RU2417789C1 - Method of rehabilitation of patients with dust bronchitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine and can be applied in rehabilitation of patients with chronic obstructive lung disease (COLD) in sanatorium-health resort conditions. Method includes breathing exercises and medical physical training in conditions of sanatorium "Prokopievskiy". Patients daily go for walks in the morning and in the evening for 60-90 min and do exercises with deep rhythmical breathing, in case of phlegm presence - with cough at exhale, during 3 days, then special complexes: static breathing exercises without hand and body movements - 4 days, dynamic breathing exercises, which are accompanied by hand and body movements - 3 days, sound gymnastics, consisting in pronunciation of specified sounds and their combinations - 3 days, respiratory gymnastics, which includes breathing exercises, which train respiratory and expiratory functions of lungs - 3 days, then patients continue exercises in home conditions.

EFFECT: method insures normalisation of breathing mechanics, increase of organism adaptation possibilities, in particular, of cardio-respiratory system, with reduction of respiratory compromise, improvement of respiratory function parametres, work of cardio-vascular, nervous systems.

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Description

The invention relates to medicine and can be used in the rehabilitation of patients with chronic obstructive pulmonary disease (COPD) in a spa.

The treatment and prevention of chronic obstructive pulmonary disease is justifiably considered one of the important problems of modern medicine and practical health care. In Russia, COPD is one of the leading causes of temporary disability; disability among them reaches 45.7%. It takes 4-5 place among the causes of mortality (Chuchalin A.G. et al., 1999; Shmelev E.I., 2003). The prevalence of COPD in the general population in different regions of Russia is 3.1-1.77% (Krasnova Yu.N. et al., 2006; Pavlov P.I. et al., 2007) and significantly increases among people with risk factors COPD

Currently, this disease is diagnosed in 5-10% of the population of industrialized countries, it affects 20% of the adult male population of the planet.

Inhalation of industrial dust and chemicals is the second leading cause of respiratory diseases after smoking (GOLD, 2006). It should be noted that this risk factor is also significantly widespread, since most types of industrial production, which employs many thousands of people, are characterized to one degree or another by pollution of the inhaled air with industrial dust.

It is known that the effect of industrial dust on the respiratory system has its own pathogenetic features, which determines the originality of the clinical manifestations of the pathology of the bronchopulmonary apparatus (Lyubchenko P.N., Vinnitskaya T.E., 2000; Belyaev E.N., Stepanov S.A., 2005 ) Dust, falling from the pulmonary alveoli into the lymphatic vessels and glands, causes reactive inflammation around the bronchi, and then into the intercellular tissue of the lung. In the future, fibrotic changes occur, bronchiectasis and pulmonary emphysema develop. Of great importance is not only the ingress of dust into the lungs, but also the delay in them.

Patients with occupational diseases of the respiratory system make up 24% of all patients with occupational diseases in need of spa treatment. Treatment and preventive measures should be aimed both at accelerating the elimination of deposited dust, self-cleaning of the lungs, improving the condition of the upper respiratory tract mucosa, and maintaining the normal functional state of the respiratory and cardiovascular systems, since COPD is a disease not only of the bronchopulmonary system, but also of many body systems (Shmelev E.I., 2007; Avdeev S.N., 2007).

Over the past 20-30 years, significant success has been achieved in the development of new methods for the diagnosis and treatment of respiratory diseases. However, long-term drug treatment with anti-inflammatory non-steroidal and antibacterial drugs leads to functional disorders of the liver and the formation of chronic metabolic disorders in it.

In this regard, it is important to develop a method of rehabilitation treatment at the sanatorium stage, since these issues have not yet been fully resolved. A worthy place in this method is physical therapy (LF).

There are a number of methods of physiotherapy in the treatment of chronic obstructive pulmonary disease.

Methods of exercise therapy by A.N. Strelnikova (Milyukova I.V., Evdokimova T.A. Physiotherapy exercises: The latest reference book / Edited by Prof. T.A. Evdokimova. - SPb .: Sova; M .: Eksmo, 2003. - P.284-284) is called paradoxical because inhalation and exhalation are performed simultaneously with movements that impede this phase of breathing: you can’t stick out your stomach (“breathe with your stomach”), raise your shoulders and straighten your chest. The technique helps to relieve asthma attacks, it is used for bronchial asthma, chronic bronchitis.

Do not take too much air during inspiration. But how to determine what means a lot? Only focusing on your own feelings, and this is very subjective.

Method Kotesheva I.A. "Physiotherapy exercises at the outpatient stage of rehabilitation of patients with chronic bronchitis" - Respiratory diseases No. 1, 2004 - involves constant training of muscle tissue with physical exercises, which helps to increase muscle strength, normalize their elastic properties after the pathological process. All this is of great importance in regulating the function of the respiratory apparatus, since the smooth muscles of the respiratory system play a significant role both in the act of external respiration and in the self-cleaning of the airways from harmful elements in the exercise of the so-called motor function of the bronchi.

There is no complex effect on the body, breathing exercises and respiratory gymnastics are not performed.

The closest is a method of rehabilitation of chronic lung diseases according to the methodology (Kokosova A.N., Streltsova E.V. Physiotherapy exercises in the rehabilitation of patients with lung diseases. L .: Medicine, 1987, p. 43-45), which offer use breathing exercises, muscle relaxation exercises that increase the mobility of the diaphragm, chest and spine, restorative in a hospital and outpatient settings. The emphasis when performing exercise therapy is to relax the muscles of the body.

