RU2466704C1 - Method for normal muscle tone recovery in infants with perinatal central nervous system damage - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: infant is examined and massaged at 24-26°C. It is followed by a a complex of physical exercises to be made in water thereafter. The exercises in water of temperature 35-36°C are made in the form of individual or small-group trainings at least 3 times a week, for 45-50 minutes. The infant is carried in water vertically and facing water and laid on back so that a body is positioned horizontally by itself. With the infant's nape supported, the exercises are started each of which is made at least 20 times and alternated by jolting of the extremity for at least 20 sec. The infant's forearm is grasped to make circular motions of the arms towards the infant's head. Then elbow flexion and unbend of the arms are alternated and followed by circular motions by the infant's unbent arms alternatively and simultaneously, up and down motions of the both arms simultaneously, slight motions of the foot in water, flexion and unbend of the leg simultaneously with jolting; then the infant's ankles are grasped to perform flexion of the both legs, jolting and unbend. Each exercise is followed by rest making at least 30 sec. After the complex is completed, the infant is turned on stomach to make supported horizontal and vertical eight curve sways.

EFFECT: recovered stability and tonic contraction of the muscles, reduced time for muscular release in the infant and rehabilitation time to 1-3 months.

5 cl, 2 ex

Description

The invention relates to medicine, in particular to pediatrics, and for the non-drug rehabilitation of children with such a perinatal lesion of the central nervous system (PPCNS) as muscle hypertension syndrome (increased muscle tone). The method can be used with a mild form of PCNS in children aged 1-3 months.

The clinical picture of perinatal lesions of the central nervous system is characterized by a disorder of cerebral circulation. Identification of even minimal cerebral disorders in newborns requires urgent elimination, since in subsequent age periods these deviations can become irreversible. PPCNS is one of the most common types of pathology of children. Early rehabilitation of children of the first year of life with PCNS is especially important for the further harmonious development of the child. Timely elimination of PCNS can prevent the formation of pathological changes and contribute to a more favorable physical and neuropsychic development of children, and in some cases the full restoration of impaired functions. A fairly common violation of perinatal brain damage is muscle hypertension (increased muscle tone) of the child.

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

Known drug methods for the rehabilitation of children with PPSNS, which include: sedatives, vascular, nootropic drugs, dehydration therapy, metabolites. However, the therapeutic effect of pharmacotherapy is not immediately apparent, but only after a long course, which is often complicated by side effects, allergization of a child's immature organism.

Of the non-pharmacological methods in complex rehabilitation, manual therapy, massage, physiotherapy, reflexology, and physiotherapy are used.

A known method of rehabilitation of children with lesions of the central and peripheral nervous system according to the method of K. A. Semenova (see Semenova K. A. Children's cerebral palsy. - M .: Medicine, 1981, p. 38-101), which consists in the use of massage, reflexology, correction of orthopedic disorders and dynamic exercises. In this case, massage is carried out by applying stroking, rubbing, kneading the affected muscles on the limbs and trunk. Dynamic exercises are carried out using special exercises and various devices (balls, swings, rocking chairs, swivel chairs, trampolines, etc.). However, the known method is used in children, mainly with cerebral palsy (cerebral palsy).

There is a method of teaching swimming infants (see ZP Firsov. Swim earlier than walk. Ser. "Physical Culture and Sports", No. 6/82, p. 25, ed. "Knowledge", Moscow). In the known method, the infant is adapted to water, swimming exercises are performed in the form of supports, wiring, sliding, and movements of the arms and legs are worked out, providing the child with learning swimming skills to move in the desired direction. However, the known method allows you to teach swimming infants.

A well-known program for swimming with infants with a mild form of encephalopathy (see Kotlyarov A.D. Swimming with infants with a mild form of encephalopathy / Swimming. Research, training, hydro-rehabilitation: Materials of the All-Russian Scientific and Practical Conference, St. Petersburg, 2001.p. 117-118). The well-known program uses massage, gymnastics and swimming. The well-known program uses active and passive movements, as well as exercises in water with exposure to reflex zones. Moreover, when swimming with children of the first or second months of life, the set of exercises in the water is as follows:

1) in an upright position, shake the child up and down, without lowering his head under water. Perform wiggle 10-15 seconds;

