Diseases of the nervous system abstract of exercise therapy. Exercise therapy for diseases and injuries of the peripheral nervous system. Fractures of the diaphysis of the femur

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Therapeutic exercise for diseases of the nervous system

Introduction

1. Therapeutic exercise for neuroses

2. General principles of the methodology of therapeutic physical culture

2.1 Neurasthenia

2.2 Psychathenia

2.3 Hysteria

Conclusion

Bibliography

exercise physical education neurosis psychasthenia hysteria

Introduction

Therapeutic physical culture (or exercise therapy for short) is an independent medical discipline that uses the means of physical culture to treat diseases and injuries, prevent their exacerbations and complications, and restore working capacity. The main such means (and this distinguishes exercise therapy from other methods of treatment) are physical exercises - a stimulator of the vital functions of the body.

Therapeutic physical training is one of the most important elements of modern complex treatment, which is understood as an individually selected complex of therapeutic methods and means: conservative, surgical, medication, physiotherapy, nutritional therapy, etc. Complex treatment affects not only pathologically altered tissues, organs or systems organs, but for the entire body. The proportion of various elements of complex treatment depends on the stage of recovery and the need to restore the person's ability to work. A significant role in complex treatment belongs to therapeutic physical culture as a method of functional therapy.

Physical exercises affect the reactivity of the whole organism and involve the mechanisms that participated in the pathological process in the overall reaction. In this regard, physical therapy can be called a method of pathogenetic therapy.

Exercise therapy provides for the conscious and active performance by patients of appropriate physical exercises. In the process of training, the patient acquires skills in using natural factors of nature for the purpose of hardening, physical exercises - for therapeutic and prophylactic purposes. This allows us to consider classes in therapeutic physical culture as a therapeutic and pedagogical process.

Exercise therapy uses the same principles of physical exercise as physical culture for a healthy person, namely: the principles of comprehensive impact, application and health-improving orientation. According to its content, therapeutic physical culture is an integral part of the Soviet system of physical education.

1. Therapeutic exercise for neurosis

Neuroses are functional diseases of the nervous system that develop under the influence of prolonged overstrain of the nervous system, chronic intoxication, severe trauma, prolonged illness, constant alcohol consumption, smoking, etc. A certain role in the occurrence of neuroses can be played by the constitutional predisposition and characteristics of the nervous system.

There are the following main forms of neurosis: neurasthenia, psychasthenia and hysteria.

Neurasthenia is based on "a weakening of the processes of internal inhibition and is clinically manifested by a combination of symptoms of increased excitability and exhaustion" (IP Pavlov). Neurasthenia is characterized by: fatigue, increased irritability and excitability, poor sleep, decreased memory and attention, headaches, dizziness, disruption of the cardiovascular system, frequent mood swings for no apparent reason, etc.

Psychasthenia occurs mainly in people of the mental type (according to I. P. Pavlov) and is characterized by processes of congestive excitation (foci of pathological congestion, the so-called sore points). Patients are overcome by painful thoughts, all kinds of fears (whether he closed the apartment, turned off the gas, fear of some kind of trouble, darkness, etc.). With psychasthenia, nervous states, depression, inactivity, autonomic disorders, excessive rationality, tearfulness, etc. are noted.

Hysteria is a functional disorder of the nervous system, accompanied by insufficiency of higher mental mechanisms and, as a result, a violation of the normal relationship between the first and second signal systems, with the former predominating. Hysteria is characterized by: increased emotional excitability, mannerisms, bouts of convulsive crying, convulsive seizures, a desire to attract attention, speech and gait disorders, hysterical "paralysis".

The treatment of neurosis should be comprehensive: the creation of optimal environmental conditions (hospital, sanatorium), drug treatment, physio-, psycho- and occupational therapy, therapeutic physical culture.

Therapeutic physical culture has a direct impact on the main pathophysiological manifestations in neurosis, increases the strength of nervous processes, helps to equalize their dynamics, coordinate the functions of the cortex and subcortex, the first and second signal systems.

2. General principles of the methodology of therapeutic physical culture

The method of therapeutic physical culture is differentiated depending on the form of neurosis. With neurasthenia, it is aimed at increasing the tone of the central nervous system, normalizing autonomic functions and involving the patient in a conscious and active struggle with his illness; with psychasthenia - to increase the emotional tone and excite automatic and emotional reactions; in hysteria - to enhance the processes of inhibition in the cortex of the cerebral hemispheres.

With all forms of neurosis, an individual approach to the patient is necessary. The instructor must be authoritative, evoke positive emotions, exercise a psychotherapeutic effect on patients in the classroom, distract them from difficult thoughts, develop perseverance and activity.
Physical therapy classes are conducted individually and in groups. When forming groups, it is necessary to take into account gender, age, degree of physical fitness, functional state of patients, concomitant diseases.

In the first half of the course of treatment (I period), it is advisable to conduct classes individually to establish contact with patients. Given their increased sensitivity and emotionality, at the beginning of classes, attention should not be fixed on mistakes and shortcomings in the exercise. In this period, simple and general developmental exercises for large muscle groups are used, performed at a slow and medium pace and not requiring intense attention. Classes should be quite emotional. Commands should be given in a calm, clear voice. Patients with neurasthenia and hysteria need to be explained exercises to a greater extent, patients with psychasthenia should be shown.

In the treatment of hysterical "paralysis" distracting tasks are used in changed conditions (in a different starting position). For example, with “paralysis”, the hands use exercises with a ball or several balls. It is imperative to draw the patient's attention to the involuntary inclusion of the "paralyzed" hand in the work.

As sick exercises with simple coordination are mastered, the exercises include balance exercises (on a bench, balance beam), as well as climbing on a gymnastic wall, various jumps, and swimming. Walking, close tourism, fishing during this period also help to unload the nervous system from ordinary stimuli, strengthen the cardiovascular and respiratory systems.

The duration of classes in the first period is 10--15 minutes at the beginning, and 35--45 minutes as you adapt. If the patient tolerates the load of the 1st period well, then in the 2nd period, exercises are introduced into the classes that help improve attention, coordination, increase the speed and accuracy of movements, develop dexterity, speed of reaction. To train the vestibular apparatus, exercises are used with closed eyes, with a sudden restructuring of movements on command during walking, running, circular movements of the head, torso tilts. Mobile and lightweight sports games, walking, short-range tourism, skiing, cycling, volleyball, tennis, etc. are widely used. The second period takes place mainly in sanatorium-and-spa treatment.

2.1 Neurasthenia

As already mentioned, neurasthenia is characterized by increased mental and physical fatigue, irritability, impaired attention and memory, lack of a sense of vigor and freshness, especially after sleep, somatovegetative disorders. Pathophysiologically, these phenomena should be considered as a manifestation of the weakness of active inhibition and the rapid exhaustion of the excitatory process. The tasks of therapeutic physical training are to train the process of active inhibition, restore and streamline the excitatory process. Therapeutic exercises (in addition to the obligatory morning hygienic gymnastics) should be carried out in the morning. The duration and number of exercises should be minimal at first and increase very gradually.

With the most debilitated patients, it is recommended to start the session with a general 10-minute massage, passive movements lying in bed and sitting during the first few days. The duration of subsequent lessons is 15-20 minutes. Then it is gradually brought up to 30-40 minutes. Starting from the 5th - 7th lesson, elements of the game are introduced into the lesson (including with the ball), and in winter - skiing.

In view of the abundance of somatovegetative disorders in patients, their preliminary psychotherapeutic preparation is required. In the process of training, the methodologist must take into account possible painful sensations (palpitations, dizziness, shortness of breath) and regulate the load so that the patient does not get tired, so that he can stop exercising for a while and rest without any hesitation. At the same time, it is necessary to involve him more and more in classes, to increase interest in them due to the variety of exercises and methods of conducting classes.

Musical accompaniment should be an important element of the lessons. Recommended music is soothing, moderate and slow tempo, combining major and minor sounds. Such music plays the role of a healing factor.

2.2 Psychasthenia

Psychasthenia is characterized by anxious suspiciousness, inactivity, focus on one's personality, on experiences. The pathophysiological basis of these features of patients with psychasthenia is the pathological predominance of the second signaling system, the presence of foci of congestive excitation in it, and the inertia of cortical processes. The obsessive states often observed in this case (obsessive thoughts, actions, drives) are a reflection of the excessive inertness of the foci of excitation, and the obsessive fears (phobias) are a reflection of inert inhibition.

The tasks of therapeutic physical training are to "loosen" the pathological inertia of cortical processes and suppress the foci of pathological inertia by the mechanism of negative induction.

These tasks can be solved by exercises that are emotional in nature, fast in pace, performed automatically. The music that accompanies the classes should be cheerful, performed at a pace that changes from moderate to faster, up to allegro. Classes are very good to start with marches and marching songs. It is necessary to widely introduce game exercises, games, relay races, elements of competitions into the complex of physical exercises.

In the future, in order to overcome feelings of inferiority and low self-esteem, shyness, it is recommended to include exercises to overcome obstacles, balance, and strength exercises in classes.

When forming a group for classes, it is advisable to include several recovering patients, emotional, with good plasticity of movements. This is important because patients with psychasthenia are characterized by non-plastic motor skills, clumsiness of movements, and awkwardness. They tend to not know how to dance, so they avoid and dislike dancing. In obsessive states, appropriate psychotherapeutic preparation of the patient, an explanation of the importance of performing exercises to overcome feelings of unreasonable fear is of great importance.

To increase the emotional tone, resistance exercises performed in pairs, mass game exercises, exercises with a medicine ball are used; to overcome feelings of indecision, self-doubt - exercises on shells, in balance, jumping, overcoming obstacles.

During classes, the methodologist should by all means contribute to increasing the contact of patients with themselves and with each other.
The task - to excite automatic reactions and raise the emotional tone of patients - is achieved by accelerating the pace of movements: from the slow pace characteristic of these patients of 60 movements per minute to 120, then from 70 to 130 and in subsequent classes from 80 to 140. exercises that contribute to some decrease in emotional tone. It is necessary that the patient leaves the therapeutic gymnastics hall in a good mood.

An approximate set of exercises for psychasthenia

1. Building in a circle facing inward. Pulse rate counting.

2. Movement in a circle alternately in one direction and the other, holding hands, with acceleration.

3. Movement in a circle on toes alternately in one direction and the other, with acceleration.

4. I. p. - the main rack. Relax, take the position of "at ease".

5. I. p. - the main rack. Alternately raise your hands up (starting from the right) with an acceleration of 60 to 120 times per minute.

6. I. p. - feet shoulder width apart, hands in the castle. 1--2 - raise your arms above your head - inhale, 3--4 - lower your arms through the sides - exhale. 4-5 times.

7. I. p. - hands forward. Squeeze and unclench your fingers with acceleration from 60 to 120 times per minute. 20--30 s.

8. I. p. - feet shoulder-width apart, hands in the castle, 1 - raise your hands above your head - inhale, 2 - sharply lower your hands between your legs with a cry of "ha". 4-5 times.

9. I. p. - legs together, hands on the belt. 1--2 - sit down - exhale, 3--4 - get up - inhale. 2-3 times.

10. I. p. - standing on toes. 1 - get down on your heels - exhale, 2 - rise on your toes - inhale. 5-6 times.

11. Resistance exercise in pairs:

a) standing facing each other, hold hands, bending them at the elbow joints. In turn, each one resists with one hand, and unbends the other at the elbow joint. 3--4 times;

b) standing facing each other, holding hands. Resting your knees on the knees of a friend, sit down, straightening your arms, then rise. 3-4 times.

12. Medicine Ball Exercises:

a) standing in a circle one after another. Passing the ball back over the head. 2--3 times;

b) throwing the ball to each other with two hands at a distance of 3 m.

13. I. p. - standing in front of the ball. Jump over the ball, turn around. 4-5 times.

14. Exercises on shells:

a) balance - walk along the bench, log, board, etc. 2-3 times;

b) jumping from a gymnastic bench, from a horse, etc. 2-3 times;

c) climb the Swedish wall, grasp the upper rail with your hands, while hanging, take your legs away from the wall to the right and left, 2-3 times. Get down, holding hands and leaning on your feet.

15. I. p. - the main rack. 1--2 - rise on toes - inhale, 3--4 - go down on a full foot - exhale. 3--4 times

16. I. p. - the main stand. Alternately relax your arms, torso, legs.

17. I. p. - the main stand. Pulse count.

2.3 Hysteria

Hysteria, as already mentioned, is characterized by increased emotivity, emotional instability, frequent and rapid mood swings. The pathophysiological basis of hysteria is the predominance of the first cortical signaling system over the second, the lack of balance and mutual coherence between the subcortical system and both cortical systems. The task of therapeutic physical culture in hysteria is to reduce emotive lability, increase the activity of conscious-volitional activity, remove the phenomena of positive induction from the subcortex and create differentiated inhibition in the cerebral cortex.

The implementation of these tasks is achieved with the help of targeted physical exercises. The pace of movement should be slow. It is necessary to calmly, but persistently demand the exact execution of all movements. Classes should include a specially selected set of simultaneous (but different in direction) exercises for the right and left sides of the body. An important methodological technique is to perform memory exercises, as well as according to the explanation of the methodologist without showing the exercises themselves.

The group should be no more than 10 people. Commands should be given slowly, smoothly, in a conversational tone. All errors must be noted and corrected. Classes are held in the absence of unauthorized persons.

A decrease in emotional tone is achieved by slowing down the pace of movements. The first lessons begin with an accelerated pace characteristic of this group of patients - 140 movements per minute and reduce it to 80, in subsequent lessons - from 130 movements to 70, then from 120 to 60.

Differentiated inhibition is developed with the help of simultaneously performed, but different tasks for the left and right hands, left and right legs. The inclusion of active-volitional acts is achieved by performing strength exercises on apparatus at a slow pace with a load on large muscle groups.

Conclusion

"If you want to live - know how to spin." Life in the modern world is like an endless race. The time in which we live is the time of the accelerated rhythm of life. Take a quick shower, eat a quick sausage, and run to work. At work, everyone also runs. Save time, time is money.

In the modern world, there are a lot of factors that have a negative attitude on the human psyche. These can be problems at work that are systematic and persistent, the lack of an established personal or family life, and many others. Against the background of constant worries about the problematic area, many people develop neuroses.

Physical exercises affect the emotional sphere of the patient, they make him feel cheerful, joyful, distract him from various painful experiences, help eliminate uncertainty, anxiety, fear, various "neurotic" manifestations and create a more balanced state. To cheer up a sick person is half to cure him (S.I. Spasokukotsky). In addition, positive emotions that arise especially during the game method of conducting physical exercises excite the functional activity of the body and create favorable conditions for the rest of the nervous system from the monotonous physical and mental labor activity.

The systematic use of physical exercises in the treatment of patients with functional disorders of the nervous system increases their neuropsychic resistance to various environmental stimuli. Physical exercises contribute to balancing the internal properties of the body with the conditions of the external environment, and the central nervous system plays a leading role in this balancing. The use of therapeutic physical culture enriches the conditionally reflex activity of the nervous system of patients.

