Paralysis in children, causes of paralysis. Epidemiological surveillance of acute flaccid paralysis (AFP)

For voluntary movements human body responds to two groups of neurons, namely peripheral and central. They have different structure and differ in the functions they perform. Therefore, the manifestations of the disease vary.

When there is a disturbance in the functioning of central neurons, spastic paralysis develops, while when there are deviations in the functioning of peripheral neurons, flaccid paralysis occurs.

Central paralysis provokes general disorder motor activity. A person develops spasticity of muscle fibers, but at the same time they do not lose their integrity and do not undergo atrophy. With the development of central paralysis in certain groups muscle tissue clinical convulsions appear, but deep tendon reflexes are completely preserved.

With this form of paralysis, it often appears positive symptom Babinsky, in which the big toe of the lower limb performs a flexion movement when the foot is irritated.

With peripheral paralysis, a decrease in muscle tone is observed and atrophic processes. In this case, there are no deep tendon reflexes, while abdominal reflexes are preserved. This form of paralysis is also characterized by a negative Babinski symptom. People often complain of loss of sensitivity.

Kinds

There are different types of disease - classification is carried out depending on the severity of the disorders, manifestations and prevalence of the pathological process. So, doctors distinguish between complete and incomplete paralysis. It can also be reversible or irreversible, local or widespread.

Depending on the affected area there is:

To indicate the number of limbs affected by the pathological process, doctors use the following terms:

Paralysis as a separate disease

In most cases, paresis and paralysis do not act as independent diseases. They are a symptom that indicates organic lesions of the central nervous system. However, there are some types of paralysis that are independent diseases.

How to treat

In most cases, paralysis and paresis are not independent diseases. That's why effective treatment impossible without adequate treatment of the underlying pathology.

If a peripheral nerve is damaged, its integrity must be restored. For this purpose, a neurosurgical operation is performed.

If a person has had a stroke, he needs to undergo full course restorative treatment. When tumor formation, which compresses nerve endings or brain structures, it should be removed.

Therapy of paralysis in the event of a stroke requires restoration of the affected area and activation of neighboring zones that are able to take on lost functions. Several categories of drugs are used for this:

Symptomatic treatment of the disease is of no small importance. To restore the function of the limbs, it is very important to position them correctly on the bed. This will reduce the risk of developing contracture.

An important component complex therapy is physiotherapy and massage. By kneading the affected limbs and stimulating nerve endings muscles, it is possible to restore broken connections with the central zones of the cortex.

Peripheral paralysis responds well to electrotherapy and other physiotherapeutic techniques. Most often, doctors prescribe galvanization and balneotherapy. In this case, massage and special exercises are also very effective.

There are no treatments for facial paralysis therapeutic exercises, and therefore such types of therapy are considered ineffective. Thanks to the use of drugs, it is possible to stimulate the restoration of the myelin sheath and the transmission of impulses.

For this purpose, B vitamins, aloe, vitreous. The same drugs are used during the rehabilitation period after surgery to restore the integrity of the nerves.

Neuropathies of a tunnel nature can be successfully treated with local drug blockades. During this procedure, painkillers and anti-inflammatory drugs are injected into the affected area and vitamin preparations. Thanks to this in short time it is possible to restore muscle mobility.

Paralysis is a fairly serious condition, which in most cases is a symptom of more dangerous pathologies. To cope with this disease, it is very important to establish the causes of its occurrence, and for this it is important to consult an experienced doctor as early as possible.

Leg paralysis is a loss of motor ability caused by damage to the spinal cord. Paralysis can be complete or partial. In the second case they talk about paresis. Paralysis may indicate the development of a large number of diseases. If the limbs are paralyzed, you should carefully monitor the dynamics of changes in the condition....

Flaccid paralysis is a dangerous complication after infectious diseases. The pathology is characterized by the progressive death of neurons in the peripheral nervous system. This leads to significant deterioration or complete impossibility of movement in the affected area. Most often, the muscles of the arms, legs and neck are paralyzed. How does this type of paralysis develop? And is it possible to restore motor function? The answers to these questions can be found in the article.

Description of the pathology

In peripheral nerves, these cells are equipped with long processes (axons) that transmit signals from the nervous system to the muscles. Thanks to these structures, a person has the ability to make movements.

In acute flaccid paralysis, motor neurons and axons are affected and gradually destroyed. The flow of signals from the nervous system to the muscles stops. As a result, the person cannot move the affected part of the body. Over time, muscle atrophy occurs, tendon reflexes are lost, and muscle tone deteriorates. Weakness of the limbs increases and progresses.

