Physiotherapy. Classification of therapeutic factors and their characteristics
Mechanism of action physical factors
The mechanism of action of physical factors is complex. The action of the factor is carried out at different levels, from intracellular, molecular to the reaction of an organ, system, and the whole organism. The absorption of factor energy (radiant, electrical, mechanical, thermal, etc.) leads to the formation of electronically excited states, a change in the ratio of ions in the cell, membrane permeability and microcirculation, the rate of redox processes, and the formation of biologically active products.
Primary reflex reactions develop, the activity of the endocrine glands intensifies, adaptive reactions are activated that ensure the function of cells, organs, systems during the period of action and aftereffect of the factor.
Along with the reflex action of physical factors, the body is influenced by humoral products formed in the skin and tissues, drug ions that penetrate the blood during electrophoresis, phonophoresis, electroaerosol therapy, chemical elements mineral waters, therapeutic mud, specific speleological aerosols in salt mines, etc. importance have the intensity, duration of the factor, the age of the sick child, the state of his reactivity.
It has been established that in children the therapeutic effect of the physical factor occurs faster and at a lower dosage due to morphofunctional features nervous system, skin, metabolic processes. The impact of each physical factor on the body is due to common non-specific features associated with the absorption of energy and specific features of the action.
For example, ultraviolet (UV) radiation causes a characteristic erythemal skin reaction, the formation of vitamin "D"; UHF electromagnetic oscillations - the formation of endogenous heat, etc.
Different factors have different penetrating power, biological activity. Acting through the skin and mucous membranes, they give energy to organs and tissues at different depths, and can affect different body systems.
Specific reactions are formed in close relationship with non-specific reactive shifts.
Deepening knowledge about the essence of specific and non-specific action helps to more purposefully prescribe a physical factor depending on its properties and the pathogenesis of the disease.
Many physical factors are powerful sources of non-specific effects, leading to changes in the functions of the nervous, endocrine systems, blood circulation, respiration, and have anti-inflammatory, analgesic, antispasmodic effects. This allows, to some extent, to replace one method with another. For example, heat treatment can sometimes be replaced by inductothermy, the effect of electric UHF fields- microwaves, etc. But it should be remembered that the anti-inflammatory or analgesic effect is formed in different ways.
For example, an analgesic effect is characteristic of many factors, but in some cases there is a direct effect on receptors (novocaine electrophoresis, diadynamic currents, UV erythema), in others it is associated with a dehydrating effect, a decrease in tissue swelling and compression. nerve endings, thirdly, with an antispasmodic effect, a change in the processes of inhibition in the brain and a change in the perception of pain, i.e., depending on the pathogenesis of the pain syndrome and specific features factor, you can apply it most rationally, with the best therapeutic effect.
"Guidelines for physiotherapy and physioprophylaxis of childhood diseases",
A.N. Obrosov, T.V. Karachevtseva
Electrotreatment Direct current (galvanization, medicinal electrophoresis); impulse currents (electrosleep, diadynamic, sinusoidal modulated currents, Darsonval currents, electrodiagnostics, electrical stimulation, etc.); inductothermy; UHF electric field; microwave therapy(microwave centimeter, decimeter range); air ionization (hydroaeroionization, electroaerosol therapy). PhototherapySolar radiation, infrared, visible, ultraviolet (shortwave, longwave); monochromatic coherent (laser) radiation. Magnet therapy Permanent, variable, pulsating magnetic field. Vibrotherapy Ultrasound, phonophoresis, vibromassage. Heat treatment Ozokerite,…
The influence of the physical factor can be enhanced by using appropriate localization to provide predominantly local, segmental or overall impact. However, in children, especially early age, local and general reactions are often interrelated. For example, during a local thermal procedure (ozocerite application, woolen wrapping, inductothermy, etc.), small patients often fall asleep peacefully due to increased inhibition processes in the cortex. big brain. Many children...
Proper use of physical factors in the system staged treatment is very important. The task of the attending physician is to develop, together with a physiotherapist, an individual rehabilitation program at different stages in order to eliminate residual effects inflammation, achieve limitation of the lesion, compensation and restoration of impaired functions. In sanatorium conditions, the use of natural factors (air, sunbathing, water…
The principle of succession in the use of physical remedies
Before prescribing physical factors, the doctor must clearly imagine what therapeutic measures were prescribed to the patient before, how he endured them, what was the result of the treatment.
When prescribing electroprocedures, it is important to know their tolerance to patients. Intolerance occurs electric current, ultrasound, hydrogen sulfide baths, etc.
The principle of succession may also include medical preparation for subsequent physiotherapy, balneotherapy, for example, in cases of chronic inflammatory foci in the body.
This principle is also observed in cases where, after one course of treatment, repeated or other courses of physiotherapy should be recommended.
The principle of early prescribing of physical remedies (PHM)
FLS can be prescribed in the acute period, at the very beginning of a number of diseases and injuries: cold on the head - with a concussion or bruise of the brain; electrical stimulation of the intestine - with its developing paresis; impulse currents - in acute pain syndromes; EP UHF - for acute inflammatory processes; medical cupping (vacuum-ray therapy) - for acute pneumonia; warm or hot bath - with an attack of gallstone disease. This principle also implies the timely appointment of a physical factor in protracted processes.
The principle of adequate individual prescription of physical remedies (principle of individualization of physiotherapy)
Methods for conducting one or more different physiotherapy procedures must correspond to the adaptive capabilities of the tissue, organ, system or organism V in general, features of the development of the disease, its phase. The principle also provides for the methodological features of performing PT in children, in elderly and senile patients (geriatric PT), in debilitated patients, in severe diseases and injuries.
The principle of using the specific properties of physical remedies
Each therapeutic physical factor has some unique, only its inherent features of the mechanism of action, which allow you to get the maximum therapeutic effectiveness. Ultrasound, for example, has a pronounced resolving effect on infiltrates, fresh scars and spikes. UHF EP has a distinct anti-inflammatory effect on fresh purulent foci in the depths of tissues.
Hydrogen sulfide baths with increasing concentration of hydrogen sulfide from 100 to 1000 mg/l improve peripheral blood flow in tissues. No other FT agent gives such activation of blood microcirculation. Cold water and air procedures stimulate the body's immune defense systems to the greatest extent.
Of course, in PT there is a certain interchangeability of physical factors, however, when choosing them for a particular patient, preference should be given to those whose mechanism of therapeutic action is most adequate to the characteristics of the disease.
The principle of prescribing optimal dosages
In physiotherapy, four dosage options are distinguished according to the strength and duration of exposure: very weak (informative), weak, medium strength and strong. Depending on the adaptive capabilities of the diseased organism, on the nature of the disease, the phase of its development, the severity of the process, one of the options for constructing a dose is chosen. As part of the course of treatment, the dosage of procedures may change: weak doses gradually turn into medium ones, strong ones can weaken, etc.
In severe acute pain syndromes, weak analgesic dosages of FF are usually chosen. With a long-term sluggish chronic disease top scores give high or medium doses of FF. The sparing effects of FF are advisable in elderly and senile people, in children, in debilitated patients, as well as in acute periods of illness and injury.
There is a close relationship between the principles of optimal dosages and individualization of therapy, since the selection of optimal procedure parameters for a particular patient is always individual.
The principle of the complexity of physiotherapy
Complex therapy of many chronic polyetiological diseases is always more effective than monotherapy, since it provides for polysystemic effects on different parts of the pathological process. In this regard, a combination of general and local FT procedures is of considerable interest.
