Neurorehabilitation of Patients

mitri.az

Neurorehabilitation is part of rehabilitation that deals with the recovery of patients from cerebrovascular accidents (strokes), spinal cord injuries, traumatic brain injuries, neurological problems, patients with protoneuropathy, vertebrogenic neurological syndromes, infantile cerebral palsy, disseminated sclerosis, Parkinson’s disease, Huntington’s disease, motor neurone diseases (amyotrophic lateral sclerosis, progressive bulbar palsy, progressive muscular atrophy), inherited neurological disorders (torsion dystonia, cerebellar ataxia), polyneuropathy, muscle diseases, vertebrogenic neurological syndromes.

Undoubtedly, the purposes and tasks of neurorehabilitation for diseases with a developed neurological defect (for example, cerebrovascular accidents, traumatic brain and spinal cord injuries) and for progressive degenerative and inherited diseases (Parkinson’s disease, motor neurone diseases etc.) differ.

Thus, the main objective of rehabilitation for the first group of diseases that includes cerebrovascular accidents, traumatic brain and spinal cord injuries, protoneuropathy and plexopathy, vertebrogenic radicular and spinal syndromes, and infantile cerebral palsy is to fully recover the functions affected by a disease or an injury or otherwise to optimally implement the physical, psychological and social potential of a disabled person, to most adequately integrate him/her into the society.

The objective of physical rehabilitation for patients with the second group of diseases which includes progressive degenerative and inherited neurological diseases is to decrease the basic symptoms, prevent and treat complications relating to diminished motor performance, correct functional disorders, adapt to the existing neurological deficit, to enhance tolerance to physical exercises, improve the quality of life, and increase social activity.

Nowadays neurorehabilitation is considered to be one of priority line in the development of the present-day medicine. This is mainly explained by findings in the field of the fundamental principles of flexible processes in affected motor cortex. Neurophysiological and neuroanatomical studies with animals as well as imaging and other non-invasive human brain mapping methods provided unquestionable evidence of the ability of adult cerebral cortex to reorganize its functions.
Irrespective of the disease neurorehabilitation is based on the following principles:

  • early start of therapeutic procedures (as soon as the physical state of the patient and his/her state of consciousness allow);
  • integrity in the application of all available and required rehabilitation measures;
  • individualization of the rehabilitation program;
  • step-by-step approach in the rehabilitation process;
  • continuity and consistency at all steps of rehabilitation;
  • social focus;
  • application of methods for controlling the adequacy of load and efficiency of rehabilitation.

Neurovascular rehabilitation of patients with injuries of the central nervous system is based on the four main components:
Medical examination and performance status evaluation..
Primary examination makes it possible for physicians to assess your performance status, physical strength, limitations and other states that influence the selection of motor, psychological, social, or logopedic rehabilitation. Physicians evaluate your risk factors in cardiovascular diseases, expansion of strokes. Based on the information received physicians develop an individual rehabilitation program which is safe and efficient exactly for you.
Complete or partial recovery of motor and sensory disturbances.
Motor disturbances are one of the most wide-spread and complex consequences of a stroke. The recovery of the motor functions is observed in most patients; with adequate remedial gymnastics and kinetotherapy patients with even rough motor disturbances begin to stand and walk unassisted at least 3-6 months after the disease. We have excellent results with the use of the robotic-assisted locomotor device, the G-EO system, with standing opportunities and further learning to walk. Absence of a positive effect in 3-6 months can be caused by loss of deep sensation in paretic extremities and (or) weak motivation of the patient for rehabilitation which is often observed in case of underestimate of the severity of the disease or its disregard (anosognosia).
Methodical life training..
Diet is one of the most important moments in neurovascular rehabilitation. You will be taught how to eat and select healthy food that best suites you avoiding excess fat, salt and cholesterol. You will be assisted to quit bad habits that are in contradiction with a healthy life style of a person who suffered from a stroke, for example, smoking. You will be taught how to cope with pain and tiredness. It is healthy nutrition that helps lose excess weight.
Psychological support.
A stroke and state after it is a serious problem that makes you feel frustrated. It can lead to depression, annoyance. You can’t work or do routine things. Therefore, psychological support is very important. If you suffer from depression don’t ignore this step of rehabilitation, otherwise recovery from the disease will become very difficult. Control of depression can be made with the help of both medication therapy and continuous exercises that allow you forget about the disease, give you confidence in successful recovery as well as strength and energy.

