RU2260417C1 - Method for treating the cases of infantine cerebral paralysis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves administering massage, fixing body members, doing passive and active exercises on a ball which diameter is not less than 45 cm, gymnastic exercises and teaching motor skills to patients. Body members are kept fixed for the whole massage process time. Fixation is released only for the body member treated with massage. The fixed body is kept in dorsal lying position and prone position with maximum permissible extension of arm and leg articulations and legs parted to maximum permissible degree. These positions are additionally fixed by placing sacks filled with 1-5 kg of sand depending on age.

EFFECT: enhanced effectiveness and safety of treatment; accelerated formation of labyrinth straightening reflex.

7 cl, 1 tbl

Description

The present invention relates to medicine, namely to physiotherapy, and can be used for physiotherapy of cerebral palsy.

A known analogue method [1] for the treatment of cerebral palsy based on physiotherapy, including: gymnastic exercises; with rotational movements of the head, neck and torso of a sick child, while the "development of motor control" occurs in the following sequence; "the movement of the head and neck is followed by the upper body - shoulders, arms, hands, fingers, then the lower body - pelvis, legs, feet." But this direction of successive transmission of movement from the head to the lower part of the patient’s body is not effective enough.

A known analogue method [2] for the treatment of cerebral palsy based on physiotherapy, including: massage with subsequent fixation of parts of the child’s body in optimal physiological positions; gymnastic exercises (flexion of the leg in the knee and hip joints, in a standing position on the other fixed leg). However, the prototype method is functionally very limited and not effective enough.

A known prototype method [3] for the treatment of cerebral palsy based on physiotherapy, including massage with subsequent fixation of the body parts of the child in optimal physiological positions; gymnastic exercises; teaching a sick child vital and applied motor skills. However, the prototype method is functionally limited and not effective enough.

The technical result of the invention is to increase the efficiency and safety of the method of treating cerebral palsy, accelerate the formation of a labyrinth straightening installation reflex, stimulating the development of symmetrical chain reflexes aimed at adapting the torso to a vertical position.

The technical result is achieved by the fact that in the method of treating cerebral palsy based on physiotherapy, including massage; fixation of parts of the child’s body in optimal physiological positions; vestibular passive and active exercises of the child on a large inflatable ball, with a diameter of at least 45 cm; gymnastic exercises; teaching a sick child vital and applied motor skills, according to the invention, the fixation of the parts of the child’s body is maintained during the entire massage, alternately removing the fixation during the massage only from that part of the body that is being massaged, which ensures the maximum suppression of pathological synkinesias; the child’s fixed body during massage is kept in the “supine” and “supine” positions with the greatest possible extension of the joints of the arms and legs with the greatest possible leg dilution, and the fixation of these positions is strengthened by applying sandbags weighing 1 on the child’s arms and legs -5 kg, depending on the age of the child.

Sandbags weighing several kilograms were previously used [4] to fix the position of the body and its parts during treatment with the position, but not during the massage.

The technical result is also achieved by the fact that the massage is carried out in the following order: face, head, chest, healthier shoulder, wrist and fingers, less healthy shoulder, wrist and fingers, stomach, healthier thigh, lower leg and back of the foot, less healthy thigh , lower leg and back of the foot, back and buttocks. For the arms and legs, only extensor muscles are massaged, performing it in the direction of extensor muscle contraction and biologically active points in the areas of distal attachment of these muscles, which provides a stream of impulses to attenuate pathological labyrinth reflexes (due to which the limb does not extend in a sick child and etc.) and pathological synkinesias (friendly movements, in which, for example, eye movement leads to forced limb movement, etc.). In addition, when performing gymnastic exercises, passive and with the help of a therapist, they use the reactions of the patient’s body, head and arms poses to the movement of his thigh in various planes, while the thigh is set in motion by the therapist, which causes subsequent movements of the body, head and hands; in this case, the child’s posture is changed behind the thigh movements in the following sequence: upsets from back to stomach and abdomen to the back, sitting with support on a healthier arm with a transition to the supine position, sitting with the support of a less healthy arm with the transition to position lying on his back, flipping to the supine position, moving to the four-kneeling position, then to the kneeling position, standing on one knee and standing on the legs, and then in the reverse order, using therapist’s help if necessary, taking into account Astana and the child's abilities. And vestibular exercises on the big ball are carried out at the following initial positions of the child, established in a certain order: on the stomach, on all fours, sitting on the knees and sitting legs apart, lying on the back, performing at each initial position of the child 8-12 swings of the ball forward- back, right, left, clockwise and counterclockwise, up and down. At the same time, the above vestibular exercises on the big ball are combined with gymnastic exercises on the big ball, which use the reactions of the posture of the body, head and hands to the movement of the thigh in various planes, while the thigh is set in motion by the therapist, which causes subsequent movements of the body, head and hands and the ball, using the therapist’s help if necessary, taking into account the age and capabilities of the child. Before the aforementioned vestibular exercises on the big ball, they additionally train the equilibrium reaction on the swinging half cylinder at various initial positions of the child, set in a certain order: on the stomach, on all fours, kneeling, kneeling, standing, squatting, sitting legs apart, using, if necessary, the help of a therapist, taking into account the age and capabilities of the child.

