in magnitude the previously established upper limit of the impact.

 Slow twisting is carried out in such a way that the rehabilitologist takes the limb of the child in his hands and slowly, at a speed of 0.5-1.0 degrees per second, twists the limb to the side to the "stop state". Then the rehabilitologist with the same slow speed turns the limb in the opposite direction also to the "state of focus".

 Slow twisting is carried out in order to reduce the tone in the rotator muscles, adductor muscles, flexor muscles and, consequently, increase the maximum twist angle. Slow twisting is carried out for 20 minutes in one session of 3-5 minutes for each affected muscle.

 For this, the rehabilitologist takes with two hands the affected limb of the child so that one arm is from below on the proximal limb, the other arm is from below on the distal limb, and twist the limb around the longitudinal frontal axis at a speed of 0.5-1.0 degrees per second in one direction. The directions of the turns are chaotic, random, not violent, that is, they are produced to the "state of stop", while the direction of rotation is changed. The procedure for each affected limb is 15-20 minutes. A rehabilitologist performs the specified manipulation without straining his own muscles.

 Slowly, at a speed of 0.5 mm per second, the muscles of the ligaments of the upper and lower limbs and neck are stretched alternately. The slower the stretching is carried out, the more relaxation will occur in the pathological focus of the cerebral cortex, which means that the contraction of muscles in the reception area of the nerve fiber, which received the signal from the cerebral cortex, will decrease.

 Thus, successive manipulations on the upper and lower extremities, neck, consisting in a slow 0.5 mm per second stretching of each joint for 3-5 minutes, and a total of 20 minutes in each session allows you to achieve the result of spastic tonus removal for the next 30 minutes with a gradual increase in the duration of the effect of removing spastic tone from session to session.

 Slow stretching at a speed of 0.5 mm per second is performed in such a way that the rehabilitologist smoothly takes his limb into his hands, for example, a hand, with a grip on the wrist so that the left hand from below takes the child’s forearm in its lower third, and the right hand of the rehabilitologist takes the brush from below child, and the hands of the rehabilitologist slowly begin to stretch the joint in different directions to the "state of focus".

 With a sensation of muscle resistance, i.e. The “state of emphasis” in the wrist joint during the process of stretching, the rehabilitologist slowly returns his hands, and therefore the joint, to its original position and moves to another joint, for example, to the elbow, at a speed of 0.5 mm per second. Thus, the rehabilitologist acts sequentially on all joints of the upper and lower extremities for 3-5 minutes for each joint in one session.

 The rehabilitator stretches the neck muscles while being behind the child, i.e. facing his nape, taking the child’s head into his hands so that the nape of the child lies in the palm of the rehabilitologist. The fingers of the rehabilitologist hold his head by the temporal, frontal and parietal areas, and the rehabilitologist slowly stretches the child’s neck at himself at a speed of 0.5 mm per second to a “stop” state. The resulting muscle resistance should not be overcome by the efforts of a rehabilitologist. It is important to give the stretching vector another direction that is possible in this joint. If a new vector of stretching cannot be found, it is necessary to slowly return the position of the muscles of the joint to its original position and proceed to the next joint, joint, tendon, muscle.

 Slow leads and adductions of the upper and lower extremities at a speed of 0.5 mm per second in combination with slow flexion and extension of the limbs, heads at a speed of 0.5-1.0 degrees per second are carried out in such a way that the rehabilitologist takes the limb of the child, for example, the hand , with his right hand behind the forearm, and with his left hand over the shoulder, he slowly bends in the elbow joint at a speed of 0.5-1.0 degrees per second until the muscles of the forearm flexors and extensors of the shoulder are “rested”. Then the rehabilitologist also slowly performs extension in the elbow joint. Flexion and extension in the joint is chaotic. This manipulation is replaced by abduction and reduction. The alternation of these movements should not be natural.

 This slow chaotic effect on the limb allows you to relieve spasm, and then muscle tone, while maintaining the effect for the next 30 minutes with a gradual increase in the duration of the positive therapeutic effect of spasm removal from session to session, until the restoration of normal muscle tone.

