What is electrosleep. Electrosleep: therapeutic effect and possible risks

Physiotherapy is common and current view treatment, which includes several dozen methods. Electrosleep ( neurosleep) is one of them, the essence of which is to influence the human nervous system with the help of low-frequency pulsed currents.

This procedure was developed by Soviet physiotherapists in the middle of the 20th century. By the beginning of the new century, the technique gained a lot of supporters among European scientists, and in Russia it began to be used in almost every field of medicine.

Impact on humans and the benefits of the technique

Specially tuned devices in constant polarity generate current pulses. They affect the human cerebral cortex, as well as subcortical formations. Impulses enter the brain structures through the eye sockets.

With the help of blood vessels, such a monotonous weak stimulus reaches the hypothalamus. The impact on this part of the brain and on the reticular formation allows you to provoke a state close to sleep. Such a psychophysical "immersion", caused by the rhythmic effect of the current, is called electrosleep.

This procedure allows:

improve blood supply to the brain;
restore mental, humoral and vegetative balance;
normalize higher nervous activity;
improve performance genitourinary system and gastrointestinal tract;
stimulate the process of hematopoiesis and lower cholesterol levels, etc.

In European countries, this technique is called electroanalgesia, because it perfectly manages to relieve spasms, restore metabolic processes and even stimulate the production of the "hormone of happiness."

Electrosleep is a common and deservedly popular type of transcerebral physiotherapy, which is relevant for almost any disease.

Indications and contraindications

Doctors of various specializations prescribe a course of electrosleep procedures, but most often neuropathologists turn to such a physiotherapeutic effect. The pathologies of this area are closely related to the human central nervous system, therefore, neurosleep treatment for such ailments is especially important.

Neurological indications for the electrosleep procedure:

Many somatic diseases, according to some experts, can be caused by neurosis, stress and emotional exhaustion. For the treatment of such ailments, electrotherapy can be used to restore the emotional and mental balance of the patient.

Contraindications:

inflammatory eye diseases such as conjunctivitis, keratitis, uveitis;
cataract, glaucoma;
the presence of metal elements in the skull;
inflammatory processes skin at the electrode fixation points.

Children's age (up to three years) is also a contraindication.

Conducting algorithm and features

Electrosleep therapy is usually carried out in a physiotherapy room, but there are also mobile devices that perform their function directly in the patient's room or at home. Before the procedure, it is recommended to arrange a light snack, and after applying to the face cosmetics should be abandoned.

The person should sit comfortably on the couch, removing the constraining elements of clothing. To achieve maximum comfort, the patient may be offered a blanket or blanket. The room itself is usually darkened and isolated from noise.

A specialist in a physiotherapy room talks about the sensations and, according to the patient, makes an additional adjustment of the device, selecting the most comfortable impulse strength. Typically, the frequency does not exceed 150 Hz, and the current strength is 10 mA. The voltage in this case reaches 80 V.

The current is supplied using a special mask. It has four metal connectors into which the electrodes are fixed.

Monotonous impact should not cause pain and even discomfort. The doctor stays next to the patient for some time and asks to describe his feelings. It is important that the person is as relaxed as possible. After a few minutes, the patient will fall into a state of drowsiness.

The duration of a session for an adult varies from 30 to 90 minutes, depending on the severity of the disease and total number procedures in the course.

From the words of the patients recorded correctly

Reviews of doctors and patients who underwent electrosleep therapy.

As a medical worker, I can say that electrosleep is a brilliant invention that really helps people. The most important thing is that the specialist who performs this procedure is competent.

Olga-Nero15

I first tried this procedure in a sanatorium. I suffered from sleep disorders and increased anxiety. Impressions are extremely positive.

Nicholas Bale

Electrosleep perfectly relaxes and restores strength, although I personally could not fall asleep. It was only mild condition naps. There are also serious contraindications!

Evgeniya24

Electrosleep for children and pregnant women

For children over three years old, the electric sleep procedure can be prescribed, but its duration should not exceed 15 minutes, and the intensity of the currents should be reduced. Depending on age and disease, the power of exposure is adjusted.

In modern perinatal centers, there are also devices for electric sleep, because women in interesting position also sometimes need a course of such physiotherapy.

Gynecologists often prescribe a technique in the second trimester of pregnancy if a woman has toxicosis. A course of 12-15 procedures is really able to reduce toxicosis or even completely get rid of it.

