Exercise therapy in diseases of the central nervous system. Therapeutic physical culture in diseases and injuries of the nervous system Complex lg in diseases of the nervous system

Nervous system controls the activities of various organs and systems that make up the whole organism, communicates with the external environment, and also coordinates the processes occurring in the body depending on the state of the external and internal environment. It coordinates blood circulation, lymph flow, metabolic processes, which, in turn, affect the state and activity of the nervous system.

The human nervous system is conditionally divided into central and peripheral (Fig. 121). In all organs and tissues, nerve fibers form sensory and motor nerve endings. The first, or receptors, provide the perception of irritation from the external or internal environment and convert the energy of stimuli (mechanical, chemical, thermal, light, sound, etc.) in the process of excitation, which is transmitted to the central nervous system. Motor nerve endings transmit excitation from the nerve fiber to the innervated organ.

Rice. 121. Central and peripheral nervous system.

A: 1 - phrenic nerve;2 - brachial plexus;3 - intercostal nerves;4 - axillary nerve;5 - musculocutaneous nerve;6 - radial nerve;7 - median nerve;8 - ulnar nerve;9 - lumbar plexus;10 - sacral plexus;11 - pudendal and coccygeal plexus;12 - sciatic nerve;13 - peroneal nerve;14 - tibial nerve;15 - brain;16 - external cutaneous nerve of the thigh;17 - lateral dorsal cutaneous nerve;18 - tibial nerve.

B - segments of the spinal cord.

B - spinal cord:1 - white matter;2 - gray

substance;3 - spinal canal;4 - front horn;5 -

rear horn;6 - front roots;7 - back roots;8 -

spinal node;9 - spinal nerve.

G: 1 - spinal cord;2 - anterior branch of the spinal nerve;3 - posterior branch of the spinal nerve;4 - anterior root of the spinal nerve;5 - posterior root of the spinal nerve;6 - rear horn;7 - front horn;8 - spinal node;9 - spinal nerve;10 - motor nerve cell;11 - spinal node;12 - terminal thread;13 - muscle fibers;14 - sensitive nerve;15 - the end of the sensory nerve,16 - brain

It is known that higher motor centers are located in the so-called motor zone of the cerebral cortex - in the anterior central gyrus and adjacent areas. Nerve fibers from the indicated region of the cerebral cortex pass through the inner capsule, the subcortical regions and at the border of the brain and spinal cord make an incomplete decussation with the transition of most of them to the opposite side. Therefore, in diseases of the brain, motor disorders are observed on the opposite side: when the right hemisphere of the brain is damaged, the left half of the body is paralyzed, and vice versa. Further, the nerve fibers descend as part of the bundles of the spinal cord, approaching the motor cells, motoneurons of the anterior horns of the spinal cord. Motor neurons that regulate the movements of the upper limbs lie in the cervical thickening of the spinal cord (level V-VIII of the cervical and I-II thoracic segments), and the lower limbs - in the lumbar (level I-V of the lumbar and I-II sacral segments). The fibers coming from the nerve cells of the nuclei of the base nodes - the subcortical motor centers of the brain, from the reticular formation of the brain stem and cerebellum are also sent to the same spinal motor neurons. Thanks to this, the regulation of coordination of movements is ensured, involuntary (automated) movements are carried out and voluntary movements are prepared. The fibers of the motor cells of the anterior horns of the spinal cord, which are part of the nerve plexuses and peripheral nerves, end in the muscles (Fig. 122).

Rice. 122. Dermatome boundaries and segmental innervation(A, B), muscles

human(B), transverse section of the spinal cord(G).

A: C 1-8 - cervical;T 1-12 - chest;L1-5 - lumbar;S 1-5 - sacral.

B: 1 - cervical knot;2 - median cervical node;3 -

lower cervical node;4 - border sympathetic trunk;

5 - cerebral cone;6 - terminal (terminal) thread

meninges;7 - lower sacral node

sympathetic trunk.

B (front view):1 - frontal muscle;2 - chewing

muscle; 3 - sternocleidomastoid muscle;4 -

pectoralis major;5 - the latissimus dorsi muscle;6 -

serratus anterior;7 - white line;8 - seed

cord;9 - thumb flexor;10 -

quadriceps femoris;11 - long fibula

muscle;12 - anterior tibialis muscle;13 - long

extensor of fingers;14 - short muscles of the rear of the foot;15 -

facial muscles;16 - subcutaneous muscle of the neck;

17 - collarbone;18 - deltoid muscle;19 - sternum;20 - biceps muscle of the shoulder;21 - rectus abdominis;22 - muscles of the forearm;23 - umbilical ring;24 - worm-like muscles;25 - wide fascia of the thigh;26 - adductor muscle of the thigh;27 - tailor muscle;28 - extensor tendon retainer;29 - long extensor of the fingers;30 - external oblique muscle of the abdomen.

B (back view):1 - belt muscle of the head;2 - the latissimus dorsi muscle; 3 - ulnar extensor of the wrist;4 - extensor of the fingers;5 - muscles of the rear of the hand;6 - tendon helmet;7 - external occipital protrusion;8 - trapezius muscle;9 - spine of the scapula;10 - deltoid muscle;11 - rhomboid muscle;12 - triceps muscle of the shoulder;13 - medial epicondyle;14 - long radial extensor of the wrist;15 - chest-lumbar fascia;16 - gluteal muscles;17 - muscles of the palmar surface of the hand;18 - semimembranous muscle;19 - biceps;20 - calf muscle;21 - Achilles (heel) tendon

Any motor act occurs when an impulse is transmitted along the nerve fibers from the cerebral cortex to the anterior horns of the spinal cord and further to the muscles (see Fig. 220). In diseases (injuries of the spinal cord) of the nervous system, the conduction of nerve impulses becomes difficult, and a violation of the motor function of the muscles occurs. Complete loss of muscle function is called paralysis (plegia), and the partial paresis.

According to the prevalence of paralysis, there are: monoplegia(lack of movement in one limb - arm or leg), hemiplegia(damage to the upper and lower limbs of one side of the body: right-sided or left-sided hemiplegia), paraplegia(impaired movement in both lower limbs is called lower paraplegia, in the upper - upper paraplegia) and tetraplegia (paralysis of all four limbs). When peripheral nerves are damaged, paresis in the zone of their innervation, called the corresponding nerve (for example, paresis of the facial nerve, paresis of the radial nerve, etc.) (Fig. 123).