If the motor function of the affected area is completely lost, then doctors call this pathology paralysis. If movements are weakened and difficult, then experts talk about muscle paresis.

The following pathological conditions do not include flaccid paralysis and paresis:

• movement disorders after injuries and injuries (including birth injuries);
• paresis and paralysis of the facial muscles.

It is also very important to differentiate this pathology from paralysis resulting from damage to the central nervous system.

Etiology

Peripheral flaccid paralysis is not an independent disease. Most often it occurs as a complication of infectious pathologies caused by enteroviruses. In most cases this type motor disorders develops after polio.

In the past, this dangerous viral disease was widespread. It often led to death and disability of the patient. Nowadays, thanks to mass vaccination, only isolated cases pathology. However, the risk of infection cannot be completely excluded. An unvaccinated person has high risk infection. Cases of imported infections are periodically recorded. Get dangerous virus It is also possible when traveling to polio-affected regions.

The polio virus is transmitted in several ways: airborne droplets, contact, and through utensils. In addition, the microorganism can live in the environment for several days. Children under 15 years of age are especially susceptible to infection.

The virus enters motor neurons and causes dystrophic changes. The nerve cell dies and is replaced by glial tissue. Subsequently, a scar forms in its place. The more motor neurons that die in polio, the faster acute flaccid paralysis develops.

Poliomyelitis is the most common, but not the only cause of this pathology. Flaccid paralysis can also develop as a result of other diseases:

1. Inflammatory process in the spinal cord (myelitis). In half of the cases, this disease is caused by an infection. Its causative agents can be enteroviruses, mycoplasmas, cytomegaloviruses, as well as the causative agent of herpes. Sometimes inflammation occurs after an injury. But even in this case, the cause of the pathology is microorganisms that have penetrated the spinal cord through the wound. With myelitis, the supply of impulses from the central nervous system to the peripheral nerves is disrupted, which becomes the cause of paralysis.
2. Poly- and mononeuropathies. These diseases are also caused various viruses. In polyneuropathy, it affects simultaneously a large number of peripheral nerves. Mononeuropathy is characterized by pathological changes in neurons in a separate area, most often in one of upper limbs.
3. Guillain-Barre syndrome. The disease occurs as an autoimmune complication after viral pathologies: mononucleosis, mycoplasmosis, cytomegaly, infection with Haemophilus influenzae. Infectious process leads to disruption of the immune system. Protective antibodies begin to attack peripheral nerve cells, which leads to flaccid paralysis.
4. Coxsackie virus infection. In most cases, this microorganism causes a disease that occurs with fever, rash and inflammation of the oropharynx. However, there is another strain of the virus that causes inflammation skeletal muscles. The consequence of this pathology can be acute flaccid paralysis in children. Adults are infected much less frequently.

Currently appeared the new kind enterovirus (type 70 strain). Most often it causes severe form conjunctivitis. But there are also atypical forms diseases that are similar in symptoms to polio. This pathology can also cause damage to peripheral nerves.

Difference from central paralysis

It is necessary to distinguish between flaccid and These two pathological conditions are accompanied by impaired motor function. However, they differ in etiology, pathogenesis and symptoms:

1. The spastic form of the pathology occurs due to damage to the central nervous system. Acute flaccid paralysis is characterized by damage to the peripheral nerves or roots of the spinal cord.
2. In spastic paralysis there is no damage to motor neurons.
3. In the peripheral form of paralysis, there are no flexion and extension reflexes, and muscle weakness is noted. With a pathology of central origin, the muscles are tense, involuntary muscle contractions are noted, and reflex movements are preserved.
4. Central paralysis can impair movement throughout the body. In the peripheral form there is deterioration motor function in a certain area.

Only a neurologist can differentiate these two forms of paralysis based on comprehensive examination.

Symptoms

Impaired motor function most often appears suddenly and increases rapidly. The following symptoms of flaccid paralysis can be distinguished:

• impossibility or difficulty of movements;
• severe weakness muscles in the affected area;
• lack of response of paralyzed muscles to mechanical stress;
• asymmetrical lesion;
• muscle atrophy (a paralyzed leg or arm becomes thinner than a healthy one).

If paralysis develops against the background of polio, then the patient’s general signs infectious pathology. Usually, shortly before the onset of movement disorders, the temperature drops and the muscle pain and spasms.

