Special Medical Group a. Organization of work in smg. Health and physical education lesson
ORGANIZATION OF CLASSES WITH STUDENTS OF THE SPECIAL MEDICAL GROUP AT THE UNIVERSITY
Tokareva Alexandra Vladimirovna
Saint Petersburg State University
Department Assistant physical education and sports
annotation
The article presents the experience of organizing classes with students of a special medical group in universities on the example of the Department of Physical Culture and Sports of the St. state university. As part of work program in Physical Culture and Sports at St Petersburg University, classes have been developed for students with health problems. The article presents indications and contraindications for common diseases.
ORGANIZATION OF CLASSES WITH STUDENTS OF SPECIAL MEDICAL GROUP IN UNIVERSITY
Tokarev Alexandra Vladimirovna
St. Petersburg State University
Assistant, Department of Physical Education and Sport
Abstract
The article presents the experience of the organization of classes with students of special medical group in higher education by the example of the Department of Physical Culture and Sports of St. Petersburg State University. As part of the work program for Physical Culture and Sports of St. Petersburg State University have developed classes for students with disabilities in the state of health. The article presents the indications and contraindications for common diseases.
According to the Order of the State Committee of the Russian Federation for Higher Education dated July 26, 1994 No. No. 777, the distribution of students into medical groups is carried out on the basis of a medical examination by a medical commission. Currently, the following medical groups are distinguished in higher educational institutions for physical education: basic, preparatory and special.
At St Petersburg University, students of the preparatory and special group "A" are united in the 3rd "improving" block, and those exempted from physical education for medical reasons (special group "B") are distributed in the 4th "additional" block.
To the preparatory medical group include practically healthy students with some morphofunctional deviations or poorly prepared physically; those at risk for the occurrence of pathology or with chronic diseases in the stage of stable remission for at least 3-5 years.
Students assigned to this group are allowed to engage in physical culture according to the curriculum, subject to the gradual mastering of a set of motor skills and abilities associated with the presentation of increased requirements to the body, a more strict dosage physical activity and exclusion of contraindicated movements.
Special Medical Group divided into: "A" and "B".
To special group "A" include students with deviations in the state of health of a permanent (chronic disease, congenital malformations in the stage of compensation) or a temporary nature.
Students assigned to this group are allowed to engage in physical education with limited physical activity and the exclusion of contraindicated physical exercises. In the classroom, the nature and severity of deviations in the state of health, physical and functional development must be taken into account.
To the special group "B" include students with significant deviations in the state of health of a permanent and temporary nature, without pronounced disturbances in well-being and admitted to attending theoretical classes.
Physical education for students with deviations in the state of health in universities throughout the country includes as a mandatory minimum theoretical, practical, including consultative and methodological classes. In the content of the course for students of the special medical department, special attention is paid to the means for eliminating deviations in the state of health and physical development. Practical classes are conducted taking into account the working capacity and functional capabilities of students.
At St. Petersburg State University, in the “Health” block, classes are held according to a special methodology in the following sports: aerobics (fitball, stretching, fitness), martial arts (wushu), skiing, athletics (health-improving running), swimming, Nordic walking, tourism ( pedestrian), badminton, special programs in the direction of "Health systems", general physical training.
Exemption from physical education classes for health reasons can only be temporary (for the period of illness). Students released from practical classes for a long period are engaged in groups of an additional block (main module), where they master theoretical and methodological material, as well as checkers and chess.
The main tasks of physical education in special medical groups are:
- promoting the versatile development of the body, maintaining and strengthening health, eliminating functional deviations and shortcomings in physical development;
- increasing the level of physical performance, the development of professionally important physical qualities;
- formation of the need for systematic physical exercises, instilling healthy lifestyle skills;
- mastering the basic motor skills and abilities;
- acquisition of knowledge and skills of hardening, methods of conducting independent studies, conducting self-control and self-massage.
According to the literature, at present, among the most common diseases among students are disorders of the cardiovascular system and the musculoskeletal system (up to 80% of deviations), the respiratory system, organs of vision, urogenital, digestive systems and etc. .
Table 1 shows, depending on the prevalence of diseases, approximate indications and contraindications for physical education classes with students who have deviations in the state of health.
Table 1
Disease |
Indications |
Contraindications |
THE CARDIOVASCULAR SYSTEM |
||
IRR for hypertensive type | Dosed walking and climbing stairs, jogging, swimming, skiing, cycling. It is possible to participate in mobile and sports games ah, not requiring intense physical effort, complex coordination of movements, intense attention. AT health-improving complexes include stretching, coordination, breathing, general developmental exercises, etc. | Exclude exercises with a large amplitude of movements for the trunk and head, exercises that cause breath holding, sudden changes in the direction of movement of the head and trunk, strength exercises |
Hypotonic disease | Open switchgear, various breathing exercises, dosed walking, running, hiking, swimming, sports and outdoor games, exercises on simulators. Strength exercises for large muscle groups with light weights, speed-strength exercises (jumps, running 20-40 m) | Exercises with holding the breath, straining, with a sharp acceleration of the pace, static tension |
Heart defects | ORU, breathing exercises with body turns, dosed walking and climbing stairs, cycling, all exercises are not significant in size and duration of the load | Exercises associated with effort, straining, carrying weights, jumping, throwing. With stenosis of the left atrioventricular orifice, exercises with deep breathing and stimulating non-cardiac circulatory factors are excluded |
Coronary artery disease | Cyclic types of physical exercises (walking, swimming, slow running, cycling, etc.) | Strength exercises, pull-ups on the hands, straining, lying down |
Phlebeurysm | Open switchgear with objects (gymnastic stick, stuffed balls) and at the gymnastic wall, abdominal exercises and deep breathing, exercises with alternating muscle contraction and relaxation, squats, walking, swimming, skiing, recreational running | Breath-holding exercises, straining, static tension, a sharp acceleration of the pace, endurance exercises are limited |
DISEASES OF THE MUSCLE-MOTOR APPARATUS |
||
Scoliosis 1 degree | Exercises for the muscles of the back and abdominals, for the lumbosacral and gluteal muscles, dynamic and static breathing exercises. Symmetrical training of all muscle groups is carried out. Recommended skiing, games, swimming (breaststroke, crawl) | |