General procedures have a predominantly normalizing effect on functioning different systems organism (nervous, cardiovascular, endocrine, immune, etc.) and through them - on the course of a local pathological process. Local, however, to a much greater extent affect its focal manifestations (local blood flow, tissue permeability, phagocytosis, production of biologically active substances, tissue regeneration, etc.).
The complex can be formulated to treat one or more diseases in one person. In the second case, the risk of disruption of the adaptation of tissues and the body increases. The medical complex can consist only of physical factors, which is often observed in sanatorium-resort conditions, or it can include physiotherapy exercises, massage, psychotherapy, medicines, etc.
The principle of dynamic physiotherapy
One of the common shortcomings in the work of many doctors, especially doctors of resort institutions, is the stability of parameters medical complex during the course of therapy.
Patients tolerate the same electro-, balneo- and peloid procedures differently. In the process of treatment, moderate and severe physio-balneo-reactions can develop and phase changes in the state of the body can be observed. In addition, in accordance with the fundamental studies of L.Kh. Garkavi, E.B. Kuzakina and M.A. Ukolova, weak dosages physical impact during the course of treatment, it should be gradually increased, and the medium ones should be changed in waves, the strong ones should be weakened.
Thus, within the framework of the course, it is necessary to make changes in the dosage and structure of the treatment complex. Correction of dosages of physiotherapy involves changes in water temperature, electric current strength or ultrasound intensity, exposure area, duration, alternation of procedures, etc., based on additional data acquired during the course of treatment. In some cases, it is possible to change the exposure parameters within the same procedure.
The principle of accounting for biological rhythms
Since there are conditionally called momentary, daily, monthly, annual and other periodic changes in the intensity various function organism, they should be taken into account in the appointment of FT. Known physiotherapy equipment based on the use of data of momentary rhythms of cardiac activity (devices "Sincardon", pressure chambers Shpilt), muscle biocurrents (devices "Mioton", "Myokor", etc.), electroencephalogram rhythms (some models of electrosleep devices).
It is recommended to prescribe physiotherapeutic procedures taking into account daily rhythms: tonic - better in the first half of the day, sedative in the second, electrosleep ~ more appropriate in the middle of the day, electrophoresis, depending on the drug - in different time day. Physical factors can be included in the complexes for the prevention of seasonal exacerbations of diseases.
The principle of psychotherapeutic potentiation of physiotherapy
It is known that suggestion, self-hypnosis, the behavior of the medical staff of offices and physiotherapy departments play a significant role in the treatment of a patient. According to various authors, the psychotherapeutic component in PT is of high importance (30-40%). Disorder in the office, negligent attitude, indifference, rudeness of the staff, of course, adversely affect the treatment.
Conversely, cleanliness, tidiness, order, courtesy, and a friendly attitude of physicians towards patients increase the effectiveness of the use of FLS. A high score is important medical staff prescribed physiotherapy procedures and concrete evidence of their usefulness. It is advisable to tell patients in a timely manner O the possibility of unpleasant sensations, temporary exacerbation of the disease, mainly at the beginning of treatment, the occurrence of physio-balneal reactions.
The principle of the preventive use of FLS
Such physical (physico-chemical) factors as air, UV rays, air and hydro ions, sauna, fresh and mineral water, general massage are common means of primary physioprophylaxis. With their help, hardening and healing of people (both healthy and those with poor health) is carried out.
Secondary and tertiary prevention (see Chapter I) uses the full arsenal of physical remedies.
Mechanisms of physiological and therapeutic action of physical factors
The reactions of the organism to physiotherapeutic influences can be predominantly local, at a distance from the place of influence (reflex within the segments, etc.) and general.
There are temporary physiotherapeutic (physiopathic) reactions (in balneology - balneological reactions), which develop more often after the first 2-3 procedures and disappear rather quickly - 2-4 days after the onset (adaptation reactions): neurasthenic, vegetative-vascular, skin-allergic, joint-muscular, dyspeptic, temperature, according to the type of exacerbation of the disease, hematological. According to the severity of the reaction can be subclinical, mild, moderate and severe.
The vast majority of patients have the first two options. The severity and nature of reactions depend on initial state organism and its organs, from the stage of the disease, from the place and area of impact (biologically active points, areas and zones), on its intensity and duration, on the specific properties of physical factors, on the rhythm of alternation, the frequency of procedures. FT reactions also occur in healthy individuals during physioprophylactic procedures.
What can happen in tissues during physiotherapy: a change (increase or decrease) in blood flow, tissue permeability, metabolic rate, muscle tone, excitability of nerve elements, intensity of formation of biologically active substances. Physical factors can have a desensitizing, antiseptic effect.
They can destroy stones in the kidneys, in the gallbladder and bladder, eliminate small papillomas, hematomas, warts, etc. Physical factors can change the excitability of the structures of the brain and spinal cord(for example, in electrosleep), affect the secretion of glands internal secretion, changing the overall vital activity of many body systems.
In some pathological processes, one procedure is enough to obtain a therapeutic effect (hot bath for cholelithiasis or nephrolithiasis, hyperthermia in the sauna for acute respiratory infections, manipulations on the spine for pain syndromes, etc.). However, in the recovery period after diseases and injuries, with chronic pathology, even a course of treatment consisting of many procedures is often insufficient. In these cases, the treatment is often complex, including 2-3 different effects. Appointed repeated courses treatment. Only physiotherapy, physiotherapy with exercise therapy, massage, medications and psychotherapy can be combined (Appendix 1).
Physical healing factors (FLF) can be applied based on purely local curative effect: treatment of ulcers, wounds, local inflammatory and other processes; in diseases of the skin, mucous membranes, eyes, ear, throat, nose, joints, etc.
FLF can be administered topically on tissue health in order to obtain reflex therapeutic effect at a distance. Example: warming the left hand improves coronary blood flow, can reduce or eliminate an attack of angina pectoris.
Physiotherapy treatments can be addressed central nervous system, brain or spinal cord (electrosleep, exposure to microwaves or UHF EP, etc.) per somatic therapeutic effect. In particular, electrosleep is indicated for bronchial asthma, gastric ulcer, obliterating endarteritis, hypertensive and coronary disease hearts, etc. At the same time, FLP is effective in many brain diseases: neuroses, cerebrovascular pathology, consequences of brain injuries and encephalitis.
Methods are being developed and applied physical therapeutic effect on endocrine glands: adrenal glands, thyroid, goiter, gonads, etc. One example: in case of systemic chronic inflammatory processes, the adrenal glands are irradiated with microwaves.
UV rays and lasers are used to direct effect on the blood, in particular, in some forms of coronary artery disease. UV irradiation of blood is also carried out in septic conditions.
In addition to all of the above, there are many general physiotherapeutic effects: general water and air baths, general franklinization, darsonvalization, galvanization, etc.
Hardening of the body by physical factors
In a deteriorating state external environment, weather changes and climatic factors and their increasing impact on the human body - the hardening of a healthy and sick person is becoming increasingly important.
Basic hardening rules:
- choice of one or more hardening methods and techniques (cold or cool water, air procedures, Sun rays, artificial ultraviolet, climatokinetic procedures, etc.) adequate to the state organism;
- a constant increase in the dose (or doses) of exposure to hardening factors;
- systematic and repeatable hardening procedures;
- individualization of procedures and methods of hardening; implementation of hardening under conditions of optimal muscle activity;
- application of general and local methods of hardening.
water hardening it is carried out more often with the help of rubdowns, douches, showers, drinking water of a gradually decreasing temperature from 37-38 ° C to 10-12 ° C.
