RU2797541C1 - Method of correcting posture in children aged 5-6 years on the background of hereditary disorders in the development of connective tissue - Google Patents

Abstract

FIELD: medicine, restorative medicine, traumatology and orthopedics.

SUBSTANCE: invention can be used for the prevention of kyphoscoliotic deformities, osteochondropathy of the spine, early juvenile osteochondrosis in 5–6-year-old children with poor posture against the background of hereditary connective tissue developmental disorders. Educational classes "Correction of posture" including a practical and theoretical part of 3 lessons lasting 1 hour are conducted. With an instructor of exercise therapy, therapeutic exercises are carried out on the "Swedish wall", and on an orthopedic ball 2 times a week for 1.5 hours for 3 years. The patients receive Calcimax dietary supplement containing calcium in the form of hydroxyapatite, trace elements, chondroitin sulfate, vitamins 1 capsule in the morning and in the evening after meals for 1 month. Repeated courses of treatment are carried out 3 times a year for 3 years. Therapeutic swimming in the style of "breaststroke" is carried out in the pool 3 times a week for 1 hour for 3 years. Diet therapy enriched with proteins, amino acids, microelements, vitamins C, E is carried out. Massage along the spine is carried out 10 sessions for 30 minutes daily in the morning from 09:00 to 11:00 an hour after breakfast monthly for 3 years, as well as physiotherapy procedures: transcutaneous electrical muscle stimulation that straightens the spine for 15 days for 20 minutes, suprathreshold current strength 40 mA, frequency 20 Hz, intermittently, lasting 3 seconds, 4 courses per year for 3 years.

EFFECT: method ensures minimization of the development of long-term complications: scoliotic, kyphotic spinal deformities, osteochondropathy, early juvenile osteochondrosis.

1 cl, 2 ex

Description

The invention relates to medicine, namely restorative medicine, traumatology and orthopedics, can be used for the prevention of kyphoscoliotic deformities, spinal osteochondropathy, early juvenile osteochondrosis in 5-6-year-old children with poor posture against the background of hereditary connective tissue developmental disorders.

The relevance of the topic is due to its prevalence, systemic lesions, involvement in the pathological process of many body structures. On the part of the osteoarticular system, the spine is more often involved in the pathological process. The direct costs associated with the treatment and rehabilitation of this category of patients cause economic and social damage to the state. Separate signs of hereditary disorders in the development of connective tissue in adolescence occur, according to the literature and our observations, with a frequency of 14 to 85%. Currently, there are difficulties and inconsistencies with such patients. There are no clear algorithms for clinical examination, patient management, certain tactical algorithms in preventive measures, diagnosis, and treatment. Since the possibility of modern methods of prevention of patients with scoliosis, kyphosis, osteochondropathy, early juvenile osteochondrosis is limited, the search for new approaches and the development of new methods are relevant.

A well-known method of therapeutic and preventive measures at the stage of early diagnosis of incorrect posture against the background of hereditary disorders in the development of connective tissue is the drug method with drugs that stimulate collagen formation, regulate the metabolism of chondrocytes, stabilize mineral metabolism, correct the bioenergetic state of the body, the level of free amino acids in the blood, and normalize the processes of peroxidation. . (Principles of rehabilitation of patients with connective tissue dysplasia / T.I. Kadurina, L.N. Abbakumova, Attending physician. 2010. No. 4. - P. 28-31.). In our opinion, the disadvantage of the known method is that the characteristics of the course of the disease require long-term use of drugs for several years. This is a risk factor for the development of kidney failure, urolithiasis, liver dysfunction, a tendency to constipation and other complications from vital organs and systems. There are no long-term results of treatment.

The closest in technical essence (prototype) is a method of therapeutic and preventive measures for children with connective tissue dysplasia (V.V. Chemodanov, E.E. Krasnova, 2018, "Principles of medical support for children with connective tissue dysplasia", Attending physician No. 11 ). The disadvantage of this method, in our opinion, is that it does not take into account the age of patients, and the dominant symptoms from the spinal column. In addition, there is no clear systematic orientation for the parents of patients, the work of the educational school is not presented in a theoretical aspect in combination with practical exercises.

