RU2315590C1 - Method for carrying out conservative myopia treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves executing manual contrasting massage acting upon ciliary muscle both in direct way and by stimulating parasympathetic nervous system contributing to increasing muscle tone.

EFFECT: enhanced effectiveness of noninvasive treatment; reduced risk of complications.

83 dwg

Description

The invention relates to medicine, in particular to ophthalmology, and can be used for the conservative treatment of myopia.

Closest to the proposed is a method of conservative treatment of myopia [1], which consists in the implementation of a treatment complex, including general gymnastics, self-massage, gymnastics for the eyes. However, it is not effective enough, and the therapeutic effect is not stable enough due to the fact that the applied massage techniques do not fully affect the mechanical receptors of the skin, which leads to insufficiently effective direct and indirect effects on the nervous tissue.

A new technical task is to increase the effectiveness of treatment by reducing complications and expanding the scope.

To solve the problem in a method of conservative treatment of myopia, including eyeball massage, the ciliary muscle of the eye is affected by massage, for which, in the first stage, linear stroking with the fingertips is performed on the entire face for 20-30 seconds, in the second stage, the thumb is worked out of the right hand and the index and middle fingers of the left hand of the exit point of the trigeminal nerve of the infraorbital and infraorbital region alternately for 10 seconds from one and the other side of the face, 4-6 times, at the third stage perform stroking movements of the lateral and posterior surfaces of the neck for 15 seconds at the fourth stage, they again return to working out in a circular motion the exit points of the nerves in the eye socket on both sides of the face alternately for 5-7 seconds, 4-7 times, at the fifth stage, they initially proceed to stroking the back of the palm of the hand and simultaneously stimulating the pectoral muscle with the fingertips for 15 seconds, at the sixth stage, treat the deltoid muscle for 15 seconds by stroking the back of the palm and simultaneously With the help of fingertip stimulation, at the seventh stage, the paravertebral muscles and the spinociliary center are worked out, while they begin to move with intensive rake-like stroking with the fingertips of the entire back surface, with emphasis on the paravertebral muscles and the spinociliary center, for 2-3 minutes, then at the eighth the stage is followed by the transition to the trapezius muscles and their intensive vibrational study for 30-40 seconds, at the ninth stage, the exit points of the occipital nerve are stimulated, which begins with stroking the palmar surface of the left hand and simultaneously carry out vibrational stimulation with the fingertips of the left hand for 15-20 seconds, at the tenth stage, without ending the stimulation with the left hand, the right simultaneously carry out grasping stroking with the palmar surface of the forearm, for 1-2 minutes, at the eleventh stage they stimulate the same zone with the fingertips of both hands for 2-3 minutes, at the twelfth stage they perform deep relaxing movements for 40-60 seconds, at the thirteenth stage they go to the neck and sleep y, 1-2 min, at the fourteenth stage, vibrational stimulation of the occipital nerves is performed for 10-15 seconds alternately, alternating with relaxing movements of 5 seconds, at the fifteenth stage, study through pulsating movements of the neck muscles on both sides for 1 min, at the sixteenth stage they stimulate the occipital nerves with pulsating movements for 10-15 seconds, alternating with smooth relaxing movements for 15-20 seconds, at the seventeenth stage trapezius muscles are worked out, for which the right they fix the muscle with the help of the left, and often perform vibratory movements with the left for 5-7 seconds, and then fix it with the left hand, and with the right hand, pinching the muscle between the index and middle fingers, perform smooth stroking along the muscle on both sides for 15 seconds 3 -4 times, at the eighteenth stage, perform a vibrating action with the palm surface on the trapezius muscles on both sides 2-3 times for 10 seconds, which then goes