Features of exercise therapy in diseases of the nervous system. Therapeutic exercise for injuries and diseases of the central and peripheral nervous system

Heading:

Functional diseases of the nervous system, or neuroses, are various disorders of nervous activity in which there are no visible organic changes in the nervous system or internal organs.

I. P. Pavlov characterized neuroses as follows: “Under neuroses we mean chronic (lasting a week, months and even years) deviations of higher nervous activity from the norm.”

In order to more clearly imagine the mechanism of the therapeutic effect of physical exercises in neuroses, let us briefly familiarize ourselves with the structure and activity of the human nervous system. The nervous system plays a leading role in regulating the activity of internal organs and provides a person with an inextricable connection with the external environment.

The nervous system is divided into central and peripheral.

The central nervous system consists of the brain and spinal cord, and the peripheral nervous system consists of numerous nerves extending from the spinal cord and brain, and a number of clusters of nerve cells located in various organs and tissues outside the central nervous system.

Peripheral nerves are divided into centripetal and centrifugal. Centripetal nerves transmit excitation from various parts of the body to the central nervous system, and centrifugal - from the central nervous system to the muscles, glands and other internal organs, causing and regulating their activity.

Various kinds of influences exerted on the body by the external and internal environment are perceived by organs - analyzers. Analyzers perceive the actions of various stimuli from the external environment - light, sound, mechanical, temperature, chemical and others.

There are analyzers that perceive changes in the contraction or relaxation of muscles, in the chemical composition of the blood, and pressure in the vessels.

Excitation from the analyzer passes into the central nervous system through the nerve cells and their processes. The final link of the analyzer is the nerve cells of the cerebral hemispheres.

Irritations acting on the analyzers cause various reactions of the organism. The responses are called reflexes.

All reflexes are divided into unconditioned and conditional.

Unconditioned reflexes are called congenital, inherited from parents and developed during the long evolutionary development of man.

Examples of unconditioned reflexes can be the secretion of saliva when food is introduced into the mouth, withdrawal of the hand when pricked, alertness at an unusual sound, etc. Although unconditioned reflexes are of great importance in human life, they are still not enough to adapt the body to constantly changing external conditions. environment. And this most important function (adaptation) is performed by conditioned reflexes.

Conditional are reflexes acquired by a person or animal throughout his life in the process of accumulating individual experience. For example, in response to a red traffic light, which is a conditioned stimulus, the driver performs a series of movements that bring the car to a stop. Depending on certain conditions, with the obligatory participation of the cerebral cortex, reflexes arise, improve, persist or fade away.

The most important feature of the formation of conditioned reflexes in humans is that they can be formed when reinforced with verbal stimuli (verbal instructions, commands, etc.).

Studying the patterns of occurrence, course and extinction of conditioned reflex reactions, IP Pavlov and his students studied in detail the processes of excitation and inhibition that develop in the cerebral cortex, which are the main ones in the activity of the central nervous system.

Excitation corresponds to an active state, inhibition - to relative rest.

It is also necessary to dwell on one more feature of higher nervous activity. In most cases, in certain periods of time, people's lives fit into certain limits, proceed in a standard, stereotypical way, for example, at school, at a university, at an institution, at a factory, in a rest home, in a sanatorium, etc. And all this habitual way, a uniformly repeating external routine, an external system of actions, techniques and deeds is reflected and formed in the cerebral cortex as a definite, well-coordinated internal system of nervous processes. This is the so-called dynamic stereotype, that is, a system of fixed, interconnected and sequentially acting conditioned reflexes.

The process of formation or development of a dynamic stereotype is the work of the nervous system, the intensity of which depends on the complexity of the stereotype and on the individual characteristics of the organism.

Soviet physiologists proved that it is easier for the nervous system, even under difficult circumstances, to repeat the same thing than to change the habitual stereotype, to adapt to new stimuli, however weak.

Switching processes are important for maintaining the active function of the central nervous system. Their essence lies in the fact that with a change in the form, nature and intensity of activity, nervous processes are rebuilt, which provides rest for the nerve centers weary from previous work.

Depending on the strength, balance and mobility of the main nervous processes of excitation and inhibition, four types of the nervous system have been identified.

The first is a strong, unbalanced, or "unrestrained" type (choleric). (Classification of the ancient Greek physician Hippocrates.)

The second is strong, balanced, lively (sanguine).

The third is strong, balanced, slow (phlegmatic).

The fourth is weak (melancholic).

Choleric and melancholic neuroses are the most frequently affected.

The type of the nervous system is not something fixed and fixed once and for all. Under the influence of education and training, it is possible to achieve an intensification of excitatory or inhibitory processes and a better balancing of them. Many cases are known when quick-tempered people and sluggish, indecisive people develop in themselves qualities that they lack.

What is the mechanism of occurrence of a functional disease of the nervous system - neurosis?

Neuroses can arise under the influence of extremely acute nervous experiences, leading to the so-called breakdown of higher nervous activity, that is, to such an overstrain of nervous processes when the situation seems or really is hopeless and the search for a way out can lead to completely unjustified actions and actions. Such a breakdown can lead to a long-term functional disease of the nervous system - neurosis. All kinds of chronic infections (tuberculosis, malaria) and poisoning (alcohol, nicotine, lead), which deplete the body, contribute to the formation of neurosis.

By the way, the opinion that many people have that only mental workers suffer from neurosis is completely unfounded, since breakdowns in higher nervous activity can occur in any person, regardless of his profession, as a result of any traumatic factors (violation of the regimen, conflicts, tension, etc.).

Neuroses can be treated with medicines and streamlining the regime of work and life (including rest, training and hardening). It is necessary to recognize both methods as effective in their combination, but it is completely wrong when the patient relies on some kind of magical effect of only “good” drugs taken orally, or on physiotherapeutic procedures, completely missing physical exercises that are distinguished by simplicity and accessibility, natural factors of nature, rational a mode that contributes to the restoration of normal performance by increasing the fitness of the whole organism, and in particular its nervous system.

Physical culture normalizes the activity of internal organs, distracts the patient from thoughts about diseases and involves him in active and conscious participation in the fight against his illness.

A huge mass of signals entering the cerebral cortex during gymnastics, games, swimming, rowing, skiing, etc., increases the tone of the central nervous system and helps eliminate neurosis. With all the main types of neurosis - neurasthenia, hysteria and psychasthenia - our recommendations remain valid, and their individualization is possible after consulting a doctor.

Patients suffering from neurosis, explain the rapid fatigue during physical education, the "weakness" of the heart and unjustifiably stop classes.

But both physical culture and natural factors of nature show their healing effect to the fullest only when combined with the observance of the regime.

A properly organized regime not only strengthens the body, protecting it from diseases (especially nervous ones), but educates the will and increases efficiency.