The disadvantage of this method is that during the period of being in the hospital the patient does not have time to master all the necessary arsenal of exercises.

The objective of the invention is the effective care for patients with chronic obstructive pulmonary disease by improving the respiratory and cardiovascular systems of the body by healing the body by the influence of the natural factor and performing special physiotherapy exercises, which they can use later at home.

The solution to this problem is achieved by the method of rehabilitation of patients with dust bronchitis, including physiotherapy exercises with the implementation of static and dynamic breathing exercises. Patients are affected by the natural factor of the Prokopyevsky sanatorium, patients take walks daily in the morning and evening for 60-90 minutes. Patients are trained, and they perform exercises with deep rhythmic breathing, if necessary, with a cough on the exhale. Patients are trained, and they perform static breathing exercises without movement of the arms and body, then dynamic breathing exercises, accompanied by movements of the arms and body. Patients perform sound gymnastics, which consists in pronouncing certain sounds and their combinations. Respiratory exercises are performed, including breathing exercises that train the respiratory and expiratory functions of the lungs. After training and acquiring skills for performing the complex of exercise therapy, patients continue classes at home.

When performing exercises with deep and rhythmic breathing, do the following exercises: take a breath, protruding the stomach, raise the shoulders in the middle of the breath and begin to retract the stomach, when exhaling, relax the diaphragm, pull the stomach in, lower the shoulders, pause 1 min.

Patients perform static breathing exercises without moving their arms and body: while standing, take a full breath and then exhale slowly through the lips, folded in a tube, exhale the air with short shocks, draw in the stomach, push the stomach between the shocks, exhale with three shocks; sitting on a chair, inhale and exhale slowly through the nose, as you exercise, exhale lengthen by 1-2 seconds every week; sitting or standing, take an intermittent breath in 3-4 strokes, each time protruding the stomach, exhaling through the nose with tremors, with each push, pull the stomach in; standing, inhale through the nose, pause for 2-3 seconds and exhale through the mouth, pronouncing the sound “ss-s”, again inhale through the nose, pause 2-3 seconds, exhale in jerks saying “fu fu fu”, retract the stomach for each push, repeat 3 times; inhale 4 seconds, pause 2 seconds, short exhale, repeat 4 times, lengthening the inhalation each time by 1 second; inhale, exhale 4 seconds, pause 2 seconds, repeat 4 times, lengthening the exhalation each time by 1 second.

Patients perform dynamic breathing exercises with movement of the arms and body: standing, legs shoulder-width apart, arms on the belt, inhale, lean back slightly, exhale - lean forward a bit, shoulders down, and lower arms; standing, legs together, hands on the belt, inhale, simultaneously step forward with the left foot, transfer the weight of the body to it, slightly tilt the head back, right foot on the toe, exhale, return to the starting position, bow your head slightly, same step with the right foot forward; standing, feet shoulder-width apart, arms along the body, inhale, raise arms above your head, leaning back slightly, exhale, simultaneously lean forward, trying to touch the floor with your hands, do not bend your knees; standing, legs together, hands on the belt, while inhaling, turn the body to the left, spreading your arms to the sides at shoulder level, while exhaling, tilt forward and to the left, moving your arms back, while inhaling - straighten and turn the body to the right, spreading your arms to the sides, as you exhale, lean forward and to the right, taking your hands back, straighten while inhaling, raise your hands up, exhale calmly, while lowering your hands; standing, feet shoulder-width apart, arms along the body, inhale, exhale slowly, lower your head to your chest, bring your shoulders forward, reach your knees with your hands, look down, inhale, raise your head, straighten your shoulders, spread your arms apart at shoulder level, look up, exhale, starting position; standing, feet shoulder-width apart, hands on chest, circular motion in the elbow joints forward, circular motion in the elbow joints backward, uniform breathing, do not hold; standing, feet together, fingers clasped on the back of the head, rise on toes and bend back - inhale, lower your entire foot, spread your arms to the sides and lower down, exhale.

Patients perform sound gymnastics, including in the first lesson: performing a “purifying exhalation” with the pronunciation of PFF 4-6 times, “closed moan” - MMM - 3 times and PFF - 1 time, pronounce BRRUH and PFF - the first time, then repeat, changing vowel in BRRUH on o, a, e, and; pronounce GRRUF and PFF - for the first time, then repeat, changing the vowel in GRRUH to o, a, e, and; in the second lesson, repeat the exercises of the first lesson, then pronounce DRRUKH and PFF - for the first time, then repeat, changing the vowel in DRRUKh about a, a, e, and, pronounce PPP - 3 times and PFF - 1 time, pronounce BRRUKH and PFF - first times, then repeat, changing the vowel in BRRUCH to o, a, e, and, PRRUCH and PFF - the first time, then repeat, changing the vowel in PRRUCH to o, a, e, and; in the third lesson, the exercises of the first and second classes are repeated, then HERE and PFF are pronounced for the first time, then they are repeated, changing the vowel in HEMO to o, a, e, and, KRUH and PFF are the first time, then they are repeated, changing the vowel in HEM о, а, е, и, ТРРУХ and ПФФ - for the first time, then repeat, changing the vowel in ТРРУХ to о, а, е, и, ФРУХ and ПФФ - for the first time, then they repeat, changing the vowel in ФРУХ to о, а, e, and.

