RU2726593C1 - Method of treating patients in acute and early recovery period of ischemic stroke - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to restorative medicine and neurology, and can be used in complex treatment of patients with ischemic stroke in acute and early recovery periods. That is followed by craniosacral manual testing, degree of postural imbalance, then successively performing complex craniosacral manual therapy in reverse order of pathobiomechanical changes and corresponding sanogenesis processes, complex consists of nine stages conducted on 3rd and 10th day from the onset of stroke: eliminating symphysis compression, eliminating pathobiomechanical disorders of sacrum, correcting iliac bones, restoration of trapezoid muscle tone, elimination of functional unit C1-C2, restoration of mobility in atlanto-occipital articulation, elimination of pathobiomechanical changes of sphenobasilar articulation and connective tissue structures of skull, elimination of peripheral pathobiomechanical changes of skull, stimulation of neurodynamic processes restoring liquor- and haemodynamics.EFFECT: method promotes recovery of mobility of atlanto-occipital, sphenobasilar articulations and connective tissue structures of skull, leads to elimination of postural imbalance, reduced intensity of paresis, reduced manifestations of cognitive-mnestic disorders and severity of anxiety and depression, increases motivation to recover, normalises arterial and venous blood flow, cerebrospinal fluid circulation, improves metabolic, neurodynamic processes of brain, improves overall health, concentration of attention, emotional background, positively affects the quality of life of patients by successive administration.1 cl, 2 ex

Description

The invention relates to medicine, namely to restorative medicine and neurology, and can be used in the complex treatment of patients with ischemic stroke in the acute and early recovery periods.

Ischemic stroke is an acute violation of cerebral circulation, which occurs as a result of obstruction or cessation of cerebral blood flow due to thrombosis or embolism of the vessel.

The variability of post-stroke motor disorders is determined by the degree of paresis, the severity of muscular-tonic disorders, the presence of sensory disorders, damage to the visual and vestibular analyzers, and atactic disorders. The clinical picture is aggravated by the presence of cognitive impairments and depressive disorders. Often, the picture of a stroke unfolds in a patient against a background of chronic cerebrovascular accident.

The recovery of postural, manual, and locomotor functions is hampered by post-stroke cognitive impairments associated with motor deficits, as well as depressive disorders. Violations of hemo- and liquorodynamics, in turn, are an important factor in the pathogenesis of all these disorders.

Recently, much attention has been paid to the early start of stroke treatment. New approaches to the treatment of ischemic stroke include the use of highly effective methods of reperfusion of the brain substance in the first hours of the disease, aimed at restoring blood flow in the affected vessel, which makes it possible to prevent irreversible damage to the brain substance, or to reduce its volume (Skvortsova VI, Shamalov NA, Ramazanov GR and other Results of the introduction of thrombolytic therapy in ischemic stroke in the Russian Federation // Journal of Neurology and Psychiatry named after S. Korsakov. Stroke, 2010. - No. 12. - P. 17-22.).

Unfortunately, this method is currently unavailable for many patients. Therefore, it remains relevant to develop new affordable methods of treating ischemic stroke in the early stages to reduce the severity of paresis, improve blood supply to the brain, reduce the level of anxiety and depression, and, as a consequence, improve the quality of life of patients.

Treatment of ischemic cerebral stroke in the acute period is complex, including: drug therapy, kinesiotherapy (exercise therapy, massage), correction of speech therapy disorders. Traditional approaches to treatment imply effects on the cardiovascular system, blood rheological properties, and brain tissue metabolism.

A known method for the treatment of chronic cerebral ischemia, including a standard set of drugs (antiplatelet agents, anticoagulants, drugs that improve cerebral blood flow and metabolism (IV Damulin. Post-stroke movement disorders // Neurology / Rheumatology, 2003. - No. 2. - T 5. - P. 64-70) There is a therapeutic approach to the treatment of chronic cerebral ischemia, based on the assessment of the state of the body's adaptive processes, the use of a generally accepted therapeutic complex, including vasoactive and nootropic drugs. (Patent for invention No. 2371193, patent for invention No. 2318430, 12.07.2010).

The disadvantage of these methods is that only drug treatment does not provide adequate correction of all links of pathogenesis, in particular, pathobiomechanical dysfunctions in the cranial region; CSF and hemodynamics are not normalized, which is necessary for the full functioning of brain structures.

A known method for the treatment of discirculatory atherosclerotic encephalopathy, including electromagnetic stimulation of the motor areas of the cerebral cortex, cervical and lumbar thickening of the spinal cord, audiovisual stimulation, conducting an immunological study and, according to its results, additional stimulation of the thymus gland. (Mikhailov V.P., Kozlov V.A., Visilo T.L., Mendelenko M.M. and others. Method for the treatment of discirculatory atherosclerotic encephalopathy, Patent No. 2186588, by application No. 2000123854/14 dated 09/18/2000, BIMP No. 22, 10.08.2002).

The disadvantage of this method is that it does not provide the normalization of arterial and venous blood supply to the brain. This is important for this pathology. In addition, immunological research is very expensive and time consuming, so its use in everyday practice is difficult.

A known method of treating the initial manifestations of cerebrovascular accidents and discirculatory encephalopathy by introducing cerebrolysate using electrophoresis. (Borisova N.A., Khaziakhmetov PM, Alsynbaev M.M., Melnikov N.V. Method of treatment of the initial manifestations of cerebrovascular accidents and discirculatory encephalopathy, Patent No. 2200033 for application No. 2001101809/14 dated 18.01.2001, publ. BIMP No. 7, 10.03.2003).

The disadvantage of this method: the use of endonasal electrophoresis in most patients is limited due to the presence of concomitant pathology (hypertension, coronary heart disease), in which electrophoresis is contraindicated.

A known method for the treatment of chronic cerebral ischemia by correcting cranial disorders using sequential cranial manual therapy techniques. (Rogozhnikova N.V., Chechenin A.G. Correction of cognitive impairments in discirculatory encephalopathy by methods of cranial manual therapy // Manual therapy, 2014. - No. 2. - pp. 32-34).

Disadvantages of the method: it is not used in the acute period of stroke; does not take into account movement disorders; requires a large number of sessions, which is laborious and impossible to carry out at the time of treatment of patients in the vascular center.

The closest to the proposed method is a method of using manual therapy in patients with cerebrovascular disease in acute, early recovery, late recovery, residual periods of cerebral infarction, with discirculatory encephalopathy, transient ischemic attacks, transient cerebral circulation disorders (Chepurnaya S.L., Shmidt I. R., Sayapin BC, Peganova MA Method for the treatment of cerebrovascular disease, Patent RU No. 2297820 on application No. 2004130011/14, 11.10.2004; publ. 27.04.07, bull. No. 12). The method consists in eliminating pathobiomechanical changes in the region of the skull and the cranio-cervical junction using the basic techniques of manual therapy.

Manual cranial therapy is performed. For this, cranial manual testing is preliminarily performed to identify dysfunctions. Then, a preparatory stage of exposure to the soft tissues of the head, collar region, myofascial release and suboccipital release is performed. At each session of manual cranial therapy, no more than two dysfunctions are eliminated. Begin and end each session with manual cranial testing. Taking into account the detected pathobiomechanical changes, to eliminate the revealed dysfunctions, the sagittal suture is relaxed by traction of the parietal bones in the lateral direction, the coronal suture is relaxed in the area of limiting its mobility by holding the frontal and parietal bones and tapping the occipital bone from the opposite side with waiting for two minutes until feelings of relaxation. Decompression of the occipital condyles is carried out by traction in the cranial, then in the lateral direction. Lateroflexion of sphenobasillar synchondrosis is carried out by rotating the main and occipital bones around the axes of torsion and lateroflexion until the state of prestressing and holding in this state, until the restriction is removed. Torsion of sphenobasillar synchondrosis on the left is carried out by cranial movement of the greater wing of the main bone and the lateral angle of the occipital bone. Relaxation of the temporoparietal sutures by external rotation of the temporal bone and stretching the temporo-parietal suture to the sides, decompression of the temporal bone from the side of dysfunction is performed by fixing the frontal bone on the opposite side and traction for the auricle into the extension phase in the dorsolateral direction, along the axis passing through the pyramid of the temporal bone. Repeat the movement of traction on both sides for bilateral dysfunction. Then, the temporal bone is rotated around the axis passing through the external auditory meatus, the zygomatic process - in the caudal-lateral direction, the mastoid process - in the dorso-medial direction. From the third session, additional "compression of the fourth ventricle" is performed using medial compression of the lateral angles of the occipital scales, synchronous rotation of the temporal bones behind the mastoid processes, with a gradual increase in the frequency and amplitude of rotational movements. The "occipital pump" is performed - by lateral traction of the mastoid processes, automobilization in the inspiratory phase - pressure in the parietal bone with simultaneous dorsiflexion of the feet, on exhalation - pressure at the midpoint of the frontal-nasal suture with plantar flexion of the feet. Flexion is strengthened by moving the large wing of the main bone downward, posteriorly and to the side, the occipital bone - downward forward, the temporal bone - laterally during the flexion phase. Extension is strengthened by moving the large wing of the main bone - upward, forward, inward, the occipital bone upward, backward, and the temporal bone - laterally. Condylar decompression is performed during the extension phase. During the flexion phase, the foramen magnum is extended laterally and caudally. Treatment is carried out daily or every other day.

