RU2786794C1 - Method for treating hyperkinetic disorders in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine and can be used for treating hyperkinetic disorders in children. The child takes the modified eight-colour Luscher test, and the dependencies between the colour chosen by the child in the Luscher test and the key of the musical composition are identified by the method devised by V. M. Elkin. The treatment is performed in two stages. The first stage is conducted in a rehabilitation centre. Local colour light therapy is performed first, wherefor one coloured patch per day is applied in the areas of the pads of the distal phalanges of the thumbs as follows: purple – lemon – red – red – light blue – purple – orange – purple. The hands are then massaged one at a time with a spiked massage ball "Su-Jok" by the method devised by M. G. Panova for 5 minutes. Music therapy is performed during the intellectual and creative educational sessions in a programme composed of musical elegies. The sessions continue for 30 minutes for children 4 to 5 years of age and for 60 minutes for children 6 to 7 years of age. The second stage of treatment is performed at home in the same order and in the same amount as at the first stage.

EFFECT: correction of hyperkinetic disorders in children due to the selection of musical compositions with certain parameters of musical characteristics and use of colour light therapy and massage.

1 cl, 5 tbl, 1 ex

Description

FIELD: medicine. the use of music, the selective genres of which have a healing and health-improving effect.

Attention deficit hyperactivity disorder has been considered in recent decades as the most common causes of behavioral disorders, difficulties in school and social adaptation in children with normal intelligence [O.B. Goncharova, L.S. Nikonova, M.V. Monakhov, M.A. Khan, E.E. Achkasov, N.Yu. Nikolenko, State of health and principles of rehabilitation of children with attention deficit hyperactivity disorder // Bulletin of restorative medicine. - 2012. - No. 2. – P.45-49.]. According to the International Classification of Diseases of the Tenth Revision (ICD-10), ADHD belongs to the heading F90 "Hyperkinetic Disorders", referring to a heterogeneous group of disorders with the preservation of intelligence.

ADHD is characterized by a triad of symptoms: inattention, hyperactivity, and impulsivity. Studies conducted in different countries show a wide range of cases of this disorder - from 1 - 3% to 24 - 28% in the population, on average, about 5% among persons under 18 years of age, 6% among schoolchildren and 3% - among teenagers. In the last decade, there has been a particularly sharp discussion in scientific circles about the increase in the incidence of ADHD. [E.V. Koren, T.A. Kupriyanova, Hyperkinetic disorders (ADHD): Recommendations for physicians./ E.V. Koren, T.A. Kupriyanov. - M.: Federal State Budgetary Institution "Federal Medical Research Center for Psychiatry and Narcology named after V.P. Serbian", 2015. - 82p.]. In 2004, the World Association of Child and Adolescent Psychiatry and Allied Professions (IACAPAP) recognized ADHD as “Problem No. 1” in child and adolescent mental health care [O.I. Romanchuk, Hyperactivity and attention deficit syndrome in children: M .: "Genesis", 2010-366s.].

In the structure of ADHD, a large proportion falls on preschoolers. On the one hand, it is at this age that the clinical picture unfolds completely, on the other hand, at this age, the child is required to have sufficient psycho-speech development for cognitive activity. The inability of the child to concentrate on the task, the tendency to jump from one task to another without completing them, unregulated excessive activity, both motor and mental and speech, is manifested, which is often accompanied by a delay in motor and language development and negatively affects the success of education. This is evidenced by the results of statistical studies by American scientists: in the United States, less than 5% of children with ADHD receive a higher education diploma, compared with 28% of the general population aged 25 and older.

It is noted that approximately 30% of children "outgrow" this syndrome, and the rest adapt to it in adulthood. In the rest of the children, the symptoms persist both at school and in adulthood, and then a lag in the assimilation of educational material, dissocial behavior, low self-esteem, and aggressiveness appear. ADHD impairs the quality of life of children with this disorder, causing impairments in social functioning, increasing the risk of injury and self-destructive behavior. Secondary disorders (self-doubt, low self-esteem, fears) often lead to manifestations of oppositional and even aggressive behavior, worsening interpersonal relationships and school adaptation [N.I. Tsygankova, Personality and interpersonal relationships of younger schoolchildren with minimal brain dysfunction and attention deficit hyperactivity disorder: Abstract of the thesis. can. pedagogical sciences -SPb., 2012. - 194 p.].

ICD-11 already classifies ADHD as a neurodevelopmental disorder. From a neurological point of view, ADHD is seen as a persistent and chronic syndrome for which no cure has been found.

To date, the treatment and rehabilitation of children with ADHD are carried out using the methods of psychopharmacotherapy, psychosocial interventions and psychotherapy. These methods are ineffective, and the use of drug therapy is associated with the risk of developing psychoses [M.N. Dmitriev, The risk of developing psychosis in nootropic and stimulation therapy for attention deficit hyperactivity disorder: dis. can. honey. Sciences. – M.: 2018. – 27p.]. Pathogenetically based psychostimulants help in the treatment of the disease, but success only concerns the short-term effects of the treatment, for the duration of the substance. In 2010, Australia published the results of a study on the lack of long-term beneficial effects of psychostimulants in ADHD. We observed 2868 families for 20 years. Short-term improvement with these ADHD medications was found to stop with long-term treatment. Perhaps this is due to long-term harmful effects, the threat of drug addiction, and animal studies show that these drugs can cause organic brain damage. The lack of effective methods of treatment for children with ADHD and their recovery, the trend towards an increase in the number of children with ADHD and the threat of an increase in the number of people with a low level of quality of life, education and antisocial behavior create a need for medical and psychological assistance [N.I. Tsygankova, Personality and interpersonal relationships of younger schoolchildren with minimal brain dysfunction and attention deficit hyperactivity disorder: Abstract of the thesis. can. pedagogical sciences -SPb., 2012. - 194 p.], in the prolonged complex rehabilitation.

