RU2726466C1 - Method for pain syndrome reduction in scoliosis in children with imperfect osteogenesis - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to rehabilitation methods, and can be used for correction of motor stereotype and pain syndrome reduction in scoliosis in children with imperfect osteogenesis. Child is provided with a complex of therapeutic exercises of 5 exercises performed with the help of methodologist for 30 minutes for 10 days: 1st exercise: initial position (IP) – the child lies on the abdomen, the methodologist places the child under the belly of the baby, the right arm of the child is elongated, methodologist arranges the child's body axis by stretching back muscles and holds the child's position for 2 minutes; 2nd exercise: IP – child lies on the right side, the methodologist places a roller under the loin, the right leg is bent in the knee, the left leg is stretched, methodologist arranges correct position of body axis of child, with his hands smoothes creases on left side of child and holds position of child in this position for 2 minutes; exercise is repeated on each side 5 times; 3rd exercise: IP – the child lies on the left side, the methodologist places a roller under the loin, asks the child to bend the right leg in the knee and put in front of him, the left leg is extended, the right hand is held by the child on the head, then the methodologist uses a gymnastic tape to lift the child's left leg and holds its shed, and in this position asks the child to pull his left leg down, resisting the tape tension, the posture is fixed for 1 minute, the exercise is repeated on each side 5 times; 4th exercise: IP – child lies on the left side, the methodologist places a lumbar roller, asks the child to bend the right leg in the knee and put in front of him, the left leg is stretched, the body axis is lined smoothly, the right hand is held by the child on the head, then the methodologist uses a gymnastic tape, one end of which holds in hands and pulls up, asks the child to take with his right hand the second end of the tape and pull the band on himself, resisting its tension, repeat the exercise on each side 5 times; 5th exercise: IP – child is lying on back, methodologist puts child's hands on lower part of its ribs and asks child to concentrate attention on hands, to make slow, even exhalation through nose, squeezing hands with rib of thorax, then the child does a slow inhalation, unclipping hands, and during an exhalation of the thorax the child again slowly compresses with two hands in the lower part of the ribs, repeated 6–10 times.EFFECT: method provides reducing pain syndrome in scoliosis in children with imperfect osteogenesis, and training in the course of the course will enable children to apply the complex independently.1 cl, 1 ex, 3 dwg

Description

The invention relates to medicine, namely to methods of rehabilitation, and can be used to correct the motor stereotype and reduce pain in scoliosis in children with osteogenesis imperfecta (OI).

Osteogenesis imperfecta is a genetic disease associated with impaired bone formation. The disease manifests itself from the very birth of pathological fragility of bones, muscle weakness, impaired growth, pain syndromes, severe deformation of the bones of the limbs and the spine.

