RU2345754C2 - Method of rehabilitation of children suffering from central and peripheral nervous system involvements - Google Patents

Abstract

FIELD: medicine; neurology.

SUBSTANCE: exercises are performed in swimming pool with dolphin and on the platform. The dolphin lies on the platform, the patient strokes dolphin body with his feet and/or both opened palms from rostrum to the tail blade, thus trying to find warm and/or cold regions of dolphin skin, and follows its movement in the swimming pool. Then the patient sits down or lies down on the platform with his feet or straightened hands in water, the dolphin rests with its rostrum against foot or opened palm in water and pushes out it from water. Rehabilitation takes two stages. At the first stage the dolphin and the patient make the exercises directed on development of tactile motor system of the patient. At the second stage the patient performs rehabilitation actions in water.

EFFECT: ability to keep balance, development of coordination movements.

3 cl, 5 ex

Description

The invention relates to the field of restorative medicine, namely neurorehabilitation, and can be used for non-drug rehabilitation of children with damage to the central and peripheral nervous system. The method can be used both for mild and severe forms of these diseases, as well as when combining them with a significant lag in mental development.

It is known that pre- and postnatal lesions of the central and peripheral nervous system are one of the most common types of pathology of children, leading to disability in society. Among children with disabilities since childhood, 87% are disability according to the neuropsychiatric profile. The complexity and, in most cases, the lack of effectiveness of measures for the rehabilitation of children with disabilities necessitate the search for new forms of correctional work with this group of patients.

For the treatment and rehabilitation of these diseases, both drug and non-drug methods of treatment are used.

With medical treatment, drugs are prescribed that reduce muscle tone: diazepine derivatives, baclofen, midocal, midantan, cyclodol, Botox. Compounds affecting cerebral metabolism: piracetam, aminalon, cerebrolysin, glutamic acid, B vitamins.

However, prolonged and intensive use of drugs can cause complications, the most common of which are allergic reactions, impaired gastrointestinal tract, liver, kidney, cardiovascular and nervous systems.

From non-pharmacological methods in complex rehabilitation, numerous methods of rehabilitation treatment are used, namely manual therapy, massage, physiotherapy, reflexology, orthopedic equipment, physiotherapy exercises.

Physio-balneological procedures are prescribed in order to target the pathological focus in the brain, reduce muscle spasticity, eliminate contractures and joint deformities, improve coordination of movements and speech. Given the characteristics of the clinical manifestations of various diseases of the nervous system, children are prescribed electrophoresis of various medicinal substances (seduxen, bromine, galantamine, proserin, succinic acid, phosphorus), heat therapy (mud, paraffin, ozocerite applications, infrared rays), muscle stimulation with sinusoidal modulated currents, electrosleep , magnetic and laser therapy.

Depending on the form and stage of the disease, various types of massage are used: classic general, systemic acupressure according to K.A.Semenova, trophic, reflex-segmental in the modification of Yu.P. Milentyev.

Various methods of individual kinesitherapy of children with motor impairment are used, in particular:

The Bobath method (1956) was developed for any patients with brain damage, but mainly for patients with cerebral palsy and having a brain stroke. The method is aimed at generating targeted voluntary movements and uses techniques to inhibit synergies and pathological postures in combination with stimulation of normal automatic motor reactions.

The Bobath technique was expanded and given its modification by V. Vojta (1981). He bases his methodology on the principle of the ontogenetic formation of motility, proposing to use innate reflex mechanisms for this purpose. This technique is used primarily for children with motor disabilities, with whom during the class it is not possible to establish contact.

The Proprioceptive Neuromuscular Facilation (PNF) technique developed by Kabat, Knott and Voss is based on the techniques of limb movements along spiral-diagonal trajectories in combination with fast muscle stretching.

Semenova K.A. (1976) offers an exercise therapy technique for children of the first years of life and older with severe forms of diseases. The technique is based on knowledge of the laws of motor development of a healthy child and the mechanisms of formation of motor pathology in sick children.

Shterengerts (1986) developed an exercise therapy technique for schoolchildren, in which, taking into account the anatomical and physiological mechanisms of the child’s body, during classes and labor skills training, special attention is paid to the emotional background.

Kaptelin A.F. indicates the effectiveness of hydrokinesitherapy - therapeutic exercises in water.

The main disadvantage of these methods is the lack of accounting for the patient's own activity. The complexity of the passive methods used to activate the movements does not correspond to their effectiveness, and they should be used when it is not possible to involve the patient himself in the motor activity.