The elements of the mode are as follows:

1. The right combination of mental and physical work.

2. Normal sleep in hygienic conditions.

3. Morning exercises.

4. Morning water procedures.

5. Regular food intake.

6. Walks (daily).

7. Active rest on a working day (physical education break), on weekends and during vacations.

8. Systematic sports.

With the constant implementation of the regimen, a certain sequence develops in the course of nervous processes (dynamic stereotype), leading to a more economical expenditure of nervous and physical energy.

In the treatment of neuroses, the following forms of therapeutic physical culture are used:

1. Gymnastics.

2. Outdoor and sports games (volleyball, tennis, etc.).

3. Walks.

4. Tourism.

5. Elements of athletics.

6. Skis and skates.

7. Swimming,

8. Rowing.

Of course, during training, strict gradualness should be observed and physical exercises (of any form) must be completed with a feeling of cheerfulness, with a feeling of desire to continue training.

Of particular value are the forms of physical exercises performed in the bosom of nature in the sense of their positive effect on the neuropsychic sphere.

1st COMPLEX OF THERAPEUTIC GYMNASTICS (with less load)

1. IP - legs apart, hands below, fingers interlaced. Raise your hands up, stretch - inhale. 4-6 times. TM.

2. IP - legs apart. Tilt forward, touch the floor with your fingers - exhale. 4 times. TM.

3. IP - the main stand. Tilt the torso to the left (and to the right), without stopping in the starting position, the arms slide along the torso. Breathing is arbitrary. 3-4 times in each direction. TM.

4. IP - hands on the belt. Squat, hands forward - exhale. 6-8 times. TM.

5. IP - legs apart, right hand forward, left bent, hands into a fist. Changing the position of the hands ("boxing"). 10-15-20 times. TB. Breathing is arbitrary.

6. IP - legs apart, hands on the belt. Elbows forward. 3-4 times. TM

7. IP - legs apart, hands on the belt. Turn the body to the left, arms to the sides. 4-5 times in each direction. TM

8. IP - sitting on a chair, legs apart and bent at the knees, hands on the belt. Pull the bent left (right) leg to the chest with your hands. 4-6 times with each leg. TM.

9. IP - hands on the belt. Jump - legs apart, arms to the sides. 10-30 times. Breathing is arbitrary.

10. Walking 1-1.5 min.

11. IP - legs apart, right hand on the chest, left hand on the stomach. Sticking out the chest and stomach-inhale. 3-4 times. TM

2nd COMPLEX OF THERAPEUTIC GYMNASTICS (greater difficulty)

1. IP - main stance - arms up, right (left) leg back on the toe. 6-8 times. TS

2. IP - legs apart, arms to the sides. Tilt forward to the left, touch the left toe with the right hand. 3-4 times in each direction. TS.

3. IP - legs apart, hands up, fingers interlaced. Tilts of the body to the right and left, without stopping in the starting position. Breathing is arbitrary. 3-4 times in each direction. TS

4. IP A - emphasis lying. B. Bend your elbows - exhale IP - inhale. B-version. Simultaneously with the bending of the arms, take the leg back. 6-8-10 times. TS.

5. IP - lying on the back, left palm on the chest, right on the abdomen. Full (diaphragmatic-thoracic) breathing. 3-4 times. TM.

6. IP - lying on your back, arms along the body. Sit down, lean forward and touch your socks with your hands - 5 times. TM

7. IP - legs apart, arms to the sides - up. Arcs forward arms back, deep squat on a full foot, 6-10 times. TS.

8. IP - legs apart, hands up, fingers interlaced. Rotation of the body 3-4 times in each direction. Breathing is arbitrary. TM

9. IP - legs apart. Rise on your toes and pull the brushes to the armpits. 4-5 times. TM.

Above we give approximate sets of gymnastic exercises that can be performed during morning exercises or during the day.

The given complexes of gymnastic exercises, of course, do not exhaust the whole variety of gymnastics. We will try to show on separate examples how it is possible to complicate the performance of some exercises, thereby increasing physical activity.

Lateral torso becomes more difficult when moving the arms up (hands on the belt, hands behind the head, hands up). The load can also be increased by increasing the number of repetitions of exercises and accelerating the pace of their implementation.

If the neurotic sufferer has any other comorbidities, we recommend that you refer to the relevant chapters of this book in order to select exercises for individual practice. Gymnastic exercises often contribute to the disappearance of a headache in a patient with neurasthenia.

When treating headaches with movement, one should avoid changing the position of the head, jerking movements (jumps, punches, etc.) and exercises associated with great straining.

The best starting position is horizontal - lying on your back with a slightly raised headboard. We recommend movements in the ankle, wrist, knee, elbow, hip and shoulder joints, for example:

1. Rotation of the feet and hands.

2. Flexion of the leg at the knee and hip joints.

3. Bending of the arms in the elbow joints.

4. Leading straight arms to the sides, etc.

Therapeutic exercise for lesions of the central nervous system

Diseases of the central nervous system due to various causes, including infection, atherosclerosis, hypertension.

Lesions of the brain and spinal cord are often accompanied by paralysis and paresis. With paralysis, voluntary movements are completely absent. With paresis, voluntary movements are weakened and limited to varying degrees. Exercise therapy is a mandatory component in the complex treatment for various diseases and injuries of the central nervous system, stimulating protective and adaptive mechanisms.

Exercise therapy for strokes:

A stroke is an acute violation of cerebral circulation of various localization. There are two types of strokes: hemorrhagic (1-4%) and ischemic (96-99%).

Hemorrhagic stroke is caused by cerebral hemorrhage, occurs with hypertension, atherosclerosis of cerebral vessels. Hemorrhage is accompanied by rapidly developing cerebral phenomena and symptoms of focal brain damage. Hemorrhagic stroke usually develops suddenly.

Ischemic stroke is caused by a violation of the patency of cerebral vessels due to blockage of their atherosclerotic plaque, embolus, thrombus, or as a result of spasm of cerebral vessels of various localization. Such a stroke can occur with atherosclerosis of cerebral vessels, with a weakening of cardiac activity, a decrease in blood pressure, and for other reasons. Symptoms of focal lesions increase gradually.

Violations of cerebral circulation in hemorrhagic or ischemic stroke cause paresis or paralysis of the central (spastic) on the side opposite the lesion (hemiplegia, hemiparesis), impaired sensitivity, reflexes.

Tasks of exercise therapy:

Restore movement function;

Counteract the formation of contractures;

Contribute to the reduction of increased muscle tone and reduce the severity of friendly movements;

Contribute to the general healing and strengthening of the body.

The method of therapeutic exercises is built taking into account clinical data and the time that has passed since the stroke.

Exercise therapy is prescribed from the 2-5th day from the onset of the disease after the disappearance of the phenomena of a coma.

A contraindication is a severe general condition with a violation of the activity of the heart and breathing.

The method of using exercise therapy is differentiated in accordance with three periods (stages) of rehabilitation treatment (rehabilitation).

