The book is a continuation of the famous monographs by V. A. Kachesov from the series “Fundamentals of Intensive Rehabilitation”. Based own experience The authors outline approaches to intensive rehabilitation of patients with paralysis of various etiologies. For the first time, the author's original simulators are described, allowing completely paralyzed patients to exercise independently and even walk. More than 80 drawings and photographs are presented. The book is intended for patients and doctors of various specialties.
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by liters company.
© V. A. Kachesov, 2016
© K. V. Kachesov, 2016
© K. Antonov, cover design, 2016
Created in the intellectual publishing system Ridero
Introduction
Currently, throughout the world there is an increase in car and plane crashes, man-made accidents, natural disasters, terrorist acts and military conflicts, accidents, which leads to an increase in the number of victims with traumatic spinal disease, with various injuries to the spinal cord, brain, and peripheral nerves.
Doctors of various specialties note an increase in diseases of various etiologies, leading to dysfunction of the musculoskeletal system.
Rehabilitation of patients with injuries and diseases nervous system and functions of the musculoskeletal system has always been a complex problem.
The relevance of the problem of rehabilitation of disabled people with diseases of the nervous system of various origins is indicated by WHO data. WHO estimates that more than a billion people, or about 15% of the world's population (based on 2010 global population estimates), live with some form of disability. Of these, 190 million people have a “severe form of disability,” i.e. These are patients with tetraplegia - paralysis of the arms and legs.
To a large extent, the difficulty of solving the problems of rehabilitation of disabled people with various diseases nervous system is that “rehabilitation is presented, explained and practiced in different ways.”
First problem. Rehabilitation is often confused with treatment. However, there is a fundamental difference between these concepts.
Treatment is a set of measures aimed at slowing down and stopping the pathological process. Treatment is “putting out a fire” in a figurative sense. Keyword Here - " stop».
Rehabilitation is a set of measures aimed at restoring and improving organ functions after stopping the pathological process.
Rehabilitation is, in a figurative sense, the restoration of impaired functions in an object after “putting out a fire.” The key word here is “ recovery».
Second problem lies in the different interpretation of the phenomena observed in traumatic diseases of the spine and other diseases leading to the development of paralysis.
This problem is due to insufficient understanding of the pathogenesis, different approaches to the issues of “primary” and “secondary” in trauma and disease. And the rehabilitation specialist’s tactics and prognosis depend on the correct explanation of the observed phenomena.
Third problem. The problem of conduction disturbances due to spinal injury or diseases causes greatest number questions and fierce debates in predicting rehabilitation outcomes.
Doctors unreasonably (!!!) associate the restoration of the functions of the limbs, pelvic organs and tissues with spinal cord injury with the concept of spinal cord regeneration. Due to the substitution of understanding of terms, most morphologists and neurosurgeons negatively assess the possibility of restoring functions after anatomical damage to the spinal cord.
These disputes are caused by the fact that in clinical practice it is completely unreasonable to identify the phenomenon of conductivity only with the nervous system. This leads to the erroneous conclusion that “with anatomical damage to the spinal cord, conduction in general is disrupted.”
Let us remind you: from manuals on physiology, histology, and biology it is known that conductivity is a property characteristic of all types of tissues, and not just the nervous system!
A correct understanding of this problem leads to the unexpected conclusion that the possibility of restoring motor functions after damage to the spinal cord or brain ALWAYS exists!
This conclusion is confirmed not only in theory, but also in practice.
It should only be understood that functional restoration does not correlate with spinal cord regeneration. Research shows and proves that function can be restored and spinal cord injuries can remain unchanged.
The most common pessimistic forecasts for trauma victims cervical spine spine and extensive damage to the spinal cord in this section. Difficulties in recovery of patients who are in a state of absolute immobility (with tetraplegia) with high level spinal cord injuries create a natural feeling of hopelessness, both among doctors and among patients and their relatives.
Therefore, the book focuses on the rehabilitation of patients with tetraplegia - the most difficult contingent in the structure of victims.
Especially in this group of patients, we should highlight the most severe part, consisting of chronic patients, supposedly without prospects for positive results, who lay motionless for more than a year after discharge from the hospital.
Trophic disorders: ulcers, bedsores; dysfunction of the pelvic organs, aggravate the patient’s condition, complicate his care and, according to experts, complicate rehabilitation. The experience we have accumulated allows us to assert that the presence of the above phenomena does not affect the possibility of carrying out rehabilitation measures.
On the contrary, the use of the rehabilitation technology we have developed accelerates the healing of bedsores and the regeneration of bone tissue, and the function of the pelvic organs is restored first at the unconditional reflex level, then gradually the possibility of volitional control of acts of defecation and urination (conditioned reflexes) appears.
