How to strengthen the nervous system. Exercise therapy for diseases of the central nervous system

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

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

Rice. 121. Central and peripheral nervous system.

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

B - segments of the spinal cord.

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

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

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

spinal node;9 - spinal nerve.

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

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

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

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

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

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

lower cervical node;4 - border sympathetic trunk;

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

meninges;7 - lower sacral node

sympathetic trunk.

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

muscle; 3 - sternocleidomastoid muscle;4 -

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

serratus anterior;7 - white line;8 - seed

cord;9 - thumb flexor;10 -

quadriceps femoris;11 - long fibula

muscle;12 - anterior tibialis muscle;13 - long

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

facial muscles;16 - subcutaneous muscle of the neck;

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

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

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

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

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

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

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

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

To correctly determine the severity of paresis, and in lung cases paresis - sometimes for its detection, a quantitative assessment of the state of individual motor functions: muscle tone and strength, range of active movements. The available methods make it possible to compare and effectively control the results of rehabilitation treatment in a polyclinic and a hospital.

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

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

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

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

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

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

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

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

The rehabilitation regimen should be adequate to the severity of the disease, which is assessed by the degree of impairment of adaptive activity. The level of damage to the central nervous system and peripheral nervous system is taken into account. Important factors are the ability to move independently, serve yourself (do housework, eat without the help of others, etc.) and family, communicate with others, evaluate the adequacy of behavior, the ability to control physiological functions and the effectiveness of training.

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

At serious illnesses(injuries) of the nervous system, rehabilitation is aimed at improving the general condition of patients, raising the emotional tone and forming the right attitude towards the prescribed treatment and the environment: psychotherapy, symptomatic drug therapy, occupational therapy, music therapy, massage in combination with therapeutic exercises, etc.

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

Special exercises can be conditionally divided into the following groups:

exercises that increase joint range of motion and muscle strength;

exercises aimed at restoring and improving coordination of movements;

antispastic and antirigid exercises;

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

a group of exercises aimed at restoring or forming motor skills (standing, walking, manipulations with simple but important household objects: clothes, dishes, etc.);

passive exercises and exercises for stretching connective tissue formations, treatment with position, etc.

All of the above groups of exercises are combined in various combinations and depend on the nature and extent of the motor defect, the stage of rehabilitation, the age and gender of the patient.

Rehabilitation of neurological patients requires long-term training compensatory mechanisms(walking with crutches, self-care, etc.) to provide sufficient compensation for lost or impaired functions. However, at a certain stage (stages), the recovery process slows down, that is, stabilization occurs. The success of rehabilitation is different for a particular pathology. So, with osteochondrosis of the spine or lumbosacral sciatica, it is higher than with multiple sclerosis or vascular diseases.

Rehabilitation largely depends on the patient himself, on how diligently he fulfills the program prescribed by the rehabilitation doctor or exercise therapy methodologist, helps to adjust it depending on his functionality and finally, whether he continues recovery exercises after the completion of the rehabilitation period.

Brain injury (concussion)

All brain injuries are characterized by increased intracranial pressure, violation of hemo- and liquor circulation with subsequent violation of cortical-subcortical neurodynamics with macro- and microscopic changes cellular elements brain. A concussion of the brain leads to headaches, dizziness, functional and persistent autonomic disorders.

In case of violations of motor functions for the prevention of contractures, exercise therapy is prescribed (passive, then passive-active movements, treatment with position, muscle stretching exercises, etc.), massage of the back and paralyzed limbs (first massage the legs, then the arms, starting from the proximal sections), and also affect the biologically active points (BAP) of the limbs.

With mild and medium degree concussion massage should be carried out from the second or third day after the injury in the patient's sitting position. First, the back of the head, neck, shoulder girdle are massaged, then the back to the lower corners of the shoulder blades, using stroking, rubbing, shallow kneading and light vibration. Finish the procedure by stroking from the scalp to the muscles of the shoulder girdle. The duration of the massage is 5-10 minutes. Course 8-10 procedures.

In the first 3-5 days, with mild to moderate concussion, cryomassage of the occipital region and muscles of the shoulder girdle is also used. The duration of the massage is 3-5 minutes. Course 8-10 procedures.

Injuries of the spine and spinal cord

Sometimes a spinal injury occurs in a position of hyperlordosis, and then a rupture of an intact intervertebral disc can occur.

The cervical spine is especially often injured when jumping into a shallow body of water, when, after hitting the head against the bottom, a traumatic prolapse of an intact intervertebral disc occurs, causing tritraplegia. Degenerative changes inevitably lead to a hernia of the intervertebral discs, which in itself is not a cause for complaints, but due to trauma, a radicular syndrome occurs.