I period - early recovery

This period lasts up to 2-3 months. (acute period of stroke). At the onset of the disease, complete flaccid paralysis develops, which after 1-2 weeks. gradually gives way to spastic and contractures begin to form in the flexors of the arm and extensors of the leg.

The process of restoring movement begins a few days after a stroke and lasts for months and years. Movement in the leg is restored faster than in the arm.

In the first days after a stroke, positional treatment, passive movements are used.

Treatment with a position is necessary to prevent the development of spastic contractures or eliminate, reduce existing ones.

Treatment by position is understood as laying the patient in bed so that the muscles prone to spastic contractures are stretched as much as possible, and the points of attachment of their antagonists are brought together. On the hands, spastic muscles, as a rule, are: muscles that adduct the shoulder while simultaneously rotating it inward, flexors and pronators of the forearm, flexors of the hand and fingers, muscles that adduce and flex the thumb; on the legs - external rotators and adductors of the thigh, extensors of the lower leg, calf muscles (plantar flexors of the foot), dorsal flexors of the main phalanx of the thumb, and often of other fingers.

When laying the legs, they occasionally give the leg a position bent at the knees; with an unbent leg, a roller is placed under the knees. It is necessary to put a box or attach a board to the foot end of the bed so that the foot rests at an angle of 90 "to the lower leg. The position of the arm is also changed several times a day, the extended arm is removed from the body by 30-40 ° and gradually to an angle of 90 °, with this shoulder should be rotated outward, forearm supinated, fingers almost straight.This is achieved with a roller, a bag of sand, which is placed on the palm, the thumb is placed in the position of abduction and opposition to the others, i.e. as if the patient captures this roller.In this position, the entire arm is placed on a chair (on a pillow) standing next to the bed.

The duration of treatment with the position is set individually, guided by the patient's feelings. When complaints of discomfort appear, the pain position changes.

During the day, treatment with the position is prescribed every 1.5-2 hours. During this period, treatment with the position is carried out in the IP lying on the back.

If the fixation of the limb reduces the tone, then immediately after it, passive movements are carried out, constantly bringing the amplitude to the limits of physiological mobility in the joint. Start with the distal limbs.

Before the passive exercise, an active exercise of a healthy limb is carried out, i.e. passive movement is previously “learned” on a healthy limb. Massage for spastic muscles is light, superficial stroking is used, for antagonists - light rubbing and kneading, h

II period - late recovery

During this period, the patient is hospitalized. Continue treatment with the position in the IP lying on your back and on a healthy side. Continue massage and prescribe therapeutic exercises.

In therapeutic gymnastics, passive exercises are used for paretic limbs, exercises with the help of an instructor in light IP, holding individual limb segments in a certain position, elementary active exercises for paretic and healthy limbs, relaxation exercises, breathing, exercises in changing position during bed rest.

Control movements to assess the function of arm movement in central (spastic) paresis

1. Raising parallel straight arms (palms forward, fingers extended, thumb abducted).

2. Abduction of straight arms with simultaneous external rotation and supination (palms up, fingers extended, thumb abducted).

3. Bending of the arms in the elbow joints without abduction of the elbows from the body with simultaneous supination of the forearm and hand.

4. Extension of the arms in the elbow joints with simultaneous external rotation and supination and holding them in front of you at a right angle with respect to the body (palms up, fingers extended, thumb abducted).

5. Rotation of the hands in the wrist joint.

6. Contrasting the thumb with the rest.

7. Mastering the necessary skills (combing hair, bringing objects to the mouth, fastening buttons, etc.).

Control movements to assess the function of movement of the legs and muscles of the trunk

1. Bending the leg with sliding the heel on the couch in the supine position (uniform sliding on the couch with the heel with a gradual lowering of the foot until the sole touches the couch at the moment of maximum flexion of the leg at the knee joint).

2. Raising straight legs 45-50 ° from the couch (position on the back,

feet are parallel, do not touch each other) - keep the legs straight with some breeding, without hesitation (if the severity of the lesion is severe, they check the possibility of raising one leg, do not check if blood circulation is disturbed).

3. Rotation of the straight leg inward in the supine position, legs shoulder-width apart (free and complete rotation of the straightened straight leg inward without simultaneous adduction and flexion with the correct position of the foot and toes).

4. "Isolated" flexion of the leg in the knee joint; lying on the stomach - full rectilinear flexion without simultaneous lifting of the pelvis; standing - full and free flexion of the leg at the knee joint with an extended hip with full plantar flexion of the foot.

5. "Isolated" dorsiflexion and plantar flexion of the foot (full dorsiflexion of the foot with an extended leg in the supine and standing positions; full plantar flexion of the foot with a bent leg in the prone and standing position).

6. Swinging of the legs in a sitting position on a high stool (free and rhythmic swinging of the legs in the knee joints simultaneously and alternately).

7. Walking up the stairs.

III period of rehabilitation

In the III period of rehabilitation - after discharge from the hospital - exercise therapy is used constantly in order to reduce the spastic state of the muscles, joint pain, contractures, friendly movements; contribute to the improvement of the function of movement, adapt to self-service, work.

The massage is continued, but after 20 procedures a break of at least 2 weeks is necessary, then the massage courses are repeated several times a year.

Exercise therapy is combined with all types of balneophysiotherapy, medicines.

Exercise therapy for diseases and injuries of the spinal cord

Diseases and injuries of the spinal cord are most often manifested by paresis or paralysis. Prolonged bed rest contributes to the development of hypokinesia and hypokinetic syndrome with its inherent violations of the functional state of the cardiovascular, respiratory, and other body systems.

Depending on the localization of the process, manifestations of paralysis or paresis are different. When the central motor neuron is damaged, spastic paralysis (paresis) occurs, in which muscle tone and reflexes are increased. Peripheral (flaccid) paralysis, paresis are caused by damage to a peripheral neuron.

For peripheral paralysis, paresis is characterized by hypotension, muscle atrophy, the disappearance of tendon reflexes. With the defeat of the cervical region, spastic paralysis, paresis of the arms and legs develop; with the localization of the process in the region of the cervical thickening of the spinal cord - peripheral paralysis, paresis of the hands and spastic paralysis of the legs. Injuries of the thoracic spine and spinal cord are manifested by spastic paralysis, paresis of the legs; lesions of the region of the lumbar thickening of the spinal cord - peripheral paralysis, paresis of the legs.

Therapeutic exercises and massage are prescribed after the acute period of the disease or injury has passed, in the subacute and chronic stages.

The technique is differentiated taking into account the type of paralysis (flaccid, spastic)

With spastic paralysis, it is necessary to reduce the tone of spastic muscles, reduce the manifestation of increased muscle excitability, strengthen paretic muscles and develop coordination of movements. An important place in the technique belongs to passive movements and massage. In the future, with an increase in the range of motion, active exercises play the main role. Use a comfortable starting position when doing exercises.

