RU2428964C1 - Method of treating spastic state of muscles after stroke - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: for 20-30 minutes at patient's forced maximal exhalation physician makes passive tension of spasmed muscle of extremity, combined with rotation of hand or foot in turns in both directions, and holds tension phase until the end of exhalation. Exercises are carried out for 3 weeks. ^ EFFECT: reduction of muscle spasm, normalisation of muscle tone.

Description

The invention relates to medicine, namely to restorative medicine.

Strokes remain an important medical and social problem, being one of the main reasons for the long-term disability of people of working age. In Russia, among stroke patients, no more than 3-23% return to work, 85% of patients require constant medical and social support. Due to the lack of timely and adequate rehabilitation treatment, leading to the occurrence of irreversible anatomical and functional changes, almost a third remain disabled (Kovalchuk V.V. Principles of organization and the effectiveness of various methods of rehabilitation of patients after a stroke: abstract of thesis ... Ph.D. - SPb., 2008. - С.3.).

During the first three months after a stroke, muscle tone builds up in the paretic limbs, and although at the first stage mild or moderate spasticity, for example, in extensors of the lower extremities will only contribute to the restoration of walking function, in most cases this progressive increase in tone will lead to the development of muscle contractures, which are combined with periodic painful attacks of muscle cramps. Subsequently, trophic changes in the joints of the paretic limbs occur and articular contractures develop. The spastic state of the muscles is a significant obstacle in the restoration of motor functions, leads to disability, self-care skills and dramatically reduces the quality of life of patients who have had a stroke (Kadykov A.S., Chernikova L.A., Shakhparonova N.V. Rehabilitation after a stroke // Atmosphere. Nervous diseases. - 2004. - No. 1. - P.21-23).

The fight against muscle spasticity, the restoration of normal muscle tone is an important and necessary component of the motor rehabilitation of stroke patients.

Known methods of restorative medicine aimed at reducing muscle spasticity:

- a method of reducing muscle spasm using position treatment by laying the arms and / or legs for 2-3 hours in a special position opposite the Wernicke-Mann position (Kadykov A.S., Chernikova L.A., Shakhparonova N.V. Rehabilitation after stroke // Atmosphere. Nervous diseases. - 2004. - No. 1. - P.23.);

- a way to reduce muscle spasm using physiotherapy, including heat therapy with paraffin or ozokerite applications and / or cold treatment (Kadykov A.S., Chernikova L.A., Shakhparonova N.V. Rehabilitation after a stroke // Atmosphere. Nervous diseases. - 2004 . - No. 1. - C.23);

- a method of treating post-stroke conditions, including daily therapeutic massage of the spine with acupressure and manual therapy of the cervicothoracic spine, pre-cooling the spine with compresses, conduct therapeutic massage of the limbs with acupressure from the knee on the back of the thigh and cool the limbs with compresses, after which perform lymphatic drainage from the knee up to the pelvis and from the foot to the knee (Pat. No. 2289380 of the Russian Federation, IPC A61H 1/00. A method for the treatment of cerebral ischemic stroke, hemorrhagic Ragic stroke and post-stroke conditions. Badaev BB / Badaev Boris Borisovich, published on December 20, 2006);

- a method for the prevention of stroke patients due to daily exposure to an electric field with voltage U, determined by law: U = -1.5 kV + 0.5 kV sin 78.5t, with a frequency of 12.5 Hz supplementing it with evening relaxation exercises (Pat. No. 2308984 of the Russian Federation, IPC A61N 1/20. A method for the prevention of stroke patients performed in a home hospital. Romanov A.I., Khatkova S.E., Panteleev S.N. , Savitskaya N.N., Doroshenko G.P., Shamin V.V., Matveeva E.V. / Epidavr Limited Liability Company. Published on 10.27.2007);

- a method of reducing increased muscle tone in cerebral palsy as a result of combined transspinal micropolarization and magnetic pulse stimulation (Pat. No. 2262357 RF, IPC A61N 1/20. Method for reducing increased muscle tone in cerebral palsy. Sirbiladze K.T., Pinchuk D.Yu., Petrov Yu.A., Iozenas N.O., Yuryeva R.G. / State Educational Institution of Higher Professional Education St. Petersburg State Academy named after I.I. Mechnikov. Published on 10.20.2005.);

- a method of normalizing muscle tone in children with spastic forms of cerebral palsy by relaxing the child on an incompletely inflated ball, laying him face down, while one methodist fixes his shoulders on the surface of the ball, hands symmetrically along the body, another methodologist fixes the lower extremities on the surface of the ball and, as relaxation is achieved, part them, performing slow swings back and forth, right-left and in a circle, then perform exercises to stretch the limbs and torso of the child symmetrically, with the same effort, in one horizontal plane, sequentially, starting from the upper limbs and shoulder girdle (Pat. No. 2289381 of the Russian Federation, IPC A61H 1/00. A method of normalizing muscle tone in children with spastic forms of cerebral palsy. Kozhevnikova V.T. ., Sologubov E.G., Polyakov S.D., Smirnov I.E. / State Institution Scientific Center for Children's Health RAMS (GU SCC RAMS), SI Children's Psychoneurological Hospital No. 18 of the Moscow Department of Health. Publ. 12/20/2006);

