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The loss of a limb is an event that forever changes a person's quality of life. Thanks to the development of medicine, today amputation does not become a death sentence and does not entail a complete loss of business and social activity, but it is still a difficult psychological and, first of all, physical test.

Rehabilitation after leg amputation begins in the postoperative period; its features are determined by the type of injury. It is necessary to clearly understand the importance of medical procedures and moderate physical activity at each stage of returning to health.

Amputation is a complex surgical procedure that results in the loss of a limb, either partially or completely. Indications for such an operation are different: infectious infection, a consequence of illness or injury. The most common cause of limb loss is mechanical damage, which results in avulsion, severe bone fragmentation, and soft tissue necrosis if help was not provided in a timely manner.

There are two types of amputations:

• primary – it is carried out if it is absolutely necessary to remove part of the leg;
• secondary (also “reamputation”) - the need for additional surgery may arise if a person’s health continues to be in danger (for example, the process of tissue necrosis has increased), in the case where there is improper formation of the stump, for a number of other indications.

Important! The decision to amputate can only be made when all other treatment options are ineffective, and surgery is the only way to preserve the patient’s health and life.

Based on the level of grip, leg surgeries are as follows:

• disarticulation of fingers - removal (often prescribed in the last stages of diabetes mellitus, with severe frostbite);
• trantibial (in the ankle area) – amputation does not involve the knee joint, as a rule, its mobility is preserved;
• disarticulation of the knee - removal of the leg up to the thigh;
• transfemoral - the entire femoral part;
• disarticulation of the hip joint - the operation involves the pelvis;
• hemipelvectomy – partial removal of the pelvis;
• hemicorporectomy - complete amputation of both legs.

Exercise therapy after leg amputation

If the patient’s health indicators are good, it is indicated to begin rehabilitation after amputation of a leg on the first day. During the initial recovery period, the patient must learn to control his body, get used to the changed load on the muscles, and independently perform basic actions to facilitate self-care (lifting the body, turning, etc.). For this purpose, they are carried out basic exercises to strengthen muscles, accompanied by breathing exercises.

By the end of the first week, if there are no negative symptoms, you can include a load on the remaining joint in the warm-up, contracting and relaxing the muscles of the formed stump. Regular exercise helps get rid of post-operative swelling, speeds up the healing process and tissue restoration.

After the stitches are removed, the second rehabilitation period begins: the load increases significantly, exercises are performed with crutches and apparatus. Preparations are underway for the installation of the prosthesis, therefore, the stump is involved to a large extent.

The support of the stump is restored first by walking on a soft surface (Fig. A above), and then on a hard one (Fig. B).

Complexes of therapeutic and rehabilitation exercises

To a large extent, the choice of exercises depends on the type of surgery performed, so rehabilitation after a below-the-knee amputation will differ from a similar recovery process after a more difficult or easier procedure with the removal of most of the leg or its preservation.

Lying down (facing the ceiling):

1. Flexion and extension of healthy preserved joints (three sets of 10 times).
2. Holding with your palms, the hips are pulled up until they touch the stomach (10 times in two approaches).
3. Exercise “bicycle” (performed whenever possible in order to develop joints and strengthen muscles).

In a standing position (emphasis on the healthy leg):

1. Raising arms and bending (8 times in three approaches).
2. Squats (10 times in two approaches).
3. Raising and lowering the stump with retraction back until it stops (10 times, two approaches).
4. Stand straight and maintain balance for as long as possible.

Attention! Any amputation in the area lower limbs inevitably leads to disturbances in the functioning of the musculoskeletal system, due to the fact that the patient’s center of gravity shifts. Great care must be taken when performing exercises, trying to maintain balance.

Rules for performing exercises after leg amputation

First of all, when performing exercises, you should protect the stump from contamination and injury. For this purpose, a special cover made of natural fabric that allows air to pass through is put on the injured leg. If surgical sutures come apart, redness or irritation occurs, you should immediately seek medical help.

Crutches and canes are selected according to height; they should be light and easy to use, like other aids for exercise.

Incorrect selection of means of support leads to changes in posture and lameness. Strong pressure from the crossbars of crutches on the axillary area can provoke inflammation of the lymph nodes, and in especially difficult cases, paralysis of the arm muscles.

You should perform the exercises in front of a mirror, ensuring correct technique and maintaining balance.

Application of massage procedures

Massage procedures are very helpful in the recovery process, they help in preparing the limb for further prosthetics and stimulate blood flow to the tissues. You can start massage from the end of the second week of the rehabilitation period.

The procedures begin with simple stroking and rubbing, which involves using all the fingers of both hands.

The pressure should not be excessive, the movements are soft, wavy, diverging, the load is distributed evenly.

This helps in reducing swelling. For better resorption of the postoperative scar, light pinching, stroking, rubbing in a spiral, and working with a soft roller are used.

Immediately after removal of the sutures, when the tissue swelling subsides, it is permissible to use sharper and rougher techniques in order to train the endurance of the stump: increased rubbing, finger pressure, patting, tapping.

Despite the importance of the patient’s independent activity, the recovery process should proceed under the supervision of specialists, with full control of the correct fusion and formation of the stump with the prospect of further prosthetics. Considering the complexity of the operation and the risks associated with it, if you suspect any violations in the rehabilitation process, you should consult with your doctor.

Where is the best place to undergo rehabilitation after amputation of a leg, you can find out at your place of residence; in regional centers of Russia, for example, in Kemerovo, Volgograd and a number of others, clinics have been opened that specialize in the preparation and implementation of high-quality installation of prostheses.

Finally

Losing a limb is a terrible prospect, but with the right therapy, a competent approach to the recovery process and, most importantly, the desire to return to normal life, nothing is impossible.

Early postoperative period

Contraindications: acute inflammatory diseases stumps, general serious condition sick, heat body, danger of bleeding.

Therapeutic exercises are prescribed on the first day after surgery. From 2-3 days - isometric tension for the remaining segments of the amputated limb and truncated muscles. From 5-6 days - phantom gymnastics (mentally performing movements in the missing joint), which is very important for the prevention of contracture and atrophy of the muscles of the stump.

Preparation period for prosthetics

After the stitches are removed

The main focus is on stump formation. It should be of correct shape, painless, supportable, strong and resistant to stress.

First, mobility is restored in the remaining joints of the amputated limb. As pain decreases and mobility in these joints increases, exercises for the muscles of the stump are included in the classes. Thus, during amputation of the lower leg, the extensors of the knee joint are strengthened, and during amputation of the thigh, the extensors and abductors of the hip joint are strengthened. The muscles that determine the correct (cylindrical) shape of the stump, necessary for a tight fit of the prosthetic socket, are uniformly strengthened. Therapeutic gymnastics includes active movements, first performed with the support of the stump, and then performed by the patient independently and with the resistance of the instructor’s hands.

Training the stump for support first involves pressing its end onto a soft pillow, and then onto pillows of varying densities (stuffed with cotton wool, hair, felt) and walking with the stump supported on a special soft bench. This type of training starts with 2 minutes and increases to 15 or more. To develop muscle-joint sense and coordination of movements, exercises should be used to accurately reproduce tasks and range of motion without vision control.

Period of mastering the prosthesis

Learning to walk with prostheses consists of 3 stages:

1. Learning to stand with equal support on both limbs and transfer the body in the frontal plane.

2. Transfer of body weight in the sagittal plane, training of the support and transfer phases of the step of the prosthetic and preserved limb.

3. Development of uniform step movements.

In the future - various walking options.

After amputation of the fingers, hand or forearm in the lower or middle third, reconstructive surgery is used. After amputation of the fingers, an operation is performed to phalangize the metacarpal bones, as a result of which partial compensation of the function of the fingers is possible. When amputating the hand and forearm, the forearm is split according to Krukenberg to form two fingers: the radial and ulnar. As a result of these operations, an active grasping organ is created, which, unlike a prosthesis, has tactile sensitivity.

Preoperative preparation of the forearm stump consists of massaging the muscles of the stump, pulling back the skin (due to its lack during local plastic surgery at the time of finger formation), restoring pronation and supination of the forearm using passive and active movements.

After surgery the goal therapeutic exercises is the development of grip by bringing together and spreading the newly formed fingers of the forearm stump. These movements are absent under normal conditions. Subsequently, the patient is taught to write, first with a specially adapted pen (thicker, with indentations for the ulnar and radial fingers). After forearm clefting for cosmetic purposes, patients are provided with a prosthetic arm.

3.8 Exercises for lower limb amputation

Exercises are prescribed to train compensatory-restorative mechanisms, restore movement function with the help of a prosthesis or crutches.

On the 1st - 2nd day after surgery, it is necessary to use breathing and general tonic exercises, and after the sharp pain has decreased, they begin to train the amputated limb and combine it with exercises for the healthy limb.

Considering the general serious condition of the patient, a minimum load is initially given, then it is gradually increased.

Flexion contractures in the knee joint are especially dangerous, which, even with limited extension by 10-12°, do not allow patients to use a prosthesis. It is known that the development of contractures is promoted by the high position of the stump, so it is necessary to give it the correct, lower position as soon as possible. Sometimes it can be fixed with a plaster splint.

If the burn is not localized on the chest and thighs, the patient is placed on his stomach. To wear a prosthesis when the stump is completely healed, it is necessary that it has a cone-shaped shape and well-trained remaining muscles. As soon as the wounds on the stump have healed, various resistance exercises begin to train its supporting function.

Particular attention should be paid to strengthening the muscles of the remaining limb, since when walking it bears a double load. Considering that part of the compensatory load also falls on the shoulder girdle and arms, it is necessary to train them, including exercises in support positions.

Special exercises used after limb amputation (bed rest)

1. Raising and lowering the stump (with the help of a methodologist and independently).

2. Abduction and adduction of the stump.

3. Rotational movements of the stumps (rotations of the stump along a straight axis).

4. Circular movements of the stumps.

All these movements are performed from various starting positions (lying on your back, on your side, on your stomach).

An approximate complex of therapeutic exercises for patients in the recovery stage (free or training mode).