There is a method of carrying out gymnastics for the correction of a motor stereotype in children with osteogenesis imperfecta, including a complex of medical gymnastics using an elastic band, according to which, with the help of a rehabilitation therapist, a complex of medical gymnastics of five exercises is carried out with the child: 1st exercise: from the starting position (and p.) - feet shoulder-width apart, without additional support, the feet are parallel to each other and begins the exercise by aligning the feet: first, the child rests on the outer edge of the feet, then touches the floor with the pads under the big toes and holds the legs in this position, keeping the transverse and the longitudinal arches of the feet, then the child strains the quadriceps and abdominal muscles, reducing the bending of the lumbar lordosis, then the child takes his shoulders back, while lowering and reducing the shoulder blades; 2nd exercise: I. p. - feet shoulder-width apart, without additional support, the feet are parallel to each other and begins the exercise by aligning the feet: first, the child rests on the outer edge of the feet, then touches the floor with the pads under the big toes and holds the legs in this position, keeping the transverse and longitudinal arches of the feet , then the child performs 5-10 squats, maintaining the aligned body axis; 3rd exercise: I. p. - the child stands with his legs apart shoulder-width apart, the feet are parallel to each other, under the feet the child holds a gymnastic elastic band, stepping on its central part, the child holds the ends of the tape of uniform length in his palms, hands along the body, then the child builds the position of the body: stands on his heels , then on the outer edge of the feet, touches the floor with the pads under the big toes and holds himself in this position, then the child lowers to the semi-squat position, bends his elbows, pulling the ends of the gymnastic ribbon, perform the exercise 10-15 times; 4th exercise: I. p. - the child sits on a chair, the legs touch the floor, the press is tense, the arms are lowered, the child holds the gymnastic ribbon in its central part at a distance of shoulder-width apart, then the child raises his straightened arms in front of the chest, with effort spreads his arms to the sides, reduces the shoulder blades, keeping the muscles press in tension, repeat this exercise 5-10 times; 5th exercise: I. p. - the child sits on a chair, the legs touch the floor, the central part of the gymnastic ribbon is under the transverse arch of the foot, the child holds the free ends of the ribbon of equal length in his hands with tension, while the child builds the physiological position of the feet while maintaining the arches, for which the child first relies on the outer the edge of the foot, then touches the floor with a pad under the big toes and holds the legs in this position, then the child raises the medial end of the foot, while the tension of the tape decreases from the medial side, support on the outer edge of the foot and heel is maintained, then the child lowers the medial end of the foot, overcoming the resistance of the tape and trying not to deflect the knee, repeats 10-15 times (patent RU No. 2682813).

A known method for the treatment of combined deformity of the pelvis and spine in children, including exercise in water: first stimulate the sensomotor integration of small muscle groups of the head, neck, hand, foot, then carry out therapeutic swimming for the muscles of the back and pelvic girdle using a special device. The child is recommended to breathe in a free mode with periodic exhalation into the water, the starting position is standing in the water, holding the pool handrail with his hands. At the same time, differentiated exercises are performed in water to stimulate each of the muscle groups: gluteal, lumbar-iliac, straining the wide fascia of the thigh, adductor muscles of the thigh, muscles of the back, lateral and anterior surfaces of the body. The total time of the procedure is 30 minutes, the course is 10 procedures (RF Patent No. 2448667).

Closest to the proposed method, according to which for the correction of lumbar scoliosis of 2-3 degrees using a special device, performing exercises in which, the child finds balance and encourages both healthy and problem muscles to work. The symmetry of the loads along all axes requires the symmetrical functioning of all muscle groups. Exercises in water are performed in conditions of a minimal effect of gravity, which makes them safer and speeds up rehabilitation (E.A. Vasilieva, V.N. Kuvina, N.I. Arsentieva, “Hydrokinesis therapy in the rehabilitation of combined pelvic and spinal deformities in dysplastic-dystrophic syndrome in children "- Bulletin of the All-Russian Scientific Center of the Siberian Branch of the Russian Academy of Medical Sciences, 2011, No. 4 (80), part 1).

The method has a minor effect on the asymmetry of the pelvis, which is pathogenetically significant in the development of scoliotic deformity of the spine in dysplastic-dystrophic syndrome.

The objective of the present invention is to develop a method for reducing pain in scoliosis in children with osteogenesis imperfecta.

The technical result of the invention is to increase the effectiveness of the treatment of dysplastic-dystrophic syndrome due to the simultaneous correction of the muscles of the pelvic girdle and back, as well as stimulation of sensory integration.

The method is carried out by carrying out an adaptive complex of medical gymnastics of 5 exercises performed with the child with the help of a methodologist daily, for 10 days, lasting 30 minutes to stimulate the autochtomous muscles.

Exercise 1: starting position (ip) - the child lies on his stomach, the methodologist puts a roller under the child's belly to reduce lumbar lordosis, while the child stretches his right arm up, then the methodologist builds the axis of the child's body, stretching the back muscles with his own hands , and holds the child in this position for 2 minutes.

