RU2743876C1 - Method for rehabilitation of children and adolescents with behavioral and emotional disorders suffering from mental disorders - Google Patents

Abstract

FIELD: medicine, pediatrics, neurology, psychiatry.SUBSTANCE: invention relates to medicine, namely to pediatrics, neurology, psychiatry. On the day of admission of the patient to the medical rehabilitation department, a psychiatrist conducts a consultation to determine the mental status, according to the result of which drug therapy is prescribed. Further, the patient is consulted by a neurologist, determines the neurological status and prescribes drug therapy. Then the patient undergoes examination by a psychologist using diagnostic tests and diagnostic techniques. From the next day of the child's stay in the department, the psychologist conducts daily psycho-correction using game therapy, body-oriented therapy, dance therapy, art therapy. Next, the child is examined by a speech therapist-defectologist with the appointment of daily classes. After all the above examinations, on the day of admission, the physical therapy doctor prescribes a course of physiotherapy exercises, which includes daily group sessions, followed by a transition to mechanotherapy using simulators. Physiotherapist prescribes massage of the neck and collar zone, electrosonic therapy, electrophoresis of 2% Ca and 2% Br according to Vermel and Shcherbak. The reflexologist prescribes a course according to the "U-sin" acupuncture method.EFFECT: provides stabilization of the emotional sphere, normalization of behavioral reactions, cognitive and emotional functions of the child due to the ongoing comprehensive rehabilitation measures for children and adolescents with behavioral and emotional disorders, suffering from mental disorders.1 cl, 3 ex

Description

The invention relates to medicine, namely to pediatrics, neurology, psychiatry, and can be used for the rehabilitation of children and adolescents with behavioral and emotional disorders, suffering from mental disorders.

Behavioral and emotional disorders in children and adolescents suffering from mental disorders at the age of 3 to 17 years are an urgent problem in social and medical aspects (see Lyalikov S.A., Lyalikova V.I.Periodization of childhood based on anthropometric indicators // Original research. 2008. No. 4. P. 28). Its importance is due to the increasing prevalence of behavioral and emotional disorders in children and adolescents with mental disorders, as well as the persistence of social maladjustment.

Insufficient effectiveness of the traditionally used treatment and rehabilitation approaches in the light of modern requirements for improving the quality of care for children and adolescents is largely due to the lack of an integrative approach that would take into account the entire spectrum of the patient's dysfunctional states that go beyond his clinical and biological determinants (see Root E V. Towards the development of a conceptual model of psychosocial rehabilitation of children and adolescents with mental disorders // Children's and adolescent rehabilitation. 2018. No. 3 (35). P. 56-62). In the population, the frequency of occurrence of this pathology is about 5% (see Safonova I.A., Prikhodko N.N., Bochkova E.N., Efremova T.E., Koltunova I.Yu., Belashev S.V., Bondarenko Yu.S., Aleksandrova BC, Pivneva AM Experience in the use of complex rehabilitation in children suffering from mental and speech development disorders in the practice of the medical rehabilitation department of the regional children's clinical hospital in the city of Rostov-on-Don // Children's and adolescent rehabilitation. 2018. No. 3 (35), pp. 56-62).

There are a number of mental illnesses, one of the syndromes in the clinical picture of which are behavioral and emotional disorders, but in our work we will not dwell on the following nosological units, such as F20 - Schizophrenia; F70-72 - Mental retardation.

Behavioral and emotional disorders in children and adolescents with mental disorders are considered in the following nosological units: hyperkinetic disorders, behavioral disorders, mixed behavioral and emotional disorders, emotional disorders, the onset of which is specific to childhood, disorders of social functioning, the onset of which is characteristic of childhood and adolescence, tics, other emotional and behavioral disorders, usually onset in childhood and adolescence. Their clinical manifestations are: affective excitability, aggressiveness, disinhibition of primitive drives, emotional volitional instability, increased suggestibility.

Currently, psychiatrists and psychologists are engaged in the problem of behavioral and emotional disorders in children and adolescents, using in their practice clinical conversation, finding out the severity, frequency and duration of aggressive, antisocial actions, clarifying their nature, focus, motivation, talking with parents about the emotional state of the child , academic performance, features of socialization; observation of the child's behavior, the peculiarities of the relationship between him and the parent, including the collection of anamnesis, observation of intra-family relations, which allows to determine the proportion of biological and social factors in the formation of the disorder; psychodiagnostics using projective methods, questionnaires, which make it possible to identify the state of maladjustment, emotional and personal characteristics; characteristics of teachers, representatives of law enforcement agencies.

Thus, the development of new highly effective methods for the rehabilitation of children and adolescents with behavioral and emotional disorders, suffering from mental disorders, is an urgent task of modern medicine.

The search carried out in the scientific, medical and patent literature found various ways of rehabilitating children and adolescents.

So, in the report "A comprehensive program for the rehabilitation of children with deviant behavior in the conditions of a child and adolescent psychiatric complex in Omsk", a rehabilitation program with the use of pharmacotherapy, with the participation of a psychiatrist, psychologist, teacher, is presented (see Grankina I.V., Ivanova T.I. , Barysheva OM Complex program for the rehabilitation of children with deviant behavior in the conditions of the child and adolescent psychiatric complex in Omsk // XVI Congress of Russian Psychiatrists, All-Russian Scientific and Practical Conference with international participation "Psychiatry at the Stages of Reforms: Problems and Prospects." , Kazan, September 23-26, 2015). The disadvantage of the proposed program is the limited functionality of the method.

The article "Psychosocial rehabilitation of children and adolescents with mental disorders in modern conditions" reflects a method of rehabilitation, which includes pharmacotherapy and the participation of a psychiatrist, psychologist, defectologist, whose task is to teach children and adolescents the necessary skills of self-control and effective interaction with others (see Root E.V. Psychosocial rehabilitation of children and adolescents with mental disorders in modern conditions // Social and clinical psychiatry. 2008. S. 5-13). The disadvantage of this method of rehabilitation is the limited functionality of the method.

From patent sources known "A method for assessing the psychoemotional level and the level of socialization of maladapted children and adolescents in the process of correcting psychoemotional disorders" (see patent RU 2497440 C1, publ. 10.11.2013, bull. No. 31). The essence of the method is that a group is created, into which children with reduced opportunities for socialization are introduced. A maladjusted teenager is introduced into the group in the status of a counselor, with whom preparatory work is first carried out. Testing is carried out three times. When testing, the children of the group choose a rectangular card, and a maladjusted teenager chooses a card in the form of a circle. The cards depict the figure of a man in a pose. The tested children paint the figure of a little man, paint or erase separate parts of the body, the image of the face or clothes of the little man, and place cards on the crown of a tree. The children of the group place the cards on the tree by moving further or closer to the card of the maladjusted teenager, which shows their attitude towards him, and also move the cards relative to each other, bringing them closer or apart, which shows the emerging bonds of cohesion or separation of the group. To do this, a transparent stencil in the shape of a circle with a radius equal to the height of four rectangular cards on the crown of a tree is applied to the crown area or its layout.

The analysis of the data obtained is carried out as follows. Determine K ₁ - an assessment of the emotional - behavioral state of the tested, K ₂ - an assessment of the emotional sphere, K ₃ - an assessment of psychoemotional disorders, K ₄ - an assessment of the comfort of the position in the group. For each grade, its value is determined in points. The comfort of the position of the tested child and the maladapted adolescent in the group of children K _{4 is} assessed by the degree of distance and the position on the crown of the tree of his card relative to the cards of the children of the group. The assessment of the state of the psychoemotional sphere and socialization of the children of the group and the maladapted adolescent is determined by summing up the assessments of K ₁ , K ₂ , K ₃ , K ₄ , and with a total of 11-15 points, the state of the tested child or maladapted adolescent is considered as a good stable psychoemotional state, indicating an adequate behavior. With a total of 6-10 points - as a satisfactorily stable psychoemotional state, in which the manifestation of emotional disorders has a situational character, which is expressed in some behavioral disorders. With a total of 0-5 points - as an unstable psychoemotional state, expressed by behavioral disorders, with discomfort from a feeling of inferiority, with withdrawal into oneself.

