Physical therapy exercises for diseases of the nervous system. Exercise therapy for diseases of the central and peripheral nervous system. Exercise therapy technique for psychasthenia

Diseases of the central nervous system are caused by various reasons, including infection, atherosclerosis, and hypertension.

Lesions of the brain and spinal cord are often accompanied by paralysis and paresis. With paralysis, voluntary movements are completely absent. With paresis, voluntary movements are weakened and limited to varying degrees. Exercise therapy is an essential component in complex treatment for various diseases and injuries of the central nervous system, stimulating protective and adaptive mechanisms.

Exercise therapy for strokes

Stroke is an acute disorder of cerebral circulation of various localizations. There are two types of strokes: hemorrhagic (1-4%) and ischemic (96-99%).

Hemorrhagic stroke is caused by hemorrhage in the brain, occurs with hypertension, atherosclerosis of cerebral vessels. Hemorrhage is accompanied by rapidly developing cerebral phenomena and symptoms of focal brain damage. Hemorrhagic stroke usually develops suddenly.

Ischemic stroke is caused by impaired patency of cerebral vessels due to blockage by an atherosclerotic plaque, embolus, thrombus, or as a result of spasm of cerebral vessels of various locations. Such a stroke can occur due to atherosclerosis of cerebral vessels, weakened cardiac activity, decreased blood pressure and other reasons. Symptoms of focal lesions increase gradually.

Cerebral circulation disorders during hemorrhagic or ischemic stroke cause paresis or central (spastic) paralysis on the side opposite to the lesion (hemiplegia, hemiparesis), sensory disturbances, and reflexes.

Tasks and exercise therapy:

• restore movement function;
• counteract the formation of contractures;
• help reduce increased muscle tone and reduce the severity of conjugal movements;
• promote overall health and strengthening of the body.

The method of therapeutic exercises is based on clinical data and the time period that has passed since the stroke.

Exercise therapy is prescribed from the 2-5th day from the onset of the disease after the disappearance of the symptoms of a coma.

The contraindication is a severe general condition with impaired cardiac and respiratory activity.

The method of using exercise therapy is differentiated in accordance with three periods (stages) of restorative treatment (rehabilitation).

I period - early recovery

This period lasts up to 2-3 months. (acute period of stroke). At the beginning of the disease, complete flaccid paralysis develops, which after 1-2 weeks. gradually gives way to spasticity and contractures begin to form in the arm flexors and leg extensors.

The process of restoring movement begins a few days after the stroke and lasts months and years. Movement in the leg is restored faster than in the arm.

In the first days after a stroke, treatment with position and passive movements is used.

Treatment with positioning is necessary to prevent the development of spastic contractures or eliminate or reduce existing ones.

By positional treatment we mean placing the patient in bed so that the muscles prone to spastic contractures are stretched as much as possible, and the attachment points of their antagonists are brought closer together. In the arms, spastic muscles, as a rule, are: muscles that adduct the shoulder while simultaneously rotating it inward, flexors and pronators of the forearm, flexors of the hand and fingers, muscles that adduct and flex the thumb; on the legs - external rotators and adductors of the thigh, extensors of the leg, gastrocnemius muscles (plantar flexors of the foot), dorsal flexors of the main phalanx of the big toe, and often other fingers.

Fixation or placement of limbs for the purpose of prevention or correction should not be prolonged. This requirement is due to the fact that by bringing the attachment points of antagonist muscles closer together for a long time, you can cause an excessive increase in their tone. Therefore, the position of the limb should be changed during the day. When laying the legs, occasionally give the leg a bent position at the knees; with the leg straightened, place a cushion under the knees. It is necessary to place a box or attach a board to the foot end of the bed so that the foot rests at an angle of 90° to the shin. The position of the arm is also changed several times a day, the extended arm is moved away from the body by 30-40° and gradually to an angle of 90°, while the shoulder should be rotated outward, the forearm should be supinated, and the fingers should be almost straightened. This is achieved with the help of a roller, a bag of sand, which is placed on the palm, the thumb is placed in the Abduction position and in opposition to the others, i.e., as if the patient is grasping this roller. In this position, the entire arm is placed on a chair (on a pillow) standing next to the bed.

The duration of positioning treatment is determined individually, guided by the patient’s feelings. If there are complaints about discomfort, pain, the position is changed.

During the day, positioning treatment is prescribed every 1.5-2 hours. During this period, positioning treatment is carried out in the IP lying on the back.

If fixation of the limb reduces the tone, then immediately after it passive movements are carried out, constantly bringing the amplitude to the limits of physiological mobility in the joint: Start with the distal parts of the limbs.

Before the passive one, an active exercise is performed on the healthy limb, i.e. the passive movement is first “unlearned” on the healthy limb. Massage for spastic muscles is light, superficial stroking is used, for antagonists - light rubbing and kneading.

II period - late recovery

During this period, the patient is hospitalized. Treatment is continued with the position in the PI lying on the back and on the healthy side. The massage is continued and therapeutic exercises are prescribed.

In therapeutic exercises, passive exercises are used for paretic limbs, exercises with the help of an instructor in lightweight IP, holding individual segments of the limb in a certain position, elementary active exercises for paretic and healthy limbs, relaxation exercises, breathing exercises, exercises in changing position during bed rest (Table 7).

Table 7. Approximate scheme of the therapeutic exercises procedure for hemiparesis in the early period for patients on bed rest (8-12 procedures)

Notes

1. During the procedure, take rest breaks of 1-2 minutes.
2. At the end of the procedure, ensure the correct position of the paretic limbs.

To prepare for getting up, you should use an imitation of walking while lying down, and gradually transfer to a vertical position. All active exercises are carried out while exhaling. In the initial sitting and standing position, light exercises are added to exercises with a gymnastic stick, using a healthy arm, exercises for the torso - turns, slight bends forward, backward, to the sides (Table 8).

Control movements to assess the function of hand movement in central (spastic) paresis

1. Raising parallel straight arms (palms forward, fingers extended, thumb abducted).
2. Abduction of straight arms with simultaneous external rotation and supination (palms up, fingers extended, thumb abducted).
3. Bending the arms at the elbow joints without moving the elbows away from the body with simultaneous supination of the forearm and hand.
4. Extending the arms at the elbow joints with simultaneous external rotation and supination and holding them in front of you at a right angle to the body (palms up, fingers extended, thumb abducted).
5. Rotation of the hands at the wrist joint.
6. Contrasting the thumb with the rest.
7. Mastering the necessary skills (combing your hair, bringing objects to your mouth, fastening buttons, etc.).

Test movements to assess the function of movement of the legs and trunk muscles

1. Bending the leg with sliding of the heel on the couch in a supine position (uniform sliding of the heel along the couch with gradual lowering of the foot until the sole completely touches the couch at the moment of extreme bending of the leg at the knee joint).
2. Raising straight legs 45-50° from the couch (position on the back, feet parallel, not touching each other) - keep the legs straight with some separation, without hesitation (if the severity of the lesion is checked, the possibility of lifting one leg is checked, if there is poor circulation, do not check) .
3. Rotation of the straight leg inward while lying on your back, feet shoulder-width apart (free and complete rotation of the straightened straight leg inward without simultaneously adducting and bending it with the correct position of the foot and toes).
4. “Isolated” flexion of the leg at the knee joint; lying on the stomach - full straight flexion without simultaneous lifting of the pelvis; standing - full and free flexion of the leg at the knee joint with an extended hip with full plantar flexion of the foot.
5. “Isolated” dorsiflexion and plantar flexion of the foot (full dorsiflexion of the foot with the leg extended in the supine and standing positions; full plantar flexion of the foot with the leg bent in the prone position and standing).
6. Swinging the legs while sitting on a high stool (free and rhythmic swinging of the legs at the knee joints simultaneously and alternately).
7. Walking up the stairs.

Table 8. Approximate scheme of the therapeutic exercises procedure for hemiparesis in the late period

III period of rehabilitation

In the third period of rehabilitation - after discharge from the hospital - exercise therapy is used constantly in order to reduce the spastic state of the muscles, joint pain, contractures, and friendly movements; help improve movement function, adapt to self-care and work.

The massage is continued, but after 20 procedures a break of at least 2 weeks is required, then the massage courses are repeated several times a year.

Exercise therapy is combined with all types of balneophysiotherapy and medications.

Exercise therapy for diseases and injuries of the spinal cord

Diseases and injuries of the spinal cord most often manifest as paresis or paralysis. Prolonged stay on bed rest contributes to the development of hypokinesia and hypokinetic syndrome with inherent disturbances in the functional state of the cardiovascular, respiratory, and other body systems.

Depending on the localization of the process, the manifestations of paralysis or paresis vary. When the central motor neuron is damaged, spastic paralysis (paresis) occurs, in which muscle tone and reflexes are increased.

Peripheral (flaccid) paralysis and paresis are caused by damage to the peripheral neuron.

Peripheral paralysis and paresis are characterized by hypotension, muscle atrophy, and disappearance of tendon reflexes. When the cervical spine is affected, spastic paralysis and paresis of the arms and legs develop; when the process is localized in the area of ​​the cervical thickening of the spinal cord - peripheral paralysis, paresis of the arms and spastic paralysis of the legs. Injuries to the thoracic spine and spinal cord are manifested by spastic paralysis and leg paresis; lesions in the area of ​​the lumbar enlargement of the spinal cord - peripheral paralysis, leg paresis.

Therapeutic exercises and massage are prescribed after the acute period of the disease or injury has passed, in the subacute and chronic stages.

The technique is differentiated taking into account the type of paralysis (flaccid, spastic) (Table 9).

Table 9. Scheme of physical therapy for various forms of movement disorders

In case of spastic paralysis, it is necessary to reduce the tone of spastic muscles, reduce the manifestation of increased muscle excitability, strengthen paretic muscles and develop coordination of movements. An important place in the technique belongs to passive movements and massage. In the future, when increasing the range of movements, active exercises play a major role. You should use a comfortable starting position when performing exercises.

Massage should help reduce increased tone. The techniques of superficial stroking, rubbing and very limited kneading are used. The massage covers all the muscles of the affected limb. Massage is combined with passive movements.

After the massage, passive and active exercises are used. Passive exercises are performed at a slow pace, without increasing pain or increasing muscle tone. To prevent friendly movements, anti-friendly movements are used: the healthy limb is used during exercises with the help of the affected one. The occurrence of active movements should be identified, provided that the starting position is as comfortable as possible. Active exercises are widely used to restore movement function. Stretching exercises are recommended. If the hands are affected, exercises in throwing and catching balls are used.

For flaccid paralysis (paresis), massage is also prescribed. The techniques of kneading, vibration, and effleurage are used with intense impact on the muscles. Massage is combined with the use of passive and active exercises. Sending impulses to movement is used. When performing active exercises, conditions are created to facilitate their work. In the future, exercises with weights and effort are used. For the arms, swing movements are used while standing with the body tilted forward, with clubs, dumbbells.

Considering pelvic disorders, it is necessary to include exercises for the pelvic muscles, sphincters, and legs.

An important place in the technique belongs to exercises for the trunk muscles, corrective exercises to restore the function of the spine. No less important is learning to walk.

Sequence of IP and exercises when learning to walk with flaccid paralysis

1. Lying on your back (side, stomach).
2. On knees.
3. Crawl.
4. On my knees.
5. Walking on your knees under a horizontal ladder.
6. Transition from a sitting position to a standing position with support on the gymnastic wall.
7. Walking under the stairs.
8. Walking on crutches with the help of an instructor.
9. Walking on crutches without the help of an instructor.

Sequence of IP and exercises when learning to walk with spastic paralysis

1. Lying on your back (side, stomach).
2. Sitting.
3. Get up and sit down with the help of staff.
4. Walking with staff support, walking with one crutch.
5. Exercises at the gymnastic wall (sitting, standing, squatting).
6. Exercises on all fours, on your knees.
7. Walking independently on crutches and with one stick.

In the late period after illness or injury, therapeutic exercises are also used using initial positions lying, sitting, standing.

Treatment by position is necessary for both spastic and flaccid paralysis.

Duration of procedures: from 15-20 minutes in the subacute period and up to 30-40 minutes in subsequent periods.

Upon discharge from the hospital, the patient continues to study continuously.

Exercise therapy for cerebral atherosclerosis

The clinical picture is characterized by complaints of headache, decreased memory and performance, dizziness and tinnitus, poor sleep.

Tasks and exercise therapy: at the initial stage of cerebral circulatory failure:

• have a general health and strengthening effect,
• improve cerebral circulation,
• stimulate the functions of the cardiovascular and respiratory systems,
• increase physical performance.

P r o t i v e d i n c a t i o n :

• acute cerebrovascular accident,
• vascular crisis,
• significantly reduced intelligence.

Forms of exercise therapy: morning hygienic exercises, therapeutic exercises, walks.

Section I of the procedure

Patients aged 40-49 years in the first section of the therapeutic gymnastics procedure should use walking at a normal pace, with acceleration, jogging, alternating with breathing exercises and exercises for the muscles of the arms and shoulder girdle while walking. Section duration is 4-5 minutes.

Section II of the procedure

In section II, exercises for the muscles of the arms and shoulder girdle are performed in a standing position using elements of static force: bending the body forward - backward, to the sides, 1-2 s. Exercises for large muscles of the lower extremities, alternating with exercises to relax the muscles of the shoulder girdle and dynamic breathing in a 1:3 combination, and also use dumbbells (1.5-2 kg). Section duration is 10 minutes.

III section of the procedure

In this section, it is recommended to perform exercises for the abdominal muscles and lower extremities in a lying position in combination with head turns and alternating with dynamic breathing exercises; combined exercises for arms, legs, torso; Resistance exercises for the muscles of the neck and head. The pace of execution is slow, you should strive for a full range of movements. When turning your head, hold the movement in the extreme position for 2-3 seconds. Section duration - 12 minutes.

IV section of the procedure

In a standing position, perform exercises with the torso tilted forward - backward, to the sides; exercises for the arms and shoulder girdle with elements of static effort; leg exercises combined with dynamic breathing exercises; balance exercises, walking. Section duration - 10 minutes.

The total duration of the lesson is 40-45 minutes.

Therapeutic gymnastics is used daily, increasing the duration of classes to 60 minutes, using, in addition to dumbbells, gymnastic sticks, balls, exercises on apparatus (gymnastic wall, bench), and general-purpose exercise equipment.

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Therapeutic exercise for diseases of the nervous system

Introduction

1. Physical therapy for neuroses

2. General principles of the methodology of therapeutic physical culture

2.1 Neurasthenia

2.2 Psychasthenia

2.3 Hysteria

Conclusion

Bibliography

exercise physical education neurosis psychasthenia hysteria

Introduction

Therapeutic physical culture (or exercise therapy for short) is an independent medical discipline that uses the means of physical culture to treat diseases and injuries, prevent their exacerbations and complications, and restore working capacity. The main means (and this distinguishes exercise therapy from other methods of treatment) are physical exercises - a stimulator of the vital functions of the body.

Therapeutic exercise is one of the most important elements of modern complex treatment, which means an individually selected set of therapeutic methods and means: conservative, surgical, medication, physiotherapy, nutritional therapy, etc. Complex treatment affects not only pathologically altered tissues, organs or systems organs, but also for the entire body as a whole. The proportion of various elements of complex treatment depends on the stage of recovery and the need to restore a person’s ability to work. A significant role in complex treatment belongs to therapeutic physical culture as a method of functional therapy.

Physical exercise affects the reactivity of the whole organism and involves the mechanisms that participated in the pathological process in the overall reaction. In this regard, physical therapy can be called a method of pathogenetic therapy.

Exercise therapy involves patients consciously and actively performing appropriate physical exercises. In the process of training, the patient acquires skills in using natural factors of nature for the purpose of hardening, physical exercises - for therapeutic and preventive purposes. This allows us to consider therapeutic physical education classes as a therapeutic and pedagogical process.

Exercise therapy uses the same principles of using physical exercises as physical culture for a healthy person, namely: the principles of comprehensive impact, application and health-improving orientation. In terms of its content, therapeutic physical culture is an integral part of the Soviet system of physical education.

1. Therapeutic exercise for neuroses

Neuroses are functional diseases of the nervous system that develop under the influence of prolonged overstrain of the nervous system, chronic intoxication, severe trauma, long-term illness, constant consumption of alcohol, smoking, etc. A certain role in the occurrence of neuroses can be played by the constitutional predisposition and characteristics of the nervous system.

The following main forms of neuroses are distinguished: neurasthenia, psychasthenia and hysteria.

Neurasthenia is based on “a weakening of the processes of internal inhibition and is clinically manifested by a combination of symptoms of increased excitability and exhaustion” (I. P. Pavlov). Neurasthenia is characterized by: rapid fatigue, increased irritability and excitability, poor sleep, decreased memory and attention, headaches, dizziness, disruption of the cardiovascular system, frequent mood changes for no apparent reason, etc.

Psychasthenia occurs predominantly in people of the thinking type (according to I.P. Pavlov) and is characterized by processes of stagnant excitation (foci of pathological stagnation, the so-called sore points). Patients are overcome by painful thoughts, all sorts of fears (whether the apartment is locked, the gas is turned off, fear of some kind of trouble, darkness, etc.). With psychasthenia, nervous conditions, depression, immobility, autonomic disorders, excessive rationality, tearfulness, etc. are noted.

Hysteria is a functional disorder of the nervous system, accompanied by a failure of higher mental mechanisms and, as a consequence, a disruption of the normal relationship between the first and second signaling systems with a predominance of the first. Hysteria is characterized by: increased emotional excitability, mannerisms, attacks of convulsive crying, convulsive seizures, a desire to attract attention, speech and gait disorders, hysterical “paralysis.”

