Physical education for diseases of the nervous system. Features of exercise therapy for diseases of the nervous system. Therapeutic exercise for diseases of the nervous system. Example: Exercise therapy technique for fractures of cervical vertebral bodies

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 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.

Nervous system is a complex system that regulates and coordinates the activities of the human body. It is based on the central nervous system (CNS), which consists of the brain and spinal cord, and the peripheral nervous system (PNS), which includes other neural elements.
In addition to the brain and spinal cord, the most important organs of the nervous system include the eyes, ears, organs responsible for taste and smell, as well as sensory receptors located on the skin, joints, muscles and other parts of the body.
Nowadays, diseases and damage to the nervous system are quite common. They can occur as a result of injury, infection, degeneration, structural defects, tumors, impaired blood flow, and also due to autoimmune diseases (when the body begins to attack itself).
Nervous system diseases can lead to movement disorders such as paralysis, paresis, hyperkinesis.
Paralysis (or plegia) is the complete loss of muscle contraction. Paresis is a partial loss of motor function of the body. Paralysis or paresis of one limb is called - monoplegia or monoparesis, two limbs of one side of the body - hemiplegia or hemiparesis, three limbs - triplegia or triparesis and four limbs - tetraplegia or tetraparesis.
There are two types of paralysis and paresis: spastic and flaccid. With spastic paralysis, only the absence of voluntary movements is observed, as well as an increase in muscle tone and all tendon reflexes. Flaccid paralysis is characterized by the absence of both voluntary and involuntary movements, tendon reflexes, as well as low muscle tone and atrophy.
Hyperkinesis is altered movements that have no physiological significance and occur involuntarily. Hyperkinesis includes convulsions, athetosis, and trembling.
There are two types of cramps: clonic, which are rapidly alternating muscle contractions and relaxations, and tonic, which are prolonged muscle contractions. Seizures occur as a result of irritation of the cortex or brain stem.
Athetosis is slow worm-like movements of the fingers and hands of the body, which lead to the body twisting in a corkscrew fashion when walking. This disease occurs when the subcortical nodes are damaged.
Trembling is characterized by involuntary rhythmic vibrations of the limbs or head. It occurs as a consequence of damage to the cerebellum and subcortical formations.
Ataxia is a lack of coordination of movements. Ataxia is of two types: static (impaired balance when standing) and dynamic (impaired coordination of movements, characterized by disproportion of motor acts). As a rule, ataxia occurs as a result of damage to the cerebellum and vestibular apparatus.

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

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

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

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

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

Thus, physical therapy and (their regular use) occupy a very important place in recovery processes and complex treatment.

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

Exercise therapy for neuroses.
Set of physical exercises for neuroses No. 1:
1. I.P. - standing, legs apart. Close your eyes, raise your arms to shoulder level, then connect your straightened index fingers in front of your chest, while opening your eyes. Raising your hands, inhale, lowering - exhale. Repeat 4-6 times.
2. I.P. - feet shoulder-width apart, arms along the body. Make movements with your hands that simulate rope climbing. Breathing is uniform. Do it 2-4 times.
3. I.P. - legs apart, hands on the belt. Take turns moving your legs to the sides until failure. Breathing is uniform. Perform 2-6 times.
4. I.P. - legs together, arms along the body. Raise your arms up and at the same time lift and bend your left leg at the knee. When raising your arms, inhale, when lowering, exhale. Then repeat the same with the other leg. Perform with each leg 2-4 times.
5. I.P. - the same. On the count of "one" - jump in place, legs apart. Clap your hands above your head. On the count of two, we jump back to the starting position. Perform 2-6 times.
6. I.P. - the same. Perform jumps on your toes, without tilting your torso forward, with your arms down. Do 5-10 times.
7. I.P. - legs apart, hands below. Perform movements with your hands that imitate the movements of a swimmer. Breathing is uniform. Perform 5-10 times.
8. I.P. - legs together, arms along the body. Raise your left and right legs forward in turn, while clapping your hands under the raised leg and behind your back. Breathing is uniform. Do 3-6 times.
9. I.P. - legs apart, arms along the body. Throw a small ball up in front of you, clap your hands behind your back and catch the ball. Breathing is uniform. Do 5-10 times.
10. I.P. - the same. Raise your arms, bend them at the elbows and bring them to your shoulders. Raising your hands, inhale, lowering - exhale. Do 4-6 times.

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

Exercise therapy for diseases, injuries and damage to the musculoskeletal system and nervous system

Lecture 3
Exercise therapy for diseases,
injuries and damage
musculoskeletal
apparatus and nervous system
1. Exercise therapy for diseases of the musculoskeletal system
2. Exercise therapy for musculoskeletal injuries
3. Exercise therapy for diseases and injuries of the spine
4. Exercise therapy for diseases and damage to the nervous system

Question 1. Exercise therapy for diseases of the musculoskeletal system

Objectives of exercise therapy:

normalization of central nervous system tone;
activation of metabolism.
activation of blood and lymph circulation in the joint;
restoration or improvement of joint mobility
prevention of further dysfunctions and
muscle atrophy;
restoration of adaptation to everyday life and work
processes.

Arthritis

are diseases that are based on
there is an inflammatory process
localized in the synovial
joint lining, articular cartilage and
periarticular tissues

Objectives of exercise therapy:

General +
increase in range of motion to
normal;
strengthening muscles in the affected area –
especially extensors;

Exercise therapy technique

1) Therapeutic massage, physiotherapeutic procedures (Ural Federal District,
ozokerite, paraffin and mud applications)
2) Therapeutic gymnastics:
I.p.: for the upper limbs - lying and sitting, for the lower limbs - lying down
passive movements for the affected joints (starting with
gentle rocking with a small amplitude)
relaxation of muscles in the area of ​​​​the sore joint (relaxation
tense flexor muscles of the diseased limb contributes to
performing active movements with a healthy limb)
exercises in water (in a pool, bath) at a temperature of 28-29°C:
active movements,
with apparatus (staircase for developing joint movements
brushes, clubs, dumbbells weighing 0.5 kg), on the gymnastics wall;
simulators.
The pace of the exercises is slow or medium;
Number of repetitions – 12-14 times (14-16 times)
Lesson duration – 35-40 minutes (40-45 minutes)

Arthrosis

are diseases that are based on
metabolic-dystrophic process,
characterized by cartilage atrophy,
loss of bone tissue (osteoporosis),
new bone formation, deposits
calcium salts in periarticular tissues, ligaments,
joint capsule.

