RU2423095C2 - Method of treating combined pelvis and spine deformity in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, orthopedics and therapeutic exercises and can be used in case of combined pelvis and spine deformities of 1-2 degree in children with dysplastic-dystrophic syndrome. Hippotherapy in combination with complex of exercises for correction of definite group of pathologically changed muscles is carried out in the following order from initial position (i.p.) sitting on horse: asymmetric position of pelvic muscles is corrected by fixation of feet in stirrups at different level - lower position of stirrup on the side of pelvis part which is located higher, asymmetric location of back muscles is corrected by asymmetric position of arms with rein behind handrails of hippotherapeutic belt, holding rider in sagittal plane; for strengthening gluteal muscles in i.p. child in turns draws straight legs backward, leaning hands on horse body, and in turns lifts bent knees up, after that lying on back, on horse's croup in turns draws each knee to stomach; for strengthening muscles straining fascia lata, child lying on back on horse's croup on count 1-2 draws straight legs aside simultaneously, on count 3-4 fixes the position, on count 5-6 - in i.p.; for strengthening adductor muscles of hip child in i.p on count 1-2 presses horse's body with straight legs, on count 3-4 - relaxation; in order to influence back muscles child in i.p. crosses arms behind back "in lock", bends forward maximally and independently returns in i.p., after that, leaning body forward, stretches for horse's ear on the side opposite to lifted half of pelvis; for strengthening muscles of lateral and anterior body surface child in i.p., with hands on waist, makes body turns to sides, after that, draws hands "in lock" behind head and in turns stretches for opposite knee with each elbow. Tempo is medium, number of each exercise repetition to 10 times, course includes 10 procedures 3 times per week.

EFFECT: method ensures simultaneous correction of muscles of pelvic girdle and back, develops musculo-articular feeling and musculo-sensoric coordination, rebuilds incorrect motor orientation and forms new motor skills.

1 ex, 4 tbl, 3 dwg

Description

The invention relates to medicine, namely to orthopedics, to physiotherapy exercises, and can be used for combined deformities of the pelvis and spine of the 1-2 degree in dysplastic-dystrophic syndrome in children.

The use of hippotherapy for cerebral palsy is known [1, 2] in combination with hyperdynamic syndrome and logoneurosis [3]. The well-known technique of Suzanne von Dietze [4], which, based on the anatomical conditions that are crucial for the rider's landing, clearly describes the rider's ability to better feel, cognize and control their own individual physical data. The method is proposed for healthy people.

However, the above methods cannot be used in the treatment of combined pelvic and spinal deformities in children, since they do not affect the asymmetry of the pelvis, which is pathogenetically significant in the development of scoliotic spinal deformity in dysplastic-dystrophic syndrome.

Based on the current level of methods for treating combined pelvic and spinal deformities in children with manifestations of dysplastic-dystrophic syndrome, the goal was to increase the effectiveness of treatment by simultaneously correcting the muscles of the pelvic girdle and back, restoring the symmetrical functioning of all muscle groups, and eliminating the negative motor skills and the formation of normal upright posture.

The problem is solved as follows.

The treatment of combined pelvic and spinal deformities in children with dystrophic-dysplastic syndrome involves the use of hippotherapy in combination with a set of physiotherapy exercises to correct a certain group of pathologically altered muscles in the following sequence: the asymmetric position of the pelvic muscles is corrected by the fixation of the legs in stirrups at different levels, while more low position of the stirrup on the side of more highly placed than half of the pelvis, the asymmetric position of the back muscles correcting unbalanced chnym hand position with the reason for the handrails ippoterapevticheskogo herd, keeping the rider in the sagittal plane; to strengthen the gluteal muscles , while sitting on a horse in the initial position, the child is offered to take straight legs back alternately, resting his hands on the horse’s torso, then, without changing the starting position, the child will raise the bended knees up, then lying on his back on the croup of the horse each knee alternately leads to the stomach; to strengthen the muscles straining the wide fascia of the thigh, the child is offered, in the initial position lying on his back, on the horse’s croup, at the expense of 1-2, straight legs apart at the same time, at the expense of 3-4 fix this position, at the expense of 5-6 back in the initial position, to strengthen the adductors of the thigh muscles, the child is offered, in the initial position, sitting on a horse, squeeze the horse’s torso with 1-2 straight legs, relax for 3-4, for the impact on the back muscles the child is recommended in the initial position sitting on horses cross their arms behind their backs in IOC "as much as possible to lean forward and self-reset, then a child, torso forward, reaching to his ear a horse on the side opposite the raised part of the pelvis, to strengthen the muscles side and the front surface of the body the child is asked, in a starting position on horseback, put your hands on your belt and rotate your torso to the sides, after which, without changing the starting position, the child puts his hands “in the lock” behind his head and alternately with each elbow reaches for the opposite knee. The rate of exercise is average, the number of repetitions for each exercise is up to 10 times, the course of treatment is 10 procedures 3 times a week.

