RU2289381C1 - Method for normalizing muscle tone in children suffering from spastic forms of cerebral paralysis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves making child relax on incompletely pumped-in ball of 120 cm large diameter. The child is laid on the ball in prone position. One methodologist fixes child shoulders on ball surface with arms placed symmetrically along corps. The other methodologist fixes lower extremities on ball surface and draws them apart as relaxation comes in fulfillment, making slow sways to and fro, from right to left and in circle. Child head is turned every several sways to one or other side and then exercises are done for symmetrically stretching extremities and torso of the child with the same force in the same horizontal plane, step-by-step beginning from upper extremities and shoulder girdle during 3-5 s with a force equal to 3-5 kg in primary school age children and 6-8 kg in secondary school age children. Then lower extremities are stretched in initial dorsal position. Muscle tone normalization is carried out 2-3 times a week in courses of 10-12 procedures during 5-10 min.

EFFECT: normalized muscle tone; enhanced effectiveness of physical rehabilitation in late residual stage.

2 cl

Description

The invention relates to medicine, namely to physiotherapy exercises, and can be used to treat cerebral palsy.

The invention can be most effectively used in rehabilitation institutions to restore the range of motion in the joints and increase the motor capabilities of patients with spastic forms of cerebral palsy.

A known method of restoring normal muscle tone in children under the age of 5 years with a spastic form of cerebral palsy (Patent RU 2214209, Rybakova N.A. et al., Published on 20.10.2003), which consists in the fact that for each muscle with expressed high tone diagnose the presence of its response to the force impact by the hands of the methodologist, expressed in the occurrence of a sharp mechanical resistance at a certain value of the impact and tactilely felt by the methodologist, take the set value as the upper pre ate effects later in the process of manipulation performed multiple, random in direction force feedback, the magnitude does not exceed the previously set, said upper exposure limit.

The disadvantages of the method is the limitation of its use for patients with spastic forms of cerebral palsy in school and high school age, when the greatest risk of formation of contractures of the joints, which can be eliminated only by surgery.

A known method of normalizing muscle tone and raising normalized motor skills in patients with cerebral palsy (cerebral palsy) according to the methodology of B. Bobat and K. Bobat described in the book (M. Weiss, A. Zembaty // Physiotherapy. M: Medicine, 1986, p.114-131), according to which on a ball of large diameter (ball), swaying a patient with cerebral palsy from side to side, back and forth and manipulating the child’s body, they transfer him from the starting position on the back and stomach to the position on all fours, sitting, with support on hands, as well as swaying the ball and directing it accordingly In this way, the support on the arms, on the legs, and the turns of the child’s body are trained.

The ball is used to relax, suppress pathological reflexes, but, first of all - to master the stages of physical development for patients - to learn how to sit and at the same time maintain balance, kneel, improve support on the hands, etc. This is good until a certain age and physical development, and when the child is already moving independently, but he has problems - increased tone, contractures begin to form, he has sufficient weight - 2-3 are needed - methodologists and ways to correct his already formed posture and walk.

The disadvantage of this method is the lack of a combination of exercises with exercises to stretch the muscles, contributing to the normalization of muscle tone.

There is a method of achieving relaxation using exercises to stretch the muscles and joint-ligamentous apparatus of the arms, legs, spine, performed with the help of partners to relieve nervous tension (Zuev E.I. // Magic power of stretching. M .: Soviet Sport, 1990. S.65).

The method consists in the fact that when the muscles of different parts of the body and the whole body are stretched in appropriate directions, changing the strength and direction of the load, using various techniques and combining them in certain combinations, many muscle groups are stretched, which results in a pronounced relaxation state for healthy children and adolescents involved in sports.

The disadvantage of this method is that this method is not applicable for children with cerebral palsy, since tensile exercises are performed without preliminary muscle relaxation, which is necessary for spastic forms of cerebral palsy. There is no possibility of manipulating the child’s body to correct pathological postures and movements during stretching, as well as the lack of training of the vestibular apparatus, contributing to the normalization of muscle tone.

The objective of the invention is to provide a method of normalizing muscle tone with spastic forms of cerebral palsy in children of preschool and school age.

