RU2361524C1 - Method of estimation of functional state of disabled people with low limb pathology and choosing type and intencity of physical exercise in process of rehabilitation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to sport medicine and therapeutic physical training. Patient performs functional tests in form of physical exercise before and after rehabilitation. At rest, in initial sitting position, disabled person's AP₀ is measured and HCF for 10 sec (P₀) is calculated, disabled person is placed into lying on stomach position and they perform 30 press-ups from couch for 30 sec, obtaining physical loading, then disabled person is placed in sitting position and their HCF is counted during recovery period during first sec of recovery (P_1a), from 20-th to 40-th seconds of first minute of recovery AP₁ is measured during last 10 sec of first minute of recovery HCF (P_1b) is measured again, similar measurements are performed on second- fifth minutes of recovery, Rouffier's index (RI) is calculated by special formula. Response of cardio-vascular system is estimated as excellent if values of RI are less than 0, if RI is from 0 to 5 - as good, if RI is from 6 to 10 - satisfactory, if RI is from 10 to 15 - weak, if RI is more than 15 - unsatisfactory, by AP change type of cardiovascular system (CVS) response is estimated as normotonic, dystonic, hypertonic, with step rise of AP or hypotonic; if type of response is normotonic and RI is excellent or good, state of cardio-vascular system is estimated as good, adaptability to physical exercise as high, there are indications that disabled people can do adaptive physical exercise and sport without limitation; if type of response is normotonic and RI is weak or unsatisfactory, conclusion about reduction of functional state of cardiovascular system is made, adaptability to physical exercise is low, there are indications that disabled people can do physical exercise with moderate loading in aerobic mode; if type of response is dystonic with drop of diastolic pressure to zero during first-second minute of recovery and if RI is excellent or good or satisfactory, state of cardio-vascular system is estimated as good, adaptability to physical loading as high, there are indications that disabled people can do adaptive physical exercises and sport without limitation; if type of response is dystonic with drop of diastolic pressure to zero more than 2 minutes of recovery, slowing down of HCF and AP recovery and RI estimation as weak or unsatisfactory, conclusion about reduction of functional state of cardio-vascular system is made, adaptability to physical lading is weak, there are indications that disabled people can do physical training with moderate loading in aerobic mode; if type of response is hypertonic and RI estimation is weak or unsatisfactory, conclusion about reduction of functional state of cardio-vascular system is made, adaptability to physical loading is weak, there are indications that disabled people can do therapeutic physical training under HCF and AP control, with small and lower than average intensity, exercises with bending, circle head movements, abrupt movements with large amplitude are limited; if type of response is with step increase of AP, irrespective of RI estimation, conclusion about reduction of functional ability of cardio-vascular system is made, adaptability to physical loading is weak, there are indications that disabled people can do exercises with loading lower than average with extension of movement loading; if type of response is hypotonic and RI estimation is weak or unsatisfactory, conclusion about reduction of functional ability of cardio-vascular system is made, there are indications that disabled people can do therapeutic exercises with loading lower than average, with change of initial positions, stimulating venous return, upturned positions are eliminated. RI index is evaluated in dynamics of training process and if RI decreases, conclusion about improvement of high training of disabled person is made.

EFFECT: ensuring possibility to dose physical loading and choose form of physical loading in process of disabled people rehabilitation, as well as to estimate functional state of disabled person in dynamics.

3 cl, 9 tbl, 5 ex

Description

The invention relates to medicine, namely to sports medicine, physiotherapy and rehabilitation, can be used to dose physical activity, assess the effectiveness of rehabilitation of disabled people with pathology of the lower extremities and to increase the effectiveness of training athletes with disabilities.

In recent years, much attention has been paid to improving the quality of life of people with disabilities with a pathology of the musculoskeletal system. Movement activity helps to improve the work of internal organs, visits to sports clubs, participation in sporting events expands the circle of people with disabilities with pathology of the musculoskeletal system, and serves as an important factor in social rehabilitation. In order to be beneficial, physical activity must correspond to the state of health of the disabled person, primarily the functional state of the cardiorespiratory system.

In sports medicine, there are a large number of functional tests designed to assess the response of the cardiorespiratory system to physical activity. Most samples are for healthy people. As a motor load, these tests include squats, climbing a step, running [Graevskaya ND, Dolmatova TI Sports medicine: a course of lectures and practical exercises. - M.: Soviet Sport, 2004. - S.175-190]. Similar tests: squats, lifts, offer to apply for disabled people using prostheses of the lower extremities [Kurdybaylo SF, Evseev SP, Gerasimova GV Medical control in adaptive physical education. - M .: "Soviet Sport, 2004. - P.78-88].

