Exercise therapy for diseases of the nervous system. Features of the methodology and specificity of therapeutic exercises for flaccid peripheral paralysis using personal training at home

The congenital disease cerebral palsy is a paralysis of the central nervous system that can occur in a child due to damage to certain parts of the brain. Impaired motor functions may begin to progress in the prenatal or childbirth period, as well as in the first days of life. With cerebral palsy, spastic syndrome is often encountered - a painful increase in muscle tone and tendon reflexes. You can reduce the negative consequences of the disorder at home with the help of gymnastic exercises recommended for cerebral palsy.

Therapeutic effect of exercise

Therapeutic physical education (PT) helps you learn to control your body. By doing special therapeutic exercises for children with cerebral palsy, you can improve coordination, inhibition processes, and motor amplitude. The technique is an integral part of an integral complex aimed at reducing the manifestations of the disease caused by cerebral disorders.

Therapeutic effects of exercise therapy on the body:

1. Strengthens the tissues and organs of the child's body.
2. Activates weakened muscles.
3. Improves posture.
4. Normalizes metabolism.
5. Improves the functioning of the brain and circulatory system.
6. Promotes overall health.

With regular training, you can achieve the following results:

• developing the child’s necessary basic skills;
• mastering simple work activities;
• servicing yourself without outside help.

It is necessary to begin exercise therapy as early as possible, in the first days of life, gradually complicating the exercises. Moreover, physical education must be carried out if the newborn has no symptoms of cerebral palsy, but is predisposed to its development.

Basic principles of the technique

1. Physical therapy is based on a number of basic principles:
2. Classes are held regularly, without absences or long breaks.
3. Gradual increase in physical activity.
4. Individual approach.
5. Conducting classes taking into account the stage of the disease, age, and mental state.

Along with exercise therapy, correctional and educational measures must be carried out to compensate for functional impairments.

Types of exercises and features of classes

Any health-improving exercises should be selected taking into account the needs of each individual patient. However, each exercise program includes the following types of exercises:

• relaxing;
• helping to improve dynamics;
• stimulating motor activity;
• performed lying down;
• performed while sitting;
• having a gaming orientation.

If gait is difficult, or the patient is unable to walk, the exercise should be carried out near bars or rigid support. At the next stage, the lesson continues near the wall. In order for the center of gravity to be equally distributed on both sides of the body, actions are performed first with some limbs, for example, the right arm or leg, then with others. The weaker side is given a greater load. Squats should not be performed deeply; most often they are performed only at a distance from the knee to the foot (half squat).

Exercises for the development of the musculoskeletal system

If the central or peripheral nervous system is damaged, a disturbance in the movement of the upper or lower extremities may occur - tetraparesis. Appropriate gymnastic exercises can strengthen the motor skills of disabled children and increase the level of control over their actions.

Exercises that improve motor activity:

1. Starting position - sitting on your heels. The adult conducting physical therapy puts his palms on his shoulders, then holds the child in the hip area, gradually pushing him to kneel.
2. At first, the child sits on his lap. Holding him in the armpit area, you should start moving from side to side so that he learns to independently transfer his body weight to one leg. He tries to lift his other leg away from the fulcrum and spread his arms to the sides.
3. You need to turn to face the child sitting on the chair. An adult fixes his legs on the floor with his own and takes him by the hands. The arms are extended forward and upward, so the patient with cerebral palsy will learn to stand up on their own.
4. Starting position - standing, feet placed in one line (one after another). You need to take turns lightly pushing the little patient in the back, then in the chest. Such actions will teach him to maintain balance.
5. Starting position - standing. Holding the child by the hand, you need to swing him in different directions so that he tries to step on his own.

Position lying on your back, with a wall or other support nearby. We must try to press our feet onto a hard surface, training our ability to stand firmly on the ground.