Rice. 123. Nerves of the upper limb;1 - radial nerve;2 - skin-

muscular nerve;3 - median nerve;4 - ulnar nerve.I - brush with damage to the radial nerve.II - brush with damage to the median nerve.III - hand with damage to the ulnar nerve

Depending on the localization of the lesion of the nervous system, peripheral or central paralysis (paresis) occurs.

With the defeat of the motor cells of the anterior horns of the spinal cord, as well as the fibers of these cells, which are part of the nerve plexuses and peripheral nerves, a picture of peripheral (flaccid), paralysis develops, which is characterized by a predominance of symptoms of neuromuscular prolapse: limitation or absence of voluntary movements, a decrease in muscle strength, decreased muscle tone (hypotension), tendon, periosteal and skin reflexes (hyporeflexia) or their complete absence. Often there is also a decrease in sensitivity and trophic disorders, in particular muscle atrophy.

To correctly determine the severity of paresis, and in cases of mild paresis - sometimes to identify it, it is important to quantify the state of individual motor functions: muscle tone and strength, and the volume of active movements. The available methods make it possible to compare and effectively control the results of rehabilitation treatment in a polyclinic and a hospital.

To study muscle tone, a tonometer is used, muscle strength is measured with a hand dynamometer, and the volume of active movements is measured with a goniometer (in degrees).

In case of violation of the cortical-subcortical connections with the reticular formation of the brain stem or damage to the descending motor pathways in the spinal cord and, as a result, the function of the spinal motor neurons is activated as a result of a disease or brain injury, a syndrome of central spastic paralysis occurs. It, in contrast to peripheral and central "flaccid" paralysis, is characterized by an increase in tendon and periosteal reflexes (hyperflexia), the appearance of pathological reflexes, the occurrence of the same movements when trying to voluntarily act on a healthy or paralyzed limb (for example, abduction of the shoulder outward when bending the forearm of the paretic hands or clenching a paralyzed hand into a fist with a similar voluntary movement of a healthy hand).

One of the most important symptoms of central paralysis is a pronounced increase in muscle tone (muscle hypertension), which is why such paralysis is often called spastic. For most patients with central paralysis due to brain disease or injury, the Wernicke-Mann posture is characteristic: the shoulder is brought (pressed) to the body, the hand and forearm are bent, the hand is turned palm down, and the leg is extended at the hip and knee joints and bent at the foot. This reflects a predominant increase in the tone of the flexor and pronator muscles in the upper limb and the extensor muscles in the lower one.

With injuries and diseases of the nervous system, disorders occur that sharply reduce the efficiency of patients, often lead to the development of secondary paralytic deformities and contractures that adversely affect the musculoskeletal function. Common to all injuries and diseases of the nervous system are limitation of the range of motion, decreased muscle tone, vegetotrophic disorders, etc.

A deep understanding of the mechanisms of the pathology of the nervous system is the key to the success of rehabilitation measures. So, with discogenic sciatica, nerve fibers are infringed, causing pain, with a stroke, certain areas of motor nerve cells cease to function, so adaptation mechanisms play an important role.

In rehabilitation, compensatory-adaptive reactions of the body are important, which are characterized by the following common features: normal physiological functions of organs and tissues (their functions); adaptation of the organism to the environment, provided by the restructuring of vital activity due to the strengthening of some and the simultaneous weakening of other of its functions; they develop on a single, stereotyped material basis in the form of continuous variation in the intensity of renewal and hyperplasia of the cellular composition of tissues and intracellular structures; compensatory-adaptive reactions are often accompanied by the appearance of peculiar tissue (morphological) changes.

The development of regenerative processes in the nervous tissue occurs under the influence of preserved functions, that is, the nervous tissue is being restructured, the number of processes of nerve cells and their branches on the periphery changes; there is also a restructuring of synaptic connections and compensation after the death of part of the nerve cells.

The process of restoration of the nervous system occurs in nerve cells, nerve fibers and structural elements of tissues due to (or due to) restoration of membrane permeability and excitability, normalization of intracellular redox processes and activation of enzyme systems, which leads to the restoration of conductivity along nerve fibers and synapses.

The rehabilitation regimen should be adequate to the severity of the disease, which is assessed by the degree of impairment of adaptive activity. The level of damage to the central nervous system and peripheral nervous system is taken into account. Important factors are the ability to move independently, take care of oneself (perform housework, eat alone, etc.) and family, communicate with others, assess the adequacy of behavior, the ability to control physiological functions, as well as the effectiveness of training.

The complex rehabilitation system includes the use of exercise therapy, hydrokinesitherapy, various types of massage, occupational therapy, physiotherapy, spa treatment, etc. In each individual case, the combination and sequence of the use of certain rehabilitation means is determined.

In case of severe diseases (injuries) of the nervous system, rehabilitation is aimed at improving the general condition of patients, raising their emotional tone and shaping their correct attitude to the prescribed treatment and the environment: psychotherapy, symptomatic drug therapy, occupational therapy, music therapy, massage in combination with therapeutic exercises, etc. .

Exercise therapy in neurology has a number of rules, the observance of which makes this method the most effective: early use of exercise therapy; the use of its means and techniques to restore temporarily impaired functions or to maximize compensation for those lost; selection of special exercises in combination with general developmental, general strengthening exercises and massage; strict individuality of exercise therapy, depending on the diagnosis, age and gender of the patient; active and steady expansion of the motor mode from the lying position to the transition to the sitting position, standing, etc.

Special exercises can be conditionally divided into the following groups:

exercises that increase joint range of motion and muscle strength;

exercises aimed at restoring and improving coordination of movements;

antispastic and antirigid exercises;

ideomotor exercises (sending a mental impulse to a trained muscle group);

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 (C 6 -T 4), flaccid paresis of the arms and spastic paresis of the legs occurs, 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.

The massage technique includes massaging the collar region, back (to the lower corners of the shoulder blades), legs, as well as the effect on the BAP by the inhibitory or stimulating method, depending on the prevalence of one or another symptom. The duration of the massage is 10-15 minutes. Course 10-15 procedures. 2-3 courses per year. With a headache, cryomassage No. 5 is indicated.

Patients are not allowed to visit the bath (sauna), sunbathe, take hyperthermic baths!