For disabled people with severe pathology of the lower extremities, these types of physical activity are not physiological, they are very difficult in terms of coordination of movements and inconvenience, since not all designs of prostheses and orthoses of the lower extremities allow squats.

A special method has been developed for dosing physical activity of persons who have lost lower limbs [Yu.A. Kobzev, V.V. Hramov RF application for invention No. 2002105293/14, Method for dosing the physical load of persons who have lost lower limbs of February 26, 2002], which consists in the fact that the subject performs successive ascents and descents along an inclined plane with the help of muscular arm strength. The power of physical activity is determined by the formula taking into account the height of the climb, the frequency of ascents and the angle of inclination of the plane.

This method has the following disadvantages: it does not take into account the reaction of the test cardiorespiratory system to the load; Only the muscles of the upper extremities and the shoulder girdle are involved in the physical work, while the samples evaluating the response of the cardiorespiratory system to physical activity should include as much muscle mass as possible to maximize activation of the circulatory system.

Closest to the claimed is a method for assessing the functional state of patients with pathology of the joints of the lower extremities during rehabilitation [Buylova T.V., Donchenko E.V., Dorofeeva G.I. The application of the Russian Federation for the invention No. 203104240/14, M.cl. 7 А61В 5/11 dated February 12, 2003, publ. BIPM No. 22 10.08. 2004, p. 41], consisting in a study before and after treatment of the following functional signs: the maximum number of lifts from a high chair; the smallest stool from which the patient can rise; the height of the step to which the patient can climb, and comparing the growth of each sign in% to the initial one and the assessment of the growth in points. The dynamics of the patient's condition is assessed as "slight improvement", "improvement" or "significant improvement".

The method has the following disadvantages:

1. It allows you to evaluate only the function of the lower extremities, while the functional state of a person is largely limited by the state of the cardiovascular system.

2. The method can be used only in patients with the ability to stand, walk, climb stairs, but patients with lower paraplegia, gross paraparesis, arthrosis of large joints of the lower extremities do not have this possibility, therefore, the method cannot be used in these patients.

3. In this way, it is impossible to determine the tolerance of physical activity by the patient and give recommendations on its dosage.

4. The use of the method cannot help in resolving the issue of admitting a disabled person to engage in adaptive physical education and sports.

5. The method cannot be used to determine the effect of physical training on the cardiovascular system of a disabled person.

The objective of the invention is the creation of a better and more accurate way to assess the reaction of the cardiovascular system to physical activity in people with disabilities with lower limb pathology during rehabilitation through the use of qualitative and quantitative assessments, to develop a method that allows you to dose physical activity and choose the type of physical activity during rehabilitation disabled people, as well as assess the functional state of the disabled person in dynamics.

The task is achieved by the following set of features. The method includes performing functional tests in the form of physical activity before and after rehabilitation.

At rest, in the initial position of the disabled person sitting, they measure blood pressure ₀ and calculate heart rate for 10 s (P ₀ ), put the disabled person in the supine position and he performs 30 push-ups from the couch for 30 seconds, receiving physical activity, then transfer the disabled person to the sitting position and during the recovery period, heart rate is calculated during the first 10 seconds of recovery (P _1a ), from the 20th to 40th seconds of the first minute of recovery, blood pressure _{1 is} measured, in the last 10 seconds of the first minute of recovery, heart rate is measured again (P _1b ), similar measurements are carried out in the second to fifth minutes of recovery.

The Ruffier index (IR) is calculated and the reaction of the cardiovascular system is evaluated for IR values less than 0 - excellent, for IR from 0 to 5 - good, for IR from 6 to 10 - mediocre, for IR from 11 to 15 - weak, for IR more than 15 - unsatisfactory.

The change in blood pressure assesses the type of reaction of the cardiovascular system (CCC) as normotonic, dystonic, hypertonic, with a stepwise rise in blood pressure or hypotonic.

With the normotonic type of reaction and the assessment of IR, the state of the cardiovascular system is assessed as good or good or mediocre as good, adaptability to physical activity is high, people with disabilities are shown adaptive physical education and sports without restriction.

With the normotonic type of reaction and the assessment of IR, a decrease in the functional state of the cardiovascular system is poorly or unsatisfactory, physical fitness is weak, physical education classes with moderate aerobic exercise are indicated for people with disabilities.

In the dystonic type of reaction with a decrease in diastolic pressure to zero in the first or second minutes of recovery and assessment of IR, the state of the cardiovascular system is assessed as good or good or mediocre as good, adaptability to physical activity is high, people with disabilities are shown adaptive physical education and sports without restrictions.

