Arising as a result of the restriction of active movements due to a violation of the 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 they affect the central and peripheral nervous systems, as a result of which the motor function is weakened. Thus, paresis occurs as a result of damage to the motor nodes of the spinal cord and / or the brain, as well as nerve fibers of the peripheral or central nervous system. Like paralysis, paresis can be central or peripheral.
Paresis caused by damage to the peripheral nervous system (peripheral paresis) is characterized by a weakening of the tendon reflexes from the paresis, as well as a decrease in muscle tone and atrophy, and involuntary contractions of some muscle fibers.
As for the central paresis, due to damage to the central nervous system, tendon reflexes on the side of the paresis are significantly enhanced. At the same time, an increase in muscle tone and an increase in the intensity of deep reflexes are observed, pathological reflexes, friendly movements appear (for example, when a person squeezes a healthy hand, a sick hand performs similar actions, but with less force), and also when exposed to muscles, their convulsive abbreviations.
According to the degree of severity, there are paresis mild and moderate, deep and complete (paralysis). By localization 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 group of muscles, 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 conditionally customary 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 the limb, while overcoming slight resistance
3) 3 points - the patient can lift the limb only if there is no resistance to it
4) 2 points - the patient is able to move only in the horizontal plane
5) 1 point - the patient can only perform active movements of very small amplitude
6) 0 points - no movement.
Paresis can be both congenital and acquired. The most common paresis are congenital paresis hands, and only one. Such paresis occurs, as a rule, due to the fact that the brachial plexus of the child is affected during birth. In this case, there is a complete absence of movements or they are limited. It should also be noted that in children with 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 in children who were born with brain damage, paresis is formed as they grow older, approximately in the second year of life.
Acquired paresis, as a rule, develop as a result of some past disease and in almost all cases are associated with disorders in the work 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 both in the skeletal muscles and in the muscular 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 - functional paresis. With organic paresis, it is possible to find out the organic cause of paresis, which provokes the fact that the nerve impulse will not reach its main goal - the muscle. And with functional paresis, there are violations of the processes of excitation, inhibition, as well as balance and maneuverability that occur in the cerebral cortex.
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 prevalence of paresis are 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 a decrease in sensitivity.
Hemiparesis can occur as a result of a stroke, encephalitis, hemorrhage into a tumor, brain abscess, multiple sclerosis, migraine.
The cause of paraparesis is damage to the thoracic spinal cord, spinal stroke, infectious or post-infectious myelitis, and paraparesis can develop due to damage to the parasagittal zone of the brain, ischemia in the basin of the anterior cerebral artery, thrombosis of the superior sagittal sinus, tumor, acute hydrocephalus.
Tetraparesis can be the result of bilateral damage to the cerebral hemispheres, damage to the trunk or upper cervical spinal cord. Acute tetraparesis, as a rule, is a manifestation of stroke, trauma, metabolic disorders.

paresis treatment.
Before talking about the treatment of paresis, it must be emphasized that paresis, like paralysis, is not an independent disease, but, as a rule, becomes a reflection of other diseases and pathologies. Therefore, first of all, the treatment of paresis should be causal, that is, directed against the underlying disease, for example, it can be suturing of a peripheral nerve in case of injury, restorative therapy after a stroke, surgical intervention in case of detection of tumors that compress nerve structures, etc. But besides this, massage must be carried out, as the muscles atrophy without movement.
Massage used in the treatment of paresis leads to an improvement in trophism, the development of nerve impulses. If muscle activity persists, the patient, in combination with massage, also needs to carry out special gymnastics, while the load should gradually increase, and movements with resistance are performed to increase the volume and strength of the muscles. In the treatment of paresis, it is necessary to combine massage with thermal exposure. As mentioned above, this improves tissue nutrition, promotes the formation of active nerve impulses. However, it must be remembered that the 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. The elimination of disorders of limb function as a result of the development of paresis begins with the fact that the affected arm or leg is placed in 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. In this case, you need to ensure that the leg and foot are not turned outward. In order to maintain the correct position of the limb, soft rollers (made of tightly rolled cotton wool, lined with cloth) or splints made of plastic materials are used. But it is important to take into account the fact that the diseased limb should not remain immobilized. For this purpose, passive therapeutic exercises for paresis begin from the very first days - alternate bending and extension in the joints of the diseased arm or leg. This gymnastics may well be performed by the patient himself, while he must first receive the exact instructions of the doctor, especially for paresis of the hand. 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 make the movement at least 1-2 cm more than in the previous one. As the strength of the muscles 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 unbearable exercises is harmful and slows down recovery. The exercise program for paresis is compiled by a methodologist in physiotherapy exercises. In order to facilitate the patient's movements in weak limbs, orthopedic devices are used.

