ELECTROSTIMULATION

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ELECTROSTIMULATION — one of types of impact on an organism impulse electric current for excitement or strengthening of function of this or that body. For this purpose use various electric impulses which are adequate irritants for the stimulated structures. AA. is one of methods electrotreatments (see).

In wider value under E. understand electric excitement or strengthening of activity of any structures of an organism with the diagnostic, medical or research purpose. In this sense it is possible to speak about E. afferent nervous structures, AA. neuromuscular educations with the diagnostic purpose (see. Elektrodiagnostika ), AA. various excitable structures with the research purpose in experiments on animals etc. It is not recommended to use the term «electrostimulation» for designation electrosleep (see) and electroanesthesias (see).

Fiziol. premises E. as method of treatment are created by works of domestic scientists I. M. Sechenov, I. P. Shchelkov, I. F. Tsiona, N. E. Vvedensky, A. A. Ukhtomsky, etc., to-rye showed value for E. parameters of current, electroexcitability and lability of the neuromuscular device (see. Excitability , Lability , Parabiosis ). Originally applied only E. skeletal muscles, in a crust, time the sphere of its use considerably of a rassha ritsya (electrostimulation of heart, ureters, a bladder and other bodies).

Distinguish a straight line E., at a cut subject to electric irritation directly stimulated fabric or body, and the indirect electrostimulation which is carried out indirectly through the next fabrics or structures of a nervous system.

Electrodes for E. can be located on a body surface (outside, or transdermal, AA.), in a cavity of internal body (intracavitary electrostimulation), are implanted into a wall of the stimulated body or into the nerves going to it.

Depending on duration of influence allocate constant (chronic), course and one-time (carried out in the form of the separate procedure) electrostimulation.

AA. it is possible to appoint the patient of any age, but with the obligatory accounting of specific features of reactivity of an organism, existence of associated diseases.

For E. use direct impulse currents with various duration (usually from 1 to 300 ms) and a form of impulses — rectangular, exponential, semi-sinusoidal, sawtooth, etc. Impulses modulate in a series of various duration and frequency at intensity to 50 ma (see. Impulse currents ). Apply for E. and the alternating harmonic modulated currents with the bearing frequencies of 2000 I am the 5000th Hz at modulation by their low frequencies (as a rule, ranging from 10 to 150 Hz), at current to 80 ma. As sources of the irritating electric impulses use various devices for treatment by impulse currents — «Incentive-1», «Incentive-2», «Amplipulse-4», etc., and also the devices which are specially intended for this or that type of electrostimulation (see below).

Electrostimulation of heart is widely applied to treatment of various disturbances of a cordial rhythm. The essence of a method consists in irritation of a myocardium the electric impulses of the set power and frequency causing systolic reductions of ventricles. AA. hearts it can be directed both to increase, and to an urezheniye of a rhythm of cordial reductions, and also to strengthening of ineffective reductions of a myocardium at different types of disturbances of cordial activity (see. Cardiostimulation ).

Electrostimulation of a diaphragm and phrenic nerves is used for stimulation of external respiration at the respiratory insufficiency which developed after heavy operations on bodies of a chest cavity owing to an injury of a phrenic nerve, various diseases of lungs, as prophylactic and treatment of postoperative pneumonia. AA. it is contraindicated at bleedings, necrotic and dystrophic processes in a chest cavity, existence of pheumothorax. Electrodes can be located outwardly (in a neck and in subclavial area), perinevralno or intravenously. Distinguish asynchronous E., at a cut the rhythm of the put electric irritations does not match a rhythm of spontaneous breath, and biosynchronized, matching a rhythm of natural breath.

In a wedge. to practice apply the portable stimulator of a diaphragm of ESD-1P allowing to carry out direct and transdermal E. Use also partially implanted electrostimulators, in to-rykh interaction between the implanted receiver and the external portable sending device and management of the mode of stimulation are carried out by means of a radio communication.

Electrostimulation of structures of a spinal cord is carried out for the purpose of activation of their activity at the functional atony of the centers of a spinal cord developing as a result of an injury. It is applied also to activation of nervous structures of back columns of a spinal cord and overlapping of ways of receipt of an afferent impulsation from the center of pain to the highest departments of c. N of page E. brake interneyron it is used at the chronic pain syndrome which is difficult giving in to treatment. Electrodes at E. structures of a spinal cord implant subduralno.

