PhD, Associate Professor S.Ya. Koval¹
PhD, Associate Professor O.V. Khomyakova¹
PhD, Associate Professor E.Y. Shishko¹
PhD, Associate Professor E.I. Nagaeva¹
PhD, Associate Professor V.F. Krovyakov^1
1V.I. Vernadsky Crimean Federal University, Simferopol

Keywords: adaptation, compensation, motor functions, gymnasts, spinal cord injuries.

Introduction. Spinal cord injuries lead to various motor, sensory, and pelvic disturbances, trophesy. Internal organs and body systems dysfunctions (viscero-cortical correlations) are found not only below but also above the injury [1]. Severe morphological and functional spinal cord disorders affect athlete’s biomechanics and movement pattern, reduce the duration and quality of life of a disabled person.

Considering the potentials of the sanatorium stage, N.E. Molskaya (1996), A.G. Stoporov, and B.P. Redko (1997) emphasize the need to continue developing scientifically substantiated training methods [2, 3].

Objective of the study was to experimentally prove the efficiency of a special physical rehabilitation model applied to gymnasts with spinal cord injuries (SCI) and geared to build up physical functionality, compensatory resource and muscular strength.

Methods and structure of the study. The model piloting experiment was performed at Burdenko Sanatorium in Saki. Sampled for the study were 30-33 year-old (n=20) former male gymnasts with 5+ year long spinal injuries at the final stage of post-spinal-cord-injury (severity class D₁₀-L₁) rehabilitation.

The disabled athletes took a 2-month rehabilitation course on a daily basis: 15-minute morning gymnastics using breathing exercises of a general strengthening effect; remedial gymnastics with the elements of corrective (muscular corset shaping practices and passive/active spine stretching exercises), coordination (equilibrium exercises) and kinetic (dynamic training for individual muscles in the isotonic mode) gymnastics, performed 3 hours after the therapeutic massage sessions (a total of 12 sessions, 25 minutes each) combined with physiotherapy - electrostimulation of the quadriceps muscle of the thigh and gluteus muscles using the Bagel bipolar technique (a total of 12 procedures, 10 minutes each, performed in the afternoon).

During the first 30 days of rehabilitation, physical exercises were performed in a partial load mode, at a slow pace, and with a small amplitude of movements (an increase in the heart rate up to 15-20% of the baseline was deemed acceptable). The training sessions were designed strictly individually, with due regard to each subject’s physical working capacity. The patients were passively raised to an upright position on a fracture table using the neuromotor reeducation and walking training techniques (correction of the locomotor functions). In the next 30 days, the physical exercises were performed in the partial load mode (the exercises were performed at a high pace with significant opposition, an increase in the heart rate up to 40-50% of the baseline was deemed acceptable).

When analyzing the clinical manifestations of SCI and their complications, it is motor activity that is estimated (lying, sitting, standing positions), as well as the walking function according to A.G. Stoporov [3, 4]. Each indicator was assessed on a 60-point ordinal scale based on the level principle of achieving the final adaptive effect, which was determined by the degree and quality of formation of the compensatory-adaptive reactions: unsatisfactory level (up to 10 points) - compensation is achieved at the expense of reserve and external components; minimum level (up to 20 points) - compensation is achieved at the expense of reserve and non-specific components; satisfactory level (up to 30 points) - compensation is achieved primarily at the expense of non-specific components, with the involvement of specific and reserve ones; optimal level (up to 40 points) - compensation is achieved primarily at the expense of non-specific components, with the involvement of specific ones. It is considered optimal as it is only the quantitative and qualitative characteristics and functions that need to be improved; normal variant (50-60 points) - compensation is achieved primarily at the expense of specific components with the involvement of non-specific ones and corresponds to the norm.

The neuromuscular system functionality was tested by the method of interferential electromyography. The analysis of the myoelectrical activity made it possible to single out 4 types of one.

The first type was characterized by different amplitudes of muscle biopotential - 60-250 Hz, registered in the patients with SCI in terms of hypodynamia and adynamia; the second type was characterized by the reduced biopotential rhythm - 40–120 Hz, registered in the patients with spastic movement disorders; the third type was characterized by EMG low-frequency high-amplitude rhythmic biopotential, registered in the patients with pronounced spastic movement disorders; the fourth type was characterized by the absence of myoelectrical activity, typical for plegia due to SCI. However, we could observe muscle electrical activity during passive movements.

Overall physical working capacity was evaluated using the upper body ergometer B-02. Sitting in a wheelchair, the subjects were to perform two types of standard physical load (50W and 100W) for 5 minutes with a 5-minute rest interval in between. The rehabilitation period lasted 60 days.

Results and discussion. Initial evaluation of the disabled athletes’ motor activity testified to poor compensation of motor disturbances and limited working capacity due to SCI. According to the electromyographic studies, this indicator amounted to 2.0±0.2 points, with the maximum score being 5 points. At the same time, their physical working capacity was at the level of 197.5±1.6 kgm/min, which indicated a low physical working capacity level.