3.9 Exercises with dumbbells from a sitting position for burns in the area of ​​the elbow and shoulder joints

1.I.p. – sitting on a chair, legs together, knees bent, dumbbells weighing 1-2 kg in hands for men and 0.5-1 kg for women (do not lean on the back of the chair). Take a breath. As you exhale, bend your elbows with tension (towards your shoulders). Repeat 6-12 times.

2.I.p. – the same, put your feet shoulder-width apart, put your hands on your knees, lean forward slightly. Slowly raise your arms up and spread them to the sides, bend over - inhale, etc. - exhale. Repeat 4-5 times.

3.I.p. - the same, place your feet shoulder-width apart, bend your arms at the elbows. Execution: slightly turning the body to the left, straighten right hand forward, returning to IP, bend your arm. The same, turning the body to the right. Repeat 5-6 times, alternately turning the torso. The pace is average. Breathing is uniform.

4.I.p. – the same, legs wider than shoulders, hands on the outside of your hips. Sliding your left hand down your leg and your right hand up your side, bend to the left - exhale, straighten up - inhale. Do the same in right side. Repeat 5-6 times, alternately leaning left and right. The pace is average.

5. And p. - the same. Raise your arms up through your sides - inhale. Lower into i.p. - exhale. Repeat 4-8 times.

6.I.p. - Same. Raise your arms forward. Move your right hand to the side and back – inhale. Starting position – exhale. Repeat the same with the other hand; alternately 6-7 times in each direction.

To increase the load, make turns, springing your hand, 2-3 times in a row while simultaneously turning your torso towards the abducted hand.

7.I.p. - Same. Raise your right hand up, and move your left hand back slightly. Swing forward to change the position of the hands, alternating breathing with each movement (short inhalation and exhalation). Repeat 8-10 times.

To increase the load, change the position of the hands with double or triple spring jerks. Alternate breathing with each movement.

8.I.p. - the same, hands with dumbbells to the shoulders. Straighten your arms in an oblique direction (up - to the sides) - inhale. Bend your arms towards your shoulders – exhale. Repeat 10-12 times.

9.I.p. - sitting on a chair, legs apart, wider than shoulders. Raise your arms to the sides - inhale. As you exhale, bend your torso towards your left knee and touch your shin with your hands. Repeat alternately in each direction 4-8 times.

10.I.p. - standing, legs together, hands with dumbbells below. With a sliding movement, raise your arms bent at the elbows under your armpits (raising your shoulders) - take a deep breath. Lower your arms down, sit on your toes (heels together, knees apart) – exhale. Repeat 4-6 times.

11.I. p. - the same, move your shoulders, arms and head back, arching your chest - take a deep breath. Tilt your torso and head forward slightly, relax your shoulders. And hands - exhale. Repeat 5-10 times.

12.I. p. - the same. Bend your left arm at the elbow, lift your hand from the dumbbells to your shoulder, and straight your right arm upward. Change the position of your hands with a movement. Breathing is voluntary. Perform 6-8 times, then change the position of your hands. Bend your right arm towards your shoulder and straighten your left arm to the side. Change the position of your hands 6-8 times. Breathing is voluntary.

13.I. p. - the same. Stand up with your hands up - inhale. Sit on a chair, tilting your torso forward and moving your arms as far back as possible - active, extended exhalation. Repeat 5-8 times (the last time do not sit down - remain standing with your arms down).

14.I.p. - standing, feet shoulder-width apart, hands with dumbbells below. Inhale, and as you exhale, tilt your torso to the left. Hands slide: the left one down (towards the knee), and the right one up (under the armpit). Imitation of a “pump”. Straighten up - take a breath and do the same in the other direction. Alternately 5-8 times in each direction. To increase the load, do springy bends to the left and right without stopping (breathing alternates with each movement) 2-3 times in a row, alternately in each direction.

Guidelines: We recommend performing the exercises at a slow to medium pace and only gradually increasing the pace. Particular attention should be paid to training diaphragmatic breathing, alternating it with chest and full breathing. For this purpose, after every 2 or 3 exercises (depending on the condition of the patients), we recommended calm chest, diaphragmatic or full breathing. At the beginning of this regime, when switching from ward to free or training, all exercises should be performed without dumbbells, in a lower dosage and in a lighter starting position (sitting). Exclude exercises with increased load. As the patient's clinical condition improves, his strength and coordination are restored, and his fitness level increases, dumbbells with a gradually increased weight (for women 0.5-1 kg, for men - 0.75-2 kg) and exercises with increased load can be included.

More difficult exercises involving and tensing a large group of muscles must be combined and alternated with easier breathing exercises. Depending on the location of the burn, increase the use of special exercises on the burned area, alternating them with general strengthening exercises.

In case of a negative reaction from the cardiovascular system and the patient feels tired, all weight-bearing objects (dumbbells, clubs) should be immediately discontinued, the effort should be reduced when performing exercises, the dosage should be reduced and the pace should be reduced.

Exercises with dumbbells in a standing starting position

An approximate set of therapeutic exercises procedures for patients in the recovery stage (free or training mode):

1.Walking in place or around the room for 1 minute. Breathing freely - accept full exhalation.

2.Walking with exercises to improve posture. From the position of the arms forward with a step forward - the arms with a slight jerk to the sides, the subsequent step - the arms forward. Every 2 steps, change the position of your arms, inhale to the sides, exhale forward. To increase the load, after 2-3 steps make springy jerks with your arms to the sides (while squeezing your hands into a fist).

3. Walking on toes with a high knee lift (hands on the belt) - 30-40 s. Breathing alternates every 2-4 steps.

4. Walking in wide springy lunges with changing the position of the hands (one step - hands on the belt, the other - hands to the sides), breathing alternates with each lunge. Spring 2-3 times with each leg, trying to ensure that the knee of the leg standing behind touches the mat.

5. I. p. - standing, arms along the body. Raise your hands up - inhale, and. n. - exhale. The pace is slow. Breathing is uniform. Repeat 5-6 times.

6. I. p. - the same. Leaning to the right, slide your right hand down and your left hand up to the armpit - exhale, and. n. - inhale. When bending, do not bend your legs. The pace is slow. Repeat 5-6 times.

7. I. p. - the same. Lunge with your right leg and at the same time raise your arms forward - exhale, and. n. - inhale. The same with a lunge with the left leg. When lunging, do not slouch or lower your head. The pace is average. Repeat 5-6 times.

8. I. p. - table, hands behind head. Extend your arms to the sides - inhale, starting position - exhale. The pace is average. Breathing is uniform. Repeat 6-8 times.

9. I. p. - arms along the body. Sit down and touch the dumbbells to the floor - exhale, return to p.i. - inhale.

10. I.p. – standing, legs apart, raise your right hand forward, left to your shoulder, pull your elbow back, turn your torso slightly to the left. Alternately extending and bending your arms to “strike.” The pace is average. One movement is inhalation, the other is exhalation. Repeat 6-8 times.

11. I.p. - standing, legs apart, dumbbells placed between the legs. Bend over without bending your knees, take dumbbells in your hands - exhale, straighten up - inhale; bend over, put dumbbells - exhale, straighten up - inhale. The pace is average. Repeat 6-7 times.

12. I. p. - standing, legs apart, arms along the body. Turning your torso to the left, bend your right arm in front of your chest, and your left arm behind your back - exhale, and. n. - inhale. The same in the other direction. The pace is average.

13. P. i. - standing, legs apart, hands at the waist, tilting the torso to the right, raise your left arm up and bend it above your head - inhale, p. i. - exhale. The same in the other direction. Do not bend your legs while bending, the pace is average, breathing is uniform. Repeat 8-10 times.

14. I. p. - standing, legs apart, hands at the waist, turn to the left, bend over, touch the dumbbells to the floor behind your left foot, return to i. n. The same in the other direction. The pace is average, breathing is uniform. Repeat 8-10 times.

15. I. p. - standing, legs apart, arms forward. Spread your arms to the sides - inhale, return to i. n. - exhale. The pace is average. Breathing is uniform. Repeat 4-6 times.

16. I. p. - o.s., dumbbells in lowered hands. Bend forward, bending forward, raising your arms up.

The successful use of physical therapy for burn disease largely depends on the high qualifications of the methodologist, his pedagogical tact and ingenuity. The ability to find quick contact with a seriously ill patient and a creative approach to designing therapeutic exercises largely determine effective rehabilitation treatment. Different localizations of burns require a thoughtful approach from the methodologist to the selection of special exercises, since very often movements along the main axes for a given joint are impossible.

A physical therapy methodologist working with this group of patients must deeply understand the essence of the changes occurring in the patient’s body, be able to creatively select the necessary exercises, and be friendly, sensitive and responsive towards patients. The procedure of therapeutic exercises as the main form of physical therapy for burn disease has a generally accepted 3-part structure (introductory, main and final parts). Its duration varies depending on the patient’s condition and the tasks set. In each lesson, as a rule, general strengthening, breathing and special exercises should be used. The most important feature of the method of physical therapy for burn disease is the need to repeatedly perform special exercises during the day aimed at preventing or eliminating disorders of the musculoskeletal system. The methodologist’s task is to explain to the patient that the successful restoration of movements in the joints largely depends on his active attitude to physical therapy exercises.

Every burn clinic and burn center should have a physical therapy room. The office should be bright and warm; with the necessary set of objects and equipment for physical therapy (gymnastic walls, benches, couches, medicine balls, dumbbells, expanders, balls; mirror - for exercising patients with facial lesions).

Taking into account the effectiveness of physical therapy exercises plays a major role in increasing the patient’s activity. Systematic carrying out of the simplest functional and anthropometric studies gives the patient a clear idea of ​​the improvement occurring under the influence of exercise. Determining bronchial patency using pneumotachometry, measuring the vital capacity of the lungs using an air or water spirometer, and studying the cardiovascular system using ECG are not burdensome for the patient, are informative and allow one to note the dynamics of improvement in the function of external respiration and the cardiovascular system under the influence of physical therapy exercises.

Goniometric (“gonion” - angle, “metreo” - measuring) studies for dysfunction of the musculoskeletal system also allow you to monitor the effectiveness of the treatment. Determination of the strength of the hand flexor muscles using a dynamometer for burns of the upper extremities should be carried out at least twice a week.

