RU2747678C1 - Method for restoring upper limb functions in patients with cervical spinal cord injury - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to physiotherapy exercises and rehabilitation and can be used to restore the functions of the hand in patients with spinal cord injury at the cervical level. For this, physical exercises are consistently done. Physical exercises shorten the tendons of the long flexors of the fingers, strengthen the extensors of the hand. A functional tendon tenodesis is performed, in which, due to extension in the wrist joint, the hand is compressed into a fist, and due to its flexion, the hand is opened. Then coordinating exercises are done. Exercises involving gripping and manipulating objects of different sizes and weights and training self-service skills are done. The duration of a lesson is 30-45 minutes. Then, for 20 minutes, hand orthosis operation is performed in a soft-tissue orthosis, which provides an extension position in the wrist joint of 30 degrees, flexion in the metacarpophalangeal joints of 70-80 degrees, flexion in the interphalangeal joints of 60-90 degrees, fixation of the first finger in the position of opposition to the distal interphalangeal joint of the second finger. The lessons are held daily, the duration of the course is 20 lessons.

EFFECT: method provides formation of the main types of hand and finger grips and ability to manipulate objects, expanding the degree of functional independence and improving the quality of life of patients with spinal cord injury at the cervical level.

1 cl, 1 tbl, 2 ex

Description

The invention relates to medicine, in particular to physiotherapy exercises, namely to the rehabilitation of patients after injury to the cervical spine, and can be used in the complex rehabilitation treatment of these patients in medical rehabilitation centers.

The incidence of spinal cord injury is 15-29 cases per million population per year, with the incidence of tetraplegia (TE) varying from 22% in Estonia to 75% in Japan (Lee B.B., 2014). The prevalence of CMT in the world over the past 40 years has increased several times, and in developed countries is 490-526 spinal injuries per million population (Kang Y., 2018). Injury of the cervical spinal cord is accompanied by damage to the motor functions of the upper and lower extremities with the development of spinal tetraplegia in severe cases. The motor function of the upper limbs with complete damage to the cervical spinal cord is primarily due to the level of its damage (Burns A.S., Ditunno J.F., 2001). In 77% of cases, patients with spinal tetraplegia associate a significant improvement in their quality of life with an improvement in hand functions (Snoek G.J. et al., 2004). Traditionally, 7 typical hand grips are described: terminal finger, lateral finger, 5-finger finger, diagonal palmar, transverse palmar (cylindrical), three-finger, spherical hand. In this case, patients with spinal tetraplegia mainly use cylindrical, digital lateral and digital end grips (Kalsi-Ryan S. et al., 2009). The method of surgical tendon transfers remains widely popular, which allow restoring not only the grips, but also providing them with sufficient strength to hold and manipulate objects (Fridén J. et al., 2015). Nevertheless, in a review of the literature on upper limb rehabilitation by SCIRE (version 5.0) (2014), it was shown that in the subacute and chronic recovery period after spinal cord injury, exercise remains one of the main rehabilitation methods that can significantly improve the residual motor functions of the upper limbs. ...

There are a number of ways to restore upper limb function in neurological patients. In particular, "A method of forming the support function of the upper limbs in patients with pathology of the spine and spinal cord at the cervical level." The authors of the method act on the patient in the prone position with the hands resting on the floor and the simultaneous application of impulse low-frequency electrical stimulation on the attachment area of the deltoid muscles, the lower portions of the trapezius muscles (patent RU 2715549, IPC A61H 1/00, A61N 1/32, A61H 7/00, authors: Konovalova N.G., Lyakhovetskaya V.V., Dedikova T.N.).

The disadvantage of this method is the focus of rehabilitation treatment only on the supporting function of the hands, while numerous functions of the hand are left unattended.