When the spinal cord is injured, flaccid paralysis occurs, which is characterized by muscle atrophy, the impossibility of voluntary movements, the absence of reflexes, etc. Each muscle is innervated from several segments of the spinal cord (see Fig. 96), therefore, with damage or diseases, there may be not only paralysis, but also muscle paresis of varying severity, depending on the prevalence of lesions in the anterior horns of the gray matter of the spinal cord.

The clinical course of the disease depends on the degree of damage to the spinal cord and its roots (see Fig. 122). So, with injuries of the upper cervical spine, spastic tetraparesis of the extremities occurs. With lower cervical and upper thoracic localization (C 6 -T 4), flaccid paresis of the arms and spastic paresis of the legs occur, with thoracic localization - paresis of the legs. With the defeat of the lower thoracic and lumbar segments of the spine, flaccid paralysis of the legs develops. The cause of flaccid paralysis can also be damage to the spinal cord with closed fractures of the spine and its injuries.

Prevention of the development of joint contractures by means of massage, exercise therapy, stretching exercises, physio- and hydrotherapy, hydrokinesitherapy - the main task with paralysis of any origin. In water, the possibility of active movements is facilitated and the fatigue of weakened muscles is reduced. Electrical stimulation of paralyzed muscles is carried out with needle electrodes with a preliminary introduction of ATP. In addition, positional treatment is included using staged plaster splints (bandages), teips, sandbags, etc., as well as staged redressing and other methods.

Timely application of the necessary rehabilitation funds allows you to completely prevent the development of contractures and other deformities.

Traumatic encephalopathy is a complex of morphological, neurological and mental disorders that occur in the late and distant periods after traumatic brain injury. Characterized by asthenic and various vegetative-vascular disorders, memory impairment by the type of retrograde amnesia, headaches, fatigue, irritability, sleep disturbance, heat intolerance, stuffiness, etc.

The recurrence of seizures indicates the development of traumatic epilepsy. In severe cases, traumatic dementia occurs with severe memory impairment, a decrease in the level of personality, etc.

Complex treatment, in addition to dehydration therapy, includes the use of anticonvulsants, tranquilizers, nootropics, etc. Massage, LH, walking, skiing help to improve the patient's well-being and prevent the onset of decompensation.

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

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

Vascular epilepsy

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

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

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

Osteocondritis of the spine

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

Speedy recovery of function spinal column general massage, cryomassage, vibration massage, LG (Fig. 124), hydrocolonotherapy help. They cause deep hyperemia, improve blood and lymph flow, have an analgesic and resolving effect.

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

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

Discogenic radiculitis

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

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

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

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

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

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

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

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

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

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

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

sciatica

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

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

Functional diseases of the nervous system, or neuroses (neurasthenia, hysteria, psychasthenia), are various kinds disorders of nervous activity, in which there are no visible organic changes in the nervous system or internal organs.

In addition to the functional overstrain of the nervous system (overwork, overtraining, negative emotions, malnutrition, lack of sleep, sexual excesses), various causes that weaken the nervous system can contribute to the development of neurosis, - infectious diseases, chronic intoxication (alcohol, lead, arsenic), autointoxication (with constipation, metabolic disorders), beriberi (especially group B) and trauma to the brain and spinal cord.

The therapeutic effect of physical exercises is manifested primarily in their general strengthening effect on the body. Physical exercises contribute to the development of initiative, self-confidence, courage, help to deal with the instability of the neuropsychic sphere and emotional manifestations. Group lessons are the most appropriate here.

The method of therapeutic physical culture is chosen taking into account the patient's condition (which is predominant - excitation or inhibition), his age and the condition of the internal organs.

To establish contact with such patients, it is advisable to conduct the first sessions individually. They use simple and general developmental exercises for large muscle groups, performed at a slow and medium pace. Gradually introduce exercises for attention, speed and accuracy of reaction and exercises in balance.

When exercising with patients with neurasthenia and hysteria, the tone of the instructor should be calm, the storytelling method is used more. Against the background of general strengthening exercises, attention tasks are given. In the treatment of hysterical paralysis, distracting tasks should be used in changed conditions (in a different starting position), for example, in case of “paralysis” of the hand - exercises with a ball or several balls. When the "paralyzed" hand is included in the work, it is necessary to fix the patient's attention on this.

When exercising with patients with psychasthenia emotional level classes should be high, the tone of the instructor is peppy, the music is major, simple exercises should be performed lively, with gradual acceleration. Classes should be conducted by demonstration method. It is desirable to use games and competition elements.

From an instructor dealing with sick neuroses, a subtle pedagogical approach, great sensitivity is required.

