Alexei Katashev, Yuri Dekhtyar, Janis Spigulis (Eds.): NBC 2008, Proceedings 20, pp. 99–102, 2008 www.springerlink.com © Springer-Verlag Berlin Heidelberg 2008

Reciprocating Orthotics Complex (ROC) for Children Suffering from Cerebral Paralysis and Spinal Diseases

E. Dukendjiev1 1 Atypical Prosthesis Laboratory Latvia, Riga

Abstract — In order to dissociate pathologic interaction of executive periphery and cerebral structures and to induce formation of new reflex bonds strengthened during treatment, it is necessary to produce mechanically forced targeted cor-rected locomotive motions by external energy. Thus, to pro-voke inborn reflexes and synergy (background levels) and to form forced (within the norm) dominants of highly automatic movements.

Keywords — palsy, treatment, reciprocal, gate, synergy

I. INTRODUCTION

For treatment of the mentioned above groups of diseases all known methods such as “Adeli”, Botatov’s, Peto’s, Voity’s, Koziavkin’s, etc. are based on the patient’s self-energy. Competence limit is determined by physical and control abilities of the patient, i.e. the process of treatment in its essence is passive and very variative and needs clinic department.

At both characteristic groups of diseases patients often suffer from vertigo, pallor, weakness, up to syncopes and fainting when getting up from the lying or sitting position (orthostatic hypotonia).

The methods of body verticalization, standing training do not improve the patient’s condition and do not contribute to ambulation and even vice versa. The reason lies in the es-sence of the process – body statics does not cause afferent muscular activity and causes little afferent control activity.

In order to dissociate pathologic interaction of executive periphery and cerebral structures and to induce formation of new reflex bonds strengthened during treatment, it is neces-sary to produce mechanically forced targeted corrected locomotive motions by external energy. Thus, to provoke inborn reflexes and synergy (background levels) and to form forced (within the norm) dominants of highly auto-matic movements.

II. METHOD

The method is formed on the level of microstructure of movement control [2]. In the phase of muscles stimulation locomotor centers release from the inhibitory influence and

become available for correction measures. Due to motoneu-ron pools, spinal interaction can be realized, which organize throbbing like stepping ones. The final aim of the method is to influence the slow moving units by compulsory exten-sion.

What is the “material basis” of the author’s idea? For example, only in the gastrocnemius muscle there are

more than 800 slow moving units, and in every moving unit there are about 2000 muscle fibres. Within the skeletal mus-cular system function hundreds of thousands of moving units and millions of muscular fibres, i.e. quite a mighty basis for the implementation of the method!

Biomechanical elements. The smallest anatomically in-dependent structural unit of the muscular system is skeletal muscle tissue. Muscle and other cells are included into the structure of muscle tissue - smooth (nonstriated) and cross-striped (striated). Striated muscles activate bones, actively change human body position.

Bioelectronics elements. The smallest anatomically in-dependent unit of nervous system is a nerve cell (neuron) with branching processes. The cell is dynamically polarized that is able to let pass the nervous impulse only in one direc-tion, from the dendrite to the axon. In the nervous system the neurons form chains, which transfer stimulation from the point of appreciation of the stimulation to the central nervous system and further to the working organ. There are three main types of neurons: 1. Sensory, receptor perceive stimulation in the tissues of

the bodies themselves, they are located in muscles, ten-dons, ligaments, fascias, bones, articular capsules, etc.

2. Intercalary neuron realizes transmission of the stimula-tion from the sensory neuron to the motor one. Interca-lary neurons are located within the central nervous system.

3. The bodies of efferent neuron are located in the central nervous system. Their axons spread to the working or-gans. Nerve endings of the axons of efferent neurons can be of two types: motor and secretory. Motor ones have their endings in muscle fibers forming neuromus-cular synapses. Biomehatronical elements. There is an end bud and

a neuromuscular synapse in each muscle fibre, which are the means of transmission of the impulse to traction. The moving units are motoneurons (the smallest functionally

100 E. Dukendjiev

_______________________________________________________________ IFMBE Proceedings Vol. 20 _________________________________________________________________

independent unit of biomechanotronics) which innervate the group of muscular fibers.

The degree of muscle contraction is controlled by three mechanisms: active moving units (motoneurons) regulation of the

given muscle; regulation of the method of their work (motoneurons

impulse frequency) regulation of temporary connection of moving units activ-

ity (motoneurons). Recruitment phenomenon of motoneurons happens ac-

cording to their size, i.e. slow, type I moving units muscles are active in any tension.

Slow motoneurons prevail, especially in childhood. It’s necessary to influence them mechanically forcibly, hence their number constitues more than 50 % of the total amount and they influence the generation of induced signals.

Movements control. Simple reflexes are effected by “lower parts of the central nervous system, i.e. spinal cord. The simplest reflex arch consists from two neurons, sensory and motor. Most often the reflex arch consists of many neurons. Then intercalary neurons are located between the afferent and efferent neurons. In such reflex arch the stimulation from the sensory neuron is trans-ferred along its central process to one or several intercalary neurons.