A fairly common form of pathology is lower flaccid paralysis. It is characterized by damage to the spinal cord roots. As a result, the patient experiences paralysis of one of the lower limbs. Most often, the innervation of the muscles of the feet is disrupted. A person cannot move his feet and it becomes very difficult for him to walk. The onset of paralysis is preceded by strong pain in the lower back. IN severe cases defeat goes to cervical region, and the patient is paralyzed on the right or left hand.

Features of pathology in a child

Flaccid paralysis is more common in children than in adults. A child is much more susceptible to infection with enteroviruses. Polio is quite rare these days. The main danger to a child is represented by other types of enteroviruses that affect peripheral nerves.

Manifestations of flaccid paralysis in children are the same as in adults. However, the child more often experiences damage to the neurons responsible for the functioning of the respiratory and swallowing muscles. Sick children breathe quickly and shallowly, which leads to hypoxia. As a result, frequent headaches, lethargy, and difficulty falling asleep occur. The child finds it difficult to swallow and often chokes on food. Children often lose weight due to lack of nutrition.

Complications

If left untreated, flaccid paralysis causes severe complications. This pathology can lead to the following dangerous consequences:

1. Ankylosis. Lack of movement in a paralyzed limb leads to fusion of bones in the articular joints.
2. Muscle contractures. Over time, the muscles in the affected area shorten and harden.
3. Persistent muscle weakness. Peripheral paralysis is accompanied by a sharp decrease in the tone of the muscles of the neck and limbs. Without treatment, muscle tissue atrophy becomes irreversible.

If the patient has already developed such complications, then restore motor function conservative methods is no longer possible. In most cases, it is necessary to resort to surgical treatment methods.

Diagnostics

A neurologist is involved in the treatment and diagnosis of this pathology. Since paralysis is usually caused by viral pathologies, consultation with an infectious disease specialist may be required.

Peripheral paralysis must be differentiated from other types of motor dysfunction. To clarify the diagnosis, the following types of examinations are carried out:

1. Neurological examination. The doctor examines the patient's muscle strength, tendon reflexes, and swallowing function.
2. Clinical and biochemical tests blood. The presence of pathology is indicated by an increase in ESR and an increased concentration of creatine kinase.
3. Virological research feces This test is performed if polio is suspected.
4. Blood toxicology test. Helps distinguish peripheral paralysis from motor dysfunction caused by chemical poisoning.
5. Electromyography. This test helps evaluate muscle electrical conductivity.
6. Test with proserine. The test allows you to distinguish paralysis from myasthenia gravis.

Drug therapy

Treatment of flaccid paralysis requires integrated approach. The main goal of therapy is to restore the normal functioning of motor neurons. Patients are prescribed nootropic and antioxidant drugs in high doses:

• "Piracetam."
• "Actovegin".
• "Mexidol".
• "Trental."
• "Cerebrolysin".

These medications help normalize metabolism in damaged nerves and protect neurons from harmful effects.

A course of injections of the drug "Proserin" is indicated. This remedy improves signal transmission from neurons to muscles and helps increase muscle tone.

Be sure to prescribe a course of vitamin therapy. It is necessary to take high doses of drugs, most often the drugs are administered intramuscularly. For treatment, vitamins B 1 and B 12 are used, which have a positive effect on the condition of the nervous tissue.

Physiotherapy and rehabilitation

Restoring movements is impossible without physiotherapy. This is the main part of the treatment of peripheral paralysis. It is impossible to get rid of motor dysfunction using medication alone. It is necessary to develop damaged muscle groups to avoid their complete atrophy.

Patients are prescribed galvanization sessions. Electrodes are applied to the affected areas and a constant electricity low voltage. This helps improve tissue metabolism and restore damaged neurons, as well as increase muscle tone. Baths with mineral waters are also shown. This allows you to influence peripheral nerves through skin receptors.

Such procedures can only be carried out after cupping acute symptoms infectious disease. Galvanization and water treatments are quite effective, but the process of restoring movements takes a long period of time.

Massage for flaccid paralysis helps restore muscle tone and prevent muscle atrophy. The impact on the affected areas should be quite intense, using kneading and rubbing of the damaged muscles. But it is very important to prevent injury to muscle tissue. Therefore, this procedure should only be trusted by a qualified specialist. It is useful to combine classical and acupressure massage.