In a hospital, therapeutic exercises, morning hygienic exercises and walking are used in combination with drug therapy and physiotherapy. In sanatorium conditions, all forms of therapeutic physical culture and natural factors of nature are widely used.

According to experts, movement is life. And with various diseases, proper physical activity can become a real panacea for the patient - they can speed up recovery, prevent relapses, improve general physical state. So with ailments of the nervous system, gymnastics is the most important part of complex treatment. And all patients with such problems, without exception, are shown the systematic implementation of a set of individually selected exercises. The topic of our today's conversation on this page www.site will be exercise therapy for diseases of the central nervous system and peripheral.

Exercise therapy for diseases of the nervous system

Therapeutic exercise for diseases of the central nervous system helps to activate the vital functions of the body: respiratory, cardiovascular, etc. Gymnastics effectively prevents the occurrence of motor and other complications, including contractures, stiffness in the joints, bedsores, congestive pneumonia, etc.

Regular exercises help restore lost functions or create temporary or permanent compensation. Physiotherapy also helps to restore the skills of walking and grasping objects. Gymnastics also perfectly increases the overall tone of the body and optimizes the mental state of the patient.

Exercise therapy for diseases of the peripheral nervous system

Gymnastics in such diseases is aimed at optimizing the processes of blood circulation, as well as trophism in the affected focus, it helps to prevent adhesions and cicatricial changes, eliminate or reduce vegetative-vascular and trophic disorders (promoting nerve regeneration).

Exercises for diseases of the peripheral nervous system help to strengthen the paretic muscles and ligamentous apparatus, to weaken muscular dystonia. Such an effect can prevent or eliminate muscle contractures, as well as stiffness in the joints.

Physiotherapy exercises also help to improve substitution movements and coordinate them with each other. Such exercises cope with the limited mobility of the spinal column and with its curvature.

Exercises for diseases of the peripheral nervous system have a pronounced general health-improving, as well as a general strengthening effect on the patient, contributing to the overall recovery of working capacity.

Features of exercise therapy for ailments of the nervous system

Patients with diseases of the nervous system are shown an early start of exercise therapy. At the same time, physical activity should be relevant: they are selected on an individual basis, should gradually increase and become more complicated.

Even a slight complication of exercises already at the level of psychology makes the previous exercises easier. However, overloads for patients with diseases of the central nervous system and peripheral nervous system are categorically contraindicated; in this case, their motor disorders may worsen. To accelerate progress, it is extremely important to finish classes on those exercises that are best obtained by patients. This ensures the most positive psychological preparation patient for the next session.

Simple exercises it is necessary to alternate with complex ones: to ensure a full-fledged training of higher nervous activity. At the same time, the motor mode should be steadily expanded: from the position lying in bed, to sitting in bed, and then standing.

Doctors strongly recommend the use of all means, as well as methods physiotherapy exercises. Patients are shown therapeutic gymnastics, posture treatment, massages. Also, an excellent effect is given by extension therapy - mechanical straightening or stretching along the longitudinal axis of certain parts of the body, which are characterized by a violation of the correct anatomical location.

However, the classic and most popular method of physical therapy for ailments of the nervous system is different exercises.

What exercises are used for diseases of the nervous system?

Patients are shown performing isometric exercises designed to strengthen muscle strength. Doctors also advise classes in which tension and relaxation of muscle groups alternate. Exercises with acceleration and deceleration, various exercises for deceleration and balance must also be performed.

Alternative medicine experts also advise paying attention to ideomotor activities, in which the mental sending of impulses occurs.

Some examples of exercise therapy for diseases of the nervous system

Quite often, patients with focal lesions of the brain are treated with position. In this case, the affected limbs (usually the arm) are fixed in a fixed position using various devices (sand roller, etc.). The duration of treatment with the position can vary from a quarter of an hour to four hours, depending on the type of disease and the condition of the patient.

In diseases of the peripheral nervous system, the patient is shown to perform exercises aimed at optimal contraction of the paretic muscles, as well as stretching their antagonists. Particular attention is paid to the development of the necessary motor skills: walking and running, the ability to write, hold and throw small objects.

Physiotherapy exercises contribute to the speedy recovery of patients with ailments of the nervous system, both peripheral and central.

Ekaterina, www.site

P.S. The text uses some forms characteristic of oral speech.

Neuritis is a disease of peripheral nerves that occurs as a result of traumatic injury, infectious, inflammatory diseases (diphtheria, influenza, etc.), beriberi (lack of B vitamins), intoxication (alcohol, lead) and metabolic disorders (diabetes).

The most common neuritis of the facial nerve, neuritis of the radial, median, ulnar, sciatic, femoral and tibial nerves.

