Thesis for the degree of a candidate of medical sciences (PhD) in specialty 14.01.33 “Medical Rehabilitation, Physiotherapy and Health Resort Medicine” (22 — Health Care (225 — Medical and Psychological Rehabilitation)). — The Odessa National Medical University, Ministry of Health of Ukraine, Odessa, 2019.
The thesis gives the theoretical summary of research results and proposes a new solution of the scientific task concerning the treatment of children of primary school age with cervicogenic headache (CH) against a background of cervical spine instability (CSI), which consists in improvement of efficiency of medical rehabilitation (MR) through separate and combined application of Kinesio Taping (KT) and exercise therapy (ETh) techniques.
The peculiarities of the clinical-functional state of children of the primary school age with CH against a background of CSI are described. It was shown that besides of headache (HA) (the intensity of HA according to VAS was 2.0 or 3.0 points in 2/3 patients) and the cervical vertebral instability in 3 or more segments, most patients had signs of dysplastic connective tissue of the locomotor apparatus (scoliosis posture associated with cervical-occipital muscles tension, strengthened lumbar lordosis with recurvation in joints, etc.), as well as asthenical manifestations (meteosensitivity, fast fatigability, etc.). The study complemented the idea of hemodynamic, psychoemotional and vegetative disorders in this patient population: 1.4–1.6 folds increase in the speed of blood flow in vertebral arteries and signs of its significant asymmetry, deterioration of elastic properties of vessels and reactions to extravasal influence with difficulty of venous outflow; increase in anxiety, deterioration of allocation, redirecting and volume of attention, as well as decrease in dynamic working activity; violation of the vegetative balance with a significant prevailing of parasympathetic influences and the hypersympathicotonic nature of vegetative reactivity .
The influence of a separate and combined application of KT and ETh on the clinical and functional status of the examined children is investigated directly and in the remote period (1 and 6 months after treatment). It has been shown that each of the investigated methods of MR leads to favorable dynamics of almost all the indicators of the survey and improves the clinical condition (reduction of frequency and intensity of HA: 72.2% (KT), 63.3% (ETh) and 86.7% (complex) children after the course did not have HA ), optimizes hemodynamics of vertebral basilar basin (VBB) vessels, psychoemotional and vegetative status (recovery of the eutonia to 66.8%, 63.3%, 76.7% correspondingly in the 1st, 2nd and 3rd subgroups p<0,001 — in comparison with the initial frequency in all cases), parameters of which worsened a little in the remote period (after 6 months). Morphological changes at the region of the cervical spine with all methods did not change significantly, only long-term improvement was achieved by decreasing the instability of 3 or more segments.
A comparative analysis of the influence demonstrated that the combined use of KT and ETh leads to a better direct and remote (in 1 and 6 months after treatment) clinical effect (as reduction of the frequency and intensity of headache) in children as compared with the separate application of these MR methods. It is established that the best and the longest clinical and functional effect is achieved by the KT and ETh combined usage, which persisted for more than 1 month, decreases in 6 months after MR, though, as a rule, remains better than before treatment (p<0.05). Partial regression of positive results confirms the need to repeat MR no later than in 6 months. Optimization of the condition of the examined children confirms the future outlook of further research in this direction.
