RU2766285C1 - Express rehabilitation of medical workers who are under increased stress during the pandemic - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to the rehabilitation of medical workers who are under conditions of increased psycho-emotional and physical exertion during the COVID-19 pandemic. Group rehabilitation is carried out within 2 days. At the same time, on the first day of rehabilitation: psychotherapeutic influence is carried out by training medical workers in stress management techniques. On the second day of rehabilitation, the effect is carried out in the following sequence: exercises of physical therapy, which includes dynamic exercises for large and small joints, exercises to relax the muscles of the trunk, coordination exercises to improve blood supply to the brain, breathing exercises - diaphragmatic breathing and sound gymnastics; manual massage of the trunk; exposure in a relaxation capsule at a temperature of 35 degrees, by aromatherapy with lavender essential oil, vibration massage, oxygen therapy, ophthalmic chromotherapy at a wavelength of 465-470 and 620-625. Then reflexotherapy is performed by Tsubo therapy, for which metal balls for "Tsubo" are applied to the biological active points of the auricles: AR55 and AR82. Hardware vibration massage of paravertebral reflexogenic zones is performed.

EFFECT: method allows for express rehabilitation of medical workers who are under conditions of increased psycho-emotional and physical exertion during the pandemic as part of an ultra-short two-day course, providing prevention of professional emotional burnout.

1 cl, 24 dwg, 3 tbl, 6 ex

Description

The field of technology to which the invention belongs

The invention relates to medicine, namely to the rehabilitation of medical workers who are under conditions of increased psycho-emotional and physical stress during the COVID-19 pandemic. Health care workers caring for infected patients are at high risk for mental health problems and need support.

State of the art

It is known from the prior art that there is a need to support and rehabilitate medical workers who have faced a number of psychological problems caused by the reorganization of their work to combat the coronovirus infection. So, according to the article by Shurupova M.A. face-to-face counseling and support turned out to be the most effective, and to identify urgent problems in organizing the work of employees and building vertical communication between staff and management, weekly calls and “social surveys” were used.

From the document “Recommendations for medical workers who are under conditions of increased psycho-emotional stress during the COVID-19 pandemic Version 1.0 dated 05/06/2020, Appendix 2”, the need to relieve emotional stress from medical personnel in a pandemic is known. These recommendations reveal a series of exercises for medical workers to overcome stressful situations. These exercises include: Daily stress relief exercise, facial muscle relaxation exercises, muscle tension management and relaxation exercises, breathing exercises, magic words exercises, anxiety reduction exercises, emotional gymnastics ”, exercise “Trash can”.

In addition, the complex rehabilitation of medical workers is known from the prior art. At the same time, the complex includes carrying out psychotherapeutic effects, physiotherapy exercises, organizing an optimal schedule of work and rest, and nutritional support. At the same time, testing for the detection of depression and anxiety on the HADS scale (Hospital Anxiety and DepressionScale, HADS) is used as a psychotherapeutic effect. Therapeutic exercise includes interval training of the cardiorespiratory system.In addition, the management of the clinic organizes a place for staff rest and meals for staff.And also sets up a work schedule for staff to avoid overload and overstrain of staff. , 07/31/2020, pp. 57-59).This method of rehabilitation of medical personnel was chosen as a prototype.

However, unlike the prototype, the proposed program provides, firstly, training in psychotherapeutic techniques for coping with stress, which can subsequently be performed independently, regardless of the participation of a psychologist, all persons participating in it, and not just those already showing signs of psychological distress, which ensures it preventive focus. Secondly, the program provides for a consistent complex impact using several methods of exposure that mutually potentiate each other. The psychophysiological approach used to create the proposed rehabilitation complex provides an impact both at the level of mental processes and at the level of various functional systems of the body. In addition, the well-known rehabilitation methods are designed for a long time, which makes it difficult to complete the full recovery cycle of medical workers and takes a lot of time either during work or during the rest of medical workers, which is undesirable in conditions of increased workload during the COVID-19 pandemic.