The nature of functional disorders in injuries of the peripheral nerves of the upper and lower extremities is determined by their localization and the degree of damage. The clinical picture in neuritis is manifested by sensitivity disorders (pain, temperature, tactile), motor and vegetotrophic disorders.

Motor disorders in neuritis are manifested in the development of paresis or paralysis.

Peripheral (flaccid) paralysis is accompanied by muscular atrophy, decrease or disappearance of tendon reflexes, muscle tone, trophic changes, skin sensitivity disorders, pain when stretching muscles.

Exercise therapy, massage and physiotherapy occupy an important place in complex rehabilitation treatment.

Tasks of complex rehabilitation treatment for peripheral paralysis:

Stimulation of the processes of regeneration and disinhibition of nerve sections that are in a state of oppression;

Improving blood supply and trophic processes in the lesion in order to prevent the formation of adhesions and cicatricial changes;

Strengthening paretic muscles and ligaments;

Prevention of contractures and stiffness in the joint;

Recovery of working capacity by normalizing motor functions and developing compensatory adaptations.

Exercise therapy is contraindicated in severe pain and heavy general condition sick. The methodology and nature of rehabilitation measures are determined by the nature of movement disorders, their localization and the stage of the disease.

The following periods are distinguished: early recovery (2-20th day), late recovery, or main (20-60th day), and residual (more than 2 months).

With surgical interventions on the nerves, the time limits of all periods are fuzzy: for example, the early recovery period can last up to 30-40 days, the late one - 3-4 months, and the residual one - 2-3 years.

early recovery period. With the development of paralysis, optimal conditions are created for the restoration of a damaged limb - treatment with position, massage and physiotherapy procedures are used.

Positional treatment is prescribed to prevent overstretching of weakened muscles; for this, splints are used that support the limb, special “laying”, corrective positions. Treatment by position is carried out throughout the entire period - with the exception of therapeutic exercises.

A feature of massage in peripheral paralysis is the differentiation of its effects on muscles, a strict dosage of intensity, the segmental-reflex nature of the effect (massage of the collar, lumbosacral regions). Favorable influence render hardware massage(vibration), carried out in the "motor points" and along the paretic muscles; vortex and jet underwater massage, combining the positive temperature effect of warm water and its mechanical effect on tissues.

In the absence of motor functions, physiotherapy (electrophoresis with calcium ions) is used to improve nerve conduction.

After physiotherapeutic procedures, therapeutic exercises are carried out; with complete paralysis, they mainly consist of passive and ideomotor exercises. It is advisable to combine passive exercises with active movements in the same joints of a symmetrical limb.

During classes, it is especially necessary to monitor the appearance of voluntary movements, choosing the optimal starting positions, and strive to support the development of active movements.

Late recovery period positional treatment, massage, remedial gymnastics and physiotherapy are also used.

Treatment by position has a dosed character and is determined by the depth of paresis: what deeper defeat, the longer the duration of treatment with the position (from 2-3 minutes to 1.5 hours).

Massage is carried out differentially, in accordance with the localization of muscle damage. Weakened muscles are massaged more intensively; using the techniques of stroking and surface rubbing, their antagonists relax.

Physiotherapy treatment is complemented by electrical muscle stimulation.

The following method of therapeutic exercises gives a positive effect: active movements in the symmetrical joints of a healthy limb, passive movements in the joints of the affected limb, friendly active, lightweight exercises involving weakened muscles. Relief of the functional load is achieved by selecting the appropriate initial positions for performing exercises that reduce the inhibitory effect of the weight of the limb segment. To reduce friction, the limb segment is supported by a soft strap (on weight). Facilitate the work of paretic muscles and exercise in warm water. In the residual period, they continue to do therapeutic exercises; the number of applied exercises for training everyday and professional skills is significantly increased; game and sports-applied elements are introduced; optimal compensatory adaptations are formed.

The patient is prescribed a massage (15-20 procedures). The massage course is repeated after 2-3 months.

Positional treatment is determined by orthopedic tasks (sagging of the foot or hand) and is carried out with the help of orthopedic and prosthetic products (devices, splints, special shoes).

In this period, contractures and stiffness in the joints are of particular difficulty in treatment. Alternating passive movements with active exercises different nature and massage of unaffected areas, thermal procedures allow you to restore the necessary range of motion.

With the persistence of secondary changes in tissues, mechanotherapy is used, which is effectively used in water.

