Coursework: The role of physical and medical rehabilitation in the recovery process

Along with the treatment of patients, artificial and especially natural therapeutic factors are used for the medical rehabilitation of patients, the prevention of various diseases, and the hardening of the body. An analysis of the priorities of civilized countries, among which the leading positions are occupied by the health of the population, led to a conscious understanding of the role and significance of therapeutic physical factors within the framework of the concept scheme: health vie-success-prosperity. Under these conditions, there is a shift in emphasis in the system of views on health in favor of restoring the maximum possible functional activity, which forms the basis medical rehabilitation sick. This trend is also manifested in the preventive use of therapeutic physical factors for the prevention of diseases and adverse reactions of a healthy organism. The latter forms the basis of one of the sections of physiotherapy - physioprophylaxis.

PHYSIOTHERAPEUTIC ASPECTS OF MEDICAL REHABILITATION

The scientific and technological revolution and the increase in the speed and volume of information flows in modern society make high demands on the intellectual and physical development of the population. However, unfavorable demographic

Physiotherapy in the system of medical rehabilitation 45 1 and the ecological situation, along with high rates of urbanization, creates the prerequisites for the deterioration of the health of the population of Russia, negatively affects the gene pool of the nation. In this regard, the problem arises of the rapid return of experienced and qualified personnel to active professional activities. Under these conditions, a complex of pathogenetically substantiated measures, united by the concept of "rehabilitation", is of priority importance for public health.

According to the WHO definition, rehabilitation is the coordinated application of medical, social, pedagogical and professional measures in order to prepare (retrain) an individual for optimal working capacity. Her ultimate- goal is the social integration of the patient, who is object rehabilitation. At the same time, doctors conduct only the medical part of the rehabilitation program, which is referred to as "medical rehabilitation.

This concept entered medical terminology at the end

60s. Introducing it into their everyday life, physicians sought to draw public attention to the need to continue therapeutic measures after the end of the patient's stay in the hospital, that is, when the problem of saving life and maintaining the structural and functional integrity of the affected organs and tissues was solved. Previously, these activities were united by the concept "restorative treatment". At present, it is the final part of medical rehabilitation, which begins with early days treatment of the patient in the hospital.

The scientific ideas that have developed to date dictate the need for its implementation in several stages with a clear separation of each of them. According to the content of therapeutic measures, there are three stage medical rehabilitation:

Therapeutic and sparing (hospital);

Functional training (outpatient clinic);

Active recovery phase (sanatorium and resort).

The proportion of physiotherapy care at these stages is different and increases significantly during the period of active recovery of the patients' ability to work, i.e. when the problem of preserving the life and functions of affected organs and tissues is solved.

452 Chapter 18

In accordance with the system of medical rehabilitation adopted by the Ministry of Health and Medical Industry of Russia, its first stage is carried out in specialized medical and rehabilitation departments of hospitals (hospitals and clinics), the second - in regional centers of medical rehabilitation and rehabilitation centers of polyclinics, and the third - in sanatoriums of the corresponding medical profile. The attending (family) doctor of the patient coordinates the interaction between the various stages of medical rehabilitation. The results of theoretical and clinical studies of scientists and specialists made it possible to formulate the following principles

medical rehabilitation of patients:

Unity of etiopathogenetic and symptomatic therapy

(unidirectionality of the stages of medical rehabilitation);

Individualization of specific medical rehabilitative programs

biliation;

Course implementation of rehabilitation activities at different stages;

Consistent use of treatment regimens of increasing intensity at each stage of medical rehabilitation;

The optimal combination of applied therapeutic physical factors and pharmacological preparations;

Dynamic implementation of the stages of medical rehabilitation, the sequence of which may be different depending on the pathology;

Integrated use of various means and methods in medical rehabilitation programs.

The essence of medical rehabilitation at the hospital stage is complex treatment based on some of the above principles, which includes interrelated blocks of various types of therapy. An individual program of medical rehabilitation at this stage is developed and controlled jointly with an organized group of clinic specialists the patient's physician. It should include an automated multiparametric assessment of the functional state of the patient, diet therapy, drug therapy, physiotherapy and psychotherapy and psychocorrection, therapeutic physical culture (therapeutic regimen, physical exercises) and some special methods (phytotherapy, gravitational blood surgery, sanitation bronchoscopy, intraorgan endolaser therapy, spinal traction and others).

Physiotherapy in the system of medical rehabilitation 453

The share of physiotherapy in the total volume of therapeutic measures at the hospital stage of medical rehabilitation does not exceed 10-30%. The sometimes carried out allocation of one of the sections of the program into an independent type of rehabilitation

(for example, physiotherapeutic, immunological, psychophysiological, etc.) is unreasonable, based on the above definition of rehabilitation as comprehensive program. It is known that structure rehabilitation program is determined mainly profile medical hospital and the presence of indications for the use of these methods. An analysis of the accumulated clinical experience and the priorities of clinical medicine shows that the creation of rehabilitation departments is expedient, first of all, in cardiological, neurological and trauma hospitals. It is in them that there is an urgent need for an early start of rehabilitation measures, the delay in which can lead to a permanent disability and disability.

patients.