Treatment of neuroses should be comprehensive: creation of optimal environmental conditions (hospital, sanatorium), drug treatment, physical, psycho- and occupational therapy, therapeutic physical training.

Therapeutic physical culture has a direct impact on the main pathophysiological manifestations of neuroses, increases the strength of nervous processes, helps to equalize their dynamics, coordinate the functions of the cortex and subcortex, the first and second signaling systems.

2. General principles of therapeutic physical culture methods

The method of therapeutic physical culture is differentiated depending on the form of neurosis. With neurasthenia, it is aimed at increasing the tone of the central nervous system, normalizing autonomic functions and involving the patient in a conscious and active fight against his illness; with psychasthenia - to increase emotional tone and excite automatic and emotional reactions; in hysteria - to enhance inhibition processes in the cerebral cortex.

For all forms of neuroses, an individual approach to the patient is necessary. The instructor must be authoritative, evoke positive emotions, exercise a psychotherapeutic effect on patients during classes, distract them from difficult thoughts, develop persistence and activity.
Therapeutic physical education classes are conducted individually and in groups. When forming groups, it is necessary to take into account gender, age, degree of physical fitness, functional state of patients, and concomitant diseases.

In the first half of the course of treatment (period I), it is advisable to conduct classes individually to establish contact with patients. Considering their increased sensitivity and emotionality, at the beginning of classes you should not focus on mistakes and shortcomings in performing the exercises. During this period, simple and general developmental exercises are used for large muscle groups, performed at a slow to medium pace and not requiring intense attention. Classes should be quite emotional. Commands should be given in a calm, clear voice. For patients with neurasthenia and hysteria, the exercises need to be explained to a greater extent; for patients with psychasthenia, they need to be shown.

When treating hysterical “paralysis,” distracting tasks are used under modified conditions (in a different starting position). For example, with “paralysis” of the hands, exercises with a ball or several balls are used. It is imperative to draw the patient’s attention to the involuntary inclusion of the “paralyzed” arm in work.

As patients master exercises with simple coordination, classes include balance exercises (on a bench, balance beam), as well as climbing on a gymnastic wall, various jumps, and swimming. Walking, short-range tourism, and fishing during this period also help relieve the nervous system from common irritants and strengthen the cardiovascular and respiratory systems.

The duration of classes in the first period is initially 10-15 minutes, and as adaptation progresses - 35-45 minutes. If the patient tolerates the load of the first period well, then in the second period exercises are introduced into classes that help improve attention, coordination, increase the speed and accuracy of movements, develop dexterity, and speed of reaction. To train the vestibular apparatus, exercises are used with closed eyes, with sudden changes in movements on command while walking, running, circular movements of the head, and bending of the torso. Active and lightweight sports games, walking, short-range tourism, skiing, cycling, volleyball, tennis, etc. are widely used. The second period takes place mainly in the conditions of sanatorium-resort treatment.

2.1 Neurasthenia

As already mentioned, neurasthenia is characterized by increased mental and physical fatigue, irritability, deterioration of attention and memory, lack of a feeling of vigor and freshness, especially after sleep, and somatovegetative disorders. Pathophysiologically, these phenomena should be considered as a manifestation of the weakness of active inhibition and rapid exhaustion of the excitatory process. The objectives of therapeutic physical education classes are to train the process of active inhibition, restore and streamline the excitatory process. Therapeutic exercises (in addition to the mandatory morning hygienic exercises) should be carried out in the morning. The duration and number of exercises should be minimal at first and increase very gradually.

For the most weakened patients, it is recommended to begin the session with a general 10-minute massage, passive movements while lying in bed and sitting during the first few days. The duration of subsequent lessons is 15-20 minutes. Then it is gradually brought to 30-40 minutes. Starting from the 5th-7th lesson, elements of the game (including with a ball) are introduced into the lesson, and in winter - skiing.

Due to the abundance of somatovegetative disorders in patients, their preliminary psychotherapeutic preparation is required. During the exercises, the methodologist must take into account possible painful sensations (palpitations, dizziness, shortness of breath) and adjust the load so that the patient does not get tired, so that he has the opportunity to stop doing the exercises for a while and rest without any embarrassment. At the same time, it is necessary to involve him more and more in classes, to increase interest in them due to the variety of exercises and methods of conducting classes.

Musical accompaniment should be an important element of classes. Recommended music is soothing, moderate and slow tempo, combining major and minor sounds. Such music plays the role of a healing factor.

2.2 Psychasthenia

Psychasthenia is characterized by anxious suspiciousness, inactivity, and focus on one’s personality and experiences. The pathophysiological basis of these features of patients with psychasthenia is the pathological predominance of the second signaling system, the presence in it of foci of stagnant excitation, and the inertia of cortical processes. The obsessive states that are often observed in this case (obsessive thoughts, actions, desires) are a reflection of excessive inertia of the foci of excitation, and obsessive fears (phobias) are a reflection of inert inhibition.

The objectives of physical therapy exercises are to “loose” the pathological inertia of cortical processes and suppress foci of pathological inertia through the mechanism of negative induction.

These tasks can be solved by exercises that are emotional in nature, fast in pace, and performed automatically. The music accompanying the classes should be cheerful, performed at a tempo that moves from moderate to faster, up to allegro. It is very good to start classes with marches and marching songs. It is necessary to widely include game exercises, games, relay races, and competition elements into the complex of physical exercises.

In the future, to overcome feelings of inferiority and low self-esteem, shyness, it is recommended to include exercises in overcoming obstacles, balance, and strength exercises in your classes.

When forming a group for classes, it is advisable to include several recovering patients, emotional ones, with good plastic movements. This is important because patients with psychasthenia are characterized by non-plastic motor skills, clumsiness of movements, and clumsiness. They usually do not know how to dance, so they avoid and do not like dancing. In case of obsessive states, appropriate psychotherapeutic preparation of the patient and explanation of the importance of performing exercises to overcome feelings of unreasonable fear are of great importance.

To increase emotional tone, resistance exercises performed in pairs, mass game exercises, and medicine ball exercises are used; to overcome feelings of indecision, self-doubt - exercises on apparatus, balance, jumping, overcoming obstacles.

During classes, the methodologist must by all means help to increase the patients’ contact with themselves and with each other.
The goal is to excite automatic reactions and raise the emotional tone of patients - is achieved by accelerating the pace of movements: from the slow pace characteristic of these patients of 60 movements per minute to 120, then from 70 to 130 and in subsequent classes from 80 to 140. In the final part of the classes, exercises that help to slightly reduce emotional tone. It is necessary that the patient leaves the therapeutic gymnastics room in a good mood.

An approximate set of exercises for psychasthenia

1. Formation in a circle facing inward. Pulse rate counting.

2. Movement in a circle alternately in one direction and the other, holding hands, with acceleration.

3. Move in a circle on your toes, alternately in one direction and the other, with acceleration.

4. I. p. - main stand. Relax, take the “at ease” position.

5. I. p. - main stand. Alternately raise your arms up (starting with the right) with acceleration from 60 to 120 times per minute.

6. I. p. - feet shoulder-width apart, hands clasped. 1--2 - raise your arms above your head - inhale, 3--4 - lower your arms to the sides - exhale. 4--5 times.

7. I. p. - hands forward. Squeeze and unclench your fingers with acceleration from 60 to 120 times per minute. 20--30 s.

8. I. p. - feet shoulder-width apart, hands locked, 1 - raise your hands above your head - inhale, 2 - sharply lower your hands between your legs shouting “ha”. 4--5 times.

9. I. p. - legs together, hands on the waist. 1--2 - sit down - exhale, 3--4 - stand up - inhale. 2--3 times.

10. I. p. - standing on tiptoes. 1 - lower on your heels - exhale, 2 - rise on your toes - inhale. 5--6 times.

11. Resistance exercise in pairs:

a) standing facing each other, hold hands, bending them at the elbow joints. Alternately, each person resists with one hand and extends the other at the elbow joint. 3--4 times;

b) standing facing each other, holding hands. Resting your knees on your friend’s knees, squat down, straightening your arms, then rise. 3--4 times.

12. Exercises with medicine ball:

a) standing in a circle one after another. Passing the ball back behind the head. 2--3 times;

b) throwing the ball to each other with two hands at a distance of 3 m.

13. I. p. - standing in front of the ball. Jump over the ball and turn around. 4--5 times.

14. Exercises on apparatus:

a) balance - walk along a bench, log, board, etc. 2-3 times;

b) jumping from a gymnastic bench, from a horse, etc. 2-3 times;

c) climb up the wall bars, grab the top rail with your hands, and while hanging, move your legs away from the wall to the right and left, 2-3 times. Lower yourself down, holding on with your hands and leaning on your legs.

15. I. p. - main stance. 1--2 - rise on your toes - inhale, 3--4 - lower to a full foot - exhale. 3--4 times

16. I. p. - main stance. Alternately relax your arms, torso, and legs.

17. I. p. - main stance. Pulse counting.

2.3 Hysteria

Hysteria, as already mentioned, is characterized by increased emotiveness, emotional instability, frequent and rapid changes in mood. The pathophysiological basis of hysteria is the predominance of the first cortical signaling system over the second, the lack of balance and mutual coherence between the subcortical system and both cortical systems. The task of therapeutic physical culture for hysteria is to reduce emotional lability, increase the activity of conscious-volitional activity, remove the phenomena of positive induction from the subcortex and create differentiated inhibition in the cerebral cortex.

The implementation of these tasks is achieved through targeted physical exercises. The pace of movements should be slow. It is necessary to calmly but persistently demand the precise execution of all movements. Classes should include a specially selected set of simultaneous (but different in direction) exercises for the right and left sides of the body. An important methodological technique is to perform memory exercises, as well as as explained by the methodologist without showing the exercises themselves.

The training group should include no more than 10 people. Commands should be given slowly, smoothly, and in a conversational tone. All errors must be noted and corrected. Classes are held in the absence of outsiders.

A decrease in emotional tone is achieved by slowing down the pace of movements. The first lessons begin with the accelerated pace characteristic of this group of patients - 140 movements per minute and reduce it to 80, in subsequent lessons - from 130 movements to 70, then from 120 to 60.

Differentiated inhibition is developed with the help of simultaneously performed but different tasks for the left and right hands, left and right legs. The inclusion of active-volitional acts is achieved by performing strength exercises on apparatus at a slow pace with a load on large muscle groups.

Conclusion

“If you want to live, know how to spin.” Life in the modern world is akin to an endless race. The time we live in is a time of accelerated pace of life. Quickly take a shower, quickly eat a sausage, and run to work. Everyone runs at work too. Time must be saved, time is money.

In the modern world there are many factors that have a negative impact on the human psyche. These could be problems at work that are systematic and persistent, the lack of an established personal or family life, and many others. Against the background of constant worries about the problem area, many people develop neuroses.

Physical exercises influence the emotional sphere of the patient, they make him feel cheerful, joyful, distract him from various painful experiences, help eliminate uncertainty, anxiety, fear, various “neurotic” manifestations and create a more balanced state. Raising the mood of a sick person is half curing him (S.I. Spasokukotsky). In addition, positive emotions that arise especially during the game method of conducting physical exercises stimulate the functional activity of the body and create favorable conditions for resting the nervous system from monotonous physical and mental work activity.

The systematic use of physical exercises in the treatment of patients with functional disorders of the nervous system increases their resistance of the neuropsychic sphere to various environmental stimuli. Physical exercise helps to balance the internal properties of the body with environmental conditions, and the central nervous system plays a leading role in this balancing. The use of therapeutic physical culture enriches the conditioned reflex activity of the nervous system of patients.

In conclusion, it should be emphasized that patients with various types of neuroses are recommended to continue exercise at home in the form of morning hygienic gymnastics (the complex should be compiled by a doctor taking into account the characteristics of the impaired functions of the patient), attend health groups, play volleyball, walk more, ride a bike, ski and skate.

Bibliography

1. Moshkov V.N. “Therapeutic physical culture in the clinic of nervous diseases” - Moscow: Medicine, 1982.

2. Vinokurov D.A. “Private methods of therapeutic physical culture” - Moscow: Medicine, 1969.

3. Kirpechenko A.A. “Nervous and mental illnesses” - Textbook - Moscow: Higher school, 1998. Electronic edition.

4. Kozlova L.V. “Fundamentals of Rehabilitation” - Rostov-on-Don: “Phoenix”, 2003

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Clinical and physiological rationale for the use of physical education in the treatment and rehabilitation of children. Methods of therapeutic physical culture in pediatrics for malnutrition, pylorospasm, cardiovascular diseases. Gymnastics for liver diseases.

abstract, added 03/23/2011


History of the development of exercise therapy. General principles of physical therapy. Forms and methods of physical therapy. Therapeutic exercise for injuries and some diseases of the movement apparatus. Exercise therapy for fractures of the lower extremities. Mechanotherapy.

abstract, added 04/10/2007


General principles of physical therapy. Classification of physical exercises. Gymnastic, general strengthening, special, sports and applied exercises. Dosage of physical activity. Forms and methods of physical therapy. List of contraindications.

abstract, added 02/20/2009


Physiological justification for the need to use therapeutic physical training for diseases of the digestive system in children. The main prospects for the use of a correctional and health-improving complex of physical exercises in secondary schools.

presentation, added 05/25/2015


Familiarization with the indications for physical therapy for gynecological diseases. Consideration and analysis of the features of Kegel exercises. Definition and characterization of the importance of choosing the starting position when performing therapeutic exercises.

presentation, added 11/05/2017


Main objectives and contraindications of therapeutic physical culture. Therapeutic physical training for acute pneumonia and bronchial asthma. Physical therapy exercises. Reducing the occurrence of bronchospasm. Counteracting the occurrence of atelectasis.

presentation, added 01/25/2016


The objectives of physical therapy for myopia are: activation of the functions of the respiratory system and blood supply to the tissues of the eye, strengthening its muscular system. Methodology and criteria for assessing the effectiveness of classes; a set of exercises for the prevention and correction of myopia.

Once a child is diagnosed with diabetes, parents often go to the library for information on the subject and are faced with the possibility of complications. After a period of worry, parents are hit with the next blow when they learn about diabetes-related morbidity and mortality statistics.

Viral hepatitis in early childhood

Relatively recently, the hepatitis alphabet, which already included hepatitis viruses A, B, C, D, E, G, was replenished with two new DNA-containing viruses, TT and SEN. We know that hepatitis A and hepatitis E do not cause chronic hepatitis and that hepatitis G and TT viruses are most likely “innocent spectators” that are transmitted vertically and do not affect the liver.

Measures for the treatment of chronic functional constipation in children

When treating chronic functional constipation in children, it is necessary to take into account important factors in the child's medical history; establish a good relationship between the health care professional and the child-family to ensure that the proposed treatment is carried out properly; a lot of patience on both sides, with repeated assurances that the situation will gradually improve, and courage in cases of possible relapses, constitute the best way to treat children suffering from constipation.

Scientists' study findings challenge assumptions about diabetes treatment

The results of a ten-year study have indisputably proven that frequent self-monitoring and maintaining blood glucose levels within normal limits leads to a significant reduction in the risk of late complications caused by diabetes and a decrease in their severity.

Manifestations of rickets in children with impaired formation of the hip joints

In the practice of pediatric orthopedists and traumatologists, the question is often raised about the need to confirm or exclude disorders of the formation of the hip joints (hip dysplasia, congenital hip dislocation) in infants. The article shows an analysis of a survey of 448 children with clinical signs of disorders of the formation of the hip joints.

Medical gloves as a means of ensuring infection safety

Most nurses and doctors don't like gloves, and for good reason. Wearing gloves, the sensitivity of your fingertips is lost, the skin on your hands becomes dry and flaky, and the instrument tends to slip out of your hands. But gloves have been and remain the most reliable means of protection against infection.

Lumbar osteochondrosis

It is believed that every fifth adult on earth suffers from lumbar osteochondrosis; this disease occurs in both young and old age.

Epidemiological control over health workers who had contact with the blood of HIV-infected people

(to help medical workers in medical institutions)

The guidelines cover the issues of monitoring medical workers who have had contact with the blood of a patient infected with HIV. Actions are proposed to prevent occupational HIV infection. A logbook and an official investigation report for contact with the blood of an HIV-infected patient have been developed. The procedure for informing higher authorities about the results of medical observation of health workers who came into contact with the blood of an HIV-infected patient has been determined. Intended for medical workers of treatment and preventive institutions.

Chlamydial infection in obstetrics and gynecology

Chlamydia of the genitals is the most common sexually transmitted disease. All over the world, there is an increase in chlamydia among young women who have just entered the period of sexual activity.

Cycloferon in the treatment of infectious diseases

Currently, there is an increase in certain nosological forms of infectious diseases, primarily viral infections. One of the directions for improving treatment methods is the use of interferons, as important nonspecific factors of antiviral resistance. These include cycloferon, a low molecular weight synthetic inducer of endogenous interferon.

Dysbacteriosis in children

The number of microbial cells present on the skin and mucous membranes of a macroorganism in contact with the external environment exceeds the number of cells of all its organs and tissues combined. The weight of the microflora of the human body is on average 2.5-3 kg. The importance of microbial flora for a healthy person was first noticed in 1914 by I.I. Mechnikov, who suggested that the cause of many diseases are various metabolites and toxins produced by various microorganisms that inhabit the organs and systems of the human body. The problem of dysbacteriosis in recent years has caused a lot of discussions with an extreme range of opinions.