The technical problem solved by the claimed method is a comprehensive express rehabilitation of medical personnel who are under conditions of increased psycho-emotional and physical stress during a pandemic.

Disclosure of the invention.

The technical result of the claimed method is the express rehabilitation of medical workers who are under conditions of increased psycho-emotional and physical stress during a pandemic within the framework of an ultra-short two-day course, while preventing professional emotional burnout.

The technical result of the claimed invention is provided by the following set of essential features:

to provide comprehensive express rehabilitation of medical workers who are under conditions of increased psycho-emotional and physical stress during the COVID-19 pandemic, they carry out psychotherapeutic effects and physiotherapy exercises,

carry out group rehabilitation for 2 days:

on the first day of rehabilitation: they carry out a psychotherapeutic effect by training medical workers in stress management techniques,

on the second day of rehabilitation, the impact is carried out in the following sequence:

physical therapy exercises:

dynamic exercises for large and small joints, exercises for relaxing the muscles of the body,

coordination exercises to improve blood supply to the brain,

breathing exercises - diaphragmatic breathing and sound gymnastics,

manual torso massage aimed at improving blood circulation and eliminating myofascial trigger points;

exposure in a relaxation capsule at a temperature of 35 degrees, by aromatherapy with lavender essential oil, vibration massage, oxygen therapy, ophthalmochromotherapy at a wavelength of 465-470 and 620-625,

reflexology is performed by Tsubo-therapy, for which purpose metal balls for "Tsubo" are applied to biologically active points of the auricles: AP55 and AP82;

hardware vibration massage of paravertebral reflexogenic zones.

At the same time, the psychotherapeutic impact carried out on the first day of the program provides for informational and motivating components - program participants are given clarifications that the stress, uncertainty and often complex medical nature of global outbreaks of infectious diseases, such as coronavirus (COVID-19), require special attention to the needs of medical personnel, with the mental health of medical professionals as important as their physical health, and the ability to take care of oneself and encourage her in colleagues ensures the ability to take care of patients in need of help. Understanding the importance of maintaining their optimal psychophysical state, the mechanisms of action of stress, its manifestations and ways to cope with it, is the initial stage of rehabilitation and motivates participants to the physiotherapy complex offered on the second day of the program.

The procedures included in the physiotherapy complex of the program have minimal contraindications for prescription, potentiate each other's action and are optimal in terms of the ratio of exposure time and relaxation effect.

Implementation of the invention

Medical workers (formation of groups of 3-4 people is optimal) are taught how to manage their emotional state and form effective adaptation strategies under the influence of chronic stressors of both physical and psychological nature (stress management - psychological support module). Program participants are trained in the skills of recognizing stress symptoms, the skills of identifying, recognizing and reducing the frequency of unwanted emotions, methods of relaxation and management of emotional states - diaphragmatic breathing, mindfulness skills, progressive muscle relaxation skills, meditation, grounding. At the same time, I tell the participants about the phenomenon of burnout of medical staff and ways to prevent or mitigate this condition.

Traditionally, before psychotherapeutic intervention, testing is carried out to determine the psychophysiological state (SAN questionnaire). Based on the identified problems, medical workers are trained in autogenic training: aimed at changing the emotional response to an extreme situation by developing new patterns of behavior and changing perceptions, assessing the significance of the situation through attitudes and beliefs.

The next day, a group of medical workers comes to the gym for physical therapy, where they are given a lesson. At the same time, the complex of therapeutic exercises is carried out in the initial standing position, begins with a warm-up, which includes exercises to relax the muscles of the body. Gradually, dynamic exercises for large and small joints are included in the complex. Exercises at a fast and slow pace alternate. Breathing exercises include diaphragmatic breathing and sound gymnastics to relax the respiratory muscles. Breathing sound gymnastics exercises allow not only to strengthen the respiratory muscles, but also to improve the draining function of the lungs. One of the important blocks of physiotherapy exercises are exercises aimed at improving coordination. This block includes multidirectional movements of the right and left upper and lower limbs. The final block of the therapeutic gymnastics complex includes exercises for general relaxation.