Our practical experience allows us to conclude that the technology of functional restoration described in the book leads to positive results in ALMOST ALL patients in both early and late post-traumatic periods!
But the amount of recovery most often depends on the wishes of the patients themselves!
The main problems that exist for patients and their relatives:
– Large physical costs for rehabilitation.
– Large financial costs for rehabilitation.
– A large loss of time for patients and relatives during daily rehabilitation.
– Due to the labor-intensive process, it is necessary to involve third parties to assist in rehabilitation.
– In patients in a state of physical inactivity (immobility), various complications arise (contractures, bedsores, pneumonia and deterioration in the function of the pelvic organs: urination and defecation).
– Patients and rehabilitation specialists often do not know what to do if such complications arise.
This book highlights the sequence of actions during intensive rehabilitation, which help solve all the above problems and lead to natural positive results:
– restoration of impaired functions of the autonomic nervous system (normalization of heat exchange, normalization of blood pressure, sweating, intestinal motility, etc.);
– restoration of tissue blood flow, elimination of trophic disorders (healing of bedsores and trophic ulcers);
– restoration hormonal levels;
– restoration of the functions of the pelvic organs;
– restoration of superficial and deep sensitivity, and, subsequently, differentiated types of sensitivity;
– restoration of the tone of the striated muscles and the emergence of the possibility of volitional control of the body and limbs;
– restoration of the ability to exercise on simulators;
– restoration of the ability to study independently, without involving relatives and instructors;
– restoration of self-care skills and movement in space.
The book discusses working algorithms tested in practice, algorithms of actions during rehabilitation, exercises and the sequence of their implementation.
The simulators and devices described in this book allow you to speed up the process of restoring lost functions and solve most of the problems that patients and their relatives face every day.
The authors' experience shows that intensive rehabilitation using specialized technical means It quickly allows even a patient with tetraplegia to take the first steps in an upright position using a special walker.
Therefore, you should not come up with reasons to justify your helpless state. Start fighting and defeating your illness, methodically winning your independence from it!
You have the advantage of the recovery technology described in this book!
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The following is an introductory fragment of the book Basics of Intensive Rehabilitation. Intensive rehabilitation of disabled people using special simulators (V. A. Kachesov) provided by our book partner -
© V. A. Kachesov, 2016
© K. V. Kachesov, 2016
© K. Antonov, cover design, 2016
Created in the intellectual publishing system Ridero
Introduction
Currently, throughout the world there is an increase in car and plane crashes, man-made accidents, natural disasters, terrorist acts and military conflicts, accidents, which leads to an increase in the number of victims with traumatic spinal disease, with various injuries to the spinal cord, brain, and peripheral nerves.
Doctors of various specialties note an increase in diseases of various etiologies, leading to dysfunction of the musculoskeletal system.
Rehabilitation of patients with injuries and diseases of the nervous system and musculoskeletal system functions has always been a complex problem.
The relevance of the problem of rehabilitation of disabled people with diseases of the nervous system of various origins is indicated by WHO data. WHO estimates that more than a billion people, or about 15% of the world's population (based on 2010 global population estimates), live with some form of disability. Of these, 190 million people have a “severe form of disability,” i.e. These are patients with tetraplegia - paralysis of the arms and legs.
To a large extent, the difficulty of solving the problems of rehabilitation of disabled people with various diseases of the nervous system lies in the fact that “rehabilitation is presented, explained and carried out in practice in different ways.”
First problem. Rehabilitation is often confused with treatment. However, there is a fundamental difference between these concepts.
Treatment is a set of measures aimed at slowing down and stopping the pathological process. Treatment is “putting out a fire” in a figurative sense. The key word here is “ stop».
Rehabilitation is a set of measures aimed at restoring and improving organ functions after stopping the pathological process.
Rehabilitation is, in a figurative sense, the restoration of impaired functions in an object after “putting out a fire.” The key word here is “ recovery».
Second problem lies in the different interpretation of the phenomena observed in traumatic diseases of the spine and other diseases leading to the development of paralysis.
This problem is associated with insufficient understanding of pathogenesis, different approaches to the issues of “primary” and “secondary” in trauma and disease. And the rehabilitation specialist’s tactics and prognosis depend on the correct explanation of the observed phenomena.
Third problem. The problem of conduction disturbances due to spinal injury or diseases raises the greatest number of questions and fierce debates in predicting the results of rehabilitation.
Doctors unreasonably (!!!) associate the restoration of the functions of the limbs, pelvic organs and tissues with spinal cord injury with the concept of spinal cord regeneration. Due to the substitution of understanding of terms, most morphologists and neurosurgeons negatively assess the possibility of restoring functions after anatomical damage to the spinal cord.