Diagnosis and treatment of infections of the female genital organs

In recent years, throughout the world and in our country, there has been an increase in the incidence of sexually transmitted infections among the adult population and, which is of particular concern, among children and adolescents. The incidence of chlamydia and trichomoniasis is increasing. According to WHO, trichomoniasis ranks first in frequency among sexually transmitted infections. Every year, 170 million people worldwide become ill with trichomoniasis.

Intestinal dysbiosis in children

Intestinal dysbiosis and secondary immunodeficiency are increasingly encountered in the clinical practice of doctors of all specialties. This is due to changing living conditions and the harmful effects of the preformed environment on the human body.

Viral hepatitis in children

The lecture “Viral hepatitis in children” presents data on viral hepatitis A, B, C, D, E, F, G in children. All clinical forms of viral hepatitis, differential diagnosis, treatment and prevention that currently exist are presented. The material is presented from a modern perspective and is intended for senior students of all faculties of medical universities, interns, pediatricians, infectious disease specialists and doctors of other specialties who are interested in this infection.

Essay

List of keywords: neurosis, therapeutic physical culture, neurasthenia, hysteria, psychasthenia, physical exercise, dosage, regimen, individual and group classes, activity, psychotherapy, rest, intensity.

The purpose of the course work: to reveal the essence of neuroses as borderline diseases of the central nervous system, to explore the main issues of the methodology for using exercise therapy and other means of physical rehabilitation in the complex treatment and prevention of neuroses.

Research methods: analysis of scientific and methodological literature.

Practical significance: the research of this work can be used in their professional activities by specialists practicing in the field of exercise therapy and physical rehabilitation.

Introduction

1. The concept of neuroses and mental disorders

1 Neurasthenia

1.2 Hysteria

3 Psychasthenia

Exercise therapy for these diseases

2 Features of exercise therapy for neuroses

3 Features of exercise therapy for neurasthenia

4 Features of exercise therapy for hysteria

5 Features of exercise therapy for psychasthenia

Disease Prevention

Conclusion

Introduction

Treatment and prevention of borderline mental illnesses (neuroses) is one of the pressing problems of modern medicine.

This problem is quite well covered in the scientific and methodological works of many authors.

Significant contributions to the development of this issue were made by: Kopshitser I.Z., Shukhova E.V., Zaitseva M.S., Belousov I.P. and etc.

In order to write this work, I collected and analyzed information from scientific and methodological literature on this issue.

After analyzing this information, the following main issues were identified: concepts of neuroses; indications, contraindications and mechanism of action of exercise therapy for neuroses, features of exercise therapy techniques for various forms of neuroses; the use of other FR methods in the treatment of neuroses; prevention of neuroses using exercise therapy methods.

When developing these questions, it was possible to find out that properly delivered physical education is a powerful factor influencing GNI, which is widely used for the prevention and treatment of all types of neuroses.

While working on my course project, I found out that there is a close connection between exercise therapy, used for neuroses, and psychology and pedagogy.

When collecting information for work, I was able to find out that the use of exercise therapy is often more therapeutically justified than the use of many medications.

However, unfortunately, exercise therapy is not widely used for the prevention and treatment of neuroses in medical institutions.

1. The concept of neuroses and mental disorders

Functional disorders of the central nervous system include those diseases in which there are no anatomical structural lesions of the nervous system, but functions are significantly impaired. These diseases have a common name - neuroses.

The scientific theory of the development of neuroses was created by I.P. Pavlov. By neuroses he understood chronic deviations of higher nervous activity from the norm of a functional nature, which occurred as a result of overstrain of nervous processes (excitation and inhibition) or changes in their mobility.

Neurosis is one of the most common types of psychogenic reactions, characterized by mental disorders (anxiety, fears, phobias, hysterical manifestations, etc.), the presence of somatic and autonomic disorders.

Neurotic reactions usually occur to relatively weak, but long-acting stimuli, leading to constant emotional stress.

Neuroses arise as a result of the combined effect of harmful effects of both mental and somatic origin and the undoubted influence of environmental conditions. In the occurrence of neuroses, a constitutional predisposition due to congenital weakness of the nervous system is important.

For the development of neuroses, overwork and overstrain of nervous activity are essential.

The pathophysiological basis of neuroses are: a) disruption of the processes of excitation and inhibition, b) disruption of the relationship between the cortex and subcortex, c) disruption of the normal relationship of signaling systems.

Neuroses usually arise from affects, negative emotions, and experiences associated with a number of social, everyday and family relationships. Neuroses can also develop secondary, against the background of previous illnesses or injuries. They often lead to a decrease in working capacity, and in some cases to its loss.

What happens in the nervous system during this?

First of all, changes in higher nervous activity can be expressed in a decrease in the strength of nervous processes. This occurs mainly in cases of overvoltage of one of the processes. At the same time, even weak stimuli become super strong for nerve cells. Nervous processes become inert and inactive. As a result, foci of the inhibitory or irritable process remain in the cortex for a long time, dominating all the activities of the body. Finally, due to the weakness of the cortical cells that carry out higher nervous activity, the cortex loses the function of the highest regulator of all other parts of the brain, in particular, the subcortical formations. Disintegration of the function of the nonspecific brain system occurs, which leads to disruption of a person’s adaptive abilities and, accordingly, the appearance of vegetative-endocrine and other disorders. The activity of the heart, blood vessels, and gastrointestinal tract often suffers. The patient is worried about palpitations and interruptions in heart function. Blood pressure becomes unstable. Appetite is disrupted, heartburn, nausea, unstable stools, etc. appear. Due to the weakening of cortical processes and their mobility in patients, the change from an irritable process to an inhibitory one occurs very slowly. As a result, at the same time, cortical cells can be either in an inhibited state, or on the verge of transition from one state to another, or in a state of excitation. This phase state of cortical cells, that is, a state intermediate between wakefulness and sleep, causes a change in their reactivity to various stimuli. If a healthy cerebral cortex gives a response to one or another stimulus, the stronger the stimulus, then with neurosis this law is violated. In mild cases, both strong and weak stimuli give a reaction of the same magnitude; in severe cases, weak stimuli can cause a more violent reaction than strong ones.

The VNI disorders observed in neuroses manifest themselves differently depending on the type of VNI. Individuals with an average type (without a predominance of one or another signaling system) more often develop neurasthenia; in persons of the artistic type (with a predominance of the first signal system in the internal nervous system) - hysteria; in the thinking type (with a predominance of the second signaling system) - psychasthenia.

Neuroses most often occur in individuals with a weak type of nervous processes. Of course, they can also arise and develop in people with strong manifestations of nervous processes and predominantly unbalanced people (cholerics), in whom the processes of excitation prevail over the processes of inhibition. Neuroses are less commonly observed in individuals with a strong and balanced type of GNI.

Such people get sick if the stimulus is too strong or their nervous system has been weakened by some serious illness or sudden overwork.

It has been proven that even a very serious illness cannot cause changes characteristic of neurosis, but can make the nervous system more vulnerable. Such disorders occur especially often in diseases of the endocrine glands.

Depending on the excitatory and inhibitory processes, the following types of neuroses are distinguished: neurasthenia, hysteria, psychasthenia. Pure types of these neuroses are rarely diagnosed.

1.1 Neurasthenia

Neurasthenia is the most common of all types of neuroses.

Neurasthenia is a disease that occurs as a result of excessive strength or duration of tension in the nervous system, exceeding the limits of endurance, which is based on a weakening of the process of internal inhibition and is clinically manifested by a combination of symptoms of increased excitability and exhaustion.

Neurasthenia develops most often under the influence of prolonged mental trauma.

Predisposing factors to the occurrence of this neurosis are non-compliance with the work and rest regime, fatigue, under-recovery of the body from day to day, prolonged, unpleasant emotional stress. Of particular importance are constant lack of sleep, intoxication, chronic infections such as tuberculosis, chronic purulent inflammation, etc.

Neurasthenia develops gradually. It is characterized, on the one hand, by increased excitability, on the other hand, by increased exhaustion of nervous processes.

Increased excitability of the nervous system manifests itself in great irritability and inadequate emotional reactions to minor influences. The neurological status of patients shows an increase in tendon and skin reflexes with an expansion of the zones. Severe autonomic disorders are observed (increased sweating, lability of dermographic reactions, sharply positive ortho-clinostatic tests). Patients with neurasthenia cannot tolerate sharp sounds, strong odors, bright light, and are extremely sensitive to painful and temperature stimuli. There is also increased sensitivity to sensations from the internal organs, which is expressed in numerous complaints of palpitations, shortness of breath, pain in the head, heart, stomach, limbs, etc. These sensations are usually not perceived by healthy people.

Increased excitability in neurasthenia is accompanied by rapid exhaustion of nervous processes, which is manifested by difficulty concentrating, weakening of memory, decreased performance, and lack of patience. With neurasthenia, as a rule, health worsens, appetite and sleep are upset. The patient develops anxious attention to his condition, lacks confidence in his abilities, and loses interest in life; suspiciousness and obsessive states may occur.

The disease leaves its mark on the patient’s appearance: his gait is relaxed or jerky, his facial expression is dull and concentrated, his body position is hunched.

Pathophysiological basis of neurasthenia.

Neurasthenic symptoms are caused by a weakening of the processes of internal inhibition and excitation in the cerebral cortex.

It must be borne in mind that inhibition moderates excitation. Cells restore their energy resources only when they are in a state of inhibition. Sleep is based on internal inhibition. Since with neurasthenia internal inhibition is disrupted (weakened), it is understandable why sleep with neurasthenia becomes superficial. This, in turn, leads to the fact that the performance of nerve cells is not fully restored, hence the feeling of fatigue very soon appears in patients during work.

Violation of attention is explained by weakening of inhibition processes. When a person begins to perform any task, a focus of excitation appears in the cerebral cortex, around which inhibition develops. If the focus of excitation is weak, then the negative induction around it is insufficient. This leads to the fact that the conditions for the emergence of new foci of excitation are preserved. Therefore, every minor noise begins to distract the patient from the main activity.

During neurasthenia there are two stages:

) hypersthenic,

) hyposthenic.

Hypersthenia is characterized by a weakening of inhibition processes and a predominance of excitation processes. This stage of neurasthenia occurs most often.

Hypersthenia is characterized by relative preservation of patients' adaptation to physical activity. Violations in the emotional sphere are expressed in irritability, incontinence, anxiety, and emotional lability. Due to increased excitability, patients have poor self-control and often conflict with others. Their sleep is disturbed - they have difficulty falling asleep and often wake up, and they often complain of headaches.

In this category of patients, a number of vegetative-dystonic phenomena occur, with disorders of the cardiovascular system (pain in the heart, tachycardia, increased blood pressure, etc.) coming to the fore. Usually there is persistent red dermographism, increased excitability of vasomotors, and increased sweating. Various autonomic asymmetries are often observed (data from oscillography, capillaroscopy, skin temperature, etc.), especially in blood pressure.

Hypostenia is characterized by the development of diffuse inhibition. The phenomena of asthenia, weakness, and a pronounced decrease in adaptation to physical activity come to the fore. The patients seemed to have lost their stamina and faith in their strength. Characterized by a sharp decrease in performance, which is associated with increased fatigue, both mental and physical. Emotional reactions are pale. Patients are usually lethargic, slow, and strive for solitude.

Their memory is reduced for both distant and recent events. They constantly experience a feeling of oppression, anxiety, expectation of unpleasant events, do not trust doctors, are reluctant to answer questions, are highly suspicious, impressionable, listen to painful sensations, overestimate the severity of their condition and, therefore, often require various repeated examinations.

Patients complain (more pronounced) of cardiovascular phenomena. Almost as a rule, they experience arterial hypotension and decreased vascular lability; they complain of pain and dysfunction of the heart, heaviness in the head, dizziness, unsteady gait, etc. Increased inhibitory functions in the cerebral cortex also extend to the subcortical autonomic centers, causing a decrease in their function.

The prognosis for neurasthenia is favorable. The disease is curable. The faster the causes of the disease are eliminated, the faster the cure occurs.

All dysfunctions of internal organs are not associated with changes in the organs themselves and can be easily eliminated during the treatment of a nervous disease and will not arise in the future.

Hysteria affects both men and women equally. The disease occurs most easily in people with a weak nervous system.

Usually the cause of the development of the disease is a psychotraumatic situation. Internal factors associated with constitutional predisposition and a number of somatic disorders are also important. Hysteria can be a consequence of improper upbringing, conflicts with the team, etc.

Hysteria is characterized by increased emotiveness, emotional instability, frequent and rapid changes in mood.

The pathophysiological basis of hysteria is the predominance of the first cortical signaling system over the second, the lack of balance and mutual coherence between the subcortical system and both cortical systems, which leads to their dissociation and a tendency to widespread inhibition of the cortex, including primarily the second cortical signaling system, and to positive induction to the subcortical region.

With hysteria, the emotional life of the patient prevails over the rational.

Hysteria is manifested by motor and sensory disorders, as well as disturbances of autonomic functions, simulating somatic and neurological diseases.

The variety of symptoms that are observed during hysteria is due to increased suggestibility and self-hypnosis, the patient’s ideas about various diseases.

The main symptoms of hysteria are divided into four groups: hysterical attack, disorder of consciousness during hysteria, somatic disorders and character traits.

Hysterical attack. The onset of a hysterical attack often depends on some external conditions, especially if they are associated with moments that traumatize the patient’s psyche, or if the present situation is somewhat reminiscent of unpleasant experiences of the past. During a hysterical attack, it is not possible to establish any sequence in the movements of patients. This is due to the fact that the nature of the movements often reflects the content of the experiences that a given patient has. In this case, consciousness is never completely darkened; one can only talk about a narrowing of the field of consciousness. Therefore, the reaction of patients to the external environment is preserved to a certain extent.

The duration of a hysterical attack can range from several minutes to several hours. The seizure always lasts longer if there are people around the patient. Hysterical attacks, as a rule, occur more often during the day and much less frequently at night. Patients usually do not suffer severe injuries.

Disorder of consciousness in hysteria. A twilight state of consciousness is typical for hysteria. At this time, patients perceive the environment from a certain angle. Everything that happens around is assessed by patients not as it really is, but in connection with ideas about previous experiences. If the patient imagines that he is in a theater, then he mistakes all the people around him for spectators or actors, and all the surrounding objects for those that he usually encounters in the theater. The duration of this state can be minutes or many hours.

Hysterical disorders of consciousness include the state of puerilism. It seems to the patient that he is a small child: an adult begins to play with dolls or jump on a stick. In their manner of speaking and behavior, patients imitate small children.

This same group of disorders of consciousness includes the picture of pseudodementia (false dementia). Such patients give ridiculous answers to the simplest questions. Moreover, the simpler the question, the more often you can get a ridiculous answer. The facial expression seems to be deliberately stupid: patients stare their eyes and furrow their forehead intensely. If with puerilism the patient imagines himself as a child, then with pseudodementia he is mentally ill.

Disorders of consciousness such as puerilism and pseudodementia last for weeks or months. Somatic disorders. In the somatic sphere there are various disorders of hysterical origin. The nature of these disorders is associated with the ideas of the patients: how the patient imagines this or that somatic or nervous disease, so will its manifestations.

With hysteria, motor and sensory disorders are common. Among the motor disorders, paresis and paralysis (monoplegia, paraplegia, hemiplegia), hyperkinesis are observed. In hysterical paralysis, muscle tone is unchanged, tendon reflexes are not impaired, there are no pathological reflexes, and there are no atrophies. In other words, in the clinical picture of paralysis there are no signs of organic damage to the central or peripheral nervous system. A peculiar movement disorder in hysteria is the so-called astasia - abasia, the essence of which boils down to the fact that the patient cannot stand and walk while maintaining all movements and coordination in the legs during examination in bed. Hyperkinesis during hysteria is of a varied nature: trembling of the arms, legs, and the whole body.

For a sensitivity disorder (usually anesthesia), it is characteristic that the boundaries of the distribution of the sensitivity disorder are not related to the anatomical location of the sensory conductors. For example, with hysterical hemianesthesia, the border of the sensitivity disorder runs strictly along the midline; with anesthesia in the hands, sensitivity is disrupted like “gloves in the feet - like “socks”, “stockings”.

In addition, hysterical speech disorders are observed: mutism (muteness), stuttering, aphonia (silence of voice) or deaf-muteness (surdomutism). There are hysterical blindness (amaurosis), blepharospasm.

Hysterical character. Increased emotionality is noted. The behavior of patients is closely dependent on their emotional sphere. Their emotions have a significant influence on the course of their ideas.

Character traits include their tendency to fantasize and lie. When they tell non-existent stories, they sometimes get so carried away that they themselves begin to believe in their verisimilitude. By any means necessary, these patients strive to be the center of attention.

Patients have an increased love for bright colors. Many of them prefer to dress up in such clothes that attract the attention of others.

Disorders of autonomic functions are often observed: increased sweating, impaired thermoregulation, spasms of smooth muscles. Shortness of breath, tachycardia, cough are noted; disorders of the gastrointestinal tract (vomiting, intestinal paresis, hiccups), urination, sexual disorders.

Such patients are highly emotional, passionately experience grief and joy, and easily move from laughter to sobs and vice versa. Due to the most insignificant reasons, their mood fluctuates sharply. Patients are characterized by a tendency to fantasize, to exaggerate colors, and unconscious deceit.

The behavior of patients is characterized by theatricality, mannerism, and lacks naturalness. Patients are egocentric, their attention is entirely focused on their experiences, they strive to evoke sympathy from others. Very typical of hysteria flight into illness . Violations take on a character conditional pleasantness or desirability . These phenomena can become protracted.