Determine the group cohesion and position of the tested child and the maladjusted teenager in the team by counting the number of cards in the stencil zone, the center of which is combined with the card of the maladjusted teenager or the tested child. If 50-100% of the cards of the children of the group are in the zone A-G of the stencil, which is a comfort zone, then the group is considered a cohesive, maladjusted teenager is considered integrated into the team, his socialization activity is effective, and the tested child is considered accepted into the team. If less than 50% of the cards of the children of the group are in the comfort zone, then they consider the group to be disunited, the socialization activity of the maladapted teenager is not effective, and the tested child is considered not accepted into the collective.

The method makes it possible to assess the change in the psychoemotional state of the children of the group and the maladjusted adolescent at the stages of correction. According to the authors, the method allows you to get a visual picture reflecting the relationship in the group and their development in the team, to evaluate the process of socialization of a maladapted teenager in a group of children, through an assessment of the cohesion and comfort of being in the team of other members, to determine the effectiveness of correctional work with children in the group, to obtain an objective assessment of the existing relations in the team as a result of the work of teachers and specialists. However, in this work, it is the method of assessing the psycho-emotional state of children and adolescents that is proposed, and not the method of rehabilitation of this category of patients.

From the same sources known "The method of preventive and rehabilitation correction of the functional state and increasing the adaptive capabilities of the body" (see patent RU 2557695 C1, publ. 27.07.2015, bull. No. 21). The authors of the method carry out three consecutive stages: setting (UE), adaptive (AE) and the stage of tactile interaction (TE) of a patient with a dolphin.

UE includes familiarizing the patient with the peculiarities of the structure and behavior of dolphins, teaching the techniques of performing the commands necessary for communicating with the dolphin, tactile communication with the dolphin. AE includes acquaintance and direct tactile contact with a live dolphin on the platform of the pool, out of water. TE includes exercises aimed at developing the patient's communication skills, fine motor skills, coordination of movements, control of motor activity, emotional state and attention, using elements of art therapy, musical exercises with the dolphin, active games with the dolphin with objects. TE is carried out in a pool with mineral water NaCl 1.8-2.0 ppm with a temperature of 25 to 28 degrees, the duration of the full course of correction is from 10 to 14 sessions, each from 30 to 40 minutes.

Duration of UE is not less than 3 sessions of 30 minutes each, AE - from 1 to 3 sessions of 30-35 minutes each, TE - from 7 to 9 sessions of 35-40 minutes each. According to the authors, the method provides an increase in stress resistance, adaptive potential of a patient with any degree of functional training, an integral increase in communication skills and focus on active purposeful activity, optimization of the duration of the rehabilitation course, depending on the psychoemotional state and abilities of the patient. However, the proposed method offers a fairly limited number of rehabilitation practices used to stabilize the emotional - volitional sphere in children and adolescents suffering from mental disorders, and dolphin therapy refers to alternative methods of rehabilitation that are not included in professional standards.

The objective of the present invention is to improve the effectiveness of complex rehabilitation measures in children and adolescents with behavioral and emotional disorders, suffering from mental disorders, due to stabilization of the emotional sphere, normalization of behavioral reactions, cognitive and emotional functions of the child.

The technical result is the development of a highly effective method for the rehabilitation of behavioral and emotional disorders in children and adolescents suffering from mental disorders.

The technical result is achieved by the fact that on the day of the patient's admission to the medical rehabilitation department with a previously established diagnosis, a psychiatrist consults to determine the mental status, as a result of which he prescribes drug therapy: neuroleptics - thioridazine - for children from 4 to 7 years old - 10 - 20 mg / day 2-3 doses per day; from 8 to 14 years old - 20-30 mg / day in 3 divided doses per day; from 15 to 18 years old - 30-50 mg / day in 2-3 doses per day or pericyazin 4% solution for oral administration, for children over 3 years old, the average daily dose is from 0.1 mg to 0.5 mg per 1 kg of body weight body, while the psychiatrist conducts daily consultations in the morning during the patient's rehabilitation; then, after consulting a psychiatrist, a neurologist consults the patient, determines the neurological status and prescribes sedative therapy: hydroxyzine at the age of 12 months to 6 years - from 1 to 2.5 mg / kg / day in 2-3 doses, from 6 years and older - from 1 to 2 mg / kg / day in 2-3 doses, nootropic therapy: glycine for children over 3 years old - 1 tablet 2-3 times a day or methionyl-glutamyl-histidyl-phenylalanyl-prolyl-glycyl-proline 0, 1% of children over 5 years old, 1-2 drops in each nasal passage 2 times a day - in the morning and in the afternoon, while a neurologist daily, in the morning, examines the patient during the period of rehabilitation in the department; then, on the same day, after examination by a psychiatrist and a neurologist, the patient is examined by a psychologist using diagnostic tests and diagnostic techniques, then, from the next day - the second day of the child's stay in the department, in the morning, regardless of age, the psychologist conducts daily psychocorrection using game therapy, body-oriented therapy, dance therapy, art therapy; further, after the conclusion of a psychologist, the child is examined by a speech therapist - defectologist with an appointment, regardless of age, daily classes in the morning during the rehabilitation period; further, after all the above examinations, on the day of admission, the physical therapy doctor prescribes a course of physiotherapy exercises lasting 10 days, which includes a daily group lesson in the morning, lasting 20 minutes, regardless of age category, with the subsequent transition, after an hour break, to mechanotherapy using simulators in the sequence - a rehabilitation simulator with functional electrical stimulation and biological feedback RT: children 3-7 years old - 5-10 minutes, load 1, children 8-11 years old - 10 minutes, load 2; children 12-17 years old - 10 minutes, load from 3 to 10; Pablo device with biofeedback with accessories: children 3-7 years old - 6 minutes with a load of 50%; children 8-11 years old - 6 minutes with a load of 75%; children 12-17 years old - 6 minutes with a load of 100%; rehabilitation platform with accessories: for children 8-11 years old - 5 minutes; children 12-17 years old - 5 minutes; hippo exercise machine RodeoPro: children 3-7 years old - 5 minutes, 1 speed; children 8-11 years old - 5 minutes, speed 2; children 12-17 years old - 5 minutes, speed 2; exercise bike Torneo B-225 GNOVA: children 3-7 years old - 5 minutes, load 1; children 8-11 years old - 5 minutes, load 2; children 12-17 years old - 5 minutes, load 3; treadmill TorneoT-205 SMARTA: children 3-7 years old - 5 minutes, 1 speed; children 8-11 years old - 5 minutes, speed 2; children 12-17 years old - 5 minutes, speed 2; mini stepper with a handle S-221 TEMPO: children 3-7 years old - 5 minutes, no load; children - 8-11 years old - 5 minutes, no load; children 12-17 years old - 5 minutes, no load; elliptical pedometer C-218 TORNEO: children 3-7 years old - 5 minutes, load 1; children 8-11 years old - 5 minutes, load 1-2; children 12-17 years old - 5 minutes, load 2-3; Domyos Essential 240 trampoline: children 3-7 years old - 5 minutes, no load; children 8-11 years old - 5 minutes, no load; in the second half of the day, after a day's rest, the patient undergoes additional physical therapy classes using game items, elements of sports medicine: dry pool - children 3-7 years old - 10 minutes, obstacle course - children 3-7 years old - 10 minutes, children 8-11 years old - 15 minutes, children 12-17 years old - 20 minutes, elements of sports medicine: badminton - children 3-7 years old - 10 minutes, children 8-11 years old - 15 minutes, children 12-17 years old - 20 minutes, basketball hoop - children 3-7 years old - 10 minutes, children 8-11 years old - 15 minutes, children 12-17 years old - 20 minutes, table tennis - children 3-7 years old - 10 minutes, children 8-11 years old - 15 minutes , children 12-17 years old - 20 minutes; a physiotherapist prescribes a massage of the cervical-collar zone, daily, ten days, lasting 20 minutes, regardless of age category, in the morning, after a 30-minute break after physiotherapy exercises and a ten-day course, including alternating electrosonic therapy - 5 procedures: for children 3-7 years old, current strength 0.6 mA - 1.0 mA, children 8-11 years old - 2 mA, children 12-17 years old - 3-4 mA, the duration of the procedure with the first exposure is 10-15 minutes, with subsequent exposure - 30 minutes with electrophoresis of 2% Ca and 2% Br according to Vermel - 5 procedures: children 3-7 years old, current strength 5 mA, procedure duration 7 minutes, children 8-11 years old, current strength 7-10 mA, duration - 10 minutes, children 12 -17 years old - 12 mA, lasting 10 minutes or by electrophoresis of 2% Ca and 2% Br according to Shcherbak: children 3-7 years old - current strength 3-5-7 mA, duration -3-5-8 minutes, children 8-11 years - current strength 4-6-8-10 mA, duration 4-6-8-10 minutes, children 12-17 years old - current strength 6-8-10-12 mA, duration - 6-8-10-12 mA in wto swarm half of the day, 40 minutes after acupuncture; in turn, the reflexologist prescribes a ten-day daily course according to the classical method of acupuncture "Wu-sin", using acupuncture points in the following sequence: vg20 - on the midline of the head, above the back border of hair growth by 7 tsun and 5 tsuns from the front border of growth hair, gi4 - between the 1st and 2nd metacarpal bones closer to the middle of the 2nd metacarpal bone in the fossa, e36 - below the upper edge of the lateral condyle of the tibia by 3 tsun, at the anterior tibial muscle, rp6 - posterior to the tibia, above the center of the medial malleolus by 3 tsunya, gi 11-in the middle of the distance between the lateral epicondyle and the radial end of the elbow folds, v11 - at the level of the interval between the spinous processes of 1 and 2 thoracic vertebrae, 1.5 tsun away from the midline, v12 - at the level of the interval between the spinous processes of the 2nd and 3rd thoracic vertebrae, 1.5 cun away from the midline, v13 - at the level of the interval between the spinous processes of the 3rd and 4th thoracic vertebrae in side from the midline by 1.5 tsun, v23 - at the level of the interval between the spinous processes of the 2 and 3 lumbar vertebrae aside from the midline by 1.5 tsun, v25 - at the level of the interval between the spinous processes of the 4 and 5 lumbar vertebrae aside from the middle line by 1.5 cunya, v36 - in the center of the sub-gluteal fold, while the reflexotherapy session is carried out 30 minutes after the exercise therapy class using game items and elements of sports medicine in the second half of the day, the duration of the procedure is 20 minutes; the frequency of such rehabilitation courses is 1-3 times a year.

