RU2581514C2 - Method for rehabilitation of patients with lung diseases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, physical therapy can be used for rehabilitation of patients with lung diseases, mainly tuberculosis. Method includes performing physical and respiratory exercises in patient's location on horse's back. During first 1-2 sessions method includes performing an adaptation stage, which involves acquaintance of patient with an instructor and horse, development of methods fit on horse without seat and dismounting. Method includes a rehabilitation phase, which includes following sequence of exercises under supervision of an instructor, for 23-26 sessions: from starting position (SP) on a horse in fixed rack patient throws his hands through sides up and inhales, when returning to SP - elongated exhale; SP is same as patient gets right ear with his left hand horse - exhale, then - SP, breath, takes a right hand left ear horse - exhale, then - SP, breath; SP is same as patient lies on his stomach along horse's back and exhales, return to SP - breath goes back along horse's back - exhale, return to SP - inhalation; SP is same as patient right hand reaches for toe of right foot - exhale, return to SP - inhale, left hand reaches for toe of left foot - exhale, return to SP; SP lying on stomach across horse's back, patient takes his hands behind his head to castle, breath, holds his breath, raise torso up and down trunk - exhale, return to SP; SP as previous one, horse in motion at a slow pace, patient is calm and even breathing for 1-2 minutes; patient for 1-2 minutes lying on his back along back of a horse in motion at a slow pace; further patient is lying across back of a horse in motion at a slow pace, first on abdomen, then on back, on right side, left side for 1-2 minutes in each position; patient for 1-2 minutes, sitting on a horse which is in change mode paces; SP sitting on a horse, located in fixed rack, patient himself tapping cam in thymus with pronunciation of a vowel sound. Then 1-2 sessions include a fixing step, where patient performs exercises on their own.

EFFECT: method provides high efficiency of rehabilitation of patients with lung diseases without substantially increasing its duration.

1 cl, 1 ex, 5 tbl

Description

The claimed invention relates to medicine, in particular to physiotherapy, and can be used for the rehabilitation of patients with pulmonary diseases and mainly pulmonary tuberculosis.

A known method of rehabilitation of patients, including performing hippotherapy exercises for the treatment of patients with cerebral palsy (patent RU No. 2469694, publ. 2012).

A known method of rehabilitation of patients, including performing hippotherapy exercises for the treatment of pelvic and spinal deformities in children (patent RU No. 2423095, publ. 2008).

However, the hippotherapy exercises described in these known methods for the rehabilitation of patients cannot be used in the rehabilitation of patients with pulmonary diseases, since they do not have the necessary therapeutic effect on the work of the respiratory system and, in particular, on the work of the affected lungs.

A known method of rehabilitation of patients with pulmonary diseases, including performing gymnastic and breathing exercises (Dubrovsky VI. Therapeutic physical education. Humanitarian. Publishing Center VLADOS. 2004, S. 464-466, 243-244).

This method of rehabilitation of patients with pulmonary diseases, which is the closest to the claimed method of rehabilitation according to the set of essential features, has limited functional capabilities and insufficient effectiveness of patient rehabilitation, since it does not involve the functionality of hippotherapy.

The technical result of the proposed method for the rehabilitation of patients with pulmonary diseases is to increase the efficiency of rehabilitation of patients with pulmonary diseases without a significant increase in the duration of rehabilitation.

The specified technical result is achieved by the fact that in the method of rehabilitation of patients with pulmonary diseases, including performing gymnastic and breathing exercises, the exercises are performed in the process of finding the patient on the horse’s back, while in the first 1-2 lessons the adaptation stage of the exercises is carried out, including the patient’s acquaintance with the instructor and horse, practicing the methods of landing on a horse without a saddle and dismounting, then carry out the rehabilitation phase, which includes the following sequence of exercises od instructor control, for 23-26 lessons:

- from the starting position (PI) on a horse in an immovable stance, the patient spreads his arms through the sides up and takes a breath, when returning to the PI - an extended exhalation;

- PI is the same, the patient takes out the horse’s right ear with his left hand - exhale, then - PI, inhale, takes the horse’s left ear with his right hand - exhale, then - PI, inhale;

- PI is the same, the patient lies on his stomach along the horse’s back and exhales, returns to PI — inhale, lies with his back along the horse’s back - exhales, returns to PI — inhale;

- IP is the same, the patient reaches the toe of the right leg with his right hand - exhale, return to the IP - inhale, with his left hand reaches the toe of his left leg - exhale, return to the IP;

