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16MEDICAL SCIENCES
EVALUATION OF THE EFFECTIVENESS OF KINESIOTHERAPY METHODS IN PRIMARY
SCHOOL CHILDREN
Vorko V., Kamyshna I.
I. Horbachevsky Ternopil National Medical University
ABSTRACT
The article is devoted to the study of the effectiveness of modern methods of kinesiotherapy, determining their place in a multidisciplinary and comprehensive approach to the rehabilitation of primary school patients with cerebral palsy.
Keywords: kinesiotherapy, cerebral palsy, physical rehabilitation, spasticity, therapeutic physical culture.
Formulation of the problem. The prevalence of child disability is nothing more than a concentrated reflection of the level of success of society, social protection, quality of life and health of the population.
Today, the problem of children with disabilities in Ukraine is of particular importance due to the constant growth of their share in the structure of the child population. Official data characterize the scale of this problem in Ukraine: as of 01.01.2017 it was 159,044 people, or 2.08% of the total child population of Ukraine. The proportion of children with disabilities, whose disability is associated with pathology of the nervous system, is 19.2%, more than 90 thousand children the problem of social maladaptation is associated with pathology of the nervous system, almost a quarter of which is spastic type of motor disorders caused by such a typical violation of muscle function as spasticity [1].
Motor disorders of the spastic type occur due to various non-progressive organic lesions of the brain. Non-progressive lesions that can damage the brain of the fetus and newborn, in addition to hypoxic-ischemic damage in the perinatal period, also include brain malformations, hemorrhagic brain lesions, intrauterine infections, brain lesions in the postnatal period; meningitis, encephalitis [3].
It should be noted that there are a number of milder, "erased" forms of motor disorders of the spastic type, namely: minimal cerebral insufficiency; minimal brain dysfunction; some types of dyspraxia; minimal spinal insufficiency; hypoxic-ischemic encephalopa-thy; combined disorders of the cerebrospinal type, as well as mild spasticity. Such deviations are quite rare, and motor disorders of the spastic type are not very pronounced [4, 6].
Most often in childhood motor disorders occur in cerebral palsy. This pathology is characterized by severe and more persistent deviations in the musculoskel-etal system.
Cerebral palsy is one of the most common causes of childhood disability, with the prevalence of cerebral palsy in Europe ranging from 2 to 3 per 1,000 live births. This figure has not changed significantly over the past 40 years. According to industry statistics, the prevalence of cerebral palsy in Ukraine is 2.56 per 1.000 infants.
In many children, the cause of cerebral palsy is unknown, but risk factors can be identified, including maternal disease and postnatal outcome. The creation of the European Register of Children with Cerebral Palsy in 1998 (SCPE - The Surveillance of Cerebral Palsy in Europe) confirms the urgency of this problem and the need to develop various studies in this area to improve the rehabilitation of children with cerebral palsy [7, 9].
Cerebral palsy (CP) is a group of stable motor and posture disorders that lead to limited functional activity and movement disorders due to non-progressive brain damage and / or abnormalities in the fetus or newborn [8].
Cerebral palsy is the most common neurological pathology that leads to disability in patients under 18 years of age. The prevalence of cerebral palsy in the world remains quite high and is 1.6-2.8 cases per 1,000 live births.
It is believed that among premature babies with extremely low birth weight, the risk of cerebral palsy increases 100-fold. This pathology affects the range of interests not only of neurologists and orthopedists, but also of many other pediatric specialties. However, in our country so far no methodology has been developed for diagnostic and rehabilitation algorithms for accompanying children with cerebral palsy by specialists in various fields. Perceptions of cerebral palsy as a predominantly motor pathology have changed significantly in recent decades, and now the disease is considered complex, affecting many brain systems, which necessitates a methodological study of this form of pathology to determine the course of the disease on treatment and rehabilitation of patients [6, 7].
The problem of cerebral palsy is the basis of research by many scientists (Kazyavkin VI, VV Besida, VA Levchenko, MD Moga, SA Kholodov, LA Khan-zeruk, etc.) all as One agrees that with timely diagnosis and the earliest possible start of treatment and rehabilitation measures for cerebral palsy, it is possible to achieve a significant improvement in general condition, and thus improve the quality of life and socialization of the child [6, 9, 12].
However, there is no single standardized method of treating this serious disease.
Great prospects for the clinical effectiveness of rehabilitation of sick children remain by non-medical methods, in particular, the use of kinesiotherapy should
be considered theoretically and physiologically justified.
The name kinesitherapy comes from the ancient Greek "kinesis" - movement + "therapy" - treatment. It is an independent rehabilitation discipline, which is based on experience and is based on all other related disciplines and includes both the theory and methods of physical therapy. Kinesitherapy is carried out in the interaction between the patient and the therapist in order to treat, improve and maintain a healthy condition, prevent recurrence and promote achieving psychophysical comfort of the person. This is an active method of treatment in which the patient takes an active part in the rehabilitation process.
Kinesiotherapy is also a scientific and applied activity, which combines knowledge: medicine, pedagogy, anatomy, physiology, biochemistry, etc.
Kinesiotherapy is based on real clinical achievements, as well as the results of scientific studies of the human muscular system, its physiology and biochemistry of the process of muscle fiber contraction and effects on the human musculoskeletal system [3].
The purpose of the study: to substantiate the need for modern methods of kinesiotherapy for children of primary school age with cerebral palsy.
Objectives of the study:
1. To determine the features and dynamics of cerebral palsy on the example of children who study and receive specialized care on the basis of the Ternopil Regional Training and Rehabilitation Center.
2. To study the clinical and instrumental characteristics and the amount of medical care for children with cerebral palsy.