It is known [5] about the use of large inflatable orthopedic balls, with a diameter of at least 45 cm, in the treatment of cerebral palsy for conducting gymnastic and vestibular exercises on them when the child is placed on the ball while lying on his stomach or sitting. But there is no information about the use of large inflatable orthopedic balls to develop the reaction of the patient’s body poses to the movements of his hips in various planes, and the proposed sequences of exercises on them were not known.

A comparison of the inventive method and the prototype method made it possible to establish that the inventive method is characterized in that the fixation of parts of the child’s body is maintained during the entire massage, alternately removing the fixation during the massage only from that part of the body that is being massaged, which ensures the maximum suppression of pathological synkinesias; the child’s fixed body during massage is kept in the “supine” and “supine” positions with the greatest possible extension of the joints of the arms and legs with the greatest possible leg dilution, and the fixation of these positions is strengthened by applying sandbags weighing 1 on the child’s arms and legs -5 kg, depending on the age of the child, and conclude that the invention meets the criterion of "novelty."

When studying other known solutions in the art, features identical to those distinguishing the claimed invention from the prototype were not identified, and therefore it meets the criterion of "inventive step".

The successful use of the claimed invention for the treatment of cerebral palsy and the use of well-known technical means and technologies provides him with the criterion of "industrial applicability".

The proposed method is as follows.

Fix the child’s body in the optimal physiological position. Massage a sick child in the following order: face, head, chest, healthier shoulder, wrist and fingers, less healthy shoulder, wrist and fingers, stomach, healthier thigh, lower leg and back of the foot, less healthy thigh, lower leg and back feet, back and buttocks. At the same time, only extensor muscles are massaged for arms and legs, performing it in the direction of extensor muscle contraction, and biologically active points are massaged in the distal attachment zones of these muscles. The above fixation of the parts of the child’s body is maintained during the whole massage, taking off the fixation for the massage period only from the part of the body that is being massaged, which ensures the maximum suppression of pathological synkinesias; the child’s fixed body during massage is kept in the “supine” and “supine” positions with the greatest possible extension of the joints of the arms and legs with the greatest possible leg dilution, and the fixation of these positions is strengthened by applying sandbags, weighing 1, to the child’s arms and leg -5 kg, depending on the age of the child.

Then, the equilibrium reaction is trained on the swinging half cylinder at various initial positions of the child, set in a certain order: on the stomach, on all fours, kneeling, kneeling, standing, squatting, sitting legs apart, using therapist’s help if necessary, taking into account the age and capabilities of the child.

Then they conduct vestibular passive and active exercises on a large inflatable orthopedic ball with a diameter of at least 45 cm, with the following initial positions of the child, set in the following order: on the stomach, on all fours, sitting on your knees and sitting legs apart, lying on your back, exercising with in each initial position of the child, 8-12 swings of the ball back and forth, left and right, clockwise and counterclockwise, up and down, using the help of a therapist if necessary, taking into account the age and capabilities of the child.

The above vestibular exercises on the big ball are combined with gymnastic exercises on the big ball, which use the reactions of the body, head and hands poses to move the thigh in different planes, while the thigh is set in motion by the therapist, which causes subsequent movements of the body, head and arms and ball , using the help of a therapist if necessary, taking into account the age and capabilities of the child.

