The method of rehabilitation of patients with diabetic angio - and neuropathy

 

(57) Abstract:

The invention relates to medicine, namely to the rehabilitation of patients with complications of diabetes. Essence: identify painful and tense muscles of the thoracic and lumbar spine, abdomen, pelvic floor and lower extremities, then stretch and normalize muscle tone by voltage, which prevents further development of diabetic complications. 1 C.p. f-crystals.

The invention relates to medicine, namely to endocrinology, rehabilitation of patients with complications of diabetes: diabetic angiopathy and diabetic neuropathy, and can be applied in the conditions of policlinic, polyclinic, hospital, sanatorium and health resort.

The social importance of rehabilitation is determined by the prevalence of the disease, the severity of vascular complications, which are the most frequent cause of morbidity and mortality in patients with diabetes mellitus.

The clinical picture as insulin-dependent (IDDM) and non-insulin dependent diabetes mellitus (NIDDM) along with complaints of dryness, thirst, fatigue, weakness, polyuria, already in the early stages of the disease most Bo, Bukovina diabetic angio - and neuropathy. The complex metabolic and vascular disorders in patients with diabetes leads to changes in the morphological and functional state of the myocardium, non cardiac activity regulation, which leads to the development of diabetic myocardiopathy and generates complaints from the side of cardiovascular system. The majority of patients with diabetes complains of serdzebienie, shortness of breath during physical activity, sometimes stabbing pain in the heart.

Along with metabolic disorders in the development of hypoxia and progression of angio - and neuropathy role play disorders of vascular tone (spasm, atony of blood vessels), which is a result of autonomic reactions, and local irritazione of the functional blocks in various parts of the spine and trigger zones in certain segments. Muscular dystonia leads to reorganization of the functional state of neuromotor system, which results in the development of functional blockade, muscle spasm with fixation occurred musculoskeletal disorders of the segment and the formation of a permanent source of irritation. In patients with IDDM and NIDDM detects changes to the function is in the upper part of the trapezoid, rhomboid muscles and the extensors of the back, square the back muscles, the rectus abdominis muscle, the lateral group of muscles of the hips, gluteal muscles, iliopsoas, straight muscle of the thigh, the calf muscles.

During instrumental examination revealed a decrease in range of motion in the lumbar spine by 10-15 degrees according to goniometry, decrease blood vessels of the lower limbs, improving the tone of the small vessels of the legs and feet according to rheovasography (EGR) and a decrease in the velocity of propagation of excitation in motor and sensory nerve fibers according to the stimulation electroneuromyography (ENMG), decreased physical performance according to the VEM, hemorheological and metabolic disorders.

Known methods of rehabilitation of patients with diabetic angiopathies by exposure to common turpentine baths of white emulsion and a yellow solution concentration of 20-50 ml per 200 l of water, the temperature of 37-38oC, duration 15 minutes, two days in a row with a break in the third, in the course of 10 treatments (Golovach, A. C. Turpentine baths in the treatment of patients with diabetic angiopathies: Diss. K. M. N.-M., 1998).

The disadvantage of this method of alepidea on the skin, contraindications in patients with concomitant pyelonephritis, decompensation of carbohydrate metabolism, symptoms of impaired venous outflow from the lower extremities, presence of CHD III-IV FC.

Also known is a method of treatment of patients with diabetic angiopathies sodium chloride baths concentration of 30 or 50 g/l, temperature 37oC, 15 minutes, 4 times a week, at the rate of 10-12 baths (Grishina E. C. Application of sodium chloride baths in the treatment of diabetes patients with micro - and macroangiopathies.: Diss...K. M. N.-M., 1998).

The disadvantage of this method is the inability to use the baths at decompensation of diabetes mellitus, as well as General contraindications for balneotherapy (including fungal infections of the feet, which are quite frequent in patients with diabetes mellitus). In addition, methods balneotherapy provide special equipment of the clinic, polyclinic, hospital, severely limiting their use.