The implementation of this complex by those involved at the beginning of the second day of the rehabilitation program allows you to tune in to positive emotions, strengthen the work of all systems and organs, improve blood circulation in the muscles and prepare the body for further, local massage to relieve myofascial trigger points. The complex of physical therapy, includes exercises for large and small muscle groups, for improving joint mobility, relaxation exercises, improving coordination and breathing, allows you to increase physical performance, relieve emotional and physical stress, activate brain activity, improve tissue trophism, in order to training of this technique for medical workers and its further inclusion in the normal daily routine.

Further, medical workers received a manual medical massage of the collar zone, back, lumbosacral spine to improve blood supply to this area, eliminate myofascial trigger points and reflexogenic healing effects on the entire body.

Further relaxation effect was carried out with the help of "Relaxation alpha-capsule", which potentiates the effect of the previously performed methods and enhances the relaxation effect. Capsule operation mode: for 30 minutes, once, temperature - 35 degrees, aromatherapy - lavender essential oil, vibration massage - affects evenly throughout the bed (on the area of the thoracic and lumbar torso, pelvis, thighs, legs) has a pronounced analgesic and relaxing an action that is accompanied by vasomotor responses, while the activation of redox processes in the muscles occurs, which contributes to the rapid removal of fatigue and the restoration of their performance; oxygen therapy - blowing the face with an air mixture with an oxygen content of 93% at a flow rate of 2 l / min, is included in the capsule work program (improves mood, increases concentration and performance, improves physical endurance and reduces emotional stress), ophthalmochromotherapy - pulsed illumination of the visible spectrum affects on a visual analyzer with a light wavelength of 465-470 (ultra blue) and 620-625 (infrared) to relieve stress and improve sleep, which further relaxes the superficial muscles.

Reflexotherapy is carried out in order to restore the functional activity of the body, relieve stress reactions of the body (psycho-emotional overstrain, suppression of immune reactions), as well as to further prolong the effects obtained.

In this case, reflexology includes two components of the therapeutic effect:

one). Tsubo-therapy - application of metal balls for "Tsubo" on BAT (acupuncture points of the auricles): AP55 and AP82. Tsubo were fixed on the skin for 3-5 days, after which the patients could remove them on their own (received appropriate instructions). Points are used for anti-stress, restorative and analgesic action.

2). Vibromassage on paravertebral reflexogenic zones at the cervical, thoracic, lumbosacral levels. The duration of the procedure is 10 minutes, the procedure is performed once, having a stimulating effect on segmental points with an effect on cerebral blood flow, cardiovascular, respiratory and digestive systems. It promotes relaxation of the paravertebral muscles with the elimination of subclinical intervertebral blockades and, thus, the elimination of pathological impulses. For this purpose, electromechanical devices for vibromassage "Ormed-relax" and "Ormed-prevention" were used.

The total exposure time is 3 hours.

An objective evaluation of the effectiveness of the program was carried out by analyzing the indicators of heart rate variability. By heart rate variability we mean fluctuations in the duration of successive RR intervals. Both links of the autonomic nervous system - sympathetic and parasympathetic - are involved in the regulation of heart rate. The parasympathetic nervous system, mediated by the activity of the vagus nerve, slows down the heart rate, i.e. reduces heart rate, and increases its variability. The sympathetic nervous system has the opposite effect, it speeds up the heart rate, i.e. increases heart rate, and reduces its variability. As is known, the parasympathetic nervous system is most active in the state of rest and recovery, and the sympathetic one mediates the reactions of acute and chronic stress. Thus, heart rate has the lowest individual values and its variability the highest values when we are at rest and fully recovered. Accordingly, during our stay in a state of stress, the heart rate has the highest values, and its variability is reduced.

