Motor Stereotype Research Articles

Features of postural control in children with severe forms of idiopathic scoliosis

Objective. The study of postural stability in children with severe degrees of idiopathic scoliosis and assessment of body balance disorders after surgical correction of spinal deformity.
 Material and methods. The study of 18 patients aged 1417 years with idiopathic scoliosis of the IIIIV degree with localization of the main arc according to Lenke I, III, V and VI was conducted. The vertical balance of the body was evaluated using a stabilometric platform MBN "Biomechanica" (LLC "MBN", Moscow) before and 910 days after the surgical correction of spinal deformity using transpedicular spinal systems. The results were compared with a stabilometric survey of 18 healthy children.
 Results. In patients with idiopathic scoliosis before surgery, a decrease in the stability of the vertical balance of the body, manifested by pronounced deviations from the nominal values of the stabilometric parameters, was revealed. The correlation analysis showed a pathologically strong relationship between the length L, the area S and the amplitude of fluctuations of the pressure center A in patients statokinesiograms compared to the group of healthy children.
 In the immediate postoperative period, the postural control system disorders are aggravated in patients.
 Conclusions. In children with severe idiopathic scoliosis, violations of the postural control system were revealed, which led to the formation of a suboptimal motor stereotype due to dysfunction of sensorimotor integration.

INFLUENCE OF MEANS OF PHYSICAL THERAPY ON SIGNS OF DORSOPATHIES AT WOMEN AFTER CESAREAN SECTION

Purpose: to determine the impact of the developed physical therapy program on the dynamics of dorsopathic symptoms in women in the postpartum period after abdominal delivery (cesarean section).
 Methods. 112 postpartum women were examined. The comparison group (CG) consisted of 47 women who gave birth naturally. The main group 1 (MG1) consisted of 32 women after cesarean section, who recovered on their own. The main group 2 (MG2) consisted of 33 women after cesarean section, who underwent postpartum physical therapy for 12 months. The developed program included: kinesitherapy, abdominal bandage, kinesiological taping, abdominal massage and general; health nutrition, psychological relaxation, education of women. The basis of kinesitherapy as the main method that influenced the symptoms of dorsopathy was functional training (to normalize the motor stereotype, restore the muscles of the torso and limbs, posture) with reference to household movements for child care. During the first weeks after the cesarean section, the movements that contributed to the tension of the postoperative suture were restricted, and the facilitated starting positions were chosen. Women were taught the optimal dynamic stereotype with the prevention of back overload during habitual movements - lifting, feeding the baby, carrying a stroller, and more.
 Determination of signs of dorsopathy (intensity of pain on a visual analog scale, the state of mobility of the spine with tests Ott, Schober, Tomaer, Sedin, changes in life on Roland-Morris Disability Questionnaire and Pregnancy Mobility Index) was performed 4 times: 5-7 days after birth, in the late postpartum period (6-8 weeks), 6 and 12 months after delivery.
 Research results. It is estimated that almost 80% of women during pregnancy were determined by signs of dorsopathies. Women after childbirth, regardless of the type of birth, there is a high risk of new and prolonged symptoms of existing dorsopathies due to increased physical and mental stress on the background of structural and functional recovery of the body and the risk of postpartum depression. In the postpartum period, dorsopathy in women manifests itself in the form of moderate back pain (diagnosed on a visual analog scale), limited mobility of the spine even in the absence of pain (determined by Ott, Schober, Tomaer, Sedin tests), limited vital functions (established by Roland-Morris Disability Questionnaire, Pregnancy Mobility Index). The use of physical therapy allowed women to have a statistically significant (p <0.05) improvement in the results of the visual-analog scale and the Roland-Morris Disability Questionnaire, Pregnancy Mobility Index compared to not only MG1 but also CG parameters. As for the flexibility of the spine, women CG and MG2 were able to achieve normalization 6 months after delivery, women MG1 - a year later. Women who underwent a cesarean section, but recovered on their own with the help of general recommendations, were able to reach the levels of women who gave birth naturally and women who underwent physical therapy only one year after giving birth.
 Conclusions. Physical therapy should be prescribed from the first day of postpartum rehabilitation to reduce the intensity of symptoms of dorsopathy and prevent chronic pain, threatens psychoneurological disorders, disability, reduced quality of life, for rapid postpartum recovery and return of women to full life.

