PHYSIOTHERAPY

IN PSYCHOMOTOR DEVELOPMENT DISORDERS AS A CONSEQUENCE OF NERVOUS SYSTEM DAMAGE

The lag in the pace of psychomotor development is noted in a large number of children of the 1st year of life with many diseases: with rickets, malnutrition, repeated diseases with acute respiratory viral infections, especially often in premature babies. These changes are not associated with brain damage and are compensated with age under favorable environmental conditions. Thus, the lag in the development of mental and motor functions is due only to a slowdown in the rate of maturation of brain structures and their functions in the absence of qualitative changes in the central nervous system [Zhurba L. T., Mastyukova E. M., 1981].

The patients of the exercise therapy room of the polyclinic, along with such relatively well-off children, are children with various disorders of the central nervous system. At the same time, a specific developmental delay is noted. These children make up 70-80% of the total number of infants - patients in the exercise therapy room of the polyclinic,.

Of particular importance is the identification of non-rough "small forms", in which it is possible and necessary to determine the microsymptoms of the disease, and therefore, start treating in time. Only early, from the first days of life, treatment, carried out persistently and with the effective help of parents, makes it possible to achieve a practical recovery of 80% of children (in the event that the damage to the brain structures is reversible) [Semenova K. A., 1989]. If the disease is diagnosed when the child is already one year old and at a later date, which, unfortunately, is observed very often, then

the prognosis is much worse, even in cases of less severe brain damage.

The main link in the monitoring of children with impaired functions of the nervous system (in the network of medical institutions) is a polyclinic. The effectiveness of the treatment of children with neurological disorders largely depends on the competence of the exercise therapy doctor and the masseur-instructor of exercise therapy working with him. )

Etiology. Harmful factors that affect the child's developing brain in utero lead to a delay in its formation and development during various periods of pregnancy. The causes of brain damage are different: chronic and acute diseases of the future mother, genetically burdened heredity, fetal hypoxia and asphyxia of the newborn, intrauterine and postnatal infections, mechanical damage to the central nervous system during childbirth, stressful conditions in the mother, bad habits of parents (alcoholism, smoking ), less often (about 20%) as a result of diseases and injuries of the brain in the neonatal period, when the child's brain is still immature.

These disorders continue to have a negative effect on the further development of the nervous system and the whole organism as a whole.

Any unfavorable factors can aggravate the development of a child with brain damage. They are non-compliance with the general regime and diet, violation of the hygienic regime, frequent and prolonged illnesses of the child with acute respiratory viral infections, rickets, malnutrition, combined diseases, etc.

Pathogenesis and clinical picture. Harmful factors affecting the fetal brain lead to developmental delay in utero, and in the 1st year of life adversely affect the development of the emotional, mental activity of the child, the formation of which occurs during this period of his life. Usually in healthy children in the 1st month of life, sometimes even earlier, a smile begins to appear. If at this age, despite the efforts of an adult, it is not possible to evoke this positive emotion, and the child is apathetic, inhibited, then this may be the initial symptom of a delay in his psychomotor development.

Often, in a child, especially a newborn, with posthypoxic changes in the brain, negative emotions are evoked by the action of the most insignificant stimulus. At the same time, the baby sleeps little, screams for no apparent reason. This pathological hyperexcitability

the child occurs with an increase in intracranial pressure, although it can be a symptom of other diseases.

Various pathological conditions associated with impaired intrauterine development, depression of the nervous system and other diseases lead to a general weakening of the child's body; in children, especially premature ones, a decrease in indicators of physical development (weight, body length) can be detected.

Of great importance for the formation of motor skills in children, general motor activity is the state of their muscle tone. Normal muscle tone determines the possibility of normal psychomotor, physical development of the child. In sick children, a violation of the physiological muscle tone is diagnosed. Their muscle tone may be increased (muscular hypertension), may be lowered (hypotension), may be impaired (dystonia), i.e. when, against the background of general muscle hypotension, there are periods of increased muscle tone associated with emotional stress, a change in body position, as well as individual muscle groups.

In the clinic, when examining children with pathological hypertension, ulnar flexion of the hand, tension of the arm flexors, adduction of the first fingers to the palm, tension of the leg extensors, adductor muscles of the thighs are most often noted. The latter is expressed in the difficulty of passive breeding of the hips in the supine position. When trying to put the child on a support, he stands on his toes and sharply unbends his legs at the knee joints, and when he leans forward, he makes stepping movements, crossing his legs. Such a symptom, revealed by the end of the 3rd month, may be one of the early signs of cerebral palsy (CP).

At the same time, muscle hypertension at the age of 1-3 months can be a symptom of many diseases, as well as in premature, immature, hyperexcitable children. Muscle hypertension in patients with perinatal pathology often leads to the formation of cerebral palsy.

Muscular hypotension in a child of 1-3 months is also a manifestation of various diseases; it is characteristic of * somatic debility, rickets, conditions after infections. In severe perinatal hypoxia and intracranial birth trauma, muscle hypotension can lead to the formation of an atonic-astatic form of cerebral palsy or be a sign of other neuromuscular hereditary diseases.

Muscle tone may be asymmetrical. Wherein

an asymmetric position of the child’s body is noted: his torso is curved as if in an arc with a bulge towards lower muscle tone, legs, pelvis are turned towards increased muscle tone, sometimes the shoulder girdle is lower on the same side, and the head is often tilted in the same direction - more tension muscles (spastic torticollis, which, when the nervous system is damaged, begins to form at the age of 1-3 months).

The asymmetry of the child's body is noted in the position both on the stomach and on the back, skin folds are also asymmetric (inguinal, gluteal, popliteal, above the heels) Movements of the limbs from the side of increased muscle tone can be either more or less pronounced than on the other side. muscle tone of the adductor muscles of the thigh, more from the side of increased muscle tone of the trunk

The asymmetric position of the child's body is often diagnosed as hemisyndrome. It is necessary to differentiate the described changes from orthopedic disorders - changes in the hip joint (dysplasia, dislocation), for which it is necessary to refer the child to an orthopedist. The asymmetry of the facial and brain skull is not always a pathological sign, but may be the result of improper care for the child, staying in bed on one side

Currently, children with hemisyndrome (out of children with CNS disorders) are the most frequent patients in the polyclinic. Dysregulation of muscle tone is closely associated with impaired development of tonic and adjusting reflexes, resulting in the formation of pathological friendly movements (pathological synkinesis), stable vicious positions ( poses) of the trunk and limbs. If it is not possible to treat the child in time and vigorously and the disease develops, secondary changes are formed in the muscles, bones and joints, contractures, deformities (scoliosis, kyphoscoliosis, pathological movements) occur. In order to find out how muscle tone and movement disorders develop in a sick child, one must have an idea of ​​the tonic congenital reflexes of a healthy child.

Labyrinth tonic reflex (LTR) is a manifestation of the functions of the vestibular apparatus. LTR is observed in a child of the first weeks of life. It is characterized (in the supine position) by a slight tension of the extensors of the neck, back, and legs. Under the influence of the same reflex, but in the prone position, the child assumes the position of the embryo ( the head is brought to the chest or thrown back excessively, the arms are bent and also brought to the chest, the hands are brought into fists, the legs are bent and brought to life). The influence of LTE disappears by 1 1/2-2 1/2 months.

Tonic reflex from head to torso. When turning the head of a child lying on his back, his torso, simultaneously with turning the head, turns in the same direction in a “block” (simultaneous turn of the upper and lower half of the body). This innate reflex normally persists in a child during the first 3 months of life. In the future, oi is converted into a rotation with torsion, i.e., into a separate rotation of the upper and lower half of the body.

Tonic reflex from the pelvis to the trunk. When the pelvis is turned to the side, the trunk simultaneously also turns in a “block” in the same direction. This reflex persists up to 2-3 months of life.

Symmetrical cervical tonic reflex (SNTR). When the child's head is lowered, the tone of the flexors of the arms and extensors of the legs increases. When the head is thrown back, the tone of the extensors of the arms and flexors of the legs increases. This reflex normally fades by 3-4 months.

Asymmetric cervical tonic reflex (ASTR). When turning the head to the side in the position on the back, the arm to which the face is turned straightens (the tone of the extensors of the shoulder, forearm, and hand increases - the fencer's position). And in the muscles of the arm, to which the back of the head is facing, the tone of the flexors increases. The reflex normally fades away by 2-3 months.

Grasping reflex. The child grabs and holds the adult's fingers (stick) placed in his palm.

Children with various disorders of the central nervous system may have different periods of extinction of these tonic reflexes. As a result, there is a delay in the psychomotor development of the child, and in combination with impaired muscle tone, pathological changes in the musculoskeletal system (contractures, kyphoscoliotic setting, etc.), pathological postures and movements of the torso develop, the coordinated action of the hands, the speed of purposeful movements are delayed. Therefore, with a delay in the extinction of congenital tonic reflexes, it is necessary to use all means of exercise therapy for the speedy repayment of these reflexes, and above all exercises according to Bobbat, Vojta, treatment with position, etc.

Thus, approximately in the period from 2 to 6 months of life in healthy children, the described tonic congenital reflexes fade away, and from that time onward reflexes begin to develop. Thanks to this, it becomes possible to hold static postures - sit, stand, the possibility of developing motor skills, voluntary movements. Of great importance in the "verticalization" of the child is the development of those brain structures that contribute to overcoming the forces of gravity - the so-called antigravity.

Of all the structures of the brain and spinal cord, the vestibular apparatus is of particular importance; in antigravitational possibilities and in the development of the balance of a growing organism. Starting from the 7th week of intrauterine development, the vestibular analyzer determines the improvement of motor skills at all levels of development of the fetus and child, and affects the activity of the whole organism.

Installation reflexes. The congenital tonic labyrinth reflex (LTR) is replaced by labyrinth installation reflex(LUR) - the first anti-gravity reflex. Thanks to him, the child begins to "keep his head"; from a position on the stomach begins to lift it, leaning on the forearms, and keep the shoulder girdle, and then the upper body raised; can move to standing on all fours, kneeling, and then to a vertical position and keep the body in a sitting, standing, walking position. Thus, LUR is the most important mechanism for overcoming gravity and developing complex chain reflexes based on this reflex, which contribute to antigravity. In patients, this defining reflex is either absent or weakened, or manifests itself unilaterally in the position of the child on the back or stomach. In case of a defect or absence of LUR in patients with cerebral palsy, the head is lowered to the chest. With this position of the head, the cervical tonic reflex is activated and the tone of the arm flexors increases. This position is very stable and gradually forms a flexion-lronator setting at the elbow and wrist joints. In this position, movements that require extension and supination of the arms are impossible.

The development of adjusting reflexes in a sick child is complicated by the fact that under the influence of a complex of tonic reflexes, the development of physiological lumbar lordosis is delayed, which leads to the formation of kyphosis and kyphoscoliosis by the 3rd month of life. The latter is also due to the weak development of the gluteal extensor muscles of the trunk and legs. Contractures in the hip joints are gradually formed on the basis of the flexion of the hips.

It is important to note that in patients, the remaining tonic reflexes prevent the appearance of not only adjusting reflexes, but also those physiological synergies (friendly movements) that provide the possibility of voluntary motor skills, that is, the coordinated, simultaneous work of many muscle groups.

As the brain develops in healthy children, other adjusting reflexes, the cervical symmetric chain adjusting reflex and the cervical asymmetric chain adjusting reflex, join the LUR. All together, these installation reflexes determine the "verticalization" of the body, keeping it in this position, the action of the hands

Installation neck chain symmetrical reflex. Thanks to him, the extensors of the neck and back are tensed (from 2 months of life), and after 4-5 months - the extensors of the legs (in the position on the stomach, and then in the standing position).

Installation neck chain asymmetric reflex It is formed from 3-4 months of life. Thanks to him, balance is maintained in any position of the child's body and active manipulative activity of the hands. At the same time, other adjusting reflexes develop: the body-to-body reflex, the Landau reflex, and others. Each of them contributes to the formation of posture tone (postural tone) and physiological muscle tone. The latter, as noted earlier, is important for the development of the child's voluntary movements.

Reflex from body to body is of particular importance, as it regulates the position of the body in space, keeping it in a normal position.

Landau reflex. First phase: a 4-month-old child, laid on the table so that the head and shoulder girdle are off the table (i.p. - on the stomach), unbends the torso, raises the head and chest, stretches the arms forward. Second phase: baby

6-8 months i. n. on the back, laid on the table so that his legs are off the table, raises his legs up to the level of the body. Thus, having mastered the tone of the posture, the child begins to master more and more complex movements.

The labyrinthine complex Landau chain reflex in patients may either be absent or partially manifested: for example, the child straightens his head, and his legs hang. In the absence of this reflex, the head, arms, and legs hang.

The physiological phenomena of paratonia and cocontraction in healthy children determine the ability to maintain the body in a certain position, as well as to ensure the plasticity of fixed postures of the trunk and limbs when performing complex movements.

Paratonia is a condition in which, in addition to the muscles, the tension of which causes a certain movement, other auxiliary muscles are included "to help". As you train, the movement is "isolated" and performed only with the help of those muscles that are necessary for this movement. For example, at the very beginning of learning to walk in a baby, almost all muscles, even mimic ones, are activated, but as the skill of walking is mastered, only a certain group of muscles begins to participate in movement, providing walking. Therefore, at first the child walks uncertainly, loses balance, falls, and, finally, by the age of 1, masters walking as a semi-automatic act. In making such a walk Active participation receives not only the actual motor analyzer, but also its kinesthetic department, where sensitive motor cells fix a trace image of the movement done, create a memory of it [Semenova K. A., 1976]. This memory of movement with the growth and development of the child becomes more diverse and deep. On the basis of the scheme of body position and the scheme of movements that are formed during the first years of a child's life, all types of movements necessary in life and work are built in the future: movements of the hand and fingers when writing or playing with a musician, etc.

Cocontraction is a simultaneous increase in the tone of the flexors and extensors of the limbs, which allows them to maintain their posture. For example, to keep the torso in a vertical position, the muscles of the legs are simultaneously tensed - the flexors and extensors, the legs, as it were, turn into pillars that hold the body.

Gradually, with the development of the installation reflexes, mastery of sitting, standing and other postures of the body, limbs, mechanisms of cocontraction are formed. Without them, it would be impossible to keep the body, its parts, limbs in any position. But cocontraction ensures not only the retention of the position, but also the implementation of any movement - after all, each movement occurs in the form of a consistent and quick change of postures.

Thus, in the motor apparatus gradually, with the growth of the child, complex transformations develop that prepare the development of voluntary motor skills. In children with cerebral palsy, manifestations of cocontraction and paratonia are pathological in nature, preventing the development of movement. For example, if a sick child tries to reach out and take a toy, then sometimes the increase in tone is so great that the child cannot make any movement. A sick child, therefore, cannot make an isolated movement in only one or two joints, since all the pathological synergy is immediately turned on, consisting of movements of many muscle groups that are not related to this movement.

Children in the 1st year of life are sent to the district children's polyclinic, to the exercise therapy room, mainly with the consequences of mild cerebrovascular accidents, birth trauma, with asphyxia, in the I, early, stage of cerebral palsy - with reversible disorders of the brain structure that cause a delay development of the psyche and motor skills of the child in the first months of life. In the future, gradually, these violations by 5-8 months can often be completely compensated. With a delay, but still, congenital motor reflexes begin to appear, and tonic reflexes (neck and labyrinth) gradually fade away, physiological muscle tone, adjusting reflexes are restored, and voluntary motor skills develop.

In the polyclinic, the examination of a child with perinatal pathology must be carried out by all means by an exercise therapy doctor and a masseur-exercise exercise instructor working with him at the reception. The activity and knowledge of the massage therapist make his work with the child the most effective, and the training of parents in the exercise therapy technique involves them in active participation in the implementation of therapeutic measures, which ensures greater effectiveness of treatment.

Physiotherapy. The need for early training of a child with CNS damage from the first weeks of life is justified by the great plasticity of the brain in this period, significant reserves of the growing organism, and its ability to respond to changing environmental conditions. It is necessary to train age-related skills both in children with severe neurological disorders and in children who are at risk for their occurrence.

Special’tasks of exercise therapy:

1) complete relaxation of spastically contracted muscles is possible with pathological hypertonicity;

2) strengthening weakened, stretched muscles;

3) improvement of respiratory function;

4) the formation of the child's psychomotor skills, taking into account its stage-by-stage ontogenetic development;

5) stimulation of absent or weakened innate reflexes;

6) development and consolidation of a sense of posture with the help of kinesthetic, optic-motor and auditory-motor connections, development of physiological adjusting reflexes;

7) prevention and treatment of thoracic and lumbar kyphosis, kyphoscoliosis, spastic torticollis, adductor spasm of the hips, pathological placement of the hands and feet with the main means of exercise therapy for the described pathology (massage, exercise, positional treatment);

8) normalization of range of motion in all joints of the trunk and limbs;

9) against the background of the formation of the correct position of the hand, hand, fingers, stimulation of the development of grasping, supporting and manipulation functions of the hand;

10) against the background of the formation of the correct position of the hip, knee joints, feet - stimulation of the support function of the feet, walking;

I) stimulation of movements in a horizontal position;

12) along with the normalization of the functions of the musculoskeletal system - constant and systematic stimulation of the development of the psyche, speech.

Guidelines for conducting exercise therapy classes.

1. Relaxation of the muscles of the trunk and limbs to carry out:

a) before the start of the exercise (procedure) exercise therapy; b) before

exercises aimed at the formation of a particular movement; c) before laying the trunk and limbs in a physiological position. With significantly pronounced pathological muscle hypertension, each exercise in the lesson should be combined with relaxing massage techniques - classical and acupressure.

2. All exercises aimed at the formation of a particular movement should alternate with breathing exercises (taking into account the constant chronic hypoxia in children with impaired nervous system function).

3. Exercise therapy should be carried out taking into account the phased ontogenetic development of motor skills. For example, if a child of 9 months does not independently turn on his side, on his back, on his stomach, does not crawl (what he should have done at 4-6 months), exercise therapy should begin with the development of these skills.

4. Against the background of general strengthening exercises, simultaneously with the relaxation of pathologically spastic muscles, the damping of tonic reflexes and the development of adjusting reflexes, correct postures and motor acts, achieve an increase in the range of motion in all joints.

5. Giving parents assignments for physical therapy at home, the masseur-instructor of exercise therapy should explain that in the exercise with the child of exercise therapy, it is necessary to combine all its means - physical exercises, massage, treatment with position. The latter has

especially important at home, since the insufficiency of motor functions, forced pathological postures must be compensated for by changes in the positions of the trunk and limbs. To attach these positions and fix them with the help of special styling, the masseur-instructor must teach parents (using visual aids in the exercise therapy room of the clinic).

6. The masseur-instructor of exercise therapy should accompany exercise therapy with a smile, encourage the child’s achievements with an affectionate intonation of the voice, and then with words indicating to the child the nature of the movement being performed: “give a pen”, “take Lyalya”; attract his attention with bright sounding toys. It is desirable to conduct classes in front of a mirror in order to consolidate the sense of posture, using not only kinesthetic and auditory-motor connections, but also optomotor reactions.

For the correct psychomotor development of the child, it is very important to match the child's muscle tone to his age. In children with perinatal diseases of the nervous system, as mentioned earlier, disturbances in muscle tone (hypertension, hypotension, dystonia, asymmetry of muscle tone) are noted. Therefore, before training motor skills, it is necessary to normalize muscle tone.

Some massage techniques and exercises that help relax spastically contracted muscles. Stroking, shaking, vibration, felting, rolling, acupressure (relaxing method - see Chapter 2), some exercises according to Bobbat, Phelps, etc. are used.

Techniques leading to a general relaxation of the muscles of the trunk and limbs .

1. Embryo position. I. p. - on the back: the child is given a half-sitting position, with the left hand supporting him under the head, with the right hand - they connect the child's hands and bent knees. In this position, it is swayed forward - backward and from side to side (Fig. 44).

2. By laying the child on the ball and rocking it in this position, it is also possible to eliminate or significantly reduce the pronounced increase in muscle tone. Exercise

niya is carried out as follows: the child is laid with his stomach and chest on the ball (on a diaper) and, holding it, swing it back and forth at an average pace (Fig. 45). After a while, when there is a decrease in the tone * of the flexor muscles, the child is turned and placed with his back on the ball. Again make several rocking movements back and forth. If muscle relaxation is insufficient, several rocking movements are made to the right - to the left and diagonally.

3. In the supine position, the child is swayed to the left - to the right. Masseur-instructor exercise therapy puts his hands under the shoulder joints of the child and the posterolateral surfaces of his torso. At the same time, the III finger of one and the other hand of the massage therapist is located at point 20 (see Appendix 9, map 11, Fig. 3, c) behind the shoulder joint, the I finger is on the front surface of the shoulder. I simultaneously conduct a point massage with the III finger (relaxing method); with his thumbs, the massage therapist slightly shakes the child’s hands, simultaneously pulling him to the sides, and then shakes the baby from side to side (Fig. 46). Then, supporting the child's pelvis on the right and left with both hands, gently shakes it from side to side.

