Physical rehabilitation of osteochondrosis of the spine

The term "rehabilitation" has spread widely in the world specialized literature and is quite popular in our country. This term is usually understood as medical, professional, social, and pedagogical measures aimed at maximizing, and in the shortest possible time, restoring health, working capacity (full or partial), self-care ability of patients with diseases of the nervous system.

Various forms of movement as a result of the impact of mechanical energy on the patient's body were widely used as a preventive and therapeutic agent even at the time of the birth of medicine. With the development of medical science, the use of various means and forms of motor activity for the needs of prevention, treatment and rehabilitation is expanding and enriched. The means of physical rehabilitation (physical exercises, massage, movement, etc.) are referred to a group of nonspecifically acting therapeutic factors. Different forms and means of movement change the general reactivity of the organism, increase its non-specific stability, destroy pathological dynamic stereotypes that have arisen as a result of the disease, and create new ones that provide the necessary adaptation. Along with this, the means of physical rehabilitation are also a pathogenetic therapy. Most of the diseases and injuries of the nervous system occur with impaired motor function. With other diseases, treatment conditions require bed rest and decreased motor activity, which leads to hypokinetic disorders. In this sense, since the means of physical rehabilitation have the main goal to restore or contribute to compensating for the upset function, and to promote the training of the cardio-vascular, respiratory and other systems that limit physical performance, it has the character of a specific therapy.

The significant prevalence of diseases of the nervous system, the complexity and persistence of impaired functions, accompanied by significant and often persistent disability, raise the problem of rehabilitation in neurology and neurosurgery in a number of important medical and social problems of public health.

The developed general principles of rehabilitation measures, specified in relation to individual nosological forms of the nervous system, contribute to more effective use of restorative therapy and to achieve a higher level of rehabilitation of patients with neurological disorders of spinal osteochondrosis.

The main principles of restoring impaired motor functions are:

• early onset of restorative pathogenetic therapy;
• duration and continuity of it with a phased construction of the rehabilitation process;
• directed complex application of various types of compensatory and restorative treatment (drug therapy, physical rehabilitation, etc.);
• fixing the results of treatment in a social aspect with the definition of household and labor arrangements of people who have undergone traumatic illness of the nervous system.

Only consistent implementation of these principles makes the rehabilitation system of impaired functions sufficiently effective.

Successful recovery therapy requires: clinical and functional assessment of the general condition of the patient and impairment of individual motor functions, analysis of the possibility of spontaneous recovery, determination of the extent and nature of the defect and on the basis of this - the choice of an adequate technique for eliminating the revealed disorder.

The development of new skills in the patient with the use of safe functions promotes an increase in overall activity, practical independence and thus more complete general rehabilitation.

Rehabilitation of patients with motor disorders requires the targeted use of all physical rehabilitation (physical exercises, position correction, massage, muscle stretching, traction treatment, physiotherapy methods, manual therapy, reflexology, etc.). Each of these means, their combination and the volume of the load depend on the nature and localization of the lesion, the general condition of the patient, the period of the disease.

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Sanogenetic mechanisms in the pathology of the nervous system

The understanding of sanogenetic mechanisms in the pathology of the nervous system is the basis for the success of rehabilitation measures, since the essence of sanogenetic mechanisms is manifested by their focus on adaptation to the environment at a qualitatively different level in connection with the existing (or existing) pathological processes in the body. As the long experience of clinical and experimental study of pathology of the nervous system has shown, such sanogenetic mechanisms that provide an adaptive effect in close interconnection and interdependence, and restoration of impaired functions, personal and social status of the patient, are restitution, regeneration, compensation and immunity.

Restitution is the process of restoring the activities of reversibly damaged structures. With pathology of the nervous system, restorative changes occur in nerve cells, nerve fibers and in structural elements of neurodystrophically altered organs and tissues. Restorative mechanisms are implemented mainly due to restoration of permeability and excitability of membranes, normalization of intracellular oxidation-reduction processes and activation of enzyme systems, which results in normalization of bioenergetic and protein-synthesizing activity of cellular structures and restoration of conduction through nerve fibers and synapses.