Exercise therapy for paresis.
Therapeutic exercise for paresis It is usually carried out simultaneously with massage, medication and physiotherapy.
In the exercise therapy complex for paresis, positional treatment or postural exercises are used. These exercises consist in a special arrangement of the body or limbs using all kinds of devices. One of the types of positional treatment is orthostatic gymnastics for paresis. Such gymnastics is very effective in the early postoperative period and with prolonged 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 an exact graduation of the inclination of rotation. Therapeutic exercises for paresis possible even with deep paresis of the legs and muscles of the body. 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 it has a normal urge to urinate in an upright position. Also, thanks to orthostatic gymnastics, the function is trained vestibular apparatus, of cardio-vascular system, especially the vessels of the legs, which prevents thrombophlebitis and other pathologies of the veins. The entire musculoskeletal system is trained - bones, ligaments, joints, muscles. At the same time, the appearance of a distracting effect is also observed: pain, dizziness, nausea, a feeling of palpitations decrease, there is a decrease in blood pressure, if it has been raised. With all this, important role plays the psychological state of the patient, who has the ability 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 done 2-3 times a day.
Among the exercises of physiotherapy exercises for paresis, there are also groups aimed at eliminating atonic and spastic paresis.
As a rule, in carrying out physiotherapy exercises after surgery for spastic paralysis and paresis, 4 stages are distinguished. The first stage is early postoperative (from the 2nd to the 10th-12th day after the operation), the second stage is the late postoperative (12th-20th day), the third stage is the actual recovery (starts from the 20th day and ends on the 40th -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 stitches usually coincides with the end of the first stage.
At the second stage, the basic motor skills are restored - sitting, standing up, walking with the help of special devices, in the uneven bars or arena.
At the third stage of exercise therapy for paresis, general strengthening exercises are carried out, which are aimed at improving functional state respiratory and cardiovascular systems. These exercises for paresis are aimed at eliminating coordination disorders, strengthening muscle strength, developing the basic methods of movement, as well as the skills necessary for self-service.
The fourth stage is carried out at home. The program for it is drawn up at the end of the third stage, while it is necessary to take into account the patient's condition.
At each stage, a certain amount of time is devoted to performing different types of exercises. So, at the first stage, most of the time is devoted to breathing exercises - up to 70% of the time. General strengthening gymnastics is 20% of the time, and special gymnastics is 10%. At the second stage, about 45% of the time is devoted to special gymnastics, restorative is 30%, respiratory - 15%. At this stage, the application of applied skills is introduced, which is approximately 10% of the total time. By the third stage, breathing exercises can be 5% of the time, general strengthening exercises - 10%, applied skills are given 20% of the total time, and special exercises spend 65% of the time. The fourth stage can pass without execution breathing exercises unless there are special indications for this. At this stage, the greatest attention is paid to the development of applied skills, which is 45% of the total time, 30% of the time is occupied by general strengthening exercises, and 25% are special ones.
Thus, in the treatment of spastic paresis, the main methodological techniques therapeutic gymnastics aimed at reducing pathologically increased muscle tone, increasing muscle strength (which means reducing the degree of paresis), preventing and eliminating pathological friendly movements, as well as restoring household and professional skills.

Prevention of paresis consists mainly in the prevention of those diseases and injuries that may be complicated by their development. Particular attention should be paid to the vaccination of children against poliomyelitis.

Finally, I would like to emphasize that the human body is a smart system that can cope with many diseases on its own. After all, science has long proven that the brain uses only 20% of its capabilities, and if 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, to use them correctly. Thus, when a person recovers, his desire and true faith in healing play an important role.

Exercise therapy for paralysis.

Paralysis- this is a loss or disturbance of movements in one or more parts of the body, due to 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 a violation of the motor function of the body.
The cause of paralysis can be: circulatory disorders, inflammatory processes, injuries, tumors of the nervous system. Also, a special kind of paralysis can be observed in hysteria.

