programs of regenerative correction perinatalnyh disturbances of nervous system at children

Augmentation of number of children who have transferred perinatalnoe lesion TSNS of a various genesis, having deviations in psychomotor and speech development in the subsequent, and also experiencing difficulties of training at school, put in number prime, a problem of timely their complex correction.

From positions of regenerative medicine in children's neurologic practice it is necessary to give special value to revealing doklinicheskih and early clinical forms of diseases for the purpose of prevention of their development. Regenerative treatment directly depends on phases of pathological process. The regenerative correction begun in the earliest terms, allows to achieve optimum results. Therapeutic actions should be thus aimed not at the suffered brain, and on aftertreatment of the most suffered systems (a muscle, easy, heart, kidneys, etc.). One of problems of early regenerative treatment - to activate reparativnye processes in the central nervous system, to take advantage of a phenomenon of self-aftertreatment and to support height nejroplastichnosti

Brain of the child. According to the majority of the experts who are engaged in regenerative treatment, positions about medical aftertreatment should contain sledujushchie.kriterii: 1 - in the aftertreatment beginning it is necessary to estimate-illness consequences, or the traumas which elimination are object of medical aftertreatment; 2 - an estimation of rehabilitational potential prior to the beginning of aftertreatment; 3 - rehabilitational actions for patients and invalids [5, 16, 17, 239].

The rehabilitational. Potential. — the forecast of possibility of restoration of functions and vital activity in the future without dependence from a condition of the patient at the moment of its definition: the Rehabilitational potential is estimated according to levels of consequences of illness or a trauma. Potential; can be functional, social and professional restoration. Distinguish three degrees of rehabilitational potential: high, average, low [94, 132].

Rehabilitational actions are effective, only at passage by the patient of three stages of medical aftertreatment: stationary, ambulatornotpoliklinicheskogo and sanatorium;

Obshchepriznanno, that components of the complex program of aftertreatment for correction of a condition of the patient are; medical, psychological, pedagogical, trudoterapevticheskaja and technical subroutines [82, 103].

For medicamental correction preparations of various pharmacological groups (nootrbpy, antioxidants, diuretics, relaxants, antiholinesteraznye preparations, vasoactive substances, hormones and their analogues, vitamin preparations, neuroleptics, tranquilizers, antidepressants, sedatives, antikonvulsanty) are used. The choice, volume and necessity of medicamental correction are defined by character of complaints which are shown by parents of the child or the child, a clinical picture of disease,

Results of additional methods of researches, individual reaction of an organism of the child to a preparation.

The carried out researches among children with perinatalnymi gipoksicheskimi encephalopathies at the age from 1 till 9 months, receiving only traditional bezlekarstvennye techniques of aftertreatment without medicamental correction, have shown their high efficiency in restoration of impellent functions, psychomotor development [40].

At a correct combination of medicamental aftertreatment (symptomatic and pathogenetic) and not medicamental (traditional and nonconventional physical therapy), it is possible to achieve the fastest restoration of the lost functions from children with perinatalnymi lesions of nervous system in a hospital at the second stage of nursing [25].

Many experts tend to wider use in programs of aftertreatment of natural physical factors (the physical activity, natural sources of heat, a cold, vibration, etc.). Some kinds of massage, medical gymnastics are based On use of natural physical factors, posturalnyh the exercises, special exercise stresses for stimulation of "normal" impellent patterns, reflexotherapy, medical gymnastics in the water, some kinds of a hydrotherapy, aeroionoterapii, barotherapies. In a number of works it is proved, that application in complex regenerative treatment of physiotherapeutic methods and medical gymnastics most effectively in an early phase spastichnosti as there is an activation of natural processes of restoration [1,2, 3, 10, 191].

Muscular activity makes essential impact on maintenance of a constancy of the basic physiological constants of an organism

The person. At movements the human body adaptation to conditions of external and internal environment [118] is improved.

There is a close interrelation between muscular activity and function of internal organs, a tonus of a smooth and sceletal musculation, therefore the condition of a tonus of last has important value for digestion function, promotes the best mastering of nutrients. Muscular activity influences glands of internal secretion, growth of bones. The special role in maintenance of excitability of a cortex of a brain is played by a positive emotional tonus. Positive emotions at children of early age, as a rule, are combined with a motor performance. Thus, to support activity of muscular system on an optimum level it is necessary from first days of a life by the organisation of an environment, a dream, wakefulness, gymnastics application as forms of the organised movement [104].

In Atlas E.E.'s works high efficiency of a kinesitherapy at children with natalnoj traumas of cervical department of a backbone and pozvonochnyh arteries with an ischemia of a reticular formation of a brainstem in shape miatonicheskogo a syndrome [8] is shown. nejrokineziologija on V.Vojtu allows to diagnose the broken impellent development of the baby and by early appointment of special exercises to relieve it of development of serious forms of a children's cerebral paralysis, in many cases completely to overcome impellent disturbances [146]. The short nejrofiziologicheskoj concepts of reflex influence on V.Vojtu consists that not separate abilities thus train, and ontogenetic programs TSNS [8] start to be realised.