Massage should help reduce increased tone. Apply techniques of superficial stroking, rubbing and, to a very limited extent, kneading. Massage covers all the muscles of the affected limb. Massage is combined with passive movements.

After the massage, passive and active exercises are used. Passive exercises are carried out at a slow pace, without increasing pain and without increasing muscle tone. To prevent friendly movements, anti-friendly movements are used: they use a healthy limb when exercising with help for the affected one. The occurrence of active movements should be detected under the condition of the most convenient starting position. Active exercises are widely used to restore the function of movement. Stretching exercises are recommended. When the hands are affected, exercises in throwing and catching balls are used.

An important place in the methodology belongs to exercises for the muscles of the body, corrective exercises to restore the function of the spine. Equally important is learning to walk.

In the late period after the disease, injuries also use therapeutic exercises using the initial positions lying, sitting, standing.

Duration of procedures: from 15-20 minutes in the subacute period and up to 30-40 minutes - in subsequent periods.

When discharged from the hospital, the patient continues to study constantly.

Exercise therapy for atherosclerosis of cerebral vessels

The clinical picture is characterized by complaints of headache, decreased memory and performance, dizziness and tinnitus, poor sleep.

Tasks of exercise therapy: at the initial stage of circulatory insufficiency of the brain:

To have a general health and general strengthening effect,

Improve cerebral circulation

Stimulate the functions of the cardiovascular and respiratory systems,

Increase physical performance.

Contraindications:

Acute cerebrovascular accident

vascular crisis,

Significantly reduced intelligence.

Forms of exercise therapy: morning hygiene

gymnastics, medical gymnastics, walks.

Patients aged 40-49 years in the first section of the procedure of therapeutic exercises should use walking at a normal pace, with acceleration, jogging, alternating with breathing exercises and exercises for the muscles of the arms and shoulder girdle while walking. The duration of the section is 4-5 minutes.

II section of the procedure

In section II, exercises for the muscles of the arms and shoulder girdle are carried out in a standing position with elements of static effort: torso tilts forward - backward, to the sides, 1-2 s. Exercises for the large muscles of the lower extremities when alternating with exercises for relaxing the muscles of the shoulder girdle and dynamic breathing in a combination of 1: 3, and also use dumbbells (1.5-2 kg). The duration of the section is 10 min.

Section III of the procedure

In this section, it is recommended to perform exercises for the muscles of the abdomen and lower extremities in the prone position in combination with head turns and in alternation with dynamic breathing exercises; combined exercises for arms, legs, torso; resistance exercises for the muscles of the neck and head. The pace of execution is slow, one should strive for a full range of motion. When turning the head, hold the movement in the extreme position for 2-3 s. The duration of the section is 12 minutes.

Section IV of the procedure

In a standing position, perform exercises with torso tilts forward - backward, to the sides; exercises for arms and shoulder girdle with elements of static effort; leg exercises combined with dynamic breathing exercises; balance exercises, walking. The duration of the section is 10 minutes.

In the sitting position, exercises with movements of the eyeballs, for the arms, and the shoulder girdle for relaxation are recommended. The duration of the section is 5 minutes.

The total duration of the lesson is 40-45 minutes.

Therapeutic gymnastics is used daily, increasing the duration of classes to 60 minutes, using gymnastic sticks, balls, exercises on apparatus (gymnastic wall, bench) in addition to dumbbells, general exercise machines are used.

Bibliography

1. Gotovtsev P.I., Subbotin A.D., Selivanov V.P. Therapeutic physical culture and massage. -- M.: Medicine, 1987.

2. Dovgan V.I., Temkin I.B. Mechanotherapy. -- M.: Medicine, 1981.

3. Zhuravleva A.I., Graevskaya N.D. Sports medicine and exercise therapy. -- M.: Medicine, 1993.

4. Therapeutic physical culture: Handbook / Ed. V.A. Epifanov. -- M.: Medicine, 1983.

5. Physical therapy and medical supervision / Ed. V.A. Epifanova, G.L. Apanasenko. -- M.: Medicine, 1990.

6. Physiotherapy exercises in the system of medical rehabilitation / Ed. A.F. Kaptelina, I.P. Lebedeva. -- M.: Medicine, 1995.

7. Loveiko I.D., Fonarev M.I. Therapeutic physical culture in diseases of the spine in children. -- L.: Medicine, 1988.

Diseases of the central nervous system due to various causes, including infection, atherosclerosis, hypertension.

Exercise therapy for strokes

A stroke is an acute violation of cerebral circulation of various localization. There are two types of strokes: hemorrhagic (1-4%) and ischemic (96-99%).

Task and exercise therapy:

restore movement function;
counteract the formation of contractures;
contribute to the reduction of increased muscle tone and a decrease in the severity of friendly movements;
contribute to the overall health and strengthening of the body.

The method of therapeutic exercises is built taking into account clinical data and the time that has passed since the stroke.

Exercise therapy is prescribed from the 2-5th day from the onset of the disease after the disappearance of the phenomena of a coma.

A serious general condition with a violation of the activity of the heart and respiration serves as a counter-indication.

The method of using exercise therapy is differentiated in accordance with three periods (stages) of rehabilitation treatment (rehabilitation).

I period - early recovery

The process of restoring movement begins a few days after a stroke and lasts for months and years. Movement in the leg is restored faster than in the arm.

In the first days after a stroke, positional treatment, passive movements are used.

Treatment with a position is necessary to prevent the development of spastic contractures or eliminate, reduce existing ones.

Fixation or laying of limbs for the purpose of prevention or correction should not be prolonged. This requirement is due to the fact that by bringing together the points of attachment of antagonist muscles for a long time, one can cause an excessive increase in their tone. Therefore, the position of the limb should be changed during the day. When laying the legs, they occasionally give the leg a position bent at the knees; with an unbent leg, a roller is placed under the knees. It is necessary to put a box or attach a board to the foot end of the bed so that the foot rests at a 90 ° angle to the lower leg. The position of the arm is also changed several times a day, the extended arm is withdrawn from the body by 30-40 ° and gradually to an angle of 90 °, while the shoulder should be rotated outward, the forearm is supinated, the fingers are almost straightened. This is achieved with the help of a roller, a bag of sand, which is placed on the palm, the thumb is set in the position of Abduction and opposition to the rest, that is, as if the patient captures this roller. In this position, the entire arm is placed on a chair (on a pillow) standing next to the bed.

The duration of treatment with the position is set individually, guided by the patient's feelings. When complaints of discomfort, pain, position change.

During the day, treatment with the position is prescribed every 1.5-2 hours. During this period, treatment with the position is carried out in the IP lying on the back.

II period - late recovery

During this period, the patient is hospitalized. Continue treatment with the position in the IP lying on your back and on a healthy side. Continue massage and prescribe therapeutic exercises.