causes of paralysis.
Paralysis should be distinguished from movement disorders that occur with inflammation of the muscles, lesions of the osteoarticular apparatus, which mechanically limit the range of motion. Paralysis can be observed in one muscle, one limb (monoplegia), in an arm and leg on the same side (hemiplegia), in both arms or both legs (paraplegia), etc.
Trauma, multiple sclerosis, infections, intoxications, metabolic disorders, malnutrition, vascular lesions, malignant neoplasms, congenital or hereditary factors - all of these are organic causes of paralysis. Also, paralysis often develops in infectious diseases such as syphilis, tuberculosis, poliomyelitis, viral encephalitis, meningitis. Toxic or nutritional causes include beriberi (deficiency of vitamin B1), pellagra (deficiency of nicotinic acid), alcoholic neuritis, poisoning with heavy metals (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 paralysis due to damage brachial plexus. In addition, a number of diseases of unknown etiology (for example, multiple sclerosis) are characterized by motor impairment of varying degrees. Injuries, such as injuries and fractures, can have the same consequences if they are associated with damage to the motor pathways or directly to the motor centers. I must say that in many cases, paralysis is psychogenic in nature and is a manifestation of hysteria - such patients can be helped by treatment with psychiatrists. ra.
The variety of causative factors cannot but affect pathomorphological changes, which in turn can have a very different nature and localization. Such pathological changes in the nervous tissue as destruction, degeneration, inflammation, formation of foci (plaques), sclerosis, demyelination are the most typical options that are detected in paralysis. From an anatomical point of view, there are 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 first, in turn, are divided into cerebral and spinal types. Cerebral palsy may be of cortical, subcortical, capsular, or bulbar origin. Spinal paralysis is the result of diseases that affect 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, but not individual muscles, usually suffers. Paralyzed muscles are spastic (convulsively tense), but do not undergo atrophy (it can only be the result of inactivity), and there are no electrophysiological signs of degeneration in them. In the paralyzed limbs, deep tendon reflexes are preserved or enhanced, clonuses (rapid spastic contractions) are often detected. Abdominal reflexes on the paralyzed side are reduced or absent. With paralysis lower extremities 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 amazed individual muscles, in which atrophy and the electrophysiological reaction of degeneration are detected. In a paralyzed limb, deep reflexes are reduced or completely disappear, clonuses are absent. Abdominal reflexes are preserved, and Babinski's reflex is not called. Also, with damage to the peripheral nerve or plexus, which contain both motor and sensory fibers, sensitivity disorders are also detected.
The main cause of central paralysis is stroke. Therefore, the treatment of stroke will be at the same time 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 small. Therefore, cases are not uncommon when a defect in the brain tissue of a significant size leads to minor motor disorders (paralysis and paresis), and a small defect causes a deep disability of a person. All the motor conductors are contained in the inner capsule in a concentrated form, and the defeat of this capsule leads to paralysis of the entire opposite half of the body.
Paralysis may present as an absence or impairment of spontaneous movements or a decrease in muscle strength, which is detected on examination. Also, paralysis is characterized by the inability to perform a movement against the resistance of the doctor or to hold a certain position for a long time, resisting gravity, for example, outstretched arms or raised legs (Barré test).
As a result of damage to the subcortical structures of the brain, extrapyramidal paralysis occurs, friendly and automated movements disappear, and there is no motor initiative (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, non-sonography. Reflexes from the lower extremities are also checked: knee reflex, Achilles reflex, Endrasek's 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 should be primarily causal, that is, it should be directed against the underlying disease: suturing of a peripheral nerve in case of traumatic injury, rehabilitation therapy for stroke, surgical removal of tumors that compress nerve structures, etc. But along with causal therapy, symptomatic therapy is also necessary, since this is an essential additional and necessary preventive measure, because muscle tissue atrophies without movement. Apply special methods of restoring limb functions, such as massage for paralysis, exercise therapy for paralysis, therapeutic exercises for paralysis and etc.

plays an important role in symptomatic treatment physiotherapy , which contributes to the restoration of movement and prevents the appearance of contractures and deformities.
Exercise therapy complex for paralysis consists of the following elements:
- laying 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, lightly stroked. The rest of the muscles are massaged in the usual way, of course, while it is necessary to take into account the state of the paralyzed. Together with these activities, physiotherapy which should include active and passive paralysis exercises.
Passive movements should be started depending on the patient's condition, preferably at the end of the first week. Initially, 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, up and to the side
3. Extension of the arm in the elbow joint with the 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. Hip rotation at the hip joint
7. Hip adduction and abduction
8. Flexion of the knee joint with an extended hip lying on its 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 the given position
12. Holding the affected foot in the given position
13. Facilitated raising and lowering of the affected arm with a healthy hand using a cord and a block (the exercise can be combined with abduction and adduction of the arm in an elevated position)
14. Facilitated raising and lowering the affected leg by hand using a cord and 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, most of the day can be spent in a comfortable chair.
When learning to walk, it is necessary first of all to teach the patient to step on the paralyzed leg. At the same time, attention should be paid to correcting the abnormal position of the flexors and muscles that turn the leg outward.
When walking, it is necessary to raise the paralyzed leg high due to the muscles of the pelvis, 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 trunk are also given a position that further prevents the development of contractures. Perhaps a little earlier, massage begins, which should also be selective. Paretic muscles are massaged with all techniques, while antagonistic muscles only stroke. Simultaneously with the massage begin to perform passive movements. When movements appear, active exercises are gradually added. Very useful gymnastics in the pool, as well as in a bath with warm water.