Exercises to strengthen joints

With cerebral palsy, various joint pathologies, cramps and joint pain are common. Exercises necessary for their development:

1. The exercise is performed lying down. One leg needs to be straightened and fixed, the other should be gradually bent at the knee. If possible, the thigh should be pressed to the stomach, then pulled back.
2. While on your side and keeping your knee bent, you need to slowly begin to abduct your hip.
3. You need to lean your stomach against the table so that your legs can hang freely, then gradually straighten them.
4. The starting position is on your back. First you need to bend your knee, then straighten it as far as possible.
5. The starting position is lying on your stomach, with a cushion placed under your chest. Holding the patient's hands, you need to lift the upper part of the body, making slightly jerky springy movements.
6. The arm of a child lying on his back must be bent so that his face remains turned in the same direction. Then the limb bends when turning the head in the other direction.

Strengthening your abdominal muscles

As part of exercise therapy, classes are conducted that develop and strengthen a group of muscles located in the abdominal cavity:

1. The child needs to be placed on his knees, pressing his back to your chest, and then you need to bend down with him. In the next step, the legs and pelvic area of ​​the small patient are fixed so that he can rise on his own.
2. Starting position - lying on your back, arms pressed to your body. Making swinging movements and not helping yourself with your hands, you should try to roll onto your stomach and back.
3. Lying on your back, inhale and exhale, drawing in your stomach as you exhale.

Improved stretching

Activities that increase stretching and flexibility help achieve the following results:

• the severity of pathologies of the back and spine decreases;
• the condition of the spinal cord and spinal nerve endings improves;
• the muscles of the limbs are strengthened.

Sitting on the floor, you need to straighten your legs, while your body should form a right angle with them. While inhaling, you should extend your arms in front of you. As you exhale, you should try to bend down to reach your toes with your hands. An adult can help by lowering the body even further so that the forehead also touches the legs.

Starting position - on your stomach, arms extended along the body. The emphasis is placed on the palms, with a gradual rise of the chest. It is important to ensure that your head is thrown back and your breathing is even.

Lying on your back, your legs, without bending at the knees, are connected and raised above your head. You should try to reach the floor above the top of your head with your toes. Hands should not be lifted off the floor.

From a sitting position on the floor, bend your right leg so that your heel reaches your left thigh. The left foot should be on the right side of the other knee joint.

The right hand is moved around the left knee, it needs to hold the left leg. After performing these actions, the left hand is removed behind the back to the other side of the waist. At the same time, the head is turned to the left side, a tilt is made to touch the chin to the left shoulder. The right knee remains pressed to the floor.

Relaxation exercises

There are exercises for the upper and lower extremities:

1. To give your upper limbs a rest, you need to lie down, then fix your head, arm and leg on one side using weights, for example, sandbags.
2. The free arm is bent at the elbow joint, the forearm is held by the adult conducting the gymnastics. The hand must be fixed until the muscle tone decreases, after which the hand is shaken, then it must be alternately bent, rotated and moved to the side.
3. In the lying position, the fixed arms and legs are in contact with the stomach. An adult holds his shins, abducting his legs at the hip joint. After fixing one leg, you should make circular movements, trying to pull the leg. Legs need to be alternated.

Breathing exercises

All actions must be performed lying on your back, sitting down some time later, then moving to a standing position. Gymnastics that correct breathing:

1. The child needs to be shown how to take a deep breath and exhale through the nose and mouth. You can inflate balls, rubber toys, soap bubbles.
2. Different vowel sounds are pronounced at different volumes. You can alternate with singing and playing wind instruments.
3. On the count of one, raise your arms up and inhale; on the count of two, extend your arms down and exhale. The exercise will be more difficult if, as you exhale, your head plunges into the water.

Game exercises

Such elements of exercise therapy help maintain interest in the activity, while at the same time promoting relaxation. Game elements of exercise therapy:

Destroyer of towers. For this game, special soft modules or ordinary pillows can be used. If a child is able to build a tower, he does it himself; if not, adults help him. The main task is to destroy the tower.

Get out quickly. You'll need pillows again. This time the child lies on a gymnastics mat, the adult puts about 6 pillows on it and explains that on the count of three he needs to free himself.

Folding knife. Starting position - fetal position. The command is given: “the knife opens”: at the same time you need to pull your arms up and your legs down, remaining on your side. The action is performed at a measured pace. Then the “knife” must be folded. Slowly, the arms are pulled up to the chest, and the legs are pulled up to the stomach. The “knife” is complicated. The exercise is repeated three times on each side.