The authors have developed and proposed a highly effective method of therapeutic and preventive measures used in children from 5-6 years of age at the stage of early diagnosis of incorrect posture against the background of hereditary disorders in the development of connective tissue, including a complex of physiotherapy exercises using the "Swedish wall", gymnastic ball, drug therapy , swimming in the pool, diet therapy, physiotherapy, training at the educational school "Posture Correction", dosed corsetry, which allows you to positively influence the dynamics of clinical manifestations, help improve long-term results of treatment, minimize the development of complications - kypho-scoliotic deformities of the spine, osteochondropathy of the spine, early youth osteochondrosis.

The technical result of the claimed invention is to minimize the development of long-term complications: scoliotic, kyphotic deformities of the spine, osteochondropathy, early juvenile osteochondrosis.

The method is carried out as follows.

The presented set of exercises allows you to:

1. Minimize the hypotension of the erectors of the spine, increase muscle mass, strength of the muscles of the back and limbs.

2. Ensure proportional development of the musculoskeletal system of the shoulder and pelvic girdle.

3. Improve overall coordination of movements, stability.

4. Increase the physical fitness of patients, performance, endurance.

A complex of therapeutic and preventive measures used in children aged 5-6 years with incorrect posture against the background of hereditary disorders in the development of connective tissue: I. p. - lying on the stomach on the couch or on the floor. Hands are extended forward. Bending back ("fish" or "swallow"). Hold this position for 1-2 minutes. Number of sets 5. Break between sets 5 minutes. Increase the holding time daily by 1-2 minutes (up to 10 minutes). I. p. - lying on a gymnastic ball on the stomach. Physical therapy instructor supports. The arms and legs are extended. Maintain balance for 1-2 minutes. Number of sets 5. Break between sets 5 minutes. Increase the holding time daily by 1-2 minutes (up to 10 minutes). I.p. - Standing facing the "Swedish wall". "Crawling" up the "Swedish wall" with a further "ejection of the lower support" - releasing the legs, while holding the crossbar with your hands. Number of sets 5. Break between sets 1 minute.

I. p. - lying on your back on a couch or on the floor. The movement of the lower limbs is performed, imitating a bicycle. Duration 5 minutes. Number of sets 5. Break between sets 1 minute. I.p. - hanging on the crossbar (you can use a rubber band) - pulling up from 1 to 5 times. Number of sets 5. Break between sets 1 minute.

I. p. - lying on the stomach on the couch or on the floor. Raising and lowering the straight lower limbs up to 20 * from the plane of the couch or floor. Number of times 10. Number of sets 5. Break between sets 1 minute.

I. p. - standing with your back to the "Swedish wall" - the back of the head, shoulder blades, buttocks, the back surface of the legs, heels - are in contact with the "Swedish wall". Raising on toes and holding this position for up to 10 seconds. Number of repetitions 5. Number of sets 5. Break between sets 1 minute.

I. p. - lying on your back on a couch or on the floor. Flexion of the lower extremities at the knee and hip joints. Clasping your knees with your hands, press them to your stomach. Return to starting position. Number of repetitions 5. Number of sets 5. Break between sets 1 minute. I. p. - lying on his stomach on the floor. Support on toes (knees). With support on the palms - push-ups with a straight back. 1 to 5 times. Number of sets 5. Break between sets 1 minute.

In order to compensate for the deficiency of mineral deficiency, minimize the decrease in bone tissue strength, and activate osteogenesis, patients received the dietary supplement Calcimax containing calcium in the form of hydroxyapatite, microelements, chondroitin sulfate, and vitamins. Assigned 1 capsule in the morning and evening after meals for 1 month. Repeated courses of treatment were carried out 3 times a year for 3 years.

They prescribed therapeutic swimming in the style of "breaststroke" in the pool located in the clinic 3 times a week for 1 hour for 3 years.