Electrostimulation of a uterus is applied for the purpose of activation of patrimonial activity, to treatment of dysfunctional uterine bleedings, puerperal uterine bleedings. Contraindications: new growths, suspicion on a hysterorrhesis, acute inflammatory process of bodies of a small pelvis.

To prevention and treatment of hypotonic and atonic bleedings in the afterbirth period apply outside E. squared monopolar impulses or so-called elektrotonization of a uterus single short-term impulse of a direct current of high tension. For the purpose of reduction of blood loss at Cesarean section right after extraction of a fruit carry once out indirect bipolar E. a uterus squared monopolar impulses using a rectal electrode. Apply E to treatment of dysfunctional uterine bleedings. necks of uterus square-wave pulses in the period of uterine bleeding (for the purpose of a hemostasis) or out of bleeding with 8 — the 10th day of a menstrual cycle. Course of treatment of 10 — 12 procedures.

For treatment of dysfunctional uterine bleedings, e.g. by electrostimulation of a neck of uterus, in the USSR the electrostimulator of EUS-5-1 creating series of square-wave pulses is developed.

For the purpose of strengthening and initiation of patrimonial activity apply square-wave and exponential pulses to impact on a uterus. For increase in efficiency of stimulation of a uterus in some cases use the principles of biocontrol, in particular use the sensors registering reductions of a uterus and synchronizing impulses with a rhythm of reductions of a uterus.

Electrostimulation of uterine tubes is carried out for the purpose of treatment of functional tube infertility. For this purpose influence sinusoidal impulses by means of a vaginal electrode uterine tubes.

Electrostimulation of a bladder is applied to normalization of function of an urination at a delay or an incontience of urine owing to injuries and diseases of a spinal cord, ginekol. diseases, extensive operative measures on bodies of a small pelvis. Contraindications: new growths, acute inflammatory process in uric ways.

Electrostimulation of an urination can be carried out by the patient with a severe injury or a disease of a spinal cord through muscles of a bladder, nerves (pelvic, sexual, sacral) and the spinal centers. Most often apply E. spinal centers and bladder. The last can be a straight line and be carried out by the implanted electrodes or mediated, by introduction of an electrode to a rectum.

At an incontience of urine E is carried out. sphincters of a bladder the cutaneous, implanted or rectal electrodes from the portable individual electrostimulator fixed on a belt of the patient (a constant E.). At not heavy neurogenic dysfunctions of a bladder, and also at decrease in a tone of a sphincter of an urethra and neck of a bladder (after an adenomectomy, at women in a climacteric, etc.) use temporary band or transdermal electrostimulation by the harmonic modulated and diadynamic currents.

For treatment of an incontience of urine and a calla the Soviet and Bulgarian specialists jointly developed an electrostimulator of a sphincter of EAS-6-1 with rectal electrodes for adults and children. The electrostimulator creates monopolar square-wave pulses or packs of bipolar impulses lasting 2 ms with a frequency of following of 150 Hz.

For recovery of function of an urination at patients with damage of a spinal cord electrostimulation of a bladder by means of the radio-frequency stimulator of a bladder developed in the USSR is effective. In this device process control of stimulation is exercised by radio-frequency power transmission from the external generator to the implanted receiver and further to the electrodes fixed directly on a bladder. Apply also the Urals. the electrostimulator of ESUR-1 generating the radio pulses filled with bipolar fluctuations with a frequency of 1 — 2,5 kHz. Impulses form packs lasting 2 — 5 sec.

Electrostimulation of ureters is carried out for the purpose of exile of stones, recovery of a tone of unstriated muscles of an ureter after operations on the upper uric ways (plastics of a lokhanochno-ureteric segment, etc.). For exile of stones use cutaneous E. the harmonic modulated currents (V. G. Yasnogorodsky's technique). In the postoperative period apply a straight line E. by means of an electrode catheter squared impulses. Contraindications: acute pyelonephritis, depression of function of a kidney, phenomenon of a hydronephrosis.