Possibilities of correction of the statodynamic stereotype violations in patients with dorsopathy at the cervical-thoracic level

Introduction. Back pain is not only a high prevalence, but also a costly health problem. That is why the search for new and the optimization of existing methods of dorsopathies treatment acquire an important clinical and medico-social significance. In recent years, the medical community has increased the interest in non-drug methods of treatment, including osteopathy. Previous studies have substantiated the possibility of effective application of osteopathic correction methods in the treatment of patients with dorsopathies. A specific object of the osteopath′s work is somatic dysfunction (SD). And if earlier SD was perceived from the standpoint of purely biomechanical disorders, then in recent years there have been serious changes in understanding the heterogeneity of this state nature. The biomechanical, rhythmogenic and neurodynamic components are conventionally distinguished in the structure of SD. One of the neurodynamic disorders types is the violation of motor stereotypes, the so-called static-dynamic disorders, revealed through special dynamic tests and manifested in the functional impossibility of building of active movement at various levels. At the same time, the generally accepted biomechanical approaches do not allow to completely eliminate violations of the statodynamic stereotype.The goal of research — the study was to research the effectiveness of the osteopathic approach using in combination with kinesitherapy for correction of the statodynamic stereotype violations in patients with dorsopathy at the cervicothoracic level.Materials and methods. A controlled randomized prospective study was conducted on the basis of a private rehabilitation center «Ezramed-Clinic» in Omsk in the period from February 2019 to December 2019. 52 patients with a diagnosis of dorsopathy at the cervicothoracic level were observed. 12 people were knocked out during the study in accordance with the exclusion criteria. As a result, 40 patients participated in the study. Depending on the applied treatment method, the patients were divided by simple randomization into two groups (main and control), each of which consisted of 20 people. Both groups of patients received osteopathic correction three times with a frequency of receptions 1 time in 7–10 days. The main group of patients additionally independently performed daily for 10 minutes a set of exercises aimed to restore the disturbed motor stereotypes (normal synkinesis). The control group of patients additionally independently performed a set of exercise therapy for the cervical spine every day for 10 minutes. All patients, regardless of the group, underwent an osteopathic examination before and after treatment with the formation of an osteopathic conclusion; the severity of pain syndrome and the volume of active movements in the cervical spine were assessed. The severity of the pain syndrome and the range of active movements were assessed before and immediately after treatment, as well as 3 months after the first session.Results. The use of osteopathic correction in conjunction with kinesitherapy (both special exercises and a complex of exercise therapy) in patients with a diagnosis of dorsopathy at the cervicothoracic level leads to a statistically significant increase in the range of motion in the cervical spine in the sagittal and frontal planes (p<0,05). The combination of osteopathic correction together with exercise therapy in patients of the control group led to a statistically more significant increase (p<0,05) in the range of motion in the cervical spine in the frontal plane after treatment compared with the results of the main group. However, 3 months after treatment, the indicators in patients of both groups did not have statistically significant differences.The combination of osteopathic correction in conjunction with kinesiotherapy in the form of special exercises for the motor stereotype correction in the main group of patients with diagnosed dorsopathy at the cervicothoracic level led to a statistically significant (p<0,05) decrease in the intensity of the pain syndrome at the 2nd session.Conclusion. In order to increase the effectiveness of treatment, osteopathic correction of somatic dysfunctions in patients with dorsopathy at the cervicothoracic level can be supplemented with complex kinesitherapy, both in the form of traditional exercise therapy, and in the form of special exercises for correction of altered motor stereotype.

EFFICIENCY OF MOTOR STEREOTYPE CORRECTION IN YOUNG PERSONS WITH POSTURE DISTURBANCES, FLAT FEET AND OBESITY BY PHYSICAL THERAPY

Objective of the study: to assess the effectiveness of the correction of the motor stereotype in young people (students) with postural disorders, flat feet and obesity by means of physical therapy. Material and methods. Surveyed 110 first-year students. The control group consisted of students with normal body weight, normal posture and no signs of flat feet. The comparison group consisted of students with obesity, impaired posture in the sagittal plane and flat feet. They were divided into two groups: group 1 - students who expressed a desire to correct diagnosed violations on their own and / or in independently selected rehabilitation institutions and / or during classroom physical education. Group 2 consisted of students undergoing rehabilitation using the developed program of physical therapy, which lasted 6 months and included kinesiоtherapy, massage, kinesiological taping, nutritional modification, behavioral psychocorrection. The movement stereotype of students was assessed by the Functional Movement Screen, the level of physical activity - by the International Physical Activity Questionnaire. Results. Students with poor posture, flat feet and obesity showed violations of the motor stereotype, which was confirmed on the basis of the worst results of all Functional Movement Screen tests (p <0.05), as well as a lower level of general motor activity (according to the levels of weekly energy consumption, determined by the International Physical Activity Questionnaire) (p <0.05) relative to the indicators of their healthy peers. Analyzing the gender difference in the test results, it was found that the guys were easier to perform exercises related to the implementation of strength (6, 7 tests), and the girls - flexibility (2, 5 tests). The developed program of physical therapy with the use of functional training on the Prosedos platform, massage, kinesiological taping, nutrition modification, behavioral psychocorrection showed a statistically significantly better effect on all characteristics of the movement pattern and the level of physical activity of students compared to the results of individuals who did non-specialized programs (p <0.05). Findings. During their studies in higher educational institutions, students with disabilities in health require increased attention in the context of identifying and correcting pathological changes, is a consequence of chronic diseases, if possible - non-drug means, in particular, physical therapy.