Scoliosis 2nd degree | Outdoor switchgear with asymmetric correction. In swimming, up to 50% of the time is devoted to the use of asymmetric starting positions to reduce the load on the concave side of the spinal arch | It is not recommended to engage in sports that increase the static load on the spine (weightlifting, hiking, high jumps, long jumps, acrobatics, choreography, figure skating, etc.). |
Posture disorder | Exercises with an emphasis on the development of strength and static muscle endurance, symmetrical corrective exercises, in which the middle position of the spinal column is maintained. | Exercises that can lead to overexertion |
flat feet | Special exercises: plantar flexion, supination of the feet. Walking on the outer edges of the foot, on toes, bending the toes, grabbing various objects with the toes, squats in the position - socks inward, heels apart, climbing the gymnastic wall and rope, rolling with the soles of small objects, etc. | Exercises that cause flattening of the arch of the foot, foot pronation (walking on the inner edges of the foot) |
Osteochondrosis cervical spine | Exercises to strengthen the muscles of the neck and shoulder girdle, swimming lessons, massage of the collar zone. | |
Osteochondrosis of the thoracic spine | With flattening of the thoracic kyphosis, it is necessary to strengthen the abdominal muscles and stretch long muscles back. With increased thoracic kyphosis, it is necessary to strengthen the back muscles, stretch the long muscles and abdominal muscles. Exercises with isometric tension of the back muscles are shown, followed by their complete relaxation. |
All exercises are performed freely, without sudden and active movements. Avoid vibration, running and riding on uneven terrain, playing sports (basketball, football, handball, hockey, volleyball, etc.), exercises with a barbell are contraindicated, exercises with a torso tilt forward, lifting straight legs from a prone position and sitting, stretching, etc. |
Osteochondrosis of the lumbosacral spine | Exercises for the lower limbs in combination with static and dynamic breathing exercises, relaxation of the muscles of the trunk and limbs, which should be performed in I.P. lying on the stomach, back, side, kneeling in emphasis. Exercises for the formation of the muscular corset. | All exercises are performed freely, without sudden and active movements. Avoid vibration, running and riding on uneven terrain, playing sports (basketball, football, handball, hockey, volleyball, etc.), exercises with a barbell are contraindicated, exercises with a torso tilt forward, lifting straight legs from a prone position and sitting, stretching, etc. Stretching exercises are not recommended. lumbar spine. |
BREATHING LIMITS |
||
Chronical bronchitis | Exercises involving the muscles of the chest and upper limbs, outdoor switchgear, swimming, rowing, athletics, skiing, cycling, etc. Widely use a long exhalation. Breathing according to the method of A.N. Strelnikova is indicated for patients with simple chronic bronchitis, without shortness of breath. | Acute stage of the disease; straining, holding the breath while inhaling. Inhalation should not be excessive, maximum, tense. |
Bronchial asthma | Special exercises: breathing exercises with an extended exhalation, holding the breath on exhalation, “sound” gymnastics, postural drainage and drainage exercises, exercises for the muscles of the upper limbs and chest, exercises aimed at relaxing the skeletal muscles. Special exercises are used in combination with outdoor switchgear | Acute stage of the disease, heart failure; swimming, exercises with straining and holding the breath (cause bronchospasm) |
DISEASES OF THE ORGANS OF VISION |
||
Myopia (nearsightedness) | Special exercises: Exercises for the external and internal muscles of the eyes (circular rotation of the eyeball, shifting gaze from a near point to a far one, etc.). Squinting, blinking. The amplitude of eyeball movements is maximum, but without pain. Perform special exercises simultaneously with breathing and ORU. Exercises to strengthen the muscles of the neck and back. It is useful to engage in sports games without jumping and jumping (badminton, table tennis), swimming, hiking, skiing |
|
Hypermetropia (farsightedness) | Use therapeutic gymnastics according to the Brega system, yoga for the eyes | Undesirable high-intensity exercises associated with jumping and jumping or requiring great tension (pull-ups, weight lifting, etc.), exercises that require a long stay in a bent position with the head tilted down or sharp torso bends. Exclude games where there is a possibility of a collision between the players, blows to the face and head. |
URINARY SYSTEM |
||
Pyelonephritis, cystitis | Practice diaphragmatic breathing. Medium-intensity outdoor switchgear, pay attention to strengthening the anterior abdominal wall | Prolonged static tension of the abdominal muscles, back, weight lifting. Jumping. |
Kidney stone disease | Running, jumping, ball games, cycling, breathing exercises | Endurance exercises |
DISEASES OF THE GASTROINTESTINAL TRACT |
||
Stomach ulcer | Cyclic, low-intensity exercises (walking, skiing, etc.), exercises for the muscles of the anterior abdominal wall, diaphragmatic breathing | Exercises for the abdominal press, with shells (dumbbells, stuffed balls) |
Gastritis
|
Exercises of a cyclic nature at a slow pace, long in time, exercises for the abdominal muscles Emotional exercises that train the nervous system (games), exercises for the abdominal muscles |
Exercises for the abdominal press, with shells (dumbbells, stuffed balls) |
DISEASES OF THE ENDOCRINE SYSTEM |
||
Obesity | Endurance exercises, sports games: basketball, football; swimming, brisk walking, running, jogging, hiking, rowing, cycling, skiing, skating, outdoor games, gymnastic exercises with dumbbells, self-massage, exercise equipment. Lessons should be at least 30 minutes long. |
Exercises on simulators (IV degree of obesity) |
Diabetes | Exercises for all muscle groups at a slow and medium pace, speed-strength exercises are possible, sports games are shown, skiing, swimming, slow running, exercises on simulators, cycling, rowing, exercises with dumbbells, rubber shock absorbers, stuffed balls and at the gym walls. | If you feel hungry, weak, trembling hands, you need to eat 1-2 pieces of sugar and stop exercising |
INJURIES OF THE LOCOMOTOR APPARATUS |
||
Ligament injury | Swimming, dosed walking, cycling or exercise bike, self-massage | During the period of scar formation, dynamic loads are contraindicated |
Damage to the meniscus of the knee joint | Exercises with a rubber bandage: lying on your back and stomach, flexion and extension of the legs, as well as exercises for the muscles of the abdomen and back, cycling, walking up stairs, swimming, hydrocolonotherapy, you can include slow running on soft ground in combination with walking. | Squats with additional load, sharp movements when bending and straightening the knee joint, rotational movements of the lower leg. In addition, one should not start training early in sports such as ice hockey, football, wrestling, etc. |
dislocations | It is necessary to fix the joint with an elastic bandage, perform gentle movements and movements in light conditions, exercises to relax the muscles and in the water | Movements of a power nature and with a large amplitude in the damaged joint |
fractures | Passive-active movements, muscle tension and stretching exercises, isometric exercises, application of axial load on a limb, swimming, exercise on simulators, running and gymnastics in water, cycling, games, skiing | Overexertion and fatigue of muscles, carrying weights, exercises that cause pain |
Preservation and promotion of health, increasing the adaptive capabilities of the body of students of special medical groups during the period of study at the university is an important component of higher education, since it is during this period that the foundation for the success and longevity of the future is laid. professional activity young professionals.