The method increases the efficiency of treatment in acute, early recovery and late recovery, residual periods of cerebral infarction, as well as in discirculatory encephalopathy, transient ischemic attacks, transient cerebrovascular accidents. The method ensures the prevention of repeated ischemic attacks, relapses of the disease.

The method has the following disadvantages:

1. Covers a wide range of pathology without taking into account the clinic and the pathobiomechanics of each of them.

2. Does not take into account the degree of postural imbalance.

3. Does not include the correction of pathobiomechanical disorders at the sacral level.

4. Does not include correction of pathobiomechanical disorders at the level of the cranio-occipital junction.

5. The sequence of techniques does not take into account the sequence of development of pathogenetic and sanogenetic processes

6. Treatment is carried out in 4-6 sessions, which makes it very time consuming and expensive.

The purpose of the invention is to increase the effectiveness of treatment of patients with ischemic stroke in the acute and early recovery period by applying successive techniques of craniosacral manual therapy, which normalize cerebrospinal fluid and hemodynamics, eliminating pathobiomechanical disorders in the skull and pelvis, restoring the craniosacral rhythm, contributing to the the very restoration of postural imbalance, a decrease in the severity of motor disorders.

The purpose is achieved by the method of treating patients in the acute and early recovery period of ischemic stroke, including the elimination of pathobiomechanical changes in the cranial region and the cranio-cervical junction using manual therapy techniques. First, cranio-sacral manual testing is performed, the degree of

postural imbalance, then sequentially perform a complex of craniosacral manual therapy in the sequence reverse to the development of pathobiomechanical changes and corresponding to the processes of sanogenesis. The complex consists of nine stages, carried out on days 3 and 10 from the onset of a stroke, namely: at the first stage, compression of the symphysis is eliminated. In the position: lying on the back, the legs are bent at the knee and hip joints, are brought, the feet are resting on the couch, the patient is trying to spread his legs, and the doctor keeps them in their original position. The doctor then spreads the patient's legs and the patient tries to bring the legs together.

At the second stage, pathobiomechanical disorders of the sacrum are eliminated, while the bilateral flexion or extension of the sacrum is corrected by increasing the tension of the tissues against resistance, while holding the sacrum. Anterior torsion of the sacrum to the left along the left oblique axis or to the right along the right oblique axis is carried out by displacing the left or right lower corner of the sacrum in the cranio-lateral-ventral direction, while the second hand shifts it caudally. The posterior torsion of the sacrum to the right along the left oblique axis or to the left along the right axis is carried out by shifting the angle forward and downward. For this, the base of the right / left hand contacts the right / left base of the sacrum and displaces it caudo-latero-ventrally, while the other hand displaces only cranially.

In the third stage, the ilium is in the correct position. In this case, the anterior rotation of the ilium is eliminated by increasing the flexion of the patient's bent leg, raising the pelvis and increasing the posterior rotation of the pelvis. Posterior iliac rotation is eliminated by raising the patient's leg, bent at the knee at a right angle, applying pressure along the iliac crest anterior to the posterior superior iliac spine.

At the fourth stage, the tone of the trapezius muscle is restored, while myofascial release is carried out in the area of the upper and horizontal portions of the trapezius muscle by palpation of the muscle area

stress, determine the point of the beginning of the impact, the area of tissue tension, press on the tissue, penetrating deep into, traction is carried out until tissue resistance is felt, avoiding pain, then the tissue is twisted until it relaxes.

At the fifth stage, the functional block C1-C2 is eliminated, while the head and cervical spine are flexed to an angle of 45 ° and the range of motion in the direction of rotation to the right and left is compared, the difference and limitation of the range of motion to one side is determined. From the created prestressing position in the direction of limited rotation, the muscle-energy technique for correcting rotational dysfunction is performed.

At the sixth stage, mobility in the atlanto-occipital junction is restored, while the extension dysfunction of the atlanto-occipital junction C0-C1 is corrected by flexion mainly in the C0-C1 segment, then the head is lateroflexed towards restricting movement to the barrier. If flexion dysfunction of the atlanto-occipital junction C0-C1 is detected, extension is carried out mainly in the segment C0-C1 and the head is lateroflexed towards restricting movement to the barrier.

At the seventh stage, pathobiomechanical changes in the spheno-basilar junction and connective tissue structures of the skull are eliminated, while the occipital condyles are decompressed by traction in the cranial and then in the lateral direction. Then, the sphenobasilar articulation is decompressed by traction on the wings of the main bone in the ventral direction, while keeping the occipital bone dorsally. Further, the correction of torsion and lateroflexia of the sphenobasilar articulation is carried out by rotating the main and occipital bones around the axes of torsion and lateroflexion against resistance. The extension of the sphenobasilar articulation is eliminated by displacing the large wings of the main bone ventro-caudally, pressure on the occipital bone is exerted caudolaterally.

The flexion of the sphenobasilar articulation is eliminated by displacing the large wings of the main bone cranio-dorsally, the occipital bone cranio-medially.

At the eighth stage, peripheral pathobiomechanical changes in the skull are eliminated. At the same time, the position of the temporal bone is restored depending on the restriction of movement by bringing the occipital bone into extension, and the temporal bone into external rotation, or by bringing the occipital bone into flexion, and the temporal bone into internal rotation. Decompression of the temporoparietal sutures is carried out by external rotation of the temporal bone and lifting of the parietal bones. Decompression of the frontal-main and coronary sutures is performed by traction for the lateral angles of the frontal bone in the ventral and then in the ventro-caudal direction. Decompression of the occipital-mastoid sutures is carried out by displacing the occipital bone caudo-ventrally around the frontal axis, while simultaneously exerting pressure on the mastoid process medio-dorsally. The position of the bones of the facial skeleton is normalized by displacing the main bone caudo-ventrally, while simultaneously applying pressure from the oral cavity to the palate in the area of the cruciate suture ventrally, then increasing pressure on the main bone in the cranio-dorsal direction, pressure from the oral cavity to the palate is carried out towards the body main bone. Dysfunction of the temporomandibular joint is eliminated by traction in the caudal and then in the ventro-caudal direction.

At the ninth stage, neurodynamic processes are stimulated that restore cerebrospinal fluid and hemodynamics, while the enlargement of the foramen magnum is carried out by pressure in the dorso-lateral-caudal direction. Compression of the fourth ventricle is carried out with the help of medial compression of the lateral angles of the occipital scales by the tenars of the hands. Lateral traction of the mastoid processes is performed. An alternative rotation of the temporal bones is performed with arcuate movements, displacing the tops of the mastoid processes in opposite directions, with a gradual increase in the amplitude of rotational movements. Carry out

relaxation of intracranial vessels by displacement of the mastoid processes dorso-medially with a simultaneous displacement of the greater wing of the main bone cranially, dorsally and medially. The cranio-sacral rhythm is restored by balancing the occipital bone and sacrum. Advantages of the method in comparison with analogues:

1. Does not require hardware.

2. Correction of all pathobiomechanical changes is carried out.

3. Available in terms of labor intensity and price.

4. Provides normalization of arterial and venous blood supply to the brain.

5. Applicable for the treatment of patients in the acute period of ischemic stroke, has no contraindications associated with concomitant pathology in the form of hypertension, atherosclerosis, coronary heart disease, diabetes mellitus, etc.

6. Aimed at correcting pathobiomechanical disorders at the level of the pelvis, sacrum, cranio-cervical junction and skull, at restoring connective tissue structures, hemo- and cerebrospinal fluid dynamics.

7. Treatment is carried out twice: on the third and tenth days from the onset of the stroke, which makes it possible to obtain a stable therapeutic effect in patients in the acute period of ischemic stroke, making it less expensive and laborious.

8. Allows to reduce the intake of medication.

The novelty of the invention:

1. First, cranio-sacral manual testing is performed to determine the degree of postural imbalance.

2. Consecutively perform a complex of cranial manual therapy in the sequence of reverse development of pathogenetic changes and corresponding to the processes of sanogenesis,

3. The complex consists of nine stages, carried out on the 3rd and 10th day from the onset of the stroke.

4. Eliminate compression of the symphysis.

5. Eliminate pathobiomechanical disorders of the sacrum.

6. Give the correct position to the ilium.

7. Restore the tone of the trapezius muscle.

8. Eliminate the functional block C ₁ -C ₂ .

9. Restore mobility in the atlanto-occipital junction.

10. Eliminate pathobiomechanical changes in the sphenobasillar joint and connective tissue structures of the skull.

11. Eliminate peripheral pathobiomechanical changes in the skull.

12. They use methods that stimulate neurodynamic processes, restore cerebrospinal fluid and hemodynamics.

The proposed sequence of techniques is determined by the sequence of development of the processes of pathogenesis: first, pathobiomechanical disorders that appeared later are eliminated, then those that developed earlier; and the sequence of development of the processes of sanogenesis: first, they stimulate processes that should appear earlier and stimulate the following recovery processes.