Exercise therapy for flaccid paralysis is a mandatory part of treatment. However, it must be taken into account that patients have weakened muscles and joints. Therefore on initial stage passive movements using support are shown. For example, the patient rests the affected foot on a special box and tries to bend the leg. Crawling on all fours is also useful. First, the patient moves the diseased limb using the muscles of the trunk, leaning on his hands. As the movements develop, the exercises are performed while kneeling.

Gymnastics in water is very useful. Exercises for the limbs can be combined with medicinal baths.

If hand movements are impaired, the patient must be taught simple household skills. For this purpose, tables with special stands are used in physiotherapy rooms. The patient learns to fasten buttons independently, press the switch button, and turn the key in the lock. Restore fine motor skills brushes help with modeling from plasticine.

Surgical methods

In severe cases and in the presence of complications, surgical treatment is indicated. The most commonly used types of operations are:

• transplantation of healthy muscles to an atrophied area;
• elimination of joint deformation due to ankylosis (osteotomy);
• plastic surgery by thickening of the lower leg (with severe muscle atrophy).

After surgery, movements are restored much faster than with conservative treatment.

Forecast

The prognosis of the disease depends on the degree of neuronal damage. If diagnosis and treatment were carried out in a timely manner, then it is quite possible to restore movement. However, this will require long-term complex therapy and rehabilitation. Typically, the process of restoring motor function takes about 2 years. After surgical treatment movements return to normal after about 1 year.

In advanced cases, it is no longer possible to restore movement even with surgery. If a patient has lost more than 70% of neurons, then such changes are considered irreversible.

Prevention

How to prevent the death of motor neurons and the occurrence of paralysis? Most often, such complications lead to enteroviral diseases. To avoid infection, the following recommendations must be followed:

• Get vaccinated against polio on time;
• avoid contact with sick people enteroviral infections;
• strengthen immune system;
• timely and completely cure infectious diseases;
• After suffering from polio, regularly visit a neurologist for 6-12 months.

These measures will help avoid dangerous complications infectious pathologies and maintain motor function.

Peripheral paralysis is the result of damage to peripheral neurons responsible for motor functions. In this case, there is a loss of reflexes, degenerative muscle atrophy, etc.

In addition, it should be noted that the process of changing electrical excitability in the affected nerves, which is called degeneration, also starts. The severity of the disease is indicated by the depth of changes in electrical excitability.

Atony and loss of reflexes occurs due to a break in the functioning of the reflex arc, and at the same time the muscles lose tone. This factor prevents the corresponding reflex from being evoked. The disconnection of muscles from the neurons of the spinal cord causes their sudden weight loss and atrophy.

From neurons that are connected to muscles, impulses responsible for normal exchange substances in the muscle tissue area.

When muscles are damaged, fibrillar twitching is observed, which looks like rapid contractions in the area of ​​individual muscle fibers. Basically, such processes occur when chronic form diseases.

Peripheral paralysis occurs when a peripheral nerve is damaged. In this case, sensitivity may be lost, and as a result they develop in the affected area.

Disease development process

The development of peripheral paralysis is associated with damage to the neuron responsible for movement and its axon. If only the kernels are affected cranial nerves and anterior horns, then along with flaccid paralysis it can develop in parallel.

In addition, these two ailments are accompanied by characteristic fascicular twitching. When a peripheral nerve is deformed, there is a high chance that the innervated muscle will be paralyzed.

Peripheral and central paralysis are 2 pathologies that are often mistaken for one disease or even confused.

But these are different violations. At central paralysis motor functions of the whole body are lost, muscles are in constant tension. In addition, there are no signs of degeneration and the muscles do not atrophy. In the case of damage to the peripheral parts, the picture is different, or rather completely opposite.

Peripheral paralysis is a disease in which there is a decrease in muscle tone and paralysis individual parts bodies.

Factors influencing the development of the disorder

Symptoms of flaccid paralysis, such as loss of motor function, are not an independent disease; they are often caused by concurrent illnesses.

Essentially, paralysis is a disorder in which a person makes involuntary movements. In some cases, patients cannot move part of the body or are completely immobilized.

Partial loss of motor functions indicates... In any case, the violation is evidence, namely, of the centers that are responsible for movement and the peripheral parts. The following factors are noted as influencing the development of pathology:

Characteristic manifestations

Signs of peripheral paralysis:

• complete or partial loss of motor functions;
• decreased muscle tone in the affected part;
• complete or partial absence of any reaction to sudden irritation of paralyzed muscles;
• denervation atrophy is observed, that is, loss of muscle mass;
• a reaction of degeneration or degeneration is also observed.

