The content of the article "Therapeutic measures patients":
Medical examination of children
Diseases of the respiratory system
Monitoring of children with allergic diseases
Functional disorders of posture and scoliosis
Therapeutic swimming in violation of posture and scoliosis in children
Prevention of postural disorders and scoliosis
The basic principle of the health — disease prevention, that is preventive measures. This is especially true for at-risk children. It is important as early as possible to identify pathological condition and eliminate it. Surveillance is not only for sick children but also for those who are at risk development of pathological conditions. They belong to the risk group.
Of particular importance is the examination of children, because the origins of all diseases of adults should seek in their childhood.
Dispensary observation to be students with the following pathologies: cardiovascular disease; chronic nonspecific diseases of respiratory organs, as well as convalescents (recovering) after acute pneumonia; chronic diseases of ENT-organs; chronic and acute diseases of the urinary system; chronic diseases of the digestive tract; blood diseases; endocrine diseases; pathology of vision (myopia, etc.); diseases and birth defects of locomotor apparatus; deviations in neuro-mental sphere;convalescents and frequently ill children with low performance and lagging in physical development.
Clinical supervision of school-age children leads the doctor in conjunction with the school physician, nurse, psychologist. In "the Medical card of the child No. 026/C" there is a special graph, which emphasizes the need of follow-up, the timing of ongoing examinations and the dynamics of the flow process recommended therapeutic measures. In the end, the pediatrician in a brief medical report noted the dynamics of disease, number of relapses and their severity. Further, a plan of therapeutic activities for next year.
In acute diseases the child is usually treated in a hospital (the hospital). After treatment it is discharged home under the supervision of the district pediatrician. Children attend school with the exemption from physical education lessons depending on the disease (injury).
Physical education students in special medical groups has the following objectives:
— improve functional status and prevent progression of the disease;
— improve physical performance;
— relieve fatigue and enhance mental performance;
— education needs hardening, recreational physical activity, that is, maintaining a healthy lifestyle.
The effectiveness of physical education in special medical groups depend on systematic training (3-5 times per grant), the adequacy of the loads, the combination of physical activity with healthy habits, diet and other methods.
The main means of physical education in special medical groups is physical exercise.
Depending on the functional state of fitness and the disease load in the beginning must be of low intensity, then medium. Monitoring the reaction of the cardiovascular system to exercise at a heart rate, respiratory rate, mood and exercise performance.
The basis of the training process for the cardiorespiratory system are cyclical exercise, in injuries and diseases of ODA — swimming, fitness classes, exercises with gymnastic stick, balls, elastic bandages, gymnastic walls, etc.
Scheme of the lesson consists of three parts: introductory, main and final. The content and duration of the parts of the lesson depends on the nature of the disease, its course and the frequency of relapses, age and sex of the child. The preamble includes General developmental exercises, walking, running, breathing exercises; the main part is a specific exercises for this pathology, outdoor games, elements of sports games; the final part — breathing exercises, walking, exercises for relaxation, education of proper posture, stretching exercises connective formations and autotronik.
Twice a year the school conducted conservative treatment of children suffering from chronic tonsillitis (washing gaps, lubrication tonsils Lugol's iodine solution, rinse, UV irradiation of the gland, kvartsevanie stop and fortified with vitamins, especially vitamin C). For children with gastroenterology is organized diet. This is especially important for students if they are in group of the prolonged day.
The pediatrician decides the question of possibility of carrying out of tempering procedures, including recreational physical activity. After suffering acute diseases of ENT-organs, lungs, and children are fully exempt from physical education for a certain period.
Properly organized physical education and hardening help restore the health of the child, increase the body's defenses, improve the functional status and mood.
Principles of dispensary observation are determined by the disease (injury) and peculiarities of pathological process.
General provisions methods of conducting classes with students suffering from diseases of the cardiovascular system:
group method of classes (preferably outdoors in a Park or in the Park, there is a need tempering effect of training);
— lesson builds so dominated by cyclic exercises (walking, Jogging, a combination of running and walking, skiing, skating, etc.);
— excludes the exercise of breathing, straining at the gym, etc.
In the course of employment necessary to monitor heart rate and breathing, skin colour and General condition of the patient.
Children who have had rheumatic attack (cases of rheumatism), from hospital, transferred to therapy, in a cardiological sanatorium. Then every three months student examines cardiac rheumatologists, blood test, ECG is performed, etc. For the prevention of exacerbations sanitize the oral cavity, foci of chronic infection (tonsils, etc.), conduct seasonal billingparadise. Twice a year the student needs to see a dentist and ENT.
