RU2326641C1 - Respiratory gimnastics technique apllied for treatment of upper airways allergic diseases of children - Google Patents

Abstract

FIELD: medicine; therapeutic physical training.

SUBSTANCE: respiratory gymnastics is performed standing in upright position, legs are shoulders width, and arms put on waist. Right arm is raised up, and simultaneously deep loud breath is taken through nose, then motion is carried out by bending trunk and stretching right arm to left leg, with three short sharp breathing out through nose. Then the same exercise is performed changing right arm to left one, further exercise is made with legs put together and arms hanged by trunk; by breathing in arms are raised up, and by breathing out trunk is bended touching floor with fingers paying attention not to bend knees and trying to make sharp triple breath out, then breath in. Within further exercise breathing in is accompanied with hands raised up, and breathing out is accompanied with squatting, though not on the whole foot but on toes. Then unloading exercise follows with legs are shoulders width and arms on waist, circus motions of pelvis. Within further exercise legs are put together, arms are hanged by trunk, by breathing in hands are raised up, and right leg is forced backward and supported with toes, breathing out arms are stretched straight, right leg is raised up paying attention not to bend knee. Similar exercise is made by changing leg. Within further exercise legs are put together, straight arms are raised and pulled apart, breath is taken followed by breath out, simultaneously leg is raised up and sideway paying attention not to bend knee. Exercise is made for another leg. Further marching walk is performed accompanying with right forefinger holding right nostril and deep loud breath in followed with long loud breath out. This exercise is repeated by changing arm and holding left nostril with deep loud breath in and long loud breath out. Then unloading exercise is made by circus motion of straight relaxed hands.

EFFECT: enables to strengthen vascular walls of upper airways mucous membrane; reduce edematous nasal duct mucous membrane.

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Description

The invention relates to medicine, in particular to physiotherapy exercises, and can be used to treat allergic rhinitis in children.

Known methods of performing breathing exercises to achieve a specific therapeutic effect.

A known method of treating inflammatory diseases of the paranasal sinuses (N.P. Yarygin, application No. 2002127977 from 2002.10.21), including respiratory gymnastics, in which, while standing, compress lips and teeth and sharply repeatedly draw air through the nose until it is fully inhaled while tilting the head back back, after which, simultaneously with a sharp exhalation, they bend forward through the mouth, then in a standing position, bending at right angles with the elbows pressed to the body and to the chest, they make a sharp breath through the nose with a simultaneous sharp movement of the teeth ka to the toe of the opposite leg, also with another fist with a sharp exhalation, in a standing position with the pads of the thumbs of both hands pressed to the chin, the forearms of which are pressed to the body, press the chin up, then one, then the other, with the head tilted back to the limit with simultaneous continuous deep breath through the nose.

However, this method of breathing exercises is ineffective in allergic rhinitis and difficult for preschool children.

Known respiratory gymnastics by the method of strong-willed elimination of deep breathing (VLGD) K.P. Buteiko (book S. Skakov "Method K.P. Buteiko", Institute of Century Medicine, 1992).

The VLDG method consists in gradually reducing the depth of breathing by relaxing until you feel a lack of air and constantly maintain this feeling throughout the workout. Each training session should begin and end with measurements of a control pause (CP), pulse rate, respiration rate. A control pause is the time of holding the breath between exhalation and the next inhalation against the background of normal breathing. You can carry out a control pause, for example, in a sitting position, relaxed, hands on the knees with palms up and breathing through the nose. Holding the breath from the end of the CP to the maximum possible is called a "volitional pause" (VP). The sum of the CP and VP is the "maximum pause" (MP). The essence of the training is the volitional overcoming of the desire for deep breathing, that is, the depth of inspiration and exhalation should be reduced to such an extent that even a normal pause seems heavy. Also, according to the VLGD method, it is recommended to bandage overnight on exhalation (from the level of the nipples of the breast to the navel line), glue a band-aid on the mouth and close one nostril with a swab, which will reduce the depth of night breathing and not lead to a decrease, but, on the contrary, to increase CP compared with her level the night before. One of the methods of VLDG is to exhale maximum breath holdings (pauses), reaching 60 seconds or more during the exercise. At the beginning, training is only carried out while sitting. Then, when breathing is completed with a pause, it must be delayed with a load (walking, exercise, running), which speeds up the healing process.

