Bases of medical physical
education at the diseases
of nervous systems .
Task of medical physical education at the
diseases of nervous systems .
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Strengthening of organism of patient.
Improvement of circulation of blood of the
lesioned parts of body .
Lowering of pathological rising paretic
muscles tone and increase of muscle
force .
Removal of harmful synchronous motions:
synergies and synkinetics.
Proceeding in a functional equilibrium
between paretic muscles and synergic.
Renewal or increase of exactness of
motions.
Renewal or improvement of nervous
conductivity from a center to periphery
and from periphery to center.
Removal or decreasing of muscles tremor.
Recreation and forming of major motive
skills, directed on mastering (studies) of
domestic and labour skills, self-service
and movement, preparation to the social
rehabilitation.
Features of TE are at neurological and
neuro-surgical pathology.
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Early setting of TE. Foresees the
use of stored and newly-created
functions, adjusted to modified terms
of neurological, somatic and visceral
status.
The selective use of TE for
reestablish in the broken functions or
indemnification of lost.
Use of the special exercises on
pathogenous principle in
combination with the general tonic
action of TE .
Observance of principle of adequacy
at permanent replacement of
physical exercises in dependence on
possibilities of patient and presence
training effect.
Gradual incessant expansion of the
motive mode from lying position to
possibility of unlimited movement.
Means of TE at nervous diseases are initial positions,
massage, special therapeutic gymnastic exercises.
The last are divided:
а) for strengthening of muscle force;
б) for receiving of strictly dosed muscular tension;
в) for receiving of differentiated tensions and relaxations of
separate muscles and muscle groups;
г) for correct recreation of motive act on the whole (speed,
smoothness, exactness of motions);
д) протиатактичні exercises, directed on renewal and
improvement of motion co-ordination;
е) antispastic and antirygid;
є) reflex and ideomotoric;
ж) on renewal or new forming of the applied motive skills
(standing, walking, domestic skills);
з) passive including manual therapy.
Sharp violation of cerebral circulation of blood – insult.
Distinguish 3 stages of rehabilitation of insult patients:
1-st – early restoring (up to 3 months)
2-nd – late restoring (up to 1 year)
3-d – residual violations of motive functions.
Degree of violation of motive functions:
1-st – light paresis;
2-nd – moderate paresis;
3-d – paresis;
4-th – considerable paresis;
5-th – plegia or paralysis.
The mode of motive activity depends on:
1 – the state of patient;
2 – the period of illness;
3 – degree of violation of motive function.
The modes of motive activity are:
1. Severe bed rest (1-3 days).
2. 2-а Extended bed rest (3-15 days). 2-б – 16-21 days.
3. Hospital ward mode.
4. Free mode.
Severe bed rest :
1. TE engagement contraindicated.
2. A patient is provided with rest, medicinal treatment.
3. Laying treatment, that is to say, lay a patient in position
opposite the pose of Vernike – Man.
This:
- diminishes spasmodic;
- prevents development of contractions;
4. A patient is layed on the back, on a side, positions change
4-6 times per day, for 30 – 60 minutes, depending on the state
of patient, tone of muscles of paretic extremity.
Extended bed rest :
2 а / 3-5 day
TE tasks:
1. An improvement of functions of cardiovascular and
respiratory system, preventing of complications from their
side.
2. Activation of motoric of intestines.
3. An improvement of tissue trophic, bedsores prevention.
4. A reduction of muscle tone in case of its rise.
5. Prophylaxis of hemiplegic contracts.
6. Preparation for the active turn on a healthy side.
7. Stimulation and renewal of isolated active motions is in
paretic extremity.
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Lying on the back, or on the side
treatment.
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2. Physical exercises:
 - Respiratory exercises;
 - Active exercises for small,
middle, and further for big joins of
healthy extremities;
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3. From 3-6 day – passive
exercises for joints of paretic
extremity.
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4. Teach will impulse sending to
moving synchronically with
isolated passive unbending of
forearm, bending of calf.
Extended bed rest:
2 b / 16-21 day.
TE tasks:
1. Strengthening of the general tone influence on patient.
2. Teaching of healthy extremity muscles relaxation.
3. Decreasing of muscles tone in paretic extremities.
4. Change pose of patient to sitting position.
5. Stimulation of active movements in paretic extremities.
6. Opposition to pathologic synkinesis.
7. Preparing of patient to standing.
8. Restoration of supporting function for lower extremities.
9. Restoration self-service function with healthy extremity.
Means:
1. Initial poses are significant during conducting of passive
movements for separate segments of extremities:
Fingers are easily bend, if hand is bend.
