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Sports medicine - Dubrovsky V.I. Introduction Dubrovsky physiotherapy exercises and medical control

TEXTBOOK

FOR UNIVERSITIES

V.I.DUBROVSKII

THERAPEUTIC

PHYSICAL CULTURE

Russian Federation as a textbook

For university students

Reviewers:

Doctor of Medical Sciences, Professor

T.V. Xymue;

Candidate of Medical Sciences,

Laureate of the State Prize of the USSR

^ I.A. Badnin;

Candidate of Medical Sciences, Associate Professor

S.G. Kurtev

Dubrovsky V.I.

D 79 Therapeutic physical culture (kinesitherapy): Proc. for stud.

Higher education, institutions. - 2nd ed., erased. - M.: Guma-nit. ed. center

VLADOS, 2001. - 608 p.: ill.

ISBN 5-691-00769-6.

The textbook was written in accordance with the new program for the study of physiotherapy exercises and massage in higher educational institutions. Much attention is paid to the systematization of physical culture means used for preventive and therapeutic purposes, as well as to issues of hydrokinesitherapy, occupational therapy, various types of massage, physiotherapy, manual therapy and many other methods of restorative medicine. For the first time, the issues of complex rehabilitation for many diseases and syndromes are covered.

The textbook is intended for students of physical culture departments of universities and institutes of physical culture, as well as students of medical universities, methodologists of physical therapy, rehabilitation therapists, physiotherapists, exercise therapy doctors and other specialists.

BBK 75.0

Center VLADOS, 2001

"Humanitarian Publishing

ISBN 5-691-00769-6 VLADOS center, 2001

INTRODUCTION

Use of means of physical culture and massage in medicinal purposes has a long history. For many centuries, complex therapy of diseases has been carried out with the help of physical exercises, massage, therapeutic nutrition, hardening, baths, hydroprocedures, dosed walking, etc. Despite the fact that science did not yet have accurate data on the adverse effects of physical inactivity, doctors of that time recommended activation motor mode for certain diseases and deviations in the state of health.

Therapeutic physical culture (LFK) is integral part motor mode of the patient. Therapeutic gymnastics (MG), dosed walking accelerate the processes of tissue regeneration, normalize breathing, the activity of the cardiovascular system, the gastrointestinal tract, the psycho-emotional state of the patient, etc.

Important in the use of physical culture for therapeutic and prophylactic purposes is the development of indications and contraindications for their use. The most effective early use of massage in combination with oxygen therapy and LH, given the functional state, sex and age of the patient.

As a result of injuries and diseases, patients often develop various functional disorders that impair their ability to work and lead them to disability.

In athletes, injuries and diseases often lead to the cessation of sports and disability. The timely use of means of rehabilitation (recovery) contributes to the elimination of the negative phenomena (consequences) of an injury (disease) that have arisen.

In separate sections of the textbook, private methods of LH are presented in combination with massage, physio- and hydroprocedures, occupational therapy, baths, hydrocolonotherapy, etc., and they are given. scientific rationale.

^ HEALING FITNESS

* Forms and methods of physiotherapy exercises

* Motor modes

* Occupational Therapy

* Manual therapy

* Hydrokinesitherapy

* Therapeutic exercises for lung diseases

* Therapeutic exercises for heart diseases

* Therapeutic exercises in pediatrics

* Therapeutic gymnastics in gynecology and obstetrics

* Therapeutic gymnastics in traumatology and orthopedics

* Therapeutic exercises for occupational diseases

* Therapeutic exercises for mental illness

* Physical education classes in special medical groups

* Physical inactivity and physical activity
^

CHAPTER I. A BRIEF HISTORY OF THE ORIGIN AND DEVELOPMENT OF THERAPY

The use of physical culture for preventive and therapeutic purposes has a long history. Already in ancient times, physical exercises, a bath, massage, hydrotherapy, diet, climate and many other methods were used for healing. Yes, in ancient india, China, Egypt, with joint stiffness, stretching exercises, massage and hydrotherapy were used. In ancient India, the surgeon Sushruta used physical, breathing exercises and massage in the treatment of various diseases.

Chinese physicians used rubbing and stretching of the joints for many diseases. The book "Cong-fou" (3000 BC) details active, passive and combined exercises in combination with massage (rubbing). It is believed that preventive (preventive) medicine originated in Ancient China. The Chinese paid much attention to disease prevention. The aphorism "A real doctor is not the one who treats the sick, but the one who prevents the disease" belongs to the Chinese.

In ancient India, yogis had more than 800 different breathing exercises, especially many for holding the breath, used for prophylactic purposes and for the treatment of many diseases.

In ancient China, almost all provinces had medical gymnastic schools, where they trained doctors - “taosse”, who knew medical gymnastics and massage. Such medical and gymnastic institutions were health centers.

AT Ancient Greece Hippocrates, Asklepiades, Gerodikos, Galen, Celsus, and others widely recommended bodily exercises, massage, hydrotherapy, dietary nutrition for the treatment of many diseases and their prevention. The Greek surgeon Antilos wrote an essay on gymnastics. In ancient Rome, bodily exercises, massage and hydroprocedures in terms (baths) were especially widely used.

The Egyptians treated rheumatic diseases with gymnastic exercises, massage, diet, water procedures.

In ancient Rome, therapeutic gymnastics reached high level development. In the collection of Oribaz, written in 360 AD, all the materials of that time were collected, while a whole book is devoted to therapeutic gymnastics. K. Galen gave a description of gymnastics for various diseases of the bone and muscle systems, for metabolic disorders, sexual weakness, etc., in addition, for therapeutic purposes, he recommended sports exercises (rowing, horseback riding, etc.), picking fruits and grapes, as well as tours and massages. In his book “The Art of Restoring Health”, K. Galen wrote: “Thousands and thousands of times I restored health to my patients through exercises.”

Abu Ali ibn Sina (Avicenna) in his works “The Canon of Medicine” and “The Book of Healing” describes in detail the use of gymnastic exercises, massage, diet, hydrotherapy, baths for the treatment of many diseases, as well as for preventive purposes.

In the Middle Ages, physical exercises, baths, massages and hygienic body care were practically forgotten.

In 1573, the first textbook on gymnastics by Mercurias, The Art of Gymnastics, appeared. The German physician F. Hoffmann (1660-1742) created a popular original system of treatment, where a large role is given to the use of gymnastic exercises, diet and massage. His aphorism sounds impressive: "Movement is the best treatment for the body."

In a two-volume book on orthopedics published in 1771, information on gymnastic exercises, massage, water procedures ah, diet. In 1780, Tissot's work "Medical gymnastics, or the exercise of human organs according to the laws of physiology, hygiene and therapeutics" appeared, which describes in detail various exercises, massage and their use in various diseases. Descriptions of bodily exercises to get rid of injuries are available in the medical books of the 17th-18th centuries. (J.M. Guardia, 1892). Englishman F. Fuller in the 18th century. wrote the book "Medical Gymnastics". In Germany in early XVII in. Goffman created the manual "Mechanotherapy", which outlines the descriptions of bodily exercises, massage and water procedures for the treatment of various diseases.

Physical exercises with a therapeutic purpose in Russia began to be used already in the 18th century. So, in the works of outstanding Russian physicians M.Ya. Mudrova, N.P. Maksimovich-Ambodik, N.I. Pirogov, S.G. Zybelina, S.P. Botkina, A.A. Ostroumova, G.A. Zakharyin, P.F. Lesgaft and many others contain statements about the importance and use of physical exercises, hardening for the treatment of diseases.

By the end of the first half of the XIX century. Russian doctors have already pointed out the therapeutic effect of dosed physical movements, for example, G.I. Sokolsky, who prescribed walking as a remedy, or A.I. Polunin, who said that gymnastics not only develops, strengthens the body and prevents the development of the disease, but even cures diseases.

AT late XVIII in. and early XIX in. the founders of military medicine and hygiene (M.Ya. Mudrov, A.G. Bekherakht, I. Enegolm, A.P. Vladimirsky and others) called for the use of natural factors and physical exercises to improve the health of soldiers and increase their combat effectiveness. In 1836, the outstanding military doctor R.S. Chetyrkin and practically applied a coherent system of functional treatment of convalescents in "weak teams" with the help of gymnastics, hardening, games, and occupational therapy.

Progress domestic science and culture in the 19th century, especially in its second half, was also reflected in the development of the science of physical education, in the growing interest in physical methods of treatment, especially in medical gymnastics, massage, and hydrotherapy. In 1870, the first doctoral dissertation on physical therapy was defended at the Medical-Surgical Academy of St. Petersburg (G.G. Benese. Rational gymnastics as a means of maintaining health and healing some chronic ailments).

In 1864, the Swede T. Brandt proposed a system of therapeutic exercises and massage for the treatment of gynecological patients. In 1881, the German Ertel developed a method of climbing mountainous terrain (health path) for the treatment of cardiovascular diseases. In 1884, Schott proposed gymnastics for heart patients, which was based on resistance exercises. In 1889, the Swiss doctor Frenkel compiled compensatory gymnastics complexes for the treatment of ataxia, paralysis, paresis and other diseases. nervous system.

In large cities of Russia in the XIX century. A number of "physician-gymnastic institutions" were opened to treat outpatients with gymnastics, massage, physiotherapy and other methods. To late XIX in. and the beginning of the 20th century. there were already many rooms for medical gymnastics, massage, mechanotherapy, there were also playgrounds, paths for health paths, baths (pools), etc. By the end of the XIX century. physical exercises, as a therapeutic method, began to be used in a number of medical institutions.

A huge role in the development, justification and implementation of medical gymnastics and massage into practice belongs to I.Z. Zabludovsky, E.N. Zalesova, G.K. Solovyov and others.

Physical exercises and massage were used for treatment in the resorts of Saki, Druskininkai, Abas-Tuman, etc.

In 1877, the first center in Russia for the rehabilitation (rehabilitation) treatment of the wounded with the use of gymnastics, massage, mechanotherapy, physiotherapy and other means appeared in St. Petersburg.

In 1888 Professor M.K. Barsov created a massage and gymnastics institute in Moscow. In 1890 in St. Petersburg V.F. Diakovsky opened a medical-mechanical institute.

An outstanding Russian surgeon N.I. Pirogov strongly recommended the use of gymnastic exercises to treat the wounded.

In 1910, Singer and Hofbauer introduced therapeutic exercises for bronchial asthma, emphysema, and bronchitis.

In Russia, after the First World War, the rehabilitation of the wounded and disabled began to develop widely. Dispensaries for war invalids are organized, as well as special schools for crippled children. In a number of hospitals and infirmaries, methods of functional treatment of bone fractures were used, etc. In 1927, Klapp proposed gymnastics for curvature of the spine. At the same time, mechanotherapy based on the local mechanical concepts of Zander, Caro, and Krukenberg became widespread in Europe.

In the first half of the XX century. a network of sanatoriums and dispensaries for children is being created.

Russian scientists M.Ya. Mudrov, N.I. Pirogov, S.P. Botkin, G.A. Zakharyin, P.F. Lesgaft, F.A. Manassein and many others promoted and defended the preventive direction in medicine and the widespread use of physiotherapy exercises, hardening, occupational therapy, and massage.