Vascular epilepsy

The occurrence of epileptic seizures in dysciculatory encephalopathy is associated with the formation of cicatricial and cystic changes in the brain tissue and regional cerebral hypoxia.

The system of rehabilitation of patients includes exercise therapy: general developmental exercises, breathing, coordination. Exercises with straining, with weights, as well as with prolonged head tilts are excluded. Therapeutic exercises are performed at a slow pace, without sudden movements. Swimming, cycling, visiting the sauna (bath) are also excluded.

Physiotherapy includes electrosleep, drug electrophoresis No. 10, oxygen therapy. A general massage is performed, with the exception of percussion techniques. Occupational therapy is carried out on stands, box gluing, bookbinding, etc.

Osteocondritis of the spine

Degenerative changes in the intervertebral discs occur as a result of the physiological neuroendocrine aging process and due to wear and tear under the influence of one-time injuries or repeated microtraumas. Most often, osteochondrosis occurs in athletes, hammerers, typists, weavers, drivers, machine operators, etc.

General massage, cryomassage, vibration massage, LG (Fig. 124), hydrocolonotherapy help to restore the function of the spinal column as soon as possible. They cause deep hyperemia, improve blood and lymph flow, have an analgesic and resolving effect.

Massage technique. First, a preliminary back massage is performed using stroking techniques, shallow kneading of the muscles of the entire back. Then they proceed to massage the spinal column, using rubbing with the phalanges of four fingers, the base of the palm, kneading with the phalanges of the first fingers, forceps, ordinary and double ring kneading of the broad muscles of the back. Particularly carefully grind, knead BAP. Rubbing and kneading techniques should be alternated with stroking with both hands. In conclusion, active-passive movements are carried out, breathing exercises with an emphasis on exhalation and compression of the chest 6-8 times. The duration of the massage is 10-15 minutes. Course 15-20 procedures.

Rice. 124. Approximate complex of LH in osteochondrosis of the spine

Discogenic radiculitis

The disease often affects the intervertebral discs of the lower part of the spinal column. This is explained by the fact that the lumbar region has greater mobility and is subjected to the most intense static-dynamic loads on the muscular-ligamentous apparatus. Pain occurs when the spinal nerve roots are compressed by a disc herniation. The pain syndrome is characterized by acute development. Pain can occur in the morning, after heavy physical exertion, and in some cases is accompanied by muscle spasm. There is some limitation of movements in the lumbar spine, lumbar discomfort.

Conservative treatment is shown. Traction is carried out on the shield with a preliminary massage or heating with a solar lamp or manual therapy. After the disappearance of pain - LH in the prone position, on all fours, in the knee-elbow position. The pace is slow to avoid pain. Exercises with inclinations in a standing position are excluded.

Massage objectives: to provide analgesic and anti-inflammatory effects, to promote the speedy recovery of spinal function.

Massage technique. First, stroking, light vibration is performed in order to relieve tension in muscle tone, then longitudinal and transverse kneading of the broad muscles of the back, rubbing with fingertips along the spinal column. Tapping, chopping should not be used to avoid muscle spasm and increased pain. After the procedure, traction is carried out on a shield or in water. The duration of the massage is 8-10 minutes. Course 15-20 procedures.

lumbosacral pain spinal injuries occur, as a rule, immediately after a fall, blow, etc. In mild cases, transient lumbodynia develops with pain in the lumbar region. Acute pain can result from excessive flexion in the lumbosacral region.

LH is performed in the supine position. Includes exercises to stretch the sciatic nerve. Raising the legs up 5-8 times; "bicycle" 15-30 s; turns of the legs bent at the knee and hip joints to the left and to the right 8-12 times; raise the pelvis, pause for a count of 5-8, then return to the starting position. The last exercise is diaphragmatic breathing.

Massage objectives: to provide analgesic and anti-inflammatory effects, improve blood and lymph flow in the damaged area.

Massage technique. The initial position of the patient is lying on his stomach, a roller is placed under the ankle joints. Planar and embracing stroking is applied with the palms of both hands. Kneading is performed with both hands both longitudinally and transversely, while massage movements are performed in ascending and descending directions. In addition, planar stroking is used with the first fingers of both hands in the upward direction, rubbing and kneading with the fingertips, the base of the palm along the spinal column. All massage techniques should be alternated with stroking. Do not use chopping, tapping and intensive kneading. In the early days, the massage should be gentle. The duration of the massage is 8-10 minutes. Course 15-20 procedures.

Lumbago (lumbago) is perhaps the most common manifestation of pain in the lumbar region. Attack-like developing acute piercing pains are localized in the muscles of the lower back and lumbo-dorsal fascia. The disease often occurs in people engaged in physical labor, in athletes, etc., with the combined effect of tension in the lumbar muscles and hypothermia. Chronic infections also play an important role. Pain usually lasts for several days, sometimes 2-3 weeks. Pathophysiologically, with lumbago, there is a tear of the muscle bundles and tendons, hemorrhages in the muscles, and the subsequent phenomena of fibromyositis.

LH (general developmental exercises, stretching exercises and breathing exercises) are performed in the prone position and knee-elbow. The pace is slow. Traction on the shield and cupping massage are shown.

Massage technique. First, a preliminary massage of all the muscles of the back is carried out, then stroking, rubbing and shallow kneading of the muscles of the lumbar region. Professor S.A. Flerov recommends massaging the lower hypogastric sympathetic plexus in the lower abdomen, at the site of bufurcation of the abdominal aorta. Observations show that massage according to the method of S.A. Flerova relieves pain. In the acute period, cryomassage No. 3 is indicated.

sciatica

According to most authors, the disease is caused mainly by congenital or acquired changes in the spinal column and its ligamentous apparatus. Significant and prolonged physical stress, trauma, unfavorable microclimatic conditions, and infections contribute to the development of the disease.

The pain of sciatica can be sharp or dull. It is localized in the lumbosacral region, usually on one side, radiates to the buttock, back of the thigh, outer surface of the lower leg, sometimes combined with numbness, paresthesia. Hyperesthesia is often found

Heading:

Functional diseases of the nervous system, or neuroses, are various disorders of nervous activity in which there are no visible organic changes in the nervous system or internal organs.

I. P. Pavlov characterized neuroses as follows: “Under neuroses we mean chronic (lasting a week, months and even years) deviations of higher nervous activity from the norm.”