Elimination of pathobiomechanical disorders at the sacral level. Decompression of the symphysis improves the blood supply to the pelvic floor muscles and the mobility of the pelvic bones. Elimination of pathobiomechanical disorders of the sacrum by eliminating bilateral flexion or extension of the sacrum, the anterior torsion of the sacrum to the left along the left oblique axis or to the right along the right axis, the posterior torsion of the sacrum to the right along the left oblique axis or to the left along the right axis, anterior rotation of the ilium, posterior rotation of the ilium allows not only to stimulate the patient's correct support and locomotor reactions, but also to restore the cranio-sacral rhythm, to balance the pelvic axis.

In order to activate neurocortical mechanisms, relieve muscle tone, improve lymphatic drainage, we use myofascial release, relieve the tension of the upper and horizontal portions of the trapezius muscle by palpating the muscle tension area, determine the point of initiation of exposure, the tissue tension area, gradually press on the tissue, penetrating gently and softly deep into , we carry out traction to the barrier (sensation of tissue resistance), avoiding painful sensations, then we carry out twisting of the tissue until relaxation is achieved after 10-60 seconds.

Elimination of pathobiomechanical disorders at the level of the cranio-cervical junction. Elimination of FB C1-2 improves blood flow through the vertebral arteries and reduces the tension of the dura mater. The same technique allows you to eliminate the tension of the soft tissues of the suboccipital region and release the condyles of the occipital bone. As a result, there is a restoration of mobility in the atlanto-occipital junction and the elimination of soft tissue tension in this area.

Correction of pathobiomechanical abnormalities at the level of the skull begins with the elimination of pathobiomechanical changes in the sphenobasillar joint and connective tissue structures of the skull. Correction of mobility disorders in the sphenobasilar joint is performed by eliminating compression, torsion and lateroflexia of the sphenobasilar joint, which contributes to the normalization of the cranial rhythm.

The restoration of peripheral pathobiomechanical changes in the skull improves the balance of the bone and connective structures of the skull, has a regulatory effect on the entire central nervous system, reducing the level of excitation processes in the cerebral cortex. Decompression of the temporal bone restores the mobility of the temporal bone. Decompression of the temporoparietal suture creates functional freedom of the suture and its constituent bones. Decompression of the frontal-main and coronary sutures allows not only to eliminate the compression of the sutures, but also to restore the normal physiological movement of the frontal bone. Decompression of the occipital-mastoid suture restores physiological mobility between the occipital and temporal bones and improves venous drainage through the jugular vein, which helps to reduce intracranial pressure.

Normalization of the position of the bones of the facial skeleton. Relieving stress from the bones of the facial skeleton normalizes the functioning of the cerebrospinal fluid and cerebrospinal fluid systems, which directly affect the state of the main elements of the central nervous system, including the brain stem, interstitial brain and pericentricular formations, which play a key role in maintaining the mechanisms of regulation of autonomic balance. Decompression of the temporomandibular joint leads to the normalization of the myofascial and bone structures associated with it, including the base of the skull, reduces fascial traction, and restores the cranial rhythm.

Methods that stimulate neurodynamic processes, restore cerebrospinal fluid and hemodynamics are no less important in eliminating pathobiomechanical changes and starting the processes of sanogenesis. The foramen magnum dilation is performed to restore its balance relative to the upper cervical vertebrae, which improves blood flow in the vertebral arteries. Compression of the fourth ventricle is necessary to normalize the cranial rhythm. Reception has a relaxing effect on the patient. The occipital pump allows you to eliminate the imbalance of the reciprocal tension membranes, especially at the level of the occipital and temporal bones, caused by a vascular catastrophe - stroke. Alternative rotation of the temporal bones is necessary to relax the intracranial vessels. Reception eliminates membrane tension, thus freeing intracranial vessels, contributes to the normalization of hemo- and cerebrospinal fluid dynamics.

Balancing the cranio-sacral rhythm by palpating the occipital bone and sacrum and aligning the rhythm has a powerful relaxing effect on the patient, helps to align muscle tone and soft tissue turgor of the right and left halves of the body.

Treatment is carried out on days 3 and 10 from the onset of stroke, since with the early onset of restoration of the cranio-sacral rhythm and correction in dynamics, the most complete regression of pathobiomechanical changes in the skull and sacrum and clinical and neurological symptoms is observed.

The combination of essential features of the invention allows you to obtain a new technical result. Restoration of mobility of the atlanto-occipital, sphenobasillar joints and connective tissue structures of the skull, elimination of pathobiomechanical disorders at the level of the neck, shoulder girdle and pelvis leads to the elimination of postural imbalance, a decrease in the severity of paresis, a decrease in the manifestations of cognitive-mnestic disorders and the severity of anxiety and depression, which motivation to recover. Normalization of arterial and venous blood flow, CSF dynamics helps to improve metabolic, neurodynamic processes of the brain, which leads to an improvement in general well-being, concentration of attention, emotional background, and has a positive effect on the quality of life of patients.

The proposed method of treatment based on cranio-sacral manual testing of pathobiomechanical changes in the bones of the pelvis and skull, neurophysiological and neuroimaging parameters provides a comprehensive effect on the disease.

The pathogenesis of damage to cerebral structures in acute and chronic vascular lesions of the brain, despite the background variety of causes that cause them, is always the same type and consists in a sequential increase in a complex of pathobiochemical disorders caused by a decrease in the level of oxygen in arterial blood (hypoxemia), on the one hand, and the effect of intermediates under-oxidized oxygen (oxidative stress), on the other hand (Gusev E.I., Skvortsova V.I., 2000; Fedin A.I., Rumyantseva S.A., 2004; Vereshchagin N.V., Piradov M.A. , Suslina Z.A., 2003). As a result of chronic disorders of cerebral perfusion and systemic blood flow, microcirculation, as well as hypoxemia, in patients with chronic cerebral ischemia, the formation of microlacunar ischemic zones occurs.

At the same time, it is known that one of the main causes of hemodynamic disorders are areas of hypertonicity of the arteries resulting from microtraumas, reflex angiospasm, arising against the background of pathobiomechanical dysfunctions of the bones of the skull and cervical spine (P. Shoffour, J.-P. Barral, F. Druel, 2003, 2004). Restoration of mobility in the atlanto-occipital junction and elimination of soft tissue tension in this area helps to improve collateral blood flow, improve venous outflow, which allows for more effective cranial manual therapy. Elimination of dysfunctions of the sphenobasilar junction helps to restore the cranial rhythm, which, in turn, normalizes CSF dynamics and intracranial pressure. Harmonizing techniques restore hemodynamics, respectively, arterial blood flow, reduce disturbances in microcirculation of the substance and membranes of the brain, skull bones, and also improve venous outflow. Decompression of peripheral sutures also ensures the normalization of hemolikvorodynamics. Relaxation of intracranial vessels eliminates intermembrane tension, areas of hypertonicity. At the same time, an improvement in arterial and venous blood flow in the area of ischemia of the brain substance is achieved, an improvement in collateral blood flow, normalization of liquorodynamic changes, an improvement in neurodynamic processes of the brain, a decrease in the exhaustion of nerve elements, an improvement in memory and attention.

To assess the effectiveness of this medical complex using cranio-sacral manual therapy in patients with ischemic cerebral stroke in the acute period, 5 people aged 20-60 years were examined. Patients received standard complex treatment according to the diagnosis reflecting the clinical syndrome, the period of illness, the severity of clinical manifestations, and pathomorphological substrate.

Neurological syndromes of ischemic cerebral stroke are presented: hemiparesis of varying severity - 100% of cases, vestibulo-atactic syndrome - 80%, cephalgic syndrome - 60%, cognitive-mnestic disorders - 100%. Anxiety - 40% and depression - 20% were also present.

After the first session of cranio-sacral manual therapy, 40% of the subjects noted a decrease in headache, 20% - a decrease in dizziness, 30% noted an improvement in stability in space and an increase in strength in the limbs, 20% noted a decrease in pain in the shoulder joint of the affected upper limb and an increase in the range of motion ...

After the second session (10th day of the disease), a positive trend was observed in 40%. By the time of discharge, 80% of the surveyed noted an improvement in symptoms. The severity of anxiety decreased in 40%. No depressive changes were observed.

The method is carried out as follows.

First, cranio-sacral manual testing is performed to determine the degree of postural imbalance. Then, a complex of craniosacral manual therapy is sequentially performed in the sequence opposite to the development of pathobiomechanical changes and corresponding to the processes of sanogenesis. The complex consists of nine stages, carried out on days 3 and 10 from the onset of a stroke, namely: at the first stage, compression of the symphysis is eliminated. In the position: lying on the back, the legs are bent at the knee and hip joints, they are brought, the feet rest on the couch, the patient tries to spread his legs, and the doctor holds them in their original position. The doctor then spreads the patient's legs and the patient tries to bring the legs together. At the second stage, pathobiomechanical disorders of the sacrum are eliminated, while bilateral flexion or extension of the sacrum is corrected by increasing the tension of the tissues against resistance, while simultaneously holding the sacrum.

