Exercise therapy for diseases of the nervous system

Physical strength exercises increase the functional restructuring of all key elements nervous system, providing a stimulating effect on both efferent and afferent systems. The basic basis of the mechanism of action of strength physical exercises is the exercise process, 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 increase (cortico-muscular, cortico-visceral, and also muscular-cortical), which contributes to a more coordinated and harmonious functioning of the main functional systems of the body.

Actively involving the patient in the process of conscious and clearly dosed exercise is a powerful stimulator of the formation of subordination influences. The plasticity of the central nervous system allows systematic complexes of physical therapy exercises develop a dynamic stereotype that determines 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 muscle fiber tissue, 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 foci of inflammation. Positive emotions when performing physical exercises develop in the patient against the background of unconditional and conditional connections. They help mobilize various physiological mechanisms and distract the patient from painful experiences.

1. Stroke.
2. Spinal cord injuries and diseases.
3. Lesions of the peripheral nervous system.

Stroke.

In the rehabilitation of patients who have suffered a stroke, there are 3 stages: early (3 months), late (up to 1 year) and the stage of compensation for residual motor function disorders. Therapeutic exercise for strokes is aimed at reducing pathological tone, reducing the degree of paresis (increasing muscle strength), eliminating synkinesis, recreating and developing the most important motor skills. Therapeutic exercises and massage are prescribed when the patient’s condition has stabilized (no increase in symptoms of cardiac and respiratory disorders). Treatment by positioning begins from the first day of illness, passively turning the patient every 1.5-2 hours during the day and 2.5-3 hours at night from the healthy side to the back and to the affected side. When placing the patient in a horizontal position (lying down), you should ensure that the hand of the affected arm is always in the mid-physiological phase, and that the leg does not rest against anything. The upper limb is abducted 90″, extended at all joints and rotated outward. When the tone of the carpal flexor muscles increases, a splint must be applied to the hand with the fingers extended and spread apart. Exposure to pressure on the surface of the hand and sole leads to increased muscle tone and the formation of vicious attitudes. A slightly elevated position of the patient (no more than 30°) with the head of the head is allowed (for mild to 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 - transfer him to a sitting position. The patient can be seated on a bed with his legs down on the 3-5th day from the start of treatment. Transfer to a sitting position is done passively, the patient is provided with sufficient support. The duration of sitting is from 15 minutes to 30-60 minutes or more with good tolerance. The question of the period of expansion of the motor regime during hemorrhagic stroke is decided individually.

1. Restoration of some components of the motor act - methods of active muscle relaxation, training in dosed and differentiated tension 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.
2. Increasing proprioception - overcoming dosed resistance to the movement being performed, using reflex mechanisms of movement (reflex exercises).
3. Restoration of simple friendly movements - training of various options for inter-articular interaction with visual and kinematic control.
4. Revival of motor skills - restoration of individual links of a motor act (skill), learning transitions (connections) from one motor element to another, revival of a motor act as a whole, automation of a restored motor act.

Restoration of impaired motor functions during 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 sections (from the center to the periphery); restoration of motor function of the flexors is ahead of the restoration of movements in the extensors; arm movements appear later than legs; specialized hand movements (fine motor skills) are especially slowly restored. In the process of practicing physical therapy with the patient, the skills of motor activity in a lying position (raising the head, pelvis and body, movements in the limbs, turns) and independent transition to a sitting position are gradually practiced. While maintaining static and dynamic balance (equilibrium) while sitting, the patient learns to move to a standing position (on average on the 7th day for 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 walking with support, however, prolonged use of walking aids inhibits defensive reactions and develops the patient's fear of falling. Gait training includes training in direction of movement (forward, backward, sideways, etc.), step length, rhythm and speed of walking, and walking on stairs. Active and passive movements should not cause increased muscle tone or 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, the complex of exercise therapy for strokes must include breathing exercises (static and dynamic), general strengthening exercises, exercises with objects, exercises on simulators, sedentary and active games. As a rule, an additional small-group or group lesson lasting 15-20 minutes is conducted.