Techniques based on the use of biological feedback (BFB) also continue to improve. The meaning of these techniques is as follows: if the patient begins to become aware of some usually unconscious processes, then he will be able to consciously control and accelerate their course. Their application is impossible with a significant lag in intellectual development.

Closest to the invention is a method of rehabilitation of children with lesions of the central and peripheral nervous system, mainly cerebral palsy, according to the method of K. A. Semenova, which consists in the use of massage, reflexology, correction of orthopedic disorders and dynamic exercises. In this case, massage is carried out by applying stroking, rubbing, kneading the affected muscles on the limbs and trunk. Reflexology includes acupressure by pressing on biologically active points and acupuncture by acupuncture on classic corporate points in a braking and exciting mode. Fixed rigid correction of orthopedic disorders is carried out using plaster casts and orthopedic shoes. Dynamic exercises are carried out using special exercises and various devices (balls, swings, rocking chairs, swivel chairs, trampolines, etc.) (RF Patent 2070816, published 1996.12.27).

Using the prototype method leads to relatively low efficiency and relatively long rehabilitation times. As a rule, 4-5 courses of comprehensive rehabilitation are carried out every month in a month during the year, and treatment according to this scheme is repeated several times, so that rehabilitation is carried out for several years.

Thus, at present, rehabilitation of patients with damage to the central and peripheral nervous system is a complex, complex, not fully resolved task. There is not one of the existing methods that could be used on its own due to the difficulty of the pathologies themselves and due to the low effectiveness of individual types of treatment. Rehabilitation of such patients requires high costs, the involvement of a large number of health workers and other specialists, the creation of rehabilitation centers.

Therefore, the search for new effective treatments is very important.

At the same time, it is known that dolphins are successfully used to rehabilitate patients with similar diseases.

Dolphin therapy was first introduced in 1978 in Philadelphia at Ocean World by David Natanson to rehabilitate children with mental retardation, aggressive behavior, and depression (Dolphin Human Therapy: A Professional Association Dedicated to Helping Disabled Children, Symposium, 1995, p .one).

Dolphin therapy involves several areas of exposure of an animal to humans:

- sonar echolocation effects;

- communicative effect (including tactile, visual).

Having a multi-frequency echolocation system (dolphin location signals are a series of very short (0.1-1 ms) broadband pulses, and each subsequent pulse is emitted after receiving the previous echo), the dolphin involuntarily affects a person who is next to him in the aquatic environment. Observations of the behavior of dolphins during therapeutic contact with people show that when a person is in the water in a supine position, the dolphin is nearby, orienting the echolocation beam in the direction of the skull. At close range, the dolphin concentrates the echolocation beam on the patient's spine. At a distance of less than 0.5 m, the dolphin uses pulses of a frequency of 500 Hz repeating every 2.5 s. Echolocation of a dolphin before contact with the patient’s skin permeates the water column, which is a highly effective medium for sound transfer. It is known that water is a highly efficient medium for sound transfer: 60 times more effective than air. The sonar-echolocation effect of the dolphin implies the simultaneous existence of three fields: electric, magnetic and acoustic, which are simultaneously recorded in the aquatic environment.

In 1992, Salvensen K.A. it has been shown that ultrasonic exposure of a dolphin to humans can cause migration of a neural impulse and concomitant changes at the cellular level (Salvensen K.A. Routine ultrasonography in utero and school perfomance. The lancet, 1992, 339, 8785, p. 85). The data obtained indicate that the echolocation effect of a dolphin on a person causes a cavitation process in the area of damaged tissues (compression and extension zones are formed with the formation of bubbles, the diameter of which reaches 100 microns). Cavitation affects the process of depolarization of molecules, which, in turn, improves intercellular exchange and fluid circulation. Ultrasound begins to redistribute fluid in stagnation zones, which contributes to more efficient drainage of body tissues.

During electroencephalographic studies, it was shown that after the sessions of dolphin therapy, the synchronization of the alpha rhythm in the occipital-parietal leads increases, the symmetry of the EEG activity in both hemispheres increases, and the zonal differences become more clear.

During contact swimming with a dolphin, the child receives a powerful positive emotional charge. The mechanisms of emotional-personal regulation are developing, on the basis of which further rehabilitation is built. Against the backdrop of positive emotional experiences, a high concentration of the child’s strength and attention occurs.