2) performing postings in the position on the chest, swaying the child up and down. Perform two or three such postings;

3) holding the child in an upright position, perform rocking up and down for 10-15 seconds;

4) put the child in a supine position. Post the baby from one side of the bath to the other 2-3 times;

5) in the supine position, place the child's feet so that they lightly touch the side of the bath or pool. This leads to reflex repulsion. The exercise is performed 3-4 times;

6) in a one-handed grip with a “bucket” under the chin (in the position on the chest), the adult gently pats the baby on the buttocks or presses the thigh muscles with the second hand. In this case, the child reflexively throws up the handles with subsequent adducing movements and slight flexion in the elbow joints. This exercise is performed 2-3 times.

Swimming lessons according to the well-known program are held with a child aged from 1 month, in several cycles, until he reaches the age of 12 months. Thus, the well-known swimming training program is designed for classes with a child for a long period, almost a whole year.

There is a method of rehabilitation of premature infants with perinatal injuries of the central nervous system (CNS) (see Physical rehabilitation in rehabilitation treatment of infants with perinatal injuries of the central nervous system, scientific notes of the PF Lesgaft University, No. 12 dated 12/1/2009 city, pp. 21-25). The known method involves conducting hydrokinesitherapy, fitball, reflex gymnastics. Moreover, hydrokinesitherapy is carried out in three stages (initial, basic, training) for 15-20 minutes in the bath, for 20-25 minutes in the small pool and for 30-40 minutes in the large pool in accordance with the stage. The water temperature, depending on the stage of rehabilitation, is 36-34 degrees, 34-32 degrees, 32-30 degrees. At the same time, the initial stage consists of passive hydrokinesitherapy and the optimal time for the beginning of the stage is 2-2.5 months of life. Therapeutic massage with elements of physiotherapy exercises and in combination with physiotherapeutic treatment is carried out in 3, 6, 9, 12 months of life, and in the intervals between courses, children receive physiotherapeutic treatment (electrophoresis and galvanotherapy, phototherapy, magnetotherapy). However, the known method is intended for the rehabilitation of a premature baby of the first year of life and is aimed at preventing pathological conditions of a premature baby and normalizing the pace of its development.

A known method of rehabilitation of children with lesions of the central and peripheral nervous system (see Ru p. 2345754, op. 10.02.2009). A known method involves the use of dolphin therapy for the rehabilitation of sick children. However, the known method involves the involvement of a large number of health workers, specialists, the creation of a special center. All this provides for high costs.

The well-known "Method of restoring motor disorders in newborns with pathology of the spine" (see RU p. No. 2199993, op. March 10, 2002). The known method includes conducting water procedures with the immersion of a child in water and the child performing various gymnastic exercises in water. However, the known method is intended to restore disorders of the muscles involved in the extension of the head and neck. This method is selected as the closest analogue.

The problem to which the invention is directed, is to create a simple non-drug way to reduce muscle hypertonicity, improve and normalize tonic muscle contraction in newborns aged 1-3 months with a mild form of PCOS, due to the complex effect of massage, gymnastics, and water exercises on the child procedures with the child's immersion in water and the child performing in water, in the bath, special gymnastic exercises.

The technical result consists in the restoration in newborns, 1-3 months of age with a mild form of PCNS, the stability of tonic muscle contraction, in reducing the time it takes for a newborn to relax muscularly, and in reducing the rehabilitation time to 1-3 months.