Drug treatment is carried out according to the prescription and under the supervision of a neuropathologist. Of the drugs used for paralysis: prozerin, dibazol, intramuscular injections of thiamine chloride. With paralysis with increased muscle tone - mellitin.

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 in the fact that in front of a patient suffering from partial or complete paralysis of one of the hands , a mirror is placed with an edge to the vertical axis of the body, and with a reflective surface towards the healthy arm. The patient looks in the mirror towards his diseased hand, and sees his healthy hand in it. In this position, at the command of the doctor, the patient tries to perform synchronous movements with both hands. In the event that the patient suffers from complete and partial paralysis, the doctor standing behind the mirror helps the paralyzed hand perform synchronous movements in relation to the healthy hand. Thus, the illusion of a healthy hand is created in the patient, and this helps him to activate his internal forces to control the diseased hand.
Another similar method consists of watching videos of the patient's hand movements in front of a mirror, which is positioned in the same way as in the experiment described above. When watching such a video, thanks to a healthy mirror hand, the patient has the impression of a synchronous movement of both hands. The patient looks at himself in the 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 do 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 yourself, work on yourself and then, sooner or later, recovery will still 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.
So, spastic paralysis and paresis develop as a result of trauma to the upper cervical spine (I-IV cervical vertebrae). In case of injuries of the lower cervical region (IV cervical and II thoracic vertebra) often there is a mixed syndrome of spastic paralysis of the lower extremities with the phenomena of paralysis or paresis of the upper extremities. With traumatic injuries of the thoracic spine (III-XII vertebrae), spastic paraplegia of the lower extremities with urination disorder is observed. With the defeat of the I lumbar - II sacral vertebrae, i.e., the area of ​​\u200b\u200bthe lumbar thickening of the spinal cord, peripheral paralysis of the lower extremities is observed with disorders of sensitivity and urination.
If the cauda equina (cauda equina) is damaged, then there is flaccid paraplegia with urination disorder and
pains.
With spinal cord injuries, the inhibitory effect of the cerebral cortex drops out, reflex excitability increases, automatic activity of the spinal cord increases, which leads to the development of friendly movements to more 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 fibrotic changes in the joints, motor function disorders are stabilized, which leads to a stable 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 one is elongated. 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, quickly tires. The 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 spasm, 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 to 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. With severe movement disorders and severe spasm, more attention is paid to massage and passive movements. As movements develop and rigidity decreases, passive exercises are gradually replaced by active ones. With spastic paralysis, it is necessary to massage all the muscles of the weakened limbs, including the most rigid, dosing the intensity of the massage in accordance with the reaction of the patient's muscles and avoiding an increase in their tension. Massage should be superficial, it is designed to lower muscle tone. It is recommended to use stroking, rubbing, kneading (limited), 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 to reduce spasm, reflex excitability, relieves pain. The usual methods of therapeutic massage performed in water additionally affect the motor apparatus, which ensures a greater usefulness of active exercises.
Massage of the paretic muscles prepares the patient for passive and active movements. Passive movements are done at a calm, slow pace and in such a volume that they do not cause pain or increase rigidity in spastic paralysis. The volume of movements is gradually increased, the pace is accelerated depending on the subjective sensations of the patient and the degree of resistance experienced. It must be taken into account that tense antagonists prevent passive movements. With spastic paralysis, it is advisable to bring the points of attachment of these muscles together, thus reducing their resistance.

So, for example, passive abduction of the hip is performed in a larger volume with a bent hip, dorsiflexion of the foot - with bent knee, extension of the fingers - with a bent brush. It is advisable to introduce passive anti-friendly movements, as they combine elements of flexion and extensor synergies. These exercises allow you to significantly stretch several spastic muscles at once (raise your arm or take it away, simultaneously supinating and unbending the forearm, hand and fingers). Exercise is recommended only when it does not increase muscle stiffness.
It is necessary to accustom patients to passive movements with the help of a healthy limb. Patients should actively perform movements several times a day. During passive exercises, it is necessary to ensure that the patient relaxes the muscles, lies or sits comfortably. The amplitude of rhythmic, calm movements should be limited. Movement should begin from an average physiological position.
active exercise are an excellent means of influencing the nervous system of the patient. When applying therapeutic gymnastics, they seek to identify initial voluntary movements. For this, starting positions that are convenient for the patient are prescribed, facilitating the implementation of even an elementary movement. When active movements appear, the patient is helped by a methodologist of physical therapy 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 volitional tension during movement. If it causes pain or cramps, then it is replaced by movements for healthy muscle groups, and return to the exercise for the paretic muscle group later. When training paretic limbs, exercises for the distal and proximal segments alternate, including between these movements 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 application of exercises are determined primarily by the localization of paralysis and paresis. Exercises for paretic limbs alternate with exercises for the spine, with general strengthening (for healthy muscle groups) and breathing exercises.
Therapeutic gymnastics with the above lesions remains the main method even in the late period. the main task exercise in flaccid forms - muscle strengthening, and in spastic ones - working out their control, therefore, with different forms of movement disorders, the set of exercises will differ 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 of spastically contracted muscle groups is considered as a special type of movement in 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 deformity in them. Movements should be performed slowly, rhythmically, as rough movements with a sharp stretch increase rigidity.
In the fight against paresis and discoordination of movements, it is advisable to take into account the recommendations of V. L. Naidin: the beginning 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 the methods of therapeutic exercises that contribute to the elimination of secondary disorders [Naidin V. L., 1972]:

