RU2410014C1 - Method of psychosomatic rehabilitation of heat injury patients - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: patients are grouped by age and physical capacities, the level of psychosomatic consequences of a previous heat injury. An amount of physical activity, background music and repertoire are specified, then a group session is held. The session includes 3 sections, namely: warm-up on which includes exercises for body preparation for physical activity, acquaintance with a musical material and a session program; sense physical activity which includes a combination of adapted exercises, and task-specific physical activity considering individual capacities and body resources, an emotional status with using verbal stimulations, there are studied special sets of motions concerted with a subject matter of a repertoire sense specified, and considering a psychosomatic status both of patients individually, and of the group as a whole; creative activity which involves subject physical activity with creating images according to the subject matter of the repertoire sense specified, creating dressed up images, discussing of the session held both in group and individually, planning the following visits, corrections of mistakes and failures. The session is held 3 times a week, with each section lasting for 10-15 minutes. It is followed with public performance with presenting the effect of rehabilitation actions and therapeutic results. ^ EFFECT: reduction of psychologic traumatic experience, recovery of a patient's mental status, formation of mechanisms and practices for psychological protection and social rehabilitation. ^ 2 ex

Description

The invention relates to medicine, namely to psychotherapy of correctional and medical psychology, can be used in physical, psychological and social rehabilitation after thermal injury.

Thermal trauma refers to the most severe damage to the body when all systems and organs, including the patient’s mental state, are affected.

Burn disease consists of periods, each of which has its own characteristics of mental disorders and central nervous system functions.

The first period is a burn shock, the duration of which is 1-3 days. The second period of burn disease is acute burn toxemia, its duration is 7-14 days. The third period is septicotoxemia, lasting from one to several months. The fourth period of a burn disease is convalescence, the duration of which can be several years, especially in children (Yudenich V.V. Treatment of burns and their consequences: Atlas. - M.: Medicine, 1980, 192 p.).

The development of neuropsychiatric disorders during the period of convalescence is based on changes that occur in the initial periods of a burn disease. With a lesion area of more than 20% of the body surface in adults, 10% or more in children, burn shock develops. For the initial period of burn shock - the erectile phase - is characterized by nullation of consciousness. This is a slight degree of stunning, characterized by fluctuations in the degree of severity, when a slight clouding of consciousness is temporarily replaced by its clarification, then dimming occurs again. In the future, the torpid phase of burn shock develops. In this phase, inhibition, adynamia intensifies, unconsciousness is replaced by a syndrome of impaired consciousness, characterized by a significant increase in the perception threshold of all external stimuli and delayed formation of association, difficulty in their flow, incomplete orientation in the environment, difficulty in understanding the meaning of the questions and incomplete and inaccurate answers to them with subsequent amnesia of what is happening - a state of stupor.

In the period of acute burn toxemia, mental disorders manifest themselves, first of all, in the form of weakness, increased fatigue, emotional lability, hypersthesia, sleep disturbances, that is, an asthenic symptom complex, the severity of which correlates with existing intoxication. Depending on its severity, mental disorders can occur at the neurotic, subpsychic and psychotic levels. Subpsychic and psychotic states, developing against the background of asthenic symptoms, proceed usually erased and atypical.

With an improvement in physical condition and a decrease in intoxication, subpsychotic and psychotic disorders are reduced. A more adequate assessment of the incident appears, leading to the formation of psychogenic disorders, the leading syndrome of which is anxiety-depressive; in the clinical picture, against the background of depressive symptoms, anxiety symptoms prevail. A constant painful expectation of misfortune is characteristic, which, according to the patient, is inevitably waiting for him and is sometimes perceived as a manifestation of bad luck, a fatal combination of circumstances.