During the period of convalescence in patients with outpatient stage there is dystrophy of the affected organs with a decrease in body weight and immunodeficiencies of varying degrees, causing a decrease in the nonspecific resistance of the organism. These individuals are characterized by a pathogenetic relationship with changes in the acute phase of a somatic disease and damage, a combination of local and general pathological consequences of the disease, a predominantly functional nature of the pathology, with disorders of the psycho-emotional status and the autonomic nervous system, a slight severity of clinical symptoms with a significant functional defect. and preservation of the pathogenetic links of the disease, changes in the immune status and trophism of the affected organs and tissues, unequal specific weight of the pathology of various organs and systems when they are combined with damage, and multimorbidity with the phenomenon of "burdening" the underlying disease with concomitant pathology.

The share of therapeutic physical factors in the correction of the functional state of convalescents at the outpatient stage increases to 40-70%. Along with them, at this stage, the choice of means and methods of therapeutic physical culture, psycho-correction (formation of a sensory image of professional activity) and immunomodulation is significantly expanding.

454 Chapter 18

Fundamental principles of physiotherapy at this stage »

are an increase in physical activity and the implementation of measures

active recovery initiatives

(skills of the relevant specialty). They should be directed to:

individualization of physiotherapy

(widespread use of biofeedback machines ^

Stimulation and correction of the regulation of the functioning of the vital functions of the body, since it is the violation of their regulation that is the main link in the pathogenesis of most somatic diseases;

Gradual increase in the proportion of irritating physical stimuli combined with a decrease in the number of analgesic procedures;

High accuracy and non-invasiveness of impacts (using

use of methods of puncture physiotherapy);

The transition from the use of high-intensity physical factors to low-intensity ones and an increase in their therapeutic effectiveness (due to the expansion of the frequency range of exposure);

The use of methods of subthreshold stimulation of the sensory systems of the body, aimed at increasing various types of sensitivity.

Coordination and responsibility for medical rehabilitation at this stage rests with polyclinic specialist. Under his direct supervision, the composition and sequence of rehabilitation methods used at this stage are drawn up in the form a comprehensive rehabilitation program, containing a list of methods and terms of current and final medical control. Correction of the ongoing rehabilitation program is carried out on the basis of the current control, and the evaluation of effectiveness - on the basis of the final one. The final result as a system-forming factor of this stage ("quantum of action" of a functional system) is of cardinal importance. It is evaluated on the basis of subjective sensations of the patient, objective parameters of the functional state and scientific comparison of the actually achieved result with the expected one. Based on theoretical ideas about the timing of recovery of functions in patients, in accordance with the duration of the formation of short-term and long-term adaptation of the patient, the current control of effects is

Physiotherapy in the system of medical rehabilitation 455 of medical rehabilitation can be carried out by a minimum number of well-tested methods for assessing the body's life support systems (measurement of pulse rate, respiration, blood pressure, body temperature, spirography, functional tests) -

At the sanatorium-resort stage, convalescents are subject to referral to specialized sanatoriums. At the same time, patients with a cardiological profile (after myocardial infarction) are sent to the sanatorium-resort stage of rehabilitation in specialized rehabilitation departments of sanatoriums, bypassing the polyclinic. The share of therapeutic physical factors at the sanatorium-resort stage of medical rehabilitation is maximum and reaches 80-90% in the total volume of therapeutic measures.

Improving physiotherapy care at the sanatorium-resort stage should follow the path of increasing the weight of active physical factors and reducing passive ones. It is necessary to gradually increase the volume of physical exercises and increase their severity, followed by a transition to physical training. Therapeutic physical culture should be combined here mainly with natural healing factors. Artificial factors are used only in case of an exacerbation of the disease and at the initial stage of acclimatization.

PHYSIOPROPHYLAXIS A

Physioprophylaxis- the use of the strengthening and training effects of therapeutic physical factors for the prevention of human diseases.

The human body in the course of its life is constantly exposed to various, including unfavorable, environmental factors. The latter include cold and hot air and water, reduced atmospheric pressure, ionizing and non-ionizing radiation, and various toxins. In the process of its development, a person develops resistance to their effects - natural and acquired. resistance organism. To increase it, along with various chemicals (adaptogens, psychostimulants, actoprotectors), therapeutic physical factors are also used. Their use to increase the functional reserves of the body and its stability to unfavorable action

456 Chapter 18 hardening.

The hardening of the organism is based on the adaptation of the organism to changing conditions of existence (adaptation to environmental factors), the essence of which is a set of morphological and functional changes developed in the process of evolution aimed at maintaining the relative constancy of the internal environment - homeostasis. I.P. Pavlov attached great importance to these processes, rightly stating that

"All human activity is the eternal and infinite with

ability."