The anterior torsion of the sacrum to the left along the left oblique axis or to the right along the right oblique axis is carried out by displacing the left or right lower corner of the sacrum in the cranio-lateral-ventral direction, while the second hand displaces it caudally. The posterior torsion of the sacrum to the right along the left oblique axis or to the left along the right axis is carried out by shifting the angle forward and downward. For this, the base of the right / left hand contacts the right / left base of the sacrum and displaces it caudo-latero-ventrally, while the other hand displaces only cranially. In the third stage, the ilium is in the correct position. In this case, the anterior rotation of the ilium is eliminated by increasing the flexion of the patient's bent leg, raising the pelvis and increasing the posterior rotation of the pelvis. Posterior iliac rotation is eliminated by raising the patient's leg, bent at the knee at a right angle, applying pressure along the iliac crest anterior to the posterior superior iliac spine. At the fourth stage, the tone of the trapezius muscle is restored, while the myofascial release is carried out in the area of the upper and horizontal portions of the trapezius muscle by palpation of the muscle tension area, the point of initiation of exposure, the area of tissue tension, is pressed on the tissue, penetrating deeply, traction is carried out until tissue resistance is felt, avoiding painful sensations, then twisting the tissue until it relaxes. At the fifth stage, the functional block C1-C2 is eliminated, while the head and cervical spine are flexed to an angle of 45 ° and the range of motion in the direction of rotation to the right and left is compared, the difference and limitation of the range of motion to one side is determined. From the created prestressing position in the direction of limited rotation, the muscle-energy technique for correcting rotational dysfunction is performed. At the sixth stage, mobility in the atlanto-occipital junction is restored, while the extension dysfunction of the atlanto-occipital junction C0-C1 is corrected by flexion mainly in the C0-C1 segment, then the head is lateroflexed towards restriction of movement

to the barrier. If flexion dysfunction of the atlanto-occipital junction C0-C1 is detected, extension is carried out mainly in the segment C0-C1 and the head is lateroflexed towards restricting movement to the barrier. At the seventh stage, pathobiomechanical changes in the sphenobasillar joint and connective tissue structures of the skull are eliminated, while the occipital condyles are decompression by traction in the cranial and then in the lateral direction. Then, the sphenobasilar articulation is decompressed by traction on the wings of the main bone in the ventral direction, while keeping the occipital bone dorsally. Further, the correction of torsion and lateroflexia of the sphenobasilar articulation is carried out by rotating the main and occipital bones around the axes of torsion and lateroflexion against resistance. The extension of the sphenobasilar articulation is eliminated by displacing the large wings of the main bone ventro-caudally, pressure on the occipital bone is exerted caudolaterally. The flexion of the sphenobasilar articulation is eliminated by displacing the large wings of the main bone cranio-dorsally, the occipital bone cranio-medially. At the eighth stage, peripheral pathobiomechanical changes in the skull are eliminated. At the same time, the position of the temporal bone is restored depending on the restriction of movement by bringing the occipital bone into extension, and the temporal bone into external rotation, or by bringing the occipital bone into flexion, and the temporal bone into internal rotation. Decompression of the temporoparietal sutures is carried out by external rotation of the temporal bone and lifting of the parietal bones. Decompression of the frontal-main and coronary sutures is performed by traction for the lateral angles of the frontal bone in the ventral and then in the ventro-caudal direction. Decompression of the occipital-mastoid sutures is carried out by displacing the occipital bone caudo-ventrally around the frontal axis, while simultaneously exerting pressure on the mastoid process medio-dorsally. Normalize the position of the bones of the facial skeleton, displacing the main bone caudo-ventrally, while applying pressure from the oral cavity to the palate in the area

a cruciate suture ventrally, then pressure is increased on the main bone in the cranio-dorsal direction, pressure from the oral cavity to the palate is carried out in the direction towards the main bone body. Dysfunction of the temporomandibular joint is eliminated by traction in the caudal and then in the ventro-caudal direction. At the ninth stage, neurodynamic processes are stimulated that restore cerebrospinal fluid and hemodynamics, while the enlargement of the foramen magnum is carried out by pressure in the dorso-lateral-caudal direction. Compression of the fourth ventricle is carried out with the help of medial compression of the lateral angles of the occipital scales by the tenars of the hands. Lateral traction of the mastoid processes is performed. An alternative rotation of the temporal bones is performed with arcuate movements, displacing the tops of the mastoid processes in opposite directions, with a gradual increase in the amplitude of rotational movements. Relaxation of intracranial vessels is carried out by displacement of the mastoid processes dorso-medially with simultaneous displacement of the greater wing of the main bone cranially, dorsally and medially. The cranio-sacral rhythm is restored by balancing the occipital bone and sacrum. Clinical examples.

Example # 1. Patient A., 52, Diagnosis: CVD, acute cerebrovascular accident in the basin of the left middle cerebral artery, acute period, right-sided hemiparesis, stage 2, decreased cognitive functions, stage 2, vestibulo-atactic symptom, stage 1. Concomitant diagnosis: Hypertension grade 3, high risk, alimentary obesity 1-2 tbsp. For a long time she suffered from hypertension, received treatment irregularly. I acutely felt weakness in the right limbs, headache, dizziness, numbness in the right arm and leg. The next day, the symptoms did not go away and the patient called an ambulance (media). Was taken to a specialized neurological

branch. Due to the prescription from the beginning of the process and the presence of concomitant pathology, thrombolysis was refused.

SCT - data of acute lacunar ischemic stroke in the basin of the left middle cerebral artery. Post-stroke cysts in the basal nuclei bilaterally. Moderate external communicating hydrocephalus of a replacement nature. CT angiography of cerebral vessels - signs of thrombotic occlusion of the left ICA and proximal parts of the right ICA. Ultrasound of brachiocephalic vessels - BCA atherosclerosis, in the sinus CCA on both sides there are small, flat ATBs, stenosis up to 20%, ICA on the right is passable, on the left stenosis is up to 75% PA hypoplasia on the left.

Complaints of weakness in the right limbs, numbness, dizziness, loss of memory and attention, disorder of coordination of movements.

Objectively: increased nutrition. The skin is clean, the lymph nodes are not enlarged. Breathing is even vesicular. The abdomen is palpable. HELL 130/80 mm. Hg Pulse 67 per minute.

In the neurological status: FMN: the pupils are equal, the palpebral fissures on the right are narrower, the nystagmus in the extreme leads is horizontal, shallow. The right nasolabial fold is smoothed. Speech and swallowing are preserved. Tongue in the midline. Dry. The reflexes on the right are higher. Right hemigipalgesia. The tone on the right is increased according to the pyramidal type up to 2 tbsp. cl. ave. Strength in the right hand 3 b. left 4 b. in the right leg 3 b. left 5 b. Stagger in Romberg's pose. PNP dysmetria on the right. Gait is hemiparetic. MMSE 25 points.

The fundus of the eye: hypertensive angiopathy.

The patient received standard complex treatment according to the diagnosis reflecting the clinical syndrome, the period of illness, the severity of clinical manifestations, pathomorphological substrate.

Cranio-sacral manual testing was performed, including examination, palpation, study of the motor stereotype, active and passive displacements of the bone and connective tissue elements of the pelvis and skull, as well as the upper shoulder girdle, palpation study of the frequency and amplitude characteristics of the cranio-sacral rhythm. Based on the data of cranio-sacral testing, the features of structural and energy disorders were determined.

Cranio-sacral manual testing revealed: compression of the symphysis, anterior torsion of the sacrum to the right along the right oblique axis, anterior rotation of the right iliac bone, unilateral flexion of the sacrum on the right, MFU in the trapezius muscle, limitation of mobility in the C ₁ -C ₂ vertebral motor segment, limitation of mobility in the atlanto-occipital joint, compression of the sphenobasillar joint, flexion of the sphenobasillar joint, impaired mobility in the sphenobasillar joint, compression of the temporal bone, dysfunction of the temporoparietal sutures, compression of the frontal-main and coronary sutures, compression of the occipital-mastoid joints of the facial sutures compression of the temporomandibular joint, compression of the occipital condyles between the articular surfaces of the atlas, compression of the fourth ventricle, decrease in the frequency of the cranial rhythm, limitation of the flexion phase.

Taking into account the peculiarities of pathobiomechanical changes, the proposed complex of cranial manual therapy was applied.

On the third child from the onset of the stroke, a session of cranio-sacral manual therapy was conducted against the background of standard drug therapy, including antihypoxants, vasoactive, nootropic drugs.

Decompression of the symphysis was performed using muscular-energy technique (“shot from a gun”). The patient was lying on her back, her legs bent at the knee and hip joints, adduced, her feet resting on the couch. The doctor grabbed the brought knees and hips, pressed them in his chest and, resisting the patient's attempt to spread the legs, held them in the initial position for 5-7 seconds. Then the doctor spread the patient's knees (feet were next to each other) and put his forearm between the patient's knees. The patient attempted to bring her legs together against adequate resistance from the physician's forearm. After relaxing, the doctor repeated the first phase. There were three such repetitions.

Anterior torsion of the sacrum to the right along the right oblique axis was carried out by placing the patient with the head turning to the left. The patient is on the left side. The patient's arms are lowered to the floor. The doctor is on the left. The control hand is set to L ₅ S ₁ . The sacrum was transferred to the left rotation. Holding the legs, the patient's right shoulder was fixed. Asked to press the shoulder on the arm while inhaling (with 30% increase), repeat 3 times. The sacrum lateroflexia was restored. Control hand on the SIJ on the left, where there is a deep groove, the patient's legs were lowered down. On inhalation, the patient pressed her legs upward, on exhalation, she relaxed, and the doctor lowered her legs even lower. After that, the doctor returned the patient to her original position.