Objectives of exercise therapy:

General +
pain reduction;
relaxation of periarticular muscles and
elimination of contracture;
increased joint space;
reduction of aseptic synovitis phenomena
(inflammation of the synovial membrane);
strengthening of periarticular muscles and increasing
their endurance;

Exercise therapy technique

1) Exercises that strengthen the muscles of the back and abdomen.
2) Special exercises
i.p. - lying on your back:
active dynamic exercises for large muscle groups
healthy limb;
FU for the ankle joint and light movements in the hip
joint (with coxoarthrosis) of the sore leg in easier conditions;
short-term (2-3 s) isometric tension of the gluteal
muscles.
I.p. - standing on a healthy leg (on an elevated platform):
free swinging of a relaxed leg in various
directions.
isometric tension and subsequent relaxation
Dynamic exercises without weights and with weights (on
exercise machines or with weights) - the weight that the patient can
lift 25-30 times until tired; performed from 1 to 3-4 series
exercises with a rest interval of 30-60 s.
The pace of all exercises is slow;
The range of movements is painful.

10. Question 2. Exercise therapy for musculoskeletal injuries

11. Trauma

is a sudden impact on
human body external factors
environment (mechanical, physical,
chemical, etc.), leading to
violation of the anatomical
tissue integrity and functional
violations in them.

12. Traumatic illness

- is a combination of general and local
pathological changes in the body with
damage to organs of support and movement

13. Precursors of the development of a traumatic disease:

Fainting (syncope) - sudden loss
consciousness due to insufficient
blood circulation in the brain.
Collapse is a form of acute vascular
insufficiency (decreased vascular tone or
circulating blood mass weakening of the heart
activity decrease in venous blood flow
to the heart, decreased blood pressure, brain hypoxia)
Traumatic shock - severe
pathological process that occurs in
body as a response to severe
injury.

14. Objectives of exercise therapy:

General tasks of exercise therapy:
normalization of psycho-emotional state
sick;
accelerating the elimination of drugs from the body
funds;
improvement of metabolism, activity of the cardiovascular and respiratory systems, excretory organs;
prevention of complications (congestive pneumonia,
flatulence, etc.).
Special tasks of exercise therapy:
acceleration of resorption of hemorrhage and swelling;
acceleration of callus formation (for fractures);
improving the process of regeneration of damaged tissues;
prevention of muscle atrophy, occurrence
contraction and joint stiffness;
prevention of adhesions;
formation of a soft, elastic scar.

15. Exercise therapy technique

ORU (for uninjured parts of the body);
breathing exercises: for bedridden patients –
in a ratio of 1:1; for walkers – 1:2(3);
active physical exercises for joints,
free from immobilization;
exercises for abdominal muscles in isometric
muscle regime in those areas of the body where they can
bedsores form;
treatment by position;
ideomotor exercises;
isometric muscle tension under
immobilization.

16. Forms of exercise therapy:

1st period: UGG (5-7 min); LH (15-25 min);
independent studies; walking down the corridor
(for example, on crutches).
2nd period: UGG, LH; independent studies;
walking; dosed walking, running,
swimming, etc.
3rd period: all available forms of exercise therapy
final restoration of lost
functions of the damaged segment and the body in
in general. He is in a rehabilitation center,
or in a sanatorium, or in a local clinic
residence (partially at home).

17. Exercise therapy technique

I.P. - various;
physiological load curve – two- or three-peak
multivertex
25% DU, 75% outdoor switchgear and control system 25% outdoor switchgear and control system and 75% control system
Means of exercise therapy: - Outdoor switchgear;
- breathing exercises in a ratio of 1:2(3);
- passive and then active exercises for
joints of the affected part of the body (it is better to perform them
in warm water);
- treatment by position;
- mechanotherapy;
- occupational therapy;
- choreotherapy;
- massotherapy.
Later:
- applied sports exercises;
- training on simulators;
- natural factors.
Exercise pace:
slow and medium – for medium and large muscle groups;
fast - for small muscle groups.
The range of motion is average (not causing pain).

18. Fractures

is a violation of the anatomical
bone integrity caused
mechanical impact and
accompanied by damage
surrounding tissues and disruption
functions of damage to a body segment.

19. Objectives of exercise therapy:

1st period:
improvement of blood and lymph circulation at the fracture site;
prevention of contractures and muscle atrophy.
2nd period:
restoration of range of motion in the joint;
increasing the strength of the muscles of the shoulder girdle and shoulder (or
lower extremities);
elimination of swelling (if it occurs).
3rd period:
final restoration of muscle function and strength
shoulder girdle and upper or lower limb.
learning to walk with and without support on crutches (with
fractures of the lower extremities)

20. Fractures of the bones of the upper limbs

21. Exercise therapy technique for a clavicle fracture

First period
1.
Classes in a fixing bandage (first week)
active finger movements,
flexion and extension at the wrist and elbow joints (rotation
contraindicated due to possible displacement of fragments).
2.
FU without a scarf in a tilt position towards the damaged collarbone:
pendulum-like movements in the shoulder joint with a small amplitude;
abduction (up to 80°) and adduction of the shoulder (after 2 weeks), above the horizontal –
in 3 weeks;
abduction and abduction of the shoulder blades.
Second period
special exercises - active movements in the shoulder joint above
horizontal;
swing exercises; exercises with objects;
mechanotherapy on block devices;
therapeutic massage of the muscles of the shoulder girdle; swimming.
Third period
load on weakened muscles on the side of the affected collarbone;
exercises with objects, with a rubber band and expander, with small
weights, on apparatus and exercise machines; swimming, skiing,
volleyball, basketball and other sports.
Training sessions with a clavicle fracture are allowed
start 6-8 weeks after injury.