into a deep relaxing stroking with the palm edge for 2-3 seconds, then stroking the back of the palm of the other hand and again performing the movements of stages 34 and 35, at the nineteenth stage, perform a sweeping stroking of the trapezius muscle for 10 seconds, and carry out intensive vibration stimulation with your fingertips at various angles of the paravertebral muscles for 5-10 seconds, at the twentieth stage smooth kneading of the trapezius muscle, while doing this first perform the thumbs for 5 seconds, then the index and ring fingers for 5 seconds and then the index and middle to meet each other for 5 seconds, at the twenty-first stage, the entire back is kneaded by intensive intersecting movements of the palmar surface for 2-3 minutes, at the twenty-second stage, the eyeball itself is fixed by vibrating movements of the index finger, fixed by the thumb of the other hand, with stimulation perform within five approaches for 30 seconds on each eye, after which they again return to the study of the back, for which an intensive vibration stimulation of paravertebral muscles with fingertips located at an angle of 90 degrees to the surface of the body for 15 seconds, on each side, at the twenty-fourth stage, the right hand continues vibration stimulation at an angle of 40-60 degrees with the fingernail, and with the left hand, at an angle of 20 40 degrees, they perform vibration in the opposite direction towards the right hand for 20-30 seconds, after which they perform the usual rake-like stroking for 5-7 seconds, at the twenty-fifth stage they work out the skin surface in the places of the triple exit of the nerve nerve, for which a smooth circular kneading with the thumbs is first performed, for 5-10 seconds, then the area of the infraorbital nerve is worked out with the fingertips and the nail plate on both sides for 10-15 seconds, alternating with the development of the infraorbital nerve for 5-10 3-5 seconds, at the twenty-sixth stage, smooth strokes of the skin surface in the projection of the occipital nerves are carried out for 10-15 seconds, and movements aimed at relaxing the neck muscles for 40-60 seconds are carried out, at the twenty-seventh stage, they are sized stroma-clavicular-mastoid muscle snapping with frequent intense movements, for which they first grab it between the thumb and the rest of the fingers for 15-20 seconds, and then perform vibrating movements with the tips of the fingers of the right hand, holding the muscle with the left hand, alternately, on each side, for 20-30 seconds, at the twenty-eighth stage, the keystone muscle is kneaded by vibrating movements with the fingertips of the right hand, holding the muscle with the left hand, alternately, on both sides, changing hands, after 15-20 seconds, 3-4 times on each side, at the twenty-ninth stage, the trapezius muscle is kneaded with the fingers of both hands, while the trapezius muscle is fixed between the fingers with one hand, and the kneading between the fingers is carried out between the fingers for 20-30 seconds at the thirtieth stage, stroking the back of the neck is performed with sweeping movements within 10 seconds, at the thirty-first stage, knead the pectoralis major muscle by slow movements of the palmar surface of the left hand for 40-60 seconds, and then grasping stroking for 10 seconds, n in the thirty-second stage, holding the head with the right hand, they stimulate the skin surface in the projection of the occipital nerves with vibrational movements, changing the position of the hands after 10-15 seconds, 5-7 times, at the thirty-third stage, with deep smooth movements of the thumbs, the infraorbital nerve is first stimulated during 15-20 seconds, and then the infraorbital nerve, alternately, 3-5 times, changing the position of the fingers during stimulation of the infraorbital nerve, at the thirty-fourth stage, the scalp of the palmar surface is stroked sti within 20-30 seconds of the surface of the occipital nerve zone for 20-30 seconds, sternocleidomastoid muscle for 20-30 seconds, pectoralis major muscles 20-30 seconds, alternating with their easy kneading for 20-30 seconds 3-4 times, at the thirty-fifth stage, stroking the neck and head is performed with alternating smooth, slow movements for 20-30 seconds, 5-7 times, 2-4 courses with a break of 2 months, and then supporting courses, at least one in 8 months.