3. To develop an algorithm of kinesiotherapy methods for children of primary school age with cerebral palsy.
Treatment with the right movements involves adapted, gradually increasing force, defined strictly individually for each patient, taking into account his history, age, physiological and other characteristics and other diseases associated with the main. Gradual learning of correct (simple and complex) movements leads to their neuroreflex fixation. Restoration of mobility, in turn, leads to the restoration of trophism and metabolism in the human musculoskeletal system. Treatment is carried out with the help of special medical and rehabilitation simulators, expanders, dumbbells, balls and other accessories, as well as without it, with the help of, for example, a partner, instructor or other device.
Currently, the rehabilitation of children with cerebral palsy includes more and more modern engineering developments and methods that differ from traditional rehabilitation technologies. The disadvantage of these technologies and techniques is their often insufficient scientific justification for use in cerebral palsy or low availability to the general public. One of the popular modern means of rehabilitation of children with cerebral palsy is the Gross exercise machine.
This device is designed to develop the ability to walk and perform various exercises in patients with musculoskeletal disorders. Currently, the Gross simulator (TG) is used as an auxiliary device for FR patients with cerebral palsy. The main feature of the device is
its ability to ensure the vertical position of the patient in any action. This simulator reduces axial load on the joints of the lower extremities and spine, protects the patient from falls, thereby helping to overcome the fear of verticalization and improves orientation in space. In addition, TG has a positive effect on joint mobility in spinal injuries and CNS diseases. To increase the therapeutic effect of TG is used in the pool, in combination with various joint simulators, cardio machines, gymnastic shells, which increases the variability of rehabilitation measures [11].
Treadmills and ergometers were used in the study.
A treadmill (treadmill) with adjustable speed and angle of ascent was used to develop the correct step movement, rhythm, endurance development and improvement of the general functional state.
Learning the technique of walking on a treadmill was one of the main forms of training, with first gradually increasing the number of steps, then speed. The main attention was paid to the elasticity of walking, walking on the whole foot, rolling from heel to toe, lifting the knees, active leg position, position of the arms and body. Those children who could not walk on their own practiced the function of walking with the help of the Gross Trainer. The child, being in the exercise machine on a treadmill, holding hands on a handrail of a treadmill, independently or forcibly (the Methodist and the father on both sides of the treadmill seized the child's shins and through the bending of the legs at the knee joint) performed step movements, emphasizing the position of the leg, and straightening the leg.
Exercise 1. The treadmill was turned on at minimum speed with further increase. Independently or forcibly after 1 - 2 minutes, then, accelerating the steps, increased the pace. Such short-term increases in the pace of exercise were positively perceived by all categories of children and contributed to the development of coordination.
Exercise 2. As a variant of this exercise, walking was performed at a slow pace in long steps, putting the foot far forward on the heel, rolling over on the sock and leaving it as much as possible on the support behind. Thus, in the course of the pedagogical experiment it was possible to significantly change the technique of transferring the swing leg, to bring the technique of transfer to the norm.
Exercise bike. For the development of motor skills and musculoskeletal sensitivity in the classes used active-passive exercise bike. This type of exercise device is especially important for the correction or development of the musculoskeletal system of children with cerebral palsy. Rhythmic alternation of contraction and relaxation of the muscles of the lower extremities at work can stimulate motor functions, normalize muscle tone, form a pattern of alternating movement of the legs, activate the mobility of the ankle and knee joints. Performing a holistic circular motion with each foot contributed to the formation of a sense of support and walking in children for whom this kind of movement was previously difficult.
The study used survey data of 12 children with a primary diagnosis of cerebral palsy, aged 4 to 12 years for 2 months.
During the study, 6 children (experimental group) in addition to therapeutic measures proposed by the educational institution worked an additional 4 times a week, for 30 minutes according to the above scheme, for two months.
Others, 6 children of primary school age (control group) performed only therapeutic measures offered by the educational institution: exercise therapy, massage, physiotherapy procedures.
In a relatively short period of 2 months (a total of 32 classes, 16 hours for each child), we got pretty good results.
Muscle hypertonia decreased, muscle contractility improved, antagonist muscle imbalance decreased, muscle trophism improved, inflammatory processes decreased, and lower extremity muscle malnutrition decreased.
The general health of the patients also improved, in two months of the study from the experimental group no child went to the medical unit for health and well-being problems, in contrast to the control group, which had as many as 3 appeals.
Walking skills improved in all participants of the experiment, children kept their balance better, the number of falls decreased, their steps became more confident, firmer and manageable. Those participants in the experiment who did not know how to walk to the experiment, can now overcome the distance of 5-10 steps on their own.
Conclusions:
Cerebral palsy is an important problem today. Every year in Ukraine and in the world the number of patients with this diagnosis is constantly growing. In turn, this creates certain economic and social difficulties for both the state and the families of a sick child.
Cerebral palsy is not the only pathology that causes spastic movement disorders, as it does not reflect the essence of the development of neurological disorders, under this name hides a wide range of different diseases that cause non-progressive organic brain damage.
Kinesiotherapy is an important condition for the development of children with spastic movement disorders. Kinesiotherapy acts as the main factor influencing the motor centers of the brain of a sick child, as the patterns of the higher nervous system in children are not yet mature and the impact on them can be very effective and to promote the functional recovery or even the formation of new motor centers.
Our proposed means of kinesiotherapy in a short time have shown good results in the rehabilitation of patients with spastic form of cerebral palsy. In the experimental group, muscle hypertonia decreased, muscle contractility improved, antagonist muscle imbalance decreased, muscle trophism improved, inflammatory
processes decreased, lower extremity muscle malnutrition decreased, general health improved, and skills improved. walk, and even those participants of the experiment who did not know how to walk to the experiment, can now independently overcome the distance of 5-10 steps.
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