Transcript Features exercise therapy in neurological and neurosurgical

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Fractures - a violation of
their integrity as a result
of external mechanical
factors or disease
process. There
diaphyseal (body bone),
metaphyseal
(bilyasuhlobovi) and
epiphyseal
(vnutrisuhlobovi)
fractures.
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Changes in the joint during prolonged
immobilization
a - front cut normally functioning joint: 1,
2 - articular ends of the bones , 3 articular cartilage, 4 - fibrous capsule (
outer layer ), 5 - subsynovialnyy
intermediate layer , 6 - synovial
membrane , 7 - joint space , 8 - lateral
glenoid cavity
b - front cut joints after prolonged
immobilization : 1 - articular ends of the
bones , 2 and 6 of the joint capsule that is
wrinkled , 3 - articular cartilage , 4 overgrown lateral articular cavity (
synovial membrane grows in areas it
dublikatur ), 5 - glenoid cavity greatly
reduced in volume , flows synovium on
cartilage
Special methods:
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continuous use throughout the
course of treatment, methods of
exercise therapy varies depending
on the treatment period;
Early use of exercise, which
provides not only improve the
overall condition of the patient, but
also prevents the occurrence of
complications (pneumonia,
contractures, atrophy);
combination treatment with
immobilization of exercise;
gradual increase in capacity:
moderation exercise intensity in
the 1st period and intensification
in the 3rd period;
use of active and passive exercise
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Contraindications to exercise therapy
appointment:
- The general condition of the patient
due to severe blood loss, trauma,
infections, co-morbidities;
- Fever, with the exception of long
subfibrylnoyi (not above 37, 5 );
- The risk of occurrence or
hemorrhage due to movement;
- The presence of foreign bodies in
the tissues located near major blood
vessels, nerves and other vital
organs;
- The presence of other diseases that
are contraindications to physical
therapy appointment.
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The period of immobilization.
Lasts 30-90 days. Clinically
characterized by acute effects
of trauma, start the
regenerative process in
damaged tissues. Coincides
with the formation of primary
callus. In the absence of
contraindications TE appointed
since the early days of
hospitalization.
Common tasks:
raising the general condition of
the patient;
improvement of vital systems:
cardiovascular, respiratory,
nervous, digestive,
increase the body's resistance;
prevent violations due to bed
rest.
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Special tasks:
improvement trophic
immobilized limb;
consolidation of the fracture
stimulation;
prevention of muscle atrophy,
joint dysfunction immobilized
limb contractures and
prevention tuhoruhomosti;
develop the necessary
temporary compensation.
Forms of TE:
therapeutic exercises, morning
hygienic gymnastics, individual
tasks for self-study.
Special tasks
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- Normalize trophic injured
limb (final formation of callus,
the elimination of muscular
atrophy);
 - To restore motion in joints
damaged limbs;
 - Restore and normalize the
function of the injured limb;
 - Restore correct posture,
normalize motor skills, to
improve their quality.
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Fig. 11 - Exercise
for people with a
fracture of the
humerus (with S.
Ivanov, 1970)
Special exercises for
persons with injuries
of the elbow joint and
correction provisions
(with AF
Kaptyelinym, 1969):
and - the movement to
the polished panels;
b - pokachuvannya at
the elbow;
in - motion using roller
carts;
r - bend at the elbow to
support healthy
hand;
d - rolling stick, e pokachuvannya
sticks;
same - laying hands
between two bags of
sand.
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Exercise therapy for
fractures of the spine.
 The course of physical
therapy is divided into
three periods (EF
Drevynh):
 I - begins a few hours after
the injury and
immobilization and lasts
for about 2 weeks;
 II - the next 2 weeks, ie
until the end of the first
month;
 III - In the 2nd month after
the fracture.
First time.Task:
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- Increasing emotional state;
- Promotion of the injured
vertebrae in functional
starting position;
- Moderate toning the
muscles of the back;
- Improve circulation;
- Prevention of pneumonia;
- Activation of intestinal
peristalsis.
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The second period.
 Features physiotherapist:
 - Vigorous exercise for the
muscles of the shoulder and
pelvic girdle;
 - Inappropriate for pelvic girdle
full load, so the movements are
carried out each leg separately;
 - Training the back muscles - the
extensor: not prescribe complex
exercises and special exercises
carried out not in full.
 The main principle of the classes
- not painful movements.
 All movements of a busy
performance facilitated inclined
position of the bed.
Third period.
Performed exercise,
requiring good motor
coordination and significant
power voltage. Includes
exercises to develop
flexibility of the spine (lateral
incline and rotation of the
spine in longitudinal axis). To
carry out strenuous bending
of large amplitude and a
burden.