The activation of central stress-limiting systems (opioidergic, serotonergic, etc.) and local neuroendocrine modulators (adenosine, prostaglandins, antioxidants, etc.) caused by therapeutic physical factors blocks the stress hormones released under the action of adverse factors and provides a cross-protective effect adaptation of the organism to multimodal environmental factors. The author of the concept of stress, G. Selye, designated this phenomenon as a "general adaptation syndrome". An important role in it is played by special stress proteins (with a molecular mass of 70-72 kDa) that accumulate under the action of physical factors, which prevent the denaturation of membrane proteins and protect subcellular structures from damage (the phenomenon of adaptive stabilization of biological structures).

Long-term adaptation is achieved in the process of long-term and targeted training of adaptation mechanisms. At the same time, due to the aftereffect during repeated exposures, conditioned reflex connections are formed in the body in the functional systems that respond to it.

Therapeutic physical factors are mainly used to prevent various diseases and increase the body's defenses. (primary - physioprophylaxis). In addition, they are used to prevent the progression and stop the main manifestations of the onset of the disease.

(secondary physioprophylaxis).

Hardening is based on the general principles of training, following which significantly increases its effectiveness. Among these principles are:

Systematically repeated, long-term and continuous impact on the body of therapeutic physical factors of gradually increasing intensity;

Physiotherapy in the system of medical rehabilitation 457

The correct choice of the zone of influence and the combination of local and general hardening ^

Accounting for the individual characteristics of the organism (gender, age, history, resistance and sensitivity to natural factors) and the conditions of its work and life;

Correspondence of the intensity of the impact of therapeutic physical factors to the functional capabilities of the body and the degree of development of compensatory-adaptive reactions;

Multifactorial hardening effect.

Based on these principles, an appropriate individual mode of hardening is developed, including therapeutic physical factors and physical exercises.

To harden the body, mainly climatic factors are used - air, solar radiation, sea water - (climate prevention). This is due to the fact that in the process of human evolution, appropriate adaptive mechanisms have developed in him to climatic and weather factors of the external environment. In this regard, climatic factors are the most adequate and effective for training adaptive mechanisms and contribute to the maximum restoration of the body's connections with the external environment. Along with natural factors, artificial physical factors are also successfully used for physioprophylaxis - fresh water, pulsed currents, ultraviolet radiation, and others. At the same time, it is necessary to remember that short, but frequent impacts are more effective than long and rare ones. The termination of hardening procedures, even for a short period, leads to a compensatory increase in the body's sensitivity to environmental factors.

For increase nonspecific resistance organisms to environmental factors are widely used solar baths of total radiation (helioprophylaxis) by regimes of moderate and pronounced impact (see Table 21). Along with them, medium-wave ultraviolet irradiation is widely used according to the accelerated scheme (see Table 10), AUFO K and ALOK

(cm. Phototherapy), transcranial electroanalgesia and electrosleep therapy (see. pulsed electrotherapy) transcerebral UHF-therapy (see. ultrahigh frequency therapy) aeroionotherapy (see. Aeroinotherapy), oxygen and pearl baths, electrophoresis of calcium, magnesium, sulfur, iodine and bromine by endonasal and transorbital methods, dibazole and pantocrine - by segmental.

458 Chapter 18

In order to increase the body's resistance to cold and warmth round-the-clock aerotherapy, air baths, aerophytotherapy and bathing in natural reservoirs are widely used according to the modes of average and maximum cold load (see table.

22), For preventive purposes, they also use vibrotherapy, self-massage, partial and full rubdowns, douches, various showers, contrast and local thermal baths.

(walking barefoot, foot and foot baths), sauna. The use of air baths and outdoor sleep for hardening the body is especially effective during the cold season, when people spend most of their time indoors. A significant contrast between body temperature and the environment provides a pronounced training of the mechanisms of adaptation to thermal factors and hardening of the body. They are even more pronounced when using water, which has a higher heat capacity than air. Wiping with snow and winter swimming in the cold water of open reservoirs ("winter swimming") have the maximum hardening effect.

hardening to low atmospheric pressure Atmospheric air is carried out at mountain resorts and by the methods of hypobarotherapy and normobaric hypoxic therapy. They are based on the training of the body's activity in conditions of hypoxic hypoxia.

To harden the body non-ionizing radiation The sun and other sources use sunbathing of gradually increasing intensity, long-wave ultraviolet irradiation. Preventive solar

(medium-wave ultraviolet) irradiation is shown primarily to persons whose living conditions and activities are associated with light starvation. Significant weakening of the effects of various areas of solar radiation underlies the protective use of artificial sources of optical radiation to harden the body to high-intensity solar radiation.