There was an urgent need to develop a non-drug, harmless, affordable and pathogenetically determined method of treating children with ADHD, for example, with the help of music, the selective genres of which have a healing and health-improving effect. In the studies of I. M. Grineva [Studying the features of musical perception in patients with initial manifestations of inferiority of the blood circulation of the brain: abstract of ... dis. can. honey. Sciences. - L., 1981. - 22 p.], it is shown that listening to melodic low-sounding music activates the central nervous system, enhances attention and stimulates intellectual activity against the background of a sedative effect. And neuroscientists [D. Campbell, The Mozart Effect: Ancient and Modern Methods of Using the Mysterious Power of Music to Heal the Body and Mind. - Minsk: Poppuri, 2011. - 162 p.] it is proved that the musical compositions of W. A. Mozart mobilize the capabilities of the human brain, facilitate its work, increase the intellectual capabilities of the individual, relieve negative emotions, raise vitality, and improve the memorability of the subject in students . The mechanism of the influence of music on a person lies in the synergy of the physical properties of sound, as a special case of mechanical vibrations and waves, and the neurophysiological capabilities of the subcortical formations of the brain [S.V. Shushardzhan, Guide to Music Therapy. - M.: "Medicine", 2005. - 450 p.]. Considering that musical sounds/tones are varied in intensity, pitch, timbre, individual coloring, L.A. Kuznetsov managed to find an objective relationship between the characteristics of the timbre by ear and its frequency (Hz). Electroencephalographic and rheoencephalographic studies N.N. Zakharova and V.M. Avdeev showed the ability to perceive and process acoustic information by the cells of the corticothalamic and cortico-limbic structures of the brain [N.N. Zavadenko, Attention Deficit Hyperactivity Disorder: New in Diagnosis and Treatment: Abstract of the thesis. can. honey. Sciences. – M.: 2014. – 27 p.].

To date, many methods and devices have been developed for the treatment of music, for example, the useful model "Program-acoustic complex "PROFI GRAND" (patent RU No. 126602, 07/16/2012, A61M 21/00). The software-acoustic complex includes a portable computer containing music therapy programs fed through a headphone amplifier to large radio headphones, point headphones in the amount of one or more pairs, and the headphones are connected in series through independent audio outputs to the headphone amplifier. The achieved technical result is to ensure effective healing and rejuvenation of the body by providing both targeted and complex stimulation of regenerative processes, skin microcirculation, including by amplifying acoustic signals that positively affect the condition of the skin and the body as a whole.

Known "Method of forming audio sequences of music for music therapy" patent (patent RU No. 2408397, September 29, 2009, IPC A61M 21/00). In this method, selection of musical works is carried out, parts forming the binaural beat of the rhythms of the organs of a healthy person are inserted into the fragments of musical works. Then the pieces of music are listened to and parts lasting 20 minutes are selected from them according to their ability to evoke positive reactions in listeners. An analysis of the selected parts of musical works is carried out, including the construction of a frequency description of notes, the distribution of the frequencies of occurrence of the notes used, their duration and loudness, the spectral analysis of the selected parts of music, during which the spectra, the dynamics of the spectra of the duration of the notes, their average estimates of the spectral parameters and dynamics are calculated in time. In this method, when creating an individual music program, the integrity of the musical canvas is “torn”, which prevents self-expression and empathy, does not allow emotions to be released, internal conflicts to be resolved, thereby not allowing to fully realize the principle of treatment through music.

There is a known method "Creating a method of music therapy" (patent RU No. 2740255, 09/27/2019, IPC A61M 21/00). In this method, a musical-acoustic effect is carried out, for which music tracks created using a musical synthesizer and "mixes" of them are used. The impact is carried out by a course of 10-20 individual or group procedures daily or every other day lasting 30-70 minutes. At the same time, music tracks are used with sizes - 6/4, 9/8, 13/8, use a tempo in the range of 60-78 beats per minute and binaural sounds with a frequency of 1000-1500 Hz and a frequency difference from 10 to 25 Hz, with the rejection of rhythmic sounds from elastic bass and percussion instruments playing on a strong or weak beat. The method allows to correct the physical, emotional and psychological levels of the body using the developed parameters of music therapy. In this method, as well as in the previous invention, when creating an individual music program, the integrity of the musical canvas, originally conceived by the author and putting into it a spiritual meaning, is so important in achieving the therapeutic effect of music therapy.

