RU2358707C1 - Rehabilitation method for children suffering from neuropathies - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine and can be used for rehabilitation of children suffering from nervous system diseases. A child is laid in unstable, semivertical or vertical position with his back placed on a ball limited with an inflatable splint. Warming-up involves serial flexion and extension of upper and lower limbs. Then with one hand fixing ankle joints and the other holding a shoulder, the child is rolled down slowly from the ball until he touches a support with his feet. Holding in semivertical position with periodical releasing shoulders, static position is changed to dynamic one. Further feet of the child are fixed to the splint edge, with his knee joints held he is assisted to flex and extend the feet. When the child completely extends legs using a ball as an additional support, he is assisted to rise to vertical position to possibility for horizontal balancing within 5-7 minutes. After that series of adducting hip movements in vertical position follows 5-10 times with each foot. The therapeutic course includes at least 15 lessons for 3-4 courses.

EFFECT: method extends range of rehabilitation means for children suffering from neuropathies.

1 tbl, 5 dwg, 1 ex

Description

The invention relates to medicine and can be used for the rehabilitation of children with diseases of the nervous system, in particular children with cerebral palsy.

Medical rehabilitation is understood to mean a system of biomedical measures aimed at restoring and compensating for functions that were impaired as a result of illness or injury, preventing complications and relapses of the disease, and developing self-care and work skills.

Known methods of rehabilitation of children with cerebral palsy by creating a metered load on the patient’s muscles through the use of the method of dynamic proprioceptive correction (Adele’s costume, Gravistat). However, this method has several disadvantages, one of which is the tough nature of the impact to give the child a forced position.

A known method of rehabilitation by conducting a set of exercises with the help of balls to strengthen the muscles of the knee joint, extensor tibia (extension of the lower leg of the affected lower limb with the push of the ball), targeted movement [7].

Known methods using simulators that train the inhibition of SShTR (symmetric neck-tonic reflex), AShTR (asymmetric neck-tonic reflex) and LTE (labyrinth-tonic reflex) on the muscles of the body when it is horizontal. However, in severe forms of the disease in patients older than 3-5 years, these reflexes are not completely eliminated even in a horizontal position. As soon as the child assumes a semi-vertical position, the labyrinth-tonic reflex resumes, which is confirmed by a comparison of clinical data and EMG studies [4].

A known method of rehabilitation, which consists in using the simulator Gross. Gross simulator is a specialized suit, which is equipped with elastic traction. The child is placed in a specialized suit and training, the instructor adjusts the load empirically. The disadvantages of this method:

1. A load is made on the unprepared musculoskeletal system of a child without taking into account its individual muscle tension.

2. The fragmented nature of the load.

3. In connection with the inadequacy of the load (from its overdose), the child develops painful sensations in places of contact with the suit, which increases muscle hypertonicity.

4. The complexity of using the suit, due to the complexity and duration of the placement on the child’s body.

5. Loss of motivation for movement due to child fatigue.

Closest to the proposed is a method of rehabilitation, consisting in the treatment of the situation, developed by K. Bobat (1967) [3-6]. The method is not effective due to the unsatisfactory state of the muscles of the chest. Optimal synergies between the muscles of the neck are not achieved, which allow you to keep the head in the position as close to the physiological state as possible. The tone of the pectoralis major muscles is slightly reduced, as a result, breeding of the shoulders is difficult. The tonus of the lumbar ileal muscles and rectus femoris decreases. Large gluteal muscles are not trained enough, which in patients with cerebral palsy are hypotonic, hypotrophic (while the main function of the gluteal muscles is the verticalization of the musculoskeletal system). The position used does not sufficiently stimulate the relationship between the central nervous system and the central nervous system. The possibility of finding a child with cerebral palsy in this position to a small extent stimulates the immature vestibular apparatus.

A new technical task: increasing efficiency by creating conditions for eliminating pathological reflexes (SSTR, ASTR and LTE) in a patient, while reducing complications, reducing time, simplifying the method.

To solve the problem in a method of rehabilitation of children with diseases of the nervous system, including performing exercises with the child laying his back on the ball, the child is placed in an unstable, semi-vertical or vertical position, placing his back on the ball, which is limited by an inflatable tire; conduct a warm-up, alternately bending and unbending the upper and lower limbs; then, fixing the ankle joints with one hand, and holding the shoulder with the other, slowly roll the child from the ball until his feet touch the support, hold it in a semi-vertical position and, periodically freeing the shoulders, change the static position to dynamic; Further, the child’s feet are fixed at the edge of the tire and, holding it by the knee joints, help to bend and straighten the legs, and during the period when the child straightens his legs completely, using the ball as an additional support, help the child to rise to a vertical position and enable horizontal balancing in within 5-7 minutes; after that, in a vertical position, a series of leading movements in the thigh is made by each leg alternately 5-10 times; the course contains at least 15 lessons, treatment includes 3-4 courses.

The method is as follows.

