Exercises during the active phase of rheumatism. Therapeutic physical training for rheumatism in children. Treatment of recurrent rheumatism

Rheumatism is an infectious-allergic disease, accompanied mainly by damage to the heart and blood vessels, and sometimes joints, the central nervous system and other organs. Mostly schoolchildren suffer from rheumatism adolescence and young people.

The goal is to restore impaired functions of the central nervous system, increase the excitability of the cerebral cortex, the mobility of nervous processes; physical exercise helps desensitize the body; increasing the general tone of the body and the physiological activity of systems and organs weakened by the disease; physical exercises contribute to the improvement of the patient’s neuropsychic sphere; eliminating congestion in tissues and organs by mobilizing extracardiac circulatory factors, which facilitates the work of the heart affected and weakened by the rheumatic process; cardiac devices vascular system to new working conditions with established heart disease; gradual training of the body, improving its functional ability, taking into account the inevitable stress at home and school.

Physiotherapy exercises for rheumatism should be used depending on the stages of treatment. The great educational and organizational significance of physical therapy in children's institutions should also be taken into account. Physical exercise promotes children’s physical mobility, thereby preventing violations of the established motor mode.

Seriously ill children with rheumatic attacks, as well as with the disease in the active phase of its course, are admitted to the hospital. Children's hospitals use a specially developed technique therapeutic exercises. Such gymnastics is used in combination with hormonal drug therapy. Organized therapeutic exercises begin after the patient is placed on bed rest and continue as long as the children are undergoing treatment. Therapeutic exercise is an integral part of the complex therapy of children with rheumatism. Clinics should treat children with rheumatism who are in the early post-attack period, who have been discharged from hospitals and who are at home or attending school. The course of treatment should be continued for at least 6 months with regular attendance at therapeutic exercise classes in the physical therapy room 2-3 times a week (Table 51). In addition, children should exercise daily individual gymnastics houses according to the recommended complexes (Table 52).

The selection of children for physical therapy should be carried out by rheumatologists at clinics. Groups consist of 8-10 children each. The course of treatment consists of 3 periods: introductory, main (training) and final. The duration of each lesson is 30-40 minutes. Exercises are used in lying, sitting and standing positions; exclude static stress. Particular attention is paid to correct positioning breathing; exercises are selected according to the principle of “dissipated load” with an emphasis on rhythmic movements in small distal joints. Walking is widely used, and dosed running is used during the training period. At the beginning and end of each lesson, body temperature is measured, pulse and breathing are checked. Classes must be conducted by specially trained nurse or physical therapy instructor. After completing the course of treatment, children can engage in physical education at school (special or preparatory group), under the supervision of a school doctor. Every school should organize physical education classes for children with rheumatism who, based on the results of a medical examination, are assigned to a special group. Instruction of physical education teachers should be carried out in a children's clinic. In sanatoriums for children, differentiated modes of movement should be used - general training, gentle and semi-bed. We present a diagram of movement modes for children with rheumatism in resort conditions (according to A.V. Ionina).

General training regime (No. 1). This regimen can be used by children who are in a non-attackable period of the disease in the absence of exacerbations over the past 2 years, with unclear cardiac changes or with mildly expressed mitral insufficiency with full compensation of the functions of the cardiovascular system. Therapeutic gymnastics classes are introduced into the movement regime of children with such diseases. The method of training children in this group is close in form and content to the school physical education lesson program; exclude only strength exercises(on gymnastic apparatus, hanging, climbing, etc.). In classes, you need to pay attention to the combination of the rhythm and phases of breathing with the exercises performed. Children are allowed to participate in morning hygienic exercises, walks, short excursions, and public events; they are allowed to play volleyball (for 15-20 minutes), gorodki, in winter - ice skating (20-60 minutes), skiing at a walking pace (45-60 minutes), etc.

Gentle mode (No. 2). This regimen is designed for children who are also in the non-attack phase of rheumatism, namely: a) with the process in the second year after suffering the last rheumatic attack with full compensation of the function of the cardiovascular system; b) with circulatory failure of the first degree (according to G. F. Lang); c) with aortic valve insufficiency in a state of stable circulatory compensation. Such children need a gentle movement regime, but the use of dosed training in the form of therapeutic exercises is indicated. The tasks of physical therapy in this period of the disease mainly include training the auxiliary factors of the circulatory system, which is achieved by carrying out basic exercises for the limbs and torso. In classes, special attention is paid to the education of breathing in combination with movement. Children in this group are shown measured walks (up to 3 km at a regular pace), health paths and sedentary games. Movements in fast pace, exercises with straining and holding your breath. These children also use double rest during the day, 24-hour stay on outdoors, air baths and water procedures.