In conclusion, it should be emphasized that patients with various types of neuroses are recommended to continue at home in the form of morning hygienic exercises (the complex should be compiled by a doctor, taking into account the characteristics of impaired functions in this patient), attend health groups, play volleyball, walk more, ride a bike, ski and skate.

Bibliography

1. Moshkov V.N. "Therapeutic physical culture in the clinic of nervous diseases" - Moscow: Medicine, 1982

2. Vinokurov D.A. "Private methods of therapeutic physical culture" - Moscow: Medicine, 1969

3. Kirpechenko A.A. "Nervous and mental diseases" - Textbook - MN .: Vyssh.shk., 1998 Electronic edition.

4. Kozlova L.V. "Fundamentals of Rehabilitation" - Rostov n\D: "Phoenix", 2003

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The purpose and objectives of physical education

The goal and objectives of exercise therapy for diseases of the ANS are to improve adaptation, increase efficiency, improve blood circulation, respiratory function, metabolism, normalize the tone of the vascular wall, relax muscles and improve coordination of movements.

When compiling a set of exercises in patients with vegetative-emotional disorders, it is necessary to determine the state of vegetative tone (sympathicotonia, vagotonia, mixed).

Patients with central disorders of a permanent nature are prescribed the following types of exercises:
1. Respiratory
2. To relax (with sympathicotonia).
3. Power - exercises with muscle strengthening, weight-bearing shells, resistance (with vagotonia).
4. Speed-strength - running, jumping, jumping, etc.

Motor modes - general, and in sanatorium conditions - sparing, sparing-training and training. In general and sparing modes, the main attention is directed to the study of the psychological characteristics of the patient, the normalization of respiratory and motor functions with a gradual increase in load under the control of vegetative indicators (vegetative tone, vegetative reactivity and vegetative support of activity). Patients should avoid sudden movements, turns, tilts. Breathing exercises are used, for relaxation, balance, coordination, then power and speed-strength are added.

With vagotonia, patients need regular, dosed physical activity throughout their lives. Of the gymnastic exercises, in addition to free movements for the arms, legs and body, it is recommended to use exercises for large muscle groups: exercises with overcoming the gravity of the body (squats, mixed hangings, soft lunges), exercises with weights (dumbbells, "medicine ball"), resistance and volitional tension (dynamic and isometric with a breath hold of no more than 2-3 s).

These exercises cause an increase in blood pressure and place increased demands on cardiac activity, so their use should be carried out within a strict dosage in alternation with breathing exercises. Individual and group methods of conducting classes are recommended. It is advisable to combine therapeutic exercises with walking, health path, swimming, tourism, skiing and massage of the head, collar zone, upper and lower extremities and reflex types of massage (segmental, acupressure, shiatsu, etc.).

With sympathicotonia, exercise therapy is used in the following forms: morning exercises, therapeutic exercises, health path, swimming, close tourism, outdoor games (volleyball, towns, badminton), physical exercises in water, exercises on simulators, massage of the collar zone, head, face, shoulder girdle.

The main form of exercise therapy is therapeutic exercises, which are carried out daily for 20-30 minutes, rhythmically, at a calm pace, with a large range of motion. It is recommended to combine with static and dynamic breathing movements, as well as special types of breathing exercises.

Special exercises for sympathicotonia include exercises to relax various muscle groups, to improve coordination. It is advisable to use linear and acupressure massage.

In the LH complex in the general regimen, there should be general strengthening exercises in combination with all types of breathing exercises.

We give an approximate list of special exercises that can be included in the exercise therapy complex for permanent manifestations of vegetative-vascular dysfunction.

Strength exercises

1. I.p. - lying on your back: raising straight legs.
2. I.p. - the same: "bicycle".
3. I.p. - the same: movements with straight legs in the vertical and horizontal plane ("scissors").
4. I.p: - sitting or standing. Hands with dumbbells lowered: bending the arms at the elbow joints.
5. I.p. - standing, hands on the belt: squat with straightening the arms forward.
6. I.p. - lying on the stomach, hands in support in front of the chest: push-ups.
7. I.p. - standing facing the partner or the wall, one leg in front, palms resting in the palms of the partner: alternately bending and unbending the arms with resistance.
8. I.p. - standing facing the partner, hands on the shoulders of the partner: torso to the side with resistance with the hands.
9. I.p. - standing, arms with dumbbells lowered, torso forward with arms extended to the sides.

The number of repetitions of each exercise is determined by the patient's condition.

Speed-strength exercises

1. I.p. - standing, arms to the sides: energetic rotations in the shoulder joints with a small amplitude at a fast pace.
2. I.p. - standing, feet shoulder-width apart, torso slightly tilted forward, arms bent at the elbow joints, elbows pressed to the body: movements that imitate the work of the hands when running, at a fast pace.
3. I.p. standing, hands on the belt: jumps on one or two legs.
4. I.p. - standing, legs apart, arms lowered, taken to the "castle": "lumberjack", at a fast pace (contraindicated in osteochondrosis of the spine).

5. I.p. - standing, arms bent at the elbows: movements imitating boxing at a fast pace.
6. I.p. - the same: running in place or in motion.

Relaxation exercises

1. I.p. - lying on your back: raise your arms up and passively lower them.
2. I.p. - sitting, the torso is slightly tilted forward: free swinging with relaxed arms lowered down.
3. I.p. - standing: the same.
4. I.p. - the same: raise your hands up and relax them to your shoulders, waist, down.

An approximate combination of massage points for vagotonia:

1st session: bai-hui (U20), he-gu (014) symmetrically, zu-san-li (EZ) on the left; gao-huang (Y43) symmetrically - 10 minutes per point, toning method.
2nd session: Wai Kuan (TK5) and Xin Shu (U15) on the right, Ling Qi on the left.
3rd session: lao-gong (SS8) and shian-wai-shu (S14) symmetrically.
4th session: nei guan (TK61) and qing li. In the evening, the patient performs self-massage he-gu (Ol4) and san-yin-jiao (NRb) symmetrically for 5 minutes.

Approximate combination of massage points for sympathicotonia

1st session: bai-hui (U020), he-gu (014) on the left, feng-chi (P20), shu-san-li (E3b) on the right - by calming down.
2nd session: shen-men (C7).
3rd session: strong irritation for 10 minutes of the shen-men point (C7) - symmetrically, moderate irritation bai-hu-hei (U020) for 1 minute, he-gu (014) symmetrically or yin-tang (VM) , shu-san-li (E3b) on the left.
4th session: massage of San-Yin-Jiao (KRb), Dv-Ling (KP7), Shen-men (C7) points.

In a crisis course of vegetative-vascular dysfunction in the interictal period, it is appropriate to carry out the therapeutic and gymnastic measures described above, depending on the sympathetic or parasympathetic predominance. In the future, therapeutic measures should be aimed at preventing vegetative paroxysms.

The main task of this period is the normalization of nervous regulation, due to the improvement of motor-visceral reflexes. The general mode of LH includes exercises for large muscle groups, the latter contribute to the activation of tissue oxidases, improve the utilization of oxygen by tissues. Breathing exercises of both static and dynamic nature should be special for the fulfillment of the assigned tasks. Exercises of an emotional nature with the use of auxiliary objects, outdoor games are widely used.

These patients are shown sanatorium treatment with the appointment of approximately the following complexes of therapeutic exercises:

For patients with sympathetic-adrenal paroxysms

gentle mode
1. I.p. - sitting, hands on knees: hands up - inhale, lower - exhale. Repeat 4-6 times. Breathing is rhythmic.
2. I.p. - sitting, legs extended: rotation of the feet and hands in both directions. Repeat 15-20 times. Breathing is arbitrary.
3. I.p. - sitting: hands up - inhale, pull the knee to the stomach - exhale. Repeat 4-6 times. Breathing with an emphasis on exhalation.
4. I.p. - sitting, arms freely lowered, brushes to reach the shoulders. Circular movements of the elbows in both directions. Repeat 4-6 times. Breathing is arbitrary.
5. I.p. - sitting, hands in front of the chest: turning the body with spreading the arms to the sides - inhale, return to SP. - exhale. Repeat 3-4 times.
6. I.p. - standing or lying down: alternate bending of the legs - exhale, return to I.p. - breath. Repeat 3-4 times.
7. I.p. - sitting, arms to the sides - inhale, cross your arms in front of your chest, bend over - exhale. Repeat 4-6 times.
8. I.p. - sitting or standing: spreading the arms to the sides and fixing them with tension, return to the SP, relax the muscles as much as possible. Repeat 4-6 times. Breathing with an emphasis on exhalation.
9. Walking with a gradual slowdown for 1.5-2 minutes.
10. Repeat exercise 1.

Gentle training mode

1. I.p. - standing, legs apart, arms lowered: raise your arms through the sides up - inhale, lower - exhale. Repeat 4-6 times. The inhalation-exhalation ratio is 1:2, 1:3.
2. I.p. - standing, hands to shoulders: circular rotation of the elbows in both directions. Repeat 6-8 times. Breathing is arbitrary.
3. I.p. - standing, hands in front of the chest: turning the body with spreading the arms to the sides - inhale, return to ip. - exhale. Repeat 6-8 times.
4. I.p. - standing, legs apart, arms lowered: squats on a full foot - exhale, return to ip. - breath. Repeat 6-8 times. Breathing with an emphasis on exhalation.
5. I.p. - standing, arms along the body: arms up - inhale, lower your hands - exhale. Repeat 3-4 times.
6. I.p. - standing, hands on the belt: bend the leg at the knee and hip joints, pull it to the stomach - inhale, return to ip. - exhale. Repeat 4-6 times.
7. I.p. - standing, in the hands of a dumbbell (1.5 kg): hands forward, fixing them with subsequent relaxation. Perform within 30 s. Do not hold your breath while exhaling.
8. I.p. - standing: calm walking for 2 minutes. Breathing is even.
9. I.p. - standing, hands lean against the wall at chest level: press the wall as much as possible, then relax the muscles of the arms and torso. Perform within 5 s. Don't hold your breath.
10. I.p. standing: repeat exercise 1.
11. I.p. - standing, in the hands of a stuffed ball. throw the ball up, turn 90 "and catch it. Perform for 1.5 minutes.

E.A. Mikusev, V.F. Bakhtiozin

Neuritis is a disease of peripheral nerves that occurs as a result of traumatic injury, infectious, inflammatory diseases (diphtheria, influenza, etc.), beriberi (lack of B vitamins), intoxication (alcohol, lead) and metabolic disorders (diabetes).

The most common neuritis of the facial nerve, neuritis of the radial, median, ulnar, sciatic, femoral and tibial nerves.

The nature of functional disorders in injuries of the peripheral nerves of the upper and lower extremities is determined by their localization and the degree of damage. The clinical picture in neuritis is manifested by sensitivity disorders (pain, temperature, tactile), motor and vegetotrophic disorders.

Motor disorders in neuritis are manifested in the development of paresis or paralysis.

Peripheral (flaccid) paralysis is accompanied by muscle atrophy, decrease or disappearance of tendon reflexes, muscle tone, trophic changes, skin sensitivity disorders, pain when stretching muscles.

Exercise therapy, massage and physiotherapy occupy an important place in complex rehabilitation treatment.

Tasks of complex rehabilitation treatment for peripheral paralysis:

Stimulation of the processes of regeneration and disinhibition of nerve sections that are in a state of oppression;

Improving blood supply and trophic processes in the lesion in order to prevent the formation of adhesions and cicatricial changes;

Strengthening paretic muscles and ligaments;

Prevention of contractures and stiffness in the joint;

Recovery of working capacity by normalizing motor functions and developing compensatory adaptations.

Exercise therapy is contraindicated in severe pain and severe general condition of the patient. The methodology and nature of rehabilitation measures are determined by the nature of movement disorders, their localization and the stage of the disease.

The following periods are distinguished: early recovery (2-20th day), late recovery, or main (20-60th day), and residual (more than 2 months).

With surgical interventions on the nerves, the time limits of all periods are fuzzy: for example, the early recovery period can last up to 30-40 days, the late one - 3-4 months, and the residual one - 2-3 years.

early recovery period. With the development of paralysis, optimal conditions are created for the restoration of a damaged limb - treatment with position, massage and physiotherapy procedures are used.

Positional treatment is prescribed to prevent overstretching of weakened muscles; for this, splints are used that support the limb, special “laying”, corrective positions. Treatment by position is carried out throughout the entire period - with the exception of therapeutic exercises.

A feature of massage in peripheral paralysis is the differentiation of its effects on muscles, a strict dosage of intensity, the segmental-reflex nature of the effect (massage of the collar, lumbosacral regions). A beneficial effect is exerted by hardware massage (vibration), carried out at the "motor points" and along the paretic muscles; vortex and jet underwater massage, combining the positive temperature effect of warm water and its mechanical effect on tissues.

In the absence of motor functions, physiotherapy (electrophoresis with calcium ions) is used to improve nerve conduction.

After physiotherapeutic procedures, therapeutic exercises are carried out; with complete paralysis, they mainly consist of passive and ideomotor exercises. It is advisable to combine passive exercises with active movements in the same joints of a symmetrical limb.

During classes, it is especially necessary to monitor the appearance of voluntary movements, choosing the optimal starting positions, and strive to support the development of active movements.

In the late recovery period, positional treatment, massage, therapeutic exercises and physiotherapy are also used.

Treatment with the position has a dosed character and is determined by the depth of the paresis: the deeper the lesion, the longer the duration of treatment with the position (from 2-3 minutes to 1.5 hours).

Massage is carried out differentially, in accordance with the localization of muscle damage. Weakened muscles are massaged more intensively; using the techniques of stroking and surface rubbing, their antagonists relax.

Physiotherapy treatment is complemented by electrical muscle stimulation.

The following method of therapeutic exercises gives a positive effect: active movements in the symmetrical joints of a healthy limb, passive movements in the joints of the affected limb, friendly active, lightweight exercises involving weakened muscles. Relief of the functional load is achieved by selecting the appropriate initial positions for performing exercises that reduce the inhibitory effect of the weight of the limb segment. To reduce friction, the limb segment is supported by a soft strap (on weight). Facilitate the work of paretic muscles and exercise in warm water. In the residual period, they continue to do therapeutic exercises; the number of applied exercises for training everyday and professional skills is significantly increased; game and sports-applied elements are introduced; optimal compensatory adaptations are formed.

The patient is prescribed a massage (15-20 procedures). The massage course is repeated after 2-3 months.

Positional treatment is determined by orthopedic tasks (sagging of the foot or hand) and is carried out with the help of orthopedic and prosthetic products (devices, splints, special shoes).

In this period, contractures and stiffness in the joints are of particular difficulty in treatment. The alternation of passive movements with active exercises of a different nature and massage of unaffected areas, thermal procedures allow you to restore the necessary range of motion.

With the persistence of secondary changes in tissues, mechanotherapy is used, which is effectively used in water.

