骨科矫正用于儿童注意缺陷多动障碍治疗的可能性

A. I. Zaev, O. V. Stenkova
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Limitations of existing pharmacological treatment methods emphasize the need to develop effective non-pharmacological interventions that improve short- and long-term results in regard to neuropsychological defi ciency symptoms and disorders of other general activity fi elds. Currently, there are publications noting the positive clinical effect of osteopathic correction on the children′s health state in various mental sphere disorders. But only a few studies are aimed at studying the effect of osteopathic correction in ADHD. At the same time, there are no publications about the osteopathic correction use in the ADHD treatment without pharmacotherapy.The aim of the study is to investigate the possibility of osteopathic correction using for the treatment of children with attention defi cit hyperactivity disorder.Materials and methods. The study was conducted on the basis of the medical organization «Health′ Clinic» Tver from March 2021 to February 2022. Inclusion criteria: children age 7–10 years; established ADHD diagnosis; absence of diseases and conditions that are an absolute contraindication for osteopathic correction; parental consent to osteopathic examination and correction. Criteria for non-inclusion: age of children younger than 7 and older than 10 years; not confi rmation of the diagnosis according to the «ADHD Assessment Scale — ICD-10 criteria»; the presence of diseases and conditions that are an absolute contraindication for osteopathic correction. Exclusion criteria: failure to attend repeated examinations. The total number of children was 38 people. The patients were distributed by randomization envelopes into 2 groups of 19 people each. The main group: the osteopathic correction and the behavioral psychotherapy were used. The comparison group: the drug hopanthenic acid and the behavioral psychotherapy were used. Before and after the treatment, osteopathic status was assessed in both groups, and the severity of ADHD was assessed according to the ADHD assessment scale (ICD-10 criteria), and an attention test was conducted in the form of a Bourdon correction test.Results. At the beginning of the study, the patients were characterized by regional biomechanical disorders of the head region — in 100 % of participants in both groups, as well as the neck (structural component) — in 63 % of participants in both groups, and the dura mater — in 89 % of participants in the comparison group and 79 % of the main group. After the course of treatment, a signifi cant (p<0,05) positive dynamics was observed in the main group according to the three above indicators, and there was no signifi cant dynamics in the comparison group. After the treatment, the statistically signifi cant (p<0,05) positive dynamics was observed in both groups with respect to the severity of ADHD and the main characteristics of attention: the indicators of the ADHD assessment scale (ICD-10 criteria) decreased, the accuracy coeffi cients and concentration of attention increased, and the fatigue index decreased. At the same time, in the main group, the fatigue index decrease was statistically signifi cant (p<0,05) more pronounced than in the comparison group.Conclusion. 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引用次数: 0