In order to more clearly imagine the mechanism of the therapeutic effect of physical exercises in neuroses, let us briefly familiarize ourselves with the structure and activity of the human nervous system. The nervous system plays a leading role in regulating the activity of internal organs and provides a person with an inextricable connection with the external environment.

The nervous system is divided into central and peripheral.

The central nervous system consists of the brain and spinal cord, and the peripheral nervous system consists of numerous nerves extending from the spinal cord and brain, and a number of clusters of nerve cells located in various organs and tissues outside the central nervous system.

Peripheral nerves are divided into centripetal and centrifugal. Centripetal nerves transmit excitation from various parts of the body to the central nervous system, and centrifugal - from the central nervous system to the muscles, glands and other internal organs, causing and regulating their activity.

Various kinds of influences exerted on the body by the external and internal environment are perceived by organs - analyzers. Analyzers perceive the actions of various stimuli from the external environment - light, sound, mechanical, temperature, chemical and others.

There are analyzers that perceive changes in the contraction or relaxation of muscles, in the chemical composition of the blood, and pressure in the vessels.

Excitation from the analyzer passes into the central nervous system through the nerve cells and their processes. The final link of the analyzer is the nerve cells of the cerebral hemispheres.

Irritations acting on the analyzers cause various reactions of the organism. The responses are called reflexes.

All reflexes are divided into unconditioned and conditional.

Unconditioned reflexes are called congenital, inherited from parents and developed during the long evolutionary development of man.

Examples of unconditioned reflexes can be the secretion of saliva when food is introduced into the mouth, the withdrawal of a hand during an injection, alertness at an unusual sound, etc. Although unconditioned reflexes are of great importance in human life, they are still not enough to adapt the body to constantly changing external conditions. environment. And this most important function (adaptation) is performed by conditioned reflexes.

Conditional are reflexes acquired by a person or animal throughout his life in the process of accumulating individual experience. For example, in response to a red traffic light, which is a conditioned stimulus, the driver performs a series of movements that bring the car to a stop. Depending on certain conditions, with the obligatory participation of the cerebral cortex, reflexes arise, improve, persist or fade away.

The most important feature of the formation of conditioned reflexes in humans is that they can be formed when reinforced with verbal stimuli (verbal instructions, commands, etc.).

Studying the patterns of occurrence, course and extinction of conditioned reflex reactions, IP Pavlov and his students studied in detail the processes of excitation and inhibition that develop in the cerebral cortex, which are the main ones in the activity of the central nervous system.

Excitation corresponds to an active state, inhibition - to relative rest.

It is also necessary to dwell on one more feature of higher nervous activity. In most cases, in certain periods of time, people's lives fit into certain limits, proceed in a standard, stereotypical way, for example, at school, at a university, at an institution, at a factory, in a rest home, in a sanatorium, etc. And all this habitual way, a uniformly repeating external routine, an external system of actions, techniques and deeds is reflected and formed in the cerebral cortex as a definite, well-coordinated internal system of nervous processes. This is the so-called dynamic stereotype, that is, a system of fixed, interconnected and sequentially acting conditioned reflexes.

The process of formation or development of a dynamic stereotype is the work of the nervous system, the intensity of which depends on the complexity of the stereotype and on the individual characteristics of the organism.

Soviet physiologists proved that it is easier for the nervous system, even under difficult circumstances, to repeat the same thing than to change the habitual stereotype, to adapt to new stimuli, however weak.

Switching processes are important for maintaining the active function of the central nervous system. Their essence lies in the fact that with a change in the form, nature and intensity of activity, nervous processes are rebuilt, which provides rest for the nerve centers weary from previous work.

Depending on the strength, balance and mobility of the main nervous processes of excitation and inhibition, four types of the nervous system have been identified.

The first is a strong, unbalanced, or "unrestrained" type (choleric). (Classification of the ancient Greek physician Hippocrates.)

The second is strong, balanced, lively (sanguine).

The third is strong, balanced, slow (phlegmatic).

The fourth is weak (melancholic).

Choleric and melancholic neuroses are the most frequently affected.

The type of the nervous system is not something fixed and fixed once and for all. Under the influence of education and training, it is possible to achieve an intensification of excitatory or inhibitory processes and a better balancing of them. Many cases are known when quick-tempered people and sluggish, indecisive people develop in themselves qualities that they lack.

What is the mechanism of occurrence of a functional disease of the nervous system - neurosis?

Neuroses can arise under the influence of extremely acute nervous experiences, leading to the so-called breakdown of higher nervous activity, that is, to such an overstrain of nervous processes when the situation seems or really is hopeless and the search for a way out can lead to completely unjustified actions and actions. Such a breakdown can lead to a long-term functional disease of the nervous system - neurosis. All kinds of chronic infections (tuberculosis, malaria) and poisoning (alcohol, nicotine, lead), which deplete the body, contribute to the formation of neurosis.

By the way, the opinion that many people have that only mental workers suffer from neuroses is completely unfounded, since breakdowns in higher nervous activity can occur in any person, regardless of his profession, as a result of any traumatic factors (violation of the regimen, conflicts, tension, etc.).

Neuroses can be treated with medicines and streamlining the regime of work and life (including rest, training and hardening). It is necessary to recognize both methods as effective in their combination, but it is completely wrong when the patient relies on some kind of magical effect of only “good” drugs taken orally, or on physiotherapeutic procedures, completely missing physical exercises that are distinguished by simplicity and accessibility, natural factors of nature, rational a mode that contributes to the restoration of normal performance by increasing the fitness of the whole organism, and in particular its nervous system.

Physical culture normalizes the activity of internal organs, distracts the patient from thoughts about diseases and involves him in active and conscious participation in the fight against his illness.

A huge mass of signals entering the cerebral cortex during gymnastics, games, swimming, rowing, skiing, etc., increases the tone of the central nervous system and helps eliminate neurosis. With all the main types of neuroses - neurasthenia, hysteria and psychasthenia - our recommendations remain valid, and their individualization is possible after consulting a doctor.

Patients suffering from neurosis, explain the rapid fatigue during physical education, the "weakness" of the heart and unjustifiably stop classes.

But both physical culture and natural factors of nature show their healing effect to the fullest only when combined with the observance of the regime.

A properly organized regime not only strengthens the body, protecting it from diseases (especially nervous ones), but educates the will and increases efficiency.