There is also known a Method of rehabilitation for self-study at home in patients with flaccid peripheral paralysis of the extremities (Shtokolok BC, Yamaletdinova G.A. Physical rehabilitation of patients with flaccid peripheral paralysis of the limbs using massage techniques and techniques of rational movements. Healthcare, education and safety, 2016. - No. 4 (8). - S. 57-62). The authors propose to use a system of physical rehabilitation, which is based on the joint activities of the instructor and the patient, including self-massage of the affected limb, massage of the cervical spine and exercise. At the first stages, passive, isometric and breathing exercises are used, then, as the patient's motor capabilities expand, movements on a sliding surface and movements with limb flexion are added. The course is completed with exercises for the inclusion of a limb in general motor stereotypes and in two-handed manipulation on the example of sculpting, throwing a ball with a gradual decrease in its size.

The disadvantages of this method are the lack of selection of active exercises, methods of their relief, depending on the degree of paresis of the muscles of the hand; purposeful training of basic hand grips, and muscle synergies, development of basic applied self-care skills necessary for spinal patients.

Also known is a method of rehabilitation associated with the use of an exoskeletal system of the upper limb, integrated with biofeedback and virtual reality modules. The most famous of the systems actively used in world practice is the Armeo Spring system (Hocoma AG, Switzerland) (Zariffa J., Kapadia N., Kramer JLK et al. Feasibility and efficacy of upper limb robotic rehabilitation in a subacute cervical spinal cord injury population . Spinal Cord, 2012; 50, p. 220-226). The patient is in a sitting position in a wheelchair in front of the monitor screen, one of the upper limbs is located in the exoskeletal system, the staff unloads the weight of the limb, adjusts the planes of flexion-extension, adduction-abduction, supination and pronation in the shoulder and elbow joints. The involvement and motivation of the patient is provided by the game interface of the motor tasks offered to the avatar (the patient from the first person). The patient performs active, active-passive exercises both with the upper limb and the trunk.

The disadvantages of this method are that in 25% of the proposed motor tasks, the participation of medical personnel is required, there is no training of the grasping and manipulative functions of the hand, as well as actual applied skills of self-service, the asymmetry of motor functions between the right and left upper limbs is not taken into account, there is no possibility of training bimanual motor skills ...

The closest in technical essence to the proposed invention is "A method for restoring hand function in patients with paralysis and paresis of the upper extremities" (Patent RU 2695721, IPC A61H 1/00, authors: Konovalova N.G., Lyakhovetskaya V.V., Khomyakova A . BUT.). This method includes massage and self-massage of the affected limb, exercise, hand manipulation with objects of different weights and shapes. The course consists of three consecutive stages, the criterion for the transition from stage to stage is the mastering of the exercises of the previous stage. Each lesson consists of three parts: introductory, main and final. In the lessons of the first stage, the introductory part includes acupressure, stretching the soft tissues of the hand and fingers, passive flexion and extension of the fingers and hand. The main part includes a set of active-passive exercises, while sequentially carrying out movements in the radiator and wrist joints, exercises for the hand and fingers. In the lessons of the second stage, the introductory part of the exercises includes repeating the exercises of the lessons of the first stage. The main part includes active exercises in lightweight conditions in a closed kinematic chain, exercises as part of synergies, the order of performing exercises: first in the radial joints and the wrist joint, then - flexion and extension in the joints of the fingers, then - the opposition of the thumb and little finger. At the third stage, the main part of the exercises includes the patient's performance of movements independently in an open kinematic chain, at the end they perform exercises that coordinate the work of all muscle groups of the upper limb and shoulder girdle, form pinch, spherical, cylindrical grips. The final part of the session is the same for all stages and includes object manipulation, massage and self-massage.

The disadvantages of this method are that it does not take into account the heterogeneity of the motor deficit depending on the level of spinal cord injury; passive mechanical properties of the hand are not realized in patients with the absence of active movements in the fingers of the hand, which are the basis of functional tendon tenodesis; the method is based on a phylogenetically determined model, which contradicts the modern functional model of movement organization; the method does not contain signs of task-orientation on the formation of applied motor skills of self-service and does not consider the use of assistive devices and substitutional strategies for the implementation of significant skills of self-service.

