Neuroses - therapeutic exercises for diseases of the nervous system. Therapeutic physical culture in diseases and injuries of the nervous system
Treatment and rehabilitation of patients with various diseases and injuries of the central and peripheral nervous system is one of the actual problems modern medicine, which requires an integrated approach using a wide range of medicinal products, including therapeutic physical culture. Diseases and injuries of the nervous system are manifested in the form of motor, sensory, coordination disorders and trophic disorders. In diseases of the nervous system, there may be the following disorders movements: paralysis, paresis, and hyperkinesis. Paralysis, or plegia, - complete prolapse muscle contraction, paresis - partial loss of motor function. Paralysis or paresis of one limb is called monoplegia or monoparesis, respectively, two limbs on one side of the body - hemiplegia or hemiparesis, three limbs - triplegia or triparesis, four limbs - tetraplegia or tetraparesis.
Paralysis and paresis are of two types: spastic and flaccid. Spastic paralysis is characterized by the absence of only voluntary movements, an increase in muscle tone and all tendon reflexes. It occurs when the cortex of the anterior central gyrus is damaged or pyramidal path. Flaccid paralysis is manifested by the absence of both voluntary and involuntary movements, tendon reflexes, low tone and muscle atrophy. Flaccid paralysis occurs when the peripheral nerves, roots of the spinal cord, or the gray matter of the spinal cord (anterior horns) are affected.
Hyperkinesias are called altered movements, devoid of physiological significance that arise involuntarily. These include convulsions, athetosis, trembling.
Seizures can be of two types: 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 - slow worm-like movements of the fingers, hand, torso, as a result of which it twists in a corkscrew shape when walking. Athetosis is observed when the subcortical nodes are affected.
Trembling - involuntary rhythmic vibrations of the limbs or head. It is observed with damage to the cerebellum and subcortical formations.
The lack of coordination is called ataxia. Distinguish between static ataxia - imbalance when standing and dynamic ataxia, manifested in impaired coordination of movements, disproportionate motor acts. Ataxia most often occurs with damage to the cerebellum and vestibular apparatus.
With a disease of the nervous system, sensitivity disorders often occur. There is a complete loss of sensitivity - anesthesia, a decrease in sensitivity - hyposthesia and an increase in sensitivity - hyperesthesia. with violations of superficial sensitivity, the patient does not distinguish between heat and cold, does not feel pricks; with a disorder of deep sensitivity, he loses an idea of the position of the limbs in space, as a result of which his movements become uncontrollable. Sensitivity disorders occur when peripheral nerves, roots, pathways and spinal cord, pathways and the parietal lobe of the cerebral cortex are damaged.
In many diseases of the nervous system, trophic disorders occur: the skin becomes dry, cracks easily appear on it, bedsores form, exciting and underlying tissues; bones become brittle. Especially severe bedsores occur when the spinal cord is damaged.
Mechanisms of the therapeutic effect of physical exercises
The mechanisms of the therapeutic effect of physical exercises in traumatic injuries and diseases of the peripheral nerves are diverse. The use of various forms of therapeutic physical culture: morning hygienic gymnastics, therapeutic exercises, gymnastics in the water, walks, some sports exercises and sports games - helps to restore nerve conduction, lost movements and the development of compensatory motor skills, stimulates regeneration processes, improves trophism, prevents complications (contractures and deformities), improves the mental state of the patient, has a general health-improving and restorative effect on the body.
General Basics methods of therapeutic physical culture
Therapeutic Physical Culture with lesions of peripheral nerves, it is carried out according to three established periods.
I period - the period of acute and subacute condition - lasts 30-45 days from the moment of injury. The tasks of therapeutic physical culture in this period: 1) removing the patient from serious condition, increased mental tone, general strengthening effect on the body; 2) improvement of lymph and blood circulation, metabolism and trophism in the affected area, resorption of the inflammatory process, prevention of adhesion formation, formation of a soft, elastic scar (in case of nerve injury); 3) strengthening of peripheral muscles, ligamentous apparatus, fight against muscle atrophy, prevention of contractures, vicious positions and deformities; 4) sending impulses to restore lost movements; 5) improving the functioning of the respiratory system, blood circulation, excretion and metabolism in the body.
Classes of therapeutic physical culture in the I period are held 1-2 times a day with an instructor and 6-8 times a day on their own (a set of exercises is selected individually). Duration of classes with an instructor - 20-30 minutes, self-study - 10-20 minutes.
II period begins from the 30-45th day and lasts 6-8 months from the moment of injury or damage to the peripheral nerve. The tasks of therapeutic physical culture in this period are: 1) strengthening the paretic muscles and ligamentous apparatus, combating atrophy and flabbiness of the muscles of the affected area, as well as training the muscles of the entire limb; 2) restoration of full volume, coordination, dexterity, speed of performing active movements in the affected area, and if it is impossible, the maximum development of compensatory motor skills; 3) prevention of the development of the vicious position of the affected area and related related disorders in the body (violations of posture, gait, torticollis, etc.).
Classes of therapeutic physical culture in the II period are held 1-2 times a day with an instructor and 4-6 times on their own (individual complex). The duration of classes with an instructor is 40-60 minutes, self-study - 25-30 minutes.
III period - training - the period of the final restoration of all functions of the affected area and the body as a whole. It lasts up to 12-15 months from the moment of injury. The tasks of therapeutic physical culture of this period are: 1) the final restoration of all motor functions of the affected area and the body as a whole; 2) training of highly differentiated movements in complex coordination, speed, strength, agility, endurance; 3) restoration of complex labor processes and general working capacity.
Therapeutic physical culture classes are held in the III period once with an instructor and 4-5 times on their own (a set of exercises prescribed by a doctor or an instructor of therapeutic physical culture is performed). The duration of classes with an instructor is 60-90 minutes, self-study - 50-60 minutes.
Therapeutic gymnastics in water is carried out in all periods of treatment. Water temperature 36-37°. In case of damage to the peripheral nerves of the upper limb, the duration of the lesson in
I period - 8-10 minutes, in II - 15 minutes, in III - 20 minutes. To generate impulses for active movements in the paretic muscles, all kinds of finger movements are performed in a friendly manner with both hands (breeding, bending, matching all fingers with the first finger, “claws”, clicks, etc.), grasping large rubber and plastic objects with fingers: ball, sponge, and etc.; all kinds of exercises for the wrist joint, including pronation and supination. By the end of period I and in period II active exercise with a paretic hand are supplemented, directed by a healthy hand of the patient. In the III period, exercises are performed in the water to develop the grip (for example, with a paretic hand to hold and try to hold a towel, and with a healthy hand to tear it out, etc.), to capture small objects and hold them, that is, to overcome resistance. With damage to the peripheral nerves of the lower limb, the duration of the lesson in the I period is 10 minutes, in the II - 15 minutes, in the III - 25 minutes. If possible, it is desirable to perform physical exercises in the pool. In the I period is given great attention sending impulses to develop active movements in the paretic muscles in combination with friendly movements of the healthy leg, as well as with the help of the patient's hands. Exercises are performed in the bath or in the pool in the initial position of sitting, standing and walking. Exercises for the fingers and ankle joint are carried out on weight, relying on the heel and on the entire foot. A lot of time is devoted to movements in the ankle joint in all directions. In the II and III periods, these movements are supplemented by exercises with objects, on the ball (rolling the ball, circular motions), on a gymnastic stick, in fins, in different ways of walking (on the entire foot, on toes, on the heels, on the outer and inner edges of the foot), with a rubber bandage (it is held by the patient or the methodologist), swimming with the participation of the legs. During surgical interventions, therapeutic physical culture in water is prescribed after the removal of sutures.
With any damage to the peripheral nerves, active movements (especially at their first manifestations) are performed in the minimum dosage: 1-2 times in the I period, 2-4 times in the II and 4-6 times in the III. If the muscle is overstressed, it will lose the ability to actively contract for several days, and the recovery of active movements will be slow. Therefore, active movements are performed in such a dosage, but repeated several times during the session.
In case of any damage to the peripheral nerves, to prevent contractures, vicious positions and deformities, a fixing bandage is necessarily applied, which is removed during classes. The instructor of therapeutic physical culture at each lesson passively works out all the joints of the paretic limb in all possible directions.
If, with damage to the peripheral nerves of the lower limb, drooping of the foot is noted, much attention is paid to teaching the patient the correct support on the leg and walking. The hanging foot must be fixed with elastic traction to ordinary shoes or a special orthopedic boot (Fig. 46). Before teaching a patient to walk, it is necessary to teach him to stand correctly, leaning on a sore leg, using an additional point of support: the back of a chair, crutches, a stick; then teach walking on the spot, walking with two crutches or sticks, with one stick, and only then without support.
Treatment of lesions of peripheral nerves is carried out in a hospital, on an outpatient basis, in sanatoriums, resorts and is complex. At all stages, the complex of medical procedures includes therapeutic physical culture, massage, electrical stimulation of paretic muscles, therapeutic exercises in water, physiotherapy and drug therapy.
abstract
List of keywords: neurosis, therapeutic physical culture, neurasthenia, hysteria, psychasthenia, physical exercises, dosage, mode, individual and group lessons, 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 the use of 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 illness (neurosis) is one of the urgent problems of modern medicine.
This problem is quite well covered in the scientific and methodological works of many authors.
A significant contribution to the development of this issue was 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 the scientific and methodological literature on this issue.
After analyzing this information, the following main questions were identified: concepts of neuroses; indications, contraindications and the mechanism of action of exercise therapy in neurosis, features of the exercise therapy technique in various forms of neurosis; the use of other PR methods in the treatment of neuroses; prevention of neurosis by methods of exercise therapy.
When developing these questions, it was possible to find out that correctly 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 a course project, I found out that there is a close connection between physical therapy, used in neuroses, with psychology and pedagogy.
When collecting information for work, I managed to find out that the use of exercise therapy is often more justified therapeutically 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 an overstrain of nervous processes (excitation and inhibition) or a change 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 cumulative action of hazards of both mental and somatic origin and the undoubted influence of environmental conditions. In the occurrence of neuroses, the constitutional predisposition on the basis of the congenital weakness of the nervous system matters.
For the development of neuroses, overwork, overstrain of nervous activity is essential.
The pathophysiological basis of neurosis is: a) disruption of the processes of excitation and inhibition, b) disruption of the relationship between the cortex and subcortex, c) disruption of the normal correlation of signal systems.
Neuroses usually arise on the basis of affects, negative emotions, experiences associated with a number of social, domestic and family relationships. Neuroses can also develop a second time, against the background of previous diseases, injuries. They often lead to a decrease in working capacity, and in some cases to its loss.
What happens in the nervous system in this case?
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. In this case, even weak stimuli become superstrong for nerve cells. Nervous processes become inert, inactive. As a result, the foci of the inhibitory or irritable process remain in the cortex for a long time, dominating the entire activity of the organism. 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, subcortical formations. There is a disintegration of the function of the non-specific system of the brain, which leads to a violation of the adaptive (adaptive) abilities of a person and, accordingly, the appearance of vegetative-endocrine and other disorders. Often suffers from the activity of the heart, blood vessels, gastrointestinal tract. The patient is concerned about the heartbeat, interruptions in the work of the heart. Your blood pressure becomes unstable. Appetite is disturbed, heartburn, nausea, unstable stools, etc. appear. Due to the weakening of cortical processes and their mobility in patients, the change from the irritable process to the inhibitory one occurs very slowly. As a result, at the same time, the cells of the cortex can be either in a state of inhibition, or on the verge of transition from one state to another, or in a state of excitation. Such a phase state of the 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 greater, the stronger the stimulus was, 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 GND disorders observed in neuroses manifest themselves differently depending on the type of GND. In persons with an average type (without the predominance of one or another signal system), neurasthenia often develops; in persons of an artistic type (with a predominance of the first signal system in the GNI) - hysteria; in the mental type (with a predominance of the second signal system) - psychasthenia.
Neurosis most often occurs in persons with a weak type of nervous processes. Of course, they can also occur and develop in people with strong manifestation nervous processes and predominantly unbalanced (cholerics), in which the processes of excitation prevail over the processes of inhibition. Less often, neuroses are observed in individuals with a strong and balanced type of GNI.
