Functional biological management and morfo-funkitsonalnoe a substantiation of its application at disorders of an emiction of an inorganic genesis and SNFTO at children.

FBU is a method of treatment and aftertreatment at which the doctor by means of electronic devices in a regimen of real time receives the information on physiological indicators of internal organs of the patient by means of electric, sound or light signals.

Leaning against this information, the doctor under the equipment control, trains the patient any way to change parametres of the organism, nonsensory in usual conditions [44, 96, 122, 180, 224, 323].

The ancestor it FBU-IS barefooted is the founder of the modern theory of management E.Dzhekobson's stress, which else in the late twenties has developed the technique of a progressive relaxation improved in J. Basmadzhanom, D.Kamijja, N.Miller, T.Brudzinskim [225, 262, 263]. FBU has received dynamic development, as an independent direction in medicine, in 60-70th of the XX-th century. At the heart of FBU domestic and foreign workings out in the field of physiology, researches of mechanisms of regulation physiological and developments of pathological processes, results of applied studying lay
Rational ways of activation of adaptive systems of a brain of the healthy and sick person [95, 113, 122, 196, 244].

The term «a biological feedback» has appeared for the first time in the wide literature in 1963 in work of American scientist Dzh. Basmadzhana, devoted to training by management of electric activity of a separate muscular fiber which examinees separately strained and relaxed in the necessary rhythm. From now on the term «a biological feedback - is barefooted» strongly has entered into world medical practice [44, 180, 225]. Considering language differences between the Russian Federation and foreign countries, domestic researchers along with the term «a biological feedback» and an abbreviation it is barefooted use synonyms: «adaptive biomanagement» (ABU) or «functional biological management» (FBU), besides last term full and most precisely reflects a short of a used technique [45, 146, 180].

In the Russian Federation and abroad for treatment of children with various implications of disturbances MI and NDMP (including with an incontience of urine of functional character), it is most often applied FBU in regimen EMG (it "MIO"). However, if abroad method FBU "MIO" is therapy of the first line in treatment and aftertreatment of children and adults with disorders MI in the Russian Federation to it resort when other kinds of the help have not achieved desirable success [113, 122, 146, 224, 266].

Technique FBU "MIO" is based on the modified system of exercises for muscles tazovogo bottoms which in the late forties has developed and the American gynecologist A.Kegel has entered into practice. It is referred on rising of a tonus of muscles of a diaphragm of a basin and development of their strong reflexogenic reduction at sudden rising of intraabdominal pressure [272, 273, 319]. Wide introduction in medicine elektronnoyovychislitelnoj technicians has led to creation of medical-diagnostic is apparatus-computer complexes (LDAKK), that has given new impulse in development of technique FBU "MIO". LDAKK FBU "MIO" erect A.Kegelja's technique to absolutely new level as allow not only to make measurement, reception and processing of the electromyographic signal received from the patient at reduction by it of muscles, but also to check correctness of performance of exercises by means of return return of the received information in verbal (sound) and-or visual (video series) a kind.

LDAKK FBU "MIO" consists of the gauges registering electromyographic signals at the patient, the converter of these signals, the computer (the system block, the screen, elements of management, an audiocolumn) and a package of special programs. The feedback occurs through the image bending around interferentsionnoj an electromyographic curve or animation picture on the screen of the computer, changing proportionally muscular activity of the patient. The image is accompanied by the various sound signals corresponding to bioelectric activity of muscles of the patient above, more low or at level of the set threshold [146, 186, 234, 244, 256, 303].

The primary goal of FBU-THERAPY "MIO" - training of the patient to the isolated reduction of groups of muscles tazovogo bottoms with simultaneous deenergizing from work of muscles of hips, a forward abdominal wall and breeches. During sessions FBU in regimen EMG the patient controls muscles, achieving their reduction and a relaxation, on

To individually picked up program. FBU-THERAPY sessions "MIO" are constructed in the form of dynamic game, trainings of muscles are combined with rest that is especially important in children's practice as it provides motivational aspect of medical procedures and excludes fading of interest to employment. Application of supporting audio-and a video series helps with achievement of the general nervously-muscular relaxation, optimum conditions of development of the central programs koordinirovannoj works of the muscles which are responsible for deduction of urine [93, 95, 182, 266, 293]. FBU-THERAPY "MIO" allows to eliminate an ischemia detruzora and organs of a small basin, normalises their somatic and vegetative regulation, well influences a basin diaphragm, including on sfinkternyj MT and rectum apparatus, that as a result allows the child to raise the control over certificate MI and defecations [109, 113, 122, 146, 242].

