Method of predicting adaptation of children to school

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to pediatrics. Parameters of cardiorhythmogram (CRG) are registered in lying position: at rest - heart rate, SDNN index; tension index (TI); total spectrum power - Total; value of power in range VLF; value of power in range LF; value of power in range HF. After that in standing position reactivity of sympathetic nervous system is determined by Lf/HF index. In five minutes in lying position recovery of initial heart rate, total spectrum power - Total, increase or reduction of initial power in range of waves: VLF, LF, HF are determined. On the basis of CRG indices, it is estimated which type of cardiac rhythm regulation level prevails: reflex or humoral-metabolic; vegetative balance of sympathetic and parasympathetic impact on cardiac rhythm; reactivity of sympathetic nervous system to functional load: adequate or inadequate. Favourable adaptation is predicted if reflex type of cardiac rhythm regulation prevails over humoral-metabolic, at rest balance of sympathetic and parasympathetic impact on cardiac rhythm is determined, under functional load adequate reactivity of sympathetic nervous system is observed. Unfavourable prediction of adaptation is made if reflex type of cardiac rhythm regulation prevails, but at rest sympathetic or parasympathetic impact on cardiac rhythm is observed, under functional load adequate or increased reactivity of sympathetic nervous system is observed. Unfavourable prediction is made if humoral-metabolic type of level of cardiac rhythm regulation prevails, at rest sympathetic impact on cardiac rhythm prevails and under functional load - inadequate: increased or reduced reactivity of sympathetic nervous system is observed.

EFFECT: method makes it possible to increase reliability of prediction of children's adaptation school.

4 tbl, 3 ex

 

The invention relates to medicine, namely to Pediatrics, and can be used to prevent disruption of adaptation of children to school.

There is a method of determining the prognosis of adaptation of children to the school is based on the compilation of the forecast tables, which are weighed down by biological factors and social history (Methodical recommendations Ivanovo research Institute of maternity and childhood of the Ministry of health of the Russian Federation "Preparing children to enter school", Ivanovo, 1986; Organization of medical control over the development and health of preschool and school children on the basis of mass screening tests and their rehabilitation in the kindergarten, school. Methodological manual/ Ed. by G.N. Serdyukov. - M., 1993). Prognostic table consists of 21 questions that parents respond to the child enters school. For each anamnestic factors highlights the corresponding gradation. After that summarizes predictive coefficients (PC)corresponding to underline gradations, considering the sign "+" or "-". When the amount of PC more (+13) points gives an opinion about the high risk of adverse currents adaptation to school. When the amount of PC less (-13) points gives an opinion on favorable prognosis of adaptation to school. If the amount is in the range between -13 and +13 points, should be expected among the unfavorable course of adaptation to school.

However, this method of predicting the course of adaptation of children to school has drawbacks: socio-biological factors are unstable and is clinically proven material. Assessment data history largely subjective, a great complexity of the method, determined by the need to evaluate a large number of features (more than 20).

Closest to the proposed method is described in Berseneva I.A. (Assessment of adaptive capacity among schoolchildren on the basis of heart rate variability at rest and during orthostatic test. Abstract. Diss., M, 2000). In this way rhythmocardiography was held in the "lying" and "standing," was the main indices of heart rate variability (HRV).

However, in this method, after carrying out the tilt-test ("lying-standing") was not conducted additional research over the past 5 minutes in the "lying", which is necessary for the evaluation of adaptive reserves of the body.

The objective of the invention: improved objectivity in the forecast adaptation of children to school.