4. Holding the child vertically on weight by the torso, the massage therapist shakes him slightly, and also turns him between his hands to the right - to the left.

5. I. p. - sitting astride the massage therapist's knee. The child is supported by the arms or torso and with springy movements of the legs they are slightly thrown up 10-12 times.

After the described techniques, which help to relax the muscles of the trunk and limbs, a general massage is performed (light stroking, rubbing, vibration).

The preliminary application of general massage creates a favorable background for the impact of acupressure and the use of physical exercises [Bortfeld SA, 1979]. After relaxing the spastic muscles, normalizing their tone, you can begin to work on increasing the range of motion in all joints, apply exercises to strengthen weakened muscles, develop adjusting reflexes and voluntary motor skills.

Some means of exercise therapy that help to relax the tone of the muscles of the hand, the development of grasping, supporting and manipulative functions of the hands. First of all, it is necessary to achieve maximum relaxation of the muscles of the whole body (see exercises 1-5 above) and especially the muscles that move in the joints of the arm and hand.

To relax the spastic muscles of the arm (adductors, flexors of the shoulder and forearm, pronators), the following massage techniques are used in combination with passive exercises: acupressure (relaxing method) of the pectoralis major muscle - 2.5-3 cm above the nipple, alternating with vibration of the pectoral muscle in the direction from the sternum to the armpit, to the shoulder. Stroking and vibration of the front surface of the arm is carried out with acupressure of the biceps muscle of the shoulder, pronator of the forearm (point on the forearm - 2-3 cm from the elbow on the line leading to the first finger).

The Phelps technique is used - light shaking of the hand to relax the muscles of the forearm. The masseur grabs the forearm in its middle part and makes 3-5 shaking movements with the child's hand. The muscles of the arm relax well when rolling the shoulder between the two hands of the massage therapist. The rolling of the child’s hands lying on a support (in I. P. on the back), in combination with acupressure at the shoulder joint at point 20 and at the point under the deltoid muscle, leads to muscle relaxation (the movements of the massage therapist when rolling the child’s hands resemble the movements of the hands when rolling test). These massage techniques are combined and alternated with passive exercises: flexion and extension of the arm in the elbow joint, abduction and adduction of straight arms, crossing them on

chest, "boxing" lying on your back. Particular attention is paid to working with the forearm, hand and fingers. The masseur places the child's palm on his own palm (the child's right hand on his right palm and moves the child's hand to the supination position. These movements are combined and alternated with flexion and extension of the arm in the elbow joint, with a deep massage of the palmar surface of the hand, fingers. To facilitate extension hands in the wrist joint do acupressure (strengthening method) in the middle of its back surface.To abduct and extend the first finger, do acupressure at its base.Activation of the reflex extension of the first finger helps to eliminate ulnar flexion of the hand; in order to relax the muscles of the hand, pat the child's palm on of his palm, on a table with springy bedding.Sometimes, extension of the first finger is achieved only after acupressure at the base of all the other fingers and their extension.Simultaneously with the described techniques, massage and exercises are carried out to strengthen the weakened, stretched muscles of the arms (stroking, rubbing , knead e, acupressure - a tonic method), reflex exercises, active, including those with resistance (see. appendix 5).

If the abduction and extension of the child's arm is at least somewhat limited, attention should be paid to the position of the Scapula relative to the spine. If the scapula moves outwards and upwards, then for correct installation shoulder blades and spine, with the help of acupressure, relax the pectoralis major muscle at a point 2.5-3 cm above the nipple and stimulate the functions of the muscles that hold the shoulder blade by shading between the shoulder blades and the spine at points along the outer edge of the trapezius muscle.

To stimulate the grasping functions of the hand with paresis of the hand, i.e., when the hand is somewhat retracted outward or hanging down, and the first finger is pressed to the palm and covered by other bent fingers, it is recommended to train the grasping reflex several times a day for the first 3 months. And if it is absent, then a ring or a toy that is easy to grip is inserted into the palm of the child, around which the child's fingers are squeezed. It is very important at the same time to ensure that the first finger wraps around the ring (toy) on one side, and the other fingers on the opposite side. After several repetitions, a grasping reflex appears. He is trained for 2-3 months. By 4 months of life, to develop an active grip, the toy is suspended at a distance convenient for gripping.

with her hand, or for the same purpose, they bring a bright sounding toy to the child, encouraging him to take it.

The following exercises are used to develop and stimulate the support function of the hand.

1 And p. - keep the child on weight, with your left hand support him under the stomach, right hand by the legs (from above with a “fork”). The masseur slightly throws the child with his left hand over the table (chair), on which lies a large soft toy or a large ball. The reflex of support on the toy is called, the arms are stretched forward and the hands and fingers are opened.

2 I. p lying on his stomach, leaning on the hands of straightened arms. The masseur carefully takes the shoulders back and presses down on the shoulder area, achieving a stable emphasis of the straightened arms.

3 I.p- standing on all fours The masseur raises the child's head up. There is a change in the position of the hands, extension of the hand and fingers. The movements are stimulated with a word, a toy (Fig. 47).

In the second half of a child's life, the manipulative function of the hand should be developed, encouraging him not only to pick up a toy, but also to perform various actions with it - examine it, shift it from hand to hand, throw, stack cubes, disassemble the pyramid.

Exercises to develop the function of the hand and strengthen the muscles of the torso. And * p. sitting in the arms of an adult, the child's legs are sandwiched between the adult's thighs. The child sits first on one leg of the massage therapist, then on the other The masseur encourages the child to move behind the toy, which is placed either in front of the chair, then on the side and behind the child. He leans forward for the toy, straightens up, passes it to the masseur, and then leans back, picks up the toy , again transfers it to the massage therapist (see Fig. 24) Exercise therapy is used to normalize the tone of the muscles of the neck and torso, to extinguish LTR, to stimulate the development of absent or weakened congenital and adjusting reflexes. For complete relaxation of the muscles of the body, exercises 1-5 are used, described on pages 82-84.

Achieving relaxation of the muscles of the body with the help of these exercises, applying the exercises according to Phelps and others described above, thus contribute to the extinction of labyrinth-tonic reflexes, and proceed to the stimulation of innate reflexes.

To stimulate the development of a protective reflex, first of all, they passively create the necessary turn of the head and neck and achieve a revival of the protective reflex by conducting a deep massage of the neck (back surface), the trapezius muscle on the side where the child's face is turned; acupressure is also carried out at a point located on the inner edge of the shoulder joint of the same name.

With the head lowered in the position of the child lying on his stomach, the masseur-instructor of exercise therapy develops a labyrinth installation reflex from the head to the neck using acupressure. It is carried out paravertebral at points at the level of Di^vi vertebrae and Cvi vii

In order to facilitate the development of this movement (lifting the head), a flat roller is placed under the child's chest, it also passes under the armpits of the child, whose arms are extended and rest on a support. In this position, acupressure is performed paravertebral.

If the described techniques do not help (the child weakly raises his head), then he is placed on the ball with his chest and stomach, and after several rocking movements, acupressure (strengthening method) is performed paravertebral in the cervical, thoracic and lumbar spine.

With kyphotic curvature of the spine, an intensive paravertebral massage is performed at the points closest to the localization of the curvature. For example, with kyphotic protrusion in the mid-thoracic spine, acupressure (strengthening method) is done paravertebral in Dvii-xn. With relatively persistent phenomena of kyphosis in the lumbar region, acupressure is performed at the level of Dxn-Lv.

The tension of the extensor muscles necessary to raise and hold the head must be supported by optical and auditory reactions, that is, to attract the child's attention with bright sounding toys.

It is necessary to strengthen the muscular corset of the spine, i.e. not only the back muscles, but also the abdominal muscles - straight and oblique: These muscles of the body in sick children are usually weakened, so special exercises and muscle massage begin from the first weeks of the child's life, especially if he does not have a protective reflex (this symptom

indicates that the labyrinth installation reflex will be incomplete, may be delayed in its development, or will not occur at all). The latter can lead to the incorrect formation of the spine in all its departments and the vicious development of the function of the muscles that provide breathing, movement and shape of the chest.

To strengthen the back muscle group of the neck and back muscles, acupressure is used - points 12, 13, 14, retreating from the spine on both sides by 1 cm, parallel to it, as well as massage techniques - stroking, rubbing, kneading. Exercises to strengthen the back muscles are selected in according to the age or psychomotor development of the child (see Appendix 5).

Appropriate exercises are used to strengthen the anterior group of muscles of the neck and chest, abdominal muscles (see Appendix 8, cards 4 and 6). The following reflex exercise is also recommended: i. p. - lying on his back, lay the child on his back on the edge of the table so that the shoulder girdle and head are off the table (the massage therapist holds the child by the pelvis and legs, first helping, slightly supporting him under the back of the head); at the same time, the child actively bends the neck and shoulder girdle forward, the child’s face is turned towards the adult, who stimulates the movement with a word, a smile, a toy, .-

Another reflex exercise is also used: the child is laid on his back on the edge of the table so that the legs, and later the buttocks, are off the table (the adult holds the child by the body and encourages him to raise his legs to the stick or to his hand). In this case, the child actively (at first with the help of an adult) raises his legs up. This exercise lasts moments when the child lowers his legs, give him a rest, laying his feet on a support (table), repeat the exercise again. At the same time, you can massage the rectus and oblique abdominal muscles.

To strengthen the gluteal muscles and extensors of the legs, an intensive massage of the buttocks and the back muscles of the thighs is done (classical techniques and acupressure). Passive and active exercises are recommended.

It is very important to encourage the baby to crawl along with other exercises in a horizontal position (torso twists).

First, strengthening techniques are performed to massage the back, abdomen, thighs, legs, feet, deep massage of the soles (in conjunction with

1 Exercise is carried out only if in this position the child’s head rises up for at least 1-2 seconds when the movement is stimulated.

reading and massage to relax spastically contracted muscles); Massage is combined with passive flexion and extension of the legs, with stimulation of the crawling reflex as an active exercise. The latter is achieved by rhythmic pressure on the soles of the child, who lies on his stomach. Thus, crawling on the stomach, semi-vertical crawling (the child’s chest lies on the massage therapist’s hand) and all fours are carried out.

The crawling skill is important not only for strengthening the muscles of the trunk, limbs, and the overall development of the child. When crawling, the increased tone of the adductor muscles of the thighs is overcome, the gluteal muscles are included in the activity, and the equinovarus position of the feet is eliminated.

With asymmetry of the muscle tone of the trunk and limbs - hemisyndrome (Fig. 48, a) - against the background of general strengthening, breathing exercises, as well as exercises and massage techniques that stimulate the phased (age-related) development of psychomotor, emotional sphere, special massage techniques, therapeutic exercises, treatment with position (Fig. 48, b). With the help of relaxing massage techniques (stroking, light rubbing, vibration, felting, rolling), as well as acupressure (relaxing method), relaxation of the flexors of the affected side (muscles of the neck, pectoralis major, trapezius,

latissimus dorsi, iliopsoas, glutes, adductors of the thighs, calf muscles). Then a firming massage of the antagonists of the back muscles is done (classical techniques and acupressure of the back muscles - a firming method). Firming back massage is carried out in more detail and deeply on the healthy side.

To eliminate torticollis, a relaxing acupressure massage is performed in the area of ​​​​attachment of the tense sternocleidomastoid muscle - on the mastoid process, on the collarbone and on the 1st rib. They also do a long-term massage of the entire muscle with relaxing techniques (light stroking and rubbing, vibration), combined with gentle kneading and light stretching of the muscle. A relaxing massage is performed not only on the sternocleidomastoid muscle, but also on the upper part of the trapezius, latissimus dorsi and rhomboid muscles of the back, in severe cases, the long round muscle of the scapula. The latter must be done because the reflex synergistic contraction of this muscle and the sternocleidomastoid often leads to the fact that shoulder adduction joins the phenomena of torticollis.

After a massage with asymmetry of the muscle tone of the trunk and limbs, in which the child's pelvis also has an asymmetric (oblique) position, special exercises are also done. They are necessarily interspersed and combined with relaxing massage techniques. So, the vibration of the muscles of the trunk and legs (from the side of increased tone) is accompanied by stretching of these muscles in the position of the child on the back, legs towards the massage therapist; in the same position, also in combination with the vibration of the muscles of the body, swaying the pelvis from side to side, a massage is performed at point 7, relaxing the adductors of the thighs. After that, the masseur brings the leg, slightly bent at the knee, to the other straightened leg, covering it with the bent leg and at the same time sipping so that the oblique position of the pelvis is slightly straightened.

We recommend the exercise, which is also carried out after taking the relaxation of the muscles of the body, according to Bobbat and other relaxing massage techniques. The exercise consists in soft plastic stretching of spastically contracted muscles, carried out simultaneously with their vibration. The massage therapist lays the child on his back, healthy side to himself, closer to the edge of the table, with both hands grabs the child from the side of spastic contracted muscles and, pressing him to his healthy side, vibrates and stretches the torso and legs, as if encircling himself with a child. Masseur's palms, fingers FRIEND to OTHER G U> lie flat on the lateral surface of the child's torso. Producing vibration and stretching at the same time, the masseur's palms move, one to the armpit of the child, the other to his leg and down the leg to the foot. The child's head, which is between the forearm and shoulder of the massage therapist, gently deviates in the direction opposite to the torticollis, the pelvis takes the position of a slight hypercorrection.

Some means of exercise therapy that help to relax the adductor muscles of the thighs, the back muscles of the legs, feet, and the development of the basic functions of the lower extremities. With increased tension of the adductor muscles of the thighs, before doing exercise therapy exercises, it is necessary to relax these muscles by applying acupressure massage. For its implementation, it is necessary to touch the skin with the pad of the third finger in the place corresponding to the projection of the hip joint from the side, feel, as it were, a recess when pressed, and then gently, slowly exert both a rotating and soft pressure on the point (zone). Initially, with a gradual increase in pressure, vibration, stop and subsequent weakening of the impact (without leaving the zone) cause a weakening of muscle tension in the adductor muscles.

Acupressure of the inner surface of the thigh for 2-

3 cm below the inguinal fold also helps to relax the adductors of the thighs. Their relaxation also causes slight swaying (left - right) of the pelvis of a child lying on a support. Relaxation of the adductor muscles can be achieved by quickly adducting the hip with simultaneous flexion in the hip and knee joints at the beginning of that leg, the adductors of which are less tense. After relaxing the muscles, the slightly bent legs of the child should be spread apart with soft vibrational movements without violence.

After relaxing the muscles, passive exercises can be done: flexion and extension of the legs, raising the straight legs and moving them to the right and left with the rotation of the pelvis. In the position of the child on his back, holding him by the shins (the hands of the massage therapist clasp the shins in front, feet on the support), guide the child's feet along the support, preferably on rough material, hit them on the support (“stomping”) *

With increased tension of the posterior muscle group of the legs, in which the child in an upright position leans on the toes or on the forefoot (the tone of the Anterior muscle group of the leg is reduced), the foot massage is performed as follows.

1. I. p. - on the back. Legs are bent at the knees, slightly apart. First, acupressure of the feet and lower legs is performed with simultaneous shaking of the feet and bending them forward to the lower leg. Then, to strengthen the stretched, weakened muscles, massage the muscles of the anterior surface of the lower leg and feet (stroking, rubbing, kneading).

2. I. p. - on the stomach. First, the lower legs are massaged to relax the back muscle group (light stroking, shaking, vibration, felting - see Chapter 2). They also do acupressure (relaxing method) of the posterior surface of the lower leg in the area of ​​​​attachment of the two heads of the gastrocnemius muscle and at the beginning of the calcaneal tendon. Then the legs are bent at the knees (feet at right angles to the shins) and, putting the hands on the child's feet, gently, plastically with vibrational movements press on the feet, bending the feet to the front surface of the lower leg, thus very carefully stretching the heel tendons. Acupressure on the dorsum of the ankle joint facilitates dorsiflexion of the foot. It is advisable to carry out this exercise alternately: for example, with the left hand, fix the right shin of the child, and with the right hand, press on the foot along the center line of the foot, bending it towards the shin, the same with the left foot of the child (see Fig. 43).

In addition, appropriate exercises are recommended to form the correct support reaction and walking skills. With all the exercises recommended for the development of support, it is useful that the feet slide, touch the rough fabric. It is best to use cardboard lined with bouclé woolen fabric for this. This is a homemade manual. It is necessary to substitute under the feet of the child during these exercises.

One of the most important reflexes that prepare the child's body for mastering the vertical position of the body is the support reflex and stepping movements. These reflexes must be stimulated in the initial position of the child standing with support; it is useful to put the child on a hard, rough surface. In this case, the extension of the legs and their support on the table occur. In the same position, supporting the child by the body with one hand, with the other hand, clasping the child’s shin, they guide him with his foot along the support, moving his leg back, and then hit the child’s leg on the support (alternately right and left). For a more stable support of the feet, a deep massage or a jerky brush massage of the soles is carried out.

To stimulate the supporting function of the foot, the Voight exercise is also successfully used. The child's leg is placed on the edge of the table so that the heel hangs down, the leg bent at the knee is held in this position. Brush grab

child's thigh so that the massage therapist's first finger is placed on the inner surface of the thigh. The child is tilted down by the arm of the same name with the knee (Fig. 49), and his torso is sharply turned. The child reflexively makes a reverse turn of the body and, straightening it and the leg, stands upright with support on the table.

It also improves the support of the feet (with tension of the adductor muscles) bringing the first toes to the normal position. This is achieved by massage at the main phalanges of the first fingers, which normalizes the position of the feet and entails a decrease in the tone of the adductors.

The support reaction is also developed on the ball (Bobbat exercise). The child is laid on the ball with his stomach. With the left hand, the massage therapist holds the child by the legs, with the right hand he conducts a stimulating acupressure in the paravertebral region. Holding the upper half of the child's body with the left hand, lower his legs down until they come into contact with the support. If this reflex has not yet manifested itself sufficiently, then it is necessary to do a deep massage of the soles before the exercise on the ball, irritating them with a brush (intermittently). It is necessary to alternate the exercise on the ball (child on the stomach) with stimulation (acupressure, classical techniques) of the muscles of the back and abdomen. Therefore, having laid the child already on his back, do a firming massage - acupressure and classical techniques - rectus and oblique abdominal muscles, as well as a relaxing massage - acupressure, stroking and expulsion of the pectoralis major muscle - to eliminate flexion synergies in the muscles of the shoulder and pelvic girdle (by synergists large muscles are other adductors of the shoulder and, most importantly, the iliopsoas muscle).

Support on the feet is also achieved in the following way. The child is placed with his back to the massage therapist on his knees on the table so that the child's feet are off the table. The masseur holds the child by the body, giving him a slightly inclined (forward) position. This stimulates the child to stand up on one foot, and then on the second foot.

Quite often at children the varus or valgus installation of feet is noted. Corrections of these installations are achieved by massage techniques. With the varus installation of the feet, the muscles that lift their outer edges are strengthened - they make a strengthening massage of the anterior and posterior tibial muscles, extensors of the foot and fingers, and a relaxing massage of the soleus muscle. With a valgus installation, a firming massage of the soleus muscle and muscles of the internal arch of the feet and legs is done (see Appendix 6). It is advisable for children from 10 months to use a board or slide sheathed with boucle material, or rubber mats with a corrugated surface for walking exercises. During the consultation at the clinic, it is important to show parents how to carry out the exercises.

Some exercises that contribute to the development of balance and coordinating functions in a child.

1 I. p. - a child in the hands of a massage therapist, facing him, supported behind his back or under his arms. Spin with the child in your arms to the right and left.

2. I. p. - a child in the hands of a massage therapist, facing him, supported behind his back. The child wraps its legs around the adult ("frog"). Shake the child away from you - towards you (down - upside down)

3. I. p. - standing on all fours. The masseur slightly pushes the child forward - back, to the sides. The exercise is carried out in the form of a game with the encouragement of the child to stay on all fours.

4. I. p. - lying on a rocking chair (on the stomach). The exercise is carried out by rocking the child on the rocking chair to the right - to the left, up - down, 10-12 times.

5. The child sits on a swing supported by an adult. Swing the swing 2-6 times.

6. On children's carousels (with the support of an adult). Spin 2-6 times.

7 Swinging on the shoulder, on the back and on the stomach with different speeds and changes in direction.

8. Swinging in a hammock.

9. Soft springy movements transmitted to the body of a child lying in a stroller (at home),

10. Active-passive springy movements of a child in jumper-spring pants with a turn to the right - to the left and pushing the legs off the floor.

Breathing exercises (see Ch. 2) should alternate all exercises and massage techniques in exercise therapy with a child (2-6 exercises). The need to include these exercises in physical therapy classes, as well as 2-4 breathing exercises in a row (outside the exercise therapy complex) during the day, is explained by chronic hypoxia in a child with neurological disorders.