Such people become ill if the irritant is too strong or their nervous system has been weakened by some serious illness or severe overwork.
It has been proven that even a very severe illness cannot cause changes characteristic of a neurosis, but can make the nervous system more vulnerable. Especially often such violations occur with a disease of the endocrine glands.
Depending on the excitatory and inhibitory processes, the following types of neuroses are distinguished: neurasthenia, hysteria, psychasthenia. pure views 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 tension in the strength or duration of the nervous system, which exceeds 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 regime of work and rest, fatigue, under-recovery of the body from day to day, long, unpleasant nature. emotional stress. Of particular importance are constant lack of sleep, intoxication, the transfer of such chronic infections as tuberculosis, chronic purulent inflammation, etc.
Neurasthenia develops gradually. It is characterized, on the one hand, by increased excitability, and, on the other hand, by increased exhaustibility of nervous processes.
Increased excitability of the nervous system is manifested in great irritability, inadequate emotional reactions to minor influences. In the neurological status of patients, there is an increase in tendon and skin reflexes with the expansion of zones. Severe vegetative disorders are observed (excessive sweating, lability of dermographic reactions, sharply positive ortho-clinostatic tests). Patients with neurasthenia cannot stand sharp sounds, strong odors, bright light, and are extremely sensitive to pain and temperature stimuli. There is also an 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.
With increased excitability in neurasthenia, the rapid exhaustion of nervous processes is combined, which is manifested by difficulty in concentrating attention, weakening of memory, decreased performance, and impatience. With neurasthenia, as a rule, the state of health worsens, appetite and sleep are upset. The patient has anxious attention to his condition, lack of confidence in his abilities, he loses interest in life; suspiciousness, obsessive states may occur.
The disease leaves an imprint on the appearance of the patient: his gait is relaxed or impetuous, his expression is sadly concentrated, his body position is hunched over.
Pathophysiological basis of neurasthenia.
Neurasthenic symptoms are due to the 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 internal inhibition is disturbed (weakened) during neurasthenia, it is understandable why sleep during neurasthenia acquires a superficial character. This, in turn, leads to the fact that the performance of nerve cells is not fully restored, hence the patients feel tired very soon during work.
Violation of attention is explained by the weakening of the processes of inhibition. When a person starts to perform some business, 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 also insufficient. This leads to the fact that the conditions for the emergence of new foci of excitation are preserved. Therefore, every slight noise begins to distract the patient from the main occupation.
During neurasthenia, two stages are distinguished:
) hypersthenic,
) hyposthenic.
Hypersthenia is characterized by a weakening of the processes of inhibition and the predominance of excitation processes. This stage of neurasthenia is the most common.
Hypersthenia is characterized by the relative preservation of the adaptation of patients to physical activity. Violations in the emotional sphere are expressed in irritability, incontinence, anxiety, in emotional lability. Due to increased excitability, patients have poor self-control and often conflict with others. Their sleep is disturbed - they fall asleep badly and often wake up, they often complain of headaches.
This category of patients has a number of vegetative-dystonic phenomena, with cardio- vascular system(pain in the heart, tachycardia, increased blood pressure, etc.). Persistent red dermographism, increased excitability of vasomotors, and increased sweating are usually noted. Various vegetative asymmetries are often observed (data from oscillography, capillaroscopy, skin temperature, etc.), especially on the part of blood pressure.
Hypostenia is characterized by the development of diffuse inhibition. The phenomena of asthenia, weakness, and a pronounced decrease in adaptation to physical exertion come to the fore. Patients seem to have lost their stamina and faith in their own strength. A sharp decrease in working capacity is characteristic, which is associated with increased fatigue, both mental and physical. Emotional reactions are pale. Patients are usually lethargic, slow, seek solitude.
Their memory is reduced for both distant and recent events. They constantly experience a feeling of oppression, anxiety, expectation of unpleasant events, they do not trust doctors, they are reluctant to answer questions, they are highly suspicious, impressionable, they listen to painful sensations, overestimate the severity of their condition and, therefore, often require various repeated examinations.
Patients complain (more pronounced) of cardiovascular events. Almost as a rule, they have arterial hypotension, a decrease in vascular lability; they complain of pain and dysfunction of the heart, heaviness in the head, dizziness, unsteady gait, etc. Strengthening of inhibitory functions in the cerebral cortex also extends to the subcortical vegetative centers, causing a decrease in their function.
The prognosis for neurasthenia is favorable. The disease is curable. The cure comes the faster, the sooner the causes that caused the disease are eliminated.
All violations of the functions of the 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 occur in the future.
Hysteria affects both men and women equally. The disease most easily occurs in people with a weak nervous system.
Usually the cause of the development of the disease is a traumatic situation. They matter and internal factors associated with constitutional predisposition, with a number of somatic disorders. Hysteria can be the result of improper upbringing, conflicts with the team, etc.
Hysteria 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, which leads to their dissociation and a tendency to diffuse inhibition of the cortex, including primarily the second cortical signaling system, and to positive induction to the subcortical area.
In hysteria, the emotional life of the patient prevails over the rational.
Hysteria is manifested by motor and sensory disorders, as well as disorders of autonomic functions that mimic somatic and neurological diseases.
The variety of symptoms that are observed in hysteria is due to increased suggestibility and self-suggestibility, the patient's ideas about various diseases.
Major Symptoms hysteria is divided into four groups: hysterical seizure, disorder of consciousness in hysteria, somatic disorders and character traits.
Hysterical fit. The onset of a hysterical seizure is more often dependent 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. With a hysterical fit, 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 the patient has. Consciousness in this case is never completely obscured, one can only speak of a narrowing of the field of consciousness. Therefore, the reaction of patients to the external environment to a certain extent is preserved.
The duration of a hysterical seizure can be from several minutes to several hours. The seizure is always longer if there are people around the patient. Hysterical seizures, as a rule, are more often noted during the day and much less frequently at night. Patients usually do not receive severe injuries.
Disorder of consciousness in hysteria. For hysteria, a twilight state of consciousness is typical. At this time, patients perceive the environment from a certain angle. Everything that happens around is evaluated by patients not as it really is, but in connection with ideas about previous experiences. If the patient imagines that he is in the theater, then he takes all the people around him for spectators or actors, all the surrounding objects - for those that you usually have to meet in the theater. The duration of this state can be calculated in minutes or many hours.
The state of puerilism belongs to hysterical disorders of consciousness. It seems to the patient that he is a small child: an adult begins to play with dolls or jump on a stick. In the manner of speaking, in behavior, patients imitate small children.
The same group of disorders of consciousness includes a picture of pseudodementia (false dementia). Such patients give ridiculous answers to the simplest questions. At the same time, the simpler the question, the more often you can get a ridiculous answer. The facial expression seems to be deliberately stupid: the patients goggle their eyes, intensely wrinkle their foreheads. If with puerilism the patient imagines himself a child, then with pseudodementia he is mentally ill.
Disorders of consciousness such as puerilism and pseudodementia last for weeks, months. somatic disorders. In the area of the somatic sphere, there are various disorders of hysterical origin. The nature of these disorders is associated with the ideas of patients: as the patient imagines this or that somatic or nervous disease, so will its manifestations.
With hysteria, motor and sensory disorders are common. Of the motor disorders, paresis and paralysis (monoplegia, paraplegia, hemiplegia), hyperkinesis are observed. In hysterical paralysis, muscle tone is unchanged, tendon reflexes are not disturbed, there are no pathological reflexes, and there is no atrophy. In other words, in the clinical picture of paralysis there are no signs of an organic lesion of the central or peripheral nervous system. A peculiar movement disorder in hysteria is the so-called astasia - abasia, the essence of which is that the patient cannot stand and walk while maintaining all movements and coordination in the legs during examination in bed. Hyperkinesias in hysteria are of a diverse nature: trembling of the hands, feet, and the whole body.
For a sensitivity disorder (more often anesthesia), it is characteristic that the boundaries of the distribution of sensitivity disorders are not associated with the anatomical location of sensitive conductors. For example, with hysterical hemianesthesia, the border of the sensitivity disorder runs strictly along the midline, with anesthesia in the hands, the sensitivity is violated by the type of “gloves in the legs - in the type of “socks”, “stockings”.
In addition, hysterical speech disorders are observed: mutism (dumbness), stuttering, aphonia (silence of the voice) or deaf-muteness (surdomutism). There is hysterical blindness (amaurosis), blepharospasm.
Hysterical temperament. There is increased emotionality. The behavior of patients is closely dependent on their emotional sphere. Their emotions have a significant influence on the flow of ideas.
Character traits include their tendency to fantasize, to lie. When they tell non-existent stories, they are sometimes so carried away that they themselves begin to believe in their plausibility. By any means, 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 toilets that draw 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 functions of the gastrointestinal tract (vomiting, intestinal paresis, hiccups), urination, sexual disorders.
Such patients are highly emotional, passionately experience grief and joy, easily move from laughter to sobs and vice versa. For the most insignificant reasons, their mood fluctuates dramatically. Patients are characterized by a tendency to fantasize, to exaggerate, unconscious deceit.