In case of a dystonic type of reaction with a decrease in diastolic pressure to zero for more than 2 minutes of recovery, a slowdown in heart rate and blood pressure recovery and an assessment of IR, a decrease in the functional state of the cardiovascular system is poorly or unsatisfactory, physical fitness is weak, exercise is moderate for people with disabilities in aerobic mode.

With the hypertonic type of reaction and the assessment of IR, a decrease in the functional state of the cardiovascular system is poorly or unsatisfactory, physical fitness is weak, physical therapy classes under the control of heart rate and blood pressure are shown to people with disabilities, with an intensity of small and lower than average, they limit exercises with inclines, circular movements of the head, sharp movements of large amplitude.

With the type of reaction with a step-wise rise in blood pressure, regardless of the assessment of IR, a decrease in the functional ability of the cardiovascular system is judged, physical fitness is weak, people with disabilities are shown exercises with a load below the average with a gradual expansion of the motor load.

With a hypotonic type of reaction and an assessment of IR, a decrease in the functional ability of the cardiovascular system is poorly or unsatisfactorily shown, people with physical exercises with a load below the average are shown to people with disabilities, with a change in initial positions that stimulate venous return, inverted postures are excluded.

The Ruffier index (IR) is calculated by the formula:

IR = [6 × (P ₀ + P _1a + P _1b ) -200]: 10

Where:

IR - Ruffier index;

P ₀ - heart rate in the initial position sitting for 10 seconds, beats .;

P _1a - heart rate in the first 10 seconds of recovery, beats;

R _1b - heart rate during the last 10 seconds of the first minute of recovery, beats.

The IR index is determined in the dynamics of the training process, and with a decrease in IR, an increase in the fitness level of a disabled person is judged.

The type of reaction of the cardiovascular system in the dynamics of the training process is determined, and when the type of reaction to the normotonic is changed, an increase in the functional state of the cardiovascular system of the disabled person is judged.

The novelty of the invention:

- At rest in the initial position of a disabled person sitting, they measure blood pressure ₀ and calculate heart rate for 10 s (P ₀ ). The disabled person is placed in a supine position and he performs 30 push-ups from the couch for 30 s, receiving physical activity, then the disabled person is placed in a sitting position and during the recovery period, heart rates are measured several times in different periods, blood pressure is measured ₁ , similar measurements are carried out on the second- fifth minute recovery.

The Ruffier index (IR) is calculated and the response of the cardiovascular system is evaluated.

The change in blood pressure assesses the type of reaction of the cardiovascular system (CCC) as normotonic, dystonic, hypertonic, with a stepwise rise in blood pressure or hypotonic.

These qualitative and quantitative indicators assess the state of the cardiovascular system, adaptability to physical activity, allow people with disabilities to engage in adaptive physical education and sports, dose physical activity and choose its type.

Determine the IR in the dynamics of the training process and, with a decrease in the IR, judge about improving the fitness of the disabled person.

The type of reaction of the cardiovascular system in the dynamics of the training process is determined, and when the type of reaction to the normotonic is changed, an increase in the functional state of the cardiovascular system of the disabled person is judged.

A comparative analysis of the proposed method and prototype shows that it has a new set of features and meets the criterion of "novelty."

A new set of features allows you to get the following technical result:

- to better carry out rehabilitation and physical training of people with disabilities with severe pathology of the lower extremities by individual dosage of physical activity,

- to determine indications for adaptive sports, to decide on the admission of disabled athletes to sports competitions,

- allows you to monitor the effectiveness of adaptive physical education and sports, motor rehabilitation of people with disabilities according to the reaction of the cardiovascular system to physical activity, timely make adjustments to the training system.

The principles of assessing the quality of the reaction:

The normotonic type of reaction of the cardiovascular system to physical activity is characterized by: an increase in heart rate appropriate to the intensity and duration of the work performed; an adequate increase in pulse pressure due to an increase in SBP and a slight decrease in DBP; 3 minutes of recovery of heart rate and blood pressure to their original values. The normotonic type of reaction reflects the body's good adaptability to physical activity.

The dystonic type of reaction is characterized by: inadequate exercise and increased heart rate; increasing or, conversely, falling DBP to 0 (the phenomenon of “infinite tone”); a significant increase in SBP. When DBP returns to its initial values in the 1-2 minutes of recovery, this type of reaction can be regarded as a variant of the norm; while maintaining the "phenomenon of infinite tone" for a longer time - as an unfavorable sign.

The hypertonic type of reaction is characterized by: inadequate load, increased heart rate and SBP; increase in DBP; slow recovery. The hypertonic type of reaction indicates a violation of the regulation of vascular tone upward.