Statement in school is possible, if the child has a normal erythrocyte sedimentation rate, white blood cells and no negative dynamics on the electrocardiogram.
Children with rheumatism in the inactive phase in the first year of observation engaged in physical culture in special medical group. If there are no signs of developing heart disease, the second year you can allow them to engage in the preparatory group. With the clinical examination of the child is removed, if under him for 5 years, there was no exacerbation of rheumatic process and is not formed heart disease.
Supervision of children with hypertensive reactions and hypertension
Increased blood pressure often seen in children of school age. The main task of the pediatrician is to find out the cause of high blood pressure. Here the necessary consultation with the endocrinologist, otolaryngologist, urologist, and other specialists, medical history of such diseases from their parents.
Children with high blood pressure is almost never the presenting complaint, although they have disturbed sleep, often headache, they are irritable, tired quickly. Usually the disease is detected at mass inspections of students.
Often, blood pressure rises pupils with impaired rates of sexual and physical development. They have to arrange the correct mode with sufficient sleep and stay outdoors, sports, especially skiing, playing outside in the Park, etc. are Excluded from participation in the competition to bring HELL to normal. Useful tempering procedures. Sick children should limit the intake of fatty and salty food.
Supervision of children with low blood pressure
In children there is often reduced blood pressure (neurocirculatory dystonia). But this is not always a pathology. Hypotension characteristic of modern students — with great mental stress, physical inactivity, etc. If hypotension is characterized by rapid fatigue, drowsiness, headache, dizziness, poor appetite, pain often in the heart and other Cause of hypotension are chronic diseases (diseases of ENT-organs, etc.), negative emotions, low physical activity, etc.
Recommended motor mode, useful tempering procedures (rubdowns, showers, baths, saunas etc.). Shown Spa treatment in the South.
Must have group method in the fresh air. In the lesson include walking, Jogging dosed in combination with walking and breathing exercises, skiing, skating, games, relay races, etc. In cold and windy weather you should not hold classes on the street, especially for people who have bronchial asthma. During sessions in the hall it is necessary to develop proper rhythmic breathing, and breathing with emphasis on exhalation (especially in patients with asthma, obstructive bronchitis, etc.).
If you have allergic diseases need to find out triggering factors and to record in the map, which drugs experience an allergic reaction, what foods should be excluded from the diet. Be sure to do the analysis on eggs of worms and protozoa.
Any allergies from the diet excludes meats, chocolate, cocoa, canned food. Recommended vegetarian soup, boiled meat and fish, vegetables, fruits, salads with vegetable oil, dairy products fortified with vitamins.
You should sanitize all the infections.
For respiratory and allergic bronchial asthma attack are out of tempering procedures, physical exercise (walking combined with Jogging, skiing, Cycling, etc.), therapeutic exercise.
When atopic dermatitis and eczema also shown to diet, fight infections, constipation. It is important to remove itching and provide normal sleep. These children are contraindicated immunizations. They need tempering procedures (a RUB-down, dousing, bathing, swimming in the sea, etc.), physical therapy, during summer — Spa treatment (sun and air baths, games on the beach, walking and running, etc.). At night itchy places treated with an ice pack (cryo-massage 2-3 min).
Chronic tonsillitis occurs in students very often. For the prevention and treatment of disease is carried out lavage of lacunas, gargling with decoction of herbs, the total UV irradiation and UV irradiation of the feet and throat, fortified with vitamins (especially in autumn and spring in vitamin C). Systematically carry out tempering procedures, physical education, morning exercises, followed by sponging with cold water, overnight — wash your legs with cold water.
With alimentary obesity — the inclusion of exercises of cyclic character (a long walk on uneven terrain, running in combination with walking, skiing, rowing), sports games, classes at the gym, swimming and playing in the water, dumbbell exercises (see Fig. Approximate complex LH in obesity in schoolchildren) and diet. In addition 1-2 times per week Banya (sauna), followed by receiving a warm bath or shower.
Approximate complex LH in obesity in schoolchildren
In classes include exercise, a gymnastic wall, printed balls, gymnastic stick, with rubber shock absorbers, exercises stretching, exercises at the gym — for the development of the muscular system (in the initial position lying on back, lying on his back with a slight lift of the pelvis to prevent compression of the spine; after class — stretching on the gym wall), as well as swimming way brass (on swimming in flippers, spatulas, rubber circles on the legs, etc.).LH is held in the initial position lying, on all fours and sitting, you should avoid stress on the spine, especially to do exercises with dumbbells in a standing position, hopping and skipping. The duration of employment and their intensity depend on the nature of the change of posture, age, gender and disease progression.