Before childbirth or emergency delivery, a woman in labor is often prescribed a therapy session, because it will allow expectant mother gain strength and calm down. The state of artificial drowsiness or sleep will restore emotional balance and allow a woman to overcome the final pregnancy milestone with the greatest possible calmness.

The cost of a therapy session

It is not always possible to take a course of physiotherapy in a municipal polyclinic free of charge. By different reasons You may need to pay for treatment. The cost of the session starts at 300 rubles. Usually more affordable prices offer district polyclinics, which provide paid services.

Private clinics are ready to offer high level service and comfort, but first of all, a session on a modern and high-tech device for electric sleep.

One of the best devices can be called "Magnon-DKS". It is he who is installed in the physiotherapy rooms of many private clinics. The cost of a course of physiotherapy, consisting of 12 procedures, in paid clinic can reach 25 thousand rubles.

Educational program for future patients

Electrosleep therapy has gained popularity relatively recently, and has a short history. If in the 60s of the last century this method was skeptical, and it was considered not fully understood, now everyone resorts to it. more of people.

Stress, emotional exhaustion and deep depressions become commonplace for the 21st century, which are helped not only by medicines, but also by electrotherapy sessions. The rhythmic effect of low-frequency current can calm a person, relax him and improve cerebral circulation.

Become the cause somatic diseases. Pediatric neuropathologists tirelessly prescribe electrosleep to children suffering from enuresis. Scientists have long stated that the basis of this disease is neurosis.

Pregnant women suffering from late toxicosis cannot find salvation in drugs, since most of them are simply contraindicated when carrying a child. In view of this, women are offered to undergo several sessions of electrotherapy in order to stimulate hematopoiesis, metabolic processes and restore the functioning of the gastrointestinal tract. This allows expectant mothers to forget about nausea and constant weakness.

The availability of the technique is also an advantage. Pass the full course it is possible in almost every clinic, only in some it will be paid service. Meanwhile, the cost of therapy is adequate and commensurate with the benefits it brings.

electrosleep- a method of electrotherapy, which consists in the impact of a rectangular pulsed current of low frequency and low intensity on the central nervous system directly or through the receptor apparatus in order to normalize its functional state.

Main in the mechanism biological action electrosleep procedures is direct action current on structural formations brain. The current penetrates through the holes of the eye sockets into the brain, spreads along the vessels to its subcortical-stem sections (hypothalamus, pituitary gland, reticular formation) and acts directly on the most important vegetative-endocrine regulation centers located there. various functions organism. In addition, the neuro-reflex mechanism associated with the influence of low-power direct current pulses as a weak, monotonous rhythmic stimulus of the receptors of an important reflexogenic zone - the skin of the orbits and upper eyelid. Irritation of this area reflex arc is transmitted to the subcortical formations and the cerebral cortex, enhancing the inhibitory processes.

Psychophysiological studies have shown that under the influence of electrosleep procedures, changes in the functional state and electrical activity structures of the limbic system, which play a leading role in the formation of motivational and emotional aspects of behavior. The impact of pulsed current on this system, as well as on the subcortical-stem sections and the cerebral cortex, restores emotional, vegetative and humoral balance, normalizes the functions physiological systems regardless of whether these functions have been strengthened or weakened.

This demonstrates the universality of the action of electrosleep procedures, which makes it possible to explain its high efficiency in the treatment of many diseases, in the genesis of which special role belongs to disorders of psycho-emotional balance (neurosis, reactive and asthenic conditions, depression, sleep disturbances, increased emotional and vascular reactivity, primary hypotension, hypertonic disease, bedwetting in children, bronchial asthma, neurodermatitis, etc.). The analgesic effect inherent in electrosleep is associated with stimulation of the production of endorphins by brain cells.

The use of this factor has a mild calming effect on the body, causes sleep close to physiological, does not side effects. Under the influence of procedures, conditioned reflex activity is normalized, breathing is equalized and slowed down, capillaries, small and medium arterioles expand, the pulse rate decreases, and blood pressure normalizes. Electrosleep has been found to increase the function external respiration, redox processes, oxygen saturation of the blood, resulting in optimization of the flow energy processes. After the procedure, regardless of whether the patient slept or not, there is a feeling of cheerfulness, mood improves, mental and physical performance increases.