Mental disorders in the period of convalescence occur against the background of transferred burn encephalopathy, which is characterized by dystrophic changes in the brain and is accompanied by mental disorders of the type of psycho-organic syndrome, symptoms with a predominance of depressive and asthenic disorders, personality changes of the excitable, inhibitory and apathetic type. Some patients have overvalued ideas of relationships, characterized by instability and a transition to suspicion and distrust. In this period, the further formation of clinical variants of burn encephalopathy occurs - apathetic, explosive (excitable, explosive), inhibitory, and mixed. Characteristic conditions are observed, such as asthenic with neurosis-like and neurotic symptoms, encephalopathic with psychopathic disorders and signs of a psycho-organic syndrome, paroxysmal disorders (epileptiform seizures, autonomic paroxysms), organic dementia.

During the period of convalescence, the compensation of the state and the restoration of mental disorders occur slowly and remain unstable for several years. With disfiguring scars, overvalued ideas of a relationship with subdepressive symptoms easily arise. Personality changes acquire psycho-organic features, suspicion and alertness may appear, as well as paranoid symptoms, characterized by the gradual formation of a systematic delirium, initially emotionally unsaturated and to some degree plausible, in some cases based on an overvalued idea.

In addition to mental disorders during convalescence, focal neurological symptoms also persist.

The treatment and rehabilitation of mental disorders during thermal injuries is carried out taking into account the clinical manifestations and the period of the burn disease. The complex of rehabilitation programs is carried out individually and consists of medical correction and psychotherapy. Drug correction of mental disorders is carried out in order to stop the painful manifestations during treatment, prevention of burn encephalopathy. The use of physical methods is limited by the localization and area of thermal injury and becomes possible only after epithelization of burn wounds. In the correction of mental disorders of the neurotic level, a significant role belongs to psychotherapeutic methods: individual rational psychotherapy, various correction methods in the group, and audiovisual methods of exposure.

The main objectives of rehabilitation are the relief of psycho-traumatic experiences, restoration of the mental status of patients, the formation of mechanisms and methods of psychological protection. This is achieved using comprehensive rehabilitation programs for general strengthening and stimulating therapy, massage, aquatic procedures, herbal medicine, physical therapy, reflexotherapy (Thermal and radiation burns: a Guide for doctors / Edited by L.I. Gerasimova, G.I. Nazarenko. - 2nd ed., Revised and enlarged. - M.: Medicine Publishing House OJSC, 2005).

There is a method of rehabilitation of burn patients, characterized in that they carry out jet irrigation under pressure of the burned areas with natural hydrogen sulfide mineral water in combination with common and / or chamber baths with the same mineral water, therapeutic massage and individual physiotherapy exercises, paravertebral zones are massaged for burns of the upper limbs innervations of the upper thoracic and cervical segments of the spine, muscles of the back and chest, and also apply compression, stretching and shaking of the chest, in case of burn The lower extremities are massaged by the paravertebral zones of innervation of the lumbar and lower thoracic segments of the spine, the zone of the lumbar region and the hip joints, and all the complex effects are carried out against a diet with an increased content of proteins, trace elements and vitamins (patent RU 2266094, 2005). The method allows to prevent and eliminate the occurrence of cicatricial contractures, to prevent transplant rejection, to increase the effectiveness of treatment.

A known method for the correction of psycho-emotional and psychosomatic disorders in children with thermal injury, including an anamnesis analysis, rational psychotherapy and relaxation, the correction is carried out according to five personality-oriented programs: the first and second programs are carried out in the acute period of burn disease and stress, the third - in subacute period, the fourth - in the chronic period of post-traumatic stress and the fifth - in the period of consequences of burn injury; each correctional program takes into account the patient’s age, state of health and well-being, his psychological characteristics, the child’s leading and personally significant mental activity, his development, the severity of the burn and stress factor, and includes five blocks: a diagnostic block containing a history collection and analysis, as well as identification of personal patient features; the installation unit includes the creation of a confidential atmosphere through empathic listening, empathy, participation; the information block includes increasing motivation for recovery and interest in psychotherapeutic activities; correction block, in which, using the methods of music therapy, art therapy, game therapy, fairy tale therapy within the framework of emotional stress and short-term rational psychotherapy, relieve the severity of experiences, activate the patient, create conditions for the transfer of trauma events from the unconscious to the conscious, develop and form a role in the child in achieving recovery, conduct exercises to master professional and labor actions, increase motivation for training and personal development, while doing muscle relaxation, and in 3-5 programs they smoothly transfer the child into a hypnotic state with the pronunciation of therapeutic self-hypnosis formulas; assessment unit includes the determination of changes in emotional, psychological status, the degree of development and acquisition of skills of emotional response, mental and psychological stability; however, the transition from one program to another is carried out upon successful achievement of the desired results by the patient (patent RU 2270036, 2006).