The task carried out due to the fact that advanced in 5 minutes determine the recovery of the original curves, the total power of the spectrum is Total, the increase or reduction of the source power in the range of waves: VLF, LF, HF; next, on the basis of the received performance AWG, assess what type of level of regulation of the heart rhythm prevails: reflex or humoral-metabolic; autonomic balance of sympathetic and parasympathetic effects on heart rate; reactivity of the sympathetic nervous system on the functional load: adequate or inadequate; and then depending on the obtained results predict adaptation of children for school: favorable - if prevails reflex type level of heart rate control on humoral-metabolic, alone marked the balance of sympathetic and parasympathetic effects on heart rate, under functional load is observed adequate reactivity of the sympathetic nervous system; crediblility prognosis of adaptation: if the predominant reflex type level of regulation of the heart rhythm, but alone it is noted the predominance of the sympathetic or parasympathetic effects on heart rate, under functional load marked adequate or increased reactivity of the sympathetic nervous system; adverse - if the predominant humoral-metabolic type level regulation of heart rate and calm the marked predominance of sympathetic effects on heart rate and under functional load - inadequate: increased or decreased reactivity with eticheskoi nervous system.

The method is as follows:

The rhythmocardiography (CRF) in children is carried out in conditions of relative peace. Record the ECG signal in one of the standard leads "lying". The recording duration is 5 minutes. Then hold orthostatic test, i.e. record the ECG signal in one of the standard leads "standing", the recording - also at least 5 minutes. The child then returns to the initial position - lying, where additionally record the ECG signal in one of the standard leads.

According to the data of cardiotocogram assess the functional state of an organism of the child, namely: the autonomic balance of the sympathetic and parasympathetic effects on heart rate and the degree of tension of regulatory systems.

The most informative parameters for prediction of flow adaptation, presented in table 1.

Indices of heart rate variability according to CWG

Table 1
ShorthandIndicesPhysiological interpretationNorma
SDNN (m/s)Standard is tkanina full array of R-interval The cumulative effect of vegetative regulation of blood circulation45-70 m/s
IN (%/s2)The tension indexThe degree of tension of regulatory systems (the degree of predominance of the activity of the Central mechanisms of regulation on Autonomous)30-90 %/s2
Total (m/s2)The total power spectrumTotal absolute level of activity of regulatory systems1500-5000 m/s2
VLF(m/s2)The power spectrum of very low frequency component of HRVThe relative level of activity of sympathetic regulation355-1175 m/s2
LF(m/c2)The power spectrum of the low-frequency component of HRVThe relative level of activity of the vasomotor center500-1500 m/s2
HF(m/s2)The power spectrum of the high frequency component of HRVRelative is the activity level of the parasympathetic regulation 500-1500 m/s2
LF/HFThe ratio of average values of low-frequency and high-frequency component of HRVThe relative activity of subcortical sympathetic nerve centerthe 3.5-15

They evaluate the performance of cardiotocogram in the supine position:

- alone record the rhythm and heart rate (HR);

- heart rate variability assessed by the SDNN index (normal, reduced, raised);

- the index of the voltage - IN (within the normal range, decrease, increase);

- total power spectrum. Total (within limits, decrease, increase);

- power value in the range of very slow waves, VLF (within limits, decrease, increase);

- power value in the range of slow waves, LF (within limits, decrease, increase);

- power value in the range of fast waves, HF (within limits, decrease, increase).

During orthostatic load:

- reactivity of the sympathetic nervous system is assessed according to the index LF/ HF (normal, reduced, increased).

After 5 minutes, determine:

- restore or not resume the original HR;

- total power spectrum, Total (within limits, decrease, increase);

- increase or decrease their original capacity in the range of waves: VLF, LF, HF.

Next, on the basis of the received performance cardiotocogram, make a conclusion:

1) the prevalence of type-level regulation of heart rhythm (reflex, humoral-metabolic);

2) autonomic balance the sympathetic and parasympathetic effects on heart rate;

3) the reactivity of the sympathetic nervous system on the functional load (adequate, inadequate).

Depending on the conclusions of the AWG determine the prognosis adaptation of children for school:

1 - positive adaptation.

The predominance of reflex type level of regulation of the heart rhythm over a humoral-metabolic, alone marked the balance of sympathetic and parasympathetic effects on heart rate, under functional load is observed adequate reactivity of the sympathetic nervous system.

2 - crediblility forecast adaptation.