At the beginning of the course, the temperature drops by 1-2°C in 2-3 days. Then remains steadily low.
Tempering are also procedures in baths, showers and dousing with water at contrasting temperatures of 38-42°C and 15-20°C. Useful in this regard can be swimming in open water. The duration of one hardening procedure at the beginning of the course is 2-3-5 minutes, and then gradually increases and becomes individual.
Hardening with water can be general and local: foot baths cool and cold temperatures; drinking cool and cold fresh or mineral waters, washing the nasal cavity with water of gradually decreasing temperature. Harden the body and year-round bathing in sea water(winter swimming), but it is not shown to everyone.
air hardening can be administered in the form of dosed air baths, walks and work in the fresh cool and cold air.
The accepted separation of air temperatures when taking air baths naked: by a person in the absence of wind and direct exposure to sunlight at optimal air humidity: warm + 22-26 ° С, indifferent temperatures + 21-22 ° С, cool + 9-16 ° С and cold -1-8°С. Hardening occurs when exposed to air at cool, moderately cold and cold temperatures.
There are cold loads small, medium, large and maximum.
Books and chapters of manuals on climatotherapy contain special tables for calculating cold loads for different weather parameters.
In spa institutions, during mass hardening procedures in climate pavilions and on beaches, their duration is calculated using computers.
Hardening by sunlight and air is carried out by calculating the intensity of thermal and ultraviolet exposure to sunlight using special tables and computer programs.
IN normal conditions in summer, hardening should be carried out in climate pavilions or on the beaches of southern Ukraine in the morning (7-10) or in the evening (16-19).
Hardening by high air temperature and cool water performed in saunas and steam baths. Dosing overheating of the body leads to stimulation of the activity of the endocrine, cardiovascular and immune systems, to an increase in metabolism, to a decrease in blood pressure, to an improvement in the function of the kidneys and urinary apparatus. As a rule, hardening in baths involves warming up the body in a sweating room or steam room, and then contrasting exposure to cool or cold water in a pool, bath or shower.
The limiting temperature of dry air in saunas is 100-110 °C, and that of wet air in steam baths is 50-55 °C. The duration of the first visits to the sweat lodge or steam room is 3-5 minutes, followed by contrast effect water and recreation. For one session at the beginning of the course of influences, 2-3 visits to the sweat room (steam room) are recommended. In the future, the time of visits and sessions gradually increases.
Walking barefoot. One of the means of hardening can be walking barefoot on cold or wet grass, on cool sand, on snow, on cold floors and sidewalks. They start walking barefoot in not very cold soil - in short procedures of 9-10 minutes, then they are gradually lengthened. After walking barefoot, it is useful to make a warm foot bath.
The goals of general health improvement of the body can be served by aero- and hydroaeroionization of domestic and industrial premises.
In addition to natural factors, almost the entire arsenal of apparatus physiotherapy can be used, especially for secondary and tertiary prevention.
To increase the nonspecific resistance of the organism, ultraviolet radiation of long and medium ranges (A and B), methods of transcerebral electrotherapy, general franklinization and aeroionotherapy, laser therapy, including ILBI or transcutaneous blood irradiation, millimeter resonance therapy, magnetotherapy, aerosol-, electroaerosol therapy of vitamins, adaptogens.
Ultraviolet rays are used for primary and secondary prevention of rickets, age-related osteoporosis, for tertiary prevention of relapses and other disorders associated with "solar starvation".
For prophylactic purposes, balneotherapy can be used: carbon dioxide, radon, hydrogen sulfide, sodium chloride, iodine-bromine baths, etc.
The above physical factors are of particular importance as agents of secondary and especially tertiary prevention, since they are able to specifically influence the etiopathogenetic nature of the disease. For example, electrosleep therapy for neuroses, arterial hypertension; intravascular laser irradiation blood - in various diseases with severe microcirculation disorders. Hydrogen sulfide baths have the ability to reduce the level of cholesterol and triglycerides in the blood, which is important for the prevention of atherosclerosis.
V.V. Kents, I.P. Shmakova, S.F. Goncharuk, A.V. Kasyanenko
In the process of phylogenesis and ontogenesis, constant environmental influences contributed to the emergence of a high degree of affinity between physical factors and the biological substrate. A person is constantly affected by the radiation of the Sun, the air environment, the magnetic field of the Earth. Electric fields play an essential role in the life of an organism. Any physiological reaction of a person is accompanied by the appearance of a difference in electrical potentials in the excited organs; nerve impulse has a electrical characteristic; proteins have the function of molecular generators of electric current. Representing the factors of evolution and development of the human body, therapeutic physical means are physiologically close and related to its vital activity.
The impact of all physical factors on a woman's body begins at the molecular level. When electrons and atomic nuclei interact with a target receptor (macromolecule of a living substrate), changes occur in the electrical conductivity, permeability, concentration and transport of ions, as well as some other biophysical properties of living tissues, as a result of which the absorbed physical (electrical, mechanical, magnetic, radiation, etc.) ) energy is converted into biological reactions, i.e. into the energy of nervous processes.
The totality of all interconnected elements during the transition of one type of energy to another with corresponding changes in biological substrates is called the mechanism of action of a physical factor.
The terms "mechanism of action" and "mechanism therapeutic action» the physical factor cannot be considered identical. The first of them is wider than the second, since the influence of the physical factor may be insufficient to obtain the desired therapeutic result or, conversely, cause a damaging rather than a healing effect. The mechanism of therapeutic action means the ways of realizing the therapeutic effect, i.e., the predominant focus and features of the normalizing influence of the physical factor on the pathological process and impaired functions of the patient's body. A system consisting of 3 links takes part in this - the primary reaction of a physical factor with a biological substrate, determining the path of metabolic changes and stabilizing metabolism [Krylov O. A].
The mechanism of the therapeutic action of physical factors, along with their local influence, is based on the reflex response of the body (segmental, regional, universal reflexes), realized by the neurohumoral way [Obrosov A. N.]. It is advisable to consider the mechanism of therapeutic action in relation to a specific clinical situation, since they are closely interrelated and in to a large extent interdependent. The mechanism of therapeutic action largely depends on the method and dose of exposure, which determine the amount physical energy absorbed by the patient's body. A certain difference in the mechanism of the therapeutic action of pre-formed and natural physical means causes a less generalized and extensive influence of the former, their lower, as a rule, energy load on the cardiovascular, nervous and other systems of the patient.
In the recent past, physical factors were considered only a means of maintaining basic physiological functions, ensuring the preservation of homeostasis, i.e., the constancy of the internal environment of the body, and considered treatment with physical methods as only non-specific therapy. Indeed, the role of non-specific reactions of the patient to the action of a physical factor is exceptionally great: they mobilize the energy resources of the body and contribute, in the language of cybernetics, to the choice the best option launch compensatory mechanisms. However, along with non-specific reactions, each factor also has a certain influence peculiar only to it, causing strictly specific long-term physiological reactions in the body [Yasnogorodsky VG]. They are the main ones and, proceeding against the background of a non-specific action common to all physical factors, determine mainly the therapeutic effect. It is achieved as a result of a selective regulatory (stimulating or inhibitory) effect on the systems of the body affected by the pathological process. According to the concept of P. K. Anokhin, this allows us to consider treatment with physical factors as a modulator of all life processes, which ensures their self-regulation on various levels- from the cellular to the organism as a whole.