These disputes are caused by the fact that in clinical practice it is completely unreasonable to identify the phenomenon of conductivity only with the nervous system. This leads to the erroneous conclusion that “with anatomical damage to the spinal cord, conduction in general is disrupted.”
Let us remind you: from manuals on physiology, histology, and biology it is known that conductivity is a property characteristic of all types of tissues, and not just the nervous system!
A correct understanding of this problem leads to the unexpected conclusion that the possibility of restoring motor functions after damage to the spinal cord or brain ALWAYS exists!
This conclusion is confirmed not only in theory, but also in practice.
It should only be understood that functional restoration does not correlate with spinal cord regeneration. Research shows and proves that function can be restored and spinal cord injuries can remain unchanged.
The most common pessimistic prognoses are for victims with trauma to the cervical spine and extensive damage to the spinal cord in this department. The difficulties of recovery for patients who are in a state of absolute immobility (with tetraplegia) with a high level of spinal cord damage create a natural feeling of hopelessness, both among doctors and among patients and their relatives.
Therefore, the book focuses on the rehabilitation of patients with tetraplegia - the most difficult contingent in the structure of victims.
Especially in this group of patients, we should highlight the most severe part, consisting of chronic patients, supposedly without prospects for positive results, who lay motionless for more than a year after discharge from the hospital.
Trophic disorders: ulcers, bedsores; dysfunction of the pelvic organs, aggravate the patient’s condition, complicate his care and, according to experts, complicate rehabilitation. The experience we have accumulated allows us to assert that the presence of the above phenomena does not affect the possibility of carrying out rehabilitation measures.
On the contrary, the use of the rehabilitation technology we have developed accelerates the healing of bedsores and the regeneration of bone tissue, and the function of the pelvic organs is restored first at the unconditional reflex level, then gradually the possibility of volitional control of acts of defecation and urination (conditioned reflexes) appears.
Our practical experience allows us to conclude that the technology of functional restoration described in the book leads to positive results in ALMOST ALL patients in both early and late post-traumatic periods!
But the amount of recovery most often depends on the wishes of the patients themselves!
The main problems that exist for patients and their relatives:
– Large physical costs for rehabilitation.
– Large financial costs for rehabilitation.
– A large loss of time for patients and relatives during daily rehabilitation.
– Due to the labor-intensive process, it is necessary to involve third parties to assist in rehabilitation.
– In patients in a state of physical inactivity (immobility), various complications arise (contractures, bedsores, pneumonia and deterioration in the function of the pelvic organs: urination and defecation).
– Patients and rehabilitation specialists often do not know what to do if such complications arise.
This book highlights the sequence of actions during intensive rehabilitation, which help solve all the above problems and lead to natural positive results:
– restoration of impaired functions of the autonomic nervous system (normalization of heat exchange, normalization of blood pressure, sweating, intestinal motility, etc.);
Year of issue: 2002
Genre: Rehabilitation
Format: DOC
Quality: eBook (originally computer)
Description: In the book “Fundamentals of Intensive Rehabilitation. Injury of the spine and spinal cord" discusses in detail the issue of "conductivity" as a property characteristic of all types of tissues. Experience accumulated over centuries and our experience shows that restoration of the function of organs located below the injury of the spine and spinal cord is possible! And the rapid restoration of functions observed with the use of intensive rehabilitation technology indicates that the restoration of these functions is not associated with the regeneration of the spinal tracts. Regeneration processes are much slower than the observed processes of functional restoration.
Our clinical observations show that after the restoration of functions in victims as a result of the use of intensive rehabilitation technologies, the X-ray picture in the area of damage to the spinal column remains unchanged. Conducted NMR studies show a lack of dynamics in areas of spinal cord damage.
These studies only confirm that the severe clinical picture in victims is associated not only with spinal cord damage, but is also due to other factors. Elimination of these factors leads to restoration of functions.
Fundamentals of Intensive Rehabilitation covers the issue of conductivity in detail because it is the issue that generates the most heated debate in predicting rehabilitation outcomes.
The most common pessimistic prognoses are for patients with trauma to the cervical spine and extensive damage to the spinal cord in this department. The difficulties of recovery of patients with tetraplegia with a high level of spinal cord damage create a natural feeling of hopelessness, both among doctors and among patients and their relatives.
Therefore, the main attention in the book is paid to the rehabilitation of patients with tetraplegia, as the heaviest contingent in the structure of victims. But even among this group, we should highlight the most severely chronic patients, who have remained motionless for more than a year after discharge from hospitals and have no prospects for positive results.
Our practical experience allows us to conclude that, using intensive rehabilitation technology, a positive result can be achieved both in the early and late post-traumatic periods in patients with injuries to the cervical and other parts of the spine.
