The present article is concerned with the substantiation of the main principles of preventive acupuncture for the management of the secondary contracture of mimic muscles taking into consideration the results of clinical and neurophysiological investigations. We have undertaken the analysis of dynamics of clinical, psychological, and neurophysiological characteristics of the patients following a course of basal treatment and maintenance courses of reflexotherapy. It has been shown that manifestations of the pain syndrome in the patients presenting with the secondary contracture of mimic muscles are consistent with high polysynaptic reflectory excitability. It is recommended, based on the results of this study, to carry out neurophysiological monitoring (for the evaluation of the eye-closure reflex) prior to the prescription of preventive acupuncture for the patients presenting with disturbances of polysynaptic reflectory excitability with a view to obviating the development of a relapse of pain syndrome.
THE ROLE OF MYOFASCIAL SYNDROME IN THE GENESIS OF NOCTURNAL PAINFUL PARESTHESIAS РезюмеЦелью нашего исследования явилось изучение клинических и нейрофизиологических особенностей ночных болезненных парестезий в верхних конечностях. Материал и методы. В статье представлены результаты обследования 107 пациентов, страдающих болями и ноч-ными парестезиями в р уках. Выявлено, что синдром ночных болезненных парестезий является смешанным по этиологии и имеет в качестве начального звена миофасциальный болевой синдром. Описана клиническая симптоматология ночных болей и парестезий в руках у больных с миофасциальным болевым синдромом плечевого пояса и верхних конечностей. Результаты. Показано, что активные миофасциальные триггерные пункты являются ключевым звеном в формировании клинической картины синдрома ночных болезненных парестезий у паци-ентов с миофасциальным болевым синдромом. При исследовании коротколатентных соматосенсорных вызванных потенциалов с верхних конечностей описан патологический пик Рх в отведении CVII-Fpz, являющийся маркером наличия генератора патологически усиленного возбуждения в надсегментарных структу рах. Заключение. Синдром ночных болезненных парестезий является смешанным по этиологии и имеет в качестве начального звена миофасциальный болевой синдром. Выявление генератора патологически усиленного возбуждения в надсегментарных отделах чувствительного пути при регистрации коротколатентных соматосенсорных вызванных потенциалов является адекватным методом диагностики болезненных парестезий. Ключевые слова: ночные болезненные парестезии, миофасциальная боль, соматосенсорные вызванные потенциалы
The purpose of the study: to study the effectiveness of active medical rehabilitation technologies among Paralympians engaged in playing sports.Materials and methods: examined 48 male patients aged 25.9 ± 2.1 years with traumatic disease of the lumbar spinal cord. All examined were divided into 2 groups: patients of the main group (19 people) against the background of standard therapy received a course of active medical rehabilitation (AMR), including mechanotherapy and electrical stimulation with biofeedback under the control of electromyography (EMG) of the muscles of the lower extremities and back. Patients in the comparison group (29 people) received standard therapy. After the AMR course, a comprehensive examination was performed, including the data of the questionnaires: the ASIA classification (American Spinal Injury Association), the FIM (Functional Independence Measure) scale of functional independence, the modified functional assessment scale of activity and quality of life VFM (Valutazione Funzionale Mielolesi), State-Trait Anxiety Inventory, the Beck depression scale; electroneurophysiological studies on the Neurosoft Neuro-EMG-Micro device, heart rate variability (HRV) on the Neurosoft Poly-Spectrum computer electrocardiograph, indicators of free movement with concentric and eccentric muscle contractions on EN-TreeM.Results: polysympathetic reflex excitability (PRV) significantly decreased in patients of the main group. There was also an improvement in vegetative reactivity (coefficient 30/15 is 1.45; p <0.001) during the orthostatic test, indicating normalization of parasympathetic regulation and heart rate. The assessment on the ASIA scale revealed an improvement in sensory function by 13.4 % and motor function by 17.4 %. On the VFM scale, an increase in indicators was observed by 14.7 % and on the FIM scale by 11.5 %. When assessing the psycho-emotional sphere on the Spielberger-Khanin scale, a significant decrease in the level of reactive anxiety was noted by 10.9 %, and the level of depression by 30.5 %. A significant increase in muscle strength by 18.1 % (p < 0.001) was also observed during concentric contractions, the average power increased by 83.1 % (p < 0.001), the average amplitude increased by 68.7 % (p < 0.001), the average speed by 27.2 % (p=0.002). When analyzing the indicators after the treatment, significant differences were obtained between the main and the comparison group (p < 0.001).Conclusion: the use of biofeedback technologies under the control of electromyography leads to an increase in the effectiveness of medical rehabilitation and improves the quality of life in Paralympians with traumatic spinal cord disease.
Reflexotherapy (acupuncture) is one of the most important and valuable part of mankind’s heritage. Reflexotherapy has a long history and was formed as a practical healing method. Reflexotherapy methods include: acupuncture (Chen); Chiu-method (cauterization or warming of acupuncture points by means of wormwood or coal cigars); multi-needle stimuli by a special hammer; vacuum effect on acupuncture points; acupressure; tsubo-therapy; and hirudotherapy. Modern modifications of reflexotherapy are applied: electroacupuncture, electropuncture, laser reflexotherapy, craniopuncture, magnetopuncture, cryotherapy, color and light therapy, and others. There are many theories about the mechanism of action of this method. The focus of the Kazan school is on the role of sensory interaction at different levels of the nervous system in the implementation of the relexotherapy effects. The reflex mechanism for the development of therapeutic effect is considered in this connection as part of a universal method of information processing — sensorimotor interaction. The therapeutic effects of reflexotherapy are realized through the formation of a local and background sensory flow, and their interaction at different levels of the nervous system. Afferent flow is processed at the peripheral, spinal-segmental, stem, subcortical levels, as well as at the level of the cortex. The realization of the positive effects of reflexotherapy occurs, including due to the phenomenon of neuroplasticity, which is implemented at the peripheral and central levels. Reflexotherapy methods can activate the phenomenon of brain neuroplasticity, leading to structural and functional changes that require further research in this direction.
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