Modern trends in the therapeutic use of physical factors are in the desire to achieve the greatest therapeutic effect with the least load on the body by increasing the specific and lowering the non-specific component of the action of each of them. These trends are most fully consistent with the use of physical factors not in continuous, but in a pulsed mode of energy generation, which in obstetric and gynecological practice usually causes a more pronounced and prolonged clinical effect and has certain advantages over continuous. In particular, in the process of carrying out procedures in a continuous mode, the patient's adaptation to the physical factor gradually increases, and with impulse influences, their rhythmic discreteness (discontinuity) upsets the mechanisms of adaptation.
The use of physical factors in a pulsed mode makes it possible to avoid energy overload of the body with negative reactions of the cardiovascular, nervous, endocrine and other systems in the treatment and expand the indications for use physical methods in obstetrics and gynecology.
The physical characteristics of impulse exposure are more variable than continuous ones. If during galvanization it is practically sufficient to take into account and regulate only the current strength, and during pelotherapy only the temperature of the dirt, then in the treatment of SMT it is possible to use and change whole line their parameters, choosing various options combinations of modulated and modulated oscillations, the frequency and depth of modulation, the duration of the series of bursts of oscillations and pauses, etc. Therefore, the use of impulse effects creates the prerequisites for individualized treatment, taking into account specific characteristics physical factor and features of impulsation from the pathological focus. In this case, that “biological resonance” arises, which is necessary for the normalization of impaired body functions and essentially plays a leading role in achieving a stable clinical effect.
The concept of “biological resonance”, first formulated by the outstanding Soviet physiotherapist A.E. Shcherbak, in last years received its structural justification. It has been experimentally established that under the conditions of a rhythmically acting stimulus, the body forms an appropriate rhythm of synthetic activity due to impulsive relationships between various cell structures and, above all, between the nucleus and protoplasm [Sarkisov D.S.]. Thus, the use of physical factors in the pulse mode of energy generation creates the fundamental possibility of individualized control of the functions of internal organs and individual body systems, simulating to some extent the physiological effects of natural nerve impulses. In particular, various impulse currents, which are resonant to their own biorhythms of certain physiological systems, allow targeted and selective electrical stimulation of the activity of the genital organs and regulators. menstrual function. Such an influence can be exerted in two ways: directly, by stimulating the cervical-hypothalamic-pituitary reflex by affecting the cervix, and indirectly, from organ-specific skin zones, innervationally connected with the uterus, fallopian tubes and ovaries or with the hypothalamic-pituitary system of the brain. It should be noted that the increasing use of physical factors in the pulsed mode does not exclude rational use traditional continuous influences and continuous improvement of the latter in medical, technical and methodological terms.
When treating with physical methods, ensuring the optimal clinical effect with a minimum load on the cardiovascular and other functional systems of a woman is largely due to the amount of physical energy absorbed by the patient's body during the procedure and the entire period of treatment, i.e. depends on a single and course dose of exposure .
Doses can be divided into large and small, taking into account, of course, the obvious conventionality of such a gradation. The assessment of the dose is always specific and depends on the nature and characteristics of the disease. The same dose of the same physical factor, such as ultrasound, can be with neuritis facial nerve large, and in chronic salpingo-oophoritis with obliteration of the fallopian tubes small. There is no contradiction in this position, since the amount of energy required for the physical factor to manifest its therapeutic effect largely depends on the localization of the pathological process, pathogenesis and clinical manifestations diseases and severity caused by the disease secondary changes in the functional systems of the body.
At higher dose physical energy, the non-specific effect of the factor prevails, which can have adverse effect on the biochemical and biophysical processes underlying the functioning of the body's systems and its interaction with the environment.
With small doses of physical energy, the specific action of the factor comes to the fore, manifesting itself at the molecular, subcellular and cellular levels. It is small doses of the factor that stimulate tissue metabolism, increase the reactivity of the body and the resistance of its systems to adverse external influences, and have a sanogenetic effect. Experimental substantiation of the action of small doses of physical factors is a fundamental achievement of the Soviet scientific school of physiotherapists and balneologists. It serves as a theoretical prerequisite for the practical use of low doses for prophylactic purposes, as well as for the treatment of a number of gynecological diseases and diseases of pregnant women at the very beginning of the development of the pathological process, when functional and morphological changes are still completely reversible [Chernekhovsky D. L., Yagunov S. Ya., Gilerson A. B., Zhelokhovtsev N. S., Preisman A. B., Dik V. G., Mazhbits A. M., Startseva L N. and others].
The optimal effect of the use of therapeutic physical factors occurs when carrying out not a single exposure, but a series of procedures - a course of treatment. At the same time, physiological shifts from each previous procedure are added to the effect of the next, as if layered on it. The summation of these influences ensures a long aftereffect of the entire course of therapy, i.e., the continuation of certain effects caused by a physical factor. physiological changes after the cessation of exposure. These changes fade gradually and slowly, so long-term results treatments are in most cases more favorable than immediate ones.
The period of aftereffect of various physical factors is not the same. In gynecological patients, it continues on average after full course mud therapy 6 months, application mineral baths and irrigation - 4 months, therapy with preformed factors - 2 months. The aftereffect of physical therapy in pregnant women is generally shorter than in non-pregnant women.
The effect on the body of various therapeutic physical factors develops more or less similarly, and it must be considered based on the most important principles of the functioning of living systems, in particular, on the principle of the unity of the organism and the external environment. The universal law of life is the adaptation (adaptation) of the body to changing environmental conditions in order to maintain homeostasis. This process is provided by a complex system of adaptive reactions, the basis of which is unconditioned reflex. The body's response to the action of therapeutic physical factors, which are complex physical and chemical stimuli that bring energy (substance, information) into it and cause changes in it, is also a systemic adaptive reaction. The structure, features and severity of this reaction depend both on physical nature and dosage of the factor, and on the initial functional state, the individual qualities of the organism and the nature of the pathological process.
Physical factors are both means of both non-specific and specific action. It is the latter that determines the special value of physiotherapeutic effects, makes it possible, along with the general stimulation of protective and compensatory-adaptive reactions, to differentially influence impaired body functions, various pathogenetic and sanogenetic mechanisms, and individual symptoms of the disease.
The chain of events occurring in the body after the application of a physical factor can be conditionally divided into three main stages: physical, physico-chemical, biological.
During physical stage energy operating factor transmitted to the biological system, tissues, cells and their environment. The interaction of physical factors with the body is accompanied by reflection, transmission, dispersion and absorption of energy. Only the absorbed part of the energy has an effect on the body. Different tissues of the human body have an unequal (selective) ability to absorb physical energy. So, the energy of the UHF electric field is more absorbed by tissues with dielectric properties (bone, fat), and the absorption of microwaves, on the contrary, is mainly observed in tissues with a high content of water and electrolytes - muscle, blood, lymph, etc. The penetration depth is no less important. , or the level of energy absorption in the body. As is known, physiotherapeutic factors differ significantly in this indicator: some of them penetrate a few millimeters and are completely absorbed by the skin, while others penetrate the entire interelectrode space. Each physical factor also has its own mechanism of energy absorption. An illustration of what has been said can be data on the absorption and heating of various tissues when using certain physiotherapeutic methods. All these differences, in general, serve as the basis for the formation of specific features of the action of individual physiotherapeutic factors already at the physical stage.