Increasing the body's resistance to ionizing radiation carried out using medicinal electrophoresis of lithium, calcium, magnesium, iodine and bromine according to endonasal and transorbital methods (see. permanent electrotherapy), high-frequency magnetic field on the thymus area (see. Phototherapy), oxygen barotherapy (see. barotherapy), aero ion therapy (see. Aeroionotherapy), oxygen, pearl, turpentine, carbonic and iodine-bromine baths.

Physiotherapy in the system of medical rehabilitation 45 9

For warnings of meteopathic reactions (meteopro prevention) use the entire arsenal of climatotherapy, which is prescribed to the patient, taking into account individual indications. Planned prevention should be carried out especially carefully during periods of unstable weather - in early spring and late autumn

(seasonal meteorological prophylaxis). In case of unfavorable meteorological medical prognosis, the therapeutic regimen is changed and the intensity of the applied therapeutic physical factors is reduced, measures are taken to prevent overheating or hypothermia of the body of a meteolabile person.

The effectiveness of hardening increases significantly with the combined effect on the body of therapeutic physical factors and therapeutic physical culture (morning hygienic gymnastics, physical exercises). For proper hardening, regular medical supervision and self-control is necessary.

Objective indicators of the effectiveness of hardening are a decrease in the amplitude of the temperature reaction and an acceleration of the recovery of the initial temperature of the skin and to the cold factor of a fixed intensity, equalization of the temperature of the skin and in usually closed and open areas of the body, a decrease in the amplitude of the responses of the pulse, blood pressure and gas exchange during the course of hardening procedures . Along with them, they also take into account the weakening of subjective sensations associated with a certain degree of cooling (numbness of the fingers, chills, etc.).

Boksha V.G. The problem of adaptation and resort treatment. M.: Medicine,

Kogan O.G., Naidin V.L. Medical rehabilitation in neurology and neurosurgery. -M.: Medicine, 1988.

Non-drug treatment in the clinic of internal diseases / Ed. L.A. Serebrimoy, N.N. Seredyuka, L.E. Mikhno. - Kyiv, 1995.

Nikolaeva L.F., Aronov D.M. Rehabilitation of patients with coronary heart disease: a guide. - M.: Medicine, 1988.

Parfenov A.P. Hardening of the body. -M.: Medicine, 1972.

Skurikhina L.A. Physical factors in the treatment and rehabilitation of pain

ny diseases of the cardiovascular system. M.: Medicine, 1979.

CHAPTER 19

ORGANIZATION

PHYSIOTHERAPEUTIC CARE IN MEDICAL INSTITUTIONS

WORK ORGANIZATION

PHYSIOTHERAPY DEPARTMENT

(OFFICE)

In the practice of a doctor of any specialty, along with drug treatment, therapeutic physical factors are also widely used. In the complex treatment of patients with acute diseases, exacerbations of chronic pathological processes, the consequences of traumatic injuries and functional disorders, they often play a leading role. For these purposes, as part of hospitals, outpatient clinics and sanatoriums, physiotherapy departments (rooms), in which physiotherapeutic care is provided to patients and convalescents. Physiotherapy help is a kind of specialized medical care provided to the population by physiotherapists using natural and artificial therapeutic physical factors. Approximately 60% of patients on inpatient treatment, at least 80% of patients on outpatient care, and almost all patients referred to a sanatorium need it.

According to the industry standard OST 42-21-16-86 "SSBT. Departments, physiotherapy rooms, general safety requirements" (1986), put into effect by order of the Ministry of Health of the USSR N1453 dated November 4, 1986, the physiotherapy department is deployed in ground floors of a medical institution.

Organization of physiotherapy care 46 1

The equipment, organizational and staffing structure and scope of work of the physiotherapy department (office) are determined by the bed capacity of the hospital or outpatient clinic and their medical profile. It may include rooms for constant, pulsed, low- and high-frequency currents, phototherapy, therapeutic massage, thermotherapy, barotherapy, an inhalatorium, a hydropathic clinic with baths and a hall for therapeutic showers, an intestinal lavage-irrigation room, a pool for an underwater shower-massage and therapeutic swimming, a mud bath and a radon clinic. It is allowed to place in one room devices for electro- and phototherapy, and in one cabin (length 2.2 m, width - at least 1.8 m) - one stationary and two portable devices.

