Arising as a result of restriction of active movements due to impaired innervation of the corresponding muscles. In other words, paresis is a partial loss muscle strength. Unlike other movement disorders, paresis is characterized by the fact that it affects the central and peripheral nervous systems, resulting in weakening of motor function. Thus, paresis occurs as a result of damage to the motor nodes of the spinal cord and/or brain, as well as nerve fibers of the peripheral or central nervous system. Like paralysis, paresis can be central or peripheral.
Paresis that is caused by damage to the peripheral nervous system (peripheral paresis) is characterized by a weakening of tendon reflexes on the part of the paresis, as well as a decrease in tone and muscle atrophy and involuntary contractions of some muscle fibers.
As for central paresis, due to damage to the central nervous system, tendon reflexes on the side of the paresis are significantly enhanced. In this case, an increase in muscle tone and an increase in the intensity of deep reflexes are observed, pathological reflexes and friendly movements appear (for example, when a person squeezes a healthy hand, the diseased hand performs similar actions, but with less force), and also when muscles are exposed to convulsive movements. abbreviations.
Depending on the severity, there are mild and moderate paresis, deep and complete (paralysis). Based on location on the body, paresis is divided into paresis of one muscle, paresis of a limb, paresis of a part of a limb, paresis of a muscle group, as well as akinetic mutism, paraparesis and paraplegia, biparesis and biplegia, triparesis and triplegia. Among other things, paresis can be psychogenic, peripheral, central and mixed. In order to assess the severity of paresis, it is conventional to use a special scale - from 0 to 5 points, reflecting a decrease in muscle strength.
1) 5 points - normal muscle strength
2) 4 points - the patient is able to lift a limb, while overcoming slight resistance
3) 3 points - the patient can lift a limb only if there is no resistance to him.
4) 2 points - the patient is capable of movements only in the horizontal plane
5) 1 point - the patient can perform active movements of only very small amplitude
6) 0 points - no movement.
Paresis can be either congenital or acquired. The most common paresis are considered congenital paresis hands, and only one. Such paresis usually occurs due to the fact that the child’s brachial plexus is affected during birth. In this case, there is a complete lack of movement or they are limited. It should also be noted that in children who have a congenital malformation of any part of the central nervous system, in some cases there are unilateral paresis of the legs and arms or only the legs. Sometimes children who were born with brain damage develop paresis as they grow older, around the second year of life.
Acquired paresis, as a rule, develop as a result of some previous disease and in almost all cases are associated with disturbances in the functioning of the peripheral or central nervous system - polyneuritis, hereditary diseases, encephalitis, tumors of the nervous system, .
Depending on which nerve centers or fibers are affected, the functions of both individual muscles and their groups may be impaired. Paresis can occur in both skeletal muscles and muscle membranes internal organs: intestines, bladder, blood vessels.
In general, all paresis can be divided into two large groups. The first group includes organic paresis, and the second group includes functional paresis. With organic paresis, it is possible to find out the organic cause of the paresis, which provokes the fact that the nerve impulse will not reach its main target - the muscle. And with functional paresis, disturbances in the processes of excitation, inhibition, as well as balance and maneuverability that occur in the cerebral cortex are observed.
As a rule, paresis is manifested by three main signs:
- increase muscle tone- hypertonicity
- increased reflexes - hyperreflexia
- the appearance of pathological reflexes and accompanying movements.
All these negative manifestations are present when the activity of the spinal cord is activated. According to the degree of prevalence, paresis is divided into:
1
.
Monoparesis- when one limb is paralyzed.
2. Hemiparesis- when half of the body is paralyzed.
3. Paraparesis- paralysis of two symmetrical limbs, upper or lower.
4. Tetraparesis- paralysis of all four limbs.
Monoparesis is associated with damage to the peripheral nervous system, with pain and decreased sensitivity.
Hemiparesis can occur as a result of stroke, encephalitis, hemorrhage into a tumor, brain abscess, multiple sclerosis, and migraine.
The cause of paraparesis is a lesion thoracic spinal cord, spinal stroke, infectious or post-infectious myelitis, as well as paraparesis can develop as a result of damage to the parasagittal zone of the brain, ischemia in the anterior cerebral artery, thrombosis of the superior sagittal sinus, tumor, acute hydrocephalus.
Tetraparesis can result from bilateral lesions of the cerebral hemispheres, brainstem or upper cervical spinal cord lesions. Acute tetraparesis, as a rule, is a manifestation of stroke, trauma, and metabolic disorders.
Treatment of paresis.
Before talking about the treatment of paresis, it must be emphasized that paresis, like paralysis, are not independent diseases, but, as a rule, become a reflection of other diseases and pathologies. Therefore, first of all, the treatment of paresis must be causal, that is, directed against the underlying disease, for example, this could be suturing a peripheral nerve in case of injury, rehabilitation therapy after a stroke, surgical intervention when tumors are detected that compress the nerve structures, etc. But in addition to this, massage must be carried out, since the muscles atrophy without movement.