Semi-bed rest (No. 3). This regimen is prescribed to children who have suffered an exacerbation of the rheumatic process in a sanatorium, as well as to children with significant insufficiency of the function of the cardiovascular system. Such children need carefully thought-out pedagogical work with them so that they are provided with full semi-bed rest as much as possible. The most difficult task of a teacher is to limit the movements of children. For this purpose, he must have at his disposal a sufficient number of toys, Board games, books, magazines for individual and collective use, material for labor processes (sewing, embroidery, modeling, coloring, etc.). The child should be involved throughout the day in activities that are interesting to him. It is necessary to monitor the child’s posture at the table and in bed, providing him with a position that facilitates the functions of breathing and circulation. It is necessary to use therapeutic exercises, while observing the principle of maximum myocardial sparing. In therapeutic gymnastics classes, elementary physical exercise in the starting position lying down; Duration of classes is 5-7 minutes. Carrying out gymnastic exercises and games with children can be organized simultaneously with hardening, using air baths. When using balneotherapeutic procedures and therapeutic exercises, the interval between them should be at least 1-2 hours.

Rheumatism

Rheumatism is a systemic infectious-allergic disease of connective tissue with a predominant localization in the heart. Rheumatism is a common disease. It mainly affects children (2–3% of schoolchildren).

Rheumatism develops after a sore throat or other infectious disease. Sensitizing agents (streptococcus, virus, nonspecific allergens, etc.) cause allergic inflammation in the heart, then an autoimmune process develops, as a result of which autoantibodies are produced that damage the heart.

The disease often begins acutely, but it happens that it develops gradually, and sometimes it can have a hidden course. Inflammation of the joints and high body temperature with rheumatism in last years are rare. Joint pain occurs without swelling, and body temperature rises to +38 °C. Heart failure often develops. Heart damage has serious consequences: rheumatic endocarditis, as a rule, leads to heart defects, and rheumatic myocarditis leads to cardiosclerosis.

The objectives of exercise therapy are:

Increasing general tone and reducing sensitization of the body;

Improving compensation through activation of extracardiac circulatory factors, improving adaptation to physical activity.

Exercise therapy in the active phase of rheumatism with endocarditis and myocarditis is prescribed when acute symptoms subside and the temperature drops to low-grade.

During strict bed rest, massage is used along with exercises that improve blood circulation by activating its extracardiac factors. Movements that cause pain are performed with incomplete amplitude.

In ward and free mode gymnastic exercises and walking (it is dosed as for patients with angina pectoris) are supplemented simulation exercises, games and game tasks, exercises to improve posture.

In the inactive phase of rheumatism, rehabilitation continues in a cardio-rheumatological sanatorium, where, depending on the functional state of the cardiovascular system and the time elapsed since the last attack of rheumatism, one of three sanatorium regimes is prescribed. For increase physical performance Therapeutic gymnastics classes should be supplemented with dosed walking, games, elements of sports, dancing, and close-range tourism.

After sanatorium treatment, patients continue to engage in therapeutic physical education in a clinic or in a special medical group schools. After 6 months after an additional medical examination, they are transferred to preparatory group, and after a year, if indicated, to the main one.

When choosing exercises and determining the dosage for exercise therapy for rheumatism, the nature of the course and phase of the disease, general condition, physical development and preliminary physical training of the patient are taken into account.

Exercise therapy is used to raise the general tone of the patient (child), improve the functional state of the myocardium and peripheral circulation (by training auxiliary circulatory factors), deepen breathing, stimulate metabolism, improve joint mobility and strengthen the nervous system.

In a hospital setting, after the acute symptoms of an attack have subsided, when the patient is in semi-bed rest, exercise therapy can be used in the supine position for 7–10 minutes. Basic exercises are used for the small joints of the arms and legs (in at a relaxed pace) in combination with respiratory. Subsequently, classes are held in the hall sitting and standing for 10–15 minutes, using exercises for the arms, legs and body.

After discharge from the hospital, children are temporarily exempt from physical education classes at school. When admitted to a sanatorium up to 1 year after an attack and with severe symptoms of circulatory failure, the patient is prescribed exercise therapy, which includes a combination of elementary exercises for small and medium muscle groups of the arms and legs with breathing exercises in a lying and sitting position for 10–15 minutes.