Neuritis of the facial nerve

The most common causes of lesions of the facial nerve are infection, hypothermia, trauma, inflammatory diseases of the ear.

clinical picture. It is mainly characterized by the acute development of paralysis or paresis of the facial muscles. The affected side becomes flabby, lethargic; blinking of the eyelids is disturbed, the eye does not completely close; the nasolabial fold is smoothed; the face is asymmetrical, drawn to the healthy side; speech is slurred; the patient cannot wrinkle his forehead, frown his eyebrows; loss of taste, lacrimation are noted.

Rehabilitation activities include positional therapy, massage, therapeutic exercises and physiotherapy.

Rehabilitation tasks:

Improving blood circulation in the face (especially on the side of the lesion), neck and the entire collar zone;

Restoration of the function of facial muscles, impaired speech;

Prevention of the development of contractures and friendly movements.

In the early period (1-10 days of illness), positional treatment, massage and therapeutic exercises are used. Treatment by position includes the following recommendations:

Sleep on your side (on the affected side);

For 10-15 minutes (3-4 times a day), sit with your head bowed in the direction of the lesion, supporting it with the back of the hand (supported by the elbow); pull the muscles from the healthy side to the side of the lesion (from bottom to top) with a handkerchief, while trying to restore the symmetry of the face.

To eliminate the asymmetry, adhesive plaster tension is applied from the healthy side to the patient, directed against the traction of the muscles of the healthy side. It is carried out by firmly fixing the free end of the patch to a special helmet-mask, made individually for each patient (Fig. 36).

Treatment position is carried out in the daytime. On the first day - 30-60 minutes (2-3 times a day), mainly during active facial actions (eating, talking). Then its duration is increased to 2-3 hours a day.

Massage begins with the collar area and neck. This is followed by a facial massage. The patient sits down with a mirror in his hands, and the massage therapist is located opposite the patient in order to be sure to see his entire face. The patient performs the exercises recommended during the procedure, observing the accuracy of their execution with the help of a mirror. Massage techniques - stroking, rubbing, light kneading, vibration - are carried out according to a gentle technique. In the first days, the massage lasts 5-7 minutes; then its duration increases to 15-17 minutes.

Massage of the muscles of the face is mainly of a point nature, so that the skin displacements are insignificant and do not stretch the skin of the affected half of the face. The main massage is carried out from the inside of the mouth, and all massage movements are combined with therapeutic exercises.

Therapeutic gymnastics is mainly addressed to the muscles of the healthy side - this is an isolated tension of the facial muscles and muscles surrounding the oral fissure. The duration of the lesson is 10-12 minutes (2 times a day).

In the main period (from the 10-12th day from the onset of the disease to 2-3 months), along with the use of massage and positional treatment, special physical exercises are performed.

Position treatment. Its duration increases to 4-6 hours a day; it alternates with LH and massage. The degree of tension of the adhesive plaster also increases, reaching hypercorrection, with a significant shift to the diseased side, in order to achieve stretching and, as a result, weakening of the muscle strength on the healthy side of the face.

In some cases, adhesive plaster tension is carried out within 8-10 hours.

Exemplary special exercises for training mimic muscles

1. Raise your eyebrows up.

2. Wrinkle your eyebrows (frown).

3. Look down; then close your eyes, holding the eyelid on the side of the lesion with your fingers, and keep them closed for 1 minute; open and close your eyes 3 times in a row.

4. Smile with your mouth closed.

5. Squint.

6. Lower your head down, take a breath and, at the moment of exhalation, “snort” (vibrate your lips).

7. Whistle.

8. Flare the nostrils.

9. Raise the upper lip, exposing the upper teeth.

10. Lower the lower lip, exposing the lower teeth.

11. Smile with your mouth open.

12. Blow on a lit match.

13. Take water in your mouth, close your mouth and rinse, trying not to pour out the water.

14. Puff out your cheeks.

15. Move air from one half of the mouth to the other alternately.

16. Lower the corners of the mouth down (with the mouth closed).

17. Stick out the tongue and make it narrow.

18. Opening your mouth, move your tongue back and forth.

19. Opening your mouth, move your tongue left and right.

20. Pull out the lips with a "tube".

21. Follow with your eyes a finger moving in a circle.

22. Draw in the cheeks (with the mouth closed).

23. Lower the upper lip to the lower.

24. With the tip of the tongue, drive along the gums alternately to the right and left (with the mouth closed), pressing the tongue against them with different efforts.

Exercises to improve articulation

1. Pronounce the sounds "o", "and", "y".

2. Pronounce the sounds “p”, “f”, “v”, bringing the lower lip under the upper teeth.

3. Pronounce sound combinations: “oh”, “fu”, “fi”, etc.

4. Pronounce words containing these sound combinations in syllables (o-kosh-ko, Fek-la, i-zyum, pu-fik, Var-fo-lo-mei, i-vol-ga, etc.).

The listed exercises are performed in front of a mirror, with the participation of an exercise therapy instructor, and are necessarily repeated by the patient on their own 2-3 times a day.

In the residual period (after 3 months), massage, positional treatment and therapeutic exercises are used, which are used in the main period. The proportion of therapeutic exercises, the task of which is the maximum possible restoration of facial symmetry, is significantly increasing. During this period, the training of facial muscles increases. Exercises for mimic muscles should be alternated with restorative and breathing exercises.

Brachial plexus neuritis

The most common causes of brachial plexus neuritis (plexitis) are: injury from dislocation of the humerus; wound; highly applied tourniquet for a long time. With the defeat of the entire brachial plexus, peripheral paralysis or paresis occurs and a sharp decrease in sensitivity in the arm.

Paralysis and atrophy of the following muscles develop: deltoid, biceps, internal shoulder, flexors of the hand and fingers (the arm hangs like a whip). In complex treatment, the leading method is position treatment: the hands are placed in a half-bent position and placed on a splint with a roller placed in the area of the metacarpophalangeal joint.

The forearm and hand (in a splint) are hung on a scarf. Special exercises for the shoulder girdle, muscles of the shoulder, forearm and hand are recommended, as well as general developmental and breathing exercises.

A set of special exercises for plexitis (according to A. N. Tranquillitati, 1992)

1. I. p. - sitting or standing, hands on the belt. Raise your shoulders up - lower. Repeat 8-10 times.

2. I. p. - the same. Squeeze your shoulder blades, then return to the starting position. Repeat 8-10 times.

3. I.p. - the same, hands down. Raise your arms up (hands to your shoulders), spread your elbows to the sides, then press them back to your body. Circular movements of the arm bent at the elbow (movements in the shoulder joint) clockwise and against it. Repeat 6-8 times. The movements of the affected hand are performed with the help of an exercise therapy methodologist.

4. I.p. - Same. Bend the injured arm, then straighten; take it to the side (straight or bent at the elbow), then return to the sp. Repeat 6-8 times. The exercise is performed with the help of a methodologist or a healthy hand.

5. I.p. - standing, leaning towards the injured arm (the other hand on the belt). Circular movements with a straight arm clockwise and against it. Repeat 6-8 times.

6. I.p. - Same. Swing movements with both hands back and forth and crosswise in front of you. Repeat 6-8 times.

7. I.p. - standing or sitting. Leaning forward, bend the sore arm at the elbow and straighten it with the help of a healthy arm. Repeat 5-6 times.

8. I.p. - Same. Turn the forearm and hand with the palm towards you and away from you. Repeat 6-8 times.

If necessary, movements are also performed in the wrist joint and finger joints.

Gradually, when the injured hand can already hold objects, exercises with a stick and a ball are included in the LG complex.

In parallel with therapeutic exercises, hydrocolonotherapy, massage and physiotherapy are prescribed.

Neuritis of the ulnar nerve

Most often, ulnar nerve neuritis develops as a result of nerve compression in the area of the elbow joint, which occurs in people whose work is associated with elbow support (on a machine, table, workbench), or when sitting for a long time, putting their hands on the armrests of a chair.

clinical picture. The brush hangs down; no supination of the forearm; the function of the interosseous muscles of the hand is disturbed, in connection with which the fingers are claw-like bent ("clawed brush"); the patient cannot pick up and hold objects. There comes a rapid atrophy of the interosseous muscles of the fingers and the muscles of the palm from the side of the little finger; hyperextension of the main phalanges of the fingers, flexion of the middle and nail phalanges is noted; it is impossible to spread and adduct the fingers. In this position, the muscles that extensor the forearm are stretched, and contracture of the muscles that flex the hand occurs. Therefore, from the first hours of damage to the ulnar nerve, a special splint is applied to the hand and forearm. The hand is given a position of possible extension in the wrist joint, and the fingers are in a half-bent position; the forearm and hand are suspended on a scarf in the position of flexion at the elbow joint (at an angle of 80°), i.e. in the middle position.

Exercise therapy is prescribed on the 2nd day after the imposition of a fixing bandage. From the first days (due to the lack of active movements), passive gymnastics, gymnastics in water begin; doing a massage. As active movements appear, active gymnastics classes begin.

A.N. Tranquillitati proposes to include the following exercises in the complex of therapeutic exercises.

1. I.p. - sitting at the table; the arm, bent at the elbow, rests on it, the forearm is perpendicular to the table. Lowering the thumb down, raise the index finger up, then vice versa. Repeat 8-10 times.

2. I.p. - Same. With a healthy hand, grab the main phalanges of the 2-5 fingers of the injured hand so that the thumb of the healthy hand is located on the side of the palm, and the others on the back of the hand. Bend and unbend the main phalanges of the fingers. Then, moving a healthy hand, also bend and unbend the middle phalanges.

Along with LH, electrical stimulation of the muscles innervated by the ulnar nerve is performed. When active movements appear, elements of occupational therapy (modeling from plasticine, clay), as well as learning to grasp small objects (matches, nails, peas, etc.) are included in the classes.

Neuritis of the femoral nerve

With neuritis of the femoral nerve, the quadriceps and tailor muscles are paralyzed. The movements of the patient with this disease are sharply limited: it is impossible to unbend the leg bent at the knee; (running and jumping are impossible; standing and climbing stairs are difficult, moving from a lying position to a sitting position. With neuritis of the femoral nerve, loss of sensitivity and acute pain are possible.

When muscle paralysis occurs, passive movements, massage are used. As the recovery progresses, active movements are used: leg extension, bringing the hip to the pelvis, moving from a lying position to a sitting position, exercises to overcome resistance (with blocks, springs, on simulators).

Along with therapeutic exercises, massage, electrical stimulation of paretic muscles, etc. are used.

Control questions and tasks

1. What symptoms are typical for the clinical picture of neuritis?

2. Tasks of complex restorative treatment of peripheral paralysis and characteristics of its periods.

3. Clinical picture of neuritis of the facial nerve and methods of rehabilitation in different periods.

4. Clinical picture of brachial plexus neuritis (plexitis). Special exercises for this disease.

5. Clinical picture of ulnar nerve neuritis. The method of exercise therapy for this disease.

Tasks of physiotherapy exercises in diseases of the nervous system. 1. Strengthening the patient's body. 2. Improvement of blood circulation of the affected parts of the body. 3. Reducing the pathologically increased tone of paretic muscles and increasing muscle strength. 4. Removal of harmful friendly actions: synergism and synkinesis. 5. Renewal of functional balance between paretic muscles and their synergists. 6. Restoring or improving the accuracy of movements. 7. Restoration or improvement of nerve conduction from the center to the periphery and from the periphery to the center. 8. Removal or reduction of muscle tremor. 9. Display and formation of the most important motor skills aimed at mastering (training) everyday and labor skills, self-service and movement, preparation for social rehabilitation.

Features of exercise therapy in neurological and neurosurgical pathology. 1. Early purpose of exercise therapy. It provides for the use of stored functions and newly created ones that are adapted to the changed conditions of the neurological, somatic and visceral status. 2. Selective use of exercise therapy to restore impaired functions or compensate for lost ones. 3. The use of special exercises according to the pathogenetic principle in combination with the general strengthening effect of exercise therapy. 4. Adhere to the principle of adequacy with a constant change of physical exercises, depending on the patient's capabilities and the presence of a training effect. 5. Gradual continuous expansion of the motor mode from the prone position to the possibility of unlimited movement.

The means of exercise therapy for diseases of the nervous system are the basic provisions, massage, special therapeutic exercises. The latter are divided: a) to strengthen muscle strength; b) to obtain strictly dosed muscle loads; c) to obtain differentiated tension and relaxation of individual muscles and muscle groups; d) for the correct display of the motor act as a whole (speed, smoothness, accuracy of movements); e) anti-attack exercises aimed at restoring and improving coordination of movements; f) anti-spastic and anti-regid; g) reflex and ideomotor; g) for the restoration or new formation of applied motor skills (standing, walking, rubble skills); h) passive, incl. manual therapy.

Acute cerebrovascular accident - stroke. There are 3 stages of rehabilitation of patients with stroke: 1st - early updated (up to 3 months) 2nd - late updated (up to 1 year) 3rd - residual impairment of motor functions. The degree of impairment of motor functions: 1st - slight paresis; 2nd - moderate paresis; 3rd - paresis; 4th - deep paresis; 5th - plegia or paralysis. The mode of motor activity depends on: 1 - the patient's condition; 2 - the period of the disease; 3 - stage of violation of motor functions. Modes of motor activity are: 1. Bed strict (1-3 days). 2. Extended bed (3-15 days). 2-b - days. 3. Ward. 4. Free.

Strict bed rest: 1. Exercise therapy is contraindicated. 2. The patient is provided with rest, drug treatment. 3. Treatment by position, i.e. settle the patient in a position opposite to the position of Wernicke - Man. It: - reduces spasticity; - prevents the development of contractures; 4. The patient is laid on his back, on his side, the position is changed 4-6 times a day, for 30-60 minutes, depending on the patient's condition, muscle tone of the paretic limb.

Extended bed rest: 2 a / 3-5 days Exercise therapy tasks: 1. Improvement of the functions of the cardiovascular and respiratory systems, prevention of complications on their part. 2. Activation of intestinal motility. 3. Improvement of tissue trophism, prevention of bedsores. 4. Decrease in muscle tone with its increase. 5. Prevention of hemiplegic contractures. 6. Preparation for an active turn on a healthy side. 7. Stimulation and renewal of isolated active movements in the paretic limb.

Methods: 1. Lying by position on the back and side. 2. Physical exercises: - Breathing exercises; - active exercises for small, medium, and later for large joints of healthy limbs; 3. From 3-6 days - passive exercises for the joints of the paretic limb. 4. They teach volitional sending of impulses to movements synchronously with isolated passive extension of the forearm, flexion of the lower leg.

Extended bed rest: 2 b / day. Exercise therapy: Exercise therapy tasks: 1. Strengthening the general tonic effect on the patient. 2. Teachings to relax the muscles of a healthy limb. 3. Decreased muscle tone in the paretic limbs. 4. Transferring the patient to a sitting position. 5. Stimulation of active movements in the paretic limbs. 6. Counteracting pathological synkinesis. 7. Preparing the patient for getting up. 8. Restoration of support functions in the lower extremities. 9. Restoration of self-service functions to a healthy limb.