Neuritis of the facial nerve

Most common causes development of lesions of the facial nerve are infection, hypothermia, trauma, inflammatory diseases ear.

clinical picture. It is mainly characterized by the acute development of paralysis or paresis of the facial muscles. The affected side becomes flabby, lethargic; blinking of the eyelids is disturbed, the eye does not completely close; nasolabial fold smoothed; the face is asymmetrical, drawn to the healthy side; speech is slurred; the patient cannot wrinkle his forehead, frown his eyebrows; loss of taste, lacrimation are noted.

Rehabilitation activities include positional therapy, massage, therapeutic exercises and physiotherapy.

Rehabilitation tasks:

Improving blood circulation in the face (especially on the side of the lesion), neck and the entire collar zone;

Restoration of the function of facial muscles, impaired speech;

Prevention of the development of contractures and friendly movements.

IN early period(1-10th day of illness) use position treatment, massage and therapeutic exercises. Treatment by position includes the following recommendations:

Sleep on your side (on the affected side);

For 10-15 minutes (3-4 times a day), sit with your head bowed in the direction of the lesion, supporting it with the back of the hand (supported by the elbow); pull the muscles from the healthy side to the side of the lesion (from bottom to top) with a handkerchief, while trying to restore the symmetry of the face.

To eliminate the asymmetry, adhesive plaster tension is applied from the healthy side to the patient, directed against the traction of the muscles of the healthy side. It is carried out by firmly fixing the free end of the patch to a special helmet-mask, made individually for each patient (Fig. 36).

Positional treatment is carried out in daytime. On the first day - 30-60 minutes (2-3 times a day), mainly during active facial actions (eating, talking). Then its duration is increased to 2-3 hours a day.

Massage begins with the collar area and neck. This is followed by a facial massage. The patient sits down with a mirror in his hands, and the massage therapist is located opposite the patient in order to be sure to see his entire face. The patient performs the exercises recommended during the procedure, observing the accuracy of their execution with the help of a mirror. Massage techniques - stroking, rubbing, light kneading, vibration - are carried out according to a gentle technique. In the first days, the massage lasts 5-7 minutes; then its duration increases to 15-17 minutes.

Massage of the muscles of the face is mainly of a point nature, so that the skin displacements are insignificant and do not stretch the skin of the affected half of the face. The main massage is carried out from the inside of the mouth, and all massage movements are combined with therapeutic exercises.

Therapeutic gymnastics is mainly addressed to the muscles of the healthy side - this is an isolated tension of the facial muscles and muscles surrounding the oral fissure. The duration of the lesson is 10-12 minutes (2 times a day).

In the main period (from the 10-12th day from the onset of the disease to 2-3 months), along with the use of massage and positional treatment, special physical exercises are performed.

Position treatment. Its duration increases to 4-6 hours a day; it alternates with LH and massage. The degree of tension of the adhesive plaster is also increased, reaching hypercorrection, with a significant shift to the diseased side, in order to achieve stretching and, as a result, weakening of the muscle strength on the healthy side of the face.

In some cases, adhesive plaster tension is carried out within 8-10 hours.

Exemplary special exercises for training mimic muscles

1. Raise your eyebrows up.

2. Wrinkle your eyebrows (frown).

3. Look down; then close your eyes, holding the eyelid on the side of the lesion with your fingers, and keep them closed for 1 minute; open and close your eyes 3 times in a row.

4. Smile with your mouth closed.

5. Squint.

6. Lower your head down, take a breath and, at the moment of exhalation, “snort” (vibrate your lips).

7. Whistle.

8. Flare the nostrils.

9. Raise the upper lip, exposing the upper teeth.

10. Lower the lower lip, exposing the lower teeth.

11. Smile with your mouth open.

12. Blow on a lit match.

13. Take water in your mouth, close your mouth and rinse, trying not to pour out the water.

14. Puff out your cheeks.

15. Move air from one half of the mouth to the other alternately.

16. Lower the corners of the mouth down (with the mouth closed).

17. Stick out the tongue and make it narrow.

18. Opening your mouth, move your tongue back and forth.

19. Opening your mouth, move your tongue left and right.

20. Pull out the lips with a "tube".

21. Follow with your eyes a finger moving in a circle.

22. Draw in the cheeks (with the mouth closed).

23. Lower the upper lip to the lower.

24. With the tip of the tongue, drive along the gums alternately to the right and left (with the mouth closed), pressing the tongue against them with different efforts.

Exercises to improve articulation

1. Pronounce the sounds "o", "and", "y".

2. Pronounce the sounds “p”, “f”, “v”, bringing the lower lip under the upper teeth.

3. Pronounce sound combinations: “oh”, “fu”, “fi”, etc.

4. Pronounce words containing these sound combinations by syllables (o-kosh-ko, Fek-la, i-zyum, pu-fik, Var-fo-lo-mei, i-vol-ga, etc.).