Managing the work of physiotherapy departments

(rooms) and the responsibility for the quality of treatment lies with the head of the department (cabinet doctor), and in his absence, one of the doctors who have undergone special training in physiotherapy. Physical factors for the treatment of patients should be started by a physiotherapist in consultation with the patient's physician. Often this rule is replaced by the postulate of the leading role of the attending physician in prescribing procedures, as bearing legal responsibility for the patient's condition. In these cases, the physiotherapist is assigned the functions of ensuring the fulfillment of the appointments of the attending physician, monitoring the prescription of his appointments and the necessary correction after agreement with him. Without opposing physicians-specialists to attending physicians, it is necessary to note the low effectiveness of physiotherapeutic prescriptions by the latter. According to the fair remark of one of the founders of Russian physiotherapy S.S. Lepsky

(1937) "Physicians who do not have sufficient knowledge in the field of physiotherapy and refer patients for special physiotherapeutic treatment do wrong by prescribing to the physiotherapist in a certain form not only the method of treatment, but also its dosage ... It is not clear why one or A different doctor who sends a patient to a radiologist for X-ray therapy does not dare to suggest the method and technique of treatment, but when referring a patient to a physiotherapist, he does not hesitate to prescribe what and how to treat. This kind of attitude is absolutely wrong. Based on this, clinicians should recommend, but not assign treatment method. For the appointment of physiotherapy procedures

462 Chapter 19 it is expedient to refer patients to a consultation with a physiotherapist.

After consulting the patient, the physiotherapist makes an appropriate detailed entry in the prescription column indicating the name of the procedure, the area of ​​influence, methodology, dosage and number of procedures. Based on an entry in the medical history or outpatient card in the physiotherapy department

(office) a physiotherapist fills out a procedure card in the form N44y (see. Appendix 3). In it, the nurse keeps a record of each procedure performed, indicating the actual dosages of physical factors and the duration of exposure. After the end of the course of treatment, the procedure card is stored in the physiotherapy department for a year. For quantitative and structural analysis of the work of the physiotherapy department (office), nurses keep logs of daily records of the work of individual rooms.

Physiotherapeutic procedures are carried out by paramedical workers who have undergone special training and have a certificate of completion of specialization courses in physiotherapy. Before starting the course of treatment, primary patients are familiarized with the rules for taking procedures. It is noted that it is inappropriate to carry them out immediately after a meal (in the first 1-2 hours) or on an empty stomach. During the procedure, the patient should not sleep, read, touch the devices, independently regulate the parameters of the therapeutic effect of factors. After the procedure, the patient is recommended to rest for 30-40 minutes in the halls of the department. The patient is introduced to the nature of the sensations that arise during the procedure, and, if necessary, the purpose of the treatment is explained.

The assessment of the work of the physiotherapy department (office) is carried out according to two main indicators. The first one total coverage of patients with physical methods of treatment - is determined by the percentage ratio of the number of patients treated in the department to the total number of patients treated in the etatsionar (sanatorium) or primary visits to the polyclinic. On average, the coverage of patients with physical methods of treatment is 40-60% for hospitals, 20-20% for polyclinics.

30% of health resorts - 50-70%. The second indicator is number of procedures per treated patient- is 15-20 for hospitals and sanatoriums, and 10-1 2 procedures for polyclinics.

Organization of physiotherapy care 46 3

Load rate Physiotherapists in accordance with the Order of the Ministry of Health of the USSR N1000 of September 23, 1981, is 5 patients per hour (40 patients per day). The number of conditional physiotherapeutic units during one procedure is determined by the Order of the Ministry of Health of the USSR N1440 dated

December 21, 1984. The average workload for nursing staff is 15,000 conventional procedural units per year. It is taken as the time (8 min) required for the preparation and conduct of the physiotherapy procedure with the appropriate coefficient of complexity. The norm of the load of a massage nurse is 30 conventional massage units per working day (6.5 hours), and their number when performing procedures is determined by Order of the Ministry of Health of the USSR N 817 of 06/18/87.

Technical control, maintenance and repair of physiotherapy equipment is carried out by persons with special education - medical technicians (engineers) of workshops for the repair of medical equipment of the "Rosmedtechnika" system. Preventive inspection of the equipment is carried out at least once every two weeks. Accounting for the hourly work of physiotherapy equipment is carried out by nurses from the passports of the devices on a quarterly basis.

SAFETY DURING PHYSIOTHERAPEUTIC PROCEDURES

Modern physiotherapy devices are sources of electric currents and electromagnetic fields, which, if used carelessly and ineptly, can cause damage to body tissues and undesirable changes in the health of both patients and attendants. Neglect of the rules for their operation can lead to electric shock to the body (electrical injury ), frostbite, burns, barotrauma, chemical poisoning (hydrogen sulfide), exposure to radioactive substances (radon).

To prevent such undesirable consequences, it is necessary for the personnel of the physiotherapy departments (offices) to strictly observe and comply with the "Safety regulations for the operation of medical equipment in healthcare institutions. General requirements.", approved by the Ministry of Health of the USSR on August 27, 1985. For carrying out procedures should use equipment and apparatus

464 Chapter 19 tour approved for use by the Ministry of Health of the Russian Federation and the relevant regulatory and technical documentation for these medical equipment products.