Explain the salient features of the proposed method.

The basics of the healing effects of riding are the natural movements of the horse, allowing the rider to organize and organize his movements. Having ceased to be a vehicle, the horse has strengthened the reputation of a kind of "medical projectile" [5]. When riding a horse, a certain pattern of body fixation is formed. The system of coordination and activity of the muscles of the pelvis and back plays a significant role in holding the body in an upright position. The correct position of the pelvis ensures the optimal position of the spine. The pelvis controls the movement of the legs and transfers them in a coordinated form to the spine, and also regulates the finest movements in the hip joints, in the lumbar spine, which allows you to maintain balance.

In the modern scientific literature, the prevailing opinion is that the pelvic asymmetry is secondary against the background of a shortening of one of the lower extremities, which forms and enhances scoliotic deformation [6, 7, 8]. Combined disorders of the spatial orientation of the spine against the background of the initial formation of multiplanar structural asymmetry of the pelvis were noted by some authors [9, 10, 11]. Thus, for the spine, with systemic changes in the growth plates, as a high-rise structure, based on a deformed foundation, the prerequisites for spatial deflection are created. Based on the foregoing, a pathogenetically substantiated approach to the simultaneous correction of deformation not only of the spine, but also of the pelvic girdle.

Direct landing provides a stable and stable location of the upper part of the body above the pelvis. The child’s body is a mobile system that finds its balance over the pelvis so imperceptibly that it looks like it has remained motionless. Many children manage to maintain direct posture in everyday life, and when riding a horse, motivation and irritating impulses resulting from the movement of the horse act as positive impulses, and a direct landing is arbitrary and natural. The dynamic load during exercise extends to the pelvis and spine, excluding the load on the lower limbs, which hang down in a relaxed state. This is only possible with horse riding.

The horse's back offers the rider a certain symmetry. The three-dimensional movement of the horse’s back in a walking step (in the frontal, sagittal, horizontal planes) corresponds to the movement of a person when walking, which forms normal sensorimotor stereotypes with the appearance of a feeling of normal upright posture. Moving with the horse, the child finds balance and encourages both healthy and problem muscles to work. The symmetry of the loads on all axes requires the symmetrical functioning of all muscle groups that ensure the landing of the child. The constant need to adapt to a new situation helps to better train unconscious reactions and reflexes that restore balance.

Therapeutic horse riding develops the orientation and sensations of your body in space. Riding affects both hemispheres of the brain, as there is a three-dimensional movement of the horse and rider with constant intersection of the midline of the body.

Medical horse riding helps to extinguish a child’s negative motor defects and feel new muscle sensations, “unknown” to the horse before treatment. The influence of low-frequency vibrational movements of a moving animal on the system of the vestibular analyzer enhances the influx of pulses along its pathways, stimulates the deep structures of the brain. Activation of the higher parts of the motor analyzer entails a change in the functional state of the neuromotor apparatus, in which it becomes possible to affect pathological motor stereotypes. During treatment, the child has a specific goal. Comparison of real actions and the results obtained takes the form of self-control. Such an interdependent process is built on biofeedback. From subcortical structures, information is projected onto the associative cortex, which automatically regulates the synchronization process by the basal parts of the frontal lobes, which in turn provides self-regulation, planning and self-control over arbitrary movements.

The thermal effect from the back of the horse, whose body temperature is 37.5-38.5 ° C, normalizes the blood circulation of the spinal cord and brain. A calmly walking horse warms up and massages the muscles of the rider that are in contact with the back muscles. The healing factor is also the biofield of the animal, adequate to its great strength and mass.

The asymmetric position of the back muscles is corrected by the asymmetric position of the hands with an occasion on the handrails of the hippotherapeutic edge, holding the rider in the sagittal plane and reducing the deviations of the general center of deviation, thereby improving the balance of the body in space.

