RU2469694C1 - Method for adaptive riding of patients with infantile cerebral paralysis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: following positions are used: a child lies on back with legs separated along horse's back; a child is pronated with legs separated along horse's back; a child lifts up his/her head while being in a pronated position with legs separated; a child is seated with legs separated and drawn down horse's hips; a child is seated with his/her head up. The therapeutic course is three-staged and consists of 23-27 sessions: a start period - 2-3 sessions, a rehabilitation period - 18-20 sessions and a reinforcement period - 3-4 sessions. At the start stage, a child learns and takes the positions with a horse standing. The rehabilitation stage involves taking the positions for a shorter period of time with a horse standing and slowly moving around a circle. At the final stage, the positions are taken for a shorter period with a horse slowly moving around a circle. During the therapeutic course, the child's involvement in taking each position is gradually increased, while the trainer and parent's involvement is decreased.

EFFECT: method provides more evident acquirement of the motor skills as compared with the previously known methods.

1 ex, 4 tbl

Description

The invention relates to medicine, in particular to pediatrics, neurology and adaptive physical education, and can be used for the rehabilitation of children with consequences of cerebral palsy.

Known methods of hippotherapy for the treatment of patients with cerebral palsy (cerebral palsy), including therapeutic horse riding in combination with a set of physical exercises [1, 2, 3].

These hippotherapy methods allow you to correct different forms of cerebral palsy.

Also known is a rehabilitation method for cerebral palsy, including therapeutic horse riding [4].

However, the method described as a prototype is not effective enough.

The task of the invention is to increase the effectiveness of treatment.

The problem is solved by applying the proposed method, which includes therapeutic horse riding.

The novelty of the method lies in the fact that therapeutic riding is carried out in a neuro-orthopedic pneumosuit by means of passively active mastery of horse poses without a saddle for a total of 23-27 lessons, and treatment is carried out in three stages: 2-3 classes - initial, then 18-20 classes - rehabilitation and 3-4 classes - fixing, while at the initial stage the child masters and performs postures in the absence of horse movement, the rehabilitation stage includes performing postures in a stationary horse stance and moving at a slow pace for a shorter time in a circle, and the final stage involves performing postures for a short time when driving a horse in slow motion in a circle, with a gradual increase during the course of the child's interest in the performance of each posture and decreasing participation instructor and parent.

The method is as follows.

Put on the child a neuroorthopedic pneumatic suit "Ippo" [5]. During the lesson, the child is insured by the hippotherapy instructor (physical therapy specialist - exercise therapy) and the child's parent. Supervises the horse’s movement (providing a fixed stand, uniform translational motion in a circle, pace of movement, etc.) the horse-drawn horse on the instruction of the instructor.

Classes are held in three stages: initial (adaptation), rehabilitation and final (fixing).

Initial (adaptation) stage

1. Riding a child on a horse with the help of an instructor and a parent. The position of the child lying on his back with diluted hips along the back of the horse head to the tail of the animal for 2-3 minutes.

2. The child is lying on his back with his thighs apart along the horse’s back with his head to the tail of the animal, the child is offered to raise his head several times, look at the toy that the instructor is holding in front of him, at the sky, etc. within 2-3 minutes

3. The position of the child lying on his stomach with the thighs apart along the back of the horse facing the head of the animal, the child’s arms grasp the horse for 2-3 minutes.

4. The child’s position lying on his stomach with the thighs apart along the horse’s back facing the animal’s head, the child’s arms grasp the horse, and the child should raise his head several times, for which he is offered to get a toy, look at the sun, etc. within 2-3 minutes

5. The position of the child sitting with the legs spread down along the sides of the horse for 2-3 minutes.

6. The position of the child sitting with his legs spread down along the sides of the horse, the child raises his head several times at the instruction of the instructor (look at the horse, look at mom, look at me, etc.) for 2-3 minutes.

7. The position of the child lying on his stomach with the thighs apart along the back of the horse facing the head of the animal, the child’s arms grasp the horse for 2-3 minutes.

The duration of the initial stage, depending on the initial state of the child, is 2-3 lessons of 20-30 minutes.

Rehabilitation phase

1. Riding a horse with the help of an instructor and parent. The position of the child lying on his back with diluted hips along the back of the horse head to the tail of the animal for 1-2 minutes.

2. The position of the child lying on his back with his thighs apart along the horse’s back with his head to the tail of the animal, the child is offered to raise his head several times, for which look at the toy the instructor is holding in front of him, at the sky, etc. within 1-2 minutes

3. The horse is moving in a circle, the pace is slow. The position of the child lying on his back with divorced hips along the back of the horse head to the tail of the animal for 2-4 minutes.