Increase in motion Range of the Cervical spine by means of physical Rehabilitation in Children with Cerebral palsy According to the severity of muscle pain

Aim: The article experimentally examines the effect of rehabilitation measures on increasing the volume of movements of the cervical spine, taking into account the severity of muscle pain in children with cerebral palsy. materials and methods: The study involved 168 children with spastic forms of cerebral palsy, they were divided into two observation groups: the main group, which conducted the proposed rehabilitation course (n = 98) and control, who underwent a course of conventional rehabilitation content (n = 70). Results: During application of the proposed method, the therapeutic effect on pathologically significant areas of bilateral muscle kinematic chains was carried out taking into account their mutual antagonism, bilateral symmetry, taking into account the course of homolateral and heterolateral muscle spirals. Positive dynamics in the clinical status in the vast majority of patients during re-observation was achieved, but the effectiveness of rehabilitation and the stability of the achieved therapeutic effect in the study groups were different. Thus, in patients of the main and control groups, changes in the mobility of the cervical spine were detected, which were recorded using the proposed integrated assessment. Namely, in patients who were engaged in the proposed method, the amount of movement in the cervical spine (passive lateral tilt with an element of rotation) probably increased when compared with the indicators before rehabilitation. Also noteworthy is statistically significant reduction in pain intensity, which allows for more manipulative rehabilitation. Conclusions: The proposed method of rehabilitation of children with spastic forms of cerebral palsy has a pronounced sanogenetic effect, meaning it stimulates their own health reserves and triggers a cascade of reactions of the body aimed at forming a healthy motor stereotype. It involves influence on organism of the patient by rehabilitation procedures with inclusion in work of all biokinematic muscular chain at the same time, taking into account spiral construction of muscles of a body, which allows to achieve a more pronounced therapeutic effect.

Effectiveness of the rehabilitation program in patients with lumbar osteochondrosis and motor stereotype disorders using shock wave therapy

The study included 80 patients aged 22-44 (31.7±4.4) years with lumbar osteochondrosis with impaired motor stereotype and myotonic reaction of the lumbar-pelvic region muscles. The patients were randomized into two homogeneous groups depending on the physical rehabilitation program: in the main group a combination of shock wave therapy (SWT) with the Masterplus MP200 extracorporeal shock wave therapy device (5 procedures with a frequency of 11 Hz, an impact force of 3.8-4.0 bar, intervals of 5-7 days) with a program of relaxing exercises according to the method of K. Levit was used; in the control group – only exercises program. The developed program of physical rehabilitation proved its effectiveness by a significant decrease in pain intensity indicators (p<0.001) by VAS scale, ODI disability level (p<0.001) and SKT kinesiophobia level (p <0.01), a significant increase in the spine mobility (p<0.05) and the lumbar spine mobility (p<0.05), flexion in the hip joints (p<0.05). The range of movements during extension, adduction and abduction of the hip joints also increased but not significantly. Normalization of the extensor muscle tone of the lumbar spine was observed in 87.5% of cases, the gluteus muscle tone – in 30.0%, and the piriformis muscle tone – in 27.5%. The frequency of registration of error patterns in the active combined movement of the lumbar segments and the pelvis decreased to 37.5% of cases as a whole. The developed program of physical rehabilitation proved to be effective compared with the results of the isolated application of relaxing exercises with a significant improvement by VAS scale (p<0.05), ODI (p<0.05) and SKT (p<0.05); normalization of the tone of the lumbar extensor muscles and the restoration of control of active movements in the lumbar-pelvic region are more often noted in more than a third of patients.

CORRECTION OF THE FALL-RISK AFTER FEMORAL BONE FRACTURES BY MEANS OF PHYSICAL THERAPY IN ELDERLY PATIENTS WITH PARKINSONISM AND FRAILTY