The stabilization of the general center of gravity in the sagittal plane at the first stages of treatment is also proved by the stabilometric study [2]. Fixation of the legs in the stirrups contributes to the correction of the rotational settings of the legs. The position of the internal rotation is achieved by setting “the toe of the foot turned inward”, the position of the external rotation - “the toe of the foot turned outward”.

To strengthen the gluteal muscles, while sitting on a horse in the initial position, the child is offered to take straight legs back alternately, resting his hands on the horse’s torso, then, without changing the initial position, the child will raise the bended knees up, then lying on his back on the horse’s croup each knee alternately leads to the stomach. Strengthening the gluteal muscles helps correct the asymmetry of the pelvis.

To strengthen the muscles straining the wide fascia of the thigh, the child is offered, in the initial position lying on his back, on the horse’s croup, at the expense of 1-2, straight legs apart at the same time, at the expense of 3-4 fix this position, at the expense of 5-6 return to the starting position. Strengthening the muscles straining the wide fascia of the thigh fixes the pelvic girdle while walking.

To strengthen the adductors of the thigh muscles, the child is offered, in an initial position, sitting on a horse, at the expense of 1-2 with straight legs, squeeze the horse's body, by 3-4 - to relax. Strengthening the adductors of the thigh provides the mid-position of the legs when upright.

To influence the muscles of the back, the child is recommended, in the initial position sitting on the horse, to cross his arms behind his back “into the lock”, lean forward as much as possible and return to the starting position on his own, then the child, bending his torso forward, stretches to the horse’s ear on the side opposite to the raised half of the pelvis. Performing a tilt of the body contributes to the stretching of the spasmodic lumbar-iliac muscle.

To strengthen the muscles of the lateral and front surfaces of the torso, the child is offered, lowering his hands to the belt in the initial position on the horse and turning the torso to the sides, after which, without changing the initial position, the child puts his hands “in the lock” behind his head and alternately with each elbow reaches for the opposite knee. This exercise allows you to maintain the balance of the body when it is tilted forward and to the side.

The rate of exercise is average, the number of repetitions for each exercise is up to 10 times, the course of treatment 10 procedures 3 times a week is optimal for the treatment of combined deformation of the pelvis and spine in children.

Patent studies on subclasses A61F 5 | 00 and analysis of scientific and medical information reflecting the current level of development for the correction of combined deformations of the pelvis and spine in dysplastic-dystrophic syndrome did not reveal technologies identical to the proposed one. Thus, the proposed method for correcting the asymmetry of the pelvis and spine is new.

The interconnection and interaction of the essential techniques of the proposed method ensures the achievement of a new technological, medical result in solving the problem, namely: to increase the effectiveness of treatment due to the simultaneous correction of the muscles of the pelvic girdle and back, to develop muscle-joint feeling and muscular-sensory coordination, to rebuild the incorrect motor orientation and form new motor skills. Thus, the proposed solution has an inventive step.

The proposed method for the treatment of combined pelvic and spinal deformities in children with dysplastic-dystrophic syndrome is applicable in the field of practical public health, as it can be used repeatedly.

The essence of the proposed method of treatment is illustrated by illustrations, where

Figure 1, a, b - radiograph of the pelvic girdle of patient I. (a - before treatment, b - after treatment after 9 months);

Figure 2, a, b - radiograph of the spine of patient I. (a - before treatment, b - after treatment after 9 months);

Figure 3 - Dynamics of EMG indicators before and after treatment:

a - gluteal muscles, b - muscles that strain the broad fascia of the thigh,

in - adducting thigh muscles; g - back muscles.

Table 1. Dynamics of electromyographic indicators of the studied muscles of patient I. before and after treatment.

Table 2. Dynamics of stabilometric indicators in groups 1 and 2 before and after treatment.

Table 3. Change in the speed of the statokinesogram before and after treatment;

Table 4. Change in the area of the statokinesogram before and after treatment.

The essence of the proposed "Method for the treatment of combined deformations of the pelvis and spine in children" is as follows.

Before the start of classes and after the course of treatment, an electromyographic study is performed of the following muscles: gluteus, back, adductors of the thigh and muscles that strain the broad fascia of the thigh.

In the preparatory period of therapeutic riding, children are introduced to the stable, the structure of the horse, its various breeds, gait, feeding, and grooming. The child is mounted on a horse from the platform with staff insurance, supporting. In the future, child insurance is provided by the instructor on the one hand. A child is placed on a horse’s back without a saddle using a hippotherapeutic edge. The breeder monitors the horse’s movements, the instructor “guides” the patient, supports him during various exercises on the horse’s back. Within 1-2 minutes, the child is offered a quiet ride without performing physical therapy exercises.