The disadvantage of this method is the inability to perform the complex for children of primary school age, as well as for a large number of patients who are in the acute stage of chronic tonsillitis and allergic rhinitis, due to the difficulty of implementation.

A known method of treating patients with various pathologies, in which complexes of breathing exercises are used in combination with physical and without them (AS USSR No. 411865, IPC A61H 1/00, publ. 15.09.74, author Strelnikova AN), selected for the prototype.

The method includes a complex of breathing exercises (in combination with physical exercises), in which exercises are performed with compression and expansion of the chest. At the same time, a sharp active breath is taken during compression, and a passive exhalation is performed during expansion, then the same exercises are performed in combination with sound exercises until a dynamic stereotype is created that creates optimal phonation conditions. The essence of the methodology of respiratory gymnastics by A.N. Strelnikova and the mechanisms of its action on body functions is as follows:

- forced, short as an injection, breaths through the nose, directing air to the entire depth of the lungs, from the tops to the base, and a complete lack of control over exhalations through the mouth;

- rhythmic exhalation of air with simultaneous physical exercises for the body at an expense almost equal to the pulse rate;

- compression of the chest by exercises to reduce lung volume;

- activation of the muscle apparatus of the diaphragm and chest, their training and restoration of upset functions;

- providing a diaphragm for ventilation with simultaneous massaging action of the muscles of the abdominal cavity organs and their valve apparatuses.

In the starting position should stand straight. Hands along the body, legs slightly less than the width of the shoulders. They make short instantaneous breaths - "sniffing", while it is necessary to clamp the wings of the nose so as to drive the air into the body, exhaling is passive. At the same time, physical exercises are performed, such as: turning the head (to the right - inhale, to the left - inspiration); “Ears” (tilting the head to the right shoulder — inhale, to the left shoulder — inhale); “Small pendulum” (tilt of the head to the chest - inhale, back to the back - inhale), “large pendulum”, “hug your shoulders”, half-squat, etc.

The disadvantage of this method is the inability to perform the complex for primary school children and its low efficiency in allergic rhinitis.

The problem to which the invention is directed, is to develop an effective method of breathing exercises for children with allergic diseases of the upper respiratory tract.

The problem is solved by the fact that breathing exercises are performed in a standing position. At the same time, the legs are placed shoulder width apart, and the hands are on the belt, the right hand is raised up and to the side, at the same time, they produce a deep loud breath through the nose. Then, a movement is performed in which the torso is tilted, and the right arm is pulled to the left leg, producing three short sharp exhalations through the nose. Then do the same exercise, changing the right hand to the left. When performing the subsequent exercise, the legs are put together, and the hands are lowered along the body; when you inhale, your hands lift up, and when you exhale, they tilt, while touching the floor with your fingers, without bending your knees, trying to make a sharp exhale three times. When performing the next exercise during inhalation, the arms are lifted up, then exhale, during which the squat is performed, and not on the entire foot, but on the toes. Next, perform a discharge exercise, in which the legs are placed shoulder width apart, and the hands are placed on the belt and perform circular movements of the pelvis. Performing the following exercise, legs are placed together, and hands are lowered along the body. Breathing in, the arms are lifted up, and the right leg is laid back and set resting on the toes of the feet, exhaling, the arms are extended straight ahead, and the right leg is lifted without bending the knee. A similar exercise is performed, changing the leg. Then they perform an exercise in which the legs are put together, and straight arms are raised and spread apart, take a breath, then exhale, in which the right leg is lifted up and to the side, without bending the knee. The exercise is repeated, changing the leg. Then they walk along the march, during which the right nostril is clamped with the index finger of the right hand and a deep loud breath is made, followed by a long drawn out loud breath. Repeating this exercise, they change their hand and pinch the left nostril, making a deep loud breath, then a long loud exhale. Then they perform the unloading exercise, in which they do circular movements with straight, relaxed hands.