The absorption of energy is accompanied by the appearance of physical and chemical shifts. Distribution of heat in individual cells. And their environment. They make up physico-chemical stage the action of physical factors on the body. The most studied primary effects are heat generation (tissue heating), changes in pH, concentration and ratio of ions in cells and tissues, formation of free forms of substances, generation of free radicals, changes in the spatial structure (conformation) of biopolymers, primarily proteins. Among the others possible mechanisms primary action physical factors should be called a change physical and chemical properties water, polarization and bioelectret effects, changes in the electrical properties of cells, the release of biologically active substances (prostaglandins, cytokines, nitric oxide, mediators, etc.). In general, as a result of the action of physiotherapeutic factors, either various physicochemical forms are formed that can enter into metabolic reactions, or physicochemical changes occur that affect the course of both physiological and pathological processes in the body. Consequently, physical and chemical changes are a kind of trigger mechanism for converting the energy of a physical factor into a biologically significant reaction of the body.
The consequences of physicochemical shifts depend on their nature, biological significance, localization of exposure, morpho-functional specialization of the tissues in which they occur. Physico-chemical changes in the skin, subcutaneous fat, muscle tissue mainly determine the local effect of physical factors. If they happen in endocrine organs, then to a large extent determine the humoral component of the action of therapeutic physical factors. The predominant absorption of energy by nerve formations (receptors, nerve fibers, brain structures, etc.) and the physicochemical changes occurring in them are the basis for the formation of the body's reflex reaction to the use of physical factors. In this case, the reactions of these structures to physical factors proceed according to the laws of sensory physiology.
It is important to keep in mind that many physical and chemical effects can be inherent in one physical factor, and the use of various physiotherapeutic methods can cause similar primary shifts. This primarily determines the universal mechanism of action of therapeutic physical factors, the unity of the general and specific in their effect on the body, the similarity and differences in indications and contraindications for the use of physiotherapeutic methods.
The third stage is biological. It is a set of direct and reflex changes in organs and tissues as a result of the absorption of physical energy by the biological systems of the body. Allocate local, reflex-segmental And general (generalized) body reactions with their many components.
Local changes occur in tissues that have absorbed the energy of the physical factor. They are expressed in changes in metabolism, regional blood circulation and microcirculation, diffusion processes, mitotic activity of cells and their functional state, formation of free radicals, biologically active substances, etc. Local shifts lead to the creation of a new level of tissue trophism, the activation of local protective reactions, and contribute to the restoration of relationships disturbed by the disease in them. The same shifts, but occurring in receptors, neurovascular plexuses and peripheral nerves, serve as a source of nervous and humoral afferentation - the basis for the formation of systemic body reactions.
An important role in the local reaction belongs to the stimulation by physical factors of the function of antagonist cells (fat, plasma, enterochromaffin, etc.). This is one of the mechanisms for maintaining regional homeostasis and deploying protective reactions aimed at eliminating local damage. In addition, due to the biologically active substances synthesized by these cells (prostaglandins, plasmakinins, cytokines, substance P, nitric oxide) and mediators (histamine, norepinephrine, acetylcholine, serotonin), antagonist cells are involved in the formation of not only local reactions, but also humoral shifts.
Due to local shifts, which are a source of prolonged irritation, as well as due to direct physicochemical changes in nerve receptors and other nerve formations, a general response of the body is formed in response to the physiotherapeutic effect. It is, as already emphasized, systemic in nature and has an adaptive-compensatory orientation. The leading component of this holistic reaction of the body is a reflex act, the nervous and humoral links of which are closely interconnected. It should be emphasized that the close interrelation of local and general reactions is largely ensured due to the peculiarities of the structure and functions of the skin, which is the entrance gate for most physiotherapeutic factors.
Schematically, this reaction can be represented as follows. The excitation of extero- and interoreceptors that occurs under the influence of physical factors along afferent pathways reaches mainly those parts of the central nervous system (CNS) that control the adaptive mechanisms of the body (subcortical nuclei, limbic-reticular complex, hypothalamus). Nervous afferentation and humoral shifts, the nature of which depends on the nature and parameters of physical factors, cause changes in the functional state of these nerve centers. This is manifested in the formation (due to convergence and summation of afferent signals) of a stream of efferent impulses that trigger specific homeostatic reactions. Their main feature is that they develop according to previously formed physiological mechanisms and are aimed at restoring the balance disturbed by a physical factor, and in conditions of pathology --for restoration functions disturbed by the disease and existing shifts, increased reactivity and immune defense of the body, strengthening of sanogenetic mechanisms, stimulation of compensatory-adaptive processes. Homeostatic regulation under the action of physical factors is provided by various mechanisms and functional systems with the leading role of the central nervous system, the universal principles of the structural organization of which determine the unity of the development processes of the body's adaptive reactions.
Efferent impulses coming from the nerve centers reach the internal organs, including the endocrine glands, and involve them in the general adaptive reaction of the organism. This is accompanied by dynamic shifts in the activity of various internal organs, general metabolic and trophic changes, and mobilization of the body's resources. And although many organs and systems take part in the formation of the general reaction of the body, the greatest shifts occur in the area of the pathological focus, which is of great therapeutic importance and is well interpreted from the standpoint of A.A. Ukhtomsky.
Participation in the adaptive reaction of all organs and systems is observed mainly after extensive or intensive physiotherapeutic procedures, as well as after exposure to special zones (acupuncture points, collar zone, Zakharyin-Ged zones, etc.). Limited physiotherapeutic effects are usually accompanied by dynamic changes. In organs and tissues belonging to the same metamer as the irritated skin surface. These shifts are realized by the type of segmental (metameric) reactions.
In the reaction of the body to the physiotherapeutic effects of the cerebral cortex takes an active part. Conditioned stimuli, combined with the unconditioned, which is the physiotherapeutic method, can significantly change its effect on the body, develop in case course application new functional relationships between the nervous system and the physiological systems regulated by it, which also affects the therapeutic effect. Consequently, the reflex reaction during physiotherapeutic procedures is conditionally unconditional. The main proof of this is the possibility of the formation of conditioned reflex connections in response to physiotherapy. According to special studies and numerous clinical observations, after several physiotherapy procedures physiological effect, characteristic for this impact, is also detected when the device is turned off.
The implementation of both local and general reactions to physiotherapy, especially during course treatment, requires energy and plastic support. Mobilization observed during physiotherapy energy resources and plastic reserves of the body, providing stimulated functions, protective-adaptive and compensatory processes - an important component of the systemic adaptive response of the body. To a large extent, it is implemented due to the adaptive synthesis of enzymes. The result of these processes will be a new coordination of metabolism and an increase in the functionality of the body. In the energy and plastic supply of changes caused by physical factors important role plays the humoral system, endocrine glands. They are included in the reaction of the body during physiotherapeutic influences due to various mechanisms, including due to the direct action of a physical factor on the specific activity of the endocrine organs.
Ministry of Education and Science of Ukraine
higher education institution
“Open International University
Human Development “Ukraine”
Gorlovka Regional Institute
Department of Physical Rehabilitation
CONTROLIRABOTA
discipline: Fundamentals of physiotherapy
"Physiotherapy. Classification of therapeutic factors and their characteristics
Gorlovka 2009
1. Physiotherapy as a science
2. Physical and chemical characteristics of rehabilitation physical factors.
3. Methods of physiotherapy in medical and physical rehabilitation.
4. Mechanisms of action of physical rehabilitation factors.
5. Indications and contraindications for physiotherapy.
6. Dosage of physical factors.
1. Physiotherapy as a science
Physiotherapy - a science that studies the effect on the human body of physical factors of the external environment and their use for therapeutic, prophylactic and rehabilitation purposes.
The main direction of physiotherapy is to determine the influence of physical factors on biological tissues and the body in order to develop methods and criteria for selecting patients for subsequent treatment.