In the main period, the child is offered active, dynamic exercises of physiotherapy exercises for the muscles of the pelvic girdle, trunk and limbs in the initial position, sitting face-down in the direction of the horse's motion and lying on his back, on the croup. Classes using the horse begin with the simplest exercises of physiotherapy for small muscle groups (muscles of the face, neck, hands, feet) with a gradual increase in load. The rate of exercise is average (1-2 movements per second). The number of repetitions for each exercise is up to 10 times.

The asymmetric position of the pelvic muscles is corrected by the fixation of the feet in the stirrups, mounted on the hippotherapeutic edge at different levels, with a lower location of the stapes on the side of the higher located half of the pelvis.

The asymmetric position of the hands with a reason on the handrails of the hippotherapeutic edge corrects the asymmetric position of the back muscles and allows you to keep the rider in the sagittal plane.

Strengthening the gluteal muscles to correct the asymmetry of the pelvis is carried out in the initial position, sitting on a horse. The child is offered to take straight legs back by turns, resting his hands on the horse’s torso, then, without changing the starting position, the child will raise the bended knees up and down, after that, lying on his back, on the croup of the horse, each knee will lead to its own stomach.

Strengthening the muscles straining the wide fascia of the thigh allows you to fix the pelvis while walking. The child is offered, in the initial position lying on his back, on the horse’s croup, to straight legs 1-2 apart at the same time at the expense of 3-4, fix this position, at the expense of 5-6 to return to the starting position.

Strengthening the adductors of the thighs to give a mid-position of the legs when upright is performed in the initial position, sitting on a horse. At the expense of 1-2 children are offered with straight legs to squeeze the horse’s body, for 3-4 - to relax.

Strengthening the muscles of the back provides stretching of the spasmodic lumbar-iliac muscle and ensures stability of the spine during upright posture. It is recommended that the child, in the starting position, sitting on a horse, cross his arms behind his back "into the castle", lean forward as much as possible and return to the starting position independently. Then the child, bending the torso forward, reaches for the horse’s ear, on the side of the opposite raised half of the pelvis.

Strengthening the muscles of the lateral and anterior surface of the torso ensures the preservation of the balance of the torso during bending, rotation and flexion of the spine. The child is offered, in the initial position, sitting on the horse, lowering his hands to the belt and turning the torso to the sides, after that, without changing the starting position, the child puts his hands “in the lock” behind his head and alternately with each elbow reaches for the opposite knee.

The rate of exercise is average (1-2 movements per second), the number of repetitions for each exercise is up to 10 times, the course of treatment is 10 procedures 3 times a week. In the final period, the child is offered exercise therapy exercises for relaxation. After dismounting, the child adapts to its original position while standing for 1-2 minutes. The course of treatment is repeated after six months.

The proposed "Method for the treatment of combined pelvic and spinal deformities in children" is illustrated by a clinical example:

Patient I., 10 years old. Diagnosis: Dysplastic-dystrophic syndrome: S-shaped thoracolumbar kyphoscoliosis of the 1st degree, pelvic asymmetry of the 1st degree, avascular necrosis of the femoral heads of the 1st degree, bilateral transverse flatfoot of the 1st degree.

On R-grams (before treatment): the right-sided arch of the curvature of the spine (Th2-L1) - 9 degrees (according to Cobb), the left-sided arc (L1-L4) - 6 degrees (see the appendix to the description of figure 2, a). Asymmetry of the pelvis (79-80 degrees) - 1 degree (I degree), cervical - diaphyseal angle (137-141 degrees) (see the appendix to the description, figure 1, a).

Before treatment, an electromyographic study (EMG) of the gluteal muscles, the muscles straining the wide fascia of the thigh, the adductors of the thigh and back muscles was performed (see the appendix to the description, table No. 1).

According to EMG data, the following was noted: a violation of the coordination of the gluteal muscles with a change in the asymmetry coefficient to 1.3, the value of bioelectrical activity at the maximum arbitrary contraction of the gluteal muscles (muscle strength) was, μV: left 303, right 242.

The average value of bioelectric activity at a 50% reduction from the maximum (muscle fatigue) for 30 seconds was, μV: left 407, right 691.