Aim: to evaluate the corrective effect of a comprehensive physical therapy program on the fall-risk after fractures of the femoral neck in elderly patients with parkinsonism (due to Parkinson's disease) and frailty.
 Material and methods. We examined 21 elderly patients with Parkinson's disease and frailty in the recovery period after a fracture of the femoral neck. They were divided into two groups: 1 (practiced according to the principles of polyclinic rehabilitation with a predominance of the use of preformed physical factors and general principles of physical therapy) and 2 (practiced according to the developed program of physical therapy with an emphasis on functional training aimed at improving physical qualities and improving motor stereotype, primarily movement, taking into account the signs of parkinsonism). The effectiveness of the program was assessed according to the results of The Short Physical Performance Battery, Berg Balance Scale, Functional Mobility Assessment in Eldery Patients, Falls efficacy Scale International, Parkinson's Disease Quality of Life Questionnaire-39.
 Results. Elderly patients with parkinsonism and frailty after a fracture of the femur have a high fall-risk, impairment of domestic and social functioning, deterioration in the quality of life, which is shown by the results of all tests performed. A pathogenetically substantiated complex program of physical therapy, created on the basis of functional training, taking into account the specificity of motor manifestations of parkinsonism, revealed a statistically significant positive effect on the fall-risk compared with the general polyclinic rehabilitation program in all its aspects studied (p <0.05).
 Conclusion. Elderly patients with complex pathology need to draw up pathogenetically based physical therapy programs, taking into account and correcting the specificity of each disease in order to increase the overall effectiveness of rehabilitation.

Оценка функциональных результатов хирургического лечения детей с болезнью Легга‑Кальве-Пертеса при помощи портативной системы анализа ходьбы

Introduction Typical consequences of Legg-Calve-Perthes disease (LCPD) in its severe stage are pathological changes in the anatomy of the hip joint which lead to functional disorders of the musculoskeletal system, clinically manifested by limp. Objective To study biomechanical characteristics of walking in children with unilateral Legg-Calve-Perthes disease to determine the functional state of the musculoskeletal system after surgical treatment with the use of various methods. Material and methods Temporal and dynamic parameters of gait were studied in 31 patients with unilateral Legg-Calve-Perthes disease aged from 8 to 13 years old. They were examined two to five years after surgical treatment. In the control group of patients (15 children), varus osteotomy (VO) was performed. In the main group (16 children), triple pelvic osteotomy (TPO) was used. All children were operated in the disease stages II–IV corresponding to the classifications of S.A. Reinberg (1964) and to groups III–IV according to the classification of Catterall (1971). To objectify the study, 18 healthy children of the same age without signs of orthopaedic pathology were examined. Gait biomechanics were studied using the STEDIS complex (Neurosoft LLC, Ivanovo) that includes a set of platformless inert sensors "Neurosens" that record the data on accelerations in three mutually perpendicular planes. The temporal characteristics of the gait cycle and shock loads during walking were recorded. Results After surgical treatment, the biometrics of the support and shock load phases in both groups of children with LCPD did not reach the level of healthy individuals. It indicates preservation of deviations in walking parameters. The least significant asymmetry between the affected and unaffected limb were detected in patients after TPO, compared with patients after VO in whom the asymmetry of temporal parameters in the phase of the forefoot rocker and asymmetry of shock loads in the phases of rocking over the heel and ankle joint were preserved. Conclusion After ТPO operations in patients with LCPD, the gait was closer to the physiological one in comparison with patients after VO who retained a non-optimal motor stereotype. The reasons for such differences in motor activity between the groups of patients lies in the gluteal muscle dysfunction due to high position of the greater trochanter after corrective (varus) femur osteotomy and iatrogenic shortening of the affected limb. Triple pelvic osteotomy lacks these negative effects.

The possibility of evaluating the readiness of osteopath and chiropractor to work independently

Introduction. One of the important tasks in preparing an osteopath and a manual therapist for independent work with patients is to assess the adequacy of the state of his neuromuscular apparatus, psycho-vegetative status for physical and psychological stress. Relevant is the search for informative express techniques for studying the state of the neuromuscular system and the doctor’s regulatory systems.The goal of research — to substantiate a non-invasive express method for assessing the state of the neuromuscular system in osteopaths and manual therapists.Materials and methods. The study was attended by specialists from the Primorsky Institute of Vertebroneurology and Manual Medicine. For the diagnosis, a method was used to assess the adequacy of the muscular effort of specialists, which has proved its effectiveness in individuals whose work is associated with physical activity against the background of emotional stress. The distribution of doctors was as follows. The first group consisted of novice specialists who did not have the practice of independent work (21 people). The second — experienced, with significant experience and showing stable treatment results (19 people). The groups did not have any special differences by age and gender. Statistical processing was carried out using standardized functions of Excel programs. The significance of differences in average values was determined using parametric analysis. Student t-test was used. Differences between groups were evaluated by the Pearson χ2 method. Differences were considered statistically significant at p<0,05.Results. Features of the state of the musculoskeletal system in both groups were analyzed. In the first group (novice specialists), non-optimal motor stereotype was found in 19 of 21 doctors (90,5 %), and in the second group (experienced specialists with work experience) — only in 3 of 19 (15,8 %), χ2=3,32, p<0,05. In the first group, 12 of 21 doctors (63,2 %) first appeared or worsened pain in the spine, somatic dysfunctions appeared in the spine, limbs, internal organs, 3 of 21 doctors (14,3 %) postural instability was observed after work. The doctors of the second group also had back pain, but they were compensated in nature, they were less worried, did not cause psycho-emotional disorders. Of the physiological parameters, a characteristic was a decrease in the strength and endurance of the muscles of the hand, increased fatigue, and, most importantly, inadequacy of muscle effort. The average value of spontaneous muscle effort in the first group was 0,56±0,12 units, significantly exceeding the figures in the second group 0,32±0,10 units. Dynamic monitoring of the work of specialists showed that after 2–3–4 months the main symptoms in most are leveled, confidence in work appears, pains go away, the optimality of the motor stereotype and autonomic regulation is restored.Conclusion. In osteopaths and manual therapists with a low degree of adaptation to the conditions of selfadministration of patients, the muscle effort during the procedure becomes inadequate to the load; fatigue occurs much faster and is more pronounced by the end of the working day. They are more often diagnosed with a non-optimal motor stereotype, which leads to an exacerbation of vertebrogenic pain syndrome and other diseases. The method of rapid diagnosis of the adequacy of muscle effort allows you too quickly and with minimal cost to identify osteopaths and manual therapists with a low degree of adaptation to working conditions and to carry out the necessary prevention.