Thus, a feature of the developed and recommended method of therapeutic exercise was that when constructing complexes of therapeutic exercises, we proceeded from the pathogenetic manifestation of burn disease and applied them taking into account surgical intervention and the functionality of the respiratory and circulatory systems.

The objectives of physical therapy in the complex treatment of burn patients were not limited to the prevention and elimination of various types of contractures and other lesions of the musculoskeletal system. Much attention was paid to the early use of therapeutic exercises, with the aim of hypostatic pneumonia and increasing the functionality of the cardiopulmonary system.

Early prescription of therapeutic exercises in the complex treatment of burnt patients, taking into account surgical intervention, stage, area of ​​damage, localization of age is effective means in the fight against the respiratory apparatus.

Consequently, the task of both restorative and reconstructive surgery and physical therapy is to restore impaired joint functions,

occurring as a result of loss of skin, restoration of ability to work and prevention of disability. Mechanotherapy, paraffin therapy, mud therapy, gymnastics in water, irradiation with a quartz lamp were necessary additional means in the fight against contractures and stiffness in the joints. With residual effects in burned tissues, in restoring range of motion and physiological functions of the body.

The solution to these important and complex issues can only be achieved through close cooperation between doctors from several specialties.

Innovative technical means, computer and telecommunication technologies. The proposed methods of examination, treatment and rehabilitation of victims with injuries to the maxillofacial area can be recommended for widespread use in the practice of maxillofacial traumatology. Scheme proposed integrated approach to the treatment and rehabilitation of this category of victims, based on...

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prof. Kruglov Sergey Vladimirovich (left), Kryuchkova Oksana Aleksandrovna (right)

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Page editor: Kryuchkova Oksana Aleksandrovna – traumatologist-orthopedist

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Leading specialists in the field of traumatology and orthopedics

Sikilinda Vladimir Danilovich

Sikilinda Vladimir Danilovich, Professor, Doctor of Medical Sciences, Head of the Department of Traumatology and Orthopedics, Rostov State medical university, Vice-President of the All-Russian Association of Traumatologists and Orthopedists of the Southern Federal District

Physical methods of rehabilitation of sick and disabled people with defects of the musculoskeletal system are widely used in prosthetic and orthopedic practice and are aimed at eliminating or reducing disorders and deformations that impede the use of prosthetics and the use of prosthetic and orthopedic products or complicate them. Rehabilitation using physical methods has not only therapeutic, but also preventive value. The most effective in prosthetic and orthopedic practice are exercise therapy, occupational therapy, sports therapy, mechanotherapy, massage, electrical muscle stimulation, and physiotherapeutic methods (dynamic currents, ultrasound, electrosleep, magnetic, laser, and acupuncture). Physical rehabilitation methods are used at all stages of the prosthetics process - from preparation for it to training in the use of prosthetics.

In the system of physical therapy (physical therapy), the leading factor acting on the patient is physical exercise. They are divided into general strengthening, special, sports and applied type, and gaming.

General strengthening exercises affect the entire body, mainly healthy areas of the body. Special (selective) exercises solve a narrower problem - restoration of impaired function of the musculoskeletal system. Both types of exercises are used in combination. It is very important to choose the right exercises and present them in an interesting way, which evokes positive emotions in patients and distracts them from “going into illness.” The therapeutic effect is achieved mainly through regular and long-term exposure to physical exercise. Their correct use is determined by the clinical condition of the patient and the corresponding individual selection, methodology and dosage of exercise therapy, taking into account the characteristics of his motor abilities.

The task of exercise therapy at the first stage of prosthetics is the physical preparation of the entire body, stump or affected limb for mastering the orthosis or prosthesis.

The main clinical features entail specific tasks for performing general strengthening and special exercises: increasing the general tone of the body, strengthening the truncated muscles of the stumps and muscles surrounding the joints, eliminating or reducing contractures and stiffness of the joints, strengthening the muscles of the trunk and shoulder girdle, training balance and vestibular function, and also coordination of movements of the upper and lower extremities, supporting function of the arms, strengthening the muscles of the remaining extremities.

In patients who have lost limbs, another type of special gymnastics is used - phantom impulse, i.e. mental reproduction of movements in the missing segment of the limb. It helps improve blood and lymph circulation in the stump, increases tone and strengthens truncated muscles, and prevents trophic disorders. Such gymnastics is advisable not only at any stage of prosthetics, but throughout the patient’s entire life. With the participation of a methodologist, the disabled person sends an impulse to “flex” or “extend” the nearest missing joint (for example, the knee when the femur is truncated). The movement is performed slowly, muscle tension is maintained for at least 1-2 s. Then there is a pause - rest, after which the exercise is repeated. To facilitate the ability to mentally bend the missing joint, the exercise is accompanied by a similar movement of the remaining leg. It can be combined with active hip extension, slight adduction of the stump, or internal rotation (simultaneous or sequential). Phantom-impulse gymnastics is carried out under a metronome with an average

at a speed of 24-26 beats per minute for 5-10 minutes 5-10 times a day.

In patients with flaccid paralysis of the limbs, ‘impulse gymnastics’ is also used, which causes mental contraction of the laretic muscles. Pulse gymnastics must be strictly dosed, because excessive and frequent muscle contractions without prior preparation lead to pain and decreased muscle tone. In the first 3-5 days, it is recommended to perform 2 contractions 2 times a day. Maximum muscle contraction should be alternated with maximum relaxation. After the extensors of the stump have become so strong that the patient can hold the stump of the foot in the correct position while walking, i.e., load the heel and raise the anterior part of the stump to the level of a normal arch, they begin to learn to walk without shoes.

After disarticulation in the hip joint, impulse gymnastics is necessary to strengthen the gluteal muscles. After hip amputation, attention is focused on strengthening the stump extensors and adductors. Simultaneous tension of these muscle groups makes it easier to use the prosthesis. After amputation of both hips, it is advisable to train the stump extensors, adductors and internal rotators. After a lower leg amputation, the knee extensors and flexors should be strengthened, with emphasis on the movements necessary to walk with a prosthesis.

All patients after amputation of the lower extremities at any level need special exercises to strengthen the muscles of the trunk in order to prevent postural disorders, eliminate pelvic distortion in the frontal plane, and strengthen weakened muscles of the back and abdomen. To do this, bend and rotate the upper and lower half of the body towards the truncated limb. Thanks to training, the patient should learn to rise with support on his hands, maintain correct posture, move from one position to another without outside help. At the same time, exercises are also necessary to strengthen the muscles of the remaining leg.

After a unilateral amputation, conditions arise that make it difficult to relax the muscles. The supporting function of the surviving limb increases, it is difficult to maintain balance, the leg quickly gets tired, pain appears in the ankle and knee joints, and the muscles of the lower leg and thigh become excessively tense. In these cases, first of all, the patient must use crutches correctly. They are selected according to his height. Shifting the remaining leg and bending the knee joint should be done freely, without significant tension in the muscle groups. The movements of the preserved leg and stump must be coordinated. The pelvis should be kept from tilting towards the stump so that the right and left halves are at the same level.

When moving the preserved leg forward, the stump must be extended backwards while simultaneously slightly adducting it. This is especially important for flexion-abduction or flexion contracts.

pax. The correct position of the stump when standing and walking prevents the development of limited mobility in the joints, helps maintain balance and coordination of movements, increases stability, strengthens the muscles of the trunk and stump, and creates favorable conditions for subsequent learning to walk on a prosthesis.

After amputation of the upper limb, an asymmetrical position of the shoulder girdle occurs, the muscles of the truncated limb and the shoulder girdle of the same name are weakened. In this regard, scoliosis is possible in the upper thoracic spine, which can become fixed if exercise therapy is not performed.

It is important to maximize the remaining functionality of the stump and shoulder girdle. It is necessary to restore full range of motion in the joints and strengthen the surrounding muscle groups. Symmetrical and asymmetrical exercises are used in dynamic and static modes of muscle work, as well as sports and game exercises using equipment. Muscle tension during exercise is alternated with relaxation, and the patient must learn to relax the muscles by feeling this state. Regardless of the length of the stump, its participation in movement is necessary. Exercises to strengthen the muscles of the shoulder girdle have great importance when mastering the prosthesis and to maintain correct posture. The mobility of the shoulder girdle is trained on the side of the truncated and preserved limb, and exercises are performed to promote lowering of the shoulder girdle.

For congenital anomalies of the limbs, early use of exercise therapy is necessary. The exercises are aimed at developing the necessary motor abilities in children, developing joint mobility and muscle strength, and correcting habitual incorrect body position. Identification and training of all possible movements in the limb make it possible to use them to control the prosthesis.

Exercise therapy for patients with the consequences of polio and flaccid paralysis of the limbs is aimed at strengthening weakened muscle groups, eliminating deformities of the musculoskeletal system, and training the supporting function of the shoulder girdle and arms. At this stage, physical exercise in an unloading position is important. Exercise therapy is combined with impulse gymnastics and massage, the intensity of which increases as the active function appears

For spastic cerebral palsy (CP), exercises are prescribed to help relax muscles, train voluntary movements, coordination and balance. Each training session should be preceded by straightening the vertical posture and correcting the posture. Only after this can you begin to master movement. It is necessary to start walking not from the toe, but from the heel, perform the front and rear pushes of the foot correctly, and during the support phase of the entire foot, you should not bend the leg at the knee joint.

The choice of exercise therapy techniques to prepare for prosthetics in patients with lower limb paralysis due to spinal cord injuries depends on the level and degree of damage, as well as on associated complications. In these cases, it is necessary to fully use active motor impulses traveling along the remaining pathways of the spinal cord. Compensatory capabilities are identified and developed in patients with the aim of maximizing their use when learning to stand and walk in orthopedic devices.

For scoliosis, during the period of preparation and use of a corset, daily special corrective gymnastics is necessary to strengthen the weakened muscles of the back and abdomen in combination with massage. Gymnastics are performed 2 times a day in an unloaded position (lying down, on all fours). In these cases, tilting towards the convexity of the main curvature is effective. Develop and train the ability to maintain the corrected position of the spine in sitting, standing, and walking.