Sausage. The starting position is lying on your back. The adult carefully grabs the baby's ankles and begins to slowly turn the child in different directions. Gradually the pace accelerates.

Lion on the hunt. Good for group activities. Children sit on their heels with emphasis on their knees around a large soft module (you can purchase a special one or use gymnastic mats as an “island”). An adult tells a short story about a lion: “Once upon a time there lived a lion. He was brave and dexterous, and he also liked hunting. He waited in ambush for prey so that no one could see him (children should, without straining, group themselves with their heads on their palms pressed to their knees). Then he quietly crept (they show how a lion sharpens its claws and stretches its back) and jumped (they rise on their hands, helping themselves with their legs, and fall onto a soft surface).”

It is impossible to say in advance exactly when improvements will occur. Much depends on the degree of damage and how severe the spastic syndrome is. To achieve a significant reduction in the manifestations of cerebral palsy, exercise therapy with such children needs to be done regularly, gradually and listening to the personal needs of each of them.

- a pathological condition that is associated with weakness of certain muscles. The main reason for this is a disruption in the connections between muscle fibers and the nervous system. Moreover, paresis is not an independent disease, but a consequence of some pathology, for example, a stroke, spinal cord injury or injury.

Therefore, it should be understood that treatment of paresis should never be carried out separately from the treatment of the disease that caused this condition. Along with exercise therapy, for paresis of the lower extremities, the doctor prescribes medication, massage and physiotherapy.

Basic exercises

The exercises performed will depend on which muscles are damaged. However, there are a number of universal exercises that all patients with this diagnosis can perform.

1. Lying on your back. Raise your right leg and inhale, lower your right leg and exhale. Do the same movements with the other leg.
2. Also on the back. Bend one leg at the knee and pull it as tightly as possible into the chest. Remain in this position for a while, then extend your leg. Repeat with the other leg as well.
3. Lying on your back. Draw circles in the air, first with one leg, then with the other.
4. Raising and lowering your legs using a block. It is important to monitor your breathing. When raising your legs, inhale, and when returning to the starting position, exhale.
5. On the back. Turn the body to the right or left side, throwing the opposite leg to the side.
6. Imitate swimming - make movements with your legs as in the water when swimming breaststroke.
7. Lying on your back. Raise your leg and draw a circle in the air with your toe. Then repeat with the other leg.
8. Lying on your back, bend and straighten your toes. In this case, you must try to follow the sequence, that is, first bend the fifth finger, then the fourth, then the third, second and first. When extending, it is advisable to spread your toes.
9. Lying on your back. Pull your feet towards you. You can do it one at a time, or you can do it with both legs at the same time.
10. Turn your feet left and right. Can be performed both lying down and sitting.
11. Bend and straighten your legs at the knee.
12. Lying on your back. Pull the foot of your right foot toward you, the foot of your left foot away from you.

Do all exercises very slowly; if you feel unwell, it is better to cancel all exercises. To perform passive movements, you need to use additional devices. This may also require the assistance of an instructor. The total duration of classes should not be more than 15 - 20 minutes, for weakened patients and bedridden patients - no more than 10 minutes. Each exercise must be repeated 3 to 4 times. In this case, the patient should not experience fatigue, shortness of breath, or other signs that could adversely affect his health.

When to do it

The peculiarity of exercise therapy is that you can perform exercises at almost any time of the day. This could be morning exercises, which have a significant positive effect on the body. Moreover, if the patient cannot get out of bed, he can perform them while lying down.

This can be an independent activity, which can also be done at home.

These can be classes in specialized exercise therapy centers, under the supervision of an instructor. In this case, breathing exercises will be performed first, then the main ones, and the final part, which includes relaxation exercises.

This can be measured walking in the fresh air, or measured ascents and descents along specially laid routes.

Contraindications

Physical therapy may not always be prescribed for paresis of the limbs. This procedure, like many others related to human health, has its own contraindications, which must be remembered.