Over time, if a person does not receive proper treatment, peripheral paralysis can develop into another form, that is, an acute infectious disease. It is often found under the name. It is characterized by intoxication, while the nervous system also suffers, paralysis and acute flaccid peripheral paresis develop.

This infection is initiated under the influence of a filter virus, which is quite resistant and has increased sensitivity to ultraviolet radiation, disinfectants and high temperature.

When the virus penetrates a neuron, a dystrophic-necrotic process is triggered, which is accompanied by the replacement of all dead neurons with glial tissue and subsequent scarring. In turn, the more neurons die, the faster they form or paralysis.

Diagnostic methods

Diagnostic measures involve performing a whole range of examinations:

• examination by a specialist – neurologist;
• basic tests are taken (general blood test and toxic);
• instrumental diagnostics (, and);
• an analysis of the patient’s complaints and medical history is carried out (the time of muscle inactivity is identified, the causes of complaints and the presence of these in other relatives and what caused such a reaction, that is, place of work, etc.);
• Often you are examined by a neurosurgeon.

In addition to the basic methods, specialists carry out differential diagnosis of the disease. At the same time, symptoms are identified that are very easily confused with signs of central paralysis.

In addition, do not forget that in some cases, the lack of motor functions can be caused by any kind of injury and such a symptom is not always a sign of peripheral paralysis. Therefore, a complete examination of the patient is carried out to identify such injuries.

Health care

First of all, treatment is aimed at getting rid of the causes contributing to the development of the disease. In some cases, which are particularly complex, specialists resort to surgical intervention.

In this case, only the part of the spinal cord on which the damaged muscles are located is affected. But we should not forget that peripheral paralysis may not be a consequence of some other disease, but it is quite likely that it will develop as an independent form of pathology.

A whole range of measures is used in treatment. In this case, both medications and more common methods are used, such as and.

The main task of specialists is to fully restore the patient’s motor functions. If this is done, the chance of developing other processes leading to deformation against this background is significantly reduced.

All this time, the patient must be under the supervision of a neurologist and follow all his instructions, including taking individually prescribed medications.

Among the medications that are often prescribed to patients suffering from flaccid paralysis are:

In addition, physiotherapeutic treatment is now actively used. This process takes quite a long time, but, nevertheless, this type of treatment is the most effective. If only this type of treatment is used, motor functions may not fully return, so a whole range of measures is required.

How dangerous is the disease?

If the treatment is prescribed incorrectly or all the specialist’s instructions are not followed, some complications and quite unfavorable consequences may occur.

The most common are:

• muscles may experience a decrease or complete absence forces, and on a permanent basis;
• joint immobility and muscle hardening are formed.

Preventive actions

In order to avoid the development of disorders, experts recommend following the following instructions:

• see a doctor when the slightest symptoms diseases and any other problems;
• arterial pressure must always remain under control;
• treatment infectious diseases on early stages preventing them from causing more serious problems;
• It's best to exclude everything bad habits, - alcohol and smoking contribute to the development of many health problems, not only peripheral paralysis;
• effective prevention is maintaining a healthy lifestyle ( proper nutrition, rest, adherence to routine and physical activity).

Flaccid paresis is a decrease in strength in one or more muscles. It develops only secondarily, that is, it is a consequence of one or another disease. In this case, strength can be measured using a special test, which cannot be said about another condition called paralysis.

Depending on how badly the muscles are damaged, there are 5 types of this condition. To determine one degree or another, you can use a scale specially developed for this purpose.

Determination system

Pathology is determined on a five-point scale, which was developed and has been successfully used in neurology for many years.

Five points are given to a person whose muscle strength is completely preserved, that is, there are no signs of paresis.

A score of four is given when the strength is slightly reduced compared to the recent past.

Three points is already a significant decrease in muscle strength.

Two points are given if the patient cannot overcome gravity. That is, he can bend the elbow joint if the arm is lying on the table, but is not able to do this if the arm is hanging along the body.

One point is given when only individual muscle bundles contract, but not the entire muscle.

Zero points – complete absence of muscle tone. This condition is also called plegia.

Depending on the root cause of paresis, two forms can be distinguished. The first form is central or spastic. The second form is peripheral, or flaccid paresis. Depending on how many limbs are affected, we can distinguish:

1. Monoparesis, diagnosed in only one arm or only one leg.
2. , diagnosed in the leg and arm on the right or left side of the body.
3. , diagnosed only in the arms or only in the legs.
4. , which covers both arms and legs.