Electrostimulation of digestive tract is shown at disturbances its motor evakuatornoy to function. It is carried out by the cutaneous and band electrodes entered into a stomach, duodenal or a rectum. AA. apply at acute or hron. weakening of motor and evakuatorny function went. - kish. a path, leading to a delay of defecation owing to a disease, the general hypodynamia, after abdominal operations, injuries of a head and spinal cord, at an incontience a calla owing to an injury, either functional insufficiency of an outside sphincter of an anus, or operation on it. Contraindications to electrostimulation: suspicion on insolvency of an anastomosis.

mechanical impassability of intestines, diffusion peritonitis, megacolon, bleedings, necrotic and dystrophic processes in went. - kish. path, acute and subacute gastroenteritis, new growths, pregnancy. The specialized device for E. went. - kish. a path the gastroenterostimulyator of «Endoton-1» is, e.g. The device generates radio pulses with the same parameters as the Urals. an electrostimulator of ESUR-1 (see above). Apply also autonomous electrostimulators in the form of the tiny capsules containing the generator of impulses and the power supply. Outside parts of the case of the capsule represent electrodes. In process of advance of the capsule entered orally on went. - kish. to a path it is carried out consecutive E. its departments.

For stimulation of an outside sphincter of an anus use band E. from an individual portable electrostimulator. AA. it is not carried out at new growths of an anus and a rectum, at acute inflammatory process and the bleeding hemorrhoids.

Electrostimulation of skeletal muscles (electrogymnastics) is appointed at paresis and paralyzes (primary and secondary) muscles of extremities, a trunk and the person (sluggish, spastic, mixed, hysterical) owing to diseases and injuries of a nervous system, bones and joints, a hypokinesia, for the purpose of prevention of postoperative tromboembolic episodes, a training of muscles and increase in their physical endurance, training in motive acts, at pain syndromes (a kauzalgiya, stump neuralgias), scoliosis. Contraindications to E. muscles: ruptures of muscles, sinews, nerves, vessels, a contracture of mimic muscles, acute inflammatory (purulent) process (thrombophlebitis, abscess, etc.) in a zone E., anchylosis of joints, arterial hypertension, circulatory unefficiency of the II—III stage.

Electrostimulation of muscles is carried out on motor points of nerves or muscles (see. Elektrodiagnostika ).

At sluggish paresis and paralyzes parameters E. muscles and nerves are defined them elektrovozbudimostyo. At normal and slightly reduced excitability use tetanizing, the diadynamic and harmonic modulated currents (see. Impulse currents ). At the expressed decrease in excitability the frequency of impulses and modulations decreases, and their duration and intervals between impulses increase. Duration of influence is from 8 to 20 min. Effektiv a nost E. higher at its daily carrying out and in combination with other procedures (local thermal, ultrasonic influence, an inductothermy, an electrophoresis of antikholinesterazny drugs).

For E. the weakened antagonists of spastic muscles are applied by the diadynamic and harmonic modulated currents.

The listed methods E. find the increasing application in clinical practice; efficiency E. depends on extent of defeat of appropriate authorities and systems, on correctness of the choice of the parameters of influence determined by specific features of an organism.

Bibliography: Antropova M. I. Electrostimulation of muscles and its medical use, M., 1960; Vishnevsky A. A., Livshits A. V. and Vilyansky M. P. Electrostimulation of digestive tract, M., 1978; Efanov O. I. and Dzanagova of T. F. Fizioterapiya of dental diseases, page 30, M., 1980; Kolesnikov G. F. Electrostimulation of the neuromuscular device, Kiev, 1977; Balneology and physical therapy, under the editorship of V. M. Bogolyubov, t. 1, page 380, M., 1985; Obrosov A. N. and Liventsev of N. M. Elektrodiagnostik and electrostimulation of muscles at defeat of peripheral nerves, M., 1953; Use of electrostimulation in clinical practice, under the editorship of M. N. Umovist, M., 1978; The Reference book on physical therapy, under the editorship of A. N. Obrosov, page 37, M., 1976; Strugatsky V. M. Physical factors in obstetrics and gynecology, page 28, M., 1981; The Electronic package for stimulation of bodies and fabrics, under the editorship of R. I. Utyamyshev and M. Vrana, M., 1983, bibliogr.

M. I. Antropova; V. A. Mikhaylov (tekhn.).

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