Hello, friends! What are children's health groups in physical education? If you ask this question to parents of schoolchildren, as well as future first-graders, then there will not be many intelligible, clear answers.
On the one hand, it's good! It means that everything is in order with the health of children, and the question is simply not relevant. But on the other hand, no one is immune from various health troubles. And then parents run the risk of being completely unprepared for problems with physical education.
And problems appear, this is evidenced by the huge number of messages and questions on this topic on various Internet forums. Therefore, I propose to deal with this right now.
Let's make it clear right away that a health group and a medical health group for physical education are two different things.
Lesson plan:
Child health groups
In accordance with Appendix No. 2 of the Order of the Ministry of Health of the Russian Federation No. 1346 n, children's health is assessed according to the following criteria:
- chronic diseases (whether they are or not);
- state of body systems (respiratory, excretory, endocrine, etc.);
- the body's resistance to external influences (cold, heat, irritants, etc.);
- physical development.
First, the doctor assesses the health of the child. And then assigns it to one of the five groups.
First
The child is healthy.
Physical development within the age norm. There are no physical defects.
Second
These are kids:
who do not have chronic diseases, but have any functional disorders (the internal organ does not function correctly, and the causes of these disorders lie outside this organ);
recovering from diseases of moderate and severe severity;
with a delay in physical development (short stature, increased or decreased body weight, etc.);
frequently ill with acute respiratory infections;
who have physical disabilities resulting from injuries or operations, but all organs and systems of the body function normally.
Third
These are kids:
with chronic diseases. But these diseases are in remission (disappearance of symptoms of the disease) with rare exacerbations, in which the functions of organs and body systems are preserved or compensated;
with physical disabilities resulting from injuries or operations. The functions of the organs and systems of the body are compensated. They are not limited in the possibility of learning and work.
Fourth
These are kids:
suffering from chronic diseases. The phase is active. Exacerbations are frequent. The functions of the organs and systems of the body are preserved or compensated or not fully compensated;
with chronic diseases that are in remission, but with such a violation of the functions of the organs and systems of the body that require supportive treatment;
with physical disabilities resulting from injuries and operations, in which the functions of the organs and systems of the body are not fully compensated. Opportunities for training and employment are limited.
Fifth
These are kids:
with chronic diseases. The form is heavy. Remissions are rare, exacerbations are frequent. Presence of complications. The functions of the organs and systems of the body are not compensated. Requires ongoing treatment.
with physical disabilities resulting from injuries and operations, with impaired functions of organs and systems of the body. Significantly limited in the possibility of training and work.
Physical education groups
When a student goes to first grade, his medical card goes to school with him. It must indicate the group in physical education. There are three of them: basic, preparatory, special.
Main
Children with the first and partially with the second group of health, physically and psychologically strong and developed, without diseases. Or having small deviations, in which physical activity is not prohibited, for example, a small overweight, or minor allergic reactions.
They are engaged in the main program, pass the established standards, they can participate in various competitions and all kinds of sporting events.
Preparatory
Children with the second group of health. They have a lag in physical development and therefore cannot study as intensively as their healthy counterparts, although they go to lessons with the class.
The task of the teacher is to choose special complexes exercises that are not harmful to health. He selects them in accordance with the medical certificate, in which the attending physician must indicate what exactly the student cannot do (tumble, swim, bend over, jump, etc.)
The transfer date must also be indicated in the certificate. After the help action ends, the student automatically gets into the main group.
In order to subject such students to tests in physical education, it is necessary to obtain permission from a doctor. Also, his permission will be required in order to attract the student to participate in sports events.
Special
In order to transfer a student to a special group, the opinion of one attending physician is not enough. In this case, a commission (KEK) is going to. Help is issued for a certain period of time.
The special group is divided into two more.
Special "A"
Children with the third group of health. Those who have significant restrictions on physical activity. They cannot study with the class. For such children, separate lessons in physical education should be held in schools and special programs should be developed. And classes should be conducted by teachers or instructors who have undergone special training.
These kids shouldn't be visiting. sport sections, to participate in competitions and sports events.
Special "B"
This includes children partially with the third and fourth health groups. They are allowed to attend theoretical classes at school. But the risk of physical activity for health is so great that they do not do physical education at school. That is, in fact, this is an exemption from school physical education lessons.
But completely without physical activity no one is going to leave them. They are recommended classes physical therapy on the basis of medical institutions and sports dispensaries, under the supervision of a physiotherapy doctor. As well as additional classes at home according to a specially designed set of exercises.
Well, kids with the fifth health group are most often in medical institutions and for them the opportunity to exercise exercise therapy is extremely individual.
How are ratings given?
Too interest Ask. Everything is clear, if the student is in the main group, then he passes the standards and on the basis of this he is given one or another mark.
And if in preparatory or special, what then? After all, he cannot pass the standards like his completely healthy classmates. In this case, the teacher focuses on class attendance, the quality of the exercises, as well as theoretical knowledge. Physical education textbooks do exist.
The teacher may also ask to prepare a project on some sports topic or on a healthy lifestyle, an essay, report or presentation. But a student cannot remain without an assessment in physical education.