For example, the main contraindications should be considered lack of contact with the patient due to certain mental disorders. Classes cannot be conducted in case of infectious diseases or intoxication. You should also postpone exercises when the patient complains of pain.

Other contraindications include:

1. or risk of thrombosis.
2. Embolism or risk of embolism.
3. Bleeding or threat of bleeding.
4. Increased body temperature.
5. Increased ESR.
6. High blood pressure, especially when the numbers are 200 to 120 and above.
7. All malignant neoplasms.
8. Metastases.

This means that before you start exercising, you must consult with a specialist.

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INTRODUCTION………………………………...…………………………...….3

1. The concept of cerebral palsy, causes, classification……………………………………………………………………………….4

2. Therapeutic physical education and massage for cerebral palsy……………………………………………………………………………………….…..8

REFERENCES………………………….…………………..33

Introduction

Cerebral palsy (CP) is a serious disease of the nervous system, which often leads to disability of the child. In recent years, it has become one of the most common diseases of the nervous system in children. On average, 6 out of 1000 newborns suffer from cerebral palsy (from 5 to 9 in different regions of the country). In Moscow alone there are about 4 thousand such children.

Cerebral palsy occurs as a result of underdevelopment or damage to the brain in early ontogenesis. In this case, the “young” parts of the brain - the cerebral hemispheres, which regulate voluntary movements, speech and other cortical functions - are most seriously affected. Cerebral palsy manifests itself in the form of various motor, mental and speech disorders. The leading clinical picture of cerebral palsy is movement disorders, which are often combined with mental and speech disorders, dysfunctions of other analytical systems (vision, hearing, deep sensitivity), and convulsive seizures. Cerebral palsy is not a progressive disease. With age and treatment, the child's condition usually improves.

1. The concept of cerebral palsy, classification

Cerebral palsy is an organic brain lesion that occurs during fetal development, childbirth or the newborn period and is accompanied by motor, speech and mental disorders. Motor disorders are observed in 100% of children, speech disorders in 75% and mental disorders in 50% of children.

Motor disorders manifest themselves in the form of paresis, paralysis, and violent movements. Particularly significant and complex are disorders of tone regulation, which can occur such as spasticity, rigidity, hypotension, and dystonia. Violations of tone regulation are closely related to the delay of pathological tonic reflexes and the immaturity of chain righting reflexes. Based on these disorders, secondary changes are formed in the muscles, bones and joints (contractures and deformities).

Speech disorders are characterized by lexical, grammatical and phonetic-phonemic disorders.

Mental disorders manifest themselves in the form of mental retardation or mental retardation of all degrees of severity. In addition, there are often changes in vision, hearing, vegetative-vascular disorders, convulsive manifestations, etc.

Motor, speech and mental disorders can be of varying degrees of severity - from minimal to maximum.

The most severely affected are the “young” parts of the brain - the cerebral hemispheres, which regulate voluntary movements and speech.

The frontal lobe of the cortex has an anterior central gyrus, in which there is a motor zone with a strictly defined projection of parts of the body. It is the center of voluntary movements. In the anterior central gyrus, the pyramidal tract begins, which goes to the brain stem, partially crossing and descending into the spinal cord. Impulses of voluntary movement are transmitted along the pyramidal pathway. The extrapyramidal center of the cortex is located in the posterior parts of the frontal lobe. The extrapyramidal system provides automatic regulation of motor acts, maintains general muscle tone, redistributes it during movements, and participates in maintaining optimal posture.

In the middle frontal gyrus there is an oculomotor center that controls the friendly rotation of the head and eyes, which is especially important in the formation of orienting reflexes.

Praxis centers are located in the parietal lobe. Praxis is an automated, purposeful movement that is developed through learning and constant practice throughout life, for example walking, eating, dressing, writing, and labor. Praxis is the highest manifestation of human motor functions.

The cerebellum is connected to other parts of the central nervous system by three pairs of peduncles, which contain pathways. The cerebellum ensures the accuracy of targeted movements, coordinates muscle activity, regulates muscle tone, and maintains balance. The cerebellum is closely connected with the vestibular apparatus, reticular formation and cortex. In this case, the cortex performs the main regulatory function, since all information from conductors and sensory organs is received and processed in the cerebral cortex.

