The dissertation provides a theoretical justification and a new solution to an actual scientific and practical task is increasing the effectiveness of physical rehabilitation of impaired motor and cognitive functions in hockey players after sport-related concussions (SRC), by developing and substantiating a physical therapy program taking into account the state of vegetative nervous system (VNS), level of regulatory systems (IN), headache level, attention disorders and executive functions. Clinical, instrumental, functional, statistical research methods were used to achieve the tasks set in the work.The work describes for the first time the main clinical and anamnestic, anthropometric, laboratory and functional characteristics of patients with bronchiectasis in Ukraine.
It was established that after SRC there is a shift in the balance of the tone of the VNS towards the sympathetic division. So, in the first two days all athletes had signs of sympatheticotonia. On the third day only 30.0% had normotonia and 70.0% had sympatheticotonia (p<0.05). On the seventh day, normotonia was determined in 60.0% and sympatheticotonia in 40.0% (р<0.05). During the three months of recovery there was a shift in the tone of the VNS towards the parasympathetic department (р<0.05). However, on the 90th day, only 20.0% of hockey players had parasympatheticotonia characteristic of professional players.
It has been proven that the stress of regulatory systems has a negative effect on motor functions, in particular, an increase in IN negatively affects the ability of patients to perform tasks for the development of balance and neuromuscular control. In the group with IN above 200 units during the first visit, the results of the ВESS test averaged 11.4±1.6 units, which was statistically significantly higher than the indicator in the group with IN less than 200 units, where they were equal to 9.8±1.1 units. (F=10.0, p=0.01).
The greater effectiveness of the developed physical therapy program compared to the standard one was proved by 26.0±2.1% in terms of disability, 9.9±0.8% in the tone of the VNS according to Kerdo index (IK), HRV according to statistical indicators of SDNN and variation range by 4.6±0.3% and 28.2±3.5%, respectively, according to IVR by 33.7±4.9%, a decrease in LF by 35.3±6.7% and an increase in HF by 33 ,6±8.1%, reduction of IN by 22.5±4.6%, improvement of static and dynamic balance according to the BESS test by 25.3±3.1%, decrease in the time of execution of the test with TW and TWC by 20.1±1.6%, with an increase in the MoCA score by 12.4±2.0% (р<0.05).
A prognostic model of the effectiveness of rehabilitation for the restoration of motor and cognitive functions in hockey players after SRC has been developed, according to which the most significant factors that aggravate the prognosis are the level of disability according to VAS (regression coefficient B=-0.12), the presence of repeated SRC (B=1 .02), the general level of cognitive functions (B=0.03), a lower level of sympatheticotonia according to IVR (B=0.03) and IC (B=-0.08), taking into account the peculiarities of the tone of the VNS during physical exercise therapy (B=0.97). The developed model predicts results within 20.0% of the existing actual values, which indicates satisfactory and effective work (determination coefficient 54.0%, p<0.05).
For the first time, it was proven that on the third day after SRC 66.7% of hockey players have symptoms of sympatheticotonia, in 80.0% pre-tension of the regulatory systems was established, which is the basis for the appointment and dosage of therapeutic loads. For the first time, the data on the characteristic dynamics of the component cognitive functions in the rehabilitation process after SRC have been specified, in particular, it has been established that the level of executive functions and attention do not change when using the SCAT 5 protocol. For the first time, the negative impact of straining the regulatory systems on motor functions has been established, in particular, an increase in IN has a negative effect on the ability of patients to perform tasks for the development of balance and neuromuscular control. For the first time, prognostic factors affecting the effectiveness of rehabilitation in restoring the ability to perform motor and cognitive tasks were identified and quantified. The study proved the cumulative negative impact of an increase in the number of SRC received during a sports career on the level of cognitive functioning of hockey players.
A program of physical therapy for motor and cognitive disorders in hockey players after SRC was developed, substantiated and implemented in health care practice. A prognostic model of the effectiveness of rehabilitation of impaired motor and cognitive functions in hockey players after SRC has been developed