A known method of music therapy is a psychotherapeutic method that uses music as a therapeutic agent. There are four main directions of the therapeutic effect of music therapy:

- Emotional activation during verbal psychotherapy;

- Development of interpersonal skills (communicative functions and abilities);

- Regulatory effect on psycho-vegetative processes;

- Increasing aesthetic needs.

The mechanisms of the therapeutic effect of music therapy include: catharsis, emotional discharge, regulation of the emotional state, facilitating awareness of one's own experiences, confrontation with life problems, increasing social activity, acquiring new means of emotional expression, facilitating the formation of new relationships and attitudes. Music therapy exists in two main forms: active and receptive.

Active music therapy is a therapeutically directed, active musical activity: reproduction, fantasizing, improvisation with the help of a human voice and selected musical instruments.

Receptive music therapy involves the process of perceiving music for a therapeutic purpose. In turn, receptive music therapy exists in three forms:

- Communicative, joint listening to music, aimed at maintaining mutual contacts of mutual understanding and trust.

- Reactive, aimed at achieving catharsis.

- Regulatory, contributing to the reduction of neuropsychic stress.

It is recommended that both forms of music therapy be used by specialists as part of an anti-stress program. More commonly used receptive music therapy. Members of the group listen to specially selected musical works, and then discuss their own experiences, memories, thoughts, associations, fantasies that arise during their listening. In one lesson, as a rule, they listen to three works or completed passages (each for 10-15 minutes). You can use the active version of music therapy. It requires simple musical instruments. Members of the group are invited to express their feelings or conduct a dialogue with any of the members of the group using the selected musical instruments. As a variant of active music therapy, choral singing can be considered (Brusilovsky L.S. Music therapy, in the book: "Guide to psychotherapy", Tashkent, 1979, p. 256-275). The advantage of music therapy is the ability to reduce psychoemotional stress and irritability, to prevent such disorders and increase vitality. However, this technique does not use physical activity as a means of rehabilitation, and there are no coordinated collective actions and the ability to survive a psychological trauma together with other members of the group.

The prototype of the invention is a method of medical rehabilitation of the human body for various diseases and injuries, "therapeutic dance", which consists in performing respiratory static and dynamic exercises, exercises for static muscle tension, their relaxation in a dance form, emotionally realizing the mental image that arises in a patient under the influence of music, while exercises are performed with a gradual gradual increase in total physical activity in the following sequence: from the starting position without tension "lying", "sitting", "standing"; dynamic breathing exercises with effects on small muscle groups, then medium and large; static tension alternates with relaxation exercises, exercises "healing dance" is performed at least 1 time per day (application RU 2003129938, 2005).

The objective of the invention is to develop a method for the rehabilitation of patients after thermal injury, with physical and psychosomatic disorders and social maladaptation, performing exercises in a dance form.

The technical result is the relief of psycho-traumatic experiences, restoration of the patient’s mental status, the formation of mechanisms and methods of psychological protection and social rehabilitation.

The proposed method for the rehabilitation of patients after thermal injury includes performing exercises in a dance form. The method can be carried out using well-known areas of dance: classical choreography, modern choreography, conceptual choreography. The formation of the group is carried out taking into account the age and physical capabilities of patients, the level of psychosomatic effects of the transferred thermal injury. Physical activity is determined by the age and physiological characteristics of the recruited group. This is a comprehensive, natural and gentle psychotherapeutic method of healing and developing the soul through artistic creation and physical, social rehabilitation.