The ratio of high frequencies to slow EMG (myodystrophic changes in the muscles) was: 1.01 on the left, 1.04 on the right; the ratio of the average amplitude to the average frequency of EMG (function of motor cells of the spinal cord) was: left 72.73, right 84.6.

Violation of coordination of the muscles straining the wide fascia of the thigh with a change in the asymmetry coefficient to 1.4, the value of bioelectrical activity with the maximum arbitrary contraction of the muscles straining the wide fascia of the thigh (muscle strength) was, μV: left: 435, right: 609; the average value of bioelectrical activity at a 50% reduction from the maximum (muscle fatigue) for 30 seconds was, μV: left 521, right 1011; the ratio of high frequencies to slow EMG (myodystrophic changes in the muscles) amounted to: left and right 1.09; the ratio of the average amplitude to the average frequency of EMG (function of motor cells of the spinal cord) was: 85.9 on the left, 91.7 on the right.

Violation of the coordination of the adducting muscles of the thigh with a change in the asymmetry coefficient to 1.3, the value of bioelectric activity at the maximum arbitrary contraction of the adducting muscles (muscle strength) was, μV: left 317, right 243; the average value of bioelectric activity at a 50% reduction from the maximum (muscle fatigue) for 30 seconds was, mV: to the left 734, to the right 657; the ratio of high frequencies to slow EMG (myodystrophic changes in the muscles) was: left 1.3, right 1.2; the ratio of the average amplitude to the average frequency of EMG (function of motor cells of the spinal cord) was: 113.71 on the left, 106.29 on the right.

According to the EMG, there was a violation of coordination of the work of the back muscles with a change in the asymmetry coefficient to 1.2 (norm 1), the value of bioelectrical activity at the maximum arbitrary contraction of the back muscles (muscle strength) was, μV: left 438, right 365 (norm 680 -725); the average value of bioelectric activity at a 50% reduction from the maximum (muscle fatigue) for 30 seconds was, μV: left 1002, right 805 (norm 1370-1450); the ratio of high frequencies to slow EMG (myodystrophic changes in the muscles) was: left 1.2, right 1.01 (norm 2.1-2.4); the ratio of the average amplitude to the average frequency of EMG (function of motor cells of the spinal cord) was: 58.64 on the left, 61.47 on the right (norm 28-32).

Medical riding lessons began with the fact that the child was introduced to the stable, the structure of the horse, its feeding, and caring for it. Then the child was put on a horse from the platform with staff insurance, supporting. Further, the child was insured by the instructor on the one hand. The child was planted on the horse’s back without a saddle using a hippotherapeutic edge. The horse guide monitors the horse’s movements, the instructor “guides” the patient, supports him during a variety of physiotherapy exercises performed on the horse’s back. Within 1-2 minutes, the child was offered a quiet ride without performing physical therapy exercises.

In the main period, the child was offered active, dynamic exercises of physiotherapy exercises for the muscles of the pelvic girdle, trunk and limbs in the initial position, sitting face-down in the direction of the horse's motion and lying on his back, on the croup. Classes began with the simplest exercises of physiotherapy for small muscle groups (muscles of the face, neck, hands, feet) with a gradual increase in load.

According to the proposed technology, the patient performed physical therapy exercises to strengthen pathologically altered muscles of the pelvic girdle and back.

Initially performed exercises to strengthen the gluteal muscles. In this case, the child alternately took straight legs back, resting his hands on the horse’s torso. Then, without changing the starting position, he also raised the bended knees one by one, after that, lying on his back on the horse’s croup, he alternately brought each knee to its own stomach.

According to the proposed technology, the patient performs exercises to strengthen the muscles straining the wide fascia of the thigh. In the starting position, lying on his back, on the croup of the horse, he counts 1-2 straight legs at the same time, counts 3-4 fixes this position, counts 5-6 and returns to the starting position.

Then the patient performed exercises to strengthen the adductors of the thighs. At the expense of 1-2, the child is offered with straight legs to squeeze the horse's body, at the expense of 3-4 - to relax.

To strengthen the muscles of the back, the child is recommended, in the initial position sitting on the horse, to cross his arms behind his back "into the castle", lean forward as much as possible and return to the original position independently. Then the child, bending the torso forward, reaches for the horse’s ear on the side opposite to the raised half of the pelvis.

The achieved therapeutic effect after the treatment according to the EMG data (see the appendix to the description, Table No. 1).