The technical result of the proposed method for restoring the functions of the upper limb in patients with spinal cord injury at the cervical level is to improve the formation of the main types of hand and finger grips and the ability to manipulate objects, expand the degree of functional independence, improve the quality of life of patients with spinal cord injury at the cervical level.

The specified technical result is achieved by consistently applying posture treatment, active-passive exercises, shortening the long flexor tendons of the fingers, strengthening the extensor muscles of the hand, forming a functional tendon tenodesis, then using coordinating exercises, manipulating objects of different sizes and weights, training self-service skills; classes lasting 30-45 minutes in combination with subsequent orthosis of the hand in a soft-tissue orthosis that provides an extension position in the wrist joint of 30 degrees, flexion in the metacarpophalangeal joints 70-80 degrees, flexion in the interphalangeal joints 60-90 degrees, fixation of 1 finger in position opposing the distal interphalangeal joint of 2 fingers, for 20 minutes, classes are carried out daily, the duration of the course is 20 sessions.

Method description

Conduct a course of study, which includes two stages. At the first stage, active-passive exercises and position treatment are used with the aim of adaptive shortening of the long flexor tendons of the fingers, strengthening the extensors of the hand, which makes it possible to form a functional tendon tenodesis. At the second stage, coordination exercises are used, manipulation of objects of different sizes and weights, and training of self-service skills. The criterion for the transition to stage 2 is the formation of functional tendon tenodesis - compression of the hand into a fist due to extension in the wrist joint, and opening of the hand due to flexion in the wrist joint. During the lesson, the patient is in a sitting position, the upper limbs are located on the table, the physiotherapy specialist (assistant) sits in front of him at the table or stands on his side facing the table, organizes the lesson based on the principles of patient-orientation, tasks-specificity , relies on the physiological principles of training, the laws of motor learning, involves assistive devices and substitution strategies, assesses the degree of motor and neurological disorders, selects burdens and facilitates the performance of exercises, creates a configuration of the biokinematic chain.

In the first stage, the main part of physical exercise includes:

1. Treatment by position

The initial position (IP) is sitting at the table, the forearms lie on the table, in the pronation position, palms are turned down, soft rollers lie under the metacarpophalangeal joints (PFC), providing flexion in the PPS of 50 degrees (gr.), Extension in the interphalangeal joints ( MFS) 0 gr., Extension in the wrist joints (LZS) 20 gr., Opposition and abduction of 1 finger;

- 5-10 minutes per lesson, performed while exercising with the other hand;

2. Exercises to shorten the flexor tendons of the fingers:

2.1 IP the patient sits at the table, the forearm lies on the table in the pronation position, rests the elbow on the table, the assistant holds the hand above the table surface with one hand, the angle of flexion in the elbow joint (LS) is 30 g, LZS is in the middle position or 10 g ... radiation deviation.

- the patient actively extends the LZS, while passive flexion occurs in the PFJ, MFS, the assistant actively-passively brings it to an angle of 90 degrees,

- static holding of the pose for 5-10 seconds, 5-10 repetitions;

2.2 SP similarly, see 2.1.

- the patient actively performs flexion in the PFJ without extension in the LZS, the assistant brings the flexion in the PFJ up to 90 degrees,

- static holding of the pose for 5-10 seconds, 10-15 repetitions;

2.3 SP similarly see 2.1.

- the patient actively performs flexion in the LZS, flexion in the PFJ, the assistant brings the flexion in the PFJ up to 90 g;

-static holding of the pose for 5-10 seconds, 5-10 repetitions;

2.4 PI the patient sits at the table, the forearm lies on the table in a neutral position between supination and pronation, the angle of flexion in the elbow joint is 30 degrees; the assistant holds the LZS in the middle position or 10 g with one hand. radiation deviation;