All these disorders have their physiological basis. Schematically, this can be represented as follows: in the cerebral cortex or subcortical formations, foci of irritative or inhibitory processes appear, which, according to the law of induction, are surrounded by a process of the opposite sign, as a result of which they acquire decisive importance for a particular function. Paralysis, for example, is a consequence of the transition of a group of cells into an inhibitory state.

Hysterical neurosis often occurs in mild forms. Signs of the disease are limited to a hysterical character and excessive manifestations of the reactivity of patients - a tendency to hysterical crying under circumstances that are traumatic to the psyche, dysfunction of internal organs. In more severe cases, the course of the disease is complicated by various combinations of the symptoms described above. Under the influence of treatment or elimination of a traumatic situation, significant improvements can occur in the condition of patients. However, new mental trauma can again lead to severe disorders.

3 Psychasthenia

Psychasthenia usually develops in people of the thinking type.

It is characterized by the predominance of the second signaling system with the presence of processes of congestive excitation in the cerebral cortex. With psychasthenia, there is inertia of cortical processes and their low mobility.

Psychasthenia is manifested by anxious suspiciousness, inactivity, and concentration on one’s personality and experiences.

The pathophysiological basis of psychasthenia is the pathological predominance of the second cortical signaling system over the first, the presence of foci of stagnant excitation in it, the inertia of cortical processes, the pathological separation of the second signaling system from the first and through it from the subcortex. The observed obsessive states are a reflection of excessive inertia of the foci of excitation, and obsessive fears are a reflection of inert inhibition.

Patients are withdrawn, their emotional mobility is reduced. In patients, increased rationality comes to the fore, and there is an extreme poverty of instincts and drives. The patient often experiences painful doubts and hesitations, does not believe in his own strength, and is overwhelmed by endless reasoning, which he uses instead of quick and decisive actions.

Psychasthenics are characterized by a lack of a sense of reality, a constant feeling of incompleteness of life, complete worthlessness in life, along with constant fruitless and distorted reasoning in the form of obsessions and phobias. Obsession is characterized by three types: obsessive ideas, obsessive movements, obsessive emotions.

A distinctive feature of these states is that they arise, as it were, without the desire of the patient, who, aware of the absurdity of these states, is nevertheless unable to get rid of them. Obsessive fears (phobias) include, for example, fear of open spaces, fear of approaching misfortune, fear of water, heights, cardiophobia, etc.

With obsessive actions, we are talking about violent counting, the desire to touch all the windows that the patient passes by, etc.

Patients tend to have decreased attention.

Gradually, self-doubt and difficulties in acting increase and manifest themselves in various unpleasant sensations: pain, muscle weakness, even transient paresis of any muscle group causing stuttering, writer's cramp, urination problems, etc.

Functional disorders of the cardiovascular system, manifested by tachycardia and extrasystole, can often occur.

All signs of psychasthenic neurosis appear in patients due to nervous overstrain and can bother them for a long period. As a result of treatment, they are gradually eliminated, but due to the imbalance of signaling systems and the weakness of nervous processes, the new task that life will set for the patient may turn out to be unbearable for him, and disorders of higher nervous activity may begin again. If the disease develops in adulthood or old age, then it is relatively mild and much easier to treat.

With psychasthenia, the symptoms of obsession are so painful for patients that they often make them completely disabled, especially during periods of exacerbation of the disease. Treatment and rest can restore the normal state of nervous processes for a long time, due to which the attitude of patients towards the environment becomes more correct, their ability to work is restored, and they can take an appropriate place in society.

2. Exercise therapy for these diseases

Physical exercises used for diseases of the nervous system have a diverse effect on the body through nervous and humoral mechanisms. The nervous mechanism is the main one: it not only determines the reaction of the whole organism, but also determines all human behavior in the process of performing exercises.

As a result of a breakdown of higher nervous activity, the strict coordination in the work of all organs and systems of the body is weakened or sharply disrupted. Clinically, this is manifested by disturbances in the interaction between mental and systems and usually leads to a decrease in motor activity, which worsens the patient’s condition.

Hypokinesia adversely affects the functional state of the whole organism; persistent disorders of the cardiovascular and respiratory systems occur, which favors the further progression of the disease. This implies the need to use physical exercises to influence the patient’s body as a whole.

Physical exercise helps normalize the relationships between various body systems. As a result of restructuring the relationships between individual systems, the performance of various organs increases and the functions of various organs improve. Thus, dosed muscular work should be considered as a good regulator of the activity of internal organs.

Physical exercise has a positive effect on the state of the cardiovascular, respiratory and muscular systems. During exercise, the amount of circulating blood increases, blood circulation in the brain increases, the outflow of lymph and venous blood and metabolism improves, the release of oxygen from the blood to tissues, muscles, and heart increases, and redox processes accelerate. Physical exercises correlate the activity of all systems, raise the tone of the body and contribute to the restoration of impaired somatic functions in patients with neuroses.

The effect of physical exercise must be considered as the influence of an organized system of stimuli acting mainly on the motor analyzer, increasing tone, which in turn affects other parts of the brain. Increasing the tone of the cerebral cortex has a beneficial effect on the course of neurosis.

In addition, physical exercise creates a background for increasing the effectiveness of complex treatment. Systematic exercise improves proprioceptive afferentation and thereby contributes to the normalization of cortical activity and motor-visceral relationships, helps to equalize the ratio of the two signaling systems, and eliminates the main symptoms of the disease. This gives grounds to consider therapeutic physical culture as a method of pathogenetic therapy for patients with neuroses. In addition, exercise increases the effectiveness of medications and other treatments.

During the treatment, the coordination activity of the nervous system is improved, and the body’s adaptation to stress increases. During physical training, the processes of excitation and inhibition are balanced, which leads to an improvement in the condition of many body systems and, in particular, the muscular system. Redox processes occur more completely in the tissues of the body. Physical exercise leads to strengthening of the muscular-visceral-cortical connections and contributes to a more coordinated functioning of the main body systems. At the same time, the activity of the body’s defenses, its compensatory mechanisms and resistance to stress increases.

Positive emotions increase muscle performance. Positive emotions that arise during physical exercise play an important role in increasing the tone of the nervous system.

Positive emotions distract the patient from painful experiences and help improve the functioning of the heart, lungs and other internal organs.

The emotional state is reflected in both the behavior and motor acts of a person. .

Physical exercise has a beneficial effect on the human psyche, strengthens his volitional qualities, emotional sphere, and increases organization. .

When performing physical exercises, the interaction of mental, autonomic and kinesthetic factors occurs.

It has been proven that verbal influence on a patient during exercise can affect the function of internal organs and metabolism. With a certain methodology, exercise therapy can be considered as one of the methods of active psychotherapy.

Physical exercises have a general hygienic, restorative, and tonic effect on the patient’s body. They increase the tone of the central nervous system, help normalize autonomic functions, and distract the patient’s attention from his painful sensations.

Physical exercise causes increased afferent impulses from proprioceptors of the musculoskeletal system to the central nervous system. Reaching the cerebral cortex, the impulses help to equalize the dynamics of the main nervous processes, normalize cortical-subcortical relationships, and restore neural trophism. Activation of various parts of the motor analyzer, including motor neurons of the spinal cord, increases the biopotential of muscles, their performance, normalizes muscle tone, which is especially important when voluntary movements are weakened (paresis) or completely absent (paralysis).

The patient's active volitional participation in physical exercises helps to mobilize the body's reserve capabilities and improve conditioned reflex activity.

The importance of exercise therapy is increasing due to the need for maintenance treatment in out-of-hospital settings after discharge from the hospital. Exercise therapy can and should be one of the means supporting remission.

Exercise therapy is an excellent means of involving patients in work processes (to destroy the fixation of a painful stereotype).

For patients with neuroses, exercise therapy has pathogenetic significance.

It has been proven that afferent impulses cause differential changes in the excitability of the cerebral cortex: short and intense physical stress increases the excitability of the cortex, and prolonged muscle tension decreases it. Some exercises help stimulate predominantly cortical processes with the participation of the second cortical signaling system (development of target movements), others stimulate the extrapyramidal and cortical signaling systems (automation of movements). Such differentiation does not depend on physical culture as such, but on the methodology of its application.

Restoring functions impaired as a result of a pathological process by the method of physical exercise is a therapeutic and educational system that provides for the conscious and active participation of the patient in the complex process of exercise.

With neuroses, patients often experience mental depression and lethargy. Under the influence of conscious-volitional performance of physical exercises, psychogenic inhibition is reduced and even disinhibition is achieved, due to an increase in the excitability of the nervous system.

Under the influence of systematic training, the function of nerve pathways and peripheral receptors improves. Training, by eliminating peripheral inhibition, seems to delay the decline in performance. The neuromuscular system becomes more stabilized.

When performing physical exercises, various reflex connections (cortico-muscular, cortico-vascular, cortico-visceral, muscular-cortical) are strengthened, which contributes to a more coordinated functioning of the main systems of the body.

Observations show that the effect of therapeutic exercises is expressed in increased lability of the nervous system.

Training leads to a decrease in the consumption of energy substances during muscle activity, and oxidation-reduction processes improve.

Under the influence of physical exercise, the content of hemoglobin and red blood cells in the blood increases, and the phagocytic function of the blood increases.

With the systematic use of physical exercises, muscles are strengthened, their power and performance increase.

1 Indications and contraindications

Exercise therapy has wide indications for so-called functional disorders of the nervous system (neuroses).

The use of exercise therapy for neuroses is justified by the simultaneous influence of physical exercise on the mental sphere and on somatic processes. With the help of physical exercises, you can also influence the regulation of excitation and inhibition processes in the cerebral cortex, level out autonomic disorders and have a positive effect on the emotional sphere of the patient.

Exercise therapy for neuroses is a method of functional pathogenetic therapy, as well as an important general hygienic and preventive remedy.

In general medical practice, there are almost no contraindications against the use of exercise therapy. Contraindications include neuroses accompanied by affective outbursts, convulsive seizures; excessive mental or physical fatigue, state of consciousness disorders, severe somatic disorders.

Old age is not a contraindication for the use of exercise therapy

2 Features of exercise therapy for neuroses

Therapeutic physical culture is understood as the application of physical exercises and natural factors to patients for faster and more complete restoration of health, ability to work and prevention of the consequences of the pathological process.

Therapeutic physical culture is a therapeutic method and is usually used in combination with other therapeutic agents against the backdrop of a regulated regimen and in accordance with therapeutic goals.

The main factor of therapeutic physical culture affecting the patient’s body is physical exercise, i.e. movements specially organized (gymnastic, applied sports, games) and used as a nonspecific stimulus for the purpose of treatment and rehabilitation of the patient. Physical exercise helps restore not only physical but also mental strength.

A feature of the method of therapeutic physical culture is also its natural biological content, since for therapeutic purposes one of the main functions inherent in every living organism is used - the function of movement.

Any set of physical exercises involves the patient in active participation in the treatment process, as opposed to other treatment methods, when the patient is usually passive and the treatment procedures are performed by medical personnel.

Therapeutic physical culture is a method of nonspecific therapy, and physical exercise serves as a nonspecific stimulus. Neurohumoral regulation of functions always determines the overall reaction of the body during physical exercise, and therefore therapeutic physical culture should be considered a method of general active therapy. Therapeutic physical culture is also a method of functional therapy. Physical exercises, stimulating the functional activity of all major systems of the body, ultimately lead to the development of functional adaptation of the patient.

Therapeutic physical culture, especially in a neurological clinic, should be considered a method of pathogenetic therapy. Physical exercises, influencing the patient’s reactivity, change both the general reaction and its local manifestation.

A feature of the method of therapeutic physical culture is the use of the principle of exercise - training with physical exercises. Training a sick person is considered as a process of systematic and dosed use of physical exercises for the purpose of general improvement of the body, improvement of the functions of one or another organ disturbed by the disease process, development, education and consolidation of motor skills and volitional qualities. From a general biological point of view, the fitness of a sick person is regarded as an important factor in his functional adaptability, in which systematic muscle activity plays a huge role.

The main means of therapeutic physical culture are physical exercises and natural factors.

Physical exercises are divided into: a) gymnastic; b) applied sports (walking, running, throwing balls, jumping, swimming, rowing, skiing, skating, etc.); c) games - sedentary, active and sports. Of the latter, croquet, bowling alley, gorodki, volleyball, badminton, tennis, and elements of basketball are used in the practice of therapeutic physical culture. For lesions of the nervous system, gymnastic exercises are most often used.

Physical exercises are used in the form of sets of exercises of varying complexity, duration and intensity.

Dosage of exercises is possible:

) by the duration of the treatment procedure in minutes;

) by the number of repetitions of the same exercise;

) by the number of different exercises during one lesson;

) by the speed and rhythm of the exercises;

) by intensity of physical activity;

) by the number of procedures during the day.

Individualization of physical exercises depending on the physical and mental state of patients, on the characteristics of the clinic is possible in methodological techniques by using:

1)massage;

2)passive movements including lying and sitting;

)joint movements with the methodologist (movements of the patient performed with the active assistance of the methodologist);

)active movements

One of the important aspects of individualizing the exercise therapy technique is the nature of the command and instructions.

In some cases, depending on the task at hand, instruction and command is accompanied by a visual demonstration of physical exercise, in others it is limited to only verbal instructions without demonstration.

Exercise therapy is used in various forms:

1)morning hygiene exercises;

2)recreational games and applied sports exercises (volleyball, tennis, skiing, skating, etc.);

)physiotherapy.

The limits of the therapeutic capabilities of exercise therapy for neuroses are different. Morning hygienic gymnastics and sports and applied games in the complex of general routine activities have mainly general hygienic and health-improving significance. Sports and applied games can also be a good means of subsequent consolidation and remission-maintaining therapy.

As for therapeutic exercises, long courses of specially selected sets of exercises already have pathogenetic significance; The effectiveness of therapeutic exercises lies in improving both the somatic and mental state up to practical recovery.

Therapeutic gymnastics is carried out according to the scheme accepted in exercise therapy.

Therapeutic gymnastics lesson diagram.

1.Introductory part (5-15% of total time)

Objectives: capturing the attention of patients, inclusion in the lesson, preparation for subsequent, more complex and difficult exercises.

2.Main part (70-80%)

Objectives: overcoming the inertia of patients, excitation of automatic and emotional reactions, development of differential inhibition, inclusion of active-volitional acts, dispersal of attention to numerous objects, increasing emotional tone to the required degree, solving assigned therapeutic tasks.

3.Final part (5-15%).

Objectives: necessary reduction of general arousal and emotional tone. Gradual reduction in pace and physical activity. In some cases - physical rest.

Methodologically correct implementation of therapeutic gymnastics procedures is possible only if the following principles are observed:

The nature of the exercises, physiological load, dosage and starting positions must correspond to the general condition of the patient, his age characteristics and fitness level.

All therapeutic gymnastics procedures must affect the entire body of the patient.

The procedures must combine general and special effects on the patient’s body, therefore the procedure must include both general strengthening and special exercises.

When drawing up the procedure, you should follow the principle of gradualness and consistency in increasing and decreasing physical activity, maintaining the optimal physiological “curve” of the load.

When selecting and applying exercises, it is necessary to alternate the muscle groups involved in physical exercises.

When carrying out therapeutic gymnastics procedures, attention should be paid to positive emotions that contribute to the establishment and consolidation of conditioned reflex connections.

During the course of treatment, it is necessary to partially update and complicate the exercises used daily. 10-15% of new exercises should be introduced into the therapeutic gymnastics procedure in order to ensure the consolidation of motor skills and consistently diversify and complicate the technique.

The last 3-4 days of the course of treatment should be devoted to teaching patients those gymnastic exercises that are recommended for them for subsequent exercises at home.

The volume of methodological material in the procedure must correspond to the patient’s movement pattern.

Each exercise is repeated rhythmically 4-5 times at an average calm pace with a gradual increase in the excursion of movements.

In the intervals between gymnastic exercises, breathing exercises are introduced to reduce physical activity.

When combining respiratory phases with movement, it is necessary that: a) the inhalation corresponds to straightening the body, spreading or raising the arms, the moment of less effort in this exercise; b) exhalation corresponded to bending the body, bringing or lowering the arms and the moment of greater effort in the exercise.

The procedure should be carried out in an interesting and lively manner in order to evoke positive emotions in patients.

Classes should be held regularly, daily, always at the same hours, if possible in the same environment, usually in tracksuits, comfortable pajamas or shorts and a T-shirt. Interruptions in classes reduce efficiency.

Carrying out therapeutic exercises requires patience and perseverance; it is necessary to systematically and persistently achieve positive results and overcome the negativism of patients.

At the first failure to involve the patient in classes, one should not give up further attempts; An important methodological technique in these cases will only be the presence of such a patient in the classes of other patients, to excite indicative and imitative reflexes.

Classes should begin with simple and short sets of exercises, with a very gradual complication and increase in their number. It is necessary to avoid patient fatigue, which usually has a negative effect on the results. The duration of classes varies depending on individual characteristics; Depending on the condition of the patients, they should begin from 5 minutes and be increased to 30-45 minutes.

It is advisable to accompany the classes with music. However, music should not be a random element of classes, but should be selected purposefully. Musical accompaniment of therapeutic exercises should be a factor that creates the emotional interest of the patient; a factor that organizes movement, trains memory and attention, stimulates activity and initiative in some cases, restraint and orderliness of movements in others.

Before the start and after the end of each lesson, it is necessary to take into account the general somatic condition of the patient, including pulse rate, respiration and, if necessary, blood pressure.

The presence of strangers in classes with patients with neuroses is undesirable.