Causes

The main cause of flaccid paresis of an arm or leg is a stroke, which results in an acute disorder of cerebral or spinal circulation. In second place in frequency are tumors of the brain or spinal cord, and head or back injuries.

Other reasons include:

1. Brain abscess.
2. Encephalitis.
3. Disseminated encephalomyelitis.
4. Poisoning with poisons, salts, alcohol.
5. Botulism.
6. Epilepsy.

Most often, identifying this symptom does not require any diagnostic measures, since making the above diagnoses already implies a decrease in muscle strength in a person.

The doctor must examine the patient and interview him. The main complaints are identified, from what period the strength in the arms or legs began to decrease, and whether anyone in the family has similar symptoms.

After this, a neurological examination is performed on a five-point scale, which allows you to identify flaccid paresis of the lower extremities and evaluate general state muscular system. After this, a general blood test is performed, and, if necessary, toxicological tests.

From others diagnostic procedures– electroencephalography, computed tomography, magnetic resonance angiography. If necessary, a neurosurgeon is consulted.

Treatment

Acute flaccid paresis is not separate disease, but just a consequence of other, more serious diseases. Therefore, treating it alone will not give any results. First of all, it is necessary to identify and direct treatment to the cause that caused this condition.

For example, it may require surgical removal of a tumor or hemorrhage caused by a stroke. The same method is used to remove the abscess (abscess) and begin antibiotic therapy.

Treatment can use drugs that improve blood circulation, lower blood pressure, and improve metabolism. Antibacterial therapy may also be carried out if infections of the brain or spinal cord have been diagnosed. For botulism - administration of serum. And, of course, drugs that improve nerve conduction are always used.

It turns out that the treatment of flaccid foot paresis will depend entirely on what causes the pathology, and the therapy itself must be strictly individual.

During treatment, massage, exercise therapy, physiotherapy and other procedures are required that are aimed at preventing the muscles from atrophying.

It is very rare to be completely cured, so in most cases the patient receives disability.

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This group includes persons with diseases of the peripheral nervous system (including degenerative-dystrophic changes in the spine), consequences of polio and central hemiparesis, not accompanied by an increase in muscle tone. Based on the nature of the indicated rehabilitation measures, patients with mild muscle spasticity are also included in the same group, in whom, using the methods described above, therapeutic measures managed to reduce pathologically increased muscle tone. After successful reduction of spasticity, further restorative treatment is indicated to gradually eliminate the neuromuscular loss present in such patients.

The main objectives of restorative treatment of patients in this group are disinhibition of inactive cells in the central nervous system, regeneration of fibers in the trunks of peripheral nerves and roots, normalization of muscle functioning and restoration of active life of patients based on dosed training and work adaptation, and the main methods are the use of electrical stimulation of muscles, therapeutic gymnastics, massage and occupational therapy.

Electrical stimulation is carried out using sinusoidal modulated or pulsed currents of exponential shape. First of all, the most weakened, hypotonic muscles are stimulated: on the upper limb - extensors of the hand and fingers, arch support, muscles that abduct the hand outwards, on the lower - dorsal flexors of the foot and extensors of the toes. As a rule, electro-gymnastics is carried out using a bipolar method with the participation of volitional tension of the exercised muscles of the patient. Such active electrical stimulation according to Obrosov-Liventsev is very important for the restoration of voluntary movements, and in the future for the resumption of purposeful labor acts. A slight increase in muscle tone is not an obstacle to electro-gymnastics of antagonists of spastic muscles. The course of treatment includes 15 - 30 procedures performed daily or every other day.

Simultaneously with electrical stimulation, it is necessary to prescribe therapeutic exercises that improve the functionality of atrophic muscles, joints and the sensitive apparatus of joints, tendons, muscles (proprioceptors), as well as coordination of movements. For flaccid paralysis, all types of movements are used: passive, active with help and in lightweight starting positions, completely independent, and as the function of the paretic muscles improves, exercises with increasing effort: with weights with projectiles and overcoming resistance. Hydrokinesitherapy (therapeutic exercises in water) is also indicated, especially for spinal cord damage, polyradiculoneuritis and polyneuritis.

Therapeutic exercises should be accompanied by a massage of the muscles of paretic limbs. When saving small increase tone, selective massage is performed: inhibitory technique acupressure spastic muscles and stimulating massage of their antagonists. In the case of flaccid paralysis, it is necessary to prescribe a deep massage using the techniques of kneading, tapping, vibration and stimulating point-to-point massage techniques, as well as an underwater shower-massage.