Patients perform respiratory gymnastics, including exercises: standing, arms along the torso, raise arms up, stretch - inhale, return to the starting position - exhale; standing, the body is slightly tilted forward, arms are lowered, to perform diaphragmatic breathing, 5-6 breaths and exhalations; standing, one arm is raised up, the other is lowered along the trunk, fingers are clenched into a fist, perform a change of position of the hands; standing, hands on the belt, perform circular movements of the pelvis to the right, then left; standing, hands on the belt, spread your arms to the sides - inhale, "hug" your shoulders - exhale; standing, arms to shoulders, with the knee of the right leg, get the elbow of the right hand - exhale, return to the starting position - inhale, with the knee of the left leg get the elbow of the left hand - exhale, return to the starting position - inhale; standing hands along the body, take - inhale, sit down, wrap your arms around your knees - exhale; exercises with a gymnastic stick: standing, arms down, bend your arms at the elbow joints - inhale, put a stick on your shoulders - exhale, straighten your arms up - inhale, return to the starting position - exhale; standing, gymnastic stick behind his back, arms down - inhale, bending the arms at the elbow joints, reach the shoulder blades - exhale; standing, arms extended forward, imitation of rowing; standing, arms extended forward, raise arms up - inhale, lean forward, lower the stick down, relax - exhale; exercises from the starting position sitting on a chair: lean back, arms on your knees, diaphragmatic breathing 1 min; lean back in the chair, hands on your knees, bend your hands at the elbow joints, wrists to the shoulders - inhale, "drop" them relaxed down - exhale; lean back, arms on your knees, slowly bend and unbend legs in the ankle joints - breathing is arbitrary; lean back, arms down, parted arms to the side - inhale, relaxed to lower down - exhale; lean back, arms down - inhale, exhale in shocks through the lips, folded tube; sitting, in the hands of a medical ball, bend your hands in the elbow joints, put the medical ball on your chest - inhale, raise your hands up - exhale, stretch your arms forward - inhale, return to the starting position - exhale.

The novelty of the method. For the first time, an integrated method is used using the natural factor of the Prokopyevsky sanatorium and physiotherapy exercises in patients with chronic obstructive pulmonary disease for the entire course of their stay in the sanatorium. The rehabilitation treatment program includes a system of specially selected physical exercises that contribute to the improvement of the respiratory and cardiovascular systems:

1. Learning how to breathe properly and performing exercises with deep rhythmic breathing normalizes breathing mechanics. Instead of breathing “right” - i.e. full breathing, most cost "partial" (high - upper chest; costal - lower chest; diaphragmatic - breathing with the stomach). Moreover, women breathe with their breasts, men and children with their stomachs. Training in the process of exercising exercise therapy for correct deep rhythmic breathing and the art of coughing on an exhale leads to the fact that with the help of a cough the contents of the bronchi are carried out by a powerful stream of air to the trachea.

2. Static breathing exercises (playing with air), which are performed without movement of the arms and body. The effect of these exercises is aimed at maximizing the restoration of the functional ability of the bronchi by releasing them from the mucopurulent contents, as well as activating blood and lymph circulation and increasing the reserves of the external respiration apparatus.

3. Dynamic breathing exercises, accompanied by movements of the arms and body, improve ventilation of certain parts of the lung and have an anti-adhesion effect. Constant training of muscle tissue by such physical exercises helps to increase muscle strength, normalize their elastic properties. All this is of great importance in regulating the function of the respiratory apparatus, since the smooth muscles of the respiratory system play a significant role both in the act of external respiration and in the self-cleaning of the airways from harmful elements in the exercise of the so-called motor function of the bronchi.

4. Sound gymnastics - these are special exercises consisting in pronouncing certain sounds. They are a type of static breathing exercises that extend and train exhalation. The pronunciation on exhalation of vibrating sounds reduces the spasm of the bronchi and bronchioles, contributes to a more complete and deep exhalation. It acts on the principle of vibration massage. When pronouncing sounds, the vibration of the vocal folds is transmitted to the respiratory tract, lungs and from them to the chest. Vibration allows you to relax spasmodic bronchi and bronchioles.

5. Respiratory gymnastics - therapeutic gymnastics, including special breathing exercises that uniformly train the respiratory and expiratory functions of the lungs, and general developmental exercises that enhance bioenergy, increase the adaptive capabilities of the body, in particular the cardiorespiratory system. At the same time, the mechanics of the respiratory act are corrected and improved, the tolerance of physical exertion increases after a course of rehabilitation therapy.

6. Daily walks contribute to the impact of the natural factor of the Prokopyevsky sanatorium. The fresh air of the forest pine has a healing effect on the body of patients with COPD, improves sleep and facilitates breathing. A beautiful landscape, a lake create a sense of peace, relieve tension and anxiety.

The entire process of rehabilitation treatment is controlled by the vital capacity of the lungs. The proposed method increases the effectiveness of treatment of patients with COPD in the form of dust bronchitis, prevents a decrease in disability. The mechanics of breathing are normalized, the adaptive capabilities of the body, in particular the cardiorespiratory system, are increased. Respiratory failure is reduced, indicators of the function of external respiration are improved, the activity of the cardiovascular and nervous systems is improved.

The method has a pronounced positive effect on the restoration of the function of the respiratory apparatus: the inflammatory process in the lungs is stopped, the severity of clinical symptoms (cough, sputum, asthma attacks) is reduced, the frequency of exacerbations and associated labor losses is reduced several times.