Ukhtomsky A.A [3]. discovered the principle of domina-tion. Functional systems combine all subordinate structures. In certain conditions the dominant nerve center can head the reflex action on the dominant enchancement and inhibition of other activities.

Later Anokhin P.K. [4] created the functional system theory. Anokhin P.K. understood “a range of certain physio-logical manifestations connected with performing some certain function (the act of breathing, the act of swallowing, locomotor act, etc.)” under the functional system.

Anokhin P.K. and his students proved the presence of the so called feedback of the working organ with the nerve centres, i.e. “reciprocal afferentation” in the course of ex-periments. The moment the efferent impulses from the nervous system centres reaches executive organs, the re-sponse appears (movement or secretion). This working effect stimulates the receptors of the executive organ itself. The impulses which appeared as a result of these processes go back to the centres of the spinal cord or the cerebrum along afferent ways in the form of information about the completion by the organ of a certain action at every certain moment. Thus, the ability of precise registration of the accuracy of orders execution in the form of nervous im-pulses, coming to the working organs from nerve centres, and their continuous correction is created. The existance of bilateral signaling in closed circular or annular reflex

nervous chains of the “reciprocal afferentation” allows to hold constant continuous corrections of the organism re-sponses to any changes in ambient and internal conditions.

The objective: in the canals of the “reciprocal afferenta-tion”, transferring to the brain the distorted because of MAD and attack angle sensor (AAS) information, it’s nec-essary to bring in the correct information, which in course of time will become dominant.

The objective: synthesis of the mechanical system with smooth movements – reciprocal orthezis complex, realizing: kinematic interdependency between large joints; kinematic interdependency between lower extremities,

body and upper extremities. In the phase of muscles stimulation (forced by ROC) lo-

comotor centers release from the inhibitory influence and become available for correction measures.

III. RESULTS

The ROC developed by the author can be conditionally called an “artificial locomotion apparatus”, which works at the expense of external energy with full deficitis of muscu-lar and control activity, i.e. with minimal, purely organic participation of brain in the process of walking.

ROS [1] is suspended with the help of a spherical junc-tion in the common center of weights several millimeters higher of treadmill and the toes of both legs are fixed firmly by horizontal reciprocal yoke.

This provides [5]: Sequence of contact of a left and right leg with a mov-

ing belt;

Fig.1. Reciprocal orthesis complex (ROC).

Reciprocating Orthotics Complex (ROC) for Children Suffering from Cerebral Paralysis and Spinal Diseases 101

_______________________________________________________________ IFMBE Proceedings Vol. 20 _________________________________________________________________

transformation of external energy pathway, produced with the principle of a flat type flywheel clutch – ROS soles in the result of the frictional force are forced to move reciprocally;

kinematic synchronization of three reciprocal mecha-nisms – for upper lower and extremities and foots, thus providing dimensionally balanced motions of the whole body.

The developed ROC which unites ROS (Fig.2.A) for the whole body with verticalization chair with a horizontal reciprocal mechanism (Fig.2.B) and treadmill (Fig.2.C) is a device stimulating artificial locomotion which works on the basis of external energy at complete deficit of muscle and control activity.

ROC can be regulated to the height, clasps “velcro” pro-vides fast system removal/putting on. It can be used at home and in clinics.

In several months, after the muscles are strengthened, the treatment is continued only with the use of ROS with own muscle abilities.

ROC were constructed for 15 patients: ICP-7, spina bi-fida-2, spinal traumatism-2, paraparesis after tick-borne encephalitis-1, hypoxic ischemic damages of CNS-1, multi-ple congenital anomalies-1, arthrogryposis-1.

IV. DISCUSSION

With the help of mechanical force realized on the macro level of the reciprocal complex with the use of internal source of energy to cause changes in the reflex influence changes from the spindles and tendinous Goldgi’s receptors, so that to get any activity flexors and extensor muscles ratios, observing the mechanism of reciprocal an-tagonist inhibition.

The source of forced bioelectric activity is afferentation going from any receptors, which inform about the course of

biomechanical task solution when mechanically forced. It incorporates into action any reflexes. Repeated reiteration cyclic actions along one and the same joints trajectory forcibly form synergies, creating and improving walking skills. The program of movements is worked out which mobilizes all necessary for the act of movement arsenal of levels and particular physiological mechanisms.

The author method has several aspects with different weight values in the process of movement realization - bioelectric, hemodynamic, biochemical.