The elements of the mode are as follows:

1. The right combination of mental and physical work.

2. Normal sleep in hygienic conditions.

3. Morning exercises.

4. Morning water procedures.

5. Regular food intake.

6. Walks (daily).

7. Active recreation on a working day (physical education break), on weekends and during vacations.

8. Systematic sports.

With the constant implementation of the regimen, a certain sequence develops in the course of nervous processes (dynamic stereotype), leading to a more economical expenditure of nervous and physical energy.

In the treatment of neuroses, the following forms of therapeutic physical culture are used:

1. Gymnastics.

2. Outdoor and sports games (volleyball, tennis, etc.).

3. Walks.

4. Tourism.

5. Elements of athletics.

6. Skis and skates.

7. Swimming,

8. Rowing.

Of course, during training, strict gradualness should be observed and physical exercises (of any form) must be completed with a feeling of cheerfulness, with a feeling of desire to continue training.

Of particular value are the forms of physical exercises performed in the bosom of nature in the sense of their positive effect on the neuropsychic sphere.

1st COMPLEX OF THERAPEUTIC GYMNASTICS (with less load)

1. IP - legs apart, hands below, fingers interlaced. Raise your hands up, stretch - inhale. 4-6 times. TM.

2. IP - legs apart. Tilt forward, touch the floor with your fingers - exhale. 4 times. TM.

3. IP - the main stand. Tilt the torso to the left (and to the right), without stopping in the starting position, the arms slide along the torso. Breathing is arbitrary. 3-4 times in each direction. TM.

4. IP - hands on the belt. Squat, hands forward - exhale. 6-8 times. TM.

5. IP - legs apart, right hand forward, left bent, hands into a fist. Changing the position of the hands ("boxing"). 10-15-20 times. TB. Breathing is arbitrary.

6. IP - legs apart, hands on the belt. Elbows forward. 3-4 times. TM

7. IP - legs apart, hands on the belt. Turn the body to the left, arms to the sides. 4-5 times in each direction. TM

8. IP - sitting on a chair, legs apart and bent at the knees, hands on the belt. Pull the bent left (right) leg to the chest with your hands. 4-6 times with each leg. TM.

9. IP - hands on the belt. Jump - legs apart, arms to the sides. 10-30 times. Breathing is arbitrary.

10. Walking 1-1.5 min.

11. IP - legs apart, right hand on the chest, left hand on the stomach. Sticking out the chest and stomach-inhale. 3-4 times. TM

2nd COMPLEX OF THERAPEUTIC GYMNASTICS (greater difficulty)

1. IP - main stance - arms up, right (left) leg back on the toe. 6-8 times. TS

2. IP - legs apart, arms to the sides. Tilt forward to the left, touch the left sock with the right hand. 3-4 times in each direction. TS.

3. IP - legs apart, hands up, fingers interlaced. Tilts of the body to the right and left, without stopping in the starting position. Breathing is arbitrary. 3-4 times in each direction. TS

4. IP A - emphasis lying. B. Bend your elbows - exhale IP - inhale. B-version. Simultaneously with the bending of the arms, take the leg back. 6-8-10 times. TS.

5. IP - lying on the back, left palm on the chest, right on the abdomen. Full (diaphragmatic-thoracic) breathing. 3-4 times. TM.

6. IP - lying on your back, arms along the body. Sit down, lean forward and touch your socks with your hands - 5 times. TM

7. IP - legs apart, arms to the sides - up. Arcs forward arms back, deep squat on a full foot, 6-10 times. TS.

8. IP - legs apart, hands up, fingers interlaced. Rotation of the body 3-4 times in each direction. Breathing is arbitrary. TM

9. IP - legs apart. Rise on your toes and pull the brushes to the armpits. 4-5 times. TM.

Above we give approximate sets of gymnastic exercises that can be performed during morning exercises or during the day.

The given complexes of gymnastic exercises, of course, do not exhaust the whole variety of gymnastics. We will try to show on separate examples how it is possible to complicate the performance of some exercises, thereby increasing physical activity.

Lateral torso becomes more difficult when moving the arms up (hands on the belt, hands behind the head, hands up). The load can also be increased by increasing the number of repetitions of exercises and accelerating the pace of their implementation.

If the neurotic sufferer has any other comorbidities, we recommend that you refer to the relevant chapters of this book in order to select exercises for individual practice. Gymnastic exercises often contribute to the disappearance of a headache in a patient with neurasthenia.

When treating headaches with movement, one should avoid changing the position of the head, jerking movements (jumps, punches, etc.) and exercises associated with great straining.

The best starting position is horizontal - lying on your back with a slightly raised headboard. We recommend movements in the ankle, wrist, knee, elbow, hip and shoulder joints, for example:

1. Rotation of the feet and hands.

2. Flexion of the leg at the knee and hip joints.

3. Bending of the arms in the elbow joints.

4. Leading straight arms to the sides, etc.

Therapeutic exercise in diseases of the nervous system plays a significant role in the rehabilitation of neurological patients. Treatment of the nervous system is impossible without therapeutic exercises. Exercise therapy for diseases of the nervous system has the main goal of restoring self-care skills and, if possible, complete rehabilitation.

It is important not to miss the time to create the correct new motor stereotypes: the earlier treatment is started, the easier, better and faster the compensatory-adaptive recovery of the nervous system occurs.

In the nervous tissue, the number of processes of nerve cells and their branches on the periphery increases, other nerve cells are activated, and new nerve connections appear to restore lost functions. Timely adequate training is important for creating the correct stereotypes of movements. So, for example, in the absence of physiotherapy exercises, a "right-brained" stroke patient - a restless fidget "learns" to walk, pulling the paralyzed left leg to the right and dragging it behind him, instead of learning to walk correctly, with each step moving the leg forward and then transferring the center of gravity of the body to it. If this happens, then it will be very difficult to retrain.

Not all patients with diseases of the nervous system can do the exercises on their own. Therefore, they cannot do without the help of their relatives. To begin with, before starting therapeutic exercises with a patient who has paresis or paralysis, relatives should master some techniques for moving the patient: transplanting from bed to chair, pulling up in bed, walking training and so on. In fact, this is a safety technique to prevent excessive stress on the spine and joints of the caregiver. Lifting a person is very difficult, so all manipulations must be performed at the level of a magician in the form of a “circus trick”. Knowing some special techniques will greatly facilitate the process of caring for the sick and help maintain your own health.