The achieved functionality must be applied in self-service activities. Manipulations with household items, clothing, eating skills, personal hygiene, housekeeping, and behavior in the city are trained. To develop daily activity skills, separate additional training should also be carried out with an occupational therapist lasting 30-40 minutes.

The massage is carried out in a differentiated manner: 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 activating patients are signs of cerebral edema, depression of consciousness; The rate of increase in exercise intensity may be limited in patients with cardiopulmonary problems (failure) and atrial fibrillation.

Spinal cord injuries and diseases.

The main task of exercise therapy for 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 muscular corset, weakening increased muscle tone, and teaching the skills of independent movement and self-care. In case of injuries and diseases of the spinal cord, the nature of motor 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 hypotonia and muscle atrophy, hypo- or areflexia. In this regard, for various forms of movement disorders, the sets of physical exercises differ significantly. The main task of LH for flaccid paralysis is to strengthen muscles, and for spastic paralysis, it is to develop skills to control them.

Exercise therapy classes begin 2-3 days after admission to the hospital; before that, only positional treatment is carried out. The starting position of the patient is lying on his back. LG Provo

do 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 physical therapy techniques are used.

1. Developing voluntary movements in segments, increasing muscle strength - active movements for the affected limbs with relief (on suspensions, in the horizontal plane, in water, after resistance of antagonists), exercises with overcoming resistance, isometric exercises with low exposure, reflex exercises using natural synkinesis , special LH techniques (method of proprioceptive facilitation, method of neuromotor retraining, etc.). If it is impossible to make active movements, use ideomotor exercises and isometric exercises for healthy limbs.
2. Prevention and treatment of muscle atrophy, contractures, deformities - training in methods of active muscle relaxation, passive movements in joints involving paretic muscles, anti-compulsive and ideomotor training, correction of the position of paretic limbs, orthopedic prevention.
3. Recreation and compensation of coordination of movements - complex vestibular gymnastics, a series of exercises for precision and accuracy of movements, training and teaching fine differentiation and dosage of efforts, speed and amplitude of movements, exercises for maintaining balance in a variety of starting positions, a combination of isolated movements in several joints.
4. 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; gradual restoration of gait kinematics, dynamic coordination gymnastics; exercises in a variety of starting positions (lying, kneeling, on all fours, standing), learning to walk independently with and without support.
5. Improving respiratory and cardiovascular activity - static breathing training with dosed resistance, dynamic breathing exercises, passive exercises for the limbs, rotations and rotations of the torso (passive and active), exercises aimed at intact muscle groups.
6. Developing self-care skills - restoring the skills of personal hygiene, nutrition, dressing, moving and housekeeping, handwriting and typing, classes in ego therapy rooms, training behavior skills in the city.
7. Work skills training - classes in occupational therapy rooms and workshops.
8. All of the listed physical therapy methods are closely interrelated and are used in different combinations depending on the patient’s individual treatment plan.

Lesions of the peripheral nervous system.

The objectives of exercise therapy in cases of damage to the peripheral nervous system are considered to be: improvement of blood circulation and trophic processes in the affected limb, strengthening of paretic muscle groups and ligamentous apparatus, prevention of the development of contractures and stiffness of joints, promotion of regeneration of the damaged nerve, development and improvement of 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. They use positioning treatment, massage, LH. Treatment by position is indicated to prevent overstretching of already weakened muscles with the help of splints, stacking, and corrective positions, with the exception of the time of gymnastics. LH uses active movements in the joints of a healthy limb, passive and ideomotor movements of the affected limb (for paralysis), friendly active exercises, active exercises for weakened muscles. Muscle training is carried out in facilitated conditions of their functioning (support 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, selecting optimal starting positions, and try to maintain the development of active movements. If muscle function is satisfactory, active exercises with additional load (resistance to movement, weighting of the limb) are used, aimed at restoring muscle strength, exercises with gymnastic apparatus and equipment, applied sports exercises, and mechanotherapy. LH is carried out for 10-20 minutes with fractional loads throughout the day due to the rapid depletion of the damaged neuromuscular system. Prevention and treatment of contractures includes performing physical exercises that help increase the volume of motor activity in the joints and balance the tone of the flexor and extensor muscles.