According to K.A. Semenova (1999), the incidence of cerebral palsy in Russia in 1962 was 0.4 per 1000 children, in 1972 - 1.72, in 1982 - 5.6, and in 1992 - 9 per 1000 people children's population.

Cerebral palsy was described in the works of Hippocrates and K. Galen. However, the founder of the study of the problem of cerebral palsy is the English orthopedic surgeon Little (1862). Subsequently, the spastic diplegia he described in detail began to be called Little's disease.

In our country they use the classification of K.A. Semenova (1978); The following forms are distinguished:

Spastic diplegia;

Double hemiplegia;

Hyperkinetic form;

Hemiparetic form;

Atonic-astatic form.

Spastic diplegia is the most common form of cerebral palsy. This is usually tetraparesis, but the legs are more affected than the arms. A prognostically favorable form in terms of overcoming speech and mental disorders and less favorable in motor terms. 20% of children move independently, 50% - with help, but can serve themselves, write, and manipulate their hands.

Double hemiplegia is the most severe form of cerebral palsy with total damage to the cerebral hemispheres. This is also tetraparesis with severe lesions of both the upper and lower extremities, but the arms “suffer” more than the legs. Chain righting reflexes may not develop at all. Voluntary motor skills are severely impaired, children do not sit, do not stand, do not walk, and hand function is not developed. Speech disorders are severe, based on the principle of anarthria, in 90% of cases there is mental retardation, in 60% there are convulsions, children are unteachable.

The prognosis for motor, speech and mental development is unfavorable.

The hyperkinetic form is associated with damage to the subcortical parts of the brain. The cause is bilirubin encephalopathy (incompatibility of the blood of mother and fetus according to the Rh factor).

Motor disorders manifest themselves in the form of hyperkinesis (violent movements), which occur involuntarily, aggravated by excitement and fatigue. Voluntary movements are sweeping, uncoordinated, writing and speech skills are impaired. In 20-25% of cases, hearing is affected, in 10% convulsions are possible. The prognosis depends on the nature and intensity of hyperkinesis.

Hemiparetic form - affects the arms and legs on one side. This is due to damage to the cerebral hemisphere (with right-sided hemiparesis, the function of the left hemisphere is impaired, with left-sided hemiparesis, the function of the right).

The prognosis for motor development with adequate treatment is favorable. Children walk on their own, learning ability depends on mental and speech disorders.

The atonic-astatic form occurs when the function of the cerebellum is impaired. In this case, low muscle tone, imbalance at rest and walking, and impaired coordination of movements are noted. Movements are disproportionate, irregular, self-care and writing are impaired. In 50% of cases, speech and mental disorders of varying severity are noted.

More than 400 factors can cause a damaging effect on the central nervous system, but this effect is especially dangerous before the 3-4th month of pregnancy. All unfavorable factors disrupt the uteroplacental circulation, causing oxygen starvation of the fetus - chronic hypoxia. The development of the central nervous system under conditions of chronic hypoxia is impaired. This is the influence of intrauterine factors. During childbirth, the cause of damage to the central nervous system (CNS) is asphyxia and cerebrovascular accident. After childbirth, the cause of damage to the central nervous system is most often neuroinfection (meningitis, encephalitis) and head trauma. Thus, cerebral palsy is a polyetiological disease of infectious, intoxication, inflammatory, toxic, radiation, environmental, traumatic and other origin.

Physical therapy for cerebral palsy can help people live normally, because cerebral palsy is the most severe disorder of motor function that can arise for a variety of reasons, of which there are approximately four hundred. With cerebral palsy, muscle tone and coordination are impaired. Cerebral palsy makes people disabled.

Cerebral palsy occurs in children under three years of age. The statistics are very sad: most children do not live to an older age. But still, if you start taking some measures to treat paralysis in time, the child will have a chance for a good future.

Necessary for many years. The treatment itself is aimed at restoring the functions of the motor system and remembering basic movements. This is very, very hard work for mom and dad, as well as for the child himself.