Rehabili2
A stroke is an acute cerebrovascular accident characterized by sudden focal or cerebral neurological symptoms that remain more than 24 hours and can result in considerable loss of health of a patient or even a death. There are two main types of a stroke: an ischemic stroke that is a result of a sudden cerebrovascular accident, and a hemorrhagic stroke that is an unprompted (non-traumatic) intracranial bleeding. A special type is a “mini” stroke when the symptoms regress within 3 weeks. Depending on the location and size of anatomical changes after a stroke, the clinical performance and motor disturbances can vary; inability to feel, problems with speaking, spatial perception, psychological disorders (perplexity, emotional instability, mental depression, increased annoyance etc.), incontinence and other symptoms can also be observed. If rehabilitation treatment is untimely and incorrect, disability among patients after a stroke amounts to 80%. Rehabilitation of post-stroke patients includes: prevention of post-stroke complications (primarily contractures), recovery of lost motion, gait, speech, psychological and social re-adaptation, recovery of independence in everyday life and working capacity, in other words maximum return of a patient to the natural mode of life. When should rehabilitation of post-stroke patients start?
Rehabilitation of post-stroke patients should start as early as possible after stabilization of the patient’s status and liquidation of life threatening events. At this step it includes passive gymnastics to avoid contractures and bed sores, equilibrium exercises to recover impaired functions (rotation of the body with assistance).
Basic principles of rehabilitation after strokes:
  • Early start of rehabilitation procedures that are carried out from the first days of the stroke (if the general state of the patient allows) and help anticipate the recovery of impaired functions and make it more complete, prevent secondary complications (hypostatic pneumonia, thrombophlebitis, contractures, bed sores, muscular dystrophy).
  • Rehabilitation shall start in the neurological department and continue in the rehabilitation institution.
  • Patients and their family members shall take an active part in the rehabilitation process (in particular, in doing home tasks in the afternoons and on weekends).
  • The recovery forecast mostly depends on the size and location of the impaired parts of brain as well as on the accuracy and completeness of rehabilitation procedures.
Rehabilitation program after a stroke:
Motor system recovery
massage (massage specialist), kinetotherapy (rehabilitation physician), remedial physical training (instructor), standing and gait recovery (rehabilitation physician, ergotherapist), physiotherapy (physiotherapist), ergotherapy (ergotherapist)
Speech and memory recovery
sound and word pronunciation (aphasiologist/logopedist), speech recovery (aphasiologist/logopedist)
Pelvis function recovery
procedures for maximum possible recovery of functions (rehabilitation physician)
Psychoemotional recovery
conversations with the patient (psychologist), walks, conversations with the patient (medical staff, relatives)
How long does rehabilitation of post-stroke patients last?
Rehabilitation terms depend on the severity of brain injuries, accompanying diseases, pre-stroke physical condition of the patient. Recovery treatment continues till improvement of motion coordination, full recovery of gait skills, self care and can take from 3 months to 2 years (speech recovery and return to professional practice). Duration of recovery is influenced by a proper rehabilitation program (kinetotherapy is of primary importance), professional skills of the specialists, feasibility of objectives (it is not correct to force a patient unable to sit to walk).
Results of neurorehabilitation after a stroke:
Neurorehabilitation after a stroke is a long-term program. The results of rehabilitation can be observed from the very beginning. You will be able to move, take care of yourself, approach a moment when you will be able to return to the working rhythm. You will learn to cope with stress and depression; it means that you will be able to encourage other persons like you. To sum up, neurorehabilitation is an integral part of treatment after a stroke.