The behavior of patients is characterized by theatricality, mannerisms, devoid of naturalness. Patients are egocentric, their attention is entirely concentrated on their experiences, they seek to arouse sympathy from others. Very typical of hysteria flight into sickness . Violations take on a character conditional pleasantness or desirability . These phenomena can become protracted. All these disorders have their own physiological basis. Schematically, this can be represented as follows: in the cerebral cortex or subcortical formations, foci of excitatory or inhibitory processes appear, which, according to the law of induction, are surrounded by a process opposite in sign, as a result of which they become decisive for a particular function. Paralysis, for example, is a consequence of the transition of a group of cells into a state of inhibition. Hysterical neurosis often occurs in mild forms. Signs of the disease are limited to a hysterical temperament and excessive manifestations of the reactivity of patients - a tendency to hysterical crying in traumatic circumstances, 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, a 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 congestive excitation processes in the cerebral cortex. With psychasthenia, there is inertia of cortical processes, their low mobility. Psychasthenia is manifested by anxious suspiciousness, inactivity, focus on one's personality, on experiences. The pathophysiological basis of psychasthenia is the pathological predominance of the second cortical signaling system over the first, the presence of foci of congestive excitation in it, the inertia of cortical processes, the pathological detachment of the second signaling system from the first and through it from the subcortex. The observed obsessive states are a reflection of the excessive inertness of the foci of excitation, and the obsessive fears are a reflection of inert inhibition. Patients are closed, their emotional mobility is lowered. In patients, increased rationality comes to the fore, an extreme poverty of instincts and drives is noted. The patient often experiences painful doubts and hesitations, does not believe in his own strength, he is overwhelmed by endless reasoning, with which he replaces quick and decisive actions. Psychasthenics are characterized by a lack of a sense of the real, a constant feeling of the incompleteness of life, complete worthlessness of life, along with constant fruitless and distorted reasoning in the form of obsessions and phobias. Compulsion is characteristic, manifested in three forms: obsessions, obsessive movements, obsessive emotions. A distinctive feature of these states is that they arise, as it were, in addition to the desire of the patient, who, realizing the absurdity of these states, is, however, 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 compulsive actions we are talking about violent counting, the desire to touch all the windows that the patient passes by, etc. Patients tend to decrease attention. Gradually, self-doubt and difficulties in actions grow and manifest themselves in various unpleasant sensations: pain, muscle weakness, up to transient paresis of any muscle group causing stuttering, writing spasm, urination disorders, etc. Often there may be functional disorders of the cardiovascular system, manifested by tachycardia, extrasystole. All signs of psychasthenic neurosis appear in patients due to nervous overstrain and may disturb them for a long period. As a result of treatment, they are gradually eliminated, but due to the imbalance of the signaling systems and the weakness of the nervous processes, the new task that life will set for the patient may be unbearable for him, and disorders of higher nervous activity may begin again. If the disease develops in adulthood or old age, then it proceeds relatively easily and is 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, in connection with which the attitude of patients to the environment becomes more correct, their ability to work is restored, and they can take their appropriate place in society. 2. Exercise therapy for these diseases Physical exercises used in diseases of the nervous system have a versatile effect on the body through nervous and humoral mechanisms. neural 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 the disruption of higher nervous activity, strict coordination in the work of all organs and systems of the body weakens or is sharply violated. 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, there are persistent disorders of the cardiovascular and respiratory systems which favors the further progression of the disease. This implies the need for the use of physical exercises to influence the patient's body as a whole. Physical exercises contribute to the normalization of the relationship between various body systems. As a result of the restructuring of the relationship between individual systems, the efficiency 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 classes, the amount of circulating blood increases, the blood circulation of the brain increases, the outflow of lymph and venous blood improves, metabolism improves, the return of oxygen from the blood to tissues, muscles, and the heart increases, redox processes accelerate. Physical exercise correlates the activity of all systems, raises the tone of the body and contributes to the restoration of disturbed somatic functions in patients with neuroses. The action of physical exercises should be considered as the influence of an organized system of stimuli, acting mainly on the motor analyzer, increasing the tone, which in turn affects other parts of the brain. An increase in the tone of the cerebral cortex favorably affects the course of neurosis. In addition, physical exercises create a background for increasing the effectiveness of complex treatment. The systematic performance of physical exercises 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 reason to consider therapeutic physical culture as a method pathogenetic therapy neurotic patients. In addition, physical exercise increases the effectiveness of medicines and other therapeutic agents. In the process of treatment, the coordinating activity of the nervous system improves, the body's adaptation to the load increases. In the process of physical training, the processes of excitation and inhibition are balanced, which leads to an improvement in the state of many body systems and, in particular, the muscular apparatus. Redox processes in the tissues of the body proceed more perfectly. Physical exercises lead to the strengthening of muscular-visceral-cortical connections and contribute to a more coordinated functioning of the main body systems. This increases the activity of the body's defenses, its compensatory mechanisms and resistance to stress. Positive emotions increase muscle performance. An important role in increasing the tone of the nervous system is played by positive emotions that arise in the process of performing physical exercises. Positive emotions distract the patient from painful experiences, improve the activity of the heart, lungs and other internal organs. The emotional state is reflected in the behavior and motor acts of a person. . Physical exercises have a positive effect on the human psyche, strengthen his volitional qualities, emotional sphere increase organization. . When performing physical exercises, the interaction of mental, vegetative and kinesthetic factors is carried out. It is proved that the verbal influence on the patient in the process of classes can affect the function of internal organs, metabolism. With a certain methodology for conducting exercise therapy, it can be considered as one of the methods of active psychotherapy. Physical exercises have a general hygienic, restorative, tonic effect on the patient's body. They increase the tone of the central nervous system, contribute to the normalization of autonomic functions, divert the patient's attention from his painful sensations. Physical exercise causes an increase in afferent impulses from the proprioreceptors of the musculoskeletal system in the central nervous system. Reaching the cerebral cortex, the impulses contribute to the alignment of the dynamics of the main nervous processes, the normalization of cortical-subcortical relationships, as well as the restoration of nervous trophism. Activation of various parts of the motor analyzer, including the motor neurons of the spinal cord, increases the biopotential of the muscles, their performance, normalizes muscle tone, which is especially important when weakening (paresis) or complete absence (paralysis) of voluntary movements. The active volitional participation of the patient in physical exercises contributes to the mobilization of the body's reserve capabilities, the improvement of conditioned reflex activity. The importance of exercise therapy is increasing due to the need for follow-up after discharge from the hospital for maintenance treatment in an out-of-hospital setting. Exercise therapy can and should be one of the means that support remission. exercise therapy is excellent remedy involvement of patients in labor processes (to destroy the fixation of a painful stereotype). For patients with neuroses, exercise therapy has pathogenetic significance. It was proved that afferent impulses cause a change in the excitability of the cerebral cortex in a differentiated way: short and intense physical stresses increase the excitability of the cortex, and prolonged muscle tension decreases it. Some exercises contribute to the stimulation of 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. Restoration of functions disturbed due to a pathological process by the method of physical exercises is a medical and educational system that provides for the conscious and active participation of the patient in the complex process of exercise. With neurosis, patients often experience depression of the psyche, lethargy. Under the influence of the conscious-volitional performance of physical exercises, psychogenic inhibition decreases 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 the conductive nerve pathways and peripheral receptors improves. Training, eliminating peripheral inhibition, as if pushes back the decline in performance. The neuromuscular apparatus becomes more stable. When performing physical exercises, various reflex connections (cortico-muscular, cortico-vascular, cortico-visceral, muscular-cortical) are enhanced, which contributes to a more coordinated functioning of the main body systems. Observations show that the effect of therapeutic exercises is expressed in an increase in the lability of the nervous system. Training leads to a decrease in the consumption of energy substances during the period of muscle activity, and redox processes improve. Under the influence of physical exercises, the content of hemoglobin and erythrocytes in the blood increases, the phagocytic function of the blood increases. With the systematic use of physical exercises, the muscles are strengthened, their power and efficiency increase. 1 Indications and contraindications Exercise therapy has wide indications for the so-called functional disorders nervous system (neurosis). The use of exercise therapy for neuroses is justified by the simultaneous effect of physical exercises on the mental sphere and on somatic processes. With the help of physical exercises, it is also possible to influence the regulation of the processes of excitation and inhibition in the cerebral cortex, the alignment of 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 prophylactic agent. In general medical practice There are almost no contraindications against the use of exercise therapy. Contraindications include neuroses accompanied by affective outbursts, seizures; excessive mental or physical fatigue, a state of mental 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 of nature to patients for a faster and more complete restoration of health, working capacity 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 background of a regulated regimen and in accordance with therapeutic tasks. The main factor of therapeutic physical culture acting on the patient's body is physical exercise, i.e. movements specially organized (gymnastic, sports-applied, game) and used as a non-specific stimulus for the purpose of treatment and rehabilitation of the patient. Physical exercises contribute to the restoration of not only physical, but also mental strength. A feature of the method of therapeutic physical culture is also its natural biological content, since in medicinal purposes one of the main functions inherent in every living thing is used body, function movement. Any complex of physical exercises includes the patient in active participation in healing process in contrast to other treatment methods, when the patient is usually passive and medical procedures are performed by medical personnel. Therapeutic physical culture is a method of non-specific therapy, and physical exercises serve as a non-specific stimulus. Neuro-humoral regulation of functions always determines general reaction organism during physical exercises, in connection with which 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 the main body systems, eventually lead to the development of the patient's functional adaptation. Therapeutic physical culture, especially in a neurological clinic, should be considered a method of pathogenetic therapy. Physical exercises, influencing the reactivity of the patient, 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 by physical exercises. The training of 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 muscular activity plays a huge role. The main means of therapeutic physical culture are physical exercises and natural factors of nature. Physical exercises are divided into: a) gymnastic; b) applied sports (walking, running, throwing balls, jumping, swimming, rowing, skiing, skating, etc.); c) games - sedentary, mobile and sports. Of the latter, croquet, bowling alley, gorodki, volleyball, badminton, tennis, basketball elements are used in the practice of therapeutic physical culture. With 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. The 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; ) according to the 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 applying: 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 the individualization of the exercise therapy methodology is the nature of the command and instruction. In some cases, depending on the task, instruction and command are accompanied by demonstration physical exercise, in others they are limited to only verbal instruction without showing. Physical therapy is used in various forms: 1)morning hygienic gymnastics; 2)recreational games and sports-applied exercises (volleyball, tennis, skiing, skating, etc.); )physiotherapy. The limits of the therapeutic possibilities of exercise therapy for neuroses are different. Morning hygienic gymnastics and sports and applied games in the complex of general events are mainly of general hygienic and health-improving significance. Sports-applied games can also be a good means of subsequent fixing and remission maintenance therapy. As for therapeutic gymnastics, long courses of specially selected sets of exercises are already pathogenetic; the effectiveness of therapeutic exercises is to improve both the somatic and mental state up to practical recovery. Therapeutic gymnastics is carried out according to the scheme adopted in exercise therapy. The scheme of the lesson of therapeutic gymnastics. 1.Introductory part (5-15% of the total time) Tasks: mastering the attention of patients, inclusion in the lesson, preparation for subsequent, more complex and difficult exercises. 2.Main part (70-80%) Tasks: overcoming the inertia of patients, excitation of automatic and emotional reactions, development of differential inhibition, activation of active-volitional acts, dispersal of attention to numerous objects, increase in emotional tone to the required degree, solution of the set medical problems. 3.Final part (5-15%). Tasks: the necessary reduction of general arousal and emotional tone. Gradual decrease in pace and physical activity. In some cases - physical rest. Methodically proper conduct therapeutic gymnastics procedures are possible only if the following principles are observed: The nature of the exercises, physiological load, dosage and starting positions should correspond to the general condition of the patient, his age characteristics and the state of fitness. All procedures of therapeutic gymnastics should affect the entire body of the patient. The procedures should combine general and special effects on the patient's body, so the procedure should include both general strengthening and special exercises. When drawing up the procedure, one should observe the principle of gradual and consistent increase and decrease in 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 the performance of physical exercises. When carrying out therapeutic exercises, attention should be paid to positive emotions that contribute to the establishment and consolidation of conditioned reflex connections. In the process treatment course it is necessary to partially update and complicate the exercises used daily. 10-15% of new exercises should be introduced into the procedure of therapeutic gymnastics in order to ensure the consolidation of motor skills and consistently diversify and complicate the methodology. The last 3-4 days of the course of treatment should be devoted to teaching patients the gymnastic exercises that are recommended for them for subsequent homework. The amount of methodological material in the procedure should correspond to the mode of movement of the patient. 