The development of visual and auditory reactions, emotional activity, intelligence of children, hand-eye coordination, hand-hearing. child learns the world based on feelings and perceptions. He recognizes this world, objects, phenomena with the help of sight, hearing, touch, therefore the education of these sensory functions is of great importance. They are all the more important because they develop in close relationship with motor skills. This relationship provides all the activities of the child: cognitive, motor, speech development. It is especially important for children with a delay in psychomotor development to educate them in the knowledge of objects that surround them. To do this, you need to use all regime moments during the day. For example, the study by a child of the face of a mother talking to him, toys. This must necessarily be carried out with the simultaneous involvement of the child's hearing, vision, using skin and muscle feelings, movement. To study the objects surrounding him, a bright sounding toy is put into the child's hand, his attention (visual and auditory) is drawn to this toy. At the same time, he is encouraged, affectionately asked to take the toy himself. It is important that the child, when communicating with an adult, sees how he pronounces certain syllables, words, sees the movements of the lips, the smile of a person bending over him. It is necessary to encourage the child, when communicating with an adult, to repeat after him syllables, words that an adult patiently repeats many times. For the development of the child, mutual understanding between parents and the child is absolutely necessary - emotional contact between them. The child responds to gestures, facial expressions, affectionately pronounced words of an adult with a “complex of revival” - he seems to “laugh” with his whole body: he joyfully moves his arms, legs, hums, smiles.

The development of vision, hearing, touch should be carried out regularly, complicating the methods of education, depending on the level of psychomotor development and the age of the child.

From the age of 6 months, the visual, auditory reactions, as well as the skin and muscle feelings of the child must be connected, combined with the word of an adult. The word should stimulate the child's perception of an object, phenomenon. For example, when giving a child a toy, it is necessary to simultaneously call: "Bear", "Lalya", etc. It is necessary to encourage the child's play activity.

Some exercises for developing the interaction of emotional, mental and motor functions.

1. I. p. - lying on your back. Calling visual, auditory concentration and tracking. An adult shows a bright, shiny (sounding) toy at a distance of 30 cm from the child's eyes

and, having caused concentration, moves it to the right, to the left, up, the child turns his head after the object.

2. I. p. - alternately lying on your back, stomach, sitting, standing on all fours. Sounding toys with an easy-to-hold handle are placed in the child's hand to develop a sense of sensation in combination with visual fixation of the eyes on the toy. Repeat in different initial positions of the child 4-5 times a day. Accompany classes with appropriate conversation with the child.

3. I. p. - the same as in the previous exercise. The training of uniform gaze mobility in all directions and the combination of the development of visual concentration with the child's motor activity are carried out as follows: bright sounding toys are placed at such a distance from the child that he can grab them with a simple contact with them.

4. I. p. - on the ball. With one hand, the mother supports the child, and in her other hand there is a bright sounding toy with which the mother attracts the attention of the child.

A child from 4-8 months of life is offered toys of different thicknesses, masses, and textures. Toys for a child from 9 months of age should also differ in size and shape. You can begin to give games with pouring and pouring water into a basin, toys, in the capture of which the first finger and nail phalanges of the fingers should participate. Thus, the coordination of vision, hearing, skin sensitivity and muscle activity is trained.

Positional treatment is an essential exercise therapy tool in the complex treatment of children with impaired nervous system function. And it is of particular importance because, due to the physiological characteristics of children in the first 6 months of life, most of the time children spend in a horizontal position, in which, in the absence of correction, pathological postures are fixed.

In the polyclinic, parents are taught various types of styling (treatment by position).

To fix the physiological position of the head with torticollis, which develops with unilateral LUR insufficiency or its uneven development on the right and left, do the following. The child's head is placed between two rollers (sandbags), which are interconnected by a wide gasket. At the same time, the body is given a physiological (axial) position, for which long sandbags are placed on its sides from the armpits to a level slightly below the knees (see Fig. 48, b).

Creation of the correct position of the hand and fingers immediately after relaxation of the muscles serving

staves, using the Phelps technique, point and classical; x massage techniques are provided by the following treatment position (laying). The masseur gives the brush the position of extension at an angle of 120-130 °, and the fingers - the position of slight flexion in all joints; The first finger is retracted outward. A small ball or a ball made of foam rubber and lined with cotton fabric is inserted into the palm of the child. The child's hand is bandaged in a given position to a slightly curved (according to the shape of the angle at which the hand is unbent) polyethylene splint (the splint is made by orthopedists of a neurological or orthopedic center or in a children's orthopedic hospital).

With hemisidroma - an asymmetric position of the trunk, head, scoliotic installation of the spine with an oblique position of the pelvis - the child is placed on a wooden shield with a very thin mattress and the child is placed with sandbags in the correct average physiological position, as well as with torticollis, for 2- 4 hours during the day during naps and at other times of the day.

For the prevention of kyphosis in the thoracic or lumbar spine, it is advisable to place a flat thin roller with sand or a roller on a dense foam lining under the lumbar region for 1-2 hours during the day.

With adductor spasm, after relaxing the adductor muscles of the thighs, a diaper folded several times is placed between the legs for 1 / 2 -2 hours 3 times a day.

To form the correct position of the foot after the maximum decrease in the tone of the muscles of the thigh, lower leg, foot with the help of the fetal position, relaxing massage techniques, do the following. The foot is given the correct mid-physiological position with a slight hypercorrection of it (depending on the nature of the installation of the foot - valgus or varus). For example, with a valgus installation, the foot is placed in a special cardboard or plastic splint with a foam pad at its inner edge. After placing the foot in the splint, an additional massage should be performed at the points at the base of the first phalanx of the toes. This is done to eliminate labyrinthine tonic reflexes leading to plantar flexion of the fingers. After that, the foot and shin are fixed in the splint with soft bandages. The feet are left in them for 2-2 1/2 hours.

The use of warm water in exercise therapy. For children with psychomotor development disorders, which, as a rule, manifest themselves against the background of a violation of the physiological muscle tone (hypotension, hypertension, dystonia, asymmetry

tone), it is difficult to overestimate the role of therapeutic swimming and exercises in the water.

In case of muscle hypertension, warm water (+36…+37 °C) helps to relax spastically contracted muscles, restore the correct relationship in the work of the flexors and extensors of the limbs. A variety of movements of the child in the water (with the help of a pool nurse, and then trained parents), repeated every day, contribute to the normalization of muscle tone, make the functions of the musculoskeletal system of the child more physiological.

It is very convenient to carry out exercises in muscle relaxation in combination with massage (point and vibration) for a child in a bath (+36 ... +37 ° C). It is advisable that he be in a special hammock, the head end of which is raised so that the child's head is above the water. At the same time, both hands of an adult are free and he can carry out the exercises and massage described in this chapter in the water.

Stroking, shaking, vibration techniques, felting, rolling, acupressure (relaxing method) are used. For a description of these techniques, see Chap. 2.

You can also recommend the “embryo” position in the water - an exercise conducted by a pool nurse, and at home by a well-trained mother (suggested for use by T. Yu. Nikolaeva, 51st Polyclinic of Moscow). In water, it is easy to give the fetal position with gentle vibration, rocking the child towards you - from yourself, to the right - to the left (Fig. 50).

With increased tension in the adductor muscles of the thighs, it is useful to use the exercises and massage techniques described on page 56.

In warm water, it is easier to dilute both thighs at once when combined with acupressure and vibrational movements of the adult's hands.

With increased tension of the posterior muscle group of the legs, acupressure of the feet and legs is carried out in water with one

changeable shaking the entire leg and back muscle group of the lower leg. After stroking, rubbing and acupressure in water, placing the palms of the hands on the child's feet, plastically do the back flexion of the feet, thereby gently stretching the calcaneal tendons. It is more convenient to do this exercise alternately, with one hand fixing the lower leg, with the other - bending the foot forward to the lower leg; while at the beginning it is better to child this exercise with the baby's legs bent, and then with straight ones.

With hypertension of the adductors of the thighs and the posterior muscles of the legs, when the child in an upright position leans on his fingers or forefoot, exercises in a bath with warm water are very useful. They are carried out immediately before bathing. The child is supported by one of the parents in an upright position under the armpits with a slight forward tilt towards him. The child leans on the feet

about the bottom of the tub. Another adult grabs the child's shins closer to the ankle joints from behind and moves the child's legs, firmly resting the feet on the bottom of the bath so that the entire foot touches it. It is advisable to put a rubber corrugated mat on the bottom of the bath for the duration of this exercise. Walking movements are stimulated by an inviting gesture, a smile, an affectionate word.

After mastering the physiologically correct support and walking, the exercises in the bath should be continued - the child should gradually master independent walking and all kinds of movements relying on the feet.

With an increased tone in the flexors of the arms, exercises in the water are also carried out: the child in the bath (+36 ... + 37 ° C) lies with his back on a hammock raised at the head of the head. They carry out light stroking of the hands, shoulder girdle, anterior surface of the chest, acupressure of the pectoralis major muscle, light shaking (alternately) of the hands in the water, swaying them, combine these exercises with acupressure.

Muscle hypotonia - weakened muscle tone of the muscles of the trunk and limbs - as a rule, is combined with a general weakening of the child.

The latter is expressed both in the paucity of active movements of the baby, and in weakness, and sometimes in the absence of unconditioned reflexes.

To strengthen various muscle groups, you can also use acupressure (stimulating) massage in water. Exercises in resistance are also advisable: pushing the legs away from the ball, sticks, side of the bath, “taking away” the toy from the child’s hands.

The wonderful property of water to reduce body weight makes it easier to perform movements that the child could not or could not perform on land. Therefore, swimming and exercises with children with reduced muscle tone (water temperature +34 ... +35 ° C) are no less useful than swimming and exercises for children with increased tone. In both cases, normalization of muscle tone occurs.

THERAPEUTIC PHYSICAL CULTURE IN OBSTETRIC PARESIS

Etiology and pathogenesis. There are several views on the etiology of this disease. One of them is damage to the brachial plexus due to excessive stretching of the latter during childbirth or direct pressure with the fingers of the obstetrician on the neck and pressing the plexus between the clavicle and the 1st rib, which can occur when the fetus is removed. A number of authors stubbornly defend the point of view about the leading role of clavicle fracture in the occurrence of brachial plexitis in newborns. A. Yu. Ratner convincingly proves that natal injuries of the spinal cord and its cervical region are the cause of obstetric paralysis. Since the Duchenne-Erb form is more often observed (with paralysis of the upper bundles of the brachial plexus of the V and VI cervical segments), we consider it appropriate to provide information on the exercise therapy method for this form of obstetric paralysis. The Duchenne-Erba form can be combined with torticollis due to damage to the sternocleidomastoid muscle.

clinical picture. With this disease, the child's arm lies motionless next to the body, the shoulder is lowered, adducted, rotated inward and pronated. The hand is in palmar flexion (flexion). Finger movements are free. Unconditioned (congenital) reflexes from the side of the paretic arm (Robinson, Babkin - upper) are weakened, the muscles of this arm are weakened, especially the deltoid, biceps of the shoulder, as well as the muscles of the scapula.

Physiotherapy. Special tasks:

1) prevention of contractures in the joints of the affected limb;

2) prevention of atrophy of the muscles of the arm, shoulder girdle, chest;

3) improvement of blood circulation in the affected limb, its trophism;

4) stimulation of active physiological movements in all joints of the hand.

Position treatment. From the first days of life, the child's arm should be fixed in the following position: the shoulder is abducted by 60°, rotated outward by 45-60°, the arm is bent at the elbow joint by 100-110°, a cotton roll is inserted and bandaged into the palm with half-bent fingers. This position of the hand (laying) is provided with a flannel diaper so that the head of the humerus is in the articular cavity. The correct position of the hand is carried out in a special tire. At the same time, one end of the splint is fixed on the back, the other fixes the arm with the shoulder retracted and the forearm bent upwards (the orthopedist in the clinic or in the orthopedic center does the child's hand in the splint).

In the first (acute) period of the disease, medication, physiotherapy and hand laying are carried out.

Massage and exercise. In the sub-acute period of the disease (up to 172-2 months), passive exercises are used for the affected limb.

Before starting classes, you need to slightly warm the child’s shoulder joint with a warm (warmed) diaper for 10 minutes, and then with warm hands make a light stroking massage of the shoulder girdle, shoulder joint, shoulder. Then move on to very careful passive movements in all joints of the paretic arm, combining these movements with a light stroking massage of the entire arm, shoulder joint, shoulder girdle. Gradually, massage of the entire body and limbs (stroking and rubbing) and some reflex exercises based on innate reflexes are included: Robinson, Babkin (upper), neck-tonic reflexes.

From the age of one month, massage should already be carried out differentially. For paretic muscles, i.e. for the muscles of the scapula, deltoid, triceps, supinators and extensors of the hand (except for the brachioradialis, as well as the long muscles of the back), strengthening techniques, i.e., a slightly stronger massage. Certainly, it is necessary to take into account the thickness of the layer of underlying tissues of the child. Stroking, rubbing, light rubbing and patting with the fingertips of the massaging hand are carried out. For tense muscles: arm flexors prone to the rapid formation of flexion contractures, subscapularis, muscles of the anterior surface of the chest (pectoralis major), biceps shoulder, brachioradialis muscles - apply relaxing massage techniques. How to carry out passive movements? First of all, you need to fix your shoulder with your hand.

joint of the paretic arm (Fig. 51), and then slowly, plastically carry out flexion of the arm (its upper part) anteriorly, extension backwards, abduction, adduction, rotation of the shoulder outward and circular movements, still fixing the shoulder joint well, combining all these movements with slight vibration.

In the elbow and wrist joints, passive movements are made in two directions - flexion, extension, and also necessarily turns the hand with the palm up. These movements, especially the last one, must be carried out several times a day, at least 8-10 times. Such repeated exercise during the day is possible for a child only at home, so the help of trained parents is absolutely necessary. Only their perseverance in carrying out the recommended exercises will help to avoid contractures, trophic changes in the muscles, stiffness in the joints of the hands, fixing vicious postures, and help to cultivate the correct (physiological) movement in the joints. Much attention during the exercises should be given to the fingers, especially the movement of the first finger of the hand.

Since the appearance of active movements of the arm, it is recommended to pay special attention to the extension of this arm with its abduction, flexion in the shoulder and elbow joints, to promote the supination of the child's forearm with exercises and massage.

Reflex exercises - active movements - are based on unconditioned reflexes: the Robinson reflex (a child grabs a toy when it touches its palm); the Moro reflex (clasp movements of the hands) is evoked by clapping hands close to the child, patting on his buttocks; cervico-tonic reflexes - symmetrical and asymmetric: ny (change in the position of the child's hands due to a change in the position of his head); Talent reflex (see Fig. I).

Active movements are caused in the child by an impulse to independent movements during affectionate treatment to him, for example: "Take a toy."

Active movements for the paretic hand are initially given in light conditions: in warm water, with the support of the hand, lying down on a surface covered with plexiglass (child in dis- pashonka with cuffed sleeves).

By turning on the tactile, visual and auditory analyzers, it is possible, when the function of the child’s hand improves, to include it in an active purposeful action: grab the toy, hold it, stimulate support on the forearms and hands from the prone position (to facilitate this position, they first put it under the child’s chest roller or several times folded flannelette diaper); sitting down with the support of both hands. To facilitate this exercise, at the very beginning of its application, it is necessary to lay the child on his back so that his head and upper body lie on a dense pillow - they are raised.

The second period of the disease and treatment begins at about 2 months of a child's life, when active movements of the arms and legs appear.

The objectives of this period are the development and active training of the psyche and motor skills of the child. In this period, as before, the tasks of preventing contractures of the affected limb and improving tissue trophism are carried out.

Passive exercises are still paid attention, especially raising the arm up, extension and abduction of the shoulder while fixing the shoulder blades, flexion in the shoulder, elbow joints with supination of the forearm.

Given the lag in psychomotor development in children with obstetric paresis, it is necessary to perform all these special exercises against the background of the development of the entire musculoskeletal system of the child, his mental, speech development. Exercises should be combined with general massage. It is necessary to select sets of exercises in accordance with the true psychomotor development of a sick child, and not with his passport age (see Appendixes 3 and 6).

In order to stimulate active movements of the paretic arm in the child, you can sew up the sleeve of the vest on the side of the healthy arm or gently swaddle the arm to the body. The action is encouraged by a favorite, bright, sounding toy in order to cause the child to reach out to it, to grab the toy with his hand.

From 4-5 months, it is necessary to ensure that the child brings the Hand to the mouth with the palm of the hand, and not with the back. By the end of the year, when the child begins to move independently, it is recommended to play games with him using various aids: a small and a large ball, games with crawling, for example, under a chair, climbing on a box 5-3 cm high, on an inclined ladder with flat steps (with adult insurance).

Here, the help of parents trained in these exercise games is invaluable, since only at home you can turn on 1-2 of the games at various * regime moments, up to 8 times during the day.

By the end of the year, as a rule, most children with; with systematic treatment, recovery occurs. >

Swimming with the correction of the movements of the child's hands by adults and targeted exercises in the bath (+ 36 ° C) help? in solving special tasks of exercise therapy (prevention of a contract tour, prevention of atrophy of the muscles of the arm, shoulder girdle, chest, improvement of nutrition in the tissues of the affected limb, development of active physiological movements in all joints of the arm, general strengthening, improvement of the child).

The technique of carrying out physical exercises in water corresponds to the method of active and passive physical exercises recommended above.

PHYSIOTHERAPY

FOR LESIONS OF THE FACIAL NERVE

BY CENTRAL TYPE

Damage to the facial nerve according to the central type in children of the 1st year of life occurs with a frequency of 3-4 cases per 1000 newborns (according to the statistics of the children's consultative neurological clinic at DCS N° 1 in Moscow, 1986-1988).

Quite often, it turns out that children are left without treatment due to the fact that this condition is regarded as a slight cosmetic defect, an “individual feature”, too “minor” a violation, which, moreover, is difficult to correct, in contrast to lesions of the facial nerve of the peripheral type, where there is a pronounced dysfunction and a gross cosmetic defect, and for the treatment of which quite effective methods of exposure have been developed.

Etiology and pathogenesis. The factor contributing to the occurrence of lesions of the facial nerve in the central type is most often a birth injury - cerebrovascular accident (hypoxic genesis), intracranial hemorrhages in the area of ​​passage of corticonuclear fibers (connection of the cerebral cortex with the nucleus of the facial nerve). With damage to the corticonuclear pathways on one side (for example, on the left), there is a rupture of connections with the cortex of only that part of the nerve nucleus that innervates the muscles

ru the lower part of the face of the opposite (right) side. The following muscles are affected (Fig. 52): lowering the corner of the mouth (triangular - 1); lowering the lower lip (square - 2); some fibers of the circular muscle of the mouth (3); part of the buccal muscle (pulls the corner of the mouth towards -4).

clinical picture. Clinically, the central paresis of the facial nerve is manifested by a misalignment of the mouth - the corner of the mouth droops to the healthy side, aggravated by laughter, crying, as well as some "sagging" of the lower part of the cheek on the side of the lesion (Fig. 53). The upper part of the face is not affected, symmetrical.

Physiotherapy. One of the leading methods of treatment is exercise therapy: massage, exercise, treatment by position.

Tasks of exercise therapy: improving blood and lymph circulation, preventing the development of muscle contractures and atrophy, normalizing muscle tone and tissue trophism, restoring the function of affected muscles and, as a result, eliminating a cosmetic defect.

Massage and exercise. Massage should be started from the neck and collar area, which improves the lymph flow through the main vessels and has a reflex effect on the vegetative formations of the neck. The direction of massage movements is along the muscle fibers. Techniques: stroking, light kneading, rubbing, vibration. Time - 1-2 minutes. Next, massage the lower part of the face. First - stroking (from the center of the chin along the lower cheekbone to the earlobe, around the mouth, 7-10 movements on both sides). The next technique - rubbing, is carried out along the muscle fibers of the triangular,

square, buccal muscles on the side of the lesion, where the nasolabial fold is smoothed, but there is no drooping of the corner of the mouth, and three separate fibers of the square muscle of the upper lip on the healthy side (Fig. 54, a), 6-8 movements each. For the same muscles, light kneading is carried out, and on the healthy side - vibration along the triangular, square muscles. Special techniques include the “reduction” method: shaking, small-point vibration, short-term pressing, carried out from the inside of the mouth by placing one finger from the side of the mucous membrane of the mouth and lips, the other from the outside. This type of massage is carried out on the side of the lesion for 3-4 repetitions of each technique. All massage techniques are applied in a gentle manner. Next is acupressure. On the side of the lesion, strong frequent pressing with the tip of the second finger for 10 s is carried out pressure (pressure) at point 1 (Fig. 54, b), then the finger slides with rubbing movements to points 2 and 3, where the same movements are made as in point 1. Points 4 and 5 are processed in the same way, but separately. Location of points: 1 - depression under the lower lip in the center of the chin; 2 - 1 cm in front and up from the angle of the lower jaw; 3 - 1 cm from the corner of the mouth; 4 - 1 cm below point 3; 5 - at the tragus of the ear. On the healthy side, these same points are massaged by “screwing” the fingertip clockwise, monotonously, then increasing, then weakening the pressure, for 30 seconds, each separately (relaxing method).

