By Academician Gennady KOTELNIKOV, Russian Academy of Medical Sciences, Head of Samara State Medical University;

Alexander YASHKOV, Dr. Sc. (Med.), Head of the Chair of Rehabilitation Medicine, SPA and Physiotherapy of the same University;

Mikhail KOTELNIKOV, Cand. Sc. (Med.), Deputy Head Physician, M. Kalinin Samara Regional Clinical Hospital

Nonmedicamentous regulatory therapy is now more and more often used in the treatment of various diseases. It is well combined with drug therapy, but can be used as monotherapy. Among the novel Russian treatment modalities in this sphere is a method developed by scientists of Samara State Medical University: treatment by means of hypergravitation.

Man has been exposed to the force of gravitation of the Earth throughout entire biological evolution. As a result, systems perceiving gravitation and reacting to its changes by special restructuring and locomotor reactions have formed in human body. The muscles, skeleton, vestibular system, viscera, blood vessels develop under conditions of permanent exposure to this force.

Due to technological progress (we mean here special centrifuges) it became possible to modify the level of gravitation for a period sufficient to evoke the physiological adaptive response with a stable trace effect in experimental conditions. Rotation in a centrifuge involves exposure to a centrifugal force of the craniocaudal (longitudinal) direction with a head-feet vector. As a result, the liquid media are redistributed in the

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body from the upper part to the vessels of the abdominal cavity and lower limbs. The feet are exposed to the greatest overloading along the longitudinal axis. These forces are negligible for the head and are not associated with appreciable disorders in the local circulation. Many scientists agree that hemodynamic disorders play the key role in the genesis of physiological shifts in human body during exposure to hypergravitation.

The creation of experimental short-radius centrifuges started in the 1960s for prevention of untoward effects of zero gravitation on aeronauts during long orbital space missions. In the USSR the first land-based designs of this type were created in 1978. We should emphasize that in contrast to aerospace medicine, investigating the compensatory potentials of various systems of normal human body in response to exposure to the threshold permissible hypergravitation, the aim of these studies was to select and validate the therapeutic levels of gravitation loading, stimulating and improving the adaptation mechanisms in various diseases. The theoretical base for these studies are the fundamental works by the leading scientists of the Institute of Biomedical Problems of the Russian Academy of Sciences - Academicians Oleg Gazenko and Anatoly Grigoryev, Adil Kotovskaya, Yevgeny Ilyin, and Inna Vil-Williams, Drs. Sc. (Med.), Alexei Shipov, Dr. Sc. (Biol.), et al.*

Simulation of artificial gravitation, providing a therapeutic effect, requires not only special medical equipment (we shall describe it in detail later), but also well-grounded therapeutic methods, promoting, among other things, elimination of ischemic symptoms in the lower limb tissues and improving the regeneration of the locomotor system elements.

Recovery of the bone integrity after bone fracture is largely determined by blood supply to bone fragments. Our experiments showed that therapeutic exposure to moderately elevated gravitation (up to +2G), consisting of two 5-day cycles of 10 - 15-min daily sessions with a 2-day interval, stimulated active growth of blood capillaries, increasing their number and thus optimizing the osteogenesis (bone formation) processes in fractures of the lower limbs. Bone bulks of spongy substance actively developed in the regeneration zone; these bulks were elongated, with a special growth vector. We attribute these characteristics to exposure to one of the resultant forces, emerging during rotation of the patient in the centrifuge. On the whole, the formation of compact bone under the effect of gravitation therapy is more intense than without this exposure.

Positive effect of the new method on muscle tissue and articular cartilage regeneration was confirmed experimentally. Improvement of blood supply to the pelvis and lower limbs, associated with this treatment,

* See: O. Gazenko, A. Grigoryev, A. Yegorov, "Space Medicine: Yesterday, Today, Tomorrow", Science in Russia, Nos. 3. 4, 2006. - Ed.

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Numerous capillaries in the zone of bone regeneration during gravitation therapy.

Formation of bone bulks: a - bone regeneration zone; b - connective tissue sites.

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prevented posttraumatic osteoporosis and osteoarthrosis deformans, atherosclerotic involvement of the vessels, and suppressed inflammation.

However, the positive effects of gravitation therapy are not confined to the trophic* effect. Its action is more extensive: as a therapeutic factor, gravitation is a potent stimulator of many biological processes in the body. Let us explain the gist in brief.

Hypergravitation simulated by means of centrifugation is associated with a peculiar static loading, causing activation of special receptor cells, sensitive to the gravitation field (a most important biological stimulus for them) in various parts of the body. The exposure is perceived by specialized nerve structures of the skin, subcutaneous tissue, blood vessels, and vestibular system. In the locomotor system these specialized structures are primarily the proprioreceptors in the muscles, tendons, and joints, forming the sensory information, maintaining the required tone of the skeletal muscles, and coordinating the locomotor function. The resultant additional flow of afferent (centripetal) pulses from the proprioreceptors activates the central nervous system, relationships between muscle tissue and viscera (the so-called motor visceral reflexes), which results in intensification of the autonomic processes.