Trophic disorders, ulcers and bedsores aggravate the patient’s condition, complicate his care and, according to experts, complicate rehabilitation (Gaidar B.V. et al., 1998). The experience gained by the author allows us to assert that the presence of bedsores and false joints does not affect the possibility of carrying out rehabilitation measures. On the contrary, the use of the described rehabilitation technology accelerates the healing of bedsores and the regeneration of bone tissue in places where false joints form (Gaidukov V.M., Kachesov V.A. 1998). Regression of pressure ulcer processes and regeneration of specialized tissues at the site of trophic disorders in chronic patients have not been described in the literature. Practitioners who first encountered this phenomenon when using intensive rehabilitation technology will find it difficult to interpret it. The book pays attention detailed description regression of symptoms of spinal injury, criteria for the rehabilitation process that the doctor should rely on.
Dysfunction of the pelvic organs and the failure of attempts to restore them force doctors at foreign rehabilitation centers to apply an epicystoma and perform permanent catheterization.
When using intensive rehabilitation technology, the function of the pelvic organs is restored first at the reflex level, then gradually the possibility of volitional control of the acts of defecation and urination appears. In addition to physical suffering, dysfunction of the pelvic organs increases the psychological suffering of such patients, so the issue of restoring these functions is considered in detail.
The book "Injury of the spine and spinal cord" covers the first stage of intensive rehabilitation, the result of which is:
1. Restoration of impaired functions of the autonomic nervous system.
2. Elimination of trophic disturbances.
3. Restoration of the functions of the pelvic organs.
4. Restoration of superficial and deep sensitivity.
5. Restoration of the tone of the striated muscles and the emergence of the possibility of volitional control of the torso and limbs.
The appendix examines the psychological aspects of a doctor’s communication with patients and their relatives.
“Fundamentals of intensive rehabilitation. Injury of the spine and spinal cord"
On the issue of terminology in rehabilitation science
Structure and function
Secretion
Conduction - transmission of nerve impulses
Function of connective tissue
Viability. Life activity. Life. Death.
Reversible and irreversible processes. Regeneration
Reversibility of dystrophic changes
Reversibility of scar changes. Regeneration
Impaired function. Pain. Causal relationship
Anatomical and physiological features of the structure of the spinal cord
Possibility of transmitting information in case of spinal cord injury
Anatomical and physiological features of the structure of the spinal cord
Neurological aspects
The role of cerebrospinal fluid in the transmission of information
The role of the autonomic nervous system in the conduction of impulses in spinal cord injury
The role of muscle tissue in conducting information in anatomical spinal cord injuries
Ephaptic transmission.
Body reactivity and spinal injury
Specific response to a nonspecific stimulus
The specific response of effectors is normal
Specific response to pathology
Addition to the pathogenesis of spinal injury. The concept of the vertebrocostosternal neurovisceral block
The concept of the vertebrocostosternal neurovisceral block
Statistical data on the main groups of patients who underwent intensive rehabilitation
Basic principles of intensive rehabilitation of patients with spine and spinal cord injuries
General recommendations
Tractional rotational manipulation technology ("generalized unlocking" method)
Segmental anterior rotation of the spine (“wheel”)
Segmental lateral rotation of the spine
Errors and complications. Indications and contraindications
Proprioceptive guidance technique for lower limbs(according to V.A. Kachesov)
Sequence of exercises for tetraplegia
Contractures. Paralysis and paresis of individual muscle groups
Principles of intensive elimination of contractures
Combating contractures in the ankle joints
Paralysis and paresis of the foot muscles
Combating spastic convulsive manifestations
Restoring the function of the pelvic organs. Defecation
Regulation of urination
Bath and sauna
Solar and ultraviolet baths
Main results of intensive rehabilitation in patients with spinal injury
Intensive rehabilitation process and regression of spinal injury symptoms
Dysfunction of the autonomic nervous system
Restoring the function of the autonomic nervous system
Features of the clinical picture urolithiasis in patients with spinal cord injury
Restoration of thermoregulation and hemodynamics
Trophic disorders. Bedsores
In situ regeneration of specialized tissues
Scar changes
Bone tissue regeneration using intensive rehabilitation methods
An example of bone tissue regeneration in the area of osteoporosis with aseptic necrosis of the left femoral head (using morphodensitometric analysis)
Dysfunction of the somatic nervous system
Restoring the functions of the somatic nervous system
Sensory impairment
Restoring sensitivity
Criteria for intensive rehabilitation process
Acoustic phenomenon
Other rehabilitation criteria established by auscultation
Visual criteria
Subjective criteria for rehabilitation (according to the patient)
Some phenomena and effects observed during rehabilitation
Some principles of deontology in rehabilitation science
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