Modern approaches to the development of motor function in younger schoolchildren with postural disorders

The article identifies the causes of deviations in the development of posture in children of primary school age and characterizes the influence of this pathology on the health and physical development of schoolchildren. The necessity of development of coordination of movements in children of 6-10 years old, as well as its role in the formation of posture, prevention and correction of its defects has been substantiated. The modern approaches to the development of the motor function of schoolchildren with postural disorders are disclosed. The specificity of the action of physical exercises for the formation of the correct motor stereotype of the posture of students is highlighted, the features of the influence of dosed muscle tensions for the prevention and correction of the posture of younger students are characterized. During primary school age it is important to form the correct posture, prevent and prevent various deformities of the spine, as well as the use of dosed muscle tension and skills to maintain physiologically correct torso position in the sagittal plane and symmetrical spine position in the front to eliminate deviations in posture development at the initial stages of the ir appearance. The degree of development and opportunities for improvement of the motor sphere of children is limited by the presence of disorders of the functional activity of sensory and physiological systems of the body, including disorders of the musculoskeletal system, which include deviations in posture development. Lag in the development of motor skills of children increases the risk of forming an incorrect motor stereotype of posture and vice versa, in children with deviations in posture development there is a complication of motor skills, insufficient development of certain muscle groups, impaired balance, coordination. There are no medical contraindications to exercise in children of primary school age with postural disorders. Formation of motor function of junior schoolchildren with posture disorders involves the use of dosed exercise for the development of musculoskeletal sensitivity, development of rational flexibility of the spine, strengthening muscle groups of the muscular corset, normalization of torso muscle tone, taking into account the type of posture disorder. The development of coordination of movements of junior schoolchildren is a necessary condition for consolidating physiologically correct tors o positions while maintaining a stable posture and movement.

Physiological Parameters of Motor Adaptation in Children with Disability

We investigated the physiological characteristics of motor adaptation in children with disabilities associated with impaired functioning of the musculoskeletal system and decreased range of motion of joints in the upper and lower extremities. The study included 90 children aged 8 to 12 years who were divided into three groups: children capable of independent locomotion; children capable of independent locomotion with support; children without disabilities. We used the methods of electromyography, rheovasography, and motion tracking. It was established that children with disabilities have a special motor stereotype associated with joint mobility limitations and based on functional compensatory mechanisms. In addition, factors that directly affect the process of functional adaptation were identified: first, the restructuring of motor programs, i.e., the formation of a special motor stereotype to compensate for the presence of biomechanical changes when walking; second, the functional reserve of hemodynamics in the proximal parts of the lower extremities; and third, the simultaneous activity of flexor and extensor muscles in the event of hypersynchronization of motor units. Thus, it has been established that limited joint mobility in the upper and lower extremities can activate the compensatory mechanisms aimed at functional compensation of lost functions by creating a special motor stereotype for the development of motor adaptation of children with disabilities. Thus, we suggest that the adaptation approach is a real opportunity to provide complete adaptation of children with disabilities, their inclusion in all spheres of public life and overcoming both social and physical barriers.