V.V. Gorinevskaya, I.A. Bogashev, V.A. Zotov, V.N. Moshkov, V.K. Dobrovolsky and many others.

In the 1920-30s. In our country, there are works devoted to the use of physiotherapy exercises in resorts and sanatoriums, the effect of physiotherapy exercises on the body of patients, and the methodology for its use in certain diseases (L.A. Klochkov, 1925; V.N. Moshkov, 1927; T. R. Nikitin, 1927; I.M. Yablonovsky, 1927, etc.).

Important for the popularization of physical therapy as a therapeutic method were the printed works of prominent clinicians D.D. Pletnev, V.K. Horoshko, M.P. Konchalovsky, A.N. Shenk, A.I. Valedinsky and many other scientists.

The creation of the exercise therapy department in such large research institutions as the State Institute of Physiotherapy and Orthopedics (V.N. Moshkov, S.A. Uvarova-Yakobson, E.A. Zakharova, M.A. Minkevich et al.), Institute of Emergency Medicine. N.V. Sklifosovsky (V.V. Gorinevskaya, E.F. Dreving, etc.), Moscow Regional Institute of Physiotherapy and Physioprophylaxis (M.O. Leikin, E.Ya. Yakubovskaya, etc.), St. Petersburg Research Institute of Obstetrics and Gynecology ( S.A. Yagunov), Military Medical Academy (L.I. Shatsky, M.M. Marinov, etc.), St. Petersburg Research Institute of Physical Education (V.K. Dobrovolsky, N.P. Belousov, etc.) and etc. .

Organizational and methodological issues of the use of exercise therapy in the wounded were also developed. During the Great Patriotic War, exercise therapy, massage, physiotherapy were used at all stages of the evacuation, in hospitals, hospitals and other medical institutions. Exercise therapy has firmly entered the system of treatment and rehabilitation of the wounded and disabled, which to a large extent contributed to an increase in the effectiveness of therapy for the sick and wounded and a high percentage of those returned to duty.

In the postwar years, scientific research on the methodology and physiological rationale for the use of exercise therapy for the prevention and restoration of the health and performance of patients was widely developed (A.N. Krestovnikov, V.N. Moshkov, V.K. Dobrovolsky, V.V. Gorinevskaya, E .F. Drewing, V.A. Zotov, A.V. Ionina and many others).

A significant contribution to the development of physical therapy, scientific justification and development of methods of physical therapy was made by V.V. Gorinevskaya, E.F. Dreving, V.N. Moshkov, B.A. Ivanovsky, A.A. Leporsky, Yu.I. Danko, S.M. Ivanov, Z.M. Ataev, A.A. Sokolov, V.K. Dobrovolsky, G.N. Propastin, I.I. Khitrik, V.A. Siluyanov, P.I. Belousov, V.I. Dubrovsky and others.

In recent years, physical therapy as a method of treatment by movement has been widely used in a comprehensive rehabilitation system in hospitals, medical and physical education dispensaries, clinics and other medical and preventive institutions.

-- [ Page 1 ] --

FOR UNIVERSITIES

V.I.DUBROVSKII

THERAPEUTIC

PHYSICAL CULTURE

Russian Federation as a textbook

For university students

2 LBC 75.0 D79 Reviewers:

doctor of medical sciences, professor T.V. Xymue;

Candidate of Medical Sciences, Laureate of the State Prize of the USSR I.A. Badnin;

Candidate of Medical Sciences, Associate Professor S.G. Kurtev Dubrovsky V.I.

D 79 Therapeutic physical culture (kinesitherapy): Proc. for stud.

higher education, institutions. - 2nd ed., erased. - M.: Guma-nit. ed. center VLADOS, 2001. - 608 p.: ill.

ISBN 5-691-00769-6.

The textbook was written in accordance with the new program for the study of physiotherapy exercises and massage in higher educational institutions.

Much attention is paid to the systematization of physical culture means used for preventive and therapeutic purposes, as well as to issues of hydrokinesitherapy, occupational therapy, various types of massage, physiotherapy, manual therapy and many other methods of restorative medicine. For the first time, the issues of complex rehabilitation for many diseases and syndromes are covered.

LBC 75. © Dubrovsky VI, © VLADOS Humanitarian Publishing Center, © Serial cover design.

"VLADOS Humanitarian Publishing Center ISBN 5-691-00769-6",

INTRODUCTION

The use of physical culture and massage for therapeutic purposes has a long history. For many centuries, complex therapy of diseases has been carried out with the help of physical exercises, massage, therapeutic nutrition, hardening, baths, hydroprocedures, dosed walking, etc. Despite the fact that science did not yet have accurate data on the adverse effects of physical inactivity, doctors of that time recommended activation motor mode for certain diseases and deviations in the state of health.

Therapeutic physical culture (LFK) is an integral part of the patient's motor regimen. Therapeutic gymnastics (MG), dosed walking accelerate the processes of tissue regeneration, normalize breathing, the activity of the cardiovascular system, the gastrointestinal tract, the psycho-emotional state of the patient, etc.

As a result of injuries and diseases, patients often develop various functional disorders that impair their ability to work and lead them to disability.

In separate sections of the textbook, private methods of LH are presented in combination with massage, physio- and hydro-procedures, occupational therapy, baths, hydrocolonotherapy, etc., and their scientific substantiation is given.

HEALING FITNESS

* Forms and methods of physical therapy * Motor modes * Occupational therapy * Massage * Manual therapy * Hydrokinesitherapy * Therapeutic exercises for lung diseases * Therapeutic exercises for heart diseases * Therapeutic exercises in pediatrics * Therapeutic exercises in gynecology and obstetrics * Therapeutic exercises in traumatology and orthopedics * Therapeutic exercises for occupational diseases * Therapeutic exercises for mental illnesses * Physical education in special medical groups * Physical inactivity and physical activity

A BRIEF HISTORY OF THE ORIGIN AND

DEVELOPMENT OF THERAPEUTIC PHYSICAL CULTURE

The use of physical culture for preventive and therapeutic purposes has a long history. Already in ancient times, physical exercises, a bath, massage, hydrotherapy, diet, climate and many other methods were used for healing. So, in ancient India, China, Egypt, with stiff joints, stretching exercises, massage and hydrotherapy were used. In ancient India, the surgeon Sushruta used physical, breathing exercises and massage in the treatment of various diseases.

Chinese physicians used rubbing and stretching of the joints for many diseases. The book "Cong-fou" (3000 BC) details active, passive and combined exercises in combination with massage (rubbing). Preventive medicine is believed to have originated in ancient China. The Chinese paid much attention to disease prevention. The aphorism "A real doctor is not the one who treats the sick, but the one who prevents the disease" belongs to the Chinese.

In ancient India, yogis had more than 800 different breathing exercises, especially many for holding the breath, used for prophylactic purposes and for the treatment of many diseases.

In ancient Greece, Hippocrates, Asklepiades, Gerodikos, Galen, Celsus, etc.

The Greek surgeon Antilos wrote an essay on gymnastics. In ancient Rome, bodily exercises, massage and hydroprocedures in terms (baths) were especially widely used.

The Egyptians treated rheumatic diseases with gymnastic exercises, massage, diet, water procedures.

In ancient Rome, therapeutic gymnastics reached a high level of development. In the collection of Oribaz, written in 360 AD, all the materials of that time were collected, while a whole book is devoted to therapeutic gymnastics.

K. Galen gave a description of gymnastics for various diseases of the bone and muscle systems, for metabolic disorders, sexual weakness, etc., in addition, for therapeutic purposes, he recommended sports exercises (rowing, horseback riding, etc.), picking fruits and grapes, as well as tours and massages. In his book “The Art of Restoring Health”, K. Galen wrote: “Thousands and thousands of times I restored health to my patients through exercises.”

Abu Ali ibn Sina (Avicenna) in his writings "The Canon of Medicine"

and "The Book of Healing" describes in detail the use of gymnastic exercises, massage, diet, hydrotherapy, baths for the treatment of many diseases, as well as for preventive purposes.

In the Middle Ages, physical exercises, baths, massages and hygienic body care were practically forgotten.

The two-volume orthopedic book, published in 1771, contains detailed information about gymnastic exercises, massage, water procedures, and diet.

In 1780, Tissot's work "Medical gymnastics, or the exercise of human organs according to the laws of physiology, hygiene and therapeutics" appeared, which describes in detail various exercises, massage and their use in various diseases. Descriptions of bodily exercises to get rid of injuries are available in the medical books of the 17th-18th centuries. (J.M. Guardia, 1892). Englishman F. Fuller in the 18th century. wrote the book "Medical Gymnastics". Germany at the beginning of the 17th century. Goffman created the manual "Mechanotherapy", which outlines the descriptions of bodily exercises, massage and water procedures for the treatment of various diseases.

Polunin, who said that gymnastics not only develops, strengthens the body and prevents the development of the disease, but even cures diseases.

At the end of the XVIII century. and the beginning of the 19th century. the founders of military medicine and hygiene (M.Ya. Mudrov, A.G. Bekherakht, I. Enegolm, A.P. Vladimirsky and others) called for the use of natural factors and physical exercises to improve the health of soldiers and increase their combat effectiveness. In 1836

outstanding military doctor R.S. Chetyrkin and practically applied a coherent system of functional treatment of convalescents in "weak teams" with the help of gymnastics, hardening, games, and occupational therapy.

The progress of Russian science and culture in the 19th century, especially in the second half of it, was also reflected in the development of the science of physical education, in the growing interest in physical methods of treatment, especially in medical gymnastics, massage, and hydrotherapy. In 1870, the first doctoral dissertation on physical therapy was defended at the Medical-Surgical Academy of St. Petersburg (G.G. Benese. Rational gymnastics as a means of maintaining health and healing some chronic ailments).

In 1889, the Swiss doctor Frenkel compiled compensatory gymnastics complexes for the treatment of ataxia, paralysis, paresis and other diseases of the nervous system.

In large cities of Russia in the XIX century. A number of "medical-gymnastic institutions" were opened to treat outpatients with gymnastics, massage, physiotherapy and other methods. By the end of the XIX century. and the beginning of the 20th century.

there were already many rooms for medical gymnastics, massage, mechanotherapy, there were also playgrounds, paths for health paths, baths (pools), etc. By the end of the XIX century. physical exercises, as a therapeutic method, began to be used in a number of medical institutions.

A huge role in the development, justification and implementation of medical gymnastics and massage into practice belongs to I.Z. Zabludovsky, E.N. Zalesova, G.K. Solovyov and others.

Physical exercises and massage were used for treatment in the resorts of Saki, Druskininkai, Abas-Tuman, etc.

In 1888 Professor M.K. Barsov created a massage and gymnastics institute in Moscow. In 1890 in St. Petersburg V.F. Diakovsky opened a medical-mechanical institute.

An outstanding Russian surgeon N.I. Pirogov strongly recommended the use of gymnastic exercises to treat the wounded.

In 1910, Singer and Hofbauer introduced therapeutic exercises for bronchial asthma, emphysema, and bronchitis.

In the first half of the XX century. a network of sanatoriums and dispensaries for children is being created.

V.V. Gorinevskaya, I.A. Bogashev, V.A. Zotov, V.N. Moshkov, V.K. Dobrovolsky and many others.