A reaction with a stepwise increase in maximum blood pressure is characterized by: a sharp increase in heart rate; the increase in the GARDEN lasting in the first 2-3 minutes of rest; slow recovery of heart rate and blood pressure. Such a reaction indicates a lack of adaptability of the circulatory apparatus to stress loads.

The hypotonic type of reaction is characterized by: a sharp, inadequate load increase in heart rate; a slight increase or unchanged GARDEN; a slight decrease, increase or unchanged DBP; as a result, PD increases by 12–25%, or does not change, a decrease in PD is possible; lengthening the recovery period. This type of reaction indicates a significant decrease in the functional abilities of the cardiovascular system.

To assess the response of the cardiovascular system to physical activity and the recovery rate in healthy people, the use of Ruffier’s test is known [G. Makarova Sports medicine. - M .: "Soviet Sport", 2002. - 478 p.]. The sample includes a heart rate (HR) count. Initially at rest, heart rate (P ₀ ) is calculated. Then the athlete performs 30 squats in 30 s, after which he has the heart rate again (P _1a and P _1b ) in his sitting position for the first 10 seconds and the last 10 seconds of the first minute of recovery. Similar measurements are carried out in the second and third minutes of rest. The calculation of the Ruffier index (IR) is performed according to the formula:

IR = [6 × (P ₀ + P _1a + P _1b ) -200]: 10

Principles of assessment: excellent - IR <0; good - IR from 0 to 5; mediocre - IR from 6 to 10; weak - IR from 11 to 15; unsatisfactory - IR> 15.

The advantage of the test is its simplicity, the possibility of using it in a medical and physical education clinic, a department of physical therapy, a rehabilitation center, and a sports club for the disabled. Sample results are quantified (numerical value of the Ruffier index). This makes it possible to more accurately track the dynamics of the reaction of the cardiovascular system to physical activity during comparative studies, studying the state of the body of a disabled person in dynamics.

The disadvantage of this method is the impossibility of a qualitative assessment of the results of the test, in relation to people with disabilities with severe pathology of the musculoskeletal system, another disadvantage is that people with disabilities cannot perform squats. Therefore, in the proposed method, this test is performed in a new way.

As physical exercise, we use push-ups from the couch, while all the muscles of the human body are included in physical activity. The muscles of the shoulder girdle and upper limbs work alternately in the inferior and overcoming modes, making movement, and the muscles of the trunk, pelvic girdle, lower extremities (if any) work in a holding mode as fixators and stabilizers.

The proposed method is as follows. After 5 minutes of calm sitting in a disabled person, blood pressure is measured and heart rate is calculated for 10 s (P ₀ ). Then the disabled person performs 30 push-ups (flexion and extension of the arms in the supine position) from the couch for 30 s, after which his heart rate is again counted in the sitting position during the first 10 seconds of recovery (P _1a ), from the 20th to the 40th the first minute of rest is measured by blood pressure, the last 10 s again measure heart rate (P _1b ). Similar measurements are carried out in the second and third minutes of rest. The calculation of the Ruffier index (IR) is performed according to the formula:

IR = [6 × (P ₀ + P _1a + P _1b ) -200]: 10.

Assess the type of reaction (qualitative assessment): normotonic, dystonic, hypertonic, with stepwise rise in blood pressure or hypotonic, and the Ruffier index (qualitative and quantitative assessment).

The normotonic type of reaction at Ruffier index values from negative to 10 with an assessment of excellent, good or mediocre reflects the good functional state of the cardiovascular system, high adaptability to physical activity. Persons with disabilities are shown adaptive physical education and sports without restrictions. A decrease in the Ruffier index in the dynamics of the training process indicates an increase in the fitness of a disabled athlete.

The normotonic type of reaction with Ruffier index values from 10 to 15 and higher, with an assessment of poorly or unsatisfactorily, indicates a decrease in the functional state of the cardiovascular system, poor adaptability to physical activity. Persons with disabilities are shown physical education with moderate exercise in aerobic mode.

The dystonic type of reaction with a drop in diastolic pressure to 0 in 1-2 minutes of the recovery period and the Ruffier index from negative values to 10, with an assessment of excellent or good or mediocre, reflects the good functional state of the cardiovascular system, high adaptability to physical stress. Persons with disabilities are shown adaptive physical education and sports without restrictions. A decrease in the Ruffier index in the dynamics of the training process indicates an increase in the fitness of a disabled athlete.

The dystonic type of reaction with a drop in diastolic pressure to 0 more than 2 minutes of the recovery period, slower recovery of heart rate or blood pressure and a Ruffier index of more than 10, with an assessment of weak or unsatisfactory, indicates a decrease in the functional state of the cardiovascular system, poor adaptability to physical activity. Persons with disabilities are shown physical education with moderate exercise in aerobic mode.