Well, that seems to be all, friends. Have questions? Ask them in the comments. We'll definitely figure it out together.
Interesting, how did you feel about physical education lessons when you were in school?
To be honest, I didn’t really like to appear on them. I had enough load without them, as I was intensively engaged in volleyball. And I was very glad when my teacher, Alexander Vasilyevich, allowed me not to come and automatically put fives. But because I still would have passed everything on five.
And now children do not belong to physical education in the best way, I think. They consider it a secondary subject. But in vain! Sports are cool! It's nice to have a flexible, slender and strong body, which you also manage without difficulty. Do you agree?
And these guys in the video with physical education at school definitely had no problems)
I wish your little schoolchildren good health and great sports achievements!
All the best!
Always yours, Evgenia Klimkovich!
With the beginning of the new academic year, one of the most requested certificates for schoolchildren is the exemption from physical education. Some schoolchildren (with the support of their parents) do not want to attend school physical education classes. Others are unable to attend standard school physical education classes for health reasons.
Exemption from physical education
And the Russian government is currently taking care of the physical education of the population. Including schoolchildren. Through various laws, the state is trying to ensure access to physical education and sports even for people with disabilities. School physical education lessons are given great, and sometimes even increased, attention.
Therefore, today only an official medical document - a certificate - can release a student from physical education lessons. Exemption from physical education can only be temporary (up to a maximum of 1 year).
Pediatrician
The pediatrician alone has the right to release the child from physical education for 2 weeks - 1 month. Such an exemption is given to the child in the ordinary certificate after illness. After the usual acute respiratory disease - a standard exemption from physical education is given for 2 weeks. But, after a more serious illness, for example, after a sore throat or pneumonia - for 1 month.
KEK
After some serious illnesses (hepatitis, tuberculosis, peptic ulcer), injuries (fractures, concussion) or operations, a longer release from physical education is required. Any exemption from physical education for more than 1 month is issued through the KEK. To issue it, you need an extract from the hospital, with recommendations regarding physical education. And (or) an entry in the outpatient card of a specialist in a child's disease with relevant recommendations. The conclusion of the KEC (control and expert commission) is certified by three signatures: the attending physician, head. polyclinic, chief physician and the round seal of the clinic. And all information about the certificate is entered in the KEK journal.
For a long time (for the entire academic year) disabled children are usually exempted from physical education. As a rule, those of them who are eligible for home schooling. The approach to this issue is strictly individual, it is decided jointly: by the attending physician-specialist, parents, taking into account the wishes of the child. Some children are allowed physical education classes in a special or even in preparatory group.
Even if the child is exempted from physical education for the entire period of schooling, the KEK certificate is updated annually.
Physical education groups
Long-term exemption from physical education is now rare. And it requires good reason. And the number of schoolchildren with health problems who cannot cope with the standard workload in physical education classes is growing every year. To select the physical activity corresponding to the state of health of the student, there are physical education groups.
Main (I)
The main group is for healthy children and children with minor functional abnormalities that do not affect their physical development and physical fitness. This group in medical and school documents is indicated by the Roman numeral I. All students fall into it. If there are no records in the child's medical record recommending physical education in another group.
Preparatory (II)
The preparatory group, denoted by the number II - for children with minor deviations in health and (or) poor physical fitness. Classes in this group may be recommended by a specialist in a child's disease. He is required to clearly record the recommendations for school physical education on the child's outpatient record. Conclusions of the KEK for classes in the preparatory group are not required. On the certificate, one medical signature and the seal of the clinic are enough. On the other hand, a clear and specific record with recommendations in the school certificate is necessary. This certificate is usually issued by the local pediatrician based on the recommendations of a specialist doctor.
The diagnosis must be indicated, the period for which classes in the preparatory group are recommended. For example, for the entire academic year, for half a year, for a quarter. And specific recommendations on what exactly should be limited to the child during physical education. For example, physical education classes on the street or in the pool are not allowed, the child is not allowed to compete or pass certain standards, somersaults over the head or jumps, etc. are not allowed.
A preparatory group for a child means that he will attend physical education classes with everyone, observing the restrictions that are indicated in his certificate. It is better if the child himself knows which exercises in the physical education lesson he cannot do. At the end of the validity period of the certificate, the child will automatically be in the main group.
Certificate form about classes in the preparatory physical education group
Special
A special group is a physical education group for children with serious health problems. A certificate defining a special physical education group for a child is issued through KEK. Diseases of the cardiovascular, respiratory, urinary and other systems of the body may be indications for a child's classes in a special group. Those who wish can familiarize themselves with an approximate list of these diseases ().
If you decide to issue a child with a certificate for classes in a special physical education group, you need to start with a visit to a doctor who specializes in the child's disease. In the outpatient card must be his record with clear recommendations. Further, the certificate is issued in the same way as an exemption from physical education, indicating its validity period (maximum for one academic year), and certified by three signatures of the KEC members and a round seal of the clinic.
Certificate form about the child's activities in a special physical education group
To date, there are two special groups: Special "A" (III group) and Special "B" (IV group).
Special "A" (III)
The special group "A" or III physical culture group includes children with chronic diseases in a state of compensation (without exacerbation).
In schools, classes in the special group "A" are held separately from general physical education classes. Those. your child will no longer attend PE with the class. But, he will do physical education in a special group at another time (not always convenient).
The special group "A" usually gathers children with health problems from different classes. If there are a lot of such children in the school, classes are held separately for junior, middle and senior schoolchildren, if there are few children - immediately for everyone. The load and exercises for the child are always selected taking into account his disease. Such children do not participate in competitions, they do not pass the standards. At the end of the validity period of the certificate, the child is automatically transferred to the main group. Parents need to keep it up to date.
Special "B" (IV)
The special group "B" or IV physical culture group includes children with chronic diseases or deviations in the state of health, including temporary ones, in a state of subcompensation (incomplete remission or at the exit from an exacerbation). Special group "B" means the replacement of physical education at school with physiotherapy exercises in a medical institution or at home. Those. in fact, this is an exemption from school physical education.
I draw the attention of parents that any certificates of physical education classes: exemption from physical education, a certificate of classes in preparatory or special physical education groups, must be updated at least once a year. If at the beginning of the school year the child does not bring a new certificate with the doctor's recommendations regarding physical education, he automatically falls into the main physical education group.