-the patient actively performs extension in the LZS and flexion in the PFJ, MFS, the assistant brings the flexion to 90 degrees;

-static holding of the pose for 5-10 seconds, 5-10 repetitions;

2.5 SP similarly see 2.4

-the patient performs flexion in the PFJ, without flexion in the LZS, the assistant brings the flexion;

-static holding of the pose for 5-10 seconds, 5-10 repetitions;

2.6 PI similarly, see 2.4.

-the patient actively maximally flexes the LZS and PPS, the assistant brings the flexion;

- static holding of the pose for 5-10 seconds, 5-10 repetitions;

3. Exercises for extension in the LZS.

3.1 IP the patient sits at the table, the elbow rests on the table, the angle of flexion in the LS is 30 degrees, the assistant holds the hand over the table with one hand, the LZS is in the middle position or 10 degrees. radiation deviation;

- the patient actively maximally unbends the LZS, static hold 5-10 sec, 5-10 repetitions;

3.2 SP similarly see 3.1

-the patient actively maximally unbends the LZS, the assistant presses on the back of the hand (with springy movements 5-8 times), the patient prevents flexion in the LZS;

- static holding of the pose for 5-10 seconds, 5-10 repetitions;

4. Tenodesic tendon exercises:

4.1 IP the patient sits at the table, the forearm lies on the table in the pronation position, the assistant holds the hand over the table with one hand and the LZS in the middle position;

- the patient independently flexes the LZS and unbends in the PFC and MFS, the assistant brings the extension;

- static holding of the pose for 5-10 seconds, 5-10 repetitions;

4.2 SP similarly see 4.1

- the patient independently unbends the LZS and flexes in the PFJ and MFJ, the assistant brings the flexion;

- static holding of the pose for 5-10 seconds, repetitions of 5-10;

4.3 IP the patient sits at the table, the forearm lies on the table in the pronation position, the assistant holds the PFJ in the flexion position of 50 degrees, the MFJ in the extension position;

- the patient independently performs extension in the LZS, the assistant holds the thumb in the opposition position, rotates it slightly in relation to the index finger, achieving the connection of the terminal phalanges of 1 and 2 fingers;

- static hold (5-10 sec), 5-10 reps;

4.4 SP similarly see 4.3

- the patient unbends the LZS, unfolding the hand to the ulnar edge, while the assistant holds the thumb in the position of support on the surface (opposition), helping to abduct it;

- static holding of the pose for 5-10 seconds, 5-10 repetitions;

5. Coordination exercises and gripping (using spherical objects (10, 7, 5, 3 cm in diameter), cylindrical (1.2.5 cm in diameter), various weights (material: metal, wood, plastic)

In the second stage, the main part of physical exercise includes:

5.1 Setting up the ball gripper

5.1.1 IP the patient sits at the table, the elbow rests on the table, the forearm is in the pronation position;

- performs simultaneous flexion in the LZS and extension in the PFC and MFS using the lower position of the thumb, grabs the ball, performs extension in the LZS, grabs it, holding the forearm in the pronation position, performs flexion, extension of the forearm, movement of the support on the table;

- static holding of the grip for 5-10 seconds, 5-10 reps;

5.1.2 IP the patient sits, the hand is in a free position, the forearm is pronated, the ball is held by the assistant above the table in different positions;

- flexion in the LZS and extension in the SFC and MFS are performed, the patient grasps the ball, performs extension in the LZS and grabs and holds the ball in space, the ball is captured from different positions (adduction, abduction in the shoulder joint (SS), extension and flexion in LS);

- 5-10 reps;

5.1.3 IP see clause 5.1.1

- holds the ball and performs active rotation of the forearm (supination, pronation) in combination with movements in LS, PS, collects balls of different sizes from different positions;

- 5-10 reps;

5.2 Setting up the hand cylindrical gripper

5.2.1 IP the patient sits at the table, the elbow rests on the table, the forearm is in the middle position between supination and pronation, cylindrical objects are laid on the table in different planes;