Known solutions have common drawbacks - the need to create tracks, audio sequences. The desire for in-depth individualization of music tracks, audio sequences in time is laborious and requires a specialist, in addition, special equipment is needed. The created tracks do not always have healing properties, [I.A. Dergaeva, Comprehensive study of the perception and psychological impact of music: Abstract of the thesis. can. psycho. Sciences. - M.: 2005. - 197p.], since. they lack musical parameters, the therapeutic effect of which has been scientifically proven [I.M. Grineva, Studying the features of musical perception in patients with initial manifestations of inferiority of the blood supply to the brain: Diss. …cand. honey. Sciences. - L., 1981; S.V. Shushardzhan, Guide to music therapy, 2005. - p.290, 300, 346] and special musical characteristics, for example, minor keys, the perception of frequencies / tones of which at the level of phonoreceptors of the brain restores disturbed interhemispheric neural connections, which is necessary for the treatment of attention deficit disorder and hyperactivity in children.

There are also known methods of treatment with music therapy against the background of basic treatment, for example, patent RU No. 2445987 "Method of complex treatment of cardiovascular diseases using music therapy", patent RU No. 2529374 "Method of neuropsychiatric rehabilitation", patent RU No. diseases with the use of music therapy. In these methods, musical works of a relaxing or tonic nature are used in accordance with individual indications.

There is a known method "Method for correcting the psychophysiological state of athletes", patent RU No. 2522377, 06/05/2013, IPC A61M 21/00. In this method, athletes pre-determine the current psycho-physiological parameters by measurement. A corrective action is produced by exposure to an acoustic field modulated by a musical composition with a predetermined effect. The acoustic field is formed with a circular pattern and a spherical distribution of sound energy in the space of the sounded room. In this case, the amplitude-frequency characteristic of the acoustic field is uneven with maxima corresponding to the product of the fundamental tone by the number of the natural series, and the fundamental tone is changed during listening. EFFECT: method makes it possible to increase the patient's susceptibility to music therapy by selecting the playback mode of a musical work in accordance with the individual preferences of the patient and adjusting the playback parameters depending on the achieved effect of exposure, fixed according to objective criteria of the state.

The disadvantages of these known methods include the fact that musical compositions, selected, especially for the correction of the psychophysiological state of athletes, are completely unacceptable for the treatment of children with ADHD. A different selection of the tone of music is needed to influence certain neurotransmitter structures of the brain that are responsible for the psychological state of children, and in addition, in the well-known solution, color light therapy and massage are not used, which enhance the effect of music therapy.

The objective of this invention is to correct the psychological state of children with attention deficit hyperactivity disorder, in which concentration appears, to reduce excessive motor and excessive speech activity, and to level impulsivity.

The technical result when using the invention is to increase the susceptibility of children with ADHD to music therapy by selecting musical works with minor musical characteristics of these works, using color light therapy and massage, while using a combination of specially selected parameters frequency/tone of the sound of music and wave characteristics synergistic to them lights/colors.

The problem is solved by the fact that in the method of treating hyperkinetic disorders in children, in which the patient is first examined and the current parameters of the body are determined by measurements, in addition, a modified eight-color Luscher test is carried out with the child and according to the method of V.M. Elkin reveal the relationship between the chosen child of color in the Luscher test and the tonality of a musical work, as well as on the subject of music perception, which serves as a criterion for selecting children in treatment groups [V.M. Elkin Healing magic of music. Harmony of music and color in the therapy of diseases. - Respeks, 200. - 224C.]. Treatment is carried out in two stages. The first stage is carried out in a rehabilitation center, where local color light therapy is initially carried out, for which one colored patch is glued to the areas of the pads of the terminal phalanges of the thumbs of the children's palms, which is attached for the entire duration of classes, per day by serial number or by day of the week purple-lemon- red-red-blue-violet-orange-violet according to the Dinshah Ghadiali system [Yu.V. Gotovsky, A.P. Vysheslavtsev, L.B. Kosareva, Yu.F. Petrov, M.M. Shraibman Color Light Therapy, IMEDIS. - M. - 2001, pp. 142-145].. The color spectrum of the patch is alternated daily. Then the palms are massaged with a massage ball with “Su-Jok” spikes according to the method of M. G. Panova for 5 minutes. After that, during intellectual and creative training sessions that require active brain work from patients, receptive music therapy of musical and psychotherapeutic regulatory influence is carried out with an audio-music program composed of musical elegies, the tones of which correspond to the colors selected by the children according to the Luscher test. The audio-musical program is made up of musical works, minor in terms of modal characteristics and keys, 56-90 metronome beats per minute with a frequency range of musical sound from 400 to 600 Hz and the exclusion of sharp dissonant intervals. The audio-musical program is represented by a specially built scheme of alternating musical works, lasting 2-4 minutes, perceived as calm. A calming effect is achieved by using the same rhythmic figures in the accompaniment with small durations of notes, including sixteenth notes, and musical works lasting 6 minutes each with the presence of major inclusions, perceived as excitement, inspiration. By alternating contrasting musical parameters in a regular order, neuro-humoral mechanisms of the brain work are trained. Classes are conducted under the supervision of a rehabilitation center specialist for 30 minutes for children 4-5 years old and 60 minutes for children 6-7 years old. The frequencies of the tones/sounds in the audio-music program and the frequency characteristics of the colors that are applied to the color light therapy patch are the same. The listed actions of the first stage are carried out in a course of 12 individual or group lessons daily or every other day, twice a year for three years. The second stage of treatment is performed at home in the same sequence and in the same volume as in the first stage. For pillow areas the terminal phalanges of the thumbs of the palms are glued one colored patch per day according to the serial number or according to the day of the week violet-lemon-red-red-blue-violet-orange-violet according to the Dinshah system. The color spectrum of the patch is alternated daily, which is attached for the entire duration of the session, then the palms are massaged for 5 minutes. Then they carry out intellectual and creative training sessions under the background audio-music program, composed of musical elegies. The listed actions of the second stage are carried out at least three times a week for three years.

