Анотація

Relevance of sensory disturbances (in particular, vibration, which refers to deep types of disturbances) and shakiness (as a manifestation of ataxia) is due to the fact that they are frequent complaints when patients (PT) go for consultation. Disorders of shakiness and ataxia occur when both central and peripheral, parts of the nervous system of various origins are affected. With damage to the posterior columns of the spinal cord and polyneuropathies (with selective damage to sensory fibers - conductors of deep types of disturbances), shakiness is a manifestation of sensitive ataxia. Purpose – to investigate the possibilities of assessing the state of the vibration disturbances of the shakiness in the as a differential diagnostic sign for clarification the type of ataxia. Materials and methods. The object of the study is the indicators of vibration disturbances in min with ataxia of various genesis. The research methods are clinical- neurological and general clinical examination with the involvement of instrumental study of vibration disturbances with the help of a medical tuning fork C-128, statistical methods. Results and discussions. The state of the vibration disturbances was assessed using an instrument – a medical tuning fork C-128. The following are indicated: 1) general characteristics of the medical tuning fork C-128 (Figure 1), amplitude of oscillations and physical parameters, chemical composition, possibilities of disinfection and surveillance); 2) methods for assessing the vibration disturbances; 3) categories of vibration in which the assessment of vibration disturbances is limited. The state of vibration disturbances was examined at 30 PT (men – 63.3%, women – 36.7%); mean age – 61.1±17.1 years; PT of old and senile age prevailed – 60%). It was found: 1) in 80% – a decrease in vibration PT (of which – in 33.3% until the complete absence of both feet in the toes); 2) in 20% of vibration was normal. The results obtained on vibration sensitivity were recorded in the form developed by us to the medical history (scheme 1) – for diagnostic purposes and the possibility of objectifying the further dynamics of the PT condition. When a decrease in vibration sensitivity in the distal extremities was detected, it was interpreted in favor of multiple diffuse lesions of sensory nerve fibers - taking into account other neurological status data - as signs of chronic polyneuropathy, clinically manifested by sensitive ataxia. Sensitive ataxia is a significant negative factor that increases the risk of falls, especially dangerous in the elderly and senile. Conclusions. Assessment of the state of vibration disturbances in PT with ataxia is one of the differential diagnostic signs for determining the type of ataxia, which contributes to the optimization of further diagnostic and therapeutic measures. The study of vibration disturbances complements – and does not replace – the assessment of the details of complaints, anamnesis and the state of other areas of neurological status. Studies of the state of vibration sensitivity using a medical tuning fork C-128 are a more sensitive method for detecting early disturbances of deep sensitivity than assessing the state of musculoskeletal sensation and Romberg's symptom. If a decrease in vibration disturbances is detected, fixation of the results, in addition to the diagnostic purpose, provides an opportunity to objectify the dynamics of the PT condition. In PT with persistent chronic ataxia, the assessment of ataxia by medical tuning fork C-128 is recommended as a mandatory method of instrumental diagnostics, which allows differentiating sensitive ataxia from other types.