The exercise program was divided into cycles:

1. Training in proper breathing with deep rhythmic breathing, if necessary with a cough on the exhale - 3 days;

2. Performing static breathing exercises without movement of the arms and body to train for full breathing (playing with air) - 4 days;

3. Performing dynamic breathing exercises, accompanied by movements of the arms and body, - 3 days;

4. Performing sound gymnastics - 3 days;

5. Respiratory gymnastics - 3 days.

In the complex of rehabilitation measures aimed at improving the function of the respiratory system, physical exercises of therapeutic gymnastics play a role. However, the methodology for the integrated use of physical exercises in a sanatorium has not been developed.

The proposed method for the rehabilitation treatment of patients with chronic obstructive pulmonary disease has significant differences from analogues and prototype, because it provides for the implementation of exercise therapy methods as an integrated rehabilitation method for the entire course of stay in the sanatorium.

Common manifestations of COPD are an almost constant or frequently recurring cough with sputum, shortness of breath as a sign of respiratory failure. With further progression, the heart is involved in the pathological process, heart failure develops. Chronic bronchitis often occurs with obstruction - a violation of the "patency" of the bronchi.

The treatment of chronic bronchitis is a very difficult task, and a full recovery is very problematic. But of great importance in ensuring free breathing, eliminating possible foci of infection in the oral cavity, nose, improving the activity of the pulmonary and cardiovascular systems is therapeutic gymnastics.

The authors believe that the program of physiotherapy exercises at the sanatorium stage will not only improve the condition of the respiratory and cardiovascular systems of the body, increase the performance of patients with chronic obstructive pulmonary disease, relieve coughing and shortness of breath, but also reduce the disability of this category of patients. Patients acquire proper breathing skills, which they can then apply at home.

The method is as follows.

Upon admission to the sanatorium, a patient with chronic obstructive pulmonary disease gets an initial appointment with a doctor. At the same time, a sanatorium-resort card is studied from the place of residence, the history of the disease, the presence of concomitant diseases are clarified, then, if there are no contraindications, a course of physiotherapy exercises is prescribed by the proposed method. When interviewing a patient, the clinical symptoms of COPD are revealed at the time of admission to the sanatorium, spirometry is performed to determine the lung capacity (VC).

Physical therapy is carried out in the warm season in the open air, in order to enhance the effect of the natural factor of the Prokopyevsky sanatorium, patients daily walk 60-90 minutes in the morning and evening at a slow pace with stops for exploring the surroundings and the lake. At stops, they offer to listen to the sounds, birdsong or silence, enjoy the smells of damp earth, forest, freshness. At the same time, it is recommended to breathe evenly and deeply, to feel that the body is recovering, health is improving, calm is coming, mood is improving.

Patients are taught the correct implementation of exercise physiotherapy exercises, and then they perform these exercises on their own.

Exercise with deep rhythmic breathing.

At the expense of 1 - take a breath, protruding belly,

2 - in the middle of the inhale raise the shoulders and begin to draw in the stomach,

3-4 - exhale - do in the same (and not in reverse) sequence, while the diaphragm relaxes, the stomach continues to retract, the shoulders lower.

1 minute pause It must be done after the exercise, because otherwise, unusually complete breathing can lead to dizziness and even loss of consciousness. In this case, if there is a cough, then you need to do it on an exhale.

Before performing the exercise, it is necessary to remove the residual air from the lungs, for which it is necessary to exhale through the lips folded in a tube.

You need to train full breathing either on an empty stomach or 3 hours after eating. A lesson lasting 15 minutes with an increase of up to 30 minutes.

Learning and performing the exercise spend 3 days.

Static breathing exercises without movement of arms and body (playing with air)

Exercise allows you to train full breath.

1. Starting position (IP) - standing, feet shoulder width apart.

Take a full breath, then slowly take a full breath through your nose and immediately exhale through your lips, folded in a tube (as if you were about to whistle), without puffing out your cheeks.

You need to exhale the air with short jerks, and during each jerk, the stomach is drawn in, and between the jerks it bulges out. One exhale “breaks” into three tremors.

2. I.P. - sitting on a chair.

Take a deep breath and exhale slowly through the nose, marking the expiration time by the second hand.

As you exercise, exhalation should be extended by 1-2 seconds every week.

3. I.P. - sitting or standing.

Take an intermittent breath in 3-4 pushes, each time protruding the stomach. Then exhale in jerks through the nose - with each jerk, the stomach is somewhat retracted.

4. I.P. - standing.

Inhale deeply through the nose, then pause for 2-3 seconds and exhale through the mouth, pronouncing the sound “ss ss”. Again, take a full breath through your nose, pause and exhale in jerks, saying "fu fu fu." At the same time with each "fu" the stomach is drawn in. Do not lift your shoulders. Repeat 3 times.

5. Gradual lengthening of the breath.

Take a breath for 4 seconds, i.e. mentally count to 4; then a pause, equal in length to 2 seconds, and a short exhale.

Repeat 4 times, and each next breath is 1 second longer than the previous one and short exhalations.

Such breathing with a long breath and short exhale has a tonic effect, so it is useful to do it in the morning immediately after waking up.

6. Gradual prolongation of exhalation.

Take a regular inhalation, and while exhaling mentally count to 4, i.e. expiration time 4 sec. After exhaling, pause for 2 seconds. Repeat 4 times, extending the exhalation each time for 1 second.

This exercise, on the contrary, has a calming and even hypnotic effect, so it is recommended to do it before bedtime, especially for those who fall asleep with difficulty.

The lesson lasts from 15 to 30 minutes.