The massage is followed by physical exercises. At an early age (up to 1 year) passive movements are used. 1 - hypercorrective exercise - pulling up the lowered corner of the mouth while simultaneously pulling down the opposite corner of the mouth, 15-20 times. 2 - stretch

perspiration cracks to the side and up on the healthy side and to the side and down on the affected side - 15-20 times. 3 - when capturing the upper and lower lips with each hand in a pinch, cause articulation movements such as "ma-ma", "i-y", "y-a" along

10 times. 4 - pull back the cheek of the affected side and release it sharply - 5-10 times.

Position treatment. After massage and exercise, it is advisable to treat with the position [Epifanov V.A., 1981], i.e., you should use patch bandages that pull the lowered corner of the mouth up for 20-30 minutes, first achieving symmetry, and after 4-5 days , carrying out hypercorrection (Fig. 54, c). After the procedure, as well as several times a day (during the first 2-3 months of life), put the child to sleep on his side (on the side of the lesion).

The above treatment of children of the 1st year of life is recommended to be carried out in courses of 10 procedures with an interval

1 1 / 2 -2 months until a permanent improvement in the condition, and special physical exercises - daily, by a trained mother.

Laying in the clinic - sandbags of various sizes and shapes, splints for hands and forearms, for ankle joints. Parents can make sandbags themselves, just like cardboard splints; splints made of plastic, gypsum are made individually for a child in an orthopedic center, orthopedic hospital.

Exercises 1 and 2 by Bobbat.

The section was written by O. M. Nikiforova.

Tasks of physiotherapy exercises in diseases of the nervous system. 1. Strengthening the patient's body. 2. Improvement of blood circulation of the affected parts of the body. 3. Reducing the pathologically increased tone of paretic muscles and increasing muscle strength. 4. Removal of harmful friendly actions: synergism and synkinesis. 5. Renewal of functional balance between paretic muscles and their synergists. 6. Restoring or improving the accuracy of movements. 7. Restoration or improvement of nerve conduction from the center to the periphery and from the periphery to the center. 8. Removal or reduction of muscle tremor. 9. Display and formation of the most important motor skills aimed at mastering (training) everyday and labor skills, self-service and movement, preparation for social rehabilitation.

Features of exercise therapy in neurological and neurosurgical pathology. 1. Early purpose of exercise therapy. It provides for the use of stored functions and newly created ones that are adapted to the changed conditions of the neurological, somatic and visceral status. 2. Selective use of exercise therapy to restore impaired functions or compensate for lost ones. 3. The use of special exercises according to the pathogenetic principle in combination with the general strengthening effect of exercise therapy. 4. Adhere to the principle of adequacy with a constant change of physical exercises, depending on the patient's capabilities and the presence of a training effect. 5. Gradual continuous expansion of the motor mode from the prone position to the possibility of unlimited movement.

The means of exercise therapy for diseases of the nervous system are the basic provisions, massage, special therapeutic exercises. The latter are divided: a) to strengthen muscle strength; b) to obtain strictly dosed muscle loads; c) to obtain differentiated tension and relaxation of individual muscles and muscle groups; d) for the correct display of the motor act as a whole (speed, smoothness, accuracy of movements); e) anti-attack exercises aimed at restoring and improving coordination of movements; f) anti-spastic and anti-regid; g) reflex and ideomotor; g) for the restoration or new formation of applied motor skills (standing, walking, rubble skills); h) passive, incl. manual therapy.

Acute cerebrovascular accident - stroke. There are 3 stages of rehabilitation of patients with stroke: 1st - early updated (up to 3 months) 2nd - late updated (up to 1 year) 3rd - residual impairment of motor functions. The degree of impairment of motor functions: 1st - slight paresis; 2nd - moderate paresis; 3rd - paresis; 4th - deep paresis; 5th - plegia or paralysis. The mode of motor activity depends on: 1 - the patient's condition; 2 - the period of the disease; 3 - stage of violation of motor functions. Modes of motor activity are: 1. Bed strict (1-3 days). 2. Extended bed (3-15 days). 2-b - days. 3. Ward. 4. Free.

Strict bed rest: 1. Exercise therapy is contraindicated. 2. The patient is provided with rest, drug treatment. 3. Treatment by position, i.e. settle the patient in a position opposite to the position of Wernicke - Man. It: - reduces spasticity; - prevents the development of contractures; 4. The patient is laid on his back, on his side, the position is changed 4-6 times a day, for 30-60 minutes, depending on the patient's condition, muscle tone of the paretic limb.

Extended bed rest: 2 a / 3-5 days Exercise therapy tasks: 1. Improvement of the functions of the cardiovascular and respiratory systems, prevention of complications on their part. 2. Activation of intestinal motility. 3. Improvement of tissue trophism, prevention of bedsores. 4. Decrease in muscle tone with its increase. 5. Prevention of hemiplegic contractures. 6. Preparation for an active turn on a healthy side. 7. Stimulation and renewal of isolated active movements in the paretic limb.

Methods: 1. Lying by position on the back and side. 2. Physical exercises: - Breathing exercises; - active exercises for small, medium, and later for large joints of healthy limbs; 3. From 3-6 days - passive exercises for the joints of the paretic limb. 4. They teach volitional sending of impulses to movements synchronously with isolated passive extension of the forearm, flexion of the lower leg.

Extended bed rest: 2 b / day. Exercise therapy: Exercise therapy tasks: 1. Strengthening the general tonic effect on the patient. 2. Teachings to relax the muscles of a healthy limb. 3. Decreased muscle tone in the paretic limbs. 4. Transferring the patient to a sitting position. 5. Stimulation of active movements in the paretic limbs. 6. Counteracting pathological synkinesis. 7. Preparing the patient for getting up. 8. Restoration of support functions in the lower extremities. 9. Restoration of self-service functions to a healthy limb.

Methods Methods: 1. Starting positions - are of great importance during the execution of passive movements of individual segments of the limbs: The fingers are easier to straighten if the whale is bent. Forearms - if the shoulder is adducted. The supination of the forearm will be full if the elbow is bent. Aversion of the thigh - complete in a bent position. 2. a) classes begin with active exercises for healthy limbs, and then passive - paralytic. b) During the performance of active exercises, it is necessary to use relief, use: - postal frames; - blocks; - hammocks to support a paralytic limb; c) exercises are performed slowly, smoothly, each movement of 4-8 races. First, the limb is rotated to its original position passively, with the help of an instructor, and also with a support. Special attention is given to the resumption of movement of the 1st finger;

D) passively or actively counteract pathological synkinesis: - During the execution of active movements with the foot, the hands are fixed behind the head or along the length of the toulub; - when the healthy arm is bent, the methodologist can passively unbend the paretic arm at this moment; - volitional efforts are used, bending the patient's leg counteracts the bending of the arm, holding it to volitional efforts in the bent position; e) ideomotor movements; f) isometric tensions by the muscle of the paretic limb.

Chamber mode. Exercise therapy tasks: 1. Decreased muscle tone. 2. Counteracting hemiplegic contractures. 3. The next resumption of active movements. 4. Transition to standing positions. 5. Teachings to walk. 6. Counteraction to synkinesis. 7. Renewal of self-service skills and applied household movements.

Free mode. Methods and methods of exercise therapy at the late renewed stage and during the period of residual motor disorders depend on the degree of motor function disorders: 1st degree (slight paresis) - general tonic effect on the body; - strengthening the muscles of the shoulder girdle and back; - posture improvement; - movement, walking. 5th degree (plegia, paralysis) - activation of the activity of the cardiovascular and respiratory systems; - the teaching of the patient turns on its side; - Preparation for the transition to a sitting or standing position; - Improvement of the supporting functions of the lower extremities; - relaxation of the muscles of healthy limbs; - Decreased muscle tone; - counteraction to contractures; - disorders of the trophism of the paretic limbs; - expanding self-service skills.

Degrees of motor and social adaptation of the patient: 1. The mildest degree - only the patient feels the defect. 2. Mild degree - the defect manifests itself during any physical activity, noticeable from the outside. 3. Medium degree - limited ability to independently perform the main aspects of motor activity. Needs partial help in everyday life, and at work - changes in profession. 4. Severe degree - the social activity of the patient is significantly limited. Almost no action, with the exception of the most elementary. Labor activity is excluded. The patient is completely disabled. 5. Very severe degree - no independent damage and dії impossible. Illness is permanently laid up in the presence of a third-party sight and help.

Exercise therapy for paralysis and paresis. Paralysis (Greek paralysis) - prolapse, paresis (Greek haresis) - 1) weakening of motor functions with the absence or decrease in muscle strength; 2) due to a violation of the structure and function of the motor analyzer; 3) as a result of pathological processes in the nervous system. The following forms of paralysis and paresis are divided: According to the nature of the injury and violations of the responsible structures of the nervous system: Organic Functional Reflex Result of organic changes in the structure of the central and peripheral bifurcated neuron (head, back, brain, peripheral nerve), which arise under the influence of various pathological processes: bruises , tumors, disorders of cerebral circulation, inflammation and other processes Inheritance of the influence of psychogenic factors that lead to neurodynamic disorders in the central nervous system and occur mainly in hysteria The result of neurodynamic functional disorders of N.S., which occur under the influence of a significant lesion, topically not associated with paralysis and paresis, which is formed

According to the nature of the tone of the affected muscles, they distinguish: central or spastic, sluggish (peripheral) and rigid paralysis and paresis. Depending on the structural level of damage to the motor analyzer, paralysis and paresis are divided into: Central (pyramidal) (spastic) Peripheral (flaccid) Extapyramidal (rigid) ) muscle tone. In case of damage to the peripheral motor neuron a) atony b) areflexia by an infectious process, infectious-allergic, degenerative process (cells of the anterior horns of the spinal cord, nuclei of the cranial nerves, anterior cords of the spinal nerves, plexuses, spinal nerves or cranial nerves) Rigid tone of the damaged muscles as a result of a violation of the kirko-subcortical stem connections. Characterized by a decrease or lack of motor activity. Loss of fellowship of automatic movements. Slowness of speech, movement in small steps due to the absence of simultaneous movements of the hands. The phenomenon of a cogwheel with a

The task of exercise therapy for central and peripheral paralysis. 1. Improvement of blood circulation and nervous trophism of the affected muscles. 2. Prevention of the development of contractures. 3. Restoration of movement and development of compensatory motor skills. 4. General-strengthening effect on the patient's body.

Forms of exercise therapy, features of their application: exercise therapy and massage begin in the early stages of treatment. From the first days, specific laying of paretic limbs. For example, with hemiplegia or hemiparesis due to ischemic stroke, positioning begins from 2-4 days. With cerebral hemorrhage - from 6-8 days (if the patient's condition allows it to be done). 1. Laying on the back is opposite to the Wernicke-Mann position: the shoulder is retracted to the side at an angle of 90, the elbow and fingers are extended, the hand is supinated, held from the side of the palm with a splint. The entire limb is fixed with sand loads. 2. The paralyzed leg is bent at the knee at an angle. The foot is in the position of dorsiflexion at an angle. Laying on the back is alternated with the position on the healthy side. The frequency of changes in positions is 1.5 - 2 hours. 4. Simultaneously use massage. Usually used stroking, rubbing, light kneading, continuous vibration.

Massage with cirrhosis is vibratory: 1) ointments with hypertonicity are massaged at a moderate pace, and they are antagonistic to smoothing, rubbing and grinding at a higher swedish pace; 2) in case of peripheral (PP): stroking all the kinks on the back of the head, and then massaging the paralyzed ointment, and their antagonisms are no longer lightly stroking. Massage is started from the proximal veins, in order to increase the vanity. For the course of sessions at the end of Indications are also point and reflex-segmental massage. 5. In parallel with the massage, passive ruhi in the glom is carried out (5-10 ruhi in the skin foll at a normal pace). 6. Active gymnastics - may be the main value. With cirrhosis - for 8-10 days, with ischemic stroke and bleeding in the brain - for a day. Start with the morning exercise in the required position, then train the ointment, the tone of such movements. Right with additional support: frame with a system of blocks and hammocks, frail surface, spring traction, gymnastic equipment. Then we prescribe active conditions for healthy and ill patients. In case of PP, you have the right to do a lot of work at the bath with warm water. 7. Start sitting in case of ischemic stroke (II) after 10 days in the presence of the cob of illness. In case of bleeding in the cerebellum - after 3-4 days. 8. Preparation before walking starts at V. p. lying down and sitting. They learn to stand on two legs, then firstly on sick and healthy, walking on a mission, with an instructor in a special wheelchair, with an additional three-footed militia, on a level surface, on gatherings.

Exercise therapy for neuritis of the facial nerve. Neuritis of the facial nerve (FN) is manifested by peripheral paresis or paralysis of the mimic muscles of a certain part of the face, accompanied by its asymmetry. Indications for exercise therapy in NLN: 1. Neuritis of infectious and vascular origin. 2. After surgical removal, the nerve was swollen and compressed. 3. After complete sanitation of an acute purulent process in the middle ear, which was called NLN. 4. NLN, as a consequence of surgery for epitympanitis (rarely). Exercise therapy tasks for NLN: 1. Improvement of regional blood circulation (face, neck). 2. Restoration of the function of mimic muscles. 3. Prevention of the development of contractures and friendly movements. 4. Restoration of correct speech. 5. Reduction of facial expression disorders in mild nerve lesions that are difficult to treat in order to hide facial defects.

Recovery periods Early Main Recovery In NP 2-12 days days 2-3 months In NH days 3-4 months 2-3 years Early period. They use therapeutic position, massage, therapeutic exercises. 1. Treatment position: - sleep on the side of the wound; - during the day, sit 3-4 times with your head tilted to the opposite side, supporting it with your hand resting on your elbow. At the same time, pulling the muscles from the healthy side to the side of the wound (from bottom to top) trying to restore the symmetry of the face; - leukoplaster tightness from the healthy side to the patient with the use of a special sholoma-mask; - tying with a scarf;

2. Massage. Start with the collar zone of the neck. The patient sits in front of a mirror. The masseur must see the entire face of the patient. All massage techniques (stroking, rubbing, light kneading, vibration) are carried out carefully, without significant reduction in the skin of the face. Reduction (meaning of muscles). 3. Therapeutic gymnastics I. - dosed tension and weakening of the muscles of the healthy side (zygomatic, laughter, circular muscles of the eye, etc.) - tension and relaxation of the muscles that form mimic images (smile, laughter, attention, sorrow). This exercise is only a preparatory stage for the main period.

Special exercises for facial muscles: 1. Raise your eyebrows up. 2. Furrow your eyebrows. 3. Close your eyes (execution steps: look down; close your eyes; supporting the eyelids with your fingers on the side of the attack, keep your eyes closed for a minute; open and close your eyes 3 times). 4. Smile with your mouth closed. 5. Shchurits. 6. Lower your head down, inhale and snort while exhaling. 7. Whistle. 8. Open the nostrils. 9. Raise the upper lip, show the upper teeth. 10. Lower the lower lip, show the lower teeth. 11. Smile with your mouth open. 12. Put out a lit match.

13. Fill your mouth with water, close your mouth and rinse without pouring out the water. 14. Inflate the chocks. 15. By moving air from one half of the mouth to the other. 16. Lower the corners of the mouth down with the mouth closed. 17. Stick out your tongue and make it narrow. 18. Move the tongue forward - backward with an open mouth. 19. Move the tongue to the right - to the left with the mouth open. 20. Pull lips forward with a tube. 21. Make a kolo with your finger, watching it with your eyes. 22. Retract the chocks with the mouth closed. 23. Lower the upper lip to the lower. 24. With the mouth closed, drive the tip of the tongue along the gums to the right and left, pressing the tongue with different efforts.

The main (late) period (ІІ) It is characterized by an instant restoration of muscle functions, which are combined with active treatment, special physical exercises and other methods of exercise therapy. - treatment of VP increases up to 4-6 hours (in some cases up to 8-10 hours). The degree of tension of the leukoplasty increases due to hypercorrection (due to overstretching and weakening of the tone of healthy muscles. Healthy muscles thereby turn from opponents into allies of diseased muscles). - Massage II. It is carried out in various ways based on the topography of the pathological process. So, the muscles that are innervated by the 1st branch of n. facialis, are massaged in the usual way. This is light and medium stroking, rubbing, vibration on the points. The main massage is carried out from the middle of the mouth and plays a dual role: muscle regulation (minor) massage itself, stimulating blood flow, trophism of paretic muscles, etc.

Trivality of massage 5-11 minutes for 2-3 days. If the effect persists, LH is continued, and the massage is applied for days. Repeated course - 20 procedures. - LG III. LH plays an important role in the primary period. All have the right to subdivide into dekіlka groups: 1) differentiation of the tension of the paretic meats (forehead, suprabrіvnі, zygomatic, smіhu square meat of the upper lip, tricot pіdborіdya, circular meat of the company); 2) dosing of tension (relaxation) of all the names of the ulcers with increasing strength and intensity; 3) notification of the inclusion of meat from the molding of various mimic images, situation, laughter, laughter, confusion, suffocation; 4) dosed tension of the meazіv pіd hіmovі zvіvіv. You should be right in front of the mirror with the participation of the instructor and independently (2-3 times a day). Residual period (following 3 months). Tasks for yourself: increase in meat activity for the creation of maximum symmetry between healthy and sick parties of disguise

Likuvalna physical culture in osteochondrosis of the ridge. The basis of osteochondrosis of the ridge is the change of the interspinal discs with the onset of retraction in the process of the body of the susterior spines of the interspinal joints and the ligamentous apparatus. The intervertebral discs play an important role in the stable position of the ridges, protect the roughness of the ridge, and function as a biological shock absorber. Factors that help to blame the development of osteochondrosis are a low-handed way of life, a trip to the body in a physiologically handicapped position (a rich one sitting at a writing table, behind a car kerm, standing at a workbench, behind a counter). It means that the blood supply and the safety of the living cavities of the bodies of the ridges, interspine discs are significantly affected. Blame the cracks of the fibrous ring. As a result of the progression of degenerative changes in the fibrous calf, the fixation of the ridges among themselves is broken, causing pathological fragility. Mіzhkhrebtsevі shіlini change, zdavlyuyutsya neuro-vascular closure, blood-bearing and lymphatic vessels - pain. In the 3rd stage of the disease, the rupture of the fibrous ring is broken, the intercostal keels are established. The final stage is characterized by painful indentations and displacement of the ridges, and the development of pathological cystic growths.

Head of jubilant gymnastics: 1. Relieve the improvement in the midst of the spinal segments with the method of removing the pathological proprioceptive impulse. 2. Relieve the decrease in pathological proprioceptive impulses. 3. Reduction of exchange processes in the aftermath of increased blood flow to the lymphatic system in the low spinal segment and core. 4. Change of sagging in tissues, placement in the space of the intervertebral opening, improvement of blood flow in the lower border. 5. Reconstruction and renewal of the total volume of ruins in the peaks and ridges; change of static-dynamic damage and compensatory damage, restoration of damaged posture. 6. Take inspiration from the trophy, tone, strength of the skin of the tunic and the ends. 7. Promotion of global physical practice.

Special tasks of calisthenics: In case of radicular syndrome: retraction of nerve trunks and roots; twisting of nerve trunks and roots; preperedzhennya myazovyh atrophy; preperedzhennya myazovyh atrophy; strengthening of the pulps of the distal tips. strengthening of the pulps of the distal tips. With humeroscapular periarthritis: prevention of the elimination of reflex neurogenic contracture of the ulnar nodule; prevention of the elimination of reflex neurogenic contracture of the ulnar nodule; strengthening of the deltoid, supraspinatus, subastal, two-headed ulcers. strengthening of the deltoid, supraspinatus, subastal, two-headed ulcers. With the posterior cervical sympathetic syndrome (syndrome of the spinal artery): take a weakened vestibular disorder. take relief from vestibular disorders.

Osteochondrosis of the cervical spine. Active circulation in the cervical vertebral ridge in the cob and main periods of the course of treatment is contraindicated, which may cause the ringing of the intersternal opening, as a result of compression of the nerve roots of the vessels. Complex V.p. - sitting on an armchair (prevented for the first 7 right), hands lowered in a tuluba. Turn your head to the left and to the right with the maximum possible amplitude. The pace is faster. 2. Lower your head down, away from the breasts. The pace is faster. 3. Put the kitty on your forehead. Press with your forehead on the whale for 10 s, remove it for 20 s. The head and the whale are not broken. 5 times 4. Put the kitty on the cover. I put pressure on the kitty for 10 s, for 20 s. The head and the whale are not broken. 5 times 5. Tse same from the other side.