There is also known a method of rehabilitation of patients with diabetic angiopathies feet sinusoidal modulated currents (from device Amplipulse-4) in the paravertebral region at the level of the lumbar-Cres, daily course of 15 treatments) (Grigorieva C. D., Samadova, M. Sinusoidal modulated currents in complex treatment of patients with diabetic angiopathies feet. /Matters. kurortol., fizioter. and Leche. physical. culture. - 1983. - N 1. - S. 54). The observed improvement of peripheral blood circulation is due to a reflex enhance blood supply to the muscle fibers and the direct action of the current on the sensitive and vegetative nerve fibers. The disadvantage of this method is the idiosyncrasy of the currents, the complexity of matching the intensity of the current on the subjective sensations of vibration due to the frequent presence of diabetic neuropathy, characterized by the violation of various kinds of sensitivity; the impossibility of application of the method in patients with varicose disease, thrombophlebitis, also often associated with diabetes.

The prototype can serve as a method of rehabilitation of patients with diabetic angiopathies I and III (functional impairment) the use of therapeutic massage lumbar-sacral area and lower extremities, which helps to improve blood circulation, normalization of muscle tone, reduction of pain (Massage coronary heart disease segm this method of rehabilitation are contraindications to its use in the presence of varicose veins, thrombophlebitis, as well as organic stages of diabetic angiopathy characterized by lower ripple on peripheral arteries, trophic changes of the skin of the legs and feet. The technical result of the invention is to prevent further progression of the neuro-vascular complications of diabetes and the possibility of application of the method in the accompanying diseases.

This technical result is achieved in that in the method of rehabilitation of patients with diabetic angio - and neuropathy physical factor, according to the invention, as a physical factor use manual therapy through differentiated muscle activation painful tight muscles of the thoracic and lumbar spine, abdominal muscles, pelvic floor and legs, and before the impact of conducting a preliminary stretching of these muscles, when this treatment is 5-8 procedures carried out daily or every other day for 20-25 minutes.

DESCRIPTION OF THE WAY

In the rehabilitation of patients with diabetic angiopathies and neuropathy use manual therapy through differentiated muscle activation painful tense muscles of the chest and poyasnee stretching these muscles. The course consists of 5-8 procedures carried out daily or every other day for 20-25 minutes.

Differentiated muscle activation in order to correct the muscle imbalance is conducted by the following methods:

1. Activation intense painful extensor muscle of the back and rear muscle groups of the thighs.

The purpose of the exercise: relaxation of muscle imbalance of the muscles, the extensors of the spine and rear muscle groups of the thighs.

Starting position: lying on back, knees bent and caught her hands, clasped in the castle. Knees as soon as possible is pressed against the abdomen and fixed hands in this position.

The technique of the exercise: keeping the knees at a fixed level, hold the pressure of the knees of his hands on the breath. Hands create opposition for 8-10 seconds, then exhale relaxes muscles without lifting your knees. At the end of the exhale knees still slightly closer to the stomach, with fixation of the new provisions. Exercise repeat 3-4 times. Comments: if the muscles on one side only, then the exercise is performed with the leg of the respective party.

2. Activation of recti.

The purpose of the exercise: removing the unbalance to the couch (lying on the back they can be fixed, if you slip them under the chair, a sofa, a cupboard). Hands outstretched.

The technique of the exercise: take up the position of proprietary, so that the torso was tilted at an angle of 45 degrees and record this position for 8-10 seconds followed by relaxation and taking a horizontal position. The exercise is repeated 3-4 times. Comments: if this exercise is fairly easy, you can increase the load by the institution of the hands behind the head.

3. Activation obliques

The purpose of the exercise: removing imbalance with obliques.

Starting position: lying on back, legs bent at the knee joints, feet fixed to the couch, hands behind his head.

The technique of the exercise: take up the position of proprietary, torso turn 45 degrees, occupied a fixed position for 8-10 seconds followed by relaxation and pastime horizontal position. The exercise is repeated 3-4 times in each direction.