Massage used in the treatment of paresis leads to improved trophism and the development of nerve impulses. If muscle activity persists, the patient must also undergo special gymnastics in combination with massage, while the load should gradually increase, and movements with resistance are performed to increase the volume and strength of the muscles. When treating paresis, it is necessary to combine massage with heat. As mentioned above, this improves tissue nutrition and promotes the formation of active nerve impulses. However, it must be remembered that massage used for peripheral paralysis must be strictly dosed.
Treatment of paresis is carried out under the supervision and prescription of a doctor and, as a rule, begins with the treatment of diseases of the circulatory system, as well as with the treatment of the central or peripheral nervous system, of which they are a complication. Elimination of limb function disorders as a result of the development of paresis begins with placing the affected arm or leg in a correct position. For the arm, this position is slight flexion at the elbow joint, extension at the wrist joint and slight flexion of the fingers, and for the leg - moderate flexion at the knee joint, dorsiflexion of the foot, preventing it from sagging. At the same time, you need to make sure that the leg and foot are not turned outward. In order to maintain the correct position of the limb, soft rollers (made of tightly twisted cotton wool covered with fabric) or splints made of plastic materials are used. But it is important to take into account the fact that the affected limb should not remain immobilized. For this purpose, passive therapeutic exercises for paresis begin from the very first days - alternate bending and extension of the joints of the sore arm or leg. This gymnastics can be performed by the patient himself, but he must first receive precise instructions from the doctor, especially with regard to paresis of the arm. The restoration of movements is also facilitated by such exercises for paresis, during which the patient tries to simultaneously move both the healthy and the diseased limb. When movements appear, we must strive to increase their volume. So, every day the patient should try to move at least 1-2 cm more than the previous day. As muscle strength increases, exercises with moderate load- rubber band, expander, rubber ball for hand exercises. Only such a gradual increase in load leads to good results. Whereas a hasty transition to excessive exercises is harmful and slows down recovery. An exercise program for paresis is drawn up by a physical therapy methodologist. In order to make it easier for the patient to move in weak limbs, orthopedic devices are used.
Exercise therapy for paresis.
Physical therapy for paresis It is usually carried out simultaneously with massage, drug treatment and physiotherapy.
The complex of exercise therapy for paresis includes treatment with position or postural exercises. These exercises involve special positioning of the body or limbs using various devices. One type of positional treatment is orthostatic gymnastics for paresis. Such gymnastics is very effective in the early postoperative period and during long-term bed rest. Its essence lies in the fact that the patient gradually assumes a normal vertical position with the help of a special turntable, on which it is fixed with seat belts. The table has a precise graduation of the rotation angle. Therapeutic exercises for paresis possible even with deep paresis of the legs and trunk muscles. Orthostatic gymnastics Exercise therapy for paresis allows the patient to be in a semi-vertical and vertical position, and this is of great importance for improving the function of the bladder, because in this case the normal urge to urinate arises in the vertical position. Also, thanks to orthostatic gymnastics, the function is trained vestibular apparatus, cardiovascular system, especially the vessels of the legs, which prevents thrombophlebitis and other vein pathologies. The entire musculoskeletal system is trained - bones, ligaments, joints, muscles. At the same time, a distracting effect occurs: pain, dizziness, nausea, palpitations decrease, and a decrease in blood pressure, in the event that it has been increased. With all this, important role plays the psychological state of the patient, who has the opportunity to be in an upright position and see the world around him in the room and outside the window from his usual position. Orthostatic gymnastics is effective method smooth transition from bed rest to standing and walking. It can be performed 2-3 times a day.
Among the physical therapy exercises for paresis, there are also groups aimed at eliminating atonic and spastic paresis.
As a rule, there are 4 stages in conducting physical therapy after surgery for spastic paralysis and paresis. The first stage is the early postoperative stage (from the 2nd to the 10-12th day after surgery), the second stage is the late postoperative stage (12-20th day), the third stage is the actual recovery stage (starts on the 20th day and ends on the 40th day). -m) and, finally, the fourth stage - residual or residual (after the 40th day). Each stage has its own tasks.
The task of the first stage is to create the functional basis that is necessary to eliminate movement disorders in the future. Removal of sutures usually coincides with the end of the first stage.
At the second stage, basic motor skills are restored - sitting, standing, walking with the help of special devices, on parallel bars or in an arena.
At the third stage of exercise therapy for paresis, general strengthening exercises are performed that are aimed at improving functional state respiratory and cardiovascular systems. These exercises for paresis are aimed at eliminating coordination problems, strengthening muscle strength, developing basic methods of movement, as well as the skills necessary for self-care.
The fourth stage is carried out at home. The program for it is drawn up at the end of the third stage, and it is necessary to take into account the patient’s condition.
At each stage, a certain time is devoted to performing different types of exercises. So, at the first stage, the main time is spent on breathing exercises - up to 70% of the total time. General strengthening gymnastics makes up 20% of the time, and special gymnastics – 10%. In the second stage, about 45% of the time is spent special gymnastics, restorative is 30%, respiratory – 15%. At this stage, the use of applied skills is introduced, which is approximately 10% of the total time. By the third stage, breathing exercises can make up 5% of the time, general strengthening exercises - 10%, applied skills are given 20% of the total time, and at special exercises spend 65% of the time. The fourth stage can take place without completing breathing exercises unless there are special indications for this. At this stage, the greatest attention is paid to the development of applied skills, which accounts for 45% of the total time, 30% of the time is occupied by general strengthening exercises, and 25% by special ones.