The hypertonic type of reaction is always accompanied by a Ruffier index of more than 10, with a rating of weak or unsatisfactory. This type of reaction indicates a decrease in the functional ability of the cardiovascular system, poor adaptation to physical activity. Persons with disabilities are shown physical therapy classes under the control of heart rate and blood pressure, the intensity is low and below average, exercises with inclinations, circular head movements, and sharp movements of large amplitude are limited. A tendency to change the type of reaction towards normotonic and a decrease in the absolute values of the Ruffier index will indicate an increase in the functional state of the cardiovascular system.

The type of reaction with a step-wise rise in blood pressure, regardless of the values of the Ruffier index, indicates a decrease in the functional ability of the cardiovascular system, poor adaptation to physical activity. Disabled people are shown training with a load below the average with a gradual expansion of the motor load. If a disabled athlete showed this type of reaction against a background of great physical exertion, he is recommended to rest for 10 days, followed by a gradual expansion of the training regime under the control of a functional test. A tendency to change the type of reaction towards normotonic and a decrease in the absolute values of the Ruffier index will indicate an increase in the functional state of the cardiovascular system.

The hypotonic type of reaction with a Ruffier index of more than 10, with a rating of weak or unsatisfactory, indicates a decrease in the functional ability of the cardiovascular system, poor adaptation to physical activity. Persons with disabilities are shown physical therapy exercises with a load below the average, a change in initial positions that stimulate venous return. Inverted poses are excluded.

Example 1. Disabled K.M., 25 years old, stump, etc., lower leg, lion. hips. From the anamnesis of life: a disabled person monitors his health, leads an active lifestyle, regularly engages in physical education. Upon receipt of rehabilitation for a disabled person, a modified Ruffier test was performed. After 5 minutes of quiet sitting, his blood pressure was measured at 120/80 and heart rate was calculated for 10 s P ₀ = 11. Then the disabled person performed 30 push-ups from the couch in 30 s, after which his heart rate P _1a = 20 was again calculated in his sitting position during the first 10 seconds of recovery, from the 20th to the 40th from the first minute of rest, he measured HELL 140/75, the last 10 s re-calculated heart rate R _1b = 17. Similar measurements were carried out in the second to fifth minutes of the recovery period. The results are listed in the table (Table 1).

Table 1 Assessment of the response of the cardiovascular system to physical activity before rehabilitation Indicator Originally Recovery period 1 minute 2 minutes 3 minutes 4 minutes 5 minutes Heart rate, beats for 10 s eleven twenty 16 fifteen 12 eleven GARDEN, mm Hg 120 140 130 130 120 120 DBP, mm Hg 80 75 80 80 80 80 Heart rate, beats for 10 s 17 fifteen 13 12 eleven

Ruffier index calculation:

IR = [6 × (11 + 20 + 17) -200]: 10 = 8.8

Conclusion: the response to physical activity is normotonic. Ruffier index rating is mediocre. Endurance training is recommended to increase the tolerance of the cardiovascular system to physical activity.

During his stay in the rehabilitation center, the athlete worked on simulators, performed a set of gymnastic exercises in aerobic mode. After 3 weeks, the test was repeated by the same method. The results are listed in table 2.

table 2 Assessment of the reaction of the cardiovascular system to physical activity after rehabilitation Indicator Originally Recovery period 1 minute 2 minutes 3 minutes 4 minutes 5 minutes Heart rate, beats for 10 s eleven eighteen fifteen fourteen 12 eleven GARDEN, mm Hg 120 140 130 130 120 120 DBP, mm Hg 80 75 80 80 80 80 Heart rate, beats for 10 s fifteen fourteen 12 12 eleven

Ruffier index calculation:

IR = [6 × (11 + 18 + 15) -200]: 10 = 6.4

Conclusion: the response to physical activity is normotonic. The assessment of the Ruffier index remains mediocre, but the numerical value of the index has decreased. It is recommended to continue training in the selected mode.

Example 2. Invalid PK, 28 years old, traumatic disease of the spinal cord, late period, syndrome of partial conduction disturbance in the spinal cord from a level of Th ₅ , lower spastic paraparesis. From the anamnesis of life: at home she is not regularly engaged in physical education, when she enters the rehabilitation center she is regularly involved in physical education.