The proposed method is as follows. The method is based on the phasing of this type of rehabilitation. At the first stage, a group is formed taking into account the age and physical capabilities of the patients, as well as the level of psychosomatic consequences of the transferred thermal injury. At the second stage, the amount of physical activity, musical accompaniment and the direction of the repertoire are determined. At the third stage, they hold a lesson with the group. The lesson is carried out in sections.

Warm up - preparing the body for physical activity, getting acquainted with the musical material and the program of the lesson. This section provides an initial level of social adaptation, stimulation of the patient's communicative properties, awareness of his own body, emotional attitude, non-verbal communication with each other. Duration 10-15 minutes.

The main section is the use of a set of adapted exercises and focused physical activity, taking into account the individual capabilities and resources of the body, emotional state using stimulation with verbal rewards. This section provides an increase in self-esteem through the development of a positive body image, improvement through group work of social skills and training of elementary social skills. Duration 10-15 minutes.

Section of semantic physical activity - includes the study of special sets of movements that are consistent with the topics of the chosen direction of the repertoire, as well as taking into account the psychosomatic state of patients individually and the group as a whole. Bringing members of groups into contact with their feelings by establishing a connection of feelings with movements. The duration of the section is 10-15 minutes.

Creative section - the use of plot physical activity with the creation of images according to the theme of the chosen repertoire, the creation of images using costumes. Discussion of the classes in the group and individually, creating plans for subsequent meetings, work on mistakes and failures. The function of group therapy - teamwork, playing and experimenting in rhythmic actions, experimenting with gestures, postures and movements, non-verbal communication with each other - serve to create a deep group experience. The duration of the section is 10-15 minutes.

The fourth, final, stage of the proposed method includes the preparation and conduct of public speaking. Demonstration of the results of rehabilitation measures and summing up the measures taken.

Conducting rehabilitation of the burned by the proposed method is a complex, but affordable set of medical and social measures for the prevention of many psychophysiological, social and physical problems and the consequences of thermal injury. A method of rehabilitation of patients who have suffered a thermal injury, including performing exercises in a dance form, is not only an effective way of rehabilitation after suffering traumatic situations, but also a way of aesthetic and cultural education.

In the available sources of scientific, medical and patent information, the authors did not find an identical method of rehabilitation using the method of rehabilitation of patients who suffered a thermal injury, including performing exercises in a dance form. Thus, the claimed invention meets the criterion of "Novelty."

The authors' studies proved that the proposed method for the rehabilitation of burn patients allows the prevention of the effects of thermal trauma, relieves traumatic experiences, restores the patient’s mental status, forms mechanisms and methods of psychological protection and social rehabilitation with a satisfactory physical and psychological functional result. Thus, the claimed invention meets the criterion of "Inventive step".

The proposed method is illustrated by the following clinical examples.

Example 1

In 2009, on the basis of the Republican Rehabilitation Center for Children and Adolescents with Disabilities, a group of 10 children was created who suffered a burn area of 10-30% with primary localization on the trunk and upper limbs, aged 8-12 years, who were treated in the burn department of the Municipal Clinical Hospital No. 18 of Ufa. Class time - 1-3 months after discharge from the hospital. The main somatic complaints in children and parents were itching in the scars, fatigue, restrictions on movement in the joints, weight loss, decreased level of physical activity. On the part of the mental state - poor sleep, tearfulness, decreased sociability, fear of being in a team, impaired contact with peers.

