Dr.Hab., Professor A.I. Seselkin¹
PhD, Associate Professor V.P. Kartashev¹
PhD, Associate Professor N.V. Karpova¹
Applicant K.A. Chernetskaya^1
1Russian State Social University, Moscow

Keywords: physical rehabilitation, injuries, musculoskeletal system.

Introduction. Musculoskeletal injuries are quite common, with the radial head fracture reported in approximately 20% of the total number of elbow joint injuries, which amounts to 4-5% of all skeletal fractures occurring in traumatology [2]. In the therapy of the elbow joint injuries, various complications are observed in 16-40% of the injured, and 20-22% become disabled [3]. In this regard, intensification of treatment of the radial head fractures and prevention of such musculoskeletal injuries are of great social importance [6]. Rehabilitation of the radial head fracture is greatly affected by the timely elbow joint motor function recovery, which is based on the use of its modern and traditional means, including passive and active participation of the patient himself in the rehabilitation process [4]. As a result of development of physical rehabilitation as a science, today, the potential for the integrated use of its various methods has increased significantly. Among them are: exercise therapy, massage, physiotherapeutic procedures in the elbow joint injuries, water rehabilitation, as well as recreational gymnastics complexes.

However, no studies were dedicated to the potential of physical rehabilitation of hearing-impaired athletes diagnosed with the radial head fractures [5].

The hypothesis of the research was the assumption that the combination of traditional methods of therapeutic physical training with the elements of "yoga", massage and water rehabilitation will significantly improve the results of physical rehabilitation of hearing-impaired athletes. Moreover, the methods used for physical rehabilitation of the hearing-impaired athletes and healthy athletes differ only in the use of visual tools, including physical or video demonstration, showing how to perform an exercise correctly, physical (rather than verbal) correction of its performance, as well as the use of sign language in case of pain.

Objectives of the study:

1. Identify specific features of physical rehabilitation of hearing-impaired athletes with the radial head fractures.

2. Diagnostics of the muscle strength, flexion-extension and rotation movements of the arm with the radial head fracture.

3. Development and approbation of the experimental methodology of physical rehabilitation of hearing-impaired athletes with radial head fractures.

Methods and structure of the study. For the purposes of the study we applied the Mironov-Burmakova’s test to rate pain in the elbow joint; the same test adapted by V.A. Kalantyrskaya to rate amplitudes of the flexion-extension and rotation movements in the elbow joint; dynamometry; bodily functional status rating tests; educational experiment; and standard mathematical methods of statistics.

The muscle strength was rated by the hand-held dynamometry with the carpal dynamometer DK-100 applied for this purpose. The measurements algorithm was as follows: the dynamometer was held with an injured hand kept aside; the other hand was lowered down and kept straight along the trunk; the dynamometer was squeezed 5 times with the injured hand applying maximum force, making pauses for several minutes, the pointer position was fixed each time. The greatest pointer deflection indicated the maximum muscle strength in the hand. After that, the average muscle strength of the hand was determined.

The educational experiment aimed at testing the developed program of physical rehabilitation of patients with radial head fractures revealed its effectiveness. The Reference Group was trained according to the traditional physical rehabilitation program, which included remedial gymnastics. The Experimental Group was trained according to the program of out design, including, apart from exercise therapy complex, such physical rehabilitation facilities as water rehabilitation and massage.

The research data was analyzed by means of the conventional mathematical  methods of  statistics, which implied calculation of arithmetic mean, standard deviation, standard error of arithmetic mean, and level of significance measured by the Student's t-criterion.

The studies were conducted at the premises of the educational center "Sambo-70". Subject to the experiment and tests were 15 hearing-impaired sambo and judo wrestlers diagnosed with the radial head fracture, who were split up into the Experimental and Reference Groups (EG, RG). The Reference Group was made of 7 18-22 year-old male athletes. The Experimental Group involved 8 20-25 year-old male athletes. The mean age of the sample was 21.5 years.

Physical rehabilitation of the Reference Group patients was carried out through exercise therapy with the use of the methods applicable for this type of injury. The Experimental Group trained for 45-60 minutes 3 times a week in accordance with the designed physical rehabilitation program with the use of the water rehabilitation methods, exercise therapy, fitness complexes (yoga), and massage therapy.

The research was arranged in three stages. The first stage (2 weeks) included:

- analysis of the scientific and methodical literature on the problem,

- selection of tests to determine the elbow joint functionality,

- development of a methodology, selection of means and forms of water rehabilitation,

- formation of Experimental and Reference Groups.

The second stage (8 weeks) was devoted to the educational experiment conducted at the premises of the educational center "Sambo-70". All patients of the Reference and Experimental Groups were under out-patient treatment.

The third stage of the study aimed to:

- process, generalize, analyze and interpret the research results,

- evaluate the effectiveness of the educational activity.

The Reference Group was engaged in the traditional physical rehabilitation program implemented within this educational institution, which included 45min exercise therapy sessions only.