In the 1920-30s. in our country, there are works devoted to the use of physiotherapy exercises in resorts and sanatoriums, the effect of physiotherapy exercises on the body of patients, and the methodology for its use in certain diseases (LA Klochkov, 1925; VN Moshkov, 1927;

T.R. Nikitin, 1927; THEM. Yablonovsky, 1927, etc.).

The creation of the exercise therapy department in such large research institutions as the State Institute of Physiotherapy and Orthopedics (V.N. Moshkov, S.A. Uvarova-Yakobson, E.A. Zakharova, M.A. Minkevich et al.), Institute of Emergency Medicine. N.V. Sklifosovsky (V.V. Gorinevskaya, E.F. Dreving and others), Moscow Regional Institute of Physiotherapy and Physioprophylaxis (M.O. Leikin, E.Ya. Yakubovskaya and others), St. Petersburg Research Institute of Obstetrics and Gynecology (S. A. Yagunov), Military Medical Academy (L.I. Shatsky, M.M. Marinov, etc.), St. Petersburg Research Institute of Physical Education (V.K. Dobrovolsky, N.P. Belousov, etc.), etc.

GENERAL BASICS

THERAPEUTIC PHYSICAL CULTURE

Physical activity is one of the important conditions for human life and development. It should be considered as a biological stimulus that stimulates the processes of growth, development and formation of the organism.

Physical activity depends on the functional capabilities of the patient, his age, sex and health.

Physical exercises (training) lead to the development of functional adaptation. Physical activity, taking into account social conditions, ecology and other factors, changes the reactivity, adaptability of the body.

Preventive and therapeutic effect with dosed training is possible if a number of principles are observed: systematic, regularity, duration, dosing loads, individualization.

Depending on the state of health, the patient uses various means of physical culture and sports, and in case of deviations in the state of health, physiotherapy exercises (exercise therapy). Exercise therapy in this case is a method of functional therapy.

Therapeutic physical education (LFK) is a method that uses the means of physical culture with a therapeutic and prophylactic purpose for a faster and more complete recovery of health and prevention of complications of the disease. Exercise therapy is usually used in combination with other therapeutic agents against the background of a regulated regimen and in accordance with therapeutic objectives.

At certain stages of the course of treatment, exercise therapy helps prevent complications caused by prolonged rest; accelerate the elimination of anatomical and functional disorders; preservation, restoration or creation of new conditions for the functional adaptation of the patient's body to physical activity.

The active factor of exercise therapy is physical exercises, that is, movements specially organized (gymnastic, sports, games) and used as a non-specific stimulus for the purpose of treating and rehabilitating the patient. Physical exercises contribute to the restoration of not only physical, but also mental strength.

A feature of the exercise therapy method is also its natural biological content, since for therapeutic purposes one of the main functions inherent in any living organism is used - the function of movement. The latter is a biological stimulus that stimulates the processes of growth, development and formation of the organism. Any complex of physical therapy includes the patient in active participation in the treatment process - as opposed to other treatment methods, when the patient is usually passive and medical procedures are performed by medical personnel (for example, a physiotherapist).

Exercise therapy is also a method of functional therapy. Physical exercises, stimulating the functional activity of all the main body systems, eventually lead to the development of the patient's functional adaptation.

But at the same time, it is necessary to remember the unity of the functional and morphological and not to limit the therapeutic role of exercise therapy to the framework of functional influences. Exercise therapy should be considered a method of pathogenetic therapy. Physical exercises, influencing the reactivity of the patient, change how general reaction and its local manifestation. The training of the patient should be considered as a process of systematic and dosed use of physical exercises with the aim of general improvement of the body, improvement of the function of one or another organ, disturbed by the disease process, development, formation and consolidation of motor (motor) skills and volitional qualities(Table 1).

Participation of organs in oxidative processes at rest and during physical exertion (in cm3 of oxygen per hour according to Barcroft) Striated Stimulating effect on the body of physical exercises is carried out through neurohumoral mechanisms.

When performing physical exercises, metabolism in the tissues increases.

For most patients, a decrease in vitality is characteristic. It is inevitable in bed rest due to a decrease in motor activity. At the same time, the flow of proprioceptive stimuli is sharply reduced, which leads to a decrease in the lability of the nervous system at all its levels, the intensity of vegetative processes and muscle tone. With prolonged bed rest, especially in combination with immobilization, there is a perversion of neuro-somatic and autonomic reactions.

Disease (trauma) and physical inactivity lead to significant changes in homeostasis, muscle atrophy, functional disorders of the endocrine and cardiorespiratory systems, etc. Therefore, the use of physical exercises for the prevention and treatment of diseases is pathogenetically justified (Table 2).

Therapeutic and prophylactic effect of physiotherapy exercises Physical exercises have a tonic effect, stimulating motor-visceral reflexes, they contribute to the acceleration of metabolic processes in tissues, the activation of humoral processes. With an appropriate selection of exercises, it is possible to selectively influence the motor-vascular, motor-cardiac, motor-pulmonary, motor-gastrointestinal and other reflexes, which allows you to mainly increase the tone of those systems and organs in which it is reduced.

Physical exercise contributes to the normalization of acid-base balance, vascular tone, homeostasis, metabolism of injured tissues, as well as sleep. They contribute to the mobilization of the protective forces of the patient's body and reparative regeneration of damaged tissues.

The use of physical exercises by patients is the main means of active intervention in the process of compensation formation.

Spontaneous compensation is formed in the form of correction of the respiratory function of operated patients with the help of breathing exercises, lengthening of exhalation, diaphragmatic breathing, etc.

Consciously formed compensations: for example, during the immobilization of the left hand, the formation of household skills for the right hand; walking on crutches for fractures of the lower limb(s); walking on a prosthesis for amputations of the lower extremities.

Compensation is necessary for various kinds of reconstructive operations that create a replacement for the lost motor function.

For example, mastering full-fledged movements of the hand and fingers after surgical interventions and muscle transplants or amputations, followed by the use of a biohand prosthesis.

Formation of compensations for disturbed vegetative functions.

The use of physical exercises in this case is based on the fact that there is not a single vegetative function that, according to the mechanism of motor-visceral reflexes, would not be subject to the influence of the muscular-articular apparatus to one degree or another.

At the same time, specially selected physical exercises consistently provide the reactions from the internal organs necessary to compensate; activate afferent signaling from the internal organs consciously involved in compensation, combining it with afferent input from the muscles involved in the movement;

provide the desired combination of motor and vegetative components of movement and their conditioned reflex fixation. These mechanisms are most easily used in lung diseases, since respiratory function can be consciously regulated during exercise. In diseases of one lung (or after surgery), it is possible, for example, to form a compensatory increase in the function of another, healthy lung due to slow and deep active exhalation.

In cardiovascular diseases, the formation of compensation is not easy to achieve. However, if a patient with circulatory insufficiency performs careful (slow) movements of the lower limbs in combination with deep breathing, some compensation for the blood supply to tissues and organs can be formed in him. With hypotension, an appropriate selection of exercises contributes to a stable compensatory increase in vascular tone.

In diseases of the gastrointestinal tract, kidneys and metabolism, it is difficult to form compensation. But, using special physical exercises, it is possible to activate, for example, insufficient or inhibit excessive motor or secretory function of the gastrointestinal tract in order to compensate for violations of its activity. This compensation can become effective in relation to changes in secretory and motor function due to food intake (dietary nutrition), mineral water (depending on acidity), medicinal substances, etc.

The use of physical exercises for therapeutic purposes is a means of conscious and effective intervention in the process of normalization of functions. For example, in patients with diseases of the cardiovascular system, the implementation of special exercises causes a flow of impulses from the vessels, heart muscle, lungs and other organs, and thereby normalizes blood pressure, blood flow velocity, venous pressure, improves blood supply to muscles, etc.

With intestinal paresis in the postoperative period, the use of breathing exercises and exercises for the abdominal muscles normalizes the lability of the peripheral nerve link, and peristalsis is restored. Special breathing exercises can, according to the mechanism of motor-pulmonary reflexes, activate the drainage function of the bronchi and provide increased sputum secretion.

The use of physical exercises for therapeutic purposes is indicated at the appropriate stages of the development of the disease, with various surgical interventions, in the clinic of nervous diseases, with gynecological, urological and other diseases. Contraindications are extremely limited, they are most often temporary.

Contraindications: the general serious condition of the patient, intense pain, the risk of increased bleeding, high body temperature, hypertensive crisis, oncological diseases and some other conditions.

In connection with the improvement of treatment methods, therapeutic exercises and massage are often used in the early stages. So, V.I. Dubrovsky (1969, 1971, 1975) applied general massage with oxygen therapy to surgical patients on operating table, and for heart attack patients - on the first day in the intensive care unit.

Characteristics of physical exercises. Physical exercises (in the form of therapeutic exercises) are the main means of exercise therapy. For therapeutic purposes, physical exercises, mobile and sport games, applied and sports exercises, passive, reflex and corrective movements, exercises on special equipment and devices (simulators), ideomotor exercises, etc.

The systematic use of physical exercises can influence the reactivity of the organism, change both the general reaction of the patient and its local manifestation. At the same time, those physiological mechanisms that participated in the pathogenetic process are usually involved in the general reaction of the organism. The choice of exercises is based on the mechanism of their action, taking into account the characteristics of the course of the disease, the age of the patient, etc. (scheme I).

The effectiveness of physical exercises depends on the nature of the movements, the number of repetitions and the involvement of one or another muscle group in the dynamic process (various movements in small, medium and large joints of the limbs, breathing exercises - diaphragmatic, pectoral, etc.).

When using therapeutic exercises (RG), physical exercises have a direct effect on both nervous and humoral mechanisms, leveling functional activity.

Scheme I. The use of exercises in training the static-dynamic function One of the characteristic features Exercise therapy is its dosing (scheme II). In exercise therapy, general and special training is distinguished.

General training contributes to the improvement and strengthening of the patient's body; during its implementation, all types of general developmental physical exercises are used.

Special training is aimed at restoring (development) of impaired functions as a result of injury or disease, while using types of exercises that have a direct effect on the injured area (segment) or functional system (exercises for arthrosis of the knee joint, breathing exercises for chronic pneumonia, etc. .).

When using exercise therapy, the following training rules must be observed: individualization (taking into account the age, gender of the patient, the nature of the course of the disease); consistency (selection of exercises and the sequence of their application); regularity (daily or several times a day the use of exercises for a long time); duration (multiple repetition of exercises during the procedure and during the course of treatment); the gradual increase in physical activity during the course of treatment (training should become more difficult).

Means of physical therapy. The main means of exercise therapy are physical exercises (Scheme III), which are divided into the following:

gymnastic (general developmental and respiratory, active and passive, without shells and on shells); applied sports (walking, running, throwing balls - stuffed, basketball, volleyball, etc., jumping, swimming, rowing, skiing, skating, etc.); games (sedentary, mobile and sports).

Gymnastic exercises are performed in certain initial positions, with a certain amplitude, speed, repeatability. They develop strength, endurance, coordination, improve joint mobility, etc. Gymnastic exercises can be conditionally divided according to the anatomical (biomechanical) feature (action): exercises for the muscles of the neck, arms, legs, torso, abdominal wall, pelvic floor, etc.; according to the methodical (pedagogical) orientation: exercises for coordination, endurance, stretching, balance, strength, etc.; by the nature of the activity of their implementation: passive, active, passive-active, ideomotor.