Thus, in the treatment of spastic paresis, the main methodological techniques therapeutic exercises are aimed at reducing pathologically increased muscle tone, increasing muscle strength (which means reducing the degree of paresis), preventing and eliminating pathological concomitant movements, as well as restoring household and professional skills.
Prevention of paresis consists mainly of preventing those diseases and injuries that may be complicated by their development. Particular attention should be paid to vaccinating children against polio.
Finally, I would like to emphasize that the human body is an intelligent system that can itself cope with many diseases. After all, science has long proven that the brain uses only 20% of its capabilities, and when some parts of the brain are damaged, others are able to take over its functions. The most important thing is to be able to apply these reserves and use them correctly. Thus, when a person recovers, his desire and true faith in healing play a big role.
Exercise therapy for paralysis.
Paralysis- is the loss or impairment of movements in one or more parts of the body, caused by damage to the motor centers of the spinal cord and brain, as well as the pathways of the central or peripheral nervous system.
Paralysis is not a separate disease and does not occur due to any one factor; it is a symptom of many organic diseases of the nervous system. Thus, any damage to the nervous system can cause disruption of the body’s motor function.
The cause of paralysis can be: circulatory disorders, inflammatory processes, injuries, tumors of the nervous system. Also, a special type of paralysis can be observed during hysteria.
Causes of paralysis.
Paralysis should be distinguished from movement disorders that occur due to muscle inflammation or damage to the musculoskeletal system, which mechanically limit the range of movements. Paralysis can be observed in one muscle, one limb (monoplegia), in the arm and leg on one side (hemiplegia), in both arms or both legs (paraplegia), etc.
Injuries, multiple sclerosis, infections, intoxications, metabolic disorders, nutritional disorders, vascular lesions, malignant neoplasms, congenital or hereditary factors - all of this refers to organic causes of paralysis. Paralysis also often develops with infectious diseases such as syphilis, tuberculosis, polio, viral encephalitis, and meningitis. Toxic or nutritional causes include beriberi disease (vitamin B1 deficiency), pellagra (niacin deficiency), alcoholic neuritis, and heavy metal poisoning (particularly lead). Congenital, hereditary and degenerative diseases of the central nervous system are also usually accompanied by movement disorders.
Also, paralysis can occur due to birth trauma - this is also paralysis due to injury brachial plexus. In addition, a number of diseases of unknown etiology (for example, multiple sclerosis) are characterized by motor disorders of varying degrees. Injuries, such as wounds and fractures, can have the same consequences if they are associated with damage to the motor pathways or directly to the motor centers. It must be said that in many cases, paralysis is of a psychogenic nature and is a manifestation of hysteria - such patients can benefit from treatment with a psychiatrist ra.
The variety of causative factors cannot but be reflected in pathomorphological changes, which in turn can have a very different character and location. Pathological changes in nervous tissue such as destruction, degeneration, inflammation, formation of lesions (plaques), sclerosis, demyelination are the most typical variants detected during paralysis. From an anatomical point of view, a distinction is made between paralysis caused by damage to the central nervous system (brain or spinal cord) - spastic paralysis, and paralysis associated with damage to peripheral nerves (flaccid paralysis). The former, in turn, are divided into cerebral and spinal types. Cerebral palsy can be of cortical, subcortical, capsular or bulbar origin. Spinal paralysis is a consequence of diseases affecting the central and/or peripheral motor neurons. Peripheral paralysis can occur when nerve roots, plexuses, nerves or muscles are affected.
Central paralysis is characterized not by a complete loss of motor functions, but by their dissociation - the loss of some and the strengthening of others. With central paralysis, the motor function of the body as a whole usually suffers, but not individual muscles. Paralyzed muscles are spastic (convulsively tense), but do not undergo atrophy (it can only be a consequence of inactivity), and there are no electrophysiological signs of degeneration. In paralyzed limbs, deep tendon reflexes are preserved or enhanced, and clonus (rapid spastic contractions) are often detected. Abdominal reflexes on the paralyzed side are reduced or absent. For paralysis lower limbs there is such a sign of damage to the brain or spinal cord as the Babinski reflex (dorsiflexion thumb foot in response to irritation of the outer edge of the sole).
With peripheral paralysis, there is a complete lack of movement; instead of increasing muscle tone, it decreases. Are affected individual muscles, in which atrophy and electrophysiological reaction of degeneration are revealed. In a paralyzed limb, deep reflexes are reduced or completely absent, and clonus are absent. Abdominal reflexes are preserved, and the Babinski reflex is not evoked. Also, with damage to the peripheral nerve or plexus, which contains both motor and sensory fibers, sensitivity disorders are also detected.