The listed exercises are performed in front of a mirror, with the participation of an exercise therapy instructor, and are necessarily repeated by the patient on their own 2-3 times a day.

In the residual period (after 3 months), massage, positional treatment and therapeutic exercises are used, which are used in the main period. Significantly increases the proportion of therapeutic exercises, the task of which is to maximize possible recovery facial symmetry. During this period, the training of facial muscles increases. Exercises for mimic muscles should be alternated with restorative and breathing exercises.

Brachial plexus neuritis

The most common causes of brachial plexus neuritis (plexitis) are: humerus; wound; highly applied tourniquet for a long time. With the defeat of the entire brachial plexus, peripheral paralysis or paresis occurs and a sharp decrease in sensitivity in the arm.

Paralysis and atrophy of the following muscles develop: deltoid, biceps, internal shoulder, flexors of the hand and fingers (the arm hangs like a whip). In complex treatment, the leading method is position treatment: the hands are placed in a half-bent position and placed on a splint with a roller placed in the area of the metacarpophalangeal joint.

The forearm and hand (in a splint) are hung on a scarf. Special exercises for the shoulder girdle, muscles of the shoulder, forearm and hand are recommended, as well as general developmental and breathing exercises.

A set of special exercises for plexitis (according to A. N. Tranquillitati, 1992)

1. I. p. - sitting or standing, hands on the belt. Raise your shoulders up - lower. Repeat 8-10 times.

2. I. p. - the same. Squeeze your shoulder blades, then return to the starting position. Repeat 8-10 times.

3. I.p. - the same, hands down. Raise your arms up (hands to your shoulders), spread your elbows to the sides, then press them back to your body. Circular movements of the arm bent at the elbow (movements in the shoulder joint) clockwise and against it. Repeat 6-8 times. The movements of the affected hand are performed with the help of an exercise therapy methodologist.

4. I.p. - Same. Bend the injured arm, then straighten; take it to the side (straight or bent at the elbow), then return to the sp. Repeat 6-8 times. The exercise is performed with the help of a methodologist or a healthy hand.

5. I.p. - standing, leaning towards the injured arm (the other hand on the belt). Circular movements with a straight arm clockwise and against it. Repeat 6-8 times.

6. I.p. - Same. Swing movements with both hands back and forth and crosswise in front of you. Repeat 6-8 times.

7. I.p. - standing or sitting. Leaning forward, bend the sore arm at the elbow and straighten it with the help of a healthy arm. Repeat 5-6 times.

8. I.p. - Same. Turn the forearm and hand with the palm towards you and away from you. Repeat 6-8 times.

If necessary, movements are also performed in wrist joint and finger joints.

Gradually, when the injured hand can already hold objects, exercises with a stick and a ball are included in the LG complex.

In parallel with therapeutic exercises, hydrocolonotherapy, massage and physiotherapy are prescribed.

Neuritis of the ulnar nerve

Most often, ulnar nerve neuritis develops as a result of nerve compression in the area of the elbow joint, which occurs in people whose work is associated with elbow support (on a machine, table, workbench), or when sitting for a long time, putting their hands on the armrests of a chair.

clinical picture. The brush hangs down; no supination of the forearm; the function of the interosseous muscles of the hand is disturbed, in connection with which the fingers are claw-like bent ("clawed brush"); the patient cannot pick up and hold objects. There comes a rapid atrophy of the interosseous muscles of the fingers and the muscles of the palm from the side of the little finger; hyperextension of the main phalanges of the fingers, flexion of the middle and nail phalanges is noted; it is impossible to spread and adduct the fingers. In this position, the muscles that extensor the forearm are stretched, and contracture of the muscles that flex the hand occurs. Therefore, from the first hours of damage to the ulnar nerve, a special splint is applied to the hand and forearm. The hand is given a position of possible extension in the wrist joint, and the fingers are in a half-bent position; the forearm and hand are suspended on a scarf in the flexion position in elbow joint(at an angle of 80°), i.e. in the middle position.

Exercise therapy is prescribed on the 2nd day after the imposition of a fixing bandage. From the first days (due to the lack of active movements), passive gymnastics, gymnastics in water begin; doing a massage. As active movements appear, active gymnastics classes begin.

A.N. Tranquillitati proposes to include the following exercises in the complex of therapeutic exercises.

1. I.p. - sitting at the table; the arm, bent at the elbow, rests on it, the forearm is perpendicular to the table. Lowering the thumb down, raise the index finger up, then vice versa. Repeat 8-10 times.