Static exercises are carried out in the form of muscle tension, holding dumbbells, stuffed balls, kettlebells, holding your own weight on simulators, while hanging, resting on the shells (or on the floor, at the gymnastic wall, etc.). Static exercises are used in the pre- and post-immobilization period to prevent the occurrence of muscle atrophy, strengthen muscles and develop strength and endurance.

Stretching exercises are used in the form of various flexions in the joints, followed by fixation of the joint in a bent position (2-10 s).

Used to relieve fatigue, with contractures, with increased muscle tone.

Relaxation exercises (relaxation). They are used to relieve fatigue (during classes), lower muscle tone (for paresis, paralysis, trauma, contractures, etc.).

Ideomotor exercises are mentally performed exercises during which an order is given to perform certain movements (paralysis and paresis, with plaster casts on the limbs, etc.). They must be combined with passive movements.

Passive exercises (movements) are performed by a methodologist (instructor) of physiotherapy exercises. Passive movements are characterized by the absence of volitional effort or muscle tension in the patient.

Passive movements are used to stimulate the recovery of movements and prevent contractures (paralysis, paresis, etc.).

Breathing exercises excite and deepen the function of breathing. They contribute to the normalization and improvement of the respiratory act. At the same time, there is mutual coordination of breathing and movements, strengthening of the respiratory muscles, improvement of chest mobility, stretching (liquidation) of adhesions in the pleural cavity, prevention and elimination of congestion in the lungs, and sputum removal.

Breathing exercises are divided into static (exercises that are not combined with the movement of the limbs and torso) and dynamic (when breathing is combined with various movements). In some diseases (bronchial asthma, pulmonary emphysema, etc.), breathing exercises are performed with an emphasis on exhalation, with the pronunciation of various sounds (especially in children), inflating toys, etc. Tilts, turns during breathing exercises contribute to greater ventilation of the lungs, stretching the pleural adhesions, resorption of the focus of inflammation (pneumonia, etc.). The effectiveness of breathing exercises is higher if they are combined with general developmental exercises, massage of the collar region (shoulder girdle muscles), intercostal and abdominal muscles.

(correction), normalization of posture. Correct posture provides the most functionally complete positioning and functioning of internal organs and systems.

Corrective exercises include gymnastic exercises for the muscles of the back, abdominals and shoulder girdle, performed in various starting positions, usually lying (on the back, stomach), sitting and standing (at the gymnastic wall, against the wall, touching the wall with the shoulder blades). Exercises can be with a gymnastic stick, rubber shock absorbers (bandages), dumbbells, on simulators, in the form of breaststroke swimming, etc. In case of spinal deformities (scoliosis, spondylolisthesis, spondylosis, etc.), corrective exercises are included in combination with general developmental exercises and massage.

Exercises on gymnastic equipment and simulators, with objects (Fig. 1). Exercises on gymnastic equipment are performed in the form of hangs, stops, pull-ups. Sticks, dumbbells, stuffed balls, maces, hoops, etc. can be objects and projectiles.

Rice. 1. Approximate complex of LH for restoring the function of the elbow joint In recent years, simulators have been widely introduced into medical practice (into the rehabilitation system), which allow you to purposefully influence one or another segment, organ, functional system, etc.

Their special value lies in the fact that, including certain exercises, they can be dosed according to strength, pace, range of motion; at the same time, the spine is unloaded, and this is extremely important in diseases such as spondylosis, spinal osteochondrosis, scoliosis, coxarthrosis, functional posture disorders, various injuries and diseases of the musculoskeletal system, especially in the postoperative period.

Gymnastics in water (hydrokinesitherapy). Swimming with fins, paddles and gymnastics in the water is a combination of physical exercises and the temperature (or chemical) factor of water with a therapeutic and prophylactic purpose. Being in water significantly increases heat transfer and metabolism, activates hemodynamics, respiration, etc.

Simply performing gymnastic exercises in water is ineffective, especially for the elderly, since hypothermia of the body is possible.

In some cases (with injuries and diseases of the musculoskeletal system, paresis and paralysis), warm water facilitates exercise. Swimming and exercise, playing in the water have a general effect on the body, improve mobility in the joints (with injuries, contractures, coxarthrosis, etc.), increase muscle fitness, relieve pain, etc.

Gymnastics in water (special exercises with dumbbells, rubber balls, etc.) helps to restore adaptation to various physical loads, and also acts as a hardening factor at low water temperatures (23-27°C) and causes muscle relaxation when it rises (37- 39°C).

Physical exercises in water are indicated for patients with diseases and injuries of the musculoskeletal system, especially after removal of immobilization, with posture disorders, contractures, muscle atrophy, metabolic disorders, diseases of the cardiovascular system, respiratory organs, as well as diseases of internal organs (cholecystitis , colitis, gastritis, etc.), with vascular pathology (varicose veins, thrombophlebitis, etc.), metabolic disorders and endocrine system(gout, obesity, diabetes mellitus, etc.), injuries and diseases of the nervous system (osteochondrosis of the spine, paralysis and paresis, neuroses, poliomyelitis, cerebral palsy, vibration disease, etc.), arthrosis (coxarthrosis), arthritis, vegetovascular dystonia and etc. With intra-articular fractures of the elbow joint, thermal procedures (paraffin, ozocerite, mud, etc.), as well as baths (hyperthermic) and gymnastics in water, are contraindicated! You should not use gymnastics and walking in water (as well as baths and saunas) for injuries of the knee and ankle joints, as this leads to increased swelling in the joint (increased synovitis), especially in the ankle joint.

Of particular importance are special exercises (with belts, fins, inflatable cuffs, etc.) for the rehabilitation of highly qualified athletes after surgical interventions and injuries of the musculoskeletal system.

The rehabilitation system includes a combination of cryomassage and swimming in case of injuries and diseases of the musculoskeletal system, after the removal of plaster bandages (longuets).

Our studies (624 highly qualified athletes aged 18 to 34 were observed) showed the high efficiency of hydrokinesitherapy in combination with various types of massage (especially cryomassage) and phonophoresis, as well as cold electrophoresis and electrical stimulation with intramuscular injection of ATP. As a result, the time of disability is sharply reduced, the processes of tissue regeneration, blood and lymph flow, metabolism are accelerated, mobility (amplitude) in the joints is restored faster.

Contraindications to exercise in water:

osteomyelitis, open wounds, furunculosis; skin diseases (pustular, eczema, epidermophytosis, etc.); diseases of the ENT organs (perforation of the tympanic membrane, otitis media, frontal sinusitis and sinusitis, etc.);

venereal diseases (AIDS, gonorrhea, syphilis, trichomonas infection, etc.); high body temperature and dysfunction of the gastrointestinal tract (diarrhea, dysentery, etc.); mental illness (schizophrenia, epilepsy, etc.); myocardial infarction, rest angina, increased blood pressure, Raynaud's disease, obliterating endarteritis, heart defects, rheumatism in the acute stage, etc .; asthmatic bronchitis, bronchial asthma, bronchiectasis, active tuberculosis, etc.; pyelonephritis, acute cystitis, etc.; severe fatigue and overwork among athletes (gymnastics in water cumulates the process of fatigue).

When conducting gymnastics in water, different immersion depths are used, games are used and, as a rule, ordinary dynamic exercises, exercises with an elastic (rubber) bandage, rubber expanders, spatulas (to increase the resistance of the stroke), fins and special cuffs on the ankle joints, etc. In addition, they use walking and running in the water (without touching the bottom of the pool with their feet) with special vests. This technique is used in the rehabilitation of athletes after surgery on the tissues of the musculoskeletal system, its injuries and chronic diseases in combination with cryomassage (duration 15-20 minutes 2-3 times a day, course 30-45 days) and subsequent application of teips, as well as gym exercises.

Gymnastics in water is an addition to exercise therapy in the gym, on the grounds, etc. It is carried out by a group method, and running is individual. Water basketball games are played in the pool.

motor actions or their elements. Such exercises are climbing, household and labor activities, jumping, throwing, swimming, skiing, rowing, walking, grabbing, moving and carrying various objects, etc.

Sports exercises are more effective for developing endurance, normalizing the functional state of the patient (especially in diseases of the cardiorespiratory system, metabolic disorders, etc.).

Exercises to restore everyday skills are used in case of movement disorders (injuries, amputations, paralysis, etc.), which are necessary for household and industrial motor acts (dressing and undressing, washing, brushing teeth, combing, as well as opening and closing a lock, a water tap, phone use, etc.). For these purposes, special stands are also used (in occupational therapy rooms).

Walking as a remedy is widely used to restore motor functions, train the cardiovascular and motor systems, etc. Also used is walking with crutches, in special "walkers", walking up stairs, in water, etc. Dosage is carried out according to the pace, length of steps, by time, by terrain (flat, rugged, etc.).

Walking is used to restore the gait mechanism (with injuries, amputations, paralysis, etc.), improve mobility in the joints, as well as to train the cardiovascular system in patients with coronary artery disease, hypertension, vegetative dystonia, pulmonary pathology (pneumonia, bronchial asthma and etc.), in case of metabolic disorders. Practiced dosed walking, walks in areas with different terrain (health path).

Running is an exercise with a general effect on the cardiorespiratory system and metabolism. In combination with walking, it is widely used in spa treatment. As the body adapts to training, the length of the run segments increases, and the walking time decreases.

Skiing promotes training of the cardiorespiratory system, stimulates metabolism in tissues, etc. Depending on the type of walking (tempo, speed, distance length, distance profile, etc.), the intensity of the exercise can be moderate, large and maximum.

Skiing has not only a training effect, but also hardening. Ski walks are widely used in sanatoriums and rest houses.

Rowing has a beneficial effect on the cardiorespiratory system, metabolic processes, on the muscular system, etc. In sanatorium conditions, rowing is widely used for various diseases of the musculoskeletal system, cardiovascular and respiratory systems, metabolic disorders.

Ice skating requires good coordination. Skating is especially useful for neuroses, diseases of the cardiorespiratory system, etc. The dosage of skating depends on the time, number of laps, pace, etc.

Cycling enhances vegetative-vestibular reactions, stimulates metabolic processes, and is also an excellent means of training the cardiovascular system, respiration, lower limb function, etc. The dosage is determined by the time of cycling, its pace, distance (distance), relief, etc. .d. It is used in sanatorium treatment, in dispensaries.

Swimming as a means of exercise therapy is used for cardiorespiratory diseases, metabolic disorders, injuries and diseases of the musculoskeletal system, etc. Swimming is a good means of training the cardiovascular and respiratory systems, as well as thermoregulation. The dosage is determined by the length of the swimming segments, the pace, the rest periods between the segments, as well as the swimming technique. If the patient does not swim well, then he spends much more energy.

Games as a means of exercise therapy are designed to improve motor skills in changing conditions, to improve the function of analyzers. Games have a training effect for a number of systems and organs, and if we take into account the emotional factor, they are also successfully used for neurosis, vegetative-vascular dystonia and other pathologies.