Exemption from physical education. Physical groups.
Spinal hernia (SMG) refers to a severe pathology affecting mainly the children's age category and newborns in particular. What threatens this disease, what is the upcoming treatment tactics and prognosis?
SMG is mainly a congenital malformation with gross structural disorders. The condition is manifested by the exit of the spinal cord and / or its membranes at a certain level through abnormal (split) vertebrae.
Classification
Regarding the levels of splitting, hernias are distinguished:
- cervical;
- chest;
- lumbar;
- sacral spine.
The formation of spinal hernias is based on a bone defect. Dysraphia (closing disorders) on the part of the spinal cord is referred to as spina bifida (split vertebrae). Depending on in which part of the vertebra there is no fusion, the anterior (body defect) and posterior forms (splitting of the spinous processes and arches) are distinguished. A separate position is occupied by hidden splitting, in which there is no hernia, but there is a morphologically altered vertebra. The latter condition is most often noted at the level of the lumbosacral region.
Spinal hernia in children
Spinal hernia belongs to the group of large developmental anomalies and is often combined with other malformations of the internal organs. In this regard, some small patients are not viable, which explains the rather high mortality in the first weeks or months after birth. Survivors often have paraplegia, an increase in head size, and kyphotic spinal deformity.
Spinal hernias can be part of chromosomal abnormalities: trisomies of 8 and 11 chromosomes, triploidy. At the same time, the severity of the condition and further prognosis are often determined by a complex of disorders.
Clinically, when examining a newborn child with a spinal hernia, the following are revealed:
- protrusion in the spine at a certain level (in 30% of cases - on the lower back);
- the skin is thinned, the structures located under it are translucent, maceration (irritation and redness) may be noted;
- cicatricial changes in the defect area;
- possible leakage of cerebrospinal fluid (CSF);
- on palpation of the formation, the child begins to cry, and a passing examination of the fontanel (due to the assessment of tension and bulging) gives an idea of possible hydrocephalus;
- feces and urine are separated gradually ("leak");
- gaping anus;
- decrease in tendon reflexes from the limbs;
- paresis and paralysis.
Note!
The presence of pigmented spots or hypertrichosis (increased growth of coarse hair in an atypical place) in the projection of the spine in the absence obvious signs neurological and orthopedic pathology may indicate the presence of anomalies from the internal organs and vertebral cleavage in particular.
Changes correspond to the level of spinal cord injury according to the principle: the higher in topical localization, the more severe.
As a rule, this pathology is recognized even during pregnancy with ultrasound screening of the fetus. At the time of the examination, a decision is made whether to carry the pregnancy or the need for termination. Techniques for intrauterine surgical intervention to eliminate the defect have been developed. neural tube. In Russia, such operations have not yet become widespread, patients are forced to seek funding for treatment abroad.
Video
An example of several families who received effective medical care in Switzerland is presented in the report.
The majority of children are operated on already in the neonatal period or in the first year of life. After conducting all studies under the control of the state of nerve fibers and roots (with the help of an intraoperative study of their electrical activity), the structures of the spinal cord are repositioned into the spinal canal. Then the hernial sac and non-viable tissues are excised. At the end of which, plastic surgery is performed with the strengthening of tendons and muscles with local tissues.
Additional Information!
When establishing a spinal hernia in the prenatal period, doctors, in order to reduce the risk of injury to the nervous tissue, take delivery by caesarean section.
Spinal hernia in adults
Do not confuse spinal hernia and protrusion of the intervertebral disc. Neurological manifestations in adults may be similar, but the causes of symptoms vary somewhat. With an intervertebral hernia, the spinal cord is located in its canal, and the main changes concern the cartilage.
The first registered spinal hernia among the adult population is based on the presence of morphological prerequisites in the form of uncomplicated spinal fusion. In the event of injury or excessive weight loads, a hernial protrusion may occur. Symptoms are manifested in the form of a violation of sensitivity, weakening of tone and strength in the limbs, pain syndrome.
When diagnosing such a condition, the patient is subject to emergency hospitalization with surgical treatment.
Diagnosis of the disease
The clinical picture of spinal hernia in some cases is not difficult to diagnose. However, in order to accurately determine the localization of the pathology, establish the contents of the hernial sac, and exclude neoplasms, additional studies are necessary:
1 transillumination (transillumination, the formation is examined in transmitted light); 2 ultrasound; 3 contrast and radioisotope myelography (X-ray examination of the cerebrospinal fluid pathways using contrast or the use of labeled elements); 4 CT, MRI; 5 spinal x-ray.X-ray examination allows you to determine the size of the intervention. So, in the presence of adhesions, adhesions and various constrictions, the spinal cord can be fixed in remote areas from the cleavage site. If you do not mobilize it, then as the child grows, distant neurological symptoms will develop.
The patient is obligatorily examined by a neurologist with diagnostic criteria(changes in reflexes and sensitivity, paresis, paralysis).
To exclude concomitant pathology, an examination by an ophthalmologist and a urologist is performed. An increase in intracranial pressure is marked by congestion on the part of the optic discs. Problems in the urinary system may be a separate disease, and not just a manifestation of neurological disorders.
Additionally, tests are prescribed to prepare for the operation (blood and urine tests, serological blood tests for HIV and syphilis).
Treatment
Spinal hernias are treated with surgical methods. In a radical way, hernia repair and subsequent hernioplasty with local tissues are carried out.
There are a number of relative contraindications to the intervention, which force the operation to be postponed to a more favorable time after the stabilization of vital signs.
In addition to the main treatment, a set of measures is carried out aimed at reducing intracranial pressure with medications (taking diuretics), they are also prescribed vitamin preparations and neurotropic drugs.
Physiotherapeutic techniques (electrophoresis, UHF), massage and exercise therapy are used.
The success of rehabilitation after surgical treatment will depend on how the appointments are made.
Additional Information!
Vertebral cleft as an x-ray finding does not require any treatment measures. A patient with an identified pathology is only observed by an orthopedist and examined by a neurologist.