22. Fractures of the scapula

ORU and remote control, exercises for fingers, wrist joint,
isometric shoulder muscle tension (depending on
fixation method).
FU on a scarf: for the elbow (flexion and extension, pronation and
supination, circular movements) and shoulder (raising the arm
forward-upward to an angle of 90° and abduction to an angle of 90°) of the joints.
Swinging movements of the arm (10-14 days after injury)
With a fracture of the neck of the scapula
1st period (on the outlet bus):
exercises for the fingers, wrist and elbow joints;
for the shoulder joint (15-20 days after injury).
2nd period (without splint) - in a month
movements in the shoulder joint (friendly with healthy
hand),
exercises with objects and on block simulators (for
3-4 weeks.
The method of exercise therapy in the 3rd period is the same as for a clavicle fracture.
Restoration of movements and ability to work occurs in 2-2.5
months; sports performance – 3 months after the fracture.

23. Fractures of the lower extremities

24. Treatment methods:

conservative method - traction
(if the fracture is displaced) behind the heel
bone, applying a blank one after 2-3 weeks
plaster cast - from toes to
upper third of the thigh;
surgical method - overlay
Ilizarov apparatus or
metal osteosynthesis with a nail or
metal plate;
immobilization.

25. Fractures of the femoral shaft

Immobilization period – skeletal
traction (1.5-2 months)
Exercise therapy is prescribed on the 2nd day after injury
ORG for the uninjured limb;
SU for the injured limb: flexion and
extension of fingers and toes; raising the pelvis with
resting on the arms and foot of a healthy leg; maximum
relaxation of the thigh muscles.
A month after the injury, exercises are added to
tension of the thigh muscles (patella movement).
Lesson duration – 25-30 minutes (4-6 times per
day).

26.

Post-immobilization period
- after removing skeletal traction
various I.P. (lying on your back, sitting, standing
gymnastic wall, while walking).
exercises in water: squats; flight feathers
movements while standing on a healthy leg; bending in
hip and knee joints.
Training period
(after 2-3 months until complete restoration of movements in
all joints and normal gait (4.5-6 months))
running, jumping, hopping, stepping over
jumping over obstacles,
exercises for coordination and balance,
outdoor games,
swimming in the pool.
Lesson duration: 40-50 minutes (3-4 times a day).

27. Fractures of the lower leg bones

28. The method of exercise therapy is the same as for a hip fracture

Immobilization period (on average 3-4 months)
Remote control and outdoor switchgear
SU: active movements of the toes;
flexion and extension at the knee and hip
joints;
isometric tension of the thigh and lower leg muscles;
ideomotor exercises for the ankle
joint
3-5 days after the injury, the patient is allowed
move within the ward, and then within the department
with the help of crutches.

29. Post-immobilization (functional) period

Objectives of exercise therapy:
restoration of movements in the ankle joint;
elimination of swelling of the injured leg;
prevention of traumatic flatfoot, deformation
feet, growth of “spurs” (most often heel spurs),
curvature of fingers. For this purpose, immediately after removal
plaster, a special instep support is inserted into the shoes.
Exercise therapy technique
ORU for all muscle groups,
SU:
active finger movements (grasping small
objects and their retention); movements of the foot, dorsal and
plantar flexion of the foot, supination and pronation,
rolling a tennis ball with your foot;
different walking options: on toes, on heels, on
external or internal arches, backwards forward, sideways,
cross step, half squat, etc.;
exercises with the foot resting on the bar; exercises for
exercise bike.
If your ankles are broken anywhere, swelling of the foot may occur.
To eliminate it, it is recommended to lie down for 10-15 minutes (3-4 times a day),
raising your legs at an angle of 120-130° in

30. Damage to the knee joint

31. Damage to the cruciate ligaments

In case of partial rupture of the cruciate
ligaments, a plaster cast is applied (up to
middle third of the thigh) for 3-5 weeks.
In case of a complete rupture, it is carried out
prompt replacement of ligaments with Mylar tape
or autoplasty.

32. Exercise therapy technique

1st period of LH exercise (1-2 days after surgery).
In addition to exercises for healthy parts of the body,
exercises for the operated limb: movements of the toes,
ankle and hip joints, isometric
muscle tension of the thigh and lower leg (from 4-6 to 16-20 times), which
patients should perform independently every hour.
2nd period (3-4 weeks after surgery)
exercises in i.p. lying on your back, later – lying on your side, on
stomach and sitting, so as not to cause stretching of the repaired ligament.
To increase the range of motion in the knee joint,
treatment by position or using slight traction on a pulley
simulator: the patient lies on his stomach and using a block
the apparatus flexes the lower leg - training to increase strength and
endurance of the muscles of the injured limb.
to restore range of motion in the knee joint
use training on a bicycle ergometer and walking on a flat floor,
stepping over objects (medicine balls, fences) and walking
On the stairs.
In the 3rd period (3-4 months after surgery)
The goal of exercise therapy is to completely restore the function of the knee joint and
neuromuscular apparatus.

33. Question 3. Exercise therapy for diseases and injuries of the spine

34.

35.

36. Spinal fractures

37. Depending on the location, there are:

compression fractures of bodies
vertebrae
fractures of the spinous and transverse
shoots;
vertebral arch fractures.

38. Treatment:

prolonged traction;
method of one-stage or gradual
correction of spinal column deformity, with
subsequent application of a plaster corset;
combined method (traction and
plaster immobilization);
surgical method (various methods
fixation of spinal column segments in the area
damage).
Application of physical factors
(physical therapy, massage and physiotherapy)
is mandatory

39. Objectives of exercise therapy

(immobilization period)
stimulation of regenerative processes in damaged
segment;
improvement of psycho-emotional state and activity
basic body systems;
prevention of congestion, atrophy of the trunk muscles
limbs, neck.
preparing the victim for vertical loads;
prevention of atrophy of the muscles of the trunk, neck and
limbs;
restoration of household skills and walking skills;
improving blood circulation in the fracture area - for
stimulation of regeneration.