Methods Methods: 1. Starting positions - are of great importance during the execution of passive movements of individual segments of the limbs: The fingers are easier to straighten if the whale is bent. Forearms - if the shoulder is adducted. The supination of the forearm will be full if the elbow is bent. Aversion of the thigh - complete in a bent position. 2. a) classes begin with active exercises for healthy limbs, and then passive - paralytic. b) During the performance of active exercises, it is necessary to use relief, use: - postal frames; - blocks; - hammocks to support a paralytic limb; c) exercises are performed slowly, smoothly, each movement of 4-8 races. First, the limb is rotated to its original position passively, with the help of an instructor, and also with a support. Special attention is given to the resumption of movement of the 1st finger;

D) passively or actively counteract pathological synkinesis: - During the execution of active movements with the foot, the hands are fixed behind the head or along the length of the toulub; - when the healthy arm is bent, the methodologist can passively unbend the paretic arm at this moment; - volitional efforts are used, bending the patient's leg counteracts the bending of the arm, holding it to volitional efforts in the bent position; e) ideomotor movements; f) isometric tensions by the muscle of the paretic limb.

Chamber mode. Exercise therapy tasks: 1. Decreased muscle tone. 2. Counteracting hemiplegic contractures. 3. The next resumption of active movements. 4. Transition to standing positions. 5. Teachings to walk. 6. Counteraction to synkinesis. 7. Renewal of self-service skills and applied household movements.

Free mode. Methods and methods of exercise therapy at the late renewed stage and during the period of residual motor disorders depend on the degree of motor function disorders: 1st degree (slight paresis) - general tonic effect on the body; - strengthening the muscles of the shoulder girdle and back; - posture improvement; - movement, walking. 5th degree (plegia, paralysis) - activation of the activity of the cardiovascular and respiratory systems; - the teaching of the patient turns on its side; - Preparation for the transition to a sitting or standing position; - Improvement of the supporting functions of the lower extremities; - relaxation of the muscles of healthy limbs; - Decreased muscle tone; - counteraction to contractures; - disorders of the trophism of the paretic limbs; - expanding self-service skills.

Degrees of motor and social adaptation of the patient: 1. The mildest degree - only the patient feels the defect. 2. Mild degree - the defect manifests itself during any physical activity, noticeable from the outside. 3. Medium degree - limited ability to independently perform the main aspects of motor activity. Needs partial help in everyday life, and at work - changes in profession. 4. Severe degree - the social activity of the patient is significantly limited. Almost no action, with the exception of the most elementary. Labor activity is excluded. The patient is completely disabled. 5. Very severe degree - no independent damage and dії impossible. Illness is permanently laid up in the presence of a third-party sight and help.

Exercise therapy for paralysis and paresis. Paralysis (Greek paralysis) - prolapse, paresis (Greek haresis) - 1) weakening of motor functions with the absence or decrease in muscle strength; 2) due to a violation of the structure and function of the motor analyzer; 3) as a result of pathological processes in the nervous system. The following forms of paralysis and paresis are divided: According to the nature of the injury and violations of the responsible structures of the nervous system: Organic Functional Reflex Result of organic changes in the structure of the central and peripheral bifurcated neuron (head, back, brain, peripheral nerve), which arise under the influence of various pathological processes: bruises , tumors, disorders of cerebral circulation, inflammation and other processes Inheritance of the influence of psychogenic factors that lead to neurodynamic disorders in the central nervous system and occur mainly in hysteria The result of neurodynamic functional disorders of N.S., which occur under the influence of a significant lesion, topically not associated with paralysis and paresis, which is formed

According to the nature of the tone of the affected muscles, they distinguish: central or spastic, sluggish (peripheral) and rigid paralysis and paresis. Depending on the structural level of damage to the motor analyzer, paralysis and paresis are divided into: Central (pyramidal) (spastic) Peripheral (flaccid) Extapyramidal (rigid) ) muscle tone. In case of damage to the peripheral motor neuron a) atony b) areflexia by an infectious process, infectious-allergic, degenerative process (cells of the anterior horns of the spinal cord, nuclei of the cranial nerves, anterior cords of the spinal nerves, plexuses, spinal nerves or cranial nerves) Rigid tone of the damaged muscles as a result of a violation of the kirko-subcortical stem connections. Characterized by a decrease or lack of motor activity. Loss of fellowship of automatic movements. Slowness of speech, movement in small steps due to the absence of simultaneous movements of the hands. The phenomenon of a cogwheel with a

The task of exercise therapy for central and peripheral paralysis. 1. Improvement of blood circulation and nervous trophism of the affected muscles. 2. Prevention of the development of contractures. 3. Restoration of movement and development of compensatory motor skills. 4. General-strengthening effect on the patient's body.

Forms of exercise therapy, features of their application: exercise therapy and massage begin in the early stages of treatment. From the first days, specific laying of paretic limbs. For example, with hemiplegia or hemiparesis due to ischemic stroke, positioning begins from 2-4 days. With cerebral hemorrhage - from 6-8 days (if the patient's condition allows it to be done). 1. Laying on the back is opposite to the Wernicke-Mann position: the shoulder is retracted to the side at an angle of 90, the elbow and fingers are extended, the hand is supinated, held from the side of the palm with a splint. The entire limb is fixed with sand loads. 2. The paralyzed leg is bent at the knee at an angle. The foot is in the position of dorsiflexion at an angle. Laying on the back is alternated with the position on the healthy side. The frequency of changes in positions is 1.5 - 2 hours. 4. Simultaneously use massage. Usually used stroking, rubbing, light kneading, continuous vibration.

Massage with cirrhosis is vibratory: 1) ointments with hypertonicity are massaged at a moderate pace, and they are antagonistic to smoothing, rubbing and grinding at a higher swedish pace; 2) in case of peripheral (PP): stroking all the kinks on the back of the head, and then massaging the paralyzed ointment, and their antagonisms are no longer lightly stroking. Massage is started from the proximal veins, in order to increase the vanity. For the course of sessions at the end of Indications are also point and reflex-segmental massage. 5. In parallel with the massage, passive ruhi in the glom is carried out (5-10 ruhi in the skin foll at a normal pace). 6. Active gymnastics - may be the main value. With cirrhosis - for 8-10 days, with ischemic stroke and bleeding in the brain - for a day. Start with the morning exercise in the required position, then train the ointment, the tone of such movements. Right with additional support: a frame with a system of blocks and hammocks, a frail surface, spring traction, gymnastic equipment. Then we prescribe active conditions for healthy and ill patients. In case of PP, you have the right to do a lot of work at the bath with warm water. 7. Start sitting in case of ischemic stroke (II) after 10 days in the presence of the cob of illness. In case of bleeding in the cerebellum - after 3-4 days. 8. Preparation before walking starts at V. p. lying down and sitting. They learn to stand on two legs, then firstly on the sick and healthy, walking on the field, with an instructor in a special wheelchair, with the help of a three-legged militia, on a level surface, on gatherings.

Exercise therapy for neuritis of the facial nerve. Neuritis of the facial nerve (FN) is manifested by peripheral paresis or paralysis of the mimic muscles of a certain part of the face, accompanied by its asymmetry. Indication for exercise therapy in NLN: 1. Neuritis of infectious and vascular origin. 2. After surgical removal, the nerve was swollen and compressed. 3. After complete sanitation of an acute purulent process in the middle ear, which was called NLN. 4. NLN, as a consequence of surgery for epitympanitis (rarely). Exercise therapy tasks for NLN: 1. Improvement of regional blood circulation (face, neck). 2. Restoration of the function of mimic muscles. 3. Prevention of the development of contractures and friendly movements. 4. Restoration of correct speech. 5. Reduction of facial expression disorders in mild nerve lesions that are difficult to treat in order to hide facial defects.

Recovery periods Early Main Recovery In NP 2-12 days days 2-3 months In NH days 3-4 months 2-3 years Early period. They use therapeutic position, massage, therapeutic exercises. 1. Treatment position: - sleep on the side of the wound; - during the day, sit 3-4 times with your head tilted to the opposite side, supporting it with your hand resting on your elbow. At the same time, pulling the muscles from the healthy side to the side of the wound (from bottom to top) trying to restore the symmetry of the face; - leukoplaster tightness from the healthy side to the patient with the use of a special sholoma-mask; - tying with a scarf;

2. Massage. Start with the collar zone of the neck. The patient sits in front of a mirror. The masseur must see the entire face of the patient. All massage techniques (stroking, rubbing, light kneading, vibration) are carried out carefully, without significant reduction in the skin of the face. Reduction (meaning of muscles). 3. Therapeutic gymnastics I. - dosed tension and weakening of the muscles of the healthy side (zygomatic, laughter, circular muscles of the eye, etc.) - tension and relaxation of the muscles that form mimic images (smile, laughter, attention, sorrow). This exercise is only a preparatory stage for the main period.

Special exercises for facial muscles: 1. Raise your eyebrows up. 2. Furrow your eyebrows. 3. Close your eyes (execution steps: look down; close your eyes; supporting the eyelids with your fingers on the side of the attack, keep your eyes closed for a minute; open and close your eyes 3 times). 4. Smile with your mouth closed. 5. Shchurits. 6. Lower your head down, inhale and snort while exhaling. 7. Whistle. 8. Open the nostrils. 9. Raise the upper lip, show the upper teeth. 10. Lower the lower lip, show the lower teeth. 11. Smile with your mouth open. 12. Put out a lit match.

13. Fill your mouth with water, close your mouth and rinse without pouring out the water. 14. Inflate the chocks. 15. By moving air from one half of the mouth to the other. 16. Lower the corners of the mouth down with the mouth closed. 17. Stick out your tongue and make it narrow. 18. Move the tongue forward - backward with an open mouth. 19. Move the tongue to the right - to the left with the mouth open. 20. Pull lips forward with a tube. 21. Make a kolo with your finger, watching it with your eyes. 22. Retract the chocks with the mouth closed. 23. Lower the upper lip to the lower. 24. With the mouth closed, drive the tip of the tongue along the gums to the right and left, pressing the tongue with different efforts.

The main (late) period (ІІ) It is characterized by an instant restoration of muscle functions, which are combined with active treatment, special physical exercises and other methods of exercise therapy. - treatment of VP increases up to 4-6 hours (in some cases up to 8-10 hours). The degree of tension of the leukoplasty increases due to hypercorrection (due to overstretching and weakening of the tone of healthy muscles. Healthy muscles thereby turn from opponents into allies of diseased muscles). - Massage II. It is carried out in various ways based on the topography of the pathological process. So, the muscles that are innervated by the 1st branch of n. facialis, are massaged in the usual way. This is light and medium stroking, rubbing, vibration on the points. The main massage is carried out from the middle of the mouth and plays a dual role: muscle regulation (minor) massage itself, stimulating blood flow, trophism of paretic muscles, etc.

Trivality of massage 5-11 minutes for 2-3 days. If the effect persists, LH is continued, and the massage is applied for days. Repeated course - 20 procedures. - LG III. LH plays an important role in the primary period. All have the right to subdivide into dekilka groups: 1) differentiation of the tension of the paretic meats (foreheads, brows, cheekbones, smіhu square meat of the upper lip, tricot pіdborіdya, circular meat of the company); 2) dosing of tension (relaxation) of all the names of the ulcers with increasing strength and intensity; 3) notification of the inclusion of meat from the molding of various mimic images, situation, laughter, laughter, confusion, suffocation; 4) dosed tension of the meazіv pіd hіmovі zvіvіv. You should be right in front of the mirror with the participation of the instructor and independently (2-3 times a day). Residual period (following 3 months). Tasks for yourself: increase in meat activity for the creation of maximum symmetry between healthy and ill sides of disguise

Likuvalna physical culture in osteochondrosis of the ridge. The basis of osteochondrosis of the ridge is the change of the interspinal disks with the onset of retraction in the process of the body of the susterior spinal joints and the ligamentous apparatus. The intervertebral disks play an important role in the stable position of the ridges, ensure the roughness of the ridge, and function as a biological shock absorber. Factors that blame the development of osteochondrosis are a small-armed way of life, a trivale of changing the body from a physiologically handicapped position (a rich one sitting at a writing table, behind a car kerm, standing at a workbench, behind a counter). It means that the blood supply and the safety of the living cavities of the bodies of the ridges, interspine discs are significantly affected. Blame the cracks of the fibrous ring. As a result of the progression of degenerative changes in the fibrous calf, the fixation of the ridges among themselves is broken, causing pathological fragility. Mіzhkhrebtsevі shіlini change, zdavlyuyuutsya nerve-sudinal endings, blood-bearing and lymphatic vessels - increase pain. In the 3rd stage of the disease, the rupture of the fibrous ring is broken, the intercostal keels are established. The final stage is characterized by painful indentations and displacement of the ridges, and the development of pathological cystic growths.

Head of jubilant gymnastics: 1. Relieve the improvement in the midst of the spinal segments with the method of removing the pathological proprioceptive impulse. 2. Relieve the decrease in pathological proprioceptive impulses. 3. Reduction of exchange processes in the aftermath of increased blood flow to the lymphatic system in the low spinal segment and core. 4. Change in the fold in the fabrics, placement in the space of the intersternal opening, improvement of the blood flow in the lower border. 5. Reconstruction and renewal of the total volume of ruins in the peaks and ridges; change of static-dynamic damage and compensatory damage, restoration of damaged posture. 6. Take inspiration from the trophy, tone, strength of the skin of the tunic and the ends. 7. Promotion of global physical practice.

Special tasks of calisthenics: In case of radicular syndrome: retraction of nerve trunks and roots; twisting of nerve trunks and roots; preperedzhennya myazovyh atrophy; preperedzhennya myazovyh atrophy; strengthening of the pulps of the distal tips. strengthening of the pulps of the distal tips. With humeroscapular periarthritis: prevention of the elimination of reflex neurogenic contracture of the ulnar nodule; prevention of the elimination of reflex neurogenic contracture of the ulnar nodule; strengthening of the deltoid, supraspinatus, subastal, two-headed ulcers. strengthening of the deltoid, supraspinatus, subastal, two-headed ulcers. With the posterior cervical sympathetic syndrome (syndrome of the spinal artery): take a weakened vestibular disorder. take relief from vestibular disorders.

Osteochondrosis of the cervical spine. Active circulation in the cervical ridge in the cob and main periods of the course of treatment is contraindicated, which can lead to the ringing of the intersternal opening, as a result of compression of the nerve roots of the vessel. Complex V.p. - sitting on an armchair (prevented for the first 7 right), hands lowered in a tuluba. Turn your head to the left and to the right with the maximum possible amplitude. The pace is faster. 2. Lower your head down, away from the breasts. The pace is faster. 3. Put the kitty on your forehead. Press with your forehead on the whale for 10 s, remove it for 20 s. The head and the whale are not broken. 5 times 4. Put the kitty on the cover. I put pressure on the kitty for 10 s, for 20 s. The head and the whale are not broken. 5 times 5. Tse same from the other side.