6. Hands lowered vzdovzh Tuluba. Raise your shoulders and hold them in this position for 10 s, relax for 15 s. 6 times 7. Self-massage of shoulders, shoulder ridges, trapezoidal meat. 5-7 min 8. Ch. - lying on the back (taken from 8 to 16 to the right), hands under the head. Press your head on your hands - see. Relax - inhale. The pace is faster. 10 times 9. Hands on the belt. Pochergovoe zginannya that razginannya nіg, not changing the bend across. Do not break the feet in front of the logs. 10 times with a skin leg. 10. Hands on the belt, legs bent. Bend over, lift the pelvis - see, v.p. - inhaling once. 11. Bend your legs and squeeze them to your stomach, hug them with your hands, head to your knees - see, in. n. - indah times. 12. Hands to the side. Swing with the right foot, with the left hand push up to the right foot. With your other foot and hand. 10 times with a skin leg. 13. Hands on the belt. Raise straight legs in front of 90 - see, lower - inhale. 15 times 14. Hands on the head. Left leg and arm to the side - inhale, v.p. - seen. The same with the other foot and hand. 10 times with a skin leg. 15. V.p. - lying on the stomach, gymnastic stick on the shoulder blades. Straight legs back-up, lift your head and shoulders, bend over. 15 times

16. V.p. - standing navkarachki (taken from 16 to 18 to the right). Do not shake your hands and knees in the podlogs, work your round back - see, v.p. - inhale. 10 times 17. Straighten the right leg - ruh with the torso and the pelvis back - vidih, v.p. - inhale. Those with the left foot. 10 times with a skin leg. 18. Turn your back and head to the left - inhale, v.p. - seen. Those same to the right. 10 times in a leather bag. 19. V.p. - standing on knees. Pull the left leg to the side, v.p. the same with the right foot. 10 times with a skin leg. 20. V. p. - sitting on a pedestal, pulling a leg in front of you, inshu, bending in a knee, put it to the side. Stretch forward to the curly leg, trying to push yourself up to the feet with your hands. Change the position nіg. 10 times in a leather bag. 21. V.p. - standing. Sit down, pulling the heels into the legs, hands forward - visible, v.p. - inhale, 15 times.

22. V.p. - standing levi sideways to the support, lion straight leg behind. Rights - bent and set forward, the toelub is straight. The springs are swaying. Change the position nіg. 10 times in skin position. 23. Hanging on the bar. Gently turn the pelvis alternately to the right and to the left. Do not strain the shoulder girdle and back - the body is as relaxed as possible. Trivality to visu - 40 seconds. Repeat dekilka once a day. 24. V.p. - standing, stick in upturned hands. Right foot forward - stick on the shoulder blades. Those with the left foot. 10 times with a skin leg. 25. Stick in upturned hands. Stick on the chest, v.p. Stick on the shoulder blades, v.p. 10 times 26. Stick on the chest. Nahil forward, put a stick on the pidlog - vidih, v.p. - inhale. 10 times 27. Stick in lowered hands behind the back (grip from below), nahil forward, hands with the stick as far back as possible, up - see, v.p. - inhale. 10 times 28. Stick in curly arms in front of the breasts. Remove the stick with a swing of the left leg, then the right. 10 times with a skin leg. 29. Swing your left foot forward, arms up - inhale, v.p. - seen. Those with the right foot. 10 times with a skin leg. 30. Feet shoulder width apart. Nahil forward, pushing the left foot with the right hand, the left hand to the side - visible, v.p. - inhale. Those are up to the right foot. 10 times to the skin leg.

Complex 2 The skin has the right to be beaten 5-6 times. 1. V.p. - lie on your back. Raising your head and shoulders, turn the toelub to the right, pull your arms forward and to the right; those are on the other side. 2. V.p. - Lie on your stomach, arms out to the side. Lift the toelub, put your hands behind your head, bend over. 3. V.p. - standing - feet shoulder width apart. Nahili head to the right, circle head to the left. Those are on the other side. 4. Feet shoulder width apart, hands on the waist. With a small fistful of the coat, stretch your right hand up to the left, flick your head to the left, pushing your shoulders with your hand. Those are on the other side. 5. Feet shoulder width apart. Circle with shoulders back, hitting the shoulder blades, napping, head back; vp, circle with shoulders forward, napіvprisid, head forward. 6. Feet shoulder width apart, hands on the waist. Rising on your toes, heal your head forward; descending on the entire foot, napіvsіd, head to the right. Those wagging their heads to the left, then back.

7. Feet shoulder width apart, arms up. Right hand forward, swing to the side. Those with the other hand. 8. Feet shoulder-width apart, arms to shoulders. Raise your shoulders and shoulder blades forward, then lower them down; straightening your arms up, two spring swings with your arms back. 9. Feet shoulder-width apart, arms to the sides. Turning the toelub to the right - shresni ruhi with your hands, turning at the VP, waving your arms to the sides. Those are in the next book. 10. Feet shoulder width apart, hands on the waist. Two spring-loaded sheepskin coats to the left, wound to the right; straight up rise on your toes and turn in v.p. Those are in the next book. 11. Feet shoulder width apart, hands behind the head. Pivkrug with a tulub to the left, fisted to the right, forward, to the left. Move smoothly. Those are on the other side. 12. V.p. - lying on your back, hands in a tuluba. Bend your legs with knees to your chest, straighten up, then forward over the slope. 13. V.p. - lying on the stomach, arms folded under the boarders. Swing your right foot up. Those with the other foot. 14. V.p. - lying on your back, hands in a tuluba. Sisti, raising your arms up, two spring swings with your arms back; bending your legs, hug them with your hands, round your back, heal your head to the knees.

15. V.p. - sitting with support on the hands behind the back, legs bent outwardly. Lower the knee of the right leg to the left. Those with the other foot. 16. V.p. - sitting, legs narizno, arms to the sides. Turning the toelub to the right, heal up to the fold, leaning on the bent arms. Those are in the next book. 17. V.p. - standing on your knees, hands down. Bring the right leg forward, sit on the heel of the left leg, heal the toelub forward, stretch your hands to the foot. Two spring-loaded ones got forward. Those with the other leg. 18. V.p. - standing on knees with support on hands. Leaning down on the front of the left hand, turn the toelub to the right, move the right hand to the side. Those are in the next book. 19. V.p. - standing. Max with the bent right foot forward, with a note on the left foot, move the right back on the toe, arms up. Those are your legs. 20. Legs wide apart. Hacking forward, hands on the line. Bend your right leg with a knee to the side, lift your heel, squat down. Those are your legs. 21. Legs narizno, hands on the belt. Rising up on your toes, turn your heels to the right and lower them to the floor. Those are leaning on the heels and turning the socks.

Osteochondrosis of the thoracic spine. As a result of degenerative-dystophic changes in the interspinal discs in the thoracic spine, there may be flattening or exacerbation of thoracic kyphosis. These changes, in order of pain syndrome, reduce the dycal excursion of the chest, lead to hypotrophy of dycal ulcers, and damage the function of the ovary indigestion. When flattening the thoracic kyphosis, it is necessary to strengthen the ointment of the cervical wall and stretch the ointment of the back. With the help of the victorious method, physical rights are right, straightened out to stretch the ridge and strengthen kyphosis. In case of strong thoracic kyphosis, likuvalny gymnastics is aimed at strengthening the back ulcers, stretching the old ulcers and the abdominal ulcers. In the lessons of vicorist, right on the ridge and chest joint, right on the links of the shoulder blades. To achieve a greater effect, include the right ones with gymnastic objects (Fig. 15, 16).

Osteochondrosis of the transverse ridge. In the period of acute illnesses, we are ill, we lie on a hard bed. For relaxation of the myaziv under the knee, a cotton-gauze roller is applied. With the method of decompression of the nerve root, reduction of blood flow, traction is prescribed. I create a calm mind for the scarring of cracks and openings of the fibrous ring. Likuvalny gymnastics is aimed at reducing the pain syndrome, relaxing the skin of the tuba and kinks, improving the bleeding of the nerve cortex. In the lesson, include the right for the distal lower limbs in both static and dynamic dichal limbs, relaxation of the meat of the tuba and the limbs, as well as bending from the outward position lying on the back, on the stomach, on the sides.

After the pain syndrome subsides, it is right to tighten the ridge, yogo kifozuvannya, to reduce the blood supply to the pit of the ridge and adjacent tissues. Right vykonuyut from the exit position lying on the back, stomach, on the hips, standing on the floor. There are ruins in the kolіnnyh and kulshovyh swamps, right on the bend of the ridge and yogo winding along the axis. It is necessary to bend right with the isometric tension of the meats: push with a transverse dilyanka on the couch with the legs bent in the knees; you can rightly fold it, straining at once the ointment of the seat and the crotch. Qi have the right to increase the intraperitoneal pressure, which leads to a change in the intradiscal pressure.

With the presence of hypotrophy of the spinal measles and the abdominal press, it is necessary to strengthen, shape the measive corset, which will help in the development of the ridge and in the victorious main static and biomechanical functions. When the pain subsides, it is possible to begin to overcome the complexes to the right 6, 7, 8 (Fig. 17, 18). To normalize the tone of the spinal ulcers and reduce the bleeding of the paravertebral tissues, it is necessary to massage the spinal ulcers across and across. In case of brown syndrome, it is possible to have a short term.

COMPLEX 8 The skin has the right to be cut 5-6 times. 1. V.p. - lying on your back, your hands are raised in a coat, your socks are pulled up and, stretching your whole body, stretch. Relax. Well, pull up socks on yourself. 2. Legs are bent, one hand is raised in a tuluba, the other is up. 3. Stretch one hand forward, the other up. Change the position of your hands. 4. The legs are bent, the hands are raised in the coat. Turn your head to the right, to the left, hands behind your head. Raise your head, heal with your hands to your chest, lean forward. 5. Hands vzdovzh tuluba. Bending one leg, pull it up with your hand to the chest, the same, bending the other leg; raise your head and shoulders, pushing your forehead to your knees.

6. V.p. - standing. He pulled his head to the right, turned his head forward, pulled his head to the left, turned his head back. 7. Hands on the belt. Raise one shoulder, lower it. Raise the other shoulder - lower it. Raise and lower offended shoulders. 8. Squat down, pull your arms forward, kititsa on yourself, stretch your shoulders and palms forward; s pіvpriyadom vіdvest hands back, without changing the position of the whale, the shoulder blades of the grass. 9. Legs narizno, arms to the side. Hands forward - forward, hug your shoulders. In a sitting position, bend your hands over your head, smearing your fingers around the lungs. 10. Legs narizno, arms to the side. 8 circular swings with hands backwards with a small amplitude, whales on themselves; 8 circular ruhіv hands forward, kititsi lowered fingers down.

10. Legs narizno, arms to the side. Horizontal whipping forward, arms forward, hands behind the head, shoulder blades zednati; with a pivsyadom, he pulled his coat to the side, stretched his elbow to the knee. Those are cheeky in the next bek. 11. Heeled the coat forward, hands on the knees; sit down, without changing the position of the coat; forcefully stiffened, straighten your legs, stretch your arms down. 12. Legs narizno, hands in front of the chest. Z pivsyadom turn the toeluba to the right, move the right leg back. Those are in the next book. 13. Legs narizno, hands on the belt. Move the pelvis to the right, keeping the position of the shoulders, do not bend the legs. Repeat to the left. Those same, pochinayuchi ruh in the next bek. 14. Legs wide apart, arms to the sides. 3 spring-loaded ones were sickened forward, stretched their arms to the bottom, hands behind their heads, forcefully sickened.

15. Legs wide apart. Bend one leg, lean on your knee with your hands, heal the toelub forward; those are bending my other leg. 16. Krok with his right foot to the side, bending її, he pulled his coat to the left, arms up, putting his right foot. Those are the next beak. 17. Vipad right foot forward, back straight, hands on knees; arms up, stretch back; squat down, repeat. Those are your legs. 18. Legs are cut. Rise on your toes, hands up; with a pіvpriyady, I will bend my leg forward, hug my knee with my hands. Those with the other foot. 19. Hands to the side. Z pivsyadom on the left swing with the right foot to the side. Clap your hands over your head. Repeat with other leg. Those wіdvodyachi leg back. 20. Legs narizno, hands on the belt. Rise on socks; rolling on heels, lifting socks uphill. Deep squat, hands up.

Therapeutic exercise in diseases of the nervous system plays a significant role in the rehabilitation of neurological patients. Treatment of the nervous system is impossible without therapeutic exercises. Exercise therapy for diseases of the nervous system has the main goal of restoring self-care skills and, if possible, complete rehabilitation.

It is important not to miss the time to create the correct new motor stereotypes: the earlier treatment is started, the easier, better and faster the compensatory-adaptive recovery of the nervous system occurs.

In the nervous tissue, the number of processes of nerve cells and their branches on the periphery increases, other nerve cells are activated, and new nerve connections appear to restore lost functions. Timely adequate training is important for creating the correct stereotypes of movements. So, for example, in the absence of physiotherapy exercises, a "right-brained" stroke patient - a restless fidget "learns" to walk, pulling the paralyzed left leg to the right and dragging it behind him, instead of learning to walk correctly, with each step moving the leg forward and then transferring the center of gravity of the body to it. If this happens, then it will be very difficult to retrain.

Not all patients with diseases of the nervous system can do the exercises on their own. Therefore, they cannot do without the help of their relatives. To begin with, before starting therapeutic exercises with a patient who has paresis or paralysis, relatives should master some techniques for moving the patient: transplanting from bed to chair, pulling up in bed, walking training and so on. In fact, this is a safety technique to prevent excessive stress on the spine and joints of the caregiver. Lifting a person is very difficult, so all manipulations must be performed at the level of a magician in the form of a “circus trick”. Knowing some special techniques will greatly facilitate the process of caring for the sick and help maintain your own health.

Features of exercise therapy in diseases of the nervous system.

one). Early initiation of exercise therapy.

2). Adequacy of physical activity: physical activity is selected individually with a gradual increase and complication of tasks. A slight complication of the exercises psychologically makes the previous tasks “easy”: what previously seemed difficult, after new slightly more complex tasks, is performed more easily, with high quality, the lost movements gradually appear. It is impossible to allow overload in order to avoid deterioration of the patient's condition: motor disturbances may increase. In order for progress to occur faster, it is necessary to finish the lesson on the exercise that this patient has, to focus on this. I attach great importance to the psychological preparation of the patient for the next task. It looks something like this: "Tomorrow we will learn to get up (walk)." The patient thinks about it all the time, there is a general mobilization of forces and a readiness for new exercises.

3). Simple exercises are combined with complex ones for training higher nervous activity.

4). The motor mode gradually steadily expands: lying - sitting - standing.

Therapeutic exercise for diseases of the nervous system.5). All means and methods of exercise therapy are used: therapeutic exercises, positional treatment, massage, extension therapy (mechanical straightening or stretching along the longitudinal axis of those parts of the human body that have a disturbed anatomical location (contractures)).

The main method of physical therapy for diseases of the nervous system is therapeutic exercises, the main means of exercise therapy are exercises.

Apply

Isometric exercises aimed at strengthening muscle strength;
- exercises with alternating tension and relaxation of muscle groups;
- exercises with acceleration and deceleration;
- coordination exercises;
- balance exercise;
- reflex exercises;
- ideomotor exercises (with mental sending of impulses). It is these exercises that I use for diseases of the nervous system - - - - most often in combination with Su-jok therapy.

Damage to the nervous system occurs at different levels, the neurological clinic depends on this and, accordingly, the selection of therapeutic exercises and other physiotherapeutic therapeutic measures in the complex treatment of a particular neurological patient.

Hydrokinesitherapy - exercises in water - a very effective method of restoring motor functions.

Exercise therapy for diseases of the nervous system is subdivided according to the parts of the human nervous system, depending on which part of the nervous system is affected:

exercise therapy for diseases of the central nervous system;
exercise therapy for diseases of the peripheral nervous system;
exercise therapy for diseases of the somatic nervous system;
Exercise therapy for diseases of the autonomic nervous system.

Some subtleties of work with neurological patients.
In order to calculate our strength in caring for a neurological patient, we will consider some significant factors, since the care process is complex, and it is not always possible to cope alone.

The state of mental activity of a neurological patient.
The patient's experience in physical education before illness.
The presence of excess weight.
Depth of damage to the nervous system.
Accompanying illnesses.

For physiotherapy exercises, the state of higher nervous activity of a neurological patient is of great importance: the ability to be aware of what is happening, to understand the task, to concentrate attention when performing exercises; volitional activity plays a role, the ability to resolutely tune in to daily painstaking work to achieve the goal of restoring the body's lost functions.

In the case of a stroke or brain injury, most often the patient partially loses the adequacy of perception and behavior. Figuratively, it can be compared with the state of a drunk person. There is a "disinhibition" of speech and behavior: the shortcomings of character, upbringing and inclination to what is "impossible" are exacerbated. Each patient has a behavioral disorder that manifests itself individually and depends on the

one). what activity the patient was engaged in before the stroke or before the brain injury: mental or physical labor (it is much easier to work with intellectuals if the body weight is normal);

2). how developed the intellect was before the disease (the more developed the intellect of a patient with a stroke, the more the ability to purposefully exercise exercise remains);

3). in which hemisphere of the brain did the stroke occur? "Right hemispheric" stroke patients behave actively, show emotions violently, do not hesitate to "express"; they do not want to follow the instructions of the instructor, they start walking ahead of time, as a result, they have a risk of forming incorrect motor stereotypes. “Left hemispheric” patients, on the contrary, behave inactively, do not show interest in what is happening, just lie down and do not want to engage in physiotherapy exercises. It is easier to work with "right hemisphere" patients, it is enough to find an approach to them; what is needed is patience, a delicate and respectful attitude, and the decisiveness of methodological instructions at the level of a military general. :)

During classes, instructions should be given decisively, confidently, calmly, in short phrases, it is possible to repeat instructions due to the patient's slow perception of any information.

In the event of a loss of behavioral adequacy in a neurological patient, I have always effectively used the “cunning”: you need to talk to such a patient as if he is a completely normal person, not paying attention to “insults” and other manifestations of “negativity” (unwillingness to engage in, denial of treatment other). It is not necessary to be verbose, it is necessary to make small pauses so that the patient has time to realize the information.

In case of damage to the peripheral nervous system, flaccid paralysis or paresis develops. If at the same time there is no encephalopathy, then the patient is capable of much: he can independently exercise a little during the day several times, which undoubtedly increases the chance of restoring movements in the limb. Flaccid paresis is more difficult to respond to than spastic paresis.

* Paralysis (plegia) - the complete absence of voluntary movements in the limb, paresis - incomplete paralysis, weakening or partial loss of movement in the limb.

It is necessary to take into account another important factor: whether the patient was engaged in physical education before the disease. If physical exercises were not included in his lifestyle, then rehabilitation in case of a disease of the nervous system becomes much more complicated. If this patient has exercised regularly, then the recovery of the nervous system will be easier and faster. Physical labor at work does not belong to physical education and does not bring benefits to the body, since it is the exploitation of one's own body as a tool for doing work; he does not add health due to the lack of dosing of physical activity and control of well-being. Physical labor is usually monotonous, so there is wear and tear of the body in accordance with the profession. (So, for example, a painter-plasterer “earns” humeroscapular periarthrosis, a loader - osteochondrosis of the spine, a massage therapist - osteochondrosis of the cervical spine, varicose veins of the lower extremities and flat feet, and so on).

For home exercise therapy for diseases of the nervous system, you will need ingenuity to select and gradually complicate exercises, patience, regularity of daily exercises several times during the day. It will be much better if in the family the burden of caring for the sick is distributed to all family members. The house should be in order, cleanliness and fresh air.

It is desirable to put the bed so that it has access from the right and left sides. It should be wide enough to allow the patient to be rolled from side to side when changing bed linen and changing body position. If the bed is narrow, then each time you have to pull the patient to the center of the bed so that he does not fall. You will need additional pillows and rollers to create a physiological position of the limbs in the supine and supine position, a splint for a paralyzed arm to prevent contracture of the flexor muscles, a regular chair with a back, a large mirror so that the patient can see and control his movements (especially the mirror necessary in the treatment of neuritis of the facial nerve).

There should be room on the floor for lying down exercises. Sometimes you need to make handrails for support with your hands in the toilet, in the bathroom, in the corridor. To practice therapeutic exercises with neurological patients, you will need a Swedish wall, a gymnastic stick, elastic bandages, balls different size, skittles, a roller foot massager, chairs of different heights, a step bench for fitness and much more.

According to experts, movement is life. And with various diseases, proper physical activity can become a real panacea for the patient - they can speed up recovery, prevent relapses, and improve overall physical condition. So with ailments of the nervous system, gymnastics is the most important part of complex treatment. And all patients with such problems, without exception, are shown the systematic implementation of a set of individually selected exercises. The topic of our today's conversation on this page www.site will be exercise therapy for diseases of the central nervous system and peripheral.