Chronic pain syndrome in diseases of periarticular tissues

The search for an effective method of treating diseases of the musculoskeletal system is a rather actual problem for a practicing physician nowadays in connection with the modern lifestyle of most people. A prolonged stay in the same position, as a rule, leads to overstrain of the capsule-joint complexes, and, as a consequence, to the development of degenerative changes in the joints and periarticular tissues. These changes can manifest themselves clinically in the form of a chronic or acute pain syndrome. One of the common diseases characterized by degenerative periarticular changes with a variety of clinical manifestations are periarthropathies. Periarthropathy or periarthrosis is still the subject of discussion by doctors of related specialties: neurologists, orthopedists, rheumatologists, etc. Pain in this case can be caused by the primary degenerative process in muscles and tendons in combination with their chronic microtraumatization, ischemia, and reactive inflammation. Periarthropathy can be considered as a «train» of any arthropathy, because pain always causes muscle spasm, a change in the motor stereotype, a limitation of motor activity in the joint, etc. In the absence of joint pathology, it should be considered as a primary disease. There is still no common understanding of this nosological unit, including pathogenesis, classification, diagnostic algorithms and therapy. Treatment is based on general recommendations: limiting the load on the damaged joint, massage (according to indications), exercise therapy, manual therapy, physiotherapy. Drug therapy includes intramuscular or intraarticular administration of glucocorticosteroids (GCS), non-steroidal anti-inflammatory drugs (NSAIDs) but these drugs have certain side-effects and contraindications. Treatment of peritropathy with chondroprotectors (chondrogard) is rapidly gaining momentum, as well as GCS and NSAIDs, they reduce pain and increase the functionality of the joints, but, unlike the latter, their safety profile is much higher. The authors summarize current findings on this issue.

Characteristics of body balance disorder in children with unilateral lower limb shortening

Background. In modern orthopedics, the problem of unilateral shortening of the lower limbs in children is extremely important. In the process of child growth, there occurs progression of the shortened segment, which leads to anatomical asymmetry of the lower limbs and an increase in the imbalance of the limb load. Secondary deformities of the pelvis and spine aggravate the patients disability. The features of abnormal postural balance of the body depending on the etiology of the disease, such as congenital or acquired, as well as the degree of preservation of motor stereotypes in children with unilateral shortening of the lower limbs, are still understudied.
 Aim. The aims of this work are to study postural stability in children with unilateral shortening of the lower limbs and to assess the disorders of body balance depending on the etiology of the lesion.
 Materials and methods. The standard stabilometric values of 11 healthy children (average age, 11.9 0.73 years) were determined (group 1), as well as the statokinesiogram parameters in 22 patients with unilateral shortening of the lower limb. The second group included 11 children (average age, 11.9 1.05 years) with congenital shortening of the lower limb (average shortening, 4.8 0.8 cm). The third group also consisted of 11 children (average age, 12.2 0.78 years), but with acquired shortening of the lower limb (average shortening, 4.5 0.38 cm). Statistical research included correlation analysis.
 Results. A significant decrease in the stability of the vertical balance was observed in both groups of patients, which was demonstrated by pronounced deviations from the nominal values of stabilometric parameters, compared with healthy children: an increased center of pressure displacement, large values of the statokinesiogram area, and the length of the pressure displacement path. It was possible to determine the state of adaptive postural mechanisms for assessing the formation of the degree of adequacy of the motor strategy in patients with unilateral shortening of the lower limb, depending on the etiology of the lesion, owing to the method of stabilometry.
 Conclusion. An appropriate adaptive motor stereotype has been formed in patients with acquired shortening of the lower limb; in the new conditions, the system for ensuring postural balance is stabilized. There is a different strategy for maintaining posture stability characterized by a nonoptimal motor stereotype in patients with congenital shortening of the lower limb. The stabilometric assessment of the asymmetry of the lower limb load is a promising method for studying the formation of compensatory mechanisms for controlling the locomotion system, which is important when planning rehabilitation measures.

Place and Possibilities of the Robotic System Lokomat in the Rehabilitation of Patients After Ischemic Stroke

Ischemic stroke is still a very common disease with quite serious consequences. Modern medicine considers in this regard its main task in the curation of such patients, the maximum possible restoration of the functions of the affected brain and the volume of its control over the body. Due to the rapid development of medicine associated with the emergence of innovative technologies in the field of rehabilitation, hardware methods of rehabilitation today have gone far ahead and have in their arsenal a lot of high-tech tools. For this purpose, a search is being made for means of increasing the activity of brain cells located in the affected area. Of particular importance in this regard are the methods of rehabilitation in the early recovery period after ischemic stroke using robotic methods of mechanotherapy, one of which is the use of the Lokomat system. Among them, a prominent place is occupied by the walking training system - Lokomat, consisting of robotic orthoses and a body support device, which are combined with a treadmill. Information about the successful use of Lokomat during the rehabilitation of patients with movement disorders is still scattered, and this required their generalization and understanding. The main advantage of this system is the ability to effectively control and ensure high intensity, repeatability (reproducibility) and purposefulness of the trained movements. The convincing advantages of automated training on the Lokomat system compared to traditional rehabilitation in terms of various clinical indicators in patients with post-stroke hemiparesis have been identified. It was shown that in patients trained on the Lokomat system, a single support on the paretic leg intensified, which contributed to a more symmetrical gait. This system is more than other devices and technologies designed for learning to walk, in line with the modern approach to the restoration of impaired motor functions. The inclusion of training sessions on the Lokomat robotic system in the comprehensive treatment of patients with post-stroke hemiparesis leads to a marked improvement in movement skills. This is associated with a pronounced restructuring against the background of its use of the motor stereotype of walking, which makes it possible to increase the effectiveness of recreational activities in post-stroke patients.