4. Activation of the square of the muscles of the back.

The purpose of the exercise: correction tone square back muscles. Starting position: sitting on a chair top, torso maximum incline towards, for example vpaivajut breath for 8-10 seconds you then exhale this slope increase. New position fix. The exercise is repeated 3-4 times. Comments: this exercise can be done with dumbbells 3-6 kg Similarly, it is when tilted in the other direction.

5. Activation of the iliopsoas muscle.

The purpose of the exercise: correcting tone of the iliopsoas muscle.

Starting position: sitting on the edge of the couch to embrace one of the knees, lie on your back, while the other leg dangle from the edge of the couch.

The technique of the exercise: produce the maximum inhalation and breath holding for 8-10 seconds, then exhale. The exercise is repeated 4-5 times. Comments: the same is the exercise for the other leg. If the exercise is performed with the doctor, then the doctor during inhalation of the patient records hanging leg from above in the lower third of the thigh in a very low position.

6. Activation of the gluteal muscles.

The purpose of the exercise: correction of muscle tone the gluteal muscles. Starting position: lying on his stomach, his hands lying on the buttocks.

Technique exercise: breathe in several plant buttocks arms and strain within 8-10 seconds. The exercise is repeated isih gluteal muscles.

7. Activation of the piriformis muscle. The purpose of the exercise: correcting tone of the piriformis muscle. Starting position: lying on his back on the couch, legs bend at the knee joints, the heel divorced and grasping the sides of the edge of the couch.

Technique exercise: breathe in is clenching heels stop the side surfaces of the couch for 8-10 seconds, then relax on the exhale, without changing its original position.

8. Activation of the extensor muscle of the leg.

The purpose of the exercise: correcting tone of the extensor muscles of the leg.

Starting position: lying on your back, legs fixed to the couch strap (if the exercise is performed on the floor, fixing can be performed in the field stop, for example, fixed them under a wardrobe, a sofa, a battery).

Technique exercise: breathe in attempts to raise the fixed leg, producing pressure her up on the locking device for 8-10 seconds, then exhale and relax. Exercise repeat 3-4 times. Comments: if the exercise is performed in a group, the legs may be fixed by one of the partners of the group.

9. Activation of the muscles, the extensors of the foot.

Naz is back, the leg is flexed at the hip with his foot with both hands, given her position most of dorsiflexion and this provision commits hands. The technique of the exercise: produce pressure on the inhale foot on the locking her hands hyperextension of the foot for 8-10 seconds, then relax on the exhale. Comments: make sure that the pressure was carried out only by foot, but not at the expense of extension of the knee and hip.

10. Activation peronealnaya muscle groups.

The purpose of the exercise: correction tone peronealnaya muscle groups.

Starting position: sitting on a chair, one leg bent at the knee and hip joint, put on seat, hands, grasp the foot, turn inwards and fixed in the end position.

The technique of the exercise: produce moderate muscle tension, torque foot outwards, by rotating it outwards for 8-10 seconds on the inhale, the exercise is repeated 3-4 times. Comments: the exercise can be carried out using any vertical emphasis (the leg of a chair, the wall, and so on), locking them notirovannyh inside foot.

11. Activation of muscles, flexors of the foot.

The purpose OPERU to another, pressing her to the floor.

The technique of the exercise: exert a moderate pressure on the bottom of the locking foot dorsal flexion of the lower foot for 8-10 seconds, then relax. The exercise is repeated 3-4 times. Comments: foot fixation can be made by hand, the foot is comfortable to put on the chair.

12. Activation of muscles, flexors of the toes.

The purpose of the exercise: correcting the tone of the flexors of the toes.

Starting position: sitting on a chair, feet on the floor.

The technique of the exercise: produce a pressure foot fingers on the floor plane for 8-10 seconds, then relax and unbend fingers. Exercise repeat 5-6 times. Comments: can be used for this exercise, a round stick with a diameter of 2-3 cm.