This result is achieved by the fact that in the method of restoring normal muscle tone in children with perinatal lesions of the central nervous system, which provides for water procedures with immersion in water and gymnastic exercises in water, according to the invention, a child is examined in advance, water procedures are immersed in water carried out in the form of individual or small-group exercises at least 3 times a week, with a duration of 45-50 minutes, before conducting water In a room with a temperature of 24-26 ° C, they massage the child, then they perform a set of gymnastic exercises with the child, which the child will subsequently perform in water, then put the child in an upright position, facing the water, at a temperature of 35- 36 ° C, they put the child in the water on his back so that his body itself is in a horizontal position and place the child so that he is facing the one who is carrying out the water procedure with the child and, while supporting the back of the child’s head with one hand, they try to perform a set of gymnastic exercises, for this they embrace the child with the other hand on the forearm of the hand, perform circular movements with this hand towards the child’s head, at least 20 times, then perform circular movements with the other hand of the child towards the child’s head, at least 20 times, then perform flexion and extension in the elbow joint with one hand of the child at least 20 times, then perform flexion and extension in the elbow joint with the other hand of the child at least 20 times, then perform shaking movements with one hand of the child in t reading for at least 20 seconds, then perform shaking movements with the child’s other hand for at least 20 seconds, then move the hand to the elbow joint of one child’s hand, then move the other hand to the elbow joint of the child’s other hand and support the child so that there is water above the water only his face, perform circular movements with the child's straightened arms at least 20 times so that when one child’s hand is behind his head, the other is located along his body, then perform shaking movements of one p with a baby’s eye, then with the other hand of the child for at least 20 seconds, then perform circular movements towards the child’s head simultaneously with both hands of the child, at least 20 times, supporting the child so that his face is above the water, then perform the movement simultaneously with both hands the child through the sides up and down, at least 20 times, then perform shaking movements with the hands of the child for at least 20 seconds, then supporting the child under the back of the head and grasping the child by the knee joint of one leg perform light striking movements of the child’s foot in the water at least 20 times, then perform light shaking movements of the lower leg and foot at least 20 times, then covering the child by the knee joint of the other leg perform light shock movements of the child’s foot in the water at least 20 times, then perform light shaking movements shin and foot at least 20 times, then place the child sideways to the one who is carrying out a water procedure with him and grabbing the child by the shin of one leg, bend and unbend this leg at least 20 times, then bend and unbend this leg at the same time swinging it, at least 20 times, then grasping the child by the shin of the other leg, bend and unbend this leg at least 20 times, then bend and unbend this leg at least 20 times, while shaking it, then grabbing the child by the ankles of both legs, perform bending both legs while shaking them and unbending both legs, at least 20 times, while after each exercise should rest for at least 30 seconds, and after completing a set of gymnastic exercises, the child is turned onto his stomach and, supporting him with one hand under the chest, and the other in such a way that only the baby’s head is above the water, swinging movements are performed horizontally, then swinging movements are performed vertically, then the movement is made in the “eight”.

It is advisable that the duration of the procedure in water is 15-20 minutes.

It is advisable that at the end of water procedures the child is wrapped in a towel, transferred to a changing table and wiped with a towel.

It is advisable that during the course of restoration of normal muscle tone, a course of physiotherapeutic procedures be carried out.

It is advisable that at the end of the course of restoration of normal muscle tone the child for at least one month, was engaged in swimming in the pool.

It was noted that the application of the proposed method in the form of individual or small group exercises at least 3 times a week, with a duration of 45-50 minutes, is the most optimal, since in this case it is possible to perform all the effects on the child most effectively. It should be noted that all the manipulations performed with the child during the lesson are usually performed by a specialist, with the partial participation of the child’s mother. Moreover, in the first lesson, they first show and explain to the mother all the techniques of exposure to massage, gymnastic exercises and the necessary supports used in gymnastic exercises in water.

For the first time, it was noticed by the authors that it was precisely this sequence proposed by them, as well as the gymnastic exercises proposed by the authors, their appearance and sequence that, thanks to regular classes, at least 3 times a week, with a duration of 45-50 minutes, in general, the activity of all functional systems of the child’s body is stimulated.

It was also experimentally determined that the proposed range of 24-26 ° C in the room and a water temperature of 35-36 ° C are the most optimal. The child is warm and comfortable both indoors and in water. Under the influence of water of this temperature on the child’s body, the number of impulses entering the central nervous system decreases. As a result, the activity of the cerebral cortex is inhibited, which leads to a decrease in muscle tone, pain and hyperkinesis.

The child is placed on a changing table and begins to influence it through massage. When exposed to massage, the following techniques are used: stroking, shaking, light vibrations, rubbing, kneading, light shock techniques. Stroking has a good effect on blood circulation, improves cardiac activity, and has a vasodilating effect. Shaking relaxes increased muscle tone. Rubbing improves blood flow. Kneading increases muscle tone.