The work with a massage ball is carried out according to the method of M. G. Panova, set out in the "Methodology for conducting reflex mechano-massage according to the Su-Jok system (offered by the speech therapist of the CGR "IMPULSE" M. G. Panova"

and consisting in performing movements with a ball on the palms, while the teacher focuses the child's attention on the color of the pasted patch. The child performs the massage himself under the guidance of a teacher or parent. Together, the method implements a tactile-visual effect on the brain structures by light waves and mechanical action.

The audio-musical program, composed of musical elegies, uses the works of J. Massenet "Elegy" for violin and orchestra, V. S. Kalinnikov "Elegy" for piano, A. S. Arensky "Elegy" from the cycle "24 Pieces for Piano ”, A. A. Babajanyan “Elegy” for piano, P. I. Tchaikovsky “October” “Autumn Song” from the cycle “The Seasons” for piano, S. V. Rachmaninov “Elegy” from the cycle “Fantasy Pieces” for piano, An. N. Aleksandrova "Elegy" from the cycle "Elegy and Waltz" for piano and J. Massenet "Elegy" arranged for electronic musical instruments. Listening to this specially designed audio-music program for children promotes their self-expression and empathy, allowing them to release emotions, resolve internal conflicts, thereby fully realizing the principle of healing through music.

Children additionally undergo course therapy with the Supradin vitamin-mineral complex every 4 months for 20 days.

The effectiveness of the method is ensured due to the coincidence of frequency vibrations of specially selected musical parameters of sounds/tones and perceiving phonoreceptors of detuned neurotransmitter structures of the brain, harmonizing their neuro-humoral work to restore multiple interhemispheric connections. This method has no side effects.

The clinical effect of music therapy is enhanced by a reflex path from distant receptor zones on the terminal phalanges of the first fingers of the hands (color light therapy according to Dinshah) and palms (Prof. Pak Zhe Wu, “Lectures on su-jok therapy, M., 1998), harmonizing the functions of the central nervous system due to the frequency coincidence of the used colors and sounds/tones in the audio-musical program "Elegy". The frequency response of musical tones and light waves in the audio program "Elegy" in combination with color light therapy is shown in Table 1.

Frequency response of musical tones and light waves in the audio program "Elegy" in combination with color light therapy

(according to the works of Dinshah Ghadiali, Yu.V. Gotovsky and co-workers)

Table 1

Name of the musical note Musical sound frequency, Hz Colour Octave frequency, Hz one mi 659 violet 665.7 2 si 494 citric 497.9 3 salt 392 purple 397.3 4 re 587 blue 598.6 five la 440 Orange 430.8

The principle of functional correspondence of music to the clinical and pathogenetic aspect of ADHD creates a platform for the best results of therapeutic action. It is known that perceiving phonoreceptors are differentially excited only to a certain amplitude modulation of musical tones, releasing biologically active chemicals strictly corresponding to the quality of the stimulus - neurotransmitters. Through them, an electrochemical impulse is transmitted from the sound-perceiving nerve cell to the auditory analyzer of the cerebral cortex, harmonizing the multiple interneuronal connections of the brain structures involved in this disease [S.V. Shushardzhan, Guide to Music Therapy. - M.: "Medicine", 2005. - 450 p.]. A number of authors on music therapy have expressed a fair opinion that the point is not so much in the acoustic properties of music, but in the meanings that people give to tonality, and in the performing traditions formed in a particular era. Based on this, knowledge of objective musical parameters such as mode, tempo, timbre, etc. allows you to effectively model the state of consciousness of an individual and a group, reduce uncertainty in the processes of musical perception and improve the effectiveness of music therapy [A.A. Volodin, “Psychological Aspects of Music Perception,” Cand. cand. psychology, 1972; I.A. Dergaeva, "Comprehensive study of the perception and psychological impact of music", abstract. cand. psih.nauk, 2005]. They determine the characteristics of perception.

Of the many well-known musical elegies, the desired ones were selected for compiling a therapeutic audio-musical program, corresponding to the developed indicators of the objective musical space, where harmonious music prevails, dissonance, tension that causes emotional and expressive impulses are excluded. The predominance of light and wise lyrical minor is associated with romantic feelings, where minor intonations act on the brain as a psychological trick and make it easier to experience one's own "tragedies". In the central parts of a number of elegies, according to the laws of contrast, interspersing major at a fast pace provides freshness of perception, charges with positive emotions, but these themes do not compete with the leading emotional tone.

The process of listening to the musical audio program "Elegy" introduces into a state of concentration on the main emotional background of the musical canvas, and at the same time restraint of its expression and generalized dominance of the main emotional state, which correlates with a sense of peace of mind with a clear brain working activity, reducing and / or leveling the leading clinical symptoms in ADHD: lack of concentration, increased motor and speech activity, impulsivity.