For the development of coordination of movements at first appoint 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 disorders, elementary anti-friendly exercises are prescribed. The methodologist of medical physical culture holds that limb, which is involuntarily included in the movement during the work of another limb. This technique contributes to the "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 an appropriate healthy limb: if bending one leg in the hip and knee joints is difficult, then simultaneously bending the diseased and healthy leg facilitates the exercise.
To reduce the rigidity of the muscles of the exercised limb, movements with a limited amplitude are made. To do this, exercises are introduced with the help of a healthy limb, the participation of which either excludes or limits the power tension of the muscle groups of the paretic limb. To reduce increased tone muscles use swing exercises for both the upper and lower limbs with a gradual increase in the range of motion. Such movements cause relaxation of muscle groups. Patients should be taught to relax the muscles, which helps to perform movements in greater volume. For this purpose, elementary massage techniques and passive movements with a limited amplitude are used. To reduce spastic phenomena in the distal segments of the limbs (hand, foot), the hand or foot is rolled over a rotating roller.
With spastic mono- and paraplegia of the upper limbs, exercises in throwing and catching balls, first volleyball and tennis, and later medical balls, are widely used. Various ways of grabbing, throwing, catching contribute to the development of coordination of movements of the upper limbs. These exercises are accompanied by joyful emotions, distract patients from leaving the disease, which helps to 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-service (buttoning and unbuttoning buttons, dressing, etc.). To this end, finger exercises with small objects and sculpting are included.
When doing therapeutic exercises with patients of this group, it is recommended to use rollers, gymnastic sticks, maces, dumbbells, tennis balls, volleyballs, medical balls and small devices of mechanotherapeutic type. They also use a gymnastic wall, high and low benches, a horizontal ladder. On high and low benches perform a variety of movements in a sitting position. The gymnastic wall and the horizontally inclined ladder serve to develop the function of the arms and upper limbs, as well as to teach walking. In the procedures of therapeutic gymnastics, special exercises for paretic muscle groups are combined with general strengthening exercises, since the 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 paralysis It is customary to understand a whole group of diseases.

With perinatal damage, some muscles undergo spasm, as a result of which the child loses the ability to sit and walk. In violation of the cortical structures, many children have problems with mental development.

To be effective, it must necessarily be comprehensive. When doing therapeutic exercises, the brain, as it were, learns the correct movement of the muscles of the body and limbs, which ultimately forces it to regulate the regulation of this process.

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Importance of physical activity

Therapeutic gymnastics with such a diagnosis is very important, because it helps to solve such problems:

• produces a restorative and healing effect on the body, which helps to 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 the nerve sheaths and nearby tissues;
• if adhesions are already present, thanks to special exercises, it is possible to form the replacement fitness of normal tissues for 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 disorders. But if you practice in accordance with a properly designed program, intact nervous system is able 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, on the basis of this, select a complex that will help stimulate his motor activity.

Children with this diagnosis have a lack of perceptual power. To deal 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 task of therapeutic exercises is to reduce primitive reflexes, to form the ability to maintain one's body. Of no small importance is also the increase in motor strength and the implementation of rhythmic movements.

Examples of exercise therapy exercises for cerebral palsy

Soon after determining the diagnosis, doctors recommend starting a course of physical exercise. It is important that the child does not have convulsions, and the indicators are within the normal range.

Rehabilitologists and neurologists select exercises that are aimed at:

• prevention of muscle weakness that cannot work due to illness;
• prevention of damage to non-working muscle tissue;
• reducing 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. The doctor-rehabilitator must necessarily monitor the condition of the child.

Complex exercise therapy exercises with cerebral palsy includes the following components:

• position therapy - in this case, the limbs are fixed in special splints or splints;
• muscle stretching - consists in swinging the limbs in all joints, and the amplitude should gradually increase;
• muscle relaxation - while the arms and legs are alternately fixed in order to reduce the number of involuntary movements and weaken 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 press and legs, and also helps to maintain balance;
• endurance exercises.