Features of exercise therapy in diseases of the nervous system.

one). Early initiation of exercise therapy.

2). Adequacy of physical activity: physical activity is selected individually with a gradual increase and complication of tasks. A slight complication of the exercises psychologically makes the previous tasks “easy”: what previously seemed difficult, after new slightly more complex tasks, is performed more easily, with high quality, the lost movements gradually appear. It is impossible to allow overload in order to avoid deterioration of the patient's condition: motor disturbances may increase. In order for progress to occur faster, it is necessary to finish the lesson on the exercise that this patient has, to focus on this. I attach great importance to the psychological preparation of the patient for the next task. It looks something like this: "Tomorrow we will learn to get up (walk)." The patient thinks about it all the time, there is a general mobilization of forces and a readiness for new exercises.

3). Simple exercises are combined with complex ones for training higher nervous activity.

4). The motor mode gradually steadily expands: lying - sitting - standing.

Therapeutic exercise for diseases of the nervous system.5). All means and methods of exercise therapy are used: therapeutic exercises, positional treatment, massage, extension therapy (mechanical straightening or stretching along the longitudinal axis of those parts of the human body that have a disturbed anatomical location (contractures)).

The main method of physical therapy for diseases of the nervous system is therapeutic exercises, the main means of exercise therapy are exercises.

Apply

Isometric exercises aimed at strengthening muscle strength;
- exercises with alternating tension and relaxation of muscle groups;
- exercises with acceleration and deceleration;
- coordination exercises;
- balance exercise;
- reflex exercises;
- ideomotor exercises (with mental sending of impulses). It is these exercises that I use for diseases of the nervous system - - - - most often in combination with Su-jok therapy.

Damage to the nervous system occurs at different levels, the neurological clinic depends on this and, accordingly, the selection of therapeutic exercises and other physiotherapeutic therapeutic measures in the complex treatment of a particular neurological patient.

Hydrokinesitherapy - exercises in water - a very effective method of restoring motor functions.

Exercise therapy for diseases of the nervous system is divided according to the parts of the human nervous system, depending on which part of the nervous system is affected:

exercise therapy for diseases of the central nervous system;
exercise therapy for diseases of the peripheral nervous system;
exercise therapy for diseases of the somatic nervous system;
Exercise therapy for diseases of the autonomic nervous system.

Some subtleties of work with neurological patients.
In order to calculate our strength in caring for a neurological patient, we will consider some significant factors, since the care process is complex, and it is not always possible to cope alone.

The state of mental activity of a neurological patient.
The patient's experience in physical education before illness.
The presence of excess weight.
Depth of damage to the nervous system.
Accompanying illnesses.

For physiotherapy exercises, the state of higher nervous activity of a neurological patient is of great importance: the ability to be aware of what is happening, to understand the task, to concentrate attention when performing exercises; volitional activity plays a role, the ability to resolutely tune in to daily painstaking work in order to achieve the goal of restoring the body's lost functions.

In the case of a stroke or brain injury, most often the patient partially loses the adequacy of perception and behavior. Figuratively, it can be compared with the state of a drunk person. There is a "disinhibition" of speech and behavior: the shortcomings of character, upbringing and inclination to what is "impossible" are exacerbated. Each patient has a behavioral disorder that manifests itself individually and depends on the

one). what activity the patient was engaged in before the stroke or before the brain injury: mental or physical labor (it is much easier to work with intellectuals if the body weight is normal);

2). how developed the intellect was before the disease (the more developed the intellect of a patient with a stroke, the more the ability to purposefully exercise exercise remains);

3). in which hemisphere of the brain did the stroke occur? "Right hemispheric" stroke patients behave actively, show emotions violently, do not hesitate to "express"; they do not want to follow the instructions of the instructor, they start walking ahead of time, as a result, they have a risk of forming incorrect motor stereotypes. “Left hemispheric” patients, on the contrary, behave inactively, do not show interest in what is happening, just lie down and do not want to engage in physiotherapy exercises. It is easier to work with "right hemisphere" patients, it is enough to find an approach to them; what is needed is patience, a delicate and respectful attitude, decisiveness of methodical instructions at the level of a military general. :)

During classes, instructions should be given decisively, confidently, calmly, in short phrases, it is possible to repeat instructions due to the patient's slow perception of any information.

In case of loss of behavioral adequacy in a neurological patient, I have always effectively used the “cunning”: you need to talk to such a patient as if he is a completely normal person, not paying attention to “insults” and other manifestations of “negativity” (unwillingness to engage in, denial of treatment other). It is not necessary to be verbose, it is necessary to make small pauses so that the patient has time to realize the information.

In case of damage to the peripheral nervous system, flaccid paralysis or paresis develops. If at the same time there is no encephalopathy, then the patient is capable of much: he can independently exercise a little during the day several times, which undoubtedly increases the chance of restoring movements in the limb. Flaccid paresis is more difficult to respond to than spastic paresis.

* Paralysis (plegia) - the complete absence of voluntary movements in the limb, paresis - incomplete paralysis, weakening or partial loss of movement in the limb.

It is necessary to take into account another important factor: whether the patient was engaged in physical education before the disease. If physical exercises were not included in his lifestyle, then rehabilitation in case of a disease of the nervous system becomes much more complicated. If this patient has exercised regularly, then the recovery of the nervous system will be easier and faster. Physical labor at work does not belong to physical education and does not bring benefits to the body, since it is the exploitation of one's own body as a tool for doing work; he does not add health due to the lack of dosing of physical activity and control of well-being. Physical labor is usually monotonous, so there is wear and tear of the body in accordance with the profession. (So, for example, a painter-plasterer "earns" humeroscapular periarthrosis, a loader - osteochondrosis of the spine, a massage therapist - osteochondrosis of the cervical spine, varicose veins of the lower extremities and flat feet, and so on).

For home exercise therapy for diseases of the nervous system, you will need ingenuity to select and gradually complicate exercises, patience, regularity of daily exercises several times during the day. It will be much better if in the family the burden of caring for the sick is distributed to all family members. The house should be in order, cleanliness and fresh air.