4. Horse in a stationary stance. The child is lying on his stomach with dilated hips along the back of the horse facing the head of the animal for 1-2 minutes.

5. The position of the child lying on his stomach with the thighs apart along the horse’s back facing the animal’s head, and the child should raise his head several times, for which he is offered to get a toy, look at the sun, etc. within 1-2 minutes

6. The horse is moving in a circle, the pace is slow. The position of the child lying on his stomach with divorced hips along the back of the horse facing the head of the animal for 2-4 minutes.

7. Horse in a stationary stance. The position of the child sitting with his legs spread down along the sides of the horse for 1-2 minutes.

8. The child’s sitting position with his legs extended along the sides of the horse, the child raises his head several times at the instruction of the instructor (look at the horse, look at mom, look at me, etc.) for 1-2 minutes.

9. The horse is moving in a circle, the pace is slow. The position of the child sitting with the legs spread down along the sides of the horse for 3-4 minutes.

10. Horse in a stationary stance. The child is lying on his stomach with dilated hips along the horse’s back facing the animal’s head, the child’s arms grasp the horse for 1-2 minutes.

In the process of mastering the poses by the child, the load gradually increases, which is achieved by reducing support from the instructor and the parent.

The duration of the rehabilitation phase, depending on the initial state of the child, is 18-20 sessions for 20-30 minutes.

The fixing (final) stage

1. Riding a horse with the help of an instructor and parent.

2. The horse is moving in a circle, the pace is slow. The position of the child lying on his back with diluted hips along the back of the horse head to the tail of the animal for 1-2 minutes.

3. The horse is moving in a circle, the pace is slow. The position of the child lying on his stomach with divorced hips along the back of the horse facing the head of the animal for 2-4 minutes.

4. The horse is moving in a circle, the pace is slow. The position of the child sitting with the legs spread down along the sides of the horse for 3-4 minutes.

5. The horse is moving in a circle, the pace is slow. The position of the child lying on his back with diluted hips along the back of the horse head to the tail of the animal for 1-2 minutes.

6. The horse is moving in a circle, the pace is slow. The position of the child lying on his stomach with divorced hips along the back of the horse facing the head of the animal for 2-4 minutes.

7. The horse is moving in a circle, the pace is slow. The position of the child sitting with the legs spread down along the sides of the horse for 3-4 minutes.

8. The horse is moving in a circle, the pace is slow. The position of the child lying on his back with diluted hips along the back of the horse head to the tail of the animal for 1-2 minutes.

9. The horse is moving in a circle, the pace is slow. The position of the child lying on his stomach with divorced hips along the back of the horse facing the head of the animal for 2-4 minutes.

10. The horse is moving in a circle, the pace is slow. The position of the child sitting with the legs spread down along the sides of the horse for 3-4 minutes.

11. Horse in a stationary stance. The child is lying on his stomach with dilated hips along the horse’s back facing the animal’s head, the child’s arms grasp the horse for 2-4 minutes.

The duration of the final stage is 3-4 lessons of 20-30 minutes.

Justification of the hallmarks

The formation of a vertical landing when moving on a horse suggests that with the help of hippotherapy, the child’s muscles become able to hold a certain position, the child can control his position in space. This is due to the development of a proprioceptive neuromuscular feeling and an increase in strength in the muscles of a sick child, a sense of balance, coordination, decreased muscle spasticity, and increased range of motion. Normal vertical landing involves maintaining a properly located center of gravity, i.e. equilibrium, which is achieved by the analysis of information at the level of the central nervous system. Information comes from the eyes, from the inner ear due to the vestibular apparatus, and from the muscles of the body via afferent sensory-somatic pathways. An ontogenetic approach to the development of human verticalization is used: the child is lying on his back along the horse’s back, the child’s lying on his stomach along his horse’s back, the head is raised from his stomach, the child’s sitting with his legs extended along the sides of the horse, the child’s sitting with his head raised . At the same time, due to the brain’s ability to “remember” during repeated repetition, certain poses of the body (body position in space) are taught to the child. It is proved that the training is more successful, the more sensations (sensory, muscle, etc.) a child receives. Hippotherapy gives such positive feelings in full. Training is carried out bareback. Contact with a large, strong animal, whose body temperature is 1.5 degrees higher than the human one, allows you to warm up and massage the spastic muscles of the child’s legs, increase blood flow in the limbs and general blood flow, which in turn improves blood circulation to the brain. When riding a horse, walking in steps, a person receives the same sensations as when walking, a complex three-dimensional movement occurs. During the horse’s movement, almost all muscle groups are involved in the rider, it is necessary to constantly control the balance, and this forces the synchronization of the muscles of the back, trunk and all other muscles, then relaxing or straining them. Mastering the position in space is achieved by passive-active development of postures on a horse without a saddle. Partially the location of the body in space helps to form and hold the instructor and parent, partially corsetting the effect of the Ippo neuroorthopedic pneumosuit, partly the child himself (depending on the initial state). Gradually, the child’s participation in each pose increases, while the participation of the instructor and parent decreases.