The principle of individualization in the implementation of the method is necessarily present. For this, the audio program "Elegy" is tested, composed of musical elegies, according to the method of V.M. Elkina (V.M. Elkin, Healing magic of music. Harmony of music and color in the therapy of diseases. - St. Petersburg: Respeks, 2000. - 224p.), where V.M. Elkin revealed the relationship between the preferred colors chosen by the person under study in the Luscher test and the corresponding keys in music. When children listen to the audio program "Elegy", the dependencies between the chosen color in the Luscher test and the tonality of the sounded musical work are determined, as well as on the subject of music perception. Based on these dependencies, children are selected into treatment groups. If the tonalities of the developed musical audio program and the selected colors coincide, a pronounced psychotherapeutic effect is achieved, since the effects of color light therapy and music therapy on the body are combined. Table 2 shows the features of human perception of musical keys in relation to the audio program Elegy.

Peculiarities of human perception of musical tonalities,

in relation to the audio program "Elegy"

 table 2

Title of the work Key Characteristics of music perception Time
sound J. Massenet "Elegy" (for violin and orchestra) e-minor
calm expectation, melancholy, obedience, patience 02:07 V. S. Kalinnikov "Elegy" (for piano) B flat minor contemplation, fantasy, contributes to a pleasant facial expression 06:42 B flat major clarity of mind, joy of love, hope for the best A. S. Arensky "Elegy" from the cycle "24 Pieces for Piano" G minor immense, wide calmness, activation of the mental function of the brain, desire for creative work 03:44 A. A. Babajanyan "Elegy" (for piano) G minor the most beautiful tone, contemplative serious mood, majesty; ambivalent: both anxiety, anxiety, sadness, and calm joy, moderate gaiety 04:05 P. I. Tchaikovsky "October" ("Autumn Song") from the cycle "The Seasons" (for piano) D minor serious and righteous, something sublime and calm, at the same time great, pleasant and joyful, contributes to a serene mood, softens feelings of melancholy, anxiety, sadness. 03:54 S. V. Rachmaninov "Elegy" from the cycle "Pieces-Fantasy" (for piano) E flat minor; deep triumph and nobility of feelings. feeling of exciting anxiety, ordered thoughts, inspiration, confidence. 06:03 G flat major bright, positive, joyful thoughts, memories An. N. Alexandrov "Elegy" from the cycle "Elegy and Waltz" (for piano) La Minor regularity, calm confidence, tenderness, concentration, work environment, a sense of devotion, humility, a desire to move forward 04:00 J. Massenet "Elegy" (arranged for electronic musical instruments) E minor inspiration, activity, positive mood, "I can do anything!" 02:10

Thus, the distinctive features of the proposed method for the treatment of hyperkinetic disorders in children make it possible to correct the clinical condition of children with attention deficit hyperactivity disorder and, thereby, increase the effectiveness of music therapy in its combined use, which allows to achieve a technical result.

Based on the foregoing, it can be concluded that the totality of the essential features of the claimed invention has a causal relationship with the achieved technical result, i.e. thanks to this set of essential features of the invention, it became possible to solve the problem. Therefore, the claimed invention is new, involves an inventive step and is suitable for use.

A method for the treatment of hyperkinetic disorders in children is carried out as follows.

Previously, a physiotherapist/rehabilitator examines the patient and determines the current parameters of the body and, through measurements, fixes the indicators of blood pressure, pulse rate, orthostatic test, the data are entered in the table. Carry out a modified eight-color Luscher test. The modified eight-color Luscher test consists in choosing the color that the child likes at the moment from the provided color cards, without associating it with foreign objects. This allows you to determine the psycho-emotional state of the child, revealing not only the subjective attitude of the child to color standards, but also unconscious reactions to them, which are closely related to the functions of the pituitary gland that determine mood and general mental activity. Based on the colors chosen by the child, they are set according to the method of V.M. Elkin's relationship between the child's choice of color and the musical key corresponding to this color, as well as on the subject of music perception. The data is used to select children for music therapy and assign them to groups based on an individual approach. According to the group, music therapy, color light therapy and massage according to the Su-Jok method are prescribed. Treatment is carried out in two stages. The first stage is carried out in a rehabilitation center, where local color light therapy is initially carried out, for which one colored patch is glued to the areas of the pads of the terminal phalanges of the thumbs of the palms, which is attached for the duration of classes, per day by serial number or by day of the week purple-lemon-red- red-blue-violet-orange-violet according to the Dinshah system. The color spectrum of the patch is alternated daily. Then the zones on the palms are massaged alternately with the right and left massage ball with Su-Jok spikes according to the method of M. G. Panova for 5 minutes with an emphasis on the color of the pasted patch. After that, during intellectual and creative training sessions that require active brain work from patients, receptive musical therapy of musical and psychotherapeutic regulatory influence is carried out with an audio-musical program composed of musical elegies. The audio-musical program is made up of musical works, minor in terms of modal characteristics and keys, 56-90 metronome beats per minute with a frequency range of musical sound from 400 to 600 Hz and the exclusion of sharp dissonant intervals. The audio-musical program is represented by a specially built scheme of alternating musical works, lasting 2-4 minutes, perceived as calm. A calming effect is achieved by using the same rhythmic figures in the accompaniment with small durations of notes, including sixteenth notes, and musical works lasting 6 minutes each with the presence of major inclusions, perceived as excitement, inspiration. In the process of classes, the teacher repeatedly draws the child's attention to the color spectrum of the pasted patch in verbal, and possibly in poetic form. The audio-music program sounds in the background (35 dB) for receptive perception. By alternating contrasting musical parameters in a regular order, neuro-humoral mechanisms of the brain work are trained. Classes are conducted under the supervision of a rehabilitation center specialist for 30 minutes for children 4-5 years old and 60 minutes for children 6-7 years old. The frequencies of tones / sounds in the audio-music program and the frequency characteristics of the colors that are applied on the patches for color light therapy are the same. The listed actions of the first stage are carried out in a course of 12 individual or group lessons daily or every other day, twice a year for three years. The second stage of treatment is performed at home in the same sequence and in the same volume as in the first stage. For pillow areas the terminal phalanges of the thumbs of the palms are glued one color patch per day according to the serial number or according to the day of the week violet-lemon-red-red-blue-violet-orange-violet according to the Dinshah system. Every day, the color spectrum of the patch is alternated, which is attached for the duration of the lesson. Then massage the palms for 5 minutes. Then they carry out intellectual and creative training sessions under the receptive audio-music program, composed of musical elegies. The listed actions of the second stage are carried out at least three times a week for three years.

