General Questions
of Rehabilitation
is the restoration of health, functional status and disability, which violated by disease, injury, or physical, chemical, and social factors.
Definition of rehabilitation of the World Health Organization (WHO):
Rehabilitation is a set of activities designed to
ensure that persons with disabilities as a
result of diseases, injuries and birth defects
adaptation to new conditions of life in the
society in which they live.
REHABILITATION From the Latin: habilis - «ability», rehabilis - «restoration of ability“
effective and early return of sick and disabled for
household and labor processes in society, restoration
of personal properties of rights
According to WHO
The rehabilitation is a process aimed at
comprehensive assistance to the sick and disabled to
achieve their maximum potential in this disease is
physical, mental, vocational, social and economic
usefulness.
The purpose of rehabilitation
recovery the patient's health through the integrated use of various tools designed to maximize the recovery of disturbed physiological functions of the body, and in failing to achieve this - and the development of compensatory substitution devices (functions).
The first and main line of rehabilitation (medical and physical)
correspond to the three classes of consequences of disease:
1) Medical and biological effects of diseases that are to deviations from the normal morphofunctional status – medical rehabilitation;
2) reduction of work capacity or operability in the broad sense – work
rehabilitation; 3) Social disadaptation - broken links with
the family and society - social rehabilitation.
Three types of rehabilitation (medical, labor, social)
full restoration of the functional
capabilities of the various systems of
the body and musculoskeletal system,
and the development of compensatory
adaptations to the conditions of
everyday life and work
The main task of medical rehabilitation is
recovery of domestic capabilities of the patient, i.e., the ability of mobility, self-care and the implementation of a simple homework;
restoration of working capacity, i.e. disabled lost skills through the use and development of the musculoskeletal system functionality;
preventing the development of pathological processes that lead to temporary or permanent disability, i.e. implementation of secondary prevention.
For special problems of rehabilitation include:
Necessary to observe following physiologically sound pedagogical principles:
1. Individual approach to the patient. When designing a rehabilitation program must take into account age, sex, profession of the patient, his experience of the motor, the nature and extent of the pathologic process, the functionality of the patient.
2. Consciousness. Only a conscious and active participation of the patient in the rehabilitation process creates the necessary psycho-emotional background and psychological mood rehabilitated, which increases effectiveness of these rehabilitation.
The main means of physical rehabilitation are exercise and elements of the sport
is especially important with increasing physical activity in all its parameters:
volume, intensity, number of exercises, number of repetitions, as the complexity of the exercises within
the same class, and throughout the rehabilitation process.
3. The principle of gradualism
4. Regularity - the basis of rehabilitative training during the rehabilitation process, sometimes flowing to several months or years.
5. Cyclicity. Work-rest cycle with observance optimal interval (rest between the two exercise, or between two classes).
6. Systemic exposure (or serialization), i.e. sequential alternation starting positions and exercises for different muscle groups.
7. Novelty and diversity in the selection and application of exercise, i.e. 10-15% of the exercise should be updated, and 85-90% for repeated successes securing treatment.
8. Moderation effects by means of physical rehabilitation means that the exercise should be moderate, perhaps more prolonged, or load must be fractional, thus achieving the adequacy of the patient load.
Early initiation of rehabilitation
Rehabilitation can not be used:
in a very serious condition of the patient, high temperature, severe intoxication , severe cardiovascular and pulmonary failure, a sharp oppression adaptive and compensatory
mechanisms.
However, this is not entirely true , as some of the Rehabilitation, for example inflating balls,
appointed in acute postoperative period sufficiently serious condition of the patient, but it
serves to prevent congestive pneumonia.
Principles of medical and physical rehabilitation
The basic principles of rehabilitation include:
Problems of medical rehabilitation are complex and require collaboration of many professionals:
physicians, surgeons, trauma surgeons, doctors and physiotherapists and physical rehabilitation physicians, psychologists, psychiatrists, etc., adequate physical and mental condition of the patient
at different stages of rehabilitation.
Integrated use of all available and necessary rehabilitation
Depending on the reasons that require rehabilitation, as well as specific features
of the sick or disabled, their functionality, movement experience, age, gender, structure of experts and the methods and tools
will be different, i.e. rehabilitation requires an individual approach to patients based on their reaction to the use of rehabilitation.
Individualization of rehabilitation programs
When the three-step rehabilitation:
1. specialized hospital;
2. specialized rehabilitation center or sanatorium;
3. rehabilitation department polyclinics.
When a four-step rehabilitation - use in
traumatology:
1. Specialized ambulance (rehabilitation measures
begin conducted specialized ambulances: prevention
and treatment of shock, haemorrhage, providing upper
airway, etc.)
2. specialized trauma hospital;
3. stationary rehabilitation center;
4. rehabilitation department polyclinics.
Stages of rehabilitationIn medical rehabilitation are 3 or 4 stages
At each stage in the rehabilitation
map was documented, what
methods and means of treatment
and rehabilitation were used, what
was the functional state of patient.
Continuity and succession in all stages of rehabilitation
The use of methods of control adequacy of loads and effectiveness of rehabilitation
In order to apply these special diagnosis and control methods of the current state of the patient in the rehabilitation process , which can be subdivided into the following types :a) medical diagnostics,b) functional diagnostics,c) motodiagnostika d ) psychodiagnosis
Social orientation The best outcomes of medical rehabilitation can be complete recovery and return to the usual professional work
MOTODIAGNOSIS - definition of motor abilities of the patient, the ability to household and labor operations, which use different postural tests, muscle testing , etc.