Then they begin to perform a set of gymnastic exercises with the child, which will subsequently be performed in water. The set of exercises includes: circular movements with one hand in the direction of the child’s head, at least 20 times, circular movements with the other hand in the child’s direction of the child’s head, at least 20 times, then with one child’s hand perform flexion and extension in the elbow joint at least 20 times, then perform flexion and extension in the elbow joint with the other hand of the child at least 20 times, then perform shaking movements with one hand of the child for at least 20 seconds, then perform shaking movements with the other hand of the child for at least 20 seconds, then move the hand to the elbow joint of one child’s hand, perform circular movements with the child’s straightened hands at least 20 times so that when one child’s hand is behind his head, the other is located along his torso, then shaking movements are performed with one child’s hand, then with the other hand the child for at least 20 seconds, then perform circular movements towards the child’s head simultaneously with both hands of the child, at least 20 times, then perform the movement simultaneously with both hands of the child through the sides up-in from, at least 20 times, then perform shaking movements with the child’s hands for at least 20 seconds, then embracing the child by the knee joint of one leg perform light shock movements with the foot of the child at least 20 times, then perform light shaking movements with the lower leg and foot for at least 20 times, then embracing the child by the knee joint of the other leg, perform light shock movements with the child’s foot at least 20 times, then perform light movements with the lower leg and foot at least 20 times, then place the child sideways to the one who is carrying out the ball with him the gymnastics exercises and bending the child by the shin of one leg bend and unbend this leg at least 20 times, then bend and unbend this leg, while shaking it, at least 20 times, then grabbing the child by the shin of the other leg bend and unbend this leg at least 20 times, while shaking it, then grabbing the child by the ankles of both legs, bend and extend both legs while shaking them at least 20 times, and after each exercise, rest for at least 30 seconds.

It was experimentally determined that such gymnastic exercises and such a number of movements do not tire the child, and rest for at least 30 seconds after each exercise helps to ensure that the child’s interest in the procedure does not disappear.

It was also experimentally established that when a child is brought into the water facing the water with his encouragement, while the voice and intonation, the child is not afraid of water and quickly adapts to water.

Then proceed to the implementation of the water complex gymnastic exercises above. The movements are repeated at least 20 times. It was experimentally observed that it is precisely such a number of movements and rest between exercises for at least 30 seconds that does not tire the child, and the child’s interest in the procedure does not disappear. A change in the position of the child’s body in the water when the child is turned over on the stomach and, supporting him with one hand under the chest, and with the other, supporting so that only the child’s head is above the water, perform horizontal swaying movements, then vertical sway movements, then perform movement along the "eight", leads to the fact that the child, using the innate swimming reflex, begins to move his arms and legs. The cerebral cortex of the child is affected by a complex of signals and irritations caused by the touch of water and its mechanical effect, the state of semi-zero gravity, a change in position in the water and repeated repetition of the same type of movements. Under the influence of such signals that are repeated at each lesson in the cerebral cortex, new nerve pathways and connections are activated, activating not only the motor centers, but also other centers that interact with them, regulating the coordination of the functions of the whole organism (which helps to improve health) also affecting the mental sphere, intelligence, mental development. This is especially important for children with PCNS, since it leads to eliminating the consequences of violations and normalizing psychomotor indicators. It was also noted that the method proposed by the authors also allows you to improve the work of all body systems, especially cardiovascular.

The method is as follows.

Restoring normal muscle tone in newborns with PPSNS is carried out comprehensively: massage, gymnastic exercises, gymnastic exercises in water, in the bath. The effects of massage, gymnastic exercises, gymnastic exercises in water, in the bath, are carried out as described above. At the same time, in the intervals between classes according to the claimed method of restoring normal muscle tone, a physiotherapeutic treatment of the child is carried out (electrophoresis with calcium chloride or vitamin PP, magnetotherapy, etc.), which is prescribed by a physiotherapist and depends on the child’s condition and related diseases.

Example 1

Boy, 1 month. A high tone of all groups of flexors was revealed, active movements in the arms and legs are absent in all muscle groups, due to the high tone, the legs constantly maintain a “cross”, the arms are constantly pressed to the chest, the cams of the arms are clenched spasmodically. According to the proposed method, the child was given a course of restoration of muscle tone, 10 lessons three times a week. Physiotherapeutic treatment of a child-electrophoresis with calcium chloride. The expressed spasticity of muscles is removed.