Then they carry out gymnastic exercises: passive exercises, exercises with the help of a therapist, reflex exercises and active exercises, as well as teaching a sick child vital and applied skills: coups from the abdomen to the back and back, sitting, standing up, squats, walking. When teaching these skills, they additionally use the reactions of the postures of the body, head and hands to the movement of the thigh in various planes, while the thigh is set in motion by the therapist, which causes subsequent movements of the body, head and hands, while the child’s posture is changed after the thigh movements in the following sequence : upsets from the back to the stomach and from the abdomen to the back, sitting with the support on a healthier arm with the transition to a supine position, sitting with the support of a less healthy arm with the transition to the supine position, a flip to a supine position, a transition to a kneeling position, then to a kneeling position, standing on one knee and standing on legs, and then in the reverse order, using therapist’s help if necessary, taking into account the age and capabilities of the child. This contributes to the formation of a labyrinth straightening installation reflex, stimulating the development of symmetrical chain reflexes aimed at adapting the torso to a vertical position.

The duration of the session is 1.0-2.0 hours, regardless of age, including 30-60 minutes for massage and 30-60 minutes for other procedures. The duration of the components of the lesson depends on the age and condition of the child. The degree of load is regulated by changing the intervals of rest of the child. For children under 3 years of age, classes are conducted daily for 15 days with an interval of 45-60 days. For older children, classes are carried out constantly 2-3 times a week.

Example.

We selected 8 sick children with a severe diagnosis of “spastic form of cerebral palsy” (cerebral palsy with increased muscle tone) and 2 children with perinatal CNS damage (PP-CNS), who are at risk of cerebral palsy and have increased muscle tone on the right and a delay in the development of statics and motility, as well as the presence of reflex-prohibitive positions. Of 8 people with a diagnosis of “spastic form of cerebral palsy,” 5 people had the most severe form of the disease — double hemiplegia (DG-Cerebral Palsy, tetraplegia) and 3 people had a less severe form of the disease — spastic diplegia (SD-Cerebral Palsy). Children with double hemiplegia had significant motor impairment, mental retardation, and contractures and deformities in the joints of the arms and legs. In children with spastic diplegia, stiffness and limitation of movements were more pronounced for the legs than for the hands. At the same time, the intellectual development of children corresponded to their age. With each sick child, the following medical procedures were carried out according to the proposed method described above.

The effectiveness of treatment was evaluated by the level of development of a sick child achieved as a result of his treatment. In this case, as is generally accepted, 6 consecutive levels of child development were distinguished for the standing position: 1 - he is able to stand with the support of the upper body, 2 - he is able to rearrange his legs with the support of the upper body, 3 - he stands at the support, holding on to her with two hands, 4 - he stands at the support, holding on to it with one hand, 5 - he stands alone, walks with support; 6 - he walks on his own.

The results are presented in the table.

Table
The results of therapeutic adaptive effects on sick children, when registering for the standing position A patient Achieving Development Levels No. Elementary number diagnosis 2 3 4 5 6 level 1 SD-cerebral palsy + + + + + 1 2 DG-cerebral palsy + + + 1 3 DG-cerebral palsy + + + 1 4 DG-cerebral palsy + + + + 1 5 PP-CNS + + + (in devices for walking) 1 6 SD-cerebral palsy + + + + + 2 7 DG-cerebral palsy + + + + 2 8 DG-cerebral palsy + + + + + 1 nine PP-CNS + + + (in devices for walking) 1 10 SD-cerebral palsy + + + + + 1

From the table it follows that when applying the proposed method for the treatment of children with severe forms of pasty tetraporesis (pastical diplegia or paraporesis) they reached high levels of development (from the 4th to the 6th level). At the same time, children under the age of 5 years reached the 6th level (mastered walking) in 4-6 months, and older children (7-12 years) and children with severe spastic tetraporesis (DG-Cerebral Palsy), with gross secondary complications, reached the 5th level of development (they began to stand on their own, walk with support) in 2.5-3 years. This is a high result.

In addition, the treatment according to the proposed method improved visual, auditory and vestibular reactions, motor coordination, hand-eye coordination, fine motor coordination, attention, memory, speech, increased physical strength and endurance, significantly improved their well-being and comfort, in all cases syndromes of different leg lengths were eliminated (due to an oblique and / or twisted pelvis) and the correct bends of the spine formed.