The choice of the frequency of classes 2-3 times a week is due to the fact that regular classes contribute to the formation of a stereotype, while more frequent classes are stressful for the child. The duration of the lesson is 20-30 minutes due to the fact that this is the most appropriate time for hippotherapy, increasing the duration of the classes does not improve the effect, but cause fatigue of the child and a loss of interest in hippotherapy. The duration of the course of 23-27 classes is due to the complexity of mastering and consolidating new skills in children with central nervous system damage, a smaller number of classes does not allow to obtain the desired effect.

Classes are held in several stages: initial (adaptation), rehabilitation and fixing (final). The adaptation stage is designed to prepare for solving the main problems: the child gets used to the Ippo neuroorthopedic pneumosuit, the horse, gets a sense of security during hippotherapy exercises, which is provided by the instructor and parent insurance, lack of movement when mastering and performing poses. The rehabilitation stage allows you to gradually form a stereotype of performing poses, reduce muscle spasticity, increase their strength, and increase the volume of active and passive movements. At the final stage, the achieved skills are consolidated.

The proposed method for the rehabilitation of patients with cerebral palsy was tested on the basis of the Autonomous non-profit organization “Hippotherapy Recreation Center” (Novosibirsk). Under observation were 40 children with cerebral palsy with intact intelligence aged 2 to 10 years (average age 5.6 ± 0.9 years), which were divided into 2 groups: the first - control (hippotherapy classes were carried out according to the prototype method) and the second is the experimental group (hippotherapy classes were carried out in accordance with the proposed method in the neuroorthopedic pneumosuit IPPO) for 3 months, 2-3 times a week. After the course, all children showed a positive dynamics of the state. Subjectively, an improvement in well-being, a decrease in general fatigue was noted, the sociability of children increased, and speech improved. However, in the first group, positive changes were less pronounced than in the second. Particular attention was paid to the mastery of certain motor skills (the ability to sit, stand, raise and hold the head) (Table 1, 2). Motor skills were evaluated using a point system: 5 points - performs the movement completely; 3 points - trying to perform or performing with; 0 points - no movement [6].

There was an improvement in mobility in the hip and knee joints (Tables 3, 4).

An example of the application of the proposed method.

Artemyeva Darina Sergeevna, 4.5 g.

Diagnosis: cerebral palsy Diplegic form. Spastic lower paraparesis.

Frontal ataxia. II level of development of motor functions according to GMFCS classification. Born from the first pregnancy, on time. Mom suffered the flu during pregnancy. From early childhood, there was a delay in the formation of installation reflexes and a lag in the formation of locomotor functions.

Before treatment, the proposed method: the child walks with the support of an adult in orthopedic shoes, the gait is unstable, sits independently, kyphosis is noted in the thoracolumbar spine, poor balance. Ankle contracture, limitation of mobility in the hip and knee joints. Speaks reluctantly 10-15 specific words. Intelligence is slightly reduced. Strabismus. I received treatment according to the proposed method for 3 months. Classes began with putting on the Ippo neuroorthopedic pneumosuit and acquaintance with the horse, then, in accordance with the developed method, all stages of treatment were carried out.

As a result of treatment, a positive effect was achieved:

1) the “muscle” corset has strengthened and the function of the vestibular apparatus has improved: it has become more stable in a vertical position and in a sitting position; increased time to maintain balance in these poses; stands in an upright position, walks confidently by the hand, “takes” mom for a walk; actively walks on the street with support; controls movements; it is noted that the activation of motor activity increases after each lesson;

2) a decrease in muscle tone of the main synergists and a decrease in the severity of pathological tonic reactions were noted;

3) the range of motion in the hip and knee joints increased, in the ankle joints unchanged;

4) fatigue of the child decreased;

5) became more contact, began to play role-playing games (animates toys, can sing a song to a toy), which was not previously observed; perception and attention intensified, more interested in others.

Parents intend to continue treatment with the proposed method.

