RU2386432C2 - Method of medical rehabilitation in motor disturbances following cerebral accidents - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, neurology, reflexotherapy. The method involves point massage of acupuncture points. At first, dominant hemisphere is determined by standard tests. Then point massage follows. The spastic limb muscle hypertension on the side homolateral to the dominant hemisphere enables the stimulating point massage of the points VB 30, RP 12 of this side and inhibiting massage of VB 30 of the opposite sides. The spastic limb muscle hypertension on the side counterlateral to the dominant hemisphere or from both sides provides the stimulating point massage of the points VB 30, RP 12 from both sides. The limb hypotension on the side counterlateral to the dominant hemisphere, or from both sides requires the inhibiting point massage of the point E 12 on the side homolateral to the dominant hemisphere and the stimulating point massage of the points VB 21, V16hV43c on both sides. The limb hypotension on the side homolateral to the dominant hemisphere, or the absence of change implies the stimulating point massage of the points VB 21, V 16 and V 43 of this side.

EFFECT: method improves the results of medicine rehabilitation due to the differentiated effect on the points considering variations of limb muscle tone and functional asymmetries of cerebrum.

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Description

The invention relates to medicine, namely to neurology.

The prevention of persistent motor disorders, muscle contractures in the acute period of cerebral stroke has acquired special significance in recent decades due to the high frequency of their development, disabling consequences that violate the human labor, social and domestic roles. In post-stroke patients, in connection with the often developing central hemiparesis and ataxia, the ability to fully and efficiently perform a certain amount of work, desire, motivation for its implementation, difficulties arise in the sphere of habitual daily life, in the performance of household manipulations and housework, shopping, communication . Reconstructive treatment of patients with motor disorders should be carried out at the optimum time, with the consistent and rational use of rehabilitation tools. Known methods of constructing rehabilitation programs for post-stroke patients with motor disorders.

For the prototype, a method was chosen for the rehabilitation treatment of motor disorders in stroke patients in the early rehabilitation wards (V. Epifanov. Recovery medicine: Reference book. - M .: GEOTAR. - Media, 2007. - P.286-290), which provides combined use of passive, passively active and active physical exercises for limbs, breathing exercises, cryotherapy and acupressure, and with high muscle tone of the arms and legs, the inhibitory method of acupressure for the extremities is shown, with a slight increase - selective massage: acupressure - for spastic muscles and superficial stroking of their hypotonic antagonists; the pre-existing treatment method does not take into account the functional asymmetries of the brain, a decrease in muscle tone of the limbs in the early stages of a stroke or the absence of its changes in the presence of other signs of motor dysfunctions, such as, for example, disdiadochokinesis, and does not provide a differentiated approach to working with biologically active points torso.

A method is proposed for the rehabilitation treatment of motor disorders after cerebral strokes with premature determination of the dominant hemisphere by standard tests, followed by differential acupressure in the body area, depending on changes in the muscle tone of the limbs and functional asymmetries of the brain and with an increase in the tone of the limbs by spastic type on the side, ipsilateral the dominant hemisphere, apply the stimulating technique of acupressure at points VB30, RP12 et side and inhibitory - at point VB30 on the opposite side, with an increase in the tone of the limbs according to the spastic type on the side, the counter-lateral dominant hemisphere, or on both sides, use the stimulating method of acupressure at points VB30, RP12 on both sides, while lowering the tone of the limbs on the side, to the contralateral dominant hemisphere, or from both sides apply the inhibitory method of acupressure at point E12 from the side, the ipsilateral dominant hemisphere, stimulating technique at points VB21, V16 and V43 from two sides, and When lowering tonus limb on the side ipsilateral hemisphere dominant or absence of change using a catalytic technique acupressure points in VB21, V16 and V43 that side.

The technical result of the proposed method is to prematurely determine the dominant hemisphere with standard tests, then conduct differentiated acupressure in the body area, depending on changes in muscle tone of the limbs and functional asymmetries of the brain.

The proposed method for the rehabilitation treatment of motor disorders after cerebral strokes increases the effectiveness of specialized rehabilitation treatment, reducing the degree of spasticity, preventing the development of synkinesias, improving the balance, optimizing the labor, social and domestic components of the quality of life associated with physical health.

A significant difference of the proposed method of treatment is premature clarification by standard tests of the functional asymmetries of the brain, taking into account the nature of changes in the muscle tone of the limbs in the presence of signs of motor dysfunctions and a differentiated approach to the method of acupressure of biologically active body points.

The literature describes many methods of treating motor disorders after cerebral strokes, however, no information has been found on such new methods of rehabilitation treatment of post-stroke motor disorders, i.e. about the base object.

We examined 321 patients who had a brain stroke. 186 patients underwent AI in CS, 99 in WBB, 9 in both vascular pools; 24 - parenchymal supratentorial GI, 3 - subtentorial.