Upon receipt of rehabilitation for a disabled person, a modified Ruffier test was performed. After 5 minutes of calm sitting, his blood pressure was measured 110/70 and his heart rate was calculated for 10 s P ₀ = 11. Then the disabled person performed 30 push-ups from the couch for 30 s, after which his heart rate P _1a = 22 was again counted in his sitting position during the first 10 seconds of recovery, from the 20th to the 40th from the first minute of rest, the BP 115/70 was measured, the last 10 s again counted heart rate P _1b = 20. Similar measurements were carried out in the second or fifth minute of rest. The results are listed in the table (Table 3).

Table 3 Assessment of the response of the cardiovascular system to physical activity before rehabilitation Indicator Originally Recovery period 1 minute 2 minutes 3 minutes 4 minutes 5 minutes Heart rate, beats for 10 s eleven 22 twenty 16 fifteen fifteen GARDEN, mm Hg 110 115 115 110 110 110 DBP, mm Hg 70 70 70 70 70 70 Heart rate, beats for 10 s twenty eighteen fifteen fifteen fifteen

Ruffier index calculation:

IR = [6 × (11 + 22 + 20) -200]: 10 = 11.8

Conclusion: the response to physical activity is hypotonic, the assessment of the Ruffier index is weak. Endurance training is recommended with a change in initial positions while sitting, standing on all fours and lying down to enhance venous return and increase the tolerance of the cardiorespiratory system to physical exertion.

During his stay in the rehabilitation center, a disabled person worked on simulators in a horizontal and inverted position, performed a set of gymnastic exercises in aerobic mode with a change of initial positions while sitting, standing on all fours, lying down. After 3 weeks, the test was repeated by the same method. The results are listed in table 4.

Table 4 Assessment of the reaction of the cardiovascular system to physical activity after rehabilitation Indicator Originally Recovery period 1 minute 2 minutes 3 minutes 4 minutes 5 minutes Heart rate, beats for 10 s eleven twenty 16 fourteen 12 eleven GARDEN, mm Hg 120 140 130 130 125 120 DBP, mm Hg 70 70 70 70 80 80 Heart rate, beats for 10 s 16 fourteen 12 eleven eleven

Ruffier index calculation:

IR = [6 × (11 + 20 + 16) -200]: 10 = 8.2

Conclusion: the response to physical activity is normotonic. The evaluation of the Ruffier index turned from a weak to mediocre, the numerical value of the index decreased. It is recommended to continue training in the selected mode.

Example 3. Disabled K. G., 52 years old. Diagnosis: traumatic disease of the spinal cord, late period, a syndrome of complete impairment of conduction from level L ₁ . Lower flaccid paraplegia. From the anamnesis of life: at home, does not engage in physical exercises, motor activity is limited to self-care. During his stay in the rehabilitation center, he is engaged under appropriate supervision.

Upon receipt of rehabilitation for a disabled person, a modified Ruffier test was performed. After 5 minutes of calm sitting, his blood pressure was measured at 140/90 and his heart rate was calculated for 10 s P ₀ = 14. Then the disabled person performed 30 push-ups from the couch in 30 s, after which his heart rate R _1a = 25 was again calculated in his sitting position during the first 10 seconds of recovery, from the 20th to the 40th from the first minute of rest, he measured BP 190/130, the last 10 s re-calculated heart rate R _1b = 22. Similar measurements were carried out in the second or fifth minute of rest. The results are listed in the table (Table 5).

Table 5 Assessment of the response of the cardiovascular system to physical activity before rehabilitation Indicator Originally Recovery period 1 minute 2 minutes 3 minutes 4 minutes 5 minutes Heart rate, beats for 10 s fourteen 25 21 17 16 fifteen GARDEN, mm Hg 140 190 170 160 155 150 DBP, mm Hg 90 130 120 110 110 one hundred Heart rate, beats 10 s 22 eighteen 16 16 fifteen

Ruffier index calculation:

IR = [6 × (14 + 25 + 22) -200]: 10 = 16.6

Conclusion: the response to physical activity is hypertonic, the Ruffier index rating is unsatisfactory. Endurance training is recommended with caution under the control of blood pressure and heart rate in the initial positions while sitting and standing in the knee. Exclude circular movements and tilts of the head.

During his stay in a rehabilitation center, a disabled person was engaged under the supervision of a methodologist. After 3 weeks, the test was repeated by the same method. The results are listed in table 6.

Table 6 Assessment of the reaction of the cardiovascular system to physical activity after rehabilitation Indicator Originally Recovery period 1 minute 2 minutes 3 minutes 4 minutes 5 minutes Heart rate, beats for 10 s 13 23 21 eighteen fourteen fourteen GARDEN, mm Hg 140 185 165 155 155 155 DBP, mm Hg 90 125 120 90 90 90 Heart rate, beats for 10 s 22 19 16 fourteen fourteen

Ruffier index calculation:

IR = [6 × (13 + 23 + 22) -200]: 10 = 14.8

Conclusion: the reaction to physical activity is still hypertonic. Estimation of the Ruffier index from unsatisfactory turned into a weak one, the numerical value of the index decreased very slightly. It is recommended at home to continue the implementation of the learned set of physical exercises under the control of heart rate and blood pressure.