Particular attention was paid to dietary patterns. The recommended food should have been rich in proteins, amino acids, trace elements, vitamins C, E. This is necessary for the normalization of collagen synthesis, which has antioxidant activity. The diet included:

- proteins of animal origin (meat, fish, seafood, milk and dairy products, cottage cheese, cheese);

- vegetable proteins (legumes);

- strong broths, jelly, aspic dishes (meat, fish, fruit jellies);

- products, calcium content (hard cheeses, fish, meat, milk, etc.);

Massage along the spine was prescribed 10 sessions for 30 minutes daily in the morning hours (from 09:00 to 11:00 h) an hour after breakfast. Sessions were conducted monthly for 3 years.

Of the physiotherapeutic procedures, transcutaneous electrical stimulation of the muscles that straighten the spine was prescribed. Conducted for 15 days for 20 minutes. Above-threshold current strength 40 mA. Frequency 20 Hz, intermittently, lasting 3 s. Appointed 4 courses per year for 3 years.

Education at the educational school "Correction of posture" for children and parents was carried out in a polyclinic. Classes were carried out according to the plan: Lesson No. 1 - lasting 1 hour. The purpose of the lesson was an introductory acquaintance of the patient and parents with the concept of "correct posture", "violation of posture", "hereditary disorders of connective tissue development".

Lesson number 2 - duration 1 hour. The purpose of the lesson was to familiarize the patient and parents with dietary patterns. The expediency of a diet rich in proteins, amino acids, trace elements, vitamins C, E to normalize collagen synthesis.

Lesson number 3 - duration 1 hour. The purpose of the lesson was to analyze and substantiate the advantage of swimming in the pool, taking into account the background pathology - hereditary disorders in the development of connective tissue. Teach the basic elements of exercise therapy so that the child can practice at home.

Lesson number 4 - duration 1 hour. Teach parents the basic elements of massage.

Lesson No. 5 with a psychotherapist - duration 1 hour. The main goal is to develop a system of adequate attitudes and consolidate a new line of behavior in the patient's family, since the disease is family in nature. Lability of nervous processes inherent in patients with connective tissue pathology, anxiety and a tendency to affective states require mandatory psychological correction in children and their parents, because neurotic behavior, suspiciousness greatly affect their attitude to treatment and the implementation of medical recommendations. An orthopedic corset was prescribed for the thoracic spine for 4 months for 3 hours a day.

The outpatient-polyclinic stage included medical observation of the patient by an orthopedist-traumatologist in a city children's clinic once every 4 months (after completion of the course of treatment) for 3 years.

The patients tolerated the treatment well, no side effects were observed. The claimed method treated 80 patients with a verified diagnosis of incorrect posture against the background of hereditary disorders of connective tissue development, of which (24) 30% were boys, (56) 70% were girls, the average age was 5.5 ± 0.4 years.

The criteria for the effectiveness of the therapeutic effect were the data of clinical examination, X-ray examination, electroneuromyographic examination, stabilographic examination. Examination of patients was carried out at the stage of primary treatment for an appointment with an orthopedic traumatologist and in follow-up after 6 and 12 months, 3 years, 7 years.

Clinical studies have shown that after complex therapeutic and preventive measures used in children from 5-6 years of age at the stage of early diagnosis of incorrect posture against the background of hereditary disorders in the development of connective tissue, including a complex of physiotherapy exercises using the "Swedish wall", gymnastic ball, drug therapy , swimming in the pool, diet therapy, physiotherapy, education in the educational school "Correction of posture", dosed bracing, a significantly positive trend was noted.

At the beginning of the dispensary observation, all patients of the main group and the comparison group (p=0.999) had fatigue of the back muscles, pain on palpation of the spinous processes, and a weak muscular corset. After 6 months from the start of treatment, patients of the main group did not have back muscle fatigue (p<0.001), in the comparison group, back muscle fatigue persisted in 50% of cases. Pain on palpation of the spinous processes was not observed in patients of the main group (p=0.003), in the comparison group it persisted in 33.3% of cases. Consistent muscle corset in patients of the main group was observed in all patients (p<0.001), in the comparison group, a weak muscle corset was observed in 88.3% of cases.