Table 7. Approximate scheme of the procedure of therapeutic exercises for hemiparesis in the early period for patients on bed rest (8-12 procedures)

Exercise	Dosage	Guidelines and Applications
		Familiarization with the patient's well-being and the correct position, counting the pulse, removing the splint
Exercise for a healthy hand	4 - 5 times	Involving the wrist and elbow joints
Exercise in bending and straightening the sore arm at the elbow	3 - 4 times	Extension with a healthy hand
Breathing exercise	3 - 4 min
Exercise for a healthy leg	4 - 5 times	Involving the ankle joint
Shoulder raise and lower exercise	3 - 4 times	Alternate option: mixing and breeding, hands are passive. Combine with breathing phases
Passive movements in the joints of the hand and foot	3 - 5 times	Rhythmically, with increasing amplitude. Combine with stroking and rubbing
Active pronation and supination in the elbow joints with the arms bent	6 - 10 times	Help with supination
Rotation of the good leg	4 - 6 times	Active, with a large amplitude
Rotation of the affected leg	4 - 6 times	If necessary, help and strengthen internal rotation
Breathing exercise	3 - 4 min	Medium depth breathing
Possible active exercises for the hand and fingers with the vertical position of the forearm	3 - 4 times	Support, help, enhance extension
Passive movements for all joints of the paralyzed limb	3 - 4 times	Rhythmically, in increasing volume depending on the state
Legs bent: abduction and adduction of the bent hip	5 - 6 times	Help and facilitate the exercise. Variation: abduction and adduction of bent hips
Breathing exercise	3 - 4 min
Active circular movements of the shoulders	4 - 5 times	With the help and regulation of the phases of breathing
Arching the back without lifting the pelvis	3 - 4 times	Voltage limited
Breathing exercise	3 - 4 min
Passive movements for the hand and fingers	2 - 3 times	Reduce stiffness as much as possible
Total:	25 - 30 mi

Notes.

1. During the procedure, make pauses for rest lasting 1-2 minutes.
2. At the end of the procedure, ensure the correct position of the paretic limbs.

To prepare for getting up, you should use an imitation of walking while lying down, gradually transfer to a vertical position. All active exercises are carried out on the exhale. In the initial position of sitting and standing, exercises with a gymnastic stick, with the help of a healthy hand, exercises for the body - turns, slight bends forward, backward, to the sides (Table 8) are added to lightweight exercises.

Control movements to assess the function of arm movement in central (spastic) paresis

Raising parallel straight arms (palms forward, fingers extended, thumb abducted).
Abduction of straight arms with simultaneous external rotation and supination (palms up, fingers extended, thumb abducted).
Flexion of the arms in the elbow joints without abduction of the elbows from the body with simultaneous supination of the forearm and hand.
Extension of the arms in the elbow joints with simultaneous external rotation and supination and holding them in front of you at a right angle with respect to the body (palms up, fingers extended, thumb abducted).
Rotation of the hands in the wrist joint.
Contrasting the thumb with the rest.
Mastering the necessary skills (combing, bringing objects to the mouth, fastening buttons, etc.).

Control movements to assess the function of movement of the legs and muscles of the trunk

Bending the leg with sliding the heel on the couch in the supine position (uniform sliding on the couch with the heel with a gradual lowering of the foot until the sole touches the couch at the moment of maximum flexion of the leg at the knee joint).
Raising straight legs 45-50 ° from the couch (position on the back, feet parallel, do not touch each other) - keep the legs straight with some dilution, without hesitation (if the severity of the lesion is severe, they check the possibility of raising one leg, do not check if blood circulation is disturbed) .
Rotation of the straight leg inward in the supine position, legs shoulder-width apart (free and complete rotation of the straightened straight leg inward without simultaneous adduction and flexion with the correct position of the foot and toes).
"Isolated" flexion of the leg at the knee joint; lying on the stomach - full rectilinear flexion without simultaneous raising the pelvis; standing - full and free flexion of the leg at the knee joint with an extended hip with full plantar flexion of the foot.
"Isolated" dorsiflexion and plantar flexion of the foot (full dorsiflexion of the foot with an extended leg in the supine and standing positions; full plantar flexion of the foot with a bent leg in the prone and standing positions).
Swinging of the legs in a sitting position on a high stool (free and rhythmic swinging of the legs in the knee joints simultaneously and alternately).
Walking up the stairs.

Table 8. Approximate scheme of the procedure of therapeutic exercises for hemiparesis in the late period

	Section and content of the procedure	Duration, min	Guidelines	Purpose of the procedure
1	IP-sitting, standing. Elementary active exercises for healthy muscle groups performed by patients without difficulty	3 - 4	You can include exercises with a healthy hand	Introductory part of the procedure with moderate general stimulation of the neuromuscular system
II	IP - sitting, lying down. Passive movements in the joints of the paretic limbs; relaxation exercises with a healthy limb; roller rolling	5 - 6	With warm hands, calmly, smoothly, with a large amplitude, avoid synkinesis accompanying the movement	Increase the range of motion in the joints, reduce the manifestation of muscle rigidity, counteract the manifestation of pathological friendly movements
III	IP - standing. Walking in different ways	3 - 4	Insure if necessary; use the pattern on the floor, carpet. Monitor the position of the foot and the posture of the patient: correct flexion synkinesis in females	To teach walking both on level ground and with overcoming elementary obstacles, as well as walking up stairs
IV	IP-sitting, lying, standing. Active exercises for paretic limbs in light initial positions, alternating with exercises for the body and breathing, exercises to improve friendly and anti-friendly movements, alternating with muscle relaxation exercises	7 - 8	If necessary, provide assistance to the patient, achieve differentiated movements. To relax muscles and reduce rigidity, introduce passive muscle shaking, massage, rolling on a roller	Development of precise coordinated and differentiated movements in the joints of paretic limbs
V	Exercises in walking, throwing and catching balls of different sizes	4 - 5	Include swing movements with the ball. Perform posture correction	Learning to walk. Increase the emotional content of the procedure
VI	IP - sitting. Exercises with balls, cubes, plasticine, stairs, rollers, balls, as well as exercises for developing practical skills (fasten buttons, use a spoon, pen, etc.)	8	Pay special attention to the development of the function of the hand and fingers	Development of practical skills needed in everyday life
Total:		30 - 35

III period of rehabilitation

The massage is continued, but after 20 procedures a break of at least 2 weeks is necessary, then the massage courses are repeated several times a year.

Exercise therapy is combined with all types of balneophysiotherapy, medicines.

Exercise therapy for diseases and injuries of the spinal cord

Peripheral (flaccid) paralysis, paresis are caused by damage to a peripheral neuron.

For peripheral paralysis, paresis is characterized by hypotension, muscle atrophy, the disappearance of tendon reflexes. With the defeat of the cervical region, spastic paralysis, paresis of the arms and legs develop; with the localization of the process in the area of the cervical thickening of the spinal cord - peripheral paralysis, paresis of the hands and spastic paralysis of the legs. Injuries of the thoracic spine and spinal cord are manifested by spastic paralysis, paresis of the legs; lesions of the region of the lumbar thickening of the spinal cord - peripheral paralysis, paresis of the legs.