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Includes some
navkarachky
movements that
increase flexibility of the
spine, the end of the
2nd month - kneeling
movements and
movements with a small
foothold.
The task of physical therapy for diseases
of the nervous system.
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Strengthening the patient.
Improved circulation lesions of the body.
Lowering elevated abnormal tone paretic
muscles and increase muscle strength.
Eliminating harmful spivdruzhnih
movements: synergies and synkineses .
Restoration of functional balance between
paretic muscles and their synergists .
Restore or improve the accuracy of
movement.
Recovery or improvement of nerve
conduction from the center to the
periphery and from the periphery to the
center.
Eliminating or weakening tremor of
muscles.
Play and forming the most important
motor skills aimed at the development (
training) and labor skills, and selfmovement , preparation for rehabilitation
Features exercise therapy in neurological
and neurosurgical disorders.
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. Early administration of TE . Involve the use of stored
functions and newly created , that are adapted to the
changed conditions of neurological, visceral and somatic
status.
Selective use of exercise therapy to restore disturbed
functions or compensate for the lost .
Use special exercises by pathogenic principle in
combination with general Firming effect of exercise
therapy .
Respect for the principle of adequacy at a constant
turnover of exercise , depending on the capabilities of the
patient and the presence of a training effect.
Gradual expansion relentless motor mode from a prone
position to unrestricted movement
Features exercise therapy in neurological
and neurosurgical disorders.
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Early administration of TE . Involve
the use of stored functions and
newly created , that are adapted to
the changed conditions of
neurological, visceral and somatic
status.
Selective use of exercise therapy to
restore disturbed functions or
compensate for the lost .
Use special exercises by pathogenic
principle in combination with general
Firming effect of exercise therapy .
Respect for the principle of
adequacy at a constant turnover of
exercise , depending on the
capabilities of the patient and the
presence of a training effect.
Gradual expansion relentless motor
mode from a prone position to
unrestricted movement.
By means of exercise therapy for diseases of the
nervous system are assumptions, massage , special
treatment and gymnastics . Latest share :
a) to promote muscle strength ;
b ) for the dosed muscular tension ;
c) to obtain the differential stresses and relaxations of
individual muscles and muscle groups;
d) the right to play in the whole motor act (speed,
smoothness , precision movements) ;
e) protyataktychni exercises aimed at restoring and
improving coordination ;
e) antyspastychni and protyryhidni ;
g) and ideomotor reflex ;
i) the restoration or new formation of applied motor
skills ( standing , walking , living skills );
c) Passive including manipulation .
Acute cerebrovascular accident - a stroke..
There are 3 stages of rehabilitation of stroke :
1st - early recovery ( up to 3 months)
2nd - late recovery (up to 1 year)
3rd - residual disturbances of motor functions.
Degree of impairment of motor functions :
1st - light paresis ;
2nd - moderate paresis ;
3rd - paresis ;
4th - deep paresis ;
5th - plehiya or paralysis.
Daily motor activity depends on:
1 - the patient's condition ;
2 - the period of the disease;
3 - stupernyu violations of motor functions.
Modes of motion activity are:
1. Cots' severe (1-3 days).
2. 2nd Advanced bed (3-15 days). 2-B - 16-21 days.
3. Ward .
4. Available .
Tools:
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1. Treating the supine position on
the side.
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2. Exercise:
 - Breathing exercises;
 - Active exercises for small,
medium, and later for large joints
healthy limbs;
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3. With a 3-6 day - passive
exercises for the joints paretic
limb.
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4. Teach a determined reference
pulses synchronized to the
movements of the isolated passive
extension of the forearm, flexion of
the lower leg.
Extended bed rest: 2b / 16-21 days.
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Objectives of TE:
Increased general tonic effect on the
patient.
Learning relaxation of muscles healthy
limb.
Decreased muscle tone in the paretic
limbs.
Transfer the patient in a sitting position.
Stimulation of active movements in the
paretic limbs.
Combating pathological synkineziyam.
Preparing the patient for ambulation.
Restoration tool support in the lower
extremities.
Restoring function self healthy limb.
Tools:
1. Assumptions - are important in the
implementation of passive movements of
individual segments of the limbs :
Fingers unbend easily if bent tassel .
Forearm - arm if given.
Supination of the forearm is complete
when the elbow is bent .
Pleas hip - fuller in a bent position.