The method is carried out in the following way.

On the day of admission of the patient to the medical rehabilitation department with a previously established diagnosis, a psychiatrist consults to determine the mental status (see Eidemiller EG Child psychiatry. 2005. S. 218-286).

On the basis of a psychiatrist's consultation, drug therapy is prescribed (neuroleptics - thioridazine (sonapax) - for children from 4 to 7 years old - 10-20 mg / day in 2-3 doses per day; from 8 to 14 years old - 20-30 mg / day in 3 admission per day; from 15 to 18 years old - 30-50 mg / day in 2-3 doses per day or peritsiazine (neuleptil) 4% solution for oral administration, for children over 3 years old, the average daily dose is from 0.1 mg to 0 , 5 mg per 1 kg of body weight).

A psychiatrist is consulted daily during the child's rehabilitation period.

Further, after consulting a psychiatrist, the child undergoes a complete neurological examination with the determination of the neurological status (see. Badalyan L.O. Pediatric neurology. 2010, pp. 71-214).

Based on the examination, a neurologist prescribes sedative therapy (hydroxyzine (atarax) at the age of 12 months to 6 years - from 1 to 2.5 mg / kg / day in 2-3 doses, from 6 years and older - from 1 to 2 mg / kg / day in 2-3 doses), nootropic therapy (glycine for children over 3 years old - 1 tablet 2-3 times a day or methionyl-glutamyl-histidyl-phenylalanyl-prolyl-glycyl-proline 0.1% (Semax) children over 5 years old, 1-2 drops in each nasal passage 2 times a day (morning and afternoon)).

Also, every day during the period of rehabilitation in the department, the child is examined by a neurologist.

Further, on the same day, after examination by a psychiatrist and a neurologist, the patient is examined by a psychologist using diagnostic tests:

- test of anxiety Tamml, Dorki, Amen (see Diagnostics of emotional and moral development of St. Petersburg; 2002, pp. 19-28. Ovcharova R.V. Practical psychology in primary school - M, 1999), test "Fairy Tale" (see Fairytale therapy for children of preschool and primary school age. Strogova N. A.), children's test "Picturesque frustration" S. Rosenzweig, "hand test", picture test Silver (technique of stimulating drawing) (see Working tool of child psychologist. Teacher. 2015) , test "Emotional spheres", test of animals, Rene Zazzo, "Color test of relationships" A. Etkind, Szondi test, Luscher color test (see M. Luscher. Psychological practice. 1999), and methods: "Non-existent animal" (see Venger AL Psychological drawing tests. M: Vlads-Press. 2003.), "House-Tree-Man", "Man in the Rain" (see. Psychological and pedagogical support of children with disorders of the emotional-volitional sphere. Staroverova M . S, Kuznetsova O. I. "Vlados" 2014), "Self-portrait", "Cactus", "Application", "Two houses", "Houses" Orekhovoy O. A., drawing of a family, Rene Gilles, "Mosaic", interview with "The Magic World" by L. D. Stolyarenko, "Contour SAT-N" (see. E. Chris. Author's modification. 2003).

Then, from the next day (the second day of the child's stay in the department), regardless of age, the psychologist conducts daily psychocorrection using game therapy, body-oriented therapy, dance therapy, art therapy.

Further, after the conclusion of a psychologist, the child is examined by a speech therapist - defectologist with an appointment, regardless of age, daily activities.

On the basis of the child's established diagnosis, all of the above examinations on the day of admission, their appointments are made: physiotherapy exercises (exercise therapy) - prescribes a course of physiotherapy exercises lasting 10 days includes in the first half of the day - a daily group lesson lasting 20 minutes, regardless of age category , with the subsequent transition, after an hour break, to mechanotherapy using simulators in order to stabilize the emotional - volitional sphere in a certain sequence:

- rehabilitation simulator with functional electrical stimulation and biological feedback RT (registration certificate for a medical device No. RZN 2013/872): children 3-7 years old - 5-10 minutes, load 1; children 8-11 years old - 10 minutes, load 2; children 12-17 years old - 10 minutes, load from 3 to 10;

- Pablo device with biofeedback with accessories (registration certificate for a medical device dated September 15, 2016 No. RZN 2016/4708): children 3-7 years old - 6 minutes with a load of 50%; children 8-11 years old - 6 minutes with a load of 75%; children 12-17 years old - 6 minutes with a load of 100%;

- rehabilitation platform with accessories (registration certificate No. FSZ 2012/13281): children 7-11 years old - 5 minutes; children 12-17 years old - 5 minutes;

- RodeoPro horse trainer: children 3-7 years old - 5 minutes, 1 speed; children 8-11 years old - 5 minutes, speed 2; children 12-17 years old - 5 minutes, speed 2;

- exercise bike TorneoB-225 GNOVA: children 3-7 years old - 5 minutes, load 1; children 8-11 years old - 5 minutes, load 2; children 12-17 years old - 5 minutes, load 3;

- treadmill TorneoT-205 SMARTA: children 3-7 years old - 5 minutes, 1 speed; children 8-11 years old - 5 minutes, speed 2; children 12-17 years old - 5 minutes, speed 2;

- mini stepper with a handle S-221 TEMPO: children 3-7 years old - 5 minutes, no load; children - 8-11 years old - 5 minutes, no load; children 12-17 years old - 5 minutes, no load;

- elliptical pedometer C-218 TORNEO: children 3-7 years old - 5 minutes, load 1; children 8-11 years old - 5 minutes, load 1-2; children 12-17 years old - 5 minutes, load 2-3;

- Essential 240 Domyos trampoline: children 3-7 years old - 5 minutes, no load; children 8-11 years old - 5 minutes, no load.

