Alexei Katashev, Yuri Dekhtyar, Janis Spigulis (Eds.): NBC 2008, Proceedings 20, pp.

99102, 2008
www.springerlink.com Springer-Verlag Berlin Heidelberg 2008
Reciprocating Orthotics Complex (ROC) for Children Suffering
from Cerebral Paralysis and Spinal Diseases
E. Dukendjiev
1

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, Botatovs, Petos,
Voitys, Koziavkins, etc. are based on the patients 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 patients 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 authors 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
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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. Its
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, its 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
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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 opresnoro complex with the use of
internal source of energy to cause changes in the reflex
influence changes from the spindles and tendinous Goldgis
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
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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;
ataxia 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).
Authors 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 (Panmiens cilvka kustbu
reciproklai vadbai un reciprokla ortou sistma visam kermenim)
Latvia. Patent X LV13100 B (in Latvian)
2. mxenxnen E. Method to compensate muscular and control defi-
ciency by the external energy (Mero xomnencannn e]nnnra
mtmeuno n ynpannxmme axrnnnocrn nnemne +neprne) 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 (Hpnnnnn omnnanrt.
Cop.cou. T 1). Collecton of works, Vol.1, Leningrad, LGU, 1950
(in Russian)
4. Anokhin P.K Problems of the higher nervous activity (Hponemt
ntcme nepnno exrentnocrn)., Academy of Science publishing,
Moscow, 1949
5. 3. Dukendjiev E. Reciprocal orthotic complex for the children with
cerebral paralysis and spinal diseases. (Reciprokl ortou komplekss
brniem ar cerebrlo trieku un spinlm slimbm). Latvijas rsts,
X5, 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