The problem is solved by conducting exercises to stretch the muscles and joint and ligamentous apparatus of the arms, legs, spine, with the help of the methodologists, for which they relax the child on a not fully inflated ball with a diameter of 120 cm, for which the child is first placed face down on the ball, with In this case, one methodologist fixes his shoulders on the surface of the ball, hands symmetrically along the body, another methodologist fixes the lower limbs on the surface of the ball, and, as relaxation is achieved, spreads them and performs slow swaying back and forth, right-left and in a circle, with the child’s head turning several times in one direction or the other, then they perform stretching exercises on the limbs and torso of the child symmetrically, with the same effort, in one horizontal plane, sequentially, starting from the upper limbs and the shoulder girdle, for 3-5 seconds, with an effort of 3-5 kg in children of primary school age or 6-8 kg - older, with subsequent stretching of the lower extremities and in the initial position on the back, and normalization of muscle tone CA spend 2-3 times a week, courses of 10-12 procedures, lasting 5-10 minutes.

If the defeat is pronounced in a child with spastic diplegia, the head is turned first towards the spastic muscles until they are completely relaxed, and then a slow turn in the opposite direction is performed.

The essence of the invention is that the relaxation is carried out by the child on a not fully inflated ball with a diameter of 120 cm, for which the child is first placed face down on the ball, while one methodologist fixes his shoulders on the surface of the ball, hands symmetrically along the body, the other methodologist fixes the lower limbs on the surface of the ball and, as relaxation is achieved, spread them, performing slow swings back and forth, left and right, and in a circle, while the child’s head after a few swings is rotated in one direction or the other well, then they perform stretching exercises for the limbs and torso of the child symmetrically, with the same effort, in the same horizontal plane, sequentially, starting from the upper limbs and shoulder girdle, for 3-5 seconds, with an effort of 3-5 kg in primary school children age or 6-8 kg - older, followed by stretching of the lower extremities and in the starting position on the back, and normalization of muscle tone is carried out 2-3 times a week, courses of 10-12 procedures, lasting 5-10 minutes. If the defeat is pronounced in a child with spastic diplegia, the head is turned first towards the spastic muscles until they are completely relaxed, and then a slow turn in the opposite direction is performed.

A significant difference between the proposed method and the known ones is to perform stretching exercises on a not fully inflated ball with a diameter of 120 cm, after general relaxation of the spastic muscles and combining them with training the vestibular apparatus, which has a positive effect on spastic muscle tone.

These distinguishing features are not found in the known methods.

The invention is new, since it is not known from the level of medicine in the field of physiotherapy for sick children with spastic forms of cerebral palsy.

The method is carried out by a set of exercises performed with the help of methodologists as follows.

Exercise 1. Starting position (I.P.) on the abdomen. The methodologist spreads his hands and puts his palms down on the ball. Continuing the fluctuations of the ball up and down, hands, clasping the ball, slowly move up, accompanied by turns of the head. Two methodologists perform the exercise of stretching the arms to the sides, the third fixes the legs on the ball surface as far as possible. Stretching is carried out with the grip of the hands on the forearm, with the support of the elbow joints in the extension position, lasting 3-5 seconds, if necessary, the child’s head is maintained in compliance with the rhythm of the vibrational movements. Stretching is repeated 2-3 times, alternating with pauses of general relaxation. The first stretching according to the “Ball-trampoline-stretching” (ICBM) technique is always aimed at relaxing the muscles of the shoulder girdle, neck and upper limbs.

Exercise 2. I.P. also. Hands are located on the ball upwards relative to the body, the head is turned to the side. The methodologist bends one leg to 90-130 ° in the knee and hip joints, sliding on the surface of the ball. If a limitation of flexion is revealed due to the pronounced spasticity of the muscles, the limb is fixed in the reached position by the hand of the methodologist and, continuing to sway, the child relaxes in the formed pose. The amount of flexion through the lead gradually increases from procedure to procedure. The second leg is fixed by another methodologist in the middle position.

Exercise 3. If the patient has an equinus installation of the feet from this initial position, the straightened leg of the child is gently brought to the middle position so that its patella is strictly down to the surface of the ball. Holding with one hand the foot by the ankle joint and with the other hand the knee joint in an unbent position, the foot gently lowers to the floor surface. Oscillations of the ball stop and, slightly rolling the ball back and forth, the support is reached on a full foot. In order to increase the amplitude of extension in the ankle joint, with each swing of the ball, this leg “recedes” from the ball and thereby increases the back flexion (extension) of the foot.

The options for supporting the knee joint during this exercise depend on its installation: if the child has a flexor installation in the knee joint, the methodologist fixes the foot on the floor surface with one hand and helps to extend the knee joint with the other, while holding the knee with a tendency to recurrence of the knee joint joint in a bent state. Tensile exercise is repeated 2-3 times. Exercise 4. Simultaneous stretching of all limbs and spine. Hands are directed up and somewhat to the sides in the form of the letter “U”, legs are in a position of possible breeding. The stretching duration is 3-5 seconds, the number of repetitions is 2-3.