MECHANOTHERAPY AND MASSAGE

Exercise therapy methods are complemented by mechanotherapy, i.e. treatment with physical exercises using special devices (devices with blocks, pendulums). The latter are used to eliminate contractures and stiffness in the knee, ankle and elbow joints. Contractures of the hip joints are eliminated using block devices. However, after amputation and especially with short femoral stumps, the best results are achieved by manual redressing after thermal procedures (paraffin and ozokerite applications). The development of contractures using mechanotherapy should be carried out at least 2 times a day. After active training, patients are prescribed to rest in bed in a special orthopedic position, which secures the position in the joint achieved by development.

For diseases of the musculoskeletal system, manual massage is used (segmental, suction, acupressure, pulling). The method and technique of massage depend on the nature of changes in the musculoskeletal system, the localization of the pathological process, the age of the patient, etc.

Indications for the use of massage are a decrease in the functional ability of muscles and ligaments, pain reflex tension, impaired peripheral circulation (swelling, congestion), phantom pain, poor mobility of scarred skin, etc.

Massage in combination with other means contributes to the formation of a new vital organ - a stump, capable of ensuring full use of a prosthetic device. Segmental massage affects the affected part and reflex zone, which allows it to be used in the early stages of treatment. Suction massage is used for congestion and swelling in tissues and begins with the upper sections. The main techniques are different kinds stroking and kneading. Acupressure is carried out taking into account nerve points, the location of which depends on the nature of the pathological process. The main techniques are rubbing and vibration. Pull-out massage is used in preparation for Plastic surgeries on the stumps of the limbs to increase the mobility of the skin and cover incompetent scar tissue. The main techniques are pinch-like pulling of the skin, stretching stroking, displacement of the skin relative to the bone bed.

Massage is most often performed before physical exercise, but it can be performed after exercise and during exercise.

IN last years in the practice of preparing patients for prosthetics, electrical muscle stimulation (ESM) is used.

Electrical stimulation (ES) of the stumps and weakened muscles of the lower extremities is carried out according to the Kotz method. It is carried out daily (10-15 sessions in total) using the Stimul-1 apparatus. After 2-3 sessions, patients develop a “feeling” of the muscle being trained and the ability to strain it, and after 6-7 sessions, an increase in the volume of the stump can be noted due to muscle mass. On average, during a course of electrical stimulation, muscle strength increases by 17g-2 times, and their electrical activity increases by 2-3 times.

Electrical stimulation makes it possible to cause greater muscle tension than during voluntary contraction, and when training atrophic muscles, an increasing number of muscle fibers are gradually involved in the contraction process.

After hip amputation, the gluteal muscles are stimulated in order to increase their strength and tone, actively influence the elimination of flexion contractures of the hip joints and improve control of the prosthesis. ES of the anterior and posterior groups of muscles of the thigh stump, in addition to strengthening these muscles, improving the trophism of the analgesic effect, helps patients feel these muscles and facilitates the performance of phantom impulse gymnastics.

After amputation of the lower leg, it is advisable to perform ES of the stump and thigh (calf, quadriceps, gluteal muscles). In this case, it is assumed that patients on a lower leg prosthesis do not sufficiently extend the hip joint, but extend the knee joint in the support phase, which distinguishes their walking from normal.

With congenital underdevelopment of the upper extremities, ES helps patients feel the corresponding muscles and increase their strength in a short time. When applying prosthetics with bioelectric prostheses, ES allows one to achieve the required amount of electrical activity of the muscles of the stumps and the individuality of their contraction necessary to control the prosthesis.

With congenital underdevelopment of the lower extremities and the use of foot movements to control movement in the knees

hinges, ES of the low-frequency muscles is performed in combination with manual development of the foot abduction movement.

The use of EFM is especially important when teaching walking on hip and shin prostheses. Contraction of the necessary muscle groups in certain phases of the stepping movement helps the patient feel this contraction and understand how and when the muscles should be activated when walking on a particular prosthesis. Its use in walking during primary prosthetics prevents the formation of irrational locomotor compensations and helps correct them if they arise during the process of learning to walk.

For hip stump, electrodes are applied to the gluteal region and the posterior surface of the stump. Patients have improved stability on the prosthetic limb, prosthetic control skills, confidence when walking, the remaining limb can step more freely, forward movement improves, and the need for additional support on a cane disappears.

For calf stump, electrodes are applied to the gluteal, quadriceps or gastrocnemius muscles. This helps to strengthen the muscles directly when performing step movements and the formation of the locomotor act of walking in new conditions - on a prosthesis. The use of EFM when standing and walking in prostheses also facilitates the training of sports exercises.

PHYSIOTHERAPEUTIC TREATMENT

In the process of preparing for prosthetics, physiotherapy is widely carried out. Such methods as treatment with ultrasound, laser radiation, magnetic field, diadynamic currents, electrosleep, as well as acupuncture have a significant effect.

Ultrasound is mechanical vibrations: particles of a medium propagating in the form of waves in the acoustic frequency range above 20 kHz, causing variable compression and irritation of the substance. High-frequency ultrasound (from 800 kHz to 3 kHz) is used to treat patients with amputation stumps of the lower extremities. Under the influence of ultrasonic vibrations that penetrate the body tissue to a depth of 5 cm, micromassage of tissue elements occurs.

Ultrasound has a local and general effect on the body. It is accompanied by phenomena of tissue biostimulation: an effect on biocolloids, intracellular metabolism, enzymes, membrane permeability, etc. Depending on the doses used, its effect can be damaging, depressive, stimulating-normalizing, anti-inflammatory and resolving. In small doses, ultrasound has analgesic, anti-inflammatory, antispasmodic, vasodilating, absorbable, desensitizing effects, and accelerates regeneration and repair processes. It increases skin permeability to medicinal substances and increases the absorption capacity of tissues.

In this case, ointments or solutions are used medicines(hydrocortisone, lrednisolone, analgin, bicillin, etc.).

The therapeutic effectiveness of ultrasound influences depends on correct selection intensity, location, area and duration of exposure, methodological techniques or methods of carrying out the procedure (labile or stable, contact or through water), mode of operation (continuous or pulsed). The duration of ultrasound exposure per field is 3-10 minutes. The course of treatment consists of 6-12, less often 15-20 procedures. Repeated ultrasound treatment is recommended no earlier than after 3-5 months. For phantom pain, trophic disturbances of the stumps, and vascular diseases, it is sometimes necessary to combine local ultrasound with segmental ultrasound (on the paravertebral region).

In case of disturbances in the trophism of the stumps (cicatricial trophic ulcers, long-term non-healing wounds, hyperkeratosis), a continuous mode is used (moving technique, direct vibrator contact). The ultrasound intensity is 0.2-0.4 W/cm2, the duration of exposure is 3-5 minutes, and with the underwater technique - 0.2-0.6 W/cm2 and 5-8 minutes, respectively. The course of treatment consists of 10-15 procedures, which are carried out every other day, less often daily. During underwater exposure, the ulcer is lubricated with indifferent ointment. During the period of epithelization of the ulcer, the dose of ultrasound is reduced so as not to cause damage to the “young” epithelium. For postthrombotic ulcers, ultrasound therapy is not performed.

In case of pain syndrome of the stump (painful neuromas, local or radiating pain, phantom pain, causality), ultrasound is applied to the area of ​​the stump and along the projection of the neurovascular bundle. Continuous mode, direct contact, mobile technique. Ultrasound intensity 0.4-0.6 W/cm2, exposure duration 5-7 minutes (every other day or daily). For phantom pain, it is also used paravertebrally on the area of ​​the corresponding sympathetic nodes. Constant or pulse mode. Ultrasound intensity 0.2-0.4 W/cm2 for 2-3 minutes on each side. The course of treatment is 6-8 procedures.

Ultrasound therapy of the ruotsa area is carried out in a continuous mode, direct contact, mobile technique. Ultrasound intensity 0.4-0.8 W/cm2, 5-8 minutes (daily or every other day). The course of treatment consists of 12-15 procedures. The best contact medium (for scar changes) is fish oil. For rough keloid scars, aminazine phonophoresis is recommended (the contact medium is a 5% solution of aminazine in glycerin).

In case of traumatoids, hidradenitis, carbuncle, ultrasound is used in initial stage development of infiltration. Continuous mode, movable technique, vibrator contact is direct or movable (for the foot and hand), ultrasound intensity is 0.4-0.8 W/cm2, the duration of the daily session is 3-5 minutes.

Contraindications to ultrasound treatment are diseases of the central nervous system (cerebrovascular accident, psychoneurosis, diencephalic syndrome, arterial hypotension), pregnancy, tendency to bleed, grade III hypertension and coronary sclerosis, angina pectoris, circulatory diseases, cachexia, malignant neoplasms.

Indications for laser therapy are trophic changes in the soft tissues of the stump with disruption of reparative regeneration processes in the form of hyperkeratosis, ulcerations, ulcers and long-term non-healing wounds, pain syndromes - phantom pain syndrome, neuralgia syndrome (in some classifications designated as ascending neuritis), local pain in the stump and painful neuromas; chronic inflammatory diseases of the soft tissues of the stump (namin, bursitis, traumatoid), degenerative-dystrophic diseases of large joints and the spine, often accompanying amputation stumps, osteochondrosis.

The variety of nosological forms and pathological conditions for which helium-neon laser radiation is used is explained by the wide therapeutic range of its action. The rationale for the use of helium-neon laser radiation is the active biological effect of monochromatic red light on the processes of skin regeneration, regeneration of damaged peripheral nerves, a beneficial effect on the course of neurotrophic processes, a reduction in the formation of arterial collaterals [Rakhishev A. R., 1981], a decrease in pain impulses from the irradiated area [Tarasov O. V., 1977].

Laser therapy is prescribed in cases where other types of treatment have proven ineffective and in patients for whom other treatment is contraindicated due to hypertension, coronary heart disease, atherosclerosis or diabetes mellitus. The use of helium-neon laser radiation in the TsNIIPP clinic in the treatment of the listed diseases and pathological conditions has shown its sufficient effectiveness.