Learning and performing the exercise spend 4 days.

Dynamic breathing exercises with movement of the arms and body.

1. I.P. - standing, feet shoulder width apart, hands on the belt.

To account:

1 - inhale, lean back slightly,

2 - exhale - lean forward a little, bringing your shoulders down, and lower your hands.

Repeat 4 times.

2. I.P. - standing, legs together, hands on the belt.

To account:

1 - inhale, simultaneously step forward with the left foot, transfer the weight of the body to it, slightly tilt the head back, the right leg on the toe.

2 - exhale, return to I.P., bow your head slightly. The same, step forward with your right foot.

Repeat 4 times.

3. I.P. - standing, feet shoulder width apart, arms along the torso.

To account:

1 - inhale, raise your hands above your head, leaning slightly back.

2 - exhale, at the same time lean forward, trying to touch the floor with your hands, do not bend your knees.

Repeat 3 times.

4. I.P. - standing, legs together, hands on the belt.

To account:

1 - on inspiration, turn the body to the left, spreading your arms to the sides at shoulder level.

2 - on the exhale, make an inclination forward and to the left, taking your hands back.

3 - on inspiration - to straighten and turn the body to the right, spreading his arms to the sides.

4 - on the exhale, bend forward and to the right, taking your hands back.

5 - on the inhale straighten, raise your hands up.

6 - exhale calmly, while lowering his hands.

Repeat 2 times.

5. I.P. - standing, feet shoulder width apart, arms along the torso.

To account:

1 - breath.

2 - exhale slowly, lower your head to your chest, bring your shoulders forward, reach with your hands to your knees, look down.

3 - inhale, raise your head, straighten your shoulders, spread your arms to the sides at shoulder level, look up.

4 - exhale - I.P.

Repeat 4 times.

6. I.P. - standing, feet shoulder width apart, hands on chest.

To account:

1-4 - circular movements in the elbow joints forward.

1-4 - circular movements in the elbow joints back.

Even breathing, do not hold.

Repeat 4 times.

7. I.P. - standing, legs together, fingers clasped on the back of the head.

To account:

1 - climb on toes and bend back - inhale.

2 - go down the whole foot, spread your arms to the sides and lower down - exhale.

Repeat 6 times.

The duration of the lesson is 10-20 minutes.

Learning and doing exercises spend 3 days.

Sound gymnastics

1 lesson

1. "Purifying expiration", pronouncing PFF - 4-6 times.

2. “Closed moan” - MMM - 3 times and PFF - 1 time.

3. Pronounce BRRUH and PFF - for the first time, then repeat, changing the vowel in BRRUH to o, a, e, and.

4. Pronounce GRRUF - once and PFF - for the first time, then repeat, changing the vowel in GRRUF to o, a, e, and.

2 occupation

Repeat the exercises of the first lesson.

1. Pronounce DRRUH and PFF - the first time, then repeat, changing the vowel in DRRUH to o, a, e, and.

2. Pronounce PPP - 3 times and PFF - the first time.

3. Pronounce BRRUH and PFF - for the first time, then repeat, changing the vowel in BRRUH to o, a, e, and.

4. Pronounce PRRUCH and PFF - the first time, then repeat, changing the vowel in PRRUCH to o, a, e, and.

3 occupation

Repeat all previous exercises of the first and second classes.

1. Pronounce HHRH and PFF - the first time, then repeat, changing the vowel in HHRH on o, a, e, and.

2. Pronounce KRUKH and PFF - the first time, then repeat, changing the vowel in KRUKH to o, a, e, and.

3. Pronounce ТРРУХ and ПФФ - for the first time, then repeat, changing the vowel in ТРУХ to o, a, e, and.

4. Pronounce FRRUH and PFF - for the first time, then repeat, changing the vowel in FRRUH to o, a, e, and.

The duration of the lesson is 10-15 minutes.

Learning and doing exercises spend 3 days.

Respiratory gymnastics

1. I.P. - standing, hands along the body. To account:

1-2 - raise your hands up, reach out - inhale,

3-4 - return to I.P. - exhale. Repeat 6-8 times.

2. I.P. - standing, the body is slightly tilted forward, arms are lowered.

Diaphragmatic breathing. 5-6 breaths. Repeat 4-6 times.

3. I.P. - standing, one hand is raised up, the other is lowered along the body, fingers are clenched into a fist.

Perform a quick change of hand position.

Repeat 6-8 times.

4. I.P. standing, hands on the belt.

To account:

1-4 - circular movements of the pelvis to the right,

1-4 - circular movements of the pelvis to the left. Repeat 4 times in each direction.

5. I.P. - also.

To account:

1-2 - to spread your arms to the sides - inhale,

3-4 - “hug” your shoulders - exhale.

Repeat 4-6 times.

6. I.P. standing, arms to shoulders.

To account:

1 - with the knee of the right leg, get the elbow of the right hand - exhale,

2 - return to I.P. - inhale

3 - knee of the left foot to reach the elbow of the left hand - exhale,

4 - return to the starting position - inhalation.

Repeat 4 times with each foot.

7. I.P. - standing, hands along the body.

To account:

1 - breath

2 - to sit down, clasp your hands around your knees - exhale.

Repeat 6-8 times.

Gym exercises

1. I.P. - standing, hands down.

To account:

1 - bend your arms at the elbow joints - inhale,

2 - put a stick on your shoulders - exhale.

3 - straighten your arms up - inhale,

4 - return to I.P. - exhale.