Heart rate variability can be quantified using a variety of methods, most commonly used in clinical practice are time domain analysis and frequency domain analysis (FFT spectral analysis or autoregressive analysis) (see Tables 1, 2, 3. Available as well as other methods, for example, numerous methods of nonlinear analysis.

To assess the overall heart rate variability, the most commonly used parameters are SDNN (standard deviation of normal RR intervals), as well as TP (total power of the fluctuation spectrum of RR intervals). The higher the parameter values, the greater the activity of the autonomic regulation of the cardiovascular system.

To assess parasympathetic regulation, parameters such as RMSSD (square root of RR-interval differences) and HP (high-frequency RR-interval fluctuation spectrum power) are used. In addition, modern digital solutions make it possible to calculate the so-called parasympathetic nervous system index (PNSindex), which combines three parameters that reflect the activity of the parasympathetic nervous system: the average RR interval (MeanRR), RMSSD and the normalized SD1 index (refers to methods of nonlinear analysis, in particular, using the Poincaré section).

Fewer parameters are available for assessing sympathetic regulation, the most commonly used is LF/HF (the ratio of the power of the low- and high-frequency oscillation spectrum of the RR intervals), however, this parameter has known limitations when used in clinical practice, since it is mixed and also reflects some amount of power parasympathetically mediated heart rate fluctuations caused by respiratory sinus arrhythmia. It is more appropriate to calculate the so-called sympathetic nervous system index (SNSindex), based on three parameters reflecting the activity of the sympathetic system: the average heart rate (MeanHR), the Bayevsky stress index (geometric analysis, Stressindex) and the normalized SD2 (Poincaré section).

The values of the indices of the parasympathetic and sympathetic nervous system can be compared with the general population in order to understand how individual values are lower or, conversely, higher than normal.

Based on the foregoing, we assessed the state of autonomic regulation of the cardiovascular system in 3 participants who completed the course of the declared complex express rehabilitation program, and also, for the purpose of comparison, in 3 volunteers who underwent alternative procedures.

Before the start of the study, participants were at rest in a prone position for 15 minutes in a separate, quiet room with a comfortable air temperature. Assessment of the autonomic nervous system included recording heart rate using a chest monitor and recording blood pressure using a shoulder cuff according to the Korotkov method. The heart rate was recorded for 5 minutes in the supine position, then the patients were asked to stand up and the heart rate was additionally recorded for 6 minutes in the standing position (active orthostatic test). Conducting an active orthostatic test was used to minimize the situational variability of the studied parameters. Blood pressure was recorded in the supine position, as well as for 1, 3 and 6 minutes in the standing position.

The recorded durations of RR intervals were exported to a working PC, where, using specialized software (KubiosHRVStandard3.5.0), an analysis of heart rate variability was carried out, and the following indicators were calculated for 5-minute recordings in the supine and standing states (2-6 minutes after the 1-minute transitional period): standard RR interval, SDNN, RMSSD, TP, HF, LF/HF, PNSindex, SNSindex.

Decrease in systolic blood pressure after verticalization more than 20 mm Hg. or diastolic blood pressure more than 10 mm Hg. regarded as the presence of orthostatic arterial hypotension.

The study of the autonomic regulation of the cardiovascular system was carried out twice: immediately before and after rehabilitation activities (for participants in the rehabilitation program) and immediately before and after alternative procedures (for volunteers).

Rehabilitation measures according to the method developed by us

Example No. 1, male M, born in 1998

Fig. 1. Vegetative parameters at rest lying down before the rehabilitation program of the subject M.

Fig. 2. Vegetative parameters at rest lying down after the rehabilitation program of the subject M.