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, in order to reduce physical activity, breathing exercises are introduced. When combining respiratory phases with movement, it is necessary that: a) inhalation correspond to the straightening of the body, spreading or raising the arms, the moment of less effort in this exercise; b) exhalation corresponded to the flexion of the body, the reduction or lowering of 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, as a rule, in tracksuits, comfortable pajamas or shorts and a T-shirt. Breaks in classes reduce efficiency. Carrying out therapeutic exercises requires patience and perseverance; it is necessary to systematically and persistently achieve positive results, to overcome the negativism of patients. At the first failures to involve the patient in occupations it is not necessary to refuse the further attempts; an important methodological technique in these cases will be only the presence of such a patient in the classes of other patients, to excite orienting and imitative reflexes. Classes should begin with simple and short sets of exercises, with a very gradual complication and an increase in their number. Fatigue of patients, which usually adversely affects the results, should be avoided. The duration of the classes varies depending on individual characteristics; they should be started, depending on the condition of the patients, from 5 minutes and brought up to 30-45 minutes. Classes should be accompanied by 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 organizing movement, training memory and attention, stimulating activity and initiative in some cases, restraint and orderliness of movements in others. Before and after the end of each lesson, it is necessary to take into account the general somatic condition of the patient, including the pulse rate, respiration rate and, if necessary, blood pressure. The stay of unauthorized persons in the classroom with sick 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. In the treatment of patients with neurosis one has to meet with a variety of clinical course, variability neuropsychiatric disorders, which makes it impossible to compile 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 to treatment. All this requires great ingenuity, pedagogical tact and patience from the teacher of physical therapy, which significantly expands the indications for the use of physical therapy. One of the objectives of treatment is to normalize the dynamics of the main nervous processes and autonomic functions. The second task is to strengthen the neuro-somatic state and increase the mental tone and efficiency of patients. The objectives of the first period of exercise therapy will be general health improvement and strengthening the patient, improving coordination of movements, distracting from thoughts about the disease, instilling the skill of correct posture, 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, 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 ever-increasing load, exercises are used for dexterity and speed of reaction, which educate the will and the ability to overcome obstacles. Coordination exercises become more difficult, jumps, jumps (overcoming fear of heights), running, jumping rope exercises are added. Exercises are used that cause a sharp inhibitory process ( sudden stop or a quick change in 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 initial sitting position, etc.; exercises with resistance, with weights, with shells and on shells. At the beginning of classes, simple exercises are used, performed at a calm pace, without tension, with the participation of small muscle groups. Such exercises normalize the activity of the cardiovascular and respiratory systems, streamline the movements of the patient. 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 complication of exercises: exercises with dosed tension, with weights, complex in coordination, requiring a quick switch of attention (throws the ball at a target with a change in direction) are introduced. With increased excitability of the patient, it is impossible to demand the exact fulfillment of the task at the beginning of classes, one should not fix his attention on mistakes and shortcomings in the performance of exercises. With a decrease in the patient's activity, lethargy, lethargy, self-doubt, it is necessary to demand the exact fulfillment of tasks, very gradually increasing their complexity; include mindfulness exercises. In the treatment of neurosis, the following forms of conducting 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, the emotional tone of the patient, functionality, and the nature of work. It is better if the first lessons are individual. This allows you to establish closer contacts with patients, identify his mood, reaction to the proposed exercises, select adequate physical exercises, take into account complaints, instill a number of skills necessary for group classes. After a period of familiarization with the patient, he should be transferred to a group for classes. Group classes for those suffering from neurosis are most useful, because. favorably affect the emotional tone of the patient, contribute to the rest of the overstrained nervous system. It is recommended to form mixed (according to the type of neurosis) groups, because at the same time, the influence of patients on each other will not be of the same type, reinforcing the existing painful manifestations. Group classes in this case should not be standard for everyone. It is necessary to take into account the individual characteristics of patients, which should be reflected in the methods of training, in the dosage of physical exercises, in the form of their implementation. The size of the group depends on many factors. But the main one is clinical indications. The general methodological setting is that in those cases when it is necessary to increase the activity of the patient, bring him out of the state of lethargy, overcome negativism, inertia, obsession, the group can be large, even up to 20 people, if active inhibition training is required, reduce excessive excitability of the patient, to overcome emotional excitability, the group should be small, no more than 5-6 people. There are also many peculiarities in the acquisition of groups. You also have to take into account clinical picture mental state, and with the somatic state of the patient; one has to keep in mind both the prescription of the disease, and the fact that some of the patients are already trained, and some are just starting classes, etc. The course of treatment in the group lasts up to two months. Group classes should be held at least 3 times a week, preferably with musical accompaniment, which always causes 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. Self-study is used when it is difficult for the patient to regularly visit medical institutions or when he has completed hospital treatment and is discharged for aftercare at home. While doing therapeutic exercises at home, the patient should periodically visit a doctor and a methodologist to control the correctness of the exercises and receive repeated instructions for further classes. Self-study increases the activity of patients and ensures the stability 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, home conditions. Patients in a state of overwork should build classes with the expectation of rest. In this case, breathing exercises are combined with physical exercises well known to the patient. The end of classes should be calm. Patients without overfatigue are offered unfamiliar physical exercises with weights, stuffed balls, complicated coordination of movements, and relay races. The selection of exercise therapy in the lesson of therapeutic exercises depends on the clinical manifestations of the disease, the somatic and neuropsychic state of the patient. In addition to gymnastic exercises, walks, close tourism, health paths, elements of sports and outdoor games (volleyball, towns, table tennis) and the widespread use of natural factors are recommended. Good therapeutic effect gives the inclusion of games in each lesson. Classes should be carried out, if possible, in the fresh air, which helps to strengthen the nervous system, improve metabolism in the body. During the classes, the methodologist should exercise psychotherapeutic influence, which is an important therapeutic factor, distract the patient from painful thoughts, cultivate perseverance and activity in him. The work 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 confidence of patients in their capabilities, to approve with the correct exercise. It is useful to conduct conversations with patients for their correct attitude to exercise therapy. switching the patient's attention to solving specific problems contributes to the normalization of the dynamics of nervous processes, the appearance of a desire to move. In the future, the patient's attention is directed to participation in labor activity, the development of a correct assessment of his condition. In addition to various exercises, patients with neurosis are recommended hardening procedures - sun therapy, air baths, water procedures. The regulation of the regime is important: the alternation of sleep and wakefulness, physical exercises and passive rest in the air or walks. In the complex treatment of neurosis, they also use: 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. In neuroses shown Spa treatment in local sanatoriums using all means complex therapy, as well as treatment at 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, and on the other, by increased exhaustion, which is a manifestation of the weakness of active inhibition and the disorder of the excitatory process. These patients are easily injured, often fall into a depressed state. When prescribing exercise therapy, first of all, it is necessary to find out the causes of the appearance of neurasthenia, tk. without removing these causes, the 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 the functions of blood circulation and respiration, restores the correct vascular reflexes, and improves the activity 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 regulation of the excitatory process. The means and methods of therapeutic exercises for this group of patients should take into account all these features. First of all, based on the increased fatigue of patients, the lack of a feeling of cheerfulness in freshness, especially after sleep and in the first half of the day, therapeutic exercises, in addition to the mandatory morning, hygienic gymnastics, 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 start classes for several days with a general 10-minute massage, passive movements lying in bed or sitting. The duration of the lessons is no more than 10 minutes. It is recommended to include repeated breathing exercises. In view of the abundance of somatovegetative disorders and complaints, preliminary psychotherapeutic preparation and removal of very frequent cases of iatrogeny are required; in the process of classes, the methodologist should be prepared to ensure that, without fixing the patient's attention on various painful sensations(for example, palpitations, shortness of breath, dizziness), regulate the load so that the patient does not get tired, so that he can stop exercising for a while and fail without any hesitation. There is no need to demand the accuracy of the exercises, but gradually the patient needs to be more and more involved in classes, more and more to increase interest in them, diversify the exercises, introduce new means and forms of exercises. In some cases, especially at the beginning of the application of therapeutic exercises, the reaction to the load may be increased, and therefore it should be strictly commensurate with the adaptive capabilities of patients. It should also be taken into account that it is difficult for patients to focus attention - it quickly weakens. Patients do not believe in themselves, in connection with which they shy away from 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 unbearable exercises to the sick. It is necessary to complicate them gradually, to explain and show very well. At the beginning of classes, patients may be absent-minded, disinterested. Therefore, the methodologist should, first of all, educate them in a positive attitude towards physical exercises. It is necessary to develop a training methodology in advance and conduct it purposefully, in a relaxed manner. Lessons can be done both individually and in groups. When the patient is overtired, individual sessions are held to establish close contact with him, to identify his individual reactivity and to select adequate physical exercises. Such patients are recommended to self-study 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 for conducting 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, and stimulating, exciting. When selecting musical melodies, the tempo of the musical accompaniment of classes, it is recommended that music be soothing, of moderate and slow tempo, combining both major and minor sounds. You should choose simple melodic music, you can use beautiful treatments folk songs. The scheme of lessons of therapeutic gymnastics for patients with neurasthenia. Introductory part. Introduction to the lesson. A gradual increase in difficulty and the number of exercises, a 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 at first is relatively small 15-20 minutes, but then it is gradually increased and brought up to 30-40 minutes. The exercises are very simple at first, not requiring any physical effort. Gradually, starting from the 5th-7th lesson, elements of the game are introduced into the lesson, especially ball games, and in winter also skiing. The introductory part lasts 5-7 minutes. In the future, its duration does not increase; total duration The lesson is lengthened only at the expense of the main part. The lesson begins with walking in a circle, at first at a slow pace, then the pace accelerates somewhat. Walking continues for 1 minute. Free movements: hands from 4 to 10 times, body - 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, is gradually changing both towards complication and towards longer duration. The first 5-7 lessons include exercises with gymnastic sticks, each 4-12 times, on the gymnastic bench - from 2 to 8 times. In summer, ball games are included, especially rounders, and in winter - skiing. The duration of the ball game should not exceed 10-15 minutes. Walking on skis should not exceed 30 minutes, the distance should not exceed 2-3 km, the pace of walking should be walking, 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 gently sloping. In the final part of the lesson, you need to gradually reduce the number of movements of those involved, make them slower. Breathing exercises are applied (from 4 to 8 times). After the lesson, you should carefully inquire about the well-being of patients, and during the course of therapeutic physical culture, periodically find out the state of sleep, appetite, emotional balance, and if some indicators worsen, find out if they are associated with an overdose of therapeutic exercises. It is recommended to use exercises with alternate muscle contraction and relaxation, breathing exercises, exercises for the upper and lower extremities should be performed at an average pace, with a small amplitude. In the future, swing exercises for the limbs, exercises that require some tension, exercises with overcoming resistance are added. Hand exercises should be combined with exercises for the body; exercises that require speed and significant muscle tension - with breathing exercises. In the main part of the lesson, various exercises with the ball in a playful way should be introduced - the ball in a circle with various methods of throwing, relay games with the transfer of balls and other objects, relay race combinations with jogging, with various tasks (jumping over a gymnastic bench, climbing over an obstacle). These exercises should be alternated with relaxation exercises and breathing exercises. During the entire course of treatment, the most serious attention should be paid to the emotional side of the classes. The instructor's command should be calm, demanding, accompanied by short and clear explanations, should encourage the manifestation of cheerfulness. Have a good mood in the course of lessons. In addition to outdoor games, it is recommended to use various sports games: croquet, skittles, towns, volleyball, tennis. Depending on the condition of the patient, his fitness, the individuality of reactions (pulse, fatigue, excitability, behavior in a team), games such as volleyball and tennis should be dosed, allowing a game with a time limit (from 15 minutes to 1 hour), short pauses should be introduced and breathing exercises, simplified rules of the game. Of the sports-applied exercises that help overcome feelings of insecurity, fear and other neurotic reactions in patients, it is recommended to use exercises in balance on a narrow and elevated support area (bench, log, etc.), climbing, jumping, jumping, and jumping into water with gradual complication, swimming, exercises in throwing balls, etc. It should be emphasized the special benefits of skiing in winter period and regular walking and short-range tourism in summer, spring and autumn. They have a training effect on the circulatory system, respiration and increase the functional adaptability of the patient's body to various physical loads. Skiing educates 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 muscular activity in the frosty air increases the overall tone and creates a cheerful mood. The beauty of changing landscapes, especially in sunny weather, and silence evoke joyful emotions in patients, contributing to the unloading of the nervous system from the usual type of professional activity. In summer, autumn and spring, regular dosed walks in the air at various times of the day, depending on the patient's work regime, acquire great therapeutic and prophylactic significance. Of particular benefit are walks outside the city, which have a positive effect on the neuropsychic sphere, distracting the patient from "going into the disease." For these patients, strict regulation of the regimen is useful, especially the alternation of sleep and wakefulness, as well as the alternation active forms Exercise therapy with passive outdoor recreation. Depending on the interests of the patient, it is also possible to recommend fishing and hunting, which cause joyful emotions and actively influence the restructuring of the neuropsychic sphere. With the hyposthenic form of neurasthenia, the training methodology is somewhat different; the main goal of using therapeutic exercises in this variant of neurasthenia is the careful training of the excitatory process, and only then - the strengthening of active inhibition. Even in cases where patients themselves begin to participate too actively in therapeutic physical culture, such excesses must be limited in a timely manner, since an overdose during hyposthenia can significantly worsen the condition of patients. Therapeutic physical culture in the hyposthenic form of neurasthenia is also shown to improve somatic indicators. Most patients, due to severe exhaustion, spend most of the day in bed or sitting. Therefore, they easily experience detraining phenomena, when even getting out of bed causes a significant increase in heart rate, shortness of breath. The first 5-7 days of exercise should be carried out in the ward, without bringing patients into the hall, and some should first be advised to practice while sitting in bed. The duration of the lesson is 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 fact, exhausts the entire lesson plan. 