It is desirable to put the bed so that it has access from the right and left sides. It should be wide enough to allow the patient to be rolled from side to side when changing bed linen and changing body position. If the bed is narrow, then each time you have to pull the patient to the center of the bed so that he does not fall. You will need additional pillows and rollers to create a physiological position of the limbs in the supine position on the side and back, a splint for the paralyzed arm to prevent contracture of the flexor muscles, a regular chair with a back, a large mirror so that the patient can see and control his movements (especially the mirror necessary in the treatment of neuritis of the facial nerve).

There should be room on the floor for lying down exercises. Sometimes you need to make handrails for support with your hands in the toilet, in the bathroom, in the corridor. To do therapeutic gymnastics with a neurological patient, you will need a wall bar, a gymnastic stick, elastic bandages, balls of different sizes, skittles, a roller foot massager, chairs of different heights, a step bench for fitness and much more.

Nervous system is a complex system that regulates and coordinates the activities of the human body. It is based on the central nervous system (CNS), which consists of the brain and spinal cord, and the peripheral nervous system (PNS), which includes the rest of the neural elements.
In addition to the brain and spinal cord, the most important organs of the nervous system include the eyes, ears, organs that are responsible for taste and smell, as well as sensory receptors located on the skin, in joints, muscles and other parts of the body.
In our time, diseases and damage to the nervous system are quite common. They can occur as a result of trauma, infection, degeneration, structural defects, tumors, blood flow disorders, and also due to autoimmune diseases (when the body begins to attack itself).
Diseases of the nervous system can lead to movement disorders such as paralysis, paresis, hyperkinesis.
Paralysis (or plegia) is the complete loss of muscle contraction. Paresis - partial loss of the motor function of the body. Paralysis or paresis of one limb is called - monoplegia or monoparesis, two limbs of one side of the body - hemiplegia or hemiparesis, three limbs - triplegia or triparesis and four limbs - tetraplegia or tetraparesis.
There are two types of paralysis and paresis: spastic and flaccid. With spastic paralysis, there is a lack of only voluntary movements, as well as an increase in muscle tone and all tendon reflexes. Flaccid paralysis is characterized by the absence of both voluntary and involuntary movements, tendon reflexes, as well as low muscle tone and atrophy.
Hyperkinesias are altered movements that are devoid of physiological significance and occur involuntarily. Hyperkinesias include convulsions, athetosis, trembling.
There are two types of cramps: clonic, which are rapidly alternating muscle contractions and relaxations, and tonic, which are prolonged muscle contractions. Seizures occur as a result of irritation of the cortex or brain stem.
Athetosis is slow worm-like movements of the fingers, hands of the body, which lead to the fact that when walking the body twists in a corkscrew shape. This disease is formed when the subcortical nodes are affected.
Trembling is characterized by involuntary rhythmic vibrations of the limbs or head. It occurs as a result of damage to the cerebellum and subcortical formations.
Ataxia is a lack of coordination of movements. There are two types of ataxia: static (impaired balance when standing) and dynamic (impaired coordination of movements, characterized by disproportionate motor acts). As a rule, ataxia is formed as a result of damage to the cerebellum and the vestibular apparatus.

Very often, in diseases of the nervous system, sensitivity disorders occur. There is a complete loss of sensitivity, which is called anesthesia, and there is also a decrease in sensitivity - hypoesthesia and an increase in sensitivity - hyperesthesia. If the patient has violations of superficial sensitivity, then in this case he does not distinguish between heat and cold, does not feel pricks. If there is a disorder of deep sensitivity, then the patient loses the idea of ​​the position of the limbs in space, which leads to uncontrollability of his movements. Damage to the peripheral nerves, roots, adductor tracts and spinal cord, as well as adductor tracts and the parietal lobe of the cerebral cortex lead to sensory disturbances.
As a result of many diseases of the nervous system, trophic disorders occur in the body, namely: the skin becomes dry, cracks appear on it, bedsores form, which also capture the underlying tissues, bones become brittle and brittle. Especially severe bedsores are observed when the spinal cord is damaged.

All of the above diseases of the nervous system are very relevant in our time, and with the help of modern medicine, which has a wide range of therapeutic agents in its arsenal, they are quite treatable. A special role in the treatment and rehabilitation of patients with various diseases and injuries of the central and peripheral nervous system is played by physiotherapy exercises in diseases of the nervous system.

Thanks to exercise therapy in diseases of the peripheral nervous system, there is a disinhibition of nerve sections that are in a state of oppression, as well as stimulation of regeneration processes, which in turn helps to restore nerve conduction, improve movements and other functions that were impaired as a result of the pathological process. Physical exercises in diseases of the nervous system help to improve trophism at the site of nerve damage, and also prevent the formation of adhesions and cicatricial changes, that is, secondary deformities. If the lesions of the peripheral nerves are irreversible, then in this case, special exercises for diseases of the nervous system provide the formation of motor compensations. Physiotherapy exercises and therapeutic exercises for diseases of the nervous system are used both for injuries of peripheral nerves and for inflammatory processes in them. Exercise therapy and LH in diseases of the nervous system are contraindicated only if the patient has a severe general condition and severe pain.

Exercise therapy for diseases of the central nervous system contributes to the restoration of impaired functions of the brain and spinal cord and is a therapeutic and educational process, which is carried out with the help of conscious and active (as far as possible) participation of the patient. Therapeutic exercises for diseases of the nervous system, which are also combined with psychotherapeutic effects, are primarily aimed at increasing the general vitality of the patient, which in turn creates favorable conditions for the restoration and compensation of lost functions.

Exercise therapy for neurosis is a natural biological method in which the use of physical exercises and natural factors of nature is physiologically justified. Thanks to exercise therapy and PH in neuroses, there is a direct effect on the main pathophysiological manifestations that are observed in this disease, physical exercises in neuroses help to equalize the dynamics of the main nervous processes, as well as coordinate the functions of the cortex and subcortex, the first and second signal systems, etc.

Thus, physiotherapy exercises and (their regular use) occupy a very important place in the recovery processes and complex treatment.