Also, in the second half of the day, after a day's rest, the physical therapy doctor prescribes - the use of game items: a dry pool (children 3-7 years old - 10 minutes), an obstacle course (children 3-7 years old - 10 minutes; children 8- 11 years old - 15 minutes; children 12-17 years old - 20 minutes), elements of sports medicine: badminton (children 3-7 years old - 10 minutes; children 8-11 years old - 15 minutes; children 12-17 years old - 20 minutes), basketball hoop (children 3-7 years old - 10 minutes; children 8-11 years old - 15 minutes; children 12-17 years old - 20 minutes), table tennis (children 3-7 years old - 10 minutes; children 8-11 years old - 15 minutes; children 12-17 years old - 20 minutes).

Physiotherapist prescribes a massage of the cervical-collar zone, daily, ten days, lasting 20 minutes, regardless of age category, in the morning, after a 30-minute break after physiotherapy exercises and a ten-day course, which includes alternating electrosonic therapy (5 procedures) with electrophoresis (5 procedures).

Electro-sleep therapy is carried out on the BTL-4000 and Magnon-SLIP devices using the fronto-mastoid technique (electrodes with a rectangular hydrophilic pad) and on the ES-10-5 device according to the orbital-retromastoidal technique with the use of bifurcated electrodes ( a rubber cuff with bifurcated electrodes is used, in the sockets of which hydrophilic pads with a thickness of 1 cm are inserted, the eye electrodes are placed on the closed eyelids and connected to the cathode, the occipital electrodes are fixed on the mastoid processes of the temporal bones and are attached to the anode) (see "Physiotherapy and balneology" , book 1 / edited by V.M.Bogolyubov. - M .: Binom, 2016.).

For children from 3-7 years old, the current strength is 0.6 mA - 1.0 mA, for children 8-11 years old - 2 mA, for children 12-17 years old - 3-4 mA, the duration of the procedure for the first exposure is 10-15 minutes, for subsequent - 30 min.

Electrophoresis of 2% Ca (+) and 2% Br (-) according to Vermel is carried out using the Potok-1M, BTL-4000 apparatus (an electrode with a pad with an area of 100-250 cm ² (depending on age) is applied to the interscapular area - the anode, two other electrodes with an area of 50-125 cm are placed on the calf muscles - the cathode), for children 3-7 years old, the current strength is 5 mA, the duration of the procedure is 7 minutes; children 8-11 years old, current strength 7-10 mA, duration - 10 minutes; children 12-17 years old - 12 mA, lasting 10 minutes (5 procedures) or electrophoresis of 2% Ca (+) and 2% Br (-) according to Shcherbak (the first electrode in the form of a collar with a total area of 400-600 cm ² is located in the area shoulder girdle - the anode, the second electrode in the form of a rectangle with an area of 150-300 cm ² is located in the lumbosacral region - the cathode), for children 3-7 years old - current strength 3-5-7 mA, duration - 3-5-8 minutes, children 8-11 years old - current strength 4-6-8-10 mA, duration 4-6-8-10 minutes, children 12-17 years old - current strength 6-8-10-12 mA, duration - 6-8- 10-12 mA (5 treatments).

The patient receives physiotherapy in the afternoon 40 minutes after the acupuncture.

Also, the doctor - reflexologist prescribes a ten-day daily course according to the classical method of acupuncture "U-sin" (see "Children's and adolescent psychotherapy. Neuroses in children", 2nd edition, Yu.A. Fesenko, V.I. Garbuzov, 2019) using acupuncture points in the following sequence: vg20 (on the midline of the head, above the posterior border of hair growth by 7 tsuni and 5 tsuni from the anterior border of hair growth), gi4 (between the 1st and 2nd metacarpal bones closer to the middle of the 2nd metacarpal bone in the fossa) , e36 (below the upper edge of the lateral condyle of the tibia by 3 tsunya, near the anterior tibial muscle), rp6 (posterior to the tibia, 3 tsunya above the center of the medial ankle), gi11 (in the middle of the distance between the lateral epicondyle and the radial end of the fold of the ulnar ), v11 (at the level of the interval between the spinous processes of the 1st and 2nd thoracic vertebrae, 1.5 cun away from the midline), v12 (at the level of the interval between the spinous processes of the 2nd and 3rd thoracic vertebrae, away from the middle 1st line by 1.5 cu), v13 (at the level of the interval between the spinous processes of the 3rd and 4th thoracic vertebrae away from the midline by 1.5 cu), v23 (at the level of the interval between the spinous processes of the 2nd and 3rd lumbar vertebrae away from the middle line by 1.5 tsun), v25 (at the level of the interval between the spinous processes of the 4 and 5 lumbar vertebrae to the side of the midline by 1.5 tsun), v36 (in the center of the subgluteal fold).

The duration of the procedure is 20 minutes. Patients undergo a reflexology session 30 minutes after the exercise therapy class using game items and elements of sports medicine, in the afternoon.

Thus, during hospitalization in the department of medical rehabilitation, the child has a stabilization of the emotional sphere, the normalization of behavioral reactions, cognitive and speech functions.

When a patient is withdrawn from the rehabilitation program (discharge from the department), specialists give detailed recommendations with an invitation to the next course, the frequency of courses is 1-3 times a year.

The practical implementation of the proposed method is illustrated by examples from clinical practice.

Example 1.

Patient A., 4 years old, was admitted to the department of medical rehabilitation of the State Budgetary Institution of the Russian Regional Children's Clinical Hospital on 02.12.2019 with complaints of impaired behavior and emotions (restlessness, disinhibition, self-will, disobedience, irritability, aggressiveness, tearfulness, rapid mood swings), weak memory, distracted attention, learning difficulties, fuzzy speech.

From the anamnesis: sick from an early age, perinatal history is burdened (first pregnancy, proceeding with fetal hypoxia; first birth, natural, rapid, stimulated, at 36 weeks, cry immediately, weight 3.400 kg; early development - with a delay); observed by a neurologist, psychiatrist at the place of residence.

He was admitted to the department of medical rehabilitation of the State Budgetary Institution of the Russian Regional Children's Clinical Hospital with the first diagnosis: "Organic lesion of the central nervous system, syndrome of emotional-volitional instability, mixed specific disorder of mental development, hyperpyretic forms of behavior, dysarthria."