Since the etiology of the disease mainly lies in embryonic disorders, it is important to carry out prenatal prevention of neural tube pathology. It is necessary to exclude the harmful effects of nicotine, alcohol, drugs, ionizing radiation. Vitamin intake has a significant effect (especially folic acid) on the correct formation of departments nervous system Therefore, it is recommended to start taking them in advance, even at the stage of pregnancy planning. No less important is the consultation of a geneticist and timely examination in the presence of SMG in previously born children or fetuses.
Forecast
The consequences of a spinal hernia are largely determined not only by the quality and timeliness of the operation and rehabilitation measures, but also by the initial condition of the patient. If a hernia is a component in a complex of developmental anomalies, then it does not become a fundamental moment in the prognostic plan. An isolated defect in the form of a split vertebrae with a hernial protrusion of the spinal cord can be treated and corrected quite successfully; in the future, children differ little from their peers.
Video
Interview of the mother of a small patient diagnosed with a fixed spinal cord or spinal hernia after surgery
After surgery for spinal hernia in adults, the prognosis remains relatively favorable.
Spinal hernia is a serious disease. But, despite this, experts have learned to cope with it. Now patients of this profile have the opportunity to assimilate normally with the environment.
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Practice shows that the organization of the work of special medical groups (SMG) in schools is still seriously lagging behind the requirements of the time. This is due to the fact that the process of physical education of weakened children is very difficult.
If the physical exercises of healthy children, adolescents and youth are based on a single methodology common to all students, then classes in the SHG should be based on completely different methods.
Profound differences in the etiology and pathogenesis of past diseases, various localizations, the nature and severity of disorders developed under the influence of the pathological process require a different approach to the exercises.
Principles of the method of practicing SMG
First of all, it is a health-improving treatment-and-prophylactic orientation of physical culture means. A teacher of physical education should know the peculiarities of the influence of physical exercises and hardening means on a sick or weakened child's body, be able to choose the means and methods of physical culture necessary for the treatment of a disease, and be able to evaluate the effectiveness of their effect on the body.
The approach to the use of physical culture means should also be differentiated, depending on the nature and severity of structural and functional disorders in the student's body caused by the pathological process.
In the preparatory period, the means and methods of physical education are used exclusively for recreational purposes.
In the main period, as the adaptation of the organism of students to the conditions of muscular activity improves and the functional state disturbed by the disease is restored, they gradually move to professional-applied physical training.
At the final stage of training, an increase in general and especially special work capacity is provided, and the body's defenses are strengthened.
Group recruitment
The main criterion for including a student in the SHG is the establishment of a diagnosis with the obligatory indication of the degree of impairment of body functions.
For a more differentiated approach to the appointment of motor modes of SHG students, it is recommended to divide them into two subgroups - "A" and "B" (according to the severity and nature of the disease).
Subgroup "A" includes those who have deviations of a reversible nature, i.e. weakened due to various diseases.
Subgroup "B" includes schoolchildren with irreversible changes in organs and systems (damage to the cardiovascular, urinary systems, liver; a high degree of refractive error with changes in the fundus, etc.).
The division into subgroups allows you to determine the mode of employment. At the same time, the most accessible criterion in the selection of appropriate loads is the pulse mode.
In cases of especially pronounced dysfunctions of the musculoskeletal and neuromuscular apparatus and significant health disorders that prevent group classes in conditions educational institution, students are sent to physical therapy classes in medical institutions. Transfer from one medical group to another is made after an additional examination.
The main form of physical education for SHG students are lessons that are held twice a week for 45 minutes. or three times a week for 30 minutes.
Usually in a group of up to 12 people. To increase the effectiveness of classes, it is extremely important to correctly select students in groups that are completed according to the nature of the disease:
of cardio-vascular system;
digestive, endocrine systems and metabolic disorders;
spine and musculoskeletal system;
organs of vision and hearing;
urinary system;
CNS and peripheral nervous system (cerebral palsy, poliomyelitis, etc.).
The relative small number of students with similar diseases does not allow them to be grouped according to the form of the disease. The following grouping is acceptable: a) chronic pathology of the cardiovascular and respiratory systems, b) pathology of the musculoskeletal system and refractive error.
Practice shows that it is most expedient to complete these groups by grade (for example, from students in grades 1–2, 3–4, 5–8, 9–11). If the number of students is not enough to complete the group, then it is advisable to combine students in three or four grades: 1–4, 5–8, 9–11. It should be emphasized the need for a strictly differentiated load, taking into account individual approach to students.
Organization of the educational process
In the SHG classes it is advisable to adhere to the generally accepted structure of physical education classes. But there is a peculiarity in the method of conducting them: the lesson consists not of three, but of four parts.
Introduction(3-4 min.): monitoring the pulse rate, breathing exercises.
Preparatory part(10–15 min.): general developmental exercises, performed first at a slow and then at an average pace. Each exercise is repeated from 4-5 times to 6-8 times. Particular attention should be paid to correct breathing. Exercises that require large muscle efforts and make breathing difficult are not recommended. With the help of general developmental exercises in the preparatory part of the lesson, it is possible to ensure the sequential (according to the principle of "dispersion" of the load) inclusion in the work of all large muscle groups. In this case, the load should not increase sharply. Special breathing exercises, used after the most tiring physical exertion, can reduce the degree of functional stress experienced by the body.
Main part(15–18 min.): learning and training. In it, new physical exercises are studied, breathing skills are trained, and motor qualities are developed. The greatest physical activity should fall on the second half of the main part of the lesson. To do this, the educational material is distributed so that the initial period of the main part is filled with lighter physical exercises. As a rule, in this part of the lesson, one new exercise is taught. At each lesson, it is also necessary to repeat several exercises that have been mastered before. It is very important to avoid fatigue during the repetition of monotonous movements. To do this, as in the preparatory part of the lesson, it is necessary to “disperse” the load on different muscle groups.
The development of gymnastics, athletics, basketball, ski training, volleyball provided for by the physical education program is provided mainly through the main part of the lesson. But for the development of individual sections of sports training, it is advisable to use its preparatory part.
Conducting classes in each of the sections of sports training, it is necessary to take care of the development of motor qualities, endurance training, strengthening the muscular structure of the body.