Exercise therapy complex for diseases of the nervous system:
(before class, you need to count the pulse)
1. Walking in a circle alternately in one direction and the other, then walking with acceleration. Perform 1-2 minutes.
2. Walking in a circle on toes, on heels alternately in one direction and the other, then with acceleration. Perform 1-2 minutes.
3. I.P. - standing, arms along the body. Relax all muscles.
4. I. P - the same. Alternately raise your hands up (first the right hand, then the left), gradually accelerate the movements. Run 60 to 120 times in 1 minute.
5. I.P. - feet shoulder-width apart, hands clasped into the castle. Raise your arms above your head - inhale, then lower your arms through the sides down - exhale. Repeat 3-4 times.
6. I.P. - feet shoulder-width apart, arms extended in front of the chest. Squeeze and unclench your fingers with acceleration - from 60 to 120 times in 1 minute. Perform 20-30 seconds.
7. I.P. - feet shoulder-width apart, hands clasped into the castle. Raise your arms above your head - inhale, then lower your hands sharply down between your legs - exhale. Repeat 3-4 times.
8. I.P. - legs together, hands on the belt. Do a squat - exhale, return to the starting position - inhale. Repeat 4-5 times.
9. I.P. - standing on toes. Get down on your heels - exhale, return to the starting position - inhale. Repeat 5-6 times.
10. This exercise is performed in pairs - to overcome resistance:
a) I.P. - standing facing each other, holding hands, which are bent at the elbows. In turn, each of the pair resists with one hand, while straightening the other hand. Repeat 3-4 times.
b) I.P. - standing facing each other holding hands. Leaning against each other with your knees, do a squat (straighten your arms), then return to the starting position. Repeat 3-4 times.
c) I.P. - the same. Raise your hands up - inhale, lower - exhale. Repeat 3-4 times.
d) I.P. - the same. Put your right foot on the heel, then on the toe and make three stomps with your feet (at a dance pace), then separate your hands and clap your palms 3 times. Repeat the same with the left leg. Do 3-4 times with each leg.
11. I.P. - standing facing the wall 3 m from it, holding the ball. Throw the ball with both hands against the wall and catch it. Repeat 5-6 times.
12. I.P. - standing in front of the ball. Jump over the ball, turn around. Repeat 3 times on each side.
13. Exercises performed on shells:
a) walk along the gymnastic bench (log, board), maintaining balance. Repeat 2-3 times.
b) perform jumps from the gymnastic bench. Do 3-4 times.
c) I.P. - standing at the gymnastic wall, with outstretched arms, hold on to the ends of the rail at shoulder level. Bend your arms at the elbows, press your chest against the gymnastic wall, then return to the starting position. Repeat 3-4 times.
14. I.P. - standing, arms along the body. Rise on toes - inhale, return to the starting position - exhale. Repeat 3-4 times.
15. I.P. - the same. In turn, relax the muscles of the arms, torso, legs.
After completing all the exercises, count the pulse again.

Exercise therapy for neurosis.
A set of physical exercises for neuroses No. 1:
1. I.P. - standing, legs apart. Close your eyes, raise your hands to shoulder level, then connect straightened index fingers in front of your chest, while opening your eyes. Raising your hands, inhale, lowering - exhale. Repeat 4-6 times.
2. I.P. - feet shoulder width apart, arms along the body. Make movements with your hands that imitate rope climbing. Breathing is even. Do 2-4 times.
3. I.P. - legs apart, hands on the belt. In turn, take your legs to the sides to failure. Breathing is even. Run 2-6 times.
4. I.P. - legs together, arms along the body. Raise your hands up and at the same time raise and bend your left leg at the knee. When raising your hands, inhale, when lowering, exhale. Then repeat the same with the other leg. Perform with each leg 2-4 times.
5. I.P. - the same. At the expense of "one" - make a jump in place, legs apart. Make a clap with your hands above your head. On the count of "two" - jump back to the starting position. Run 2-6 times.
6. I.P. - the same. Perform jumps on toes, while not tilting the torso forward, arms below. Do 5-10 times.
7. I.P. - legs apart, arms below. Perform hand movements that mimic the movements of a swimmer. Breathing is even. Run 5-10 times.
8. I.P. - legs together, arms along the body. Raise the left and right legs in turn forward, while clapping your hands under the raised leg and behind your back. Breathing is even. Do 3-6 times.
9. I.P. - legs apart, arms along the body. Throw a small ball up in front of you, clap your hands behind your back and catch the ball. Breathing is even. Do 5-10 times.
10. I.P. - the same. Raise your arms, bend at the elbows and bring them to the shoulders. Raising your hands, inhale, lowering - exhale. Do 4-6 times.

A set of exercises for neuroses No. 2:
1. Sit on a chair, stretch your arms in front of you. Take a breath - take your hands to the sides, bend in the chest area. Exhale - return your hands to their original position and lower your head. The pace is slow. Do 6-8 times.
2. Sit on the mat (legs straight), two-kilogram dumbbells in your hands. Inhale - touch the toes with the dumbbells, exhale - pull the dumbbells towards you. Do 12 times.
3. Stand up, lower your arms, put your left foot forward (heel to toe of your right foot). Standing still, maintaining balance, imitate the movements of the windmill wings with your hands. Having lost balance, return to the starting position and start the exercise again.
4. I.P. - standing, legs together. Inhale - take two steps (from the left foot), exhale - two jumps on the left leg and two jumps on the right, while moving forward. Do 8 times.
5. I.P. - the same. Inhale - raise your arms to the sides, exhale - put your left foot close to your right and, closing your eyes, maintain balance. Take a breath - return to the starting position. Run 8 times.
6. Place a chair at a distance of 4 steps from the wall, then stand in front of the chair. Throw a tennis ball at a wall, sit on a chair and catch the ball after it bounces off the floor. Do 10 times.
7. Lie on your back, relax. Inhale - tighten the muscles of the arms and legs (in turn), exhale - relax. Do 3-4 times.
8. Feet together, arms down. Rhythmically walk around the room, while changing the position of the hands: first put them on the hips, then raise them to the shoulders, then to the head and clap in front of you. Repeat 3 times.
9. Sit on a chair, bend your legs, put your hands on the edge of the chair. Take a breath, then a long exhale and pull the bent legs to the chest, then straighten them, spread them apart, bend and put them on the floor. Do 8 times.
10. I.P. - standing, legs together. Take two steps - inhale, raise your arms to the sides, then take the third step - sit down and stretch your arms forward. Then stand up, put your hands down. Do 4 times.
11. Stand on the bar with one foot, pick up a tennis ball. Stand on one foot (on the left, then on the right), hitting the ball on the floor with one hand and catching with the other. Do 15 times.