Deficiency in the impact of the external environment, which is especially evident during space flights, leads to disruption of the normal course of life processes in the body and, in severe cases, to the development of diseases. Since ancient times, man has used physical factors not only to obtain comfortable sensations (warmth, sunlight, mechanical effects), but also to heal wounds and diseases. Organized treatment at resorts in Russia dates back to the time of Peter I. In the 19th century, M.Ya. Mudrov wrote “... You will reach the time of wisdom that you will not believe in health in only apothecary flasks. Your pharmacy will be all nature at the service of you and your sick...”. In his works, emphasis was placed on treating not the disease, but the patient “... I intend to tell you a new truth, which many will not believe, and which, perhaps, not all of you will comprehend. Medicine does not consist in curing disease. Healing consists in the treatment of the patient himself ... ". This principle is one of the leading in physiotherapy. Z.P. Solovyov pointed out “... that the main course that should be taken by medical medicine is the course towards the widespread use of physical methods of treatment. To put a man as close as possible to nature - to this huge reserve of therapeutic agents - that is a noble task ... ".
Timely and correct use of physical methods of treatment contributes to the rapid development of compensatory-adaptive reactions, optimization of the healing of damaged tissues, stimulation of defense mechanisms and restoration of impaired functions of organs and systems. Professor V.N. For the first time in physiotherapy, Sokruty introduces the “principle of the optimality of the disease”, which determines the norm of the disease, its optimal variant and adequate physiotherapy tactics, when the cost of health resources for the quality of recovery is minimal. The principle has been previously tested on a large experimental material. It has been shown that myocardial healing outcomes after irreversible ischemic damage(heart attack) are determined by its compliance (non-compliance) with the optimal variant of the course of the disease. The theory has been introduced not only into clinical practice, but has withstood the test of time and clinical trials in a large number of diseases and has become “ calling card” Donetsk School of Physiotherapists.
The principle of the optimality of the disease substantiates the strategy and tactics of the physiotherapeutic treatment of the patient through the normalization of the disease by bringing its course to the conditions of the optimal variant. The solution of particular problems should not deviate the course of the disease from its optimal variant. The postulates of the principle of optimality of the disease - the philosophy of health and disease, the theory of optimality of processes, the principle of optimality in biology.
In philosophy, measure is a category, norm is a concept. Every measure contains many norms. This means that the measure of the disease also has its own norms. As well as a measure of health. Like any measure, the norm of the disease is its variant, when the cost of health resources for it is minimal. The philosophy of the “principle of disease optimality” was developed by N.I. Yabluchansky. A similar understanding of health and disease is found among ancient thinkers. “... Health is natural in a person in known state; under other circumstances, illness is just as natural a state ... ”(Holbach). The formation of these views was also promoted by the principle of optimality in biology by R. Rosen and the principle of optimal design by N. Rashevsky. The works of I. Davydovsky had an important influence on the formation of the idea. The doctor is faced with the need not only to observe the spontaneous, automatically unfolding process of inflammation, but also to be ready to intervene in it ... ”. Please note that according to I. Davydovsky, the doctor should intervene in the inflammatory process only in case of violations of its natural (optimal) course.
The basis for the implementation of the "principle of the optimality of the disease" are genetically fixed mechanisms of recovery. The task of the doctor, including the rehabilitologist, is to help the patient go through the disease with minimal losses. Such was also the philosophy of zemstvo doctors - "... to lead the patient through the disease ...".
The optimal course of the disease provides:
1. Recovery (complete) in acute forms.
2. Persistent remission, more rare and easily resolved exacerbations in chronic forms.
3. The maximum possible, with this disease, the quality of life of the patient.
The principle of the optimality of the disease requires supplementing the diagnosis with information about the degree of optimality (non-optimality) in the course of the disease. The diagnosis of the disease, the diagnosis of the patient is never complete if they do not contain information about the degree of optimality (the degree of deviation from the optimal variant) of the disease and the main syndromes. Outside of these data, the doctor does not have sufficient information for the correct implementation of the treatment process.
2. Physical and chemical characteristics of rehabilitation physical factors
Rehabilitation factors used in physiotherapy are divided into natural (water, climate, mud, etc.) and preformed, obtained by artificial means(electricity and its derivatives, ultrasound, etc.).
According to physical characteristics, they are classified as follows:
1. Low voltage direct currents:
a) continuous current: galvanization and medicinal electrophoresis;
b) impulse current: diadynamic therapy and diadynamophoresis; electrosleep; electrical stimulation; short-pulse electroanalgesia; amplipulse therapy (rectified mode) and amplipulsforesis; interference therapy.
2. Alternating currents:
a) low and audio frequency and low voltage:
amplipulse therapy (variable mode); fluctuation;
b) overtone and high frequency and high voltage:
overtone frequency currents (TNFC); darsonvalization.
3. Electric field:
a) ultra-high frequency therapy (UHF);
b) franklinization;
c) air ionization.
4. Magnetic field:
a) low-frequency magnetotherapy (PEMP LF);
b) high-frequency alternating magnetic field (AMF HF) - inductothermy.
5. Electromagnetic radiation:
a) microwave therapy (UHF therapy): centimeter wave (CMW), decimeter wave (UHF) therapy;
b) extremely high frequency therapy (EHF-therapy): millimeter wave (MMW) therapy;
c) light therapy: infrared, visible, ultraviolet, monochromatic coherent (laser) and polychromatic incoherent polarized (pyler-) radiation.
6. Mechanical vibrations and movement:
a) vibration therapy;
b) ultrasound;
c) massage;
d) reflexology;
e) traction (dry and underwater);
e) manual therapy;
g) kinesitherapy.
7. Water: hydrotherapy and balneotherapy.
8. Temperature factor (thermotherapy):
a) heat therapy (therapeutic mud, peat, paraffin, ozocerite);
b) cryotherapy (cold treatment).
9. Changed atmospheric pressure and air components:
a) local barotherapy;
b) oxygen barotherapy.
In practical medicine, the “old” classification of electrotherapy continues to be used:
1. Treatment with direct currents of low voltage:
2. Treatment with alternating currents of low and audio frequency and low voltage:
amplipulse therapy (variable mode); fluctuorization.
3. Treatment with alternating currents of high frequency and high voltage and electromagnetic field:
darsonvalization; inductothermy; UHF-, SHF- and EHF-therapy.
4. High intensity electric field treatment:
franklinization; air ionization.
3. Methods of physiotherapy in medical and physical rehabilitation
Currently developed and widely used in clinical practice the following methods:
1. General (according to Vermel, collar according to Shcherbak, four-chamber baths, general UVR, etc.).
2. Local (transverse, longitudinal, tangential (oblique), focal, perifocal).
3. Influences on reflex-segmental zones with a site of metameric innervation. The significance of the reflexogenic zones and the resulting reactions are covered in the works of physiotherapists A.E. Shcherbak, A.R. Kirichinsky and others.
4. Impact on the Zakharyin-Ged zones.
5. Effects on biologically active skin points, which are widely used in reflexology.
With the method of local exposure, reactions from the organ are mainly observed, although in the whole living organism, even with low intensity effects on a small surface of the skin, local changes affect the system (systems) of the body as a whole. However, these changes are mild and not always manifested by clinical symptoms. Involvement in reflex reactions of most organs and systems is observed mainly after extensive impacts (for example, general baths) or with an intense impact of a physical factor on the reflexogenic zones of an organ.
Physiotherapy methods are divided into superficial (skin) and cavity (nasal, rectal, vaginal, oral, ear, intravascular), for which special electrodes are provided.
Depending on the density of contact with the body surface, the methods are divided into contact and efluvial (an air gap between the body and the electrode is provided).