The effectiveness of the proposed method of treatment is 2 or more times higher than the effectiveness of the prototype method and analog methods. So, in the treatment of children with the most severe spastic forms of cerebral palsy, all of them (100%) achieved high levels of development (from the 4th to the 6th), which is not achievable when using the known analogue methods or the prototype method.

Sources of information

1. RU 96120155 A from 1999-06-27 "Method of medical conductive rehabilitation of patients with cerebral palsy." IPC: A 61 N 1/00. Author - Isanova V.A.

2. RU 2076678 C1 of 1997.04.10 "A method for the treatment of cerebral palsy and a device for its implementation." IPC: A 61 H 23/00, author - A. Gritsenko

3. RU 99114734 A dated 2001.04.27 "Method for the rehabilitation treatment of patients with late stage residual stage of cerebral palsy. IPC A 61 N 1/00. Authors: Semenova K.A. Shvarkov SB

4. Bortfeld S. A., Rogacheva E.I. Physiotherapy exercises and massage for cerebral palsy. / L .: Medicine, 1986. 182 p.

5. Finney N.R. A child with cerebral palsy. Help, care. Development. Book for parents. (Translation from English by Yu.V. Lepes, A.V. Snegovskaya. Edited and foreword by E.V. Klochkova) / M.: Terevinf. 2001 .-- 336 p. - A special child., P. 127.

Claims (7)

1. A method of treating cerebral palsy based on physiotherapy, including massage, fixation of body parts, passive and active vestibular exercises on a ball with a diameter of at least 45 cm, gymnastic exercises, training the patient in motor skills, characterized in that the fixation of body parts is maintained in the process of massage, alternately removing fixation for the duration of the massage only from that part of the body that is being massaged, the fixed body during massage is kept in the “supine” and “supine” position with maximum possible straightening of the joints of hands and feet at the maximum possible dilution of the legs and fixing these provisions enhance the application to the hands and feet of sandbags weighing 1-5 kg, depending on age. 2. The method according to claim 1, characterized in that the massage is carried out in the following order: face, head, chest, healthier shoulder, wrist and fingers, less healthy shoulder, wrist and fingers, stomach, healthier thigh, lower leg and back feet, less healthy thigh, lower leg and back of the foot, back and buttocks. 3. The method according to claims 1 and 2, characterized in that for the arms and legs they massage only extensor muscles and biologically active points in the areas of distal attachment of these muscles. 4. The method according to claim 1, characterized in that when performing gymnastic exercises, passive and with the help of a therapist, use the reaction of the patient’s body, head and hands poses to the movement of his thigh in various planes, while the thigh is set in motion by the therapist, which causes subsequent movements of the body, head and hands, while changing the pose of the child is performed behind the movements of the thigh in the following sequence: flips from the back to the abdomen and from the abdomen to the back, sitting down resting on a healthier arm with the transition to the supine position, living with support on a less healthy arm with a transition to the supine position, a coup to the supine position, a transition to the all fours, then to the kneeling position, standing on one knee and standing on legs, and then in reverse order, using, if necessary, the help of a therapist, taking into account the age and capabilities of the child. 5. The method according to claim 1, characterized in that the above exercises on the big ball are carried out at the following initial positions of the child, set in the following order: on the stomach, on all fours, sitting on the knees and sitting legs apart, lying on the back, performing at each the initial position of the child for 8-12 swings of the big ball back and forth, left and right, clockwise and counterclockwise, up and down. 6. The method according to claim 1, characterized in that the above vestibular exercises on the big ball are combined with gymnastic exercises on the big ball, which use the reactions of the posture of the body, head and hands to move the thigh in different planes, while the thigh is set in motion by the therapist , which causes subsequent movements of the body, head and arms and the ball, using, if necessary, the help of a therapist, taking into account the age and capabilities of the child. 7. The method according to claims 1 and 6, characterized in that before the above vestibular exercises on the big ball, an equilibrium reaction is additionally trained on the swinging half cylinder at different initial positions of the child, set in a certain order: on the stomach, on all fours, sitting on the knees, standing, squatting, sitting legs apart, using therapist's help if necessary, taking into account the age and capabilities of the child.