It is important to note that each inhalation is performed for 1-1.2 s through the nose with tightly compressed lips, and each exhalation is performed abruptly for 0.2-0.3 s.

Significant differences of the proposed method from known methods is that when performing combined respiratory and physical exercises, inhalation and exhalation are performed with tightly pressed lips, inhaling loudly (one long inhalation, for 1-1.2 s), and exhaling (three abrupt exhalations , each of which takes 0.2 s). The motor load is evenly distributed on the shoulder girdle, upper and lower extremities, spinal column, as well as the abdominal press.

The invention is new, since it is not known in the field of medicine, in the practice of treating allergic diseases of the upper respiratory tract, in children.

The method is carried out by carrying out a complex of the following exercises.

Exercise 1: Starting position (I.P.) - legs are placed shoulder width apart, hands are on the belt. The right hand is lifted up and taken to the side, at the same time produce a deep loud breath through the nose with tightly compressed lips for 1.0-1.2 s. Further, when torso is tilted, the right arm is pulled to the left leg and three short sharp exhalations are made through the nose for 0.2-0.3 s. Repeating the exercise, change the right hand to the left.

Exercise 2: I.P. - legs put together, hands - along the body. When inhaling, the arms are raised upward, while exhaling, a tilt is made, in which the fingers touch the floor without bending the legs at the knees.

Exercise 3: I.p. - legs put together, hands - along the body.

When inhaling - arms are raised up, when exhaling - they are crouching, while at the moment of squatting, we put our feet not on the whole foot, but on the toes.

After the third exercise, an unloading exercise is recommended, in which the legs are placed shoulder width apart, the hands on the belt and perform circular movements of the pelvis. The rhythm of breathing is arbitrary. Measure the pulse, blood pressure. Exercise 4: I.P. - legs put together, hands - along the body. When inhaling - the arms are raised up, the right leg is taken back and placed with support on the toes. On exhalation, the arms are extended straight ahead, the right leg is raised without bending the knee. Repeat the exercise, changing the leg.

Exercise 5: I.P. - legs put together, straight arms raise and spread apart. Make a deep loud breath through the nose with tightly pressed lips for 1.0-1.2 s, then exhale, in which the right leg is lifted up and to the side, without bending the knee. The exercise is repeated, changing the leg.

Exercise 6: Perform a walk on a march. In this case, the right nostril is clamped with the index finger of the right hand and a deep loud breath is made for 1-1.2 s, then a loud prolonged exhalation. The exercise is repeated, changing the arm, squeezing the left nostril and repeating inhalation / exhalation in the same rhythm.

An unloading exercise is performed, in which circular relaxed movements ("mill") are performed with straight, relaxed hands. The rhythm of breathing is arbitrary.

The whole range of exercises is divided into "triples". After each "three" of breathing exercises, an unloading, relaxing exercise is performed to restore the normal breathing rhythm, and in weakened children and heart rhythm. In this case, after the unloading exercise, health, pulse and arterial pressure are monitored, and after the exercise, air passages of the nasal passages are expressed, expressed as a percentage (to 100%), and obtained using rhinomanometric studies. Each exercise is repeated 3-5 times. In conclusion - the measurement of heart rate, blood pressure and rhinomanometric study.

To evaluate the effectiveness of this technique, rhinomanometric examination, an ultrasound examination of the nasal passages (the thickness of the mucous membrane is recorded before a two-week gymnastics course and after), a blood test for the concentration of nitric oxide metabolites.

Examples of specific implementation of the method.

Example 1. Boy Dolgushin Gregory, 10 years old. Received with a diagnosis of hay fever; bronchial asthma (mild course). At the time of admission, he complains of rhinorrhea, nasal congestion, lacrimation, itchy sensations in the nose. On examination: hyperemia of the skin over the upper lip; injection of sclera and conjunctiva; rhinoscopically: the mucous membranes of the nasal passages are swollen, cyanotic, in the nasal cavity there is a liquid mucous discharge, whitish, an increase in the size of the lower nasal concha; with pharyngoscopy: in the nasopharynx - copious serous-mucous discharge flowing down the back of the throat. The mucous membrane of the pharynx is hyperemic.

Previously, the following examinations were carried out.