If a child is diagnosed with spastic diplegia, exercises are used that are accompanied by continuous movement.

If he has an asthenic form of the disease, then all exercises should be short in time. In addition, you should definitely take breaks between them. The atonic form requires exercise to develop balance.

Support for motor functions

In this case, perform the following exercises:

The kid should sit on his heels	You need to stand in front of him and put his hands on your shoulders. Fixing the baby in the pelvic area, stimulate his attempt to kneel.
The child needs to kneel	It is necessary to support the baby under the armpits and move him in both directions. He must learn to transfer the weight of the body on one leg. In this case, the child must tear off the second limb from the floor, while spreading his arms to the sides.
The child needs to squat	You need to stand behind and press on your knees. Then gradually move the baby's body forward so that his knees straighten.
The child should sit on a chair	You need to stand facing the baby and with your feet press his legs to the floor, and also take his hands. Stretch your arms forward and up to make the child stand up on their own.
The child should stand up and put one leg forward	In turn, you should push the baby in the back and chest to teach him to keep balance.
The child must get up	It is necessary to take his hand, pull and push in different sides to make him take a step.
The child needs to lie on his back and press his feet on a hard surface	Thanks to this exercise, it will be possible to improve the support ability.

joints

To normalize the work of the joints, you should do the following exercises:

The child needs to lie on his back.	One leg of the baby should be kept in the extension position, and the other should be gradually bent at the knee and hip joint. If possible, the thigh should be brought to the stomach, and then slowly take it to the side.
The baby needs to lie on its side and slowly move the hip	The knee should be bent while doing this.
The child should lie on his stomach on the edge of the table and hang his legs down	He should gradually unbend the limbs.
The baby should lie on his back	First bend the knee, and then straighten the leg as much as possible.
The child needs to lie on his stomach, and place a roller under his chest	It is necessary to lift it by straightened arms and, making small jerks, perform springy extensor movements of the upper body.
The child needs to lie on his back.	The baby's arm should be bent so that his face is turned in the direction of this limb. Then bend, turning your head to the other side.

Abdominal muscles

To strengthen the abdominal muscles, the following exercises are useful:

To consolidate the results, be sure to do stretching exercises:

The child should sit on the floor and stretch their legs forward so that the torso is at a right angle.	Hands should be placed in front of you and inhale. On exhalation, the body must be bent forward so that the palms reach the toes. The torso should be tilted more and more so that the forehead touches the legs. By using this exercise you can make the spine more flexible and cope with the stiffness of the back muscles. Also, thanks to this, it will be possible to normalize blood circulation and the work of the spinal nerves.
The child should lie on his back and stretch his arms along the body	Then you should lean on your palms and gradually lift up chest. The torso from the waist to the feet should touch the support. The head should be thrown back, and the legs should be together. It is important to monitor breathing - it should be deep and slow. Thanks to this, throughout the spine it is possible to increase the tone of muscle tissue and ligamentous apparatus. The work of the nerve trunks and blood vessels is also significantly improved.
The child should lie on his back, put his feet together	Straight legs should be raised above the head, hands should be placed on the floor, while the knees do not need to be bent. The kid should try to reach with his fingertips to the floor above his head. Then you can slowly return to the starting position. Such an exercise is useful to perform not only for the spinal cord and spine - it perfectly works out the muscles of the limbs.
The child should sit on the floor and bend right leg to reach the left thigh with the heel	Then the left foot should be placed on the floor with right side right knee and right hand move around the left knee and fix the foot of the left leg with it. Then left hand position behind the back towards the right side of the waist. In this case, the head should be turned to the left and tilted so as to reach the left shoulder with the chin. It is important to ensure that the right knee does not come off the floor. With this exercise, back defects can be corrected. Toddlers should perform it with the participation of adults who help fix the initial position.

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	It is necessary to hold the baby's body on both sides and gently rock his torso from side to side. It is important to ensure that the child does not resist. After that, holding the baby's head, gently shake it, replacing swaying with head turns.
The child should lie on the right side, place the right hand under the head, and stretch the left along the body.	Then you should gently push the baby so that he falls on his stomach or back. At the same time, it is important that he maintains his original position, and you can relax your muscles and fall only on a signal.
The child should sit in a chair, put his hands on the armrests, lower his head to his chest	With the help of an adult, you need to perform passive tilts and turns of the head, bend and unbend the neck. In this case, the baby should not resist.

It is important that the child fixes the head when performing passive movements, after which it actively relaxes the muscles so that the head seems to fall on the chest.