The method is as follows. The implementation of the method is illustrated in figures 1-83. The massage begins with a straight stroking with the fingertips of the entire face surface (Fig. 1) for 20-30 seconds, then work out with the thumb of the right hand and the index and middle fingers of the left hand the exit points of the trigeminal nerve of the infraorbital and infraorbital region alternately for 10 seconds from one and the other side of the face (figure 2) 4-6 times. Then, stroking movements of the lateral and posterior surface of the neck are performed for 15 seconds (Fig. 3), after which they again return to working out circular points of the nerve exit points in the eye socket on both sides of the face alternately for 5-7 seconds (Figs. 4, 5, 6, 7 ) 4-7 times and go first to stroking the back side and simultaneously stimulating with the fingertips of the pectoralis major muscle for 25-30 seconds (Fig. 8), with the transition to the deltoid muscle for 15 seconds (Figs. 9, 10).

After this movement, they proceed to study the paravertebral muscles and the spinociliary center. The movement begins with an intensive rake-like stroking with the fingertips of the entire back surface, with an emphasis on the paravertebral muscles and the spinociliary center for 2-3 minutes (Fig. 11). This is followed by the transition of the trapezius muscles and their intensive vibrational study for 30-40 seconds (Fig. 12), after which the stimulation of the exit points of the occipital nerve begins, which begins with stroking the palmar surface of the left hand and simultaneous vibration stimulation with the fingertips of the left hand 15-20 seconds (Fig.13). Without stopping the stimulation with the left hand, the right hand holds a sweeping stroking with the palm surface and forearm for 1-2 minutes (Fig. 14), replaced by stimulation with the fingertips of both hands for 2-3 minutes (Fig. 15, 16, 17, 18, 19), after followed by deep relaxing movements of 40-60 seconds (Figs. 20, 21, 22) with a transition to the neck and back for 1-2 minutes (Figs. 23, 24, 25, 26), and again followed by vibrational stimulation of the occipital nerves 10-15 seconds (Fig. 27, 28), alternating with relaxing movements of 5 seconds (Fig. 29). Then follows the study of pulsating movements of the muscles of the neck on both sides for 1 min (Fig. 30), passing into the pulsating stimulation of the cranial nerves for 10-15 seconds (Figs. 31, 32), alternating with smooth relaxing movements of 15-20 seconds (Fig. 33, 34, 35).

Next, they go on to work out the trapezius muscles. The muscle is fixed with the right hand, and frequent vibrational movements of 5-7 seconds are performed with the left hand (Fig. 36). After that, the muscle is fixed with the left hand, and the right hand, clamping the muscle between the index and middle fingers, performs smooth stroking along the muscle on both sides for 15 seconds 3-4 times (Fig. 37). The next movement is the vibrating effect of the palm surface on the trapezius muscles on both sides 2-3 times for 10 seconds (Fig. 38), which goes into a deep relaxing stroking with the palm edge for 2-3 seconds (Fig. 39), followed by a transition to another side with a strong stroking movement of the back of the hand (Fig.40) and again perform movements 36 and 37.

After that, a sweeping stroking of the trapezius muscle is performed for 10 seconds (Fig. 41) with a transition to intensive vibration stimulation with the fingertips at various angles of the paravertebral muscles for 5-10 seconds (Figs. 42, 43), which turns into a smooth kneading of the trapezius muscle, performed first with the thumbs 5 seconds (Fig. 45), then index and anonymous 5 seconds (Fig. 46) and index and middle towards each other for 5 seconds (Figs. 47, 48). This is followed by a strong crossing kneading the entire back with the palmar surface for 2-3 minutes (Fig. 49).

After this follows the study by vibrating movements of the index finger directly of the eyeball itself, fixed by the thumb of the other hand (Fig. 50). Stimulation is performed five times within 30 seconds on each eye, after which they again return to working out the back.

Start with intensive vibrational stimulation of the paravertebral muscles with the fingertips at an angle of 90 degrees for 15 seconds on each side (Fig. 51), after which the right hand continues the vibration, but at an angle of 40-60 degrees, and the stimulation is performed with a nail plate, which is adds more contrast, and with the left hand at an angle of 20-40 degrees they perform vibration, but towards the right hand for 20-30 seconds (Fig. 52), after which they perform the usual rake-like stroking for 5-7 seconds (Fig. 53).

Then they again proceed to the elaboration of the trigeminal nerve exit points. First, a smooth circular kneading is performed with the thumbs (Fig. 54). After 5-10 seconds, we proceed to the development of the infraorbital nerve with the fingertips and the nail plate on both sides for 10-15 seconds (Figs. 55, 56), alternating with the development of the infraorbital nerve for 5-10 seconds 3-5 times (Fig. 57). After that, smooth strokes of the occipital nerves follow for 10-15 seconds (Figs. 58, 59) with the transition to relaxation of the neck muscles for 40-60 seconds (Fig. 60).