40. Objectives of exercise therapy

restoration of mobility in
damaged part of the spine;
strengthening the muscles of the back, neck and shoulder
belts;
elimination of coordination violations;
adaptation to domestic and professional
loads

41. Example: Exercise therapy technique for fractures of the cervical vertebrae

42. Exercise therapy technique

(immobilization period)
In the first half period
movements in the shoulder joints and head movements are prohibited
Outdoor switchgear for small and medium muscle groups
upper and lower extremities (without lifting them from the plane of the bed),
static breathing exercises,
movements of the lower jaw (opening the mouth, movements to the right, left,
forward).
Exercises are performed at a slow pace (4-8 times)
In the second half period
forward body movements are contraindicated
i.p. lying, sitting, standing;
exercises for balance and coordination of movements;
walking and walking exercises;
exercises to maintain correct posture.
Isometric exercises are used to strengthen the neck muscles.
muscle tension (from 2-3 to 5-7 s).
Number of repetitions – 3-4 times a day;
Lesson duration – 15-20 minutes

43. Exercise therapy technique

(post-immobilization period)
And. p. lying down, then turn on and. n. sitting and standing
isometric tension of the neck muscles, including with
resistance
FU in keeping the head in a raised position - in i.p. lying down
on the back, on the stomach and on the side
FU for limbs (especially upper) - hand movements
above the horizontal level, raising the shoulder girdles,
abduction of arms to the sides by 90° using various
burdens
training on simulators
tilts and turns of the torso and head and circular movements
head
exercises for balance, coordination of movements,
formation of correct posture.

44. Question 4. Exercise therapy for diseases and damage to the nervous system

45. MAIN CLINICAL MANIFESTATIONS

Motor
disorders
1. paralysis or
paresis
central
(spastic)
peripheral
(sluggish)
2. seizures
3. athetosis
4. shaking
Disorders
sensitivity
anesthesia
hyposthesia
hypersthesia
neuralgia
ataxia
apraxia

46. ​​Paralysis (plegia) – waste of the ability to voluntarily muscle contraction

Paresis – partial loss of voluntary movements
called
central (spastic) - damage
central motor neuron,
providing conscious control
muscle contraction.
2. peripheral (sluggish) - damage
peripheral motor neuron,
caused by injury or disease of the spinal cord
brain, manifests itself at the level of innervation from
this segment
1.

47. Cramp (spasm) is an involuntary contraction of a muscle or group of muscles, usually accompanied by sharp and aching pain.

Cramp (spasm) - involuntary
contraction of a muscle or group of muscles, usually
accompanied by sharp and aching pain.
clonic - rapidly alternating
muscle contraction and relaxation
tonic - prolonged contractions
muscles

48. Athetosis is slow worm-like movements of the fingers, hand, and torso.

Trembling is an involuntary
rhythmic oscillations of the limbs
or heads.

49. Anesthesia - a decrease in the sensitivity of the body or part of it, up to the complete cessation of perception of information about the environment

environment and
own condition.
Hyposthesia - partial decrease in sensitivity,
decreased sensitivity to external irritations,
weakening of perception in strength (these conditions are more often
observed in neuroses).
Hyperesthesia - a sharp increase
sensitivity to weak stimuli,
affecting the senses.

50. Neuralgia – pain that develops when sensory nerves are damaged by a traumatic or inflammatory nature in the area

innervation or
location of the nerve.

51. Ataxia – disorders of proprioceptive (muscular-articular) sensitivity leading to disruption of coordinating

relationships, precision of movements.

52. Apraxia (“inactivity, inaction”) – a violation of purposeful movements and actions with the preservation of its components

elementary movements; occurs when
focal lesions of the large cortex
cerebral hemispheres or conductive
pathways of the corpus callosum.
This is the loss of the ability to produce
systematic and expedient actions
while maintaining motor capabilities
for their implementation, which were previously
were performed automatically.

53. Aphasia is a systemic disorder (disorder) of already formed speech.

motor - impaired ability
turn concepts into words,
sensory - speech perception disorder,
amnestic - loss of memory,
alexia - loss of reading ability,
agraphia - loss of the ability to write
agnosia - disturbance of perception and
recognition of objects and faces.

54. 4.1 Exercise therapy for DISEASES OF THE PERIPHERAL NERVOUS SYSTEM

55. Neuritis is a disease of the peripheral nerves that occurs as a result of:

traumatic injury,
infectious,
inflammatory diseases (diphtheria,
flu, etc.)
avitaminosis (lack of vitamins
group B),
intoxication (alcohol, lead)
metabolic disorders (diabetes).

56. Tasks:

stimulation of regeneration processes and
disinhibition of nerve areas located in
state of oppression;
improvement of blood supply and trophic processes
in the affected area in order to prevent the formation
adhesions and scar changes;
strengthening paretic muscles and ligaments;
prevention of contractures and stiffness in the joint;
restoration of working capacity through
normalization of motor functions and development
compensatory devices.

57. Treatment:

position treatment
massage
physiotherapy (electrophoresis)
electrical muscle stimulation
physiotherapy
mechanotherapy - implementation
exercise using special
simulators and devices.

58. Exercise therapy technique

Treatment by position
Carried out in doses throughout the entire period
– with the exception of FU classes (from 2-3 minutes to 1.5 hours)
splints are used to support the limb,
special “layouts”, corrective positions
using orthopedic and prosthetic products
(devices, splints, special shoes).
Physiotherapy
passive and ideomotor exercises
combination of passive exercises with active ones
movements in the same joints of a symmetrical limb
FU in warm water on simulators
Monitor the appearance of voluntary movements,
selecting optimal starting positions, and
strive to support the development of active movements

59. Neuritis of the facial nerve - acute development of paralysis or paresis of facial muscles

Neuritis of the facial nerve, acute development of paralysis
or facial paresis
muscles

60.

