Therapeutic Effectiveness of Dynamic Electric Neurostimulation for Treatment of Children with Bronchial Diseases
Khan M.A. 1, Malakhov V.V.2, Chernyshev V.V.2, Borovitskiy I.P. 1, Dmitrienko E.G.,1 Kononova I.P.,1 Vakhova E.L. 1
1 Scientific Center for Restorative and Resort Medicine RAMS, Moscow.
2 Research Studies Institute of International Academy of Fundamental Education (MAFO), Yekaterinburg.
Respiratory diseases in children present one of the most acute problems for Pediatrics. Up to the present, respiratory diseases gain the lead in children’s illness patterns (50-75 %). The bronchitis incidence rate varies from 15 to 50%, the rate growing up to 60-75 % in children who are frequently ill with acute respiratory disease. And at the same time obstructive syndrome is observed in most children.
Along with the steady development of pharmacotherapy applied to the treatment of bronchopulmonary pathology, the search for new types of physical treatment enabling to increase efficiency and quality of medical care for children and having no side effect is still acute.
Among a wide variety of physical treatments much attention is given to impulse current. The impulse current allows drawing more high-grade sensitivity as compared with continuous wave operation, and reducing the rate of energetic stimulation, what is of high importance for growing organism.
In pediatrics a priority use of physical factors of low intensity, low-power, and pulse sequence is generally explained by the physical therapeutic response. Peculiarities of physical therapeutic response demonstrated by children are a result of more delicate nervous system, more intensive metabolic and reparative processes.
In recent years much attention has been given to dynamic electric neurostimulation and to the development of the devices, enabling to usefully increase the efficiency of the physical factor.
Purpose and Objectives
The purpose of the research was to scientifically prove the use of dynamic electric neurostimulation delivered by the DENAS apparatus for treatment of respiratory diseases in children. During the work the peculiarities of the influence provided by dynamic electric neurostimulation on the clinical course of bronchial asthma, acute and recurrent bronchitis were discovered and therapeutic action and influence of dynamic electric neurostimulation on respiratory and autonomic nervous system, immunity indexes, lipid peroxidation and haemogram data were studied.
Patients and Methods
In order to fulfill the purpose of the research, we provided clinical observation of 94 3-to-15-year-old children with bronchial asthma and acute and recurrent bronchitis. 64 children were receiving dynamic electric neurostimulation, the rest (30 patients) formed the control set (without physical therapy).
To get an objective verification of results, additional diagnostic techniques were applied before and after the course of treatment for all the children. Such diagnostic techniques as pressure monutiring (PM), heart-rate monitoring (HRM), measurement of peak inspiratory flow rate (PIFR), investigation of respiratory function (RF), evaluation of bronchi patency, cardiographia, peripheral blood investigation, immunologic assessment, measurement of erythrocyte membrane lipid peroxidation.
The following techniques were applied when delivering dynamic electric neurostimulation by the DENAS apparatus for children with respiratory diseases. The stimulation was targeted at such impact areas as:
1. Jugular fossa (projection of trachea). The electrodes of the apparatus are inclined 45 degrees with respect to the breast bone. Stable manipulation.
2. Submandibular area (projection of larynx, vocal cords, submandibular lymph nodes). Stable manipulation.
3. Supraclavicular fossa (apex of lung projection). Stable manipulation along the midclavicular line.
4. Anterior surface projection of the upper lobes: from clavicles to the axillary creases. Instable manipulation, the electrodes moving top-down and ectoentad to the breast bone.
5. Posterolateral surface projection of bronchopulmonary tree and lungs. Manipulation by electrodes is delivered to the eighth intercostal space along the midclavicular line, to the tenth intercostal space through the scapular region, and to the level of the eleventh thoracic vertebral spinous process along paravertebral line. Manipulation is instable: the electrodes are being moved from the periphery of ribs toward the spine, top-down and ectoentad, beginning with the lower border of the impact areas (lower border of lung). Both straight-line and spiral motions may be used for massage sessions. Simultaneous exploitation of two apparatus is possible (in this case manipulation is delivered to the both sides of the areas at the same time).
6. Nuchal bone area. Stable manipulation.
Zonal treatment was delivered with the “Therapy” regime (77 Hz) of the DENAS apparatus, comfortable energy range being chosen for children over seen years old and minimal energy range – for children under seven years old. Treatment with the “Test” regime (10 Hz) was provided for all the children independent of their age.
Dynamic electric neurostimulation delivered by the DENAS apparatus was perceived by children with high tolerability, no side effects being observed.
Results and Conclusion
The conducted research showed that Dynamic electric neurostimulation makes positive influence on clinical signs of bronchopulmonary pathology in 62.5 % of patients. Thus, after the first two procedures, amelioration and reduction of cough frequency, elimination or relief of nocturnal coughing and easier sputum discharges were observed. In one third of children with bronchial asthma application of the DENS helped reduce the frequency of apnea attacks, fits of non-productive coughing, and resulted in disappearance or significant decrease of dyspnea and brought to an increase in the exercise tolerance.
By the fourth and fifth sessions of DENS the number of pulmonary rales (both dry and moist) decreased in 81, 2 % of the patients. The results allowed reducing the volume of medication.