It is very important to take into account the effectiveness of exercise therapy. The best criterion for effectiveness is the positive dynamics of the clinical picture, which is recorded by the attending physician in the medical history.

When treating patients with neuroses, one has to encounter a variety of clinical courses and variability of neuropsychic disorders, which makes it impossible to draw up unambiguous sets of exercises. The effectiveness of treatment with physical exercises largely depends on taking into account the individual characteristics of patients, their emotional and volitional orientation and attitude towards treatment. All this requires great ingenuity, pedagogical tact and patience from the physical therapy teacher, which significantly expands the indications for the use of physical therapy.

One of the goals of treatment is to normalize the dynamics of basic nervous processes and autonomic functions. The second task is to strengthen the neurosomatic state and increase the mental tone and performance of patients.

The objectives of the first period of using exercise therapy will be the general improvement and strengthening of the patient, improving coordination of movements, distracting from thoughts about the disease, instilling the skill of correct posture, and establishing pedagogical contact with the patient. In the first period of treatment, exercises for all muscle groups are widely used to develop coordination of movements and improve posture. Exercises should evoke positive emotions, for which games are successfully used.

In the second period, special exercises are introduced, which should help improve memory and attention, speed and accuracy of movements, and improve coordination.

In addition to general developmental exercises, which are gradually given with an increasingly increasing load, agility and reaction speed exercises are used, which develop willpower and the ability to overcome obstacles. Coordination exercises become more complicated, jumping, dismounts (overcoming fear of heights), running, and exercises with a skipping rope are added. Exercises are used that cause a sharp braking process (sudden stop or quick change of body position on command, etc.), outdoor and sports games are used. To train the vestibular apparatus, exercises are introduced with closed eyes (walking with turns), circular movements of the head and torso from the starting position while sitting, etc.; exercises with resistance, with weights, with apparatus and on apparatus.

At the beginning of classes, simple exercises are used, performed at a calm pace, without tension, involving small muscle groups. Such exercises normalize the activity of the cardiovascular and respiratory systems and streamline the patient’s movements. The number of repetitions of exercises ranges from 4-6 to 8-10 with frequent rest breaks. Breathing exercises (static and dynamic) are widely used; they should contribute not only to the restoration of proper breathing, but also to the normalization of cortical processes.

As the patient adapts to the load, it increases due to the complexity of the exercises: exercises are introduced with dosed tension, with weights, complex in coordination, requiring a quick switch of attention (throwing a ball at a target with a change in direction).

If the patient is hyperexcitable, you should not demand that the task be completed accurately at the beginning of the exercises; you should not focus his attention on mistakes and shortcomings when performing the exercises. When the patient’s activity decreases, lethargy, lethargy, and self-doubt decrease, it is necessary to demand accurate execution of tasks, very gradually increasing their complexity; include attention exercises.

In the treatment of neuroses, the following forms of classes are used: individual, group, homework.

The method of training for neuroses is chosen based on the characteristics of the disease, taking into account gender, age, general physical fitness, emotional tone of the patient, functionality, and nature of work activity. It is better if the first lessons are individual. This allows you to establish closer contacts with the patient, identify his mood, reaction to the proposed exercises, select adequate physical exercises, take into account complaints, and instill a number of skills necessary for group exercises.

After a period of familiarization with the patient, he should be transferred to a group for classes.

Group classes for those suffering from neuroses are most useful because... have a beneficial effect on the emotional tone of the patient and promote relaxation of the overstrained nervous system. It is recommended to form mixed (according to the type of neurosis) groups, because Moreover, the influence of patients on each other will not be of the same type, increasing the existing painful manifestations. Group classes in this case should not be standard for everyone. The individual characteristics of patients should be taken into account, which should be reflected in the method of training, in the dosage of physical exercises, and in the form of their implementation.

The size of the group depends on many reasons. But the main thing is clinical indications. The general methodological setting is that in cases where it is necessary to increase the patient’s activity, to bring him out of a state of lethargy, to overcome negativism, inertia, obsession, the group can be large, even up to 20 people, but if active inhibition training is required, to reduce excessive excitability of the patient, overcome emotional excitability, the group should be small, no more than 5-6 people.

There are also many unique features in the composition of groups. We have to take into account both the clinical picture of the mental state and the somatic state of the patient; we have to take into account how long the disease is, and the fact that some patients are already trained, while others are just starting training, etc.

The course of treatment in a group lasts up to two months.

Group classes should be held at least 3 times a week, preferably with musical accompaniment, which always evokes positive emotions, especially necessary for patients with neuroses.

It is important to ensure that the load corresponds to the functional capabilities of each student and does not cause overwork.

Independent studies are used when it is difficult for a patient to regularly attend medical institutions or when he has completed hospital treatment and has been discharged for follow-up treatment at home.

When doing therapeutic exercises at home, the patient must periodically visit the doctor and methodologist to monitor the correctness of the exercises and receive repeated instructions for further exercises.

Self-study increases the activity of patients and ensures the persistence of the therapeutic effect in the future.

When conducting physical exercises, it is necessary to take into account the nature of the patient’s work and home conditions. For patients in a state of overfatigue, classes should be structured with rest in mind. In this case, breathing exercises are combined with physical exercises well known to the patient. The end of classes should be calm.

Patients without overwork are offered unfamiliar physical exercises with weights, a medicine ball, complicated coordination of movements, and relay races.

The selection of exercise therapy tools during a therapeutic gymnastics lesson depends on the clinical manifestations of the disease, the somatic and neuropsychic state of the patient.

In addition to gymnastic exercises, walks, short-range tourism, health paths, elements of sports and outdoor games (volleyball, playgrounds, table tennis) and the widespread use of natural factors are recommended. A good therapeutic effect comes from including games in every lesson. Classes should be carried out, if possible, in the fresh air, which helps strengthen the nervous system and improve metabolism in the body.

During classes, the methodologist must provide psychotherapeutic influence, which is an important therapeutic factor, distract the patient from painful thoughts, and cultivate his perseverance and activity.

The classroom environment should be calm. The methodologist sets specific tasks for patients, selects exercises that are easy to perform and positively perceived. He is obliged to maintain the patients’ confidence in their capabilities and to approve the correct execution of exercises. It is useful to conduct conversations with patients to determine their correct attitude towards exercise therapy. switching the patient’s attention to solving specific problems helps to normalize the dynamics of nervous processes and the emergence of a desire to move. In the future, the patient’s attention is directed to participation in work activities and the development of a correct assessment of his condition.

In addition to various exercises, hardening procedures are recommended for patients with neuroses - sun treatment, air baths, water procedures.

Regulating the regimen is important: alternating sleep and wakefulness, physical exercise and passive rest in the air or walking.

In the complex treatment of neuroses, the following are also used: drug treatment, occupational therapy, psychotherapy, electrosleep, landscape therapy, walks, massage, physiotherapy, hydrotherapy, etc.

Skiing, cycling, fishing, picking mushrooms and berries, swimming, rowing, etc. have a positive effect on neuroses.

For neuroses, sanatorium-resort treatment in local sanatoriums using all means of complex therapy is indicated, as well as treatment in the resorts of the Crimea and the North Caucasus.

2.3 Features of exercise therapy for neurasthenia

As already mentioned, patients with neurasthenia are characterized, on the one hand, by increased excitability, on the other, by increased exhaustion, which is a manifestation of the weakness of active inhibition and disorder of the excitatory process. These patients are easily vulnerable and often fall into a depressed state.

When prescribing exercise therapy, it is first necessary to find out the causes of neurasthenia, because Without removing these causes, treatment will be ineffective; explaining to the patient the causes of the ailment; his active participation in his treatment provide significant assistance in eliminating the disease.

For patients with neurasthenia, the use of exercise therapy with its regulatory effect on various processes in the body is literally a pathogenetic form of treatment. In combination with streamlining the daily routine, drug treatment, and physiotherapy, a gradual increase in load improves circulatory and respiratory functions, restores correct vascular reflexes, and improves the functioning of the cardiovascular system.

When organizing and conducting therapeutic exercises with patients with neurasthenia, the target setting should be based on the need to train and strengthen the processes of active inhibition, restoration and streamlining of the excitatory process.

Means and methods of therapeutic exercises for this group of patients must take into account all these features.

First of all, based on the increased fatigue of patients, the lack of a feeling of vigor in freshness, especially after sleep and in the first half of the day, therapeutic exercises, in addition to the mandatory morning, hygienic exercises, should be carried out in the morning, the dosage of the duration and number of exercises should increase very gradually and start with minimal loads.

With the most weakened, asthenic patients, it can be recommended to begin classes for several days with a general 10-minute massage, passive movements while lying in bed or sitting.

Lesson duration is no more than 10 minutes. It is recommended to include repeated breathing exercises.

Due to the abundance of somatovegetative disorders and complaints, preliminary psychotherapeutic preparation and removal of very frequent cases of iatrogenism are required; During the training, the methodologist must be prepared to, without fixing the patient’s attention on various painful sensations (for example, heartbeat, shortness of breath, dizziness), regulate the load so that the patient does not get tired, so that he can stop performing for a while without any embarrassment exercise and fail. There is no need to require precision in performing the exercises, but gradually the patient needs to be drawn more and more into the exercises, interest in them increased more and more, the exercises diversified, and new means and forms of exercise introduced.

In some cases, especially at the beginning of the use of therapeutic exercises, the reaction to the load may be increased, and therefore it should be strictly proportioned to the adaptive capabilities of the patients.

One should also take into account the fact that it is difficult for patients to concentrate - it quickly weakens. Patients do not believe in their abilities, and therefore avoid performing difficult tasks; if they fail at something, they proceed to solve a similar problem in the future without faith in success. Knowing this, the methodologist should not give patients excessive exercises. They need to be made more complex gradually, explained and shown very well.

At the beginning of classes, patients may be distracted and uninterested. Therefore, the methodologist must, first of all, instill in them a positive attitude towards physical exercise. It is necessary to develop a training methodology in advance and conduct it purposefully, in a relaxed manner.

Classes can be conducted both individually and in groups.

If the patient is overtired, individual classes are conducted to establish close contact with him, identify his individual reactivity and select adequate physical exercises. Such patients are recommended to practice independently after a preliminary explanation of the content of the exercise. At the same time, periodic monitoring is carried out, adjustments are made to the methodology of the exercises.

One of the very important elements of classes should be not only their musical accompaniment, but also the use of music as a healing factor, as a means of sedation, stimulating, exciting. When selecting musical melodies and the tempo of musical accompaniment for classes, we recommend soothing music of moderate and slow tempo, combining both major and minor sounds. You should choose simple melodic music, you can use beautiful arrangements of folk songs.

Scheme of therapeutic exercises lessons for patients with neurasthenia.

Introductory part. Introduction to the lesson. Gradual increase in difficulty and number of exercises, gradual increase in effort.

Main part. Further gradual complication of exercises and efforts. Increased emotional tone.

Final part. Gradual decrease in physical effort and emotional tone.

Methodology.

The duration of the lesson is relatively short at first, 15-20 minutes, but then it is gradually increased and brought to 30-40 minutes. The exercises are very simple at first and do not require any physical exertion. Gradually, starting from the 5th-7th lesson, elements of the game are introduced into the lesson, especially playing with a ball, and in winter also skiing.

The introductory part lasts 5-7 minutes. In the future, its duration does not increase; The total duration of the lesson is extended only due to the main part. The lesson begins with walking in a circle, at first at a slow pace, then the pace speeds up somewhat.

Walking lasts 1 minute. Free movements: arms from 4 to 10 times, torso - each from 4 to 10 times, legs - each from 4 to 10 times, sitting and lying exercises - each from 4 to 10 times.

The main part, as already mentioned, gradually changes both towards complexity and towards longer duration. The first 5-7 lessons include exercises with gymnastic sticks, each 4-12 times, on a gymnastic bench - from 2 to 8 times. In the summer, ball games are included, especially lapta, and in the winter, skiing is included. The duration of the ball game should not exceed 10-15 minutes. A ski walk should not exceed 30 minutes, the distance should not be more than 2-3 km, the pace of walking should be leisurely, attempts to walk at a fast, athletic pace should be stopped. There should be no steep ascents or descents. You can organize skiing from the mountains, but only flat ones.

In the final part of the lesson, you need to gradually reduce the number of movements the students make and make them slower. Breathing exercises are used (from 4 to 8 times). After the lesson, you should carefully inquire about the well-being of the patients, and during the course of therapeutic physical education, periodically find out the state of sleep, appetite, emotional balance, and if some indicators worsen, find out whether they are associated with an overdose of therapeutic exercises.

It is recommended to use exercises with alternate contraction and relaxation of muscles, breathing exercises, exercises for the upper and lower extremities should be performed at an average pace, with a small amplitude. Later, swinging exercises for the limbs, exercises that require some tension, and exercises with overcoming resistance are added. Exercises for the arms should be combined with exercises for the torso; exercises that require speed and significant muscle tension - with breathing exercises. In the main part of the lesson, various exercises with the ball should be introduced in a game form - a ball in a circle with various methods of throwing, relay games with passing balls and other objects, relay combinations with runs, with various tasks (jumping over a gymnastic bench, climbing over an obstacle). These exercises must be alternated with relaxation exercises and breathing exercises.

During the entire course of treatment, you should pay the most serious attention to the emotional side of classes. The instructor's command should be calm, demanding, accompanied by short and clear explanations, and should contribute to the manifestation of cheerfulness and good mood during the lessons.

In addition to outdoor games, it is recommended to use various sports games: croquet, skittles, gorodki, volleyball, tennis. Depending on the patient’s condition, his fitness level, individual reactions (pulse, fatigue, excitability, behavior in a group), games such as volleyball and tennis should be dosed, allowing play with a time limit (from 15 minutes to 1 hour), introducing short pauses and breathing exercises, simplified game rules.

Among applied sports-type exercises that help overcome feelings of uncertainty, fear and other neurotic reactions in patients, it is recommended to use balance exercises on a narrow and elevated support area (bench, log, etc.), climbing, jumping, jumping, and jumping water with gradual difficulty, swimming, exercises in throwing balls, etc. The special benefits of skiing in winter and regular walking and hiking in summer, spring and autumn should be emphasized. They have a training effect on the circulatory and respiratory systems and increase the functional adaptability of the patient’s body to various physical activities. Downhill skiing fosters and develops confidence, determination and has a beneficial effect on the function of the vestibular apparatus. Skiing has a positive effect on the neuropsychic sphere of patients with neurasthenia, which is associated with favorable environmental conditions. Active muscle activity in the frosty air increases overall tone and creates a cheerful mood. The beauty of changing landscapes, especially in sunny weather, and silence evoke joyful emotions in patients, helping to relieve the nervous system from the usual type of professional activity.

In summer, autumn and spring, regular dosed walks in the air at different periods of the day, depending on the patient’s work schedule, are of great therapeutic and preventive importance. Of particular benefit are walks outside the city, which have a positive effect on the neuropsychic sphere, distracting the patient from “going into illness.”

For these patients, strict regulation of the regimen is useful, especially the alternation of sleep and wakefulness, as well as the alternation of active forms of exercise therapy with passive rest in the air.

Depending on the patient’s interests, we can also recommend fishing and hunting, which evoke joyful emotions and actively influence the restructuring of the neuropsychic sphere

With the hyposthenic form of neurasthenia, the training method is somewhat different; The main goal of using therapeutic exercises for this variant of neurasthenia is careful training of the excitatory process, and only then - strengthening active inhibition. Even in cases where patients themselves begin to participate too actively in therapeutic physical training, it is necessary to promptly limit such excesses, since an overdose during hyposthenia can significantly worsen the patient’s condition. Therapeutic physical training for the hyposthenic form of neurasthenia is also indicated to improve somatic indicators.

Most patients, due to severe exhaustion, spend most of the day in bed or sitting. Therefore, they easily develop symptoms of detraining, when even getting out of bed causes a significant increase in heart rate and shortness of breath.

For the first 5-7 days, it is advisable to carry out the exercises in the ward, without bringing patients into the room, and some should initially be recommended to exercise while sitting in bed. Lesson duration 5-10 minutes; only after 5-7 days of classes can you increase the duration of the lesson to 20-30 minutes.

The introductory part in the first week of classes, in essence, exhausts the entire lesson outline. It consists of very slow floor exercises performed without any tension (4-8 times). Walking can be recommended starting from the second week of classes; it should be slow, in small steps. As with the hypersthenic version, with hyposthenia the duration of the introductory part of the lesson does not exceed 5-7 minutes.

The main part of the lesson is added to the introductory part only starting from the 2nd week of classes. The duration of the main part in the 2nd week is 5-7 minutes, then it is gradually extended to 12-15 minutes. In this part, simple exercises are performed with a volleyball ball (7-12 times), gymnastic sticks (6-12 times each). Starting from the 3rd week, you can introduce simple game exercises with a ball into the main part of the lesson (throwing up to 10 times, throwing a basketball into a basket).

When prescribing therapeutic physical training to such patients (with severe asthenia and a sharp violation of adaptation to physical activity), it is necessary to further limit physical activity, i.e., prescribe the most lightweight, simplest exercises. During the procedure, pauses for rest are included, exercises are introduced in easier starting positions (lying and sitting), for the purpose of general toning, corrective exercises are included and with dosed tension, which alternate with breathing ones. Exercises are also used to develop the function of the vestibular apparatus. Classes are conducted individually or in a small group.

The task of therapeutic physical culture in relation to this group of patients is to, through targeted physical exercises, achieve a decrease in emotional lability and increase the activity of conscious-volitional activity; pathophysiologically, this means increasing the activity of the second cortical signaling system, removing the phenomena of positive induction from the subcortex and creating differential inhibition in the cerebral cortex.