13. Activation of the muscles, extensor of the toes.

The purpose of the exercise: correction tone extensor of the toes.

Starting position: sitting on a chair, feet on the floor.

The technique of the exercise: the toes of the foot is fixed to the floor with the other foot for 8-10 seconds, produce pressure fingers on the bottom of the foot on the bottom of the locking foot, Erekcija muscle tone of the pelvic floor. Starting position: sitting on a chair, his hands rested on the seat side.

The technique of the exercise: squeeze the buttocks. Thus figuratively represent the connection of the anus to navel. Exercise perform for 8-10 seconds with intense tension, followed by relaxation. The cycle is repeated 3-4 times. Comments: during the day you should repeat these exercises 2-3 times.

EXAMPLES OF THE METHOD.

Example 1.

Patient 33 years, Dr. f: diabetes mellitus, insulin-dependent type, severe, diabetic angiopathy of the lower extremities, neuropathy, proliferative retinopathy, chronic pyelonephritis, chronic cystitis, varicose saphenous vein of the leg.

Was admitted with complaints of pain, hand numbness, pain at rest and when walking in the footsteps of, sensitivity to cold toes, pain, feeling of heaviness in the lumbar region, weakness, fatigue, often dizziness, headaches, frequent hypoglycemic events. From the anamnesis: diabetes developed during the first pregnancy. From the very beginning of the disease receives intensive insulin therapy in a daily dose of 40-46 Ed. Notes labile diabetes with sconnectionname in the last 7 years. Medication without effect. Due to the presence of chronic pyelonephritis and cystitis turpentine baths patient is not shown, after a course of sodium chloride baths, conducted a year ago, noted some improvement within 2-3 months, the last time pain in the hands and feet increased sharply, practically continuously, limiting physical activity.

Objectively: body shape correct. The skin is clean. In the lungs vesicular breathing, wheezing no. Heart sounds are clear, rhythmic, HR - 78 1 min, BP 130/80 mm RT.article The abdomen is soft, painless on palpation. Liver at the edge of the costal arch. The spleen is not enlarged. Symptom of Pasternack negative on both sides. The mind is clear, focused, contact, focal neurological symptoms no. Status localis: the feet warm. Peripheral edema no. Palpation of the calf muscles slightly painful. Ripple on aa. dorsalis pedis et tibialis posterior is reduced from both sides. Marked trophic changes of the skin of the legs and feet. Pain and thermal sensation on the feet is reduced. When viewed chiropractor defined blockade lumbosacral junction on the right, the muscles, the extensors of the back, and the rear group is har fasting blood 12.2 mmol/l, 2 hours after Breakfast - 14.0 mmol/l In daily urine 24 g of glucose. Biochemical blood test: triglycerides 1,2; cholesterol of 6.5; beta-lipoproteins 4,23; alpha-cholesterol 3,4; beta-cholesterol 2,56; the step. haemoglobin 0,91; type GLP normal; platelet aggregation induced by ADP 52,5; platelet aggregation induced by adrenaline 67,5. ECG: sinus rhythm, the correct normal position of the electrical axis of the heart. VEM: the threshold capacity of 450 KGM, running time 9 minutes, the amount of work done 2700 KGM, double product at standard load 145.E.; double product at the threshold load 225,4.E.; the consumption ratio of reserves attacks of 7.7.E.; the performance index of the left ventricle of 2.8.E. The reason for the cessation of stress: fatigue, pain in the legs. RVG: trunk type circulation in the lower limbs, signs of reduced blood supply to the feet and legs (eographically index - RI - on the shins 0,03 right and 0.035 left, on the feet - 0,05 right and 0.06 left). Laser Doppler flowmetry (LDF): indicators of basal blood flow in the system microvasculature of the skin of the legs is reduced mainly to the left (right 7,56; left 1,64), when carrying out functional tests decreased response eve. Electroneuromyography (ENMG): when supramaximal stimulation n. peroneus d. et's. was determined by the decrease in the amplitude of the M-response to the left and to the right, a significant increase in residual latency to the left (-4,1 mV). CPB is within normal limits. When supramaximal stimulation n.tibialis d. et's. determined a significant decrease in the amplitude of the M-response in the distal point on the left (-0,57 mV) and the proximal point to the right

(-2,13 mV). CPB n.tibialis d. reduced (-36,1 MS), left within normal limits.