The asymmetry coefficient of the gluteal muscles was 1.03, the value of bioelectric activity at the maximum arbitrary contraction of the gluteal muscles (muscle strength) was, mcV: left 349, right 360; the average value of bioelectric activity at a 50% reduction from the maximum (muscle fatigue) for 30 seconds was, mkV: to the left 659, to the right 742; the ratio of high frequencies to slow EMG (myodystrophic changes in the muscles) was: left 1.3, right 1.4; the ratio of the average amplitude to the average frequency of EMG (function of motor cells of the spinal cord) was: left 33.6, right 37.42.

According to EMG data, coordination of the work of muscles straining the wide fascia of the thigh was restored (1), the value of bioelectrical activity at the maximum arbitrary muscle contraction (muscle strength) was, μV: left 769, right 775; the average value of bioelectrical activity at a 50% reduction from the maximum (muscle fatigue) for 30 seconds was, μV: left 650, right 1126; the ratio of high frequencies to slow EMG (myodystrophic changes in the muscles) was: left 1.9, right 1.7; the ratio of the average amplitude to the average frequency of EMG (function of motor cells of the spinal cord) was: 65.9 on the left, 71.3 on the right.

The asymmetry coefficient of the adductor muscles of the thigh was 1.08, the value of bioelectrical activity at the maximum arbitrary contraction of the adductor muscles (muscle strength) was, μV: left 551, right 510; the average value of bioelectric activity at a 50% reduction from the maximum (muscle fatigue) for 30 seconds was, mkV: 815 on the left, 953 on the right; the ratio of high frequencies to slow EMG (myodystrophic changes in the muscles) was: left 1.5, right 1.4; the ratio of the average amplitude to the average frequency of EMG (function of motor cells of the spinal cord) was: 70.6 on the left, 89.5 on the right.

The coordination of the work of the back muscles was restored (1), the value of bioelectrical activity at the maximum arbitrary contraction of the back muscles (muscle strength) was, μV: left 532, right 530; the average value of bioelectric activity at a 50% reduction from the maximum (muscle fatigue) for 30 seconds was, mkV: left 1296, right 1066; the ratio of high frequencies to slow EMG (myodystrophic changes in the muscles) was: left 1.4, right 1.3; the ratio of the average amplitude to the average frequency of EMG (function of motor cells of the spinal cord) was: left 32.5, right 41.13.

Thus, as a result of the treatment performed in the gluteal muscles, coordination of muscle work with restoration of the asymmetry coefficient was restored from 1.3 to 1.03, muscle strength increased 1.2 times on the left, 1.5 times on the right, fatigue of the buttocks muscles decreased 1.6 times on the right, 1.07 on the right times, myodystrophic changes in the gluteal muscles decreased left and right - 1.3 times, the function of motor nerve cells of the spinal cord improved 2.2 times on the left, on the right - 2.3 times. In muscles of tensioners of the broad fascia of the thigh, the asymmetry coefficient was reduced from 1.4 to 1, muscle strength increased 1.8 times on the left, right 1.3 times, muscle fatigue on the left decreased 1.2 times, on the right 1.1 times, myodystrophic changes in the muscles decreased 1.7 on the left times and right - 1.6 times, the function of motor nerve cells of the spinal cord improved 1.3 times on the left and right. In the adductors of the thigh, the coefficient of asymmetry of muscle work decreased from 1.3 to 1.08, the strength of the muscles increased 1.7 times on the left, on the right - 2 times, the fatigue of the adductors of the thigh on the left decreased 1.1 times, on the right - 1.5 times, myodystrophic changes in the adductors of the thigh decreased left and right - 1.2 times, the function of motor nerve cells of the spinal cord improved 1.6 times on the left, on the right - 1.2 times. In the back muscles, a decrease in the coefficient of asymmetry of muscle work was noted from 1.2 to 1, muscle strength increased on the left by 1.2 times, on the right - by 1.4 times, fatigue of the muscles of the back on the left and on the right decreased by 1.3 times, myodystrophic changes in the muscles of the back decreased by 1.2 times on the left , on the right - 1.3 times, the function of motor nerve cells of the spinal cord improved 1.8 times on the left, on the right - 1.5 times.

On the R-grams (9 months after treatment): the right-sided arch of the curvature of the spine (Th2-L2) - 2 degrees (according to Cobb), the left-sided arc (L1-L4) - 4 degrees (see figure 2, b). Asymmetry of the pelvis (80-78 degrees) - 2 degrees (I degree), cervical-diaphyseal angle (143-147 degrees) (see figure 1, b).