During laser therapy, patients are prescribed the usual orthopedic regimen for this pathology. It is possible to combine laser therapy with exercise therapy, massage, ESM, and in case of wound processes - with the use of antiseptic solutions, proteolytic enzymes, and ultrasonic sanitation of wounds. During treatment with helium-neon laser radiation, drowsiness (a feeling of weakness) and a slight decrease in blood pressure may occur, which is not an indication for its cessation.

For treatment, domestic gas-based continuous lasers LG-75, LG-12, LG-36, LG-38 (helium, neon) are used, emitting polarized monochromatic red light (wavelength 632 nm), with an output power of 15 to 50 mW A laser therapy session is carried out with the patient lying or sitting and consists of irradiating certain areas and areas of the body

with precise exposure. The total irradiation time during one session should not exceed 20-30 minutes. The course of laser therapy is 15-20 sessions, carried out whenever possible daily. Laser therapy is contraindicated for cancer, in the first half of pregnancy, for dysfunctional uterine bleeding, active tuberculosis, thrombophlebitis.

Clinical observations indicate the sedative, analgesic, antipruritic and anti-inflammatory effects of a constant magnetic field (PMF). When using PMP, emotional stress is reduced, sleep is normalized, blood circulation and tissue trophism are improved, and their swelling is reduced.

Since there is no standard mass-produced equipment, rubber-based elastic tape recorders are used, which create PMFs with voltages from 11,940 to 160,000 A/m or more. Magnetic recorders are produced in the form of rectangular plates measuring 40X120x3 mm in a polyethylene shell. The tape recorders are fixed to the body with gauze bandages. Session duration is from 20 minutes to 18 hours per day. The course of treatment takes from 2 to 8 weeks. Treatment is also carried out using the Polyus-1 apparatus by exposure to a magnetic field of alternating direction. The magnetic field is effective for the following diseases of the musculoskeletal system: osteochondrosis of the spine with concomitant radiculitis, arthrosis of the joints, bursitis, phantom pain, diseases of the veins of the surviving limb after unilateral amputation, trophic ulcers and non-healing wounds of the stumps.

For trophic ulcers and non-healing wounds, they are exposed to a low-frequency magnetic field. The procedure can be carried out with a bandage moistened with wound discharge. In this case, the cylindrical inductor is installed on the bandage without an air gap. The current is half-wave, the magnetic field mode is pulsed. Intensity 270-350 E (III-IV stage). Duration of procedures is from 10 to 20 minutes. They are carried out daily; for a course of treatment 10-20 procedures. With excessive exudation of a wound or ulcer, the tension is reduced to 175 Oe, and sometimes to 120 Oe.

In case of disturbance of the trophic tissue of the stump, phantom pain affects the paravertebral zones of the cervicothoracic or lumbar spine (sympathetic nodes of the autonomic nervous system, corresponding to the level of innervation of the upper or lower extremities). Rectangular inductors are installed with a gap of 5 mm. Sinusoidal current, continuous mode, voltage 190 Oe for 10 minutes. At the second stage, the mstpo influences the stump with cylindrical inductors. Sinusoidal current, continuous mode, intensity. 175-350 E, procedures are carried out for 10-20 minutes daily (15 procedures in total).

For diseases of the joints, osteochondrosis of the spine, epijondylitis, spurs of the heel bones, local effects are applied to the affected joints, but no more than two joints in one procedure. Cylindrical inductors are used and placed on the affected joint. The current is sinusoidal, continuous mode, voltage 175-270 Oe (tension increases from the 5th procedure). The duration of the procedure is from 10 to 20 minutes. The course of treatment is 10-15 procedures.

After surgical interventions (reamputation, scar excision, skin grafting, etc.), magnetic therapy is used 5 days after surgery. They affect areas more distant from the operated area (for example, during surgery on the stump of the leg, magnetic therapy is performed in the lower third of the thigh). In this case, cylindrical inductors are used, the intensity is 270 E. The current is sinusoidal, the mode is continuous, the duration of the procedure is 10-15 minutes (5 procedures in total). After 5 days, a local effect is applied to the operated area. Inductors are used cylindrical, their location is transverse. The current is sinusoidal, continuous mode, intensity 175-270 Oe when used daily for 10-15 minutes (course of treatment 15 procedures).

In case of chronic venous insufficiency of the lower extremities, the consequences of thrombophlebitis, procedures are performed on a couch with the leg end raised by 30 cm. Cylindrical inductors are placed in contact without a gap longitudinally (on the inner surface of the thigh or lower leg and on the thigh in the area of ​​the vascular bundle) or transversely (in case of trophic changes or trophic ulcer of the lower leg). Sometimes a two-moment effect is carried out, combining longitudinal and transverse arrangement of inductors. A sinusoidal current is used, continuous mode, and after the 5-7th procedure - half-wave current, intermittent mode, voltage 270 Oe. Duration of the procedure is 15-20 minutes (with two-stage exposure 30-40 minutes) daily; There are 20 procedures per course. For a trophic ulcer, one inductor is used, which is placed contactally on the area of ​​the ulcer above the bandage. In case of profuse discharge from the ulcer, the magnetic field strength is 175 Oe, in other cases it is 270 Oe. A sinusoidal current is used, continuous mode, duration of exposure is 10-20 minutes daily; There are 20-30 procedures per course. A repeat course is indicated after 6-10 months.

Contraindications to the use of a magnetic field are severe hypotension, a tendency to hemorrhage, angina pectoris, post-infarction condition, pregnancy, malignant neoplasms, blood diseases, individual intolerance.

Diadynamic currents cause rhythmic contraction of muscles, which increases blood circulation and stimulates trophic processes in tissues, both in the area of ​​influence of currents and in reflexively associated areas of the body and organ.

new Due to the antispasmodic and vasodilating effects, diadynamic currents have a beneficial effect on peripheral and collateral circulation. Course and single exposure to these currents reduces vascular tone, improves blood supply to tissues, accelerates capillary blood flow, and increases the number of functioning capillaries. Diadynamic currents in tissues cause the formation of biologically active substances such as histamine, acetylcholine, etc. A full-wave continuous current has an inhibitory effect on the function of the sympathetic nervous system, increases the threshold of its excitability, resulting in reduced spasm of large and small vessels and improved blood circulation. The analgesic effect of current is associated with improved blood supply and normalization of redox processes in tissues.

For treatment with diadynamic currents, domestic devices “Model-7’17”, “Tonus-1”, “Tonus-2” are used.

Diadynamic currents can also be used for the purpose of medicinal electrophoresis (diadynamophoresis). With pulsed current electrophoresis, drugs are introduced into tissues faster and much deeper than with direct current electrophoresis.

Indications for the use of diadynamic currents: 1) pain syndromes caused by diseases of the peripheral nervous system (plexitis, neuralgia, neuritis, radiculitis, painful neuromas), phantom pain; 2) pain syndromes associated with traumatic lesions (bruises of soft tissues, muscles, joints, sprains); 3) degenerative-dystrophic diseases of the joints and spine, delayed healing of wound surfaces (subject to good wound drainage) 4) stiffness after prolonged immobilization of joints, scar and muscle contractures, keloid scars.

Treatment with diadynamic currents can be combined with inductotherapy, exercise therapy, massage, thermal, water and balneological procedures. For diadynamic therapy, the same electrodes are used as for galvanization. The size and shape of the electrodes must correspond to the painful area and fit snugly to the patient’s body.

In case of pain in the stump, electrodes are placed on painful areas of the stump, often transversely. They are exposed to a two-phase continuous current (DC) for 2 minutes, and then to a current modulated by short periods (CP) for 3-4 minutes, 1-2 times a day. When the intensity of pain decreases during treatment, exposure to current modulated by long periods (LP) is added. for 2-3 minutes. The course of treatment is 10-12 sessions.

When local pain is combined with phantom pain, the sympathetic nodes are first treated with a DN current for 2-3 minutes on each side. The electrodes are placed paravertebrally - the anode above, the cathode below, and then act locally on the limb stump. In the postoperative period, to eliminate pain (before removing the sutures), the electrodes are placed proximally

bandages, transverse to the axis of the limb and apply a biphasic wave current (WW) or DN for 2-3 minutes, then a current modulated by the CP. After removing the sutures, to eliminate edema and improve tissue trophism, use a DN current for 2-3 minutes, then a modulated CP - 6 minutes (direct and reverse polarity) or calcium-diadynamoelectrophoresis.

In case of trophic disorders in the stumps of the limbs (ulcers, hyperkeratoses, congestion), a diadynamic current is applied to the area of ​​the distal end of the stump, placing the electrodes transverse to the axis of the limb. A DN current is applied for 2 minutes, then modulated currents KP - 3-6 minutes and DP - 3-4 minutes.

For rough, immobile scars such as keloids, to flatten, soften and resolve the keloid, a double local electrode or small plate electrodes are placed longitudinally on the scar. Apply DP current for 10 minutes. Then the area of ​​the sympathetic node of the segment that corresponds to the location of the keloid is affected. For scars on the arm or face, the stellate ganglion of the affected side is affected, for scars on the legs - paravertebral to the area of ​​the lumbar sympathetic nodes with a DN current (anode above, cathode below) daily for 3 minutes; Every 5 sessions they take a break for 7-10 days. A second course of treatment is carried out after a month.

When there is stiffness of the knee joint, two rectangular electrodes are applied first to the lateral, and then to the front and back surfaces of the knee joint. The exposure to DN current begins (1 min), and then CP and DP currents are applied for 4 min each. In the middle of exposure to the CP and DP currents, the polarity is reversed. The course of treatment is 6-10 daily procedures.

Contraindications to the prescription of diadynamic therapy are: individual intolerance to current, violations of the integrity of the skin, the presence of a purulent infection, pain syndromes (caused by a fracture or dislocation of joint bones or hemorrhage), thrombophlebitis, renal gallstone disease, cardiovascular diseases with circulatory disorders of the third degree, inclination to bleeding, malignant neoplasms.

E l e c t r o s o n. The central nervous system is exposed to a pulsed current of low frequency and low strength. To carry out the procedure for one patient, the “Electroson-2” and “Electroeon-4T” devices are used, and to carry out the procedure for 4 patients simultaneously, the “Electroson-3” device is used with individual adjustment of the pulse frequency and current value for each patient. During the procedure (when the electrodes are located in the area of ​​the eye sockets and mastoid processes), a pulsed current penetrates the cranial cavity and affects the subcortical-stem region of the Brain, where the hypothalamus, nuclei of the visual thalamus, reticular formation, limbic system, etc. are located.