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, small steps. As with the hypersthenic variant, with hyposthenia, the duration of the introductory part of the lesson does not exceed 5-7 minutes. The main part of the lesson joins the introductory only starting from the 2nd week of the lesson. The duration of the main part in the 2nd week is 5-7 minutes, then it is gradually lengthened to 12-15 minutes. In this part, simple exercises are performed with a volleyball (7-12 times), gymnastic sticks (6-12 times). throwing a basketball into a basket). When prescribing therapeutic physical culture to such patients (with severe asthenia and a sharp violation of adaptation to physical exertion), it is necessary to further limit physical activity, that is, to prescribe the most lightweight, simple exercises in construction. During the procedure, pauses for rest are included, exercises are introduced in light initial positions (lying and sitting), for the purpose of general toning, exercises of a corrective nature and with dosed tension, which alternate with breathing exercises, are included. Exercises are also used to develop the function of the vestibular apparatus. Classes are conducted individually or in small groups. The task of therapeutic physical culture in relation to this group of patients is to achieve a decrease in emotive lability through targeted physical exercises, to 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 requirement for the accuracy of performing 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. The scheme for constructing lessons in therapeutic gymnastics in 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. The duration of the lesson is 45 minutes. Methodology. In order to avoid induction by emotive patients, the group should not include more than 10 people. The command is given slowly, smoothly, conversational type. Calm, but strict demands on the accuracy of the exercises. All errors are noted and corrected. The demand for accuracy should be gradually increased. 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 - 140 movements per minute and reduce it to 80, subsequent lessons start at 130 and slow down to 70, then from 120 to 60 per minute. Differential inhibition is developed 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, gymnastic combinations. You can use mindfulness exercises. In addition to gymnastic exercises, exercises in balance, jumping, throwing, some games (relay races, towns, volleyball) are recommended. In conclusion, the patients perform exercises lying on a rug or on a folding bed (their goal is to reduce their emotional tone as much as possible), and, finally, a complete physical rest is given 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 according to this method should know that this method for emotionally labile patients is difficult, difficult to perform, as it requires the mobilization of active attention and concentration. Therefore, its success is achieved slowly, not immediately. Impatient, excitable and explosive patients may have “breakdowns”, up to a complete refusal to exercise. It is necessary to persevere and firmly strive to continue the studies. To facilitate the fulfillment of the assigned tasks, it is necessary to interest the patients, the first time classes can be accompanied by music. However, music should also be selected such that would help concentration of 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 in accordance with the task facing the methodologist. An important element is the performance of memory exercises, without a command. At first, it can be recommended to combine this or that exercise with certain music so that the music later becomes a conditional signal to perform the exercise; by increasing the number of melodies and combining them with certain exercises, one can achieve a significant increase in attention. However, the task is that in the end the patient performs the exercises without a command and without music accompaniment; this greatly trains attention, memory, promotes orderliness of motor skills, a decrease in emotional lability, and excessive haste. Especially good effect is achieved when patients consciously seek to perform versatile 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 zone of the motor analyzer, inhibition of certain sections of it, weakness of the irritant process in the second signal system. Therapeutic measures should be aimed at eliminating these changes. The use of exercise therapy for hysterical paralysis has a positive effect on the patient's emotional state, helps to eliminate uncertainty in recovery, and involves the patient in a conscious and active fight against the disease. Passive movements of the paretic limbs cause a flow of impulses to the motor analyzer and bring it out of the state of inhibition. Active movements in healthy limbs also affect. Therapeutic exercises for hysterical paralysis should be combined with the impact on the patient through the second signal system, with his persistent conviction of the need to perform movements. It is very important to get the patient to help the methodologist in performing passive movements in the paralyzed limbs, and then try to independently reproduce the movements. The patient must be convinced of the preservation of his function of movement and the absence of paralysis. Recommended group classes in therapeutic exercises, rhythmic exercises with a change in pace. In classes, strong emotional stimuli should be avoided, but it is important to use games that require the concentration of attention of intensive work of muscles that are 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, depressed. Capabilities therapeutic action physical exercises for psychasthenia are very diverse and effective. The main mechanism of the impact of physical exercises is to “loosen” the pathological inertia of cortical processes, to suppress the foci of pathological inertia by the mechanism of negative induction. The implementation of these tasks corresponds to physical exercises that are emotionally saturated, fast in pace, performed automatically. The music accompanying the classes should be cheerful, from slow and moderate tempos, as well as movements, should move to faster ones up to “allegro”. It is very good to start classes with marches and marching songs (Dunaevsky's march from the movie "Circus"). Most often and most of all, it is necessary to introduce game exercises, short relay races, elements of competitions into the complex of physical exercises. In the future, to overcome the feeling of low value and low self-esteem, shyness, so characteristic of psychasthenic people, it is recommended to introduce exercises to overcome obstacles, to balance, and strength exercises. When forming a group for classes, it is advisable to include in the group several recovering patients with good emotionality, with 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 awkwardness. They tend to be unable to dance, avoid and dislike dancing. In the presence of obsessive phenomena, fears, the appropriate psychotherapeutic preparation of the patient is of great importance, explaining the importance of overcoming feelings unreasonable fear performing exercises. Thus, a feature of the therapeutic physical culture of this group is its combination with psychotherapy and music. These three factors, in a complex complement each other, give a good effect. Scheme of building classes for patients with psychasthenia. Introductory part. Introduction to the lesson. Excitation of automatic in emotional reactions. Main part. Dispersion of attention to numerous objects and acceleration of automatic reactions. Increase emotional tone to the maximum. Z. Final part. Incomplete decrease in emotional tone. The duration of the lesson is 30 minutes. Methodology. The number of patients being treated is 12-15 people. The team is live. Excessive exactingness and strictness to mistakes and great accuracy in performing exercises are harmful. Errors should be corrected by demonstrating good exercise performance by one of the patients. It is not recommended to make comments to those patients who do not succeed in this exercise. With the tone of the command, the timbre of the voice, a lively response to the positive emotions of the patients, active participation in their emotional upsurge, the methodologist should help to increase the contact of the patients with themselves and with each other. The task of inducing automatic reactions into emotional tone is achieved by accelerating the rate of movements: from the slow rate 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 the emotional tone, resistance exercises in pairs, mass game exercises, exercises with a medicine ball are used. To overcome feelings of indecision, shyness, self-doubt - exercises on shells, balance, jumping, overcoming obstacles. In the final part of the lesson, exercises are carried out that contribute to an incomplete decrease in emotional tone. It is necessary that the patient leaves the therapeutic gymnastics hall 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 accounts for 5-7 minutes, the main part - 20-30 minutes, the final part - 5-10 minutes. In the introductory part, the lesson begins with walking in a circle (1 minute), and then floor exercises follow with arms (8 times), trunk (8 times), legs (8 times) and sit and lie down (8 times). The main part is built quite differently, in each lesson the set of exercises changes. In the main part, you need to widely use exercises with a volleyball (15 times), gymnastic sticks (8-12 times), jump ropes (16 times). Particular attention should be paid to exercises that require sufficient firmness, self-confidence, precise coordination of movement, balance, frequent changes in excitation and inhibition. These include exercises with throwing a basketball into the basket (10 times), walking along the rail of the gymnastic bench, first with open and then with eyes closed (4-5 times). Subsequently, if possible, you need to increase the height of the rail or switch to walking on a balance beam. Walking on a rail or log should be gradually complicated by performing various exercises during the passage: hitting a hanging ball, various free movements, turns, overcoming obstacles. Of the game exercises, competitions in high jumps, bast shoes, volleyball (both with and without a net) work favorably, and in winter - skiing from the mountains with gradually more difficult descent conditions, skating, sledding from the mountains. In the final part of the lesson, an incomplete decrease in emotional tone is achieved by its short duration (1 minute), by performing a small number of dynamic breathing exercises for relaxation. It should end with a survey of well-being. When combined with asthenia, the scheme for constructing a course of treatment and lessons changes somewhat. In this case, the duration of the lesson at first does not exceed 5-7 minutes and only gradually increases to 20-30 minutes. The lesson is built on the same principles. Classes with patients with psychasthenia should be carried out using a game method, including games, elements of sports exercises and competitions, and excursions in classes. In the process of training, it is necessary to distract the patient's attention from obsessive thoughts, to interest him in the 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 them. In the presence of phobias, obsessions, psychotherapeutic preparation of the patient is necessary, which is of particular importance for overcoming the feeling of unreasonable fear of doing exercises. So, with a phobia of heights, in addition to the above features of the lesson, you need to gradually force them to perform such exercises that instill confidence in the patient, remove 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 get acquainted in great detail not only with the mental, but also with the physical condition of the patient. Classes of therapeutic physical culture should be preceded by detailed somatic studies, 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, height, excitement, fatigue, etc.) In accordance with these data, a scheme of therapeutic exercises is built. Of course, we are talking about people who have a violation coronary circulation(or some other cardiovascular pathology, with or without heart pain) is completely absent, but the patient has an intense fear heart attack, fear of dying from myocardial infarction. Especially indicated for the treatment of therapeutic physical culture of persons who have<приступы>heart pain associated with excitement. 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 lessons are very short and are limited only by slow walking in a circle (without floor exercises) and some floor exercises with legs (4-8 times) and torso (4-8 times). Then the duration of the lesson can be increased by exercises with gymnastic sticks, walking on the gymnastic bench and its rail, with the gradual addition of additional exercises while walking. With the successful completion of these exercises, starting from the 3rd week, you can introduce free movements with your hands, throwing a volleyball (10-15 times), and at the end of the course (4-5 weeks) exercises with ropes, game exercises with a volleyball, bouncing, long jumps, skiing on the plain. The tactics of the physical culture methodologist and the attending physician in case of heart pain in the patient during the exercise are quite complicated. On the one hand, you need to listen to such complaints, but if there is confidence that these pains are not supported by some somatic basis, you should boldly recommend to the patient not to pay attention to pain, to focus on the correct implementation of the recommended exercises, especially that the exercises themselves exclude the possibility of deterioration from the side of the cardiovascular apparatus. A peculiar technique is prescribed for fear of physical stress. Most often this obsessive fear appears in individuals with postoperative wound when doctors give advice at first not to lift weights, not to do any heavy work at all physical work. In the future, despite the good course of the postoperative period, the fear of lifting weights, physical stress is fixed and then a course of special exercises should be carried out. At first, patients perform only floor exercises with their hands (the duration of the lesson is 5-7 minutes) and walking. A week later, in the main part of the lesson, exercises with sticks (4-8 times), free movements of the body, legs, sitting and lying (8-12 times) are introduced. After another week, you can add exercises on the gymnastic bench, throwing a volleyball, skiing (without steep ascents and descents, no more than 30 minutes). Later, in the main part of the lesson, they introduce exercises with ropes, bouncing, playing volleyball, and finally, throwing a medical ball of increasing severity. From what has been said above, the need for a thorough acquaintance with the characteristics of the patient, the structure of his experiences, clearly follows. This rule, valuable in general for all types of patients, becomes especially necessary here. Therefore, the physical therapy methodologist should get acquainted with the medical history in detail, 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 remedial physical culture, and also constantly keep in touch with the attending physician and evaluate changes together, occurring in the structure of the disease, to plan further training programs, taking into account the changes that have occurred. An important result of the application of therapeutic exercises to patients with psychasthenic syndromes is the possibility of using motor skills to work the patient on himself; hence the transition from therapeutic gymnastics in a group in a hospital to its use at home; at the same time, there is an undoubted positive effect from the participation of these patients in the game in volleyball teams, in cycling competitions, and, where the state of health allows, in football training and competitions. Dances, especially collective dances, are of great positive significance for these persons. 