Next, they proceed to frequent, intensive kneading of the sternocleidomastoid muscle, first grasping between the thumb and other fingers for 15-20 seconds (Fig. 61), and then vibrating movements with the fingertips of the right hand, holding the muscle with the left hand (Fig. 62) alternately on each side for 20-30 seconds, after which we proceed to kneading the trapezius muscle with vibrating movements with the fingertips of the right hand, holding the muscle with the left hand (Fig. 63), alternately on both sides, changing hands, (Fig. 64), through 15-20 seconds 3-4 times. This movement is replaced by kneading the trapezius muscle with the fingers of both hands, with one hand fixing the neck and between the fingers of the trapezius muscle, and the other producing kneading of the muscle between the fingers for 20-30 seconds (Fig.65, 66). Next, perform a sweeping stroking of the back of the neck for 10 seconds (Fig. 67), and proceed to kneading the pectoralis major muscle with slow movements of the palmar surface of the left hand for 40-60 seconds (Fig. 68, 69), ending with a sweeping stroking of 10 seconds (Fig. 70) .

Further, holding the head with the right hand, they again return to the stimulation of the occipital nerves by vibrational movements (Fig. 71), changing the position of the hands after 10-15 seconds (Fig. 72), and so 5-7 times, then with deep smooth movements stimulate the infraorbital nerve region thumbs for 15-20 seconds (Fig. 73) and the infraorbital nerve (Fig. 74), alternately 3-5 times, changing the position of the fingers when stimulating the infraorbital nerve (Fig. 75).

The massage is completed by stroking the scalp with the palmar surface for 20-30 seconds (Fig. 76), the area in the projection of the occipital nerves for 20-30 seconds (Fig. 77), the sternocleidomastoid muscle for 20-30 seconds (Fig. 78), large pectoral muscles 20-30 seconds (Fig), alternating with easy kneading 20-30 seconds 3-4 times (Fig. 80, 81). The massage ends with an alternation of smooth, slow stroking of the neck for 20-30 seconds (Fig. 82) and head, 20-30 seconds (Figs. 83, 84), 5-7 times.

The basis of the invention is the creation of a method of conservative treatment of myopia through the use of contrast massage elements, a feature of which is a complex effect on the skin mechanoreceptors and, as a result of this effect, the effect of a direct and indirect effect on the nervous tissue, amplified by the summarized excitation. Massage is carried out in the above sequence. The course includes 8-12 sessions, treatment is carried out 2 times a week, a break between courses of 30-45 days, and, further, supporting courses, at least one for eight months.

The relevance of the problem of eye diseases in modern man is obvious. According to various authors, from 28.4 to 35% of the world's population suffer from myopia, of which 49% have high myopia [2, 3]. Myopia is growing especially fast among children and young people, which is not surprising, because if the eye of an adult is stable to some extent and can withstand the loads presented by both the abundance of technical devices and the rhythm of modern life, then the growing eye of a child is labile and suffers from them. In most cases, myopia develops after a partial or complete spasm of accommodation resulting from prolonged and intense work near. Thus, maintaining the functional state of the accommodative apparatus of the eyes within individual maximum limits is a paramount step in the prevention of myopia and farsightedness. There are no effective medications for the treatment of myopia. Correction of contact lenses, widely used by ophthalmologists, does not stop the progression of the disease. A radical method of treatment is laser vision correction. But the problem of achieving the planned refractive effect as a result of surgical treatment is still relevant. This is indicated by numerous publications in specialized journals, which provide disappointing statistics of under-correction and hyper-correction of the initial refraction. This, in turn, explains a rather large percentage (18%) of patients dissatisfied with the results of surgical treatment [3]. Of the non-pharmacological methods, infrasound pneumomassage is used as a concomitant treatment of myopia (EI Sidorenko, SA Obrubov, AR Tumasyan) [4], which positively affects the main pathogenetic links of myopia, such as improved accommodation, hemodynamics, ophthalmotonus and biomechanical properties of sclera. But this technique is not effective enough with severe myopia.

The aim of our work is to develop an optimal, non-invasive, non-drug treatment for myopia.

To achieve this goal, the following tasks were set: to use the possibility of direct and indirect mechanical stimulation of the ciliary muscle; identify the need for contrasting effects on the nervous system and muscles of the eye.

It is proposed to treat myopia by means of manual contrast massage, the essence of which is an intensive effect on the ciliary muscle, both direct and through action on the parasympathetic nervous system, which helps to increase the tone of this muscle. Since only the anterior, smaller part of the eye is accessible to the direct effect, and the rest, most of it, lies deep in the orbit, the main effect on it should be indirectly through the nervous system.