On the 30th day of the rehabilitation course, the physical activity rate in this group, when performing physical exercises in the partial load mode, was as follows: in the lying position - 37 points, in the sitting position - 32 points, in the standing position - 30 points, while walking - 22 points, which confirmed that the physical rehabilitation means had been chosen right and that the compensatory and adaptive abilities of the body started to increase. The data obtained indicate a satisfactory level of compensation, since the subjects learnt to perform specific movements with the paretic extremities or body segments. The electromyographic index increased slightly and amounted to 3.2±0.1 points, with the maximum being 5 points. The physical working capacity rate PWC₁₅₀ equaled 229.5±1.1 kgm/min.

Performance of physical exercises in the partial load mode for the next 30 days led to a significant growth of the indicators in the SCI group as compared to the first day of rehabilitation. Thus, the electromyographic index equaled 3.6±0.1 points (p_1-60<0.05), the physical working capacity rate increased to 262.5±1.1 kgm/min (p_1-60<0.001). Restoration of the lost motor functions and vocational rehabilitation significantly improved the disabled athletes’ compensatory abilities, as confirmed by the physical activity rates versus the first day of rehabilitation. For instance, the group physical activity indicators were as follows: in the lying position - 43 points (p_1-60<0.05), in the sitting position - 38 points (p_1-60<0.05), in the standing position - 35 points (p_1-60<0.05), while walking - 37 points (p_1-60<0.05). On the 60th day of rehabilitation, compensation reached an optimal level at the expense of non-specific and specific components.

The data obtained upon physical rehabilitation of the athletes testify to the progress in their motor abilities driven by the replacement compensation principle, i.e. with the impaired muscles of the transitional zone above the injury being engaged in the practices together with healthy muscle groups

Obviously, the main physiological mechanism of motor rehabilitation consists in the creation and reinforcement of a new movement pattern, i.e. a strict sequence of conditioned motor reflexes that make up a complete motor action.

Conclusion. Hence, the proposed physical rehabilitation model was tested to improve the bodily adaptive, reserve and compensatory resources and, therefore, may be recommended for rehabilitation of athletes after spinal (lower thoracic) cord injuries at the sanatorium stage.

References

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2. Koval S.Y., Khomyakova O.V., Redko A.B. et al Innovatsionnye podkhody v reabilitatsii bolnykh s nizhnimi parezami vsledstvie spinno-mozgovoy travmy na urovne D10-L1 [Innovative approaches in rehabilitation of patients with lower paresis due to spinal cord injury levels D10-L1]. Tavricheskiy mediko-biologicheskiy vestnik, 2013, vol. 16, no. 3-3, pp. 48-51.
3. Kondrakov G.B., Andryushchenko L.B., Bezveselnaya Z.V. et al Kontseptsiya formirovaniya rekreatsionnoy fizicheskoy kultury v ekonomicheskom vuze [The concept of formation of recreational physical culture in institution of economics]. Teoriya i praktika fiz. kultury, 2016, no. 9, pp. 22-24.
4. Mamonova O.V., Andryushchenko, L.B., Filimonova Y.B. et al Osobennosti fizicheskogo samovospitaniya studentov s osobymi obrazovatelnymi potrebnostyami [Features of Physical Self-Education of Students with Special Educational Needs]. Kultura fizicheskaya i zdorovye, 2018, no. 1 (65), pp. 20-23.
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7. Stoporov A.G. Nekotorye aspekty integralnoy otsenki obschey kompensatsii bolnykh perenesshikh pozvonochno-spinnomozgovuyu travmu [Some aspects of integrated assessment of general compensation for patients with spinal cord injury]. Vestnik fizioterapii i kurortologii, 2007, no. 2, pp. 172–177.

Corresponding author: andryushenko-lil@mail.ru

Abstract

The study analyzes benefits of a special physical rehabilitation model applied to gymnasts with spinal cord injuries and geared to build up physical functionality, compensatory resource and muscular strength. The model piloting experiment has been performed at Burdenko Sanatorium in Saki for 2 months on a daily basis. Sampled for the study were 30-33 years old (n=20) former gymnasts with 5+ year long spinal injuries at the final stage of post-spinal-cord-injury (severity class D10-L1) rehabilitation.

The physical rehabilitation model was found beneficial as verified by the sample’s progress in the motor abilities driven by the replacement compensation principle i.e. with the impaired muscles of the transitional zone above the injury being engaged in the practices together with healthy muscle groups. A set of special isometric, dynamic and corrective exercises applied by the model was intended to build strength in the muscles and scale down the muscular deformations, overtone and hyperspasticity rates. The rehabilitation processes were facilitated by the therapeutic massage to normalize the metabolic processes in the body tissues, improve the lymph/ blood flows, mitigate pains, speed up the nervous fibers regeneration, reinforce the musculoskeletal system, build up strength, prevent and reduce atrophy and, hence, to make the patients more physically active. The physical rehabilitation model was tested to improve bodily adaptive, reserve and compensatory resources and, therefore, may be recommended for rehabilitation of athletes after spinal (lower thoracic) cord injuries.