Example 4. Disabled person 1 group, 30 years. Diagnosis: stumps of both thighs. From the anamnesis of life: a disabled person trains independently, performs at competitions in athletics in wheelchair races.

Applied for admission to sports competitions. A modified Ruffier test was performed. After 5 minutes of quiet sitting, his blood pressure was measured at 130/85 and heart rate was calculated for 10 s P ₀ = 12. Then the disabled person performed 30 push-ups from the couch in 30 s, after which his heart rate R _1a = 24 was again calculated in his sitting position during the first 10 seconds of recovery, from the 20th to the 40th from the first minute of rest, he measured HELL 140/80, the last 10 s re-calculated heart rate R _1b = 20. Similar measurements were carried out in the second or fifth minute of rest. The results are listed in the table (Table 7).

Table 7 Assessment of the response of the cardiovascular system to physical activity before rehabilitation Indicator Originally Recovery period 1 minute 2 minutes 3 minutes 4 minutes 5 minutes Heart rate, beats for 10 s 12 24 twenty eighteen fifteen fifteen GARDEN, mm Hg 130 140 150 140 135 130 DBP, mm Hg 85 80 85 85 80 80 Heart rate, beats for 10 s twenty eighteen 16 fifteen fifteen

Ruffier index calculation:

IR = [6 × (12 + 24 + 20) -200]: 10 = 13.6

Conclusion: response to physical activity with a step-wise rise in blood pressure, the Ruffier index score is weak. Given that the athlete trained independently, without special education and without the supervision of a coach, you can think about overtraining. Not allowed to compete. Recommended: rest for 10 days, protein-potassium diet, sleep 8-10 hours a day, re-examination after 10 days.

The athlete complied with the recommendations. After 10 days, the sample was repeated. The results are listed in the table (Table 8)

Table 8 Assessment of the response of the cardiovascular system to physical activity after rest Indicator Originally Recovery period 1 minute 2 minutes 3 minutes 4 minutes 5 minutes Heart rate, beats for 10 s 12 twenty eighteen 16 fourteen 12 GARDEN, mm Hg 120 150 140 130 130 120 DBP, mm Hg 80 80 80 80 80 80 Heart rate, beats for 10 s eighteen 16 fourteen 13 12

Ruffier index calculation:

IR = [6 × (12 + 20 + 18) -200]: 10 = 10.0

Conclusion: the response to physical activity is normotonic, the assessment of the Ruffier index is mediocre. The athlete is recommended to gradually expand the training regime with the limitation of speed-power loads, with a slow increase in the intensity of endurance training. It is recommended to train under the guidance of a coach. Re-examination after 1 month.

Example 5. Disabled L.T., 27 years old. Diagnosis: traumatic disease of the spinal cord, late period, a syndrome of complete impaired conduction from level L ₁ , lower flaccid paraplegia. From the anamnesis of life: engaged in athletics - wheelchair racing for 4 years under the guidance of a coach. Successfully performs in competitions.

Applied for admission to sports competitions. A modified Ruffier test was performed. After 5 minutes of calm sitting, his blood pressure was measured 110/70 and heart rate was calculated for 10 s P ₀ = 10. Then the disabled person performed 30 push-ups from the couch in 30 s, after which his heart rate R _1a = 17 was again calculated in his sitting position during the first 10 seconds of recovery, from the 20th to the 40th from the first minute of rest, he measured BP 140/0, the last 10 s re-calculated heart rate R _1b = 14. Similar measurements were carried out in the second and third, fourth and fifth minutes of rest. The results are listed in the table (Table 9).

Table 9 Assessment of the reaction of the cardiovascular system to the physical activity of a disabled athlete before the competition Indicator Originally Recovery period 1 minute 2 minutes 3 minutes 4 minutes 5 minutes Heart rate, beats per 10 s 10 17 fourteen 13 12 eleven GARDEN, mm Hg 110 140 130 120 110 110 DBP, mm Hg 70 0 fifty 60 60 70 Heart rate, beats per 10 s fourteen 13 13 12 eleven

Ruffier index calculation:

IR = [6 × (10 + 17 + 14) -200]: 10 = 4.6

Conclusion: the reaction to physical activity is dystonic, the Ruffier index score is good. Given that the athlete regularly trains for endurance, such a reaction indicates a high functional ability of the cardiovascular system. Talks about good training. Admitted to the competition.