The predominance of reflex type level of regulation of the heart rhythm, but alone it is noted the predominance of the sympathetic or parasympathetic effects on heart rate, under functional load is observed adequate or increased reactivity of the sympathetic nervous system.

3 - poor prognosis adaptation.

The prevalence of humoral-metabolic type level regulation of heart rate, at rest, the mark is moved predominance of sympathetic effects on heart rate, under functional load celebrated inadequate (increased or decreased) the reactivity of the sympathetic nervous system.

The sample of 52 children before entering school. Positive adaptation was observed in 52.4% of children crediblility - 37,64% of children and poor prognosis adaptation was observed in 9,96% of children.

The method is illustrated by the following examples:

Example 1.

Ilya, 7 years. Before entering school had the following indicators cardiotocogram:

IndicatorsPeaceOrlistat.RecoveryNorma
Heart rate (beats/min)71836960-80
SDNN (m/s)65,838,776,945-70 m/s
IN (%/c2)44,5117,136,130-90 %/s2
Total (m/s2)1447 46822911500-5000 m/s2
VLF (m/c2)24155135355-1175 m/s2
LF (m/c2)233327780500-1500 m/s2
HF (m/c2)972861376500-1500 m/s2
LF/HF0,243,790,57the 3.5-15

The study cardiotocogram in the supine position:

- alone registered sinus rhythm with normal heart rate (60-80);

- heart rate variability of normal (SDNN>45);

- the index of the voltage within the normal range (IN 30-90);

- total power spectrum, Total moderately low (500-1500);

- power value in the range of very slow waves is reduced (VLF<355);

- power value in the range of slow waves is reduced (LF<500);

- power value in the range of fast waves in the norm (HF 500-1500).

When orthostatic n the burden:

- reactivity of the sympathetic nervous system in normal (LF/HF 3,5 to 15).

After 5 minutes orthostatic samples identified:

- restore the original HR;

- increasing the total capacity Total spectrum;

- power reduction is very slow VLF waves.

Conclusion: the observed prevalence of reflex on humoral-metabolic level of regulation of the cardiac rhythm; alone notes the balance of sympathetic and parasympathetic effects on heart rate; under functional loads observed adequate reactivity of the sympathetic nervous system. Forecast adaptation is favorable.

During the first year of training the boy was not observed neurotic reactions were observed favorable emotional profile, good weight gain (more than 1500 g per year), suffered from respiratory disease 1 time per year, the level of knowledge of modes of action (performance) above average. The prediction was confirmed.

Example 2.

Masha, 7 years. Before entering school had the following indicators cardiotocogram:

IndicatorsPeaceOrlistat.RecoveryNorma
Heart rate (beats/min)1 807060-80
SDNN (m/s)85,6to 78.3to 89.545-70 m/s
IN (%/s2)of 37.8to 45.431,030-90 %/c2
Total (m/s2)2778190130821500-5000 m/s2
VLF (m/s2)270467508355-1175 m/s2
LF (m/s2)531672989500-1500 m/s2
HF (m/s2)19767621585500-1500 m/s2
LF/HF0,270,880,62the 3.5-15

Research is their cardiotocogram in the supine position:

- alone registered sinus rhythm with normal heart rate (60-80);

- heart rate variability of normal (SDNN>45);

- the index of the voltage within the normal range (JN 3-90);

- total power spectrum within the normal range (Total 1500-5000);

- power value in the range of very slow waves is reduced (VLF<355);

- power value in the range of slow waves in the normal range (LF 500-1500);

- power value in the range of fast waves increased (HF>500).

During orthostatic load:

- reactivity of the sympathetic nervous system is reduced (LF/HF<3,5).

After 5 minutes orthostatic samples identified:

- restore the original HR;

- restore the original total capacity Total spectrum;

the power increase is very slow VLF waves.

Conclusion: the observed prevalence of reflex on humoral-metabolic level of regulation of the cardiac rhythm; alone notes the balance of sympathetic and parasympathetic effects on heart rate; under functional loads, there is insufficient reactivity of the sympathetic nervous system. Forecast adaptation - crediblility.