Such an effect is based on the anticonvulsive, anti-edema and antichloristic actions of the factor on bronchi. The stimulation improves the drainage function of bronchi with the direct influence of electrical pulse on muscular and mucous layers of the bronchi wall and brings to the norm internal and external self regulation processes.
Improvement in clinical signs was followed by the positive dynamics of peripheral blood indexes. In 56, 8 % of children with acute and recurrent bronchitis WBC (white blood cell) differential and erythrocyte sedimentation rate reached normal values, and the total amount of leucocytes decreased. That was the evidence of the antichloristic actions of dynamic electric neurostimulation. Authentical decrease of eosinophils (from 10,06±0,22 % to 4,22±0,13 %, (р<0,05) was observed in all children with bronchial asthma. These changes marked the regression of the allergic processes.
Along with the improvement of clinical state of the patients positive dynamics of respiratory function was observed. Under the influence of the single session of dynamic electric neurostimulation the rate of peak inspiratory flow rate (PIFR) in children with depressed indicators increased by the end of the treatment course. At the same time the dymanic of PIFR was characterized by meaningful increase in 80 % of children with bronchial asthma and 77, 2 % of patients suffering from acute and recurrent bronchitis with bronchospasm.
According to the findings of the experiment, patency of bronchi in all parts of the bronchial segments increased. In 85, 0 % of children with bronchial asthma favorable results in patency of bronchial tubes were admitted (Peak Expiratory Flow Rate – PEFR 75-85). In 79, 5 % of children with acute and recurrent bronchitis the evident positive dynamics of PEFR 25 and PEFR 50 illustrating the patency of superior and middle bronchi were marked.
The results of the immunological researches proved favorable influence of dynamic electric neurostimulation on the immune competence of children suffering from bronchial asthma and acute and recurrent bronchitis. In case of acute and recurrent bronchitis, lower-grade evidence of inflammatory process was found, as elevated IgM decreased in 65, 9 % of children and the tendency to stabilization of IgM was observed in 72, 7 % of patients. The increased immune reactivity was characterized by significant decrease of depressed IgM level in 56, 8%, and at the same time IgM level tended to reach the normal volumes in all the patients with a lack of IgM. Thus, depressed IgM level in one third of children doubled and approximated the norm. In children with bronchial asthma more evident dynamics of serum immunoglobulin referred to IgE concentration: by the end of the treatment course with DENS the ratio of IgE concentration was twice as little. This process correlated with the decrease of eosinophils in peripheral blood and indicated the ruction of the allergic inflammation activity.
According to the data of pressure monutiring (PM) and heart-rate monitoring (HRM), DENS has no adverse effect on physical state of cardiovascular system, as along the treatment course blood pressure indexes and heart-rate varied within normal age range. In children with instable blood pressure indexes and heart-rate dynamic electric neurostimulation made for decrease in manifestations of vegetative dysfunction.
According to cardiography, the single session of DENS demonstrated positive effect on neurohumoral regulation. The treatment course with DENS method resulted in improvement of all types of vegetative dysfunctions and had positive impact on stabilization of elevated and depressed indexes of the initial vegetative tonus. The number of children with normotonia became half as large again and equaled 43, 2 %.
Under the influence of dynamic electric neurostimulation the embrane metabolism improved in two thirds of children (the stimulation helped recover ability of cells to produce secondary metabolite and normalize lipid peroxidation). Sifnificant reduction of lipid peroxidation (from 4-5 to 2-3) in 48, 4 % of children indicated stabilization of cell membrane.
Clinical observations discovered the improvement of psychoemotional state in children. Under the influence of DENS decreased irritation and emotional instability, elimination of sleep disturbance in overwhelming majority of children were admitted.
The results achieved in the clinical trials and biochemical screen and immunological study allow establishing high therapeutic effectiveness of dynamic electric neurostimulation for treatment of respiratory diseases in children. Cure rates in case of bronchial asthma averaged 80% and 90 % in case of bronchial asthma, while cure rates of the control set formed 60 % for bronchial asthma and 70 % for acute and recurrent bronchitis, respectively. Thus, on the basis of the conducted research it can be concluded that the use of dynamic electric neurostimulation is effective and expedient for treatment of bronchial asthma and acute and recurrent bronchitis in children.
In consequence of improvement in the blood circulation, lymphokinesia, metabolic processes the antiphlogogenic action of dynamic electric neurostimulation was found. The antiphlogogenic action was characterized by the disappearance of coughing and rales, improvement of the property of sputum, normal hemogram, lipid peroxidation and concentration of serum immunoglobulin.
Antispasmodic action was discovered due to the evident improvement in the patency of bronchi, drainage function of bronchi and recovery of autonomic nervous system role in regulation of the bronchial tone.
Dynamic monitoring used in the apparatus helps promote adaptive and self-regulating properties.
High efficiency of dynamic electric neurostimulation, high tolerability of the treatment, availability of domestic equipment allows recommending application of the DENS for treatment of children with bronchial asthma and acute and recurrent bronchitis (the treatment may be delivered at polyclinic, hospital, health centre, or convalescent center).