The main cause of central paralysis is stroke. Therefore, the treatment of stroke will simultaneously be the treatment of paralysis. It should be noted that the density of nerve conductors in different parts of the brain is not the same: somewhere they are extremely concentrated, and somewhere their density is quite low. Therefore, there are often cases when a defect in brain tissue of significant size leads to minor motor disorders (paralysis and paresis), and a small defect causes deep disability in a person. The internal capsule contains all motor conductors in a concentrated form, and damage to this capsule leads to paralysis of the entire opposite half of the body.
Paralysis may manifest itself as the absence or impairment of spontaneous movements or decreased muscle strength, which is revealed upon examination. Paralysis is also characterized by the inability to perform a movement against the doctor’s resistance or hold a certain position for a long time, resisting gravity, for example, outstretched arms or raised legs (Barre test).
As a result of damage to the subcortical structures of the brain, extrapyramidal paralysis occurs, friendly and automated movements disappear, and motor initiative is absent (akinesis). Muscle tone is characterized by plasticity - the limb is held in a passive position given to it.
Diagnosis of paralysis includes examination by a neurologist, x-ray, myography, and neurosonography. Reflexes from the lower extremities are also checked: knee reflex, Achilles reflex, Jendraszek maneuver, plantar reflex.
As for the treatment of paralysis, before considering it, it is necessary to emphasize the fact that paralysis is not an independent disease, it is a reflection of other diseases and pathological processes. Therefore, treatment must first of all be causal, that is, it must be directed against the underlying disease: suturing a peripheral nerve in case of traumatic damage, restorative therapy for stroke, surgical removal of tumors compressing nerve structures, etc. But along with causal therapy, symptomatic therapy is also necessary, since this is a significant additional and necessary preventive measure, because without movement, muscle tissue atrophies. Special methods are used to restore limb function, such as massage for paralysis, exercise therapy for paralysis, therapeutic exercises for paralysis etc.
The leading role in symptomatic treatment is played by physical therapy
, which helps restore movement and prevents the appearance of contractures and deformities.
Exercise therapy complex for paralysis consists of the following elements:
- placing the paralyzed limb in the correct position
- massage
- passive movements
- active movements.
With central paralysis, the limbs must be given a special position that prevents the formation of contractures. Starting from the second week, the patient is prescribed a massage. Muscles with increased tone are lightly stroked. The remaining muscles are massaged using the usual techniques; of course, it is necessary to take into account the state of the paralyzed person. In conjunction with these events, it is held therapeutic exercises which should include active and passive exercises for paralysis.
Passive movements should begin depending on the patient’s condition, preferably at the end of the first week. At first, exercises are limited to a few minutes. Exercises are performed at a slow pace and in full in all joints of the paralyzed limbs. With the help of these exercises, they also try to prevent incorrect positions of the limbs - excessive flexion, adduction or extension.
Therapeutic exercises for central paralysis:
1. Passive shoulder movements
2. Passive abduction of the shoulder forward, upward and to the side
3. Extension of the arm at the elbow joint with abduction of the straightened arm to the side
4. Extension elbow joint in the position of supination and external rotation of the shoulder
5. Supination and pronation of the forearm
6. Rotation of the femur at the hip joint
7. Hip adduction and abduction
8. Flexion of the knee joint with the hip extended while lying on the side
9. Passive flexion and extension of the leg at the knee joint
10. Passive movements in the ankle joint
11. Holding the affected hand in its given position
12. Keeping the affected foot in its assigned position
13. Easier raising and lowering of the affected arm with the healthy arm using a cord and a block (the exercise can be combined with abduction and adduction of the arm in an elevated position)
14. Easier raising and lowering of the affected leg by hand using a cord and a block
As for active exercises, their choice in each individual case depends on the group of affected muscles.
Starting from the 2nd - 3rd week (for weak and elderly patients this should be done more gradually), the patient should be transferred to a semi-sitting position for 1-2 hours a day.
By the end of the 3rd – 4th week, you can spend most of the day in a comfortable chair.
When learning to walk, it is necessary first of all to teach the patient to step on the paralyzed leg. In this case, you need to pay attention to correcting the abnormal position of the flexors and muscles that rotate the leg outward.
When walking, it is necessary to lift the paralyzed leg high using the pelvic muscles so as not to touch the floor with the toe. At first, the patient can walk with outside help, and then - leaning on a stick.
With peripheral paralysis in the first days, the limbs and torso are also given a position that subsequently prevents the development of contractures. Perhaps the massage begins a little earlier, which should also be selective. Paretic muscles are massaged using all techniques, while antagonist muscles are only stroked. Simultaneously with the massage, passive movements begin to be performed. As movements appear, active exercises are gradually added. Gymnastics in the pool, as well as in a bath with warm water, is very useful.
Drug treatment is carried out as prescribed and under the supervision of a neurologist. Medicines used for paralysis include: prozerin, dibazol, intramuscular injections of thiamine chloride. For paralysis with increased muscle tone - melliktin.