- PI lying on his stomach across the horse’s back, the patient takes his hands in the lock behind his head, inhale, holds his breath, raises the torso up, lowers the torso - exhale, return to the PI;

- PI, as the previous one, the horse is moving at a slow pace, the patient lies calmly and breathes evenly for 1-2 minutes;

- the patient lies on his back for 1-2 minutes along the back of the horse, which is in motion at a slow pace;

- then the patient lies across the back of the horse, which is in motion at a slow pace, first on the stomach, then on the back, on the right side, on the left side for 1-2 minutes in each position;

- the patient sits on a horse in the mode of changing gait for 1-2 minutes;

- PI sitting on a horse, which is in an immovable stance, the patient beat himself with a fist in the thymus gland with the pronunciation of a vowel;

then, during 1-2 classes, a fixing stage is carried out, at which the patient performs the exercises listed above on his own.

Performing gymnastic and breathing exercises while the patient is on the horse’s back makes it possible to significantly increase the efficiency of rehabilitation of patients with pulmonary diseases due to the special complex healing effect on the work of the horse’s light natural movements and the heat effect from the horse’s back.

Comparative analysis with the prototype shows that the claimed method of rehabilitation of patients with pulmonary diseases differs in that the exercises are performed while the patient is on the horse’s back, while in the first 1-2 lessons the adaptation stage of the exercises is carried out, including acquaintance of the patient with the instructor and the horse, practicing techniques landing on a horse without a saddle and dismounting, then carry out the rehabilitation phase, which includes the following sequence of exercises under the supervision of an instructor, for 23 -26 lessons:

- from the starting position (PI) on a horse in an immovable stance, the patient spreads his arms through the sides up and takes a breath, when returning to the PI - an extended exhalation;

- PI is the same, the patient takes out the horse’s right ear with his left hand - exhale, then - PI, inhale, takes the horse’s left ear with his right hand - exhale, then - IP, inhale;

- PI is the same, the patient lies on his stomach along the horse’s back and exhales, returns to PI — inhale, lies with his back along the horse’s back - exhales, returns to PI — inhale;

- IP is the same, the patient reaches the toe of the right leg with the right hand — exhale, return to the IP — inhale, with the left hand reaches the toe of the left leg — exhale, return to the IP;

- PI lying on his stomach across the horse’s back, the patient takes his hands in the lock behind his head, inhale, holds his breath, raises the torso up, lowers the torso - exhale, return to the PI;

- PI, as the previous one, the horse is moving at a slow pace, the patient lies calmly and breathes evenly for 1-2 minutes;

- the patient lies on his back for 1-2 minutes along the back of the horse, which is in motion at a slow pace;

- then the patient lies across the back of the horse, which is in motion at a slow pace, first on the stomach, then on the back, on the right side, on the left side for 1-2 minutes in each position;

- the patient sits on a horse in the mode of changing gait for 1-2 minutes;

- PI sitting on a horse, which is in an immovable stance, the patient beat himself with a fist in the thymus gland with the pronunciation of a vowel;

then, during 1-2 classes, a fixing stage is carried out, at which the patient performs the exercises listed above on his own. This difference from the prototype gives reason to argue that the proposed method of rehabilitation meets the criteria of patentability of the invention of "novelty." Comparison of the proposed method of rehabilitation not only with the prototype, but also with other similar methods of rehabilitation in this area, it was not possible to identify signs similar to the distinctive features, which allows us to conclude that the claimed method of rehabilitation meets the patentability condition of the invention “inventive step”.

The essence of the proposed method for the rehabilitation of patients with pulmonary diseases is illustrated by the tables where table 1 shows the dynamics of the health status of children in need of long-term treatment at the beginning and end of the experiment, table 2 shows the location of respondents by the levels of physical health of children at the beginning and end of the experiment, in table 3 shows the location of children at the levels of adaptive potential for the period of the experiment, tables 4 and 5 show the results of comparison of measurements of VC, Sample Stange, Sample Genchi , Skibinsky index at the beginning and end of the experiment.