Since myopia reveals weakened accommodation and a deterioration in the contractility of the ciliary muscle disrupts the metabolism of the lens and vitreous body, it is necessary to direct the main effect to increase its contractility. Thus, the main task of massage is to increase accommodation by enhancing the contractility of all the muscles of the eyeball, and especially the ciliary muscle. To achieve a higher effect, it is necessary to stimulate the ciliary muscle and lens in as many directions as possible, that is, either directly, through the eyelids, or indirectly through the nervous system of the eye.

The proposed method uses traditional movements used in cosmetic massage - stroking, rubbing, kneading and vibration, but adapted accordingly to the principles of: contrast, local study; varying angles; vibratory movements; deep relaxation; circular impact.

The principle of contrast is the alternation of strong and weak, hard and soft effects that affect nerve and muscle cells in different ways, causing a diverse response. Let us explain the need to observe the principle of contrast.

According to the general adaptive characteristics, the receptors located in the skin are divided into fast (speed receptors - Meissner bodies), very fast (acceleration receptors - Pacini bodies, also called vibration receptors) and slowly adapting (force receptors - Merkel disks, Rufini endings). The former are characterized by the ability to selectively display in their activity the properties of only the dynamic components of the acting adequate stimulus with the rapid restoration of the initial state of the receptive mechanisms. Slowly adapting receptors respond to the stimulus throughout its duration, providing the nervous system with information about the parameters of the static component of the acting stimulus (for example, the end of Rufini). Such adaptive properties of receptors can significantly fix certain properties of the stimulus in the form of transient phenomena in it [5]. Thus, slow adaptive receptors are receptors that respond to a constant stimulus with a gradually decreasing pulse frequency, and fast adaptive receptors are receptors that respond to sudden changes in the stimulus and provide information on the dynamics of the stimulus.

The principle of local study is that despite the spatial continuity of massage movements, the front surface of the eyeball is exposed to the main study.

The principle of varying angles is realized in a constant change in the inclination of the fingers to the massaged surface, which gives additional irritation to various types of nerve receptors and, therefore, has an additional effect on the muscles of the eyeball.

The principle of vibrational movements. The maximum vibration speed is used to achieve a smooth tetanus in the massaged muscle. Vibration is also necessary to summarize the results of the simultaneous activation of spatially separated synapses, which gives a higher exciting postsynaptic potential. The synaptic potentials remain for a certain time, therefore, if a new synaptic excitation occurs before the discharge is completed, then the induced depolarization is summed up with the residual, therefore, there is more excitation and a greater effect on the muscular system.

The principle of deep relaxation. It consists in smooth, deep effects on the muscle in the stage of smooth tetanus, which helps to reduce the phase of absolute refractoriness that occurs after depolarization and prolonged muscle excitation, not interrupted by periods of relaxation.

The principle of circular impact. The transition from one problem zone to another, and so on, until we again return to the zone that was worked out at the beginning.

The proposed massage application regimen was based on an analysis of the results of clinical observations of this category of patients. In clinical trials, 15 people with an experience of myopia of 5 years or more at the age of 17 to 22 years with a degree of myopia from low to high were involved. It should be noted that clinical trials were conducted during the session, that is, with increased load on the patient. All patients underwent 6-8 sessions of contrast massage twice a week. As a result of clinical studies, it was found: an increase in visual acuity was obtained without spectacle correction - from 0.2 to 0.41, with correction - from 0.62 to 0.89; a slight decrease in refraction from 3.9D to 3.1D was obtained; an increase in accommodation volume from 10.0D to 11.36D, probably due to an increase in the positive part of the relative accommodation volume from 9.0D to 10.0D and a decrease in the negative part of the relative accommodation volume from 4.35D to 3.6D.

A month after treatment, visual acuity without correction increased from 0.41 to 0.49; visual acuity with correction decreased slightly from 0.89 to 0.88; there was a slight increase in refraction from 3.18D to 3.2D; accommodation volume decreased from 11.36D to 11.3D. It was noted that the positive part continues to increase from 10.0 D to 11.1 D, while the negative part increased to a lesser extent compared with the results obtained immediately after treatment, from 3.6 D to 3.62 D. This makes it possible to conclude that after the treatment, even with a high eye strain, a pronounced positive therapeutic effect was obtained, which a month after the course of contrast massage, according to some indicators, not only did not decrease, but even increased. Thus, the proposed method is an effective non-drug treatment for myopia.