Preoperative rehabilitation care in total hip joint replacement by rapid recovery approach in Slovakia

Relevance of research: Hip fractures and arthrosis are currently one of the serious illnesses presenting as a serious health problem faced by the aging population. The health problem is not just the wound itself or arthrotic changes accompanied by severe pains and difficulties to get up and walk on the affected lower limb, but also the risk of inadequate healing after surgery. Also, significant disability and reduced ADL performance may continue despite the immense advances in surgical techniques, nursing care and rehabilitation. Nowadays, which is primarily aimed at reducing the cost of health care, it is necessary to ensure that this reduction in costs is not at the expense of the quality of health care and future medical success. In general, physiotherapy for total hip joint replacement is considered to be a routine matter that deals mainly with mobility training, increased muscular strength, and basic day-to-day activities such as bed-to-chair transition, standing and walking. In addition to these attributes, physiotherapists also need the patient's own experiences and psychological responses such as anxiety and fear. Goal and methods of research: The aim of the thesis is to point out the importance of preoperative preparation of the patient for total replacement of the hip joint and its impact on the reduction of recovery after surgery. As a method, a case study of the 33 year patient indicated for total hip replacement was selected. The patient underwent a comprehensive preoperative three-month preoperative treatment (from the moment of indication to surgery to performance itself) and subsequent post-operative rehabilitation treatment of three and a half months. Results: A comprehensive rehabilitation program was developed taking into account the patient's health and Rapid recovery recommendations in preoperative and postoperative care. During the preparatory phase of the operation, the patient was modified by motor stereotype walking, strengthened lower limb muscles, especially musculus quadratus femoris and pelvis stabilizers. Lower limb circumference values increased by 2 cm, hip muscle strength increased from grade 3 to grade 4 of the Janda muscle tests, and shortened muscles iliopsos were released on the affected side. Taking into account the operational complications and subsequent comprehensive care according to Rapid Recovery recommendations, the stay in the hospital was reduced from 12 days to 5 and the patient returned to normal working life from 6 months to 4 months. Conclusion: Rapid recovery program requires the development of a new culture not only in normal orthopedic outpatient clinics but also in hospitals. In the past, and nowadays in some regions of the world, slow recovery with extended acute hospitalization for several weeks has been thought to be the best way for patients to recover and achieve a good result after complete replacement of either the hip or knee joint. The results of total hip joint surgery studies showed a significant reduction in hospital stay without increasing the remission rate. Subsequently, patient satisfaction increased, accompanied by a reduction in health care costs and a faster return to normal daily life.

Оцінка структурних змін хребтових сеґментів у хворих на поперековий остеохондроз з порушеннями рухового стереотипу з використанням методів променевої діаґностики

Aim. To investigate the lumbar segments roentgenanatomic changes in patients with vertebral osteochondrosis with a disturbance of the motor stereotype. Material and Methods.The material of the study were protocols of clinical and radiological examination of 80 patients of 22-44 years of agewith lumbar osteochondrosis with a disturbance of the male motor stereotype . X-ray characteristics and signs of degeneration of elements of lumbar segments were evaluated. Statistical methods used were ones of descriptive statistics, and t-criterion by Student method with significance level of p<0,05. Results and Discussion. In the course of lumbar spondylograms analysis, a significant predominance of structural asymmetry of the elements of the lumbar segments was established: asymmetry of articular processes (in LIII - LIV - 77.5%, LIV - LV - 85.0%, LV - SI - 70.0%, disconverting of articular facets - 72.5%, 81.3%, 57.5% respectively, the asymmetry of the transverse processes is 51.3%, 46.4%, and 76.3%, respectively. Anomalies of the tropism, and rotation of the spinous processes were observed in more than half of the patients. All patients showed signs of degeneration of all elements of the investigated lumbar segments. On the magnetic resonance imaging scans, changes in end-plates of the vertebral bodies of Modic 1 and Modic 2 types were dominant, which amounted to 63.8% for the LIII - LIV segment, 82.6% for LIV - LV and 87.5% for LV - SI. There were signs of degeneration of intervertebral discs of varying degrees in all the studied lumbar segments. Conclusions. The roentgenanatomic characteristics of lumbar segments in patients with spinal osteochondrosis with motor stereotype disturbance are characterized by a significant predominance of the structural asymmetry of the LIII, LIV, and LV vertebrae: the asymmetrical value of articular (77.5%, 85.0%, 70.0%, respectively) and transverse (51, 3%, 46.4%, 76.3%, respectively) of the processes, discontinuity of the articular facies (72.5%, 81.3%, 57.5% respectively), anomalies of tropism (47.5%, 55.0%, 52.5%, respectively), rotation of spinous processes (67.5%, 63.8%, 33.8%, respectively). Dysplastic and degenerative deformations of the lumbar segments visualized in radiography and magnetic resonance imaging in patients with vertebral osteochondrosis with the motor stereotype disturbance can potentiate the development of vertebral pain syndromes.