A method for the rehabilitation of patients with pulmonary diseases includes performing gymnastic and breathing exercises, while gymnastic and breathing exercises are carried out with the patient directly on the horse’s back in different positions relative to the horse’s back and head, which is either in an immovable stance or in motion. The rehabilitation course is divided into adaptation, rehabilitation and fixing stages, with 1-2 classes for adaptation and fixing stages and 23-26 classes for rehabilitation. The number of repetitions for each exercise is up to 8 times. The duration of each lesson is 20-30 minutes. All classes for the implementation of exercises are carried out preferably in the coniferous forest. A horse breeder takes part in the classes, who directs the horse’s movements according to the instructions of the hippotherapy instructor, supports the patient and helps him with various exercises directly on the horse’s back; a specialist in adaptive physical education, who sequentially, taking into account the patient’s functional state of health, indications and contraindications, increases the patient’s physical activity; and a medical professional who records changes in the respiratory and cardiovascular systems, monitors external signs of fatigue, and exercises medical monitoring of the adequacy and effectiveness of physical activity.

At the adaptation stage, the patient is introduced to the hippotherapy instructor and the horse. The hippotherapy instructor receives basic information about the patient, his physical and psychological capabilities, provides practical assistance to the patient to establish contact with the horse. During this period, the very first and simplest hippotherapy exercises are carried out, and the necessary methods of landing on a horse without a saddle and dismounting are practiced.

The rehabilitation phase includes performing gymnastic and breathing exercises in the process of finding the patient on the horse’s back and is aimed at solving rehabilitation problems in restoring the disturbed respiratory functions, restoring and improving the patient’s physical health.

Gymnastic and breathing exercises of the rehabilitation phase are performed under the supervision of an instructor in the following sequence:

- from the starting position (PI) on a horse in an immovable stance, the patient spreads his arms through the sides up and takes a breath, when returning to the PI - an extended exhalation;

- PI is the same, the patient takes out the horse’s right ear with his left hand - exhale, then - PI, inhale, takes the horse’s left ear with his right hand - exhale, then - PI, inhale;

- PI is the same, the patient lies on his stomach along the horse’s back and exhales, returns to PI — inhale, lies with his back along the horse’s back - exhales, returns to PI — inhale;

- IP is the same, the patient reaches the toe of the right leg with his right hand - exhale, return to the IP - inhale, with his left hand reaches the toe of his left leg - exhale, return to the IP;

- PI lying on his stomach across the horse’s back, the patient takes his hands in the lock behind his head, inhale, holds his breath, raises the torso up, lowers the torso - exhale, return to the PI;

- PI, as the previous one, the horse is moving at a slow pace, the patient lies calmly and breathes evenly for 1-2 minutes;

- the patient lies on his back for 1-2 minutes along the back of the horse, which is in motion at a slow pace;

- then the patient lies across the back of the horse, which is in motion at a slow pace, first on the stomach, then on the back, on the right side, on the left side for 1-2 minutes in each position;

- the patient sits on a horse in the mode of changing gait for 1-2 minutes;

- PI sitting on a horse, which is in an immovable stance, the patient beat himself with a fist in the thymus gland with the pronunciation of a vowel;

then, during 1-2 classes, a fixing stage is carried out, at which the patient performs the exercises listed above on his own.

In the process of mastering the whole complex of gymnastic and breathing exercises by the patient while the patient is on the horse’s back, the load is gradually increased, the horse’s pace of movement is changed and the support from the instructor is reduced.

At the fixing stage, the patient must remember the sequence of exercises and perform them yourself with instructor insurance. The duration of the final stage is 1-2 lessons of 20-30 minutes.

The proposed method for the rehabilitation of patients with pulmonary diseases was tested on the basis of the Rostok Center for Medical and Social Rehabilitation of Persons with Disabilities in the Trans-Baikal Territory (Chita). Under supervision were 50 children in need of long-term treatment, aged 7 to 11 years. After the course of rehabilitation, all children have an improvement in physical activity, emotional state. A survey of students at the sanatorium school showed that the following changes occurred during the experiment:

1) in 8 children, the incidence of digestive organs decreased, in 5 - diseases of the nervous system, in 6 children the incidence of the respiratory system decreased, 5 respondents improved posture disturbance, and 6 children reduced the number of ENT diseases; These facts confirm that the number of concomitant diseases in children requiring long-term treatment decreased over the period of the experiment (Table 1);

2) improved chest size in 37.6% of children;

3) the level of children's physical health has improved (according to S.V. Khrushchev), with a probability of p≤0.05 according to Pearson's criterion (chi-square). Over the period of the experiment, the number of children assigned to the average level of physical health (from 48% to 68%) and above the average level of physical health (from 8% to 14%) increased. The number of children classified as below average decreased by 16%. A high level of physical health in children who need long-term treatment has not been identified. The results are presented in table 2;

4) improved indicators of the adaptive capabilities of the body (according to P.M. Baevsky 1987). At the end of the experiment, it was revealed that 6% of the respondents reached the level of “satisfactory adaptation”, reducing the number of children at the level of “unsatisfactory adaptation” by 16%. The number of children assigned to the level of “tension of adaptation mechanisms” increased by 10% with a probability of p≤0.05. The results are shown in table 3.