The method is used at the Federal State Institution Novokuznetsk Scientific and Practical Center for Medical and Social Expertise and Rehabilitation of Persons with Disabilities, at the Faculty of Physical Culture of the Kuzbass State Pedagogical Academy and at the Novokuznetsk Municipal Medical and Physical Dispensary.

The technical result of using the method is a more accurate determination of the functional state of the cardiovascular system of persons with disabilities with severe pathology of the lower extremities; the ability to competently solve the issue of admitting disabled athletes to adaptive physical education and sports; dosage of physical exertion in the process of practicing medical, adaptive physical education and sports, which ultimately determines an increase in the effectiveness of rehabilitation of disabled people with severe pathology of the lower extremities.

Claims (3)

1. A method for assessing the functional state of people with disabilities with pathology of the lower extremities and choosing the type and intensity of physical activity during rehabilitation, including performing functional tests in the form of physical activity before and after rehabilitation, characterized in that at rest in the initial position of a disabled person sitting, they measure blood pressure ₀ and HR counted for 10 sec (P ₀₎ is converted into a disabled pronation and it performs push-ups on the couch 30 for 30 seconds to obtain exercise, then transferred to a disabled position between sitting and Restore occurrence count heart rate during the first 10 s recovery (P _1a), the 20th to 40th of a second first minute recovery measured BP ₁ in the last 10 with the first minute recovery again measured heart rate (R _1b), similar measurements carried out at the second the fifth minute of recovery, calculate the Ruffier index (IR) according to the formula
IR = [6 · (P ₀ + P _1a + P _1b ) -200]: 10,
where IR is the Ruffier index;
P ₀ - heart rate in the initial position sitting for 10 s, beats .;
R _1a - heart rate in the first 10 s of recovery, beats;
P _1b - heart rate during the last 10 from the first minute of recovery, beats, and they assess the reaction of the cardiovascular system with IR values less than 0 - excellent, with IR from 0 to 5 - good, with IR from 6 to 10 - mediocre, IR from 11 to 15 is weak, with IR over 15 it is unsatisfactory, according to the change in blood pressure, the type of reaction of the cardiovascular system (CCC) is assessed as normotonic, dystonic, hypertonic, with a stepwise rise in blood pressure or hypotonic, and with a normotonic type of reaction and assessment of IR excellent, or good, or mediocre assess the condition with cardiovascular system as good, adaptability to physical activity as high, disabled people are shown adaptive physical education and sports without restriction; when the normotonic type of reaction and the assessment of IR weakly or unsatisfactorily judge the decrease in the functional state of the cardiovascular system, adaptability to physical exertion is weak, physical education classes with moderate aerobic exercise are indicated for people with disabilities; in case of a dystonic type of reaction with a decrease in diastolic pressure to zero in the first or second minutes of recovery and assessment of IR, the state of the cardiovascular system is assessed as good or good or mediocre, good, adaptability to physical activity is high, people with disabilities are shown adaptive physical education and sports without restrictions ; with a dystonic type of reaction with a decrease in diastolic pressure to zero for more than 2 minutes of recovery, slowing down the recovery of heart rate and blood pressure and assessing IR, a decrease in the functional state of the cardiovascular system is poorly or unsatisfactory, physical fitness is weak, physical culture exercises with moderate exercise are shown to people with disabilities in aerobic mode; with a hypertonic type of reaction and an assessment of IR, a decrease in the functional state of the cardiovascular system is poorly or unsatisfactory, physical fitness is weak, people with exercise therapy under the control of heart rate and blood pressure, with an intensity of low and lower than average, are limited to exercises with inclinations, circular movements of the head, sharp movements of large amplitude; with the type of reaction with a step-wise rise in blood pressure, regardless of the assessment of IR, a decrease in the functional ability of the cardiovascular system is judged, the adaptability to physical activity is weak, people with disabilities are shown exercises with a load below the average with an extension of the motor load; when the hypotonic type of reaction and the assessment of IR weakly or unsatisfactorily judge the decrease in the functional ability of the cardiovascular system, disabled people are shown physical therapy exercises with a load below the average, with a change in initial positions that stimulate venous return, inverted postures are excluded. 2. The method according to claim 1, characterized in that they determine the index of IR in the dynamics of the training process and, with a decrease in IR, judge about improving the fitness of the disabled person. 3. The method according to claim 1, characterized in that the type of reaction of the cardiovascular system is determined in the dynamics of the training process, and when the type of reaction to the normotonic is changed, an increase in the functional state of the cardiovascular system of the disabled person is judged.