61. Clinic:

the affected side becomes flabby, lethargic;
Blinking of the eyelids is impaired, not completely
the eye closes;
the nasolabial fold is smoothed;
the face is asymmetrical, drawn into a healthy one
side;
speech is slurred;
the patient cannot wrinkle his forehead or frown
brows;
loss of taste and lactation are noted.

62. Tasks:

improving blood circulation in the facial area
(especially on the affected side), neck and
the entire collar area;
restoration of the function of facial muscles,
impaired speech;
preventing the development of contractures and
friendly movements;
maximum possible recovery
facial symmetry

63. Exercise therapy technique

Treatment by position
Band-Aid Tension
Physiotherapy

64. Treatment by position

During sleep:
i.p. - lying on your side (on the affected side);
During the day:
total duration from 30-60 minutes (2-3 times per
day) up to 4-6 hours per day
sit for 10-15 minutes (3-4 times a day),
bowing his head in the direction of defeat, supporting
with the back of the hand (resting on the elbow);
pull the muscles from the healthy side to the side
lesions (from bottom to top) using a scarf,
while trying to restore facial symmetry.

65. Adhesive plaster tension:

carried out over 8-10 hours.
carried out with a healthy
sides to the patient
anti-thrust
muscles of the healthy side
strong fixation of free
end of the patch to
special helmet-mask
(individually)

66. Therapeutic gymnastics

Lesson duration: 10-12 minutes (2 times per
day)
FUs are performed in front of a mirror, with the participation
exercise therapy instructor
isolated tension of facial muscles
muscles of the healthy side and muscles surrounding
mouth gap.
independent exercises 2-3 times a day
Special exercises:
to train facial muscles (raise eyebrows
up, frown, puff out your cheeks, whistle, etc.)
to improve articulation (pronounce sounds,
sound combinations, words containing these
sound combinations, syllable by syllable)
SU alternate with restorative and respiratory

67. Ulnar nerve neuritis

Causes:
compression of the nerve in the elbow area
joint that occurs in people, work
which is connected to the support with the elbows (about
machine, table, workbench),
when sitting for a long time with your hands on
chair armrests.

68. Clinic

the brush hangs down;
there is no supination of the forearm;
the function of the interosseous muscles of the hand is impaired, in
due to which the fingers are bent claw-shaped
(“clawed hand”);
the patient cannot grasp and hold objects.
atrophy of the interosseous muscles of the fingers and muscles
palms from the little finger side;
hyperextension of the main phalanges of the fingers,
flexion of the middle and nail phalanges;
it is impossible to spread and adduct the fingers.

69. Treatment with position:

a splint is applied to the hand and forearm
the brush is given a possible position
extension in the wrist joint,
the fingers are given a half-bent position;
the forearm and hand are suspended on a scarf
in the position of flexion in the elbow joint (under
angle 80°)

70. Exercise therapy technique (on the 2nd day after applying the bandage).

passive gymnastics,
gymnastics in water;
massage
electrical muscle stimulation
When active movements occur:
active gymnastics
elements of occupational therapy (plasticine modeling,
clay),
learning to grasp small objects
matches, nails, peas, etc.).

71. 4.2 Exercise therapy for CENTRAL NERVOUS SYSTEM DISEASES

72. The signaling system is a system of conditioned and unconditioned reflex connections of the higher nervous system of animals (humans) and

Signal system
- is a system of conditioned and unconditioned reflex connections of the higher nervous system
animals (humans) and the environment.
The first is the emergence of sensation,
perceptions, representations (signals
arise under the influence of the sense organs)
The second is the emergence and development of speech
(signals are converted into signs in direct
sense of the word).

73.

Second signaling system
First signaling system

74. Neurosis

- it is long and pronounced
higher nervous system deviation
activities from the norm due to
overstrain of nervous processes and
changes in their mobility.

75. Reasons:

processes of excitation and inhibition;
relationships between the cortex and subcortex;
normal relationship between 1st and 2nd
signaling systems.
psychogenic disorders (experiences,
various negative emotions, affects,
anxiety, phobias (fears))
constitutional predisposition.

76. Clinic:

neurotic reactions usually occur
to relatively weak, but long-lasting
active stimuli that lead to
to constant emotional
tension.
overstrain of the main nerves
processes - excitation and inhibition,
excessive requirement for mobility
nervous processes.

77. Forms of neuroses:

1) neurasthenia
2) psychasthenia
3) hysteria

78.

Neurasthenia (asthenic neurosis)
– characterized by weakening
processes of internal inhibition,
increased mental and physical
fatigue, absent-mindedness,
decreased performance.

79. Objectives of exercise therapy for neurasthenia:

active process training
braking;
normalization (strengthening)
excitatory process.

80. Exercise therapy technique for neurasthenia

in the morning
duration from 10 minutes to 15-20 minutes
to music: soothing, moderate and
slow tempo, combining major and
minor sound
minimal load increases
gradually.
simple exercises for complex coordination
sports games with simplified rules
(volleyball, table tennis, croquet, golf,
towns) or elements of various games
walking, close-range hiking, fishing

81. Psychasthenia (obsessive-compulsive neurosis)

this is the predominance of the 2nd signaling system with
congestive excitation in the cerebral cortex
brain
Neurosis characterized by obsessiveness
conditions: self-doubt,
constant doubts, anxiety,
suspiciousness.

82. Objectives of exercise therapy for psychasthenia:

activation of processes
life activity;
"loosening" of the pathological
inertia of cortical processes;
bringing the patient out of the oppressed
moral and mental state,
facilitating his communication with others.