During the first year of training the girl mentioned motility disorders asthenic syndrome, weight gain amounted to $ 1450 for the year was marked srednekaloriyny the tip of the regional profile, moved 2 colds per year, the level of knowledge of modes of action (performance) average. The prediction was confirmed.

Example 3.

Cyril, 7 years. Before entering school had the following indicators cardiotocogram:

IndicatorsPeaceOrlistat.RecoveryAppropriate indicators
Heart rate (beats/min)77967660-80
SDNN (m/s)37,049,749,145-70 m/s
IN (%/s2)121,7to 124.487,430-90%/c2
Total (m/s2)4555399661500-5000 m/s2
VLF (m/c2)106140181355-175 m/s 2
LF (m/c2)149294398500-1500 m/s2
HF (m/s2)200105387500-1500 m/s2
LF/HF0,752,801,03the 3.5-15

The study cardiotocogram in the supine position:

- alone registered sinus rhythm with normal heart rate (60-80);

- heart rate variability moderately reduced (SDNN 20-44);

- the index of the voltage within the normal range (JN 31-45,4);

- total power spectrum is significantly reduced (Total<500);

- power value in the range of very slow waves is reduced (VLF<355);

- power value in the range of slow waves is reduced (LF<500);

- power value in the range of fast waves is reduced (HF<500).

During orthostatic load:

- reactivity of the sympathetic nervous system is reduced (LF/HF<3,5).

After 5 minutes after exercise identified:

- restore the original HR;

- restore the original total power spectrum, Total;

- zoom is the power very slow waves, VLF.

Conclusion:

predominantly humoral-metabolic above the reflex level of regulation of the cardiac rhythm; alone there is an imbalance of the autonomic regulation of heart rhythm with increased tone of the sympathetic nervous system; functional loads, there is insufficient reactivity of the sympathetic nervous system. Forecast adaptation - negative.

During the first year of training the boy noted the lack of weight gain (less than 1500 g per year)developed severe neurotic reaction (asthenic, phobic syndrome, reactions of protest), was observed adverse emotional profile, frequent colds (4 times per year), the level of knowledge of modes of action is below average. The prediction was confirmed.

The proposed method allows to objectively and reliably assess the adaptive ability of each child before school.

The way of forecasting the adaptation of children to the school, including the assessment of heart rate variability, which initially assess the performance of cardiotocogram (KRG) in the supine position: alone record the rhythm and heart rate (HR), heart rate variability - the SDNN index; the tension index (ti); total spectral power (Total); power value in the range of very slow waves (VLF); is generating the spine in the range of slow waves (LF); power value in the range of fast waves (HF); standing with orthostatic load assess the reactivity of the sympathetic nervous system index LF/HF, characterized in that it further after 5 min in the supine position define the restoration of the original HR, total spectral power (Total), increase or reduction of the source power in the range of waves: VLF, LF, HF; next, on the basis of the received performance AWG assess what type of level of regulation of the heart rhythm prevails: reflex or humoral-metabolic; autonomic balance of sympathetic and parasympathetic influences on heart rate; reactivity of the sympathetic nervous system on functional load: adequate or inadequate; and then depending on the obtained results predict adaptation of children for school: favorable - if prevails reflex type level of heart rate control on humoral-metabolic, alone marked the balance of sympathetic and parasympathetic influences on heart rate, under functional load is observed adequate reactivity of the sympathetic nervous system; crediblility prognosis of adaptation: if the predominant reflex type level of regulation of the heart rhythm, but alone it is noted the predominance of the sympathetic or parasympathetic alongside the effects on heart rate, under functional load marked adequate or increased reactivity of the sympathetic nervous system; adverse - if the predominant humoral-metabolic type level regulation of heart rate and calm the marked predominance of sympathetic effects on heart rate and under functional load - inadequate: increased or decreased reactivity of the sympathetic nervous system.



 

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