Reactivation of motor function
with neurodynamic methods of rehabilitation
Department of neurology and neurosurgery of Advanced Training Faculty and Professional Retraining of specialists
SEI HVE «Kazan state medical university»
Reactivation of motor function after brain damages is possible in case of reactivation of vital actions in lesional tissues of brain, and in case of constant fuctionally anatomic defects by means of reorganization of functions on the ground of adaptive compensatory mechanisms with the help of different «reserve» possibilities of central nervous system, that especially refers to cerebral cortex.
The latter is of great importance in case of less inversive nervous breakdowns for practical habituation of patient to active everyday life and is the base of his social rehabilitation.
In literature attention is given to the data of tomographic examinations of brain (1,2,3), which showed that functional recovery after ischemia is connected with the processes of significant reorganization of cerebral activity. These results help to clarify mechanisms of spontaneous recovery of some patients and let us pay attention to importance of usage of specific, pathogenetically based medical technologies of proprioceptive stimulation, having a significant impact on functional flexibility of brain and on acceleration of recovery of structural and functional changes in brain in order to activate central nervous system…
In that connection we used the method «Kinesitherapy in medical conductive rehabilitation of neurologic patients with motor defects» (№FA-2006/135, is worked out on the groud of the method PNF) as a whole with neuro-orthopedic device «Atlant».
Rehabilitational, technical device «Atlant», adapted pressure-suit garment PSG 6,is registered as a new medical technical device of rehabilitation. Neurophysiological features of rehabilitational suit are the same as in kinesitherapy, that is to activate autoregulation of muscle tone at spinal level in reply to intense afference in the process of approximation of muscular-arthral system and ligamentous apparatus with the help of tensioning devices in the suit.It is applied in developed system of rehabilitation since 1996 in patients with infantile cerebral paralysis aged from 14 till 19. At the present time indications for its use have expanded so these are patients with apoplectic stroke, traumatic brain injury, cerebrospinal trauma, multiple sclerosis.
The objective of the present research was to study influence of kinesitherapy method (home equivalent of PNF) and of device «Atlant» in the method on recovery of ambulation in neurologic patients at distance from 50 metres and more, symmetry of gait and step acceleration.
In the training participated patients in residual period of disease, after acute cerebrovascular stroke from one to three months 13 patients,aged 50 till 70 (10 men, 3 women) and 20 patients with different forms of infantile cerebral paralysis upwards 16. All the patients had difficulties of walking independently till 50 metres, had defects in step symmetry and walking speed.
Control group of patients consisted of 25 people aged 27 till 40 with motor defects, with infantile cerebral paralysis and after apoplectic stroke. They underwent rehabilitation with the help of exercise therapy, massage and physical medicine.
Rehabilitation of patients was held from two weeks till three months depending on severity of motor defects. Rehabilitation was organized under the conditions of hospital and outpatiently.
An emphasis was put on postural control, ability to walk, to turn, to start and to stop movement, to draw nearer gait to physiologic movement pattern through step symmetry and speed for all the patients in the training. For these purposes certain tests after Bokhannon, Bradstatera were used.
In the training on reactivation postural control in the standing position and while walking with the help of orthopedic device «Atlant» attention was paid to posture extension, footing on whole foot and rock-up from heel on the whole foot in the first phase of double step, when the leg is in front of the body.
At the stage of training of stabile gait in the suit «Atlant» attention was paid to cyclic movements, connected with repulsion of the body from footplate and its movement in space. While patient learns to move steadily, afferent proprioception decreases through regulated pressure in elastic rods, arranged in the suit along the antagonistic muscles of extremities and soma (body), along with it time of wearing neuro-orthopedic device reduces.
Training of patients with motor deficiency on reactivation proper ambulation for more than 50 metres, was carried out successively, in two stages.
At the first stage, ability of patient to keep the body and extremities in the given position was trained with the help of kinesitherapy method. It was carried out by the instrumentality of specific samples of spirally diagonal models of movement in the method training on initiation proper fragments of gait is carried out.
Methods of rhythmical stabilization and controlled mobility in original lying position, on all fours, when seated and in modified “bear” pose, which are used in kinesitherapy, were applied here.