A year after an attack of rheumatism, with mitral valve insufficiency and symptoms of circulatory failure of the first degree, a gentle regimen is prescribed: morning hygienic gymnastics, therapeutic exercises, dosed walking walks at measured steps of up to 3 km, health path, sedentary games; in therapeutic exercise procedures lasting 20–25 minutes. free exercises are used for the arms, legs, and body in sitting and standing positions.

In the absence of exacerbations for two years, with full compensation of circulatory function, a general tonic regimen is prescribed: morning hygienic exercises, therapeutic exercises, walking, health path, excursions, games, skiing (45–60 min.).

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Rheumatism, affecting the heart and joints, leads to joint deformation. 2-3% of schoolchildren suffer from this disease. According to WHO, the cause of death in people under 35 years of age in 3.5% of cases is acquired heart defects.
Rheumatism refers to systemic inflammatory infectious-allergic diseases with morphological changes in the joints. The causative agent of the disease is considered to be beta-hemolytic streptococcus group A. The disease occurs 1-2 weeks after suffering a nasopharyngeal infection or hypothermia. With allergic influences, changes occur in connective tissues, primarily in the tissues of the musculoskeletal system (cartilage, muscles, ligaments). Changes occur not only locally (in the joints), metabolic processes in all systems suffer, and immunity decreases.
The most characteristic manifestation of the disease- damage to the heart (rheumatic carditis, endocarditis, myocardiosclerosis) and other organs and systems. In some cases, acute polyarthritis develops - inflammation of the joints; rheumatic pleurisy; with brain damage - encephalitis, meningo-encephalitis, cerebral vasculitis; possible damage to the nervous system - chorea; kidney damage - nephritis; damage to the skin, eyes, etc.
In children with this disease The heart is predominantly affected, that is, acquired heart defects occur. This is expressed primarily in the limitation of its contractile function, which leads to expansion of the boundaries of the heart, mitral valve insufficiency due to the loss of elastic support by the fibrous ring of the valve apparatus and weakening of the tension of the tendon threads. When listening to the heart, a systolic murmur is heard, tachycardia occurs, and blood pressure decreases. ECG changes indicate myocardial hypertrophy. Patients complain of severe pain in the joints, swelling and redness. Usually the joint syndrome goes away within a few days, and later transient pain in the joints is possible.
In the active phase of rheumatism children fall into a depressed state, lose their cheerfulness, and quickly get tired. With chorea (damage to the subcortical nodes of the brain), motor and mental disorders may occur.
First stage of rehabilitation- clinical. Based on the characteristics of the rheumatic process, the following tasks must be solved in the hospital:
1) elimination of the infectious source of the disease;
2) compensation for developing circulatory failure, and subsequently improvement of the function of the cardiovascular system, adaptation to the motor mode in accordance with the nature and activity of the process;
3) reduction and elimination of inflammatory processes in the tissues of the musculoskeletal system;
4) prevention of the formation of valve disease;
5) normalization of the neuropsychic sphere.
Rehabilitation of children, patients with rheumatism, at all stages is carried out comprehensively, taking into account age, severity and severity of the process, the nature of clinical manifestations and the degree of heart damage.
In therapeutic and protective motor mode combines strictly dosed rest and movement, a smooth transition from rest to the loads of the ward and general regimes in accordance with the increasing adaptive capabilities of the patient's cardiovascular system.
Strict bed rest is prescribed in the active phase of rheumatism if the child has intoxication, high fever, pain in the joints, significant changes in the heart, symptoms of circulatory failure at rest or with minor exertion. In this mode, complete physical and mental rest is maintained, which helps compensate for heart failure.
When the temperature normalizes and joint pain disappears, the child is allowed to play in bed (sculpting, drawing, etc.), walks on a gurney are recommended. This regime is established for 3-4 weeks.
Semi-bed rest is administered when the acute manifestations of the active phase of rheumatism subside, the child is allowed to get up.
In ward mode the child serves himself within the ward, has lunch in the dining room, and visits the toilet. Walking and medium-intensity games are allowed.
The general regime provides complete self-care, walks with games, hardening.
Pharmacological rehabilitation: antibiotics according to the regimen, salicylates, analgin or amidopyrine, non-steroidal drugs (indomethacin), etc. In the active phase of rheumatism, hormonal drugs, vitamins, and multivitamin complexes are used. If a child is given steroids, potassium salts are given, while sodium salts are limited. Heart medications are prescribed for symptoms of heart failure.
During bed rest do general massage, excluding striking techniques, Exercise therapy- 5-8 minutes for small muscle groups, passive exercises for medium muscle groups. The exercises are performed at a slow pace and include breathing exercises.
Exercise therapy promotes improving metabolic processes in the heart muscle, activating blood circulation, reducing oxygen starvation, eliminating congestion, and enhancing the effects of medications. Exercise therapy is also the prevention of physical inactivity (hypokinesia). With a gradual expansion of the motor mode, the duration of classes, the pace and rhythm of the exercises increase, and the starting positions change. Use relaxation exercises and breathing exercises. During runtime breathing exercises the child should be taught proper breathing, achieving restoration of its normal rhythm and depth, combination of the phases of the respiratory cycle with movements.
Forms of exercise therapy for patients with rheumatism: group, small group, morning exercises, outdoor games, occupational therapy.
Physiotherapy And hydrobalneotherapy: ultraviolet irradiation (UVR) locally or using a segmental technique. Electrophoresis of calcium, sulfur, potassium chloride, etc. If sleep disturbances are noted, then electrophoresis with bromine and electrosleep are prescribed. Locally OKUF of the throat (tonsils), stop.
Psychotherapy
A psychologist conducts classes aimed at restoring the psyche of a sick child and teaches autogenic training. Classes are conducted accompanied by music and color music. The environment at home and at school is of great importance.
Diet therapy
A child needs proteins, fats, carbohydrates, and vitamins. Food should have enough salts, vitamins and microelements (potassium, calcium, magnesium, manganese, etc.) from fruits, vegetables, and dairy products. It is necessary to take into account the condition of the children, their age, tastes, and appetite.
Sanatorium stage of rehabilitation carried out at a local cardio-rheumatology sanatorium. Objectives of this stage of rehabilitation:
— complete elimination of the activity of the rheumatic process;
- normalization of functional indicators of the cardiovascular system, and in case of defect - stable compensation;
— increasing nonspecific resistance and normalizing reactivity;
— normalization physical development And motor sphere;
— adaptation of sick children to physical and mental stress.
Second stage of rehabilitation aimed at further treatment of the child. They include motor modes and widely use natural factors.
Rheumatic children in schools do physical education in special groups 2-3 times a week for 30-35 minutes. In a physical education lesson, general developmental exercises, games, exercises for maintaining balance, and acquiring correct posture, breathing exercises, etc. Power and jumping exercises. It is necessary to observe the principle of gradualness when increasing physical activity.
The training regimen is prescribed to children who do not have heart damage or chronic foci of infection. Includes therapeutic exercises, outdoor games, dosed walking, etc.