Already in the early phases of rehabilitation treatment, occupational therapy is regularly carried out, which is varied in nature and includes a gradual increase in physical activity, degrees of difficulty and differentiation of exercises performed. At the initial stage of treatment, elementary exercises related to self-care and performing simple labor processes, which gradually become more complex, accompanied by training on special simulators. Subsequently, patients proceed to work in special labor therapy workshops using writing and calculating machines, carpentry, drilling, turning and other equipment. When treating lesions of individual nerve trunks of the upper extremities, separate occupational therapy complexes developed by L. A. Lasskaya, G: A. Pavlova and R. M. Golubkova are recommended (they are described in Chapter III).

The background for the rehabilitation treatment of patients with flaccid paralysis are medications and physiotherapeutic procedures that help improve the regeneration of nervous tissue, facilitating nerve impulses and disinhibiting inactive neurons, as well as activating psychotherapy.

The most commonly used medications are anticholine esterase drugs (prozerin, galantamine, oxazil, nibufin), vitamins B (B1, B6, B12, calcium pantothenate) and C, dibazol, pyrimidine derivatives (pentoxyl, methyluracil), glutamic acid, phosphorus preparations and potassium (ATP, MAP, panangin, etc.). To accelerate the process of regeneration of nervous tissue, biogenic stimulants are prescribed (aloe extract, humisol, rumolon, plasmol, pyrogenal, etc.), and to disinhibit inactive nerve cells- drugs of the strychnine group (strychnine, securinine, etc.). In order to activate the regeneration of nerve fibers, galvanic current is widely used, often in the form of electrophoresis on the paretic limb of novocaine, anticholinesterase agents (proserin, galantamine), dibazol, vitamin B15 iodine, applications to the limb and the corresponding segments of the spine of paraffin, ozokerite or mud at a temperature of 42 - 46 ° in the absence of pain and 36 - 40° - in its presence. Local exposure to centimeter and decimeter waves in a low dose, general or local hydrogen sulfide, radon, carbon dioxide and oxygen baths are also used.

In accordance with the described basic principles, restorative treatment of patients with damage to the facial nerve is carried out. You just need to remember about easily occurring contractures of the facial muscles, and therefore the use galvanic current and electrical stimulation during the rehabilitation treatment of patients with neuritis of the facial nerve should be carried out with great caution.

Psychotherapy in patients with predominant symptoms of neuromuscular loss is carried out in the form of explanatory conversations aimed at developing faith in the possibility of restoring lost motor function, but only if the necessary volitional and physical efforts are mobilized to achieve this goal. In addition, a special technique is used autogenic training, aimed at eliminating the existing motor defect and activating voluntary movements. In patients with severe loss of motor functions, the system of stage-by-stage positive emotions is important: every, even small, improvement in the patient’s condition appears to him as a significant achievement, which, however, is only one of the stages on the path to better performance. full use available opportunities.

When implementing stimulating rehabilitation treatment, a certain sequence of therapeutic measures is advisable. At the beginning of the day, the patient is given medications that facilitate the conduction of nerve impulses and promote the resumption of activity of inhibited nerve cells (anticholinesterase drugs, dibazole, strychnine group drugs, B vitamins), after which he is sent to a psychotherapy session. 1 - 1.5 hours after the administration of the drugs, an electrical stimulation procedure is carried out, after a 15 -20-minute rest - therapeutic exercises with stimulating massage and an occupational therapy session.

In a significant proportion of cases, diseases of the peripheral nervous system are secondary in nature and are associated with degenerative changes (osteochondrosis) in the spine. Rehabilitation therapy for patients with spinal lesions retains all the main features inherent in the treatment of flaccid paresis, but also has its own specific features. First of all, it includes such a pathogenetic method of influence as various techniques of spinal traction: vertical, on an inclined plane and horizontal, “dry” and in water.

Another feature of the treatment of patients with spinal osteochondrosis is a special set of gymnastic exercises aimed at reducing pathological impulses from the spine to the upper or lower limbs and restoration of full range of motion. If the cervical spine is affected, a complex of therapeutic exercises according to Z. V. Kasvande is prescribed, which is carried out with mandatory immobilization of the cervical vertebrae with a cotton-gauze collar of the Shants type and includes exercises for the muscles of the limbs and strengthening the muscular corset of the neck, alternating with relaxation exercises and breathing exercises. For lumbosacral localization of osteochondrosis, a gymnastic complex according to V.N. Moshkov is used with primary movements in the hip and knee joints, in lighter starting positions - at the beginning of treatment, with a consistent increase in muscle tension, and gradual learning to walk.