The implementation of these tasks is achieved, first of all, by a slow pace of movements, a calm but persistent demand for accuracy in performing the exercises, and a specially selected set of simultaneous, but different in direction, exercises for the right and left sides. An important methodological technique is to perform memory exercises, as well as according to the methodologist’s story without illustrations of the exercise itself.

Scheme for constructing therapeutic gymnastics lessons for hysteria.

Introductory part. Inclusion in the lesson. Decreased emotional tone.

Main part. Focusing on the task at hand.

Development of differentiated braking. Inclusion of active-volitional acts.

Final part. Decreased emotional-volitional activity. Complete physical rest.

Lesson duration 45 minutes.

Methodology.

To avoid induction by emotional patients, the group should not include more than 10 people. The command is given slowly, smoothly, and conversationally.

Calm, but strict demands on the accuracy of the exercises. All errors are noted and corrected.

The requirement for accuracy should be gradually increased.

Classes are held in the absence of outsiders. A decrease in emotional tone is achieved by slowing down the pace of movements. The first lessons begin with the accelerated tempo characteristic of this group - 140 movements per minute and reduce it to 80, subsequent lessons begin with 130 and slow down to 70, then from 120 to 60 per minute. Differential inhibition is produced by simultaneously performed but different tasks for the left and right arms and legs. The inclusion of active-volitional acts is achieved by performing strength exercises on apparatus at a slow pace with a load on large muscle groups.

It is advisable to use various chains of movements and gymnastic combinations. You can use attention exercises. In addition to gymnastic exercises, balance exercises, jumping, throwing, and some games (relay races, small towns, volleyball) are recommended.

In conclusion, the patients perform exercises while lying on a rug or on a folding bed (their goal is to reduce emotional tone as much as possible), and finally, they are given complete physical rest for 1.5 minutes, during which the patient lies on the bed or sits on the floor, relaxed, with head down and eyes closed.

A methodologist in therapeutic physical culture who conducts classes using this method should know that this method for emotionally labile patients is difficult and difficult to perform, as it requires the mobilization of active attention and concentration. Therefore, its success is achieved slowly, not immediately. “Failures” are possible for impatient, excitable and explosive patients, to the point of complete refusal to exercise. It is necessary to persistently and firmly strive to continue classes.

To make it easier to complete the tasks, it is necessary to interest the patients; at first, the classes can be accompanied by music. However, the music should also be selected in a way that would help focus attention; it should be calm, melodic, attracting the attention of patients, cheerful in nature, with a clear rhythm; The tempo of the music should gradually slow down according to the task facing the methodologist. An important element is to perform memory exercises without command. At first, it can be recommended to combine this or that exercise with certain music, so that the music subsequently serves as a conditioned signal to perform the exercise; By increasing the number of melodies and combining them with certain exercises, you can achieve a significant increase in attention. However, the goal is for the patient to eventually perform the exercises without command and without music accompaniment; This greatly trains attention and memory, promotes orderly motor skills, reduces emotional lability, and excessive haste.

A particularly good effect is achieved when patients consciously strive to complete diverse tasks and learn to use motor skills to master their emotions. One of these methodological techniques is the conscious, active-volitional performance of all actions (in everyday life) “quietly and slowly.”

Hysterical paralysis is based on functional disturbances in the area of ​​the motor analyzer, inhibition of certain areas of it, and weakness of the irritable process in the second signaling system. Treatment measures should be aimed at eliminating these changes.

The use of exercise therapy for hysterical paralysis has a positive effect on the emotional state of the patient, helps eliminate uncertainty about recovery, and involves the patient in a conscious and active fight against the disease. Passive movements of paretic limbs cause a flow of impulses to the motor analyzer and remove it from the state of inhibition. Active movements in healthy limbs also have an effect.

Therapeutic gymnastics for hysterical paralysis should be combined with influencing the patient through the second signaling system, with persistent convincing of the need to perform movements. It is very important to get the patient to help the methodologist perform passive movements in the paralyzed limbs, and then try to independently reproduce the movements. The patient must be convinced that he retains the function of movement and the absence of paralysis. Group therapeutic exercises and rhythmic exercises with changes in tempo are recommended. In classes, strong emotional stimuli should be avoided, but it is important to use games that require concentration and intensive work of muscles not involved in contractures and paralysis. Gradually, the paralyzed limb is included in the movement.

2.5 Features of exercise therapy for psychasthenia

Patients with psychasthenia are suspicious, inactive, focused on their personality, inhibited, and depressed.

The therapeutic effects of physical exercises for psychasthenia are very diverse and effective.

The main mechanism of action of physical exercise is to “loose” the pathological inertia of cortical processes, to suppress foci of pathological inertia through the mechanism of negative induction.

The implementation of these tasks corresponds to physical exercises that are emotionally intense, fast in pace, and performed automatically.

The music accompanying the classes should be cheerful, from slow and moderate tempos, like movements, should move to faster ones up to “allegro”.

It is very good to start classes with marches and march-like songs (Dunaevsky’s march from the film “Circus”). Most often and most of all, it is necessary to introduce game exercises, short relay races, and elements of competition into the complex of physical exercises.

In the future, in order to overcome the feeling of self-worth and low self-esteem, shyness, so characteristic of people of a psychasthenic type, it is recommended to introduce exercises to overcome obstacles, balance, and strength exercises.

When forming a group for classes, it is advisable to include in the group several recovering patients with good emotionality and good plasticity of movements. This is important because, as experience has shown, patients in this group are characterized by non-plastic motor skills, clumsiness of movements and clumsiness. They, as a rule, do not know how to dance, avoid and do not like dancing.

In the presence of obsessive phenomena and fears, appropriate psychotherapeutic preparation of the patient and an explanation of the importance of overcoming the feeling of unreasonable fear of performing exercises are of great importance.

Thus, a feature of the therapeutic physical culture of this group is its combination with psychotherapy and music. These three factors comprehensively complement each other and give a good effect.

Scheme for constructing classes for patients with psychasthenia.

Introductory part. Introduction to the lesson. Stimulation of automatic emotional reactions.

Main part. Dispersing attention to numerous objects and accelerating automatic reactions. Increasing emotional tone to the maximum.

H. Final part. Incomplete decrease in emotional tone. Lesson duration 30 minutes.

Methodology.

The number of people being treated is 12-15 people. The command is given lively. Excessive demands and strictness towards mistakes and great precision in performing exercises are harmful.

Errors should be corrected by showing one of the patients to perform the exercises well. It is not recommended to make comments to those patients who do not succeed in this exercise.

With the tone of command, the timbre of the voice, a lively response to the positive emotions of patients, and active participation in their emotional uplift, the methodologist should help increase the contact of those being treated with themselves and with each other. The goal of arousing automatic reactions into an emotional tone is achieved by accelerating the pace of movements: from the slow pace characteristic of these patients of 60 movements per minute to 120, then from 70 to 130 movements and in subsequent sessions from 80 to 140 movements per minute. To increase emotional tone, resistance exercises in pairs, mass game exercises, and medicine ball exercises are used.

To overcome feelings of indecision, shyness, self-doubt - exercises on apparatus, balance, jumping, overcoming obstacles.

In the final part of the lesson, exercises are performed that contribute to an incomplete decrease in emotional tone. It is necessary that the patient leaves the therapeutic gymnastics room in a good mood.

In patients without significant asthenia, the duration of the lesson can immediately be 30-45 minutes. Of these, the introductory part takes 5-7 minutes, the main part - 20-30 minutes, and the final part - 5-10 minutes.

In the introductory part, the lesson begins with walking in a circle (1 minute), followed by floor exercises with arms (8 times), torso (8 times), legs (8 times), and sitting and lying (8 times).

The main part is structured quite variedly; the set of exercises changes in each lesson. In the main part, you need to widely use exercises with a volleyball ball (15 times), gymnastic sticks (8-12 times), and jump ropes (16 times). Particular attention should be paid to exercises that require sufficient firmness, self-confidence, precise coordination of movement, maintaining balance, and frequent changes of excitation and inhibition. This includes exercises with throwing a basketball into a basket (10 times), walking on the rail of a gymnastic bench, first with open and then with closed eyes (4-5 times). In the future, if possible, you need to increase the height of the bar or switch to walking on a gymnastic balance beam. Walking on a slate or log should be gradually made more difficult by performing various exercises during the walk: hitting a hanging ball, various free movements, turns, overcoming obstacles. Among the game exercises, high jump competitions, rounders, volleyball (both with and without a net) are beneficial, and in winter - skiing from the mountains with gradually more difficult conditions for the descent, ice skating, and sledding from the mountains.

In the final part of the lesson, an incomplete decrease in emotional tone is achieved by keeping it short (1 minute) and performing a small number of dynamic breathing exercises for relaxation. It should end with a survey of your well-being.

When combined with asthenization, the scheme for constructing a course of treatment and lessons changes somewhat. In this case, the duration of the lesson initially does not exceed 5-7 minutes and is only gradually increased to 20-30 minutes. The lesson is based on the same principles.

It is advisable to conduct classes with patients with psychasthenia using the play method, to include games, elements of sports exercises and competitions, and excursions in classes. During the exercises, it is necessary to divert the patient’s attention from obsessive thoughts and interest him in exercises.

Some features of the use of physical exercises in classes with patients with psychasthenia are associated with the presence of obsessive fears (phobias). In the presence of phobias and obsessions, psychotherapeutic preparation of the patient is necessary, which becomes especially important to overcome the feeling of unreasonable fear before performing exercises.

So, with a phobia of heights, in addition to the above-mentioned features of the lesson, you need to gradually force them to do exercises that instill confidence in the patient and relieve the fear of heights. These include walking on a log with a gradual increase in the height at which these exercises are performed, jumping from any elevation with a gradual increase in its height.

With cardiophobic syndrome, first of all, you need to become very familiar with not only the mental, but also the physical condition of the patient. Therapeutic physical education classes should be preceded by detailed somatic examinations and consultation with an experienced therapist. You should also carefully study the features in which a cardiophobic attack appears, in particular the connection of these attacks with some situation (physical activity, altitude, anxiety, fatigue, etc.) In accordance with these data, a scheme of therapeutic exercises is built. Of course, we are talking about people who have no coronary circulation disorder (or any other cardiovascular pathology, accompanied or not accompanied by heart pain), but the patient has an intense fear of a heart attack, a fear of dying from myocardial infarction. Particularly indicated for treatment with therapeutic physical culture are persons who have<приступы>Heart pain is associated with anxiety. At first, patients do not participate in the exercises at all, but only attend the classes of other patients. Only then can you gradually involve them in therapeutic exercises. The first classes are very short and are limited to only slow walking in a circle (without floor exercises) and some floor exercises with the legs (4-8 times) and the torso (4-8 times each). Then the duration of the lesson can be increased through exercises with gymnastic sticks, walking on a gymnastic bench and its rail, with the gradual addition of additional exercises while walking. If these exercises are successfully completed, starting from the 3rd week, you can introduce freestyle arm movements, throwing a volleyball (10-15 times) into the introductory and main parts of the lesson, and at the end of the course (4-5 weeks) exercises with jumping ropes, game exercises with a volleyball, bouncing, long jumping, skiing on the plain.

The tactics of the physical education methodologist and the attending physician when heart pain appears in a patient while performing an exercise are quite complex. On the one hand, you need to listen to such complaints, but if you are confident that these pains are not supported by some somatic basis, you need to boldly recommend that the patient not pay attention to the pain, focus on the correct performance of the recommended exercises, especially that the exercises themselves exclude the possibility of deterioration in the cardiovascular system.

A unique technique is prescribed for fear of physical stress. Most often, this obsessive fear appears in people with a postoperative wound, when doctors advise not to lift heavy objects for the first time, or to do any heavy physical work at all. In the future, despite the good course of the postoperative period, the fear of lifting weights and physical stress is fixed and then a course of special exercises should be carried out.

At first, patients perform only floor exercises with their arms (lesson duration 5-7 minutes) and walking. A week later, the main part of the lesson includes exercises with sticks (4-8 times), free movements of the body, legs, sitting and lying (8-12 times each). After another week, you can add exercises on a gymnastic bench, throwing a volleyball, skiing (without steep ascents and descents, no more than 30 minutes).

Even later, exercises with skipping ropes, jumping, playing volleyball, and finally throwing a medicine ball of increasing weight are introduced into the main part of the lesson.

From the above, it most definitely follows that it is necessary to thoroughly familiarize yourself with the characteristics of the patient and the structure of his experiences. This rule, valuable in general for all types of patients, becomes especially necessary here. Therefore, the therapeutic physical education methodologist must familiarize himself in detail with the medical history, find out all the nuances of obsessive fears, “rituals” of the patient, in a conversation with the attending physician, jointly outline a scheme for the use of therapeutic physical education, and also constantly keep in touch with the attending physician and evaluate changes together. occurring in the structure of the disease, outline further training programs taking into account the changes that have occurred.

An important result of the use of therapeutic exercises for patients with psychasthenic syndromes is the ability to use motor skills to work on the patient’s self; hence the transition from therapeutic exercises in a group in a hospital setting to its use at home; At the same time, there is an undoubted positive effect from the participation of these patients in playing on volleyball teams, in cycling competitions, and, where health conditions allow, in football training and competitions.

Dancing, especially collective dancing, has a great positive meaning for these individuals.

3. Disease prevention

Disease prevention is an extremely important task.

The preservation of health in the working conditions of people is facilitated by: optimal working hours, annual leave, compliance with safety precautions and labor protection rules, annual medical examination of workers in order to identify the initial symptoms of diseases for faster and more effective treatment.

For the prevention and treatment of neuroses, sanatorium-resort institutions and rest homes are widely used.

In order to prevent the development of neuroses, it is necessary to eliminate from childhood those factors that contribute to the formation of a person with a weak type of GND.

Preventing neuroses is an extremely important task.

Considering the connection proven by many scientists with the development of neuroses in children with toxicosis of pregnancy in their mothers, the state of their nervous system, it is necessary to carefully monitor the health of the expectant mother, create a calm environment at home so that your child is born strong and healthy.

Since the formation of the type of higher nervous activity begins in infancy, it is necessary from the first days to create conditions for strengthening and training the most vulnerable process of higher nervous activity - the process of inhibition. To this end, the mother must strictly adhere to the child’s feeding regimen and not indulge his screams and whims.

Of exceptional importance is the fight against childhood infections and strict adherence to follow-up treatment periods. We must remember that the weakening of the nervous system of a child who has suffered a serious illness creates a favorable background for the development of neurosis.

We need to pay special attention to children during critical periods of their development. A child at the age of three or four begins to form his own “I”, so the constant obstacle to developing initiative, pulling children back makes them withdrawn and indecisive. At the same time, we must avoid the second extreme - allowing everything. This leads to indiscipline and non-recognition of prohibitions. The calm, even and firm demands of parents help establish their authority and discipline their children.

From the age of 3-4 years, a child must be taught to look after himself independently: dress, wash, eat, put away toys. In the future, he must be taught to clean his dress, shoes, make his bed, clear the table, etc. In each individual case, you should evaluate the child’s capabilities and not give unbearable tasks, as this can also lead to a neurotic state. You should always strictly monitor the daily routine, nutrition, and use of the time allotted to the child for outdoor activities and sleep.

Timely training of the child in personal hygiene skills and hardening is of great importance. He should, together with adults (but according to a complex appropriate for him), do morning hygienic gymnastics, which helps fight inhibition, makes him dexterous and strong. Daily wiping of the body with water or washing up to the waist, in addition to the habit of maintaining personal hygiene, develops resistance to colds.

It is very important to protect the child from harsh influences on his psyche. We must remember that quarrels and scandals between parents or the breakdown of family relationships have a very painful effect on the nervous system of children. You should not tire them with an excessive number of impressions: frequent visits to the cinema, watching TV shows, long or frequent stays of children in the menagerie, circus, fast driving, etc.

Proper sexual education of a child is very important in the formation of personality. You should not allow him to develop sexual feelings, which can be caused by excessive caress, careless touching during bathing, etc. You should not take children to bed with adults or put them to bed with other children. We must try to develop in the child a calm, natural attitude towards the issue of having children, which usually begins to interest him at the age of 3-7. These questions must be answered in a form accessible to the child.

Children are especially successfully raised in a team: in nurseries, kindergartens, schools, where experienced specialists supervise. However, being in a children's team does not relieve parents of responsibility for raising a child.

If, to prevent neurosis in childhood, the main attention is paid to creating a strong type of higher nervous activity in the child, then to prevent neurosis in adults, the main thing is to prevent the causes that cause weakening of the basic nervous processes. The fight against overwork plays a big role in this.

In production, appropriate conditions have been created for this. During the lunch break, workers rest and do industrial exercises. But people in some professions, as well as students continue to work at home. In such cases, it is important to observe occupational hygiene; if properly organized, overwork does not develop.

The main condition for this is labor planning.

It is very important to diversify your work: alternate mental work with reading fiction or a walk, or, even better, playing sports. Every one and a half to two hours you should take a 5-1 minute break. It is good to fill it with gymnastics or sports games.

Sports games, just like sports in general, help maintain health and develop human endurance. They not only strengthen muscles, improve blood circulation and metabolism, but also significantly normalize the functioning of the cerebral cortex and contribute to the training of basic nervous processes. All people should play sports, regardless of age. There are many examples of elderly people who have been involved in sports for a long time, maintaining health, clarity of mind, vigor, normal performance and good mood.

It is especially valuable to combine sports with water procedures - rubbing, dousing, cool showers, sea bathing, as well as taking air baths, sleeping in the air.