The challenge lies in the fact that by means of physical culture to suspend the progression of the disease and in functional disorders of posture is to normalize it.
The usual position of the body the person is called posture. Normal posture provides the harmonic structure of the body, the symmetry of its individual parts, which is an important biomechanical prerequisite for lasting physiological support of each segment of the spine to the upper division.
There are two types of violations (changes) on the part of the spine: posture (functional changes) and scoliosis — structural changes in the vertebrae, intervertebral discs and associated apparatus. Scoliosis can be congenital or acquired.
Functional abnormalities of posture due to weakness of the muscles of the trunk and shoulder girdle.
Scoliosis is a disease of bone and muscular system in the spine that causes a progressive lateral curvature of the latter with the torsion by changing the shape of the vertebrae a wedge-shaped character of development of deformation of ribs and the formation of rib humps, front and rear, increased lumbar lordosis, thoracic kyphosis and the development of compensatory arcs of curvature. The development of scoliosis leads to the impairments of the function of the heart and lungs.
There are 4 degrees of scoliosis: the first is a slight curvature of the spine in the frontal plane. A noticeable asymmetry of the muscles; the second is clearly noticeable lateral curvature of the spine, there is a rib hump; the third — scoliotic deformity is fixed, rib hump height up to 3 cm, a deviation of the case towards the main arc; fourth degree scoliosis — a pronounced kyphoscoliosis fixed, a considerable deviation of the case aside, markedly pronounced rib hump in the back.
Its for scoliosis can be neprognoziruemami, slowly progressive and rapidly progressive. It is therefore necessary to determine the prognosis of scoliosis, on the basis of which to develop the most rational system of treatment.
The prognosis of scoliosis depends on the age of the child, which developed the disease (younger than he is, the worse the prognosis). Scoliosis progresses until the child grows. Thus affecting the growth and strength of muscles, functions of internal organs (especially heart, lungs).
In early childhood, should avoid prolonged wearing the baby, early planting, walking. The child should be forced to crawl, lie on your stomach, roll over in bed, she must be tough. When the child began to walk, to run, need to include a variety of games, exercises with objects (balls, balls, hoops, etc.), to run, to include a tempering procedure, etc. When visiting the school you must follow fit at the table at home, and at a Desk (at school).The diet should be balanced with enough vitamins and minerals (calcium, phosphorus, magnesium, etc.), vegetables, fruits. Gymnastics and various games.
A comprehensive treatment aimed at reducing strain the suspension of its development, compensation and stabilization by strengthening the muscles with the formation of a muscular corset. Included treatment status and laying to unload the spine, physiotherapy, swimming (breaststroke only), a special set of physical therapy, etc.
Widely practiced therapeutic swimming, as one of the methods of functional treatment. Swimming is recommended for children of I—III degree of scoliosis is contraindicated in progressive form of scoliosis, acute and chronic skin diseases, diseases of ENT-organs.
Tasks medical swimming in scoliosis: acquisition posture; correction of spinal curvature; development of proper breathing; increase strength and muscle tone; improving the function of the cardiorespiratory system; the hardening of the body, the acquisition of swimming skills.
The groups are formed by age, diagnosis, clinical course of the disease, etc., consist of 8-10 people.
Classes are held first in the hall (dry swimming), exercise performed lying on the back and stomach, making symmetrical movements of the hands, etc., then in water. The duration of treatment is 10 months. Therapeutic swimming is based on the standard pattern: introduction, main and final. Held 3-4 times a week in the indoor pool when the temperature is below 26°C. the Total duration of the lesson 35-45 min in fin Swimming with a Board, also include exercises at the side with rubber shock absorbers, breathing exercises, running in water etc.
For dealing with children need constant medical supervision, including definition of pulmonary function (VC, FVC, PTP, etc.), anthropometric indices (weight, height, standing and sitting, the shape of the thorax and the formation of a muscular corset, etc indicators to make the map, which must be from a teacher of physical education.
Academician of the Russian Academy of Natural Sciences,
IANPO and the New York Academy of Sciences,
Doctor of Medical Sciences, Professor,
A.V. Dubrovskaya, pediatrician
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