Breath Correction

To improve the breathing process, you need to do the following exercises:

1. The child should be shown how to inhale deeply and exhale through the nose and mouth, and then invite him to exhale into his palm or a thin sheet of paper. It is also very useful to blow bubbles or inflate toys.
2. To improve the functioning of the respiratory system, you should teach the baby to exhale sounds with different volumes. Singing, playing the harmonica, whistling helps a lot.
3. The child should take a breath at the expense of "1, 2, 3" and raise his hands up. Then exhale to the count of “4, 5, 6” and lower your hands at the same time. 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, it will be possible to correctly respond to negative emotions, which will ensure mental comfort and physical health.

It is necessary to teach the baby to imitate different emotions in order to subsequently be able to distinguish them in everyday life.

By using facial muscles he must carry out the discharge of emotions. This is the main task of psycho-gymnastics.

Emotions

To train emotions, perform the following exercises:

interest, attention	You need to show the baby how the fox eavesdrops or the 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 child to show how angry mom or dad is.
Disgust	Ask the child to imagine that he needs to drink salt water.
Joy, pleasure	You need to ask the baby to show how the cat behaves when it is stroked. It is also worth asking to smile, imagining that Santa Claus came and brought sweets.
Fear	Ask the kid 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 a swimming pool

Water procedures can be used for the physical recovery of children with this diagnosis. Everyone knows that water promotes excellent muscle relaxation, helps to stabilize muscle tone, fills with energy. Thanks to such activities, you can weaken the effect of stressful situations and cope with depression.

A special effect can be achieved with a combination of therapeutic exercises and stay in the water. This method is called hydrokinesitherapy. It includes performing certain exercises in the water, playing sports, underwater massage.

Excellent results can be achieved when a baby 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 is started, 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 simulators.

The first simulators

To increase efficiency, you need to purchase special simulators for your baby:

Rug with bumpy surface	First, the child needs to be laid out for several minutes on the back and stomach. You can also massage the limbs on it - for this you should rest the baby's heels on the surface or help him touch the tubercles with his hands. Ordinary rugs in the form of a heel equipped with plastic spikes are also perfect for such children. It is enough to put such devices near the baby's crib and every morning you need to offer the child to walk on them. The positive effect of such training is obvious - there are quite a lot of nerve endings in the human heel. In addition, it normalizes blood circulation in the legs. To harmonize physical and intellectual development, mom can make a multi-colored cover for a massage mat. It can be depicted with beautiful patterns and pictures. Thanks to this, it will be possible not only to improve the health of the baby, but also to arouse his cognitive interest.
Expander	For babies, you can make a rattle from a dense material. It can be filled with buckwheat or rice. Such a simulator will help develop a grasping reflex and eliminate spasticity of the fingers.
Jumpers and walkers	Of no small importance for the recovery of the child is the use of jumpers and walkers. In this case, it is necessary to remember the strength of materials and the stability of all devices. Since babies with cerebral palsy have poor coordination, plastic walkers that are unstable can be dangerous. Jumpers for children with such a diagnosis should be equipped with an orthopedic insert, wall mount and durable fastex. At the same time, it should be borne in mind that the use of jumpers and walkers for such children is an ambiguous issue. Some doctors believe that the baby will have enough simulators for support and pushing. This is due to the fact that the skills that a child acquires with the help of a walker are very different from the norm, so there may be a need to retrain the baby. However, the parents must make the final decision.

Sports and household

Of no small importance for the recovery of children with cerebral palsy is a pool filled with plastic balls. Experts advise using exclusively solid materials as the basis. It is important to consider that inflatable options or tents are absolutely not suitable.

An excellent solution would be a frame made of a chipboard sheet, 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 done 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 act as a vertical walking lock.

Personal trainers deserve special attention, which contain stretch marks, splints, orthopedic shoes and supports in an upright position. Such devices are made individually in orthopedic workshops based on the prescription of the attending physician.

To work out the tactile activity of the fingers, relief paintings are perfect. Great option become wooden toys or rough wallpaper. To train the initial functions of walking, you can use themed carpets and special massage paths.

It is very important to keep the child interested in activities. Therefore, the training process should be presented in the form of a game.

If a child does not succeed or feels pain, there is a risk that he will refuse to make an effort. It is very important for parents to persuade the child to continue the lesson.

To ensure normal coordination of movements, you should use comfortable furniture with various recesses and tacks.

Swedish wall and Gross simulator

Gross simulator

A system that provides organic support for a variety of exercises. In this device, you can not fall or take the wrong position. Since the simulator provides reliable fixation, it is possible to correct the curvature of the spine and pelvis of the baby. Thanks to this device, the child can learn to walk, do special exercises and even ride a bicycle. The soft helmet protects the head from impacts, and the design promotes the development of the musculoskeletal system. Without this, it is difficult to imagine the full intellectual development of the baby. The Gross simulator can be used in the process of training on the rings. It is used for insurance and ensures the normal position of the spine. It can also be used to teach your baby to sit or crawl. It allows you to do gymnastics on special devices.