According to the data of electroneuromyography (assessment of the bioelectrical activity of the muscles that straighten the spine), at the time of the start of the dispensary observation, pathological changes were detected in all patients of the main group and the comparison group (p>0.05). After 6 months and after a year, the changes persisted. Three years after the dispensary observation, the changes progressed in 15 children of the comparison group. No pathological changes were detected in all children of the main group (p<0.001).

During stabilographic examination, tests were performed with open eyes. Differences in the frequency values of oscillations of the center of gravity appeared both in the frontal and sagittal planes at the time of the start of treatment. After 6 months, in the main group, positive dynamics was noted in 70.0% of patients, and in the comparison group, not in a single patient (p<0.001). After 12 months, positive dynamics in the main group was noted in 86.7%, and in the comparison group in 53.3% (p<0.001).

There was a clear X-ray staging of the pathological process (osteochondropathy in the thoracic spine). The first stage of the pathological process was observed in children aged 10-11 years. The second stage was diagnosed by the age of 12-14. The third stage - by 15-17 years. Visually, the presence of thoracic kyphosis was determined in patients - the Cobb angle of deformity was from 20 to 45 degrees or more. Later, in patients of the comparison group, kyphotic (scoliotic) changes progressed. In patients of the main group in 16.7% of cases, in patients of the comparison group in 50% of cases (p=0.024). After 7 years, early juvenile osteochondrosis in patients of the main group was observed in 6.7% of cases, in the comparison group in 26.7% of cases (p=0.023). In patients of the main group, prevention of the progression of the disease, the transition to subsequent stages in osteochondropathy of the spine can be traced.

Clinical example 1

A 5-year-old girl went with her mother to a scheduled appointment with an orthopedic traumatologist. Examined by the doctor on duty. From the anamnesis - a child from the first pregnancy, which proceeded without any features. Heredity - the father and mother have hypermobility of the joints (not examined, not treated). Up to 3 years of age, the child was repeatedly referred to a trauma center due to subluxations of the heads of the radial bones on the right and left after a slight fall on a soft surface. When examining the child - the skin is clean, dry, pale in color. According to the mother: "The child often complains of pain in the joints and coccyx, not associated with traumatic injuries." Increased extensibility of the skin is noted, kyphosis of the thoracic spine is enhanced, hypotension of the back muscles, funnel chest, flat-valgus position of the feet, hypermobility of large, medium, small joints.

Diagnosis: Dysplastic status. Incorrect posture (against the background of a hereditary disorder in the development of connective tissue?). Funnel chest. Plano-valgus position of the feet. The patient performed a complex of therapeutic and preventive measures using the "Swedish wall", a gymnastic ball in a clinic with an exercise therapy instructor. She took the dietary supplement "Calcimax", containing calcium in the form of hydroxyapatite, trace elements, chondroitin sulfate, vitamins - 1 capsule in the morning and evening after meals for 1 month. Repeated courses of treatment were carried out 3 times a year for 3 years. Assigned diets. The recommended food was rich in proteins, amino acids, microelements, vitamins C, E. This is necessary for the normalization of collagen synthesis. The patient and her mother had classes at the educational school "Correction of posture" on the basis of the city children's clinic - 3 classes for 1 hour. Educational school "Correction of posture" included a practical and theoretical part. An orthopedic corset was prescribed for the thoracic spine for 4 months for 3 hours a day. Massage along the spine was prescribed 10 sessions for 30 minutes daily in the morning hours (from 09:00 to 11:00 h) an hour after breakfast. Massage courses were carried out monthly for 3 years. Of the physiotherapeutic procedures, transcutaneous electrical stimulation of the muscles that straighten the spine was prescribed. Conducted for 15 days for 20 minutes. Above-threshold current strength 40 mA. Frequency 20 Hz, intermittently, lasting 3 s. The outpatient stage included medical observation of the patient by an orthopedist-traumatologist in a city children's clinic once every 4 months.