3. Disease prevention Disease prevention is an extremely important task. Preservation of health in the working conditions of people is facilitated by: optimal working hours, annual labor leave, compliance with safety regulations 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 neurosis, sanatorium-and-spa institutions and rest houses 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 GNA. The prevention of neurosis is an extremely important task. Considering the connection between the development of neuroses in children with toxicosis of pregnancy in their mothers, the state of their nervous system, proven by many scientists, 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 from 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 feeding regimen of the child, not indulge his cry and whims. Of exceptional importance is the fight against childhood infections, strict adherence to the terms of aftercare. It must be remembered that the weakening of the nervous system of a child who has undergone a serious illness creates a favorable background for the development of neurosis. Particular attention should be paid to children in critical periods of their development. At the age of three or four, a child begins to form his own "I", therefore, the constant obstacle to developing initiative, pulling children back makes them withdrawn, indecisive. At the same time, it is necessary to avoid the second extreme - to allow everything. This leads to indiscipline, to non-recognition of prohibitions. Calm, even and firm exactingness of parents contributes to the assertion of their authority and disciplines children. A child from 3-4 years old must be taught independently, to serve himself: dress, wash, eat, fold toys. In the future, he must be taught how to clean his dress, shoes, make a bed, clear the table, etc. In each individual case, the child’s capabilities should be assessed and not given overwhelming orders, as this can also lead to a neurotic state. It is always necessary to strictly monitor the daily regimen, nutrition, the use of the time allotted for the child for outdoor activities, sleep. Great importance has timely training of the child in personal hygiene skills and hardening. He must, together with adults (but according to the complex appropriate for him), do morning hygienic gymnastics, which contributes to the fight against lethargy, makes him dexterous and strong. Daily wiping the body with water or washing up to the waist, in addition to the habit of personal hygiene, develop resistance to colds in him. It is very important to protect the child from gross influences on his psyche. It must be remembered that quarrels and scandals of parents or a break in family relations have a very painful effect on the nervous system of children. You should not tire them with an excessive amount of impressions: frequent visits to the cinema, watching TV shows, long or frequent stays of kids in the menagerie, circus, fast driving etc. Very important in the formation of personality is the correct sexual education of the child. He should not be allowed to have a sexual feeling, which can be caused by immoderate caress, careless touch while bathing, etc. Children should not be taken to bed with adults or put 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 way that is understandable to the child. Children are brought up especially successfully in a team: in nurseries, kindergartens, schools, where this is led by experienced specialists. However, being in a children's team does not relieve parents of responsibility for raising a child. If, in order to prevent neurosis in childhood The main attention is paid to the creation of a strong type of higher nervous activity in a child, then for the prevention of neurosis in adults, the main thing is to prevent the causes that cause a weakening of the basic nervous processes. This is where overwork plays an important role. In production, appropriate conditions have been created for this. During the lunch break, the workers rest and do industrial gymnastics. But people of certain professions, as well as pupils and students, continue to work at home. In such cases, it is important to observe occupational hygiene, with the correct organization of which overwork does not develop. The main condition for this is the planning of work. It is very important to diversify your work in such a way: to alternate mental work with reading fiction or walking, or, even better, playing sports. Every one and a half to two hours, a 5-10 minute break should be taken. It is good to fill it with gymnastics or sports games. Sports games, as well as sports in general, contribute to the preservation of health and the development of human endurance. They not only strengthen muscles, improve blood circulation and metabolism, but also largely normalize the work of the cerebral cortex, contribute to the fitness of the main nervous processes. Sports should be practiced by all people, regardless of age. There are many examples when people of advanced age, who have been involved in sports for a long time, retained their health, clarity of mind, cheerfulness, normal working capacity and good mood. It is especially valuable to combine sports with water procedures - wiping, 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 steadily take care of its usefulness. Chronic sleep deprivation contributes to the weakening of nerve cells, resulting in the development of signs of chronic overwork - irritability, intolerance to strong sound stimuli, lethargy, fatigue. An adult needs to sleep 7-8 hours a day. Sleep should not only be sufficiently long, but also deep. It is necessary to strictly observe the regime - go to bed at the same time. A sharp excitement before bedtime or prolonged work can serve as an obstacle to falling asleep quickly. Going to bed with a full stomach is very harmful. Dinner is recommended 2-3 hours before bedtime. In the room where they sleep, there should always be fresh air - you need to accustom 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 sufficiently high-calorie and varied in the selection of products. Fats and carbohydrates are the main energy substance of working cells, and therefore they are especially necessary in cases of intense work. Proteins are the basic substance, living matter for higher nervous activity. In cases of restriction of protein intake into the body, 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 content of mineral substances in food can also determine the state of excitatory and inhibitory processes. Vitamins are just as important. We should not forget that drinking alcohol and smoking contribute to the emergence of neuroses. Both lead to slow poisoning of the nervous system, causing severe changes in itself and in a number of other organs and systems. Conclusion As a result of the analysis of scientific and methodological literature on the topic of term paper, I came to the conclusion that neuroses are functional diseases CNS resulting from overstrain of nervous processes. There are the following types of neuroses: neurasthenia, hysteria, psychasthenia. The use of exercise therapy for neuroses is justified by the simultaneous effect of physical exercises 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 prophylactic agent. The great advantage of exercise therapy is the possibility of strict individualization and dosing of physical exercises. The selection of exercise therapy means 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 of nature, etc. There are various forms of exercise therapy: morning hygienic gymnastics, games, therapeutic exercises. In the treatment of neurosis, there are two periods of exercise therapy: sparing 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 the classes, the exercise therapy methodologist should exercise a psychotherapeutic effect on the patient and widely use pedagogical methods and principles in his practice. Exercise therapy for neurosis 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. Popov. - 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 blade 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 illness. - 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 control and exercise therapy. - M.: Physical culture and sport, 1968. - 296 p.
Physical strength exercises increase the functional restructuring of all key elements nervous system, exerting a stimulating effect on both efferent and afferent systems. The basic basis of the mechanism of influence of strength physical exercises is the process of exercise, therefore, the dynamic restructuring of the nervous system also affects cerebral cortex cells, and peripheral nerve fibers. When performing physical exercises, all kinds of reflex connections (cortico-muscular, cortico-visceral, and also muscular-cortical) increase, which contributes to a more coordinated and harmonious functioning of the main functional systems of the body.
Active involvement of the patient in the process of conscious and well-dosed exercise is a powerful stimulator of the formation of subordinate influences. The plasticity of the CNS allows systematic complexes of exercise therapy develop a dynamic stereotype that determines the accuracy, coordination and impressive economization of reactions.
Exercise therapy for diseases of the nervous system has a normalizing effect on imbalances in inhibition and excitation. An important role in neurohumoral regulation during strength exercises is played by the autonomic nervous system, which innervates the tissues of muscle fibers, regulates the metabolic process in them, and adapts it to functional activity. The function of the cardiovascular system, respiratory and other body systems is also stimulated, which improves the nutrition of working muscles, eliminates congestion, and accelerates the resorption of inflammatory foci. Positive emotions when performing physical exercises develop in a patient against the background of unconditional and conditional connections. They help mobilize various physiological mechanisms and distract the patient from painful experiences.
Stroke.
In the rehabilitation of patients who have had a stroke, there are 3 stages: early (3 months), late (up to 1 year) and the stage of compensation for residual motor function disorders. Physiotherapy in strokes, it is aimed at reducing the pathological tone, reducing the degree of paresis (increasing muscle strength), eliminating synkinesis, recreating and forming the most important motor skills. Therapeutic exercises and massage are prescribed when the patient's condition stabilizes (there is no increase in symptoms of cardiac and respiratory disorders). Treatment with the position begins from the first day of the disease, passively turning the patient every 1.5-2 hours during the day and 2.5-3 hours at night from a healthy side to the back and to the affected side. When placing the patient in a horizontal position (lying), it should be ensured that the hand of the affected arm is always in the middle physiological phase, and the leg does not rest on anything. The upper limb is abducted to 90", unbent in all joints and rotated outwards. With an increase in the tone of the carpal flexor muscles, a splint must be applied to the hand with fingers extended and spread apart. Exposure to pressure on the surface of the hand and sole leads to an increase in muscle tone and the formation of vicious attitudes. A little elevated position of the patient (no more than 30°) head (with mild and moderate ischemic stroke) for 15-30 minutes 3 times a day already on the 1st day of the disease.
It is necessary to try to activate the patient as early as possible - transferring him to a sitting position. The patient can be seated on a bed with lowered legs on the 3rd-5th day from the start of treatment. Transfer to a sitting position is passive, the patient is provided with sufficient support. The duration of sitting in a sitting position is from 15 minutes to 30-60 minutes or more with good tolerance. The issue of the period of expansion of the motor regime in hemorrhagic stroke is decided individually.
Motor rehabilitation in stroke includes a number of successive stages. Preference is given to functional exercises.
- Restoration of some components of the motor act - methods of active muscle relaxation, training in dosed and differentiated tensions of muscle groups, differentiation of the amplitude of movements, training in minimal and isolated muscle tension, training and mastering the optimal speed of movements, increasing muscle strength.
- Increasing proprioception - overcoming the dosed resistance to the movement being made, the use of reflex mechanisms of movement (reflex exercises).
- Restoration of simple friendly movements - training of various options for inter-articular interaction with visual and kinematic control.
- The revival of motor skills - the restoration of individual parts of a motor act (skill), learning the transitions (connections) from one motor element to another, the revival of the entire motor act, automation of the restored motor act.
Restoration of impaired motor functions in central paresis occurs in a certain sequence: first, reflex movements and muscle tone are restored, and then friendly and voluntary movements appear, which are restored from the proximal to the distal (from the center to the periphery); restoration of the motor function of the flexors is ahead of the restoration of movements in the extensors; hand movements appear later than legs, specialized hand movements (fine motor skills) are restored especially slowly. In the course of LH training, the patient is gradually working out the skills of motor activity in the prone position (lifting the head, pelvis and body, movements in the limbs, turns) and an independent transition to a sitting position. Subject to the static and dynamic balance (balance) while sitting, the patient learns to move to a standing position (on average on the 7th day in case of uncomplicated ischemic stroke). Learning to walk independently requires the patient to be able to stand up and sit down independently, maintain a standing posture, transfer body weight and place the supporting leg correctly. Training begins with assisted walking, but long-term use of walking aids inhibits protective reactions and develops the patient's fear of falling. Walking training includes training in the direction of movement (forward, backward, sideways, etc.), stride length, walking rhythm and speed, and walking up and down stairs. Active and passive movements should not cause an increase in muscle tone and pain.
LH classes with stroke patients are carried out individually due to the significant variability of motor and sensory disorders. The duration of the LH procedure is 20-25 minutes with bed rest and 30-40 minutes with free rest. In addition to special exercises, it is necessary to include in the exercise therapy complex for strokes breathing exercises (static and dynamic), general strengthening exercises, exercises with objects, exercises on simulators, sedentary and outdoor games. As a rule, they conduct an additional small-group or group lesson lasting 15-20 minutes.
The achieved functionality should be applied in self-service activities. Manipulations with household items, clothes, skills of eating, personal hygiene, housekeeping, behavior in the city are trained. To develop daily activity skills, separate additional training sessions with an ergotherapist lasting 30-40 minutes should also be carried out.
The choice of exercises and the planning of individual complexes depend on the severity and degree of movement disorders, the presence of accompanying symptoms(spastic, synkinesia, aphasia) and diseases, the patient's behavior, his general development and exercise tolerance.
Massage is carried out in a differentiated way: on muscles whose tone is increased, only gentle methods of stroking and rubbing are used, and on stretched (weakened) muscles, all massage techniques are allowed. The duration of the massage is 20-25 minutes, 30-40 sessions per course, with breaks between courses of 2 weeks.
Contraindications for the activation of patients are signs of cerebral edema, depression of consciousness; the rate of expansion of exercise intensity may be limited in patients with cardiopulmonary problems (failure) and atrial fibrillation.
Injuries and diseases of the spinal cord.
The main task of exercise therapy in spinal cord lesions is to normalize the patient's motor activity or develop adaptive capabilities. The complex of therapeutic measures includes exercises that stimulate voluntary movements, exercises aimed at strengthening the muscle corset, weakening increased tone muscles, learning the skills of independent movement and self-service. In injuries and diseases of the spinal cord, the nature of movement disorders depends on the location of the lesion. Spastic paresis and paralysis are accompanied by increased muscle tone and hyperreflexia. Flaccid paresis and paralysis are characterized by hypotension and muscle atrophy, hypo- or areflexia. In this regard, with various forms of movement disorders, the complexes of physical exercises differ significantly. The main task of LH in flaccid paralysis is to strengthen the muscles, and in spastic ones it is to develop the skills to manage them.
Exercise therapy classes begin from the 2-3rd day after admission to the hospital, before that only treatment with the position is carried out. The starting position of the patient is lying on his back. lg provo
children 2-3 times a day from 6-8 minutes to 15-20 minutes. Forms and means of exercise therapy are selected taking into account motor modes and, depending on the objectives of treatment, both strengthening and special methods of LH are used.
- Development of voluntary movements in the segments, increase in muscle strength - active movements for the affected limbs with relief (on suspensions, in a horizontal plane, in water, after the resistance of antagonists), exercises to overcome resistance, isometric exercises with low exposure, reflex exercises using natural synkinesis , special methods of LH (the method of proprioceptive relief, the method of neuromotor retraining, etc.). If it is impossible to make active movements, ideomotor exercises and isometric exercises for healthy limbs are used.
- Prevention and treatment of muscle atrophies, contractures, deformities - training in active muscle relaxation techniques, passive movements in the joints with the involvement of paretic muscles, anti-friendly and ideomotor trainings, correction of the position of paretic limbs, orthopedic prophylaxis.