- the patient performs flexion in the LZS and extension in the PFJ and MFS, captures different cylinders, due to extension in the LZS, he holds them; makes movements in drugs,

- static holding of the grip for 5-10 seconds, 5-10 reps;

5.2.2 IP the patient sits at the table, the arm is in a free position, the forearm and hand are in a neutral position between supination and pronation,

- due to active flexion in the LZS and simultaneous extension in the PPS, MFS, abduction of the thumb, the patient grasps the cylinder, performs extension in the LZS, holds and collects the cylinders from different positions, due to adduction, abduction in the PS, extension and flexion in the LZ ,

- 5-10 reps;

5.2.3 IP similarly, see clause 5.2.2.

- the patient holds the cylinder, actively rotates the forearm (supination, pronation), collects the cylinders from different projections (with adduction, abduction in the PS, extension and flexion in the LS);

- 5-10 reps;

5.3 Setting the finger ball gripper

1 IP the patient sits at the table, the elbow rests on the table, on which small objects (balls) are scattered, the forearm is in pronation, the patient due to actin flexion in the LZS, extension of the PFJ, the MFS grasps the ball between 1 and 2 fingers, performs supination metacarpus with support on the ulnar edge of the hand and opposes 1 finger to a slightly rotated index finger, unbends the LZS captures the ball and holds the ball, forearms in the pronation position 10-15 g .;

- performs a static hold of the pose for 5-10 seconds, 5-10 repetitions;

5.3.2 MT similarly see 5.3.1

The patient holds the ball between 1 and 2 fingers, holds the forearms in the 10 g position. pronation, produces supination, pronation of the forearm, adduction to the PS, flexion, extension to the LS,

- static-dynamic posture holding 5-10 sec, 5-10 repetitions;

5.3.3 IP the patient sits, the hand is in space, the assistant holds balls of different diameters (2-5 cm) in his hand at different points of the working space, the patient grabs between 1 and 2 fingers, holds the ball, supination, pronation of the forearm, adduction , abduction in the PS, flexion, extension in the LS, collects objects from different points of the workspace,

- 5-10 reps;

5.4 Placing a finger grip

5.4.1 IP the patient sits at a table with support on the elbow, sticks of 1-2 cm in diameter (pen, pencil, catheter, cord, brush, drinking tube) are placed on the table in different planes, the forearm is in the middle position between supination and pronation,

The patient, due to bending in the LZS, grabs objects between 1 and 2 fingers, maximally unbending the PPS, MFS; performs supination of the metacarpus with support on the ulnar edge, which leads to opposing 1 finger to the rotated index finger, due to extension in the LZS, maintaining the extension position in the MFS of 1 and 2 fingers, holds the object and performs movements in the LN,

- static holding of the pose for 5-10 seconds, 5-10 reps;

5.4.2 IP similarly see 5.4.1 the hand is in a free state,

- the patient grabs and holds the object at the expense of 1 and 2 fingers, then makes active movements in the LS, PS, pronation and supination of the forearm, collects objects from different projections;

- 5-10 reps;

6. Self-service skills:

6.1. Eating

6.1.1 A properly sized wheelchair is of great importance. Utensils for classes should have rims. It is advisable to use individual special cutlery with strap fasteners (on the hand, on the forearm) and with a thickened handle. The training begins with viscous, easily sticky products (for example, cereals, cottage cheese, mousses, soufflés, mashed potatoes, salads).

The IP patient sits in a comfortable position at the table, resting on the elbow, the forearm is in pronation, due to flexion and extension in the LZS, he performs a wrist cylindrical grip with opposing the thumb to an adapted spoon with a thickened handle, then he grips the product from the plate with a spoon, while the patient maintains support on the elbow and keeps the forearm in a neutral position, brings the spoon to the mouth.