It is impossible to cure this disease with medications alone. It is necessary to constantly engage in physical therapy, which will allow the baby to learn to move correctly. Physical therapy for cerebral palsy gives a positive result in any case. Parents of children suffering from cerebral palsy must decide on the age at which it is necessary to carry out various exercises for cerebral palsy. The answer is very simple: from birth, but under the careful supervision of a doctor.

The influence of exercise therapy on children's health

Therapeutic exercise has a positive effect on the human body. It stimulates the tissues and muscles in the body to strengthen. Metabolic processes are regulated in the body. The activity of the brain and cardiovascular system improves greatly.

But it is worth remembering that physical therapy alone is unable to cope with such a serious disease as cerebral palsy. It is necessary to create a holistic complex, which will include massage, physical therapy, manual therapy, and various hardening of the body.

An individual set of exercises is developed for each child. All complexes include the following types of exercises: with a ball, in a lying and sitting position, relaxation exercises, stimulating exercises.

Tips and recommendations regarding the correct performance of physical therapy

Absolutely all methods when performing physical therapy for cerebral palsy have general recommendations. Classes must be systematic; they must be conducted regularly and continuously. Only such a gymnastics schedule will help achieve a good positive result. A set of exercises should be selected individually by a qualified specialist for each small patient.

In this case, it is necessary to take into account the complexity of the disease and all the features of the course of the disease. Physical activity should gradually increase.

Exercises for children who have cerebral palsy should develop absolutely all muscles and joints. To do this, the gymnastics complex should include the following exercises:

• for muscle stretching;
• to develop muscle strength and sensitivity;
• to develop the sensitivity of the nervous system;
• to strengthen the main muscle groups that take part in all movements;
• so that all organs have good endurance;
• to relax muscles, relieve cramps and spasms;
• to teach a child to walk correctly;
• so that the senses are developed;
• to improve the patient's balance and sense of support.

Exercises to do to develop movement skills

The most common form of cerebral palsy is atonic. It manifests itself in the fact that the child has severely impaired coordination and low muscle tone. With this form of paralysis, special attention must be paid to those activities that can strengthen the muscles, especially the muscles of the trunk. After all, it is the muscle corset that is the main core of the human motor system as a whole.

In this case, elementary exercises are effective, for example, raising and lowering the torso from the starting position lying on your back. You can also perform these movements while lying on your stomach. You can do a variety of bends from a sitting position. From the same position you can try to make circular turns of the body. This complex can also include exercises that will strengthen your arms and legs.

It is necessary to understand that cerebral palsy also affects the functionality of the child’s brain.

Therapeutic exercise should help the brain learn to be responsible for those movements that directly depend on its work: movements of the arms and legs, crawling on all fours, squatting, running, walking. The development of the areas of the brain responsible for these movements is achieved through regular, repeated repetition of the same actions.

As a result, a “feeling” effect occurs, after which you can perform a number of specific exercises:

1. Starting position: the child sits on his heels. You need to stand in front of the baby, take his hands and put them on your shoulders. Having secured the child in the pelvic area, begin to place him on his knees.
2. Starting position: the child is on his knees. It is necessary to support the baby under the arms. Transfer the weight of his body from one leg to the other, alternately lifting them off the floor.
3. Starting position: the child sits on a high chair. Take the baby by the hands and fix his legs on the floor. Encourage your child to stand up by pulling his arms up and forward.
4. Starting position: the child stands with one leg extended forward. It is very easy to push the baby in the back and chest to develop balance skills.
5. Starting position: the child is standing. Take him by the hands and push him in different directions so that he can take a step on his own.
6. Starting position: the child lies on his back. The baby's support ability improves if the child presses his feet on some hard surface.

Exercises used to develop joints

1. Starting position: the child lies on his back. One leg must be kept in an extended position, and the other must be bent. It is advisable that the thigh reaches the stomach.
2. The child lies on his side. Bend the child's leg at the knee and gently move the hip away.
3. The child lies on his stomach on some surface with his legs hanging down. The limbs must be straightened very slowly.
4. The child lies on his back. You need to bend and straighten your baby's knees.