Classes were held in the hall of physiotherapy and rehabilitation in the presence of parents, a doctor, under the guidance of a tutor-choreographer. The warm-up was carried out for 10-15 minutes to the accompaniment of muscle groups from top to bottom, starting with the muscles of the neck. Held familiarization with the musical material and the lesson program. After a warm-up and a short rest, combined with listening to a selected musical theme, we conducted a section of semantic physical activity, the duration of which is 10-15 minutes according to the repertoire of "Spanish dance". Subsequently, after mastering the minimum skills according to the chosen repertoire, the participants of the selected group took part in a theatrical-dance production composition, where each of the participants had both a solo part and danced in an ensemble. Throughout the lesson, motivations were created and stimulations were used with verbal rewards. At the end of the lesson, children and parents are given homework to consolidate the acquired skills. The lesson is scheduled, 3 times a week. After mastering the planned repertoire and preparing a theatrical and dance performance, costumes are adjusted and made according to the repertoire. We held a public speech in front of parents, children and adolescents in a rehabilitation center.

According to the results of using the method for the training period, the range of movements in the joints increased for 2 months, the psychosomatic status stabilized, the fear of being in a team and public speaking disappeared.

Example 2

In 2009, on the basis of the Republican Rehabilitation Center for Children and Adolescents with Disabilities, a group of children was created in the amount of 10 people who suffered a burn area of 10-30% with primary localization on the trunk and lower extremities, aged 8-12 years, who were treated in the burn department of the Municipal Clinical Hospital No. 18 of Ufa. Class time - 1-3 months after discharge from the hospital. The main somatic complaints in children and parents were itching in the scars, fatigue, restrictions on movement in the joints, weight loss, decreased level of physical activity. On the part of the mental state - poor sleep, tearfulness, decreased sociability, fear of being in a team, impaired contact with peers.

Classes were held in the hall of physiotherapy and rehabilitation in the presence of parents, a doctor, under the guidance of a tutor-choreographer. The warm-up was carried out for 10-15 minutes to the accompaniment of muscle groups from top to bottom, starting with the muscles of the neck. Held familiarization with the musical material and the lesson program. After a warm-up and a short rest, combined with listening to a selected musical theme, we conducted a section of semantic physical activity, the duration of which is 10-15 minutes according to the repertoire of the sailor's dance “Yablochko”. Subsequently, after mastering the minimum skills according to the chosen repertoire, the participants of the selected group took part in a theatrical-dance production composition, where each of the participants had both a solo part and danced in an ensemble. Throughout the lesson, motivations were created and stimulations were used with verbal rewards. At the end of the lesson, children and parents are given homework to consolidate the acquired skills. The lesson was held on a schedule, 3 times a week. After mastering the planned repertoire and preparing a theatrical and dance performance, costumes are adjusted and made according to the repertoire. We held a public speech in front of parents, children and adolescents in a rehabilitation center.

According to the results of using the method for the training period, the range of movements in the joints increased for 2 months, the psychosomatic status stabilized, the fear of being in a team and public speaking disappeared.

The proposed method is easily reproducible in a hospital environment and when it is used, the indicated technical result is achieved. Thus, the claimed invention meets the criterion of "Industrial applicability".

Claims (1)

A method of rehabilitation of patients who have suffered a thermal injury, including performing exercises in a dance form, characterized in that the group is first formed taking into account the age and physical capabilities of the patients, the level of psychosomatic effects of the transferred thermal injury, and then the amount of physical activity, musical accompaniment and the direction of the repertoire are determined , then conduct a lesson with a group including 3 sections, namely a warm-up, on which exercises are performed to prepare the body for physical activity, familiarization with the musical material and the program of the lesson; semantic physical activity, on which they perform a set of adapted exercises and targeted physical activity, taking into account individual capabilities and resources of the body, emotional state using stimulation with verbal rewards, study special sets of movements that are consistent with the theme of the chosen direction of the repertoire, as well as taking into account the psychosomatic condition of patients individually and the group as a whole; creative workload on which the plot physical activity is carried out with the creation of images according to the theme of the chosen repertoire, the creation of images using costumes, discussion of the lesson in the group and individually, the creation of plans for subsequent meetings, work on mistakes and failures, while the lesson is carried out 3 times week, the duration of each section is 10-15 minutes, after which they perform in public with a demonstration of the results of rehabilitation measures and the results of the therapy.