Informative criteria for the method of rehabilitation treatment of motor disorders after cerebral strokes is to increase the effectiveness of specialized rehabilitation treatment with a decrease in the degree of spastic-paretic manifestations and optimization of the statics of these patients.

The method is as follows.

We diagnose a cerebral stroke, diagnose a syndromic diagnosis, determine the presence of motor disorders (International Classification of Diseases (ICD - X). - 1995. - T.I. - 158 p.) And the nature of changes in muscle tone, namely its increase, decrease or absence of changes. We identify the dominant cerebral hemisphere with standard tests, namely N. M. Timchenko’s “Test for hemispheric dominance,” which includes 20 statements, and, with dubious results of this test, “Methods for determining the dominance of the right / left hemisphere”, which contains 5 tasks (Workshop on Sports Psychology / Under the editorship of IP Volkov. - St. Petersburg: Peter, 2002. - 288 pp. - (Series "Workshop on Psychology")).

According to the results of our examinations, in all cases, the dominance of one or another hemisphere of the brain was revealed. When identifying a mixed type, without signs of dominance of any hemisphere of the brain on the basis of N. M. Timchenko’s “Test for hemispheric dominance” and “Methods for determining the dominance of the right / left hemisphere”, we do not recommend using the proposed treatment method.

Then we carry out differentiated acupressure in the trunk: with an increase in the tone of the extremities in the spastic type on the side, in the ipsilateral dominant hemisphere, we use the stimulating method of acupressure at points VB30, RP12 of this side and inhibitory at the point VB30 of the opposite side, with an increase in the tone of the extremities in spastic the type on the side, the counter-lateral dominant hemisphere, or on both sides use the stimulating method of acupressure at points VB30, RP12 on both sides, with a decrease in tone of the limbs on the side of the contralateral dominant hemisphere, or on both sides, apply the inhibitory method of acupressure at point E12 on the side, the ipsilateral dominant hemisphere, which stimulates the technique at points VB21, V16 and V43 on both sides, and when the tone of the limbs on the side decreases, the ipsilateral dominant the hemisphere, or the absence of its change, use the stimulating method of acupressure at points VB21, V16 and V43 of this side. The above biologically active points for acupressure are proposed on the basis of recommendations described in other literature data (Avakyan G.N. Reflexotherapy of diseases of the nervous system: a Guide for doctors. - M .: Uzorochye, 1999.- p. 188; Luvsan G. Traditional and modern aspects of oriental reflexology. - 3rd ed., revised. - M .: Nauka, 1992 - p. 544; Vasichkin V.I. Handbook of massage. - 2nd ed. stereotypes. - St. Petersburg: Hippocrates, 1992 . - S.115-116; Therapeutic physical training in the rehabilitation of post-stroke patients / Dobrovolsky V.K., Vishnevskaya AM, Kor Vitsyna V.A. et al. - L .: Medicine, 1986. - P.37; Sulie de Moran J. Chinese acupuncture: Classified and refined Chinese tradition. - M.: Profit Style, 2005. - T.V. C 71).

Clinical example.

1. Patient N., 48 years old, was in a specialized angioneurological hospital with a diagnosis of Ischemic stroke in the pool of the right middle cerebral artery from 07/30/2006. Left-sided spastic hemiparesis: moderate in the arm, slight in the leg. Left-side humeroscapular periarthrosis with impaired joint function of the first degree. Hypertension stage I. Arterial hypertension of the I degree. Risk IV. H IIA. Atherosclerosis of cerebral vessels. Patient N. was diagnosed with a cerebral stroke, a syndromic diagnosis was made, the presence of motor disorders in the form of left-sided spastic hemiparesis was determined. The muscle tone of the left limbs is increased. The dominant hemisphere was detected by standard tests. According to the "Test for hemisphere dominance" N.M. Timchenko, the score on the "Preliminary conclusion" scale was 2. The left hemisphere is more active. The score on the "Main Conclusion" scale was 4. The left hemisphere is more active. The preliminary and main conclusion coincided, they indicated the predominance of activity of the left hemisphere. Therefore, the dominance of the left hemisphere of the brain was diagnosed. Then, a differentiated acupressure was performed in the body area. Because increased tone of the left extremities in spastic type, i.e. on the side of the ipsilateral dominant hemisphere, we applied the stimulating method of acupressure at points VB30, RP12 of the left side and inhibitory - at point VB30 of the right side.