The safety of work in the department, according to OST 42-21-16-86, is achieved:

Technologically and sanitary-hygienic justified placement, layout and decoration of premises;

Rational organization of work;

Rational organization of workplaces;

Using proper equipment and protective equipment

data that meet safety requirements;

Compliance with the rules for the operation of electrical installations,

connections and equipment;

Training of personnel in safe working methods and techniques;

The use of effective means of protecting personnel.

Work in the physiotherapy department (office) is allowed for persons who have undergone safety briefing, which, according to the order of the Ministry of Health of the USSR No. 862 of 20.08.62, is carried out upon employment, then quarterly and registered in a special journal. The head of the department or the doctor responsible for the work of the department (office) is responsible for ensuring safe work on physiotherapeutic equipment.

A technical passport containing a list of premises, their equipment and protective devices must be issued for each office. The head of the department (office) is obliged to develop safety instructions for each office (see. Appendix 4). They must be approved by the administration of the institution and posted in a place visible to the staff. In addition, the department should have a first aid kit with the necessary set of medicines (see. Appendix 5).

The greatest danger during physiotherapeutic procedures is electric shock - electrical injury. It occurs when the patient or sister comes into direct contact with the current-carrying elements of the apparatus and is manifested by convulsive contractions of the skeletal muscles, pain, and a sharp blanching of the visible skin. Subsequently, depending on the strength of the current passing through the tissues of the affected person, respiratory arrest, cardiac arrhythmias and loss of consciousness develop, which can lead to the death of the patient.

Electrical shock requires immediate resuscitation. First of all, it is necessary to

Organization of physiotherapeutic care 465 cut off the contact of the victim with the current source (open the electrical circuit, turn off the breaker). In case of respiratory and cardiac disorders, in accordance with the ABC rule, the victim is sucked out the secret of the tracheobronchial tree, ensures the patency of the airways (Airway open), performs artificial respiration using the mouth-to-mouth or mouth-to-nose method

(Breath support) and support blood circulation through chest compressions (Circulation support). After the restoration of effective blood circulation, the affected person is administered intravenously according to indications 0.5

(0.3) ml of 0.1% adrenaline solution, 0.5-1 ml of 0.1% atropine solution, 2-4

ml of 2% lidocaine solution, 5-8 ml of 25% magnesium sulfate solution in 50 -

100 ml glucose solution, and 200 ml 2% sodium bicarbonate solution

(or trisamine). Urgent resuscitation continues until complete recovery of cardiac and respiratory activity.

According to the methods of protection against electric shock, all devices are divided into 4 classes. Devices of 01 and I classes have protective earth terminals with an external contour of the building. In devices \\ Class III devices are equipped with protective insulation of the casing, and Class III devices are powered by an isolated low voltage current source. For their safe operation, it is necessary to strictly observe the requirements for power supply and grounding of the devices. When working with lasers, it is necessary to comply with the safety requirements set forth in GOST R 507023-94 "Laser safety. General requirements" and Sanitary norms and rules for the design and operation of lasers No. 5804-91. Lasers are installed in cabins, curtained with curtains of light-absorbing material. It is forbidden to look towards the direct and specularly reflected beam. In the case of using laser radiation in the visible range, as well as medium-wave ultraviolet radiation, dark-colored goggles should be worn on the eyes of medical personnel and patients.

Currently, the following methods have been developed and are widely used in clinical practice:

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).

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 the energy of 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. The primary reflex reactions of the nerve endings of the skin are closely intertwined with the humoral changes resulting from the physicochemical processes of nervous excitation. 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, the 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 organism. 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 body. 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 physicochemical and vascular reactions are played out in the skin - an important organ of 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. myorelaxation 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.

Rehabilitation is a wide and complex system of medical and social measures elevated to the rank of state tasks and aimed at restoring health, impaired functions and the patient's ability to work.

The main principles of rehabilitation are: early start, complexity (drug therapy, physiotherapy, exercise therapy and psychotherapy) and continuity between stages (hospital, sanatorium - rehabilitation center, clinic).

To carry out rehabilitation activities in the Polyclinic No. 1 of the UDP, a department of "Medical Rehabilitation and Physiotherapy" was created. The main task of the department is: the development of individual programs and the implementation of a complex of therapeutic and rehabilitation measures using a modern arsenal of complementary medicine. The department includes: departments of physiotherapy, exercise therapy, manual therapy and reflexology. The centerpiece of the rehabilitation department is the department of physiotherapy.

Until recently, the influence of physical factors was considered as the action of nonspecific stimuli that improve the adaptive and compensatory capabilities of the organism. Currently, physiotherapy is considered as a field of medicine that affects the body of natural and artificially created (preformed) physical factors used to treat patients, prevent diseases and medical rehabilitation, affecting the pathogenesis of the disease.