Shanin G. E in the research underlines, that at any impellent training the brain practises first of all. Physical

The culture bridges in a single whole social and biological in the person [166].

In Kuznetsova O. F's works from co-workers. [80], Ponomarevoj S.O. from co-workers. [115] it has been shown, that use in a complex of regenerative actions of a version of massage (kriomassazh), peloidoterapii (application ilovoj silnosulfidnoj by means of apparatus "Пилотерм" on the amazed extremities) improvement in sphere of movements against depression of excitability, quality of a day dream allow to achieve a medical mud. Kriomassazh allows to achieve! To improve quality of tests for coordination and balance. [80, 115]

In treatment of children with perinatalnoj an encephalopathy such methods of treatment, as an ionophoresis of various medicinal substances, various kinds of an electrical stimulation of muscles and nerves, a magnetotherapy, rezonansoterapija, laserotherapy, an electrotherapy by constants and alternating currents of various frequency and modulirovannosti are often used. In spite of the fact that treatment by means of artificial physical factors frequently brings notable effect, there is no yet a demonstrative base of physiotherapeutic influence [8, 44, 70-75, 118].

Izmaylov Etc. and co-workers. Have shown efficiency of influence of electromagnetic radiation of a millimetric range at postgipoksicheskih encephalopathies at children of early age and have proved, that at this kind of physiotherapeutic influence it is possible to achieve positive influence on metabolic processes in cells of nervous system [62].

The method of micropolarization developed in the seventies of the last century at Institute of physiology of name Pavlova I.P. NIIEM AMN the USSR, under the guidance of the professor Vartanjana G. A, influences various links of the pathogenetic processes occurring in

To the central nervous system. Use of the given method allows to reduce hyperkinesias, stimulates motor and kognitivnye functions, improves spinal cord functioning, reduces frequency and expression of epileptic attacks [169].

In Zubkovoj S.M.'s work it is shown, that nervous system most tropna to such methods of physiotherapeutic influence as a superhigh-frequency therapy, krajnevysokochastotnaja, therapy that allows is proved to apply the given methods fiziolechenija in a complex of medical aftertreatment at children with lesions of nervous system [60].

The analysis of data of the literature for last decades testifies, that with development of computer technologies, modern reabilitologija has received set of new, effective correctional and training techniques [23, 75, 83, 113]. Special developing and corrective computer games, techniques of a biological feedback, computer testing and neuropsychological correction. Most widely the technique of return biological communication is used (IS barefooted). For the aid to teachers many specialised computer programs («KID / the Kid», «we we Will make a cartoon film», etc.) [86, 87] recently are developed.

One of the major programs of aftertreatment is psihologoyopedagogicheskaja and social correction. For many parents news that their child requires treatment or has vital activity restriction is stress. Intrafamily relations frequently fall, the relation to the child and, sometimes, not to the best [83] varies.

A number of authors within the limits of complex mediko-socially-psihologoyopedagogicheskoj aftertreatments assume to break off a vicious circle:
Disfiguration — a psychological disadvantage — deterioration of disfigurations [89].

Gerasimov O. JU [38] notices, that for integration of the child with the limited possibilities in a society and regenerative correction with application of psycho-social and mediko-pedagogical aftertreatment where in the attention centre there should be a family, for successful process of restoration of the lost functions of the child [38].

Children receiving the help in connection with diseases of nervous system, according to different authors in 15-30 % of cases suffer a delay of informative activity. Thereof such children have disturbances and in game activity [18, 83, 113]. By means of game the child learns the world, game forms spatially — logic communications and social skills. At early age game elements are very important for development of a fine motility, coordination, physical skills, speech. Therefore the important stage of rehabilitational correction are individual and group employment with the special teacher. As the child with special requirements can have the accompanying behavioural problems in which decision the psychologist [86 is engaged, 87, 167].

One of widely proved methods of complex aftertreatment of children with a pathology of nervous system is Maria Montessori's method. At the heart of its system three principles lay: 1) the account of individuality of each child; 2) maintenance of freedom of development; 3) wide use of possibilities sensory and physical training as bases of the subsequent intellectual development of the child. The method is based on the special developing exercises including all systems of an organism [48].

Various damages of the central nervous system (gipoksicheskogo, ischemic, hemorrhagic, infectious,

Traumatic character) to some extent influence development of speech function in the child. It is bound, first, to immediate influence of the pathological agent on primary and secondary word centres, secondly, with an arrest of development at a part of children of informative activity, a fine motility, thirdly, with socially-household - factors. The prespeech various disturbances prespeech and speech developments, special employment with the logopedist are extremely important for children. Contrary to traditional opinions, it is proved, that logopedic correction should begin not aged 3th years, and as soon as possible, on the first year of a life of the child. The most significant positive takes are reached when employment with the child are spent in common by the logopedist, the teacher and, at necessity, the psychologist [126].