1. The method of studying the function of external respiration (HFD) allows you to graphically display the change in air velocity in the airways depending on the volume of the lungs during forced inspiration and expiration. At the same time, pulmonary volume on the abscissa axis and volume velocities on the ordinate axis are simultaneously recorded. Registration of the flow-volume curve is carried out on a pneumotachograph. The resulting curves are recorded on the display for visual inspection. The curve “flow - volume” is recorded after 5-10 minutes of rest. Breathing is carried out through the mouthpiece tube, a clip is applied to the nose. The child should sit upright, comfortable, without stooping and not throwing his head back, be attentive and trained in the correct execution of the maneuver, which includes the maximum inhalation and the subsequent maximum forced exhalation. In this case, the beginning of forced expiration should be quick and sharp. Maximum effort should be maintained throughout the expiration. The maneuver is repeated 3-4 times under visual control of the recorded curve on the display.

The following indicators are calculated from the flow-volume curve.

Pulmonary volumes: - forced vital capacity of the lungs (FVC) - deep exhalation is recorded after a short holding of breath at the height of a deep inspiration (1-2 s), and the patient should exhale at maximum speed. Forced expiratory volume (FEV 1) in the first second; this indicator characterizes approximately 2/3 of the initial part of the air flow. The Tiffno IT Index is calculated as the percentage of FEV1 to the proper FVC value (× 100%).

2. Speed indicators: the air velocity during forced expiration is determined by the ratio of forces acting on the bronchial wall, which are different in different phases of expiration. Therefore, the calculation of flow rates in individual sections and points allows you to obtain objective information about the mechanical properties of the respiratory system. PSV is the peak expiratory flow rate.

MOS 25, MOS 50, MOS 75 - maximum volumetric flow rates of the curve at points corresponding to lung volume 25%, 50%, 75% VC. Graphically on the axis "volume" points are determined 25%, 50% and 75% of FVC.

According to the study of the function of external respiration conducted on the Spiro-test-PC apparatus, Razvitie, Russia, a child had a violation of bronchial conduction, mainly at the level of peripheral departments. (FVC% - 101; FEV% - 82; IT% - 88; PSV% - 86; MOS 25% - 65; MOS 50% - 58; MOS 75% - 56).

2. Rhinomanometry. When conducting rhinomanometric examination on the apparatus "Rinoscreen", the company "Jaeger", (Germany), a decrease in air flow was detected, more to the right. (The total air flow is 200 ml / s, (which is 48% of the norm); the flow on the right is 64 ml / s (31%); the flow on the left is 136 ml / s (66%)).

3. Ultrasound examination of the mucous membrane of the nasal passages. The study was conducted on an ultrasound device "Lodgik-9", the company "Daewoo electronics" (Kopeya), a linear sensor with a frequency of 14.0 MHz.

It was established that the thickness of the mucous membrane of the nasal passages was: 7.5 mm on the right and 7 mm on the left. In this case, an increase in blood flow to the right was found.

4. Spectrophotometric determination of nitric oxide content. The concentration of nitrogen metabolites in the blood was determined by the total content of nitric oxide metabolites - nitrates and nitrites on a DU-50 spectrophotometer, Becman (USA) using a J-6 centrifuge with cooling, Becman (USA) and high-frequency centrifuge "J-21", the company "Becman" (USA). A 5 ml blood sample was taken from a vein. The metabolite concentration was determined to be -41.6 mmol / L, with a norm of -24.09 +/- 3.45 mmol / L.

Non-drug treatment was carried out, in which the child performed a complex of therapeutic respiratory gymnastics according to the claimed method for a month and a half. Classes were held in the morning, for 15-20 minutes, while the number of repetitions of each exercise was 6 times, in the first 15 classes and the whole complex took 15 minutes. The next 30 lessons were held for 20 minutes and the number of repetitions of each exercise was 8.

The child did not receive medications for this period.

At the end of the course of therapeutic respiratory gymnastics, the following assessment examinations of the state of health were carried out.

1. FVD (from 05.24.06). According to the study of the function of external respiration, all parameters are within normal limits (FVC% - 124; FEV% - 118; IT% - 101; PSV% - 110; MOS25% - 103; MOS50% - 86; MOS75% - 102).