- Recreation and compensation of coordination of movements - complex vestibular gymnastics, a series of exercises for the accuracy and accuracy of movements, training and teaching fine differentiation and dosage of efforts, speed and amplitude of movements, exercises to maintain balance in various starting positions, a combination of isolated movements in several joints.
- Restoration and compensation of movement skills - development of support ability of the lower extremities, special exercises to strengthen the ligamentous-muscular apparatus of the feet, restoration of the spring function of the feet; exercises that restore the direction of movements in space; phased restoration of the kinematics of walking, dynamic coordinating gymnastics; exercises in various starting positions (lying, kneeling, on all fours, standing), learning to walk independently with and without support.
- Improving the activity of the respiratory and cardiovascular system - static breathing training with dosed resistance, dynamic breathing exercises, passive exercises for the limbs, rotations and turns of the body (passively and actively), exercises oriented to intact muscle groups.
- Development of self-care skills - restoration of personal hygiene, nutrition, dressing, moving and housekeeping, handwriting and typewriting, classes in ego therapy rooms, training in behavior skills in the city.
- Work skills training - classes in occupational therapy rooms and workshops.
- All of the above methods of exercise therapy are closely interconnected and are used in different combinations depending on the individual treatment plan of the patient.
With spastic paralysis, movements leading to the convergence of the points of attachment of spastic muscles or associated with force tension, as well as massage techniques that increase muscle tone, are contraindicated. With flaccid paralysis, you should not use exercises related to stretching the paretic muscles.
Damage to the peripheral nervous system.
The tasks of exercise therapy in case of damage to the peripheral nervous system are considered to be: improving blood circulation and trophic processes in the affected limb, strengthening paretic muscle groups and ligamentous apparatus, preventing the development of contractures and stiffness of the joints, promoting the regeneration of the damaged nerve, developing and improving replacement movements and coordination of movements, general strengthening effect on the patient's body.
The method of using exercise therapy is determined by the volume of movement disorders (paresis, paralysis), their localization, the degree and stage of the disease. Use treatment by position, massage, LH. Positional treatment is indicated to prevent overstretching of already weakened muscles with splints, laying, corrective positions, except during gymnastics. In LH, active movements in the joints of a healthy limb, passive and ideomotor movements of the affected limb (with paralysis), friendly active exercises, and active exercises for weakened muscles are used. Muscle training is carried out in facilitated conditions of their functioning (reliance on a smooth surface, the use of blocks, straps), as well as in warm water. During classes, it is necessary to monitor the occurrence of voluntary movements, choosing the optimal initial positions, and try to support the development of active movements. With satisfactory muscle function, active exercises are used with additional load(resistance to movement, burdening the limb), aimed at restoring muscle strength, exercises with gymnastic objects and apparatus, sports and applied exercises, mechanotherapy. LH is carried out for 10-20 minutes with fractional loads during the day due to the rapid depletion of the damaged neuromuscular apparatus. Prevention and treatment of contractures includes the performance of physical exercises that increase the volume of motor activity in the joints and balance the tone of the flexor and extensor muscles.
Nervous system is a complex system that regulates and coordinates the activities of the human body. It is based on the central nervous system (CNS), which consists of the brain and spinal cord, and the peripheral nervous system (PNS), which includes the rest of the neural elements.
In addition to the brain and spinal cord, the most important organs of the nervous system include the eyes, ears, organs that are responsible for taste and smell, as well as sensory receptors located on the skin, in joints, muscles and other parts of the body.
In our time, diseases and damage to the nervous system are quite common. They can occur as a result of trauma, infection, degeneration, structural defects, tumors, blood flow disorders, and also due to autoimmune diseases (when the body begins to attack itself).
Diseases of the nervous system can lead to movement disorders such as paralysis, paresis, hyperkinesis.
Paralysis (or plegia) is the complete loss of muscle contraction. Paresis - partial loss of the motor function of the body. Paralysis or paresis of one limb is called - monoplegia or monoparesis, two limbs of one side of the body - hemiplegia or hemiparesis, three limbs - triplegia or triparesis and four limbs - tetraplegia or tetraparesis.
There are two types of paralysis and paresis: spastic and flaccid. With spastic paralysis, there is a lack of only voluntary movements, as well as an increase in muscle tone and all tendon reflexes. Flaccid paralysis is characterized by the absence of both voluntary and involuntary movements, tendon reflexes, as well as low muscle tone and atrophy.
Hyperkinesias are altered movements that are devoid of physiological significance and occur involuntarily. Hyperkinesias include convulsions, athetosis, trembling.
There are two types of cramps: clonic, which are rapidly alternating muscle contractions and relaxations, and tonic, which are prolonged muscle contractions. Seizures occur as a result of irritation of the cortex or brain stem.
Athetosis is slow worm-like movements of the fingers, hands of the body, which lead to the fact that when walking the body twists in a corkscrew shape. This disease is formed when the subcortical nodes are affected.
Trembling is characterized by involuntary rhythmic vibrations of the limbs or head. It occurs as a result of damage to the cerebellum and subcortical formations.
Ataxia is a lack of coordination of movements. There are two types of ataxia: static (impaired balance when standing) and dynamic (impaired coordination of movements, characterized by disproportionate motor acts). As a rule, ataxia is formed as a result of damage to the cerebellum and the vestibular apparatus.
Very often, in diseases of the nervous system, sensitivity disorders occur. There is a complete loss of sensitivity, which is called anesthesia, and there is also a decrease in sensitivity - hypoesthesia and an increase in sensitivity - hyperesthesia. If the patient has violations of superficial sensitivity, then in this case he does not distinguish between heat and cold, does not feel pricks. If there is a disorder of deep sensitivity, then the patient loses the idea of the position of the limbs in space, which leads to uncontrollability of his movements. Damage to peripheral nerves, roots, adductor tracts and spinal cord, as well as adductor tracts and the parietal lobe of the cerebral cortex lead to sensory disturbances.
As a result of many diseases of the nervous system, trophic disorders occur in the body, namely: the skin becomes dry, cracks appear on it, bedsores form, which also capture the underlying tissues, bones become brittle and brittle. Especially severe bedsores are observed when the spinal cord is damaged.
All of the above diseases of the nervous system are very relevant in our time, and with the help of modern medicine, which has a wide range of therapeutic agents in its arsenal, they are quite treatable. A special role in the treatment and rehabilitation of patients with various diseases and injuries of the central and peripheral nervous system is played by physiotherapy exercises in diseases of the nervous system.
Thanks to exercise therapy in diseases of the peripheral nervous system, there is a disinhibition of nerve sections that are in a state of oppression, as well as stimulation of regeneration processes, which in turn helps to restore nerve conduction, improve movements and other functions that were impaired as a result of the pathological process. Physical exercises in diseases of the nervous system help to improve trophism at the site of nerve damage, and also prevent the formation of adhesions and cicatricial changes, that is, secondary deformities. If the lesions of the peripheral nerves are irreversible, then in this case, special exercises for diseases of the nervous system provide the formation of motor compensations. Physiotherapy exercises and therapeutic exercises for diseases of the nervous system are used both for injuries of peripheral nerves and for inflammatory processes in them. LFK and LH in diseases of the nervous system are contraindicated only if the patient has a severe general state and there is severe pain.
Physical therapy exercises for diseases of the central nervous system contribute to the restoration of impaired functions of the brain and spinal cord and are a therapeutic and educational process that is carried out with the help of conscious and active (as far as possible) participation of the patient. Therapeutic exercises for diseases of the nervous system, which are also combined with psychotherapeutic effects, are primarily aimed at increasing the general vitality of the patient, which in turn creates favorable conditions for the restoration and compensation of lost functions.
Exercise therapy for neurosis is a natural biological method in which the use of physical exercises and natural factors of nature is physiologically justified. Thanks to exercise therapy and PH in neuroses, there is a direct effect on the main pathophysiological manifestations that are observed in this disease, physical exercises in neuroses help to equalize the dynamics of the main nervous processes, as well as coordinate the functions of the cortex and subcortex, the first and second signal systems, etc.
Thus, physiotherapy exercises and (their regular use) occupy a very important place in the recovery processes and complex treatment.
Exercise therapy complex for diseases of the nervous system:
(before class, you need to count the pulse)
1. Walking in a circle alternately in one direction and the other, then walking with acceleration. Perform 1-2 minutes.
2. Walking in a circle on toes, on heels alternately in one direction and the other, then with acceleration. Perform 1-2 minutes.
3. I.P. - standing, arms along the body. Relax all muscles.
4. I. P - the same. Alternately raise your hands up (first the right hand, then the left), gradually accelerate the movements. Run 60 to 120 times in 1 minute.
5. I.P. - feet shoulder-width apart, hands clasped into the castle. Raise your arms above your head - inhale, then lower your arms through the sides down - exhale. Repeat 3-4 times.
6. I.P. - feet shoulder-width apart, arms extended in front of the chest. Squeeze and unclench your fingers with acceleration - from 60 to 120 times in 1 minute. Perform 20-30 seconds.
7. I.P. - feet shoulder-width apart, hands clasped into the castle. Raise your arms above your head - inhale, then lower your hands sharply down between your legs - exhale. Repeat 3-4 times.
8. I.P. - legs together, hands on the belt. Do a squat - exhale, return to the starting position - inhale. Repeat 4-5 times.
9. I.P. - standing on toes. Get down on your heels - exhale, return to the starting position - inhale. Repeat 5-6 times.
10. This exercise is performed in pairs - to overcome resistance:
a) I.P. - standing facing each other, holding hands, which are bent at the elbows. In turn, each of the pair resists with one hand, while straightening the other hand. Repeat 3-4 times.
b) I.P. - standing facing each other holding hands. Leaning against each other with your knees, do a squat (straighten your arms), then return to the starting position. Repeat 3-4 times.
c) I.P. - the same. Raise your hands up - inhale, lower - exhale. Repeat 3-4 times.
d) I.P. - the same. Put your right foot on the heel, then on the toe and make three stomps with your feet (at a dance pace), then separate your hands and clap your palms 3 times. Repeat the same with the left leg. Do 3-4 times with each leg.
11. I.P. - standing facing the wall 3 m from it, holding the ball. Throw the ball with both hands against the wall and catch it. Repeat 5-6 times.
12. I.P. - standing in front of the ball. Jump over the ball, turn around. Repeat 3 times on each side.
13. Exercises performed on shells:
a) walk along the gymnastic bench (log, board), maintaining balance. Repeat 2-3 times.
b) perform jumps from the gymnastic bench. Do 3-4 times.
c) I.P. - standing at the gymnastic wall, with outstretched arms, hold on to the ends of the rail at shoulder level. Bend your arms at the elbows, press your chest against the gymnastic wall, then return to the starting position. Repeat 3-4 times.
14. I.P. - standing, arms along the body. Rise on toes - inhale, return to the starting position - exhale. Repeat 3-4 times.
15. I.P. - the same. In turn, relax the muscles of the arms, torso, legs.
After completing all the exercises, count the pulse again.
Exercise therapy for neurosis.
A set of physical exercises for neuroses No. 1:
1. I.P. - standing, legs apart. Close your eyes, raise your hands to shoulder level, then connect straightened index fingers in front of your chest, while opening your eyes. Raising your hands, inhale, lowering - exhale. Repeat 4-6 times.
2. I.P. - feet shoulder width apart, arms along the body. Make movements with your hands that imitate rope climbing. Breathing is even. Do 2-4 times.
3. I.P. - legs apart, hands on the belt. In turn, take your legs to the sides to failure. Breathing is even. Run 2-6 times.
4. I.P. - legs together, arms along the body. Raise your hands up and at the same time raise and bend your left leg at the knee. When raising your hands, inhale, when lowering, exhale. Then repeat the same with the other leg. Perform with each leg 2-4 times.
5. I.P. - the same. At the expense of "one" - make a jump in place, legs apart. Make a clap with your hands above your head. On the count of "two" - jump back to the starting position. Run 2-6 times.
6. I.P. - the same. Perform jumps on toes, while not tilting the torso forward, arms below. Do 5-10 times.
7. I.P. - legs apart, arms below. Perform hand movements that mimic the movements of a swimmer. Breathing is even. Run 5-10 times.
8. I.P. - legs together, arms along the body. Raise the left and right legs in turn forward, while clapping your hands under the raised leg and behind your back. Breathing is even. Do 3-6 times.