Therapeutic exercises and massage are prescribed after the acute period of the disease or injury has passed, in the subacute and chronic stages.

The technique is differentiated taking into account the type of paralysis (flaccid, spastic) (Table 9).

Table 9. Scheme of physiotherapy exercises for various forms of movement disorders

Type of exercise	With sluggish forms	With spastic forms
Sending an impulse	Required	not significant
Massage	Deep	Surface
Exercises for "isolated" paretic muscles	not significant	Very important
The fight against increased reflex excitability	Need not	Required
Exercises that bring muscle attachment points closer together	Showing	Contraindicated
Exercises that remove muscle attachment points (stretching)	Contraindicated	Showing
Force Exercises	Required	Contraindicated
Position correction	Required	Required
Movements in water (in a warm bath)	Showing	Very important
Support function development	Extremly necessary	Necessary

Massage should help reduce increased tone. Apply techniques of superficial stroking, rubbing and very limited kneading. Massage covers all the muscles of the affected limb. Massage is combined with passive movements.

With flaccid paralysis (paresis), massage is also prescribed. Apply kneading, vibration, tapping techniques with an intense effect on the muscles. Massage is combined with the use of passive and active exercises. Sending impulses to the movement is used. When performing active exercises, conditions are created to facilitate their work. In the future, exercises with weights, effort are used. For hands, standing swing movements are used with the body tilted forward, with maces, dumbbells.

Considering pelvic disorders, it is necessary to include exercises for the muscles of the pelvis, sphincters, legs.

An important place in the methodology belongs to exercises for the muscles of the body, corrective exercises to restore the function of the spine. Equally important is learning to walk.

The sequence of IP and exercises in learning to walk in flaccid paralysis

Lying on your back (side, stomach).
On knees.
Crawl.
On my knees
Walking on your knees under a horizontal ladder.
The transition from a sitting position to a standing position with support on the gymnastic wall.
Walking under the stairs.
Walking on crutches with the help of an instructor.
Walking on crutches without the help of an instructor.

The sequence of IP and exercises in learning to walk with spastic paralysis

Lying on your back (side, stomach).
sitting.
Get up and sit down with the help of staff.
Walking with staff support, walking with one crutch.
Exercises at the gymnastic wall (sitting, standing, squatting).
Exercises on all fours, on your knees.
Independent walking on crutches and with one stick.

In the late period after the disease, injuries also use therapeutic exercises using the initial positions lying, sitting, standing.

Treatment with position is necessary for both spastic and flaccid paralysis.

Duration of procedures: from 15-20 minutes in the subacute period and up to 30-40 minutes - in subsequent periods.

When discharged from the hospital, the patient continues to study constantly.

Exercise therapy for atherosclerosis of cerebral vessels

The clinical picture is characterized by complaints of headache, decreased memory and performance, dizziness and tinnitus, poor sleep.

Task and exercise therapy: at the initial stage of cerebral circulatory insufficiency:

to have a general healing and strengthening effect,
improve cerebral circulation,
stimulate the functions of the cardiovascular and respiratory systems,
improve physical performance.

R o t i n o o p o n o n i o n :

acute violation of cerebral circulation,
vascular crisis,
significantly reduced intelligence.

Forms of exercise therapy: morning hygienic gymnastics, therapeutic exercises, walks.

I section of the procedure

II section of the procedure

Section III of the procedure

In this section, it is recommended to perform exercises for the muscles of the abdomen and lower extremities in the prone position in combination with head turns and in alternation with dynamic breathing exercises; combined exercises for arms, legs, torso; resistance exercises for the muscles of the neck and head. The pace of execution is slow, you should strive for a full range of motion. When turning the head, hold the movement in the extreme position for 2-3 s. The duration of the section is 12 minutes.

Section IV of the procedure

The total duration of the lesson is 40-45 minutes.

The modern world is mobile, each person daily encounters a huge number of people, faces flicker in public transport, at work, in shops, in parks. Also, every person in this life lies in wait for problems and worries. In such a situation, perhaps, it is difficult to do without stress. The nervous system is “responsible” for the stability of the human psyche. And, if stress is almost impossible to avoid, then taking care of your nerves is possible.

How to strengthen the nervous system? We will talk about this in this article.

General information

An active lifestyle, regular walks in the fresh air will help strengthen the nervous system.

In order to increase efficiency, reduce fatigue, better resist stress, it is necessary to strengthen the nervous system. The following methods will help you do this:

hardening;
physical exercise;
avoiding excessive alcohol consumption, smoking, and the use of psychoactive substances;
the use in nutrition of products useful for the nervous system;
rational organization of work and rest, good sleep;
if necessary, the use of medicinal plants and certain medicines;
psychophysical practices, such as yoga, meditation.

hardening

Hardening consists in a systematic, repeated exposure to the body of some external factors: cold, heat, ultraviolet rays. In this case, the body's reflex responses to these stimuli are modified. As a result, not only increases the resistance to cold, heat, and so on. Hardening has a pronounced non-specific effect, which manifests itself in improving performance, educating the will and other useful psycho-physiological qualities.

Hardening can only be successful if it is applied correctly. For this, the following conditions must be met:
1. A gradual increase in the strength of the stimulus, for example, start water procedures with water at room temperature.
2. The systematic nature of hardening procedures, that is, their daily use, and not from case to case.
3. The correct dosage of the irritant, given that the strength of the stimulus is decisive, and not the duration of its action.

There is a lot of literature on hardening with which you can develop your own personal training program. At the same time, one should not forget about the rule “everything is good in moderation”.

Physical exercise

Physical exercises are varied. Conventionally, they can be divided into gymnastics, sports, games and tourism. Regular physical activity helps to increase mental and physical performance, slow down the development of fatigue, prevent many diseases of the nervous system and internal organs, as well as the musculoskeletal system.

Physical exercise relieves mental stress. This is especially important for people engaged in mental work. The alternation of mental work with physical work switches the load from one brain cell to another, which helps to restore the energy potential of tired cells.
Of great importance for strengthening the nervous system is regular walking in the fresh air. It combines elements of physical exercise and hardening, is easily dosed, and does not require any financial costs.

Rejection of bad habits

As you know, alcohol is a poison that primarily affects the nervous system. It causes increased excitation and disrupts the processes of inhibition. Long-term use of alcohol, even in small doses, leads to the development of alcoholic encephalopathy, a brain disease accompanied, among other things, by memory loss, impaired thinking and learning ability.

Smoking leads to a deterioration in memory and attention, a decrease in mental performance. This is due to the narrowing of the brain vessels during smoking and its oxygen starvation, as well as the direct toxic effect of nicotine and other harmful substances contained in tobacco smoke.