83. Exercise therapy technique for psychasthenia

well-known exercises of an emotional nature,
performed at a fast pace without emphasis on precision
their implementation;
correcting errors by showing the correct
performed by any of the patients;
psychotherapeutic preparation, explanation of the importance
doing exercises to overcome feelings
unreasonable fear;
game method of conducting classes,
performing exercises in pairs;
the methodologist's voice and musical accompaniment should be
cheerful.
This category of patients is characterized by a slow pace: initially from
60 to 120 movements per minute, then from 70 to 130 and on
subsequent classes - from 80 to 140. In the final part
classes, it is necessary to slightly reduce the load and its
emotional coloring.

84. Hysteria (hysterical neurosis)

this is the predominance of the subcortical function and
influence of the 1st signaling system.
Impaired coordination of the cortex and
subcortex promotes increased
excitability, mood swings,
mental instability, etc.

85. Objectives of exercise therapy for hysterical neuroses:

decreased emotional excitability;
development in the cerebral cortex
braking process;
creating a sustainable calm
moods.

86. Exercise therapy technique for hysteria

pace of movement - slow;
exercises for attention, accuracy of execution,
coordination and balance;
simultaneous execution of various movements
left and right hand or foot;
balance exercises, jumping, throwing,
whole combinations of gymnastic exercises.
games (relay races, towns, volleyball);
methodologist's voice and musical accompaniment
must be calm (commands are slow,
smooth);
primarily a method of explanation rather than showing
exercises.

87. Questions for independent work:

1. Exercise therapy for brain disorders
blood circulation
2. Exercise therapy for injuries
peripheral nerves
3. Exercise therapy for myopathy.
4. Exercise therapy for cerebral palsy

Of primary importance in the functional therapy of injuries and disorders of the peripheral nervous system is the course of the nerve fibers that make up the pyramidal motor tract. It is from this that the impulses are sent along nerve fibers to the motor cells of the anterior horns of the spinal cord, from where through the fibers of the peripheral neuron, which form the motor roots, they are sent to the muscles. Therefore, any pathological influence on any part of this pathway causes disorders of the motor system, expressed in paralysis, paresis, as well as a decrease in the strength of the corresponding muscles. Such influences include trauma, hemorrhage, intoxication, infection, compression of nerve roots by bone growths, etc. A characteristic feature of movement disorders with lesions of a peripheral neuron are flaccid paralysis and paresis with decreased or complete absence of tendon reflexes, often with impaired skin sensitivity. With traumatic neuritis, in addition to local damage to the nerve trunk, disturbances in the nerve roots, elements of the spinal cord, and functional disorders in the somatic and autonomic centers of the brain are also noted.

In neuritis, the lesion is localized in the peripheral nerve trunks, usually of mixed nerves, as a result of which the main symptoms are paralysis or paresis of the peripheral type, corresponding to the muscular innervation of this nerve. Flaccid paralysis, most often accompanied by muscle atrophy with a decrease or disappearance of tendon reflexes, with a decrease in muscle tone. Along with impaired muscle function, skin sensitivity disorders may occur, pain appears when pressure is applied to the affected trunks and muscles when they are stretched.

Neuritis comes from different origins. The most common are traumatic neuritis. They occur with bruises in areas of the body through which nerve trunks pass, or with fractures of bones in the vicinity of which motor nerve fibers are located.

For neuritis, it is most often necessary to use complex treatment, an integral part of which is exercise therapy and massage. The forms of application of exercises and their relationship in the treatment complex are determined by the causes of the disease, its stage, form and characteristics of the course, as well as the individual characteristics of the patient.

IN tasks Exercise therapy for peripheral motor neuron damage includes:

• 1) restoration of the functions of the nerve elements of the damaged neuron;
• 2) normalization of the activity of muscles innervated by the damaged neuron;
• 3) general strengthening effect.

Afferent stimuli arising at the moment of performing passive or active movement serve as factors that pave the nerve paths, support their function, and coordinate the combined functioning of all nervous elements that have become disordered. In addition, these impulses stimulate the regeneration of nerve conductors damaged by disease or injury. The fact is that due to axon degeneration and myelin breakdown, the conductivity of the nerve pathways is disrupted. Performing physical exercises enhances metabolic (and ionic) processes in the fiber, thereby increasing its conductivity. Such influences are especially effective in the first periods of illness or injury. In cases where a significant period of time has already passed, connective scar tissue begins to form at the site of the lesion, and the regeneration of neuron elements becomes difficult, although physical exercise still contributes to the partial resorption of this tissue and an increase in its elasticity.

The use of exercise therapy for traumatic neuritis is divided into two periods. In the early stages of the wound process, it is used to stimulate wound healing, improve circulation in the innervated tissue areas, prevent complications, and the development of a rough scar at the wound site. Preventive measures against complications affecting the functional state of the nerve and the muscles and other tissues innervated by it include a light massage of parts of the limb after preliminary warming, which creates moderate hyperemia of the tissues surrounding the wound. This improves circulation in the injured limb, reduces swelling and maintains tissue nutrition, and reduces irritation of nerve conductors. Where the condition of the wound and pain disorders do not interfere with movement, you can begin therapeutic exercises from the very first days after injury or surgery: passive and, where possible, active exercises, ideomotor efforts and sending impulses. When immobilizing the affected limb, physical exercises must be carried out on the healthy limb in anticipation of their reflex effect on the processes of blood circulation and nervous excitability in the diseased limb.

To restore the functional ability of an injured nerve, stimulate the growth of nerve fibers, and to bring the central nervous formations associated with the affected nerve to a normal functional state, ensuring a sufficient number of afferent impulses traveling along the affected nerve from the periphery of the organ is of exceptional importance.

In cases where paralysis prevails and pain does not occur, or from the moment when it no longer interferes with movements, it is necessary to begin active and passive gymnastics, paying attention to those exercises that correspond to the function of the affected muscle groups. Signs of fatigue or increased pain that occur in some cases after performing gymnastic exercises most often disappear under the influence of a subsequent, even short, thermal procedure.