Repeat 4 times.

2. I.P. - standing, gymnastic stick behind his back, arms down.

To account:

1 - breath

2 - bending the arms in the elbow joints, get the shoulder blades - exhale.

Repeat 6-8 times.

3. I.P. - standing, arms extended forward.

Imitation of rowing. The breath is arbitrary. Repeat 6-8 times.

4. I.P. - standing arms extended forward.

To account:

1 - raise your hands up - inhale,

2 - lean forward, lower the stick down, relax - exhale.

Repeat 4 times.

Exercises from I.P. - sitting on a chair.

1. I.P. - leaning back in his chair, hands on his knees. Diaphragmatic breathing for 1 min.

2. I.P. - also.

3. To the account:

1 - bend your arms at the elbow joints, hands to the shoulders - inhale,

2 - “drop” them relaxed down - exhale. Repeat 4-6 times.

4. I.P. - also.

Slowly bend and extend the legs in the ankle joints. The breath is arbitrary.

Repeat 10-12 times.

5. I.P. - leaning back in her chair, arms down.

To account:

1-2 - to spread your arms to the sides - inhale,

3-4 - relax relaxed down - exhale.

Repeat 6-8 times.

5. I.P. also.

To account:

1 - breath

2-3-4 - exhalation with tremors through the lips, folded in a tube.

6. I.P. - sitting, in the hands of the medical ball.

1 - bend your arms at the elbow joints, put the medicine on your chest - inhale.

2 - raise your hands up - exhale.

3 - stretch your arms forward - inhale,

4 - I.P. - exhale.

Repeat 4-6 times.

Complex exercises are performed to light fatigue.

As objective criteria in assessing the effectiveness of ongoing rehabilitation treatment before and after treatment, the following were used:

1. Vital capacity of the lungs (VC).

2. Signs of chronic respiratory failure (cough, shortness of breath, sputum, asthma attacks) according to the point system.

To assess the severity of dyspnea, the MRS scale was used.

3. a. Stange test - breath holding on inhalation.

4. Genche test - after the usual, not excessive, exhalation, the patient holds his breath (Physiotherapy: Handbook edited by V. Epifanov - Moscow: Medicine, 1987. - Pages 56-57).

5. Economic efficiency.

Efficiency was considered as the sum of the following components:

- preventing patients from becoming disabled and saving costs on disability pensions;

- prevention of drug costs.

Statistical processing of the results was carried out using the software package Statistica for Windows (6.0). For the calculations, methods of variation statistics were used: the arithmetic mean (M) and the error of the mean value (m) were calculated. The significance of changes in the arithmetic mean values of the compared groups was assessed using Student's t-test with Bonferoni correction (Glants S., 1999). The results were considered reliable at a level of p <0.05.

The results of rehabilitation treatment were analyzed for 52 men, the average age of which was 44.5 ± 4.1 years, with chronic obstructive pulmonary disease of dust origin, aimed at rehabilitation treatment at the Prokopyevsky sanatorium. The average work experience was 17.4 ± 5.9 years, and the average disease duration was 10.4 ± 3.1 years. There were 28 patients with the first stage, 24 people with the second stage.

Patients were randomly selected. The criteria for inclusion in the study were: the lack of a history of smoking information and the absence of exacerbation of the disease. The exclusion criterion is the presence of other occupational pathologies and concomitant diseases that could affect the reliability of the research results.

The results of the study are shown in tables 1, 2, 3, 4.

The values of the main spirometric indicators in the observation groups at the treatment stages

Table 1 Spirometric indicators Study groups Stage 1 (n = 28) Stage 2 (n = 24) JELL ml before treatment 2.6 ± 0.16 2.2 ± 0.19 * after treatment 3.4 ± 0.12 2.7 ± 0.16 * Note: * - p <0.05 - significant difference in indicators in patients with stages 1 and 2 of COPD.

The results of the study of VC before and after treatment indicate a positive effect. Moreover, the best results were achieved in patients with stage 1 COPD - VC increased by 0.8 ± 0.1 ml. A significant increase (p <0.05) in VC was also observed in patients with stage II COPD by 0.5 ± 0.2 ml.

Prevalence of the main symptoms of COPD

table 2 Clinical symptoms Stage 1 (n = 28) Stage 2 (n = 24) Abs. % Abs. % 1. cough - fickle 6 21 - - permanent 22 79 24 one hundred 2. shortness of breath eighteen 63 24 one hundred 3. sputum 16 57 24 one hundred 4. asthma attacks 8 24 10 40

Prevalence of the main symptoms of COPD after treatment

Table 3 Clinical symptoms Stage 1 (n = 28) Stage 2 (n = 24) Abs. % Abs. % 1. cough - fickle 12 43 6 29th - permanent 16 57 eighteen 71 2. shortness of breath 10 39 eighteen 75 3. sputum 12 63 twenty 81 4. asthma attacks 2 7 6 29th

The second stage of COPD before treatment was characterized by more severe symptoms. All patients (100%) experienced persistent cough with sputum, shortness of breath and sputum, suffocation attacks in 10 patients - 40%.

After treatment, persistent cough was observed in 18 patients - 71%, intermittent in 6 patients - 29%, shortness of breath in 18 people - 75%, sputum in 20 people - 81%, asthma attacks in 6 patients - 29%.

The first stage before treatment - persistent cough in 22 people - 79%, intermittent - in 6 - 21%, shortness of breath in 18 people - 63%, sputum in 16 - 57%, asthma attacks in 8 patients - 24%.