It should be noted that now in Western medicine the following method of treating paralysis is gaining momentum: by mobilizing the patient’s inner will, with the help of a mirror or videos, the patient is given “mirror therapy,” which consists of presenting the patient in front of a patient suffering from partial or complete paralysis of one of the arms , place the mirror with its edge to the vertical axis of the body, and the reflective surface towards the healthy arm. The patient looks in the mirror towards his sore arm, and sees his healthy arm in it. In this position, at the doctor’s command, the patient tries to perform synchronous movements with both hands. In the event that the patient suffers from complete or partial paralysis, the doctor standing behind the mirror helps the paralyzed arm perform synchronous movements in relation to the healthy arm. Thus, the patient is created with the illusion of a healthy hand, and this helps him to activate his internal forces to control the diseased hand.
Another similar method consists of watching videos that record the movements of the patient's hands in front of a mirror, which is located in the same way as in the experiment described above. When watching such a video, thanks to a healthy mirrored hand, the patient gets the impression of synchronous movement of both hands. The patient looks at himself on TV as if from the outside, and tries to imagine that both his hands are healthy. After watching the video, the patient tries to repeat his own movements seen on TV. Then he watches the video again and again tries to perform the movements he saw. That is, in this case, as in the “mirror method,” doctors are trying to mobilize the power of the patient’s self-hypnosis - self-hypnosis. And self-hypnosis is very effective method in the treatment of paralysis. The main thing is to believe in your strength, work on yourself and then, sooner or later, recovery will come.
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Loss or limitation of movement of the upper and lower extremities depends on the location of the spinal cord injury.
Thus, spastic paralysis and paresis develop as a result of trauma to the upper cervical spine (I-IV cervical vertebrae). For injuries of the lower cervical region (IV cervical and II thoracic vertebra) often occurs a mixed syndrome of spastic paralysis of the lower extremities with symptoms of paralysis or paresis of the upper extremities. In case of traumatic injuries of the thoracic spine (III-XII vertebrae), spastic paraplegia of the lower extremities with urination disorder is observed. When the I lumbar - II sacral vertebrae are affected, i.e. the area of lumbar thickening of the spinal cord, peripheral paralysis lower extremities with disorders of sensitivity and urination.
If the cauda equina is damaged, then there is flaccid paraplegia with urination disorder and
pain.
With spinal cord injuries, the inhibitory influence of the cerebral cortex is lost, reflex excitability increases, and the automatic activity of the spinal cord increases, which leads to the development of conducive movements to spasms. strong muscles limbs. This contributes to the occurrence of spastic contractures, and the antagonists, being in a stretched state, weaken even more. Spastic contractures create conditions for fibrous changes in the joints, impaired motor function is stabilized, which causes a persistent forced posture of the patient.
The characteristic posture of such patients is that the arm is adducted, the forearm is bent and pronated, the hand and fingers are bent, the leg is extended at the hip and knee joints, the foot is bent at the sole, in other words, the upper limb is shortened, the lower limb is lengthened. The spastic state of the muscles makes both passive and active movements extremely difficult.
Patients perform active movements with considerable effort, as they have to overcome the resistance of antagonist muscles. This causes a change in posture and facial expression, and quickly tires. Freestyle performs movements slowly, their amplitude is limited and the amount of energy expended does not correspond to the final result of the movement.
The main difficulties in therapeutic exercises are to overcome spasms, reduce reflex excitability, convulsions, strengthen paretic muscles and develop coordination of movements. It is important to choose a position that is comfortable for the patient, which in itself would help relax spastically tense muscles.
Reflex excitability of the spinal cord and muscle rigidity are reduced by massage and passive gymnastics. Passive movements are usually combined with active ones. In case of severe movement disorders and severe spasms, more attention is paid to massage and passive movements. As movements develop and rigidity decreases, passive exercises are gradually replaced by active ones. In case of spastic paralysis, it is necessary to massage all the muscles of weakened limbs, including the most rigid ones, dosing the intensity of the massage in accordance with the reaction of the patient’s muscles and not allowing their tension to increase. The massage should be superficial, it is designed to reduce muscle tone. It is recommended to use stroking, rubbing, kneading (to a limited extent), rolling, shaking and stretching. These techniques are combined with passive movements.
Massage in warm water reduces spastic tension in the muscles of the limbs. The thermal and mechanical action of water helps reduce spasms, reflex excitability, and relieves pain. Conventional therapeutic massage techniques performed in water additionally affect the musculoskeletal system, which ensures greater usefulness of active exercises.
Massage of paretic muscles prepares the patient for passive and active movements. Passive movements are performed at a calm, slow pace and in such a volume as not to cause pain or increased rigidity in spastic paralysis. The range of movements is gradually increased, the pace is accelerated depending on the patient’s subjective sensations and the degree of resistance experienced. It must be taken into account that tense antagonists interfere with passive movements. In case of spastic paralysis, it is advisable to bring together the points of attachment of these muscles, thus reducing their resistance.
So, for example, passive hip abduction occurs to a greater extent with a flexed hip, dorsiflexion of the foot occurs with bent knee, extension of the fingers - with the hand bent. It is advisable to introduce passive countermovements, since they combine elements of flexion and extension synergies. These exercises allow you to significantly stretch several spastic muscles at once (raise your arm or abduct it while simultaneously supinating and extending your forearm, hand and fingers). Exercises are only recommended if they do not increase muscle stiffness.