Swedish wall

Such simulators can be wooden or metal. They are equipped with hanging ladders, rings, a counterweight system. It is very important for children with such a diagnosis to exercise on such simulators, since they contribute to the development of coordination of movements, help to cope with spastic phenomena and the consequences of paresis.

Exercise therapy for cerebral palsy can help to live normally, because cerebral palsy is the most severe violation of motor function that can occur for a variety of reasons, of which there are about four hundred. With cerebral palsy, muscle tone and coordination are disturbed. Cerebral palsy makes people disabled.

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

Needed for many years. The treatment itself is aimed at restoring the functions of the motor apparatus, memorizing elementary movements. This is a very, very hard work of mom and dad, as well as the child himself.

One medicines there is no cure for this disease. It is necessary to constantly engage in physiotherapy exercises, which will allow the baby to learn how to move correctly. Physical therapy for cerebral palsy gives a positive result in any case. Parents of children with cerebral palsy should 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 impact of exercise therapy on children's health

Therapeutic exercise has a positive effect on the human body. It gives an incentive to the tissues and muscles in the body to strengthen. The body regulates metabolic processes. The activity of the brain and the cardiovascular system is greatly improved.

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 an integral complex, which will include massage, physiotherapy, manual therapy, various hardening of the body.

Designed for every child individual complex exercises. All complexes include the following types of exercises: with a ball, in a lying and sitting position, relaxing exercises, stimulating exercises.

Tips and recommendations on the correct implementation of physiotherapy exercises

Absolutely all methods, when physiotherapy exercises are carried out for cerebral palsy, have general recommendations. Classes should be systemic, they should be held regularly and continuously. Only such a schedule of gymnastics will help to achieve a good positive result. A set of exercises should be selected by a qualified specialist for each small patient individually.

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 exercise 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 exercises:

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

Exercises that need to be done in order to develop movement skills

The most common form of cerebral palsy is atonic. It is manifested by 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.

Effective in this case are elementary exercises, for example, to raise and lower the torso from starting position lying on your back. You can also perform these movements while lying on your stomach. You can make a variety of slopes 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 the arms and legs.

It must be understood that cerebral palsy also affects the functionality of the child's brain.

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

As a result of this, there is a “feeling” effect, 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 fixed the child in the pelvic region, begin to put 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 another, alternately lifting them off the floor.
3. Starting position: the child is sitting on a chair. Take the baby by the hands, and fix his legs on the floor. Awaken in the child the desire to stand up by pulling his arms up and forward.
4. Starting position: the child stands with one leg forward. It is very easy to push the baby in the back and chest to develop the skill of balance.
5. Starting position: the child is standing. Take his 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 child's support is improved if the child presses his feet on some hard surface.

Exercises that are used to develop joints

1. Starting position: the child lies on his back. One leg must be held in an extended position, and the other must be bent. It is desirable that the thigh reaches the stomach.
2. The child lies on its side. Bend the child's leg at the knee and gently abduct the hip.
3. The child lies on his stomach on some surface so that his legs hang down. Very slowly, the limbs must be straightened.
4. The child lies on his back. You need to bend and unbend the knees of the baby.

Additional exercises

Exercises that train the abdominal muscles:

1. Starting position: put the child on your lap. Pull his back towards you. Make slopes with the baby, and he must rise on his own.
2. Starting position: the child lies on his back with his hands pressed to the body. The baby should try to roll over from his back to his stomach, while not using his hands.
3. Starting position: the child lies on his back. It is necessary to take a deep breath, and as you exhale, the baby should draw 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 kid should take a deep breath, and as you exhale, bend over and touch your toes with your fingers.
2. Starting position: the child lies on his stomach with outstretched arms. Focusing on the palm of your hand, the baby should lift upper part body above the floor.

As for developmental exercises fine motor skills, then here it is simply necessary to perform turns of the child’s hand in different directions.

Ball exercises:

1. It is necessary to put the child with his back to the ball. The legs should rest on the toy. Put the child in the center of the ball and roll back a little. This exercise is good for developing balance.
2. Place the baby on their stomach on a ball that fits 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 the ball and easily rock it back and forth, then the muscle tone is perfectly reduced.

Walking exercises:

1. Take the child by the hips, stand behind him. Gradually turn the baby by the hips in different directions to provoke him to take an independent step.
2. Help your child do squats - 50 per day.

A great helper is a special device called a verticalizer. It can fix the baby in a standing position. It is simply indispensable in training or in preparing a child for independent performance of basic functions. The verticalizer fixes the child's torso, and, if necessary, his feet and knees.