The use of psychoactive substances leads to a rapid excitation of the nervous system, which is replaced by nervous exhaustion. This is also true for caffeine, which in large doses often leads to a decrease in mental performance.

Proper nutrition

Vitamin B1 is very important for the nervous system. You should eat enough foods containing it.

The normal content of protein in food is very important for the state of higher nervous activity. It increases the tone of the central nervous system and accelerates the development of reflexes, improves memory and learning ability. Proteins of chicken meat, soy, fish are useful for the nervous system. In addition, it is recommended to consume more proteins with a phosphorus content. They are found in egg yolks, milk, caviar.

Fats cannot be excluded from the diet, as they have a tonic effect on the nervous system, improving performance and emotional stability.

Carbohydrates are a source of energy for the brain. Carbohydrates contained in cereals are especially valuable in this respect. A decrease in the content of carbohydrates in the body causes general weakness, drowsiness, memory loss, and headaches.

Vitamins are very important for the function of the nervous system. The lack of vitamin B1 is expressed in the weakening of memory, attention, irritability, headache, insomnia, increased fatigue. It is found in bran bread, peas, beans, buckwheat, oatmeal, liver, kidneys, egg yolk.
Hypovitaminosis B6 is a rare occurrence, accompanied by weakness, irritability, and gait disturbance. Vitamin B6 is synthesized in the intestines, found in the liver, kidneys, wholemeal bread, and meat.

Of the microelements, phosphorus will help strengthen the nervous system. It is found in the greatest quantities in cheese, cottage cheese, eggs, caviar, buckwheat and oatmeal, legumes, fish and canned fish.
The inclusion of these substances in the diet will help strengthen the nervous system.

Daily regime

Daily routine - the distribution in time of various activities and recreation, meals, exposure to fresh air, sleep. The correct mode of the day increases efficiency, forms emotional stability. The daily routine is individual for each person and depends on age, profession, state of health, climatic and other conditions. It is desirable that it be permanent. It is necessary to take into account the daily rhythm of the physiological functions of the body, adapt to it, increase or decrease the load in certain periods of the day.

Night sleep should last at least 7 hours. The younger the person, the longer the sleep should be, the earlier it should begin. Systematic lack of sleep and insufficiently deep sleep lead to exhaustion of the nervous system: irritability, fatigue appear, appetite worsens, and the activity of internal organs suffers.

The most useful sleep that begins no later than 23 - 24 hours and ends by 7 - 8 hours. Afternoon sleep lasting 1 - 2 hours is recommended for children and the elderly. It is important to have a constant time for going to bed and getting up. Before going to bed, a walk in the fresh air is advisable, dinner should be 2 to 3 hours before bedtime. It is necessary to create a favorable environment: silence, darkness or twilight, air temperature not higher than 18 - 20 ° C, clean air and a comfortable bed.

Medicinal plants and medicines

In some cases, for good performance, increased tone of the nervous system, improved memory, attention, pharmacological agents (plants and medicines) can be prescribed. Decoctions and infusions with lemon balm, viburnum, wild rose, motherwort, chamomile, valerian and other plants will help strengthen the nervous system. With depression, apathy, weakness, lemongrass, eleutherococcus, echinacea can help.

To restore the balance of excitation and inhibition, drugs are sometimes prescribed, such as Persen, Novo-Passit and others. Most of them are of plant origin. More serious drugs can be taken only as prescribed by a doctor.

Psychophysical practices

The simplest method of strengthening the nervous system is massage and self-massage. There are many different methods, the essence of which lies in the influence of certain physical and mental stress on the activity of the nervous system. These include primarily yoga, as well as some martial arts. The combination of meditation and exercise has a beneficial effect on the function of the nervous system.
Do not get carried away by the dubious practices offered at various seminars. Most often, they will not strengthen the nervous system, but will lead to the opposite result.

One of the leading directions in the therapy of vegetative-vascular disorders is exercise therapy. Its therapeutic effect in diseases of the autonomic nervous system (ANS) is due to the fact that proprioceptive impulses in combination with skin reception form a complex differentiation that suppresses pathological interoreceptive impulses, thereby normalizing the functions of the autonomic nervous system.

The purpose and objectives of physical education

The goal and objectives of exercise therapy for diseases of the ANS are to improve adaptation, increase efficiency, improve blood circulation, respiratory function, metabolism, normalize the tone of the vascular wall, relax muscles and improve coordination of movements.

When compiling a set of exercises in patients with vegetative-emotional disorders, it is necessary to determine the state of vegetative tone (sympathicotonia, vagotonia, mixed).

Patients with central disorders of a permanent nature are prescribed the following types of exercises:
1. Respiratory
2. To relax (with sympathicotonia).
3. Power - exercises with muscle strengthening, weight-bearing shells, resistance (with vagotonia).
4. Speed-strength - running, jumping, jumping, etc.

Motor modes - general, and in sanatorium conditions - sparing, sparing-training and training. In general and sparing modes, the main attention is directed to the study of the psychological characteristics of the patient, the normalization of respiratory and motor functions with a gradual increase in load under the control of vegetative indicators (vegetative tone, vegetative reactivity and vegetative support of activity). Patients should avoid sudden movements, turns, tilts. Breathing exercises are used, for relaxation, balance, coordination, then power and speed-strength are added.

With vagotonia, patients need regular, dosed physical activity throughout their lives. Of the gymnastic exercises, in addition to free movements for the arms, legs and body, it is recommended to use exercises for large muscle groups: exercises with overcoming the gravity of the body (squats, mixed hangings, soft lunges), exercises with weights (dumbbells, "medicine ball"), resistance and volitional tension (dynamic and isometric with a breath hold of no more than 2-3 s).

These exercises cause an increase in blood pressure and place increased demands on cardiac activity, so their use should be carried out within a strict dosage in alternation with breathing exercises. Individual and group methods of conducting classes are recommended. It is advisable to combine therapeutic exercises with walking, health path, swimming, tourism, skiing and massage of the head, collar zone, upper and lower extremities and reflex types of massage (segmental, acupressure, shiatsu, etc.).

With sympathicotonia, exercise therapy is used in the following forms: morning exercises, therapeutic exercises, health path, swimming, close tourism, outdoor games (volleyball, towns, badminton), physical exercises in water, exercises on simulators, massage of the collar zone, head, face, shoulder girdle.

The main form of exercise therapy is therapeutic exercises, which are carried out daily for 20-30 minutes, rhythmically, at a calm pace, with a large range of motion. It is recommended to combine with static and dynamic breathing movements, as well as special types of breathing exercises.

Special exercises for sympathicotonia include exercises to relax various muscle groups, to improve coordination. It is advisable to use linear and acupressure massage.

In the LH complex in the general regimen, there should be general strengthening exercises in combination with all types of breathing exercises.