The therapeutic effect of the proposed method is based on the universal patterns of perception of sound frequencies of the objective musical space (music), specially selected components of the musical space for the pathogenetic features of ADHD in combination with color light therapy and massage, which ensures the successful use of the universal musical audio program "Elegy".

To confirm the effectiveness of the proposed method, a clinical study of 152 children aged 4 to 7 years inclusive with a verified diagnosis of ADHD was conducted for three years. according to ICD 10 and different types according to DSM-5, which were divided into three groups according to the types of rehabilitation factors to be studied, namely: the main group, where the children underwent a combination of clinical music therapy with the audio program "Elegy" with local color light therapy massage according to the method Su-Jok and two comparison groups, where one received only music therapy, and the other only color light therapy.

The analysis of clinical symptoms in dynamics over three years reliably confirmed positive dynamics in a larger number of children who received combined rehabilitation factors (music therapy and color light therapy) than in those who received one rehabilitation factor: in 84.7% (61) of the observed. Confirmation of the best effect of rehabilitation from a combination of factors is a more pronounced decrease in the total indicator of the symptoms of the disease: from 101±2.39 to 22±1.27 points with a decrease and leveling of all the main symptoms of ADHD (inattention, hyperactivity, impulsivity) table 3.

Indicators of clinical symptoms of attention deficit hyperactivity disorder over three years (2018-2020)

Table 3

Indicators main group
(n=72) comparison group No. 1
(n=55) comparison group №2
(n=25) before after R before after R before after R Symptoms of inattention forgetfulness 8±0.15 2±0.3 <0.01 9±0.8 1±0.3 <0.001 5±0.7 2±0.2 >0.05 does not listen to spoken word 7±0.53 - <0.05 8±0.06 1±0.2 <0.05 7±0.04 6±1.3 <0.001 does not pay attention to details, makes many mistakes 6±0.41 2±0.4 <0.001 6±0.67 1±1.1 <0.05 6±0.02 5±0.02 <0.05 often distracted 8±0.24 1±1.2 <0.05 9±0.07 1±0.8 <0.001 8±0.04 6±0.05 <0.05 does not follow instructions, does not follow through 8±0.82 1±0.08 <0.01 7±0.34 2±0.08 <0.05 7±0.12 5±0.06 >0.05 often loses things 5±0.34 - <0.001 3±0.7 1±0.2 <0.05 2±0.07 - >0.05 can't stand things that require mental stress 8±0.07 2±0.06 <0.01 8±0.5 2±0.8 <0.001 6±0.06 5±0.04 <0.05 Difficulty retaining attention when completing learning tasks 7±0.8 2±0.7 <0.05 8±0.06 2±0.07 <0.001 7±0.06 5±0.5 <0.05 Total 57±0.42 10±0.35 52±0.4 11±0.29 48±0.14 34±0.27 Symptoms of hyperactivity aimless motor activity 9±0.22 1±0.55 <0.05 8±0.12 2±0.01 <0.001 9±0.04 4±0.08 <0.001 rampant talkativeness 4±0.55 1±0.06 <0.05 6±0.23 1±0.02 <0.05 2±0.06 2±0.06 <0.05 can't play quietly 5±0.21 2±0.07 <0.001 6±0.08 2±0.09 <0.01 7±0.06 3±0.6 <0.05 can't sit still when needed 7±0.54 2±0.13 <0.01 8±0.12 3±0.6 <0.001 7±0.55 4±0.05 <0.05 Total 25±0.4 6±0.2 28±0.1 8±0.18 25±0.18 13±0.2 Symptoms of Impulsivity answers questions without hesitation 4±0.34 2±0.5 <0.05 6±0.08 3±0.02 <0.05 3±0.08 3±0.03 >0.05 impatient waiting for your turn 8±0.22 3±0.13 <0.05 9±0.32 4±0.3 <0.05 7±1.2 5±0.06 <0.05 interrupts people, interrupts other people's conversation 7±0.56 1±0.17 <0.05 8±0.22 4±0.06 <0.001 6±0.09 3±0.1 >0.05 Total 19±0.37 6±0.26 23±0.2 11±0.12 16±0.48 11±0.06 Total: 101±0.39 22±0.27 103±0.24 30±0.2 89±0.26 58±0.18

Note: 1. clinical indicators are expressed in points on a 10-point scale.

2. Р – reliability of differences with initial values.