Considering the importance of sleep, which protects nerve cells from exhaustion, one should constantly take care of its usefulness. Chronic lack of sleep contributes to the weakening of nerve cells, as a result of which signs of chronic fatigue develop - irritability, intolerance to strong sound stimuli, lethargy, and fatigue.

An adult needs to sleep 7-8 hours a day. Sleep should not only be long enough, but also deep. It is necessary to strictly follow the regime - go to bed at the same time.

Sudden excitement before bed or prolonged work can serve as an obstacle to falling asleep quickly. Going to bed with a full stomach is very harmful. It is recommended to have dinner 2-3 hours before bedtime. There should always be fresh air in the room where you sleep - you need to train yourself to sleep with the window open. Saturation of nerve cells with oxygen is a very important factor for health.

No less important for the normal functioning of nerve cells is the quality and diet. It should be quite high in calories and varied in the selection of products. Fats and carbohydrates are the main energy source of working cells, and therefore they are especially necessary in cases of intense work. Proteins are the main substance, living matter for higher nervous activity. In cases where protein intake is limited, the strength of nervous processes decreases. The diet should also include various minerals: phosphorus, iron, potassium, calcium, iodine, etc. These substances in the form of salts, oxides or chemical elements are found in meat, milk, liver, cheese, egg yolk, bread, cereals, beans, fruit juices, vegetables, green parts of plants, yeast and other products. The mineral content of food can also determine the state of irritative and inhibitory processes. Vitamins are no less important.

We should not forget that drinking alcohol and smoking contribute to the occurrence of neuroses. Both lead to slow poisoning of the nervous system, causing severe changes in it and in a number of other organs and systems.

Conclusion

As a result of analyzing scientific and methodological literature on the topic of my course work, I came to the conclusion that neuroses are functional diseases of the central nervous system that arise as a result of overstrain of nervous processes.

The following types of neuroses are distinguished: neurasthenia, hysteria, psychasthenia.

The use of exercise therapy for neuroses is justified by the simultaneous influence of physical exercise on the mental sphere and on somatic processes.

Exercise therapy for this disease is a method of both pathogenetic and functional therapy, as well as an important general hygienic and preventive remedy.

The great advantage of exercise therapy is the possibility of strict individualization and dosing of physical exercises.

The selection of exercise therapy depends on the age, gender, form of neurosis, professional activity, somatic and neuropsychic state of the patient.

The main means of exercise therapy in the treatment of neuroses are: physical exercises, games, walks, natural factors, etc.

There are various forms of using exercise therapy: morning hygienic exercises, games, therapeutic exercises.

In the treatment of neuroses, there are two periods of using exercise therapy: gentle and training.

In psychoneurological practice, the following forms of conducting classes are used: individual, group, independent.

There are special methods of exercise therapy for various forms of neuroses.

During classes, the exercise therapy methodologist must exercise psychotherapeutic influence on the patient and widely use pedagogical methods and principles in his practice.

Exercise therapy classes for neuroses should be carried out with musical accompaniment.

From all of the above, it follows that exercise therapy in the treatment of neuroses should find wider application in the practice of medical institutions.

neurosis disease psychasthenia hysteria

List of sources used

1. Therapeutic physical culture. / Ed. S.I. Popova. - M.: Physical culture and sport, 1978. - 256 p.

Dubrovsky V.I. Healing Fitness. - M.: Vlados, 1998. - 608 p.

Healing Fitness. / Ed. V.E. Vasilyeva. - M.: Physical culture and sport, 1970. - 368 p.

Moshkov V.N. Therapeutic physical culture in the field of nervous diseases. - M.: Medicine, 1972. - 288 p.

Shukhova E.V. Treatment of neuroses at the resort and at home. - Stavropol: Book publishing house, 1988. - 79 p.

Morozov G.V., Romasenko V.A. Nervous and mental illnesses. - M.: Medicine, 1966, - 238 p.

Zaitseva M.S. Therapeutic physical culture in the complex treatment of patients with neuroses. - M.: Medicine, 1971. - 104 p.

Vasilyeva V.E., Demin D.F. Medical supervision and exercise therapy. - M.: Physical culture and sport, 1968. - 296 p.

Exercise therapy tasks for diseases of the nervous system. 1. Strengthening the patient’s body. 2. Improving blood circulation in the affected parts of the body. 3. Reducing the pathologically increased tone of paretic muscles and increasing muscle strength. 4. Removal of harmful friendly actions: synergism and synkinesis. 5. Renewal of the functional balance between paretic muscles and their synergists. 6. Restoring or increasing the accuracy of movements. 7. Restoration or improvement of nerve conduction from the center to the periphery and from the periphery to the center. 8. Removal or reduction of muscle tremors. 9. Display and formation of the most important motor skills aimed at mastering (training) household and work skills, self-care and movement, preparation for social rehabilitation.

Features of exercise therapy for neurological and neurosurgical pathologies. 1. Early purpose of exercise therapy. Provides for the use of preserved functions and newly created ones, which are adapted to the changed conditions of neurological, somatic and visceral status. 2. Selective use of exercise therapy to restore impaired functions or compensate for lost ones. 3. The use of special exercises according to the pathogenetic principle in combination with the general strengthening effect of exercise therapy. 4. Adhere to the principle of adequacy when constantly changing physical exercises depending on the patient’s capabilities and the presence of a training effect. 5. Gradual continuous expansion of the motor mode from a lying position to the possibility of unlimited movement.

The means of exercise therapy for diseases of the nervous system are basic positions, massage, and special therapeutic and gymnastic exercises. The latter are divided: a) to strengthen muscle strength; b) to obtain strictly dosed muscle loads; c) to obtain differentiated tension and relaxation of individual muscles and muscle groups; d) for the correct display of the motor act as a whole (speed, smoothness, accuracy of movements); e) anti-attack exercises aimed at restoring and improving coordination of movements; f) antispastic and anti-regulatory; є) reflex and ideomotor; g) for the restoration or new formation of applied motor skills (standing, walking, climbing skills); h) passive, incl. manual therapy.

Acute cerebrovascular accident – ​​stroke. There are 3 stages of rehabilitation of patients with stroke: 1st – early updated (up to 3 months) 2nd – late updated (up to 1 year) 3rd – residual impairment of motor functions. Degree of motor dysfunction: 1st – mild paresis; 2nd – moderate paresis; 3rd – paresis; 4th – deep paresis; 5th – plegia or paralysis. The mode of physical activity depends on: 1 – the patient’s condition; 2 – period of illness; 3 – stage of motor dysfunction. Modes of physical activity are: 1. Bed strict (1-3 days). 2. Extended bed (3-15 days). 2-b – days. 3. Ward. 4. Free.

Strict bed rest: 1. Exercise therapy classes are contraindicated. 2. The patient is provided with rest and drug treatment. 3. Treatment by position, i.e. position the patient in the opposite position to the Wernicke-Mann position. This: - reduces spasticity; - prevents the development of contractures; 4. The patient is placed on his back, on his side, the position is changed 4-6 times a day, for 30-60 minutes, depending on the patient’s condition and the muscle tone of the paretic limb.

Extended bed rest: 2 a / 3-5 days Exercise therapy tasks: 1. Improving the functions of the cardiovascular and respiratory systems, preventing complications on their part. 2. Activation of intestinal motility. 3. Improvement of tissue trophism, prevention of bedsores. 4. Decreased muscle tone when it increases. 5. Prevention of hemiplegic contractures. 6. Preparation for active turning onto the healthy side. 7. Stimulation and renewal of isolated active movements in a paretic limb.

Methods: 1. Treatment by position on the back and side. 2. Physical exercises: - Breathing exercises; - active exercises for small, middle, and later large joints of healthy limbs; 3. From 3-6 days – passive exercises for the joints of the paretic limb. 4. They teach volitional sending of impulses to movements synchronously with isolated passive extension of the forearm and flexion of the lower leg.

Extended bed rest: 2 b/day. Exercise therapy: Exercise therapy tasks: 1. Strengthening the general tonic effect on the patient. 2. Teaching to relax the muscles of a healthy limb. 3. Decreased muscle tone in paretic limbs. 4. Transfer the patient to a sitting position. 5. Stimulation of active movements in paretic limbs. 6. Counteractions to pathological synkinesis. 7. Preparing the patient to stand up. 8. Restoration of support functions in the lower extremities. 9. Restoring self-care functions to a healthy limb.

Methods Methods: 1. Starting positions - are of great importance during the execution of passive movements of individual segments of the limbs: The fingers bend more easily if the toe is bent. Forearms – if the shoulder is adducted. The supination of the forearm will be complete if the elbow is bent. The hip is released completely in a bent position. 2. a) classes begin with active exercises for healthy limbs, and then passive exercises for paralytic ones. b) When performing active exercises, it is necessary to use position relief, use: - postal frames; - blocks; - hammocks to support a paralytic limb; c) exercises are performed slowly, smoothly, each movement is performed 4-8 times. First, the limb is rotated to its original position passively, with the help of an instructor, and also with support. Special attention is paid to the resumption of movement of the 1st finger;

D) passively or actively counteract pathological synkinesis: - During active movements of the leg, the hands are fixed behind the head or along the length of the toe; - when the healthy arm bends, the methodologist can at this moment passively extend the paretic arm; - use volitional efforts, bending the leg, the patient counteracts the flexion of the arm, holding it in a straightened position with volitional efforts; e) ideomotor movements; f) isometric muscle tension of the paretic limb.

Ward mode. Exercise therapy tasks: 1. Decreasing muscle tone. 2. Counteracting hemiplegic contractures. 3. Next resumption of active movements. 4. Transition to a standing position. 5. Learning to walk. 6. Counteracting synkinesis. 7. Renewal of self-care skills and applied everyday movements.

Free mode. The methods and methodology of exercise therapy at the late updated stage and during the period of residual motor disorders depend on the degree of motor dysfunction: 1st degree (mild paresis) - a general tonic effect on the body; - strengthening the muscles of the shoulder girdle and back; - improved posture; - movement, walking. 5th degree (plegia, paralysis) - activation of the cardiovascular and respiratory systems; - the patient's position is turned on his side; - Preparation for the transition to a sitting or standing position; - Improving the supporting functions of the lower extremities; - relaxation of the muscles of healthy limbs; - Decreased muscle tone; - counteraction to contractures; - trophic disorders of paretic limbs; - expanding self-service skills.

Degrees of motor and social adaptation of the patient: 1. The mildest degree - the defect is felt only by the patient himself. 2. Mild degree - the defect manifests itself during any physical activity, noticeable from the outside. 3. Average degree – limited ability to independently perform the main aspects of motor activity. Needs partial assistance in everyday life, and at work - a change in profession. 4. Severe degree - the patient’s social and everyday activity is significantly limited. Almost no action, except for the most basic ones. Labor activity is excluded. The patient is completely disabled. 5. Very severe degree – no independent failures and very difficult actions. The sick should lie quietly away from outside scrutiny and help.

Exercise therapy for paralysis and paresis. Paralysis (Greek: paralysis) – loss, paresis (Greek: haresis) – 1) weakening of motor functions with absence or decrease in muscle strength; 2) due to a violation of the structure and function of the motor analyzer; 3) as a result of pathological processes in the nervous system. The following forms of Paralysis and paresis are divided: Depending on the nature of the injury, there is a violation of the responsible structures of the nervous system: Organic Functional Reflex The result of organic changes in the structure of the central and peripheral adductor neuron (head, back, brain, peripheral nerve), which arise under the influence of various pathological processes: injuries , tumors, cerebrovascular accidents, inflammation and other processes. Inheritance of the influence of psychogenic factors that lead to neurodynamic disorders in the central nervous system and occur mainly in hysteria. The result of neurodynamic functional disorders N.S., which arise under the influence of a significant lesion, not necessarily related to paralysis and paresis that is formed

According to the nature of the tone of the muscles, they are distinguished: central or spastic, flaccid (peripheral) and rigid paralysis and paresis. Depending on the structural level of the movement of the motor analyzer, paralysis and paresis are divided into: Central (pyramidal) (spastic) Peripheral (flaccid) Extapyramidal (rigid) Spastic nature of the muscle hypertonicity hyperreflexia, pathological and protective reflexes, pathological friendly movements, absence of skin reflexes Decreases (flaccid ) muscle tone. When a peripheral motor neuron is affected a) atony b) areflexia by an infectious process, infectious-allergic, degenerative process (cells of the anterior horns of the spinal cord, nuclei of the cranial nerves, anterior corinx of the spinal nerves, plexuses, spinal nerves or cranial nerves nerves) Rigid muscle tone as a result of disruption of the circulatory-subcortical stem connections. Characterized by a decrease or absence of motor activity. Falling together with automatic movements. Slowness of speech, movement in small steps due to the absence of simultaneous movements of the hands. The phenomenon of a stuck gear wheel

Exercise therapy task for central and peripheral paralysis. 1. Improving blood circulation and nervous trophism of affected muscles. 2. Prevention of the development of contractures. 3. Restoration of movement and development of compensatory motor skills. 4. Obshche-strengthening effect on the patient’s body.

Forms of exercise therapy, features of their application: exercise therapy and massage begin in the early stages of treatment. From the first days, specific placement of paretic limbs. For example, with hemiplegia or hemiparesis due to ischemic stroke, positional treatment begins from 2-4 days. For cerebral hemorrhage – from 6-8 days (if the patient’s condition allows this). 1. Laying on the back is the opposite of the Wernicke-Mann position: the shoulder is moved to the side at an angle of 90, the elbow and fingers are extended, the hand is supinated, held on the palm side with a splint. The entire limb is fixed using weights with sand. 2. The paralyzed leg is bent at the knee at an angle. The foot is in dorsiflexion at an angle. Laying on the back is alternated with a position on the healthy side. The frequency of position changes is 1.5 – 2 hours. 4. Massage is used at the same time. Typically, stroking, rubbing, light kneading, and continuous vibration are used.

Massage for cerebral cirrhosis: 1) massage with hypertonicity and smoothing at a slow pace, and their antagonism to stroking, rubbing and kneading at a faster pace; 2) for peripheral (PP): the kidney is smoothed at all ends, and then the paralyzed tissue is massaged, and its antagonists are lightly stroked. Massage begins with the proximal veins, gradually increasing the intensity. For a course of sessions on xv. Indications include acupressure and reflex-segmental massage. 5. In parallel with the massage, perform passive rubs in the skin (5-10 rubs in the skin at a comfortable pace). 6. Active gymnastics is of primary importance. For cirrhosis for 8-10 days, for ischemic stroke and hemorrhage in the cerebrum - for a day. Begin by straightening the end in the required position, then exercise the muscles and tone any movements. Right with the help of various attachments: a frame with a system of blocks and hammocks, a thin surface, a spring rod, gymnastic equipment. Then, active rights are used for healthy and sick ends. With PP, you have the right to work completely in a bathtub with warm water. 7. Begin to sit with ischemic stroke (II) after 10 days from the onset of illness. In case of bleeding in the brain - after 3-4 days. 8. Preparation before walking begins with V. lying and sitting. Begin by standing on two legs from the beginning, then in sick and healthy conditions, walking on the spot, with an instructor in a special wheelchair, with the help of a three-legged police, on a level surface, on descents.

Exercise therapy for neuritis of the facial nerve. Facial nerve neuritis (FN) is manifested by peripheral paresis or paralysis of the facial muscles of a certain part of the face, accompanied by its asymmetry. Indications before exercise therapy for NLN: 1. Neuritis of infectious and vascular origin. 2. After surgical examination, there was swelling and compression of the nerve. 3. After complete recovery of an acute purulent process in the middle ear, which is caused by NLN. 4. NLN, as a consequence of surgery for epitympanitis (rare). Tasks of exercise therapy for NLN: 1. Improvement of regional blood circulation (face, neck). 2. Restoring the function of facial muscles. 3. Prevention of the development of contractures and joint movements. 4. Restoration of correct speech. 5. Reduction of facial expression disturbances in severe nerve injuries that are difficult to treat in order to hide facial defects.

Recovery periods Early MainRecovery In NP 2-12 days days 2-3 months In NH days 3-4 months 2-3 years Early period. They use therapeutic positioning, massage, and therapeutic exercises. 1. Treatment position: - sleep on the side of the exercise; - throughout the day, sit 3-4 times with your head tilted in the opposite direction, supporting it with your hand resting on your elbow. At the same time, pulling the muscles from the healthy side to the side of the exercise (from bottom to top) trying to restore the symmetry of the face; - leukoplaster tension from the healthy side to the patient using a special sholom mask; - tying with a scarf;

2. Massage. Start from the collar area of ​​the neck. The patient sits in front of a mirror. The massage therapist must see the patient’s entire face. All massage techniques (stroking, rubbing, light kneading, vibration) are carried out carefully, without significant damage to the facial skin. Reduction (muscle assignment). 3. Therapeutic gymnastics I. - dosed tension and relaxation of the muscles of the healthy side (zygomatic, laughter, circular muscles of the eye, etc.) - tension and relaxation of the muscles that form facial images (smile, laughter, attention, sorrow). This exercise is only a preparatory stage for the main period.

Special exercises for facial muscles: 1. Raise your eyebrows up. 2. Frown your eyebrows. 3. Close your eyes (exercise steps: look down; close your eyes; supporting your eyelids with your fingers on the side of the exercise, keep your eyes closed for an extended minute; open and close your eyes 3 times). 4. Smile with your mouth closed. 5. Shchurits. 6. Lower your head down, inhale and snort while exhaling. 7. Whistle. 8. Open your nostrils. 9. Raise the upper lip, show the upper teeth. 10. Lower your lower lip and show your lower teeth. 11. Smile with your mouth open. 12. Extinguish the lit match.