摘要

介绍。注意缺陷多动障碍(ADHD)在儿童时期被诊断出来,是儿童中最常见的精神障碍,约占学龄儿童的5 - 7%。临床观察表明,没有一种治疗方法对治疗ADHD是完全有效的。在大多数情况下,主要的治疗方法是药物治疗。但是,尽管药物治疗短期有效,但可能有局限性:部分反应或无反应,副作用,长期效益可疑,治疗方案的依从性差,父母的消极态度。现有药物治疗方法的局限性强调需要开发有效的非药物干预措施,以改善有关神经心理缺陷症状和其他一般活动领域障碍的短期和长期结果。目前,有出版物指出骨科矫正对各种精神障碍儿童健康状况的积极临床效果。但只有少数研究旨在研究骨科矫正对ADHD的影响。同时,目前尚无文献报道骨科矫正在非药物治疗的ADHD治疗中的应用。本研究的目的是探讨骨科矫正用于治疗儿童注意力缺陷多动障碍的可能性。材料和方法。该研究于2021年3月至2022年2月在医疗组织“健康诊所”Tver的基础上进行。纳入标准:7-10岁儿童;确定ADHD诊断;没有骨科矫正绝对禁忌症的疾病和状况;家长同意骨科检查和矫正。未列入标准:7岁以下和10岁以上儿童的年龄;未根据“ADHD评估量表- ICD-10标准”确认诊断;存在绝对禁忌症的疾病和状况。排除标准:未参加重复检查。儿童总数为38人。采用随机信封法将患者分为两组,每组19人。主要组:采用整骨矫正和行为心理治疗。对照组:采用药物贯花酸和行为心理治疗。治疗前后评估两组患者的骨科状态,根据ADHD评估量表(ICD-10标准)评估ADHD严重程度,并以波登矫正测验的形式进行注意力测试。在研究开始时,患者的特征是头部区域的区域性生物力学障碍-两组中100%的参与者,以及颈部(结构部件)-两组中63%的参与者,以及硬脑膜-对照组中89%的参与者和主要组中79%的参与者。治疗结束后,主组以上三项指标均有显著(p< 0.05)正动态变化,对照组无显著动态变化。治疗后,两组在ADHD严重程度和注意力主要特征方面均有统计学意义(p< 0.05)的正动态变化:ADHD评估量表(ICD-10标准)各项指标降低,注意力准确度系数和注意力集中度提高,疲劳指数降低。同时,主治疗组患者疲劳指数下降较对照组明显,差异有统计学意义(p< 0.05)。获得的结果使我们能够推荐在治疗ADHD儿童时采用整骨矫正,特别是在由于某些原因对药物使用有限制的情况下。
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The possibilities of osteopathic correction using for the treatment of children with attention defi cit hyperactivity disorder
Introduction. Attention defi cit hyperactivity disorder (ADHD) is diagnosed in childhood and is the most common mental disorder in children — about 5–7 % among school-age children. None of the treatment methods, as clinical observations showed, is completely effective for the treatment of ADHD. In most cases, the main method of treatment is pharmacotherapy. But despite the proven short-term effectiveness, pharmacotherapy may have limitations: partial response or no response, side effects, questionable long-term benefi ts, poor adherence to the treatment regimen, negative attitude of parents. Limitations of existing pharmacological treatment methods emphasize the need to develop effective non-pharmacological interventions that improve short- and long-term results in regard to neuropsychological defi ciency symptoms and disorders of other general activity fi elds. Currently, there are publications noting the positive clinical effect of osteopathic correction on the children′s health state in various mental sphere disorders. But only a few studies are aimed at studying the effect of osteopathic correction in ADHD. At the same time, there are no publications about the osteopathic correction use in the ADHD treatment without pharmacotherapy.The aim of the study is to investigate the possibility of osteopathic correction using for the treatment of children with attention defi cit hyperactivity disorder.Materials and methods. The study was conducted on the basis of the medical organization «Health′ Clinic» Tver from March 2021 to February 2022. Inclusion criteria: children age 7–10 years; established ADHD diagnosis; absence of diseases and conditions that are an absolute contraindication for osteopathic correction; parental consent to osteopathic examination and correction. Criteria for non-inclusion: age of children younger than 7 and older than 10 years; not confi rmation of the diagnosis according to the «ADHD Assessment Scale — ICD-10 criteria»; the presence of diseases and conditions that are an absolute contraindication for osteopathic correction. Exclusion criteria: failure to attend repeated examinations. The total number of children was 38 people. The patients were distributed by randomization envelopes into 2 groups of 19 people each. The main group: the osteopathic correction and the behavioral psychotherapy were used. The comparison group: the drug hopanthenic acid and the behavioral psychotherapy were used. Before and after the treatment, osteopathic status was assessed in both groups, and the severity of ADHD was assessed according to the ADHD assessment scale (ICD-10 criteria), and an attention test was conducted in the form of a Bourdon correction test.Results. At the beginning of the study, the patients were characterized by regional biomechanical disorders of the head region — in 100 % of participants in both groups, as well as the neck (structural component) — in 63 % of participants in both groups, and the dura mater — in 89 % of participants in the comparison group and 79 % of the main group. After the course of treatment, a signifi cant (p<0,05) positive dynamics was observed in the main group according to the three above indicators, and there was no signifi cant dynamics in the comparison group. After the treatment, the statistically signifi cant (p<0,05) positive dynamics was observed in both groups with respect to the severity of ADHD and the main characteristics of attention: the indicators of the ADHD assessment scale (ICD-10 criteria) decreased, the accuracy coeffi cients and concentration of attention increased, and the fatigue index decreased. At the same time, in the main group, the fatigue index decrease was statistically signifi cant (p<0,05) more pronounced than in the comparison group.Conclusion. The obtained results allow us to recommend osteopathic correction in the treatment of children with ADHD, especially in the cases where, for some reasons, there are restrictions on the medications use.
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