After treatment, in patients of the first stage, a decrease in the severity of clinical symptoms is observed (p <0.05). A permanent cough was noted by 16 people - 57%, intermittent - 12 - 43%, shortness of breath - in 10 patients - 39%, sputum in 18 - 63%, asthma attacks persist only in 2 people - 7%.

The results of the study at the stages of treatment (Stange test and Genche test)

Table 4 Samples Stage 1 (n = 28) Stage 2 (n = 24) 1. Stange test (sec) before treatment 31 ± 0.4 26 ± 0.3 after treatment 42 ± 0.7 32 ± 0.8 2. Genche test (sec) before treatment 24 ± 0.2 21 ± 0.4 after treatment 32 ± 0.1 27 ± 0.1

After the treatment, with increasing training of the respiratory apparatus, the time of holding the breath by the Stange test in the group of a patient with stage 1 disease increased by 9 seconds, by the Genche test - by 8 seconds. In the group of patients with stage 2, the breath-holding by the Stange test increased by 6 seconds, by the Genche test by 4 seconds.

Cost effectiveness

Five victims who were treated with the proposed method were threatened with disability. It was prevented as a result of treatment.

The consumption of drugs halved in 16 people.

1. The annual cost savings for disability pensions (X1) are found by the formula:

X1 = 12 × k1 × i,

where k1 is the number of patients with prevented disability,

their 5 patients

i - the average disability pension, it is 1.5 thousand rubles, 12 - the number of months in a year.

X ₁ = 1.5 × 12 × 5 = 90,000 rubles.

2. The prevented costs of drugs (X3) are found by the formula:

X2 = 12 × st × k3,

where st is the average cost of drugs per patient per month;

it is equal to 1408 rubles.

The need for medicines decreased by 2 times, therefore, 1408 rubles .: 2 = 704 rubles. - amount for medication after treatment.

k3 - the number of patients who began to need medicine is half as much.

Patients 16 people.

12 - the number of months in a year.

X2 = 704 rubles. × 12 × 16 = 135,168 rubles.

The final value of the average annual efficiency (X) is found by the formula:

X = X1 + X2 = ∑Xj, X = 90,000 rubles. +131168 rub. = 225,168 rubles.

EXAMPLE 1

Patient B. Diagnosis at admission to the sanatorium: chronic obstructive pulmonary disease of the 1st stage: dust bronchitis. He has been working as a stoner in underground operations for 8 years. He considers himself sick for 6 years. The last 3 years notes a constant cough with sputum, shortness of breath, notes catarrhal diseases 3-4 times a year. Before treatment, VC - 2.6 ml, Stange test - 31 sec, Genche test - 24 sec. A course of a 16-day exercise therapy program has been assigned.

At the end of the course of treatment: shortness of breath is not observed, a decrease in the frequency of cough and sputum level, VC - 3.4 ml, Stange test - 42 sec, Genche test - 33 sec.

EXAMPLE 2

Patient C. Diagnosis at admission to the sanatorium: chronic obstructive pulmonary disease, stage 2: dust bronchitis. He has been working as a miner in underground work for 12 years. He considers himself sick for 7 years. The last 5 years marks shortness of breath, asthma attacks, green viscous sputum, especially in the morning, exacerbation of bronchitis notes 4-5 times a year. Before treatment, VC - 2.1 ml, Stange test - 25 sec, Genche test - 19 sec. A course of a 16-day exercise therapy program has been assigned.

At the end of the course of treatment: a decrease in shortness of breath, no asthma attacks, a decrease in the frequency of cough and sputum levels, VC - 2.7 ml, Stange test - 35 sec, Genche test - 26 sec.

The results obtained showed that the systematic application of the proposed method has a pronounced positive effect on the restoration of the function of the respiratory apparatus:

1. Relief of the inflammatory process in the lungs.

2. Reducing the severity of clinical symptoms (cough, sputum, asthma attacks).

3. Reducing the frequency of exacerbations and associated labor losses by several times.

4. Improving the performance of VC.

5. Reducing the duration of disability and disability.

Thus, the proposed method for the rehabilitation of patients with COPD with exposure to a natural factor and a special complex of physiotherapy exercises improves the respiratory and cardiovascular systems of the body, which contributes to its recovery.

Claims (1)