The advantage of the games is also that during their holding periods of stress alternate with periods of rest. Games are especially useful for children. Such qualities as dexterity, quick reaction, attention, etc. are developed in games. Sedentary, active and sports games, games in water, etc. are used for therapeutic purposes. Games on the spot, sedentary and mobile are included in exercise therapy group procedures. Games are widely used in children's medical institutions, sanatoriums, boarding schools and other institutions.

The duration and intensity of the games are regulated, the height of the net (in volleyball), the number of participants and the rules of the game are changed, they include pauses for rest and breathing exercises, and the size of the playgrounds is changed.

Games should not be included in exercise therapy classes for groups of patients with diseases of the cardiovascular system, dysfunction of the vestibular apparatus, with severe cerebral sclerosis, intermittent claudication (obliterating endarteritis), etc. treatment. Loads are regulated by the selection of games, rest intervals, change of "leader", etc.

Forms of application of medical physical culture. The main one is the procedure of therapeutic gymnastics (LG). It is carried out individually and in groups. A gradual increase in physical activity is achieved by changing the initial position (lying, sitting, standing, on the side, on all fours, etc.), selecting exercises, increasing the complexity of exercises, increasing the range of motion, the degree of force tension, the rate of exercise and breathing exercises.

Physical exercises should consistently cover various muscle groups. The exercise is performed rhythmically, at a calm, average pace. Each exercise is repeated 5-8-12 times. The number of exercises in the complex is 5-12 or more. Each LH procedure consists of three sections: introductory, main and final.

In the introductory section, use simple exercises, mainly for small and medium muscle groups, walking, breathing exercises. The introductory part is 15-20% of the time. Exercises contribute to workability, preparation for the main part of the classes.

The main section consists of general developmental and special exercises. Walking, games, applied exercises, exercises with objects, on equipment, etc. can be used. In terms of time, the main section takes 65-70% of the time.

general physiological load through the use of breathing exercises, walking, relaxation exercises, etc. The final section takes 10-20% of the time.

Breathing exercises in LH are used to train skills correct breathing, reducing physical activity, as well as a special effect on the respiratory system. It is especially important to use breathing exercises in the early postoperative period, in diseases of the cardiorespiratory system, etc. All breathing exercises are performed freely, without any effort. With pulmonary pathology, the exhalation should be elongated.

In LH procedures, the dosage of physical activity is of great practical importance. It is necessary that it be adequate to the patient's condition, cause moderate excitability of the functional systems of the body, as a rule, not be accompanied by increased pain, would not cause severe fatigue and deterioration in the general well-being of the patient.

Using all of the above methodological techniques, you can optimally regulate the physical activity.

Schematically, the magnitude of the load is divided into three categories:

I - load without restriction, with the permission of running, jumping and other complex and general developmental (general load) exercises;

II - load with restriction, with the exception of running, jumping, exercises with a pronounced effort and exercises that are difficult in coordination in relation to breathing exercises 1: 3 and 1: 4;

III - weak load using elementary gymnastic exercises, mainly in the initial position (ip) lying, sitting, with a ratio of 1: 1 or 1: 2 with breathing exercises.

There are three methods of carrying out therapeutic exercises procedures:

individual, group and advisory (or independent).

The individual method is used in surgical patients in the early postoperative period, in severe patients with limited motor ability (paralysis, spinal fracture, traction, etc.).

The group method is used in a group of patients with homogeneous disease. When selecting groups, they proceed from nosological forms, and when conducting classes, they are based on the functional state of patients.

Usually, the patient is taught the PH complex in the hospital, and upon discharge, he is given a set of therapeutic exercises on his hands.

health value. It is carried out after a night's sleep, at home or during spa treatment in combination with air baths and hydroprocedures.

Dosed walks (walking) are a natural form of movement. Walking has a moderate effect on the cardiorespiratory system, useful for convalescents with diseases of the cardiovascular and respiratory systems, with neurosis, etc. Walking is used in hospitals, but especially widely - in sanatorium treatment. The load during walking is regulated by the pace, terrain, distance, step length. A favorable factor is the fact that walking is carried out in the fresh air (park, square, garden, resort area, etc.).

Dosed climbing (terrenkur) is a kind of walking. Unlike dosed walks on flat terrain, health path routes pass through rough terrain in the conditions of a sanatorium-resort zone. The amount of physical activity depends on the length of the route (usually 500, 1500, 3000 m), terrain, pace, number of stops. Terrenkur is indicated for diseases of the cardiorespiratory system, neurosis, endocrine diseases, obesity, etc.

Near tourism usually consists of walking for -3 or more days and is considered as a method of training the whole body.

Close tourism is used in sanatorium treatment, as well as in tourist bases. Walks can be carried out on boats, bicycles, horses, etc. Change of various terrain, sun and air baths - all this has a positive effect on the psyche of patients.

Motor modes (motion mode). In the organization of the treatment process in hospitals, the motor regime is one of the important factors.

Passive mode (physical inactivity) adversely affects the recovery of patients. The active mode (with appropriate medical indications) promotes the development of positive emotions, increased metabolic processes, tissue regeneration, improved functions of the cardiovascular system, etc. When prescribing an active mode, it is necessary to proceed from the characteristics and course of the disease, age, profession, and living conditions, fitness states, etc. The rest mode (sparing) is designed for patients who are emaciated, weakened, tired, with manifestations of asthenia, after undergoing complex surgical interventions, cardiovascular diseases, etc.

The PH prescribed to the patient should correspond to the clinical course of the disease, the functional state of the patient and his adaptability to physical activity.

Mode I, bed rest (rest mode) is divided into two phases: A - strict bed mode, in compliance with the rest mode; B - bed mode facilitated (extended), with a gradual expansion of the patient's motor activity (turns, sitting position, etc.).

The content of the regimen: stay in bed more often in the supine position or half-sitting. With a generally satisfactory condition, active and leisurely turns in bed are allowed, short-term (2-3 times a day for 5-30 minutes) stay in bed in a sitting position, active reception food and an active toilet. Morning exercises and LH in bed - depending on medical indications. Mandatory ventilation and wet cleaning of the ward several times a day.

Mode II, semi-bed (ward). Mode content:

transition to sitting on the bed with legs down or in an armchair (2-4 times a day for 10-30 minutes). A few days later - the transition to a standing position and walking around the ward, followed by rest in a sitting or lying position. In this period, the patient independently carries out a change in position in bed, chair, toilet and eating. Alternates walking with rest in a chair (on a chair). Morning exercises, hygienic gymnastics - according to individual indications.

Mode III, free (training). Mode content:

free walking around the department. Walking stairs from 1st to 3rd floors with rest. Walk in the air for 15-30 minutes with rest. Morning exercises and exercise therapy are used for medical reasons.

In the conditions of sanatorium-resort treatment of patients with diseases of the cardiovascular system, respiratory organs and digestion, three types of regimens are used - sparing, sparing-training and training.

The mode of movement must be set strictly individually, depending on the personality of the patient, the characteristics of his character and disease.

The mode of movement should include specific activities. The individual mode of movement and rest is determined by the attending physician in each individual case, depending on medical indications, the profile and geographical location of the resort, as well as the season, and provide for a sequence of application various elements Exercise therapy throughout the day, a combination with the use of all other therapeutic factors of this resort. A properly developed and accurately executed regimen of movements is in itself a powerful factor in the treatment of patients in resorts and sanatoriums.

The World Health Organization (WHO) distinguishes two periods in the rehabilitation of patients: hospital and post-hospital.

One of the characteristic features of exercise therapy is the process of dosed training. Training in exercise therapy permeates the entire period of the use of physical exercises for therapeutic purposes, while other methods of treatment are sometimes powerless to ensure the functional restoration of the affected systems. In therapeutic physical culture, general and special training is distinguished.

General training pursues the goal of healing, strengthening and general development of the patient's body; during its implementation, a wide variety of types of general developmental and developmental physical exercises are used.

Special training aims to develop functions that are impaired due to illness or injury. When it is carried out, types of physical exercises are used that have a direct impact on the area of injury or functional disorders of a particular affected system (breathing exercises for pulmonary diseases, exercises for injuries and diseases of the joints, etc.).

Balance exercises are used to improve coordination of movements, improve impaired functions, the vestibular apparatus, etc.

Reflex exercises are exercises aimed at training muscles distant from injury, for example, the use of exercises for the shoulder girdle will have a reflex effect on the muscles of the lower extremities, or movements of one lower extremity cause vascular changes in the other extremity.

Breathing exercises occupy an important place in the LH. All breathing exercises are conventionally divided into dynamic and static. Dynamic breathing exercises are a combination of movement and breathing; static - no movement; during active breathing exercises, the exercise therapy methodologist squeezes chest on the exhalation of the patient (the so-called activation of breathing). Breathing exercises are with holding the breath and with active (prolonged) exhalation.

Treatment by position is a method of fixing the affected muscles with an adhesive plaster (with paresis of the facial nerve), as well as giving them a physiological position with an elastic bandage (with clubfoot), a splint, a roller (with paralysis) of the armpit, a drawer (with paralysis) for the legs (feet), etc. Positional treatment is used in the early stages of the onset of the disease, it is aimed at eliminating the pathological position in the joint or muscles (for example, the facial muscles with paresis of the facial nerve), preventing contractures and pathological synkinesis and synergy.

Correction with a bandage, splint, etc. should be short - from 15-30 minutes to 1.5-3 hours, since long-term correction can lead to increased muscle spasm, especially in patients with paralysis (strokes), injuries of the musculoskeletal system and other diseases.

Trainers. One of the forms of exercise therapy is the exercise of patients on simulators and block devices (Fig. 2). They are designed to develop strength, muscle endurance, joint development, that is, to increase mobility in the joint (joints).

The exercises used on the simulators affect certain (separate) muscle groups and joints. In addition, the implementation of such exercises requires a certain starting position. Classes on simulators (and lightweight devices) contribute to the development of basic movements in the joints and strengthen the muscles. Properly organized exercises on simulators should not cause pain.

Block devices and various devices for exercise therapy are especially important for restoring the function of the hand, fingers, large joints, etc. (see Fig. 2).

Rice. 2. An approximate set of exercises performed on block simulators Last years simulators are widely used in the system of rehabilitation of athletes with consequences of injuries and diseases of the musculoskeletal system, as well as after operations. But exercises on simulators should be started no earlier than after 2-3 weeks of treatment and in combination with cryomassage.

Early exercise on simulators (for example, after meniscectomy) may worsen (slow down) cartilage regeneration, increase synovitis (effusion in the joint), limit movement, and cause pain, especially if the load falls on the lower limbs. Such exercises in squats, jumps, etc. are excluded for -6 months. Initially, exercise therapy, massage, running (in combination with walking) in the water are carried out.

With obesity, osteochondrosis of the spine, exercise on simulators, the use of a sauna (bath), diet, walking and running give a noticeable positive result.

Exercises on simulators that are gentle on the spine (ip lying, half-sitting, etc.) in combination with segmental reflex massage, cryomassage are indicated for scoliosis of I and II degrees (according to Chaklin), breaststroke swimming is useful.

Exercises on simulators (block devices) should be used with caution in patients with joint diseases (arthritis, polyarthritis, etc.), they are especially contraindicated in coxarthrosis. In any case, classes should be with small loads, slight tension and in combination with cryomassage of the joint (joints), frequent repetition (2-3 times a day), but short (10-15 minutes).