Additional exercises

Exercises that train the abdominal muscles:

1. Starting position: place the child on your lap. Press his back to you. Bend over with your baby, but he must climb up on his own.
2. Starting position: the child lies on his back with his arms pressed to his body. The baby should try to roll over from his back to his stomach, without using his arms.
3. Starting position: the child lies on his back. It is necessary to take a deep breath, and as you exhale, the baby should pull in his stomach.

A set of stretching exercises:

1. The child is sitting on the floor. Stretch your legs forward, your back is straight. Stretch your arms forward parallel to your legs. The baby should take a deep breath, and as he exhales, bend over and touch his toes with his fingers.
2. Starting position: the child lies on his stomach with his arms outstretched. Focusing on the palms, the baby should raise the upper body above the floor.

As for exercises for the development of fine motor skills, here it is simply necessary to rotate the child’s hand in different directions.

Exercises with the ball:

1. It is necessary to place the child with his back to the ball. The legs should rest on the toy. Place the child in the center of the ball and roll it back a little. This exercise develops balance well.
2. Place the child with his stomach on a ball that is suitable for the baby in size. Hands should be extended forward. Hold the child by the hips and push the ball forward a little.
3. If you put the baby on a ball and easily rock it back and forth, muscle tone is greatly reduced.

Walking development exercises:

1. Hold your child by the hips and stand behind him. Gradually turn your baby's hips in different directions to encourage him to take an independent step.
2. Help your child do squats - 50 per day.

An excellent assistant is a special device called a verticalizer. It can hold the baby in a standing position. It is simply irreplaceable during training or when preparing a child to independently perform basic functions. The verticalizer fixes the child’s torso, and, if necessary, his feet and knees.

Unlike spastic paralysis, flaccid paralysis is characterized by more profound dysfunction of the motor system. Patients cannot move independently. The muscle tone of paretic limbs is sharply reduced, they are flabby and atrophic. While passive movements are maintained, active ones are difficult to carry out due to muscle weakness. Deep trophic disturbances are characteristic. Therapeutic effects should include, along with stimulation of the neuromuscular system, improved nutrition of the tissues of paretic limbs. For this purpose, massage is introduced into the physical therapy complex. A deep massage is used using kneading, vibration, effleurage, as well as a stimulating acupressure technique. With flaccid paralysis, passive movements are combined with massage and active restorative movements, with paresis - with active movements for paretic limbs.

Passive exercises for flaccid paralysis, along with massage, help restore active movements. Active exercises are most important for restoring the function of movement and support. When an active impulse to movement appears, one should strive to systematically evoke it, using the sending of impulses to contract paretic muscle groups. When a motor reaction appears, the most basic exercises are prescribed in the most favorable starting positions.

Assisted movements are widely used. At first, the movements are performed in the horizontal plane, and as the motor function increases, they are performed in the vertical plane, which makes it possible to include the heaviness of the limb being exercised. For flaccid paresis of the upper limbs, it is advisable to use swinging movements of the entire limb in different directions. To complicate the exercises with a paretic hand, grab (or tie to it) a light dumbbell or mace. It is advisable to carry out the exercise of the hands and fingers with a stable support of the forearm (sitting at a table). Generally accepted exercises for the hand and fingers are used using small equipment.

With flaccid paresis of the lower extremities, movements that promote the development of support function are indicated. Patients with pelvic organ dysfunction should include exercises that improve blood and lymph circulation in the pelvic area and strengthen the pelvic floor and sphincter muscles. For flaccid forms of paralysis, restorative gymnastics is important. It is especially important to pay attention to the compensatory development of the muscles of the upper limbs and shoulder girdle, which bear the main load when patients move on crutches.

In table 8 shows an approximate diagram of therapeutic exercises for flaccid spinal paralysis.

Guidelines: the choice of positions and movements, as well as the method of their use, are determined by the clinical picture (spastic, flaccid forms, disorders of the pelvic organs). In case of loss of function of individual muscle groups, the method of physical therapy is the same as for damage to peripheral nerves. Massage treatment. Repeating the therapeutic exercise procedures in the afternoon under the supervision of the ward nurse.

Demidenko T. D., Goldblat Yu. V.

"Therapeutic exercise for flaccid paralysis" and others