In those who received only music therapy with the audio program "Elegy", the number of children with improvement was comparable to the main group: 85.4% (47 people), however, the total total indicator of clinical symptoms decreased by a slightly lower value: from 103±2, 24 to 30 ± 1.2 points, due to the preservation in a number of children in the structure of clinical symptoms of lower rates of reduction and rare signs of symptom leveling, namely: the symptom of impulsivity decreased by 16.2% less than in the main group. This is probably due to the lack of visual and tactile influence of color light therapy as a factor in enhancing the effectiveness of rehabilitation. In those who received only color light therapy, positive dynamics was significantly higher than the natural dynamics of the disease (according to world statistics 30%) over the course of three years as the child grows up and general rehabilitation measures are carried out in the rehabilitation center and standard social psychological and pedagogical work, but less than in children who underwent music therapy: the number of children with improvement was 52% (13 people), and the total symptom score decreased from 89±2.26 to 58±1.18 points.

An analysis of physical studies over time confirms the harmonizing effect of music therapy on the autonomic regulation of the body (Table 4 "Hemodynamic parameters over three years in observed children with ADHD" and Table 5 "Indicators of an orthostatic test over three years in observed children with ADHD") .

Hemodynamic parameters in dynamics for three years

in observed children with attention deficit hyperactivity disorder

Table 4

Indicators heart rate HELL SV (ml.) / IOC (l / min 2018 2019 2020 2018 2019 2020 2018 2019 2020 Main group 110±6 103±6 100±3 110±5
60±3 101±3
62±4 102±2
67±2 23±6
1.9±3 22±6
2.1±2 26±2
2.4±2 Comparison group No. 1 112±4 107±2 99±5 112±5
58±3 103±3
62±3 103±5
66±1 20±2
2.1±3 23±6
2.3±2 25±3
2.5±3 Comparison group No. 2 109±6 104±6 102±3 105±5
70±3 98±5
71±3 90±5
79±3 21±3
2.0±3 25±6
2.0±2 23±4
2.4±4

HR - heart rate (norm for 4 years - 110 per minute, for 6 years - 100 per minute)

IOC - the amount of blood ejected by the heart in one minute, the norm is 2.1

and 2.5 for 4 and 6 years.

SV - the amount of blood ejected by the heart in one contraction, the norm is 19 and 25 ml for 4 and 6 years.

BP - blood pressure (BP norms for children from 4 to 7 years old - 80-100 / 60-80 mm Hg). Norms according to P. Kishsh., D. Sutreli, 1962

Indicators of orthostatic test in dynamics for three years

observed children with attention deficit hyperactivity disorder

Table 5

Indicators Main group 2018 2019 2020 before after before after before after heart rate 110±6 115±2 103±4 105±3 95±5 96±2 HELL 92±5
47±3 94±4
48±5 97±5
50±7 98±6
52±3 93±5
61±3 95±4
62±3 Comparison group No. 1 heart rate 112±6 112±3 103±6 104±4 97±5 97±3 HELL 95±5
47±3 96±4
49±2 94±4
49±3 100±3
53±4 97±4
54±3 99±5
59±2 Comparison group No. 2 heart rate 112±6 116±4 103±5 107±4 95±6 99±5 HELL 94±5
49±5 97±4
47±3 90±5
44±6 95±6
48±3 93±5
45±3 96±6
47±4

Note: before - before the test; after - after the test.

Conducting a course of therapeutic regulatory music therapy with the audio program "Elegy" and local color light therapy made it possible to reduce increased motor, speech and emotional activity, made it possible to manifest concentration when performing work, improve speech motor skills in children with ADHD. The best results were noted in the children of the main group who underwent regular music therapy for three years both in a rehabilitation center and at home.

A positive result of music therapy using the Elegy audio program and local color light therapy can fill in the missing knowledge of various specialists working in the field of studying hyperkinetic disorders, and will contribute to the development of parity medical, psychological and pedagogical support for these children at different stages of providing them with multidisciplinary care .

The inventive method does not require special training of a doctor, does not require complex technical devices, both diagnostic and sound-reproducing, which provides ample opportunities for its use in remote areas of the country where highly specialized specialists are not provided.

Thus, the claimed method of treating children with attention deficit hyperactivity disorder through clinical music therapy in combination with local color light therapy and massage is an effective method for correcting the main clinical symptoms of the disease: inattention, hyperactivity and impulsivity.

To confirm the application of the proposed method, the applicant cited one of a number of clinical cases with children, conducted in a rehabilitation center and prolonged at home.

A clinical case of a child from the main group with a combined form of attention deficit disorder and hyperactivity.

Child K., 4 years old, (male) the main observation group, was in rehabilitation on 11.01-28.01.2018. and from 07.08.-24.08.2018

Diagnosis: Hyperkinetic disorder (F90.).

Complaints of frequent headaches, discomfort in the neck, poor sleep, increased motor activity, impulsiveness, inattention, conflict in society. The first signs of the disease are suspected at 2 years of age. He did not receive specific drug therapy due to the manifestation of the side effect of the psychostimulant drug in the form of a sharp excitation.

Initially, the clinical picture was mild distractibility, forgetfulness, daydreaming, disorganization, low concentration and difficulty with tasks. Excessive anxiety and agitation, increased motor activity, restlessness, often destructive actions towards peers, animals, toys significantly worsened the quality of life of the child and his parents. Violation of speech development was expressed in the fact that the speech was so hasty that the child did not have time to think about how to build sentences and this made the process of cognition and communication difficult. Symptoms of the disease manifested themselves both at home and in public (kindergarten, rehabilitation center) places.