The child arrived for rehabilitation with the results of the examination: EEG - slight diffuse changes of an irritative nature; on MRI of the brain + MRA - on a series of tomograms, images of sub-, supratentorial structures of the brain in sagittal, frontal and axial projections were obtained. No pathologically altered MP signal was found in the brain substance, trunk, cerebellum. Differentiation of gray and white matter is not reduced. In the white matter of the frontal-parietal lobes on both sides, multiple elongated zones of the hyperintense MP signal are determined due to the expansion of the perivascular spaces. The ventricles of the brain are not dilated, the lateral ventricles are symmetrical, slightly dilated. Subarachnoid convexital spaces are not enlarged. There is no displacement of the median structures. In the area of MMU on both sides of the pathological masses is not determined. Base tanks are not widened. The chiasmally sellar region is unremarkable; the pituitary gland has a typical MP signal. The craniovertebral junction was unremarkable; the cerebellar tonsils were located at the BZO level. Hypertrophy of the nasal mucosa. In the right half of the main sinus, the cyst measures 6.5 × 11.1 mm. Deviation of the nasal septum in the middle third to the left. When performing MP angiography, the left and right internal carotid and its siphon of the usual direction and diameter, without signs of displacement or external compression, the MP signal inside the lumen of the vessels is homogeneous. The circle of Willis is closed, hypoplasia of the PCA on both sides, the intracranial spine of the vertebral arteries is not changed, the MP signal is uniform, and no filling defects were found. Aneurysms and AVMs of cerebral vessels were not identified. Conclusion: MP signs of slight expansion of the lateral ventricles, expansion of the perivascular spaces. Variant of the structure of the circle of Willis. Cyst of the main sinus. Deviation of the septum of the nose.

12/02/2019 - examination by a psychiatrist and a neurologist, as well as a psychologist: according to the results of an experimental psychological study, the child has pronounced changes in the emotional-volitional, behavioral and cognitive spheres. Decreased concentration of voluntary attention. Changes in the emotional-volitional sphere: emotional lability, hyperthymic variant. Increased psychomotor irritability. Hyperkinetic forms of behavior. Decreased ability to mental stress. Decrease in criticality, underdevelopment of the sphere of self-control).

12/02/2019 - examination of a speech therapist - defectologist - confirmed the presence of dysarthria.

The consultations of these specialists in the department of medical rehabilitation confirmed the established diagnosis: "Organic lesion of the central nervous system, syndrome of emotional-volitional instability, mixed specific disorder of mental development, hyperpyretic forms of behavior, dysarthria."

The rehabilitation course included:

drug therapy prescribed by a psychiatrist and a neurologist: sonapax - 10-20 mg / day in 2-3 doses per day, glycine - 1 tablet 2-3 times a day, - 14 days, starting from 03.12. on an outpatient basis after discharge;

doctor's prescription - exercise therapy - a course of physiotherapy exercises, starting from 12/03/2019, lasting 10 days, includes in the first half of the day a daily group lesson, lasting 20 minutes, followed by a transition, after an hour's break, to mechanotherapy using simulators in order to stabilize emotionally - volitional sphere in a certain sequence:

- rehabilitation simulator with functional electrical stimulation and biological feedback RT (registration certificate for a medical device No. RZN 2013/872): - 5-10 minutes, load 1;

- Pablo device with biofeedback with accessories (registration certificate for a medical device dated September 15, 2016 No. RZN 2016/4708): - 6 minutes with a load of 50%;

- rehabilitation platform with accessories (registration certificate No. FSZ 2012/13281): - 5 minutes; hippo exercise machine RodeoPro: - 5 minutes, 1 speed;

- exercise bike TorneoB-225 GNOVA: - 5 minutes, load 1;

- treadmill TorneoT-205 SMARTA: - 5 minutes, 1 speed;

- mini stepper with S-221 TEMPO handle: - 5 minutes, no load;

- elliptical pedometer C-218 TORNEO: - 5 minutes, load 1;

- Essential 240 Domyos trampoline: - 5 minutes, no load;

- after a 30-minute break - a massage of the cervical-collar zone is prescribed, daily, ten days, lasting 20 minutes;

- in the afternoon, after a day's rest - use of game items: dry pool (- 10 minutes), obstacle course (- 10 minutes), elements of sports medicine: badminton (-10 minutes), basketball hoop (-10 minutes), table tennis (- 10 minutes).

The doctor - reflexologist prescribes a ten-day daily course according to the classical method of acupuncture "Wu-sin", starting from 03.12.2019, using acupuncture points in the following sequence: vg20 (on the midline of the head, above the posterior border of hair growth by 7 tsuni and 5 tsuni from the front boundaries of hair growth), gi4 (between the 1st and 2nd metacarpals closer to the middle of the 2nd metacarpal bone in the fossa), e36 (below the upper edge of the lateral condyle of the tibia by 3 cunya, at the anterior edge of the tibial muscle), rp6 (posterior to the tibia, above the center of the medial malleolus by 3 cunya), gi11 (in the middle of the distance between the lateral epicondyle and the radial end of the ulnar fold), v11 (at the level of the interval between the spinous processes of 1 and 2 thoracic vertebrae, away from the midline by 1.5 cunya), v12 (at the level of the interval between the spinous processes of the 2nd and 3rd thoracic vertebrae, 1.5 tsun away from the midline), v13 (at the level of the interval between the spinous processes of the 3rd and 4th thoracic vertebrae vertebrae away from the midline by 1.5 tsun), v23 (at the level of the interval between the spinous processes of the 2 and 3 lumbar vertebrae aside from the midline by 1.5 tsun), v25 (at the level of the interval between the spinous processes of the 4 and 5 lumbar vertebrae away from the midline by 1.5 cunya), v36 (in the center of the subgluteal fold).

The duration of the procedure is 20 minutes. A reflexology session takes place 30 minutes after the exercise therapy session with the use of game items and elements of sports medicine in the afternoon.

The physician on FTL prescribes a ten-day course from 03.12.2019, which includes alternating electrosonic therapy after one day, a total of 5 procedures, with a current strength of 0.6 mA - 1.0 mA, the duration of the procedure for the first exposure is 10-15 minutes, for subsequent 30 minutes, with electrophoresis of 2% Ca and 2% Br according to Vermil, starting from 04.12.2019, 5 procedures in total, with a current of 5 mA, the duration of the procedure is 7 minutes.

The procedures are carried out in the afternoon 40 minutes after the acupuncture session.

From 03.12.2019 - they conduct daily examinations by a psychiatrist and a neurologist, psychocorrection carried out by a psychologist, with a child and mother, daily speech therapy sessions.

Against the background of the ongoing complex of rehabilitation measures on the 5-7th day, the child shows stabilization of the emotional sphere, normalization of behavioral reactions, cognitive and speech functions. This made it possible to reduce the rehabilitation period to 14 days.

The child underwent 1 course of rehabilitation. When the patient is withdrawn from the rehabilitation program and is discharged from the department, the specialists issued detailed recommendations with an invitation to a second course of rehabilitation, if necessary.

Example 2.

Patient N., 7 years old, was admitted to the Department of Medical Rehabilitation of the State Budgetary Institution of Regional Development of the CSTO on November 18, 2019 with complaints of restlessness, rapid distraction, mood swings, irritability, tearfulness, memory and attention loss.

Anamnesis: sick from an early age; the perinatal history is burdened (pregnancy - the first, proceeding with the threat of a breakdown in the second trimester, childbirth - the first, at 40 weeks, with the stimulation of labor, squeezed out, weight - 4300 g, screamed at once); the child is monitored by a psychiatrist at the place of residence, a neurologist in the conditions of the CSTO.

He was admitted to the department of medical rehabilitation of the State Budgetary Institution of the Russian Regional Children's Clinical Hospital with the first diagnosis: "Organic lesion of the central nervous system, hyperpyretic forms of behavior, syndrome of emotional-volitional instability, mixed specific disorder of mental development."