- 10-15 repetitions;

6.1.2 Putting on the T-shirt

The IP patient sits in a wheelchair, in a bed or on a chair, the T-shirt lies on his knees. T-shirt positioning options: front side up, back side up, hole for the head at the knees, hole for the torso to the torso;

- the patient with his right hand grasps the opening of the left sleeve with a wrist grip, with his left hand enters his hand into the left sleeve through the opening for the body, holding the sleeve with his right hand, pulls the sleeve above the LS, with his left hand captures the opening of the right sleeve, with his right hand enters the hand into the right sleeve through the hole for the torso, holding the sleeve with the left hand, pulls the sleeve above the LS, then with the leading hand (more force, amplitude, individually) holds the clothes by the edge of the neck (from the back), and passes the head through the hole, bends slightly forward, raises his arms alternately up , and alternately puts his hand behind the back, grabs the hem of the shirt and straightens it.

The procedure for orthotics of the hand is performed after the main lesson at stage 1 for 20 minutes, 2 times a day, and at stage 2 for 20 minutes, 1 time per day. The procedure includes putting on the soft tissue orthosis "Ripsel" on the hand, which provides an extension position in the LZS 30 g., Flexion in the PPS 70-80 g., Flexion in the MFS 60-90 g., Fixation of 1 finger in the position of opposing the distal interphalangeal joint 2 fingers ; for this, a soft roller with a diameter of 1-2 cm is additionally inserted into the brush, depending on its size.

Indicators of the adequacy of physical activity during this method of treatment are the absence of sensations of a pre-syncopal state (weakness, headache, impaired consciousness, darkening in the eyes), adequate reactions of blood pressure, heart rate in relation to the baseline against the background of an orthostatic and stress test. Before starting treatment, patients are interviewed using the COPM questionnaire in order to find problem areas of vital activity, the leading activity is highlighted, the desired result for the near future is prescribed using the GAS scale.

Examples of implementation of the method:

Example 1

Patient B-ko D.V., 15 years old, diagnosis: Complicated fracture of the C6 vertebra dated 06/12/2019, subacute period, complete tetraplegia, motor level C6, type A (ASIA). Orthostatic hypotension. Dysfunction of the pelvic organs. Condition after surgical treatment: cervical corporodesis C5-C7 (from 14.06.2019), early postoperative period.

Upon admission, ASIA motor score (international standard of neurological assessment) 14 (14%) points, functional motor FIM (Functional Independent Measure) score 15 (16%) points, upper limb function assessment by VLT (Van Lieshout Test) (short version ) 6 (6%) points, quality of life WHOQOL-BREF (WHO Quality of Life-BREF) - 53 (50%) points. Contractures of the joints of the hand and fingers were not found, passive movements in the shoulder and elbow joints were found in full, the phenomena of moderate orthostatic hypotension. There are no active movements in the fingers, the grasping function of the hands is minimal, the self-service restriction is pronounced, the quality of life is significantly reduced.

The patient was engaged in remedial gymnastics according to the given method. Lessons of stage 1 were performed in the ward in a bed with a raised head end; later, the patient was placed in a wheelchair in an abdominal band, which made it possible to conduct classes in the exercise therapy room. Strengthening the muscles of the extensors of the hand, adaptive shortening of the flexors, the formation of functional tenodesis and main grips and orthotics were spent 5 weeks, 25 sessions. After that, the patient proceeded to the second stage of rehabilitation, which lasted another 7 weeks (only 3 months of rehabilitation). As a result, the patient mastered independent eating, grabbing small and medium-sized objects of various shapes, using a telephone, a computer, a number of personal hygiene skills, partial dressing, undressing. Discharge score: ASIA 18 (18%) FIM38 (42%), VLT 56 (56%), WHOQOL-BREF 65 (62%) points.