The patient's age is from 1.5 years to 12 years. Before starting a child’s rehabilitation course, they are tested according to the following criteria: limitation of vital activity and social insufficiency of children according to the international nomenclature of violations. They evaluate such parameters as self-care, movement, training, game activity, orientation, communication, control over their behavior.

The number of procedures in the course is at least 15.

In the exercise room, the child is placed in the space between the tire and the ball, laid with his back on the ball, which is limited by an inflatable tire of size 13.6-38 TU 38.05.01.014-94 (diameter about 1.6 meters), the size of the ball depends on the age of the child (from 55 cm to 85 cm in diameter) (Figs. 1, 2a, b).

The body position of the child with this method of rehabilitation is unstable, semi-vertical, vertical.

A conventional warm-up for children with cerebral palsy is performed on the ball:

- bend and unbend the lower limbs in the knee joints alternately, 5-6 times;

- take and bring the thigh of each leg alternately to the side, at the time of abduction, the knee joint is bent, 5-6 times;

- take away and bring the upper limbs in turn;

- give the child to grab the hands of the methodologist or gymnastic stick for active flexion movements (for training support reactions of the arms and legs) (figure 3), 5-10 times

- the instructor fixes one hand on the ankle joints, and the other holds the child by the shoulder, stimulating to active flexion-extensor movements, 5-6 times;

- the instructor slowly “rolls” from the ball and “rolls” the child onto the ball (Fig. 2a, b), 5-6 times;

- the child’s feet are fixed at the edge of the tire, the instructor is facing the child, sitting on the camera, and holds the child by the knee joints, helping to bend - straighten the legs. At the moment when the child straightens the legs completely, the instructor offers to maintain a vertical position, using the ball as an additional support for 10-15 seconds after each series of flexion-extension, the desired number of episodes is 4-6 (based on the capabilities of the child);

- the instructor slowly helps the child to rise to a vertical position and gives him the opportunity to carry out horizontal balancing for 5-7 minutes (before touching the support with his feet), holds him in a semi-vertical position for 5-7 minutes, periodically the instructor releases the child’s shoulder girdle from insurance hand, thereby changing the static position to dynamic (Fig. 4);

- after each balancing in an upright position, a series of leading movements in the thigh is made by each leg alternately 5-10 times, thereby developing a stereotype of walking.

In this case, the tire provides support and protects in case of loss of balance from injury.

The course contains at least 15 lessons, treatment includes 3-4 courses.

Example 1

Patient K. was admitted to the rehabilitation center at the age of 2.5 with a diagnosis of intrauterine infection (IUI), CNS damage (cystic formation in the posterior cranial fossa), convulsive syndrome, motor impairment syndrome, stigma of dysembryogenesis, congenital heart disease. Weight at birth 780 g, height 29 cm, prematurity 4 degrees.

Before starting the rehabilitation course, the child was tested according to the following criteria: disability and social insufficiency of children according to the international nomenclature of violations. The following parameters were evaluated: self-service, movement, training, game activity, orientation, communication, control of one’s behavior [1].

The child was found to be incapable of self-care (grade 3 restriction). He was determined by the inability to move independently and complete dependence on other persons (grade 3 restrictions). The girl had a learning disability (grade 3 restriction). Game activity was carried out using auxiliary means (2 degree of restriction). She was not oriented in space (3 degree of restriction). Communicated with the help of assistive devices and with the help of other persons (2 degree of restriction). The girl did not control her behavior.

Given the limitations of life, we were diagnosed with ICD-10:

G 80,1-cerebral palsy; spastic diplegia of the lower extremities; G 91 - mixed, internal and external hydrocephalus; F 80.2 - expressive speech disorder (OHP-2); H 35 - retinopathy of premature grade 3 OD; H 55 - horizontal nystagmus; H 52.2 - myopic astigmatism; Q 67.4 - deformation of the nasal septum; J 35.1 - hypertrophy of the tonsils.

The child was given 4 courses of rehabilitation treatment (rehabilitation) according to the proposed method. The number of procedures in the course of 15.

1. In the exercise room, the child was laid with his back on the ball, which is limited by an inflatable tire measuring 13.6-38 TU 38.05.01.014-94 (diameter about 1.6 meters).

2. The body position of the child is unstable, semi-vertical, vertical.

3. On the ball, a generally accepted warm-up was performed for children with cerebral palsy - flexion and razboobraznye exercises to warm the limbs.

4. Next, the instructor fixed one arm on the ankle joints, and the other held the child by the shoulder.

5. The instructor slowly rolled the child from the ball until he touched his feet support and held him in a semi-vertical position for 5-7 minutes. Periodically, the instructor released the child’s shoulder girdle from hand insurance, thereby changing the static position to dynamic.

6. The instructor slowly helped the child to rise to a vertical position and gave him the opportunity to carry out horizontal balancing for 5-7 minutes. After each balancing in an upright position, a series of adducing movements in the thigh were made with each leg alternately 5-10 times, thereby developing a stereotype of walking.