According to the technique of performing the technique, there are stable (the electrode is fixed) and labile (the electrode is movable).
4. Mechanisms of action of physical rehabilitation factors
The general mechanisms of action of physical factors must be considered from the standpoint of interrelated reflex and humoral effects on the body. Their primary action is carried out through the skin, its receptor apparatus, the vascular system and is associated with a change in the physicochemical processes in the skin, and, therefore, the implementation of the action of physical factors on the whole organism and the therapeutic effect has a number of features.
In the mechanism of action of a physical factor on the body, three groups of effects are distinguished: physicochemical, physiological and therapeutic.
Physico-chemical effect physiotherapeutic factor on the body is associated with molecular changes in tissues during its use. It is based on the absorption of energy and its transformation inside the cell into energy. biological processes. In this regard, physical, chemical and structural transformations occur in the tissues, which form the primary basis for the reactive response of complex functional systems of the body.
Physiological effect based on reflex and neurohumoral mechanisms. Electrical, temperature, mechanical, chemical, radiation and other irritations inherent in physical factors, exerting an effect on the skin, cause reactions of its receptor apparatus and blood vessels in the form of a change in the excitability threshold of receptors and the tone of the vessels of the microvasculature (skin-vasomotor reflexes). Afferent impulses from sensory nerve fibers through the interneurons activate the motor neurons of the anterior horns of the spinal cord, followed by the formation of effector impulse flows that propagate to various organs with the corresponding segmental innervation. Primary reflex reactions of the nerve endings of the skin are closely intertwined with humoral changes resulting from physical and chemical processes. nervous excitement. They are also a source of nervous afferent impulses, and not only during the period of the factor (primary effect), but also after the cessation of such a factor for several minutes, hours, and even days (trace effect). The main humoral (chemical changes) in the skin itself are reduced to the formation of biologically active substances (histamine, acetylcholine, serotonin, kinins, free radicals), which, entering the blood, cause changes in the lumen of capillaries and blood flow in them, improve transcapillary metabolism, which enhances diffusion of gases and other substances, tissue metabolism. With convergence to the central neurons of afferent impulse flows from visceral conductors, activation of neurosecretion of releasing factors by the hypothalamus occurs, the production of hormones by the pituitary gland, followed by stimulation of the synthesis of hormones and prostaglandins. Homeostasis, or more correctly, homeokinesis in the body is determined by the "triangle of homeostasis" - the nervous, immune and endocrine systems.
Therapeutic effect is formed on the basis of the integral response of the body to the physiotherapeutic effect. It can be non-specific or specific, which is determined by the characteristics of the acting factor.
Non-specific effect associated with increased activity of the pituitary-adrenocorticotropic system. Catecholamines and glucocorticoids entering the bloodstream increase the affinity of adrenoreceptors, modulate inflammation and immunity.
Specific effect(for example, analgesic), taking into account the initial state of the body, is observed in diseases of the peripheral nerves under the influence of diadynamic or sinusoidally modulated currents. For electrical stimulation of denervated muscles, pulsed low-frequency currents are more suitable. The anti-inflammatory effect is most pronounced with UHF and magnetotherapy. To a large extent, the influence of physical factors is realized through the known skin-visceral, ionic, etc. reflexes. In the reflex response, phases are distinguished: irritation, activation and development of compensatory-adaptive mechanisms, such as increased regeneration with an increase in nonspecific resistance of the organism. In this case, biologically active substances (BAS) play an important role: neuropeptides (substance P and b-endorphins), eicosanoids (prostaglandins, in particular, E2 and F2a, B4 leukotrienes), mediators (histamine, serotonin, norepinephrine, acetylcholine, adenosine), products of lipid peroxidation (LPO), cytokines, nitric oxide, released into the interstitium through the vascular endothelium. Moreover, substance P determines nociceptive, and b-endorphins - antinociceptive sensitivity, with the activation of leukocytes in the first case and fibroblasts - in the second. Prostaglandin F2a - increases the permeability of the cell plasmolemma, activates the axonal transport of trophogens, increases oxygen consumption, modulates the intensity of inflammation, and prostaglandin E2, on the contrary, has an anabolic effect, activates the proliferation and maturation of granulation tissue.
The influence of a physical factor on an organism is essentially determined by its initial state. Therefore, in the doctor's tactics, it is especially important to determine the indications and choose the method of physiotherapy.
Recovery processes in organs and tissues are realized through inflammation, the intensity of which is largely determined by the reactivity of the body. In turn, reactivity forms the body's stress response, the severity of which depends on the balance of regulatory systems and antisystems. With eustress, there is a favorable outcome and uncomplicated healing after injury. On the contrary, distress with increased and decreased reactions causes an imbalance in regulatory mechanisms, the development of a disadaptation syndrome, and, ultimately, an unfavorable outcome or complicated healing. Hence, the impact must be adequate and it must be carried out, first of all, in order to optimize the recovery processes, taking into account the “optimality of the disease” proposed by us, which provides for measures aimed at bringing the disease to such a course in which a favorable outcome is observed. The principle of disease optimality is based on evolution-selected and genetically fixed disease mechanisms as mechanisms of recovery. Violations in the optimality of the disease are violations in the mechanisms of recovery, but not the "pathological" nature of these mechanisms. This is the individualization of treatment. This task is difficult, since it provides for the allocation of uncomplicated and complicated forms of the disease and, on this basis, the construction of treatment tactics. This approach to rehabilitation treatment and treatment in general is promising and deserves attention. With severe inflammation against the background of hyperreactivity, it is necessary to reduce it. In this case, magneto-, UHF-therapy, etc. is indicated. In mild inflammatory processes against the background of hyporeactivity, on the contrary, it is necessary to influence their intensification, which indicates the expediency of using ultrasound, ultraviolet and laser radiation, microwave therapy, and oxygen barotherapy.
Physical factors cause a variety of physiological responses that can be used for therapeutic purposes. Reactions occur, as a rule, according to the “activation-stabilization-addiction” scheme (adaptation with the mobilization of the compensatory-adaptive capabilities of the body - “adaptation therapy”). Moreover, the activation of any system is accompanied in parallel by an increase in the anti-system.
Therefore, it is very important to highlight the primary direction of influences (the first phase is the primary effect) and, taking into account this direction, develop indications for the treatment of patients. The direction of the trace effect (second phase - secondary effect) reflects the reserve capacity of the organism. Changes in microcirculation observed under the influence of physical factors form a therapeutic effect. However, the ways of formation of this mechanism are different for different physical factors. Significant are those chemical changes in the skin, blood and tissues that occur as a result of the penetration of the chemical components of mineral waters through intact skin. Many of them also affect vascular reception and vascular tone, platelet aggregation, oxyhemoglobin dissociation, and blood oxygen capacity.
Of particular importance in the mechanism of the therapeutic action of physical factors is the change in the sensitivity of vascular receptors, especially the especially sensitive chemoreceptors of the carotid and aortic zones. From the receptor zones, reflexes arise that change the tone of arterial and venous vessels, blood pressure, heart rate, excitability of the vasomotor and respiratory centers. A decrease in the sensitivity of vascular adrenoreceptors has been proven when using radon procedures and carbon dioxide baths, photoinactivation of skin receptors is observed during light therapy. Primary physico-chemical and vascular reactions are played out in the skin - important body immunogenesis. The combination of metabolic, morphological and vascular changes in the skin, neurohumoral and hormonal changes provides a restructuring of the body's immunological reactivity. The local physical action, which is the initial trigger, is transformed into a chemical one, which, in turn, is transformed into a single neuro-reflex and humoral process involving various body systems in the responses.
