Diagnosis and Treatment of Motor Disorders Using a Bilateral Stabilographic Platform in Clinics for Nerve Diseases

Ustinova, K.I.; Chernikova, L.A.; Матвеев, Е.В.; Лукьянова, Ю.А.; Алешкин, Д.В.; Васильев, А.А.

Авторы: Ustinova K.I., Chernikova L.A., Матвеев Е.В., Лукьянова Ю.А., Алешкин Д.В., Васильев А.А.
Журнал: Biomedical engineering
Том: 34
Номер: 6
Год издания: 2000
Издательство: United Trade Press.
Местоположение издательства: London, England
Первая страница: 313
Последняя страница: 317
DOI: 10.1023/A:1002872619577
Аннотация: A method for determination of the projection of the center of gravity of the human body onto a horizontal plane was first suggested by E. B. Babskii et al. in 1952 [1]. Since then this simple, illustrative, and objective method has been widely used in medical research and practice. Combined use of the stabilographic method and the personal computer is particularly promising. It allows visualization of an examination procedure and quantitative mathematical processing of examination results [2, 3]. The method has been applied to patients with various diseases of locomotion [5, 6, 8, 10]. It also provides quantitative objective estimates of the functional state and various latent reactions of the human body [4, 9]. This method has been successfully used in the Clinics of Nerve Diseases, Scientific-Research Institute of Neurology, Russian Academy of Medical Sciences, for studying mechanisms of regulation of posture stability in patients with locomotor disorders of various etiology (e.g., post-stroke hemiparesis [9, 17] and parkinsonism [7, 15, 19]). For example, posture coordination disorders in patients with hemiparesis were attributed by some authors to asymmetric load distribution between damaged and undamaged legs resulting in a lateral shift of the center of mass (CM) toward the healthy leg [14, 16]. Other researchers believe that equilibrium function disorders are due to deficiency of somatosensory information [11] and insufficient rate of correction of posture reactions [6, 13]. Posture instability in patients with parkinsonism is attributed by some researchers to the talocrural articulation constraint and deceleration of postural reflexes [7, 15, 19]. Computer stabilometry also provides a methodological basis for new rehabilitation technologies. These technologies are based on intentional feedback control of CM position (stabilographic biocontrol). This method has been used for training static and dynamic stability [5, 10, 12, 18, 20, 21]. In these tests, the CM position was intentionally shifted by the patient toward the boundary of the support area and back to the center [10, 21]. This method was shown to have a positive effect on vertical posture asymmetry, walking speed, self-service ability of patients, etc. [12, 18, 20]. However, rapid progress in recovery medicine requires continuous and rapid upgrading of stabilometric methods. Monoplatform methods do not provide sufficient diagnostic and therapeutic efficacy. The list of stabilometric parameters used in diagnosis should also be extended to increase the range of patients with locomotor disorders who can be served. The goals of this work were: 1) to reveal specific features of posture support in patients with various motor disorders (post-stroke hemiparesis and parkinsonism) using a computer stabilographic system (CSS) equipped with a bilateral platform; 2) to develop computer rehabilitation programs taking into account specific features of posture instability in these groups of patients; 3) to test the efficacy of the rehabilitation programs in patients with motor disorders of different genesis. MATERIALS AND METHODS Fifty-six patients (24 females and 32 males) with ages ranging from 22 to 75 years (average age, 47.8 years) were studied. Of these patients, 43 and 13 were with post-stroke hemiparesis and parkinsonism, respectively. In addition, 50 apparently healthy subjects without neurological disorders of the locomotor apparatus were tested as stabilographic controls. A bilateral platform CSS model developed at the Scientific-Research Institute for Medical Instrument Engineering, Russian Academy of Medical Sciences (VNIIMP-VITA) was used. The bilateral stabilographic platform allows monitoring of CM projection in patients with body weight ranging from 15 to 120 kg. Both lateral and sagittal movements of each foot can be monitored within the range of ±60 mm from the geometrical center with measuring error of no more than ±2%. Patients with hemiparesis were tested in three postures, 30 sec each: quiet standing (parallel feet at one foot distance apart) with open (1) and closed (2) eyes and in central position with feedback correction (3). Patients with parkinsonism were tested in four postures, 20 sec each: quiet standing (feet close to each other) with open (1) and closed (2) eyes; right (3) and left (4) voluntary swings of the body. Control subjects were divided into two subgroups. The first and second subgroups (34 and 16 people, respectively) were tested using the programs for patients with hemiparesis and parkinsonism, respectively. Lateral sagittal stabilograms of integral CM (ICM) and of right and left leg were recorded. The following parameters were calculated (Fig. 1): mean CM velocity (V, mm/sec); mean radius of CM deviation (R, mm); weight distribution (W, %) calculated as the derivative of the mathematical expectation of sagittal displacement of CM (percentage of total load); and mean halfperiod of CM displacement in lateral (Tx) and sagittal (Ty) planes. The frequency of stabilogram sampling was 20 Hz. Asymmetry angle (An) was introduced as an additional parameter (Fig. 2). This parameter is the quotient of the difference between lateral CM displacements of the left and right legs divided by the distance between the longitudinal axes of the stabilographic platform. Positive or negative sign corresponds to predominant forward displacement of right or left foot, respectively. All stabilographic parameters were assessed twice (before and after treatment).
Добавил в систему: Черникова Людмила Александровна

	ИСТИНА	Войти в систему Регистрация
	ФНКЦ РР
	Главная Поиск Статистика О проекте Помощь

ИСТИНА

ФНКЦ РР

Diagnosis and Treatment of Motor Disorders Using a Bilateral Stabilographic Platform in Clinics for Nerve Diseasesстатья

Прикрепленные файлы