Example 2

Patient Gl-v SE, 35 years old, diagnosis: Consequences of complicated fracture of the C7 vertebra (2 years), incomplete tetraplegia, motor level C7, type C (ASIA). Upon admission, AISA 40 (40%) points, functional assessment for motor FIM (Functional Independence Measure) 74 (81%) points, assessment of upper limb functions VLT (Van Lieshout Test) 74 (74%) points, orthostatic test - physiologically inadequate , quality of life WHOQOL-BREF (WHO short questionnaire of quality of life) 79 (75%) points. The patient immediately proceeded to the second stage of the exercises and to the orthosis of the hand. Exercises were performed to improve the opening phase of the hand and improve the opposition of the first finger, coordinated exercises with blocking one of the components, strength exercises for the upper limb, which made it possible to improve the dexterity of finger grips (the patient began to take beads, buttons, coins), to increase the ability to grip large objects with one hand (apple, pear, food container). The course of treatment was 30 days, 20 sessions. At discharge, the neurological status - no dynamics AISA 40 (40%) points, functional status FIM 80 (88%), VLT 82 (82%), quality of life WHOQOL-BREF 86 (82%) points - positive dynamics.

This method of restoring the functions of the upper limb in patients with pathology of the spine and spinal cord at the cervical level was tested at the JSC Rehabilitation Center for Disabled People "Overcoming" (Moscow), where in 2011-2018, 90 patients with injuries of the cervical spinal cord were treated. with a prescription of spinal cord injury 3.4 ± 1.2 years, the age of the patients was 27 (21.0; 36.0) years, of which there were 75 men and 15 women. Patients received rehabilitation, which included exercise therapy according to our proposed method. The rehabilitation course lasted for 30 days, during which the patients received 20 sessions of 30-45 minutes duration, followed by hand orthosis in a soft tissue orthosis for 20 minutes. As a result of rehabilitation, 52% of patients showed positive dynamics in manipulative and grasping skills of the hand (VLT up to 31 ± 19.1 after 47 ± 21.2 points), in 56% of patients - in terms of the degree of functional independence (FIM up to 35 ± 19.4 after 45 ± 21.4 points), in 25% - according to the quality of life (WHOQOL-BREF up to 50 ± 11.3 after 60 ± 15.8 points) (Table 1).

Table 1

Scales At the beginning of treatment At the end of the treatment VLT 31 ± 19.1 47 ± 21.2 FIM 35 ± 19.4 45 ± 21.4 WHOQOL-BREF 50 ± 11.3 60 ± 15.8

Based on the foregoing, it should be said that the proposed method is a clinically effective and biomechanically grounded method for restoring the functions of the upper limb in patients with spinal cord injury at the cervical level.

The data obtained indicate that the proposed method allows us to form the main types of hand and finger grips and improve the degree of manipulation of objects in patients, taking into account the characteristics of the level of spinal cord injury, the method implements passive mechanical properties of the hand in combination with residual motor functions in patients with a lack of active movements in the fingers of the hand, the method also provides for a multidirectional order of mastering self-service skills, which corresponds to the functional model of the organization of movements; the task-orientation of the method contributes to the formation of relevant and applied skills of self-service, taking into account the use of assistive devices and substitution strategies, the method increases the degree of functional independence, improves the quality of life of patients with spinal cord injury at the cervical level.

Claims (1)

A method for restoring the functions of the upper limb in patients with spinal cord injury at the cervical level by performing therapeutic exercises, including physical exercises and manipulation of the hand with objects, characterized by the fact that positional treatment, active-passive exercises, shortening the long flexor tendons of the fingers, strengthening muscles extensors of the hand, form a functional tendon tenodesis, then use coordinating exercises, manipulation of objects of different sizes and weights, training of self-service skills; classes lasting 30-45 minutes in combination with subsequent orthosis of the hand in a soft-tissue orthosis that provides an extension position in the wrist joint of 30 degrees, flexion in the metacarpophalangeal joints 70-80 degrees, flexion in the interphalangeal joints 60-90 degrees, fixation of 1 finger in position opposing the distal interphalangeal joint of 2 fingers, for 20 minutes, classes are carried out daily, the duration of the course is 20 sessions.