In order to improve the redox reactions of the body, the child is offered breathing exercises. In the initial position, sitting on a horse, the child raises his hands through the sides up and takes a breath, while exhaling, he lowers his hands.

When performing exercises, the child's attention is focused on the symmetrical execution of movements, on learning to self-control the actions performed. To ensure a symmetrical landing on a horse when performing exercises for the muscles of the pelvic girdle, trunk and lower extremities, stirrups of equal length are used. Effectively performing exercises with a change in the general center of body pressure (torso back and forth, lifting on stirrups).

In the final period, the child is offered relaxation exercises. After dismounting, the child adapts to its original position while standing for 1-2 minutes.

As a result of treatment, a positive effect was achieved: 1) pelvic asymmetries are stabilized; 2) the progression of scoliotic deformity in dysplastic-dystrophic syndrome stops; 3) the coordination of the work of the muscles of the pelvic girdle and back is restored; 4) increased muscle strength; 5) their fatigue decreases; 6) eliminates the asymmetry of the muscles of the pelvic girdle and back; 7) eliminated neuromyodystrophic changes in them; 8) improves the function of nerve cells of the spinal cord; 9) the ligamentous apparatus and the “muscle corset” are strengthened. The above positive changes, as a rule, are observed after 10 procedures. To consolidate the effect obtained, a second course of treatment is carried out after 6-8 months.

The proposed "Method for the treatment of combined pelvic and spinal deformities in children" was tested on 23 patients of the 1st and 2nd degree of deformation: 10 boys and 13 girls aged 6-16 years. As a result of the treatment, the progression of the disease was stopped in 65% of patients, clinical improvement, including the elimination of asymmetry in the strength of the gluteal muscles, in 62%, muscles straining the wide fascia of the thigh - in 49%, adductors of the femur - in 58%, back muscles - in 53% of patients. Fatigue of the gluteal muscles was reduced in 61%, muscles straining the wide fascia of the thigh in 60%, adductors of the thigh in 57%, and back muscles in 45% of patients (see figa, b, c, d).

Reduction of neuromyodystrophic changes in the gluteal muscles in 77%, muscles straining the wide fascia of the thigh in 54%, adductors of the thigh in 64%, and back muscles in 69% of patients.

Improvement of the function of nerve cells on the right by 37%, on the left - by 42%. Improvement of tissue trophism at 100%. Strengthening the ligamentous apparatus and the “muscle corset” in 88% of patients.

At the same time, 2 groups of patients with manifestations of combined deformations of the pelvis and spine were monitored. In group 1, horse-riding was used without selective fixation of the legs in stirrups, in group 2 - with selective fixation of the legs in stirrups.

In a stabilometric study, both with open and closed eyes in patients of groups 1 and 2, increased fluctuations of the main center of pressure (OCD) in the frontal and sagittal plane were recorded, which indicates a violation of the supporting function and spatial orientation of the spine. An increase in the length, speed, and area of the statokinesogram was noted when performing the test with open and closed eyes in 2 groups.

Patients of group 1 showed less positive dynamics in the studied parameters. In group 2, the digital values of the length, speed and area of the statokinesogram are as close as possible to the conventional norm when performing tests with open and closed eyes. A decrease in the deviations of DCD in the frontal and sagittal planes was also noted in patients of the 2nd group (see Tables 2, 3, 4).

Subjectively, there is a decrease in pain symptoms, a decrease in general fatigue, and easier tolerance of school loads.

Thus, the proposed "Method for the treatment of combined pelvic and spinal deformities in children" in comparison with other known technologies provides a high therapeutic effect due to the simultaneous correction of the muscles of the pelvic girdle and back, the development of muscular-articular feeling and muscular-sensory coordination, restructuring and the formation of a new motor skill.