2. I.p. - Same. With a healthy hand, grab the main phalanges of the 2-5 fingers of the injured hand so that the thumb of the healthy hand is located on the side of the palm, and the others on the back of the hand. Bend and unbend the main phalanges of the fingers. Then, moving a healthy hand, also bend and unbend the middle phalanges.

Along with LH, electrical stimulation of the muscles innervated by the ulnar nerve is performed. When active movements appear, elements of occupational therapy (modeling from plasticine, clay), as well as learning to grasp small objects (matches, nails, peas, etc.) are included in the classes.

Neuritis of the femoral nerve

With neuritis of the femoral nerve, the quadriceps and tailor muscles are paralyzed. The movements of the patient with this disease are sharply limited: it is impossible to unbend the leg bent at the knee; (running and jumping are impossible; standing and climbing stairs are difficult, moving from a lying position to a sitting position. With neuritis of the femoral nerve, loss of sensitivity and acute pain are possible.

When muscle paralysis occurs, passive movements, massage are used. As the recovery progresses, active movements are used: leg extension, bringing the hip to the pelvis, moving from a lying position to a sitting position, exercises to overcome resistance (with blocks, springs, on simulators).

Along with therapeutic exercises, massage, electrical stimulation of paretic muscles, etc. are used.

Control questions and tasks

1. What symptoms are typical for the clinical picture of neuritis?

2. Tasks of complex restorative treatment of peripheral paralysis and characteristics of its periods.

3. Clinical picture of neuritis of the facial nerve and methods of rehabilitation in different periods.

4. Clinical picture of brachial plexus neuritis (plexitis). Special exercises for this disease.

5. Clinical picture of ulnar nerve neuritis. The method of exercise therapy for this disease.

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Therapeutic exercise for diseases of the nervous system

Introduction

1. Therapeutic exercise for neurosis

2. General Basics methods of therapeutic physical culture

2.1 Neurasthenia

2.2 Psychathenia

2.3 Hysteria

Conclusion

Bibliography

exercise physical education neurosis psychasthenia hysteria

Introduction

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

Therapeutic exercise is one of the essential elements modern complex treatment, which is understood as an individually selected complex of therapeutic methods and means: conservative, surgical, medical, physiotherapeutic, medical nutrition and others. Comprehensive treatment affects not only pathologically altered tissues, organs or organ systems, but also the whole organism as a whole. The proportion of various elements of complex treatment depends on the stage of recovery and the need to restore the person's ability to work. A significant role in complex treatment belongs to therapeutic physical culture as a method of functional therapy.

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

Exercise therapy provides for the conscious and active performance by patients of appropriate physical exercises. In the process of training, the patient acquires skills in using natural factors of nature for the purpose of hardening, physical exercises - for therapeutic and prophylactic purposes. This allows us to consider classes in therapeutic physical culture as a therapeutic and pedagogical process.

Exercise therapy uses the same principles for the use of physical exercises as physical culture for healthy person, namely: the principles of comprehensive impact, application and health orientation. According to its content, therapeutic physical culture is an integral part of the Soviet system of physical education.

1. Therapeutic exercise for neuroses

neurosis is functional diseases nervous system, developing under the influence of prolonged overstrain of the nervous system, chronic intoxication, severe injury, prolonged illness, constant alcohol consumption, smoking, etc. A certain role in the occurrence of neuroses can be played by the constitutional predisposition and characteristics of the nervous system.

There are the following main forms of neurosis: neurasthenia, psychasthenia and hysteria.

Neurasthenia is based on "a weakening of the processes of internal inhibition and is clinically manifested by a combination of symptoms of increased excitability and exhaustion" (IP Pavlov). Neurasthenia is characterized by: fast fatiguability, increased irritability and excitability, bad dream, decreased memory and attention, headaches, dizziness, impaired activity of cardio-vascular system, frequent mood swings for no apparent reason, etc.

Psychasthenia occurs mainly in people of the mental type (according to I. P. Pavlov) and is characterized by processes of congestive excitation (foci of pathological congestion, the so-called sore points). Patients are overcome by painful thoughts, all kinds of fears (whether he closed the apartment, turned off the gas, fear of some kind of trouble, darkness, etc.). With psychasthenia, nervous states, depression, inactivity, autonomic disorders, excessive rationality, tearfulness, etc. are noted.

Hysteria is a functional disorder of the nervous system, accompanied by insufficiency of higher mental mechanisms and, as a result, a violation of the normal relationship between the first and second signal systems, with the former predominating. Hysteria is characterized by: increased emotional excitability, mannerisms, bouts of convulsive crying, seizures, desire to attract attention, speech and gait disorders, hysterical "paralysis".