The child arrived for rehabilitation with the results of examination: on EEG - moderate diffuse changes of an irritative nature, on MRI of the brain + MRA - images of sub-, supratentorial structures of the brain in sagittal, frontal and axial projections were obtained on a series of tomograms. The ventricles of the brain are not dilated, IV is without features. The lateral ventricles are symmetrical, not dilated. Subarachnoid convexital spaces are not enlarged. There is no displacement of the median structures. In the area of MMU on both sides of the pathological masses is not determined. Base tanks are not widened. The chiasmally sellar region is unremarkable; the pituitary gland has a typical MP signal. The craniovertebral junction was unremarkable; the cerebellar tonsils were located at the BZO level. The sinuses are airy. Adenoids. Total darkening of the main sinus, hypertrophy of the nasal mucosa, ethmoid cells. When performing MP angiography, the left and right internal carotid and its siphon of the usual direction and diameter, without signs of displacement or external compression, the MP signal inside the lumen of the vessels is homogeneous. The circle of Willis is closed, the hypoplasia of the PCA is on the left, the intracranial spine of the vertebral arteries is asymmetric, the MP signal is uniform, and there are no filling defects. Aneurysms and AVMs of cerebral vessels were not identified. Conclusion: MP signs of pathological changes in the substance of the brain were not revealed, a variant of the structure of the circle of Willis, ethmoiditis, sphenoiditis.

11/18/2019 - examination by a psychiatrist and a neurologist, as well as a psychologist: according to the results of an experimental psychological study with an existing specific disorder of psychological development, the child has pronounced changes in the emotional-volitional and behavioral spheres, cognitive, sensory-perceptual; immaturity of visual-figurative thinking, violation of the formation of verbal-logical thinking; low arbitrariness of activity; decreased concentration of voluntary attention, with an uneven decrease in mnestic functions; changes in the emotional - volitional sphere: emotional lability, hyperthymic variant, increased psychomotor excitability; decreased ability to mental stress; especially in the communicative - behavioral sphere: violations of communicative behavior, with unevenly expressed isolation, lack of emotional contact; rigidity of psycho-emotional attitudes.

11/18/2019 - examination of a speech therapist - defectologist did not reveal a speech therapy defect.

The consultations of these specialists in the department of medical rehabilitation confirmed the established diagnosis: "Organic lesion of the central nervous system, hyperpyretic forms of behavior, syndrome of emotional-volitional instability, mixed specific disorder of mental development."

The rehabilitation course included:

drug therapy prescribed by a psychiatrist and a neurologist (sonapax - 10-20 mg / day in 2-3 doses per day, glycine - 1 tablet 2-3 times a day) - 14 days, starting from 11/19/2019 with subsequent continuation outpatient therapy after discharge;

doctor's prescription - exercise therapy - a course of physiotherapy exercises, starting from 11/19/2019, lasting 10 days, includes in the morning a daily group lesson, lasting 20 minutes, followed by a transition, after an hour's break, to mechanotherapy using simulators in order to stabilize emotionally - volitional sphere in a certain sequence:

- rehabilitation simulator with functional electrical stimulation and biological feedback RT (registration certificate for a medical device No. RZN 2013/872): - 5-10 minutes, load 1;

Pablo device with biofeedback with accessories (registration certificate for a medical device dated September 15, 2016 No. RZN 2016/4708): - 6 minutes with a load of 50%;

- rehabilitation platform with accessories (registration certificate No. FSZ 2012/13281): - 5 minutes; hippo exercise machine RodeoPro: - 5 minutes, 1 speed;

- exercise bike TorneoB-225 GNOVA: - 5 minutes, load 1;

- treadmill TorneoT-205 SMARTA: - 5 minutes, 1 speed;

- mini stepper with S-221 TEMPO handle: - 5 minutes, no load;

- elliptical pedometer C-218 TORNEO: - 5 minutes, load 1;

- Essential 240 Domyos trampoline: - 5 minutes, no load;

- after a 30-minute break - a massage of the cervical-collar zone is prescribed, daily, ten days, lasting 20 minutes;

- in the afternoon, after a day's rest - use of game items: dry pool (- 10 minutes), obstacle course (- 10 minutes), elements of sports medicine: badminton (-10 minutes), basketball hoop (-10 minutes), table tennis (- 10 minutes).

The doctor - reflexologist prescribes a ten-day daily course according to the classical method of acupuncture "Wu-sin", starting from 11/19/2019, using acupuncture points in the following sequence: vg20 (on the midline of the head, above the back border of hair growth by 7 tsuni and 5 tsuni from the front the boundaries of hair growth), gi4 (between the 1st and 2nd metacarpal bones closer to the middle of the 2nd metacarpal bone in the fossa), e36 (below the upper edge of the lateral condyle of the tibia by 3 cunya, at the anterior edge of the tibia muscle), rp6 (posterior to the tibia, above the center of the medial ankle by 3 tsunya), gi11 (in the middle of the distance between the lateral epicondyle and the radial end of the ulnar fold), v11 (at the level of the gap between the spinous processes of 1 and 2 thoracic vertebrae, away from the midline by 1.5 tsunya) , v12 (at the level of the interval between the spinous processes of the 2nd and 3rd thoracic vertebrae, away from the midline by 1.5 cunya), v13 (at the level of the interval between the spinous processes of the 3rd and 4th thoracic vertebrae vertebrae away from the midline by 1.5 tsun), v23 (at the level of the interval between the spinous processes of the 2 and 3 lumbar vertebrae aside from the midline by 1.5 tsun), v25 (at the level of the interval between the spinous processes of the 4 and 5 lumbar vertebrae away from the midline by 1.5 cunya), v36 (in the center of the subgluteal fold).

The duration of the procedure is 20 minutes. A session of acupuncture takes place 30 minutes after the exercise therapy class using game items and elements of sports medicine in the afternoon.

The FTL doctor prescribes from 11/19/2019 a ten-day course, which includes alternation after one day of electrosonic therapy, a total of 5 procedures, with a current of 0.6 mA - 1.0 mA, the duration of the procedure for the first exposure is 10-15 minutes, for subsequent - 30 minutes, with Vermil electrophoresis, starting from 20.11.2019, 5 procedures in total, with a current of 3 mA, 3 minutes - the first procedure, 5 mA, 5 minutes - the second procedure, 7 mA, 8 minutes - the third procedure, the next two procedures - 7 mA, 8 minutes. The procedures are carried out in the afternoon 40 minutes after acupuncture sessions.

From 19.11.2019 - they conduct daily examinations by a psychiatrist and a neurologist, psychocorrection carried out by a psychologist, with a child and a mother.

Against the background of the ongoing complex of rehabilitation measures on the 5-7th day, the child shows positive dynamics in the form of stabilization of the emotional sphere, normalization of behavioral reactions, cognitive and speech functions. This made it possible to reduce the rehabilitation period to 14 days.

When the patient is withdrawn from the rehabilitation program and is discharged from the department, the specialists issued detailed recommendations with an invitation to the next course.

The second course on this method of rehabilitation was carried out to the patient from 03/02/2020 to 03/16/2020. Against the background of the ongoing complex of rehabilitation measures, the child's emotional sphere stabilized, behavioral reactions, cognitive and speech functions normalized. The rehabilitation period was 14 days.

Example 3.

Patient K., 13 years old, was admitted to the Department of Medical Rehabilitation of the State Budgetary Institution of the Regional Children's Clinical Hospital on 03/04/2019 with complaints of disinhibition, restlessness, excitability, mood swings, irritability, tearfulness, weak memory, distracted attention, and fuzzy speech.

Anamnesis: sick from an early age; perinatal history (pregnancy - the first, preeclampsia (edema, increased blood pressure up to 170/100 mm Hg), childbirth - the first, cesarean section, planned (according to the mother's indications), 37 weeks. Weight - 3120 g, cried immediately); observed by a neurologist at the place of residence and in the CSTO, by a psychiatrist at the place of residence.

He was admitted to the department of medical rehabilitation of the State Budgetary Institution of Regional Development of the CSTO with the first diagnosis: "Organic lesion of the central nervous system, hyperkinetic forms of behavior, syndrome of emotional-volitional instability, dysarthria, mixed specific disorder of mental development."

