Physical rehabilitation for osteochondrosis of the spine

The term "rehabilitation" is widely used in the world's specialized literature and is quite popular in our country. This term usually refers to medical, professional, social, and pedagogical measures aimed at the maximum and shortest possible restoration of health, working capacity (full or partial), and 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 have been widely used as a preventive and therapeutic means since the early days 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 enriching. Physical rehabilitation means (physical exercises, massage, motor regime, etc.) are classified as a group of non-specifically acting therapeutic factors. Various forms and means of movement change the general reactivity of the body, increase its non-specific resistance, destroy pathological dynamic stereotypes that have arisen as a result of the disease, and create new ones that ensure the necessary adaptation. Along with this, physical rehabilitation means are also pathogenetic therapy. Most diseases and injuries of the nervous system occur with impaired motor function. In other diseases, treatment conditions require bed rest and reduced motor activity, which leads to hypokinetic disorders. In this sense, since the means of physical rehabilitation have the main goal of restoring or helping to compensate for the impaired function, as well as promoting the training of the cardiovascular, 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 functional disorders, accompanied by significant and often permanent loss of ability to work, put the problem of rehabilitation in neurology and neurosurgery among the most important medical and social problems of health care.

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

The main principles of restoration of impaired motor functions are:

• early initiation of restorative pathogenetic therapy;
• its duration and continuity with the phased construction of the rehabilitation process;
• targeted complex use of various types of compensatory and restorative treatment (drug therapy, physical rehabilitation means, etc.);
• consolidation of treatment results in the social aspect with determination of the living and working arrangements of people who have suffered from traumatic disease of the nervous system.

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

For successful implementation of restorative therapy, the following is necessary: a clinical and functional assessment of the general condition of the patient and the impairment of individual motor functions, an analysis of the possibility of spontaneous recovery, determination of the degree and nature of the defect and, based on this, the choice of an adequate method for eliminating the identified disorder.

The development of new skills in the patient using preserved functions contributes to an increase in overall activity, practical independence and, thus, a more complete overall rehabilitation.

Rehabilitation of patients with movement disorders requires targeted use of all means of physical rehabilitation (physical exercises, positional correction, massage, muscle stretching techniques, traction treatment, physiotherapeutic methods, manual therapy techniques, 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 pathology of the nervous system

Understanding sanogenetic mechanisms in 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 shown by many years of experience in clinical and experimental study of pathology of the nervous system, such sanogenetic mechanisms that in close interconnection and interdependence provide an adaptive effect, and in pathology - restoration of impaired functions, personal and social status of the patient, are restitution, regeneration, compensation and immunity.

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

Restorative mechanisms are facilitated by:

• elimination of compression (resorption of hematomas, removal of bone fragments and tissues compressing the brain and nerve roots, torn discs and ligaments, etc.);
• elimination of hypoxia by increasing blood flow both in the brain and in neurodystrophic tissues and organs (skin, muscles, kidneys, etc.);
• elimination of edema by normalizing 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 ganglia, between afferent and efferent links of spinal, animal, autonomic, animal-autonomic and autonomic-animal reflexes, in particular in the elimination of spinal shock;
• normalization of metabolism, reduction of intoxication, etc.;
• activation of the functioning of reversibly damaged brain structures with positive emotions, strong and adequate motivations with the installation of performing all necessary measures to restore 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 pathologies of the nervous system, as it participates in them by:

• regeneration of elements of nervous tissue;
• tissue regeneration (epithelial, connective, muscle, etc.) in neurodystrophically altered organs.

Compensation is a process that combines various complex and diverse reactions to functional replacement or compensation for lost or insufficient functions.

The general theoretical position on the principle of compensatory reactions of the organism was formulated by P.K. Anokhin (1955). It includes the following principles:

• defect alarms;
• progressive mobilization of mechanisms;
• continuous reverse afferentation of compensatory devices;
• sanctioning afferentation;
• relative stability of compensatory devices.

The clinical significance of the compensation process in the restoration of impaired functions is quite large, since, unlike the restitution process, compensatory mechanisms can proceed for a much longer period of time and improve under the influence of training. The process of compensation of impaired functions is an active process, since the human body uses a rather complex set of various reactions, the most appropriate in a given situation, to ensure the greatest degree of control over body parts for the purpose of optimal strategy and tactics in relationships with the external environment.

There are three known possible structures that provide compensation of functions in patients with damage to the nervous system:

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

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

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

In patients with pathology of the nervous system, compensatory mechanisms, according to O.G. Kogan and V.L. Naidin (1988), go through the following stages: a) inclusion; b) formation; c) improvement; d) stabilization.

The period of inclusion begins immediately after, for example, brain damage. Its initial moment is obviously the absence of the corresponding afferentation to the higher parts of the central nervous system, both via specific and non-specific conduction pathways.

The formation of compensation is physiologically connected with the search for a model of the compensatory mechanism necessary to replace this impaired function. The human body, unlike a robot, actively solves such a problem not by the “trial and error” method, but by predicting the probable and necessary future, in connection with which those systems are immediately included in the compensatory mechanism that can compensate for this structural and functional defect with the greatest probability and expediency.

The period of improvement of compensatory mechanisms is the longest and continues throughout the entire recovery period, as well as the residual period.

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

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

The close interrelation and interdependence of the main sanogenetic mechanisms - restitution, regeneration, compensation - ensure a certain degree of restoration of the physiological functions of the body and human adaptation to the environment with the performance of the corresponding social functions. It is precisely these main sanogenetic processes that rehabilitation measures should be addressed to facilitate the stimulation of the mechanisms of restoration of structure and function in patients with damage to the nervous system.