Pain syndrome, reflex contractures, increased blood pressure, myocardial infarction, peptic ulcer of the stomach and duodenum in the acute stage, thrombophlebitis, aortic aneurysm, myocarditis, heart defects, acute infectious diseases, rest angina, pregnancy, myopia (more than 3 units), diabetes mellitus, obliterating endarteritis are contraindications for exercising on simulators!

In diseases of the cardiovascular, pulmonary systems, exercises on simulators are also undesirable. Such patients are more likely to show cyclic activities (running, skiing, cycling, etc.).

When prescribing exercise therapy to a patient in a polyclinic (or VFD, an outpatient clinic, at home), one should take into account his motor activity (fitness) in Everyday life, occupation, age and gender.

In a state of relative physical rest (sitting and standing), the average human energy consumption is approximately 1-1.25 kcal/min. This value varies depending on height, body weight, sex and environment(air temperature).

It is known that in order to maintain health, maintain high physical performance and the normal course of oxidative-metabolic processes, a person must spend approximately 1200-2000 kcal per day on physical activity in excess of the basic metabolism, which is usually 1600-1800 kcal.

But the energy value of the diet in most people exceeds energy consumption, which leads to disruption of metabolic processes and the emergence of obesity, diabetes, deterioration of the cardiorespiratory system, gastrointestinal tract and other organs.

Degree of intensity physical activity, their volume should correspond to the mode of motor activity prescribed by the doctor:

sparing mode, sparingly-training and training.

When testing patients before discharge from the hospital, exercise tolerance is determined. At self-fulfillment physical exercises (walking, running, breathing and general developmental exercises, swimming, etc.) it is also necessary to know the reaction of the body.

When calculating energy consumption during exercise therapy, one should take into account the ratio of heart rate achieved during exercise with energy consumption (Tables 3, 4).

Approximate energy consumption at dosed loads Morning hygienic gymnastics, 15 min 45- Therapeutic gymnastics, 30 min (training mode) to Improving gymnastics, 60 min (training mode) to Therapeutic gymnastics in the pool, 25-30 min 150- Terrenkur (walking with an elevation angle 15° and a speed of 2 km/h, 60 min With spa treatment physical activity for patients with cardiovascular diseases is: with a gentle mode - 4-5 hours, with a gentle training mode - 5-7 hours, with a training mode - 6-8 hours.

One or another type of physical activity of the patient is controlled by heart rate during preliminary testing on a bicycle ergometer (or treadmill, step test), where his tolerance to physical activity is determined.

Testing makes it possible to judge the functional state of the cardiorespiratory system, on which the patient's tolerance to physical activity largely depends.

electrocardiographic indicators, blood pressure serve as the initial data for dosing physical activity (therapeutic exercises, walking, running, games and other types of physical activity).

adverse (pathological) changes on the ECG, then when performing physical activity in everyday and professional activity(work), as well as when performing training physical activity, such changes in the work of the heart should not be allowed.

It is necessary to observe the principle of gradual increase in physical activity in order to adapt the cardiorespiratory system to it.

Monitoring the reactions of the cardiorespiratory system of patients to physical activity makes it possible to select adequate physical activity and evaluate their effectiveness in complex rehabilitation, more often of a cyclic nature (metered walking, skiing, running, swimming, etc.).

Calculation of energy consumption (kcal/min) by heart rate (A. Buskirik, 1960) In cardiovascular diseases, heart rate control (especially telemetric) allows you to avoid overload and at the same time maintain the necessary tonic effect from the use of physical activity.

To expand the motor regimen for patients with diseases of the cardiovascular system (when switching from bed rest to the ward, and then to the training regimen), an orthostatic test and a Romberg test are used to assess the response of the cardiovascular system to physical activity.

In patients with injuries and diseases of the musculoskeletal system, as well as in surgical patients in the postoperative period, the effectiveness of exercise therapy is assessed by monitoring the state of the neuromuscular apparatus (muscle tone, dynamometry, pneumometry, etc.).

Occupational therapy (treatment by labor) was used in practice by Russian clinicians M.Ya. Mudrov, G.A. Zakharyin, A.A. Ostroumov and others. active method rehabilitation of the patient. Occupational therapy is based on the systematic training of everyday and industrial movements, the restoration of lost motor skills. Occupational therapy normalizes the patient's psyche, stimulates the functions of the affected system (organ) and is an important component in common system rehabilitation of patients. Various types of activities are used in occupational therapy: work in the garden and garden (in winter in the greenhouse), cleaning, weaving, sewing, carpentry and locksmith work, modeling, etc.

Currently, occupational therapy is of great importance in the rehabilitation of patients. Occupational therapy requires well-equipped special rooms. Due to the complex nature of rehabilitation, occupational therapy rooms should be located near the exercise therapy room, swimming pool, massage room, and physiotherapy. In a hospital, occupational therapy is carried out both in a ward and in specially equipped rooms (workshops, etc.).

The use of occupational therapy in the rehabilitation system depends on the clinical features of the disease, the dynamics of reparative processes and aims to prevent the development of secondary pathological changes in the tissues of the musculoskeletal system that limit motor function. The method of using labor processes is based on the physiology of labor movements. As a result of injuries and various orthopedic diseases, pathologies of the central nervous system, spine, patients develop severe functional disorders that impair their ability to work, which often leads to disability. According to the medical and labor examination, the reason for the decrease and disability of patients is not only the severity of injuries and diseases, but also untimely and irregular rehabilitation (restorative) treatment, as well as the incomplete use of all means of rehabilitation designed to restore and develop temporarily lost functions of the patient .

Practice shows that the early use of occupational therapy and other rehabilitation means allows you to fully (or partially) restore the patient's ability to work, contributes to the acquisition of work and household skills for self-service and helps to avoid disability.

Tasks of occupational therapy: restoration of lost functions through the use of differentiated types of labor; restoration of professional and everyday skills (self-service, movement, etc.) and social reintegration (employment, material support, return to the workforce); provision of general strengthening and psychological impact on the patient's body.

When applying occupational therapy, it is necessary to take into account the anatomical and physiological characteristics of the patient, and the selection of movements should be based on the nature of the disease and the characteristics of its course, which determines the dosage, complexity and starting position when performing labor processes (exercises). Exercises should be performed for a long time, systematically, with a gradually increasing load. Exercises (operations) that can lead to the fixation of a vicious (unnecessary for this profession) motor stereotype should be avoided.

The main factors (aspects) of occupational therapy (according to the materials of the UN Economic and Social Department) are as follows:

restoration of motor functions, work skills and training in daily activities; production (together with prosthetists) of the simplest devices that help develop self-service skills; determination of the degree of restoration of professional ability to work.

Occupational therapy has two main areas: occupational work and occupational therapy.

Occupation with labor is the filling of the patient's free time with drawing, modeling, making souvenirs that improve the psycho-emotional state of the patient in the hospital.

Labor therapy is the use of various labor processes, labor operations for therapeutic purposes.

There are three main forms of labor therapy: restorative labor activity aimed at preventing movement disorders or restoring impaired functions; occupational therapy aimed at general strengthening, maintaining the functional state and ability to work in the event of a long course of the disease;

industrial occupational therapy, which prepares the patient for professional work (activity), carried out in conditions close to production (on machine tools, simulators, stands, etc.).

Taking into account the clinic of the disease, the existing functional changes (functional defect), the type of occupational therapy is also selected. Rehabilitation of the lost motor function is carried out in two ways: through the development of lost motor functions and adaptation (adaptation) of the patient to work.

There are three groups of labor operations (exercises): occupational therapy in light mode (cardboard work, winding threads, making toys from foam rubber, gauze masks, etc.); occupational therapy, which develops (develops) strength, endurance of the muscles of the hands (sculpting, work with a planer, file, etc.); occupational therapy, which develops (develops) fine coordination of finger movements, increasing their sensitivity (knitting, weaving, printing, etc.).

With a significant movement of the motor function of the hand (arms), special devices are used to support it when performing work (straps, suspension, etc.). The selection of exercises is carried out on the basis of dynamic anatomy, labor physiology. In addition, labor processes (exercises) are prescribed taking into account the profession of the patient, his age, functional disorders, etc.

With persistent, irreversible defects of the musculoskeletal system (amputations, ankylosis, etc.), occupational therapy is aimed at developing the patient's compensatory (compensated) capabilities (functions) of an intact limb.

Restorative occupational therapy is a means of increasing physical performance. Under the influence of labor occupations, the psycho-emotional state of the patient and the function of the musculoskeletal system improve.

During bed rest, patients are assigned to work on knitting, weaving, modeling, sewing, drawing, etc.

Walking patients are able to make a bed, clean a room, territory, they can work in workshops, flower greenhouses, etc.

Industrial occupational therapy is associated with work on various machines (weaving, woodworking, carpentry, cardboard, etc.). It makes it possible to orient the patient to work in the former specialty or to obtain a new specialty.

In the course of occupational therapy, the patient acquires psychological and physical training to their work activities. For the patient, conditions are created that are close to production conditions, the patient's residual working capacity, his working capacity are checked, a number of professional skills (skills) temporarily lost by the patient are restored.

Occupational therapy is used at various stages of rehabilitation and includes several periods.

The first period (2-4 weeks) - from the moment of the operation to the removal of the plaster splint. From 2-3 days, active and passive exercises are recommended and facilitated labor processes are performed with a healthy limb and fingers of an injured hand, free from immobilization.

The second period (3-4 weeks) - after the removal of sutures and plaster splints.

The complex of exercise therapy and labor operations is expanding, requiring the active participation of the injured hand.

The third period (6-12 months or more) - after discharge from the clinic throughout the entire period of recovery of the damaged nerve. Occupational therapy, exercise therapy and massage (self-massage, cryomassage) are carried out for a long time in the clinic and at home.

The main ones in the complex of movements are exercises that develop self-care skills (washing, dressing, undressing, shaving, tying a scarf, etc.), cleaning the premises, working in the garden (garden), etc.

Weaving, embroidery, modeling, knitting, making cardboard toys, disassembling small parts, drawing, typing, carpentry (planing, polishing wooden surfaces), etc. are also recommended.

Occupational therapy should be differentiated at different stages of rehabilitation. According to the selection of exercises and load, it is subdivided according to the magnitude of the load (the intensity of the manipulations), the selection of manipulations, etc.; on the achieved mastering of manipulations (movements); on the localization of effects on the musculoskeletal system.

The load in the dosing of labor processes (skills) is carried out by selecting the weight of the working tool, the initial position (posture), the duration of the manipulations, the selection of the grip of the tool handle, special devices for tools and household appliances (spoon, razor, etc.).

In the process of occupational therapy, a gradual transition is made from the use of tools that facilitate the involvement of a diseased limb in work, to conventional tools. To keep the hand in a comfortable position, stands, devices for fixing the forearm, tools, etc. are used. In occupational therapy, various types of manipulations with tools, on stands, etc. are used, which help to restore the range of motion in the joints, the strength of the muscles of the hands, develop fine coordination of finger movements and increase their sensitivity.