Conducted 6 procedures manual therapy, every other day for 20 minutes each session.

During procedures used manual therapy through differentiated muscle activation painful tight muscles of the thoracic and lumbar spine, abdominal muscles, pelvic floor and legs, and before the exposure was carried out by pre-stretching of these muscles.

After treatment, the condition has improved significantly decreased weakness, fatigue, pain in the hands and feet bother much less, the intensity decreased, not worried about the headaches, dizziness, hypoglycemia, nor during, nor after the procedure were noted. Manual status: increased range of motion in the lumbar spine e resumed, normalized muscle tone, extensor back and rear muscle groups of the hip, iliopsoas, calf muscles, palpation of the calf muscles painless.

After treatment was also observed that the decrease of glycemia (fasting 9.4 mmol/l, 2 hours after Breakfast, 10.1 mmol/l) and daily glycosuria (15 g / day); the improvement of lipid profile: reduction of triglycerides to 0.6; cholesterol to 5.8; beta-lipoproteins to 3.7; reducing the aggregation activity of platelets, indicating the improvement of rheological properties of blood (platelet aggregation induced by ADP - 15 and adrenaline - 15). ECG without significant change. When conducting VEM-samples marked increase in the efficiency of cardiac activity and economization of the work of the heart muscle: threshold capacity of 450 KGM, running time 9 minutes, the amount of work done 2700 KGM, double product at standard load decreased to 112.E.; double product at the threshold load at 235.E.; the consumption ratio of reserves infarction decreased to 5.07.E.; the performance index of the left ventricle increased to 3.0 in.E. According to the RVG increased blood vessels of the legs and feet, as evidenced by the increase eographical index (0,035 on the rights of the and (right 11,09; left 3,31), significantly increased response to thermoprobe (69,8 right and 24,31 left) and postocclusion ischemia (47,06 right and 14,12 to the left), which indicates the improvement of microcirculation processes under the influence of treatment. ENMG: when supramaximal stimulation n. peroneus d. increased amplitude of the M-response from 0.55 to 0.79 mV, the stimulation of n. peroneus s. decreased latency M-response from 5.1 to 3.4 MS and increased the amplitude of the M response in the distal point of 0.48 to 1.18 MB. Residual latency to the left within the normal range. When supramaximal stimulation n. tibialis marked increase in the amplitude of the M-response in the distal (equal to 4.97 to 6.57 MB right and from 0.57 to 5,73 left) and proximal (2.13 to mV 4,28 right and with a 3.83 to 5.43 MB left) points. The speed of propagation of excitation (CPB) n. tibialis d. increased from 36.1 to 41.1 MS. The results of the nerve conduction testify about improving processes elektrovojvodina of sensory and motor nerve fibers.

Example 2.

Patient aged 63, d-W: diabetes mellitus, non-insulin dependent type, moderate, diabetic angiopathy of the lower extremities, neuropathy, ischemic heart disease, angina II FC, myocardial infarction, hypertensive heart disease IIB, NC 0. Chronic cholecystoenteric.

From the anamnesis: diabetes suffer for 7 years, regularly takes maninil-5 three times a day, also receives hamiton on 0,00075 twice a day and nitrosorbid 0.01 twice a day regularly. 3 years ago, I had a small heart attack, followed by angina with mild exertion, intractable nitroglycerin, the last year of the attacks concerned mainly with a significant rise HELL to 200/100 mm RT. Art. Pain and cramps in the legs concerned about the last two years, medication (trental, nicotinic acid) without any significant effect.