6. Hands lowered vzdovzh Tuluba. Raise your shoulders and hold them in this position for 10 s, relax for 15 s. 6 times 7. Self-massage of shoulders, shoulder ridges, trapezoidal meat. 5-7 min 8. Ch. - lying on the back (taken from 8 to 16 to the right), hands under the head. Press your head on your hands - see. Relax - inhale. The pace is faster. 10 times 9. Hands on the belt. Pochergovoe zginannya that razginannya nіg, not changing the bend across. Do not break the feet in front of the logs. 10 times with a skin leg. 10. Hands on the belt, legs bent. Bend over, lift the pelvis - see, v.p. - inhaling once. 11. Bend your legs and squeeze them to your stomach, hug them with your hands, head to your knees - see, in. n. - indah times. 12. Hands to the side. Swing with the right foot, with the left hand push up to the right foot. With your other foot and hand. 10 times with a skin leg. 13. Hands on the belt. Raise straight legs in front of 90 - see, lower - inhale. 15 times 14. Hands on the head. Left leg and arm to the side - inhale, v.p. - seen. The same with the other foot and hand. 10 times with a skin leg. 15. V.p. - lying on the stomach, gymnastic stick on the shoulder blades. Straight legs back-up, lift your head and shoulders, bend over. 15 times

16. V.p. - standing navkarachki (taken from 16 to 18 to the right). Do not shake your hands and knees in the podlogs, work your round back - see, v.p. - inhale. 10 times 17. Straighten the right leg - ruh with the torso and the pelvis back - vidih, v.p. - inhale. Those with the left foot. 10 times with a skin leg. 18. Turn your back and head to the left - inhale, v.p. - seen. Those same to the right. 10 times in a leather bag. 19. V.p. - standing on knees. Pull the left leg to the side, v.p. the same with the right foot. 10 times with a skin leg. 20. V. p. - sitting on a pedestal, pulling a leg in front of you, inshu, bending in a knee, put it to the side. Stretch forward to the curly leg, trying to push yourself up to the feet with your hands. Change the position nіg. 10 times in a leather bag. 21. V.p. - standing. Sit down, pulling the heels into the legs, hands forward - visible, v.p. - inhale, 15 times.

22. V.p. - standing levi sideways to the support, lion straight leg behind. Rights - bent and set forward, the toelub is straight. The springs are swaying. Change the position nіg. 10 times in skin position. 23. Hanging on the bar. Gently turn the pelvis alternately to the right and to the left. Do not strain the shoulder girdle and back - the body is as relaxed as possible. Trivality to visu - 40 seconds. Repeat dekilka once a day. 24. V.p. - standing, stick in upturned hands. Right foot forward - stick on the shoulder blades. Those with the left foot. 10 times with a skin leg. 25. Stick in upturned hands. Stick on the chest, v.p. Stick on the shoulder blades, v.p. 10 times 26. Stick on the chest. Nahil forward, put a stick on the pidlog - vidih, v.p. - inhale. 10 times 27. Stick in lowered hands behind the back (grip from below), nahil forward, hands with the stick as far back as possible, up - see, v.p. - inhale. 10 times 28. Stick in curly arms in front of the breasts. Remove the stick with a swing of the left leg, then the right. 10 times with a skin leg. 29. Swing your left foot forward, arms up - inhale, v.p. - seen. Those with the right foot. 10 times with a skin leg. 30. Feet shoulder width apart. Nahil forward, pushing the left foot with the right hand, the left hand to the side - visible, v.p. - inhale. Those are up to the right foot. 10 times to the skin leg.

Complex 2 The skin has the right to be beaten 5-6 times. 1. V.p. - lie on your back. Raising your head and shoulders, turn the toelub to the right, pull your arms forward and to the right; those are on the other side. 2. V.p. - Lie on your stomach, arms out to the side. Lift the toelub, put your hands behind your head, bend over. 3. V.p. - standing - feet shoulder width apart. Nahili head to the right, circle head to the left. Those are on the other side. 4. Feet shoulder width apart, hands on the waist. With a small fistful of the coat, stretch your right hand up to the left, flick your head to the left, pushing your shoulders with your hand. Those are on the other side. 5. Feet shoulder width apart. Circle with shoulders back, hitting the shoulder blades, napping, head back; vp, circle with shoulders forward, napіvprisid, head forward. 6. Feet shoulder width apart, hands on the waist. Rising on your toes, heal your head forward; descending on the entire foot, napіvsіd, head to the right. Those wagging their heads to the left, then back.

7. Feet shoulder width apart, arms up. Right hand forward, swing to the side. Those with the other hand. 8. Feet shoulder-width apart, arms to shoulders. Raise your shoulders and shoulder blades forward, then lower them down; straightening your arms up, two spring swings with your arms back. 9. Feet shoulder-width apart, arms to the sides. Turning the toelub to the right - shresni ruhi with your hands, turning at the VP, waving your arms to the sides. Those are in the next book. 10. Feet shoulder width apart, hands on the waist. Two spring-loaded sheepskin coats to the left, wound to the right; straight up rise on your toes and turn in v.p. Those are in the next book. 11. Feet shoulder width apart, hands behind the head. Pivkrug with a tulub to the left, fisted to the right, forward, to the left. Move smoothly. Those are on the other side. 12. V.p. - lying on your back, hands in a tuluba. Bend your legs with knees to your chest, straighten up, then forward over the slope. 13. V.p. - lying on the stomach, arms folded under the boarders. Swing your right foot up. Those with the other foot. 14. V.p. - lying on your back, hands in a tuluba. Sisti, raising your arms up, two spring swings with your arms back; bending your legs, hug them with your hands, round your back, heal your head to the knees.

15. V.p. - sitting with support on the hands behind the back, legs bent outwardly. Lower the knee of the right leg to the left. Those with the other foot. 16. V.p. - sitting, legs narizno, arms to the sides. Turning the toelub to the right, heal up to the fold, leaning on the bent arms. Those are in the next book. 17. V.p. - standing on your knees, hands down. Bring the right leg forward, sit on the heel of the left leg, heal the toelub forward, stretch your hands to the foot. Two spring-loaded ones got forward. Those with the other leg. 18. V.p. - standing on knees with support on hands. Leaning down on the front of the left hand, turn the toelub to the right, move the right hand to the side. Those are in the next book. 19. V.p. - standing. Max with the bent right foot forward, with a note on the left foot, move the right back on the toe, arms up. Those are your legs. 20. Legs wide apart. Hacking forward, hands on the line. Bend your right leg with a knee to the side, lift your heel, squat down. Those are your legs. 21. Legs narizno, hands on the belt. Rising up on your toes, turn your heels to the right and lower them to the floor. Those are leaning on the heels and turning the socks.

Osteochondrosis of the thoracic spine. As a result of degenerative-dystophic changes in the interspinal discs in the thoracic spine, there may be flattening or exacerbation of thoracic kyphosis. These changes, in order of pain syndrome, reduce the dichal excursion of the chest, lead to hypotrophy of the dycal ulcers, and the function of the upper respiratory tract is impaired. When flattening the thoracic kyphosis, it is necessary to strengthen the ointment of the cervical wall and stretch the ointment of the back. With the help of the victorious method, physical rights are right, straightened out to stretch the ridge and strengthen kyphosis. In case of strong thoracic kyphosis, likuvalny gymnastics is aimed at strengthening the back ulcers, stretching the old ulcers and the abdominal ulcers. In the lessons of vicorist, right on the ridge and chest joint, right on the links of the shoulder blades. To achieve a greater effect, include the right ones with gymnastic objects (Fig. 15, 16).

Osteochondrosis of the transverse ridge. In the period of acute illnesses, we are ill, we lie on a hard bed. For relaxation of the myaziv under the knee, a cotton-gauze roller is applied. With the method of decompression of the nerve root, reduction of blood flow, traction is prescribed. I create a calm mind for the scarring of cracks and openings of the fibrous ring. Likuvalny gymnastics is aimed at reducing the pain syndrome, relaxing the skin of the tuba and kinks, improving the bleeding of the nerve cortex. In the lesson, include the right for the distal lower limbs in both static and dynamic dichal limbs, relaxation of the meat of the tuba and the limbs, as well as bending from the outward position lying on the back, on the stomach, on the hips.

After the pain syndrome subsides, it is right to tighten the ridge, yogo kifozuvannya, to reduce the blood supply to the pit of the ridge and adjacent tissues. Right vykonuyut from the exit position lying on the back, stomach, on the hips, standing on the floor. There are ruins in the kolіnnyh and kulshovyh swamps, right on the bend of the ridge and yogo winding along the axis. It is necessary to bend right with the isometric tension of the meats: push with a transverse dilyanka on the couch with the legs bent in the knees; you can rightly fold it, straining at once the ointment of the seat and the crotch. Qi have the right to increase the intraperitoneal pressure, which leads to a change in the intradiscal pressure.

With the presence of hypotrophy of the spinal ulcers of the back of the abdominal press, it is necessary to strengthen, shape the corset of the ulcers, which will help in the development of the ridge and the viconann of the main static and biomechanical functions. When the pain subsides, it is possible to begin to overcome the complexes to the right 6, 7, 8 (Fig. 17, 18). To normalize the tone of the spinal ulcers and reduce the bleeding of the paravertebral tissues, it is necessary to massage the spinal ulcers across and across. In case of brown syndrome, it is possible to have a short term.

COMPLEX 8 The skin has the right to be cut 5-6 times. 1. V.p. - lying on your back, your hands are raised in a coat, your socks are pulled up and, stretching your whole body, stretch. Relax. Well, pull up socks on yourself. 2. Legs are bent, one hand is raised in a tuluba, the other is up. 3. Stretch one hand forward, the other up. Change the position of your hands. 4. The legs are bent, the hands are raised in the coat. Turn your head to the right, to the left, hands behind your head. Raise your head, heal with your hands to your chest, lean forward. 5. Hands vzdovzh tuluba. Bending one leg, pull it up with your hand to the chest, the same, bending the other leg; raise your head and shoulders, pushing your forehead to your knees.

6. V.p. - standing. He pulled his head to the right, turned his head forward, pulled his head to the left, turned his head back. 7. Hands on the belt. Raise one shoulder, lower it. Raise the other shoulder - lower it. Raise and lower offended shoulders. 8. Squat down, pull your arms forward, kititsa on yourself, stretch your shoulders and palms forward; s pіvpriyadom vіdvest hands back, without changing the position of the whale, the shoulder blades of the grass. 9. Legs narizno, arms to the side. Hands forward - forward, hug your shoulders. In a sitting position, bend your hands over your head, smearing your fingers around the lungs. 10. Legs narizno, arms to the side. 8 circular swings with hands backwards with a small amplitude, whales on themselves; 8 circular ruhіv hands forward, kititsi lowered fingers down.

10. Legs narizno, arms to the sides. Horizontal whipping forward, arms forward, hands behind the head, shoulder blades zednati; with a pivsyadom, he pulled his coat to the side, stretched his elbow to the knee. Those are cheeky in the next bek. 11. Heeled the coat forward, hands on the knees; sit down, without changing the position of the coat; forcefully stiffened, straighten your legs, stretch your arms down. 12. Legs narizno, hands in front of the chest. Z pivsyadom turn the toeluba to the right, move the right leg back. Those are in the next book. 13. Legs narizno, hands on the belt. Move the pelvis to the right, keeping the position of the shoulders, do not bend the legs. Repeat to the left. Those same, pochinayuchi ruh in the next bek. 14. Legs wide apart, arms to the sides. 3 spring-loaded ones were sickened forward, stretched their arms to the bottom, hands behind their heads, forcefully sickened.

15. Legs wide apart. Bend one leg, lean on your knee with your hands, heal the toelub forward; those are bending my other leg. 16. Krok with his right foot to the side, bending її, he pulled his coat to the left, arms up, putting his right foot. Those are the next beak. 17. Vipad right foot forward, back straight, hands on knees; arms up, stretch back; squat down, repeat. Those are your legs. 18. Legs are cut. Rise on your toes, hands up; with a pіvpriyady, I will bend my leg forward, hug my knee with my hands. Those with the other foot. 19. Hands to the side. Z pivsyadom on the left swing with the right foot to the side. Clap your hands over your head. Repeat with other leg. Those wіdvodyachi leg back. 20. Legs narizno, hands on the belt. Rise on socks; rolling on heels, lifting socks uphill. Deep squat, hands up.

Therapeutic exercise in diseases of the nervous system plays a significant role in the rehabilitation of neurological patients. Treatment of the nervous system is impossible without therapeutic exercises. Exercise therapy for diseases of the nervous system has the main goal of restoring self-care skills and, if possible, complete rehabilitation.

It is important not to miss the time to create the correct new motor stereotypes: the earlier treatment is started, the easier, better and faster the compensatory-adaptive recovery of the nervous system occurs.

In the nervous tissue, the number of processes of nerve cells and their branches on the periphery increases, other nerve cells are activated, and new nerve connections appear to restore lost functions. Timely adequate training is important for creating the correct stereotypes of movements. So, for example, in the absence of physiotherapy exercises, a "right-brained" stroke patient - a restless fidget "learns" to walk, pulling his paralyzed left leg to his right and dragging it behind him, instead of learning to walk correctly, with each step moving his leg forward and then transferring the center of gravity of the body to it. If this happens, then it will be very difficult to retrain.

Not all patients with diseases of the nervous system can do the exercises on their own. Therefore, they cannot do without the help of their relatives. To begin with, before starting therapeutic exercises with a patient who has paresis or paralysis, relatives should master some techniques for moving the patient: transplanting from bed to chair, pulling up in bed, walking training and so on. In fact, this is a safety technique to prevent excessive stress on the spine and joints of the caregiver. Lifting a person is very difficult, so all manipulations must be performed at the level of a magician in the form of a “circus trick”. Knowing some special techniques will greatly facilitate the process of caring for the sick and help maintain your own health.

Features of exercise therapy in diseases of the nervous system.

1). Early initiation of exercise therapy.

2). Adequacy of physical activity: physical activity is selected individually with a gradual increase and complication of tasks. A slight complication of the exercises psychologically makes the previous tasks “easy”: what previously seemed difficult, after new slightly more complex tasks, is performed more easily, with high quality, the lost movements gradually appear. It is impossible to allow overload in order to avoid deterioration of the patient's condition: motor disturbances may increase. In order for progress to occur faster, it is necessary to finish the lesson on the exercise that this patient has, to focus on this. I attach great importance to the psychological preparation of the patient for the next task. It looks something like this: "Tomorrow we will learn to get up (walk)." The patient thinks about it all the time, there is a general mobilization of forces and a readiness for new exercises.

3). Simple exercises are combined with complex ones for training higher nervous activity.

4). The motor mode gradually steadily expands: lying - sitting - standing.

Therapeutic exercise for diseases of the nervous system.5). All means and methods of exercise therapy are used: therapeutic exercises, positional treatment, massage, extension therapy (mechanical straightening or stretching along the longitudinal axis of those parts of the human body that have a disturbed anatomical location (contractures)).

The main method of physical therapy for diseases of the nervous system is therapeutic exercises, the main means of exercise therapy are exercises.

