Exercise therapy for diseases and injuries of the spinal cord

Diseases and injuries of the spinal cord may be accompanied by a motor, sensitive, reflex, vascular, secretory disorders. The prevalence and depth of these disorders depend on the level of the lesion. For example, in case of injury of the upper cervical spine can cause paralysis or irritation of the diaphragm (shortness of breath, hiccup), spastic paralysis of upper and lower limbs, full anesthesia down from the site of the damage, urination disorders, may be pain in the neck type of radiculitis; for injuries so-called cauda equina - flaccid paralysis of the lower limbs with disorders of urination, full anesthesia of the lower extremities and in the perineum and cruel, radikulitnye nature and pain in the feet; trauma anterior horns or the front of the spine musculoskeletal segmental disorder, having the character of peripheral paralysis, with the defeat of the rear sensitive spine, the back horns or grey front spikes - various sensitive and reflectory-segmental disorders; trauma musculoskeletal ways (in front or lateral post) -Central paralysis of the muscles that receive innervation from the underlying segments; for injuries sensitive ways (in the side or rear pillar), violations of the sensitivity in all areas relevant downstream segments.
When the Central or spastic, paralysis increases muscle tone, leading the arm at the shoulder joint, flexor tendons in the elbow joint, the model of the forearm, flexor tendons of the hand and fingers (arm close to the body is bent at the elbow joint and awarded with a bent wrist and fingers); increased muscle tone-extensor femur and tibia, flexors and arch supports feet (leg straightened in a knee joint, stop spinarova in position plantar flexion).
Therapeutic effect of exercise for diseases and injuries of the spinal cord is manifested in their tonic effect. Under the influence of muscular activity improves the conduction of impulses on motor and sensory nerves and blood supply to the affected areas, strengthen the weakened muscles and stretch lightweight. Exercises prevent the development of contractures and contribute to the restoration of impaired coordination of movements. Early practice of medical physical culture helps prevent complications associated with long lying (pneumonia, constipation, etc.,), and the formation of compensatory motor skills.
The value of restorative action of physical exercises for diseases and injuries of the spinal cord increases many times in comparison with diseases and injuries of the peripheral nervous system because suffering from illness or injured spinal cord physically helpless and depressed mentally. It is very important conscious, active participation of the patient in treatment.
Spinal cord injuries. If the damage occurred gap spinal cord, to restore the traffic is almost impossible. In this case, applied exercises that strengthen the muscle groups that survived the innervation. The patient is taught the elements of self-service, use a stroller or orthopaedic devices. Often when injury or tumor is not a complete rupture of the spinal cord. In these cases, to achieve the effect instructor and the patient needs long-term (over a year) work to restore movements. Even in the later period - 2 years and more - after illness or injury systematic training of medical physical culture in combination with physiotherapy and occupational therapy yielded positive results.
The main form of medical physical culture in diseases and injuries of the spinal cord is healing gymnastics. The main task of the exercise with sluggish form to strengthen the muscles, but in spastic - to learn to control the muscles, therefore, the selection of exercises with different forms of movement disorders will be different (table. 9).

Table 9. Scheme of medical physical culture with various forms of musculoskeletal disorders (S. I. Ugarova-Yakobson and B. N. Moshkov)
Exercise type At languid forms In spastic forms
Sending pulses Necessary Insignificant
Massage Deep, active Surface
Exercises for "isolated" paretic muscles Insignificant Necessary
The struggle with increased reflex excitability Not needed Necessary
Exercise common point of attachment of muscles Shows Contraindicated
Exercises that removes the point of attachment of muscles (tensile) Contraindicated Shows
Exercises with effort Necessary Contraindicated
Correction of the position Necessary Necessary
Movement in the water (in a warm bath) Shows Very important
The development of the support functions Vital Must

When performing physiotherapy sessions complied with the above principles. With the aim of restorative actions are training a muscle group is not involved in the disease process or less affected. Any classes always start with a healthy limbs. To stimulate recovery movements should by sending pulses, passive movements, the combination of both active movements. If there gipertonus muscles, the classes include relaxation exercises. As a rule, the first signs of a movement is detected in the classroom for therapeutic physical training. We should focus attention on this patient.
Until then, until the active movement, warning contractures and deformities, you must apply passive movements and treatment provision.
Extension of motor activity begin the lesson of therapeutic exercises are always in the same sequence, as at compression fractures of the spine (see chief 24), but much slower (get on her hands and knees, on my knees, based on the headboard to omit one leg to stand on her feet, walking with artificial support and so on). If necessary teach the use of orthotic devices.
Sometimes the movement is restored, and muscle and joint feeling it with a deep lesion of the rear pillars), and patient when walking is not "feel the earth". Then it is recommended that training in walking under visual control (on the Board, drawing, traces).
When spinal cord injury patient may be depending on the place of fracture (traumatic lesion of the spinal cord is always associated with fractures of the bones) in position on your side or stomach. Therapeutic gymnastics should start in the same position as it is, without waiting for will be allowed to turn on his back.
When the damage associated with the tumor, therapeutic gymnastics start up operations - in order to establish contact with the patient, to reveal its movement capabilities and to introduce the exercises that will have to do after the operation. Due to the fact that during the operation to remove the tumor always otkazyvayutsya bow vertebra, 10-12 days after the lessons are conducted in the position of the patient on his side.