Upon receipt objective: the correct shape, the skin is dry. In the lungs vesicular breathing, wheezing no. Muffled heart sounds, rhythmic, HR - 64 in 1 min, BP 150/90 mm RT.article The abdomen is soft, painless on palpation. Liver at the edge of the costal arch. The spleen is not enlarged. Symptom of Pasternack negative on both sides. The mind is clear, focused, contact, focal neurological symptoms no. Status localis: the Feet cool. Perifericheskim. Marked trophic changes in the skin of legs and feet: loss of hair, liver spots, thickening of the nail plate. Pain and temperature sensitivity in the feet and legs is reduced. When viewed chiropractor defined blockade lumbosacral junction on the right, the voltage of the extensors of the back, square back muscles more right iliopsoas, calf muscles, decreased tone obliques.

If goniometry marked decrease in range of motion in the lumbar spine: forward 35 degrees, backwards is 45, right 30, left 30, right - 60, left 60.

General analysis of blood and urine without features. Blood sugar fasting - 9.6 mmol/l, daily urine 9,12 g glucose. Biochemical blood test: triglycerides 3,2; cholesterol of 5.5; beta-lipoproteins 6,27; alpha-cholesterol 1,8; beta-cholesterol 2,24; the step. haemoglobin 2,05; type GLP - IV; platelet aggregation induced by ADP 50; platelet aggregation induced by adrenaline 75. ECG: sinus rhythm, correct the deviation of the electric axis of the heart to the left, signs of left ventricular hypertrophy, moderate changes in power in the rear wall. VEM: the threshold power 150 KGM, working time 3 minutes, on the threshold load for 194.3.e; the consumption ratio of reserves attacks of 6.4.E.; the performance index of the left ventricle of 1.36.E. The reason for the cessation of stress: the rise of HELL up to 200/110 mm RT.article RVG: trunk type circulation in the lower limbs, signs of reduced blood supply to the feet and legs (eographically index - RI - on the shins 0,035 right and 0.03 on the left, on the feet - 0,055 right and 0.08 on the left). Laser Doppler flowmetry (LDF): indicators of basal blood flow in the system microvasculature of the skin of the legs is reduced (right 3,23; left 3,28), when carrying out functional tests decreased response to thermoprobe left (right 47,92; left 27,45) and postocclusion ischemia (right 31,37; left 11,76) more pronounced on the left. ENMG: when supramaximal stimulation n. tibialis d. et's. marked decrement in the amplitude of the M-response during stimulation in the proximal point, residual latency increased right (3,8).

Conducted 7 procedures manual therapy daily for 25 minutes each session.

During procedures used manual therapy through differentiated muscle activation painful tight muscles of the thoracic and lumbar spine, abdominal muscles, pelvic floor and legs, and before vozraste improved: reduced weakness, fatigue, pain and cramps in the calf muscles do not worry, pain and numbness in the feet decreased. Neither during nor after the procedures were not observed pain in the heart and behind the sternum, raises HELL. Manual status: increased range of motion in the lumbar spine: according to goniometry angle of inclination increased to 60 degrees, back - 50, right - 45, left 45, turn left and right a - 80. Previously discovered blockade lumbosacral junction is not resumed, normalized tone extensor back, square back muscles, iliopsoas, calf muscles, obliques.

After treatment was also a decrease of glycemia (fasting 6,4 mmol/l) and daily glycosuria (5.6 g per day); the improvement of lipid profile: reduction of triglycerides to 2.4; cholesterol to 5.3; reducing the aggregation activity of platelets, indicating the improvement of rheological properties of blood (platelet aggregation induced by ADP -31,25 and adrenaline - 72). ECG without significant change. When conducting VEM-samples marked increase tolerance to physical activity, economization of the work of the heart muscle: threshold power 150 KGM, running time 4 minutes, the amount of work done 7 the consumption ratio of reserves infarction decreased to 4,21.E.; the performance index of the left ventricle of 1.43.E. According to the RVG increased blood vessels of the legs and feet, as evidenced by the increase eographical index (0,035 on the right and 0.04 in the left tibia and 0.08 on the right and 0.1 on the left foot). LDF: the observed increase in basal blood flow in 3.5 times (right 8,59; left 11,19), significantly increased response to thermoprobe left (59,61 right and 61,18 left) and postocclusion ischemia (21,96 right and 15,69 left), which indicates the improvement of microcirculation processes under the influence of treatment. ENMG: when supramaximal stimulation n. peroneus d. increased amplitude of the M-response from 0.55 to 0.79 mV, residual latency within normal limits.