2. Rhinomanometry (from 05.24.06). According to the rhinomanometric examination, after a course of therapeutic respiratory gymnastics, a positive dynamics was revealed: the child showed a slight decrease in air flow, more on the right (total air flow - 93%; flow on the right - 91%; flow on the left - 96%).

3. Ultrasound examination of the mucous membrane of the nasal passages (from 05.24.06). We found that the thickness of the mucous membrane of the nasal passages significantly decreased, which indicates a decrease in swelling. The following parameters were recorded: on the right, the thickness of the mucous membrane was 6.8 mm, on the left - 6.0 mm.

4. Spectrophotomeric determination of nitric oxide. At the end of the course of therapeutic respiratory gymnastics, the concentration of nitrogen metabolites in the blood was 30.08 mmol / L.

As a result of the non-drug treatment, the FVD indicators improved (normal parameters were achieved); rhinomanometry improved by 45%; according to ultrasound, the edema of the mucous membrane was eliminated, the concentration of nitrogen metabolites in the blood decreased by 11.52 mmol / L.

The following examples are given in the table.

The inventive method of breathing exercises allows you to strengthen the walls of the vessels of the mucous membrane of the upper respiratory tract, reduce swelling of the mucous membrane of the nasal passages, and this leads to an improvement in air permeability of the upper respiratory tract and a decrease in the level of respiratory failure present in children suffering from allergic diseases of the respiratory apparatus, in particular allergic rhinitis.

Breathing exercises according to the proposed method allow you to adjust physical activity according to the following parameters: an increase in the number of repetitions, and it is recommended to perform it in the period before seasonal exacerbations of allergic rhinitis, as well as as a way of general physical preparation before starting water procedures, training in the pool.

The method is used to prevent exacerbations of allergic rhinitis and is characterized by wide availability, non-invasiveness, repeatability, mobility.

A positive effect of the invention is achieved by the fact that the implementation of general strengthening exercises simultaneously with specific breathing through the nose leads to normalization of the tone of the vascular wall in the mucous membrane of the upper respiratory tract.

Claims (1)

A method of respiratory gymnastics for allergic diseases of the upper respiratory tract in children, including performing breathing exercises with an active breath, in combination with physical exercises, characterized in that during breathing exercises, each breath is exhaled through the nose with tightly pressed lips, while breathing is performed within 1-1.2 s, and the exhalation is performed forcefully, abruptly for 0.2-0.3 s, breathing exercises are performed in a standing position, when performing the first exercise, the legs are placed shoulder width apart, and the arms are placed on belt, the right hand is lifted up and to the side, at the same time they make a deep loud breath, then they tilt, and the right hand is pulled to the left foot and three short sharp exhalations are performed, then they perform the same exercise, changing the right hand to the left, the next the legs are put together in an exercise, and the arms are lowered along the body, when you inhale the arms are raised up, and when you exhale, you tilt, with your fingers touching the floor, without bending your knees; then they inhale, during which the hands are raised up, then exhale, during which they do the squat, and not on the whole foot, but on the toes of the feet; then perform a discharge exercise, in which the legs are placed shoulder width apart, and the hands are placed on the belt and perform circular movements of the pelvis; the next exercise is performed by setting the legs shoulder-width apart, and lowering the arms along the torso, breathing in, at the same time lifting the arms up and placing the right leg back on the toes, then exhaling, with the arms extended straight ahead and raise the right leg without bending the knee; a similar exercise is performed by changing the leg, then an exercise is performed in which the legs are put together and the straight arms are raised and spread apart, they inhale, followed by exhalation, while the right leg is lifted up and to the side, without bending the knee; the exercise is repeated, changing the leg, then marching is performed, during which the right nostril is clamped with the index finger of the right hand and a deep loud breath is made, followed by a long loud breath, while this exercise is repeated, the arm is changed and the left nostril is clamped, making a deep loud breath, followed by loud prolonged exhalation, then perform an unloading exercise, in which they make circular movements with straight, relaxed hands with an arbitrary rhythm of breathing.