The anterior rotation of the right ilium was eliminated by increasing the flexion of the patient's bent leg, raising the pelvis and increasing the posterior rotation of the pelvis. The patient lay on her stomach at the right edge of the couch, her leg bent at the knee joint and lowered over the edge of the table. The doctor gave the patient's leg a position of abduction, external rotation and flexion to the barrier, the patient's foot rested on the doctor's thigh. The second hand controlled the change in the ilium. The patient tried to straighten the leg against the resistance of the doctor's hip; during the relaxation period, the doctor increased the flexion of the leg, lifting the pelvis and increasing the posterior rotation of the pelvis. Reception was repeated 3 times.

Eliminated the one-sided flexion of the sacrum on the right. The patient was lying on her stomach. The doctor stood to the right of the patient and controlled mobility in the SIJ with his left hand, and with his right hand gave the leg a 15 ° abduction position, internal rotation until the SIJ slit opened. then the doctor moved his right hand with the base of his palm to the lower sacral angle on the right and moved it ventrally to the barrier, continuing to palpate the SIJ with the fingers of the other hand.

A myofascial release was carried out in the area of the horizontal portion of the trapezius muscle: by palpation, they determined the point of tissue tension (onset of exposure), gradually pressing on the tissue, gently and gently penetrated deep into the depths, traction to the barrier, then twisted the tissue until it relaxed.

Mobility was restored in the C ₁ -C ₂ PDS by means of MET correction of rotational dysfunction in the C ₁ -C ₂ segment. Head flexion and CS were performed to an angle of about 45 ° and the range of motion was compared in the direction of rotation to the right and to the left. From the created position of rotation to the right and the state of prestress in the direction of limited rotation, MET was performed.

Restored mobility in the atlanto-occipital junction. The ERS of the atlanto-occipital junction was corrected by flexion mainly in the C ₀ -C ₁ segment, then the head was lateroflexed towards restriction of movement to the barrier, and facilitated the opening of the DFS.

Decompression of the sphenobasillary articulation was performed by traction for the wings of the main bone in the ventral direction, while holding the occipital bone dorsally.

The flexion of the sphenobasillar articulation was eliminated by displacing the large wings of the main bone cranio-dorsally, the occipital bone - cranio-medially.

Correction of impaired mobility in the sphenobasillar joint was performed. Using the "frontal-occipital grip" - the patient lay on his back, one hand of the doctor was located under the patient's head and held the occipital bone, and the other hand covered the frontal bone, contacting the outer surface of the large wings of the main bone with the pad of the first finger on one side and the pad of the third finger from the opposite side. The doctor carried out light ventral traction for the wings of the main bone, while simultaneously holding the occipital bone dorsally, achieving displacement of the main bone, then rotated the main and occipital bones around the sagittal and vertical axes against resistance and keeps them in a state of prestress until the restriction is removed and freedom of movement is restored in this direction.

Decompression of the temporal bone and restoration of its position.

Held in order to reduce the unilateral tension of the temporal bone. At the same time, the patient was lying on her back, relaxed. The position of the doctor was sitting at the patient's head, the forearms were on a couch with an adjusted height. The doctor's hands on the side of the injury controlled the temporal bone as follows: the first and second fingers held the zygomatic process of the temporal bone: the first finger was at the apex, and the second was under it, the third was located in the external auditory canal, the fourth and fifth fingers covered the mastoid process. The cup-shaped occipital scales were located in the concavity of the palm of the other hand, located across the bone. Discovered a restriction of unilateral external rotation, the doctor brought the occipital bone into extension, which facilitated the opening of the suture from the side of the restriction. Simultaneously, the doctor performed external rotation of the temporal bone: the first and second fingers shifted the zygomatic process caudo-laterally, and the fourth and fifth fingers pulled the mastoid process dorso-medially. This position was held until relaxation began. After that, he checked the symmetry of the temporal bones movement.

We performed decompression of the temporoparietal sutures by external rotation of the temporal bone and lifting the parietal bones. The patient lay on her back, relaxed. The position of the doctor was sitting at the patient's head, the forearms were on a couch with an adjusted height. The first finger of the doctor's left hand was located on the parietal bone near the suture, and the first finger of the right hand was on the scales of the temporal bone, the second and third fingers of the right hand were located above the mastoid process. The first finger of the left hand applied pressure medially, the second and third fingers of the right hand pressed on the mastoid process caudo-dorsally, causing external rotation of the temporal bone. The first fingers stretched the temporo-parietal suture to the sides. This position was held until the onset of relaxation.

Decompression of the frontal-main and coronary sutures was performed by traction at the lateral angles of the frontal bone in the ventral and then in the ventro-caudal direction. At the same time, the patient's position was lying on her back, relaxed. The position of the doctor is sitting at the patient's head, leaning slightly forward towards the couch with an adjusted height. The doctor's fingers are interlaced over the metopic suture. The elevations of the hypotenars were located at the prominent lateral angles of the frontal bone anterior to the coronary suture. The doctor's intertwined fingers performed traction of the frontal bone for its lateral angles ventrally on both sides, and then ventro-caudally. This position was held until the onset of relaxation.

Decompression of the occipital-mastoid sutures was performed by displacing the occipital bone caudo-ventrally around the frontal axis, while simultaneously applying pressure on the mastoid process medio-dorsally. The patient was lying on her back, the doctor was sitting at the head of the bed, one of the doctor's hand controlled the temporal bone: the first finger lay on the zygomatic process, the second - under it, the terminal phalanx of the third finger - in the external auditory canal, the fourth finger - in front of the mastoid process, the fifth finger - behind mastoid process. The palm of the other hand was located across the scales of the occipital bone. The doctor rotated the temporal bone outward, displacing the mastoid process medio-dorsally with simultaneous traction of the temporal bone laterally from the occipital bone. The other hand rotated the occipital bone ventro-caudally around the frontal axis and around the vertical axis from the temporal bone. The position was held until the onset of relaxation. This technique restores physiological mobility between the occipital and temporal bones and improves venous drainage through the jugular vein.

The position of the bones of the facial skeleton was normalized. The patient lay on her back, relaxed. The position of the doctor was sitting at the patient's head on the side opposite to the injury, on a couch with an adjusted height. The cranial hand was located on the frontal bone with the first and third fingers on the large wings of the main bone. The second finger of the caudally located hand touched the cruciate suture in the oral cavity without applying pressure. The cranial hand extended the large wings in the caudo-ventral direction, while simultaneously applying pressure from the oral cavity to the palate at the cruciate suture ventrally. Then the cranially located hand increased the pressure on the occipital bone in the cranio-dorsal direction, at the same time the finger in the oral cavity exerted pressure on the cruciate suture in the direction of the main bone body. This was repeated until relaxation occurred. Relieving stress from the bones of the facial skeleton normalizes the functioning of the cerebrospinal fluid and cerebrospinal fluid systems, which directly affect the state of the main elements of the central nervous system, including the brain stem, interstitial brain and peri-ventricular formations, which play a key role in maintaining the activity of the mechanisms of regulation of autonomic balance.

Decompression of the temporomandibular joint. The patient lay on her back, relaxed. The position of the doctor was sitting at the patient's head, the forearms were on a couch with an adjusted height. The second fingers of both hands of the doctor were in contact with the lifting ramus of the lower jaw, the terminal phalanges of the first fingers for palpation were located freely above the scaly suture. Traction of the temporomandibular joint was performed, traction was performed ventro-caudally. A state of pre-tension was achieved and held until relaxation. Decompression of the temporomandibular joint leads to the normalization of the myofascial and bone structures associated with it, including the base of the skull, reduces fascial traction, and restores the rhythm.

Performed decompression of the occipital condyles by traction in the cranial and then in the lateral direction. The patient lay on her back, the doctor sat at the head of the bed, the back of the patient's head lay on the doctor's palms, the end phalanges of the doctor's fingers were bent at an angle of 90 degrees and applied light pressure on the suboccipital region until soft tissue relaxation was felt, while the doctor's fingertips rested against the arch of the atlas. At the next stage, the doctor carried out light traction for the condyles of the occipital bone in the cranial and then in the lateral direction. This technique relieves the tension of the soft tissues of the suboccipital region and releases the condyles of the occipital bone.

The enlargement of the foramen magnum was carried out by pressure in the dorso-latero-caudal direction. The patient lay on her back, relaxed. The position of the doctor was sitting at the patient's head, the forearms were on a couch with an adjusted height. The doctor tried to maintain contact as close to the foramen magnum as possible. In this case, the pads of two fingers penetrated from both sides into a depression localized between the two dorsal and lateral muscle masses of the neck. The forearms of the doctor lay on the back surface with a cup-shaped arrangement of hands on the skull, softly and with equal effort. The foramen magnum was expanded by pressure of two fingers in the dorso-latero-caudal direction until prestressing was created. This process continued until relaxation occurred.