The patient tolerated the treatment well, no side effects were observed.

The criteria for the effectiveness of the therapeutic effect were the evaluation data of patients in the comparison group, which were based on clinical and additional methods of examination. Comparative analysis revealed a certain relationship between the degree of development of the pathological process and ongoing complex preventive functional measures. The results of the study after 6 months from the start of the complex preventive functional programs revealed an increase in the endurance of the back muscles (p<0.001), a year later, the absence of manifestations of arthralgic syndromes (p<0.001), coccygodynia (p<0.001). After 3 years, there was a good posture, a developed muscular corset (p<0.001). In patients of the main group, who were engaged in the proposed program in the process of dynamic observation (after 7 years), complications were statistically significantly minimized. These are kyphoscoliotic deformity of the thoracic spine (p=0.023), early juvenile osteochondrosis (p=0.174). In follow-up after 7 years, the patient continued to follow the lifestyle recommendations received at the Posture Correction Educational School, which contributed to maintaining the achieved indicators for adherence to general treatment, drug treatment, and lifestyle changes.

Clinical example 2

A 6-year-old boy applied with his mother for an appointment at a children's trauma center. According to the mother of the child: “Yesterday I twisted my leg in kindergarten. Cold was applied to the ankle joint. Today it is improving." When examined by a doctor on duty, the child walks independently, does not limp, there is no edema, on palpation there is slight pain in the area of the medial section of the right ankle joint. An X-ray examination was ordered. Diagnosis: Sprain of the right ankle joint. Treatment has been given. When examining a child, attention is drawn to the dysplastic status - pallor of the skin, increased skin extensibility, increased kyphosis of the thoracic spine, hypotension of the back muscles, back fatigue, pain on palpation of the spinous processes in the thoracic spine, keeled chest, flattening of the arch of the feet, incorrect bite and growth of teeth, decreased physical activity, restless sleep.

Diagnosis: Dysplastic status. Kyphotic posture (against the background of a hereditary disorder in the development of connective tissue?). Keeled chest. Plano-valgus position of the feet.

The patient performed a complex of therapeutic and preventive measures using the "Swedish wall", a gymnastic ball in a clinic with an exercise therapy instructor. He took the dietary supplement "Calcimax", containing calcium in the form of hydroxyapatite, trace elements, chondroitin sulfate, vitamins - 1 capsule in the morning and evening after meals for 1 month. Repeated courses of treatment were carried out 3 times a year for 3 years. A diet enriched with proteins, amino acids, microelements, vitamins C, E was prescribed. For the patient and his mother, classes were held at the Posture Correction educational school based on the city children's clinic - 3 classes for 1 hour. Educational school "Correction of posture" included a practical and theoretical part. An orthopedic corset was prescribed for the thoracic spine for 4 months for 3 hours a day. Massage along the spine was prescribed 10 sessions for 30 minutes daily in the morning hours (from 09:00 to 11:00 h) an hour after breakfast. Of the physiotherapeutic procedures, transcutaneous electrical stimulation of the muscles that straighten the spine was prescribed. Conducted for 15 days for 20 minutes. Above-threshold current strength 40 mA. Frequency 20 Hz, intermittently, lasting 3 s. The outpatient-polyclinic stage included medical observation of the patient by an orthopedist-traumatologist in a city children's polyclinic once every 4 months. The patient tolerated the treatment well, no side effects were observed.

In the process of dynamic observation, a positive trend was noted. After 6 months from the start of the recommended programs, the patient had a statistically significant increase in physical activity (p<0.001), improved sleep (p=0.016), no fatigue of the back muscles (p<0.001), pain on palpation of the spinous processes (p<0.001 ), hypotension of the back muscles (p=0.233). A year after the start of the recommended programs, the patient had statistically significantly improved indicators of stabilographic examination - the center of gravity normalized (p<0.001), electroneuromyographic examination of the muscles that straighten the spine (p<0.001). After 7 years from the start of the recommended programs, the indicators were statistically stable - there was no fatigue of the back muscles (p<0.001), pain during palpation of the spinous processes (p=0.003), hypotension of the back muscles (p<0.001). The patient had no radiographic signs of Schuermann's disease - May (p=0.001).