2. a) classes begin the active exercise for
healthy limbs first , then passive - paralytic
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b ) during active exercise is necessary to
use lightweight provision using:
- Bed frame;
- Blocks ;
- Hamachky to maintain paralytic limbs ;
c) exercises performed slowly, slowly ,
every movement 4-8 times. First limb
returns to the starting position passively ,
through the instructor and support.
Particular attention is paid to the recovery
movement 1 - the first finger ;
d) passively or actively oppose pathological synkineziyam:
- During the execution of active movements of foot hands
fixed behind head or across the body, brush under the
buttocks;
- When healthy arm bent, Methodist can at this time
passively straighten paretic hand;
- Use willpower, bending the leg the patient prevents
bending arm, holding it in an effort to straighten position;
e) ideomotor movements;
e) isometric muscle tension paretic limb.
ward mode
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Objectives of TE:
Decreased muscle tone.
Combating
hemiplehichnym
contractures.
Further recovery of active
movements.
Switching to a standing
position.
Learning to walk.
Combating synkineziyam.
Restoration and applied
skills of self-domestic
movements.
Free mode .
Objective means and methods of exercise therapy in late
stage restorative and during the remaining movement
disorders depends on the disturbances of motor functions
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1st degree (mild paresis )
- General tonic effect on the body ;
- Strengthening the muscles of the shoulder girdle and
back;
- Improve posture;
- Travel, walking.
5th degree ( plehiya , paralysis )
- Activation of the cardiovascular and respiratory systems;
- Training the patient to return to the side ;
- Preparing to move into a sitting position or standing ;
- Better support of the lower extremities;
- Relaxation of the muscles of healthy limbs;
- Decrease in muscle tone ;
- Anti contractures ;
- Violation of trophic paretic extremities;
- Expanding the skills of self .
Exercise therapy in paralysis and paresis.
Paralysis (Greek paralysis) - loss, paresis (Greek haresis) - 1) attenuation of
motor function with no or decreased muscle strength, and 2) because of a
violation of the structure and function of the motor analyzer, and 3) as a result of
pathological processes in the nervous system.
Shared by such forms of paralysis and paresis:
The nature of the damage and the violation of the relevant structures of the
nervous system:
Organic
Functional
Reflector
Result of organic changes
in the structure of the
central and peripheral
motor neuron (head, back,
brain, peripheral nerve)
which occur under various
pathological processes:
trauma, tumors, stroke,
inflammation and other
processes
Investigation of influence of
psycho-genetic factors that
lead to neyrodyna-nomic
disturbances in the central
nervous system and meet
him head-way in hysteria
Result neurodegenerative
disorders dynamically
functional NS arising under
the influence of significant
focus porazhennya, topical
not linked to paralysis and
paresis, which is formed
The nature of the affected muscle tone distinguished: central or
spastic, flabby (peripheral) and rigid paralysis and paresis.
Depending on the level of structural lesions of the motor analyzer
paralysis and paresis divided into:
Central
(pyramidal) (spastic)
Spastic muscle hypertonus
character hyperreflexia,
patho-logical and protective
reflexes, abnormal
movements spivdruzhni,
absent cutaneous reflexes
Peripheral
(flabby)
Creep (flaccid) muscle tone.
When porazhenni peripheral
Hexadecimal motor neu-ron
a) atony
b) arefleksiya
of infection, infectious,
allergic, a degenerative
process (anterior horn cells
of the spinal cord, the nuclei
of cranial nerves, anterior
roots of the spinal nerves of
the brain, plexus,
cerebrospinal nerves or
cranial nerves)
Ekstapiramidal
(rigid)
Rigid muscle tone lesions
resulting from violations stem
peel-subcortical connections.
It is characterized by a
decrease or lack of physical
activity. Loss spivdruzhnih
automatic movements. The
slowness of speech, gait
small steps with the lack of
co-movements with his
hands. The phenomenon of
"cogwheel" rigidity of
Objectives of gymnastics in the
central and peripheral paralysis.
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. Improved blood flow and nerve trophic
lesions of muscles.
Prevention of contractures.
Restoration of movement and
development of compensatory motor
skills.
General-firming effect on the patient's
The early period
Use the treatment position, massage,
medical gymnastics.
Treatment provision:
sleep on the side (on the affected side);
during the day, 3-4 times to sit, head
bent in the opposite direction,
keeping her hand on elbow with
resistance. At the same time tighten
the muscles of the healthy side to
side lesions (bottom to top) tries to
restore the symmetry of the face;
leykoplasternyy tension with the healthy
side in patients using a special
helmet mask;
tying a handkerchief;
Special exercises for facial muscles:
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1. Raise your eyebrows upwards.