We give an approximate list of special exercises that can be included in the exercise therapy complex for permanent manifestations of vegetative-vascular dysfunction.

Strength exercises

1. I.p. - lying on your back: raising straight legs.
2. I.p. - the same: "bicycle".
3. I.p. - the same: movements with straight legs in the vertical and horizontal plane ("scissors").
4. I.p: - sitting or standing. Hands with dumbbells lowered: bending the arms at the elbow joints.
5. I.p. - standing, hands on the belt: squat with straightening the arms forward.
6. I.p. - lying on the stomach, hands in support in front of the chest: push-ups.
7. I.p. - standing facing the partner or the wall, one leg in front, palms resting in the palms of the partner: alternately bending and unbending the arms with resistance.
8. I.p. - standing facing the partner, hands on the shoulders of the partner: torso to the side with resistance with the hands.
9. I.p. - standing, arms with dumbbells lowered, torso forward with arms extended to the sides.

The number of repetitions of each exercise is determined by the patient's condition.

Speed-strength exercises

1. I.p. - standing, arms to the sides: energetic rotations in the shoulder joints with a small amplitude at a fast pace.
2. I.p. - standing, feet shoulder-width apart, torso slightly tilted forward, arms bent at the elbow joints, elbows pressed to the body: movements that imitate the work of the hands when running, at a fast pace.
3. I.p. standing, hands on the belt: jumps on one or two legs.
4. I.p. - standing, legs apart, arms lowered, taken to the "castle": "lumberjack", at a fast pace (contraindicated in osteochondrosis of the spine).

5. I.p. - standing, arms bent at the elbow joints: movements imitating boxing, at a fast pace.
6. I.p. - the same: running in place or in motion.

Relaxation exercises

1. I.p. - lying on your back: raise your arms up and passively lower them.
2. I.p. - sitting, the torso is slightly tilted forward: free swinging with relaxed arms lowered down.
3. I.p. - standing: the same.
4. I.p. - the same: raise your hands up and relax them to your shoulders, waist, down.

An approximate combination of massage points for vagotonia:

1st session: bai-hui (U20), he-gu (014) symmetrically, zu-san-li (EZ) on the left; gao-huang (Y43) symmetrically - 10 minutes per point, toning method.
2nd session: Wai Kuan (TK5) and Xin Shu (U15) on the right, Ling Qi on the left.
3rd session: lao-gong (SS8) and shian-wai-shu (S14) symmetrically.
4th session: nei guan (TK61) and qing li. In the evening, the patient performs self-massage he-gu (Ol4) and san-yin-jiao (NRb) symmetrically for 5 minutes.

Approximate combination of massage points for sympathicotonia

1st session: bai-hui (U020), he-gu (014) on the left, feng-chi (P20), shu-san-li (E3b) on the right - by calming down.
2nd session: shen-men (C7).
3rd session: strong irritation for 10 minutes of the shen-men point (C7) - symmetrically, moderate irritation bai-hu-hei (U020) for 1 minute, he-gu (014) symmetrically or yin-tang (VM) , shu-san-li (E3b) on the left.
4th session: massage of San-Yin-Jiao (KRb), Dv-Ling (KP7), Shen-men (C7) points.

In a crisis course of vegetative-vascular dysfunction in the interictal period, it is appropriate to carry out the therapeutic and gymnastic measures described above, depending on the sympathetic or parasympathetic predominance. In the future, therapeutic measures should be aimed at preventing vegetative paroxysms.

The main task of this period is the normalization of nervous regulation, due to the improvement of motor-visceral reflexes. The general mode of LH includes exercises for large muscle groups, the latter contribute to the activation of tissue oxidases, improve the utilization of oxygen by tissues. Breathing exercises of both static and dynamic nature should be special for the fulfillment of the assigned tasks. Exercises of an emotional nature with the use of auxiliary objects, outdoor games are widely used.

These patients are shown sanatorium treatment with the appointment of approximately the following complexes of therapeutic exercises:

For patients with sympathetic-adrenal paroxysms

gentle mode
1. I.p. - sitting, hands on knees: hands up - inhale, lower - exhale. Repeat 4-6 times. Breathing is rhythmic.
2. I.p. - sitting, legs extended: rotation of the feet and hands in both directions. Repeat 15-20 times. Breathing is arbitrary.
3. I.p. - sitting: hands up - inhale, pull the knee to the stomach - exhale. Repeat 4-6 times. Breathing with an emphasis on exhalation.
4. I.p. - sitting, arms freely lowered, brushes to reach the shoulders. Circular movements of the elbows in both directions. Repeat 4-6 times. Breathing is arbitrary.
5. I.p. - sitting, hands in front of the chest: turning the body with spreading the arms to the sides - inhale, return to SP. - exhale. Repeat 3-4 times.
6. I.p. - standing or lying down: alternate bending of the legs - exhale, return to I.p. - breath. Repeat 3-4 times.
7. I.p. - sitting, arms to the sides - inhale, cross your arms in front of your chest, bend over - exhale. Repeat 4-6 times.
8. I.p. - sitting or standing: spreading the arms to the sides and fixing them with tension, return to the SP, relax the muscles as much as possible. Repeat 4-6 times. Breathing with an emphasis on exhalation.
9. Walking with a gradual slowdown for 1.5-2 minutes.
10. Repeat exercise 1.

Gentle training mode

1. I.p. - standing, legs apart, arms lowered: raise your arms through the sides up - inhale, lower - exhale. Repeat 4-6 times. The inhalation-exhalation ratio is 1:2, 1:3.
2. I.p. - standing, hands to shoulders: circular rotation of the elbows in both directions. Repeat 6-8 times. Breathing is arbitrary.
3. I.p. - standing, hands in front of the chest: turning the body with spreading the arms to the sides - inhale, return to ip. - exhale. Repeat 6-8 times.
4. I.p. - standing, legs apart, arms lowered: squats on a full foot - exhale, return to ip. - breath. Repeat 6-8 times. Breathing with an emphasis on exhalation.
5. I.p. - standing, arms along the body: arms up - inhale, lower your hands - exhale. Repeat 3-4 times.
6. I.p. - standing, hands on the belt: bend the leg at the knee and hip joints, pull it to the stomach - inhale, return to ip. - exhale. Repeat 4-6 times.
7. I.p. - standing, in the hands of a dumbbell (1.5 kg): hands forward, fixing them with subsequent relaxation. Perform within 30 s. Do not hold your breath while exhaling.
8. I.p. - standing: calm walking for 2 minutes. Breathing is even.
9. I.p. - standing, hands lean against the wall at chest level: press the wall as much as possible, then relax the muscles of the arms and torso. Perform within 5 s. Don't hold your breath.
10. I.p. standing: repeat exercise 1.
11. I.p. - standing, in the hands of a stuffed ball. throw the ball up, turn 90 "and catch it. Perform for 1.5 minutes.

E.A. Mikusev, V.F. Bakhtiozin