It is necessary to accustom patients to passive movements using a healthy limb. Patients should actively perform the movements several times a day. During passive exercises, it is necessary to ensure that the patient relaxes his muscles and lies or sits comfortably. The amplitude of rhythmic, calm movements should be limited. The movements should begin from the average physiological position.
Active exercises are an excellent means of influencing the patient’s nervous system. When using therapeutic exercises, they strive to identify the initial voluntary movements. For this, starting positions that are convenient for the patient are prescribed, making it easier to perform even basic movements. When active movements occur, the patient is helped by a physical therapy methodologist or a nurse who supports the limb with a hand or a strap (such as a hammock) to prevent friction of the limb on the bed. It is necessary to encourage the patient to exert volitional tension when moving. If it causes pain or cramps, then it is replaced with movements for healthy muscle groups, and return to the exercise for the paretic muscle group later. When training paretic limbs, alternate exercises for the distal and proximal segments, including general developmental and breathing exercises. Active movements for the upper and lower extremities are usually combined with corrective exercises for the spine.
The selection and use of exercises are determined primarily by the localization of paralysis and paresis. Exercises for paretic limbs alternate with exercises for the spine, general strengthening (for healthy muscle groups) and breathing exercises.
Therapeutic gymnastics for the above lesions remains the main method even in the late period. Main task physical exercise for flaccid forms - strengthening the muscles, and for spastic forms - practicing their control, therefore, for different forms of movement disorders, the set of exercises will vary significantly (Table 8).
Table 8
Scheme of methodological features of the use of physical exercises in various forms of movement disorders (according to the scheme of S. I. Uarova-Yakobson, supplemented by V. N. Moshkov)
Stretching spastically contracted muscle groups is considered as a special type of movement for spastic paresis. Care should be taken to ensure that the patient’s limbs do not remain in incorrect positions due to the spastic state of the muscles, which limit movement in the joints and contribute to the development of deformation in them. Movements should be performed slowly and rhythmically, as rough movements with sudden stretching increase rigidity.
In the fight against paresis and incoordination of movements, it is advisable to take into account the recommendations of V.L. Naidin: the start of movement and the accuracy of stopping, the speed of movement, acceleration and deceleration, and also constantly keep in mind the amplitude and dosage of exercises. Here are methods of therapeutic exercises that help eliminate secondary disorders [Naidin V.L., 1972]:
To develop coordination of movements, at first the most simple exercises(for individual joints) performed in any one plane. Sometimes such “isolated” (for limited muscle groups) movements are very difficult for patients due to developed synkinesis. To combat this type of movement disorder, basic anti-cooperative exercises are prescribed. The methodologist of therapeutic physical training holds the limb that involuntarily joins in the movement when the other limb is working. This technique promotes “isolation” of the movement of paretic muscle groups. In addition to anti-friendly movements, friendly ones are also prescribed. They are performed with the help of the corresponding healthy limb: if bending one leg at the hip and knee joints is difficult, then bending the sore and healthy leg at the same time makes it easier to perform the exercise.
To reduce the rigidity of the muscles of the exercised limb, movements are made with a limited amplitude. To do this, exercises are introduced using a healthy limb, the participation of which either excludes or limits the force tension of the muscle groups of the paretic limb. To reduce increased tone muscles use swing exercises for both the upper and lower extremities with a gradual increase in the amplitude of movements. Such movements cause relaxation of muscle groups. Patients should be taught to relax their muscles, which helps them perform movements to a greater extent. For this purpose, elementary massage techniques and passive movements with limited amplitude are used. To reduce spastic phenomena in the distal segments of the limbs (hand, foot), the hand or foot is rolled on a rotating roller.
For spastic mono- and paraplegia of the upper extremities, exercises in throwing and catching balls, first volleyball and tennis, and later medicine balls, are widely used. Various methods of grasping, throwing, and catching contribute to the development of coordination of movements of the upper limbs. These exercises are accompanied by joyful emotions and distract patients from going into illness, which helps reduce muscle tone and perform movements in a large volume. An important element Methods, according to Forster, should be considered the education of the simplest motor skills of self-care (buttoning and unbuttoning buttons, dressing, etc.). For this purpose, finger exercises with small objects and modeling are included.
When doing therapeutic exercises with patients in this group, it is recommended to use rollers, gymnastic sticks, clubs, dumbbells, tennis balls, volleyballs, medicine balls and small mechanotherapeutic devices. They also use a gymnastic wall, high and low benches, and a horizontal ladder. On high and low benches they perform various movements in a sitting position. The gymnastic wall and horizontally inclined staircase are used to develop the function of the arms and upper limbs, as well as to teach walking. Therapeutic gymnastics procedures combine special exercises for paretic muscle groups with general strengthening exercises, since restoration of the function of pathologically altered muscles is possible not with their isolated contraction, but with the simultaneous use of the entire coordination activity of the musculoskeletal system.
Under the term "children's cerebral palsy“It is common to understand a whole group of diseases.
When perinatal injury occurs, some muscles go into spasm, causing the baby to lose the ability to sit and walk. When cortical structures are disrupted, many children experience problems with mental development.