mitri.az
Traumatic brain injury (TBI) is a result of a strong insult to the head with damage of soft tissues, bones and the brain substance. TBI symptoms can be primary, directly induced by the injury, and secondary, developed as a result of impairment of control processes, ischemia and other pathological changes in the brain. Correctly organized rehabilitation procedures are extremely important for TBI patients, as they enhance their chance to recover brain functions. Depending on the location and size of anatomical changes after TBI, the clinical performance and motor disturbances can vary; inability to feel, problems with speaking, spatial perception, psychological disorders (perplexity, emotional instability, mental depression, increased annoyance etc.), incontinence and other symptoms can also be observed. If rehabilitation treatment is untimely and incorrect, disability among TBI patients is high. Rehabilitation of TBI patients includes: prevention of post-traumatic complications (primarily contractures), recovery of lost motion, gait, speech, memory, psychological and social re-adaptation, recovery of independence in everyday life and working capacity, in other words maximum return of a patient to the natural mode of life. When should rehabilitation of TBI patients start? Rehabilitation of TBI patients should start as early as possible after stabilization of the patient’s status and liquidation of life threatening events. At this step it includes passive gymnastics to avoid contractures and bed sores, equilibrium exercises to recover impaired functions (rotation of the body with assistance). Basic principles of rehabilitation after TBI: Early start of rehabilitation procedures that are carried out from the first days after TBI (if the general state of the patient allows) and help anticipate the recovery of impaired functions and make it more complete, prevent secondary complications (hypostatic pneumonia, thrombophlebitis, contractures, bed sores, muscular dystrophy). Rehabilitation shall start in the neurological department and continue in the rehabilitation institution. After the period of hospitalization patients and their family members shall take an active part in the rehabilitation process (in particular, in doing home tasks in the afternoons and on weekends). The recovery forecast mostly depends on the size and location of the impaired parts of brain as well as on the accuracy and completeness of rehabilitation procedures. Psychological support TBI and state after it is a serious problem that makes you feel frustrated. It can lead to depression, annoyance. You can’t work or do routine things. Therefore, psychological support is very important. If you suffer from depression don’t ignore this step of rehabilitation, otherwise recovery from the disease will become very difficult. Control of depression can be made with the help of both medication therapy and continuous exercises that allow you forget about the disease, give you confidence in successful recovery as well as strength and energy. Rehabilitation program after TBI: Motor system recovery massage (massage specialist), kinetotherapy (rehabilitation physician), remedial physical training (instructor), standing and gait recovery (rehabilitation physician, ergotherapist), physiotherapy (physiotherapist), ergotherapy (ergotherapist) Speech and memory recovery sound and word pronunciation (aphasiologist/logopedist), speech recovery (aphasiologist/logopedist) Pelvis function recovery procedures for maximum possible recovery of functions (rehabilitation physician) Psychoemotional recovery conversations with the patient (psychologist), walks, conversations with the patient (medical staff, relatives) Principles of the most effective remedial physical training: Remedial physical training in case of brain injuries has a number of peculiarities that if adhered to make this method most effective: • Early start of remedial physical training • Targeted application of remedial physical training methods to recover lost functions • Directed action on higher cortical functions in order to teach and re-teach motions • Selection of special exercises by the pathogenetic principle in combination with general strengthening effect of remedial physical training • Strict adequacy and dynamic changeability depending on the capabilities of the patient • Active expansion of the motor mode. Types of exercises for remedial gymnastics: Special types of remedial physical training are classified in accordance with the nature of kinetic problems taking into account the disease, intensity of impaired functions, stage of treatment etc. The basic type of remedial physical training is remedial gymnastics that contains a number of training exercises. These exercises can be divided into the following groups: • Exercises to increase muscle size • Exercises to achieve strictly graduated muscle strain • Exercises to achieve differentiated muscle strain • Antiataxic exercises • Antispasmodic and antirigid exercises • Antiassociated exercises • Reflex and ideomotor exercises • Passive movements including manual therapy In practice these exercises shall be combined with one another in different ratios. This combination is determined by the nature and size of motor disturbances, step of rehabilitation and the specific medical and social tasks the patient and his/her physician face. How long does rehabilitation of TBI patients last? Rehabilitation terms depend on the severity of brain injuries, accompanying diseases, physical condition of the patient before the injury. Recovery treatment continues till improvement of motion coordination, full recovery of gait skills, self care and can take from 3 months to 2 years (speech recovery and return to professional practice). Duration of recovery is influenced by a proper rehabilitation program (kinetotherapy is of primary importance), professional skills of the specialists, feasibility of objectives. Results of remedial therapy after TBI: Rehabilitation after TBI is often a long-term program. You will observe the results of remedial therapy when you are able to move, take care of yourself, approach a moment when you are able to return to the working rhythm. You will learn to cope with stress and depression; it means that you will be able to encourage other persons like you. To sum up, rehabilitation is an integral part of treatment after TBI.