Given the above, the authors suggested that interaction with dolphins during the rehabilitation process can significantly stimulate the mental and physical development of the child. The ability to arouse in a child such a strong and multidirectional motivation that accompanies the activities of dolphin therapy (DT), contributes to the maximum mobilization of emotional and volitional activity, as a result of which the feeling of fear, self-doubt is suppressed, mechanisms are included that ensure the most complete and correct implementation of the recommended exercises. It is also obvious that the inclusion at the time of interaction of an additional set of exercises aimed at stimulating sensory and motor activity, can dramatically increase the effectiveness of general rehabilitation measures. In addition, exposure to physical factors, such as water and ultrasound, emitted by dolphins in the process of communication, contributes to speedy results during rehabilitation measures.

The method is as follows.

Work is carried out with representatives of the Cetacean class, the Toothed whale department, the Dolphin subdivision in an outdoor or indoor pool with mineral water (1.8-2 NaCl) washed at a temperature of 25-28 degrees.

Before work, the dolphin is trained according to a special program. Interaction with a dolphin is aimed at performing a set of exercises for the development and consolidation of new sensorimotor skills in a child, and activation of the emotional-volitional sphere.

Dolphin therapy is carried out for children and adults aged 2.5 to 16; from 16 and older.

A prerequisite for dolphin therapy is the presence of minimal water skills in children (since the absence of such skills significantly prolongs the duration of therapy). In any case, a swimming vest is put on the patient, it is best to take your own, the one to which the patient is accustomed and in which he feels comfortable.

The technique of dolphin therapy itself is carried out in two stages. At the first stage, work with the dolphin is carried out on the platform.

The dolphin lies on the platform, the patient strokes the dolphin's body with the open palms of both hands from the rostrum to the tail lobe 1-3 times for 1-2 minutes. The instructor begins to work with the patient hand in hand, shows a warm area of the skin of the dolphin in the area of the tail lobe, compares it with colder areas of the skin in the area of the tail, 2-4 times for 1-2 minutes. Then the instructor offers the patient to find other warm skin areas on the dolphin’s body 1-2 times within 1-2 minutes. When performing movements, sound and speech stimuli are widely used. Then the patient, standing independently on one leg and trying to maintain balance, strokes the dolphin's body with the foot of the second leg, first right, then left 2-4 times for 2-4 minutes. Then the patient, with the help of an instructor, touches the dolphin in different parts of the body 1-2 times 3-5 s for each contact. Further, the instructor offers the patient to massage the dolphin, showing parts of the body with different elasticities. The instructor controls that the patient presses on the skin of the dolphin in the back, melon, abdomen and compares the elasticity of different parts of the body 1-3 times for 1-2 minutes.

The purpose of the proposed exercises is to establish psychological contact with the dolphin, as well as the activation of the sensitivity of the fingertips of the fingers and toes, the development of differentiated movements of the fingers and toes, the ability to maintain balance, the development of coordination of movements.

Then the patient, sitting or standing on the platform, takes a quick deep breath, holds his breath and makes a strong full exhalation and immediately a quick breath, imitating the dolphin breathing in water 3-5 times for 1 minute.

The purpose of the proposed exercise is to teach the patient to arbitrarily change the respiratory rate, increase concentration.

Then the patient lies on his stomach at the edge of the platform and, having found the eyes of a dolphin, monitors his movements in the pool, holding his raised head in an unchanged position. The instructor can slightly support the head by the chin, monitors the setting of the head and corrects its position in a timely manner. Exercise time 1-4 minutes.

The aim of the proposed exercise is to keep the head in an upright position, while simultaneously stimulating the extensor muscles of the neck and lumbar spine, training the functions of the oculomotor muscles, and expanding the fields of vision.

The patient sits or lies on the platform, lowering his legs or arms straightened at the elbows into the water. Dolphin rests against the rostrum in the foot or open palm dipped into the water and pushes it out of the water. The patient slowly presses the dolphin’s rostrum with the foot or open palm, trying to overcome the resistance and immerse the foot or palm in the water without bending the elbow. It is performed alternately with the right hand or foot and the left hand or foot. The exercise time is 3-5 times with each arm or leg for 1-2 minutes.

The purpose of the proposed exercise is to strengthen the muscles of the shoulder girdle, extensor muscles.

The patient stands on the platform and throws the ball with both hands or one in front, and / or to the right, and / or to the left from behind his head, or in front of himself in the water. The patient bends down and, clapping on the surface of the water, calls for the dolphin, taking the ball from his mouth with two hands or one.

The purpose of the proposed exercise is to develop kinesthetic and visual sensations of the movement pattern, prevent the development of contractures and deformations, and develop isolated movements.

The next step in the method is to work with a dolphin in water.