Exercise therapy for diseases of the nervous system

Physical therapy for diseases of the central nervous system helps to activate the vital functions of the body: respiratory, cardiovascular, etc. Gymnastics effectively prevents the occurrence of motor and other complications, including contractures, stiffness in the joints, bedsores, congestive pneumonia, etc.

Regular exercises help restore lost functions or create temporary or permanent compensation. Physiotherapy also helps to restore the skills of walking and grasping objects. Gymnastics also perfectly increases the overall tone of the body and optimizes the mental state of the patient.

Exercise therapy for diseases of the peripheral nervous system

Gymnastics in such diseases is aimed at optimizing the processes of blood circulation, as well as trophism in the affected focus, it helps to prevent adhesions and cicatricial changes, eliminate or reduce vegetative-vascular and trophic disorders (promoting nerve regeneration).

Exercises for diseases of the peripheral nervous system help to strengthen the paretic muscles and ligamentous apparatus, to weaken muscular dystonia. Such an effect can prevent or eliminate muscle contractures, as well as stiffness in the joints.

Physiotherapy exercises also help to improve substitution movements and coordinate them with each other. Such exercises cope with the limited mobility of the spinal column and with its curvature.

Exercises for diseases of the peripheral nervous system have a pronounced general health-improving, as well as a general strengthening effect on the patient, contributing to the overall recovery of working capacity.

Features of exercise therapy for ailments of the nervous system

Patients with diseases of the nervous system are shown an early start of exercise therapy. At the same time, physical activity should be relevant: they are selected on an individual basis, should gradually increase and become more complicated.

Even a slight complication of exercises already at the level of psychology makes the previous exercises easier. However, overloads for patients with diseases of the central nervous system and peripheral nervous system are categorically contraindicated; in this case, their motor disorders may worsen. To accelerate progress, it is extremely important to finish classes on those exercises that are best obtained by patients. This ensures the most positive psychological preparation of the patient for the next classes.

Simple exercises must be alternated with complex ones: to ensure a full-fledged training of higher nervous activity. At the same time, the motor mode should be steadily expanded: from the position lying in bed, to sitting in bed, and then standing.

Doctors strongly recommend the use of all means, as well as methods of physical therapy. Patients are shown to conduct therapeutic exercises, treatment by position, massages. Also, an excellent effect is given by extension therapy - mechanical straightening or stretching along the longitudinal axis of certain parts of the body, which are characterized by a violation of the correct anatomical location.

However, the classic and most popular method of physical therapy for ailments of the nervous system is different exercises.

What exercises are used for diseases of the nervous system?

Patients are shown performing isometric exercises designed to strengthen muscle strength. Doctors also advise classes in which tension and relaxation of muscle groups alternate. Exercises with acceleration and deceleration, various exercises for deceleration and balance must also be performed.

Alternative medicine experts also advise paying attention to ideomotor activities, in which the mental sending of impulses occurs.

Some examples of exercise therapy for diseases of the nervous system

Quite often, patients with focal lesions of the brain are treated with position. In this case, the affected limbs (usually the arm) are fixed in a fixed position using various devices (sand roller, etc.). The duration of treatment with the position can vary from a quarter of an hour to four hours, depending on the type of disease and the condition of the patient.

In diseases of the peripheral nervous system, the patient is shown to perform exercises aimed at optimal contraction of the paretic muscles, as well as stretching their antagonists. Particular attention is paid to the development of the necessary motor skills: walking and running, the ability to write, hold and throw small objects.

Physiotherapy exercises contribute to the speedy recovery of patients with ailments of the nervous system, both peripheral and central.

Ekaterina, www.site

P.S. The text uses some forms characteristic of oral speech.

One of the leading directions in the therapy of vegetative-vascular disorders is exercise therapy. Its therapeutic effect in diseases of the autonomic nervous system (ANS) is due to the fact that proprioceptive impulses in combination with skin reception form a complex differentiation that suppresses pathological interoreceptive impulses, thereby normalizing the functions of the autonomic nervous system.

The purpose and objectives of physical education

The goal and objectives of exercise therapy for diseases of the ANS are to improve adaptation, increase efficiency, improve blood circulation, respiratory function, metabolism, normalize the tone of the vascular wall, relax muscles and improve coordination of movements.

When compiling a set of exercises in patients with vegetative-emotional disorders, it is necessary to determine the state of vegetative tone (sympathicotonia, vagotonia, mixed).

Patients with central disorders of a permanent nature are prescribed the following types of exercises:
1. Respiratory
2. To relax (with sympathicotonia).
3. Strength - exercises with muscle strengthening, weight-bearing shells, resistance (with vagotonia).
4. Speed-strength - running, jumping, jumping, etc.

Motor modes - general, and in sanatorium conditions - sparing, sparing-training and training. In general and sparing modes, the main attention is directed to the study of the psychological characteristics of the patient, the normalization of respiratory and motor functions with a gradual increase in load under the control of vegetative indicators (vegetative tone, vegetative reactivity and vegetative support of activity). Patients should avoid sudden movements, turns, tilts. Breathing exercises are used, for relaxation, balance, coordination, then power and speed-strength are added.

With vagotonia, patients need regular, dosed physical activity throughout their lives. Of the gymnastic exercises, in addition to free movements for the arms, legs and body, it is recommended to use exercises for large muscle groups: exercises with overcoming the gravity of the body (squats, mixed hangings, soft lunges), exercises with weights (dumbbells, "medicine ball"), resistance and volitional tension (dynamic and isometric with a breath hold of no more than 2-3 s).

These exercises cause an increase in blood pressure and place increased demands on cardiac activity, so their use should be carried out within a strict dosage in alternation with breathing exercises. Individual and group methods of conducting classes are recommended. It is advisable to combine therapeutic exercises with walking, health path, swimming, tourism, skiing and massage of the head, collar zone, upper and lower extremities and reflex types of massage (segmental, acupressure, shiatsu, etc.).

With sympathicotonia, exercise therapy is used in the following forms: morning exercises, therapeutic exercises, health path, swimming, close tourism, outdoor games (volleyball, towns, badminton), physical exercises in water, exercises on simulators, massage of the collar zone, head, face, shoulder girdle.

The main form of exercise therapy is therapeutic gymnastics, which is carried out daily for 20-30 minutes, rhythmically, at a calm pace, with a large range of motion. It is recommended to combine with static and dynamic breathing movements, as well as special types of breathing exercises.

Special exercises for sympathicotonia include exercises to relax various muscle groups, to improve coordination. It is advisable to use linear and acupressure massage.

In the LH complex in the general regimen, there should be general strengthening exercises in combination with all types of breathing exercises.

We give an approximate list of special exercises that can be included in the exercise therapy complex for permanent manifestations of vegetative-vascular dysfunction.

Strength exercises

1. I.p. - lying on your back: raising straight legs.
2. I.p. - the same: "bicycle".
3. I.p. - the same: movements with straight legs in the vertical and horizontal plane ("scissors").
4. I.p: - sitting or standing. Hands with dumbbells lowered: bending the arms at the elbow joints.
5. I.p. - standing, hands on the belt: squatting with straightening the arms forward.
6. I.p. - lying on the stomach, hands in support in front of the chest: push-ups.
7. I.p. - standing facing the partner or the wall, one leg in front, palms resting in the partner's palms: alternately bending and unbending the arms with resistance.
8. I.p. - standing facing the partner, hands on the shoulders of the partner: torso to the side with resistance with the hands.
9. I.p. - standing, arms with dumbbells lowered, torso forward with arms extended to the sides.

The number of repetitions of each exercise is determined by the patient's condition.

Speed-strength exercises

1. I.p. - standing, arms to the sides: energetic rotations in the shoulder joints with a small amplitude at a fast pace.
2. I.p. - standing, feet shoulder-width apart, torso slightly tilted forward, arms bent at the elbow joints, elbows pressed to the body: movements that imitate the work of the hands when running, at a fast pace.
3. I.p. standing, hands on the belt: jumps on one or two legs.
4. I.p. - standing, legs apart, arms lowered, taken to the "castle": "lumberjack", at a fast pace (contraindicated in osteochondrosis of the spine).

5. I.p. - standing, arms bent at the elbows: movements imitating boxing, at a fast pace.
6. I.p. - the same: running in place or in motion.

Relaxation exercises

1. I.p. - lying on your back: raise your arms up and passively lower them.
2. I.p. - sitting, the torso is somewhat tilted forward: free swinging with relaxed arms lowered down.
3. I.p. - standing: the same.
4. I.p. - the same: raise your hands up and relax them to your shoulders, waist, down.

An approximate combination of massage points for vagotonia:

1st session: bai-hui (U20), he-gu (014) symmetrically, zu-san-li (EZ) on the left; gao-huang (U43) symmetrically - 10 minutes per point, toning method.
2nd session: Wai Kuan (TK5) and Xin Shu (U15) on the right, Ling Qi on the left.
3rd session: lao-gong (SS8) and shian-wai-shu (S14) symmetrically.
4th session: nei guan (TK61) and qing li. In the evening, the patient performs self-massage he-gu (Ol4) and san-yin-jiao (NRb) symmetrically for 5 minutes.

Approximate combination of massage points for sympathicotonia

1st session: bai-hui (U020), he-gu (014) on the left, feng-chi (P20), shu-san-li (E3b) on the right - by calming down.
2nd session: shen-men (C7).
3rd session: strong irritation for 10 minutes of the shen-men point (C7) - symmetrically, moderate irritation bai-hu-hei (U020) for 1 minute, he-gu (014) symmetrically or yin-tang (VM) , shu-san-li (E3b) on the left.
4th session: massage of San-Yin-Jiao (KRb), Dv-Ling (KP7), Shen-men (C7) points.

In a crisis course of vegetative-vascular dysfunction in the interictal period, it is appropriate to carry out the therapeutic and gymnastic measures described above, depending on the sympathetic or parasympathetic predominance. In the future, therapeutic measures should be aimed at preventing vegetative paroxysms.

The main task of this period is the normalization of nervous regulation, due to the improvement of motor-visceral reflexes. The general mode of LH includes exercises for large muscle groups, the latter contribute to the activation of tissue oxidases, improve the utilization of oxygen by tissues. Breathing exercises of both static and dynamic nature should be special for the fulfillment of the assigned tasks. Exercises of an emotional nature with the use of auxiliary objects, outdoor games are widely used.

These patients are shown sanatorium treatment with the appointment of approximately the following complexes of therapeutic exercises:

For patients with sympathetic-adrenal paroxysms

gentle mode
1. I.p. - sitting, hands on knees: hands up - inhale, lower - exhale. Repeat 4-6 times. Breathing is rhythmic.
2. I.p. - sitting, legs extended: rotation of the feet and hands in both directions Repeat 15-20 times. Breathing is arbitrary.
3. I.p. - sitting: hands up - inhale, pull the knee to the stomach - exhale. Repeat 4-6 times. Breathing with an emphasis on exhalation.
4. I.p. - sitting, arms freely lowered, brushes reach the shoulders. Circular movements of the elbows in both directions. Repeat 4-6 times. Breathing is arbitrary.
5. I.p. - sitting, hands in front of the chest: turning the body with spreading the arms to the sides - inhale, return to SP. - exhale. Repeat 3-4 times.
6. I.p. - standing or lying down: alternate bending of the legs - exhale, return to I.p. - breath. Repeat 3-4 times.
7. I.p. - sitting, arms to the sides - inhale, cross your arms in front of your chest, bend over - exhale. Repeat 4-6 times.
8. I.p. - sitting or standing: spreading the arms to the sides and fixing them with tension, return to the SP, relax the muscles as much as possible. Repeat 4-6 times. Breathing with an emphasis on exhalation.
9. Walking with a gradual slowdown for 1.5-2 minutes.
10. Repeat exercise 1.

Gentle training mode

1. I.p. - standing, legs apart, arms lowered: raise your arms through the sides up - inhale, lower - exhale. Repeat 4-6 times. Inhale-exhale ratio 1:2, 1:3.
2. I.p. - standing, arms to shoulders: circular rotation of the elbows in both directions. Repeat 6-8 times. Breathing is arbitrary.
3. I.p. - standing, hands in front of the chest: turning the body with spreading the arms to the sides - inhale, return to ip. - exhale. Repeat 6-8 times.
4. I.p. - standing, legs apart, arms lowered: squats on a full foot - exhale, return to ip. - breath. Repeat 6-8 times. Breathing with an emphasis on exhalation.
5. I.p. - standing, arms along the body: arms up - inhale, lower your hands - exhale. Repeat 3-4 times.
6. I.p. - standing, hands on the belt: bend the leg at the knee and hip joints, pull it to the stomach - inhale, return to ip. - exhale. Repeat 4-6 times.
7. I.p. - standing, in the hands of a dumbbell (1.5 kg): hands forward, fixing them with subsequent relaxation. Perform within 30 s. Do not hold your breath while exhaling.
8. I.p. - standing: calm walking for 2 minutes. Breathing is even.
9. I.p. - standing, hands lean against the wall at chest level: press the wall as much as possible, then relax the muscles of the arms and torso. Perform within 5 s. Don't hold your breath.
10. I.p. standing: repeat exercise 1.
11. I.p. - standing, in the hands of a stuffed ball. throw the ball up, turn 90 "and catch it. Perform for 1.5 minutes.

E.A. Mikusev, V.F. Bakhtiozin

Exercise therapy for diseases, injuries and injuries of the musculoskeletal system and nervous system

Lecture 3
exercise therapy for diseases
injuries and injuries
musculoskeletal
apparatus and nervous system
1. Exercise therapy for diseases of the musculoskeletal system
2. Exercise therapy for musculoskeletal injuries
3. Exercise therapy for diseases and injuries of the spine
4. Exercise therapy for diseases and injuries of the nervous system

Question 1. Exercise therapy for diseases of the musculoskeletal system

Tasks of exercise therapy:

normalization of the tone of the central nervous system;
activation of metabolism.
activation of blood and lymph circulation in the joint;
restoring or improving joint mobility
prevention of further dysfunctions and
muscle atrophy;
restoration of adaptation to domestic and labor
processes.

Arthritis

are diseases that are
is the inflammatory process,
located in the synovium
joint sheath, articular cartilage and
periarticular tissues

Tasks of exercise therapy:

General +
increase in range of motion up to
normal;
strengthening muscles in the affected area -
especially extensors;

Exercise therapy technique

1) Therapeutic massage, physiotherapy procedures (UVI,
ozokerite, paraffin and mud applications)
2) Therapeutic gymnastics:
I.p .: for the upper limbs - lying and sitting, for the lower - lying
passive movements for affected joints (starting with
gentle swings with a small amplitude)
relaxation of muscles in the area of ​​​​the diseased joint (relaxation
tense flexor muscles of the diseased limb contributes to
performing active movements with a healthy limb)
exercises in water (in the pool, bath) at a temperature of 28-29 ° C:
active movement,
with shells (ladder for developing movements in the joints
brushes, clubs, dumbbells weighing 0.5 kg), on the gymnastic wall;
simulators.
The pace of the exercises is slow or medium;
Number of repetitions - 12-14 times (14-16 times)
Duration of the lesson - 35-40 minutes (40-45 minutes)

Arthrosis

are diseases that are based on
metabolic-dystrophic process,
characterized by cartilage atrophy,
loss of bone tissue (osteoporosis),
neoplasm of bone tissue
calcium salts in periarticular tissues, ligaments,
joint capsule.

Tasks of exercise therapy:

General +
pain reduction;
relaxation of the abdominal muscles and
elimination of contracture;
an increase in the joint space;
reduction of the phenomena of aseptic synovitis
(inflammation of the synovial membrane);
strengthening of the periarticular muscles and increase
their endurance;

Exercise therapy technique

1) Exercises that strengthen the muscles of the back and abdomen.
2) Special exercises
i.p. - lying on your back:
active dynamic exercises for large muscle groups
healthy limb;
FU for the ankle joint and light movements in the hip
joint (with coxoarthrosis) of a sore leg in light conditions;
short-term (2-3 s) isometric tension of the gluteal
muscles.
I.p. - standing on a healthy leg (on a dais):
free swaying of a relaxed leg in various
directions.
isometric tension and subsequent relaxation
Dynamic exercises without weights and with weights (on
simulators or with weights) - the weight that the patient can
raise 25-30 times to fatigue; performed from 1 to 3-4 series
exercises with a rest interval of 30-60 s.
The pace of all exercises is slow;
The range of motion is painful.

10. Question 2. Exercise therapy for injuries of the musculoskeletal system

11. Injury

is a sudden impact on
human body external factors
environment (mechanical, physical,
chemical, etc.), leading to
violation of the anatomical
tissue integrity and functional
violations in them.

12. Traumatic illness

is a combination of general and local
pathological changes in the body
damage to the organs of support and movement

13. Harbingers of the development of a traumatic disease:

Syncope (syncope) - sudden loss of
consciousness due to insufficient
circulation in the brain.
Collapse is a form of acute vascular
insufficiency (decreased vascular tone or
circulating blood mass weakening of the heart
reduced venous blood flow
to the heart, lowering blood pressure, hypoxia of the brain)
Traumatic shock - severe
pathological process in
body as a response to severe
trauma.

14. Tasks of exercise therapy:

General tasks of exercise therapy:
normalization of the psycho-emotional state
sick;
accelerate the elimination of drugs from the body
funds;
improvement of metabolism, activity of the cardiovascular and respiratory systems, excretory organs;
prevention of complications (congestive pneumonia,
flatulence, etc.).
Special tasks of exercise therapy:
acceleration of resorption of hemorrhage and edema;
acceleration of the formation of callus (for fractures);
improvement of the process of regeneration of damaged tissues;
prevention of muscle atrophy
contract and stiffness in the joints;
prevention of adhesive process;
the formation of a soft, elastic scar.

15. Exercise therapy technique

ORU (for non-injured parts of the body);
breathing exercises: for bedridden patients -
in the ratio 1:1; for walkers - 1:2(3);
active physical exercises for the joints,
free from immobilization;
exercises for abdominal muscles in isometric
muscle mode of those parts of the body where they can
bedsores to form;
position treatment;
ideomotor exercises;
isometric muscle tension
immobilization.

16. Forms of exercise therapy:

1st period: UGG (5-7 min); LH (15-25 min);
self-study; walking down the corridor
(for example, on crutches).
2nd period: UGG, LG; self-study;
hiking; dosed walking, running,
swimming, etc.
3rd period: all available shapes exercise therapy
final restoration of lost
functions of the damaged segment and organism in
in general. He's in a rehab center
or in a sanatorium, or in a local clinic
residence (partially at home).

17. Exercise therapy technique

I.P. - various;
physiological load curve - two- or three-peak
multi-vertex
25% control, 75% outdoor switchgear and control room 25% control switchgear and remote control control and 75% control switchgear
Means of exercise therapy: - outdoor switchgear;
- breathing exercises in the ratio 1:2(3);
- passive and then active exercises for
joints of the affected part of the body (it is better to perform them
in warm water)
- treatment position;
- mechanotherapy;
- occupational therapy;
- choreotherapy;
- massotherapy.
Later:
- sports-applied exercises;
- training on simulators;
- natural natural factors.
Exercise pace:
slow and medium - for medium and large muscle groups;
fast - for small muscle groups.
The range of motion is medium (not causing pain).

18. Fractures

is an anatomical disorder
bone integrity caused
mechanical action and
accompanied by damage
surrounding tissues and damage
functions damage to a segment of the body.

19. Tasks of exercise therapy:

1st period:
improvement of blood and lymph circulation at the fracture site;
prevention of contractures, as well as muscle atrophy.
2nd period:
restoration of range of motion in the joint;
increased strength of the muscles of the shoulder girdle and shoulder (or
lower limbs);
elimination of puffiness (if any).
3rd period:
final restoration of muscle function and strength
shoulder girdle and upper or lower limb.
learning to walk with crutches and without support (with
lower limb fractures)

20. Fractures of the bones of the upper limbs

21. Method of exercise therapy for fracture of the clavicle

First period
1.
Classes in a fixing bandage (first week)
active finger movements
flexion and extension in the wrist and elbow joints (rotation
contraindicated due to possible displacement of fragments).
2.
FU without a scarf in the position of inclination towards the damaged collarbone:
pendulum movements in the shoulder joint with a small amplitude;
abduction (up to 80°) and adduction of the shoulder (after 2 weeks), above the horizontal -
in 3 weeks;
adduction and expansion of the shoulder blades.
Second period
special exercises - active movements in the shoulder joint above
horizontal;
swing exercises; exercises with objects;
mechanotherapy on block devices;
therapeutic massage of the muscles of the shoulder girdle; swimming.
Third period
load on weakened muscles from the affected collarbone;
exercises with objects, with a rubber bandage and an expander, with small
weights, on shells and simulators; swimming, skiing,
volleyball, basketball and other sports.
To training sessions with a fracture of the clavicle is allowed
start 6-8 weeks after the injury.