In the implementation of the biological effect of electrosleep procedures on the human body, the ability to nerve cells the brain to assimilate the rhythm of the stimulus falling on it, i.e. pulse rhythm. By choosing an adequate frequency of impulses, it is possible to change the bioelectrical activity of the brain in the desired direction. Hence the requirement individual approach to the choice of the optimal frequency of the pulsed current when using this factor.

The expediency of prescribing electrosleep procedures in cerebral palsy is also due to the fact that in the genesis of this disease special meaning have disorders of psycho-emotional balance and cortical-subcortical relationships. These procedures are especially indicated for patients with hyperkinetic and mixed forms of cerebral palsy, since they give a clear decrease in hyperkinesis, muscle spasticity, and improve gait and speech.

For therapeutic purposes, the Electrosleep-4T and Electrosleep-5 devices are used, which do not require special grounding, installed in a specially equipped, darkened room. The patient can lie or sit in a comfortable chair. Before the procedure, the physiotherapist conducts a conversation with the patient and warns him about the sensations that he will experience during the action of the current.

The patient is put on a rubber half-mask with metal cups-electrodes 2 cm in diameter, which are inserted into it. cotton swabs dipped in warm tap water. One pair of electrodes (cathode) is placed on the eyelids closed eyes patient, and the other (anode) - on the region of the mastoid processes. The half mask with electrodes is attached to the head with rubber straps. This arrangement of electrodes is called oculo-occipital.

Given the peculiarities of the child's psyche, including the fear of applying electrodes to the eyes, the first procedure is sometimes carried out without turning on the electric current. For the same reason, procedures are often dispensed with the frontal-occipital location of the electrodes, when one pair of electrodes is applied not to the eyes, but to the forehead area. It is generally accepted that with this arrangement of electrodes, the effect is less effective. The effect on the humoral link of regulation in this case is less pronounced, but the sedative and hypotensive effects persist.

The current frequency (10-70 Hz) is selected depending on the indications; with cerebral palsy, a frequency of 10-20 Hz is more often used. Turning the device on and off, the supply of electric current are carried out by smoothly turning the “Patient Current” knob, which makes it possible to avoid discomfort at the beginning of the procedure and not interrupt the evoked sleep after it ends. The current strength is adjusted individually depending on the sensitivity of the patient in the range from 3 to 10 mA (average 5-6 mA). The duration of the procedure is 15-20 minutes, for children adolescence- up to 30-60 min. The course is prescribed from 10 to 20 procedures daily or every other day.

Monitoring the condition and behavior of the patient during the session leads nurse, which should not leave the office until its completion. Sensations from the passage of current are localized in the depth of the patient's eye sockets, have the character of unsharp pressure, tapping, vibration and should not cause unpleasant emotions and irritate the patient. If he has other sensations and restless behavior, you should check the tightness of the electrodes, their localization, and reduce the current strength. Before removing the electrodes, the patient should be warned not to look at bright light. It is supposed to gradually adapt to the light in a semi-dark room in order to avoid unpleasant sensations that may appear in the eyes after removing the electrodes.

It is expedient for children and asthenized patients to carry out “central analgesia” procedures using the Lenar portable apparatus, which also generates rectangular current pulses at a current strength of up to 5 mA. The possibility of using the pulse frequency of this device up to 2000 Hz allows you to eliminate the discomfort under the electrodes, which sometimes appear when using the Electrosleep devices. In addition, this method of influencing the brain provides for the fronto-cervical location of the electrodes (on the skin of the forehead - the cathode, on the neck - the anode), which many patients prefer over the oculo-occipital location. The exposure time can be increased compared to the method described above, even for small children.

Clinical observations testify to the high efficiency of electrosleep, carried out by sinusoidal modulated currents from the Amplipulse devices.

The impact is carried out:
. with the oculo-occipital location of the electrodes;
. variable mode is used, III PP;
. frequency - 100 Hz;
. modulation depth - 75%;
. duration of sending-pauses - 1-1.5 s;
. exposure time - 15 min;
. daily or every other day;
. per course - 10-15 procedures. SMT electrosleep can be used in combination with SMT electrical stimulation of the extremities. Wherein local procedure carried out before the electrosleep procedure.