For cervical and lumbosacral radiculitis, plexitis and radiculoneuritis, absorbable agents are used: bijoquinol and lidase; lidase and some biogenic stimulants (aloe, vitreous) can also be administered by electrophoresis to the affected area of ​​the spine or limb. Ultrasound also has a resolving and analgesic effect, the effect of which can be enhanced by the introduction of painkillers and anti-inflammatory drugs (ultraphonophoresis of analgin, anesthesin, hydrocortisone).

Pain syndromes with vertebrogenic lesions of the peripheral nervous system require the use of analgesics (amidopyrine, analgin, butadione, reopirin), preparations from bee and snake venom (venapiolin, apizartron, vipraxin, viperalgin, etc.), ganglion blockers (benzohexonium, pentamin, pyrylene and others). etc.) and physiotherapeutic procedures. Local effects on the cervical spine are carried out using diadynamic and sinusoidal modulated currents, ultrasound, and erythemal doses of ultraviolet rays; electrophoresis of novocaine (according to I.G. Shemetilo, it is better to administer novocaine using sinusoidal modulated currents), analgesics, ganglion blockers, bee and snake venom, as well as the use of vibration and turpentine baths. With damage to the peripheral nervous system, especially accompanied by pain syndrome, the use of acupuncture is indicated, which not only reduces pain, but also helps improve motor, sensory and trophic functions.

Expressed degenerative changes in the spine, leading to the formation of a hernia intervertebral disc and accompanied by signs of increasing compression of the nerve roots or spinal cord, are, in the absence of effect from complex therapy, indications for neurosurgical surgery to remove the disc herniation and stabilize the spine. After spinal surgery, patients should also receive comprehensive rehabilitation treatment.

A peculiarity of the treatment of patients with polyneuritis of infectious and infectious-allergic origin is the inclusion of anti-inflammatory, analgesic and anti-intoxication medications and physiotherapeutic procedures in the recovery complex. A 40% solution of hexamine, 20 - 40% solution of glucose with ascorbic acid, antibiotics are prescribed internally wide range actions - terramycin, tetracycline, etc., antihistamines (diphenhydramine, diprazine, suprastin) and analgesics (analgin, amidopyrine, reopirin). Physiotherapeutic procedures include: inductothermy of the limbs, four-chamber, general or local hydrogen sulfide baths, long-term (40 - 60 min) general wet wraps, ultraviolet irradiation of the hands, forearms, feet and legs in an erythemal dosage, mud, ozokerite or paraffin applications in the form of stockings or gloves. Rehabilitation treatment patients with vegetative polyneuritis will be described below.

Rehabilitation measures for patients with polio are carried out in recovery and residual periods diseases. In addition to the treatment prescribed for all types of flaccid paralysis, various methods of combating the increased tone of antagonists of weakened muscles are used: alcohol-novocaine blockades, thermal procedures, and in severe cases - corrective surgical interventions. Anti-inflammatory physiotherapeutic procedures are indicated with effects on the spine according to the level of the lesion (UHF or inductothermy - transverse technique) and longitudinally on paretic limbs, as well as mud (40 - 42 °), paraffin or ozokerite (45 - 48) applications on the same areas, electrophoresis iodine and calcium on the spine, general salt and hydrogen sulfide baths. Has some features and treatment of patients with neuralgia trigeminal nerve. From medicines the greatest efficiency Carbamazepine (Tegretol) has an anticonvulsant and ganglion blocking agent, the course of treatment is 40 days. Drugs with antidepressant effects are also used - morpholep and nialamide, phenothiazine derivatives (especially aminazine), ganglion blockers (pachycarpine, pyrylene and pentamin), analgesics (amidopyrine, analgin, etc.), vitamins (B1, B6, B12), ATP. Physiotherapeutic procedures include the appointment of diadynamic and sinusoidal modulated currents, or pulsed ultrasound to the exit points of the corresponding branches of the trigeminal nerve, a UHF electric field in a weak dose or darsonvalization to the affected area, as well as electrophoresis using a Bergonier half mask of aconitine, novocaine, analgin, amidopyrine or iodine.

Demidenko T. D., Goldblat Yu. V.

"Rehabilitation complex for the treatment of patients with flaccid paralysis" and others