In the treatment of reflex contractures, the first step is to remove the peripheral source of irritation, which is usually done surgically and conservatively. Physical exercises used in this case actively help to reduce the excitability of the central reflex devices and reduce the tone of muscles that are in a state of spasm. Depending on the timing of the development of spasm, movement treatment is combined with various orthopedic measures (fixing bandages, corrective operations, heat treatment, massage, etc.), the features of which should be taken into account in the construction of exercise therapy.

The effectiveness of exercise therapy for neuritis is determined not only by the correct selection and implementation of physical exercises, but also by the mode of their implementation. It must fully comply with the relationship between the duration and intensity of the exercises; it requires achieving fatigue when performing each complex and gradually increasing the load. Therefore, in the first period, with a complex duration of 10-15 minutes, it should be repeated at least 6-8 times during the day. During breaks between exercise therapy complexes, tissue massage (self-massage) is performed in the area of ​​innervation of the damaged neuron for 10-12 minutes.

The second period of functional therapy for traumatic neuritis corresponds to the stage after wound healing. It is characterized by the presence of late residual clinical phenomena, the development of scar tissue at the wound site, disturbances of blood circulation and trophism, the phenomena of paralysis, contractures and a pain symptom complex. As a result of rationally constructed and long-term exercise therapy, all these phenomena are eliminated (or at least alleviated) due to the normalization of nutrition of the tissues innervated by the affected nerve, the restoration of blood circulation in them with the active removal of residual inflammatory products from the affected nerves themselves and surrounding tissues. A favorable circumstance in this case is that physical exercise helps strengthen paretic muscles, joint capsules and ligamentous apparatus, maintain joint mobility and their functional readiness for the moment of restoration of the nervous system.

In the second period, the duration of the exercise therapy complex gradually increases to 30-40 minutes, and the repetition of its implementation is 2-3 during the day. The duration of the massage (self-massage) can reach 20-30 minutes.

As an example of the use of exercise therapy for neuritis, let us consider the relatively common neuritis of the facial and sciatic nerves.

Neuritis of the facial nerve is manifested mainly by paralysis of the facial muscles of the affected side of the face: the eye does not close or does not close completely, the blinking of the eyelids is impaired, the mouth is pulled to the healthy side, the nasolabial fold is smoothed, there is no movement of the lips in the direction of the neuritis, the corner of the mouth is lowered, wrinkling of the forehead is impossible, The patient cannot frown. Depending on the severity of the neuritis, it lasts from two weeks to many months and does not always end in complete recovery.

The cause of neuritis is various damage to the nerve as it passes through the canal of the pyramidal part of the temporal bone, inflammatory processes in the middle ear, intoxication, infections, postoperative and surgical complications. The course of neuritis of the facial nerve is accompanied by such a complication as contracture of the facial muscles of the affected side, when the corner of the mouth is pulled to the affected side, the nasolabial fold becomes deeper, the palpebral fissure narrows, remaining half-closed, and facial asymmetry becomes more pronounced. Both contracture and conjugate movements interfere with facial movements and aggravate the severity of paralysis.

The treatment complex for neuritis of the facial nerve is combined and includes drug therapy, exercise therapy with massage and physiotherapy.

Physiotherapy. At the onset of the disease, it is of particular importance to ensure adequate afferent impulses from the periphery, due to which the conductivity of nerve fibers is maintained and the preservation of motor skills of the facial muscles is stimulated. To do this, it is recommended to use passive exercises and a special massage of the entire face and neck using light stroking, light rubbing and, finally, vibration along the nerve branches with your fingertips. The set of physical exercises includes special exercises in wrinkling the forehead by raising the eyebrows, moving them (furrowing), blinking eyelids, baring teeth and folding lips to whistle, puffing out a sore cheek, etc.

The exercise therapy regime requires repeated physical exercises throughout the day, in particular those performed independently by the patient. However, there is a danger that independent exercises in facial gymnastics in front of a mirror are not always performed correctly (for example, when practicing closing the eyes in the presence of paralysis of the lower eyelid, the patient tries to close it by propping up the eyelid by pulling up the corner of the mouth). At the same time, as a result of repeated exercises, a stable perverted conditioned reflex connection is organized to perform a friendly movement. Therefore, it is extremely important to teach the patient to independently correctly perform corrective exercises.

When independent facial movements (or at least the manifestation of minimal contractile activity) appear in any facial muscle, the main emphasis should be transferred from passive exercises to repeatedly repeated active efforts on the part of this particular muscle.

The causes of sciatic nerve neuritis can be very diverse - infections, metabolic disorders (gout, diabetes), injuries, cooling, spinal disease, etc.

When the sciatic nerve is damaged, sensory disturbances occur, paresis and muscle paralysis appear. If the damage to the nerve trunk is highly localized, the function of turning the thigh outward, as well as flexing the tibia towards the thigh, suffers, and walking becomes very difficult. With complete damage to the entire diameter of the nerve, loss of movement of the foot and fingers is added.

Already during the period of keeping the patient in bed, it is necessary to take care to prevent foot drop. In addition to passive correction (in particular, with the help of a splint that holds the foot in an average physiological position) and giving a semi-bent position in the knee and ankle joints when lying on the side, passive exercises are used. With the advent of active movements, special exercises are used to bend the lower leg to the thigh, rotate it outward, extend the foot and toes, abduct it to the side and inward, and extend the big toe.

The effectiveness of therapeutic exercises increases when a warming massage and a number of physiotherapeutic effects, mainly of a thermal nature, are used before the exercises. In addition to increasing the elasticity of soft tissues and the articular-ligamentous apparatus, allowing movements with greater amplitude, this measure reduces pain. For the same purposes, thermal effects can be used after performing gymnastic exercises.

Taking into account these circumstances, the selection of means and methods of exercise therapy for lesions of the tibial nerve should be based on the need to increase the tone of muscles that are in a state of loss and reduce the tone of spasmodic muscles.