 Slow relaxation music, closed eyes of the child, soft relaxed hands of a rehabilitologist, easily touching the child’s body, his quiet, calm voice can reduce the possible inappropriate reactions of the child.

 Example 1

 Patient O., a boy of 4 years. Double hemiplegia was detected, characterized by motor disorders in all limbs, with arms and legs affected equally. Due to the high tone of all the flexor groups, the child does not hold the pose while lying on his stomach with legs extended, does not hold his head in the supine position, there are no active movements in the arms and legs in all muscle groups, due to the high tone of the adductors the legs constantly maintain “cross”, hands are constantly pressed to the chest, hands are sharply bent.

 The treatment according to the patented method. The manipulations were carried out in two courses, each of 10 sessions. The duration of the sessions is 90-120 minutes each. The impact was carried out for 3-5 minutes alternately for each affected muscle. The pronounced spasticity of the adductors has been partially removed, the restriction on the passive movement of the hands has been lifted, the bringing of the hands to the chest has been lifted completely, the hands are freely located along the body, passively lift up without failure and to the side, partially restored movement in the fingers. The child holds a pose while lying on his stomach for 15-20 minutes, holds his head in a pose on his stomach for 3-5 minutes, passively puts his hands forward.

 Treatment for the revealed double hemiplegia gave an effect after two courses, each of 10 sessions, there are no relapses according to the achieved result during one year of follow-up.

 Example 2

 Patient N., a girl of 4 years.

 Left-sided hemiplegia was revealed, and the arm is affected more than the leg. A persistent gait on tiptoe was also revealed. Due to high muscle tone, a child does not take objects from any surface with his left hand. With an increase in walking speed, it falls, does not run, does not jump.

 The treatment according to the patented method. Manipulations were carried out in one course - 11 sessions. The duration of the sessions is 90-120 minutes each. The impact was carried out for 3-5 minutes alternately for each affected muscle.

 The pronounced spasticity of the muscles of the left arm is partially removed. The child takes objects from a hard surface with his left hand and holds them. The tiptoe gait is 80% removed. The child confidently increases the walking speed, runs for 10-15 minutes, and the ability to jump has appeared. A stable result was obtained.

 Using the patented technique, five rehabilitations of children aged 3.5-5 years were carried out. In all cases, an improvement in the condition of the patients was obtained, namely, a confident result: the tone was restored in some rehabilitations by 50 percent.

 The duration of remission in all cases is at least one year.

Claims (8)

 1. A method of restoring normal muscle tone in children, based on mechanical manipulations with the muscles of the child, characterized in that initially, for each muscle with a pronounced high tone, it is diagnosed as having a response to the force impact by the hands of a rehabilitologist, which manifests itself in the appearance of a sharp mechanical resistance at a certain value impact and tactilely felt by a rehabilitologist, take the set value as the upper limit of exposure, then in the process I manipulations performed multiple, random in direction force feedback, the magnitude does not exceed the previously set upper limit of said feedback.  2. The method according to claim 1, characterized in that the force effects use stretching, and / or twisting, and / or rotation, and / or bending, or extension, and / or abduction, or reduction.  3. The method according to claim 1 or 2, characterized in that the stretching is carried out at a speed of 0.4-0.6 ml / s, and rotation, flexion, extension, abduction or reduction is carried out at a speed of 0.5-1.0 degrees ./from.  4. The method according to claims 1 to 3, characterized in that they manipulate the muscles of the upper shoulder girdle, neck, upper and lower extremities.  5. The method according to PP. 1-4, characterized in that before the start of the manipulations, a surface massage is performed to relax the tissues, including lightly stroking the child’s head, back and affected limbs, and randomly touching the child’s body with the fingers of the rehabilitologist.  6. The method according to claims 1-5, characterized in that the manipulations are carried out with sessions lasting 90-120 minutes each, while acting for 3-5 minutes alternately for each affected muscle.  7. The method according to any one of claims 1 to 6, characterized in that the manipulation is carried out with the eyes closed, if necessary by a bandage, of the child in a supine position.  8. The method according to any one of claims 1 to 7, characterized in that the manipulations are carried out with relaxing musical accompaniment.