To be effective, it must be comprehensive. When doing therapeutic exercises, the brain seems to learn the correct movement of the muscles of the body and limbs, which ultimately forces it to establish regulation of this process.
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The importance of physical activity
Therapeutic gymnastics for such a diagnosis is very important, because it helps to solve the following problems:
- produces a general strengthening and healing effect on the body, which helps restore its performance;
- normalizes blood circulation and metabolism in the affected area, which allows you to fully or partially cope with metabolic and neurovascular disorders;
- prevents the appearance of adhesions between nerve sheaths and nearby tissues;
- if adhesions are already present, thanks to special exercises it is possible to form a replacement adaptation of normal tissues to such formations;
- strengthens the weak muscle tissue;
- develops coordination of movements;
- helps to cope with concomitant pathologies - for example, curvature and impaired mobility of the spine.
Of course, there are no treatments that help restore brain damage. But if you practice in accordance with a properly designed program, the intact nervous system has the ability to perform its functions.
Exercise therapy programs are a very important part of the comprehensive rehabilitation of such children. The specialist must analyze in detail the condition of each child and, based on this, select a complex that will help stimulate his physical activity.
Children with this diagnosis have a lack of perceptual power. To cope with this problem, you need to perform special exercises. In this case, the training program includes movements that help develop tactile and visual sensations.
Also, the goal of therapeutic exercises is to reduce primitive reflexes and develop the ability to support your body. Increasing motor strength and implementing rhythmic movements is also of no small importance.
Examples of exercise therapy exercises for cerebral palsy
Soon after the diagnosis is made, doctors recommend starting a course of physical exercise. It is important that the child does not have seizures and that the indicators are within normal limits.
Rehabilitation doctors and neurologists select exercises that are aimed at:
- preventing weakness of muscles that cannot work due to illness;
- prevention of damage to non-working muscle tissue;
- decline muscle tension- this is done in order to prevent the development of contracture, in which the muscles are fixed in an abnormal position.
Training should be carried out every day, and the load should be increased gradually. A rehabilitation doctor must monitor the child’s condition.
Complex physical therapy exercises with cerebral palsy includes the following components:
- positional therapy - in which the limbs are fixed in special splints or splints;
- muscle stretching - consists of swinging the limbs in all joints, and the amplitude should gradually increase;
- muscle relaxation - in this case, the arms and legs are fixed alternately to reduce the number of involuntary movements and ease the increased tone;
- walking;
- exercises with the participation of muscle agonists and antagonists - involve flexion and extension of all joints, and this process is accompanied by muscle massage;
- climbing up inclined surface with the help of an instructor - this allows you to train the muscle tissue of the abs and legs, and also helps to maintain balance;
- exercises to build endurance.
If a child is diagnosed with spastic diplegia, exercises that are accompanied by continuous movement are used.
If he has an asthenic form of the disease, then all exercises should be short in duration. In addition, you should definitely take breaks between them. The atonic form requires exercise to develop balance.
Motor support
In this case, perform the following exercises:
| The baby should sit on his heels |
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| The child needs to kneel |
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| The child needs to squat |
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| The child should sit on a chair |
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| The child should stand up and put one leg forward | You should take turns pushing the baby in the back and chest to teach him to maintain balance. |
| The child must stand up | You need to take him by the hand, pull and push him in different sides to get him to take a step. |
| The child needs to lie on his back and press his feet on a hard surface | Thanks to this exercise, you will be able to improve your support ability. |
Joints
To normalize joint function, you should do the following exercises:
| The child needs to lie on his back |
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| The baby needs to lie on his side and slowly abduct the hip | The knee should be bent. |
| The child should lie on his stomach on the edge of the table and hang his legs down | He should gradually straighten his limbs. |
| The baby should lie on his back | First, bend your knee and then straighten your leg as much as possible. |
| The child needs to lie on his stomach and place a cushion under his chest. | You need to lift him by straightened arms and, making small jerks, perform springy extension movements of the upper body. |
| The child needs to lie on his back |
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Abdominal muscles
The following exercises are useful to strengthen abdominal muscle tissue:
To consolidate the results obtained, be sure to do stretching exercises:
| The child should sit on the floor and stretch his legs forward so that his torso is at a right angle |
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| The child should lie on his back and extend his arms along his body |
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| The child should lie on his back with his feet together |
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| The child should sit on the floor and bend right leg to reach your left thigh with your heel |
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Muscles of the trunk and neck
To strengthen the muscle tissue of the neck and body, you should do the following exercises:
| The child should lie on his back |
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| The child should lie on his right side, place his right hand under his head, and extend his left along the body |
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| The child should sit in a chair, put his hands on the armrests, and lower his head to his chest |
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It is important that the child fixes his head when performing passive movements, and then actively relaxes the muscles so that the head seems to fall on the chest.
Breathing correction
To improve the breathing process, you need to do the following exercises:
- The child should be shown how to inhale and exhale deeply through the nose and mouth, and then invite him to exhale into his palm or a thin piece of paper. It is also very useful to blow bubbles or inflate toys.