Decompression of the fourth ventricle was performed using medial compression of the lateral angles of the occipital scales with the tenars of the hands. The patient lay on her back, relaxed. The position of the doctor was sitting at the patient's head, the forearms were on a couch with an adjusted height. The doctor's hands were folded in a cup-like manner and were located under the scales of the occipital bone. The thenars were located lateral to the external occipital protuberance and performed light medial compression of the lateral angles of the occipital scales. The pressure was held until relaxation, along with a feeling of softening and warmth in the back of the head. Iatrogenic limitation of the mobility of the occipital bone causes an increase in the displacement of other bones of the skull. The technique is used to restore cranial rhythm and has the most extensive range of indications in cranio-sacral therapy.

The occipital pump was performed by lateral traction of the mastoid processes. The patient lay on her back, relaxed. The position of the doctor was sitting at the patient's head, the forearms were on a couch with an adjusted height. The pads of the second and third toes are in the digastric notches, behind the mastoid processes. The patient was asked to breathe slowly and deeply, while performing lateral traction of the mastoid processes until prestressing was created. This process continued until relaxation occurred. Stimulation of the pump-like drainage function of the jugular vein restores physiological mobility between the jugular process of the occipital bone and the jugular surface of the temporal bones. The "occipital pump" allows to eliminate the existing imbalance of reciprocal tension membranes, especially at the level of the occipital and temporal bones.

Alternative rotation of the temporal bones. The position of the temporal bone was restored by bringing the occipital bone into extension, and the temporal bone into external rotation. The patient lay on her back, relaxed. The position of the doctor was sitting at the patient's head, the forearms were on a couch with an adjusted height. The doctor's hands were intertwined and with their back surface captured the upper cervical region and the occipital scales, and the first fingers were located parallel to the anterior edge of the mastoid processes, the elevations of the thenars were in contact with the corresponding mastoid parts of the temporal bones. They performed arcuate movements, displacing the tops of the mastoid processes in opposite directions. The amplitude of rotational movements was gradually increased. Alternative rotation of the temporal bones is carried out with the aim of a sedative, harmonizing effect on the patient's body. It aims at restoring the balance of the cranial mechanism, as well as providing a relaxing effect on the patient.

Relaxation of intracranial vessels. It was performed to eliminate membrane tension and release intracranial vascular channels, contributing to the normalization of cerebral hemo- and cerebrospinal fluid dynamics. The position of the patient in this case is lying on her back, relaxed. The position of the doctor is sitting at the patient's head, the forearms are on the couch with an adjusted height. The doctor's hands were positioned asymmetrically on the skull. The first finger of the right hand was located along the mastoid process with the elevation of the thenar on the mastoid part. The other fingers covered the occipital bone. The first finger of the left hand touched the left outer surface of the major wing of the main bone. Movement: the first finger of the right hand gradually displaced the mastoid process dorso-medially, while the first finger of the left hand displaced the large wing of the main bone cranially, dorsally and medially. These movements were repeated until relaxation occurred.

The cranio-sacral rhythm was restored by balancing the sacrum and occipital bone. The patient was lying on her right side. One hand of the doctor was in close contact with the os occipitale, the other with the os sacrum. The contact of the center of the palm with S ₂ (axis of rotation) was carefully observed. The rhythm was observed. There was an impression of a synchronous rocking between the os sacrum and the os occipitale. The initiation of the "rest point" and the restoration of the synchronous rhythm were carried out.

The session lasted 30-40 minutes. Then it was repeated on the tenth day from the onset of the disease.

In the course of treatment, the patient's condition improved. The strength in the right limbs increased to 4b., Sensitivity appeared in the hand. Has become more stable in the Romberg position.

The patient was examined in a month - her condition improved. Independently moves around the house, paresis in the leg 1 tbsp., In the hand 2 tbsp., The disorder of coordination of movements remains, but less pronounced.

The use of the proposed method allows to significantly increase the effectiveness of complex treatment of patients with acute cerebrovascular accident.

Example # 2. Patient M., 47 years old. Diagnosis: CVD, acute cerebrovascular accident in the basin of the right middle cerebral artery and VBD acute period left-sided hemiparesis stage 2, decreased cognitive functions stage 1, vestibulo-atactic syndrome stage 2. Concomitant diagnosis: Hypertension 3 tbsp., High risk.

For a long time she suffered from hypertension, received treatment irregularly.

In the evening I felt weakness in the left extremities, severe dizziness, numbness in the left arm and leg, could not stand up. In the morning, the patient called the ambulance team. Was taken to a specialized neurological department. Due to the prescription from the beginning of the process and the presence of concomitant pathology, thrombolysis was refused.

SCT - data of acute lacunar ischemic stroke in the basin of the right middle cerebral artery and cerebellum. Post-stroke cysts in the basal nuclei bilaterally. Moderate external communicating hydrocephalus of a replacement nature.

Ultrasound of brachiocephalic vessels - BCA atherosclerosis, in the CCA on both sides there are small, flat ATBs, stenosis up to 20%, ICA on the right is passable, on the left stenosis is up to 35%. Hypoplasia of the right PA, pathological tortuosity of the left PA ..

Complaints of weakness in the left extremities, numbness, difficulty walking, dizziness, loss of memory and attention, disorder of coordination of movements.

Objectively: The skin is clean, the lymph nodes are not enlarged. Breathing is even vesicular. The abdomen is palpable. HELL 130/80 mm. rt. Art. Pulse 67 per minute. Rhythmic heart sounds, systolic murmur at the apex of the heart. No rhythm disturbance.

In the neurological status: FMN: the pupils are equal, the palpebral fissures on the left are narrower, nystagmus in the extreme leads is horizontal, setting. The left nasolabial fold is smoothed. Speech and swallowing are preserved. Tongue in the midline. Dry. Reflexes on the left are higher. Hemigipalgesia on the left. The tone on the left is increased according to the pyramidal type up to 2 tbsp. Right hand strength 5 pts. left 3 b. in the right leg 5 b. left 4 b. In the Romberg position, ataxia 1 tbsp. PNP dysmetria on the left. PEP dysmetria on the left. Gait is hemiparetic.

MMSE 26 points.

The fundus of the eye: hypertensive angiopathy.

The patient received standard complex treatment according to the diagnosis reflecting the clinical syndrome, the period of illness, the severity of clinical manifestations, pathomorphological substrate.

Cranio-sacral manual testing was performed, including examination, palpation, study of the motor stereotype, active and passive displacements of the bone and connective tissue elements of the pelvis and skull, as well as the upper shoulder girdle, palpation study of the frequency and amplitude characteristics of the cranio-sacral rhythm. Based on the data of cranio-sacral testing, the features of structural and energy disorders were determined.

When cranio-sacral manual testing revealed: compression symphysis, sacrum TORZ front left along the left oblique axis, double-sided inflexion of the sacrum, in the MFP trapezius muscle, limit the mobility of C ₁ -C ₂ spinal motion segment, limiting the mobility in the atlanto-occipital junction, compression sphenobasillar joint, impaired mobility in the sphenobasillar joint, compression of the temporal bone on the left, dysfunction of the temporoparietal sutures, compression of the frontal-main and coronary sutures, compression of the occipital-mastoid sutures, violation of the position of the bones of the facial skeleton, compression of the temporomandibular condyle on the left, compression of the temporomandibular joint on the left bones between the articular surfaces of the atlas, compression of the fourth ventricle, decrease in the frequency of the cranial rhythm, limitation of the phase of flexion and extension.

On the third child from the onset of the stroke, a session of cranio-sacral manual therapy was conducted against the background of standard drug therapy, including antihypoxants, vasoactive, nootropic drugs.

Taking into account the peculiarities of pathobiomechanical changes, the proposed complex of cranial manual therapy was applied.

Decompression of the symphysis was performed using muscular-energy technique (“shot from a gun”). The patient was lying on her back, her legs bent at the knee and hip joints, adduced, her feet resting on the couch. The doctor grabbed the brought knees and hips, gave them in his chest and, resisting the patient's attempt to spread the legs, held them in their original position for 5-7 seconds. Then the doctor spread the patient's knees (feet were next to each other) and put his forearm between the patient's knees. The patient attempted to bring her legs together against adequate resistance from the physician's forearm. After relaxation, the doctor repeated phase 1, such repetitions were performed 3.

Anterior torsion of the sacrum to the left along the left oblique axis was performed by placing the patient with the head turning to the right. The patient is on the right side. The patient's arms are lowered to the floor. The doctor is on the right. The controlling hand is set to L ₅ S ₁ . The sacrum was transferred to the right rotation. Holding the legs, the patient's left shoulder was fixed. Asked to press the shoulder on the arm while inhaling (with 30% increase), repeat 3 times. The sacrum lateroflexia was restored. The control hand on the SIJ on the right, where there is a deep groove, the patient's legs were lowered down. On inhalation, the patient pressed her legs upward, on exhalation, she relaxed, and the doctor lowered her legs even lower. After that, the doctor returned the patient to her original position.