Complex influence FBU in regimen EMG on functional disturbances sfinkternogo the apparatus as MVS, and distal departments of the alimentary system (proctal inkontinentsija) is caused by close anatomic communication and similar physiological functions of MT and a rectum (accumulation, deduction and evacuation of products of vital activity of an organism), and also a generality of blood supply and an innervation of muscles (urethral and proctal sphincters), participating in this process. In particular, nervous fibers to these muscles approach as a part of pudental (somatic fibers), hypogastric (sympathetic) and tazovogo (parasympathetic) nerves. It is known, that the various reasons of occurrence can have an urine and feces incontience, but from the pathogenetic point of view they are related among themselves so in their basis musculation dysfunction tazovogo lays bottoms. Therefore the generality of mechanisms of development of these pathological processes gives the chance to survey together and similar methods of their treatment [34, 94, 122, 182, 238].

For understanding of pathophysiological processes of disturbance MI and degree of participation in it of muscles tazovogo bottoms, it is necessary to survey a structure tazovoj diaphragms. Tazovoe a bottom (tazovaja the diaphragm, a bottom of a small basin) is a complex of striated muscles and the fascias which are settling down between osteal sciatic hillocks from sides, a pubic adnation in front and coccyx behind. Into structure tazovoj diaphragms enters about 20 muscles, their basic part is presented by rudiments of the powerful muscular groups participating in movement of a tail at animal and almost disappeared at person [109, 128, 181, 182].

One of the main things in tazovoj to a diaphragm is the muscle lifting an anus (m. levator ani). The given muscle is didymous structure, its each half has the triangular form, is referred from an internal surface of haunch bones to a median line. Both muscles, forming similarity of the turned dome, make a basis tazovogo bottoms. The part of fibers of the muscle lifting an anus, at women participates in formation szhimatelja vaginas. Behind the layer of muscles tazovogo is supplemented bottoms with a coccygeal muscle (m. coccygeus). tazovoj diaphragms are included Into structure also various superficial and deep muscles, the greatest interest from which on a discussed problematics represent sedalishchno-peshcheristaja (m. ischiocavernosus) and lukovichno-cavernous (m. bulbocavernosus) muscles, urethra and rectum sphincters. Any muscle-sphincter of an urethra (m. sphincter urethrae) in the form of ring structure covers a webby part mocheispuskatelnogo the channel and at the reduction compresses it. Unlike men, at
Women of a fiber of a sphincter of an urethra are developed much more weakly, however, besides mocheispuskatelnogo the channel they cover also a vagina, in common compressing them at the reduction [109, 182].

On the morphology of a muscle tazovogo bottoms are not homogeneous structures, they consist of the fibers 1 and 2 types which are carrying out own specific functions. To fibers of 1 type carry so-called slow muscular fibers with a diameter 45,8 microns. They are intended for long tonic reductions and provide a tonus of muscles of a bottom of a small basin. It is necessary to notice, that in comparison with a usual cross-section-striatal musculation of a muscle of a diaphragm of a basin contain more fibers of 1 type. Muscular fibers 2 types (so-called fast fibers) possess the big diameter (59,5 microns) and are responsible for strong short-term reductions, basically, sphincters. Fibers 2 types accept immediate participation in compression of sphincters at sharp and sudden augmentation of intraabdominal pressure (laughter, tussis, a raising of gravities), therefore their training has paramount value in therapy of pathology MI and urine incontiences [94, 113, 122, 181].