Effectiveness of correction of post-stroke motor disorders using the methods of functional electrostimulation and BFB-stabilometric postural control

To evaluate the effectiveness of complex rehabilitation with the inclusion of functional electrostimulation (FES) and BFB-stabilometric postural control in patients with post-stroke motor disorders in the late recovery period. Sixty-seven patients in the late recovery period of stroke, 31 women and 36 men, mean age 58.4±6.4 years, were studied. The duration of stroke was 228.59±31.9 days. Ischemic stroke was in 71.9% of patients, hemorrhagic stroke in 28.1%. The first group included 42 patients with stroke, who, in addition to standard treatment regimen, had FES and BFB stabilometric training. The second group comprised 25 patients with stroke, the rehabilitation of which did not include above-mentioned methods. A complex of rehabilitation measures with the inclusion of FES and BFB stabilometric postural training made it possible to significantly improve the function of walking in the form of restoration of the motor stereotype. The clinical effect was traced 3 weeks after the beginning of rehabilitation, reaching a maximum by the 5th week. Inclusion of BFB-based methods in the rehabilitation process leads to earlier motor and social adaptation of the patient, restoration of the disturbed equilibrium function, which is associated with an increase in the plastic and associative processes of the brain.

Efficiency of Kinesio Taping in Adolescents with Cervicogenic Headache: a Blind Placebo-Controlled Study

The research covered 101 adolescents aged 14–16 years with cervicogenic headache (CHA) caused by myogenic trigger zones (MTZ) in the neck muscles. The research aims at estimation of elastic kinesio taping effectiveness in the treatment of myogenic CHA in adolescents. Patients were divided into three groups: 34 teenagers (Group A) were treated with kinesio tapes, 34 teenagers (Group B) received placebo—the simulation of kinesio tapes with a non-elastic medical hypoallergenic plaster (similar to the width of elastic tapes), 33 teenagers (Group C) were prescribed physical exercises for 20 min for the formation of correct motor stereotype. All indicators were evaluated before treatment (Eval-1), immediately after 1 month of treatment (Eval-2) and 1 month after treatment (Eval-3). At Eval-2 in Group A, there were observed statistically significant decrease in the number of days with a headache and headache intensity, and also increase in pain thresholds. In Groups B and C, there were no statistically significant changes in the indices compared to the Eval-1. At Eval-3 in the Group A, there was recorded positive dynamics in the studied indicators. In Group C, there was a positive statically significant dynamics, in comparison with Eval-1. There were no statistically significant changes in the patients of Group B. Group A in all indicators was statistically significant superior to the results of B and C. The authors conclude that kinesio taping is effective in treating myogenic CHA in the presence of an upper cross syndrome of muscle imbalance in adolescents.

Comprehensive rehabilitation of herniated disc in the lumbar section of the spine

Herniated disc is one of the most common problems of the musculoskeletal system, and the spine, in particular. This article presents a modern algorithm of methods of treatment constituting comprehensive rehabilitation of herniated disc in the lumbar section of the spine, including: physical therapy, active and passive kinesitherapy, medical massage and manual techniques, applied in the medical practice. Rehabilitation and physioprophylaxis facilitate the reduction of the risk of occurrence and development of herniated disc in the lumbar section of the spine through natural (water, air, movement and sunshine) and preformed physical factors, the main aim being achieving a good quality of life of both the sick and the healthy. The so called ‘spine school’, which includes training the patient to have a good posture, a good stance, to walk correctly and to improve his/her motor stereotype through control and self-control, plays a major role. In developing the individual treatment scheme for each patient at a certain stage of his/her condition, it is vital to attempt to achieve a synergic effect of the optimal combination of electrotherapeutic, peloid therapeutic and kinesitherapeutic methods. Regular courses in physioprophylaxis and kinesio-prophylaxis significantly boost the effect of the medicamentous therapy in patients with herniated lumbar disc and improve their quality of life.

Іпотерапія в системі корекції рухового стереотипу дітей з церебральним паралічем

Іпотерапія в системі корекції рухового стереотипу дітей з церебральним паралічем