Bioelectric aspect is the most important as with the help of the aspect the correct long-term movement stereotypes are formed. The processes of transformation of the external mechanical energy begin from the reaction of propriocep-tors of muscle cells and tissues for forced extension. Under normal conditions the micro movement of one bone to the other bone is the result of muscle-antagonists work, regu-lated by the reciprocal reflex. The succession is as follows: agonist actively contracts and antagonists relax. In case of cerebral palsy spinal column and cord traumas the normal activities of the movement units are violated - they are con-tracted simultaneously generating trembling movement of six moves per second amplitude. The proposed inversion of "cause-consequence" of movement solves the problem - the "solid" links of the biokinematic chain of a limb after the external mechanical forced extension become the "cause" of the movement and antagonist muscles are forced to re-lax/contract passively without usage of inner energy, so they become "consequence"/ In such transformation the significant part of the inner energy is redirected to compen-sate MAD.

Haemodynamical aspect of the method is based on the structure of the arterial walls and muscle type veins. In arteria myocytes are 2-3 times bigger than in vein. That is why in MAD activities the blood system is also works ab-normally not even considering orthostatic hypotonia. The forced extension of muscles by external energy beside nega-tive effects generates peristaltic transversal muscle waves directed from microvasculature to heart. In other words so called "vein pump" activates. This "pump" corresponds to normal pressure up to 40% of the rising blood flow in very intensive muscle activity.

Biochemical aspect of the method is related to the cell metabolism. The weak flow among patients suffering from MAD and CAD is not sufficient to remove carbon dioxide from tissues and therefore lactic acid is accumulated and acid substances level sharply increases. This complex of factors causes cerebral type diatonic reaction, oxygen defi-ciency and so on. The forced extension of muscle fiber inverts the succession in the contraction/relaxation cycle where the most important factor is the reversible change of characteristics - electric polarization and penetrability of

(A) (B) (C) Fig.2. The developed ROC.

102 E. Dukendjiev

_______________________________________________________________ IFMBE Proceedings Vol. 20 _________________________________________________________________

muscle fiber membrane and intracellular membrane and reversible change of Calcium free ions concentration in cell fluid. As the result the usage of the rosette-forming cells causes significant acceleration and improvement of metabo-lism.

Biomechanical aspect. The lower extremities are not crossed and do not rotate inside, a rotation of pelvis is pro-vided, as well as dimensional balance of the whole body in the process of locomotion, walking speed and gait phases are changed.

Registered: increase of growth and weight, increase of miopotentials, support ability is achieved and the skill of cyclic motion in ROS and without it, the speech, sense of vision and orexia are improved, the level of verbality and social activity is improved.

Reciprocate orthesis complex can be prescribed for:

spina bifida; sklerosis multiplex, cerebrospinalis; paraparesis extremitatum inferiorum; t i cerebrellaris; anomalia systematis nervosum centrale congenita; meningomyelocele regionis lumbosacralis; hydrocephalia congenita; paraplegia spinalis; functio laesa organum plevis; insufficientia musculorum; paresis/paralysis cerebralis; fracturae corporus vertebrarum thoracicae/lumbalis; fractura osseum non consolidata (pseudoarthrosis).

Author’s method is contra-indicated with epilepsy, vege-tative disfunctions, spasms, intoxications, infectious dis-eases, repeated brain traumas, hereditary diseases of neural system, spinal cord or peripheral nerves affections, schizo-phrenia, hypertension.

V. CONCLUSION

The method and ROC replace wheelchairs securing movement activities of handicapped person with non-amputated limbs on a principally higher level.

The method does not apply medicines, pharmaceutical preparations, surgery, soft and hard bandages, food supple-ments, electric medical devices and equipment.

Method is non-invasive, and application of ROC does not harm a patient.

From the economic point of view, the method and ROC are on the whole much cheaper than classic rehabilitation including multiple treatment courses, transportation and etc.

The results decisively depend on day-to-day application of ROC.

REFERENCES

1. Dukendjiev E. Method for the reciprocal control of the human body and total-body reciprocal orthosis system (Pa miens cilv ka kust bu reciprok lai vad bai un reciprok la ortožu sist ma visam ermenim) Latvia. Patent LV13100 B (in Latvian)

2. . Method to compensate muscular and control defi-ciency by the external energy (

) Inter-national Conference on Bionics Prosthetics, Biomechanics and Me-chanics, mechatronics and robotics. June 5 -6, 2006 Varna, Bulgaria pp 5-13. (in Russian)

3. Ukhtomsky A.A . Principle of dominant ( . . . 1). Collecton of works, Vol.1, Leningrad, LGU, 1950

(in Russian) 4. Anokhin P.K Problems of the higher nervous activity (

)., Academy of Science publishing, Moscow, 1949

5. 3. Dukendjiev E. Reciprocal orthotic complex for the children with cerebral paralysis and spinal diseases. (Reciprok l ortožu komplekss b rniem ar cerebr lo trieku un spin l m slim b m). Latvijas rsts,

5, p 42.

Author: Evgueni Dukendjiev Institute: Atypical Prosthesis Laboratory Street: 3 Liepajas Street, LV-1002 City: Riga Country: Latvia, Email: e-mail: dukendjievl@inbox.lv