At the second stage, training of retention proper position during gait (ambulation) is carried out with the help of rehabilitation suit “Atlant”. Also by the instrumentality of this suit proper pace of step, its symmetry and speed of gait of the patient is developed.
At the first stage, kinesitherapy method activated motor fuctional system which has several nodular mechanisms as a universal model of brain: afferent synthesis, «decision making», acceptor of action results.
In pursuing these aims training of motor skills in patient started from making the most primitive, but «recognizable» by muscular, arthral systems and central nervous system movement - «mass flexion» or embryo position, which is made by the patient actively in case of skillful hand operation of the assistant. Measure of physical support from the assistant depends on state of supraspinal motor control of the patient. Made by the patient motor patterns work at the level of muscular synergism. They initiate weak muscles and by means of central nervous system mechanisms involve them into active muscular activity, thereby functionally the patient has possibility for dynamic actions.
At the second stage, in order to train proper gait, rehabilitation suit “Atlant” was used, its approximating influence of tensioning devices (chambers under pressure) on muscular-ligamentous and arthral apparatus intensifies impulses of proprioceptors and improves function of motor centres of all the three levels of central nervous system. Patient is able to keep proper position and move in a proper way at the first procedure already. Effectiveness of rehabilitation in the suit increases, if it is combined with kinesitherapy. We used three operating modes for training in the suit “Atlant”. The first mode is of keeping position, unilateral model for upper extremity, in original dorsal position, roll sidelong and pronate roll. The second mode includes original standing position, backed on upper extremities in modified position of a “bear” in the suit “Atlant”, training of gait fragments at opposite resistance.
The third mode consists of gait in the suit “Atlant” in different directions, frontwards, backwards, chasse step at opposite resistance. Each training terminated with retention of position or gait without suit.
Results of the training were evaluted according to FAC-category of independence in gait and according to indicants of step speed, step length, its amplitude,and duration of covered distance.
Usage of kinesitherapy method worked out on the ground of principles and of rehabilitation device “Atlant” in rehabilitation of patients with neurologic motor deficiency showed that walking ability improved in all the patients after executed rehabilitation.
Some patients, who resorted to support from time to time, managed to move independently. Step speed of all the patients increased at the average twofold, metering step and amplitude increased approximately twofold, duration of stable gait from one hundred metres and more took place of all the patients.
Pic. 5. Indications of categories of functional movement in the process of trainig. Course А1 and А2 – usage of the method NTD and neuro-orthopedic suit. Course of trainigs В– traditional scheme of exercise therapy and physiotherapy.
Pic. 6. Gait speed. Course А1 and А2 – usage of the method NTD and neruro-orthopedic suit. Course of trainigs В – traditional scheme of exercise therapy and physiotherapy.
1. Training of the patients with disordered motor functions by the method of kinesitherapy and with the help of neuro-orthopedic device “Atlant” lets us achieve high level of their rehabilitation, reactivate functional independence and advance social and labour readaptation of patients.
2. Regular and sequential trainings of patients with motor defects can reactivate proper gait of 24% patients under study, physiologic stereotype of 23% patients. Gait speed increased of all the patients under study in the main group.
1. Batisheva Т.Т., Artemova I.Y. Chronic ischemia of brain: mechanisms of development and modern comprehensive treatment. Guide of practical doctor. M. 2004;
2. Gusev E.I. ,Skvorcova V.I.. Ischemia of brain M: Medicine 2001;
3. Bo bath B. Adult Hemiplegia. 2nd edn. William Heinemann Medical Books. London, 1978.
4. Mauritz K-H. General rehabilitation. Current Opinion Neurol Neurosurgeri.- 1990.-№3.-Р.714-718.
5. Voss D.E., Ionta M.K., Meyers B.J. Proproceptive Neuromuscular Facilitation. 3nd edn. Harper & Row. New York, 1985.
6. Kogan О.G.,Naidin V.L. Medical rehabilitation in neurology and in neurosurgery - M.: Mdicine, 1988.-304 p.
7. Isanova V.A. Neurorehabilitation.- Kazan, 2004.-288 p.