General physical examination revealed no abnormalities. In the neurological status, there were signs of mild pyramidal insufficiency, manifested by uncertainty when walking; violation of fine motor skills; testing revealed a decrease in the indicators of figurative and verbal-logical thinking. Laboratory blood tests are normal. EEG initially dominated alpha rhythm in the range of 7-9 Hz, which was regarded as the norm. At the same time, signs of immaturity of the fronto-thalamic structures were noted, where the degree of synchronization of alpha oscillations is low compared to signals from the anterior-central parts of the brain. Increased levels of alpha waves were registered in the leads of the left hemisphere with a focus in the temporal and occipital leads. Epi-signals are not registered. In Doppler study of cerebral hemodynamics, cerebral blood flow velocity and resistance indices at the intracranial level are reduced.

Initially, psychological and diagnostic testing “Pyramid in the colors of Luscher”, a diagnostic album for the development of the cognitive activity of the child (Semago N.Ya., Semago M.M., testing the audio program “Elegy” for music perception) was carried out.

In the conditions of the rehabilitation center, six rehabilitation courses were conducted over three years of music therapy with the audio program "Elegy" and local color light therapy during intellectual and creative classes and massage according to Su-Jok in the amount of 12 times per course against the background of a general rehabilitation program (enteral oxygen therapy, massage, exercise therapy, hydrotherapy, psychological and pedagogical correction, course therapy with the Supradin vitamin and mineral complex every 4 months for 20 days). At home, receptive music therapy with the Elegy audio program, local color light therapy and Su-Jok massage during developmental games and classes and in subsequent years of preparatory tasks for school were prolonged at least 3-4 times a week continuously for three years. Initially, parents were trained in the methodological skills of conducting classes at home.

The first year of rehabilitation showed a significant (p<0.05) decrease in the clinical symptoms of ADHD: hyperactivity decreased by 23 points, inattention by 33 points from the baseline. The child became calmer, excessive movements decreased, speech production became more understandable, measured. Episodes of impulsivity persisted. After the second year of rehabilitation, behavior improved markedly: the child began to listen to addressed speech and try to follow instructions more accurately, episodes of interrupting adults during a conversation (evaluative intellectual function) noticeably decreased. Signs of impulsivity became isolated, more often in the form of sudden movements, he no longer showed aggression. By the end of the third year of rehabilitation, the speech therapist confirmed age-appropriate speech development. Test samples confirmed psychological stability. Echoencephalographic deviations remained minimal, and Doppler parameters of cranial and extracranial blood flow corresponded to the age norm. Sufficient perseverance and calm behavior made it possible to prepare well for school in the preparatory class and get along with peers.

At annual follow-up examinations by a neurologist, specific drug therapy was not prescribed due to the positive dynamics of clinical symptoms.

In this clinical case, regular and long-term music therapy in combination with color light therapy and massage for three years was the main method of a positive result, because. long-term regular exposure to problematic receptor-mediator structures of the brain in attention deficit hyperactivity disorder by specially selected objective musical space, perceived by the individual, pathogenetically restored and day by day fixed the broken interhemispheric connections in the brain.

Claims (4)

1. A method for the treatment of hyperkinetic disorders in children aged 4-7 years, including carrying out a modified eight-color Luscher test with a child and identifying the relationship between the color chosen by the child and the tonality of a musical work according to the method of V.M. Elkin, which serves as a criterion for selecting a child in the treatment group, the treatment is performed in two stages, the first stage is carried out in a rehabilitation center, where local color light therapy is initially carried out by gluing one colored patch onto the pads of the end phalanges of the thumbs for the entire duration of the session, every day, one color of the patch is used sequentially: purple - lemon - red - red - blue - purple - orange - purple, then the palms are massaged with a massage ball with Su-Jok spikes according to the M.G. method. Panova lasting 5 minutes, after which, during intellectual and creative training sessions, receptive music therapy is carried out with a program composed of musical elegies, and musical works lasting 2-4 minutes and musical works lasting 6 minutes alternate, classes are carried out under the supervision of a rehabilitation center specialist in for 30 minutes for children 4-5 years old and 60 minutes for children 6-7 years old in a course of 12 sessions, twice a year for three years, the second stage of treatment is performed at home in the same sequence and in the same volume as on the first stage, at least three times a week for three years. 2. The method according to claim 1, characterized in that the classes of the first stage are carried out daily or every other day, individually or in a group. 3. The method according to claim 1, characterized in that receptive music therapy is carried out by sequentially playing musical elegies: J. Massenet "Elegy" for violin and orchestra, V. S. Kalinnikov "Elegy" for piano, A. S. Arensky " Elegy" from the cycle "24 Pieces for Piano", A. A. Babadzhanyan "Elegy" for piano, P. I. Tchaikovsky "October" "Autumn Song" from the cycle "The Seasons" for piano, S. V. Rachmaninov "Elegy ” from the cycle “Fantasy Pieces” for piano, An. N. Alexandrova "Elegy" from the cycle "Elegy and Waltz" for piano and J. Massenet "Elegy" arranged for electronic musical instruments. 4. The method according to claim 1, characterized in that the children are additionally given course therapy with the Supradin vitamin-mineral complex every 4 months for 20 days.