mitri.az
Spinal cord injury (SCI) is one of the most serious injuries in terms of both physical health problems and negative influence on the psychoemotional state of a person. These injuries can be caused by direct damage, compression by a hematoma, pressure of the spinal cord and intervertebral discs by bone fractures, as well as by ischemic disorders that accompany spinal cord swelling. The severity of this injury and its clinical performance generally depend on the level of insult, presence of a pain syndrome, muscle palsy, impaired sensation, problems with pelvic organs functioning. Some patients demonstrate reaction rate inhibition, emotional instability, aggression, susceptibility to fear and disorganization. Depression common in this category of patients is often accompanied with loss of appetite, weeping and laughter, insomnia, self-deprecation and exaggerated anxiety. All the above-mentioned as well as the high risk of possible complications confirm the importance to carry out a remedial program in case of SCI. Here not single but repeated regular rehabilitation courses are meant. When should rehabilitation of SCI patients start? Rehabilitation of SCI patients should start as early as possible after stabilization of the patient’s status and liquidation of life threatening events. At this step it includes passive gymnastics to avoid contractures and bed sores, equilibrium exercises to recover impaired functions. Basic principles of rehabilitation after SCI: • Early start of rehabilitation procedures that are carried out from the first days of the injury (if the general state of the patient allows) and help anticipate the recovery of impaired functions and make it more complete, prevent secondary complications (hypostatic pneumonia, thrombophlebitis, contractures, bed sores, muscular dystrophy). • Rehabilitation shall start in the neurological department and continue in the rehabilitation institution. • After the period of hospitalization patients and their family members shall take an active part in the rehabilitation process (in particular, in doing home tasks in the afternoons and on weekends). • The recovery forecast is mostly determined by the degree of impairment and level of insult on the spinal cord as well as on the accuracy and completeness of rehabilitation procedures. Self care ability recover. A patient shall be dependent on others as less as possible. This is psychologically important: a person feeling his/her inferiority and permanently requiring help experiences low self-esteem, sinks into depressions more often, loses motivation. Working capacity recovery Here ergotherapy – recovery and formation of required skills – is very important. Psychoemotional recovery Psychological support on behalf of the medical staff, relatives, conversations with the psychologist help in the difficult process of rehabilitation and in finding one’s role in the society. Rehabilitation program after SCI: Motor system recovery massage (massage specialist), kinetotherapy (rehabilitation physician), remedial physical training (instructor), standing and gait recovery (rehabilitation physician, ergotherapist), physiotherapy (physiotherapist), ergotherapy (ergotherapist) Pelvis function recovery procedures for maximum possible recovery of functions (rehabilitation physician) Psychoemotional recovery conversations with the patient (psychologist), walks, conversations with the patient (medical staff, relatives) How long does rehabilitation of SCI patients last? Rehabilitation terms depend on the severity of brain injuries, accompanying diseases, physical condition of the patient before the injury. Recovery treatment continues till full recovery of gait skills, self care and can take from 3 months to 2 years (return to professional practice). Duration of recovery is influenced by a proper rehabilitation program (kinetotherapy is of primary importance), professional skills of the specialists, feasibility of objectives.