The patient, lying on the water on his chest, holds with his straight hands behind the back of a motionless dolphin, takes a breath, then lowers his head into the water and slowly exhales. The exhalation should be continuous and long, three times longer than the inspiration. The exercise takes 3-5 times for 1 min.

The purpose of the proposed exercise is to prepare to work in water with a dolphin, to remove the psychological barrier of fear and fear with tactile contact in water with a dolphin, and to learn how to control your breathing.

Then the patient is in the water in the fins and imitates the movements of the tail fin of the dolphin with his feet. The exercise takes 5-10 minutes.

The purpose of the proposed exercise is to strengthen the muscles of the pelvis, abdominal muscles, legs, increase the mobility of the lower part of the spinal column, hip, knee, ankle joints.

Then the patient calls the dolphin to him by patting him in the water, grabs the dorsal fin and holds onto it. At the command of the trainer, the dolphin quickly takes the patient in a circle with a radius of no more than 3 meters, first clockwise, then counterclockwise 2-5 times in each direction, then around the entire perimeter of the pool 2-5 times in each direction. During movement, the child releases one hand and raises it up, while continuing to hold on to the fin with the other hand. Then the patient takes up the pectoral fins of the dolphin, like hands. The dolphin, standing upright in the water, circles the patient-child first to the right, then to the left (dancing a waltz) 2-5 times in each direction.

The purpose of the proposed exercise is to improve the functional state of the vestibular apparatus, cerebellum, neuromuscular apparatus; training the functional capabilities of the hands and fingers, practicing arbitrary capture of objects with a brush and its release (releasing).

Then the patient, lying on his chest or back on the surface of the water in front of the dolphin’s nose, puts his foot or open palm of the right or left hand forward, and the dolphin, with the rostrum resting on the child’s palm or foot, slowly carries him 1-5 times 1-2 minutes.

The purpose of the proposed exercise is the ability to feel the state of hydrostatic weightlessness, to keep your body in balance at the surface of the water, without performing any movements, to master sliding on the chest and back with different positions of the hands.

Then the patient and the dolphin swim freely in the pool, throwing each other inflatable balls of different diameters, the exercise takes 3-5 minutes.

The purpose of the proposed exercise is to strengthen the muscles of the shoulder girdle, the education of adequate emotional reactions.

The method is carried out by classes lasting 30-40 minutes, 5 times a week, only 10 lessons per course, the continuation of the course depends on the condition of the child.

The invention is illustrated by the following examples.

Using the claimed method, rehabilitation was carried out for 62 sick children aged 2.5 years to 16 years with disease duration from 1 month to 16 years with diseases such as cerebral palsy, single and bilateral hemiparesis, monoparesis, encephalopathy, the consequences of spinal injury, retinopathy of premature infants, early childhood autism, cm Down. The effectiveness of rehabilitation was assessed by indications of motor and mental activity three and six months after the start of treatment. In this case, the group of indicators of motor activity included: a change in the tone of spastic and paretic muscles, determined by clinical examination and electromyography; the appearance of previously absent arbitrary purposeful movements with increasing in time the degree of their physiology, volume and strength. The volume was estimated using the angles of dilution and flexion of the spine and limbs, and the force was determined using a dynamometer; normalization of the ratio of supporting articular surfaces was determined radiographically.

The group of indicators of mental activity included: the appearance of intellectual and emotional contact; the appearance and development of speech; development of sustainable positive emotions; approximation of the mental development of the child to the corresponding age group.

Statistical processing of the results was carried out according to the student method.

Analysis of the data showed that the use of the claimed method provides the effectiveness of rehabilitation in terms of motor activity and mental activity.

The invention can also be illustrated by the following specific examples.

Boy Gleb K., 4 g., Cerebral palsy, atonic-astatic form. On admission, he does not hold his head, a weak reaction to external stimuli is noted, his gaze is not fixed. 3 rehabilitation courses were carried out (5 consecutive sessions, 2 days off, 5 consecutive sessions - one dolphin therapy course), repeated after 3 months. The child began to hold his head, fix his gaze on a moving subject, horizontal nystagmus decreased, sleep improved, adequate emotions appeared.

Boy Sasha P., 7 years old, cerebral palsy, right-sided hemiparesis, residual stage. Upon admission, the child is hyperactive, impaired coordination of movements, works only with the left hand ("compensated left-handed"), dysarthria. 2 dolphin therapy courses were carried out with an interval of 2 months; in the classroom, the right hand was constantly included in the work. Motility disinhibition significantly decreased, self-esteem increased, he began to speak in phrases, it was better to learn educational material.