Eliminated the bilateral flexion of the sacrum. The patient sat on a stool, legs firmly resting on the floor, feet turned inward, hands dropped between knees, spinal flexion to L ₅ S ₁ . The doctor stood to the right of the patient and the left hand was located at the base of the sacrum, the right hand was on the thoracic spine. The patient pressed her back to the ceiling against the resistance of the doctor's hand; in the relaxation phase, the doctor increased the flexion of the spine and simultaneous pressure on the apex of the sacrum. This was repeated 3 times.

A myofascial release was carried out in the area of the horizontal portion of the trapezius muscle: by palpation, they determined the point of tissue tension (onset of exposure), gradually pressing on the tissue, gently and gently penetrated deep into the depths, traction to the barrier, then twisted the tissue until it relaxed.

Mobility was restored in the C ₁ -C ₂ PDS by means of MET correction of rotational dysfunction in the C ₁ -C ₂ segment. We carried out flexion of the head and CS to an angle of about 45 ° and compared the range of motion in the direction of rotation to the right and to the left. From the created position of rotation to the right and the state of prestress in the direction of limited rotation, MET was performed.

Restored mobility in the atlanto-occipital junction. The ERS of the atlanto-occipital junction was corrected by flexion mainly in the C ₀ -C ₁ segment, then the head was lateroflexed towards restriction of movement to the barrier, and facilitated the opening of the DFS.

Decompression of the sphenobasillary articulation was performed by traction for the wings of the main bone in the ventral direction, while holding the occipital bone dorsally.

Correction of impaired mobility in the sphenobasillar joint was performed. Using the "frontal-occipital grip" - the patient lay on his back, one hand of the doctor was located under the patient's head and held the occipital bone, and the other hand covered the frontal bone, contacting the outer surface of the large wings of the main bone with the pad of the first finger on one side and the pad of the third finger from the opposite side. The doctor carried out light ventral traction for the wings of the main bone, while simultaneously holding the occipital bone dorsally, achieving displacement of the main bone, then rotated the main and occipital bones around the sagittal and vertical axes against resistance and keeps them in a state of prestress until the restriction is removed and freedom of movement is restored in this direction.

Decompression of the left temporal bone and restoration of its position. Held in order to reduce the unilateral tension of the temporal bone. At the same time, the patient was lying on her back, relaxed. The position of the doctor was sitting at the patient's head, the forearms were on a couch with an adjusted height. The doctor's hands controlled the left temporal bone in the following way: the first and second fingers held the zygomatic process of the temporal bone: the first finger was at the apex, and the second was under it, the third was in the external auditory canal, the fourth and fifth fingers covered the mastoid process. The cup-shaped occipital scales were located in the concavity of the palm of the other hand, located across the bone. Discovered a restriction of unilateral external rotation, the doctor brought the occipital bone into extension, which facilitated the opening of the suture from the side of the restriction. Simultaneously, the doctor performed external rotation of the left temporal bone: the first and second fingers shifted the zygomatic process caudo-laterally, and the fourth and fifth fingers pulled the mastoid process dorso-medially. This position was held until relaxation began. After that, he checked the symmetry of the temporal bones movement.

We performed decompression of the temporoparietal sutures by external rotation of the temporal bone and lifting the parietal bones. The patient lay on her back, relaxed. The position of the doctor was sitting at the patient's head, the forearms were on a couch with an adjusted height. The first finger of the doctor's left hand was located on the parietal bone near the suture, and the first finger of the right hand was on the scales of the temporal bone, the second and third fingers of the right hand were located above the mastoid process. The first finger of the left hand applied pressure medially, the second and third fingers of the right hand pressed on the mastoid process caudo-dorsally, causing external rotation of the temporal bone. The first fingers stretched the temporo-parietal suture to the sides. This position was held until the onset of relaxation.

Decompression of the frontal-main and coronary sutures was performed by traction at the lateral angles of the frontal bone in the ventral and then in the ventro-caudal direction. At the same time, the patient's position was lying on her back, relaxed. Position of the doctor - sitting at the patient's head, leaning slightly forward towards the couch with an adjusted height. The doctor's fingers were interlaced over the metopic suture. The elevations of the hypotenars were located at the prominent lateral angles of the frontal bone anterior to the coronary suture. The doctor's intertwined fingers performed traction of the frontal bone for its lateral angles ventrally on both sides, and then ventro-caudally. This position was held until the onset of relaxation.

Decompression of the occipital-mastoid sutures was performed by displacing the occipital bone caudo-ventrally around the frontal axis, while simultaneously applying pressure on the mastoid process medio-dorsally. The patient was lying on her back, the doctor was sitting at the head of the bed, one of the doctor's hand controlled the temporal bone: the first finger lay on the zygomatic process, the second - under it, the terminal phalanx of the third finger - in the external auditory canal, the fourth finger - in front of the mastoid process, the fifth finger - behind mastoid process. The palm of the other hand was located across the scales of the occipital bone. The doctor rotated the temporal bone outward, displacing the mastoid process medio-dorsally with simultaneous traction of the temporal bone laterally from the occipital bone. The other hand rotated the occipital bone ventro-caudally around the frontal axis and around the vertical axis from the temporal bone. The position was held until the onset of relaxation. This technique restores physiological mobility between the occipital and temporal bones and improves venous drainage through the jugular vein.

The position of the bones of the facial skeleton was normalized. The patient lay on her back, relaxed. The position of the doctor was sitting at the patient's head on the side opposite to the injury, on a couch with an adjusted height. The cranial hand was located on the frontal bone with the first and third fingers on the large wings of the main bone. The second finger of the caudally located hand touched the cruciate suture in the oral cavity without applying pressure. The cranial hand extended the large wings in the caudo-ventral direction, while simultaneously applying pressure from the oral cavity to the palate at the cruciate suture ventrally. Then the cranially located hand increased the pressure on the occipital bone in the cranio-dorsal direction, at the same time the finger in the oral cavity exerted pressure on the cruciate suture in the direction of the main bone body. This was repeated until relaxation occurred. Relieving stress from the bones of the facial skeleton normalizes the functioning of the cerebrospinal fluid and cerebrospinal fluid systems, which directly affect the state of the main elements of the central nervous system, including the brain stem, interstitial brain and peri-ventricular formations, which play a key role in maintaining the activity of the mechanisms of regulation of autonomic balance.

Decompression of the temporomandibular joint on the left. The patient lay on her back, relaxed. The position of the doctor was sitting at the patient's head, the forearms were on a couch with an adjusted height. The second fingers of both hands of the doctor were in contact with the lifting branch of the lower jaw on the left, the terminal phalanges of the first fingers for palpation were located freely above the scaly suture. Traction of the left temporomandibular joint was performed, traction was performed ventro-caudally. A state of pre-tension was achieved and held until relaxation. Decompression of the temporomandibular joint leads to the normalization of the myofascial and bone structures associated with it, including the base of the skull, reduces fascial traction, and restores the rhythm.

Performed decompression of the occipital condyles by traction in the cranial and then in the lateral direction. The patient lay on her back, the doctor sat at the head of the bed, the back of the patient's head lay on the doctor's palms, the end phalanges of the doctor's fingers were bent at an angle of 90 ° and applied light pressure on the suboccipital region until soft tissue relaxation was felt, while the doctor's fingertips rested against the arch of the atlas. At the next stage, the doctor carried out light traction for the condyles of the occipital bone in the cranial and then in the lateral direction. This technique relieves the tension of the soft tissues of the suboccipital region and releases the condyles of the occipital bone.

The enlargement of the foramen magnum was carried out by pressure in the dorso-latero-caudal direction. The patient lay on her back, relaxed. The position of the doctor was sitting at the patient's head, the forearms were on a couch with an adjusted height. The doctor tried to maintain contact as close to the foramen magnum as possible. In this case, the pads of two fingers penetrated from both sides into a depression localized between the two dorsal and lateral muscle masses of the neck. The forearms of the doctor lay on the back surface with a cup-shaped arrangement of hands on the skull, softly and with equal effort. The foramen magnum was expanded by pressure of two fingers in the dorso-latero-caudal direction until prestressing was created. This process continued until relaxation occurred.

Decompression of the fourth ventricle was performed using medial compression of the lateral angles of the occipital scales with the tenars of the hands. The patient lay on her back, relaxed. The position of the doctor was sitting at the patient's head, the forearms were on a couch with an adjusted height. The doctor's hands were folded in a cup-like manner and were located under the scales of the occipital bone. The thenars were located lateral to the external occipital protuberance and performed light medial compression of the lateral angles of the occipital scales. The pressure was held until relaxation, along with a feeling of softening and warmth in the back of the head. Iatrogenic limitation of the mobility of the occipital bone causes an increase in the displacement of other bones of the skull. The technique is used to restore cranial rhythm and has the most extensive range of indications in cranio-sacral therapy.

The occipital pump was performed by lateral traction of the mastoid processes. The patient lay on her back, relaxed. The position of the doctor was sitting at the patient's head, the forearms were on a couch with an adjusted height. The pads of the second and third toes are in the digastric notches, behind the mastoid processes. The patient was asked to breathe slowly and deeply, while performing lateral traction of the mastoid processes until prestressing was created. This process continued until relaxation occurred. Stimulation of the pump-like drainage function of the jugular vein restores physiological mobility between the jugular process of the occipital bone and the jugular surface of the temporal bones. The "occipital pump" allows to eliminate the existing imbalance of reciprocal tension membranes, especially at the level of the occipital and temporal bones.