This method of rehabilitation was applied on 62 patients with diabetes mellitus with diabetic angio - and neuropathy, among them, 30 patients with insulin-dependent and 32 - non-insulin-dependent diabetes.

As a result of application of the method revealed that in the process of elimination of functional blockades and normalization of muscle tone in patients with an improvement of the General condition, decrease of weakness, increase range of motion in the joints of the lower extremities and lumbar spine, reduction or disappearance of pain and nab the General condition and increase motor activity is the improvement in carbohydrate and lipid metabolism, state of the cardiovascular system and peripheral circulation.

According to the RVG in patients with diabetic angiopathies after a course of manual therapy marked decrease in the effects of spastic-atony of the vessels of the lower extremities, there is an increase in blood vessels of the legs and feet.

The results of the LDF evidence about the improvement of microcirculation in vascular bed of the skin of the legs, thereby reducing insufficiency of the tissues and reduce pain.

According to ENMG under the influence of manual therapy in patients with diabetes is the improvement of the propagation of excitation in motor and sensory nerve fibers, indicating a decrease in the manifestations of distal diabetic neuropathy.

The rehabilitation also caused a pronounced and authentic dynamics of indicators of physical health when conducting hems-sample showed a significant increase in the amount of completed work, the double reduction works on a standard load, indicating the economization of cardiac activity, as evidenced by the reduction in the rate of spending of reserves attacks. Improving the production capacity of the left ventricle, the power increase threshold load. Favorable dynamics of hemodynamic parameters, caused by the influence of this method of manual therapy, is associated with improved innervation of the myocardium, metabolism, microcirculation, peripheral blood circulation.

Dynamics of clinical symptoms, the results of instrumental methods of research, data functional tests show an improvement of neurotrophic processes in tissues, regional blood flow and microcirculation due to the elimination of functional blockades and muscle dysfunction, normalize reflex connections, which allows to interpret the treatment using this method of manual therapy as an effective method of non-medical effects on the course of diabetic angio - and neuropathy.

Thus, the proposed method of rehabilitation of patients with diabetic angio - and neuropathy contributes to the prevention of further progression of complications of diabetes, extends the treatment of patients with related disorders such as thrombophlebitis, varicose veins, coronary heart disease FK, pyelonephritis, as well as with the organic phase of diabetic the mi skin of the legs and feet.

1. The method of rehabilitation of patients with diabeticakimi angio - and neuropathy physical factor, wherein reveal painful and tense muscles of the thoracic and lumbar spine, abdomen, pelvic floor and lower extremities, and as a physical factor using the technique of manual therapy, which consists in pre-stretching and subsequent normalization of muscle tone by voltage.

2. The method according to p. 1, characterized in that the course of treatment is 5 to 8 of the procedures carried out daily or every other day for 20 - 25 minutes

 

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3 cl, 4 dwg

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: the present innovation deals with treating degenerative-dystrophic diseases of patient's hip joint resulting into deforming coxarthrosis. One managed to stop the process of destruction of cartilaginous surface of adjoining surfaces of cotyloid cavity and caput femoris at subsequent providing restoration of affected cartilaginous part and providing articular biomechanics due to including dairy-vegetable diet into the main diet as products of bee family due to removing muscular contractures by technique of separating tendinous fibers in cross-sectional direction against the log of tendinous part in areas of the onset and fixation of muscular tendons that provide bending, adduction, abduction, external and internal femoral rotation without changing muscular length, improving regional microcirculation due to functioning reserve collateral bonds of femoral, obturator and branch of the lower and superior gluteal arteries, techniques of chondroprotectors, vitamin complex of C, B1 and B12 group after the onset of functioning of reserve capillaries of articular and peri-articular areas, due to removing relative difference of legs length, pelvic curving due to removing functional blocks in sacro-iliac, sacro-lumbar pubic joints and in transitional vertebral departments, due to performing techniques that enable to polish articular surfaces and their congruence. The result mentioned could be achieved by performing the above-mentioned techniques in strictly suggested sequence only.