The combined method of treatment of SMT-electrosleep with simultaneous impact on structural formations and centers of the brain with variables is effective. magnetic field. The latter is created using devices for magnetotherapy "Pole-1" or "Pole-2". To do this, the patient, on whose head is wearing a half mask with electrodes connected to the Electrosleep apparatus, inductors generating a magnetic field are installed bitemporally (parallel at the level of the temples) with an air gap of 3-5 cm (see section "Magnetotherapy"). These procedures increase blood circulation and reduce venous congestion in cerebral vessels, normalize the ratio of the processes of excitation and inhibition in the cerebral cortex. Improving functional state peripheral link of the motor analyzer.

For treatment patients with cerebral palsy also used the method of introducing medicinal substances devices "Electroson" directly in brain structures with oculo-occipital application of electrodes. In this case, an "additional constant component" (DPC) is superimposed on the pulsed current. On the panels of the Electrosleep devices there is a button for turning on the DPS and a knob for its adjustment. Thus, it is possible to administer seduxen, vitamins B1, B6, B12, potassium iodide, calcium chloride, sodium and potassium succinate.

Indications for electrosleep procedures: atonic-astatic, cerebellar, hyperkinetic and mixed forms of cerebral palsy. Indications for the appointment of electrosleep procedures for other forms of cerebral palsy are the presence in patients of sleep disorders, decreased or increased blood pressure, emotional and motor anxiety, other neurotic reactions.

ON THE. Usakova, A.S. Levin, V.V. Nikolaev

Physiotherapy is a very common form of treatment in modern medicine. One of her procedures is electrosleep, or, as it is also called, neurosleep. The effect of this physiotherapy is that the nervous system is affected by low-frequency current impulses that bring the brain into a state close to sleep. This method of physiotherapy was developed in the USSR in the 50s. Today, in many European countries, the technique is recognized as very effective and at the same time completely safe and is widely used to eliminate diseases of various directions. This is due to the fact that at the time of such a procedure, the work of the brain, which is responsible for all processes in the body, is restored.

How does the procedure affect a person?

Such physiotherapy is carried out without fail in a hospital environment, since it requires the presence of a complex special equipment. The device is adjusted in such a way that it continuously delivers current pulses of the frequency required for a particular patient. They enter through the eyes. Such a weak electrical stimulus reaches the hypothalamus due to a particularly dense vascular network in the brain, as a result of which the patient develops a state as close as possible to normal sleep. During this process, under the influence of electrical impulses, the work of the central nervous system, the blood supply to the brain improves and (if necessary) the restoration of its damaged tissues occurs. Since it is the brain that is responsible for all the processes occurring in the body, when its condition improves, a number of disorders in the work of other systems and organs are also eliminated.

Indications for the electrosleep procedure

The indications for this procedure are various violations in the work of the nervous system, as well as brain injury. In addition, the procedure is also prescribed if malfunctions in the functioning of organs and systems are caused by neurotic disorders. Doctors prescribe a course of electrosleep when diagnosed the following diseases or states:

encephalopathy;
atherosclerosis at any stage;
vegetovascular dystonia;
neurosis:
neurasthenia;
sleep disorders;
chronic fatigue;
traumatic brain injury;
excessive mental overload;
enuresis;
the recovery period after a stroke, but not earlier than 40 days after the disease;
Raynaud's disease;
residual effects after the transfer of tick-borne encephalitis;
somnambulism;
severe stress;
emotional shock;
recovery period after a stroke;
urinary incontinence of nervous origin;
digestive disorders of nervous origin;
cardiovascular diseases of nervous origin;
nervous tic.

In addition, the physician may prescribe this procedure the patient and in diseases not related to the nervous system, but requiring additional rest for the brain, which the patient is not able to provide for himself on his own. Such prescriptions are purely individual and can only be determined by the attending physician.