With strict bed rest, active movements in the distal joints of the limbs, passive exercises, and massage are used. As the motor regimen expands, classes gradually include more difficult exercises for larger muscle groups. Movements that cause pain in inflamed joints are performed with incomplete amplitude. Therapeutic physical training for rheumatism is prescribed by the attending physician, and the method of exercise is determined by a specialist in therapeutic physical training. It is not recommended to start classes on your own - this can lead to a worsening of the condition.

Morning complex Tibetan gymnastics will help with rheumatism. Its implementation is possible in almost any condition, since all exercises are performed without getting out of bed. These exercises affect the cardiovascular and central nervous system, as well as on the functioning of the endocrine glands.

After gymnastics, drink a glass of water with a spoonful of honey, infused in the evening.

So, the complex includes only 10 exercises:

1. Ear massage: lying in bed on your back, put thumbs behind the ears and with clasped palms, move from top to bottom 30 times so that the index fingers move along the ears. Concentrate completely on the actions you are performing, close your eyes.
2. Forehead massage: palm right hand place it on the forehead, the left one on the right one and move it along the forehead left and right 20 times so that the little fingers move above the eyebrow. With this exercise you can get rid of headaches.
3. Eye massage: use the back of your bent thumbs to massage eyeballs- 15 times. In addition to its general health benefits, this exercise improves vision and calms the nervous system.
4. Massage the thyroid gland: with bent palms, gently massage the thyroid gland from top to bottom, hugging the gland, 30 times. This exercise improves the regulation of all metabolic processes in the body and the functioning of internal organs.
5. Abdominal massage: place your right palm on your left and make circular movements 20-30 times, but so that the stomach moves up and down, which is achieved by turning the palm.
6. Abdominal retractions: lying on your back, strongly pull your stomach towards the spine, and then bulge - 20 times. It is useful to do this exercise several times during the day. It has a beneficial effect on liver function, and at the same time helps to get rid of excess fat in the abdominal area.
7. Leg bending: lying on your back, bend your legs alternately at the knee joints and pull each leg tightly towards your chest so that all internal organs are massaged. Repeat 15 times with each leg. Exercise improves the functioning of all internal organs.
8. Foot massage: sitting on the bed, lower your legs to the floor, place the left one on the right, with the palm of your right hand massage the indentation of the foot - 20 times, then change legs and massage the indentation of the other leg, also 20 times. Exactly this effective exercise for the treatment of rheumatism and regulation of heart function.
9. Massage the back of the head: sitting on the bed, clasp your hands, place them on the back of your head and massage it in both directions 10 times. This exercise improves blood circulation and the movement of cerebrospinal fluid.
10. Last – energy exercise: while sitting, place your palms on your ears, press tightly and alternately hit the back of the head with the fingertips of both hands, making 25-30 hits in total. Such movements stimulate the cerebral cortex and relieve headaches.