PSYCHODIAGNOSIS - psychologist determines the structure and degree of change in mental functions, types of memory disorders, attention, thinking, emotional and volitional, explores the personal characteristics and the impact on all rehabilitation.
active,passive andregulating psyche
For active agents include all forms of therapeutic physical culture:
a variety of exercise, sport items and sports training, walking, running and other cyclical
exercise and sports, work in the gym, dance treatment, occupational therapy, etc.;
Means of physical rehabilitation can be divided into
To Passive - massage, manual therapy, physiotherapy, and preformed natural environmental factors;
To regulating psyche - autogenous training, muscle relaxation, etc.
This is theoretical and practical, medical and educational discipline that studies the theoretical foundations and methods of use of physical culture for the treatment, rehabilitation and prevention of various diseases.
TPC feature compared to other methods of treatment and rehabilitation is that it uses as the main therapeutic agent exercise - a potent stimulator of the vital functions of the human body
Notion of therapeutic physical culture (TPC)
General training is used for rehabilitation, strengthening and overall development of the body, in this case used restorative and general developmental exercise.
The purpose of special training - development and restoration of body functions involved in the pathological process.
Apply special exercises that directly affect the infected system, a diseased organ traumatic hearth (breathing exercises with pneumonia, exercises to develop paralyzed limbs, etc.).
One of the characteristic features of the process of physical therapy is dosed training exercise.Are distinguished general and specific training dosage
As the recovery reduces the amount of breathing exercises, increasing the number of special exercises. On physical exercise is important cause the patient positive emotions, which improves health and fitness effect and postpones the onset of fatigue.
The Ratio of exercise for the overall development and breathing exercises depends on the period of the disease.
There are three types of therapists:restorative,reconstructive,professional.
Restorative occupational therapy increases vitality of the patient, creates preconditions for psychological rehabilitation;replacement - aimed at preventing patient movement disorders and restore lost functions;
Professional - restores impaired production skills, held at the final stage of rehabilitation treatment
Under work therapy mean restoration of disturbed functions with special selected work processes
- a restoration of lost functions with the help of
special devices. Mainly used to prevent
contractures (stiffness) of the joints.
Apparatotherapy
are specially selected combination of natural human movements, separated into components.
Physical exercise is classified by the following characteristics: anatomical - exercises for the muscles of the head, neck, torso, shoulders, upper extremities, abdominal and pelvic floor muscles of the lower extremities; on the basis of activity - active (performed by the patient), passive (performed by an exercise physiologist with an effort of the patient) and active-passive exercise (performed by the patient with the help of an instructor LFK)
Gymnastic exercises
breathing exercises (static, dynamic, and drainage).- Static breathing exercises performed in a different starting positions without moving the legs, arms and torso- Dynamic operate in combination with the movements of limbs, trunk, etc.
- To drain include breathing exercises, specifically aimed at the outflow of fluid from the bronchi and use them in various diseases of the respiratory system. Should distinguish drainage exercises (breathing) and positional drainage (especially given positional assumptions as well as the outflow of fluid towards the airway on a "gutter).
- Exercises on coordination and balance used for training of the vestibular apparatus in hypertension, neurological diseases and otherPerformed in the main home position: standard rack, on a narrow bearing surface, standing on one leg, on his toes, with open and closed eyes, with or without objects.It also includes exercises forming household skills lost as a result of a disease
On the basis of species and character are allocated
In medical physical culture choice of assumptions depends on the motor mode, prescribed by a doctor.
There are three basic starting position - lying down, sitting and standing,
each of which has its own variants: lying on his back, on his stomach, on his side, sitting up in bed, on a chair on the mat with legs straight, sitting in bed or in a chair with their pants legs, standing on all fours; standing without support; standing building on crutches, sticks, "hodilki" on the boards, with reliance on the lintel and the climbing wall, chair, etc.
the original position of the body
There are several forms of physical therapy lessons:- morning hygienic,- physiotherapy,- independent physical exercise,- therapeutic dosed walking and- the ascent (terrenkur)- mass forms of Physical Culture,- dosage swimming, rowing, running, etc.
TPC form:
Therapeutic dosed walking is shown to normalize the patient's gait after injuries and diseases of the nervous system, musculoskeletal, and metabolic disorders, for training the cardiovascular and respiratory systems. Dispensed medical walking speed of movement, long distance, terrain.
Morning hygienic gymnastics for the body of the patient - is a specially selected complex of physical exercises, promotes translation of the body of the sleep state-braking - with the active state of the day.
treatment dosage walking with gradual climb and descent on special routes. Used in diseases of the cardiovascular, respiratory, and metabolic disorders, traumatic lesions of the musculoskeletal system and the nervous system. Depending on the gradient terrainkur routes are divided into groups: a an elevation angle of from 4 to 10 °, with an elevation angle of 11-15 ° and with an elevation angle of 16-20 °.
Dosed the ascent (terrenkur)
and others may be not only means of physical therapy (as a kind of exercise), but also its independent form. They are designed to further the training function of the affected organs and the whole body, as well as improving efficiency convalescents. Apply individually tailored indications, contraindications and appropriate dosages. Recently, widely used in rehabilitation of athletes, young and middle ages.
include sports games, close tourism, sport items, trips, mass gymnastic performances, holidays. These forms are used in the final period of recovery and training of all organs and body systems are selected individually. Mass forms of physical therapy are used not only to treatment and rehabilitation, but also as a prophylactic measure, especially in groups of "Health" and to practice with the elderly.
It forms a mass of improving physical training elements