Functions of muscles tazovoj diaphragms are rather various:

• fixing - maintenance of maintenance of organs of an abdominal cavity and a small basin in physiological position; the tonic strain of muscles tazovogo prevents bottoms shift of internal organs downwards by gravity and at sudden sharp rising of intraabdominal pressure; the given muscles also form «suspending apparatus» organs of a small basin that plays the important role at realisation MI and defecations;

• sfinkternaja - urine and feces deduction is provided at the expense of constant physiological tonic muscular activity and reflex compression of an urethra and a fundament, preventing their opening and zijanie between oporozhnenijami MT and a rectum;

• obstetrical (at adults) - creation of the soft patrimonial channel activly participating in advancement of the born child, thus muscles tazovoj diaphragms undergo appreciable reductions and stretchings, but finally come back in an initial condition;

• reproduktivnovspomogatelnaja (at adults) - muscles tazovogo bottoms, both at men, and at women accept active participation in process of conception, a fertilization and vynashivanija pregnancy [113, 128, 181].

Considering, that at trainings of muscles of a perineum is activly used analno-detruzornyj and is urethral-detruzornyj reflexes, it is necessary to shine short morfo-functional and physiological features of MT and the rectum, framing preconditions for realisation of conscious management by these organs.

The bladder is the hollow muscular organ which wall consists from intertwining gladkomyshechnyh the fibers forming three layers (external, average and internal). Them in aggregate name detruzorom - a muscle expelling urine (m. detrusor). At the expense of fibers of an average muscular layer in
Areas of a neck of MT the internal (consensual) sphincter (m is formed. sphincter urethrae internus or m. sphincter vesicae). It is important, that at physiological certificate MI the internal sphincter should reveal only at reduction detruzora, thus mocheispuskatelnyj the channel is shortened under the influence of longitudinal fibers intertwined in it that conducts to passive disclosing of an internal sphincter. Besides a consensual sphincter allocate external (any) sphincter (m. sphincter urethrae externus or m. sphincter urethrae). It consists of a cross-section-striatal musculation of a perineum in the field of urethra passage through tazovoe a bottom. As it became perceptible earlier, the given sphincter at women is developed more weakly, than at men, that is the important anatomic precondition (besides physiological estrogenizatsii) for formation of various kinds of pathology MI, mainly, urine incontiences. Men, besides internal (consensual) and external (any) sphincters, in a prostatic part mocheispuskatelnogo the channel have a ring gladkomyshechnyh the fibers which are settling down on a circle. They play a role of an additional consensual sphincter, paternal a prostate quite often name the third sphincter [94, 109, 113, 181, 182].

The rectum is the distal department of a colon which are settling down between a sigmoid intestine (from level of cape of a sacrum) and an anal orifice, at adults reaches at length 15-20 see Feature of a rectum that a little below sacrum cape muscular fibers form a continuous longitudinal layer is, unlike three longitudinal muscular tapes of overlying departments of an intestine. A part of a rectum from a place of an attachment of the muscle lifting an anus, to a proctal aperture allocate as the anal (proctal) channel. In a close condition the anal channel represents a cleft of the wrong zvezdchato-shaped form, which wall densely prilezhat to each other. In the field of the top part of the anal channel circular gladkomyshechnye fibers, utolshchajas, form an internal (consensual) sphincter of a rectum (m. sphincter ani internus). Outside gladkomyshechnye fibers of an internal sphincter are surrounded by the striated muscles forming external (any) sphincter of a rectum (m. sphincter ani externus). The external sphincter is presented by three fascicles of muscular fibers: in the hypodermic, superficial and deep portions. The hypodermic portion as follows from the name, is located most superficially, it is closely bound to a skin which surrounds an anus. The superficial portion goes from suhozhilnogo the perineum centre, from two parties covers the anal channel, and is fixed to coccyx. Fibers most glubokoraspolozhennoj, the third portion, basically consisting of circular muscles, also cover an internal sphincter of a rectum. It is necessary to notice, that fibers of the third portion are bound to muscles tazovogo bottoms: a muscle lifting an anus, lobkovoyoprjamokishechnoj, lukovichno-cavernous (at men) and szhimatelem vaginas (at women). The important anatomic feature of internal and external sphincters of a rectum is that their fibers, despite a good differentiation, are bound by fascicles of the muscle among themselves penetrating them, lifting back passage (m. levator ani) [94, 128, 146].