mitri.az
Infantile cerebral palsy (ICP) is a brain disorder that begins in the period of intrauterine development, in the period of delivery or in the neonatal period. This disease lasts for many years, but more often the pathological state is present during the whole life. It is caused by different internal and external harmful factors influencing an embryo, fetus or a new-born. The clinical performance is represented by motor disorders (palsies, pareses, hyperkinesias, ataxia, forced movements, lack of coordination of muscle movements etc.), speech and mental disturbances, and depends on the nature, degree of impairment, development of the pathological state of the brain as a whole and mainly some of its systems. Due to combination of underdevelopment and motor development pathology, muscle tonus regulation disorders in the form of spasticity, rigidity, dystonia, hypotonia are particularly important and difficult. Muscle tonus regulation disorders, especially in the beginning of a disease, are closely related with pathology of tonic and righting reflex development, formation of pathologic synergisms. In the course of the disease secondary alterations in muscles, bones and joints occur such as contractures, deformations, scoliosis and kyphoscoliosis develop, a pathologic movement stereotype is formed. Pathologic tonic reflex activity develops that leads to an increase in the muscle tonus and formation of pathologic postures. Equilibrium control mechanisms when standing and walking are affected; a pathologic movement stereotype, incorrect body and extremity postures, and, later, contractures and deformations are formed. Along with these symptoms, delay in psychic development with mental retardation, epileptic seizures, oculomotor disorders (strabismus, nystagmus), speech and hearing disorders are often observed. ICP is treated in our institute mainly by means of training physical and psychic functions with the use of special techniques, the most famous of which are the Voight therapy, Bobath therapy, dynamic proprioceptive gymnastics (the ADELI Suit), Kozyavkin method. Psychotherapeutic, logopedic, orthopedic support, timely speech, sight and hearing correction are of great importance. When should rehabilitation of ICP patients start? Treatment should start as early as possible as a child’s brain in the first years of life is very flexible, which makes it possible to hope for deficiency compensation. The treatment shall be uninterrupted during many years. Causes of ICP: ICP can be caused by different exogenic and endogenic factors that can interact. Thus, ICP can be regarded as a multifactorial disease. ICP can be caused by intrauterine infections, intrauterine hypoxia (for example, due to impaired placental circulation), mother and fetus Rh factor incompatibility with nuclear icterus development, premature delivery and birth injury, hypoxia and asphyxia in case of prolonged or complicated delivery, traumas, vascular injuries, infections in the postnatal period. Important risk factors for ICP are premature birth and low weight at birth. The efficiency of ICP treatment depends on the following: • Age of a child examined by a specialist for the first time • Severity of ICP • Presence of different forms of disability • Level of physical development and correspondence to the chronological age, • Level of intellectual development of a patient estimated by clinical psychologists, specialists in cognitive research • Social status and education of caretakers (first of all parents) • Number of brothers and sisters • Living conditions. Rehabilitation program in case of ICP: Motor system recovery massage (massage specialist), kinetotherapy (rehabilitation physician), remedial physical training (instructor), standing and gait recovery (rehabilitation physician, ergotherapist), physiotherapy (physiotherapist), ergotherapy (ergotherapist) Sight recovery procedures for correction of strabismus and nystagmus (ophthalmologist) Speech recovery sound and word pronunciation (aphasiologist/logopedist), speech recovery (aphasiologist/logopedist) Psychoemotional recovery conversations with the patient (psychologist), walks, conversations with the patient (medical staff, relatives) Role of surgery in ICP treatment: In case of stable contractures and deformations plaster bandages are used or a surgery is made (for example, tendon lengthening, muscle transposition). The main objective of these surgeries is to increase the volume of movements, provide correct alignment of segments and joints that carry the weight of the body. This treatment is mainly used after the age of five or six. Post-surgery patient care shall be performed by a rehabilitation physician to avoid post-surgery complications (recurvation, tibial syndrome). IT IS STRICTLY PROHIBITED TO WALK IMMEDIATELY AFTER THE SURGERY, kinetotherapy is required during 6 weeks to establish the balance of antagonistic muscles.