Alternative rotation of the temporal bones. The position of the temporal bone was restored by bringing the occipital bone into extension, and the temporal bone into external rotation. The patient lay on her back, relaxed. The position of the doctor was sitting at the patient's head, the forearms were on a couch with an adjusted height. The doctor's hands were intertwined and with their back surface captured the upper cervical region and the occipital scales, and the first fingers were located parallel to the anterior edge of the mastoid processes, the elevations of the thenars were in contact with the corresponding mastoid parts of the temporal bones. They performed arcuate movements, displacing the tops of the mastoid processes in opposite directions. The amplitude of rotational movements was gradually increased. Alternative rotation of the temporal bones is carried out with the aim of a sedative, harmonizing effect on the patient's body. It aims at restoring the balance of the cranial mechanism, as well as providing a relaxing effect on the patient.

Relaxation of intracranial vessels. It was performed to eliminate membrane tension and release intracranial vascular channels, contributing to the normalization of cerebral hemo- and cerebrospinal fluid dynamics. The position of the patient in this case is lying on her back, relaxed. The position of the doctor is sitting at the patient's head, the forearms are on the couch with an adjusted height. The doctor's hands were positioned asymmetrically on the skull. The first finger of the right hand was located along the mastoid process with the elevation of the thenar on the mastoid part. The other fingers covered the occipital bone. The first finger of the left hand touched the left outer surface of the major wing of the main bone. Movement: the first finger of the right hand gradually displaced the mastoid process dorso-medially, while the first finger of the left hand displaced the large wing of the main bone cranially, dorsally and medially. These movements were repeated until relaxation occurred.

The cranio-sacral rhythm was restored by balancing the sacrum and occipital bone. The patient was lying on her right side. One hand of the doctor was in close contact with the os occipitale, the other with the os sacrum. The contact of the center of the palm with S ₂ (axis of rotation) was carefully observed. The rhythm was observed. There was an impression of a synchronous rocking between the os sacrum and the os occipitale. The initiation of the "rest point" and the restoration of the synchronous rhythm were carried out.

The session lasted 30-40 minutes. Then it was repeated on the tenth day from the onset of the disease.

In the course of treatment, the patient's condition improved. The strength in the right limbs increased to 4b., Sensitivity appeared in the hand. Has become more stable in the Romberg position.

The patient was examined in a month - her condition improved. Independently moves around the house, paresis in the leg 1 tbsp., In the hand 1 tbsp., The disorder of coordination of movements remains, but less pronounced.

The use of the proposed method allows to significantly increase the effectiveness of complex treatment of patients with acute cerebrovascular accident.

The result of the claimed method is as follows:

Elimination of imbalance in the pelvic and shoulder girdle area helps to eliminate postural imbalance.

Restoration of mobility of the atlanto-occipital, sphenobasillar joints and connective tissue structures of the skull, as well as the correction of peripheral pathobiomechanical changes, helps to reduce the manifestations of cognitive-mnestic disorders, cephalgic and vestibulocerebellar syndromes.

Balancing the cranio-sacral rhythm helps to harmonize processes and accelerate the restoration of tone in the affected limbs. The complex and consistent implementation of the techniques of cranio-sacral manual therapy is due to the fact that the leading role of cerebral ischemia is played by impaired mobility in the atlanto-occipital and sphenobasillar joints, the elimination of which ensures the normal functioning of arterial and venous blood flow, CSF dynamics, which helps to improve metabolic, neurodynamic processes of the brain. brain. Restoration of optimal statics helps to balance the body's axes and reduce postural imbalance, which helps to stimulate the restoration of strength and movement in the affected limbs.

Claims (1)

A method of treating patients in the acute and early recovery period of ischemic stroke, including the elimination of pathobiomechanical changes in the skull region and the cranio-cervical junction using manual therapy techniques, characterized in that first, craniosacral manual testing is performed, the degree of postural imbalance is determined, then the craniosacral complex is sequentially performed. manual therapy in the sequence reverse to the development of pathobiomechanical changes and corresponding to the processes of sanogenesis, the complex consists of nine stages, carried out on the 3rd and 10th day from the onset of stroke, namely: at the first stage, the compression of the symphysis is eliminated: in the supine position, the legs are bent at the knee and the hip joints are brought, the feet rest on the couch, the patient tries to spread his legs, and the doctor holds them in their original position, then the doctor spreads the patient’s legs, and the patient tries to bring his legs together; at the second stage, pathobiomechanical disorders of the sacrum are eliminated, while the bilateral flexion or extension of the sacrum is corrected by strengthening the tension of the tissues against resistance, while holding the sacrum, the anterior torsion of the sacrum to the left along the left oblique axis or to the right along the right oblique axis is carried out by shifting the left or right lower angle the sacrum in the cranio-latero-ventral direction, while the second hand displaces it caudally, the posterior torsion of the sacrum to the right along the left oblique axis or to the left along the right axis is carried out by shifting the angle forward and downward, for this the base of the right / left hand contacts the right / left the base of the sacrum and displaces it caudo-latero-ventrally, and the second hand displaces only cranially; at the third stage, the correct position of the ilium is given, while the anterior rotation of the ilium is eliminated by increasing the flexion of the patient's bent leg, lifting the pelvis and increasing the posterior rotation of the pelvis, the posterior rotation of the ilium is eliminated by raising the patient's leg, bent at the knee at a right angle, applying pressure along the iliac crest anterior to the posterior superior iliac spine; at the fourth stage, the tone of the trapezius muscle is restored, while myofascial release is carried out in the area of the upper and horizontal portions of the trapezius muscle by palpation of the area of muscle tension, the point of initiation of the action, the area of tissue tension, is pressed on the tissue, penetrating deeply, traction is carried out until tissue resistance is felt, avoiding pain, then twisting the tissue until it relaxes; at the fifth stage, the functional block C1-C2 is eliminated, while the head and cervical spine are flexed to an angle of 45 ° and the range of motion is compared in the direction of rotation to the right and left, the difference and limitation of the range of motion in one of the sides, from the created prestress position to in the direction of limited rotation, the muscle-energy technique for correcting rotational dysfunction is performed; at the sixth stage, mobility is restored in the atlanto-occipital junction, while the extension dysfunction of the atlanto-occipital junction C0-C1 is corrected by flexion mainly in the C0-C1 segment, then the lateroflexion of the head towards restriction of movement to the barrier, upon detection of flexion dysfunction of the atlanto-occipital joints C0-C1 carry out extension mainly in the segment C0-C1 and lateroflexion of the head towards restriction of movement to the barrier; at the seventh stage, pathobiomechanical changes in the sphenobasilar articulation and connective tissue structures of the skull are eliminated, while decompression of the occipital condyles is performed by traction in the cranial, and then in the lateral direction, then decompression of the sphenobasilar articulation is carried out by traction of the main bone in the ventral direction, at the same time dorsally, then correction of the torsion and lateroflexion of the sphenobasilar articulation is carried out by rotating the main and occipital bones around the axes of torsion and lateroflexion against resistance, the extension of the sphenobasilar articulation is eliminated by displacing the large wings of the main bone ventro-caudally, pressure on the occipital bone is exerted by the caudo-lateral articulation eliminated by displacing the large wings of the main bone cranio-dorsally, the occipital bone - cranio-medially; at the eighth stage, peripheral pathobiomechanical changes in the skull are eliminated, while restoring the position of the temporal bone, depending on the restriction of movement, by bringing the occipital bone into extension, and the temporal bone into external rotation, or by bringing the occipital bone into flexion, and the temporal bone into internal rotation, decompression is performed temporo-parietal sutures by external rotation of the temporal bone and lifting the parietal bones, decompression of the frontal-main and coronary sutures is performed by traction for the lateral angles of the frontal bone in the ventral and then in the ventro-caudal direction, decompression of the occipital-mastoid sutures is performed by displacing the occipital caudal bone - ventrally around the frontal axis, while simultaneously exerting pressure on the mastoid process medio-dorsally, normalize the position of the bones of the facial skeleton, displacing the main bone caudo-ventrally, while applying pressure from the oral cavity to the palate in the area of the cruciate suture ventrally, then increase the pressure f on the main bone in the cranio-dorsal direction, the pressure from the oral cavity to the palate is carried out towards the body of the main bone, the dysfunction of the temporomandibular joint is eliminated by traction in the caudal and then in the ventro-caudal direction; at the ninth stage, neurodynamic processes are stimulated that restore cerebrospinal fluid and hemodynamics, while the enlargement of the foramen magnum is carried out by pressure in the dorsal-lateral-caudal direction, the compression of the fourth ventricle is carried out using medial compression of the lateral angles of the occipital bone scales with tenars of the hands, lateral traction of the mastoid processes is performed , an alternative rotation of the temporal bones is performed with arcuate movements, displacing the tops of the mastoid processes in opposite directions, with a gradual increase in the amplitude of rotational movements, relaxing the intracranial vessels by displacing the mastoid processes dorso-medially with a simultaneous displacement of the large wing of the main bone cranially, dorsally and medially, restoring -sacral rhythm by balancing the occipital bone and sacrum.