The child arrived for rehabilitation with the results of the examination:

on the EEG - with open eyes, diffuse changes of an irritative-dysrhythmic nature; epic activity is not traced.

on MRI of the brain + MRA - on a series of tomograms, images of sub-, supratentorial structures of the brain in sagittal, frontal and axial projections were obtained. No pathologically altered MP signal was found in the trunk or cerebellum. Differentiation of gray and white matter is not reduced. The ventricles of the brain are not dilated, the lateral ventricles are symmetrical, not dilated. Between the contours of the lateral ventricles there is a slit-like cyst of the transparent septum. At the posterior horn of the left lateral ventricle there is a zone of gliosis. Subarachnoid convexital spaces are slightly enlarged. There is no displacement of the median structures. In the area of MMU on both sides of the pathological masses is not determined. Base tanks are not widened. The chiasmally sellar region is unremarkable; the pituitary gland has a typical MP signal. The craniovertebral junction was unremarkable; the cerebellar tonsils were located at the BZO level. A cyst with dimensions of 20.2 × 11.1 mm is determined retrocerebellar. Hypertrophy of the nasal mucosa, ethmoid cells, parietal hypertrophy of the maxillary sinus mucosa. Adenoids. When performing MP angiography, the left and right internal carotid and its siphon of the usual direction and diameter, without signs of displacement or external compression, the MP signal inside the lumen of the vessels is homogeneous. The circle of Willis is closed, the intracranial part of the vertebral arteries is not changed, the MP signal is uniform, and no filling defects were found. Aneurysms and AVMs of cerebral vessels were not identified. Conclusion: MP signs of slight expansion of subarachnoid convexital spaces, slit cyst of the transparent septum, retrocerebellar cyst, gliosis zone at the posterior horn of the left lateral ventricle. Signs of ethmoiditis, rhinosinitis.

03/04/2019 - examination by a psychiatrist and a neurologist, as well as a psychologist: according to the results of an experimental psychological study with an existing specific disorder of psychological development, the child has pronounced changes in the behavioral, emotional-volitional and cognitive spheres. Underdevelopment of visual-figurative thinking, a pronounced decrease in the rate of formation of verbal-logical thinking. Low randomness of activity. Decrease in concentration of voluntary attention, with an uneven decrease in mnestic functions. Increased psychomotor irritability. Hyperkinetic forms of behavior. Changes in the emotional - volitional sphere: emotional lability, hyperthymic variant. Decreased ability to mental stress. Features of conditions, signs of noophobia. Violation of the development of the adaptation sphere.

03/04/2019 - examination of the speech therapist revealed Dysarthria.

The consultations of these specialists in the department of medical rehabilitation confirmed the established diagnosis: "Organic lesion of the central nervous system, hyperkinetic forms of behavior, syndrome of emotional-volitional instability, dysarthria, mixed specific disorder of mental development."

The rehabilitation course included:

drug therapy prescribed by a psychiatrist and a neurologist (sonapax - 20-30 mg / day in 2-3 doses per day, glycine - 1 tablet 2-3 times a day) - 14 days, starting from 8.10.2019 with subsequent continuation outpatient therapy after discharge;

doctor's prescription - exercise therapy - a course of physiotherapy exercises, starting from 03/05/2019, lasting 10 days, includes in the first half of the day a daily group lesson, lasting 20 minutes, followed by a transition, after an hour's break, to mechanotherapy using simulators in order to stabilize emotionally - volitional sphere in a certain sequence:

- rehabilitation simulator with functional electrical stimulation and biological feedback RT (registration certificate for a medical device No. RZN 2013/872): - 10 minutes, load from 3 to 10;

Pablo device with biofeedback with accessories (registration certificate for a medical device dated September 15, 2016 No. RZN 2016/4708): - 6 minutes with a load of 100%;

- rehabilitation platform with accessories (registration certificate No. FSZ 2012/13281): - 5 minutes;

hippo exercise machine RodeoPro: - 5 minutes, 2 speed;

- exercise bike TorneoB-225 GNOVA: - 5 minutes, load 3;

- treadmill TorneoT-205 SMARTA: - 5 minutes, 2 speed;

- mini stepper with S-221 TEMPO handle: - 5 minutes, no load;

- elliptical pedometer C-218 TORNEO: - 5 minutes, load 2-3;

After a 30 minute break, a massage of the neck and collar zone is prescribed, daily, ten days, lasting 20 minutes;

- in the second half of the day, after a day's rest - use of game items: obstacle course (- 20 minutes), elements of sports medicine: badminton (- 20 minutes), basketball hoop (- 20 minutes), table tennis (- 20 minutes).

The doctor - reflexologist 03/04/2019 prescribes a ten-day daily course according to the classical method of acupuncture "Wu-sin", starting from 03/05/2019, using acupuncture points in the following sequence: vg20 (on the midline of the head, above the posterior border of hair growth by 7 tsuni and 5 tsuni from the anterior border of hair growth), gi4 (between 1 and 2 metacarpal bones closer to the middle of the 2nd metacarpal bone in the fossa), e36 (below the upper edge of the lateral condyle of the tibia by 3 tsunya, at the anterior edge of the tibial muscle), rp6 (posterior to tibia, above the center of the medial malleolus by 3 tsunya), gi11 (in the middle of the distance between the lateral epicondyle and the radial end of the ulnar fold), v11 (at the level of the interval between the spinous processes of 1 and 2 thoracic vertebrae, away from the midline by 1, 5 tsun), v12 (at the level of the interval between the spinous processes of the 2 and 3 thoracic vertebrae, aside from the midline by 1.5 tsun), v13 (at the level of the interval between the spinous processes of 3 and 4 thoracic vertebrae away from the midline by 1.5 tsun), v23 (at the level of the interval between the spinous processes of 2 and 3 lumbar vertebrae aside from the midline by 1.5 tsun), v25 (at the level of the interval between the spinous processes 4 and 5 lumbar vertebrae to the side of the midline by 1.5 tsun), v36 (in the center of the subgluteal fold).

The duration of the procedure is 20 minutes. A reflexology session takes place 30 minutes after the exercise therapy class with the use of game items, elements of sports medicine.

The FTL doctor on 03/04/2019 prescribes a ten-day course from 03/05/2019, which includes alternating electrosonic therapy after one day, only 5 procedures, with a current strength of 3 mA - 4 mA, the duration of the procedure for the first exposure is 10-15 minutes, for subsequent ones - 30 minutes, with electrophoresis according to Vermil, 5 procedures in total, with a current of 12 mA, lasting 10 minutes. The procedures are carried out in the afternoon 40 minutes after acupuncture sessions.

From 03/05/2019 - they conduct daily examinations by a psychiatrist and a neurologist, psychocorrection carried out by a psychologist, with a child and a mother.

Against the background of the ongoing complex of rehabilitation measures on the 5-7th day, the child shows positive dynamics in the form of stabilization of the emotional sphere, normalization of behavioral reactions, cognitive and speech functions. This made it possible to reduce the rehabilitation period to 14 days.

When the patient was withdrawn from the rehabilitation program and was discharged from the department, the specialists issued detailed recommendations with an invitation, if necessary, to the next course.

The second course of rehabilitation according to the proposed method was carried out from 24.06.2019 to 08.07.2019.

The rehabilitation period is 14 days.

The third course of rehabilitation according to the proposed method was carried out from 04.11.2019 to 18.11.2019.

The rehabilitation period was 14 days.

Thus, the child underwent 3 rehabilitation courses according to the proposed scheme, and against the background of a complex of rehabilitation measures, the child's emotional sphere stabilized, behavioral reactions, cognitive and speech functions normalized.