Assessment of the condition of the child was carried out after a year. The child was tested according to the criteria: disability and social insufficiency of children according to the international nomenclature of violations. The following parameters were evaluated: self-service, movement, training, game activity, orientation, communication, control of one’s behavior. The child has the ability to self-service with the help of assistive devices and other persons (2 degree of restriction).

Movement. She began to move independently using assistive devices and other persons (2 degree of restriction). The child began to study in a rehabilitation center under a special program (1 degree of restriction). Game activity began to improve (1 degree of restriction). The child disappeared disorientation (2 degree of restriction). The ability to communicate has improved (1 degree of restriction). The girl began to control her behavior (2nd degree of restriction).

To justify the proposed method, 60 children with various forms of cerebral palsy were examined. Assessment of their condition was carried out before and after treatment according to the proposed method.

The limitation of children's life and social deficiency was assessed by the international nomenclature of violations. As a result of rehabilitation according to the proposed method, a positive dynamics was observed in all children according to all criteria of limitation of vital activity. Of particular value is the reduction of the most pronounced degree of restriction as a result of rehabilitation. So, 22 children had the third degree of self-care restriction, after using this methodology, the third-degree self-care restriction remained in 12 children. Restriction of movement of the 3rd degree was observed in 18 children, and after rehabilitation in 8, learning disabilities were noted in 29 children, the 3rd degree of restriction, after applying this technique, 18 children retained the third degree. Game activity of the third degree of restriction was in 19 children; after rehabilitation, the third degree was retained by 7 children. Orientation was severely impaired in 19 children; after applying this technique, 8 children retained the third degree of restriction. Communication difficulties before rehabilitation were observed in 12 children; after rehabilitation, only 2 children had a third degree of restriction in this parameter. 14 children with a third degree of restriction did not control their behavior, and after rehabilitation they retained the third degree of restriction of 5 children (see table, diagram).

The fundamental in the selection of elements, the sequence of their implementation, the volume of the load in the proposed method was the following: accounting and gradual increase in physical activity, its versatile nature to increase coordination capabilities, development of the functions of the cardiovascular and respiratory systems, overall performance, an adequate amount of individual exercises for the formation of a motor stereotype, the use of the game method to create conditions for the implementation of success, taking into account age and nutritional features in the education of physical qualities. Improving the effectiveness of rehabilitation is associated, on the one hand, with the creation of conditions for the expansion of motor activity, and on the other, with the child staying in an upright position, body verticalization, training the vestibular apparatus, normalizing spatial perceptions and increasing the patient's functional capabilities.

Moreover, as a result of using the proposed method, an improvement in the state of the muscles of the chest was noted due to the achievement of optimal synergies between the muscles of the neck, which allow to keep the head as close as possible to the physiological state. Decreased tone of the pectoralis major muscles. It was also noted a reduction in the execution time of the method for obtaining a stable therapeutic effect with a significant simplification of the method — the absence of the need for complex simulators, special suits, the best psychological tolerance on the part of patients who perceive the rehabilitation measures as a game.

Information sources

1. The international nomenclature of violations, disabilities and social insufficiency (II section "Nomenclature of violations", Ministry of Health of Russia, Moscow, 1995).

2. Order No. 535, Ministry of Health and Social Development of Russia, August 22, 2005.

3. Semenova K.A. To questions about the possibility of correcting disturbed movements of the upper limbs in patients with cerebral palsy. Anniversary almanac "Healing". - Moscow, 2000.

4. Semenova K.A. Reconstructive treatment of patients with residual stage of cerebral palsy. - Moscow, 1999.

5. Semenova K.A. Reconstructive treatment of patients with cerebral palsy. // Neurological journal. - 1997, No. 1.

6. Semenova K.A., Mastyukova E.M., Smuglin M.Ya. Clinic and rehabilitation therapy for children with cerebral palsy. - Moscow: Medicine, 1972.

7. Schenk N.A. Therapeutic exercises and massage for children with paralysis. - Medgiz, 1956

Claims (1)

A method of rehabilitation of children with diseases of the nervous system, including performing exercises with laying the child with his back on the ball, characterized in that the child is placed in an unstable, semi-vertical or vertical position, placing his back on the ball, which is limited by an inflatable tire, carry out a warm-up, bending and unbending the upper and lower limbs, then, fixing the ankle joints with one hand and holding the shoulder with the other, slowly roll the child from the ball until the feet touch his feet, hold him in the semi-vertical floor When the child’s legs are lifted and periodically freeing his shoulders, they change their static position to dynamic, then the child’s feet are fixed at the edge of the tire and, holding it by the knee joints, help to bend and straighten the legs, and during the period when the child straightens his legs completely using the ball as an additional support , help the child to rise to a vertical position and make it possible to carry out horizontal balancing for 5-7 minutes, then in a vertical position make a series of adducing movements in the thigh with each leg alternately 5-10 times, the course contains at least 15 lessons, treatment includes 3-4 courses.

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