The condition sfinkternogo the rectum apparatus reflects the so-called proctal reflex which is an important point for understanding of main principles of the organisation of FBU-THERAPY in regimen EMG, A.Kegelja based on a technique. The proctal reflex represents reduction of an external sphincter of an anus and anal orifice retraction. The given reflex can be caused a touch to a mucosa of the anal (proctal) channel or to a skin of perianal area. Besides an external sphincter of a rectum at a proctal reflex the external sphincter mocheispuskatelnogo the channel, lukovichno-peshcheristaja and lobkovo-prjamokishechnaja muscles is reduced also. The proctal reflex also can be caused an electrical stimulation and strong-willed effort [104, 286].

The important link in the compounded work, maintenance of a basal tonus and regulation of the muscles expelling urine and a feces, and muscles, their keeping (urethral and proctal sphincters), belongs to the centres of the regulation, located in various departments TSNS. The centres of vegetative nervous regulation MI and defecations settle down in lumbar and kresttsovyh spinal cord segments. Excitation diffusion on the parasympathetic nervous fibers, leaving averages kresttsovyh spinal cord segments (S2-S4), causes reduction detruzora MT, and also longitudinal muscles of descending, sigmoid and direct intestines with a simultaneous relaxation of their internal (unconditional) sphincters. As a result of MT and a rectum are released from contents. The boring of sympathetic nerves (from the top lumbar segments - L1-L2), on the contrary, conducts to a relaxation detruzora, to inhibition of a motility of a muscular layer of distal department of a colon and reduction of internal sphincters that promotes urine and feces deduction. Thus, the parasympathetic nervous system is responsible for performance of certificate MI and defecations. External (any) sphincters innervirujutsja impellent fibers of the somatic nerves which bodies of motor-neurones are located in averages kresttsovyh spinal cord segments (S2-S4). Therefore reduction of external sphincters can be carried out as reflex under the influence of the signals arriving in a spinal cord on ascending (eisodic) fibers tazovyh of nerves, and at the expense of supraspinal activation somatic efferentov in S2-S4 [4, 94, 128, 163, 181, 182].

MI it is provided certainly - and conditioned-reflex mechanisms. Accumulation in MT of certain volume of urine conducts to the expressed stretching of its walls and excitation baro - and mechanioreceptors, impulses from which on ascending fibers tazovyh nerves are referred to the spinal centres of regulation (S2-S4), and then and in overlying departments TSNS. Reflex arch MI at the healthy person becomes isolated in the neurones located at level of the bridge. Thus there is an activation of the parasympathetic neurones regulating activity detruzora, and inhibition of somatic motor-neurones kresttsovyh segments that is accompanied by a reflex relaxation of external (any) sphincter. Though MI also is the automatic reflex certificate, but it is influenced by overlying departments of a brain, including a cortex of the big hemispheres. Influences have basically brake character that provides realisation MI only in appropriate socially favorable surrounding conditions [163, 180, 323]. Thus, only co-ordinated work of eisodic and efferent links as
Somatic, and vegetative nervous systems allows is high-grade to carry out the basic functions of MT and a rectum: rezervuarnoj (urine and feces deduction) and evakuatornoj (excision of products of vital activity from an organism), that is inconvenient at patients with disorders MI and SNFTO [4, 31, 79, 94, 100, 113].

Any reductions external proctal and external urethral sphincters under control LDAKK FBU, a means analno-detruzornogo and urethrally-detruzornogo reflexes lead to inhibition sokratitelnoj to activity detruzora, that does FBU-THERAPY "MIO" irreplaceable in nefro - urological practice. Possibility to enlarge activity and sokratitelnuju ability of any urethral sphincter and also to reach hypertrophies of its muscular fibers at the expense of conscious trainings for the purpose of maintenance urethral kontinentsii allow to use widely technique FBU in regimen EMG at patients with various implications of disorders MI (including with an urine incontience), both in a nursery, and in adult practice [182, 231, 283, 235, 275, 323].

The method of FBU-THERAPY has no absolute contraindications. The dependant position of the patient and its unwillingness concern the relative to take part in treatment [4, 44, 113, 146] infektsionnoyovospalitelnye diseases MVS in exacerbation stages, organic lesions TSNS and a rasping delay of the psychological development, the expressed anatomic defects of area of the perineum, accompanying diseases in decompensation stages, age less than 4-5 years.