Exercise 5. I.P. on the back. One methodologist is located on the side of the child’s head and reliably fixes the child’s shoulder joints and arms in a position along the trunk with his palms and forearm. The second methodologist, controlling the movements of the ball and fixing the child’s body on the ball with a grip in the lower third of the hips, rolls the ball on himself in order to create an elevated position for the head - a lightened position for the neck flexors, which are in a state of some tension due to the tilted position of the head on the round the surface of the ball. A proper bending of the head is performed - without shifting it to the sternum. The importance of this training is due to the strengthening of cervical lordosis with the head tilted anteriorly in patients walking. Raising the head from a supine or abdominal position is carried out using a block with the movement of the upper part of the body, and head turns from side to side in an incomplete volume, their amplitude can be different, especially with pronounced laterality of the lesion. The stabilization of the head position achieved as a result of these measures is in some cases an indicator of a significant improvement in the condition of the child.

Exercise 6. PI on the back. Exercise for stretching the muscles of the shoulder girdle and upper limbs. After stretching, the hands are laid along the body or are freely located on the ball.

Exercise 7. IP is the same. The bending of the head is accompanied by the bending of one leg and pulling it to the stomach until the body forms a concave arc. If tibial synkinesia is detected during a child’s flexion, the methodologist motionlessly fixes the foot in the flexion position and, having applied adequate force, stretching the extensors of the foot, holds it in this position. The second leg is fixed on the ball.

Exercise 8. I.P. also. The child’s hands are somewhat in abduction, the shoulders are firmly fixed with the palms and forearm of the methodologist from the side of the child’s head. The second methodologist, standing to the right of the child, puts his left hand (palm down) under the child’s right thigh, grabs the left leg and moves it to himself free, gradually turning the pelvis to the left and assisting the rotation with the palm lying on the sacrum. The third participant supports the knee and lower leg of the right leg, making a turn, in the same plane with the surface, performing synchronous swaying along with all participants in the procedure. According to indications, local hypothermia or cryocontrast for spastic muscles responsible for the formation of a pathological installation in a patient can be preliminarily performed.

The exercise is performed very smoothly, with the application of adequate efforts at the time of rotation, until the gradual, staged achievement of the rotation of the pelvis with respect to the body is not more than 90-130 °. After fixing in the final position for 2-3 seconds, a slow return of the trunk and limbs to their original position and relaxation follows. Similarly, the rotation is performed in the opposite direction.

Under the control of the activity of the cardiovascular system, the child was slowly transferred to an upright position.

An absolute contraindication for the use of the ICBM technique is the presence of organic contractures and joint deformities, congenital and acquired diseases and spinal deformities in a patient. A relative contraindication is a feeling of fear of body movements (in our observation, 1 child). The following are examples of specific implementation of the method.

Example 1. Patient K., 12 years old, with a diagnosis of cerebral palsy, spastic diplegia, equinus installation of the right foot. Got 3 courses of complex treatment using the ICBM technique. In order to stretch the calf muscles, which cause the flexion ability of the right knee and ankle joints in a standing position and when walking, when performing exercises according to the ICBM method, taking into account the asymmetry of the lesion, emphasis was placed on the use of ankle and knee sprains - exercises 3 and 8.

As a result of treatment, the patient’s vertical posture improved, he became more stable when walking, falling to the right leg decreased significantly. Biomechanically, an increase in the extension amplitude in the knee and ankle joints by 23 ° and 14 °, respectively, was established. Stabilographic studies confirmed a clinically detectable improvement in patient stability in the vertical stance - the area of the statokinesigram with open eyes decreased by 48%, with closed eyes - by 25%.

Example 2. Patient U., 14 years old, diagnosis: cerebral palsy, spastic diplegia, secondary mild tibial syndrome. I received 2 courses of complex physical therapy using the ICBM technique. During treatment, emphasis was placed on the use of exercises 3 and 7, special attention was paid to eliminating the manifestations of tibial syndrome.

As a result of treatment, the patient moves with straightening of the knee joints in the phase of support, with the coordinated participation of the upper limbs when walking, she became more stable, the walking pace increased, and fatigue due to reliance on the bone skeleton of the lower extremities decreased. A biomechanical study revealed an increase in the amplitude of extension in the knee joint by 18 ° and an increase in the back push - the flexion of the foot increased by 12 °. During a stabilographic study, the role of the visual analyzer in controlling vertical stability was noted to increase - the visual coefficient increased from 1.45 before treatment to 1.9 after treatment (norm 2.2).