2nd exercise: I. p. - the child lies on the right side, the methodologist puts a roller under the lower back, asks to bend the right leg at the knee, extend the left leg, put the left hand on the head, then the methodologist builds the correct position of the child's body axis, smooths out the folds on the child's left side with his own hands and holds in this position of the child for 2 minutes, repeat the exercise 5 times on each side.

3rd exercise: I. p. - the child lies on his left side, the methodologist puts a roller under his lower back, asks the child to bend his right leg at the knee and put it in front of him, the left leg is extended, the child holds his right hand on his head, then the methodologist, using a gymnastic ribbon, raises the child's left leg and holds it canopy, and in this position asks the child to pull the left leg down, resisting the tension of the tape, fix the pose for 1 minute, repeat the exercise 5 times on each side;

4th exercise: I. p. - the child lies on his left side, the methodologist puts a roller under his lower back, asks the child to bend his right leg at the knee and put it in front of him, the left leg is extended, the body axis is aligned, the child holds his right hand on his head, then the methodologist uses a gymnastic ribbon, one end which he holds in his hands and pulls up, asks the child to take the second end of the tape with his right hand and pull the tape towards himself, resisting its tension, repeat the exercise 5 times on each side;

5th exercise: I. p. - the child lies on his back, the methodologist puts the child's hands on the lower part of his ribs and asks the child to concentrate on the hands, to exhale slowly, evenly through the nose, squeezing the ribs of the chest with his hands, then the child takes a slow breath, unclenching his hands, and while exhaling the chest the child again slowly squeezes the cage with both hands in the lower part of the ribs, repeat 6-10 times.

The study involved three children with osteogenesis imperfecta (OI) aged 12 to 14 years. Children with OI type 3 are unable to walk on their own. The children received an adaptive complex of therapeutic gymnastics developed in the department of physical therapy of the Federal State Autonomous Institution "National Medical Research Center of Children's Health" of 5 exercises performed with the child with the help of a methodologist daily for 10 days, lasting 30 minutes to stimulate the autochtomous muscles. The result of the complex was assessed on the scale of pain syndrome: 0 points - no pain, 1 point - mild pain, 2 points - moderate pain, 3 points - severe pain, 4 points - very severe pain. When children are admitted, the pain syndrome usually corresponds to 3-4 points, after a course of rehabilitation, a decrease in pain sensitivity to 1-2 points is noted. The assessment was carried out three times: before the beginning of the complex, at the end of the complex, i.e. after 10 days and after a month of daily exercise. After 1.5 months of daily exercise, the reduced pain sensitivity persisted. Evaluation of the results of patient questionnaires helps to identify violations that affect the quality of life in children, and allows the exercise therapy methodologist to dose the intensity of the load on a particular child, and the patient to pay attention to the formation of vital skills.

Clinical example of the method.