Girl Lisa B., 5 l., Cerebral palsy, spastic diplegia. The girl noted walking with a defective gait, but independent for short distances, lack of fine motor skills, difficulty orienting in space, limited understanding of inverted speech, uses vocalizations and monosyllables in her own speech, high exhaustion, which manifests itself in a decrease in productivity, avoiding activities. Conducted 4 courses of dolphin therapy, every 2 months. There was a breakthrough in speech: there is a conversion, about 40 words, a short phrase. The child carries out an arbitrary grip of objects with a brush, finger grip is turned on, finger contrast appeared.

Boy Alyosha S., 10 years old, cerebral palsy, spastic tetraparesis, sensorineural hearing loss 3 tbsp. The child moves only with the support of the escort from behind, sagging on his hands, a cross of the lower extremities at the level of the middle third of the lower leg, sits in a defective position, total kyphosis of the spine, part of the tonic reflexes is preserved, intelligence is preserved, there is no speech. 2 dolphin therapy courses were conducted with an interval of 4 months, at which time I attended classes once a week. He began to roll over from his back to his stomach, in a position on his back he was able to stretch his arms up, increased physical activity, normalized stool. Fine motor skills improved significantly, began to write in written letters, the fears of darkness and animals disappeared.

Girl Tanya S., 9 l., Cerebral palsy, right-sided hemiparesis. The child has severe kyphoscoliotic deformity of the spine, in the right elbow, wrist joint and in the fingers, hypertonicity of the flexors. Can write with his right hand, but more often he writes with his left. When walking, he drags his right leg, is afraid to walk without the support of his mother. 2 courses of dolphin therapy were conducted with an interval of 3 months. The amplitude of active and passive movements in the right shoulder joint increased significantly, the fingers straightened, there was the possibility of extending the fingers to the sides, contrasting the thumb with the rest. She began to move around the apartment on her own, the chair returned to normal, sleep and appetite improved.

Thus, the proposed method allows to achieve high efficiency in the rehabilitation of children with damage to the central and peripheral nervous system.

Claims (3)

1. A method of rehabilitation of children with damage to the central and peripheral nervous system, including classes for the rehabilitation of children, while the lesson is carried out in two stages: at the first stage, work with a dolphin is carried out on a platform; the dolphin lies on the platform, the patient strokes the body of the dolphin with the feet and / or open palms of both hands from the rostrum to the tail lobe, trying to independently find warm and / or cold patches of skin on the dolphin's body, while performing movements, sound and speech stimuli are used, then the patient makes massage to the dolphin, for which it presses on the skin of the dolphin in various parts of the body and compares their elasticity, then the patient, sitting or standing on the platform, takes a quick deep breath, holds his breath and makes a full exhalation, then immediately a quick breath, simulating the dolphin’s breathing in water, after which the patient lies on his stomach at the edge of the platform and, finding the dolphin through his eyes, monitors his movements in the pool, keeping his head raised in the same position, then the patient sits down or lies on the platform, legs down or straightened at the elbows of the hand in the water, the dolphin rests against the foot of the rostrum or an open palm dipped into the water and pushes it out of the water, the patient presses on the dolphin rostrum with the foot or open palm, trying to overcome the resistance and immerse the foot or palm into the water without bending the elbow, then the patient stands on the platform and throws the ball with both hands or one in front and / or to the right and / or left from behind the head or in front of himself into the water, then he calls the dolphin, takes the ball from his mouth with two hands or one; at the second stage, work with a dolphin is carried out in water: the patient, lying on the water on his chest, holds with his straight hands behind the back of a motionless dolphin, takes a breath, then he lowers his head into the water and slowly exhales, then the patient is in the water in the fins and simulates movements the dolphin’s tail fin is kicked, after which the patient calls the dolphin to him, grabs the dorsal fin and holds it, the dolphin takes the patient in a circle with a radius of not more than 3 m, then around the entire perimeter of the pool, while moving the child releases one the arm and raises it up, continuing to hold on to the fin with the second hand, then the patient takes on the pectoral fins of the dolphin, as if holding hands, the dolphin, standing upright in the water, circles the patient, then the patient, lying on his chest or back on the surface of the water in front of the dolphin’s nose , exposes the foot or open palm of the right or left hand forward and the dolphin, resting on the child’s palm or foot with the rostrum, slowly carries it around the pool, after which the patient and the dolphin swim freely in the pool, throwing inflatable balls of different diameters to each other. 2. The method according to claim 1, characterized in that the duration of the lesson is 30-40 minutes 3. The method according to claim 1, characterized in that the classes are held 5 times a week, a total of 10 lessons per course.