Example 3. Patient G., 6 years old, diagnosed with cerebral palsy, spastic diplegia, condition after surgical treatment of equinus deformity of the feet on both sides. On examination: the patient has the consequences of the influence of a pathological symmetric cervical-tonic reflex - the patient moves independently with an extensor installation of the trunk, hyperlordosis of the lumbar spine, pronounced tilt of the pelvis anteriorly, recurrence of the knee joints in the support phase and slightly expressed sagittal and frontal oscillations of the body. Heels when walking completely does not load, unstable, quickly tires. I received 3 courses of rehabilitation treatment using the ICBM technique. The emphasis was on exercises 1, 3 and 5, 6, 8. After treatment, the patient noted significant improvements: posture and pelvic position normalized, pathological swaying of the body disappeared, the patient fully loads the feet in the support phase, recurrence of the knee joints is leveled by wearing the “eight” from an elastic bandage on the right knee joint and the left knee joint is independently held in the correct position. She began to walk considerable distances independently with less fatigue, confidently performs turns, upper limbs take a coordinated part when walking. Biomechanical studies indicate a decrease in knee extension in the support phase by 14 ° to the right and 8 ° to the left.

For the first time it was found that using stretching exercises against the background of preliminary relaxation, it is possible to reduce spastic tone and eliminate the pathological settings of joints characteristic of patients with spastic forms of cerebral palsy of preschool and school age.

The advantage of the proposed method is:

- the use of an incompletely inflated ball with the effect of a trampoline as support for the patient’s body, while the child’s body can sway up and down, similar to vibrations of a trampoline with a large surface (55-60 vibrations per minute);

- the indicated swaying of the patient on the ball is accompanied by the appearance of accelerations that have a training effect on the patient’s vestibular apparatus;

- a combination of the use of the trampoline effect and the performed stretching exercises is achieved in order to relax spastic muscles and restore range of motion in the joints of the patient’s trunk and limbs;

- when using an incompletely inflated ball, its conditionally horizontal surface in contact with the body increases, it is more stable, which contributes to a more confident and calm patient behavior during the procedure;

- with the help of the ball, control of the child’s body is facilitated in order to correct his pathological postures when performing exercises, especially for school-age children;

- preliminary relaxation of all the muscles of the body before performing stretching exercises corresponds to one of the fundamental principles of physiotherapy for children with cerebral palsy at any stage of the disease, including late residual.

The difference between the proposed “Ball-trampoline-stretching” (ICBM) technique and the common stretching exercises is that the common tensile exercises, as a rule, affect one or several joints and are performed against the background of drug treatment, thermal procedures, alcohol-novocaine blockades .

Both spastic muscles and their antagonists are exposed. The group of observed children who included the ICBM technique in the individual rehabilitation program consisted of 137 children whose motor development corresponded to different levels of motor development - from W to U. Classes according to this method were held 2-3 times a week, in courses, 2-3 once a year. As a result of treatment using the "Ball-trampoline-stretching" technique, a significant improvement was observed in 33 children (24.1%) and in 104 children, an improvement (75.9%). Negative dynamics in the condition of patients was not detected.

After complex treatment using the ICBM technique, a positive dynamics of the temporal and spatial characteristics of the gait was observed in all 137 patients, normalized range of motion, primarily in the sagittal plane, in the hip and knee joints.

Consequently, the use of the “Ball-trampoline-stretching” technique in combination with the differentiated use of fixed assets of exercise therapy as part of a complex, staged treatment of patients with cerebral palsy allows to increase the effectiveness of physical rehabilitation in the late residual stage.

Claims (2)

1. A method of normalizing muscle tone in children with spastic forms of cerebral palsy, including exercises to stretch the muscles and joint-ligamentous apparatus of the arms, legs, spine, using methodologists, characterized in that the child is relaxed on an incompletely inflated ball with a diameter of 120 cm, why, first, the child is laid on the ball face down, while one methodologist fixes his shoulders on the surface of the ball, hands symmetrically along the body, the other methodologist fixes the lower limbs on the surface of the ball and, as Achievements of relaxation spread them, performing slow swings back and forth, left and right, and in a circle, while the child’s head is rotated in one or the other direction after several swings, then they perform stretching exercises on the limbs and trunk of the child symmetrically, with the same effort , in one horizontal plane, sequentially, starting from the upper extremities and shoulder girdle, for 3-5 s, with an effort of 3-5 kg in children of primary school age or 6-8 kg - older, with subsequent stretching of the lower echnostey and in the initial position on the back, with normalization in muscle tone is performed 2-3 times per week courses 10-12 sessions lasting 5-10 min. 2. The method according to claim 1, characterized in that when the defeat is pronounced in a child with spastic diplegia, the head is turned first towards the spastic muscles until they are completely relaxed, and then a slow turn is performed in the opposite direction.