- a way to reduce muscle spasticity as a result of being in the following positions: lying on your back, on the cushion, and on your stomach, propping your lower jaw with your palms (Kachesov VA, Fundamentals of Intensive Rehabilitation. - M., 1999. - P.76);

- a way to relax spastic muscles due to the massage in the form of stroking, rubbing, shaking, kneading segmental zones (Belova AN Neurorehabilitation. - M .: Antidor, 2000. - P.163);

- a way to relax spastic muscles using therapeutic exercises with exercises aimed at relaxing muscles, by using the weight of the limb to shake or lower it freely, and suppressing pathological synkinesias by eliminating vicious friendly movements (Belova A.N. Neurorehabilitation. - M .: Antidor , 2000. - S. 107);

- a way to reduce the spasticity of the limb, due to the fixation of the limb and the doctor performing a movement in the direction of spasticity of the contracting muscle, with flexion and rotation of contracting muscles (Kachesov VA Fundamentals of intensive rehabilitation. - M., 1999. - P.76)

A known method of treating muscle spasm using postisometric relaxation, consisting of two phases, alternating 5-6 times, is first performed isometric contraction of the muscle during inspiration for 8-10 s, using light resistance provided by the doctor in the opposite direction to muscle contraction, then passive stretching of the muscle on the exhale for 10-20 s (Belova A.N. Neurorehabilitation. - M.: Antidor, 2000. - P.115). This method is selected for the prototype.

However, this method cannot be used to treat severe muscle spasticity, since it is performed when the muscle performs the contraction phase, which is possible only with unexpressed spasm; muscle contraction and retention of this phase for 8-10 s through the resistance created by the doctor causes the patient to have persistent pain and provokes the subsequent progression of spasticity; with concomitant osteoporosis, with the development of muscle or articular contracture, with the use of more force by a doctor to stretch a muscle, a limb fracture is possible during the passive stretching phase.

The objective of the invention is to increase the effectiveness of the treatment of spastic muscle condition after a stroke.

The technical result is to reduce muscle spasm, normalize muscle tone.

This is achieved due to the fact that for 20-30 minutes the doctor performs passive stretching of the spasmodic limb muscle, combined with rotation of the hand or foot alternately in both directions, on the forced maximum expiration of the patient, and holds the stretching phase until the end of the expiration, exercises are carried out for 3 weeks.

After the patient’s limbs are placed in a comfortable position, which helps to relax spasmodic muscles, the doctor performs a passive exercise, as the patient cannot perform active movements on his own; Considering that the length of the spasmodic muscle is sharply shortened, they do a stretching exercise, which increases the length of the muscle and ensures its relaxation reflexively; turns of the hand or foot during the exercise create the direction of the physiological movement of the spasmodic muscle along the biomechanics of movement, contributing to its uniform extensibility and restoration of physiological tone; performing an exhalation exercise creates conditions for reflex relaxation of the muscle, forced expiration will allow the patient to exhale as much as possible, which will extend the time it takes to stretch and allow the muscle to work out more efficiently; the retention of the phase of passive extension of the muscle on the exhale contributes to its deeper relaxation and getting used to the muscle in a “healthy” state, preventing its subsequent persistent spasm; exercises are performed until a feeling of stretching occurs, saving the patient from persistent pain and limb injury; the duration of one lesson of 20-30 minutes allows you to repeatedly repeat the exercise, increasing the angle of extension in the joint of the spasmodic limb, due to a gradual increase in the length of the muscle and its relaxation; a course of 3 weeks, as practice has shown, will reduce muscle spasm, restore muscle tone, achieve full movement.

A method of treating a spastic muscle condition after a stroke is as follows.

The spasmodic limb is placed in a comfortable position, providing muscle relaxation, after which the doctor performs passive stretching of the spasmodic limb muscle for 20-30 minutes, combined with rotation of the hand or foot alternately in both directions, on the forced maximum expiration of the patient, and holds the stretching phase until the end exhalation, exercises are carried out for 3 weeks.

Clinical example.

Patient J., and / b No. 22547. Diagnosis: Condition after acute circulatory failure in the pool of the right anterior cerebral artery, dated March 22, 2009. Complaints about the lack of movement in the left arm, its constant bent position, periodic pain in the left shoulder.

The patient underwent reconstructive treatment, in which the left hand was laid on a hard roller without leading to the side, providing support from the shoulder joint to the elbow inclusively, which ensured muscle relaxation, after which the doctor performed passive stretching of the spasmodic limb muscle, combined with rotation of the hand alternately in both hand, on the forced maximum expiration of the patient with retention of the stretching phase until the end of expiration. The exercise was performed daily for 20-30 minutes. The course of treatment was 3 weeks.

As a result of the treatment, the patient experienced a steady decrease in spasticity of the muscles of the left upper extremity, movement in her elbow joint was restored, at rest she acquired her normal “straightened” position.

Claims (1)

A method for treating a spastic muscle condition after a stroke by passively stretching an expiratory muscle, characterized in that for 20-30 minutes the doctor performs passive stretching of the spasmodic limb muscle, combined with rotation of the wrist or foot alternately in both directions, on the forced maximum expiration of the patient, and holds the stretching phase until the end of exhalation, exercises are carried out for 3 weeks.