2. Nahmuryty eyebrows.
3. Close Your Eyes (phases of the
exercise: look down, close your eyes,
holding the eyelid with your fingers on
the side of injury, keep your eyes
closed for a minute, close your eyes
and open 3 times).
4. Smile with your mouth closed.
5. Schurytysya.
6. Lower your head down, take a
breath and exhale during the "snort".
7. Whistle.
8. Expand nostrils.
9. Lift the upper lip, upper teeth show.
10. Lowering the lower lip, the lower
teeth show.
11. Smile with your mouth open.
12. Redeem a match.
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13. A mouthful of water, and rinse your
mouth shut , not pouring water.
14. Inflate cheeks.
15. Move air from the mouth of one
half to the other.
16. Lower down the corners of his
mouth with a closed mouth.
17. Protruding tongue and make it
narrower.
18. Move the tongue forward - back
with open mouth.
19. Move your tongue right - left with
an open mouth.
20. Outstretched lips " tube ".
21. Finger make a circle , watching
him eyes.
22. Retract the cheek with a closed
mouth.
23. Lower the upper lip to the bottom .
24. In the closed mouth to drive the tip
of the tongue on the Desna left or right,
tongue pressing various efforts.
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13. A mouthful of water, and rinse your
mouth shut , not pouring water.
14. Inflate cheeks.
15. Move air from the mouth of one
half to the other.
16. Lower down the corners of his
mouth with a closed mouth.
17. Protruding tongue and make it
narrower.
18. Move the tongue forward - back
with open mouth.
19. Move your tongue right - left with
an open mouth.
20. Outstretched lips " tube ".
21. Finger make a circle , watching
him eyes.
22. Retract the cheek with a closed
mouth.
23. Lower the upper lip to the bottom .
24. In the closed mouth to drive the tip
of the tongue on the Desna left or
right, tongue pressing various efforts.
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Exercise therapy in spinal osteochondrosis .
At the heart of spinal osteochondrosis is changing
intervertebral disc with subsequent involvement in
the process of vertebral bodies adjacent
intervertebral joints and ligaments .
Intervertebral discs play an important role in the
stable position of the vertebrae , provide mobility of
the spine, act as biological shock absorber.
Factors that contribute to the emergence and
development of osteochondrosis is a sedentary
lifestyle , prolonged exposure of the body
physiologically in an awkward position ( many hours
sitting at a desk, driving a car , standing next to the
machine, behind the counter ). This greatly impairs
blood circulation and providing nutrients to the
vertebral bodies , intervertebral discs. There are
cracks fibrous ring . Due to the progression of
degenerative changes in the fibrous ring fixing
broken vertebrae together , there is abnormal
mobility . Intervertebral gap reduced, compressed
neurovascular end , blood and lymph vessels amplified pain. In the 3rd stage of the disease there
is a rupture of the annulus fibrosus , intervertebral
hernia formation . The final stage is characterized by
a painful thickening and displacement of the
vertebrae, the formation of abnormal bone growths .
The task of the physiotherapist :
Help to increase the distance between individual
vertebral segments to relieve pathological
proprioceptive impulses.
Help to reduce pathological proprioceptive
impulses.
Improving metabolism due to increased blood and
lymph circulation in the damaged vertebral
segment and roots.
Reduce swelling in the tissues located in the region
of the intervertebral foramen, improve blood
circulation in the affected limb .
Increasing and restoring full range of motion in the
extremities and spine , reducing static and
dynamic disturbances and compensatory
movements, restoration of impaired posture .
Help restore trophic, tone, muscle strength of the
trunk and extremities.
Improve overall physical performance.
Special task gymnastics:
When radicular syndrome:
stretching of nerve trunks and roots;
prevention of muscle atrophy;
strengthening muscles distal extremities.
When glenohumeral peryartryti:
prevention of the formation of neurogenic reflex contracture of
the elbow joint;
strengthening the deltoid, nadostnoho, pidostnoho, the biceps
muscle.
In the posterior cervical pretty syndrome (vertebral artery
syndrome):
contribute to the weakening of vestibular disorders.
Osteochondrosis of the cervical
spine.
Active movement of the cervical spine in the initial and main periods of
treatment are contraindicated, as it can cause narrowing of the
intervertebral foramen, which cause compression of the nerve roots and
blood vessels.
Fig. 15 - Exercise for the development of the back muscles.
Fig. 16 - Exercise for the flexibility of the spine (set of
4) and upper shoulder girdle (set of 5).
Complex 6
Fig. 17 - Exercise for the
muscles of the lower back and
abdominals.
Fig. 18 - Exercise for the flexibility of the
spine.