A complex of therapeutic and preventive measures using the "Swedish wall", gymnastic ball, drug therapy, swimming in the pool, diet therapy, physiotherapy, training at the educational school "Correction of posture", dosed corsetting is justified. This method, which gives real, tangible positive dynamics after 6 months from the start of classes and favorable long-term results. The rehabilitation treatment complex has a positive effect on the main clinical symptoms of the background pathology, and can be used in outpatient, inpatient and sanatorium treatment conditions.

Thus, the claimed method of therapeutic and preventive measures used in children of 5-6 years of age with impaired posture against the background of hereditary disorders in the development of connective tissue is highly effective, allows for the correction of risk factors and is easy to use.

Claims (10)

A method for correcting posture in children aged 5-6 years on the background of hereditary disorders in the development of connective tissue, characterized in that with an exercise therapy instructor they perform therapeutic exercises on the "Swedish wall" and an orthopedic ball 2 times a week for 1.5 hours for 3 -s years: Starting position (I. p.) - lying on the stomach on the couch or on the floor; arms extended forward: bending back, holding this position for 1-2 minutes, the number of sets is 5, the break between sets is 5 minutes, the holding time is increased daily by 1-2 minutes to 10 minutes; I. p. - lying on a gymnastic ball on the stomach; exercise therapy instructor supports, arms and legs are extended, maintaining balance from 1-2 minutes, the number of sets is 5, the break between sets is 5 minutes, the holding time should be increased daily by 1-2 minutes to 10 minutes; I. p. - standing facing the "Swedish wall"; crawling up the "Swedish wall" with further releasing of the legs, while holding the crossbar with the hands, the number of approaches is 5, the break between sets is 1 minute; I. p. - lying on your back on a couch or on the floor; movement of the lower limbs is performed, imitating a bicycle, duration 5 minutes, number of sets 5, break between sets 1 minute; I. p. - hanging on the crossbar - pulling up from 1 to 5 times, the number of approaches is 5, the break between sets is 1 minute with or without a rubber band; I. p. - lying on the stomach on the couch or on the floor; raising and lowering the straight lower limbs up to 20° from the plane of the couch or the floor, the number of times 10, the number of sets 5, the interval between sets is 1 minute; I. p. - standing with his back to the "Swedish wall" - the back of the head, shoulder blades, buttocks, the back surface of the legs, heels - are in contact with the "Swedish wall"; lifting on toes and holding this position for up to 10 seconds, the number of repetitions is 5, the number of sets is 5, the break between sets is 1 minute; I. p. - lying on your back on a couch or on the floor; flexion of the lower extremities in the knee and hip joints, clasping the knees with your hands, press to the stomach, return to the starting position, the number of repetitions is 5, the number of sets is 5, the break between sets is 1 minute; I. p. - lying on the stomach on the floor; support on toes or knees, with support on the palms - push-ups with a straight back, from 1 to 5 times, the number of approaches is 5, the break between sets is 1 minute; patients receive a dietary supplement "Calcimax" containing calcium in the form of hydroxyapatite, trace elements, chondroitin sulfate, vitamins 1 capsule in the morning and evening after meals for 1 month, repeated courses are carried out 3 times a year for 3 years; patients use an orthopedic corset on the thoracic spine for 4 months for 3 hours a day; conduct therapeutic swimming in the style of "breaststroke" in the pool 3 times a week for 1 hour for 3 years, diet therapy enriched with proteins, amino acids, trace elements, vitamins C, E, massage along the spine 10 sessions for 30 minutes daily in the morning from 09:00 to 11:00 an hour after breakfast monthly for 3 years, physiotherapy procedures: transcutaneous electrical muscle stimulation, straightening the spine for 15 days for 20 minutes, suprathreshold current strength 40 mA, frequency 20 Hz, intermittently, duration 3 seconds 4 courses per year for 3 years.