Apply

Isometric exercises aimed at strengthening muscle strength;
- exercises with alternating tension and relaxation of muscle groups;
- exercises with acceleration and deceleration;
- coordination exercises;
- balance exercise;
- reflex exercises;
- ideomotor exercises (with mental sending of impulses). It is these exercises that I use for diseases of the nervous system - - - - most often in combination with Su-jok therapy.

Damage to the nervous system occurs at different levels, the neurological clinic depends on this and, accordingly, the selection of therapeutic exercises and other physiotherapeutic therapeutic measures in the complex treatment of a particular neurological patient.

Hydrokinesitherapy - exercises in water - a very effective method of restoring motor functions.

Exercise therapy for diseases of the nervous system is subdivided according to the parts of the human nervous system, depending on which part of the nervous system is affected:

exercise therapy for diseases of the central nervous system;
exercise therapy for diseases of the peripheral nervous system;
exercise therapy for diseases of the somatic nervous system;
Exercise therapy for diseases of the autonomic nervous system.

Some subtleties of work with neurological patients.
In order to calculate our strength in caring for a neurological patient, we will consider some significant factors, since the care process is complex, and it is not always possible to cope alone.

The state of mental activity of a neurological patient.
The patient's experience in physical education before illness.
The presence of excess weight.
Depth of damage to the nervous system.
Accompanying illnesses.

For physiotherapy exercises, the state of higher nervous activity of a neurological patient is of great importance: the ability to be aware of what is happening, to understand the task, to concentrate attention when performing exercises; volitional activity plays a role, the ability to resolutely tune in to daily painstaking work to achieve the goal of restoring the body's lost functions.

In the case of a stroke or brain injury, most often the patient partially loses the adequacy of perception and behavior. Figuratively, it can be compared with the state of a drunk person. There is a "disinhibition" of speech and behavior: the shortcomings of character, upbringing and inclination to what is "impossible" are exacerbated. Each patient has a behavioral disorder that manifests itself individually and depends on the

1). what activity the patient was engaged in before the stroke or before the brain injury: mental or physical labor (it is much easier to work with intellectuals if the body weight is normal);

2). how developed the intellect was before the disease (the more developed the intellect of a patient with a stroke, the more the ability to purposefully exercise exercise remains);

3). in which hemisphere of the brain did the stroke occur? "Right hemispheric" stroke patients behave actively, show emotions violently, do not hesitate to "express"; they do not want to follow the instructions of the instructor, they start walking ahead of time, as a result, they have a risk of forming incorrect motor stereotypes. “Left hemispheric” patients, on the contrary, behave inactively, do not show interest in what is happening, just lie down and do not want to engage in physiotherapy exercises. It is easier to work with "right hemisphere" patients, it is enough to find an approach to them; what is needed is patience, a delicate and respectful attitude, and the decisiveness of methodological instructions at the level of a military general. :)

During classes, instructions should be given decisively, confidently, calmly, in short phrases, it is possible to repeat instructions due to the patient's slow perception of any information.

In the event of a loss of behavioral adequacy in a neurological patient, I have always effectively used the “cunning”: you need to talk to such a patient as if he is a completely normal person, not paying attention to “insults” and other manifestations of “negativity” (unwillingness to engage in, denial of treatment and others). It is not necessary to be verbose, it is necessary to make small pauses so that the patient has time to realize the information.

In case of damage to the peripheral nervous system, flaccid paralysis or paresis develops. If at the same time there is no encephalopathy, then the patient is capable of much: he can independently exercise a little during the day several times, which undoubtedly increases the chance of restoring movements in the limb. Flaccid paresis is more difficult to respond to than spastic paresis.

* Paralysis (plegia) - the complete absence of voluntary movements in the limb, paresis - incomplete paralysis, weakening or partial loss of movement in the limb.

It is necessary to take into account another important factor: whether the patient was engaged in physical education before the disease. If physical exercises were not included in his lifestyle, then rehabilitation in case of a disease of the nervous system becomes much more complicated. If this patient has exercised regularly, then the recovery of the nervous system will be easier and faster. Physical labor at work does not belong to physical education and does not bring benefits to the body, since it is the exploitation of one's own body as a tool for doing work; he does not add health due to the lack of dosing of physical activity and control of well-being. Physical labor is usually monotonous, so there is wear and tear of the body in accordance with the profession. (So, for example, a painter-plasterer “earns” humeroscapular periarthrosis, a loader - osteochondrosis of the spine, a massage therapist - osteochondrosis of the cervical spine, varicose veins of the lower extremities and flat feet, and so on).

For home exercise therapy for diseases of the nervous system, you will need ingenuity to select and gradually complicate exercises, patience, regularity of daily exercises several times during the day. It will be much better if in the family the burden of caring for the sick is distributed to all family members. The house should be in order, cleanliness and fresh air.

It is desirable to put the bed so that it has access from the right and left sides. It should be wide enough to allow the patient to be rolled from side to side when changing bed linen and changing body position. If the bed is narrow, then each time you have to pull the patient to the center of the bed so that he does not fall. You will need additional pillows and rollers to create a physiological position of the limbs in the supine and supine position, a splint for a paralyzed arm to prevent contracture of the flexor muscles, a regular chair with a back, a large mirror so that the patient can see and control his movements (especially the mirror necessary in the treatment of neuritis of the facial nerve).

There should be room on the floor for lying down exercises. Sometimes you need to make handrails for support with your hands in the toilet, in the bathroom, in the corridor. To do therapeutic gymnastics with a neurological patient, you will need a wall bar, a gymnastic stick, elastic bandages, balls of different sizes, skittles, a roller foot massager, chairs of different heights, a step bench for fitness and much more.

According to experts, movement is life. And with various diseases, proper physical activity can become a real panacea for the patient - they can speed up recovery, prevent relapses, and improve overall physical condition. So with ailments of the nervous system, gymnastics is the most important part of complex treatment. And all patients with such problems, without exception, are shown the systematic implementation of a set of individually selected exercises. The topic of our today's conversation on this page www.site will be exercise therapy for diseases of the central nervous system and peripheral.

Exercise therapy for diseases of the nervous system

Physical therapy for diseases of the central nervous system helps to activate the vital functions of the body: respiratory, cardiovascular, etc. Gymnastics effectively prevents the occurrence of motor and other complications, including contractures, stiffness in the joints, bedsores, congestive pneumonia, etc.

Regular exercises help restore lost functions or create temporary or permanent compensation. Physiotherapy also helps to restore the skills of walking and grasping objects. Gymnastics also perfectly increases the overall tone of the body and optimizes the mental state of the patient.

Exercise therapy for diseases of the peripheral nervous system

Gymnastics in such diseases is aimed at optimizing the processes of blood circulation, as well as trophism in the affected focus, it helps to prevent adhesions and cicatricial changes, eliminate or reduce vegetative-vascular and trophic disorders (promoting nerve regeneration).

Exercises for diseases of the peripheral nervous system help to strengthen the paretic muscles and ligamentous apparatus, to weaken muscular dystonia. Such an effect can prevent or eliminate muscle contractures, as well as stiffness in the joints.

Physiotherapy exercises also help to improve substitution movements and coordinate them with each other. Such exercises cope with the limited mobility of the spinal column and with its curvature.

Exercises for diseases of the peripheral nervous system have a pronounced general health-improving, as well as a general strengthening effect on the patient, contributing to the overall recovery of working capacity.

Features of exercise therapy for ailments of the nervous system

Patients with diseases of the nervous system are shown an early start of exercise therapy. At the same time, physical activity should be relevant: they are selected on an individual basis, should gradually increase and become more complicated.

Even a slight complication of exercises already at the level of psychology makes the previous exercises easier. However, overloads for patients with diseases of the central nervous system and peripheral nervous system are categorically contraindicated; in this case, their motor disorders may worsen. To accelerate progress, it is extremely important to finish classes on those exercises that are best obtained by patients. This ensures the most positive psychological preparation of the patient for the next classes.

Simple exercises must be alternated with complex ones: to ensure a full-fledged training of higher nervous activity. At the same time, the motor mode should be steadily expanded: from the position lying in bed, to sitting in bed, and then standing.

Doctors strongly recommend the use of all means, as well as methods of physical therapy. Patients are shown to conduct therapeutic exercises, treatment by position, massages. Also, an excellent effect is given by extension therapy - mechanical straightening or stretching along the longitudinal axis of certain parts of the body, which are characterized by a violation of the correct anatomical location.

However, the classic and most popular method of physical therapy for ailments of the nervous system is different exercises.

What exercises are used for diseases of the nervous system?

Patients are shown performing isometric exercises designed to strengthen muscle strength. Doctors also advise classes in which tension and relaxation of muscle groups alternate. Exercises with acceleration and deceleration, various exercises for deceleration and balance must also be performed.

Alternative medicine experts also advise paying attention to ideomotor activities, in which the mental sending of impulses occurs.

Some examples of exercise therapy for diseases of the nervous system

Quite often, patients with focal lesions of the brain are treated with position. In this case, the affected limbs (usually the arm) are fixed in a fixed position using various devices (sand roller, etc.). The duration of treatment with the position can vary from a quarter of an hour to four hours, depending on the type of disease and the condition of the patient.

In diseases of the peripheral nervous system, the patient is shown to perform exercises aimed at optimal contraction of the paretic muscles, as well as stretching their antagonists. Particular attention is paid to the development of the necessary motor skills: walking and running, the ability to write, hold and throw small objects.

Physiotherapy exercises contribute to the speedy recovery of patients with ailments of the nervous system, both peripheral and central.

Ekaterina, www.site

P.S. The text uses some forms characteristic of oral speech.

The purpose and objectives of physical education

When compiling a set of exercises in patients with vegetative-emotional disorders, it is necessary to determine the state of vegetative tone (sympathicotonia, vagotonia, mixed).

Patients with central disorders of a permanent nature are prescribed the following types of exercises:
1. Respiratory
2. To relax (with sympathicotonia).
3. Strength - exercises with muscle strengthening, weight-bearing shells, resistance (with vagotonia).
4. Speed-strength - running, jumping, jumping, etc.

The main form of exercise therapy is therapeutic gymnastics, which is carried out daily for 20-30 minutes, rhythmically, at a calm pace, with a large range of motion. It is recommended to combine with static and dynamic breathing movements, as well as special types of breathing exercises.

Special exercises for sympathicotonia include exercises to relax various muscle groups, to improve coordination. It is advisable to use linear and acupressure massage.

In the LH complex in the general regimen, there should be general strengthening exercises in combination with all types of breathing exercises.

We give an approximate list of special exercises that can be included in the exercise therapy complex for permanent manifestations of vegetative-vascular dysfunction.

Strength exercises

1. I.p. - lying on your back: raising straight legs.
2. I.p. - the same: "bicycle".
3. I.p. - the same: movements with straight legs in the vertical and horizontal plane ("scissors").
4. I.p: - sitting or standing. Hands with dumbbells lowered: bending the arms at the elbow joints.
5. I.p. - standing, hands on the belt: squatting with straightening the arms forward.
6. I.p. - lying on the stomach, hands in support in front of the chest: push-ups.
7. I.p. - standing facing the partner or the wall, one leg in front, palms resting in the partner's palms: alternately bending and unbending the arms with resistance.
8. I.p. - standing facing the partner, hands on the shoulders of the partner: torso to the side with resistance with the hands.
9. I.p. - standing, arms with dumbbells lowered, torso forward with arms extended to the sides.

The number of repetitions of each exercise is determined by the patient's condition.

Speed-strength exercises

5. I.p. - standing, arms bent at the elbows: movements imitating boxing, at a fast pace.
6. I.p. - the same: running in place or in motion.

Relaxation exercises

1. I.p. - lying on your back: raise your arms up and passively lower them.
2. I.p. - sitting, the torso is somewhat tilted forward: free swinging with relaxed arms lowered down.
3. I.p. - standing: the same.
4. I.p. - the same: raise your hands up and relax them to your shoulders, waist, down.

An approximate combination of massage points for vagotonia:

1st session: bai-hui (U20), he-gu (014) symmetrically, zu-san-li (EZ) on the left; gao-huang (U43) symmetrically - 10 minutes per point, toning method.
2nd session: Wai Kuan (TK5) and Xin Shu (U15) on the right, Ling Qi on the left.
3rd session: lao-gong (SS8) and shian-wai-shu (S14) symmetrically.
4th session: nei guan (TK61) and qing li. In the evening, the patient performs self-massage he-gu (Ol4) and san-yin-jiao (NRb) symmetrically for 5 minutes.

Approximate combination of massage points for sympathicotonia

These patients are shown sanatorium treatment with the appointment of approximately the following complexes of therapeutic exercises:

For patients with sympathetic-adrenal paroxysms

gentle mode
1. I.p. - sitting, hands on knees: hands up - inhale, lower - exhale. Repeat 4-6 times. Breathing is rhythmic.
2. I.p. - sitting, legs extended: rotation of the feet and hands in both directions Repeat 15-20 times. Breathing is arbitrary.
3. I.p. - sitting: hands up - inhale, pull the knee to the stomach - exhale. Repeat 4-6 times. Breathing with an emphasis on exhalation.
4. I.p. - sitting, arms freely lowered, brushes reach the shoulders. Circular movements of the elbows in both directions. Repeat 4-6 times. Breathing is arbitrary.
5. I.p. - sitting, hands in front of the chest: turning the body with spreading the arms to the sides - inhale, return to SP. - exhale. Repeat 3-4 times.
6. I.p. - standing or lying down: alternate bending of the legs - exhale, return to I.p. - breath. Repeat 3-4 times.
7. I.p. - sitting, arms to the sides - inhale, cross your arms in front of your chest, bend over - exhale. Repeat 4-6 times.
8. I.p. - sitting or standing: spreading the arms to the sides and fixing them with tension, return to the SP, relax the muscles as much as possible. Repeat 4-6 times. Breathing with an emphasis on exhalation.
9. Walking with a gradual slowdown for 1.5-2 minutes.
10. Repeat exercise 1.

Gentle training mode

1. I.p. - standing, legs apart, arms lowered: raise your arms through the sides up - inhale, lower - exhale. Repeat 4-6 times. Inhale-exhale ratio 1:2, 1:3.
2. I.p. - standing, arms to shoulders: circular rotation of the elbows in both directions. Repeat 6-8 times. Breathing is arbitrary.
3. I.p. - standing, hands in front of the chest: turning the body with spreading the arms to the sides - inhale, return to ip. - exhale. Repeat 6-8 times.
4. I.p. - standing, legs apart, arms lowered: squats on a full foot - exhale, return to ip. - breath. Repeat 6-8 times. Breathing with an emphasis on exhalation.
5. I.p. - standing, arms along the body: arms up - inhale, lower your hands - exhale. Repeat 3-4 times.
6. I.p. - standing, hands on the belt: bend the leg at the knee and hip joints, pull it to the stomach - inhale, return to ip. - exhale. Repeat 4-6 times.
7. I.p. - standing, in the hands of a dumbbell (1.5 kg): hands forward, fixing them with subsequent relaxation. Perform within 30 s. Do not hold your breath while exhaling.
8. I.p. - standing: calm walking for 2 minutes. Breathing is even.
9. I.p. - standing, hands lean against the wall at chest level: press the wall as much as possible, then relax the muscles of the arms and torso. Perform within 5 s. Don't hold your breath.
10. I.p. standing: repeat exercise 1.
11. I.p. - standing, in the hands of a stuffed ball. throw the ball up, turn 90 "and catch it. Perform for 1.5 minutes.