Clinical examples of the method.

Example 1. Smirnova Olga Vladimirovna. 30 years. Nurse. Myopia: right eye - 3.5D, left eye - 1.5D.

The treatment according to the proposed method in the amount of 2 courses of 12 sessions with a break of 2 months (45 days). As a result of treatment, vision was fully restored.

Example 2. Zhukov Evgeny Valerevich. 30 years. Working. Myopia, the right eye is 2.5, the left eye is 1D.

The treatment was carried out according to the proposed method - 2 courses of 8 sessions with a break of 30 days. As a result of treatment, vision was fully restored.

Example 3. Moskalenko Elena Alexandrovna. 18 years old, student, myopia of the right eye with -3D, left eye with -2.5D

The treatment according to the proposed method 4 courses of 12 sessions with a break of 45 days. As a result of treatment, vision was fully restored.

As a result of clinical studies, it was concluded that it is recommended to conduct three to four courses of contrast massage with a break of two months, which will improve the results immediately before recovery and continue to continue supporting courses with a frequency of 1 time in 8 months.

This technique has been used for 5 years. The age of patients varies from 7 to 55 years. In all cases, clearly positive dynamics are achieved. Vision is restored completely with myopia to -3.5D and partially on average by 1.0-1.5 with more severe forms of myopia.

Literature:

1. Patent No. 2105534, "A method for the treatment of eye diseases", BI dated 02.27.1998 (prototype).

2. Osipov A.E. Substitution of the lens volume after cataract extraction with high myopia: Dis. ... cand. honey. sciences. - M., 1999 .-- 129 s.

3. Angle J., Wissman D.A. The epidemology of myopia // Am. J. Epidemol. - 1980. - Vol. 111. - P.220.

4. Rumyantseva O.A. Psychological problems that arise during the selection and treatment of patients using photorefractive keratectomy.

5. Ophthalmology. / Ed. Sidorenko. - M., 2003, p. 115.

6. Physiology of sensory systems. (Under the editorship of Corresponding Member of the Russian Academy of Sciences, Prof. Y. A. Altman). - St. Petersburg: "Parity", 2003, p. 61.

Claims (1)