An increase in the PNSH index, a decrease in the SNS index after passing the measures according to the claimed method, shown in FIG. 1 and FIG. 2 indicates an increase in the activity of the parasympathetic NS and a decrease in the activity of the sympathetic NS, that is, an increase in the predominance of restorative activity over stressful adrenergic activity.

Fig. 3. Vegetative parameters in the standing position before the rehabilitation program of the subject M.

Fig. 4. Vegetative parameters in the standing position after the rehabilitation program, subject M.

An increase in the PNSH index, a decrease in the SNS index after passing the measures according to the claimed method, shown in FIG. 3 and FIG. 4 indicates that despite the predominance of the activity of the sympathetic NS at the time of the study, the process of reducing its action and the growth of the activity of the parasympathetic NS, that is, an increase in restorative activity, starts.

Example No. 2, female K1, born in 1997

Fig. 5. Vegetative parameters at rest lying down before the rehabilitation program, subject K1.

Fig. 6. Vegetative parameters at rest lying down after the rehabilitation program of the subject K1.

An increase in the PNSH index, a decrease in the SNS index after passing the measures according to the claimed method, shown in FIG. 5 and FIG. 6 indicates an increase in the activity of the parasympathetic NS and a decrease in the activity of the sympathetic NS, that is, an increase in the predominance of restorative activity over stressful adrenergic activity.

Fig. 7. Vegetative parameters in the standing position before the rehabilitation program, subject K1.

Fig. 8. Vegetative parameters in the standing position after the rehabilitation program, subject K1.

An increase in the PNSH index, a decrease in the SNS index after passing the measures according to the claimed method, shown in FIG. 7 and FIG. 8 indicates that despite the predominance of the sympathetic NS activity at the time of the study, the process of reducing its action and increasing the activity of the parasympathetic NS, i.e., an increase in restorative activity, starts.

Example No. 3, female K2, born in 1989

Fig. 9. Vegetative parameters at rest lying down before the rehabilitation program, subject K2.

Fig. 10. Vegetative parameters at rest lying down after the rehabilitation program, subject K2.

An increase in the PNSH index, a decrease in the SNS index after passing the measures according to the claimed method, shown in FIG. 9 and FIG. 10 indicates an increase in the activity of the parasympathetic NS and a decrease in the activity of the sympathetic NS, that is, an increase in the predominance of restorative activity over stressful adrenergic activity.

Fig. 11. Vegetative parameters in the standing position before the rehabilitation program, subject K2.

Fig. 12. Vegetative parameters in the standing position after the rehabilitation program, subject K2.

An increase in the PNSH index, a decrease in the SNS index after passing the measures according to the claimed method, shown in FIG. 11 and FIG. 12 indicates that despite the predominance of the sympathetic nervous system (NS) activity at the time of the study, the process of reducing its action and increasing the activity of the parasympathetic NS, i.e., an increase in restorative activity, starts.

Examples with alternative procedures

Example No. 4, woman I, born in 1974

Fig. 13. Vegetative parameters at rest lying before alternative procedures, subject I.

Fig. 14. Vegetative parameters at rest lying down after alternative procedures, subject I.

Increase in SNSH index The decrease in PNS index after undergoing alternative procedures, shown in FIG. 13 and FIG. 14 indicates an increase in the activity of the sympathetic NS, i.e. the development of stress adrenergic activity and a decrease in the activity of the parasympathetic, restoring NS.

Fig. 15. Vegetative parameters in the standing position before alternative procedures, subject I.

Fig. 16. Vegetative parameters in the standing position after alternative procedures of the subject I.

Increase in SNSH index The decrease in PNS index after undergoing alternative procedures, shown in FIG. 15 and FIG. 16 indicates an increase in the activity of the sympathetic NS, i.e. the development of stress adrenergic activity and a decrease in the activity of the parasympathetic, restoring NS.

Example No. 5 woman O, born in 1975

Fig. 17. Vegetative parameters at rest lying before alternative procedures, subject O.