In the Experimental Group, we applied our complex system, which included:

- exercise therapy sessions,

- additional exercises using fitness complexes (yoga),

- massage,

- water rehabilitation.

Prior to the rehabilitation activities and at the end of the experiment, we examined the Reference and Experimental Group athletes.

The features of the physical rehabilitation model were determined based on the clinical data.

Results and discussion. Upon introduction of the series of physical exercises, we re-tested the hearing-impaired athletes using the chosen methods.

Table 1. Amount of pain in the elbow joint (%)

According to the results obtained in the Reference Group 14.2% of the athletes (versus 0% before) demonstrated the low amount of pain; 57.3% (versus 57.2%) – average; 28.5% (versus 42.8%) - high. In the Experimental Group, the low amount of pain was registered in 50% of the athletes (versus 0%); average - in 50%; while high amount of pain was not registered.

According to the results of the analysis of the amplitude of flexion-extension and rotation movements in the elbow joint in the Reference Group, 28.5% of the athletes had no differences in the amplitude of movements of the healthy and injured arms; in 71.5% of the athletes the amplitude of movement of the injured elbow joint decreased by 30°. In the Experimental Group, 50% of the athletes had no differences in the amplitude of movements of the healthy and injured arms, in 50% the amplitude of movement of the injured elbow joint decreased by 30°.

The analysis of the amplitude of rotation movements in the Reference Group revealed that in 28.5% of the subjects no differences were observed in the amplitude of rotation movements of the healthy and injured arms, 57.3% were found to have a decrease in the amplitude of movement of the injured elbow joint by 30°, 14.2% - a decrease by 60°. In the Experimental Group, 62.5% of the athletes had no differences in the amplitude of rotation movements of the healthy and injured arms (before the experiment it was not visualized), in 37.5% the amplitude of movement of the injured elbow joint decreased by 30° (62.5%).

Table 2. Effect of physical rehabilitation on the dynamics of muscle strength (kg) in the injured arm

As follows from the data presented in Table 1, after the experiment, the muscle strength in both the Reference and Experimental Groups increased by 9 kg on the average after two months of rehabilitation.

Conclusions. The first measurement taken according to the developed method showed that the Experimental and Reference Group subjects diagnosed with the radial head fractures did not have any statistically significant differences in the muscle strength, flexion-extension and rotation rating tests. The second measurement found significant differences in the muscle strength, flexion-extension and rotation values in the Experimental Group versus the Reference one, which indicates the benefits of the developed physical rehabilitation model including physical therapy, additional exercises with the use of fitness complexes (yoga), massage and water rehabilitation.

References

1. Belaya N.A. Lechebnaya fizkultura i massazh. Uchebno-metod. posobie dlya meditsinskih rabotnikov [Therapeutic physical training and massage. Teaching aid for medical workers]. Moscow: Lira publ., 2012, 699 p.

2. Boyko I.V., Kondrashova A.N. Osobennosti meditsinskoy reabilitatsii bolnyih s posledstviyami travm loktevogo sustava [Specifics of medical rehabilitation of patients after elbow joint injuries]. Skoraya med. pomoshch, 2013. Spec. is., pp. 24-25.

3. Kalantyrskaya V.A. Lechenie perelomov golovki luchevoy kosti. Avtoref. dis. kand. med. nauk [Treatment of radial head fractures. PhD diss. abstract]. Moscow, 2012, 18 p.

4. Kaptelin A.F., Lebedeva I.P. Lechebnaya fizkultura v sisteme meditsinskoy reabilitatsii. Rukovodstvo dlya vrachey [Therapeutic physical training in medical rehabilitation system. Doctor's Guide]. Moscow: Meditsina publ., 2015, 312 p.

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6. Shmeleva S.V., Taktarov V.G. Soderzhanie i metodika sotsialno-meditsinskoy raboty. Ucheb. posobie [Content and methodology of social and medical work. Study guide]. Moscow: Akademiya publ., 2010.

Corresponding author: fizkult@teoriya.ru

Abstract

The study analyzes benefits of a new physical rehabilitation method for the hearing-impaired athletes after musculoskeletal injuries, with the radial head fracture taken for the case study to analyze benefits of the immobilizing, post-immobilizing and rehabilitation process stages with application of exercise therapy, massage, yoga and water rehabilitation methods. For the purposes of the study we applied the Mironov-Burmakova’s test to rate pain in the elbow joint; the same test adapted by V.A. Kalantyrskaya to rate amplitudes of the flexion-extension and rotation movements in the elbow joint; hand-held dynamometry; bodily functional status rating tests; educational experiment; and standard mathematical methods of statistics; with the muscular strength rated by the hand-held dynamometry. Subject to the experiment and tests were 15 hearing-impaired sambo and judo wrestlers; diagnosed with radial head fracture; and split up into Experimental and Reference Groups (EG, RG). The physical rehabilitation model was found beneficial as verified by the significant progress of the EG versus RG in muscle strength, joint flexion and rotation rating tests.