Based on clinical observations and the use of spices

nal methods of research V. S. Vereshchagin, V. M. Banshchikov, E. I. Kulikova and others distinguish two phases in the therapeutic effect of electrosleep: 1) inhibitory, associated with stimulation of subcortical formations by pulsed current and clinically manifested by drowsiness, drowsiness, sleep ; 2) the disinhibition phase, associated with the activation of the functional ability of the brain, self-regulation systems and clinically manifested vigor, increased performance and good mood.

The impact of pulsed currents on the subcortical-stem region of the brain causes functional changes in it, leading to the restoration of emotional and vegetative-humoral balance in the body, which determines its use for diseases of amputation stumps.

Electrosleep procedures are carried out in a ventilated room isolated from noise. The patient is on closed eyes and the area of ​​the mastoid processes, electrodes with hydrophilic pads are applied and fixed. The ocular electrodes are connected to the cathode, and the electrodes located on the mastoid processes are connected to the anode. The pulse frequency is selected individually depending on the functional state of the nervous system, the phase and severity of the disease, the patient’s age, etc. In cases of severe weakness of the basic nervous processes, as well as in cases of pronounced organic changes, a low pulse frequency (5-20 Hz) and a short duration of procedures are used (15-20 min). As the basic nervous processes normalize, the frequency of impulses (40-100 Hz) and the duration of the procedure (40-60 minutes) are increased.

For increased emotional lability, neuroses, the initial stage of hypertension, sleep disorders, itchy dermatoses, etc., a frequency of 40-120 Hz is used. The current strength is adjusted depending on the patient’s sensations. During the procedure, the latter should feel a slight vibration under the electrodes in the eye area.

During the procedure, the current strength should be constant, and during subsequent procedures it is slightly increased if no discomfort occurs. At the end of the procedure, the device is turned off, and the patient can sleep until he wakes up on his own. After awakening, the electrodes are removed, but the patient is warned not to look at bright light to avoid discomfort. The duration of the procedures is from 30 minutes to 2-3 hours (depending on the characteristics of the nervous system). Procedures are carried out daily. 12-20 procedures are prescribed for a course of treatment.

Indications for the use of electrosleep are: diseases concomitant with amputation (neuroses, neurasthenia, initial forms schizophrenia, long-term consequences of traumatic brain disease, sclerosis of cerebral vessels in the initial period), hypertension stages I and II, hypotension, obliterating vascular diseases of surviving co-

values, sleep disorders, stump diseases (eczema, dermatoses, neurodermatitis).

Contraindications: current intolerance, inflammatory eye diseases, weeping dermatitis of the face, hysteria, arachnoiditis, severe circulatory disorders, diabetes severe in the stage of decompensation, cataracts and glaucoma.

Needle reflexology helps reduce pain syndromes, improve blood circulation, normalize metabolic processes and tissue nutrition, and increase skin resistance. Acupuncture involves the impact on the body of irritations of varying strength and nature, intensity and duration, applied to certain point areas of the body - biologically active points (BAP), located in the area of ​​the skin surface of the head, face, torso and limbs. It is carried out through the use of special acupuncture metal needles, acupressure, finger pressure, electric current, radiant energy, and medicines.

Treatment of patients with amputated limb stumps is carried out according to the principle of joint action through points of general action, segmental acupuncture points and pain points of zones of skin hyperalgesia, located in most cases: also segmentally. Acupuncture points of general action (corporally located) are localized mainly in the distal parts of the limbs. There are also points of general action on the auricle. Acupuncture points corresponding to the zones of segmental innervation of the integument of the body are located along paravertebral lines.

The general strengthening and normalizing result of influencing these points is explained by the peculiarities of their location and the close connections of the autonomic and somatic innervation not only at the level of spinal reflexes, but also at the level of the subcortex and cerebral cortex. When exposed to them, the process of adaptation of patients to new conditions of movement is accelerated, negative psychological reactions to prosthetics are reduced, fitting of prostheses and mastering the use of them are facilitated. In addition, the sleep of sick and disabled people is normalized. arterial pressure, improving general state. For analgesic effects in phantom pain syndromes, except? points of general action and segmental zones, use certain combinations of points (corporal and auricular).

Medical indications for the use of reflexology in prosthetic and orthopedic practice are phantom pain syndrome and local pain in the stump, trophic disorders (wounds, ulcers, atrophy, edema, infiltrates, venous stagnation, hyperkeratosis, pianosis), abrasions of the stump, negative psychological reactions associated with loss of a limb, postoperative complications (reflex urinary retention, swelling of the stump, delayed healing of postoperative wounds), associated radicular pain.

Contraindications to the use of reflexology are tuberculosis, osteomyelitis, weakened condition and exhaustion of patients, simultaneous use of physiotherapeutic procedures or hormonal drugs.

The technique of acupuncture is generally accepted. The pose is chosen individually. For patients with upper limb stumps, the best position is the “sitting” position. A pad is placed under the stump and the remaining limb in order to maximize the relaxation of the muscles of the stump. For patients with stumps of the lower extremities, a supine or abdominal position is recommended. To enhance the effect of the needle, it is possible to burn it with wormwood cigarettes, which are held over the needle (hot needle). Applying heat to the pain points of the end part of the stump for 10 minutes and to the points of the segmental zones relieves pain and improves blood circulation in the stump. If the effect is insufficient, electroacupuncture is used on the same pain points. Direct current mode with polarity change - negative (30-50 s) and positive (3-5 s). Current strength is up to 50 µA, pulse frequency is 10-12 Hz.

Acupuncture therapy for phantom pain syndrome is carried out on pain areas in combination with points at the segmental level and general action. Painful areas are determined anamnestiically, by palpation and using the indication of search devices “PEP-1”, “Elita-4”. These zones are located within the missing part of the limb - I or At the toe (hand). In this regard, after unilateral amputation, the limbs are affected by the pain zones of the remaining limb, which are projectionally associated with the pain zones of the missing limb. After bilateral amputation, the active points of the auricle are affected mainly in combination with points of general action.

Studies conducted at the Central Scientific Research Institute of Applied Physics have shown that in the treatment of phantom pain syndrome, the analgesic effect is effective with the following treatment regimen:

1st procedure - impact on points of general action.

2nd procedure - impact on the points of pain zones (corporal and auricular) in combination with points of general action.

3-5th procedure - impact on points of segmental zones in combination with points of general action.

6-8th procedure - impact on points of the stump - painful and segmentally located in combination with points of general action.

9-10th procedure - impact only on points of general action (corporal and auricular).

When phantom pain syndrome is combined with pathological condition stumps affect both the painful points (zones) of the stump and the pathological area on the stump by piercing it and thermal exposure with wormwood cigarettes. Painful areas on the stump often correspond to a painful scar or neuroma. In these cases, you should also act around the source of pain. At the same time, acupuncture points are pricked on the culm

those. It is possible to influence acupuncture and pain points on the stump only at the 6-7th procedure, when a positive result has been achieved: the result of influencing general and segmental points (sleep and blood pressure have normalized, a tendency to reduce pain has appeared). The painful stump scar is pricked with several needles, which are inserted to a depth of 2-3 cm into healthy tissue. Procedure time 45-60 minutes.

For a trophic ulcer on the stump, needles are inserted into and around the ulcer, into acupuncture points located nearby, and into points of general action. It is recommended to combine acupuncture with the thermal effects of wormwood cigarettes (30 min).

For painful neuromas, at the beginning of treatment, needles are inserted into distant acupuncture points and then approached to the neuroma. The needles are inserted around it under the control of tolerable sensations, without allowing them to intensify.

The segmental points of the stumps of the upper limbs are the acupuncture points of the first and second lateral lines of the back, corresponding to the upper and middle thoracic spine. Acupuncture points in the collar zone are preferred. An important place in the treatment of phantom pain syndrome in patients with stumps of the upper extremities is occupied by the impact on the acupuncture points of the remaining limb, which are projection-related to the pain zones of the missing limb (similar to the impact on the stumps of the lower extremities). On the auricle, active points are used, projectionally connected to the amputated part of the limb, and points of analgesic action.

Patients who have lost limbs due to vascular diseases (obliterating atherosclerosis, endarteritis, thromboangiitis, diabetic arteritis) often experience pain not only in the stump, but also in the remaining limb, which is accompanied by significant trophic disorders. The basis of these diseases, as is known, is a violation of collateral circulation, a decrease in the volume and speed of blood flow, a violation of microcirculation, which results in the development of tissue hypoxia and, as a consequence, pain. Phantom pain syndrome manifests itself mildly. Ischemic type pain prevails (constant, aching, squeezing). There are almost no clear painful phantom sensations (“absence” of fingers of the limbs); they are of an uncertain nature. In these patients, treatment is aimed at improving blood circulation in the stump and remaining limb, eliminating hypoxia of the stump tissue, preventing the progression of the disease and normalizing the functional state of the central nervous system. In this regard, acupuncture points of general and antispasmodic action, located in reflexogenic and segmental zones and points on the stump, prevail in the treatment regimen. In patients with stumps of the lower extremities, the segmental zones are the paravertebral lines of the lumbosacral spine, and in patients with pain

those with the stumps of the upper limbs - paravertebral lines of the upper thoracic spine. Preference is given to deep injections (.8-10 cm). Acupuncture points of paravertebral lines are combined with points of general action on the distal limbs. Locus points and antispasmodic action points are used on the auricle. These points combine well with analgesic points.

In case of trophic changes in the stump and preserved limb as a result of obliterating diseases, heating the changed tissue of the stump and over points located close to the lesion is effective. When using electropuncture in these patients, a low current strength (20-30 μA), a low frequency of pulse current (3-10 Hz), a mild polarity (from -20 to +10-15 s), and an exposure time of 20 minutes are used.