The method "Method for the rehabilitation of children and adolescents with behavioral and emotional disorders, suffering from mental disorders" is available and can be applied in specialized rehabilitation departments of medical institutions.

The technical and economic efficiency of the method lies in the fact that the use of the method in children and adolescents with behavioral and emotional disorders allows achieving stabilization of the emotional sphere, normalization of behavioral reactions, cognitive and emotional functions of the child.

Claims (1)

The method of rehabilitation of children and adolescents with behavioral and emotional disorders suffering from mental disorders, which consists in the fact that on the day of admission of the patient to the medical rehabilitation department with a previously established diagnosis, a psychiatrist consults to determine the mental status, according to the result of which he prescribes drug therapy: antipsychotics - thioridazine - children from 4 to 7 years old - 10-20 mg / day in 2-3 doses per day; from 8 to 14 years old - 20-30 mg / day in 3 divided doses per day; from 15 to 18 years old - 30-50 mg / day in 2-3 doses per day or peritsiazin 4% solution for oral administration to children over 3 years old, the average daily dose is from 0.1 mg to 0.5 mg per 1 kg of body weight , while the psychiatrist conducts daily consultations in the morning during the patient's rehabilitation; then, after consulting a psychiatrist, the patient is consulted by a neurologist, determines the neurological status and prescribes sedative therapy: hydroxyzine at the age of 12 months to 6 years - from 1 to 2.5 mg / kg / day in 2-3 doses, from 6 years and older - from 1 to 2 mg / kg / day in 2-3 doses, nootropic therapy: glycine for children over 3 years old - 1 tablet 2-3 times a day or methionyl-glutamyl-histidyl-phenylalanyl-prolyl-glycyl-proline 0.1 % for children over 5 years old, 1-2 drops in each nasal passage 2 times a day - in the morning and in the afternoon, while the neurologist examines the patient daily in the morning during the period of rehabilitation in the department; then, on the same day, after examination by a psychiatrist and a neurologist, the patient is examined by a psychologist using diagnostic tests and diagnostic techniques, then, from the next day - the second day of the child's stay in the department - in the morning, regardless of age, the psychologist conducts daily psychocorrection using game therapy, body-oriented therapy, dance therapy, art therapy; further, after the conclusion of a psychologist, the child is examined by a speech therapist-defectologist with an appointment, regardless of age, daily classes in the morning during the rehabilitation period; further, after all the above examinations, on the day of admission, the physician of physiotherapy exercises prescribes a course of physiotherapy exercises lasting 10 days, which includes a daily group lesson in the morning for 20 minutes, regardless of age category, with the subsequent transition, after an hour's break, to mechanotherapy using simulators in sequence - rehabilitation simulator with functional electrical stimulation and biological feedback RT: children 3-7 years old - 5-10 minutes, load 1, children 8-11 years old - 10 minutes, load 2; children 12-17 years old -10 minutes, load from 3 to 10; Pablo device with biofeedback with accessories: children 3-7 years old - 6 minutes with a load of 50%; children 8-11 years old - 6 minutes with a load of 75%; children 12-17 years old - 6 minutes with a load of 100%; rehabilitation platform with accessories: for children 8-11 years old - 5 minutes; children 12-17 years old - 5 minutes; hippo exercise machine RodeoPro: children 3-7 years old - 5 minutes, 1 speed; children 8-11 years old - 5 minutes, speed 2; children 12-17 years old - 5 minutes, speed 2; exercise bike Torneo B-225 GNOVA: children 3-7 years old - 5 minutes, load 1; children 8-11 years old - 5 minutes, load 2; children 12-17 years old - 5 minutes, load 3; treadmill Torneo Т-205 SMARTA: children 3-7 years old - 5 minutes, 1 speed; children 8-11 years old - 5 minutes, speed 2; children 12-17 years old - 5 minutes, speed 2; mini-stepper with a handle S-221 TEMPO: children 3-7 years old - 5 minutes, no load; children - 8-11 years old - 5 minutes, no load; children 12-17 years old - 5 minutes, no load; elliptical pedometer C-218 TORNEO: children 3-7 years old - 5 minutes, load 1; children 8-11 years old - 5 minutes, load 1-2; children 12-17 years old - 5 minutes, load 2-3; Domyos Essential 240 trampoline: children 3-7 years old - 5 minutes, no load; children 8-11 years old - 5 minutes, no load; in the second half of the day, after a day's rest, the patient undergoes additional physical therapy classes using game items, elements of sports medicine: dry pool - children 3-7 years old - 10 minutes, obstacle course - children 3-7 years old - 10 minutes, children 8-11 years old - 15 minutes, children 12-17 years old - 20 minutes, elements of sports medicine: badminton - children 3-7 years old - 10 minutes, children 8-11 years old - 15 minutes, children 12-17 years old - 20 minutes, basketball hoop - children 3-7 years old - 10 minutes, children 8-11 years old - 15 minutes, children 12-17 years old - 20 minutes, table tennis - children 3-7 years old - 10 minutes, children 8-11 years old - 15 minutes , children 12-17 years old - 20 minutes; a physiotherapist prescribes a massage of the cervical-collar zone, daily, ten days, lasting 20 minutes, regardless of age category, in the morning, after a 30-minute break after physiotherapy exercises and a ten-day course, which includes alternating electrosonic therapy - 5 procedures: for children 3-7 years old, current strength 0.6-1.0 mA, children 8-11 years old - 2 mA, children 12-17 years old - 3-4 mA, the duration of the procedure with the first exposure is 10-15 minutes, with the next - 30 minutes with electrophoresis of 2% Ca and 2% Br according to Vermel - 5 procedures: children 3-7 years old, current strength 5 mA, procedure duration 7 minutes, children 8-11 years old, current strength 7-10 mA, duration - 10 minutes, children 12- 17 years old - 12 mA, lasting 10 minutes or electrophoresis of 2% Ca and 2% Br according to Shcherbak: children 3-7 years old - current strength 3-5-7 mA, duration -3-5-8 minutes, children 8-11 years old - current strength 4-6-8-10 mA, duration 4-6-8-10 minutes, children 12-17 years old - current strength 6-8-10-12 mA, duration -6-8-10-12 mA during second polo wine of the day, 40 minutes after acupuncture; in turn, the reflexologist prescribes a ten-day daily course according to the "Wu-sin" acupuncture technique, using acupuncture points in the following sequence: vg20 - on the midline of the head, 7 tsun and 5 tsuns above the back border of hair growth from the front border of hair growth , gi4 - between the 1st and 2nd metacarpal bones closer to the middle of the 2nd metacarpal bone in the fossa, e36 - below the upper edge of the lateral condyle of the tibia by 3 tsun, at the anterior edge of the tibial muscle, rp6 - posterior to the tibia, above the center of the medial malleolus by 3 Tsunya, gi11- in the middle of the distance between the lateral epicondyle and the radial end of the ulnar folds, v11 - at the level of the interval between the spinous processes of 1 and 2 thoracic vertebrae, 1.5 Tsun away from the midline, v12 - at the level of the interval between the spinous processes 2 and 3 thoracic vertebrae, aside from the midline by 1.5 tsun, v13 - at the level of the interval between the spinous processes of the 3 and 4 thoracic vertebrae away from the middle days of the line by 1.5 tsun, v23 - at the level of the interval between the spinous processes of the 2 and 3 lumbar vertebrae aside from the midline by 1.5 tsun, v25 - at the level of the interval between the spinous processes of the 4 and 5 lumbar vertebrae away from the midline by 1.5 cu, v36 - in the center of the subgluteal fold, while a reflexotherapy session is carried out 30 minutes after a physical therapy lesson using game items and elements of sports medicine in the afternoon, the duration of the procedure is 20 minutes; the frequency of such rehabilitation courses is 1-3 times a year.