Dosing load in occupational therapy. At every stage of rehabilitation treatment, we monitor its effectiveness. This makes it possible to make adjustments to the work. The dosage of the load is determined by the state of health of the patient, the stage of rehabilitation, the volume of functional disorders, etc. One of the methods of dosage in occupational therapy is the time (duration) of performing labor manipulation or work, the amount of work, the weight of the tool, the mode of work, the nature of the work performed, the working posture, etc. .

Occupational therapy should be combined with exercise therapy, massage, position correction (positional treatment). Before occupational therapy, a complex of exercise therapy and massage (self-massage) is carried out for 5-8 minutes, and occupational therapy itself takes 30-45 minutes daily or every other day.

When developing the correct stereotype of working movements, the following rules must be observed: familiarize the patient with the labor operation (movement); show the technique of performing a labor operation; to promote the mastery of labor skills as a result of repeated repetitions of the labor operation.

Types of work performed in the process of occupational therapy For occupational therapy, patients with the consequences of injuries and diseases of the musculoskeletal system of the upper limbs are assigned the following work: knitting, weaving, modeling; artistic and applied works; typescript;

sawing, hand carpentry, burning; work on a sewing machine; manual locksmith work; work on a weaving loom, on a machine for processing (grinding) ceramic products; work on assembling various parts with instrumentation; work in a flower garden.

From a psychological point of view, labor activity must be brought closer to work of a production type. With the final choice of occupational therapy, its nature, scope, it is necessary to carefully analyze the patient's functional capabilities, the participation of the right and left hands in this work, and also to know which muscles are most involved in the work, which joints have the greatest load.

Occupational therapy is widely used for damage to the central nervous system, polio, stroke, mental illness, injuries of the musculoskeletal system and other diseases.

Occupational therapy is combined with therapeutic exercises and massage. Before occupational therapy, active and passive exercises, massage (self-massage) are carried out. Exercise should not cause pain. The exercise therapy complex before occupational therapy includes 8-10 exercises in combination with massage (or self-massage) for the muscles of the shoulder girdle, joints of the limb, and especially the fingers in the ip. standing, sitting.

By the nature of the movements produced, occupational therapy also includes the mastery of everyday skills. Exercises for mastering household skills (for example, using an electric razor, taps, switches, combing, fastening and unbuttoning buttons, eating, washing dishes, etc.) prepare the patient for labor operations.

In the process of training to master household skills, the patient gradually develops fine coordination of movements necessary to perform various labor operations.

In specially equipped rooms with a set of household appliances, stands on which they are mounted and fixed, patients develop self-service skills, and also train the grip of an artificial hand during prosthetics. There are door handles of various shapes and sizes, switches, plugs, locks with keys, water taps, etc. on the wall stands. Bolts, knife switches, switches, etc. are mounted on the production stand.

Occupational therapy in traumatology and orthopedics. When applying a plaster cast, self-care must be performed with a healthy hand, with partial help from the fingers of the injured hand. After removing the plaster cast, the task of rehabilitation is to increase the range of motion in the joints of the upper limb. As pain decreases, occupational therapy, massage, and cryomassage are used to increase the strength and range of motion in the shoulder joint.

Occupational therapy includes ironing clothes, gluing envelopes for storing x-rays, making paper toys, sorting small parts by shape and size. The duration of classes is 10-15 minutes - 3 times a day.

As the muscles strengthen, the amplitude of movements increases, the processes of occupational therapy complicate. They include work with a planer, grinding, various types of cardboard work (gluing envelopes, boxes), weaving, sewing work, etc. Duration 20-30 minutes 2-3 times a day, during breaks - massage (self-massage, cryomassage).

For more late stage rehabilitation (1-1.5 months after the injury) use occupational therapy, which requires more and more dynamic and static efforts. This includes carpentry, glass wiping, locksmith work, etc. 2-3 times a day for 30-40 minutes with pauses for rest and massage (self-massage).

Occupational therapy for injuries of the brachial plexus and peripheral nerves of the upper limb. Fractures of the humerus, clavicle, dislocation of the shoulder are often accompanied by damage to the peripheral nerves (often the radial, ulnar or median nerves), while certain movement disorders occur. Occupational therapy plays a significant role in complex rehabilitation. At the beginning, simple movements are recommended, and then more active ones and with objects, on simulators, etc.

Occupational therapy for movement disorders of the upper limbs as a result of various injuries: for injuries of the bones of the shoulder girdle (collarbone, shoulder blade, etc.); damage to the clavicular-acromial joint; dislocation of the head of the humerus and damage to the proximal end of the humerus; fractures of the diaphysis of the humerus; fractures of the bones of the elbow joint; fractures of the bones of the forearm, hand, fingers; injuries of the brachial plexus and traumatic paresis of the peripheral nerves of the upper limb (limbs); contractures.

Labor treatment is also indicated for injuries of the lower extremities (fractures, damage to the nervous system, contractures, etc.).

Occupational therapy for injuries of the lower extremities. It is used for bone fractures, injuries of the ankle joint, injuries of the Achilles tendon, peripheral nervous system and other pathologies. Of particular note is the poor adaptation of elderly patients, they require an earlier and more active start of occupational therapy.

Occupational therapy, gymnastics and massage (self-massage) are used in combination in the early stages of injury. Occupational therapy in the early stages of rehabilitation in the elderly is purely distracting, psychological in nature. The most shown labor operations are the manufacture of tampons and napkins from gauze, knitting, simple cardboard work, etc.

With the expansion of the motor regimen, patients who are able to sit are entrusted with gluing boxes, envelopes, sewing, typing, etc.

At the end of the immobilization of the lower limb (removal of the plaster bandage), rehabilitation is aimed at restoring the motor function, and then the support function (exercise therapy is used, physical exercises in the water, cryomassage, training on simulators). All this serves as a preparation for the application of occupational therapy, including sewing on a sewing machine, carpentry and locksmithing, and later on a grinder and a foot-powered loom. Training of the supporting function of the limb is carried out (various squats, riding a bicycle ergometer, running on a treadmill, etc.).

Occupational therapy and training on special simulators serve as preparation for production activities, restoration of the physical condition of patients who have undergone an injury (operation) of the lower limb (limbs).

Occupational therapy in orthopedics. With deformities of the musculoskeletal system (clubfoot, habitual dislocation of the hip, etc.), paralysis (poliomyelitis, cerebral palsy, etc.), the function of the limbs is sharply impaired.

Occupational therapy has great importance in restoration, correction, motor function, especially of the upper limbs.

Polio. Complex treatment is shown in the recovery and residual periods. Occupational therapy, exercise therapy, massage, prosthetic and orthopedic devices, etc. are used. Occupational therapy is selected using labor operations adequately to pathological changes in muscles, joints, localization and nature of injuries. In the implementation of occupational therapy, an important role is played by the initial position of the limb when performing movements (manipulations), for this they use hammocks, suspension brackets or special devices, tires, etc. The use of special devices ensures stable performance of limb movements. Before occupational therapy, LH and massage (or self-massage) are performed.

The duration of occupational therapy is 10-30 minutes with active rest, and in between - with massage.

Occupational therapy is carried out in the initial sitting position and begins with simple manipulations. It includes: selection, sorting of material for work; production of various paper products (napkins, flowers, etc.), balls (from gauze and cotton wool); cardboard work (gluing envelopes, boxes, etc.), bookbinding, modeling from plasticine, clay, etc.;

sewing work; burning, sawing; carpentry (planing, sawing, etc.); work at household and production stands (using a key, a tap, turning on the light, dressing and undressing, using a spoon, a razor, etc.).

When performing this or that work, muscle training occurs, limb function is restored, etc., while restoring the finger grip with a decrease in the strength of the flexor muscles is important.

Postpartum plexitis (paresis) occurs in children as a result of birth trauma. The disease is accompanied by contractures in the joints of the upper extremities. They use conservative methods of treatment (therapeutic exercises, massage, prosthetic and orthopedic means, occupational therapy, physiotherapy, etc.). Occupational therapy classes are built in accordance with the nature of the deformations, age. Classes with children should take place in a playful way and imitate labor manipulations.

Occupational therapy includes sorting flowers, buttons, folding cubes, mosaics, modeling from plasticine, making souvenirs from paper, cardboard, etc., coloring, sewing clothes for dolls, etc., as well as bookbinding, wood carving, sawing, twisting screws, using taps on the training stand, drawing, etc. Children are also taught household self-service skills.

Infantile cerebral palsy (ICP). The disease is characterized by spastic paresis (increased tone of certain muscle groups, the formation of contractures).

For rehabilitation, occupational therapy, training in everyday skills, exercise therapy in water, walking training and other means are used.

Goals of occupational therapy in cerebral palsy: normalization of muscle tone;

improved coordination of movements; learning to walk, the correct posture in a sitting position; reduction of contractures.

The main thing in the rehabilitation of sick children with cerebral palsy is the implementation of occupational therapy. For patients with cerebral palsy, it is very important to develop the correct working posture, which helps to relax the spastic muscles, as well as teaching the technique of a labor skill (showing the method of performing a labor operation, explaining a labor task, passive reproduction of the main labor movement, etc.).

Initially, patients with cerebral palsy are offered elementary labor operations that require equally simple work with both hands, then work with improved coordination of movements. In addition, more time is allocated for the performance of labor operations. The type of occupational therapy is also determined psychological features childhood, maintaining a certain posture during work.

The main types of work recommended for children, patients cerebral palsy: drawing, coloring simple drawings, etc.; making dresses for paper dolls, dressing and undressing dolls, disassembling and assembling toys; weaving, modeling; gluing boxes, envelopes; carpentry work (planing, grinding, etc.); hand sewing, winding thread on a spool, etc.

Nonspecific polyarthritis. Polyarthritis is observed in both adults and children and is accompanied by limited movement in the joints, the presence of contractures and ankylosis; all this sharply reduces the physical performance and working capacity of patients.

The lower limbs are characterized by flexion contractures, and in the upper limbs there is a restriction of movement and contractures in the shoulder (shoulder), elbow joints and typical deformities of the hand and fingers, flexion contractures in the interphalangeal joints and extensor contractures in the metacarpophalangeal joints.

In the subacute period and during the period of exacerbation, positional treatment (tires, fixing bandages), exercise therapy, massage (cryomassage), medications, occupational therapy and other means.

Occupational therapy is used to reduce the existing functional disorders of the limb, restore the strength of the muscles necessary to perform work with the hand; developing self-care skills.

If the patient works, then exercise therapy, massage and occupational therapy are aimed at maintaining professional working capacity and preventing the progression of the disease.

cardboard, bookbinding and booklet works; carpentry, metalwork, sewing works; modeling, drawing, etc.

To develop the correct finger grip and develop the function of flexion in the metacarpophalangeal joints, the following types occupational therapy: plasticine modeling; work on a sewing machine; typescript;

weaving, unwinding and winding threads into a ball; "kneading" foam rubber, sponges in a basin with warm water; grabbing a tennis ball production of tampons, napkins from gauze and envelopes, boxes from paper, sorting of buttons, etc.

Before occupational therapy, therapeutic exercises and massage are carried out, preparing for the implementation of manipulations. Training of various adaptive movements (functions) for self-service (combing, brushing teeth, using water taps, ironing, etc.), as well as for performing general labor processes (cleaning the room, easy job garden, orchard, greenhouse).