E.A. Mikusev, V.F. Bakhtiozin

Exercise therapy for diseases, injuries and injuries of the musculoskeletal system and nervous system

Lecture 3
exercise therapy for diseases
injuries and injuries
musculoskeletal
apparatus and nervous system
1. Exercise therapy for diseases of the musculoskeletal system
2. Exercise therapy for musculoskeletal injuries
3. Exercise therapy for diseases and injuries of the spine
4. Exercise therapy for diseases and injuries of the nervous system

Question 1. Exercise therapy for diseases of the musculoskeletal system

Tasks of exercise therapy:

normalization of the tone of the central nervous system;
activation of metabolism.
activation of blood and lymph circulation in the joint;
restoring or improving joint mobility
prevention of further dysfunctions and
muscle atrophy;
restoration of adaptation to domestic and labor
processes.

Arthritis

are diseases that are
is the inflammatory process,
located in the synovium
joint sheath, articular cartilage and
periarticular tissues

Tasks of exercise therapy:

General +
increase in range of motion up to
normal;
strengthening muscles in the affected area -
especially extensors;

Exercise therapy technique

1) Therapeutic massage, physiotherapy procedures (UVI,
ozokerite, paraffin and mud applications)
2) Therapeutic gymnastics:
I.p .: for the upper limbs - lying and sitting, for the lower - lying
passive movements for affected joints (starting with
gentle swings with a small amplitude)
relaxation of muscles in the area of the diseased joint (relaxation
tense flexor muscles of the diseased limb contributes to
performing active movements with a healthy limb)
exercises in water (in the pool, bath) at a temperature of 28-29 ° C:
active movement,
with shells (ladder for developing movements in the joints
brushes, clubs, dumbbells weighing 0.5 kg), on the gymnastic wall;
simulators.
The pace of the exercises is slow or medium;
Number of repetitions - 12-14 times (14-16 times)
Duration of the lesson - 35-40 minutes (40-45 minutes)

Arthrosis

are diseases that are based on
metabolic-dystrophic process,
characterized by cartilage atrophy,
loss of bone tissue (osteoporosis),
neoplasm of bone tissue
calcium salts in periarticular tissues, ligaments,
joint capsule.

Tasks of exercise therapy:

General +
pain reduction;
relaxation of the abdominal muscles and
elimination of contracture;
an increase in the joint space;
reduction of the phenomena of aseptic synovitis
(inflammation of the synovial membrane);
strengthening of the periarticular muscles and increase
their endurance;

Exercise therapy technique

1) Exercises that strengthen the muscles of the back and abdomen.
2) Special exercises
i.p. - lying on your back:
active dynamic exercises for large muscle groups
healthy limb;
FU for the ankle joint and light movements in the hip
joint (with coxoarthrosis) of a sore leg in light conditions;
short-term (2-3 s) isometric tension of the gluteal
muscles.
I.p. - standing on a healthy leg (on a dais):
free swaying of a relaxed leg in various
directions.
isometric tension and subsequent relaxation
Dynamic exercises without weights and with weights (on
simulators or with weights) - the weight that the patient can
raise 25-30 times to fatigue; performed from 1 to 3-4 series
exercises with a rest interval of 30-60 s.
The pace of all exercises is slow;
The range of motion is painful.

10. Question 2. Exercise therapy for injuries of the musculoskeletal system

11. Injury

is a sudden impact on
human body external factors
environment (mechanical, physical,
chemical, etc.), leading to
violation of the anatomical
tissue integrity and functional
violations in them.

12. Traumatic illness

is a combination of general and local
pathological changes in the body
damage to the organs of support and movement

13. Harbingers of the development of a traumatic disease:

Syncope (syncope) - sudden loss of
consciousness due to insufficient
circulation in the brain.
Collapse is a form of acute vascular
insufficiency (decreased vascular tone or
circulating blood mass weakening of the heart
reduced venous blood flow
to the heart, lowering blood pressure, hypoxia of the brain)
Traumatic shock - severe
pathological process in
body as a response to severe
trauma.

14. Tasks of exercise therapy:

General tasks of exercise therapy:
normalization of the psycho-emotional state
sick;
accelerate the elimination of drugs from the body
funds;
improvement of metabolism, activity of the cardiovascular and respiratory systems, excretory organs;
prevention of complications (congestive pneumonia,
flatulence, etc.).
Special tasks of exercise therapy:
acceleration of resorption of hemorrhage and edema;
acceleration of the formation of callus (for fractures);
improvement of the process of regeneration of damaged tissues;
prevention of muscle atrophy
contract and stiffness in the joints;
prevention of adhesive process;
the formation of a soft, elastic scar.

15. Exercise therapy technique

ORU (for non-injured parts of the body);
breathing exercises: for bedridden patients -
in the ratio 1:1; for walkers - 1:2(3);
active physical exercises for the joints,
free from immobilization;
exercises for abdominal muscles in isometric
muscle mode of those parts of the body where they can
bedsores to form;
position treatment;
ideomotor exercises;
isometric muscle tension
immobilization.

16. Forms of exercise therapy:

1st period: UGG (5-7 min); LH (15-25 min);
self-study; walking down the corridor
(for example, on crutches).
2nd period: UGG, LG; self-study;
hiking; dosed walking, running,
swimming, etc.
3rd period: all available forms of exercise therapy
final restoration of lost
functions of the damaged segment and organism in
in general. He's in a rehab center
or in a sanatorium, or in a local clinic
residence (partially at home).

17. Exercise therapy technique

I.P. - various;
physiological load curve - two- or three-peak
multi-vertex
25% control, 75% outdoor switchgear and control room 25% control switchgear and remote control control and 75% control switchgear
Means of exercise therapy: - outdoor switchgear;
- breathing exercises in the ratio 1:2(3);
- passive and then active exercises for
joints of the affected part of the body (it is better to perform them
in warm water)
- treatment position;
- mechanotherapy;
- occupational therapy;
- choreotherapy;
- massotherapy.
Later:
- sports-applied exercises;
- training on simulators;
- natural natural factors.
Exercise pace:
slow and medium - for medium and large muscle groups;
fast - for small muscle groups.
The range of motion is medium (not causing pain).

18. Fractures

is an anatomical disorder
bone integrity caused
mechanical action and
accompanied by damage
surrounding tissues and damage
functions damage to a segment of the body.

19. Tasks of exercise therapy:

1st period:
improvement of blood and lymph circulation at the fracture site;
prevention of contractures, as well as muscle atrophy.
2nd period:
restoration of range of motion in the joint;
an increase in the strength of the muscles of the shoulder girdle and shoulder (or
lower limbs);
elimination of puffiness (if any).
3rd period:
final restoration of muscle function and strength
shoulder girdle and upper or lower limb.
learning to walk with crutches and without support (with
lower limb fractures)

20. Fractures of the bones of the upper limbs

21. Method of exercise therapy for fracture of the clavicle

First period
1.
Classes in a fixing bandage (first week)
active finger movements
flexion and extension in the wrist and elbow joints (rotation
contraindicated due to possible displacement of fragments).
2.
FU without a scarf in the position of inclination towards the damaged collarbone:
pendulum movements in the shoulder joint with a small amplitude;
abduction (up to 80°) and adduction of the shoulder (after 2 weeks), above the horizontal -
in 3 weeks;
adduction and expansion of the shoulder blades.
Second period
special exercises - active movements in the shoulder joint above
horizontal;
swing exercises; exercises with objects;
mechanotherapy on block devices;
therapeutic massage of the muscles of the shoulder girdle; swimming.
Third period
load on weakened muscles from the affected collarbone;
exercises with objects, with a rubber bandage and an expander, with small
weights, on shells and simulators; swimming, skiing,
volleyball, basketball and other sports.
To training sessions with a fracture of the clavicle is allowed
start 6-8 weeks after the injury.

22. Fractures of the scapula

ORU and DU, exercises for fingers, wrist joint,
isometric muscle tension of the shoulder (depending on
fixing method).
FU on the scarf: for the elbow (flexion and extension, pronation and
supination, circular movements) and shoulder (raising the arm
forward-up to an angle of 90 ° and abduction to an angle of 90 °) of the joints.
Hand swings (10-14 days after injury)
With a fracture of the neck of the scapula
1st period (on the outlet bus):
exercises for fingers, wrist and elbow joints;
for the shoulder joint (15-20 days after injury).
2nd period (without tire) - in a month
movements in the shoulder joint (friendly with a healthy
hand),
exercises with objects and on block simulators (during
3-4 weeks.
The exercise therapy technique in the 3rd period is the same as for a clavicle fracture.
Restoration of movements and ability to work occurs after 2-2.5
month; sports capacity for work - 3 months after the fracture.

23. Fractures of the lower extremities

24. Methods of treatment:

conservative method - traction
(if the fracture is displaced) behind the calcaneus
bone, imposing in 2-3 weeks deaf
plaster cast - from the toes to
upper third of the thigh;
operational method - overlay
Ilizarov apparatus or
metal osteosynthesis with a nail or
metal plate;
immobilization.

25. Fractures of the diaphysis of the femur

Immobilization period - skeletal
traction (1.5-2 months)
Exercise therapy is prescribed on the 2nd day after the injury
ORU for an intact limb;
SA for injured limb: flexion and
extension of the fingers and feet; elevation of the pelvis
resting on the arms and foot of a healthy leg; maximum
relaxation of the thigh muscles.
A month after the injury, exercises are added to
tension of the thigh muscles (movement of the patella).
The duration of the lesson is 25-30 minutes (4-6 times per
day).

26.

Post-immobilization period
- after removal of skeletal traction
various I.P. (lying on back, sitting, standing
gymnastic wall, walking).
water exercises: squats; flywheels
movements, standing on a healthy leg; bending in
hip and knee joints.
Training period
(after 2-3 months until full recovery of movements during
all joints and normal gait (4.5-6 months))
running, jumping, jumping, stepping
jumping over obstacles
coordination and balance exercises
outdoor games,
swimming in the pool.
The duration of the lesson is 40-50 minutes (3-4 times a day).

27. Fractures of the bones of the lower leg

28. Exercise therapy technique - the same as for a hip fracture

Immobilization period (average 3-4 months)
remote control and outdoor switchgear
SU: active movements of the toes;
flexion and extension at the knee and hip
joints;
isometric tension of the muscles of the thigh and lower leg;
ideomotor exercises for the ankle
joint
3-5 days after the injury, the patient is allowed
move within the ward, and then the department
with the help of crutches.

29. Post-immobilization (functional) period

Tasks of exercise therapy:
restoration of movements in the ankle joint;
elimination of swelling of the injured leg;
prevention of traumatic flat feet, deformity
feet, growths of "spurs" (most often heel),
curvature of the fingers. For this purpose, immediately after the removal
plaster in shoes put a special arch support.
Exercise therapy technique
ORU for all muscle groups,
SU:
active finger movements (capturing small
items and their retention); foot movements, back and
plantar flexion of the foot, supination and pronation,
rolling the foot of a tennis ball;
different walking options: on toes, on heels, on
external or internal arches, forward with the back, sideways,
cross step, in a semi-squat, etc .;
exercises with the support of the foot on the crossbar; exercises for
exercise bike.
An ankle fracture can cause swelling anywhere in the foot.
To eliminate it, it is recommended to lie down for 10-15 minutes (3-4 times a day),
raising legs at an angle of 120-130 ° in

30. Damage to the knee joint

31. Damage to cruciate ligaments

With a partial rupture of the cruciate
ligaments, a plaster cast is applied (up to
middle third of the thigh) for 3-5 weeks.
With a complete rupture,
surgical replacement of ligaments with lavsan tape
or autoplasty.

32. Exercise therapy technique

1st period of LH classes (1-2 days after the operation).
In addition to exercises for healthy parts of the body,
exercises for the operated limb: movements of the toes, in
ankle and hip joints, isometric
muscle tension of the thigh and lower leg (from 4-6 to 16-20 times), which
patients should perform independently every hour.
2nd period (3-4 weeks after surgery)
exercises in i.p. lying on your back, later - lying on your side, on
stomach and sitting, so as not to cause stretching of the restored ligament.
To increase the range of motion in the knee joint,
position treatment or a small pull on the block is used
simulator: the patient lies on his stomach and with the help of a block
apparatus flexes the lower leg - training to increase strength and
endurance of the muscles of the injured limb.
to restore range of motion in the knee joint
use training on a bicycle ergometer and walking on a flat floor,
stepping over objects (medicated balls, fences) and walking
On the stairs.
In the 3rd period (3-4 months after the operation)
the task of exercise therapy is the complete restoration of the function of the knee joint and
neuromuscular apparatus.

33. Question 3. Exercise therapy for diseases and injuries of the spine

34.

35. 36. Fractures of the spine

37. Depending on the localization, there are:

body compression fractures
vertebrae
spinous and transverse fractures
processes;
vertebral arch fractures.

38. Treatment:

prolonged traction;
one-time or gradual
correction of deformity of the spinal column, with
subsequent imposition of a plaster corset;
combined method (traction and
plaster immobilization);
operational method (various ways
fixation of segments of the spinal column in the zone
damage).
Application of physical factors
(exercise therapy, massage and physiotherapy)
is mandatory

39. Tasks of exercise therapy

(immobilization period)
stimulation of regenerative processes in the damaged
segment;
improvement of psycho-emotional state and activity
the main systems of the body;
prevention of congestion, atrophy of the muscles of the body
limbs, neck.
preparation of the victim for vertical loads;
prevention of atrophy of the muscles of the trunk, neck and
limbs;
restoration of everyday skills and walking skills;
improvement of blood circulation in the fracture area - for
stimulation of regeneration.

40. Tasks of exercise therapy

restoration of mobility in
damaged spine;
strengthening the muscles of the back, neck and shoulder
belts;
elimination of coordination disorders;
adaptation to household and professional
loads

41. Example: Exercise therapy technique for fracture of the cervical vertebral bodies

42. Exercise therapy technique

(immobilization period)
In the first half
movements in the shoulder joints, head movements are prohibited
ORU for small and medium muscle groups
upper and lower limbs (without taking them off the plane of the bed),
static breathing exercises,
movements of the lower jaw (opening the mouth, movements to the right, to the left,
forward).
Exercises are performed at a slow pace (4-8 times)
In the second half
forward movement of the body is contraindicated
i.p. lying, sitting, standing;
exercises for balance and coordination of movements;
walking and walking exercises;
exercises to maintain correct posture.
Isometric exercises are used to strengthen the muscles of the neck.
muscle tension (from 2-3 to 5-7 s).
The number of repetitions - 3-4 times a day;
duration of the lesson - 15-20 minutes

43. Exercise therapy technique

(post-immobilization period)
And. n. lying down, then turn on and. n. sitting and standing
isometric tension of the neck muscles, including with
resistance
FU in keeping the head in an elevated position - in I.p. lying down
on the back, on the stomach and on the side
FU for the limbs (especially the upper ones) - hand movements
above the horizontal level, raising the shoulder girdle,
abduction of arms to the sides by 90 ° using various
weights
training on simulators
tilts and turns of the torso and head and circular movements
head
exercises for balance, coordination of movements,
formation of correct posture.