Forearm – if shoulder is adducted.
Forearm supination will be of full value, if elbow is bend.
Hip conducting is more full in bending position.
2. а) classes begin from active movements (at first for healthy
extremities and than (passive) - paralyzing.
b) During conduction of active exercises it’s necessary to use
more easy positions:
- bed frames;
- blocks;
- hammocks for support of paralyzing extremity;
c) exercises are conducted slowly, smoothly, every movement 4-8
times. At first, extremity is returning to initial position passively,
with the instructor and supporting help.
Exclusive attention is payed to movement restoration of the
thumb;
d) Passively or actively oppose to pathological synkinesis:
- during conduction of active movements with a leg, arms
are fixed behind the head or along the trunk, hands under
buttocks;
- when healthy arm is bended, methodologist can, at the
same time, unbend paretic arm passively;
- will efforts are used, bending leg (patient oppose to arm
bending, supporting it by will efforts in unbend position);
e) ideomotoric movements;
f) isometric tension of paretic extremity muscles.
Hospital ward mode.
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TE tasks:
Decreasing of muscles tone.
Opposition to hemiplegics contractures.
Further restoration of active movements.
Change pose of patient to standing position.
Teaching of walking.
Opposition to synkinesis.
Restoration of self-service and applied
movements and domestic skills.
Free mode.
TE tasks, methods and means in the last restoration stage and in
period of rest movement disorders depends on movement function
disorder degree:
1st stage (easy paresis)
- General strengthening influence on an organism;
- Strengthening of shoulder and spine muscles;
- posture improvement;
- movements, walking.
5th stage (plegia, paralisis)
- Activation of the cardiovascular and respiratory systems;
- teaching of patient to turn on a side;
- preparation to sitting or standing pose change;
- improvement of lover extremities supporting function;
- healthy extremities muscles relaxation;
- decreasing of muscles tone;
- opposition to contractures;
- improvement of the paretic extremities trophic;
- Extension of self-service skills.
Degrees of patient’s movement and socialdomestic adaptation:
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The most easy degree – defect is felt only by patient.
Easy degree – defect is felt during any physical activity is
seen from the side, but not invalidating patient.
Moderate degree – limited possibility of independent
conduction of movement action. Needs partial outside
help in private life, and at works – profession change.
Severe degree – social and domestic patient activity is
significantly limited, for exception the most elementary
actions, which are impossible without outside help. Works
is excepted. The patient is invalid.
Very severe degree – neither independent movements or
actions are impossible. Patient constantly needs outside
care and help.
TE tasks in case of central and
peripheral paralysis.
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Impovement of кровотоку і nervous
trophic of stricken muscles.
Contracts development prevention.
Movement restoration and development
of compensatory movement skills.
Strengthening influence on the organism
of patient.
TE forms, the peculiarities of their application:
TE and a massage is begun in the early terms of treatment .
From the first days the paretic extremities are specially laid. For
example, For example, at hemiplegia or hemiparesis as a result of
ischemic stroke, position treatment begins from 2-4 day. At a
hemorrhage in a brain – from 6-8 day (if the state of patient allows
to do it).
1. A patient is layed on the back oppositely to Vernike-Man pose:
a shoulder is taken aside under the corner of 90, an elbow and
fingers are unbent, a hand is supinated, held from the side of palm
by лонгетою. Whole extremity is fixed with the help of sacs with
sand.
2. The paralysed leg is bent in a knee under the corner of 15-20.
A foot is in position of the back bending under the corner of 90.
3. Position on the back is altered with position on a healthy side.
Periodicity of position change is 1,5 – 2 hours.
4. At the same time a massage is applied.
Usually stroking , rubbing, continuous vibration are applied.
TE in case of neuritis of facial nerve.
Neuritis of facial nerve (NFN) becomes apparent in peripheral
paresis or paralisis of mimic musculature of the corresponding
side of a person, causing its asymmetry.
TE actions in case of NFN:
1. Neuritises of infectious and vascular origin.
2. After an surgical oncotomy and nerve incarceration.
3. After complete rehabilitation of sharp festering process in a
middle ear which caused NFN.
4. NFN, as a result of surgical interference concerning
епітимпаніту (rarely).