Traction12
An intervertebral disc with its jelly-like central part having hydraulic functions plays an important role in the spine mechanics. It is a flexible connection between vertebrae that gives them mobility by assisting intervertebral joints. An intervertebral disc is able to transform vertical pressure into horizontal pressure; this means that a disc is a good shock absorber that protects vertebrae and caudal structures (bones, joints) against loads a human body is exposed to in an everyday life at home and at work. These qualities of a disc are diminished in case of degenerative changes among which the first place is taken by the intervertebral disc hernia. The clinical performance of the intervertebral disc hernia is represented by the pain syndrome. However, very often there are cases when motor functions are lost, this leads to weakening and atrophy of some muscles and muscle groups and some movements and especially gait become difficult. Intervertebral disc hernias don’t occur abruptly, usually they are preceded by several unfavorable states that develop in spine segments the ultimate of which is an intervertebral disc extrusion. This pathology is characterized by impairment of the integrity of a disc fibrous ring and a bulge of the nucleus pulposus that is partially restricted by a ligament located longitudinally. Treatment of degenerative changes in an intervertebral disc can be operative and conservative. The purpose of conservative treatment is to remove pain, improve the functional capability of the patient, interrupt the development of the pathological progress, which is a preventive measure for disease recurrence. This is mainly a combined treatment that includes bed rest (in the acute period), medication therapy, and especially physiotherapy and kinetotherapy. Stages of hernia formation: Initial degenerative processes in an intervertebral disc. They are caused by changes resulting from impairment of local blood circulation and influence of other negative factors such as osteochondrosis of the spine. As a result deficiency of nutritional substances and fluid occur leading to defects in the form of small cracks on the disc. Protrusion is the formation of a disc bulge 1-5 mm in size. This disease is characterized by the bulging of the problem area of the intervertebral disc outside the vertebra; the integrity of the fibrous ring is not impaired. The most probable cause of protrusion is osteochondrosis of the spine, but there may be other factors promoting this defect. Extrusion is a bulge with impairment of the integrity of the fibrous ring and a prolapsed nucleus pulposus restricted only by a longitudinal ligament of the spine. Pain in case of this type of pathology is caused only by compression of the nerve root, but this does not happen very often. Extrusion of disc L5-S1 (lumbar-sacral area of the spine) is the most dangerous, this location of extrusion can result in compression of the sciatic nerve. Causes of intervertebral disc defects: Intervertebral disc defects are caused by degenerative processes resulting from spinal curvature (scoliosis), osteochondrosis of the spine, spondylosis and other diseases that lead to a spinal disc bulge. These diseases impair trophism of some elements of the spine, which becomes the main cause of flexibility loss, shrinkage and deformation of intervertebral discs. In some cases a spinal disc bulge can be caused by spinal injury, especially when the ligament apparatus is depressed. Non-uniform distribution of physical load also results in spinal extrusions; segments of the lumbar area of the spine at the highest risk. Treatment of disc extrusion: Small defects (up to 5 mm) can be treated by means of spine extension, remedial physical training. If extrusion exceeds 8 mm physicians prescribe combined therapy that includes massage, physiotherapeutic procedures, acupuncture, it is also possible to use remedial physical training in a reduced regime. Surgery is not required in this case. If extrusion is more than 12 mm in size special treatment methods are required, to select them it is necessary to hospitalize the patient and carry out comprehensive examination; only in this way correct treatment can be selected. First of all, it is necessary to remove tissue inflammation, pain syndrome, if required, and then to strengthen back muscles in order to create a reliable muscle sling. In this case physiotherapeutic procedures and remedial physical training are prescribed. Physiotherapy includes the following procedures and manipulations: • Warming procedures (UHF, paraffin bath etc.) • Ultrasound therapy • Electrical nerve stimulation • Electrophoresis • Magnetotherapy Other methods of combined therapy: • Massage • Remedial gymnastics • External fixation devices (spinal assistants). In case of nerve root compression nonsteroidal anti-inflammatory drugs are widely used; they help quickly remove inflammation and local pain. Pain specialists (algologists) may proceed to stronger methods of influence. They prescribe hormonal drugs that are injected directly into the spinal cord canal. This injection method makes it possible not only to diminish the severe pain syndrome but also considerably decrease inflammatory reactions. If conservative treatment methods do not lead to patient recovery and his/her state becomes worse, it is appropriate to proceed to operative treatment methods to radically remove the extrusion. The most widespread types of surgeries are discectomy, microdiscectomy, endoscopy, laser discoplastics. Some words about preventive measures. To prevent extrusions manage your weight, eat healthy food, lead an active lifestyle, go in for sports, try not to overload your spine. Basic rules for intervertebral disc recovery: An intervertebral disc bulge can occur in any direction, therefore, when selecting exercises pay attention to what you feel. If you don’t feel uncomfortable when doing an exercise, you should undoubtedly do it, it is “your” exercise. If you feel uncomfortable (a slight pain), you also should do this exercise, but more careful. If you feel an acute pain in your spine when starting to do an exercise, you should