For rheumatism, the patient must select a treatment and exercise program with his physiotherapist and think through a training plan that is suitable specifically for this patient.

In the hospital, patients with rheumatism engage in physical exercises only under the guidance of an instructor. So, in the first days of an exacerbation of the disease or the first attack while lying in bed, careful movements of the arms, legs, and turns on the side are permissible. Over time, the patient acquires the skills to move from a horizontal position to a sitting position: placing his hands under lumbar region, inhales and sits up with the help of your hands while exhaling. After 4-5 weeks you can start special complex exercises that should be performed at a slow or medium pace.

The number of repetitions of each exercise is 4-6 times. After every three exercises, you need to rest - take 3-4 inhalations and exhalations. Duration of classes is 15-20 minutes.

Hands on knees, feet shoulder-width apart. Spread your arms to the sides - inhale, lower them to your knees - exhale.

Feet together. Alternately bend and straighten your legs at the knee joints (sliding). Breathing is voluntary.

Feet together, knees bent, hands on the waist. Alternately straighten your legs at the knee joints. Breathing is voluntary.

Feet shoulder-width apart, hands on the waist. Raise your arms to the sides - inhale, lower them to the starting position - exhale.

Feet together, hands on knees. Spread your arms to the sides - inhale, pull your knee to your stomach - exhale. Same with the other leg.

Feet shoulder-width apart, arms bent in front of the chest. Turn your torso to the left while simultaneously extending your left arm - inhale. Return to the starting position - exhale. Repeat the same on the right side.

Rest your hands behind you on the seat of the chair, legs together and straightened. Alternately slide to the sides straight, then right, then left leg. Breathing is voluntary.

Sit upright, back touching the back of the chair, palms on your knees. Bend and straighten your fingers. Breathing is voluntary.

In the same position, bend and straighten your feet. Breathing is voluntary.

After 2-3 weeks, the load is increased, the number of repetitions of each exercise is increased, and they are done standing rather than sitting. The duration of classes is increased to 30 minutes.

If shortness of breath does not appear, and the pulse rate compared to the initial one increases by no more than 10-15 beats per minute, then after two months, after consulting with a doctor, you can move on to heavy-load complexes. As one of them, intended for practicing at home, we can recommend the following (the first ten exercises are performed standing, the rest while sitting).

Alternately abducting the arms to the sides with turning the head - 5-6 times.

Hands down. Pull your shoulders back and bend over - inhale. Return to the starting position - exhale. Repeat 8-10 times.

Hands in front of chest. Turns to the sides while simultaneously raising your arms - 5-6 times.

Hands down. Bend to the side, while sliding your arms along the body - 6-8 times.

Holding the back of the chair, alternately move your legs to the side - 5-7 times.

Stand behind the chair one step away from him. Leaning on the back of the chair and bending your arms in elbow joints, bend the body forward - 4-6 times.

One hand is on the stomach, the other is on the chest. Calmly, take a deep breath and exhale 8-10 times.

Holding the back of the chair, alternately move your legs back while bending. Repeat 5-7 times.

Holding the back of a chair, do 5-6 squats. When squatting, inhale, while rising, exhale.

Walking in place - 45-60 s.

Hands on shoulders. Circular rotations V shoulder joints 4-6 times inside and out.

Hands on the belt. Circular movements with your feet, without lifting them from the floor, 5 times inward and outward.

In addition to therapeutic exercises, other forms of therapeutic exercise, such as walking, can be recommended for rheumatism. They can be performed on flat terrain, but slight inclines are also acceptable. Such walks are useful at any time of the day.

It is recommended to walk at an average pace, gradually increasing the distance from 500 m to 2-3 km, resting periodically. You can exercise while you're on vacation breathing exercises. On weekends, you can go on a hiking trip no more than 8-10 km long.

Boat trips are useful, and in winter - cross-country skiing and ice skating with breaks for rest and breathing exercises. In persons with compensated heart defects, more complex types of physical education, including games, can be used.