9. I.P. - legs apart, arms along the body. Throw a small ball up in front of you, clap your hands behind your back and catch the ball. Breathing is even. Do 5-10 times.
10. I.P. - the same. Raise your arms, bend at the elbows and bring them to the shoulders. Raising your hands, inhale, lowering - exhale. Do 4-6 times.
A set of exercises for neuroses No. 2:
1. Sit on a chair, stretch your arms in front of you. Take a breath - take your hands to the sides, bend in the chest area. Exhale - return your hands to their original position and lower your head. The pace is slow. Do 6-8 times.
2. Sit on the mat (legs straight), two-kilogram dumbbells in your hands. Inhale - touch the toes with the dumbbells, exhale - pull the dumbbells towards you. Do 12 times.
3. Stand up, lower your arms, put your left foot forward (heel to toe right foot). Standing still, maintaining balance, imitate the movements of the windmill wings with your hands. Having lost balance, return to the starting position and start the exercise again.
4. I.P. - standing, legs together. Inhale - take two steps (from the left foot), exhale - two jumps on the left leg and two jumps on the right, while moving forward. Do 8 times.
5. I.P. - the same. Inhale - raise your arms to the sides, exhale - put your left foot close to your right and, closing your eyes, maintain balance. Take a breath - return to the starting position. Run 8 times.
6. Place a chair at a distance of 4 steps from the wall, then stand in front of the chair. Throw a tennis ball at a wall, sit on a chair and catch the ball after it bounces off the floor. Do 10 times.
7. Lie on your back, relax. Inhale - tighten the muscles of the arms and legs (in turn), exhale - relax. Do 3-4 times.
8. Feet together, arms down. Rhythmically walk around the room, while changing the position of the hands: first put them on the hips, then raise them to the shoulders, then to the head and clap in front of you. Repeat 3 times.
9. Sit on a chair, bend your legs, put your hands on the edge of the chair. Take a breath, then a long exhale and pull the bent legs to the chest, then straighten them, spread them apart, bend and put them on the floor. Do 8 times.
10. I.P. - standing, legs together. Take two steps - inhale, raise your arms to the sides, then take the third step - sit down and stretch your arms forward. Then stand up, put your hands down. Do 4 times.
11. Stand on the bar with one foot, pick up a tennis ball. Stand on one foot (on the left, then on the right), hitting the ball on the floor with one hand and catching with the other. Do 15 times.
This is an introductory and informational article about the role it plays, the principles, methods and means of exercise therapy. Let's talk about the factors that are important for the implementation of the rehabilitation of neurological patients: what complicates and what facilitates the process of restoring the nervous system.
Therapeutic exercise for diseases of the nervous system plays an essential role in the rehabilitation of neurological patients. Treatment of the nervous system impossible without medical gymnastics. has the main goal of restoring self-care skills and, if possible, full rehabilitation.
It is important not to miss the time to create the correct new motor stereotypes: the earlier treatment is started, the easier, better and faster the compensatory-adaptive recovery of the nervous system occurs.
In the nervous tissue, the number of processes of nerve cells and their branches on the periphery increases, other nerve cells are activated, and new nerve connections appear to restore lost functions. Timely adequate training is important for creating the right movement stereotypes. So, for example, in the absence of physiotherapy exercises, a "right-brained" stroke patient - a restless fidget "learns" to walk, pulling his paralyzed left leg to his right and dragging it behind him, instead of learning to walk correctly, with each step moving his leg forward and then transferring the center of gravity of the body to it. If this happens, then it will be very difficult to retrain.
Not all patients with diseases of the nervous system can do the exercises on their own. Therefore, they cannot do without the help of their relatives. To begin with, before starting therapeutic exercises with a patient who has paresis or paralysis, relatives should master some techniques for moving the patient: transplanting from bed to chair, pulling up in bed, walking training and so on. In fact, this is a safety technique to prevent excessive stress on the spine and joints of the caregiver. Lifting a person is very difficult, so all manipulations must be performed at the level of a magician in the form of a “circus trick”. Knowing some special techniques will greatly facilitate the process of caring for the sick and help maintain your own health.
Features of exercise therapy in diseases of the nervous system.
one). Early initiation of exercise therapy.
2). Adequacy of physical activity: physical activity is selected individually with a gradual increase and complication of tasks. A slight complication of the exercises psychologically makes the previous tasks “easy”: what previously seemed difficult, after new slightly more complex tasks, is performed more easily, with high quality, the lost movements gradually appear. Overload should not be allowed to avoid deterioration of the patient's condition: movement disorders. In order for progress to occur faster, it is necessary to finish the lesson on the exercise that this patient has, to focus on this. I attach great importance to the psychological preparation of the patient for the next task. It looks something like this: "Tomorrow we will learn to get up (walk)." The patient thinks about it all the time, there is a general mobilization of forces and a readiness for new exercises.
3). Simple exercises are combined with complex ones for training higher nervous activity.
four). The motor mode gradually steadily expands: lying - sitting - standing.
5). All means and methods of exercise therapy are used: therapeutic exercises, positional treatment, massage, extension therapy (mechanical straightening or stretching along the longitudinal axis of those parts of the human body that have a disturbed anatomical location (contractures)).
The main method of physical therapy for diseases of the nervous system is therapeutic exercises, the main means of exercise therapy are exercises.
Apply
- isometric exercises aimed at strengthening muscle strength;
- exercises with alternating tension and relaxation of muscle groups;
- exercises with acceleration and deceleration;
- coordination exercises;
- balance exercise;
- reflex exercises;
- ideomotor exercises (with the mental sending of impulses). It is these exercises that I use most often in combination with Su-jok therapy for diseases of the nervous system.
Damage to the nervous system occurs in different levels, the neurological clinic depends on this and, accordingly, the selection of therapeutic exercises and other physiotherapeutic therapeutic measures in the complex treatment of a particular neurological patient.
Hydrokinesitherapy - exercises in water - very effective method restoration of motor functions.
Exercise therapy for diseases of the nervous system subdivided according to the parts of the human nervous system, depending on which part of the nervous system is affected:
exercise therapy for diseases of the central nervous system;
exercise therapy for diseases of the peripheral nervous system;
exercise therapy for diseases of the somatic nervous system;
Exercise therapy for diseases of the autonomic nervous system.
I suggest watching a video about the human nervous system in order to have an idea of its structure and functions.
Some subtleties of work with neurological patients.
- The state of mental activity of a neurological patient.
- The patient's experience in physical education before illness.
- The presence of excess weight.
- Depth of damage to the nervous system.
- Accompanying illnesses.
For physiotherapy exercises, the state of higher nervous activity of a neurological patient is of great importance: the ability to be aware of what is happening, to understand the task, to concentrate attention when performing exercises; volitional activity plays a role, the ability to resolutely tune in to daily painstaking work to achieve the goal of restoring the body's lost functions.
In the case of a stroke or brain injury, most often the patient partially loses the adequacy of perception and behavior. Figuratively, it can be compared with the state of a drunk person. There is a "disinhibition" of speech and behavior: the shortcomings of character, upbringing and inclination to what is "impossible" are exacerbated. Each patient has a behavioral disorder that manifests itself individually and depends on the
one). what activity the patient was engaged in before the stroke or before the brain injury: mental or physical labor (it is much easier to work with intellectuals, provided normal weight body);
2). how developed the intellect was before the disease (the more developed the intellect of a patient with a stroke, the more the ability to purposefully exercise exercise remains);
3). in which hemisphere of the brain did the stroke occur? "Right hemispheric" stroke patients behave actively, show emotions violently, do not hesitate to "express"; they do not want to follow the instructions of the instructor, they start walking ahead of time, as a result, they have a risk of forming incorrect motor stereotypes. “Left hemispheric” patients, on the contrary, behave inactively, do not show interest in what is happening, just lie down and do not want to engage in physiotherapy exercises. It is easier to work with "right hemisphere" patients, it is enough to find an approach to them; what is needed is patience, a delicate and respectful attitude, and the decisiveness of methodological instructions at the level of a military general. 🙂
During classes, instructions should be given decisively, confidently, calmly, in short phrases, it is possible to repeat instructions due to the patient's slow perception of any information.
In the event of a loss of behavioral adequacy in a neurological patient, I have always effectively used the “cunning”: you need to talk to such a patient as if he were completely normal person, not paying attention to "insults" and other manifestations of "negativity" (unwillingness to engage, denial of treatment, and others). It is not necessary to be verbose, it is necessary to make small pauses so that the patient has time to realize the information.
In case of damage to the peripheral nervous system, flaccid paralysis or paresis develops. If at the same time there is no encephalopathy, then the patient is capable of much: he can independently exercise a little during the day several times, which undoubtedly increases the chance of restoring movements in the limb. Flaccid paresis is more difficult to respond to than spastic paresis.
* Paralysis (plegia) - the complete absence of voluntary movements in the limb, paresis - incomplete paralysis, weakening or partial loss of movement in the limb.
It is necessary to take into account another important factor: whether the patient was engaged in physical education before the disease. If physical exercises were not included in his lifestyle, then rehabilitation in case of a disease of the nervous system becomes much more complicated. If this patient has exercised regularly, then the recovery of the nervous system will be easier and faster. Physical labor at work does not belong to physical education and does not bring benefits to the body, since it is the exploitation of one's own body as a tool for doing work; he does not add health due to the lack of dosing of physical activity and control of well-being. Physical labor is usually monotonous, so there is wear and tear of the body in accordance with the profession. (So, for example, a painter-plasterer “earns” humeroscapular periarthrosis, a loader - osteochondrosis of the spine, a massage therapist - osteochondrosis of the cervical spine, varicose veins of the lower extremities and flat feet, and so on).
For homework physical therapy for diseases of the nervous system it will take ingenuity to select and gradually increase the complexity of exercises, patience, regularity of daily exercises several times during the day. It will be much better if in the family the burden of caring for the sick is distributed to all family members. The house should be in order, cleanliness and fresh air.
It is desirable to put the bed so that it has access from the right and left sides. It should be wide enough to allow the patient to be rolled from side to side when changing bed linen and changing body position. If the bed is narrow, then each time you have to pull the patient to the center of the bed so that he does not fall. You will need additional pillows and rollers to create a physiological position of the limbs in the supine and supine position, a splint for a paralyzed arm to prevent contracture of the flexor muscles, a regular chair with a back, a large mirror so that the patient can see and control his movements (especially the mirror necessary in the treatment of neuritis of the facial nerve).
There should be room on the floor for lying down exercises. Sometimes you need to make handrails for support with your hands in the toilet, in the bathroom, in the corridor. To do therapeutic gymnastics with a neurological patient, you will need a wall bar, a gymnastic stick, elastic bandages, balls of different sizes, skittles, a roller foot massager, chairs of different heights, a step bench for fitness and much more.
Watch the neurological care training video to understand the principles of the technique and how to use it correctly so as not to harm your health. You need to watch carefully, it is better to train on a healthy person who will imitate a paralyzed patient.
"Patient transfer".
"Nursing: Turning to the side for a long time". If the bed is a little wider, then you will not have to pull the patient to the center of the bed each time, it will be enough just to roll him from side to side and put pillows for the physiological position of the limbs and to prevent joint sprains. It is advisable to change the position of the patient every 2 hours in order to avoid bedsores. From this video, remember well that you cannot leave it on the paralyzed side for a long time.
"Patient care: pulling up the patient". Pulling up the patient is one of the most difficult manipulations: you need to save your back and pull up the patient so that the patient's bed linen and shirt do not move; there should be no folds under the patient's body. Remember that you can not pull on the hand to avoid dislocation of the joints and stretching of the ligamentous apparatus.
Treatment of the nervous system It is never easy, you need to tune in to painstaking hard work and create conditions for facilitating patient care as much as possible. Exercise therapy for diseases of the nervous system relates in part to general nursing care. Each neurological disease has its own characteristics, which we will consider in other articles. Therapeutic exercise for diseases of the nervous system in combination with massage, DENS-therapy, Su-jok therapy and other methods of treatment with the obligatory fulfillment of the appointments of a neurologist will surely give positive result. Sometimes it is possible to achieve maximum recovery of movements and even working capacity.