Information sources

1. Patent RU 2423095 from 06/27/2010. A method of treating combined pelvic and spinal deformities in children. Authors: Kuvina V.N., Vasilieva E.A., Glebets V.A.

2. Sokolov P.L. Hippotherapy as a method of complex rehabilitation of patients in the late residual stage of cerebral palsy / P.L. Sokolov, G.V. Dremova, S.V. Samsonova // J. Neurology and Psychiatry. - 2002. - T. 102. No. 10. S.42-45.

3. Schwartz I. Hippotherapy. Neurophysiological treatment using horse riding: trans. from English - M.: Moscow Equestrian Club of the Disabled, 2000. - 98 p.

4. Denisenkov A.I., Robert N.S., Spitsberg I.L. Hippotherapy: opportunities and prospects for rehabilitation in cerebral palsy. Methodical manual / A.I. Denisenkov, N.S. Robert, I.L. Svalbard. - M., 2004 - 51 p.

5. Patent No. 88956 for the utility model "Neuroorthopedic pneumosuit."

6. Semenova K.A. Cerebral Palsy / K.A. Semenova. - M.: Medicine. 2005 .-- 259 p.

Table 1 The dynamics of growth of indicators for assessing motor tests in the control group after a course of treatment Test name (M ± m) to (M ± m) after Growth, % R Head holding 4.1 ± 0.31 4.3 ± 0.30 4.8 <0.05 Sitting skills 3.4 ± 0.58 3.8 ± 0.48 11.1 <0.05 Ability to stand 2.0 ± 0.62 2.3 ± 0.59 13.9 <0.05 Walking skill 3.5 ± 0.28 3.7 ± 0.30 5,6 <0.05 P> 0.05 - differences are significant according to the Wilcoxon criterion; P <0.05 - differences are unreliable according to the Wilcoxon criterion.

table 2 The growth dynamics of the indicators for assessing motor tests in the experimental group after treatment Test name (M ± m) to (M ± m) after Growth, % R* Head holding 4,5 ± 0,28 5.0 ± 0.00 10.5 <0.05 Sitting skills 3.0 ± 0.52 4,5 ± 0,28 40,0 > 0.05 Ability to stand 3.2 ± 0.55 4.3 ± 0.30 29.3 > 0.05 Walking skill 2.9 ± 0.62 4.1 ± 0.31 34.2 > 0.05 * P> 0.05 - differences are significant according to the Wilcoxon criterion; P <0.05 - differences are unreliable according to the Wilcoxon criterion.

Table 3 Dynamics of indicators of mobility of the joints of the lower extremities in the control group after a course of treatment mobility (M ± m) (M ± m) Growth, R* before after % The angle of flexion of the knee joint, (degree) Right leg 54.5 ± 5.04 51.2 ± 5.24 6.24 <0.95 Left leg 52.5 ± 5.27 53.7 ± 5.23 2.26 <0.95 Hip flexion angle, (degree) Right leg 67.9 ± 5.16 65.5 ± 5.42 3.60 <0.95 Left leg 68.4 ± 5.25 64.5 ± 5.24 5.87 <0.95 * P <0.95 - differences are unreliable according to the Z-criterion.

Table 4 Dynamics of indicators of range of motion in joints in the experimental group after a course of treatment Indicators (M ± m) (M ± m) Growth, % P * before after The angle of flexion of the knee joint, (degree) Right leg 39.7 ± 2.91 55.5 ± 5.13 33.19 ≥0.95 Left leg 38.5 ± 2.99 52.9 ± 5.29 31.51 ≥0.95 Hip flexion angle, (degree) Right leg 47.8 ± 2.17 69.2 ± 5.35 36.58 ≥0.95 Left leg 48.4 ± 2.09 68.5 ± 5.28 34.39 ≥0.95 * P <0.95 - differences are unreliable according to the Z-criterion; P≥0.95 - differences are significant by the Z-criterion.

Claims (1)

A method of hippotherapy for patients with cerebral palsy, including therapeutic horse riding, characterized in that therapeutic horse riding is carried out in a neuro-orthopedic pneumocostum by passively-active mastery of horse-bareback postures for a total of 23-27 lessons, the treatment being carried out in three stages: 2- 3 lessons - initial, then 18-20 lessons - rehabilitation and 3-4 lessons - reinforcing, while at the initial stage the child masters and performs postures in the absence of horse movement, the rehabilitation stage includes performing postures for more a short time in a stationary stance of a horse and when it moves at a slow pace in a circle, and the final stage includes performing postures for a shorter time when a horse moves at a slow pace in a circle, with a gradual increase in the child’s participation during each course and a decrease instructor and parent involvement.