When performing exercises, special attention was paid to the patient's proper breathing. The functional state of the external respiration system was evaluated using spirometry (a study of the vital capacity of the lungs), hypoxic tests (Genchi test, Stange test), and Skibinsky index. According to the data given in tables 4 and 5, it is seen that in children who need long-term treatment, there is a positive dynamics of the functional state of the respiratory system.

The effectiveness of the proposed method for the rehabilitation of patients with pulmonary diseases is illustrated by the following example.

Patient A., 11 years old. Diagnosis: in 2007, diagnosed with tuberculosis of the internal lymph nodes on the left, the calcination phase, taken to the dispensary. In 2010, she studied at a sanatorium boarding school.

Before treatment, the proposed method: data Rg-logical examination 16.08.2010, p - 18 mm, 08/16/2011 p - 15 m; Genchi test - 14.3 s, Stange test - 20.2 s, VEL volume - 800 ml, Skibinsky index - 179.5 cu Passed a full rehabilitation course for the proposed method for 4 months.

As a result of treatment, the following positive effect was achieved.

After treatment, the proposed method: Diagnosis - clinically cured tuberculosis of the internal lymph nodes on the left, a form of calcification. The data of the Rg-logical examination on August 28, 2012, p - 12 mm, August 27, 2013 p - 5 mm. These results confirm that during the period of the rehabilitation course an accelerated restoration of the functional capabilities of the body occurs, the shift in the Mantoux test improved by 7 mm. Of these diseases - rare ARI. Not registered with specialists. In addition, the patient's muscle corset strengthened, the chest volume increased by 1.3 cm, the volume of the VC increased by 200 ml and amounted to - 1000 ml, the indices of breath holding on inspiration (Genchi test) improved - 18.25 s and expiration (test Stange) - 24.4 s, there is a positive trend in assessing the Skibinsky index - 271.1, which reveals the functional capabilities of the respiratory and circulatory organs and shows an improvement in the resistance of the human body to hypoxia.

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Claims (1)

A method of rehabilitation of patients with pulmonary diseases, including performing gymnastic and breathing exercises, characterized in that the exercises are performed in the process of finding the patient on the horse’s back, while in the first 1-2 lessons the adaptation stage of the exercises is carried out, including introducing the patient to the instructor and the horse, practicing techniques landing on a horse without a saddle and dismounting, then carry out the rehabilitation phase, which includes the following sequence of exercises under the supervision of an instructor, during 23-26 Occupation:
- from the starting position (PI) on a horse in an immovable stance, the patient spreads his arms through the sides up and takes a breath, when returning to the PI - an extended exhalation;
- PI is the same, the patient takes out the horse’s right ear with his left hand - exhale, then - PI, inhale, takes the horse’s left ear with his right hand - exhale, then - PI, inhale;
- PI is the same, the patient lies on his stomach along the horse’s back and exhales, returns to PI — inhale, lies with his back along the horse’s back - exhales, returns to PI — inhale;
- IP is the same, the patient reaches the toe of the right leg with his right hand - exhale, return to the IP - inhale, with his left hand reaches the toe of his left leg - exhale, return to the IP;
- PI lying on his stomach across the horse’s back, the patient takes his hands in the lock behind his head, inhale, holds his breath, raises the torso up, lowers the torso - exhale, return to the PI;
- PI, as the previous one, the horse is moving at a slow pace, the patient lies calmly and breathes evenly for 1-2 minutes;
- the patient lies on his back for 1-2 minutes along the back of the horse, which is in motion at a slow pace;
- then the patient lies across the back of the horse, which is in motion at a slow pace, first on the stomach, then on the back, on the right side, on the left side for 1-2 minutes in each position;
- the patient sits on a horse in the mode of changing gait for 1-2 minutes;
- PI sitting on a horse, which is in an immovable stance, the patient beat himself with a fist in the thymus gland with the pronunciation of a vowel;
then, during 1-2 classes, a fixing stage is carried out, at which the patient performs the exercises listed above on his own.