As with other types of lesions of the peripheral nervous system, in exercise therapy it is necessary to adhere to a dense repeated and repeated regimen of exercises. In this case, you should carefully monitor the state of tone and activity of the affected muscles, and at the first signs of improvement in their condition, transfer more and more of the load to them, increasingly giving preference to active exercises over passive ones.

At diseases and injuries of peripheral nerves the following disorders may appear: a) decreased involuntary innervation tension (tone) of muscles, b) impaired motor function (paralysis, paresis), c) sensitivity disorder in the affected area, d) impaired nervous trophism - muscle atrophy, e) decreased or disappearance of reflexes and e) pain.

Such signs are characteristic of flaccid paralysis, the severity of which depends on the location, extent and severity of the lesion. For example, when the entire brachial plexus is damaged, a picture of flaccid atrophic paralysis and anesthesia of the upper limb develops with the loss of all reflexes on this arm; when the ulnar nerve is damaged, weakening of the palmar flexion of the hand, the disappearance of flexion of the 4th-5th and partly the 3rd fingers, and the impossibility of abduction and extension are observed. fingers, adduction of the thumb. In addition, with damage to the ulnar nerve in the skin of the 5th and ulnar surface of the 4th finger and the corresponding ulnar part of the hand, surface sensitivity is impaired, and in the little finger the joint-muscular sense (proprioceptive sensitivity) is disrupted. Blueness, impaired sweating, and decreased skin temperature in the area of ​​sensitivity may also appear. Muscle atrophy is very pronounced - retraction of the interosseous spaces and flattening of the palmar eminence at the 5th finger.

The picture of the lesion does not always indicate a complete interruption of the nerve; sometimes this is a consequence of partial damage with phenomena of depression, inhibition in the nerve trunks with subsequent restoration of conductivity. However, this also requires long-term treatment.

The therapeutic effect of physical exercises for diseases and injuries of the peripheral nervous system is manifested primarily in a general tonic effect, which is of utmost importance, since the duration of the disease and insufficient motor activity sharply reduce the general tone of patients.

Physical exercises have a trophic effect, promoting the restoration of innervation mechanisms and preventing the formation of secondary contractures and deformities during prolonged absence of movement. If necessary (in case of unsuccessful treatment), physical exercises contribute to the formation of compensation.

The general tonic effect is ensured by performing general strengthening exercises on a wide scale for all muscle groups not involved in the disease process. For example, if the right peroneal nerve is damaged, extension and outward rotation of the right foot, as well as extension of the toes, become impossible. This means that all movements in other joints can be used as general strengthening ones. The volume and intensity of the load (their individualization) will depend on the condition of other organs, age and physical fitness of the patient.

Against the background of a general tonic effect, restoration of innervation should be achieved through active volitional training, and in cases where there are no active movements, by sending impulses to movement, mentally performing the movement simultaneously with a healthy limb, as well as using passive movements, combining sending impulses with passive ones. movements. In the future, when signs of active movements appear, they should be performed in facilitating starting positions. As you recover, in normal starting positions, then more complicated ones, with weights and resistance.

Active exercises are given in divided doses several times a day. Simultaneous long-term work can cause a state of extreme inhibition of the damaged area of ​​the neuromuscular system due to its rapid exhaustion. A necessary condition for performing active movements must be a certain goal setting (fastening buttons, modeling from plasticine, etc.).

The formation of contractures and deformities is counteracted by passive movements and fixation of the limb in the correct position during free time. It is first necessary to find out what movements are missing and in what position the limb is located. For example, if the radial nerve is damaged in the forearm, extension of the hand and fingers is impossible and a drooping hand occurs. Passive movements will be aimed at straightening the hand (together with impulses towards extension), and fixation will consist of placing the forearm on a splint or splint so that the hand is straightened, the fingers are half-bent, and the thumb is in an abducted position. You should not get carried away with passive movements, as there is a danger of overstretching the affected, weakened muscles.

If complex conservative treatment does not help, then surgical intervention is resorted to, for example, releasing the nerve from the scar. If a complete rupture of the nerve is detected, it is sutured and the limb is fixed in a position that promotes the convergence of the sutured ends. In the first case, exercises with the affected limb begin 2-3 days after surgery, in the second - after 3 weeks (after removing the fixing bandage).

The formation of compensation for lost functions is achieved in two ways: training synergists (if any) and (or) reconstructive operations and the use of orthopedic devices. For example, if the musculocutaneous nerve is damaged, the biceps brachii muscle ceases to function and flexion at the elbow joint can be performed using the brachioradialis muscle (from a position of incomplete pronation), innervated by the radial nerve; if the extension function in the wrist joint is irretrievably lost (and the extensors do not have synergists), then the ulnar and radial flexors of the hand can be sutured to the extensor tendons, respectively (operation according to I. I. Dzhanelidze).

Considering the extraordinary plasticity of the nervous system, it is possible through special training (before and after surgery) to achieve functional restructuring in the nerve centers, and then extension in the wrist joint will occur due to the transplanted flexors. If it is impossible to perform this operation, they surgically create immobility in the joint in the extension position and resort to wearing an orthopedic device that fixes the hand in the same position.

All the above principles of the methods of practicing therapeutic physical culture also apply to private methods - for diseases and injuries of various localizations. In case of damage to individual nerves - neuritis and neuralgia (the leading symptom is pain) - in the main part of the lesson, physical exercises will be performed with the affected muscles. For example, in case of neuritis or injury to the radial nerve, the wrist extensors and supinators should be exercised using already known means (sending impulses, passive movements, a combination of both, active movements) in the starting position with the forearm and hand supported; in case of damage to the median nerve - flexors of the hand, 1st-2nd fingers and opposing muscles; if the peroneal nerve is damaged, the extensors of the foot; with brachial plexitis (damage to the brachial plexus) - all muscles of the shoulder and shoulder girdle. With plexitis and polyneuritis, the prevalence of the lesion is greater and, naturally, it takes longer and more painstaking work to normalize functions, since the number of muscle groups not involved in the disease process decreases.