Information sources

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Table 1 Dynamics of electromyographic indicators of the studied muscles of patient I. before and after treatment. Indicator Gluteal muscles Muscle tensing the wide fascia of the thigh Adductors of the thigh Back muscles 1 muscle coordination Before treatment 1.3 1.4 1.3 1.2 After treatment 1.03 one 1.08 one 2 value of bioelectric activity at max. (100%) reduction Before treatment: left 303 435 317 438 on right 242 609 243 365 After treatment: left 349 769 551 532 on right 360 775 510 530 3 average bioelectric activity at 50% reduction 407 521 734 1002 Before treatment: left on right 691 1011 657 805 After treatment: left 659 650 815 1296 on right 742 1126 953 1066 4 the ratio of high frequencies to slow (myodystrophic changes) to treatment: left 1.01 1.09 1.3 1.2 on right 1.04 1.09 1.2 1.01 After treatment: left 1.3 1.9 1.5 1.4 on right 1.4 1.7 1.4 1.3 5 ratio of the average amplitude to the average frequency of EMG (function of motor nerve cells of the spinal cord) Before treatment: left 72.73 85.9 113.71 58.64 on right 84.6 91.7 106.29 61.47 After treatment: left 33.6 65.9 70.6 32.5 on right 37.42 71.3 89.5 41.13

table 2 Dynamics of stabilometric indicators in group 1 (the effect of corrective hippotherapy on the muscles of the back) and in group 2 (the effect of corrective hippotherapy on the muscles of the pelvic girdle and back) Change the length of the statokinesogram Statokinesogram length Before the course of corrective hippotherapy After a course of corrective hippotherapy Eyes Open (conditional norm 435.3) Closed (conditional norm 613.1) Open (conditional norm 435.3) Closed (conditional norm 613.1) Scoliosis 1 687.9 905 545.3 631.6 degrees of 1 group 2 group 569.7 684.1 463.4 614.3 Scoliosis 2 704.7 903.1 502.5 657.1 degrees of 1 group 2 group 698.5 753.6 448.3 625

Table 3 Changing the speed of the statokinesogram Statokinesogram Speed Before the course of corrective hippotherapy After a course of corrective hippotherapy Eyes Open (conditional norm 10.6) Closed (conditional norm 11.5) Open (conditional norm 10.6) Closed (conditional norm 11.5) Scoliosis 1 17.4 19.8 13.6 14.3 degrees of 1 group 2 group 13.6 16.82 10.5 11.4 Scoliosis 2 18.2 20.8 12.6 14.3 degrees of 1 group 17.5 19.37 11.7 12.1 2 group

Table 4 Changing the area of the statokinesogram Statokinesogram area Before the course of corrective hippotherapy After a course of corrective hippotherapy Eyes Open (conditional norm 99.5) Closed (conditional norm 258.4) Open (conditional norm 99.5) Closed (conditional norm 258.4) Scoliosis of the 1st degree 125.6 306 118.8 273 1 group 2 group 129 295.1 100.1 260 Scoliosis 2 degrees 123.6 299 113.5 281 1 group 2 group 127.3 304.2 104 269.4

Claims (1)

A method of treating combined pelvic and spinal deformities in children, characterized in that hippotherapy is used in combination with a set of physical therapy exercises to correct a certain group of pathologically changed muscles in the following sequence: the asymmetric position of the pelvic muscles is corrected by fixing the feet in stirrups at a different level, while more the low position of the stapes on the side of the higher located half of the pelvis, the asymmetric position of the back muscles is corrected by the asymmetric position of the hands with a reason om behind the handrails of the hippotherapeutic edge, holding the rider in the sagittal plane; to strengthen the gluteal muscles, while sitting on a horse in the initial position, the child is offered to take straight legs back alternately, resting his hands on the horse’s torso, then, without changing the starting position, the child will raise the bended knees up, then lying on his back on the croup of the horse each knee alternately leads to the stomach; to strengthen the muscles straining the wide fascia of the thigh, the child is offered, in the initial position lying on his back, on the horse’s croup, at the expense of 1-2, straight legs apart at the same time, at the expense of 3-4 fix this position, at the expense of 5-6 return to initial position; To strengthen the adductors of the thigh muscles, the child is offered, in the initial position, sitting on the horse, to compress the horse’s trunk with 1-2 straight legs, to relax for 3-4; to influence the muscles of the back, the child is recommended, in the initial position sitting on the horse, to cross his arms behind his back “into the lock”, lean forward as much as possible and return to the initial position independently, then the child, tilting the torso forward, stretches to the horse’s ear on the side opposite to the raised half of the pelvis; To strengthen the muscles of the lateral and front surfaces of the torso, the child is offered to lower his hands to the belt and to rotate the torso to the sides in the initial position while sitting on the horse, after which, without changing the initial position, the child puts his hands “in the lock” behind his head and alternately with each elbow reaching for the opposite knee; the rate of exercise is average, the number of repetitions for each exercise is up to 10 times, the course of treatment is 10 procedures 3 times a week.

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