Contraindications for the electrosleep procedure

There are many contraindications for this procedure. This is due to the fact that the effect is directly on the brain, and in a number of diseases this leads to their very serious exacerbation which can sometimes even threaten the life of the patient. It is for this reason that this physiotherapy is carried out exclusively on the prescription of a doctor who knows about the characteristics of the patient's condition and can accurately determine whether such a procedure can be performed or not. Prohibitions for conducting electric sleep are:

Epilepsy. In the presence of this disease exposure of the brain to electrical impulses can lead to extremely negative consequences, provoking not just an attack, but an epileptic status, which, in the absence of an urgent and highly qualified medical care can easily lead to the death of the patient. Even if only suspected epilepsy is present, the procedure is not performed.
Stroke. At the time of the development of a stroke or immediately after a hemorrhage has occurred, the effect of current can adversely affect the patient's condition, causing repeated hemorrhage. The procedure is possible no earlier than 40 days after overcoming the acute phase of the disease.
The presence of metallic inclusions in the bones of the skull. Since metal is an excellent conductor of electric current, if it is present during the procedure, the risk of electric shock to the brain with serious injury to it is extremely high.
Cataract. Due to the fact that the supply of impulses occurs through the orbits, in the presence of the disease, it is possible to provoke its rapid progression.
Glaucoma. The reason is the same as with cataracts.
Skin diseases in the area of electrode application. AT this case exacerbation of these diseases is possible.
Wounds on the skin in the area of electrodes. If there is damage to the skin, exposure to current can cause a burn.
Children's age up to 3 years.

The minimum age for the procedure is 3 years. This is due to the fact that more younger age the child is not yet able to understand what is happening, and this can cause the development of a shock state. It is strictly forbidden to neglect contraindications, as this can lead to the most disastrous consequences.

How is the procedure carried out

The procedure is carried out in a hospital or physiotherapy room of a polyclinic. In some cases, if doctors have a portable device and the patient does not have the opportunity to visit medical institution, therapy at home is allowed. The room in which this physiotherapy is carried out must certainly be darkened and with good sound insulation.

Before a session of electrosleep, you should definitely have a bite to eat, since during the procedure on an empty stomach, unpleasant sensations may occur that will not allow the patient to fully relax. Before the procedure, women should refuse to apply cosmetics to their faces, which, under the influence of current, can lead to backfire. Do not forget that it is necessary to remove contact lenses before applying the electrodes.

During the procedure, a person in a comfortable position for himself is located on the couch. You should dress in pajamas or a nightgown, because only if the clothes do not constrain the body, you can get the full relaxation needed during the procedure. After that, the patient is covered with a blanket or blanket so that he does not freeze. The doctor, having informed the patient about what will happen during the procedure, tunes the device to the required frequency and sets the electrodes on the eyelids of the patient, whose eyes must be tightly closed.

The procedure should not cause pain or discomfort in a sick person. The doctor, until the moment the patient falls asleep, is nearby and asks to report all the sensations. If they become unpleasant, another mode of electrical impulses is selected. The procedure (sleep session), depending on the age of the patient and the disease from which he suffers, can last from 20 minutes to 1.5 hours.

The method of physiotherapeutic influence, which is based on the influence on the central nervous system (CNS) with a pulsed current of low frequency, low strength and voltage up to 60-100 V, was called electrosleep. Electricity with such parameters leads the human brain (GM) to a state close to standard sleep.

Special devices are used to carry out the electrosleep procedure.

During the procedure, the work of the central nervous system stabilizes, and tissue trophism improves throughout the body. In parallel, there is an increase in the minute volume of respiration, which allows the tissues to receive large quantity oxygen, oxidation and reduction processes are normalized. Interestingly, electrosleep during pregnancy helps to reduce the manifestations of toxicosis and, unlike medications, is completely harmless in the first half of the term.

Who is shown the procedure?

Electrosleep, the indications for the appointment of which are quite extensive, has several therapeutic effects at once. Among them, it should be noted sedative, muscle relaxant, secretory and trophic. The main indications for such a physiotherapeutic effect were:

some diseases of the central nervous system, for example, neuroses;
arterial hypertension;
toxicosis in the first half of pregnancy;

Electrosleep is used to treat early toxicosis of pregnant women.

atherosclerosis in the initial stages;
myocardial ischemia;
bronchial asthma;
hormonal disruptions;
problems with potency and libido;
skin diseases;
enuresis;
transient disorders of cerebral circulation;
rehabilitation of drug addiction and alcoholism;
obliterating vascular diseases;
ulcer disease.

Restrictions for assigning electric sleep

Electrosleep has contraindications for use

Electrosleep, for which there are still contraindications, despite the high degree of safety, cannot be prescribed in the following cases:

epilepsy;
decompensated circulatory disorders;
fever;
some mental disorders(hysteria);
hemorrhagic stroke or suspicion of it;
metal-containing objects in the skull;
inflammatory reactions on the skin at the places where the electrodes are attached;
up to three years of age.