Final part classes (5 min.) includes breathing and relaxation exercises. The main task of this part of the lesson is to restore the functional state of the body of students after physical exertion. Here, exercises for those muscle groups that were not involved in the lesson are advisable. The intensity of these exercises, which provide active rest for tired muscle groups, should be lower than in the main part of the lesson.
In order to control the correct distribution of the load during the lesson, students must be able to independently measure the heart rate, which, at the signal of the teacher, they determine within 10 seconds. Such a calculation is made 4 times: before the lesson, in the middle - after the most tiring exercise of the main part (in the first 10 seconds), after the lesson and after 5 minutes. recovery period.
The practical sections of the physical education program for students of the main and special medical groups are significantly different. SHG students are exempted from fulfilling any practical standards. But the requirements for certain sports that are mandatory for them include:
- gymnastics - performing drill exercises, posture exercises, basic movements of the arms, torso, dance steps, acrobatic elements, balance, vaults; lifting and carrying small weights, exercises on gymnastic equipment and with equipment;
- athletics - running technique for short and medium distances, methods of throwing grenades, long jumps;
– ski training – possession technique in separate ways movement on skis, climbs and descents from the mountains, turns on the spot and when moving (on the instructions of the teacher);
- swimming - the correct execution of movements with arms and legs, the ability to stay on the water and swim, on the instructions of the teacher, a segment of the distance in the studied way, the ability to combine the movements of the arms and legs with breathing when studying the technique of swimming in one of the ways.
About contraindications to classes
With relatively the same functional state of SHG students, one should take into account contraindications for practicing certain types of exercises, characteristic for each group of diseases.
Diseases of the cardiovascular system suggest a group method of training (preferably outdoors, in a park or square). The lesson is structured in such a way that cyclic exercises predominate (various types of walking, skiing, skating, etc.). Exercises with breath holding, straining, with static tension, with a sharp acceleration of the pace are excluded. General developmental exercises, covering all muscle groups, are performed in the prone position, sitting, standing.
In the process of training, it is necessary to control heart rate and breathing, skin color and general condition child.
In case of respiratory diseases, the lesson includes walking, dosed running in combination with walking and breathing exercises, skiing, skating, games, relay races. In cold and windy weather, classes should not be held outdoors, especially for those suffering from bronchial asthma. When conducting classes in the hall, it is necessary to develop correct rhythmic breathing, as well as breathing with an emphasis on exhalation (especially for patients with bronchial asthma, obstructive bronchitis, etc.). Exercises performed on exhalation through the mouth with the simultaneous pronunciation of vowels [a], [y], [e], [i], [o] and consonants [p], [g], [w], [ u], [h], [s] or combinations thereof (for example, bre,sconces, bru etc.). These exercises should be recommended to be performed at home 3-5 times a day; dosage for one exercise - 2-3 times, the number of exercises - 3-4. After 2-3 months of systematic physical exercise, swimming is advisable.
In case of obesity, the training program includes: long walking over rough terrain, running combined with walking, skiing, training on simulators, swimming and playing in water, dumbbell gymnastics, etc.
In classes with students with kidney disease (nephritis, pyelonephritis, nephrosis), physical activity is significantly reduced, jumping is excluded, hypothermia is not allowed. When conducting general developmental exercises, special attention is paid to strengthening the muscles of the anterior wall of the abdomen. When swimming, the time spent in the water is limited (5-10 minutes - the first year of study, 10-15 minutes - the second year of study). The permission of the doctor for swimming lessons for this contingent of children is negotiated additionally.
For schoolchildren with disorders of the nervous system, exercises that cause nervous overstrain (in balance on an elevated support) are limited, the time for games is reduced, etc.
In diseases of the organs of vision, jumping, somersaults, exercises with straining, headstands and handstands are excluded.
In chronic diseases of the gastrointestinal tract, gallbladder, liver, the load on the abdominal muscles decreases, and jumping is limited. Experience shows that for younger children age group it is advisable to include outdoor games in the lessons, for the older one - elements of dancing.
The activities of children with disorders of the musculoskeletal system include exercises at the gymnastic wall, with stuffed balls, a gymnastic stick, rubber shock absorbers, traction exercises, exercises on simulators. The task is to stop the progression of the disease through physical exercises, and in case of functional posture disorders, to normalize it.
Pedagogical control over students is carried out by the teacher at each lesson. In the first fifteen to twenty lessons, signs of fatigue (sweating, reddening of the skin, etc.) should not be allowed to appear. In the future, with good health, you can use short-term loads that cause a feeling of pleasant fatigue. The criterion for the correct dosing of the load is the change in heart rate during both one lesson and a series of lessons. The pulse of the bulk of the children after the lesson should return to the original data within 15–20 minutes.
In addition to monitoring the level of physical fitness of students, the teacher, as the material progresses, evaluates the correctness of the exercises, the improvement in strength, flexibility, and endurance.
Homework
logical continuation academic work in the lesson there are homework assignments that will help increase the volume of physical activity of students, improve their physical fitness, improve their health, and introduce physical education into everyday life. The teacher must first show the exercises given at home, clarify the load. The total time for completing homework should not exceed 15–20 minutes. Most often, homework includes the following exercises:
1. Walking in place with correct posture, high hips and arm movement (at the mirror).
2. Jumping in place (height 20-30 cm) with a soft landing.
3. Keeping the balance of the bent and straightened leg.
4. Exercises from ip: lying on the stomach, arms bent at the elbow joints and spread apart, hands - one on top of the other under the chin, feet together. Raising the head and arms back or to the sides; raising the head and arms bent at the elbow joints (elbows back, shoulder blades connected); raising the head and torso, hands on the belt.
5. Exercises from ip: lying on your back, arms along the body: raising the head while bending the feet; alternating leg raises (at different angles), cyclist movements; lifting the body with the support of hands on the floor, the same - hands on the belt.
6. Exercises to relax the arms and legs alternately, performed from the SP: standing.
7. Exercise from SP: standing, arms to the sides: touch the left knee with the heel of the right foot, fix this position, maintaining balance. The same with closed eyes.
8. Squats on a full foot, stretching your arms forward. Squats on toes, hands in front. The same - hands on the belt.
9. Exercises for the muscles of the foot: grasping light objects (a small ball, a box of matches, etc.) with your toes, bending the foot in a sitting position.