reserve this exercise for the future; it will be your diagnostician. You should return to it after a while and if you feel less uncomfortable, you are on the right track. • At the initial stage avoid body twisting exercises. • Avoid jumps, jerks and back strokes. • Exercises should be done as often as possible during a day (2 to 6 times). You should divide the whole exercise complex into parts (with 1 to 3 exercises each) and do different exercises in different time of the day. • Don’t make abrupt efforts to the problem area of the spine. • Begin with exercises with minimum load and amplitude and increase them gradually. • Don’t try to set intervertebral discs or vertebrae in one day. Exercises are aimed at soft extension of the spine and increase of blood circulation in the problem area. Exercises for spine extension in case of a lumbar herniated disc: These exercises must be done to remove pain and create favorable conditions for spine restoration. Incline extension. Spine extensions should be done every day during 5 - 20 minutes. You need a wide and smooth board with about 50 cm straps on one side. The straps are fixed to a board end shoulder length apart. The upper edge of the board should be installed at a height of 100 - 130 cm from the floor (table, window sill). You can lie on the board on your face up or down, passing your hands through the straps; the straps are under your armpits and fix the shoulder girdle. The muscles of your body should be relaxed as much as possible. To better relax the muscles put a cushion under your knees (in the face up position) or your lower legs (in the face down position). Extension should be painless, its strength can be controlled by changing the inclination of the board. Forward bend extension. To extend you should lie with your belly on a knee high support. You can use a narrow table stool (so that your shoulders and hang down) with a cushion on it as a support. The top of the body bending should be in the blocking area. The body weight should partially account for knees and elbows and partially for the support under the belly. You should relax your muscles as much as possible and breathe with upper lungs. Lateral bend extension. In case of a unilateral pain syndrome you should lie on the healthy side, and on both sides in turn in case of a pain on the both sides of the spine. You should put a roller under the blocking area. The height of the support should be enough to provide sufficient extension of muscles without significant discomfort. The upper part of the body should be turned a little backward to the back, and the lower part should be turned a little forward to the belly. Walking on hands and knees. Take a hands and knees position, with your arms and back straight. In this position you should walk around the room. You should not bend your arms. Lie on your back, your body and legs straight. Slightly pull your toes, and try to touch your breast bone with your chin. As a result of stretching neck and calf muscles the spine extends. Swimming. Exercises in water provide minimum load on the spine. The natural posture of the spine is achieved by crawling and backstroking. Breast stroking gives excessive pressure on the long muscles of the back and neck therefore it is not recommended at the initial stage. Exercises for strengthening spine muscles and ligaments in case of a lumbar herniated disc: The main task of these exercises is to increase blood circulation in the lumbar spine. Doing these exercises concentrate on this area of your back. Lying on your back, bend your legs in the knees, arms along the body. Resting on your shoulder blades, shoulders and feet, raise your hips and fix them in the upper position for a few seconds, then return them back. Repeat 3 - 5 times. In a hands and knees position. Simultaneously raise opposite arm and leg, fix them for a few seconds and return to the initial position. Repeat 5 - 7 times. Lying with your face down, place your hands one on the other under your chin. Slightly raise your arms, breast and head simultaneously keeping your legs, hips and belly on the floor. Hold this position for 5 - 7 seconds. Repeat 3 - 4 times. Repeat this exercise raising your straight legs simultaneously. A more complicated version. Stretch your arms along your body. Simultaneously slightly raise your head and shoulders stretching your straight arms backward to the legs (inhale). Return to the initial position (exhale). It is impossible to get rid of an intervertebral disc bulge once and for all. You should observe specific rules to reduce the risk of possible complications. After lifting a weight, it is safe to hold it as closer to you as possible, this reduces pressure on the spine. It is not recommended to carry a heavy burden with one hand especially for long distances. It is unacceptable to abruptly bend forward or unbend. When lifting a weight you should bend legs in the knees rather than your back. An intervertebral disc hernia is not a verdict; observing the rules and doing exercises you can live a full life. When is a surgery required in case of an acute disc hernia? Don’t be in a hurry with operative treatment of this pathology! Some authors think that only in 0.5% of all acute herniated disc cases operative treatment was required after rehabilitation, while more “energetic” surgeons think that approximately 20% of these patients finally make it to surgery treatment although in years. Surgical indications include: • Cauda equine compression in case of a medial herniated disc (immediate surgery is required) • Persisting and recalcitrant cases • Frequent recurrence that leads to disability • Progressive loss of motor functions. Is a surgery a solution? You should not forget that a surgery is accompanied with hernia excision and release of nerve roots from compression, however it does not recover the functional capacity of the degenerated disc. On the contrary, after a surgery the stability of the appropriate segment of the spine become worses and the degenerative changes continue to develop. Very often these changes also affect other discs so that the patient continues to complain even after the surgery.