Fig. 18. Vegetative parameters at rest lying down after alternative procedures, subject O.

Increase in SNSH index The decrease in PNS index after undergoing alternative procedures, shown in FIG. 17 and FIG. 18 indicates an increase in the activity of the sympathetic NS, i.e. the development of stress adrenergic activity and a decrease in the activity of the parasympathetic, restoring NS.

Fig. 19. Vegetative parameters in the standing position before alternative procedures of the subject O.

Fig. 20. Vegetative parameters in the standing position after alternative procedures of the subject O.

Increase in SNSH index The decrease in PNS index after undergoing alternative procedures, shown in FIG. 19 and FIG. 20 indicates an increase in the activity of the sympathetic NS, i.e. the development of stress adrenergic activity and a decrease in the activity of the parasympathetic, restoring NS.

Example M6, female K3, born in 1989

Fig. 21. Vegetative parameters at rest lying before alternative procedures, subject K3.

Fig. 22. Vegetative parameters at rest lying down after alternative procedures of subject K3.

The increase in the SNS index and the decrease in the PNS index after undergoing alternative procedures, as shown in FIG. 21 and FIG. 22 indicates an increase in the activity of the sympathetic NS, i.e. the development of stress adrenergic activity and a decrease in the activity of the parasympathetic, restoring NS.

Fig. 23. Vegetative parameters in the standing position before alternative procedures of the subject K3.

Fig. 24. Vegetative parameters in the standing position after alternative procedures of the subject K3.

Despite a slight decrease in the SNSH index, the increase in the PNS index after undergoing alternative procedures, shown in FIG. 23 and FIG. 24, the predominance of sympathetic NS activity over parasympathetic activity is still very significant with a high predominance of stress adrenergic activity. Thus, the indicators of the average heart rate and the Baevsky stress index, both before and after the complex of procedures, remain far beyond the deviation of 2 SDot of the standard values.

Table 1 highlights the expected changes in parameters that are considered favorable in terms of restoring the functional reserves of the cardiovascular system, and also highlights the expected changes in parameters that are considered unfavorable in terms of restoring the functional reserves of the cardiovascular system.

Thus, when using alternative methods, namely Charcot's soul, darsonvalization of the scalp and the use of classical acupuncture, we could not achieve a pronounced relaxation of the patient in one day, as evidenced by the state of autonomic regulation of the cardiovascular system recorded by the devices. Although each of the above methods is a classic of medical rehabilitation and an active healing factor. Darsonvalization of the head improves blood supply to the brain, relieves headaches, Charcot's shower improves metabolic processes in the body, improves blood circulation and enhances lymphatic drainage, acupuncture affects biologically active points. This set of techniques is good for course treatment (for example, a spa treatment), but in this case, when 3 hours are given to get the effect, this complex is not effective.

Claims (12)

A method for complex express rehabilitation of medical workers who are under conditions of increased psycho-emotional and physical stress during the COVID-19 pandemic, including a psychotherapeutic effect and a physiotherapeutic complex, characterized in that group rehabilitation is carried out for 2 days, on the first day of rehabilitation: they carry out a psychotherapeutic effect by training medical workers in stress management techniques, on the second day of rehabilitation, the impact is carried out in the following sequence: physical therapy exercises: dynamic exercises for large and small joints, exercises to relax the muscles of the body, coordination exercises to improve blood supply to the brain, breathing exercises - diaphragmatic breathing and sound gymnastics, manual body massage; exposure in a relaxation capsule at a temperature of 35 degrees by aromatherapy with lavender essential oil, vibration massage, oxygen therapy, ophthalmic chromotherapy at a wavelength of 465-470 and 620-625, perform reflexology by Tsubo-therapy, for which they apply metal balls for "Tsubo" on the biological active points of the auricles: AP55 and AP82; hardware vibration massage of paravertebral reflexogenic zones.

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