22. Fractures of the scapula

ORU and DU, exercises for fingers, wrist joint,
isometric muscle tension of the shoulder (depending on
fixing method).
FU on the scarf: for the elbow (flexion and extension, pronation and
supination, circular movements) and shoulder (raising the arm
forward-up to an angle of 90 ° and abduction to an angle of 90 °) of the joints.
Hand swings (10-14 days after injury)
With a fracture of the neck of the scapula
1st period (on the outlet bus):
exercises for fingers, wrist and elbow joints;
for the shoulder joint (15-20 days after injury).
2nd period (without tire) - in a month
movements in the shoulder joint (friendly with a healthy
hand),
exercises with objects and on block simulators (during
3-4 weeks.
The exercise therapy technique in the 3rd period is the same as for a clavicle fracture.
Restoration of movements and ability to work occurs after 2-2.5
month; sports capacity for work - 3 months after the fracture.

23. Fractures of the lower extremities

24. Methods of treatment:

conservative method - traction
(if the fracture is displaced) behind the calcaneus
bone, imposing in 2-3 weeks deaf
plaster cast - from the toes to
upper third of the thigh;
operational method - overlay
Ilizarov apparatus or
metal osteosynthesis with a nail or
metal plate;
immobilization.

25. Fractures of the diaphysis of the femur

Immobilization period - skeletal
traction (1.5-2 months)
Exercise therapy is prescribed on the 2nd day after the injury
ORU for an intact limb;
SA for injured limb: flexion and
extension of the fingers and feet; elevation of the pelvis
resting on the arms and foot of a healthy leg; maximum
relaxation of the thigh muscles.
A month after the injury, exercises are added to
tension of the thigh muscles (movement of the patella).
The duration of the lesson is 25-30 minutes (4-6 times per
day).

26.

Post-immobilization period
- after removal of skeletal traction
various I.P. (lying on back, sitting, standing
gymnastic wall, walking).
water exercises: squats; flywheels
movements, standing on a healthy leg; bending in
hip and knee joints.
Training period
(after 2-3 months until full recovery of movements during
all joints and normal gait (4.5-6 months))
running, jumping, jumping, stepping
jumping over obstacles
coordination and balance exercises
outdoor games,
swimming in the pool.
The duration of the lesson is 40-50 minutes (3-4 times a day).

27. Fractures of the bones of the lower leg

28. Exercise therapy technique - the same as for a hip fracture

Immobilization period (average 3-4 months)
remote control and outdoor switchgear
SU: active movements of the toes;
flexion and extension at the knee and hip
joints;
isometric tension of the muscles of the thigh and lower leg;
ideomotor exercises for the ankle
joint
3-5 days after the injury, the patient is allowed
move within the ward, and then the department
with the help of crutches.

29. Post-immobilization (functional) period

Tasks of exercise therapy:
restoration of movements in the ankle joint;
elimination of swelling of the injured leg;
prevention of traumatic flat feet, deformity
feet, growths of "spurs" (most often heel),
curvature of the fingers. For this purpose, immediately after the removal
plaster in shoes put a special arch support.
Exercise therapy technique
ORU for all muscle groups,
SU:
active finger movements (capturing small
items and their retention); foot movements, back and
plantar flexion of the foot, supination and pronation,
rolling the foot of a tennis ball;
different walking options: on toes, on heels, on
external or internal arches, forward with the back, sideways,
cross step, in a semi-squat, etc .;
exercises with the support of the foot on the crossbar; exercises for
exercise bike.
An ankle fracture can cause swelling anywhere in the foot.
To eliminate it, it is recommended to lie down for 10-15 minutes (3-4 times a day),
raising legs at an angle of 120-130 ° in

30. Damage to the knee joint

31. Damage to cruciate ligaments

With a partial rupture of the cruciate
ligaments, a plaster cast is applied (up to
middle third of the thigh) for 3-5 weeks.
With a complete rupture,
surgical replacement of ligaments with lavsan tape
or autoplasty.

32. Exercise therapy technique

1st period of LH classes (1-2 days after the operation).
In addition to exercises for healthy parts of the body,
exercises for the operated limb: movements of the toes, in
ankle and hip joints, isometric
muscle tension of the thigh and lower leg (from 4-6 to 16-20 times), which
patients should perform independently every hour.
2nd period (3-4 weeks after surgery)
exercises in i.p. lying on your back, later - lying on your side, on
stomach and sitting, so as not to cause stretching of the restored ligament.
To increase the range of motion in the knee joint,
position treatment or a small pull on the block is used
simulator: the patient lies on his stomach and with the help of a block
apparatus flexes the lower leg - training to increase strength and
endurance of the muscles of the injured limb.
to restore range of motion in the knee joint
use training on a bicycle ergometer and walking on a flat floor,
stepping over objects (medicine balls, fences) and walking
On the stairs.
In the 3rd period (3-4 months after the operation)
the task of exercise therapy is the complete restoration of the function of the knee joint and
neuromuscular apparatus.

33. Question 3. Exercise therapy for diseases and injuries of the spine

34.

35.

36. Fractures of the spine

37. Depending on the localization, there are:

body compression fractures
vertebrae
spinous and transverse fractures
processes;
vertebral arch fractures.

38. Treatment:

prolonged traction;
one-time or gradual
correction of deformity of the spinal column, with
subsequent imposition of a plaster corset;
combined method (traction and
plaster immobilization);
operational method (various ways
fixation of segments of the spinal column in the zone
damage).
Application of physical factors
(exercise therapy, massage and physiotherapy)
is mandatory

39. Tasks of exercise therapy

(immobilization period)
stimulation of regenerative processes in the damaged
segment;
improvement of psycho-emotional state and activity
the main systems of the body;
prevention of congestion, atrophy of the muscles of the body
limbs, neck.
preparation of the victim for vertical loads;
prevention of atrophy of the muscles of the trunk, neck and
limbs;
restoration of everyday skills and walking skills;
improvement of blood circulation in the fracture area - for
stimulation of regeneration.

40. Tasks of exercise therapy

restoration of mobility in
damaged spine;
strengthening the muscles of the back, neck and shoulder
belts;
elimination of coordination disorders;
adaptation to household and professional
loads

41. Example: Exercise therapy technique for fracture of the cervical vertebral bodies

42. Exercise therapy technique

(immobilization period)
In the first half
movements in the shoulder joints, head movements are prohibited
ORU for small and medium muscle groups
upper and lower limbs (without taking them off the plane of the bed),
static breathing exercises,
movements of the lower jaw (opening the mouth, movements to the right, to the left,
forward).
Exercises are performed at a slow pace (4-8 times)
In the second half
forward movement of the body is contraindicated
i.p. lying, sitting, standing;
exercises for balance and coordination of movements;
walking and walking exercises;
exercises to maintain correct posture.
Isometric exercises are used to strengthen the muscles of the neck.
muscle tension (from 2-3 to 5-7 s).
The number of repetitions - 3-4 times a day;
duration of the lesson - 15-20 minutes

43. Exercise therapy technique

(post-immobilization period)
and. n. lying down, then turn on and. n. sitting and standing
isometric tension of the neck muscles, including with
resistance
FU in keeping the head in an elevated position - in I.p. lying down
on the back, on the stomach and on the side
FU for the limbs (especially the upper ones) - hand movements
above the horizontal level, raising the shoulder girdle,
abduction of arms to the sides by 90 ° using various
weights
training on simulators
tilts and turns of the torso and head and circular movements
head
exercises for balance, coordination of movements,
formation of correct posture.

44. Question 4. Exercise therapy for diseases and injuries of the nervous system

45. MAIN CLINICAL MANIFESTATIONS

Motor
disorders
1. paralysis or
paresis
central
(spastic)
peripheral
(sluggish)
2. convulsions
3. athetosis
4. jitter
Disorders
sensitivity
anesthesia
hypoesthesia
hyperesthesia
neuralgia
ataxia
apraxia

46. ​​Paralysis (plegia) - wasting the possibility of voluntary muscle contraction

Paresis - partial loss of voluntary movements
called
central (spastic) - damage
central motor neuron
providing conscious control
muscle contraction.
2. peripheral (sluggish) - damage
peripheral motor neuron
caused by injury or disease of the spinal cord
brain, manifests itself at the level of innervation from
this segment
1.

47. Cramp (spasm) - involuntary contraction of a muscle or group of muscles, usually accompanied by sharp and aching pain.

Cramp (spasm) - involuntary
contraction of a muscle or group of muscles, usually
accompanied by sharp and aching pain.
clonic - rapidly alternating
muscle contraction and relaxation
tonic - long contractions
muscles

48. Athetosis is slow worm-like movements of the fingers, hand, torso.

Trembling is involuntary
rhythmic vibrations of the limbs
or heads.

49. Anesthesia - a decrease in the sensitivity of the body or part of it up to the complete cessation of perception of information about the environment

environment and
own state.
Hypothesia - partial decrease in sensitivity,
decrease in susceptibility to external stimuli,
weakening of perception by strength (these conditions are more often
observed in neurosis).
Hyperesthesia - a sharp increase
sensitivity to weak stimuli,
affecting the sense organs.

50. Neuralgia - pain that develops when sensory nerves of a traumatic or inflammatory nature are damaged in the area

innervation or
location of the nerve.

51. Ataxia - disorders of proprioceptive (muscle-articular) sensitivity leading to impaired coordination

relationships, accuracy of movements.

52. Apraxia ("inactivity, inaction") - a violation of purposeful movements and actions while preserving its components

elementary movements; occurs when
focal lesions of the cortex of large
cerebral hemispheres or conductive
tracts of the corpus callosum.
It is the loss of the ability to produce
planned and purposeful actions
while maintaining mobility
for their implementation, which previously
were performed automatically.

53. Aphasia is a systemic disorder (disorder) of already formed speech.

motor - impaired ability
turn concepts into words
sensory - impaired speech perception,
amnestic - loss of memory,
alexia - loss of the ability to read,
agraphia - loss of the ability to write
agnosia - impaired perception and
recognition of objects and persons.

54. 4.1 Exercise therapy FOR DISEASES OF THE PERIPHERAL NERVOUS SYSTEM

55. Neuritis is a disease of peripheral nerves that occurs as a result of:

traumatic injury,
infectious,
inflammatory diseases (diphtheria,
influenza, etc.)
avitaminosis (lack of vitamins
group B)
intoxication (alcohol, lead)
metabolic disorders (diabetes).

56. Tasks:

stimulation of regeneration processes and
disinhibition of parts of the nerve located in
a state of oppression;
improvement of blood supply and trophic processes
in the lesion to prevent the formation
adhesions and cicatricial changes;
strengthening paretic muscles and ligamentous apparatus;
prevention of contractures and stiffness in the joint;
rehabilitation through
normalization of motor functions and development
compensatory devices.

57. Treatment:

position treatment
massage
physiotherapy (electrophoresis)
muscle electrical stimulation
physiotherapy
mechanotherapy - execution
exercise with special
simulators and devices.

58. Exercise therapy technique

Position treatment
It is carried out dosed throughout the entire period
- with the exception of FU classes (from 2-3 minutes to 1.5 hours)
splints are used to support the limb,
special "laying", corrective positions
using orthopedic and prosthetic products
(devices, braces, special footwear).
Physiotherapy
passive and ideomotor exercises
combination of passive and active exercises
movements in the same joints of a symmetrical limb
FU in warm water on simulators
Watch for voluntary movements
selecting the optimal starting positions, and
strive to support the development of active movements

59. Neuritis of the facial nerve - acute development of paralysis or paresis of facial muscles

Neuritis of the facial nerve acute development of paralysis
or mimic paresis
muscles

60.

61. Clinic:

the affected side becomes flabby, lethargic;
blinking of the eyelids is disturbed, not completely
the eye closes;
the nasolabial fold is smoothed;
the face is asymmetrical, constricted into a healthy
side;
speech is slurred;
the patient cannot wrinkle his forehead, frown
brows;
there is a loss of taste, leprosy.

62. Tasks:

improvement of blood circulation in the face
(especially on the side of the lesion), neck and
the entire collar zone;
restoration of the function of mimic muscles,
impaired speech;
prevention of contractures and
friendly movements;
maximum possible recovery
facial symmetry

63. Exercise therapy technique

Position treatment
Adhesive tension
Physiotherapy

64. Treatment by position

During sleep:
i.p. - lying on the side (on the affected side);
Daytime:
total duration from 30-60 minutes (2-3 times per
day) up to 4-6 hours a day
sit for 10-15 minutes (3-4 times a day),
bowing his head in the direction of defeat, supporting
her back of the hand (with support on the elbow);
pull muscles from healthy side to side
lesions (from bottom to top) with a handkerchief,
while trying to restore the symmetry of the face.

65. Adhesive tension:

carried out within 8-10 hours.
carried out with healthy
side to the patient
anti-draught
healthy side muscles
strong fixation of free
the end of the patch to
special helmet-mask
(individually)

66. Therapeutic gymnastics

class duration - 10-12 minutes (2 times a day)
day)
FU are performed in front of a mirror, with the participation
exercise therapy instructor
isolated tension of mimic muscles
muscles of the healthy side and muscles surrounding
mouth gap.
self-study 2-3 times a day
Special exercises:
for training mimic muscles (raise eyebrows
up, frown, puff out cheeks, whistle, etc.)
to improve articulation (pronounce sounds,
sound combinations, words containing these
sound combinations, by syllables)
SU alternate with restorative and respiratory

67. Neuritis of the ulnar nerve

Causes:
nerve compression in the ulna
joint that occurs in humans, work
which is connected with the support of the elbows (about
machine, table, workbench)
when sitting for a long time, putting your hands on
chair armrests.

68. Clinic

the brush hangs down;
no supination of the forearm;
impaired function of the interosseous muscles of the hand,
due to which the fingers are claw-like bent
("clawed brush");
the patient cannot pick up and hold objects.
atrophy of the interosseous muscles of the fingers and muscles
palms on the side of the little finger;
hyperextension of the main phalanges of the fingers,
flexion of the middle and nail phalanges;
it is impossible to spread and adduct the fingers.

69. Treatment by position:

a splint is applied to the hand and forearm
the brush is given the position of the possible
extension in the wrist joint,
the fingers are given a bent position;
forearm and hand are hung on a scarf
in the position of flexion in the elbow joint (under
angle 80°)

70. Exercise therapy technique (on the 2nd day after bandaging).

passive gymnastics,
gymnastics in water;
massage
muscle electrical stimulation
When active movements appear:
active gymnastics
elements of occupational therapy (plasticine modeling,
clay),
learning to grasp small objects
matches, nails, peas, etc.).

71. 4.2 Exercise therapy for diseases of the central nervous system

72. The signal system is a system of conditioned and unconditional reflex connections of the higher nervous system of animals (humans) and

Signal system
- this is a system of conditioned and unconditional reflex connections of the higher nervous system
animals (humans) and the environment.
The first is the sensation
perceptions, representations (signals
occur under the influence of the sense organs)
The second is the emergence and development of speech
(signals are converted to characters in direct
sense of the word).

73.

Second signal system
First signal system

74. Neurosis

is long and pronounced
deviation of the higher nervous
activities from the norm due to
overstrain of nervous processes and
changes in their mobility.

75. Reasons:

processes of excitation and inhibition;
relationships between the cortex and subcortex;
normal relationship 1st and 2nd
signal systems.
psychogenic disorders (experiences,
various negative emotions, affects,
anxiety, phobias (fears)
constitutional predisposition.

76. Clinic:

neurotic reactions usually occur
on relatively weak, but long-term
active stimuli that cause
to permanent emotional
voltage.
overexertion of major nerves
processes - excitation and inhibition,
excessive requirement for mobility
nervous processes.

77. Forms of neuroses:

1) neurasthenia
2) psychasthenia
3) hysteria

78.

Neurasthenia (asthenic neurosis)
- characterized by weakening
processes of internal inhibition,
increased mental and physical
fatigue, distraction,
decrease in performance.

79. Tasks of exercise therapy for neurasthenia:

active process training
braking;
normalization (strengthening)
excitatory process.

80. Exercise therapy technique for neurasthenia

in the morning hours
duration from 10 minutes to 15-20 minutes
to music: soothing, moderate and
slow tempo, combining major and
minor sound
minimum load increases
gradually.
simple complex coordination exercises
sports games with simplified rules
(volleyball, table tennis, croquet, golf,
small towns) or elements of various games
walks, hiking, fishing

81. Psychasthenia (compulsive disorder)

is the predominance of the 2nd signaling system with
congestive excitation in the cerebral cortex
brain.
Neurosis characterized by obsessive
conditions: self-doubt,
constant doubts, anxiety,
suspiciousness.

82. Tasks of exercise therapy for psychasthenia:

process activation
life;
"loosening" of the pathological
inertia of cortical processes;
bringing the patient out of the oppressed
moral and mental state,
facilitating communication with others.

83. Exercise therapy technique for psychasthenia

well-known exercises of an emotional nature,
performed at a fast pace without emphasis on accuracy
their implementation;
correcting errors by showing the correct
performance by any of the patients;
psychotherapeutic training, clarification of the importance
doing exercises to overcome feelings
unreasonable fear;
game method of conducting classes,
performing exercises in pairs;
the methodologist's voice and musical accompaniment should be
cheerful.
This category of patients is characterized by a slow pace: at first, from
60 to 120 movements per minute, then from 70 to 130 and on
subsequent classes - from 80 to 140. In the final part
classes, it is necessary to slightly reduce the load and its
emotional coloring.

84. Hysteria (hysterical neurosis)

is the predominance of the function of the subcortex and
influence of the 1st signaling system.
Impaired cortical coordination and
subcortex promotes increased
excitability, mood swings,
mental instability, etc.

85. Tasks of exercise therapy for hysterical neuroses:

decrease in emotional excitability;
development in the cerebral cortex
inhibitory process;
creation of sustainable calm
moods.

86. Method of exercise therapy for hysteria

the pace of movements is slow;
exercises for attention, accuracy of execution,
coordination and balance;
simultaneous execution of various movements
left and right hand or foot;
balance exercises, jumping, throwing,
whole combinations of gymnastic exercises.
games (relay races, towns, volleyball);
Methodist voice and musical accompaniment
should be calm (commands are slow,
smooth);
predominantly a method of explaining, not showing
exercises.

87. Questions for independent work:

1. Exercise therapy for brain disorders
blood circulation
2. Exercise therapy for injuries
peripheral nerves
3. Exercise therapy for myopathy.
4. Exercise therapy for cerebral palsy

Any movement occurs when impulses are transmitted from the cerebral cortex to the anterior horns of the spinal cord. At the same time, it has been proven that normal brain function requires a constant influx of impulses from the periphery: skin, muscles and joints. In diseases and injuries of the central nervous system, the conduction of nerve impulses is difficult, due to a violation of the innervation of the muscles, there are paresis(weakening of voluntary movements) and paralysis(lack of voluntary movements).

When the cells of the anterior horns of the spinal cord and their fibers are damaged, a sluggish(peripheral) paralysis or paresis accompanied by paresis or paralysis, muscle hypotension or atony, and hyporeflexia, or total absence tendon, periosteal and skin reflexes. Sensitivity is often reduced and trophism is disturbed, which can lead to muscle atrophy.

With injuries and diseases of the brain or spinal cord, the inhibitory effect of the cerebral cortex on spinal motor neurons is reduced, and their functions are activated. As a result, there is a central spastic paralysis: increased muscle tone, hyperreflexia, the appearance of pathological reflexes, and on the arm the tone is increased mainly of the flexors and pronators, and on the leg - mainly of the extensors. The patient takes the Wernicke-Mann position: the shoulder is brought to the body, the hand and forearm are bent, the hand is turned palm down, the leg is extended at the knee and hip joints, the foot is bent.

Common for all injuries and diseases of the nervous system are limitation of the range of motion, decreased muscle tone, vegetotrophic disorders, etc.

Physical exercise:

• cause an influx of impulses into the cerebral cortex, which regulates all body functions;
• by activating the motor neurons of the spinal cord, they increase the biopotential of the muscles and restore their functions.

Special exercises conditionally divided into the following groups:

• exercises that increase joint range of motion and muscle strength;
• exercises aimed at restoring and improving coordination of movements;
• antispastic exercises;
• ideomotor exercises (sending a mental impulse to a trained muscle group);
• a group of exercises aimed at restoring or forming motor skills (standing, walking, manipulations with simple household objects - clothes, dishes, etc.);
• passive exercises and exercises for stretching connective tissue formations, treatment with position, etc.

The contusion of the brain in its severity, symptoms and clinical manifestations gives a picture of severe concussion with deep damage. The most common complications of brain contusion include paresis and paralysis of the limbs, disorders of hearing, vision, smell, taste, speech and intellect (traumatic dementia).