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

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

2. General principles of the methodology of therapeutic physical culture

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

In all forms of neuroses it is necessary individual approach to the patient. The instructor must be authoritative, evoke positive emotions, exercise a psychotherapeutic effect on patients in the classroom, distract them from difficult thoughts, develop perseverance and activity.
Physical therapy classes are conducted individually and in groups. When forming groups, it is necessary to take into account gender, age, degree of physical fitness, functional state patients, comorbidities.

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

In the treatment of hysterical "paralysis" distracting tasks are used in changed conditions (in a different starting position). For example, with “paralysis”, the hands use exercises with a ball or several balls. It is imperative to draw the patient's attention to the involuntary inclusion of the "paralyzed" hand in the work.

As you master sick exercises with simple coordination, classes include exercises in balance (on a bench, beam), as well as climbing on gymnastic wall, various jumping, swimming. Walking, close tourism, fishing during this period also help to unload the nervous system from ordinary stimuli, strengthen the cardiovascular and respiratory systems.

The duration of classes in the first period is 10--15 minutes at the beginning, and 35--45 minutes as you adapt. If the patient tolerates the load of the 1st period well, then in the 2nd period, exercises are introduced into the classes that help improve attention, coordination, increase the speed and accuracy of movements, develop dexterity, speed of reaction. For training vestibular apparatus exercises are used eyes closed, with a sudden restructuring of movements on command during walking, running, circular movements of the head, torso tilts. Mobile and lightweight sports games, walking, short-range tourism, skiing, cycling, volleyball, tennis, etc. are widely used. The second period takes place mainly in sanatorium-and-spa treatment.

2.1 Neurasthenia

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

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

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

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

2.2 Psychasthenia

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

The tasks of therapeutic physical training are to "loosen" the pathological inertia of cortical processes and suppress the foci of pathological inertia by the mechanism of negative induction.

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

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

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

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

During classes, the methodologist should by all means contribute to increasing the contact of patients with themselves and with each other.
The task - to excite automatic reactions and raise the emotional tone of patients - is achieved by accelerating the pace of movements: from the slow pace characteristic of these patients of 60 movements per minute to 120, then from 70 to 130 and in subsequent classes from 80 to 140. exercises that contribute to some decrease in emotional tone. It is necessary that the patient leaves the therapeutic gymnastics hall in a good mood.

An approximate set of exercises for psychasthenia

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

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

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

4. I. p. - the main rack. Relax, take the position of "at ease".

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

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

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

8. I. p. - feet shoulder-width apart, hands in the castle, 1 - raise your hands above your head - inhale, 2 - sharply lower your hands between your legs with a cry of "ha". 4-5 times.

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

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

11. Resistance exercise in pairs:

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

b) standing facing each other, holding hands. Resting your knees on the knees of a friend, sit down, straightening your arms, then rise. 3-4 times.

12. Medicine Ball Exercises:

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

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

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

14. Exercises on shells:

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

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

c) climb the Swedish wall, grasp the upper rail with your hands, while hanging, take your legs away from the wall to the right and left, 2-3 times. Get down, holding hands and leaning on your feet.

15. I. p. - the main rack. 1--2 - rise on toes - inhale, 3--4 - go down on a full foot - exhale. 3--4 times

16. I. p. - the main stand. Alternately relax your arms, torso, legs.

17. I. p. - the main stand. Pulse count.

2.3 Hysteria

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

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

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

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

Differential braking is generated using simultaneously performed, but different tasks for the left and right hand, left and right leg. The inclusion of active-volitional acts is achieved by performing strength exercises on apparatus at a slow pace with a load on large muscle groups.

Conclusion

"If you want to live - know how to spin." Life in the modern world is like an endless race. The time in which we live is the time of the accelerated rhythm of life. Take a quick shower, eat a quick sausage, and run to work. At work, everyone also runs. Save time, time is money.

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

Physical exercise affects emotional sphere the patient, they evoke in him a feeling of cheerfulness, joy, distract him from various painful experiences, help eliminate uncertainty, anxiety, fear, various “neurotic” manifestations and create a more balanced state. To cheer up a sick person is half to cure him (S.I. Spasokukotsky). In addition, positive emotions that arise especially during the game method of conducting physical exercises excite the functional activity of the body and create favorable conditions for the rest of the nervous system from the monotonous physical and mental labor activity.

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

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

Bibliography

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

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

3. Kirpechenko A.A. "Nervous and mental diseases" - Textbook - MN .: Vyssh.shk., 1998 Electronic edition.

4. Kozlova L.V. "Fundamentals of Rehabilitation" - Rostov n\D: "Phoenix", 2003

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How to strengthen the nervous system. Exercise therapy for diseases of the central nervous system

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