Physiotherapy occupies one of the first places in terms of use in the rehabilitation of patients with various nosological forms. This is confirmed by the analysis of the use of non-pharmacological methods in Polyclinic No. 1: physiotherapy 58%, exercise therapy - 10% and reflexology - 31%. Despite this, in recent years, in the scientific literature and in the main documents (standards for the provision of medical care), only physical rehabilitation has been discussed.

Physiotherapy is one of the fastest growing areas of clinical medicine. This is explained by the fact that, firstly, physiotherapy methods are devoid of side effects; secondly, they are non-invasive, painless, accessible, well tolerated by patients, including children and the elderly; proved to be highly effective in a number of diseases. Thirdly, the rapid development of physiotherapy is due to the close connection with advances in the field of technical sciences, physics and chemistry.

Recently, biofeedback devices (BFB) have been widely used in physiotherapy. Biosynchronized, often with the frequency of pulse and respiration, the effects are less stressful and more physiological than conventional methods, while they have a more effective effect without causing exacerbations. There is no longer any doubt about the effectiveness of using technologies and methods based on the phenomenon of biological resonance. It is known that even low-intensity effects, provided that their frequency coincides with the endogenous rhythms of the body, are accompanied by pronounced physiological and therapeutic effects. In practice, this principle is used quite successfully in laser therapy with a certain long wavelength, various variants of EHF therapy (millimeter-wave therapy with a fixed wavelength, microwave resonance therapy, information therapy, as well as exposure to background resonant radiation). Currently, this direction is being successfully developed in Polyclinic No. 1 and is being used in medical centers of the Federation Council and the State Duma.

EHF-therapy is widely used in the Department of Physiourology of Polyclinic No. 1 of the UDP RF. EHF-therapy is a highly effective method of symptomatic treatment of patients with bacterial and abacterial prostatitis with chronic pelvic pain syndrome. So, before the start of the course of treatment, more than 60% of patients report discomfort or pain during urination, and about 40% - a pronounced pain syndrome. In the course of treatment, already after the 1st procedure, the number of patients with severe pain syndrome decreases by 2.5 times. After the fifth procedure, the disappearance of pain is completely noted by 25% of patients and 75% of patients note a significant decrease in pain. After 10 procedures, in 75% of patients the pain was completely gone and in 25% it was of a moderate nature. At the same time, the dysuria index decreases from 3.19 to 1.65, and the quality of life of patients significantly improves in the course of physiotherapeutic treatment.

Another promising area of ​​physiotherapy is the combined use of physical factors. With the combined use of physical factors, their physiological and therapeutic effects are potentiated. The positive aspects of this direction is that addiction develops less often and more slowly, combined physiotherapy procedures can be carried out at lower dosages of each of the combined factors, which reduces their burden on the body. This makes it possible to reduce the treatment process in time, making it less tedious for patients, which is very important in modern conditions. One of the new high-tech physical factors is extremely high frequency electromagnetic radiation combined with optical and infrared electromagnetic radiation. In the technologies of these types of influence, a non-drug method of highly effective correction of pathological changes is implemented, which contributes to the activation of protective and adaptive mechanisms that develop over the course of the disease and are aimed at restoring the disturbed self-regulation of the body.

Such combined factors as magneto-laser therapy, vacuum laser therapy, phono-laser therapy, photomagnetotherapy, electrophonotherapy, thin-layer mud applications with magnetotherapy, etc. are well known and successfully used. Recently, new combined effects have appeared, for example, underwater vacuum massage, etc. Polyclinic No. 1 the method of combined therapy is successfully used - underwater vacuum massage from the Aqua Tornado hardware complex. A unique method of treatment, rehabilitation and aesthetic correction. As a result of the use of underwater vacuum massage, good clinical effects were obtained in patients with gonarthrosis and dorsopathy of the spine. Analgesic and antispasmodic effects were noted in the absence of side effects. Significantly increases the mobility of the joints, increase the range of motion and improve the quality of life of patients. One of the directions in the mechanism of therapeutic action is the elimination of disturbances in the microcirculation system under the action of vacuum hydromassage. According to the study of the peripheral circulatory system by laser Doppler flowmetry (LDF), which was carried out using a laser capillary blood flow analyzer LAKK-01, normalization of arteriole tone, improvement of blood flow in the capillaries and a decrease in congestion in the venular link of the microvasculature are noted. The results of the treatment allow us to state that the method of underwater vacuum massage is an effective means of complex therapy and rehabilitation of patients with degenerative diseases of the joints and spine.

The inclusion of physical factors in the complex treatment of various diseases makes it possible to optimize the course of the therapeutic process by influencing the mechanisms of sanogenesis through the normalization of the immune response, the acceleration of cell proliferation processes, and the strengthening of the body's adaptive capabilities. Moreover, it is possible to use physical factors at all stages of treatment: a hospital, a rehabilitation center, a sanatorium, a clinic and at home.