Example 1. Girl M., 12 years old, diagnosis: Osteogenesis imperfecta of type 3, unable to move independently. In order to reduce pain, the methodologist daily, for 10 days, conducted an adaptive complex of 5 exercises with a duration of 30 minutes with the child with the maximum possible impact on the back muscles to stimulate the autochtomous muscles. Exercise 1: starting position (ip) - the child lies on his stomach, the methodologist places a roller under the child's belly to reduce lumbar lordosis, while the child stretches his right arm up, then the methodologist builds the axis of the child's body, stretching the back muscles with his own hands and holds in this position of the child for 2 minutes (Fig. 1); 2 - exercise: I. p. - the child lies on the right side, the methodologist puts a roller under the lower back, asks to bend the right leg at the knee, extend the left leg, put the left hand on the head, then the methodologist builds the correct position of the child's body axis, smoothes the folds on the child's left side with his own hands and holds in this position of the child for 2 minutes, repeat the exercise 5 times on each side (Fig. 2); 3 - exercise: I. p. - the child lies on his left side, the methodologist puts a roller under his lower back, asks the child to bend his right leg at the knee and put it in front of him, the left leg is extended, the child holds his right hand on his head (Fig. 3), then the methodologist lifts the left one with the help of a gymnastic ribbon the child's leg and holds it overhang, and in this position asks the child to pull the left leg down, resisting the tension of the tape, fix the position for 1 minute, repeat the exercise 5 times on each side; 4 - exercise: I. p. - the child lies on his left side, the methodologist puts a roller under his lower back, asks the child to bend his right leg at the knee and put it in front of him, the left leg is extended, the body axis is aligned, the child keeps his right hand on his head (Fig. 3), then the methodologist uses a gymnastic ribbon, one end of which is held in his hands and pulls up, asks the child to take the other end of the ribbon with his right hand and pull the ribbon towards himself, resisting its tension, repeat the exercise 5 times on each side; 5 - exercise: I. p. - the child lies on his back, the methodologist puts the child's hands on the lower part of his ribs and asks the child to concentrate on the hands, exhale slowly, evenly through the nose, squeezing the ribs of the chest with his hands, then the child takes a slow breath, unclenching his hands, and while exhaling, the chest the child again slowly squeezes the cage with both hands in the lower part of the ribs, repeat 6-10 times. The girl performed the complex daily for 10 days. Pain syndrome was assessed on the scale of pain syndrome, the assessment was carried out three times: before the beginning of the complex, at the end of the course and after a month of daily exercises. On admission, the child's pain syndrome was assessed at 3-4 points; after the rehabilitation course, a decrease in pain sensitivity to 1-2 points was noted. After 1.5 months of daily exercise, pain sensitivity of 1–2 points persisted.

The developed set of exercises allows to reduce the pain syndrome in scoliosis in children with osteogenesis imperfecta, and teaching during the course will enable children to use the complex independently.

Claims (1)

A method of reducing pain in scoliosis in children with osteogenesis imperfecta, including a complex of therapeutic exercises for the rehabilitation of combined deformities of the pelvis and spine, characterized in that with the help of a methodologist, a child is daily, for 10 days, a complex of therapeutic exercises consisting of 5 exercises, lasting 30 minutes: 1st exercise: starting position - I. p. - the child lies on his stomach, the methodologist places a roller under the child's belly to reduce lumbar lordosis, the child pulls his right hand up, then the methodologist builds the correct position of the child's body axis, stretches the back muscles with his own hands and holds the child in this position for 2 minutes; 2nd exercise: I. p. - the child lies on the right side, the methodologist puts a roller under the lower back, asks to bend the right leg at the knee, extend the left leg, put the left hand on the head, then the methodologist builds the correct position of the child's body axis, smoothes the folds on the child's left side with his own hands and holds in this position of the child for 2 minutes, repeat the exercise 5 times on each side; 3rd exercise: I. p. - the child lies on his left side, the methodologist puts a roller under his lower back, asks the child to bend his right leg at the knee and put it in front of him, the left leg is extended, the child holds his right hand on his head, then the methodologist, using a gymnastic ribbon, raises the child's left leg and holds it canopy, and in this position asks the child to pull the left leg down, resisting the tension of the tape, fix the pose for 1 minute, repeat the exercise 5 times on each side; 4th exercise: I. p. - the child lies on his left side, the methodologist puts a roller under his lower back, asks the child to bend his right leg at the knee and put it in front of him, the left leg is extended, the body axis is aligned, the child holds his right hand on his head, then the methodologist uses a gymnastic ribbon, one end which he holds in his hands and pulls up, the methodologist asks the child to take the second end of the tape with his right hand and pull the tape towards himself, resisting its tension, repeat the exercise 5 times on each side; 5th exercise: I. p. - the child lies on his back, the methodologist puts the child's hands on the lower part of his ribs, asks the child to concentrate on his hands, exhale slowly, evenly through the nose, squeezing the ribs of the chest with his hands, then the child takes a slow breath, unclenching his hands, and exhaling the child again slowly squeezes the chest with both hands in the lower part of the ribs, repeat the exercise 6-10 times.

Images