Example 2

Girl, 3 months old. Identified right high tone. According to the proposed method, the child underwent a course of restoration of muscle tone, 20 sessions three times a week. Physiotherapeutic treatment of the child - magnetotherapy. The expressed spasticity of muscles is removed. Then for one month the child was engaged in the pool, where he studied swimming.

The invention is the result of lengthy observations and subsequent reflection, allowing the use of accumulated experience. Using the proposed method conducted twenty-five rehabilitation of children aged 1-3 months. In all cases, an improvement in the condition of children was obtained, namely a confident result: normal muscle tone was fully restored.

It was also experimentally determined by the authors for the first time that, according to the claimed method, for mild forms of PCNS in newborns aged 1-3 months, the stability of tonic muscle contraction is achieved within 10-20 sessions. When using the claimed method, there is a reduction in the time it takes for a newborn to achieve muscle emancipation and a reduction in rehabilitation time. Thus, a technical result is achieved that satisfies a long-standing social need.

Claims (5)

1. A method of restoring normal muscle tone in children with perinatal lesions of the central nervous system, which provides for water procedures with immersion in water and gymnastic exercises in water, characterized in that the child is pre-examined, water procedures with immersion in water are carried out in the form individual or small-group exercises at least 3 times a week, with a duration of 45-50 minutes, before conducting water procedures in a room with a temperature of 24-26 ° C the child is exposed to massage, then they perform a set of gymnastic exercises with the child, which the child will subsequently perform in water, then the child in an upright position, facing the water, put into the water, the temperature of which is 35-36 ° C, put the child in water on the back in such a way that his body itself is in a horizontal position, and the child is placed so that he is heading to the one who is carrying out the water procedure with the child, and supporting the back of the child’s neck with one hand, they begin to perform gymnasium complex exercises for this, with the other hand covering the child’s forearm, perform circular movements with this hand towards the child’s head at least 20 times, then perform circular movements with the other child’s hand towards the child’s head at least 20 times, then bend with one hand and extension in the elbow joint at least 20 times, then perform flexion and extension in the elbow joint with the other hand at least 20 times, then perform shaking movements with one hand of the child for at least 20 s, then perform shaking movements with the other hand of the child for at least 20 s, then moving the hand to the elbow joint of one child’s hand, then moving the other hand to the elbow joint of the other hand of the child and supporting the child so that only his face is above the water, perform circular movements straightened with the child’s hands at least 20 times, so that when one child’s hand is behind his head, the other is located along his torso, then perform shaking movements with one child’s hand, then with the other hand with the child’s reading for at least 20 s, then perform circular movements towards the child’s head simultaneously with both hands of the child at least 20 times, supporting the child so that his face is above the water, then perform simultaneous movements with both hands of the child through the up and down sides for at least 20 times, then perform shaking movements with the child’s hands for at least 20 s, then, supporting the child under the back of the head and covering the child by the knee joint of one leg, perform light shock movements with the child’s foot in the water at least 20 times, then m perform light shaking movements with the lower leg and foot at least 20 times, then, covering the child by the knee joint of the other leg, perform light shock movements with the child’s foot in the water at least 20 times, then perform light shaking movements with the lower leg and foot at least 20 times, then place the child sideways to the one who is conducting the water procedure with him, and, having covered the child by the shin of one leg, bend and unbend this leg at least 20 times, then bend and unbend this leg, while shaking it, at least 20 times, then embracing a child for deer of the other leg, bend and unbend this leg at least 20 times, then bend and unbend this leg at least 20 times, shaking it at the same time, then, embracing the child by the ankles of both legs, bend both legs while shaking them and unbend both legs at least 20 times, while after each exercise should rest for at least 30 s, and after completing a set of gymnastic exercises, turn the child on his stomach and, supporting him with one hand under his chest, and the other so that he finds above the water only the child’s head, they perform horizontal swaying movements, then perform vertical swaying movements, then perform the “eight” movement. 2. The method according to claim 1, characterized in that the duration of the procedure in water is 15-20 minutes 3. The method according to claim 1, characterized in that at the end of the water procedures the child is wrapped in a towel, transferred to a changing table and wiped with a towel. 4. The method according to claim 1, characterized in that during the course of restoration of normal muscle tone conduct a course of physiotherapy procedures. 5. The method according to claim 1, characterized in that at the end of the course of restoration of normal muscle tone, the child is engaged in swimming in the pool for at least one month.