- To improve the functioning of the respiratory system, you should teach your baby to speak sounds at different volumes while exhaling. Singing, playing the harmonica, and whistling help a lot.
- The child should inhale to the count of “1, 2, 3” and raise his arms up. Then exhale to the count of “4, 5, 6” and lower your arms. You can also lower your head into the water and exhale.
Facial expressions
It is very important for children with this diagnosis to learn to recognize the feelings of other people. Thanks to this, you will be able to respond correctly to negative emotions, which will ensure mental comfort and physical health.
It is necessary to teach the baby to imitate different emotions so that you can subsequently distinguish between them in everyday life.
By using facial muscles he must discharge emotions. This is the main task of psycho-gymnastics.
Emotions
To train emotions, perform the following exercises:
| Interest, attention | You need to show your child how a fox eavesdrops or a dog sniffs, and then ask him to repeat what he saw. |
| Suffering | Show the baby how the stomach hurts or the baby is crying. Then you can ask him to repeat. |
| Anger | Ask the baby to show how angry mom or dad is. |
| Disgust | Ask your child to imagine that he needs to drink salt water. |
| Joy, pleasure | You need to ask the baby to show how a cat behaves when it is petted. It is also worth asking to smile, imagining that Santa Claus came and brought candy. |
| Fear | Ask your child to imagine how the bunny lost his house. |
| Guilt and shame | Invite the child to remember how he lost his mother’s favorite thing and ask for forgiveness. |
In the pool
Water procedures can be used for the physical recovery of children with this diagnosis. Everyone knows that water promotes excellent muscle relaxation, helps stabilize muscle tone, and fills with energy. Thanks to such activities, you can reduce the effects of stressful situations and cope with depression.
A special effect can be achieved by combining therapeutic exercises and staying in water. This method is called hydrokinesotherapy. It includes performing certain exercises in water, game types sports, underwater massage.
Excellent results can be achieved when a child swims in a dolphinarium, because dolphins have a pronounced therapeutic effect on such children.
Rehabilitation
In order for the rehabilitation of children with this diagnosis to be as successful as possible, parents should definitely use special simulators. Even if the baby’s spastic limb syndrome is not very pronounced, close attention should be paid to its correction.
The sooner the problem is identified and home rehabilitation begins, the easier it is to correct the consequences of cerebral palsy.
In addition to drug therapy, such children need massage and the use of special exercise equipment.
The first simulators
To increase efficiency, you need to purchase special exercise equipment for your baby:
| Rug with a bumpy surface |
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| Expander |
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| Jumpers and walkers |
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Sports and at home
A swimming pool filled with plastic balls is of no small importance for the recovery of children with cerebral palsy. Experts advise using exclusively solid materials as a base. It is important to note that inflatable options or tents are absolutely not suitable.
An excellent solution would be a frame made from a sheet of chipboard, which needs to be sheathed with padding polyester and fabric. The role of the base can be performed by a massage mat with tubercles.
All the simulators that are needed to restore impaired functions can be made independently. For example, it is quite possible to hang an elastic band from the ceiling, which will help develop strength and coordination of movements. It can also serve as a vertical movement lock.
Personal trainers that contain stretch marks, splints, orthopedic shoes and supports in an upright position deserve special attention. Such devices are made individually in orthopedic workshops based on the instructions of the attending physician.
To practice the tactile activity of the fingers, relief paintings are perfect. Great option wooden toys or rough wallpaper will become. To train the initial functions of walking, you can use themed carpets and special massage paths.
It is very important to keep your child interested in activities. Therefore, the training process should be presented as a game.
If a child fails at something or feels pain, there is a risk that he will refuse to make an effort. It is very important for parents to persuade their child to continue the activity.
To ensure normal coordination of movements, you should use comfortable furniture with various recesses and grips.
Swedish wall and Gross machine
| Gross simulator |
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| Swedish wall |
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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.
Alone medicines it is impossible to cure this disease. 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 with 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 that will include massage, physical therapy, manual therapy, various hardening of the body.
Developed for each baby individual complex exercises. 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 muscle corset- the main core of the human motor system as a whole.
In this case, elementary exercises are effective, for example, raising and lowering the body from starting position lying on your back. You can also perform these movements while lying on your stomach. You can make various inclinations from 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:
- 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.
- 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.
- 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.
- 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.
- 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.
- 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
- 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.
- The child lies on his side. Bend the child's leg at the knee and gently move the hip away.
- The child lies on his stomach on some surface with his legs hanging down. The limbs must be straightened very slowly.
- The child lies on his back. You need to bend and straighten your baby's knees.
Additional exercises
Exercises that train the abdominal muscles:
- 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.
- 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.
- 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:
- 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.
- Starting position: the child lies on his stomach with his arms outstretched. Focusing on the palms, the baby should raise top part bodies above the floor.
Regarding development exercises fine motor skills, then here it is simply necessary to rotate the child’s hand in different directions.
Exercises with the ball:
- 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.
- 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.
- If you put the baby on a ball and easily rock it back and forth, muscle tone is greatly reduced.
Walking development exercises:
- 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.
- 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.