13. Take water into your mouth, close your mouth and rinse without throwing out the water. 14. Inflate the cheeks. 15. Moving air from one side of the mouth to the other. 16. Lower the corners of your mouth down with your mouth closed. 17. Stick out your tongue and make it narrow. 18. Move your tongue forward and backward with your mouth open. 19. Move your tongue to the right - left with your mouth open. 20. Pull your lips forward with a tube. 21. Make a colo with your finger, watching it with your eyes. 22. Retract your cheeks with your mouth closed. 23. Lower your upper lip onto your lower lip. 24. With your mouth closed, move the tip of your tongue along the gums from right to left, pressing your tongue with different efforts.

The main (late) period (II) is characterized by immediate restoration of muscle function, which is combined with active treatment, special physical exercises and other methods of exercise therapy. - treatment of VP increases to 4-6 hours (in some cases up to 8-10 hours). The degree of tension of the leukoplasty increases due to hypercorrection (due to overstretching and weakening the tone of healthy muscles. Healthy muscles thereby turn from opponents into allies of diseased muscles). - Massage II. It is carried out using different techniques based on the topography of the pathological process. So, the muscles that are innervated by the first branch of n. facialis, are massaged in the usual way. This includes light and medium stroking, rubbing, and vibration at points. The main massage is carried out from the middle of the mouth and plays a dual role: muscle regulation (minor), massage itself, stimulating blood flow, trophism of paretic muscles, etc.

The duration of the massage is 5-11 minutes on the prosthesis 2-3 times. If there is no effect, continue to chew the LH and apply the massage daily. Repeated course – 20 procedures. - LG III. LH plays an important role in the recent period. All the right to the dele of the group: 1) the differential -to -corruption of the fringes of the paretic meaz (loboni, overslevni, sculpture, mly smoke of the square mly of the upper basts, tricuspid pydborni, circles of the mandy of the company); 2) dosed tension (relaxation) of all named muscles with increasing strength and force; 3) awareness of the exclusion of meat from the formation of various mimetic images, situation, chuckle, laughter, embarrassment, wonder; 4) dosed tension of the muscles according to the frequency of sounds. Do everything in front of the mirror with the participation of an instructor and independently (2-3 times a day). Residual period (after 3 months). Zavdannya TI Sami: Zbilnenya of the Meazovo Dianosti for the wire maximum sinimi, with a good sides of the Ostacchy (in the Tsomo periodi nudi, often May, the contractor of the contractor of the miz

Physical exercise for osteochondrosis of the ridge. Osteochondrosis of the ridge is based on the change of the intervertebral discs with subsequent retractions in the process of the body of the spinal ridges, the intervertebral joints and the ligamentous apparatus. The intervertebral discs play an important role in the stable position of the ridges, ensure the smoothness of the ridge, and perform the function of a biological shock absorber. The factors, the vinikenny of the Osteochondrosis of osteochondrosis є Little -Roussebomiy Zhitty, the trival of the excitement of the fіziologically unhealthy position (Bagatutinne Sidinnya at the letter, at the Kermobil Kermobil, the standing of the derivatives, behind the counter). This significantly reduces bleeding and the provision of living tissues to the spines and interspine discs. Cracks in the fibrous ring appear. As a result of the progression of degenerative changes in the fibrous ring, the fixation of the ridges between each other is destroyed, resulting in pathological looseness. The intervertebral clefts change, the nerve-vascular endings, blood vessels and lymphatic vessels are compressed - the pain intensifies. In the 3rd stage of the disease, the annulus fibrosus ruptures and the intercostal carina hardens. The final stage is characterized by painful strengthening and displacement of the ridges, the formation of pathological cystic growths.

Instructions for physical exercises: 1. Increase the distance between the adjacent spinal segments in order to remove pathological proprioceptive impulses. 2. Accept a decrease in pathological proprioceptive impulses. 3. Reduction of metabolic processes as a result of increased blood flow to lymph circulation in the damaged spinal segment and circulation. 4. Changes in swelling in tissues located in the area of ​​the intervertebral opening, reduction in blood flow at the end. 5. Increase and renewal of the full volume of rivers in the ends and ridges; changes in static-dynamic disorders and compensatory movements, renewal of poor posture. 6. Improve trophism, tone, strength of the muscles of the body and ends. 7. Promote extra physical activity.

Special branches of cervical gymnastics: For radicular syndrome: stretching of nerve trunks and cords; stretching of nerve trunks and cords; development of meat atrophy; development of meat atrophy; strengthening the flesh of the distal ends. strengthening the flesh of the distal ends. For glenohumeral periarthritis: prevention of reflex neurogenic contracture of the ulnar tendon; prevention of reflex neurogenic contracture of the elbow joint; strengthening of the deltoid, supraspinatus, infraspinatus, double-headed muscles. strengthening of the deltoid, supraspinatus, infraspinatus, double-headed muscles. For posterior cervical sympathetic syndrome (spinal artery syndrome): relief of weakened vestibular disorders. Accept weakened vestibular damage.

Osteochondrosis of the cervical spine. Active pain in the cervical region of the ridge in the cobalt and main periods of the treatment course is contraindicated, which may cause the intercrestal opening to occur due to compression of the nerve cords and vessels. Complex V.p. – sitting on a chair (save for the first 7 to the right), hands lowered to the sides of the coat. Turn your head left and right with the maximum possible amplitude. The pace is faster. 2. Lower your head down, reaching the chins of your chest. The pace is faster. 3. Place the whale on your forehead. Press your forehead on the whale for 10 s, then press it for 20 s. The head and the whale of an indestructible woman. 5 times 4. Place the whale on the crown. Press the button for 10 s, then press for 20 s. The head and the whale of an indestructible woman. 5 times 5. Same on the other side.

6. Hands are lowered to the sides of the sheepskin coat. Raise your shoulders and hold them in this position for 10 s, relax for 15 s. 6 times 7. Self-massage of the neck, shoulder joints, trapezius muscle. 5-7 xv 8. V.p. – lying on your back (stay from 8 to 16 to the right), hands under your head. Press your head on your hands - see. Relax - breathe. The pace is relaxed. 10 times 9. Hands on the belt. Pochergova zginannya and rozginannya nіg, without changing the progina across. Do not bury your feet under the covers. 10 times with a skin foot. 10. Hands on the belt, legs bent. Bend over, lifting your pelvis - see, v.p. - breathe in once. 11. Bend your legs and press them to your stomach, hug them with your hands, head to your knees - see, c. n. – inhale once. 12. Hands to the sides. Swing your right leg, push your left hand to your right foot. The same foot and hand. 10 times with each foot. 13. Hands on the belt. Raise your legs straight up 90 - see, lower - inhale. 15 times 14. Hands on head. Left leg and arm to the side – inhale, v.p. – see. Same with the other leg and arm. 10 times with each foot. 15. V.p. – lying on your stomach, gymnastic stick on your shoulder blades. Straighten your legs back and up, raise your head and shoulders, bend over. 15 times

16. V.p. – standing kneeling (keep from 16 to 18 to the right). Without shaking your hands and knees under the support, create a round back - see, v.p. - inhale. 10 times 17. Straighten your right leg - arch with the sheepskin and pelvis back - vidikh, v.p. - inhale. The same with your left foot. 10 times with each foot. 18. Turn your back and head to the left - inhale, v.p. – see. Same to the right. 10 times per skin. 19. V.p. - standing on knees. Stretch your left leg to the side, v.p. the same with the right foot. 10 times with each foot. 20. V. p. – sitting on the back, stretch one leg in front of you, and place the other leg bent at the knees to the side. Stretch forward until your stretched leg, pressing your hands towards the foot. Change your position. 10 times per skin. 21. V.p. - standing. Squat, placing your heels under the supports, arms forward – see, v.p. – inhale, 15 times.

22. V.p. – standing with your left side to the support, your left leg straight behind you. The rights are bent and placed forward, the coat is straight. The springs are swaying. Change your position. 10 times per skin application. 23. Hanging on the bar. Carefully rotate your pelvis alternately to the right and left. Do not strain your neck, shoulder girdle or back - the body is as relaxed as possible. The duration of the hang is 40 seconds. Repeat once a day. 24. V.p. - standing, stick in arms stretched upward. Right foot forward - stick on the shoulder blades. The same with your left foot. 10 times with each foot. 25. A stick in hands stretched upward. Stick on the chest, v.p. Stick on the shoulder blades, v.p. 10 times 26. Stick on the chest. He leaned forward, put the stick on the pad - see, v.p. - inhale. 10 times 27. The stick is in the lowered hands behind the back (grip from below), stretched forward, hands with the stick as far back as possible, up - vidih, v.p. - inhale. 10 times 28. A stick in clasped hands in front of the chest. Remove the stick with a swing of your left leg, then your right. 10 times with each foot. 29. Swing your left leg forward, arms up - inhale, v.p. – see. The same with the right foot. 10 times with each foot. 30. Feet shoulder width apart. He leaned forward, pushing his left foot with his right hand, left hand to the side - visible, v.p. - inhale. The same to the right foot. 10 times to the skin of the leg.

Complex 2 Wash the skin 5-6 times. 1. V.p. - lying on your back. Raising your head and shoulders, turn your coat to the right, pull your arms forward and to the right; those in the other direction. 2. V.p. – lie on your stomach, arms to the sides. Raising your coat, place your hands behind your head and bend over. 3. V.p. – standing – feet shoulder-width apart. Move your head to the right, turn your head to the left. Those are in the other direction. 4. Feet shoulder-width apart, hands on the waist. With a small fringe of the tulub, stretch your right hand up to the left, tilt your head to the left, touching your shoulders with your ear. Those are in the other direction. 5. Feet shoulder width apart. Circle your shoulders back, shave your shoulder blades, squat, tilt your head back; vp, circle with shoulders forward, squat, tilt your head forward. 6. Feet shoulder-width apart, hands on the waist. Rising on your toes, tilt your head forward; lowering your entire foot into a squat, tilt your head to the right. The same ones tilt their heads to the left, then back.

7. Feet shoulder-width apart, arms up. Right hand forward, swing to the side. The same with the other hand. 8. Feet shoulder-width apart, arms to shoulders. Raise your shoulders and shoulder blades forward, then lower them down; straightening your arms up, two spring swings with your arms back. 9. Feet shoulder-width apart, arms to the sides. When turning the tulub to the right, move your arms, turning at the top, swinging your arms to the sides. Those are in a different way. 10. Feet shoulder-width apart, hands on the waist. Two spring heels to the left, one to the right; straightening up, rising on your toes and turning into v.p. Those are in a different way. 11. Feet shoulder-width apart, hands behind the head. Turn the sheepskin around to the left, bend to the right, forward, left. Ruhi vikonuvati smoothly. Those are in the other direction. 12. V.p. – lying on your back, hands in a tulub. Bend your knees to your chests, straighten them up, then forward over your back. 13. V.p. – lying on your stomach, arms bent under your chins. Swing your right leg up. The same with the other foot. 14. V.p. – lying on your back, hands in a tulub. Sit, raising your arms up, two spring swings with your arms back; bending your legs, wrap your arms around them, round your back, bend your head to your knees.

15. V.p. – sitting with the back of your hands supported, legs bent. Lower the knee of your right leg to the left. The same with the other foot. 16. V.p. – sitting, legs apart, arms to the sides. Turning the coat to the right, lean up to the base, leaning on your bent arms. Those are in a different way. 17. V.p. - standing on your knees, hands down. Bring your right leg forward, sit on the heel of your left leg, bend the sheepskin forward, and stretch your arms to your foot. Two spring ones moved forward. The same with the other leg. 18. V.p. - standing on knees, supported by hands. Lowering yourself onto the forearm of your left hand, turn the top to the right and move your right hand to the side. Those are in a different way. 19. V.p. - standing. Swing the bent right leg forward, with a sign on the left nose, bring the right leg back onto the toe, arms up. The same legs. 20. Legs wide apart. Leaning forward, hands on the support. Bend your right leg with your knee to the side, lift your heel, and squat intensely. The same legs. 21. Legs apart, hands on the belt. Rising on your toes, turn your heels to the right and lower them onto the support. They lean on their heels and turn their toes.

Osteochondrosis of the thoracic spine. As a result of degenerative-dystrophic changes in the intervertebral discs in the thoracic region of the ridge, thoracic kyphosis may become flattened or worsened. These changes, along with pain syndrome, reduce the respiratory excursion of the chest, lead to hypotrophy of the respiratory muscles, and the function of the external respiratory system is impaired. In case of flattening of the thoracic kyphosis, it is necessary to strengthen the tissues of the lumbar wall and stretch the other tissues of the back. With this method, physical movements to the right are performed, straightening the ridge and strengthening kyphosis. When thoracic kyphosis is worsened, physical exercises are aimed at strengthening the back muscles, stretching the long muscles and the abdominal muscles. In exercises, stand on the right to straighten the ridge and chest area, to the right from the retracted shoulder blades. To achieve a greater effect, include the right hand with gymnastic objects (Fig. 15, 16).

Osteochondrosis of the transverse ridge. During the period of acute illness, we should lie down on a hard bed. To relax the sores, place a cotton-gauze roll under the knee. By decompressing the nerve core, reducing its bleeding, traction therapy is used. The calmness of the damaged part of the ridge creates a reservoir for scarring cracks and ruptures of the fibrous ring. Likuvalny gymnastics is aimed at reducing pain syndrome, relaxing the muscles of the spine and ends, reducing bleeding of the nerve core. In the exercise, include the right for the distal sections of the lower ends in conjunction with static and dynamic breathing rights, relaxation of the muscles of the tubule and the ends, which will result from the exit position lying on the back, on the stomach I, on the side.

After the pain syndrome subsides, you can proceed to stretching of the ridge, kyphosis, to reduce bleeding of the damaged part of the ridge and adjacent tissues. You have the right to retire from the rest position, lying on your back, stomach, on your hips, or standing on your hands. The ribs act in the columns and kulshov corners, right on the curved ridge and its twisting along the axis. It is necessary to bend to the right with isometric tension on the muscles: press the cross section onto the couch with your legs bent at the knees; on the right you can fold it, straining the flesh of the seat and crotch at the same time. They have the right to increase the internal pressure, leading to a change in the intradiscal pressure.

If hypotrophy of the back and abdominal muscles is detected, it is necessary to strengthen them, form a muscle corset, in order to assist in the development of the spine and the viconning of the main static and biomechanical functions. When the pain subsides, you can begin to relax the complexes to the right 6, 7, 8 (Fig. 17, 18). To normalize the tone of the back muscles and reduce the bleeding of paravertebral tissues, it is necessary to massage the back muscles across the back. In case of cincin syndrome, the cincination is messy and damaged.

COMPLEX 8 The skin should be shaved 5-6 times. 1. V.p. – lie on your back, put your hands in your sheepskin coat, pull out your socks and, straining your whole body, stretch. Relax. The same tight socks you're wearing. 2. Legs are bent, one hand is on the side of the coat, the other is up. 3. Stretch one hand forward, the other up. Change the position of your hands. 4. Legs are bent, arms are in a sheepskin coat. Turn your head to the right, left, hands behind your head. Raising your head, stretch your arms to your chests, elbows forward. 5. Hands vdovzh tulub. Bend one leg, pull it up with your hand to the breasts, and bend the other leg; Raise your head and shoulders, trying to touch your forehead to your knees.

6. V.p. - standing. He tilted his head to the right, twisted his head forward, tilted his head to the left, twisted his head back. 7. Hands on the belt. Raise one shoulder and lower it. Raise the other shoulder and lower it. Raise and lower the offended shoulder. 8. In a squat, stretch your arms forward, with your hands on you, stretch your shoulders and ankles forward; In a squat, bring your arms back, without changing the position of the bow, and press your shoulder blades together. 9. Legs apart, arms to the sides. Hands forward - crosswise, hug your shoulders. Bend your arms above your head in a squat, pressing your fingers around your palms. 10. Legs apart, arms to the sides. 8 circular movements with hands back with a small amplitude, kitty on yourself; 8 circular movements with hands forward, fingers down.

10. Legs apart, arms to the sides. Horizontal bend forward, arms forward, hands behind the head, shoulder blades together; With a squat, he pulled his coat to the side, stretching his elbow to his knee. Those with impudence in another b_k. 11. Nail the sheepskin coat forward, hands on knees; squat down, without changing the position of the shoe; lean as hard as you can, straighten your legs, stretch your arms down. 12. Legs apart, hands in front of the chests. In a squat, turn the toe to the right, bring your right leg back. Those are in a different way. 13. Legs apart, hands on the belt. Move your pelvis to the right, maintaining the position of your shoulders, and do not bend your legs. Repeat to the left. Those who are starting to fall into another direction. 14. Legs wide apart, arms to the sides. 3 spring leaned forward, stretched your arms to the underbelly, hands behind your head, pulled as hard as you could.

15. Legs wide apart. Bend one leg, lean your hands on your knees, and pull the sheepskin forward; the same ones bending the other leg. 16. Crook with your right foot to the side, bending, pull your coat to the left, arms up, placing your right foot. Same other b_k. 17. Lean forward with your right leg, back straight, hands on knee; arms up, stretch back; squat as hard as you can, repeat. The same legs. 18. The legs are cut. Rise on your toes, arms up; In a squat, raise your bent leg forward and wrap your hands around your knee. The same with the other foot. 19. Hands to the sides. Squat down on the left swing with your right leg to the side. Clap your hands above your head. Repeat on the other legs. Just bring your leg back. 20. Legs are cut, hands are on the belt. Get up on your toes; roll on your heels, raising your toes uphill. Deep squat, arms up.