Restorative mechanisms are facilitated by:

• elimination of compression (resorption of hematomas, removal of the compressing brain and nerve roots of bone fragments and tissues, ruptured discs and ligaments, etc.);
• elimination of hypoxia due to increased blood flow both in the brain and in neurodystrophic tissues and organs (skin, muscles, kidneys, etc.);
• elimination of edema due to normalization of blood circulation, permeability of vascular walls and local regulation of water-salt metabolism both in the brain and in neurodystrophic tissues and organs;
• restoration of adequate neurodynamic relationships between segmental and suprasegmental levels of the central nervous system, between the spinal cord and autonomic ganglions, between afferent and efferent links of spinal, animal, vegetative, animal-vegetative and vegetative-reflex reflexes, particularly in the elimination of spinal shock;
• normalization of metabolism, reduction of intoxication, etc .;
• activation of functioning of reversibly damaged structures of the brain with positive emotions, strong and adequate motivations with the installation to perform all necessary measures for restoring functions, personal and social status.

Regeneration is a structural and functional restoration of the integrity of damaged tissues and organs due to the growth and reproduction of specific tissue elements. Regeneration as one of the sanogenetic mechanisms is of great importance in the recovery processes in the pathology of the nervous system, since it participates in them by:

• regeneration of nervous tissue elements;
• regeneration of tissues (epithelial, connective, muscular, etc.) in neurodistrophically altered organs.

Compensation is a process that combines various complex and diverse reactions to the functional replacement or recovery of lost or insufficient functions.

General theoretical position on the principle of compensatory reactions of the body was formulated by PK Anokhin (1955). It includes such principles:

• Defect signaling;
• progressive mobilization of mechanisms;
• continuous reverse afferentiation of compensating devices;
• sanctioning afferentation;
• relative stability of compensatory devices.

The clinical significance of the process of compensation in the restoration of impaired functions is large enough, since, in contrast to the process of restitution, compensatory mechanisms can proceed for a much longer time and be improved under the influence of training. The process of compensating for impaired functions is an active process, because the human body uses a rather complex set of various, most appropriate reactions in this situation, to ensure the most controllable parts of the body for the purpose of optimal strategy and tactics in relations with the external environment.

There are three possible structures that provide compensation for functions in patients with a lesion of the nervous system:

• preserved elements of the damaged structure;
• structures that are close in functional terms;
• additional structures and mechanisms. It should be noted that the substitution mechanisms involving these structures often act in a friendly manner in the compensatory act, but their sequential inclusion is more likely.

In functional restructuring aimed at compensating for impaired functions, the nervous system manifests itself as a single whole due to reflex mechanisms of various complexity, respectively, closing at different levels:

• autonomic ganglia;
• integrative-coordinative apparatus of the spinal cord;
• analyzer-coordinator apparatus of various analyzers;
• system of analyzers.

In patients with pathology of the nervous system, the compensatory mechanisms undergo, according to OG Kogan and VL Naidin (1988), the following stages: a) inclusion; b) formation; c) improvement; d) stabilization.

The onset period starts immediately after, for example, brain damage. The initial moment of it, obviously, is the lack of an appropriate afferentation in the above-mentioned sections of the CNS both by specific and by non-specific conducting paths.

The formation of compensation is physiologically associated with the search for a model of the compensatory mechanism necessary to replace this impaired function. The human organism, unlike a robot, actively accomplishes such a task by not using the method of "trial and error", but by predicting a probable and necessary future, in this connection, the compensatory mechanism immediately includes those systems that are most likely and expedient to compensate this structural and functional defect.

The period of improvement of the compensatory mechanisms is the most prolonged and lasts throughout the restorative as well as the residual period.

Long training compensatory mechanisms can provide sufficient compensation for impaired functions, but at a certain stage further improvement of complex reflex mechanisms does not lead to a significant change, i.e. Stabilization of compensation begins. In this period, a dynamically stable equilibrium of the human body with a definite structural and functional defect in the external environment is established.

A necessary condition for the stability of compensations arising in the pathology of the nervous system is the systematic training and use of compensatory mechanisms in life (household and industrial activities).

The close interconnection and interdependence of the basic sanogenetic mechanisms - restitution, regeneration, compensation - provides a certain degree of restoration of the physiological functions of the organism and adaptation of man to the environment with the fulfillment of the corresponding social functions. It is precisely these basic sanogenetic processes that rehabilitation measures should be aimed at to promote the stimulation of mechanisms of restoring structure and function in patients with nervous system damage.