TRAINING IN THE USE OF PROSTHETIC AND ORTHOPEDIC PRODUCTS

The general objectives of training are to develop adaptation to the prosthesis, strengthen the muscles of the pelvis and stump, learn the correct skill to control the prosthetic limb, reduce contractures and stiffness in the joints, strengthen the muscles of the remaining limb, train muscle relaxation and coordination of movements of the upper and lower extremities, balance training, vestibular functions, orientation in space, development of stability on a prosthetic limb.

The main task of teaching the use of prosthetic and orthopedic products is to develop a dynamic stereotype of movements. It is produced as a result of the formation of new conditioned reflexes through training certain motor functions- walking, self-care, mastering labor processes with the help of a prosthetic limb. When training patients with various levels of lower limb truncation, a common point is the need to restore the functions of support and movement. The complexity of coordinating control of a prosthetic limb increases depending on the level of truncation and the multiplicity of defects. Learning to walk with prostheses includes three stages.

The first stage of training, especially for primary patients, begins with the use of a therapeutic-training or primary-permanent prosthesis. The patient is taught to stand with equal support on both limbs, transfer body weight to the prosthetic limb or alternately from the prosthetic limb to the preserved one, or from one prosthetic limb to the other, stand on one prosthetic limb, get up from a chair, put on the prosthesis and fastening, and correct alternation of tension and relaxation of muscle groups involved in controlling the prosthesis, controlling the prosthetic limb in a standing position. The duration of the stage is up to 7 days. Criteria

The key to the transition to the second stage is the ability to maintain balance while standing on a prosthetic limb for 2-3 seconds.

The second stage of training is transitional from standing to walking on prostheses. The skill of balance in two- and single-support positions, standing on both limbs in a step position, and mastering dynamic balance when leaning on is developed. prosthetic limb. Learning the movements of a step with a prosthetic limb and controlling it comes down to training the support and transfer phases of a step with a prosthetic and preserved limb. The complexity of element-by-element learning to step determines the use of various methods of correction and self-correction, as well as monitoring the quality of step movement.

At the third stage of training, rhythmic, coordinated, smooth and stable walking, walking on an inclined plane and stairs, turning, overcoming obstacles, and self-control techniques are developed. As a rule, deficiencies in the fit of the prosthetic socket are identified and must be corrected. At the beginning of walking, stiffness in the movements of the torso and limbs and a forward tilt of the head are noted. As walking is mastered, a relaxed gait and coordinated interaction between the upper and lower limbs are developed.

With a unilateral stump, the first step is taken with the remaining limb. This requires the patient to be able to correctly shift the body while walking on the prosthesis and take the next step. First, they learn a single step, after which they move on to mastering two or more steps. The step with the prosthesis should be shorter than the step with the preserved leg, since in this case the steps are aligned in time. It is advisable to take small steps, since this moves the center of mass by a smaller amount, and therefore makes it easier to maintain balance. Walking is carried out relative to a straight line on the floor - the so-called walking guide in front of two mirrors located opposite. Pay attention to the fact that the patient does not spread his legs too wide. In the process of training, they achieve uniformity in both time and length of steps.

By this time, the patient is able to include the flexors and extensors of the hip joint in the control of the knee joints of the femoral prosthesis: when resting on the heel of the prosthesis and in the phase of full support on the foot, the limb should be extended in the hip joint (which ensures stability in the knee joints), after rolling over the toe and in the swing phase of the prosthetic limb, bend it at the hip joint. To properly hold the torso while supporting the prosthetic limb, special training is carried out for the muscles of the stump and torso.

For abductor contracture, it is recommended to walk in a cross step, exercises in a standing position on both legs (springing bends towards the remaining leg), for adductor contracture - walking towards the prosthetic limb, exercises in a standing position on both legs (springing bends of the torso).

in the direction of the prosthesis), with flexion - exercises in a standing position on both legs at a distance of 0.6 m from the gymnastic wall with sticks to it (spring extension of the torso with support on the rail, feet in the position of maximum dorsiflexion with support on the toes), with extensor - exercises in a standing position on both legs, spring flexion of the torso in the hip joints with a forward bend.

When moving the prosthesis forward, flexion should only occur at the hip joint. If there is a lock in the knee joints, the patient is gradually taught to walk with the lock open. As a result of learning to walk on a hip prosthesis, the arrhythmia of stepping movements is reduced.

After bilateral amputation of the hips, the constant use of additional support (cane, crutches) is specific, so gymnastics is of great importance for training the supporting function of the arms, balance, stability, and coordination of movements. It is necessary to achieve a gradual decrease in step width and hyperlordosis of the lumbar spine. Exercises are recommended to strengthen the abdominal muscles and hip extensors.

To control the prosthesis after disarticulation in the hip joint, patients are taught to move the pelvis in the sagittal plane (forward push). This movement is performed in the preparatory period and further when mastering the prosthesis. The forward movement of the pelvis helps to lock the knee and hip joints when supporting the prosthesis, providing an upright posture. Walking on prostheses after bilateral disarticulation of the hip joints requires intensive and systematic training, which allows you to first replace crutches with canes, and then use one cane for support. Such patients should practice moving the pelvis forward alternately from the right and left.

After amputation at the level of the lower leg, attention is paid to the thigh muscles of the truncated limb. The ability to flex and straighten the knee joint, keeping it half-bent while leaning on a prosthetic limb helps to develop a gait with bending in the joint in the support phase of the step, which approaches normal walking. Patients using deep-fitting lower leg prostheses are taught how to contract the calf muscles during the period of transfer of the prosthetic limb (in order to best hold the prosthesis on the stump) and how to relax these muscles during the period of support on the prosthesis.

Walking training is carried out in shoes with heels, the height of which the artificial foot is designed for. They use additional means of support: canes, crutches, walkers, parallel bars, obstacles for training in walking, a special platform with steps that imitate the landing area of ​​urban transport.

The time frame for mastering correct walking skills varies from person to person. After hip amputation, learning to walk is possible within 2 weeks,

after amputation of the lower leg - 7 days, after bilateral amputations - 3 weeks. Walking training begins with 15-20 minutes, and after... 3-4 days bring its duration to 1-2 hours a day with breaks.

For developmental anomalies of the lower extremities early learning'Walking on prostheses contributes to the formation of a dynamic' walking stereotype, close to normal. In this group of patients, the lower limb, as a rule, is in a position of external rotation. The objectives of exercise therapy are to strengthen the hip flexors and extensors, achieve the maximum equinus position of the foot, strengthen the muscles that abduct and adduct the foot. In the case of placing the foot in the receiving socket of the prosthesis develop the supporting function of the foot. If the ankle joint of an underdeveloped limb is located in the prosthesis at the level of the knee joint of a normally developed leg, then the patient is taught to move in the knee joint of the prosthesis due to the movements of the ankle joint of the underdeveloped limb. Prosthetics and walking training for children with congenital underdevelopment of the limb should begin as soon as possible earlier - at the age of 1 year.

Learning to walk in orthoses is also carried out in three stages. In the preparatory period, when mastering orthoses, it is important to train: the muscles that ensure stable standing of the gluteal, quadriceps, calf, hip and calf flexors, and trunk muscles. support, which contributes to passive stability of the knee joint. Then they are taught to roll over the foot, over the toe, and transfer the prosthetic limb.

With varying degrees of muscle paresis, the lower limb is brought forward in different ways. In this regard, when the hip flexors are weakened, they are tensed when stepping on the front part of the orthosis shoe. With significant muscle paresis, pendulum-like movements of the leg are developed forward with a simultaneous deviation of the body back; while the other leg is extended at the hip joint.

In case of complete paralysis of the hip flexors, the extension is carried out: by a pendulum-like or rocking movement of the leg forward with simultaneous rotation of the torso and pelvis forward. Shoes with heels must be worn on orthoses. The training begins with 5-10 minutes and increases its duration to 1-2 hours with breaks for rest in the first 2-3 days. Walking begins with a healthy or less affected leg. Then, when the body is moved forward, the heel of the shoe in the orthosis easily comes off the surface of the support. It’s better to learn to walk with self-control (in front of a mirror).

Daily exercise therapy, massage and training in walking in lockless orthoses help to increase the rhythm of walking, improve the functions of the hip and knee joints, developing confidence in movement. Additional support is used on one or two canes, and in case of widespread paralysis - on

crutches. The time required to master walking in the apparatus (from 2 weeks to l’/g month) depends on the degree of paralysis, the patient’s age, his level of fitness, and the design of the orthosis.

It is advisable to train patients with scoliosis in the use of a functional corset only in combination with exercise therapy and exercise therapy. massage. Some exercises for the muscles of the trunk and limbs should be performed in a corset in an upright position of the body. If, along with a corset, shoe braids are prescribed, then special asymmetrical walking is taught. Its goal is to enhance the corrective effect of the braid on the lumbar curvature. Occupational therapy in a standing position with objects that require raising the arms is useful: (working on a hanging loom, on electrical switch stands, writing and drawing on a high-hanging blackboard), skiing with an asymmetrical grip of poles.

OCCUPATIONAL THERAPY

Occupational therapy is an active method of exercise therapy using labor skills and movements associated with self-care. She. It is carried out in combination with exercise therapy, mechanotherapy, massage, sports exercises and is a method of psychological and physical preparation of patients for prosthetics. Its result depends on the correct choice of labor operations, as close as possible to the patient’s profession and becoming more complex as they are mastered. Involvement of the prosthetic limb in the accessible: labor process leads to the development of new motor skills, which are useful for self-care.

First, with the help of labor techniques, the corresponding muscles of the stump and torso are strengthened and elements of self-care are taught without prostheses and with the help of simple devices: (in cases of loss of the upper limb) or therapeutic and training prostheses (in case of loss of the lower limb). Then (at the final stage of prosthetics), when the patient receives permanent prostheses, occupational therapy makes it possible to teach the use of prostheses: both for self-care and. to perform available work processes.

Occupational therapy methods and tools should be used after upper limb amputation at any level of truncation, including shoulder disarticulation. The tasks of labor loss come down to overcoming the oppressed mental state, achieving mobility in the joints, forming stumps, developing compensatory movements of the body, coordinating the movements of the stumps, training the muscular-articular sense and touch.