TE tasks in case of NFN:
1. Improvement of local blood circulation (in the face, in the neck).
2. Restoration of mimic muscles function .
3. Prevention of contracts and parallel motions development .
4. Restoration of a correct pronunciation.
5. Diminishing of violations of mimicry at the heavy lesion of nerve,
which badly respond to treatment, in order to hide facial defects.
Restoration stage
Early
Basic
Restorative
2-12 days
20-40 days
2-3 months
30-40 days
3-4 months
2-3 years
Early period.
Massage, medical gymnastics, position treatments are used.
1. Position treatment:
to sleep on a side (on the side of lesion);
during a day 3-4 times to sit, bending the head to the opposite direction,
supporting it with a hand leaning on an elbow. Herewith muscles should be
pulled up from a healthy side to lesioned side (from below up), trying to
restore facial symmetry;
adhesive plaster tension from a healthy side to sick with the use of special
helmet-mask;
tying up with a handkerchief;
2. The massage.
Procedure begins from the collar area of neck. A patient
sits before a mirror. A masseur must see the face of patient
fully. All methods of massage (stroking, rubbing, vibration)
conduct carefully, without considerable displacement of
facial skin.
Reduction (denotation of muscles).
3. Medical gymnastics І.
- tension and weakening of muscles of healthy side is
dosed (скулової, laughter, circle a muscle eye, and ін)
- tension and weakening of muscles which form mimic
emotions (smile, laughter, attention, sorrow). These
exercises are only the preparatory stage to the basic
period.
Special exercises for mimic muscles
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. To rise eyebrows.
2. To frown eyebrows.
3. To close eyes (stages of implementation
of exercise: to look downward; to close
eyes; holding an eyelid with fingers on the
side of lesion, to hold eyes closed during a
minute; to open and close eyes 3 times).
4. To smile with the closed mouth.
5. To narrow eyes.
6. To hang one's head downward, to do
inhalation and during exhalation to ”snort”.
7. Whistle.
8. To extend nostrils.
9. To heave up an upper lip, showing upper
teeth.
10. To drop a lower lip, showing lower teeth.
11. To smile with the opened mouth.
12. To liquidate the inflamed match.
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13. To take water in a mouth, to close a
mouth and rinse, not outpouring water.
14. To inflate cheeks.
15. To transfer air from one half of mouth in
other.
16. To drop the corners of mouth downward
at the closed mouth.
17. To put out a tongue and do it narrow.
18. To move a tongue forwards –
backwards at the opened mouth.
19. To move a tongue to the right - to the
left at the opened mouth.
20. To put out forward lips by a ”tube”.
21. To do a circle by a finger , tracing it with
eyes.
22. To pull in cheeks at the closed mouth.
23. To put an upper lip on the lower.
24. At the closed mouth to move with a tip
of the tongue agains a gums to the right to
the left, pressing a tongue with various
effort.
Tasks of medical gymnastics:
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Cooperate in increasing of distance between separate
vertebral segments with the purpose of removal of pathological
proprioceptive impulsation.
Cooperate in declining of pathological proprioceptive
impulsation.
An improvement of trophics as a result of improvement of
blood- and lymphokinesis in the lesioned vertebral segment
and radices.
Diminishing of edema in tissues, in the area of intervertebral
opening, improvement of blood circulation, in the lesioned
extremity.
Increase and restoration of the whole amount of motions in
extremities and spine; diminishing of static and dynamic
violations and compensatory motions, restoration of the
violated carriage.
Cooperate in restoration of trophism, tone, force of muscles of
trunk and extremities.
To increase a general physical capacity for work.
Special tasks of medical gymnastics:
At a radicularis syndrome:
 drawing out of nervous trunks and radices;
 prevention of muscular atrophy;
 strengthening of muscles of distal parts of extremities.
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At shoulder and scapular periarthritis:
prophylaxis of reflex neurogenic contracts of elbow joint
formation;
strengthening delta-shaped, supra- and subspinalis, biceps
muscles.
At a back-neck sympathetic syndrome (syndrome of
vertebral artery):
Cooperate in reduction of vestibular violations.
COMPLEX 3
Pic. 15 - Exercises for development of back muscles.
Pic. 16 - Exercises for development of spine (complex 4)
and upper humeral muscles group flexibility (complex 5).
COMPLEX 5
COMPLEX 4
COMPLEX 6
Pic. 17 Exercises for the
lumbar and abdominal
muscles.
COMPLEX 7
Рic. 18 - Exercises for flexibility of spine development.
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