Говерса симптом (2) <приём>


William Richard Gowers (1845-1915)


Компенсаторный приём, применяемый больными с мышечными дистрофиями при вставании («вставание лесенкой»): больной встаёт поэтапно, опираясь руками о нижние конечности.

Описан английским неврологом сэром Уильямом Говерсом в его фундаментальной работе 1886г. «Руководство по нервным болезням» (Gowers W.R. A manual of diseases of the nervous system. London: Churchill, 1886;1:391-394). См. тж. Шерешевского симптом.

Кстати, именно Говерс в 1885г. ввёл в употребление термин «базальные ганглии».

Цитата из работы Говерса (цит. по Pearce J.M.S. Gowers’ sign // J Neurol Neurosurg Psychiatry 2000; 68:149)

«The difficulty in going upstairs is especially due to the weakness of the extensors of the knee and hip. The defect of theextensors of the hip causes the gait to have a peculiar oscillatingcharacters.

The greatest defect, however, is in the power of rising from the floor, and the most characteristic peculiarity is the modein which this is achieved, if it be still possible, and no objectsnear, by which the patient can aid himself. He commonly has notsufficient power to extend the knees when the weight of the trunkis on the upper extremity of the femur, which is then a leverin which power, applied between the fulcrum and the weight, actsat least advantage. He therefore places his hands on his knees,his arms thus bring much of the weight of the upper part of thetrunk on the femur close to the fulcrum, between this and thepower, which can then act at greater advantage. When the kneesare extended, the power of the extensors of the hip may be sufficientto raise the body into the upright position, or the patient mayaid them by an upward push with the hand as he takes it off. If,however, these extensors are weak, the hands are often moved higherand higher up the thighs, grasping alternately, and thus pushingup the trunk. To get thus the requisite support, the knees mustnot he quite extended, and if their extensors have no power, thedevice cannot be employed, and the patient is altogether unableto rise. In many cases, especially when extension of the hip iseasy, the patient achieves the extension of the knees in anotherway; he puts the hands on the ground, stretches out the legs behindhim far apart, and then, the chief weight of the trunk restingon the hands, by keeping the toes on the ground and pushing thebody backwards, he manages to get the knees extended, until thetrunk is supported by the hands and feet, all placed as widelyapart as possible. Next the hands are moved alternately alongthe ground backwards, so as to bring a larger portion of the weightof the trunk over the legs. Then one hand is placed upon the knee,and a push with this, and with the other hand on the ground, issufficient to enable the extensors of the hip to bring the trunkinto the upright position.»

 Говерса приём

Приём Говерса (источник: Мисюк Н.С., Гурленя А.М. Нервные болезни. Часть 2. Клиника, диагностика, лечение: Учебник для мед. институтов. – Минск: Вышэйшая школа, 1985. – 318с)


(у больного с мышечной дистрофией Беккера)