Occupational therapy for patients with upper limb stumps is carried out in several stages. In the preparatory period, training is carried out without prostheses using the simplest devices. stumps, instrument attachments and working accessories. During the performance of labor operations, coordination of movements is developed, the muscles of the stump are strengthened, retention and retention are mastered.

46. ​​Teaching a patient after shoulder amputation self-care skills using a cuff, and - before prosthetics; b, c - after prosthetics.

grasping objects, movements in the joints of the truncated limb develop, and rotational movements of the stump develop. To develop all-round movements, they give appropriate work tasks (working with paper, modeling, polishing, cardboard work, performing installation work), and offer support and holding various items.

With the help of simple self-care devices, procedures are made more complex. The patient is taught writing, eating, typing on a typewriter, and sewing on a sewing machine (Fig. 46). Then they conduct classes using working prostheses and attachments. tools. After receiving active prostheses with their help, patients are taught work and everyday movements. Training is carried out at special stands for household and work operations with a set of various items. When the full range of movements is performed, the control light comes on. It is possible to train movements of the prosthetic limb in all directions. The stand allows you to objectively assess the quality of prosthetics and the degree of fitness of the patient.

In lower limb prosthetics, occupational therapy helps develop stability, balance and coordination. After hip amputation, patients perform tasks to strengthen the muscles of the stump (for example, controlling the electric drive of a sewing machine using the stump). In this case, disabled people make movements associated with standing (even distribution of the load on both lower limbs) and movement (self-care, carpentry and plumbing) on ​​a prosthesis.

SPORTS THERAPY

In the process of prosthetics, applied sports-type physical exercises are widely used: regular walking and skiing, running, cycling, table tennis, basketball, volleyball, badminton, billiards on exercise machines, dance moves. Elements sports games(sports exercises) are used in doses and under the supervision of a physician. Positive emotions that arise during sports games and exercises stimulate the physical activity of the body and create a favorable psycho-emotional background for successful prosthetics. Sports exercises and games accelerate adaptation to new conditions, expand the functional capabilities of patients, improve and restore coordination of movements, spatial orientation, accelerate the development of prostheses and orthoses, educate and develop the necessary physical and moral-volitional qualities (strength, endurance, speed, agility, attention, self-confidence).

In preparation for prosthetics, sports therapy is carried out without the use of prosthetic and orthopedic products. Patients with upper limb stumps should be recommended to play table tennis, basketball, volleyball, and billiards. In this case, the racket is secured with a special rubber cuff directly on the palmar or back surface of the stump. To increase the contact of the racket with the stump or lengthen the lever (with short stumps), the racket handle should be longer. The racket is attached to the palmar or back surface of the stump. During tennis lessons and

basketball pay attention to the combination of various positions of the truncated upper limb in relation to the direction of beating tennis ball, passing and throwing the ball into a basketball basket from different starting positions.

The elements of the game of volleyball consist of hitting and receiving the ball with the stump and the remaining hand from different starting positions. Billiards is indicated for patients with one and bilateral stumps of the upper extremities when mastering the hold of the cue with a special cuff fastening. After prosthetics, an upper limb prosthesis is used for sports therapy.

For patients with lower limb stumps, sports games and exercises are not limited. They are carried out with patients sitting in a wheelchair, chair or standing on a preserved limb (with breaks for rest). Table tennis, volleyball, badminton and billiards are available. The rules of the games are generally accepted, but also simplified depending on the conditions of the game. After patients receive therapeutic-training or permanent prostheses sports activities continue. At the first stage of learning to stand with prostheses, exercises are used on the “health wall” or a kayak simulator. The latter help strengthen the muscles of the shoulder girdle, torso, pelvis, and stump of the lower limb in a standing position. Elements of sports games are also used in a standing position, which helps speed up the adaptation of the stump to the prosthesis or orthosis.

At the second stage of learning to walk with prostheses, the same types of sports exercises are used, but not only in a standing position, but when performing individual step movements. At this stage, the use of dance movements helps to perform them correctly in various rhythms. By changing the tempo and rhythm of the musical accompaniment, you can adjust during training physical activity. At the third stage of learning to move with prostheses, all elements of sports games and exercises are used, but the clinical condition of the patient and the degree of functionality of the prosthetic and orthopedic product are taken into account. Sports competitions are held among disabled people, the results of which consolidate the achieved results of stump training and training in the use of prosthetic products.

Limb amputations

Amputation - cutting off (complete or partial) of a limb (upper or lower) - occurs with a wide variety of injuries, as well as with diseases associated with a sharp circulatory disorder (for example, obliterating endarteritis).

Level of amputation - within the limb segment: upper third, middle third, lower third - thigh, lower leg, shoulder or forearm. The remaining part of the limb is called the stump.

Mandatory for any amputation physiotherapy. In the first period of treatment, they begin to practice immediately after amputation until the sutures are removed (in case of healing of the stump by primary intention) or until the wound surface is completely healed (in case of secondary intention, when for some reason it is impossible to suture the skin of the stump).

The first stage requires special attention, since it is during this period that many unnecessary, unnecessary movements are observed, which are consolidated during the stabilization stage and are subsequently corrected with great difficulty.

In the therapeutic method physical culture, used after amputation of limbs, there are three periods:

Early postoperative (from the day of surgery until the removal of sutures);

The period of preparation for prosthetics (from the day the sutures are removed until receiving a permanent prosthesis);

The period of mastering the prosthesis (from the day of receiving the permanent prosthesis until its complete mastery).

The objectives of exercise therapy in the first period are to help improve the mental state of the injured person, remove drugs from the body, resolve postoperative infiltration and eliminate swelling of the stump, stimulate metabolism and the functioning of the respiratory and circulatory system.

Objectives of exercise therapy of the second period for any amputation of a limb:

Promote the formation of a mobile, soft, elastic scar that is not fused with the underlying tissues;

Prevent atrophy of the muscles of the stump;

Prepare the stump for prosthetics;

Train a sense of balance and coordination of movements, especially with amputation of the lower limb;

Maximize compensatory motor skills (learn to do everything with one hand or stand, step over and walk on one leg, leaning on crutches).

Exercises are performed from starting positions lying on the back, stomach, on the side opposite to the amputation, sitting, standing (leaning on crutches, the back of a chair and without support), on a gymnastic wall, gymnastic bench and exercise equipment, in water (bath, pool).

It is very important to strengthen and train the muscles of the healthy leg and back (natural muscle corset), as well as restore full range of motion in all joints of the stump.

The support of the stump is restored by walking first on a soft surface, then on a hard one.

Objectives of exercise therapy of the third period: medical and labor rehabilitation.

It is advisable to involve those who have undergone limb amputation in sports. Experience has shown that people using prosthetics can engage in any kind of sport; they experience great pleasure from the fact that they can swim, ski, ride a bike, etc., and take part in competitions.

The International Olympic Committee includes the International Federation of Sports for the Disabled, which has developed sports standards for those who have undergone amputation of the upper or lower extremities, taking into account age characteristics and level of amputation. Special equipment has also been created (fins and prostheses for swimming, crutches for skis, etc.).

This text is an introductory fragment.

28. Amputation of limbs In traumatology, the term “amputation” refers to the operation of removing part of a limb between the joints. If a limb is cut off at the joint level, this is called disarticulation, or disarticulation. The decision on the need for truncation (removal)

29. Methods of amputation The guillotine method is the simplest and fastest. The soft tissues are crossed at the same level as the bone. It is indicated only in cases where there is a need for rapid truncation of a limb. The circular method involves cutting the skin,

18. Limb amputation Limb amputation is a severe and complex operation, including separation (removal) of the peripheral part along the bone. Removal of a limb with the intersection of soft tissues at the level of the joint space is called disarticulation. For

19. Amputation of limbs In traumatology, the term “amputation” refers to the operation of removing part of a limb between the joints. If a limb is cut off at the joint level, this is called disarticulation, or disarticulation. The decision on the need for truncation (removal)

3. Limb amputation Limb amputation is a severe and complex operation, including separation (removal) of the peripheral part along the bone. Removal of a limb with the intersection of soft tissues at the level of the joint space is called disarticulation. Amputation

Limb massage

FREEZING LIMBS To rejuvenate the entire vascular system (according to St. Hildegard): 100 g of barely blossomed hawthorn flower buds, 700 ml of cognac, 1 g of vanilla and cinnamon, 30 g of honey. Grind the buds, mix with honey and spices, then pour in cognac and shake

Anolyte saves me from amputation “Anolyte helped save my leg.” Treatment of a leg wound with anolyte (from the story of patient L.F. Zlatkis, Latvia): “In 1993, I was in a terrible accident, and my leg was almost amputated, but the doctor at the hospital said: “We’ll always have time to amputate, we’ll try.”

Massage of the limbs When affecting areas located on the limbs, the massage should be carried out from top to bottom, preferably along long lines (Fig. 27). If you have tumors or skin diseases, massage should not be done. Rice. 27. Massage

Swelling of the limbs During pregnancy, the body retains more water in the tissues; this is normal, but it is still necessary to control the swelling. You may be bothered by swelling of the hands that appears at night, during sleep. Therefore, try to avoid this situation

Injuries of the extremities Injuries are called dysfunctions of one or another joint of the body: fractures, dislocations. In case of fractures, you should immediately go to the hospital, without waiting for complications and the onset of inflammatory processes. Dislocations, if they are minor, can be partially

Swelling of the extremities Cooling of the extremities can develop into systematic swelling of the legs. This disease is further aggravated by the fact that the patient’s kidneys and heart function are impaired. Therefore, with swelling of the legs, complete prevention of the body is necessary, starting with the gastrointestinal

Fractures of the limbs With a closed fracture, the limb often looks shortened, and even a light touch to it causes pain in the victim. Any wound in the area of ​​the fracture indicates its open nature. First aid: before delivering

Amputation of limbs Amputation - cutting off (complete or partial) of a limb (upper or lower) - occurs with a wide variety of injuries, as well as with diseases associated with a sharp disturbance of blood circulation (for example, obliterating endarteritis). Level

Paralysis of the limbs - 30 g each of lavender flowers, sweet clover herb and oregano, mustard seeds pour 0.7 l apple cider vinegar, cook for 15 minutes. For rubbing during paralysis