44. Question 4. Exercise therapy for diseases and injuries of the nervous system

45. MAIN CLINICAL MANIFESTATIONS

Motor
disorders
1. paralysis or
paresis
central
(spastic)
peripheral
(sluggish)
2. convulsions
3. athetosis
4. jitter
Disorders
sensitivity
anesthesia
hypoesthesia
hyperesthesia
neuralgia
ataxia
apraxia

46. Paralysis (plegia) - wasting the possibility of voluntary muscle contraction

Paresis - partial loss of voluntary movements
called
central (spastic) - damage
central motor neuron
providing conscious control
muscle contraction.
2. peripheral (sluggish) - damage
peripheral motor neuron
caused by injury or disease of the spinal cord
brain, manifests itself at the level of innervation from
this segment
1.

47. Cramp (spasm) - involuntary contraction of a muscle or group of muscles, usually accompanied by sharp and aching pain.

Cramp (spasm) - involuntary
contraction of a muscle or group of muscles, usually
accompanied by sharp and aching pain.
clonic - rapidly alternating
muscle contraction and relaxation
tonic - long contractions
muscles

48. Athetosis is slow worm-like movements of the fingers, hand, torso.

Trembling is involuntary
rhythmic vibrations of the limbs
or heads.

49. Anesthesia - a decrease in the sensitivity of the body or part of it up to the complete cessation of perception of information about the environment

environment and
own state.
Hypothesia - partial decrease in sensitivity,
decrease in susceptibility to external stimuli,
weakening of perception by strength (these conditions are more often
observed in neurosis).
Hyperesthesia - a sharp increase
sensitivity to weak stimuli,
affecting the sense organs.

50. Neuralgia - pain that develops when sensory nerves of a traumatic or inflammatory nature are damaged in the area

innervation or
location of the nerve.

51. Ataxia - disorders of proprioceptive (muscle-articular) sensitivity leading to impaired coordination

relationships, accuracy of movements.

52. Apraxia ("inactivity, inaction") - a violation of purposeful movements and actions while preserving its components

elementary movements; occurs when
focal lesions of the cortex of large
cerebral hemispheres or conductive
tracts of the corpus callosum.
It is the loss of the ability to produce
planned and purposeful actions
while maintaining mobility
for their implementation, which previously
were performed automatically.

53. Aphasia is a systemic disorder (disorder) of already formed speech.

motor - impaired ability
turn concepts into words
sensory - impaired speech perception,
amnestic - loss of memory,
alexia - loss of the ability to read,
agraphia - loss of the ability to write
agnosia - impaired perception and
recognition of objects and persons.

54. 4.1 Exercise therapy FOR DISEASES OF THE PERIPHERAL NERVOUS SYSTEM

55. Neuritis is a disease of peripheral nerves that occurs as a result of:

traumatic injury,
infectious,
inflammatory diseases (diphtheria,
influenza, etc.)
avitaminosis (lack of vitamins
group B)
intoxication (alcohol, lead)
metabolic disorders (diabetes).

56. Tasks:

stimulation of regeneration processes and
disinhibition of parts of the nerve located in
a state of oppression;
improvement of blood supply and trophic processes
in the lesion to prevent the formation
adhesions and cicatricial changes;
strengthening paretic muscles and ligamentous apparatus;
prevention of contractures and stiffness in the joint;
rehabilitation through
normalization of motor functions and development
compensatory devices.

57. Treatment:

position treatment
massage
physiotherapy (electrophoresis)
muscle electrical stimulation
physiotherapy
mechanotherapy - execution
exercise with special
simulators and devices.

58. Exercise therapy technique

Position treatment
It is carried out dosed throughout the entire period
- with the exception of FU classes (from 2-3 minutes to 1.5 hours)
splints are used to support the limb,
special "laying", corrective positions
using orthopedic and prosthetic products
(devices, braces, special footwear).
Physiotherapy
passive and ideomotor exercises
combination of passive and active exercises
movements in the same joints of a symmetrical limb
FU in warm water on simulators
Watch for voluntary movements
selecting the optimal starting positions, and
strive to support the development of active movements

59. Neuritis of the facial nerve - acute development of paralysis or paresis of facial muscles

Neuritis of the facial nerve acute development of paralysis
or mimic paresis
muscles

60. 61. Clinic:

the affected side becomes flabby, lethargic;
blinking of the eyelids is disturbed, not completely
the eye closes;
the nasolabial fold is smoothed;
the face is asymmetrical, constricted into a healthy
side;
speech is slurred;
the patient cannot wrinkle his forehead, frown
brows;
there is a loss of taste, leprosy.

62. Tasks:

improvement of blood circulation in the face
(especially on the side of the lesion), neck and
the entire collar zone;
restoration of the function of mimic muscles,
impaired speech;
prevention of contractures and
friendly movements;
maximum possible recovery
facial symmetry

63. Exercise therapy technique

Position treatment
Adhesive tension
Physiotherapy

64. Treatment by position

During sleep:
i.p. - lying on the side (on the affected side);
Daytime:
total duration from 30-60 minutes (2-3 times per
day) up to 4-6 hours a day
sit for 10-15 minutes (3-4 times a day),
bowing his head in the direction of defeat, supporting
her back of the hand (with support on the elbow);
pull muscles from healthy side to side
lesions (from bottom to top) with a handkerchief,
while trying to restore the symmetry of the face.

65. Adhesive tension:

carried out within 8-10 hours.
carried out with healthy
side to the patient
anti-draught
healthy side muscles
strong fixation of free
the end of the patch to
special helmet-mask
(individually)

66. Therapeutic gymnastics

class duration - 10-12 minutes (2 times a day)
day)
FU are performed in front of a mirror, with the participation
exercise therapy instructor
isolated tension of mimic muscles
muscles of the healthy side and muscles surrounding
mouth gap.
self-study 2-3 times a day
Special exercises:
for training mimic muscles (raise eyebrows
up, frown, puff out cheeks, whistle, etc.)
to improve articulation (pronounce sounds,
sound combinations, words containing these
sound combinations, by syllables)
SU alternate with restorative and respiratory

67. Neuritis of the ulnar nerve

Causes:
nerve compression in the ulna
joint that occurs in humans, work
which is connected with the support of the elbows (about
machine, table, workbench)
when sitting for a long time, putting your hands on
chair armrests.

68. Clinic

the brush hangs down;
no supination of the forearm;
impaired function of the interosseous muscles of the hand,
due to which the fingers are claw-like bent
("clawed brush");
the patient cannot pick up and hold objects.
atrophy of the interosseous muscles of the fingers and muscles
palms on the side of the little finger;
hyperextension of the main phalanges of the fingers,
flexion of the middle and nail phalanges;
it is impossible to spread and adduct the fingers.

69. Treatment by position:

a splint is applied to the hand and forearm
the brush is given the position of the possible
extension in the wrist joint,
the fingers are given a bent position;
forearm and hand are hung on a scarf
in the position of flexion in the elbow joint (under
angle 80°)

70. Exercise therapy technique (on the 2nd day after bandaging).

passive gymnastics,
gymnastics in water;
massage
muscle electrical stimulation
When active movements appear:
active gymnastics
elements of occupational therapy (plasticine modeling,
clay),
learning to grasp small objects
matches, nails, peas, etc.).

71. 4.2 Exercise therapy for diseases of the central nervous system

72. The signaling system is a system of conditioned and unconditional reflex connections of the higher nervous system of animals (humans) and

Signal system
- this is a system of conditioned and unconditional reflex connections of the higher nervous system
animals (humans) and the environment.
The first is the sensation
perceptions, representations (signals
occur under the influence of the sense organs)
The second is the emergence and development of speech
(signals are converted to characters in direct
sense of the word).

73.

Second signal system
First signal system

74. Neurosis

is long and pronounced
deviation of the higher nervous
activities from the norm due to
overstrain of nervous processes and
changes in their mobility.

75. Reasons:

processes of excitation and inhibition;
relationships between the cortex and subcortex;
normal relationship 1st and 2nd
signal systems.
psychogenic disorders (experiences,
various negative emotions, affects,
anxiety, phobias (fears)
constitutional predisposition.

76. Clinic:

neurotic reactions usually occur
on relatively weak, but long-term
active stimuli that cause
to permanent emotional
voltage.
overexertion of major nerves
processes - excitation and inhibition,
excessive requirement for mobility
nervous processes.

77. Forms of neuroses:

1) neurasthenia
2) psychasthenia
3) hysteria

78.

Neurasthenia (asthenic neurosis)
- characterized by weakening
processes of internal inhibition,
increased mental and physical
fatigue, distraction,
decrease in performance.

79. Tasks of exercise therapy for neurasthenia:

active process training
braking;
normalization (strengthening)
excitatory process.

80. Exercise therapy technique for neurasthenia

in the morning hours
duration from 10 minutes to 15-20 minutes
to music: soothing, moderate and
slow tempo, combining major and
minor sound
minimum load increases
gradually.
simple complex coordination exercises
sports games with simplified rules
(volleyball, table tennis, croquet, golf,
small towns) or elements of various games
walks, hiking, fishing

81. Psychasthenia (compulsive disorder)

is the predominance of the 2nd signaling system with
congestive excitation in the cerebral cortex
brain.
Neurosis characterized by obsessive
conditions: self-doubt,
constant doubts, anxiety,
suspiciousness.

82. Tasks of exercise therapy for psychasthenia:

process activation
life;
"loosening" of the pathological
inertia of cortical processes;
bringing the patient out of the oppressed
moral and mental state,
facilitating communication with others.

83. Exercise therapy technique for psychasthenia

well-known exercises of an emotional nature,
performed at a fast pace without emphasis on accuracy
their implementation;
correcting errors by showing the correct
performance by any of the patients;
psychotherapeutic training, clarification of the importance
doing exercises to overcome feelings
unreasonable fear;
game method of conducting classes,
performing exercises in pairs;
the methodologist's voice and musical accompaniment should be
cheerful.
This category of patients is characterized by a slow pace: at first, from
60 to 120 movements per minute, then from 70 to 130 and on
subsequent classes - from 80 to 140. In the final part
classes, it is necessary to slightly reduce the load and its
emotional coloring.

84. Hysteria (hysterical neurosis)

is the predominance of the function of the subcortex and
influence of the 1st signaling system.
Impaired cortical coordination and
subcortex promotes increased
excitability, mood swings,
mental instability, etc.

85. Tasks of exercise therapy for hysterical neuroses:

decrease in emotional excitability;
development in the cerebral cortex
inhibitory process;
creation of sustainable calm
moods.

86. Method of exercise therapy for hysteria

the pace of movements is slow;
exercises for attention, accuracy of performance,
coordination and balance;
simultaneous execution of various movements
left and right hand or foot;
balance exercises, jumping, throwing,
whole combinations of gymnastic exercises.
games (relay races, towns, volleyball);
Methodist voice and musical accompaniment
should be calm (commands are slow,
smooth);
predominantly a method of explaining, not showing
exercises.

87. Questions for independent work:

1. Exercise therapy for brain disorders
blood circulation
2. Exercise therapy for injuries
peripheral nerves
3. Exercise therapy for myopathy.
4. Exercise therapy for cerebral palsy

Any motor act occurs when
transmission of impulses along nerve fibers
cerebral cortex to anterior horns
spinal cord and further to the muscles.
In diseases (injuries of the spinal cord)
nervous system conduction of nerves
impulses is difficult, and there is
dysfunction of the muscles.
Complete loss of muscle function
called paralysis (plegia), and
partial - paresis.

According to the prevalence of paralysis, there are:

monoplegia (lack of movement in one limb -
arm or leg)
hemiplegia (damage to the upper and lower limbs)
one side of the body: right-sided or left-sided
hemiplegia),
paraplegia (impaired movement in both lower
limbs is called lower paraplegia, in the upper -
upper paraplegia)
tetraplegia (paralysis of all four limbs).
Peripheral nerve damage causes paresis
in the zone of their innervation, called
of the corresponding nerve (for example, paresis of the facial nerve,
paresis of the radial nerve, etc.).

Nerves of the upper limb: 1 - radial nerve; 2 - musculocutaneous nerve; 3 - median nerve; 4 -
ulnar nerve.
I - brush with damage to the radial nerve. II - brush with damage to the median nerve.
III - hand with damage to the ulnar nerve

The rehabilitation regime should be
adequate to the severity of the disease, which
assessed by the degree of violation
adaptive activity.
The level of damage to the CNS is taken into account and
peripheral nervous system.
Factors such as the ability to
move independently,
serve yourself.

Exercise therapy in neurology has a number of rules

early use of exercise therapy;
the use of means and techniques of LG for
restoration of temporarily impaired functions or
for maximum compensation of lost;
selection of special exercises in combination with
general developmental, general strengthening
exercises and massage;
strict individuality of exercise therapy, depending on
diagnosis, age and gender of the patient;
active and steady expansion of motor
mode from the prone position to the transition to
sitting, standing, etc.

Special exercises can be conditionally divided into
the following groups:
exercises that increase joint range of motion
and muscle strength
recovery exercises and
improved coordination of movements;
antispastic and antirigid exercises;
ideomotor exercises (sending a mental impulse
to the muscle group being trained)
a group of exercises aimed at restoring or
development of motor skills (standing, walking,
manipulations with simple but important household
objects: clothes, utensils, etc.);
passive and stretching exercises
connective tissue formations, treatment
position, etc.

All of the above groups of exercises
combined in various combinations and
depends on:
nature and volume of motor
defect,
stage of rehabilitation
the age and sex of the patient.

Brain injury (concussion)

All brain injuries are
increased intracranial pressure.
For motor dysfunctions
prevention of contractures prescribe exercise therapy
(passive, then passive-active movements,
positioning, stretching exercises
muscles, etc.)
massage of the back and paralyzed limbs
(first massage the legs, then the arms, starting with
proximal parts)
and also affect biologically active
limb points.

Injuries of the spine and spinal cord

The clinical course of the disease depends on the degree
lesions of the spinal cord and its roots.
So, with injuries of the upper cervical region
spinal spastic tetraparesis occurs
limbs.
With lower cervical and upper chest localization
(C6-T4) flaccid hand paresis and spastic
paresis of the legs.
With thoracic localization - paresis of the legs.
With damage to the lower thoracic and lumbar
spinal segments develop flaccid paralysis
legs.

Flaccid paralysis can also be caused
be spinal cord injury
closed fractures of the spine and its
wounds.

methodical methods of LG

performance of ideomotor exercises;
isometric muscle tension;
water exercises;
choice of starting positions, facilitating
muscles to perform movements;
passive and active-passive
exercises;
use of various devices
reducing weight and friction (blocks and loops,
smooth surfaces, exercise in the water).

Seal

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