How is the procedure carried out?

Electrosleep, the methodology of which is associated with the need for constant medical supervision is carried out in a specially equipped physiotherapy room. AT recent times it is also possible to conduct it in other places - more and more new mobile devices appear, and the procedure can be carried out, for example, in the patient's ward in a sanatorium, or directly at home.

This physiotherapy is carried out in a darkened room, in the position of a person lying on a semi-soft couch / sofa. All restrictive clothing should be removed beforehand so that the person does not experience discomfort. The room must be well-insulated from any outside noise. Shortly before a session of hardware electrosleep, a light snack is recommended.

During the session, the patient falls into a state of drowsiness or sleep

Since the effectiveness of the impact depends on the ease of penetration of electrical impulses through the skin, the use of cosmetics is prohibited before the procedure. If this cannot be avoided, the face should be thoroughly cleansed before applying the electrodes.

After preparing the person, the physiotherapist tells the patient about the method of conducting electrosleep and sets up the equipment individually. The standard voltage applied to the electrodes does not exceed 80 V, the current strength is 10 mA, and the frequency is 150 Hz. A mask with holes in which the electrodes are located is put on the patient's face. A few minutes after turning on the device, drowsiness and sleep begin, the duration of which can reach one and a half hours.

Features of carrying out during pregnancy and in childhood

The answer to the question of why electrosleep is prescribed during pregnancy can be toxicosis - this procedure gently and without harm to the baby helps the expectant mother. Treatment course in medicine consists of 10-15 procedures, depending on the intensity of the symptoms of toxicosis. In some cases, there is not only a decrease in the intensity of manifestations, but also a complete disposal of them.

Some experts prescribe such physiotherapy before emergency delivery. Even in one session, a pregnant woman calms down, receives a “reserve” of new forces, and the emotional background stabilizes.

For children, such physiotherapy is prescribed after reaching the age of three. Electrosleep indications and contraindications for children are the same as for adults. Despite the relative harmlessness, the impact on the child turns out to be currents of lesser intensity, and total time each session should not exceed 15 minutes. During sleep, parents or medical staff are present in the ward.

Electrosleep for children is usually prescribed from 3-5 years.

Electrosleep stages

What is electrosleep in medicine has been known for a long time, and during this time all the phases that successively replace each other during such therapeutic effect. There are 4 stages of electrosleep.

Drowsiness. In this phase, human consciousness is preserved, since inhibition reactions have not yet begun in the cerebral cortex. All reflexes are preserved in full.
Deep sleep. A slight inhibition of the cerebral cortex and an increase in the hypnotic phases of sleep are characteristic. All reactions become unstable and are noted only when long-term exposure a specific stimulus.
Deep dream. It occurs with the development of significant inhibition in the cortex. Conditioned reflexes are completely lost, but the unconditional ones are preserved. auditory analyzer disabled.
Deepest sleep. Inhibition affects not only the cortex, but also the subcortical-stem formations, which leads to the loss of even unconditioned reflexes. Standard medical practice the onset of such a phase is practically not used.

Optimal therapeutic results from this physiotherapeutic procedure are noted in the first two phases. Even a short procedure removes psycho-emotional stress, improves mood, relieves fatigue. In most cases, night sleep is also normal.

The main therapeutic effects of electrosleep

Pulse current, penetrating into cranium moves through tissues and fluids with the highest electrical conductivity, and affects the main parts of the central nervous system. Increasing inhibition leads to an acceleration in the production of serotonin and a pronounced decrease in emotional activity. As a result, the following effects are noted:

a significant increase in the oxygen content in the blood;
decrease in the level of lipoproteins in the blood;
the release of endorphins increases, which leads to an improvement in mood;
pain sensitivity decreases;
return to normal protein and carbohydrate metabolism.

With such a wide positive impact on the body, electrosleep, the indications and contraindications for which are indicated above, is not addictive. This makes it indispensable in the treatment of many pathologies, and electrosleep in a sanatorium, often prescribed in rehabilitation period almost doubles the recovery time after serious illnesses. It is important that electrosonotherapy does not cause a decrease in memory and intelligence, which is often observed with drug exposure.