2. Patient B., 66 years old, was in a specialized angioneurological hospital with a diagnosis of Ischemic stroke in the basin of the left middle cerebral artery from 06/03/2006. Moderate right-sided spastic hemiparesis. Moderate motor dysphasia. Hypertension stage II. Arterial hypertension of the II degree. Risk IV. H IIA. Atherosclerosis of cerebral vessels. Patient B. was diagnosed with a cerebral stroke, a syndromic diagnosis was made, and motor impairment was determined in the form of right-sided spastic hemiparesis. The muscle tone of the right limbs is increased. The dominant hemisphere was detected by standard tests. According to the "Test for Hemispheric Dominance" N.M. Timchenko, the score on the "Preliminary conclusion" scale was 3. The left hemisphere is more active. The score on the "Main Conclusion" scale was 6. The left hemisphere is more active. The preliminary and main conclusion coincided, they indicated the predominance of activity of the left hemisphere. Therefore, the dominance of the left hemisphere of the brain was diagnosed. Then, a differentiated acupressure was performed in the body area. Because increased spastic tone of the right limbs, i.e. on the side of the counterlateral dominant hemisphere, we applied the stimulating technique of acupressure at points VB30, RP12 on both sides.

3. Patient A., 53 years old, was in a specialized angioneurological hospital with a diagnosis of Ischemic stroke in the vertebral-basilar basin of June 14, 2007. Moderate atactic syndrome. Chronic glomerulonephritis, mixed form, NFP ₀ . Arterial hypertension of the III degree. Hypertensive heart. Risk IV. H _I-IIA .

Patient A. was diagnosed with a cerebral stroke, a syndromic diagnosis was made, the presence of motor disorders in the form of an atactic syndrome was determined. The muscle tone of all four limbs is reduced. The dominant hemisphere was detected by standard tests. According to the "Test for hemisphere dominance" N.M. Timchenko, the score on the "Preliminary conclusion" scale was 7. The right hemisphere is more active. The score on the "Main Conclusion" scale was 16. The right hemisphere is more active. The preliminary and main conclusion coincided, they indicated the predominance of activity of the right hemisphere. Therefore, the dominance of the right hemisphere was diagnosed. Then, a differentiated acupressure was performed in the body area. Because the tone of all four limbs is lowered, then we applied the braking technique of acupressure at point E12 from the side of the ipsilateral dominant hemisphere, i.e. on the right, a stimulating technique at points VB21, V16 and V43 on both sides.

4. Patient B., 77 years old, was in a specialized angio-neurological hospital with a diagnosis of Ischemic stroke in the vertebral-basilar basin of 04/02/2006. Slight hematological syndrome on the left. Chronic glomerulonephritis, mixed form, NFP ₀ . Arterial hypertension of the III degree. Hypertensive heart. Risk IV. H _I-IIA .

Patient B. was diagnosed with a cerebral stroke, a syndromic diagnosis was made, the presence of motor disorders in the form of a hematological syndrome on the left was determined. The muscle tone of the left limbs is lowered. The dominant hemisphere was detected by standard tests. According to the "Test for Hemispheric Dominance" N.M. Timchenko, the score on the "Preliminary conclusion" scale was 3. The left hemisphere is more active. The score on the "Main Conclusion" scale was 9. Mixed type. Hemisphere dominance not defined. The preliminary and main conclusions did not coincide: the preliminary conclusion indicated the predominance of the left hemisphere, the main one - an equal degree of activity of both hemispheres. It is recommended to conduct additional examinations to clarify the result. According to the "Methodology for determining the dominance of the right / left hemisphere" the number of results diagnosing the predominance of the left hemisphere is 4; the number of results diagnosing the predominance of the right hemisphere is 1. Thus, in patient B., the left hemisphere was dominant. Then, a differentiated acupressure was performed in the body area. Because decreased tone of the left limbs, i.e. on the ipsilateral dominant hemisphere side, the stimulating acupressure technique was applied at points VB21, V16 and V43 on the left.

Claims (1)

A method of restorative treatment of motor disorders after cerebral strokes, including acupressure, characterized in that the dominant hemisphere is first determined by standard tests, then differentiated acupressure is performed in the trunk area depending on changes in the muscle tone of the limbs and functional asymmetries of the brain and with an increase in the tone of the limbs according to the spastic type on the side, ipsilateral dominant hemisphere, a stimulating acupressure technique is used points VB30, RP12 of this side and inhibitory - in VB 30 of the opposite side, while increasing the tone of the extremities in the spastic type on the side of the contralateral dominant hemisphere, or on both sides, use the stimulating method of acupressure in VB 30, RP 12 on both sides, while lowering tonus of extremities on the side, the contralateral dominant hemisphere, or on both sides, apply the inhibitory method of acupressure in E 12 from the side, the ipsilateral dominant hemisphere, which stimulates the technique in VB 21, V 16 and V 43 on both sides, and when lowering the tone of the limbs on the side, the ipsilateral dominant hemisphere, or the absence of its change, use the stimulating method of acupressure in VB 21, V 16 and V 43 of this side.