Breathing exercises and exercises for small and medium muscle groups are prescribed after the cessation of nausea and vomiting, active therapeutic exercises - a few days before the victim is allowed to sit down. With paresis and paralysis, passive therapeutic exercises are prescribed, despite the serious condition of the patient, even in the intensive care unit or intensive care unit.

Contraindications to the use of exercise therapy in neurology:

• exacerbation of ischemic brain disease;
• repeated stroke;
• vascular thrombosis;
• hypertensive crisis;
• pronounced pain syndrome;
• acute encephalitis, myelitis;
• neuritis;
• repeated trauma to the brain and spinal cord;
• exacerbation of concomitant chronic diseases of internal organs;
• acute intercurrent diseases.

This is an introductory and informational article about the role it plays, the principles, methods and means of exercise therapy. Let's talk about the factors that are important for the implementation of the rehabilitation of neurological patients: what complicates and what facilitates the process of restoring the nervous system.

Therapeutic exercise for diseases of the nervous system plays an essential role in the rehabilitation of neurological patients. Treatment of the nervous system impossible without medical gymnastics. has the main goal of restoring self-care skills and, if possible, full rehabilitation.

It is important not to miss the time to create the correct new motor stereotypes: the earlier treatment is started, the easier, better and faster the compensatory-adaptive recovery of the nervous system occurs.

In the nervous tissue, the number of processes of nerve cells and their branches on the periphery increases, other nerve cells are activated, and new nerve connections appear to restore lost functions. Timely adequate training is important for creating the right movement stereotypes. So, for example, in the absence of physiotherapy exercises, a "right-brained" stroke patient - a restless fidget "learns" to walk, pulling the paralyzed left leg to the right and dragging it behind him, instead of learning to walk correctly, with each step moving the leg forward and then transferring the center of gravity of the body to it. If this happens, then it will be very difficult to retrain.

Not all patients with diseases of the nervous system can do the exercises on their own. Therefore, they cannot do without the help of their relatives. To begin with, before starting therapeutic exercises with a patient who has paresis or paralysis, relatives should master some techniques for moving the patient: transplanting from bed to chair, pulling up in bed, walking training and so on. In fact, this is a safety technique to prevent excessive stress on the spine and joints of the caregiver. Lifting a person is very difficult, so all manipulations must be performed at the level of a magician in the form of a “circus trick”. Knowing some special techniques will greatly facilitate the process of caring for the sick and help maintain your own health.

Features of exercise therapy in diseases of the nervous system.

one). Early initiation of exercise therapy.

2). Adequacy of physical activity: physical activity is selected individually with a gradual increase and complication of tasks. A slight complication of the exercises psychologically makes the previous tasks “easy”: what previously seemed difficult, after new slightly more complex tasks, is performed more easily, with high quality, the lost movements gradually appear. It is impossible to allow overload in order to avoid deterioration of the patient's condition: motor disturbances may increase. In order for progress to occur faster, it is necessary to finish the lesson on the exercise that this patient has, to focus on this. I attach great importance to the psychological preparation of the patient for the next task. It looks something like this: "Tomorrow we will learn to get up (walk)." The patient thinks about it all the time, there is a general mobilization of forces and a readiness for new exercises.

3). Simple exercises are combined with complex ones for training higher nervous activity.

4). The motor mode gradually steadily expands: lying - sitting - standing.

5). All means and methods of exercise therapy are used: therapeutic exercises, positional treatment, massage, extension therapy (mechanical straightening or stretching along the longitudinal axis of those parts of the human body that have a disturbed anatomical location (contractures)).

The main method of physical therapy for diseases of the nervous system is therapeutic exercises, the main means of exercise therapy are exercises.

Apply

1. isometric exercises aimed at strengthening muscle strength;
2. exercises with alternating tension and relaxation of muscle groups;
3. exercises with acceleration and deceleration;
4. coordination exercises;
5. balance exercise;
6. reflex exercises;
7. ideomotor exercises (with the mental sending of impulses). It is these exercises that I use most often in combination with Su-jok therapy for diseases of the nervous system.

Damage to the nervous system occurs at different levels, the neurological clinic depends on this and, accordingly, the selection of therapeutic exercises and other physiotherapeutic therapeutic measures in the complex treatment of a particular neurological patient.

Hydrokinesitherapy - exercises in water - a very effective method of restoring motor functions.

Exercise therapy for diseases of the nervous system subdivided according to the parts of the human nervous system, depending on which part of the nervous system is affected:

exercise therapy for diseases of the central nervous system;
exercise therapy for diseases of the peripheral nervous system;
exercise therapy for diseases of the somatic nervous system;
Exercise therapy for diseases of the autonomic nervous system.

I suggest watching a video about the human nervous system in order to have an idea of ​​its structure and functions.

Some subtleties of work with neurological patients.

1. The state of mental activity of a neurological patient.
2. The patient's experience in physical education before illness.
3. The presence of excess weight.
4. Depth of damage to the nervous system.
5. Accompanying illnesses.

For physiotherapy exercises, the state of higher nervous activity of a neurological patient is of great importance: the ability to be aware of what is happening, to understand the task, to concentrate attention when performing exercises; volitional activity plays a role, the ability to resolutely tune in to daily painstaking work to achieve the goal of restoring the body's lost functions.

In the case of a stroke or brain injury, most often the patient partially loses the adequacy of perception and behavior. Figuratively, it can be compared with the state of a drunk person. There is a "disinhibition" of speech and behavior: the shortcomings of character, upbringing and inclination to what is "impossible" are exacerbated. Each patient has a behavioral disorder that manifests itself individually and depends on the

one). what activity the patient was engaged in before the stroke or before the brain injury: mental or physical labor (it is much easier to work with intellectuals if the body weight is normal);

2). how developed the intellect was before the disease (the more developed the intellect of a patient with a stroke, the more the ability to purposefully exercise exercise remains);

3). in which hemisphere of the brain did the stroke occur? "Right hemispheric" stroke patients behave actively, show emotions violently, do not hesitate to "express"; they do not want to follow the instructions of the instructor, they start walking ahead of time, as a result, they have a risk of forming incorrect motor stereotypes. “Left hemispheric” patients, on the contrary, behave inactively, do not show interest in what is happening, just lie down and do not want to engage in physiotherapy exercises. It is easier to work with "right hemisphere" patients, it is enough to find an approach to them; what is needed is patience, a delicate and respectful attitude, and the decisiveness of methodological instructions at the level of a military general. 🙂

During classes, instructions should be given decisively, confidently, calmly, in short phrases, it is possible to repeat instructions due to the patient's slow perception of any information.

In the event of a loss of behavioral adequacy in a neurological patient, I have always effectively used the “cunning”: you need to talk to such a patient as if he is a completely normal person, not paying attention to “insults” and other manifestations of “negativity” (unwillingness to engage in, denial of treatment other). It is not necessary to be verbose, it is necessary to make small pauses so that the patient has time to realize the information.

In case of damage to the peripheral nervous system, flaccid paralysis or paresis develops. If at the same time there is no encephalopathy, then the patient is capable of much: he can independently exercise a little during the day several times, which undoubtedly increases the chance of restoring movements in the limb. Flaccid paresis is more difficult to respond to than spastic paresis.

* Paralysis (plegia) - the complete absence of voluntary movements in the limb, paresis - incomplete paralysis, weakening or partial loss of movement in the limb.

It is necessary to take into account another important factor: whether the patient was engaged in physical education before the disease. If physical exercises were not included in his lifestyle, then rehabilitation in case of a disease of the nervous system becomes much more complicated. If this patient has exercised regularly, then the recovery of the nervous system will be easier and faster. Physical labor at work does not belong to physical education and does not bring benefits to the body, since it is the exploitation of one's own body as a tool for doing work; he does not add health due to the lack of dosing of physical activity and control of well-being. Physical labor is usually monotonous, so there is wear and tear of the body in accordance with the profession. (So, for example, a painter-plasterer “earns” humeroscapular periarthrosis, a loader - osteochondrosis of the spine, a massage therapist - osteochondrosis of the cervical spine, varicose veins of the lower extremities and flat feet, and so on).

For homework physical therapy for diseases of the nervous system it will take ingenuity to select and gradually increase the complexity of exercises, patience, regularity of daily exercises several times during the day. It will be much better if in the family the burden of caring for the sick is distributed to all family members. The house should be in order, cleanliness and fresh air.

It is desirable to put the bed so that it has access from the right and left sides. It should be wide enough to allow the patient to be rolled from side to side when changing bed linen and changing body position. If the bed is narrow, then each time you have to pull the patient to the center of the bed so that he does not fall. You will need additional pillows and rollers to create a physiological position of the limbs in the supine and supine position, a splint for a paralyzed arm to prevent contracture of the flexor muscles, a regular chair with a back, a large mirror so that the patient can see and control his movements (especially the mirror necessary in the treatment of neuritis of the facial nerve).

There should be room on the floor for lying down exercises. Sometimes you need to make handrails for support with your hands in the toilet, in the bathroom, in the corridor. To do therapeutic gymnastics with a neurological patient, you will need a wall bar, a gymnastic stick, elastic bandages, balls of different sizes, skittles, a roller foot massager, chairs of different heights, a step bench for fitness and much more.

Watch the neurological care training video to understand the principles of the technique and how to use it correctly so as not to harm your health. You need to watch carefully, it is better to train on a healthy person who will imitate a paralyzed patient.

"Patient transfer".

"Nursing: Turning to the side for a long time". If the bed is a little wider, then you will not have to pull the patient to the center of the bed each time, it will be enough just to roll him from side to side and put pillows for the physiological position of the limbs and to prevent joint sprains. It is advisable to change the position of the patient every 2 hours in order to avoid bedsores. From this video, remember well that you cannot leave it on the paralyzed side for a long time.

"Patient care: pulling up the patient". Pulling up the patient is one of the most difficult manipulations: you need to save your back and pull up the patient so that the patient's bed linen and shirt do not move; there should be no folds under the patient's body. Remember that you can not pull on the hand to avoid dislocation of the joints and stretching of the ligamentous apparatus.

Treatment of the nervous system It is never easy, you need to tune in to painstaking hard work and create conditions for facilitating patient care as much as possible. Exercise therapy for diseases of the nervous system relates in part to general nursing care. Each neurological disease has its own characteristics, which we will consider in other articles. Therapeutic exercise for diseases of the nervous system in combination with massage, DENS-therapy, Su-jok therapy and other methods of treatment with the obligatory fulfillment of the appointments of a neurologist will undoubtedly give a positive result. Sometimes it is possible to achieve maximum recovery of movements and even working capacity.

Of primary importance in the functional therapy of injuries and disorders of the peripheral nervous system is the course of the nerve fibers that make up the pyramidal motor pathway. It is from him that the impulse along the nerve fibers is directed to the motor cells of the anterior horns of the spinal cord, from where it is directed to the muscles through the fibers of the peripheral neuron, which form the motor roots. Therefore, any pathological influences on any of the sections of this path cause disorders of the musculoskeletal system, expressed in paralysis, paresis, and also manifested by a decrease in the strength of the corresponding muscles. Such influences include injuries, hemorrhages, intoxications, infections, compression of the nerve roots by bone growths, etc. A characteristic feature of movement disorders in lesions of a peripheral neuron is flaccid paralysis and paresis with a decrease or complete absence of tendon reflexes, often with impaired skin sensitivity. With traumatic neuritis, in addition to local lesions of the nerve trunk, there are also disorders in the nerve roots, in the elements of the spinal cord, and functional disorders in the somatic and autonomic centers of the brain.

With neuritis, the lesion is localized in the peripheral nerve trunks of usually mixed nerves, as a result of which the main symptoms in them are paralysis or paresis of the peripheral type, corresponding to the muscular innervation of this nerve. Paralysis is flaccid, most often accompanied by muscle atrophy with a decrease or disappearance of tendon reflexes, with a decrease in muscle tone. Along with a violation of muscle function, disorders of skin sensitivity can be observed, pain appears with pressure on the affected trunks and muscles when they are stretched.

Neuritis is of different origin. Traumatic neuritis is the most common. They occur with bruises in areas of the body through which the nerve trunks pass, with fractures of the bones, next to which motor nerve fibers are located.

With neuritis, it is most often necessary to use complex treatment, an integral part of which are exercise therapy and massage. The forms of application of exercises and their ratio in the medical complex are determined by the causes of the disease, its stage, the form and characteristics of the course, as well as the individual characteristics of the patient.

V tasks Exercise therapy for damage to a peripheral motor neuron includes:

• 1) restoration of the functions of the nerve elements of the damaged neuron;
• 2) normalization of the activity of the muscles innervated by the damaged neuron;
• 3) general strengthening effect.

Afferent stimuli that arise at the moment of performing a passive or active movement serve as factors that cut through the nerve pathways, support their function, and coordinate the combined functioning of all nervous elements that have come into disorder. In addition, these impulses stimulate the regeneration of nerve conductors disturbed by illness or injury. The fact is that due to the degeneration of the axon and the breakdown of myelin, the conductivity of the nerve pathways is impaired. The performance of physical exercises contributes to the enhancement of metabolic (and ionic) processes in the fiber, thereby increasing its conductivity. Such influences are especially effective in the first periods of illness or injury. In cases where a significant period of time has already passed, and connective scar tissue begins to form at the site of the lesion, and the regeneration of neuron elements becomes difficult, although physical exercises still contribute to the partial resorption of this tissue and an increase in its elasticity.

The use of exercise therapy for traumatic neuritis is divided into two periods. In the early stages of the wound process, it is used to stimulate wound healing, improve circulation in the innervated tissue areas, prevent complications, and develop a rough scar at the wound site. To the number preventive measures against complications affecting the functional state of the nerve and the muscles and other tissues innervated by it, one can attribute a light massage of the parts of the limb after its preliminary heating, which creates moderate hyperemia of the tissues surrounding the wound. This improves circulation in the injured limb, reduces swelling and maintains tissue nutrition, and reduces irritation of nerve conductors. Where the condition of the wound and pain disorders do not prevent movement, it is possible to start therapeutic exercises from the very first days after the injury or operation: passive, and where possible, active exercises, ideomotor efforts and sending impulses. When immobilizing the affected limb, physical exercises should be carried out for a healthy limb, based on their reflex effect on the processes of blood circulation and nervous excitability in the diseased limb.

To restore the functional capacity of the injured nerve, stimulate the growth of the nerve fiber, to bring the central nervous formations associated with the affected nerve to a normal functional state, it is of paramount importance to ensure that a sufficient number of afferent impulses flow along the affected nerve from the periphery of the organ.

In cases where paralysis phenomena prevail, and pain does not occur, or from the moment when they no longer interfere with movements, it is necessary to start active and passive gymnastics, paying attention to those exercises that correspond to the function of the affected muscle groups. The signs of fatigue or increased pain that occur in some cases after performing gymnastic exercises most often disappear under the influence of a subsequent, even a short thermal procedure.

In the treatment of reflex contractures, the issue of removing the peripheral focus of irritation is primarily addressed, which is usually carried out by surgical and conservative methods. The physical exercises used in this case actively contribute to a decrease in the excitability of the central reflex devices and a decrease in the tone of the muscles that are in a state of spasm. Depending on the timing of spasm development, movement treatment is combined with various orthopedic measures (fixing bandages, corrective operations, heat therapy, massage, etc.), the features of which should be taken into account in the construction of exercise therapy.

The effectiveness of exercise therapy for neuritis is determined not only by the correct selection and implementation of physical exercises, but also by the mode of their implementation. It must fully correspond to the relationship between the duration and intensity of exercises, it requires the achievement of fatigue during the performance of each complex and a gradual increase in load. Therefore, in the first period, with a complex duration of 10-15 minutes, it should be repeated at least 6-8 times during the day. In between exercise therapy complexes, massage (self-massage) of tissues in the area of ​​innervation of the damaged neuron is performed for 10-12 minutes.

The second period of functional therapy of traumatic neuritis corresponds to the stage after wound healing. It is characterized by the presence of late residual clinical phenomena, the development of scar tissue at the site of the wound, circulatory and trophic disorders here, paralysis, contractures, and pain symptoms. As a result of rationally constructed and long-term exercise therapy, all these phenomena are eliminated (or at least facilitated) due to the normalization of the nutrition of tissues innervated by the affected nerve, the restoration of blood circulation in them with the active removal of residual inflammatory products from the affected nerves themselves and surrounding tissues. A favorable circumstance in this case is that physical exercises help strengthen the paretic muscles, articular bags and ligamentous apparatus, maintain joint mobility and their functional readiness by the time the nervous apparatus is restored.

In the second period, the duration of the exercise therapy complex gradually increases to 30-40 minutes, and the repetition of its implementation - 2-3 during the day. The duration of massage (self-massage) can reach 20-30 minutes.

As an example of the use of exercise therapy for neuritis, consider the relatively common neuritis of the facial and sciatic nerves.

Neuritis of the facial nerve is manifested mainly by paralysis of the mimic muscles of the affected side of the face: the eye does not close or does not completely close, the blinking of the eyelids is disturbed, the mouth is drawn to the healthy side, the nasolabial fold is smoothed, there is no movement of the lips in the direction of the neuritis, the corner of the mouth is lowered, wrinkling of the forehead is impossible, the patient cannot raise his eyebrows. Depending on the severity of neuritis, it lasts from two weeks to many months and does not always end in complete recovery.

The cause of neuritis is various nerve lesions during its passage through the canal of the pyramidal part of the temporal bone, inflammatory processes in the middle ear, intoxication, infection, postoperative and surgical complications. The course of neuritis of the facial nerve is accompanied by such a complication as contracture of the facial muscles of the affected side, when the corner of the mouth is already drawn to the diseased side, the nasolabial fold becomes deeper, the palpebral fissure narrows, remaining half-closed, and the asymmetry of the face becomes more pronounced. Both contracture and friendly movements interfere with mimic movements, exacerbate the severity of paralysis.

The treatment complex for neuritis of the facial nerve is of a combined nature and includes drug therapy, exercise therapy with massage and physiotherapy.

Physiotherapy. At the onset of the disease, it is of particular importance to ensure adequate afferent impulses from the periphery, due to which the conduction of nerve fibers is maintained and the preservation of motor skills of the facial muscles is stimulated. To do this, it is recommended to use passive exercises and a special massage of the entire face and neck using light stroking, light rubbing and, finally, vibration along the nerve branches with your fingertips. The complex of physical exercises includes special exercises in wrinkling the forehead by raising the eyebrows, moving them (frown), blinking the eyelids, baring the teeth and folding the lips for a whistle, puffing out the sore cheek, etc.

The regimen of exercise therapy requires repeated use of physical exercises during the day, in particular, independently performed by the patient. However, at the same time, there is a danger that independent exercises of mimic gymnastics in front of a mirror are not always performed correctly (for example, when exercising in closing the eyes in the presence of paralysis of the lower eyelid, the patient tries to close it by propping up the eyelid by pulling up the corner of the mouth). At the same time, as a result of repeated exercises, a stable perverted conditioned reflex connection is organized to perform a friendly movement. Therefore, it is extremely important to teach the patient to independently correctly perform corrective exercises.

When independent mimic movements appear (or at least manifestations of minimal contractile activity) in any mimic muscle, the main emphasis should be shifted from passive exercises to repeatedly repeated active efforts from this particular muscle.

The causes of sciatic nerve neuritis can be very diverse - infections, metabolic disorders (gout, diabetes), trauma, cooling, spinal disease, etc.

With lesions of the sciatic nerve, sensitivity disorders occur, paresis and muscle paralysis appear. With a high localization of damage to the nerve trunk, the function of turning the thigh outward suffers, as well as flexion of the lower leg to the thigh, walking is very difficult. With a complete lesion of the entire diameter of the nerve, the loss of movement of the foot and fingers is added.

Already during the period of bed keeping of the patient, it is necessary to take care of preventing the sagging of the foot. In addition to passive correction (in particular, with the help of a splint that holds the foot in the middle physiological position) and giving half-bent position in the knee and ankle joints while lying on the side, passive exercises are used. With the advent of active movements, special exercises are applied in bending the lower leg to the thigh, turning it outward, in unbending the foot and fingers, moving it to the side and inward, and extending the thumb.

The effectiveness of therapeutic exercises increases when using a warming massage and a number of physiotherapeutic effects, mainly of a thermal nature, before exercises. In addition to increasing the elasticity of soft tissues and the articular-ligamentous apparatus, allowing for movements with a greater amplitude, this measure reduces pain. For the same purpose, thermal exposure can be used after performing gymnastic exercises.

Given these circumstances, in the selection of funds and exercise therapy techniques with lesions of the tibial nerve, one should proceed from the need to increase the tone of the muscles that are in a state of loss, and reduce the tone of spasmodic muscles.

As with other types of lesions of the peripheral nervous system, in exercise therapy it is necessary to adhere to a dense repeated and repeated exercise regimen. At the same time, one should carefully monitor the state of tone and activity of the affected muscles, and at the first signs of improvement in their condition, transfer an increasing part of the load to them, increasingly preferring active exercises over passive ones.