A method of conservative treatment of myopia, including eyeball massage, characterized in that it acts on the ciliary muscle by massage, for which the first step is to perform straight stroking with the fingertips of the entire face for 20-30 seconds, in the second step, work out with the thumb of the right hand , with the index and middle fingers of the left hand, the exit points of the trigeminal nerve of the infraorbital and infraorbital region alternately for 10 s from one and the other side of the face 4-6 times, at the third stage, stroking movements are performed I of the lateral and posterior surfaces of the neck for 15 s, at the fourth stage they again return to working out in a circular motion the exit points of the nerves in the eye socket on both sides of the face alternately for 5-7 with 4-7 times, at the fifth stage, they first go to stroking the back side of the palm and simultaneous stimulation with the fingertips of the pectoralis major muscle for 25-30 s, at the sixth stage, the deltoid muscle is treated for 15 s by stroking the back of the palm and simultaneous stimulation with the fingertips, on the seventh the tapes work out the paravertebral muscles and the spinociliary center, while they begin to move with intensive rake-like stroking with the fingertips of the entire back surface with an emphasis on the paravertebral muscles and the spinociliary center for 2-3 minutes, then at the eighth stage, the transition to the trapezius muscles and their intense vibration working out for 30-40 s, at the ninth stage, stimulation of the exit points of the occipital nerve is carried out, which begins with stroking the palmar surface of the left hand and at the same time I carry out vibrational stimulation with the fingertips of my left hand for 15-20 seconds, at the tenth stage, without ending the stimulation with my left hand, hold the right hand at the same time grasping my palms on the forearm for 1-2 minutes, at the eleventh stage I stimulate the same area with my fingertips already both hands for 2-3 minutes, at the twelfth stage they perform deep relaxing movements for 40-60 s, at the thirteenth stage they switch to the neck and back for 1-2 minutes, at the fourteenth stage they perform vibrational stimulation for of the neural nerves for 10-15 s, alternating with relaxing movements of 5 s, at the fifteenth stage, they work out with pulsating movements of the muscles of the neck on both sides for 1 min, at the sixteenth stage they stimulate the occipital nerves with pulsating movements for 10-15 s, alternating with smooth relaxing movements for 15-20 s, at the seventeenth stage, the trapezius muscles are worked out, for which, first, the muscle is fixed with the right hand, and frequent vibrational movements are performed for 5-7 s, then fix it with the left hand, and with the right hand, pinching the muscle between the index and middle fingers, perform smooth stroking along the muscles on both sides for 15 to 3-4 times, at the eighteenth stage, perform a vibrating action with the palmar surface on the trapezius muscles on both sides 2 -3 times for 10 s, which then goes into a deep relaxing stroking with the edge of the palm for 2-3 seconds, then the back side of the palm is stroked and the movements 34 and 35 are performed again, at the nineteenth stage sweeping stroking of the trapezius muscle for 10 s, and intensive vibrational stimulation with the fingertips at various angles of the paravertebral muscles for 5-10 s is carried out, at the twentieth stage, the trapezius muscle is smoothly kneaded, first with the thumbs for 5 s, then the index and unnamed for 5 s and further pointing and middle towards each other for 5 s, at the twenty-first stage, the entire back is kneaded with intense intersecting movements of the palmar over for 2-3 minutes, at the twenty-second stage they work directly with the vibrating movements of the index finger the eyeball itself, fixed by the thumb of the other hand, while the stimulation is performed for five approaches for 30 seconds in each eye, after which they return to work back, for which at the twenty-third stage they carry out intensive vibrational stimulation of the paravertebral muscles with the fingertips located at an angle of 90 ° to the body surface for 15 s, on each side, for twenty-four In the first stage, the right hand continues vibration stimulation at an angle of 40-60 ° with the fingernail plate, and with the left hand at an angle of 20-40 °, the vibration is counter-directed towards the right hand for 20-30 seconds, after which the usual rake-like stroking is performed for 5-7 s, at the twenty-fifth stage, the skin surface is worked out at the places of the trigeminal nerve exit, for which, first, smooth circular kneading is performed with the thumbs for 5-10 s, then the infraorbital nerve zone is worked out with the fingertips and the nail plate both sides for 10-15 s, alternating with the development of the infraorbital nerve for 5-10 s 3-5 times, at the twenty-sixth stage, smooth strokes of the skin surface in the projection of the occipital nerves are performed for 10-15 s and movements are directed to relaxation of the muscles of the neck, for 40-60 s, at the twenty-seventh stage, kneading the sternocleidomastoid muscle with frequent intense movements, for which they first grab it between the thumb and other fingers for 15-20 s, and then perform vibrating movements tips fingers of the right hand, holding the muscle with the left hand, alternately on each side for 20-30 s, at the twenty-eighth stage, the trapezius muscle is kneaded by vibrating movements with the fingertips of the right hand, holding the muscle with the left hand alternately on both sides, changing hands, after 15-20 c, 3-4 times on each side, at the twenty-ninth stage, the trapezius muscle is kneaded with the fingers of both hands, while the trapezius muscle is fixed between the fingers with one hand, and it is kneaded between the fingers with the other for 20-30 , at the thirty stage, stroking the back of the neck with grasping movements for 10 s, at the thirty-first stage, knead the pectoralis major muscle with slow movements of the palmar surface of the left hand for 40-60 s and then grasping stroking for 10 s, at the thirty-second stage, holding the head with his right hand, the skin surface is stimulated in the projection of the occipital nerves by vibrational movements, changing the position of the hands after 10-15 seconds, 5-7 times, at the thirty-third stage with deep smooth movements of the big fingers first, the infraorbital nerve is stimulated for 15-20 s, and then the infraorbital nerve is alternately 3-5 times, changing the position of the fingers during stimulation of the infraorbital nerve, at the thirty-fourth stage, the scalp of the palmar surface is stroked for 20-30 s, the surface zones of the occipital nerves for 20-30 s, sternocleidomastoid muscle for 20-30 s, pectoralis major muscles 20-30 s, alternating with their easy kneading for 20-30 s 3-4 times, by thirty-fifth stage perform stroking the neck and head a series of schimisya smooth, slow movements for 20-30 seconds, 5-7 times, 2-4 courses with a break of 2 months and further supports the policy, at least one in 8 months.

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