mitri.az
Compression neuropathy or tunnel syndromes are caused by compression of nerves in osteofibrous-muscular canals (tunnel neuropathy) or by external pressure. Tunnel neuropathies make the third part of all diseases of the peripheral nervous system. There are more than 30 forms of tunnel neuropathies described in literature: carpal, cubital, radial, crural, fibular tunnel syndromes. Tunnel syndromes are promoted by recurring stereotype movements, injuries. Tunnel syndromes are characterized by numbness, pain, paresthesia, muscle weakness, and hypotrophy. Different forms of compressive-ischemic neuropathies have their peculiarities. For example, the cubital tunnel syndrome is characterized by numbness of the minimus and the medial surface of the hand; the carpal tunnel syndrome is characterized by pains at night that irradiate into the forearm and shoulder. Causes: Tunnel syndromes occur after one-time long-term compression of the nerve (during several hours); these syndromes can often be caused by alcohol ingestion. The Friday syndrome is a classical example of this: having celebrated the end of the week a patient wakes up with a “drop wrist”, paresis of the common digital extensor caused by radial nerve compression in the spiral canal in the shoulder during sleep. The patient exactly names the time when the paresis occurred; in the absence of treatment muscle atrophies begin to appear in 2-3 months. Another cause of the tunnel is recurring slight compression of the nerve; the tunnel syndrome appears gradually, at the initial stage only transient numbness in the area of impaired nerve innervations is observed then the numbness becomes stable, muscle weakness appears, then muscle atrophies develop. The precise diagnosis is made during examination by the neurologist — electroneuromyography helps determine the degree of forearm muscle disturbance. The combined treatment includes first of all physiotherapy and kinetotherapy (ionophoresis, phonophoresis, laser therapy, paraffin bath). Vasoactive, antioedematic and nootropic drugs, muscle relaxants, ganglionic blockers etc. are also prescribed. The most widespread syndromes are: • Carpal (compression of the median nerve at the level of the wrist); • Cubital (compression of the ulnar nerve at the level of the cubital canal (at the level of the elbow); • Fibular (compression of the fibular nerve behind the head of fibula); • Tarsal (compression of the tibial nerve at the level of the tarsal canal); • Compression of the radial nerve in the spiral canal (the “drop wrist” syndrome or “Friday” syndrome). Tunnel syndrome diagnostics: • Clinical picture of the isolated disorder of the appropriate nerve (unilateral or bilateral) • Sometimes painfulness in the canal on palpation; when palpating paresthesia appears • The denervation-reinnervation syndrome in muscles innervated by the impaired nerve below the compression level and intactness of muscles innervated by the same nerve above the canal level (for example, in case of the carpal canal it is denervation in hand muscles and intactness of forearm muscles) • Stimulation EMG • Research into the conductive functions of motor nerves Initial stage: Local reduction of the conduction velocity at the level of the canal (for carpal and tarsal tunnels – increase in residual latency). Middle stage: Reduction of the M-response amplitude and conduction velocity at the level of the canal or accentuated reduction of conduction velocity (by more than 40% below the norm). Advanced stage: Accentuated reduction of the M-response amplitude, reduction of the conduction velocity at a distance from the tunnel area, increase in residual latency. Treatment of tunnel syndromes: At the initial stage blocking with glucocorticoids (diprospan or dexamethasone + local anesthetic (Lidocain) are injected into the canal area) are most effective. Everyday remedial physical training, regular physiotherapy, massage, resolving therapy (Lydazum), neurotrophic therapy (Milgamma, Neuromultivit), Neuromidin can be effective. At the middle stage the efficiency of conservative therapy will be incomplete. At the advanced stage conservative therapy is normally ineffective and a surgery is required (neurolysis, a surgery during which the nerve is released from adnations, connective tissue that compress it). How can you avoid a tunnel syndrome? A tunnel syndrome is a disease typical for office employees, teenagers and people with sedentary lifestyle. The basic prevention methods are special exercises, work breaks to do exercises, as they improve circulation in muscles and promote their stretching. It is also important to arrange your workplace correctly and comfortably following the rules of ergonomics.
AZ RU EN Mobile : +994502634075/77 E-mail : info@itrdi.az +994 (12) 404 83 10/11 FAQ