10. Walking on the gymnastic bench (lines on the floor) with the ball tossing up, hitting it on the floor and catching.
11. Exercises with a gymnastic stick: tilt forward, stick horizontally up, behind the head, behind the shoulder blades (in one motion, bring the stick held in front of you with both hands behind your back).
12. Balance on the left (right) leg ("swallow").
13. Jumping rope on one and both legs with a soft landing on the toes.
14. From a kneeling position, sit on the floor on the side (right, left) and return to SP.
15. Learning hand movements in a certain way of swimming from a standing position, the same with legs, but in a sitting position.
16. Mastering the coordination of movements in a certain way of swimming.
To increase the effectiveness of homework, it is useful to hold meetings, talks with parents, invite them to lessons, explain to them how to stimulate and encourage children to complete the given exercises.
Carrying out sports and outdoor games
Particular attention is required to the methodology of the games. The outdoor games and elements of sports games included in the program material require strict dosage. An increased emotional state during outdoor and especially sports games can cause imperceptible fatigue of students, so the teacher should closely monitor its first signs, finish the game in a timely manner, preventing the occurrence of overwork.
1. Race balls (volleyball or basketball). It is carried out in the form of relay races:
a) passing the ball overhead (2 times);
b) passing the ball between the legs (2 times);
c) passing the ball to the right, to the left (2 times each);
d) passing the ball under the feet, over the head, on the right, on the left (2 times each).
2. Passing a volleyball and its varieties:
a) tossing the ball over oneself, catching it and passing it to a friend. The game is played when building in 2 lines, facing each other, at a distance of 4–6 m (3–5 times each);
b) the same, but when building in 2 columns facing each other, after the transfer the player goes to the end of the opposite column (2 times each);
c) throwing the ball over the net: 2.1. Two balls - simultaneous throwing on a signal. Two halves of 3 minutes; 2.2. With one ball - whoever catches it throws it. One half 3 min.
3. Passed - sit down:
a) passing the ball by the captain (the captain stands facing the column at a distance of 1-3 m) to each player. The student, having received the ball and giving it to the captain, sits on the floor (1-2 times);
b) the same, but the last one in the column, having received the ball, says: “Gop!”, Everyone gets up and passes the ball to the right or left, between the legs, over the head (by agreement) (1–2 times).
4. Basketball techniques. Pupils are built in 2 lines facing each other:
a) passing the ball with two hands from the chest (5 times);
b) passing the ball from the chest with a hit on the court (5 times);
c) dribbling (5 hits with the right hand, 5 hits with the left) (3 times);
d) imitation of throwing the ball into the ring (5 times);
e) dribbling and throwing it into the ring (3 times);
f) a combination of dribbling and passing the ball (3 times).
5. The game "Ball to the captain":
a) change of players after 3 minutes;
b) change of players after 5 minutes.
6. Relay race with elements of basketball:
a) the duration of the relay is up to 3 minutes;
b) the duration of the relay is up to 5 minutes. The team consists of 6-8 players.
7. Playing basketball according to simplified rules:
a) change of players after 3 minutes;
b) change of players after 5-6 minutes.
Games 1–4 are recommended for schoolchildren in grades 4–8 in the first year of study, games 1–5 are already held in the second year, games 1–5 are given for grades 9–10 in the first year of study, and in the second year - 5-7, in addition, add elementary techniques for playing basketball and volleyball according to simplified rules. The dosage of games is given for one-time holding. In the lessons of the second year of study, it is possible to conduct these games with two or even three repetitions, but between them there must be an interval of at least 5 minutes, which is filled with muscle relaxation exercises, walking, breathing exercises and rest for at least 1 minute.
One of the criteria for the correct dosage and conduct of the game can be recovery period heart rate, which should be no more than 5-7 minutes.
Ski lessons require careful thought and attention. Before starting ski training, students must undergo an additional medical examination. In the classroom, the tasks of learning to ski and hardening are solved in parallel. The main attention should be paid to mastering the technique of movement, turns, ascents and descents. During classes, it is necessary to strictly monitor the implementation of all sanitary and hygienic rules: rational clothing appropriate for the weather, air temperature not lower than -15 degrees, correct mode classes. It is necessary to avoid both overheating and hypothermia involved. Since the speed of movement is low, teachers need to control that students breathe in and out only through the nose, which will avoid hypothermia of the upper respiratory tract.
Working with parents
From the first days of work on the physical education of SHG students, great importance should be attached to systematic work with parents. Although all parents want to see their children healthy, strong, slender, hardy, doing well in school, but only in 8% (out of 100 surveyed) families, children with health problems systematically use physical culture to improve it. One of the main reasons for the underestimation of the role of physical exercises is the lack of awareness of parents about their benefits for improving the health and proper physical development of the child. Parent meetings, conversations, lectures, no doubt, will make it possible to achieve positive changes in solving this problem.
Medical supervision during physical exercises
Under medical supervision, the natural conditions in which classes are held are studied, indicators of the intensity and volume of the physical work done are taken into account. Great importance at the same time, as already mentioned, it has the observation of external signs of fatigue in the process of performing physical activity. If students experience an unsatisfactory state after a lesson, due to a discrepancy between the physical stress regimen and their health status, the degree of fitness, it is necessary to reduce physical activity, give children rest, and in some cases conduct an in-depth clinical study.
The reaction to physical activity in the process of training should be manifested by moderate shifts in physiological parameters. Depending on the nature and intensity of the loads, the heart rate, blood pressure, respiratory rate increase, the period of recovery of indicators to the initial level usually does not exceed 5 minutes. Body weight does not change significantly. Vital capacity of the lungs and muscle strength may increase or decrease moderately, indicating in the latter case the appearance of fatigue. A small degree of fatigue in physical exercises with students who have deviations in health status is quite acceptable.
The physiological curve of physical activity is determined by counting the pulse immediately before the start and immediately after the end of each part of the lesson. The resulting pulse curve to a certain extent reflects the reaction of the body caused by exercise, and allows you to trace it in dynamics. In classes with students of the SMG, the so-called undulating nature of the curve is recommended.