Корекція Рухового Стереотипу Жінок З Цукровим Діабетом І Типу, Які Перенесли Кесарів Розтин, Засобами Фізичної Терапії

Abstract

Abstract. The Purpose is to determine the effectiveness of the use of physical therapy for the correction of the motor stereotype of women with type I diabetes that underwent cesarean section in the postpartum period.
 Methods 35 women with type 1 diabetes who underwent abdominal delivery (caesarean section) 1 month before the initial examination took part in the study. The control group consisted of 17 women, who recovered in the postpartum period without rehabilitation interventions or according to self-selected methods. 18 women of the comparison group were engaged in a physical therapy program, the effectiveness of which is presented in this study, which lasted 1 month. Within its framework, kinesitherapy was performed with women (therapeutic exercises for the upper and lower limbs, back, abdomen, chest; functional training to correct the movements of habitual activities and those that take care of a child); manual massage (back, abdomen, lower limbs). Means of physical therapy were used to improve the physical qualities of women - flexibility, strength, endurance, dexterity, speed; normalization of psycho-emotional status, which can be changed due to the risk of postpartum depression; improvement of peripheral blood circulation, changed due to diabetic angiopathy; improvement of sensitivity of peripheral tissues and neuromuscular control, altered due to diabetic neuropathy; improvement of tissue sensitivity to insulin and normalization of glucose utilization by tissues.
 The effectiveness of physical status correction was performed according to the standard Functional Movement Screen technique.
 Results The movement capabilities of women with diabetes according to the Functional Movement Screen in the postpartum period were relatively low, which was due to a long period of reduced physical activity, changes in the biomechanics of the body, and postpartum reorganization of the body.
 During the re-examination, the improvement in exercise performance was (respectively in the control group and the comparison group): "deep squat" – 11.9% and 49.2%; "hurdle step" – 17.2% and 31.7%; "in-line lunge" – 35.4% and 86.8%; "shoulder mobility" – 14.0% and 50.3%; "active straight leg raise" – 24.1% and 47.0%; "trunk stability push-up" – 20.0% and 60.4%; "rotary stability" – 34.0% and 67.1%. This is evidenced by the results of FMS in women of the control group, which were statistically significantly better (p<0.05) compared to the original data, but the number of women with low scores was still significant. At the same time, the determination of FMS parameters in women of the comparison group during the repeated examination showed the feasibility of using physical therapy to improve the condition of women with diabetes in the postpartum period, since in this group the repeated results were better not only the initial levels, but also the corresponding indicators of the control group upon re-examination (p<0.05).
 Conclusions After the implementation of a physical therapy program with the use of therapeutic exercises of various orientations, functional training, a statistically significantly better result was found on all tests of the Functional Movement Screen compared to women with type I diabetes who recovered after cesarean section on their own. Therefore, it is advisable to prescribe physical therapy in the process of postpartum recovery of women with diabetes in order to improve their movement pattern and speed up recovery.