The special importance some researchers give to emotionally-mental methods of aftertreatment to which carry also a musicotherapy with use of products of Vivaldi A, Mozart V. A, Schubert F, Tchaikovsky P. I, Baha I.S., helping in psihoyosensornoj to stimulation of the child [25].

For the prevention of development of deformations and contractures in joints, correction already existing, in a complex of rehabilitational treatment of impellent and motor disturbances at children with the remote consequences perinatalnoj pathologies TSNS, use various orthopedic packings, plastering of extremities, various splints and a splint, the special orthopedic adaptations, processes facilitating to the child vertikalizatsii, prjamohozhdenija, sitting. Widely applied earlier orthopedic operative measures (on Ulzibatu, transplantation of tendons, etc.) in modern reabilitologii is recommended to apply only in extreme, to not giving in other methods of treatment, cases [86, 87]. Along with work of the surgeon on

spazmirovannyh muscles, tendons, joints, functional neurosurgical operations [87] recently are more and more widely applied. Among them the greatest diffusion was received selective dorzalnaja by a rhizotomy, chronic epidural stimulation, chronic intrathecal introduction of preparation Baklofen [168]. It is necessary to underline, that to operative treatment resort only in the cases which are not giving in to conservative correction.

One of the perspective and well proved complexes of restoration are Programs of an early intervention. Programs of an early intervention (EARLY INTERVENTION PROGRAMS) are developed for children of first three years of a life and for the first time have started to be carried out by the St.-Petersburg Institute of the Early Intervention in 1992. The program is based on a principle of normalisation of a life and considers features of functions and structures of an organism, activity and participation of the individual in a society life [6, 7, 12, 46, 70-75,77, 83,84, 101, 126, 161].

The traditional approach to aftertreatment in Russia provides "biological" aftertreatment. The "social" aftertreatment including a principle of "life normalisation», is developed insufficiently. The programs of an early intervention developed Sankt - the Petersburg Institute of an early intervention, use a principle of normalisation of a life in the principle. A principle of normalisation of a life: a normal (usual) regimen of day (rest, a free time, study); a normal (usual) rhythm of week (alternating of the working days and days off); a normal (usual) rhythm of year (a vacation, holidays); normal (usual) development of life cycle (the childhood, adolescence, a youth, a maturity and an old age) [75].

The purpose of the program of an early intervention (early intervention programs) is early revealing of disturbances of a condition of the child,

The rendering assistance, referred on normalisation of development of kids to develop interdisciplinary interaction between experts.

Indications for a direction of children in service of an early intervention is the following:

1. Backlog in the development, taped by means of scales KID-R and R-CDT (the Russified adapted American questionnaires).

2. Disturbances which probabilities with high degree will lead

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To backlog in development: depression of hearing of 2-4 degrees; blindness, slabovidenie; cerebral and rachioplegias; генетические¹ syndromes and chromosomal aberrations; genetically-degenerate diseases of nervous system; congenital anomalies of development TSNS; serious organic lesions TSNS; malignant forms of an epilepsy; suspicions on an early children's autism; serious changes in behaviour of the child as a result of the gone through stress;

3. Biological group of risk: not full-term and malovesnye children born with mass of a body less 1500 gramme; children born on term gestatsii less ZZ'nedel.

4. Social group of risk: children of the parents having psychiatric diseases; children who are exposed to violence; children of the parents, suffering an alcoholism, a narcomania; young mums till 17 years [12, 126].

The service of an early intervention provides the complex approach to regenerative correction, interdisciplinary interaction of experts (the psychologist, the logopedist, the pediatrist, the neurologist, the special teacher, the physical therapist), work as a uniform command (spend joint receptions, consultations and adhere to uniform tactics of conducting clients).

Such is standard, but certainly not exhaustive representation about methods of regenerative correction of neurologic disturbances at children.

Numerous publications of domestic and foreign researchers prove the leading part of lesions of the nervous system which have arisen in perinatalnyj the period, with the subsequent disadaptation and an invalidism of children. Children with perinatalnoj an encephalopathy and its consequences quite often have vegetative dizreguljatsija, depression of resistance of an organism and immunologic disturbances, and as consequence, frequent diseases ORVI. Therefore, pediatrists, neurologists, psychologists, logopedists should participate in aftertreatment of children with perinatalnymi lesions TSNS and their consequences. The uniform system of aftertreatment of children should be characterised etapnostju, continuity, a continuity [9, 10, 23, 44, 56, 86, 87, 191, 205, 246].

Summarising the given literatures set forth above, it is possible to note the following: at the present stage, the majority of authors consider, that only under condition of the complex approach to aftertreatment of children with perinatalnymi lesions TSNS and their consequences with observance of principles etapnosti, continuity and a continuity achievement of its maximum effect is possible. Only rational combination of all forms of regenerative treatment (physical methods, psihologoyopedagogicheskaja correction) are pledge of successful aftertreatment of patients with consequences perinatalnoj encephalopathies [3, 10, 18, 21, 40, 41,46, 70, 153,167, 239].

Necessity of search of new effective techniques of aftertreatment of children with perinatalnoj an encephalopathy has defined necessity of carrying out of the given research.