A method for the rehabilitation of patients with dust bronchitis, including spa treatment and breathing exercises, characterized in that physiotherapy exercises are carried out in the conditions of the Prokopyevsky sanatorium, patients walk for 60-90 minutes daily in the morning and evening, patients are trained and they additionally perform exercises with deep rhythmic breathing, in the presence of sputum in the airways with a cough on the exhale, 3 days: inhale, protruding the stomach, in the middle of the inhale raise your shoulders and begin to retract the stomach, when exhaling relax the diaphragm stew, retract the stomach, lower the shoulders, pause 1 min; perform static breathing exercises without movement of the arms and body, 4 days: standing, take a full breath and then exhale slowly through the lips, folded in a tube, exhale the air with short jerks, pull in the stomach while pushing, stretch the stomach between the jerks, exhale with three jerks; sitting on a chair, inhale and exhale slowly through the nose, as you exercise, exhale lengthen by 1-2 seconds every week; sitting or standing, take an intermittent breath in 3-4 strokes, each time protruding the stomach, exhaling through the nose with tremors, with each push, pull the stomach in; standing, inhale through the nose, pause for 2-3 seconds and exhale through the mouth, pronouncing the sound “ss ss”, again inhale through the nose, pause 2-3 s, exhale in jerks, saying “fu fu fu” , for each push, pull the stomach in, repeat 3 times; inhale 4 s, pause 2 s, short exhale, repeat 4 times, lengthening the inhalation each time by 1 s; inhale, exhale 4 s, pause 2 s, repeat 4 times, lengthening the exhalation each time by 1 s; perform dynamic breathing exercises, accompanied by movements of the arms and body, 3 days: standing, legs shoulder-width apart, arms on the belt, inhale, lean back slightly, exhale, lean forward a bit, bring your shoulders and lower your arms; standing, legs together, hands on the belt, inhale, simultaneously step forward with the left foot, transfer the weight of the body to it, slightly tilt the head back, the right foot on the toe, exhale, return to the starting position, bow the head slightly, the starting position is the same, step right foot forward; standing, feet shoulder-width apart, arms along the body, inhale, raise arms above your head, leaning back slightly, exhale, simultaneously lean forward, trying to touch the floor with your hands, do not bend your knees; standing, legs together, hands on the belt, while inhaling, turn the body to the left, spreading your arms to the sides at shoulder level, while exhaling, tilt forward and to the left, taking your arms back, straighten while inhaling and turn the body to the right, spreading your arms to the sides, while exhaling lean forward and to the right, putting your hands back, straighten while inhaling, raise your hands up, breathe out calmly, while lowering your hands; standing, feet shoulder-width apart, arms along the body, inhale, exhale slowly, lower your head to your chest, bring your shoulders forward, reach your knees with your hands, look down, inhale, raise your head, straighten your shoulders, spread your arms apart at shoulder level, look up, exhale, starting position; standing, feet shoulder-width apart, hands on chest, circular motion in the elbow joints forward, circular motion in the elbow joints backward, uniform breathing, do not hold; standing, legs together, fingers clasped on the back of the head, rise on toes and bend backward, inhale, lower the entire foot, spread your arms to the sides and lower down, exhale; perform sound gymnastics, consisting in pronouncing sounds and their combinations, 3 days: in the first lesson they perform a “purifying exhalation” with the pronunciation of PFF 4-6 times, “closed moan” - MMM - 3 times and PFF - 1 time, pronounce BRRUH and PFF - the first time, then they repeat, changing the vowel in BRRUH to o, a, e, and pronounce GRRUF and PFF - the first time, then they repeat, changing the vowel in GRUH to o, a, e, and in the second lesson repeat the exercises of the first lesson, then pronounce DRRUCH once and PFF - the first time, then repeat, changing the vowel in DRRUCH to o, a, e, and pro carry RRR-3 times and PFF - 1 time, pronounce BRRUH and PFF - the first time, then repeat, changing the vowel in BRRUCH to o, a, e, and, PRRUCH and PFF - the first time, then repeat, changing the vowel to PRRUCH to o, a, e, and in the third lesson, repeat the exercises of the first and second classes, then pronounce HHRH and PFF - the first time, then repeat, changing the vowel in HHRH on o, a, e, and, KHPH and PFF - the first time, then repeat by changing the vowel in CUCCH to o, a, e, and TRUCCH and PFF - the first time, then repeat, changing the vowel in CUCCH to o, a, e, and, FRUCCH and PFF - the first time, then repeat t, changing the vowel in FRUH to o, a, e, and; perform respiratory gymnastics, including breathing exercises, training the inhalation and exhalation functions of the lungs, 3 days: standing, arms along the body, raise arms up, stretch - inhale, return to the starting position - exhale; standing, the body is slightly tilted forward, arms are lowered, to perform diaphragmatic breathing, 5-6 breaths and exhalations; standing, one arm is raised up, the other is lowered along the trunk, fingers are clenched into a fist, perform a change of position of the hands; standing, hands on the belt, perform circular movements of the pelvis to the right, then left; standing with your hands on your belt, spread your arms to the sides — inhale, “hug” your shoulders — exhale; standing, arms to shoulders, with the knee of the right leg, get the elbow of the right hand - exhale, return to the starting position - inhale, with the knee of the left leg get the elbow of the left hand - exhale, return to the starting position - inhale; standing, hands along the body, inhale, sit down, clasp your hands around your knees - exhale; exercises with a gymnastic stick: standing, arms down, bend your arms at the elbow joints - inhale, put a stick on your shoulders - exhale, straighten your arms up - inhale, return to the starting position - exhale; standing, gymnastic stick behind his back, arms down - inhale, bending the arms at the elbow joints, get the shoulder blades-exhale; standing, arms extended forward, imitation of rowing; standing, arms extended forward, raise arms up - inhale, lean forward, lower the stick down, relax - exhale; exercises from the starting position sitting on a chair: lean back, arms on your knees, diaphragmatic breathing 1 min; lean back in the chair, hands on your knees, bend your hands at the elbow joints, wrists to the shoulders - inhale, "drop" them relaxed down - exhale; lean back, arms on your knees, slowly bend and unbend legs in the ankle joints - breathing is arbitrary; lean back, arms down, parted arms to the side - inhale, relaxed to lower down - exhale; lean back, arms down - inhale, exhale in shocks through the lips, folded tube; sitting, in the hands of a medical ball, bend your hands in the elbow joints, put the medical ball on your chest - inhale, raise your hands up - exhale, stretch your arms forward - inhale, return to the starting position - exhale; then patients continue their studies at home.