Massage is widely used not only for the treatment of injuries, diseases, but also for preventive purposes. Massage is a set of mechanical techniques, through which the massage therapist has an impact on surface tissues, and in a reflex way - on functional systems and organs (Fig. 3). Unlike physical exercises, where the main thing is training, massage is not able to increase the functional adaptation of the body, its fitness. But at the same time, massage significantly affects blood and lymph circulation, tissue metabolism, endocrine gland functions, and metabolic processes.

Under the influence of massage, hyperemia of the skin occurs, that is, an increase in the temperature of the skin and muscles, and the patient feels warmth in the area of the massaged area, while blood pressure decreases, muscle tone (if it is increased), breathing normalizes.

Massage has a reflex effect on the function of internal organs, as a result of which congestion is eliminated due to the acceleration of blood and lymph flow (microcirculation), metabolic processes are normalized, regeneration (healing) of tissues is accelerated (with injuries and in the postoperative period in surgical patients), decreases ( disappears) pain. Massage in combination with therapeutic exercises increases mobility in the joint (joints), eliminates effusion in the joint.

The physiological effect of massage is primarily associated with the acceleration of blood and lymph flow (Fig. 4) and metabolic processes.

The effect of massage on blood circulation and lymph circulation is associated with its effect on the skin and muscles (Fig. 5).

Rice. 3. The mechanism of action of massage on the human body (according to V.I. Dubrovsky) Acceleration of blood and lymph flow in the massage area, and at the same time reflexively throughout the system - a very important factor in the therapeutic effect of bruises, synovitis, inflammation, swelling and others diseases.

There is no doubt that the acceleration of blood and lymph flow not only contributes to the resorption of the inflammatory process and the elimination of stagnation, but also significantly improves tissue metabolism, increases the phagocytic function of blood.

Massage technique consists of many different techniques. In table. the main massage techniques are presented, which are used both in therapeutic and sports massage.

The use of various massage techniques may be associated with the anatomical and physiological characteristics of the massaged area of the body, the functional state of the patient, his age, gender, nature and stage of a particular disease.

When conducting a massage, as you know, one technique is rarely used. Therefore, in order to achieve a good result, it is necessary to alternately apply the main massage techniques or their varieties.

They are held alternately with one or both hands. Or like this: right hand performs kneading, and the left - stroking (combined use of techniques).

"The ABC of Self-Massage" (a pocket trainer for those who practice on their own) by Vladimir Dubrovsky is an illustrated mini-book from the series "Library of the Journal of Physical Culture and Sport", which contains recommendations on the technique of self-massage and its use for recreational purposes.

Biomechanics

The textbook was written in accordance with the new program for the study of biomechanics in higher educational institutions.

Much attention is paid to the biomechanical substantiation of the use of physical culture and sports means on the example of various sports. Modern approaches to assessing the impact of various physical and climatic factors on an athlete's technique are reflected, and a biomechanical characteristic of various sports is given.

For the first time, sections on medical biomechanics, biomechanics of disabled athletes, biomechanical control of locomotion, etc. are presented.

Healing Fitness

For the first time, the issues of complex rehabilitation for many diseases and syndromes are covered. The textbook is intended for students of physical culture departments of universities and institutes of physical culture, as well as students of medical universities, methodologists of physical therapy, rehabilitation therapists, physiotherapists, exercise therapy doctors and other specialists.

Massotherapy

Description: This book is one of many written by this author, but, nevertheless, it is full of interesting and important information. The work contains twenty chapters that summarize many years of both theoretical and practical experience in the use of many types of massage for different purposes and under different conditions.

The information described here will serve and be useful to both beginners and professionals of various health-improving practices, in particular massage and complex rehabilitation.

A practical guide to massage

Massage is one of effective methods prevention and treatment of various injuries and diseases.

The massage techniques proposed in the book will help relieve pain, psycho-emotional stress and physical fatigue, improve well-being, increase efficiency and sexual function.

Designed for doctors, massage therapists and a wide range of readers interested in practical medicine.

Rehabilitation in sports

Modern sport makes very high demands on the athlete's body.

Frequent physical overload is fraught with overstrain of the musculoskeletal system and pre-pathological conditions. Therefore, the problem of recovery in sports is extremely important.

The author of the book talks about the causes and mechanism of fatigue, its diagnosis, and means of dealing with it. The book deals with issues of nutrition, pharmacology, massage, sports tape, physio- and hydrotherapy and other means of rehabilitation, the complex use of which is the key to the effectiveness of the training process.

sports medicine

The textbook is written in accordance with the new program of study of sports medicine in higher education.

Much attention is paid to the anatomical and physiological substantiation of the use of physical culture and sports in the prevention and treatment of various injuries and diseases, methods of control and diagnosis, as well as the basics of general pathology, first aid, environmental hygiene of physical culture and sports, etc. Significantly differs from earlier published content, illustrations and style of presentation of the material.

The textbook is intended for students of the faculty of physical culture of universities and institutes of physical culture, medical universities, as well as sports doctors, trainers, massage therapists and other specialists.

Acupressure

From ancient times, a description of the so-called "vital points" came to us, through which it is possible to influence the activity of certain organs.

The book gives the topography of these points on the human body, describes the methods of their massage and self-massage in a number of diseases. An independent section is devoted to methods of influencing biologically active points (BAP) with ointments, copper, pepper plaster, etc. Designed for the general reader.

Physiology of physical education and sports

The textbook was written in accordance with the new study program "Physiology of Physical Education and Sports" in various educational institutions. Much attention is paid to the physiology of the central nervous system and the neuromuscular system, thermoregulation and acclimatization, biorhythms, hormonal regulation during physical activity, other issues related to physical work, physiological changes in functional systems and organs under the influence of physical activity; the characteristic of the state of the body during various sports and health-improving physical education is given.

The textbook is intended for students of colleges, faculties of physical culture of universities and institutes of physical culture, medical universities, as well as coaches, sports doctors and other specialists.

Healing touch. The path to longevity

The increased interest of people in massage and self-massage is not accidental: due to the impact on the human body, special techniques stimulate the body's defenses, which helps to maintain and strengthen health, prevent various ailments, and in case of illness, restore health.

Especially popular is the so-called acupressure, which came to us from ancient times. The book gives the topography of "vital points" on the human body, describes the methods of their massage and self-massage in a number of diseases, as well as to increase the vitality of the body.

INTRODUCTION

As a result of injuries and diseases, patients often develop various functional disorders that impair their ability to work and lead them to disability.

a group of exercises aimed at restoring or forming motor skills (standing, walking, manipulations with simple but important household objects: clothes, dishes, etc.);

passive exercises and exercises for stretching connective tissue formations, treatment with position, etc.

All of the above groups of exercises are combined in various combinations and depend on the nature and extent of the motor defect, the stage of rehabilitation, the age and gender of the patient.

Rehabilitation of neurological patients requires long-term training of compensatory mechanisms (walking on crutches, self-care, etc.) to ensure sufficient compensation for lost or impaired functions. However, at a certain stage (stages), the recovery process slows down, that is, stabilization occurs. The success of rehabilitation is different for a particular pathology. So, with osteochondrosis of the spine or lumbosacral sciatica, it is higher than with multiple sclerosis or vascular diseases.

Rehabilitation largely depends on the patient himself, on how diligently he performs the program prescribed by the rehabilitation doctor or exercise therapy methodologist, helps to correct it depending on his functional capabilities, and, finally, whether he continues recovery exercises after the rehabilitation period is over.

Brain injury (concussion)

All brain injuries are characterized by an increase in intracranial pressure, a violation of hemo- and liquor circulation, followed by a violation of cortical-subcortical neurodynamics with macro- and microscopic changes in the cellular elements of the brain. A concussion of the brain leads to headaches, dizziness, functional and persistent autonomic disorders.

In case of violations of motor functions for the prevention of contractures, exercise therapy is prescribed (passive, then passive-active movements, positional treatment, muscle stretching exercises, etc.), massage of the back and paralyzed limbs (first the legs are massaged, then the arms, starting from the proximal sections), and also affect the biologically active points (BAP) of the limbs.

With mild and moderate concussion, massage should be carried out from the second or third day after the injury in the patient's sitting position. First, the back of the head, neck, shoulder girdle are massaged, then the back to the lower corners of the shoulder blades, using stroking, rubbing, shallow kneading and light vibration. Finish the procedure by stroking from the scalp to the muscles of the shoulder girdle. The duration of the massage is 5-10 minutes. Course 8-10 procedures.

In the first 3-5 days, with mild to moderate concussion, cryomassage of the occipital region and muscles of the shoulder girdle is also used. The duration of the massage is 3-5 minutes. Course 8-10 procedures.

Injuries of the spine and spinal cord

Sometimes a spinal injury occurs in a position of hyperlordosis, and then a rupture of an intact intervertebral disc can occur.

The cervical spine is especially often injured when jumping into a shallow body of water, when, after hitting the head against the bottom, a traumatic prolapse of an intact intervertebral disc occurs, causing tritraplegia. Degenerative changes inevitably lead to herniation of the intervertebral discs, which in itself is not a cause for complaints, but due to trauma, a radicular syndrome occurs.

When the spinal cord is damaged, flaccid paralysis occurs, which is characterized by muscle atrophy, the impossibility of voluntary movements, the absence of reflexes, etc. Each muscle is innervated from several segments of the spinal cord (see Fig. 96), therefore, with damage or diseases, there may be not only paralysis, but also muscle paresis of varying severity, depending on the prevalence of lesions in the anterior horns of the gray matter of the spinal cord.

The clinical course of the disease depends on the degree of damage to the spinal cord and its roots (see Fig. 122). So, with injuries of the upper cervical spine, spastic tetraparesis of the extremities occurs. With lower cervical and upper thoracic localization (C6-T4), flaccid paresis of the arms and spastic paresis of the legs occur, with thoracic localization - paresis of the legs. With the defeat of the lower thoracic and lumbar segments of the spine, flaccid paralysis of the legs develops. The cause of flaccid paralysis can also be damage to the spinal cord with closed fractures of the spine and its injuries.

Prevention of the development of joint contractures by means of massage, exercise therapy, stretching exercises, physio- and hydrotherapy, hydrokinesitherapy is the main task for paralysis of any origin. In water, the possibility of active movements is facilitated and the fatigue of weakened muscles is reduced. Electrical stimulation of paralyzed muscles is carried out with needle electrodes with a preliminary introduction of ATP. In addition, positional treatment is included using staged plaster splints (bandages), teips, sandbags, etc., as well as staged redressing and other methods.

Timely use of the necessary rehabilitation means can completely prevent the development of contractures and other deformities.

Traumatic encephalopathy is a complex of morphological, neurological and mental disorders that occur in the late and long-term periods after a traumatic brain injury. Characterized by asthenic and various vegetative-vascular disorders, memory impairment by the type of retrograde amnesia, headaches, fatigue, irritability, sleep disturbance, heat intolerance, stuffiness, etc.

The recurrence of seizures indicates the development of traumatic epilepsy. In severe cases, traumatic dementia occurs with severe memory impairment, a decrease in the level of personality, etc.

In addition to dehydration therapy, complex treatment includes the use of anticonvulsants, tranquilizers, nootropics, etc. Massage, LH, walking, skiing help to improve the patient's well-being and prevent decompensation.