EFFECT: higher efficiency of therapy.

1 ex

FIELD: medicine.

SUBSTANCE: method involves manually treating the vertebral column by applying vertebral column distraction, stage-by-stage transposition of injured vertebral column, motor segment and/or degenerative transformed disk in lateral approach from both sides by manipulating with fingers and fixing an injured motor segment of the vertebral column and/or degenerative transformed disk in given position to create conditions for restituting intervertebral disk.

EFFECT: enhanced effectiveness of treatment.

8 cl

FIELD: medicine.

SUBSTANCE: method involves manually treating the vertebral column by applying vertebral column distraction, transposition of injured vertebral column applied to the vertebral column segment where postoperative recurrence of intervertebral disk pulpous nucleus extrusion has occurred. Finger manipulations are applied followed by vertebral column motor segment fixation.

EFFECT: enhanced effectiveness of anatomical vertebral column structure repair.

4 cl

FIELD: medicine, curative physical culture.

SUBSTANCE: the present innovation deals with prescribing a dosed moderate, broken physical loading upon different body areas. Loading should be prescribed at the level of regional hemodynamics. One should perform smooth forward inclinations in patient's sitting position at the rate of 3-30 inclinations/min, total quantity up to 900 inclinations daily, during performing inclinations it is necessary to put one's hands on knee joints. Then one should prescribe smooth forward inclinations in one's standing position, total quantity of which should reach 300-600 inclinations daily. Then it is necessary to prescribe bending-unbending of inferior limbs in one's sitting position at the quantity up to 500 daily. The method enables to remove the causes and mechanism for the development of cardio-vascular pathology due to increasing circulation in different body areas at the level of regional hemodynamics and restoring both reserve and total metabolic surface of capillaries at adequate level.

EFFECT: higher efficiency of prophylaxis, treatment and regression.

7 ex

FIELD: medicine, gymnastics.

SUBSTANCE: the suggested plastic-rhythmic gymnastics includes the combination of physical exercises, postures, gestures, mimicry and movements performed under musical accompaniment, moreover, every exercise or movement is being continuation of previous one. Moreover, a person should render sense content of musical accompaniment by performing movements, gestures, mimicry and postures out of movements bank. Moreover, a person feels and fixes own state by performing movement and co-movement that corresponds to muscular group being statically loaded, and another muscular group taking part in co-movement is loaded dynamically. Co-movement is simultaneously the next movement, and another muscular group works in a movement-corresponding co-movement. The present gymnastics enables to carry out sanitation and reveal person's plastic-rhythmical abilities.

EFFECT: higher efficiency.

FIELD: medicine, curative physical culture.

SUBSTANCE: the present innovation deals with forming patient's body posture due to the system of body points. The method includes the system of trainings where formation of body posture should be performed through developing an idea upon body carcass model in a patient as the system of body points followed by training for the skills to handle this model. A patient should keep human body points in position that corresponds to body carcass model. Moreover, in human body carcass model, at its vertical static position, one should isolate vertical direct line, a rectangular parallelepiped of thoracic body carcass part interconnected with vertical direct line, with possibility to rotate against it, a rectangular parallelepiped of lumbar body carcass part interconnected with vertical direct line with possibility to rotate against it, moreover, the edges of lumbar parallelepiped are parallel to corresponding edges of thoracic parallelepiped.

EFFECT: higher efficiency of one's body posture formation.

3 cl, 1 dwg

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