The analysis of data of the literature allows to tell with confidence, that unlike symptomatic character of pharmacotherapy, FBU has a pathogenetic orientation, it restores normal activity reguljatornyh organism systems (at various level), eliminates pathological symptoms of disturbances MI and improves quality of a life of children [113, 213, 266, 238].

Unlike FZT, where the patient tests influences of various factors (light, heat, an electric current etc.), the classical equipment it FBU-IS barefooted (without components for an electrical stimulation) only registers biological signals of an organism (frequency of breath, pulse, brain rhythms, electromyographic indicators etc.) Not rendering thus on the person of immediate any influence. Under control LDAKK, the operator (doctor) of FBU-THERAPY, at active participation of the patient, gradually helps to restore the broken functions of its organism. FBU that and especially, that treats not a medicine or any apparatus, and the organism itself restores the functions lost for whatever reasons. Important is it is long a remaining positive take from procedures FBU. So, FZT and pharmacological therapy, in overwhelming majority of cases, the basic medical effect show or during their contact to an organism, or during the short period after it. And skill of self-control of organs and the systems, got during trainings FBU, remains with the patient for the long period, it is fixed both on conditional, and at unconditional level, rendering on the patient in passing psychocorrecting effect. At necessity, the child can repeat the techniques mastered by it on sessions FBU, even at absence nearby LDAKK (for example, on rest, in transport or even in breaks between study) [45, 95, 113, 164, 231].

Despite high formal interest of domestic doctors of various specialities to studying of disorders MI at children, and also on the given pathology, it is necessary to ascertain numerous publications and researches, that the problem successful highly effective etiopatogeneticheskoj and simultaneously with it maloinvazivnoj therapies urethral inkontinentsii for today definitively is not solved and remains rather actual. Unlike the countries of Europe and the North America in the Russian Federation, to techniques of not medicamental and non-invasive treatment of functional disturbances of MT - FBU-THERAPIES - the minor and auxiliary role is taken away. Completion existing Federal standards of diagnostics, treatment and aftertreatment of children with functional disorders MI and SNFTO taking into account FBU-THERAPY possibilities demand. Despite proved efficiency FBU at adults, in children's practice a technique it FBU-IS barefooted it is used it is isolated only in a number of hospitals of the Central, Northwest, Siberian and Far East federal districts only thanks to innovators and devotees from medicine. The publications devoted to application FBU "MIO" at children with pathology MI, are not numerous, separated and maloinformativny. There is no due advancement FBU-IS barefooted in the market of medical services, about the given technique parents of children, suffering disturbances MI, often learn casually, not from medical community, and from foreign persons. The Russian association of a biological feedback organised in 1990th years (St.-Petersburg, president A.A.Smetankin), unfortunately, and not became the high-grade federal uchebno-methodical centre on preparation of experts FBU-IS barefooted. To remain konkurentno a capable kind of therapy, LDAKK FBU, and also software packages to them demand regular monitoring and updating. As practice shows, in methods of treatment of disorders MI used for today at children (medicamental, FZT, etc.) influence psychological both microsocial factors on occurrence and disease is not considered. Disturbances MI, including an urine incontience, reducing quality of a life of children and their relatives, conduct to social dizadaptatsii patients that demands not only medicamental treatment, but also the timely qualified help of the clinical psychologist. Besides, uneasy modern sotsialnoyoekonomicheskie conditions dictate to treatment-and-prophylactic establishments total optimisation of budgetary funds, that also can promote introduction in practice malozatratnyh, but effective methods of treatment which FBU-THERAPY concerns. The marked problems which promote formation and maintenance of pathology MI at children, have defined the purpose and problems of our research.

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Scientific source MIRONOV ANDREY ANATOLEVICH. the CLINICO-PSYCHOLOGICAL SUBSTANTIATION of APPLICATION of the METHOD of FUNCTIONAL BIOLOGICAL MANAGEMENT At CHILDREN With the EMICTION PATHOLOGY. The dissertation on competition of a scientific degree of the candidate of medical sciences. Moscow - 2014. 2014

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  1. Functional biological management and morfo-funkitsonalnoe a substantiation of its application at disorders of an emiction of an inorganic genesis and SNFTO at children.