From the modern physiological viewpoint, changes in the myoreception (muscle analyzer) as a rule involve appropriate modifications of visceral functions, which are autoregulated by interoception (visceral analyzer). The leading coordinating role in this "set-up" belongs to the motor visceral reflexes, governing the viscerovisceral (between the organs) ones. That is, the external exposure (hypergravitation) leads to predominance of the former over the latter ones. In other words, the muscle weight with its considerable volume and extensive reflexogenic zone modifies numerous autonomic functions and this modification can be regulated.

The knowledge of these regularities suggests the use of gravitation therapy in visceral diseases. During a therapeutic session the organs are partially shifted in comparison with their initial position, the ligaments are stretched, and due to innervation** the exterior receptor - central nervous system - autonomic organ mechanism works. Visceral reflex reactions, in turn, involve the locomotor function, primarily the function of the lower limbs.

Rotation of a patient in a centrifuge and the hemodynamic changes it involves cause significant reflex reactions from the sinocarotid node*** of the vestibular system. Without going into details, let us just say that these physiological shifts are realized through an intricate system of nerve bonds with a neurohumoral base.

Extension of the adaptation potential is the next important factor of the suggested therapy. We mean one of the basic characteristics of human body. Any disease is regarded as a result of exhaustion of mechanisms providing adaptation. The nervous system plays the predominant role in response to hypergravitation. Shifts of its lability (instability) emerging during therapeutic sessions establish a new level for this characteristic, universal for all reflex systems involved in the reaction, including the adaptation and trophic regulation of metabolic processes. As a result, a common reaction to a physiotherapeutic factor is formed, associated with functional and morphological rearrangement of body structures to the optimum, maintaining the required level of vital activity. For example, the reduction of the initially predominant effect of the sympathetic and activation of the parasympathetic compartments of the autonomic nervous system and subsequent normalization of their balance were observed after the therapeutic course in patients with benign forms of essential hypertension.

Positive results of experiments prompted introduction of gravitation therapy in medical practice. We suggested new methods for the treatment of traumatological and orthopedic patients, consisting in exposure to hypergravitation in combination with dosed exercise of the lower limbs. These methods are corroborated by 15 patents of the Russian Federation for invention. During trials more than 6,000 patients with ischemic and inflammatory diseases and lower limb injuries were treated. The time course of clinical manifestations was evaluated by the most up-to-date methods. Computer-aided tomography confirmed the positive effects of the sessions on microcirculation. Thermoasymmetry of the soles of the involved and normal limb disappeared in comparison with the initial status, which indicated normalization of circulation in tissues.

The new rehabilitation method is widely used in traumatology and orthopedics for the treatment of such diseases as slow consolidation of bone fracture, posttraumatic osteoporosis, false joint, arthrosis deformans; in surgery it is used in patients with atherosclerosis of the lower limb vessels, obliterating endarteritis, osteomyelitis. The efficiency of gravitation therapy in

* Trophies is a sum total of cell nutrition processes, maintaining the structure and function of tissue or organ. - Ed.

** Innervation is connection of organs and tissues to the central nervous system via nerves. - Ed.

*** Sinocarotid node is the site of dilatation of the common carotid artery before its bifurcation into the external and internal; an important reflexogenic zone, involved in the maintenance of permanent arterial pressure, heart work, and gaseous composition of the blood. - Ed.

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Computer thermogram of the feet of the patient with right shin bone fracture before (left) and after a course of gravitation therapy.

combination with traditional drug therapy is scientifically validated for arterial hypertension of the 1st and 2nd degrees, in otorhinolaryngology for the treatment of patients with Menier's disease, characterized by hearing and vestibular disorders. We consider that this method is a promising treatment modality for gynecology, andrology, urology; the list of indications for its use is increasing.

Due to experience gained by our team in cooperation with the Salyut plant (Samara), an original therapeutic artificial gravitation complex (a short-radius centrifuge) was created. The design allows rendering the optimal position to the patient during rotation. The velocity in the therapeutic mode is 33 - 36 rpm, load build-up rate 0.08 m/sec, session duration up to 15 min. The complex was registered at the Federal Service for Control in the Sphere of Public Health and Social Development and was entered in the State Register of Articles of Medical Application and Medical Technology, which opens the vistas for its use on the territory of Russia.

The Center of Gravitation Therapy was created on the basis of clinics of the Samara State Medical University in 2003. Among its tasks are development and introduction of research results into practical medicine, consultations. A complex of research with participation of many specialized departments of our University is carried out; postgraduates are trained here for future work at therapeutic and prophylactic institutions.

Artificial gravitation complexes work now at three medical institutions of Samara and at the Therapeutic Rehabilitation Center of the Russian Ministry of Public Health in Moscow. Today commercial manufacture of these devices in accordance with applications from the regions of the Russian Federation and the CIS countries is in full swing.

Due to new noninvasive technology of rehabilitation medicine, no additional operations had to be performed in the one-third of patients treated with the use of the new method, the price of treatment has been reduced by 25 - 30 percent, drug doses have been reduced and their side effects have been eliminated, disability was prevented. High therapeutic and economic efficiency of gravitation therapy prompts extension of indications for its medical use at rehabilitation centers, therapeutic, prophylactic, and SPA institutions of the Russian Federation.

The team of authors headed by Gennady Kotelnikov was awarded the Prize of the Government of the Russian Federation for 2006 for Achievements in Science and Technology for the development of a new scientific trend, gravitation therapy, and its introduction into practice.