Therapeutic effects during physiotherapy, depending on the factor and its dose, can be distinguished as follows:
1. immunomodulation (hyposensitization, immunostimulation);
2. analgesia, by creating a new dominant in the brain, increasing the threshold of conduction and excitability of peripheral nerves and improving microcirculation, relieving spasm and edema in the lesion;
3. muscle relaxation and myostimulation (direct effect on muscle tissue or indirectly through activation of the receptor apparatus);
4. increase or decrease in blood clotting;
5. hyperplasia and defibrolization through changes in microcirculation, metabolic processes and cell activity;
6. increase or decrease in the functional activity of the central nervous system, autonomic nervous system.
5. Indications and contraindications for physiotherapy
Indications for physiotherapy
Without a correct understanding of the syndromic-pathogenetic and clinical-functional approaches to the use of rehabilitation physical factors, indications and contraindications for their use, which are usually built on the basis of syndromes, cannot be assessed.
Physiotherapeutic methods can be aimed at the prevention and treatment of diseases as part of rehabilitation measures.
1. For preventive purposes, resort, climatic and mechanical factors are currently most widely used: thalasso, speleo, and aerotherapy, some types of hydrotherapy (showers, baths), heliotherapy and (UV, exercise therapy and massage. Over time, Apparently, magnetic and microwave therapy will find application.
2. In the treatment of the main clinical syndromes: general inflammatory changes; intoxication; painful; broncho-obstructive; the presence of fluid in the pleural cavity; some cardiac arrhythmias; respiratory, vascular, cardiac, hepatic, renal insufficiency I-II stage; hypertensive; hypotensive; thrombophlebitic; phlebothrombosis; dyspeptic; stool disorders; jaundice; exocrine pancreatic insufficiency; hepatic and renal colic; dysuric syndrome; nephrotic; urinary; convulsive; muscular-tonic; Raynaud; dysfunction of the joints; spinal deformities, defiguration of the joints (including the syndrome of increased production of synovial fluid); skin; violations of the integrity of tissues; allergic; anemic; hyperglycemic; hyperthyroid; hypothyroid; obesity menopausal; cephalgic; encephalopathy; encephalomyelopathy; hypothalamic; polyneuropathy; neuropathy; dyscirculatory encephalopathy; vestibular; meningeal; liquor hypertension; dyskinetic (spastic and atonic); edematous; cerebroischemic; atrophic; asthenic; neurotic (asthenoneurotic, neurosis-like); vegetative-vascular dystonia; radicular; radicular-vascular; reflex.
3. For diseases and conditions:
3.1. Traumatic injuries.
3.2. Inflammatory diseases.
3.3. Metabolic-dystrophic diseases.
3.4. Functional disorders of the central nervous system and autonomic system.
3.5. Secretion disorders in organs.
3.6. Motor disorders of the gastrointestinal tract.
Contraindications for physiotherapy
According to syndromic-pathogenetic and clinical-functional signs, contraindications (general (absolute) and relative) to the use of physical rehabilitation factors are also built.
General (absolute) contraindications:
1. Hyperthermic syndrome (feverish state of the patient at a body temperature above 38 ° C), which is associated with the occurrence of endogenous heat when exposed to physical factors. However, cold, as a physical factor, is shown in this case.
2. Hemorrhagic, hemolytic, myeloplastic syndromes, taking into account the antispastic, activating and fibrinolytic effects of physical factors.
3. Epileptic syndrome (due to the activating influence of physical factors).
4. Cardiac, vascular, respiratory, renal, liver failure with decompensation. Physiotherapeutic treatment is aimed primarily at mobilizing the body's reserves, which in this case are depleted.
5. Cachexia syndrome.
The nosological principle of contraindications is preserved in the following areas of medicine:
1. Oncology and hematology ( malignant neoplasms And systemic diseases blood). All physiotherapeutic factors are energetic and increase metabolism in the body, which is contraindicated in the tumor process.
2. Narcology. The narcotic state and alcohol intoxication are a contraindication due to the impossibility of dosing physiotherapeutic procedures according to the patient's feelings, as well as their unmotivated behavior, which can lead to tragic consequences.
3. Obstetrics (pregnancy of the second half: physiological - after 26 weeks; pathological - over 24 weeks). Physical factors have a load effect on the body, which can lead to a threat of termination of pregnancy.
4. Resuscitation (acute urgent severe conditions at infectious diseases, acute period some diseases of internal organs, for example, myocardial infarction, cerebral stroke, etc.).
Currently, the number of general contraindications is decreasing. Quite a lot of facts have been accumulated on the effectiveness of treating tuberculosis with the help of intraorganic tubazid electrophoresis, dimethyl sulfoxide electrophoresis, magnetic laser therapy and other methods, which makes it possible to remove this disease as an absolute contraindication to physiotherapy.
6. Dosage of physical factors
The category of "measures" is the leading one in physiotherapy and determines the doctor's tactics depending on the reactivity of the organism and the phase of the disease. In the acute period of the disease, predominantly low-intensity physical factors are used on segmental reflex zones. On the contrary, subacutely and chronic phase diseases, the intensity of the factor increases and affects directly the pathological focus. For example, in the first week of pneumonia, low-intensity UHF EP (up to 20 W) is prescribed, from the second week - high intensity (40-70 W). General UVR with good body reactivity is prescribed according to the main scheme, for weakened patients - for slow, and physically strong - for accelerated. The impact of a physical factor of low force is accompanied by unsharp changes in the functions of organs belonging to the same metamer of the body as the irritated skin surface, while the impact of a greater force is accompanied by significant changes.
The basis of dosing physical factors are:
1. Sensations of the patient: warmth, vibration, tingling, tingling.
2. Duration of the procedure: the duration of the procedure can be from several minutes (light therapy) to several hours (magnetotherapy).
3. Number of procedures: from 5-6 with UHF, up to 20 with galvanization, which can be carried out daily, every other day or for 2 days with a break for the third.
The cardinal sign of inadequate physiotherapy is the exacerbation of the pathological process with the formation of a maladjustment reaction.
In chronic diseases against the background of reduced reactivity of the patient's body, recovery can occur through an exacerbation of the process at the initial stages of treatment, which, on the contrary, reflects the development of the adaptation syndrome and should not be regarded as a complication.
Inadequate response to treatment may be general or local.
With a general reaction proceeding according to the type of vegetative-vascular syndrome, there is a deterioration in well-being, increased irritability, fatigue, decreased performance, sleep disturbance, excessive sweating; there is a change in the temperature curve, lability of the pulse and blood pressure, exacerbation of concomitant chronic diseases.
With a focal (local) reaction observed when exposed to a pathological focus, collar zone, cervical sympathetic nodes, eyes or with an endonasal technique, a violation of cerebral hemodynamics, headaches, dizziness, swelling of the nasal mucosa, persistent local hyperemia, irritation, itching is characteristic.
In case of an inadequate response, the intensity of the applied physical factors is reduced, the method of their application is changed, or a break in physiotherapy is taken for 1-2 days. A second course is prescribed depending on the period of aftereffect of physical factors, which in most cases ranges from 0.5 to 6 months.
List lAndliteratures
1. Pankov E.Ya. Physical factors and recovery processes. - Kharkov, 1989. - 48 p.
2. Technique and methods of physiotherapeutic procedures / Ed. V.M. Bogolyubova.- M.: Medicine, 1983.-352 p.
3. Physiotherapy: Per. from Polish / Ed. M. Weiss and A. Zembaty.- M.: Medicine, 1985.-496 p.