The results of treatment in a hospital, as well as its cost-effectiveness, can be judged on the basis of two parameters: the length of the patient's stay in the hospital in days (bed-day) and the cost of one day of stay and treatment in the hospital. According to the literature, the length of stay of patients in the hospital with thrombophlebitis of superficial and deep veins, respectively, with drug therapy is 21±2 days and 91±7 days; at the same time, when using physiotherapy (magnetotherapy, pneumocompression), they are halved: 10±2 days and 31±6 days. When studying the results of treatment of patients who underwent preoperative (1-3 days before surgery) preparation, including exposure to low-intensity laser radiation (LILI), a significant decrease in the number of thromboembolic and wound complications was shown, which made it possible to reduce the duration of inpatient treatment and post-hospital rehabilitation. Early appointment (on the 2nd-3rd day of the disease) of millimeter-wave EMR in patients with acute destructive pancreatitis can reduce the average length of stay in the hospital from 36±4.2 days to 20.6±3.7 days, as well as mortality - in the main group 6.4% of patients with a general hospital rate of 20.1%.

The experience of using millimeter waves (MMW) in patients with acute cerebrovascular accident has shown that their use in the acute stage contributes to the rapid regression of neurological symptoms, is well tolerated by patients, has no side effects, and does not cause complications. With the inclusion of MMV in the treatment complex of patients with ischemic stroke, the restoration of speech functions is observed twice as often as with standard treatment, and contributes to a more frequent and more complete recovery of working capacity.

The role of the doctor in assessing the patient's condition, choosing treatment regimens is exceptionally large and determines the success of treatment, especially for severe forms of the disease. To increase the effectiveness of treatment, a patient rehabilitation program is created taking into account the characteristics of the disease, the severity of the patient's condition, and his characterological features. For this, the method of electroacupuncture diagnostics is being introduced, which allows using the indicators of the electrical conductivity of the skin near BAP not only for diagnosis, but also for obtaining its psychological type. At the same time, electroacupuncture diagnostics is supplemented with data on the parameters of adaptive reactions of the human body according to leukogram data (according to L.Kh. Garkavi et al.). its effectiveness.

It is known that the body's response to any impact consists of general and local reactions. General reactions are the reactions of the whole organism as a whole. And the human body is a super-complex, hierarchical, oscillatory, self-regulating system. Such systems, according to the theory of behavior of complex systems, are unusually sensitive to smallest in impact. Subsystems of the body are less complex and their sensitivity is lower.

For any extreme impact - trauma or traumatic situation - the body responds with the development of acute stress. Acute stress is characterized by: leukocytosis, aneosinophilia, lymphopenia. Chronic stress lasts a long time. It could be an infectious disease, or chronic inflammation, or tumor growth, or long-term exposure to toxic substances. Chronic stress is characterized by: depletion and a decrease in the level of glucocorticoids, while the number of eosinophils increases, blood clotting increases, the process of catabolism predominates in metabolism, only a low percentage of lymphocytes in the leukogram remains unchanged - less than 20% (Garkavi, Ukolova, 1990). Stress is bad for the body. Promotes the development of disease, aging and early death.

Research L.Kh. Garkavy et al found that adaptive responses (AR) develop in the human body in response to various physiological and pathological stimuli: training response (RT), activation response (RA), and stress response (RS). The training reaction, the adaptation reaction is a physiological response to stimuli of different origin and strength. They are accompanied by an increase in nonspecific resistance and adaptive potential of the human body. These processes do not entail a significant increase in energy costs. The stress reaction refers to pathological reactions, in which there is a decrease in the nonspecific resistance of the body and its adaptive potential. For their implementation, pathological reactions require significant energy costs.

Complex neuroendocrine changes that characterize each of the adaptive reactions are reflected in the morphological composition of white blood. This makes it possible to use simple indicators for each of the reactions, and, therefore, to carry out controlled non-specific therapy and manage the body's resistance.

The calm activation reaction (the content of lymphocytes is 28-33%) contributes to the successful treatment of cardiovascular diseases, oncological diseases, as well as to rehabilitation and prevention. In order to induce an activation reaction and maintain it steadfastly, it is necessary to gradually, non-linearly, wave-like reduce the value of the acting factor ...

The reaction of increased activation (the content of lymphocytes is 34-40%) is accompanied by the secretion of glucocorticoids at the level of the upper limit of the norm, therefore, the anti-inflammatory effect is pronounced, the state of immunity is high activity, the psycho-emotional state is excellent mood, optimism is expressed, working capacity is high, appetite and sleep are good. It is advisable to induce and maintain an increased activation reaction for active prevention, combating aging and impotence, chronic inflammation in various diseases. This reaction is a reaction of recovery!

Lymphocytosis exceeding 40% indicates overactivation of the body's adaptive capabilities. The reactivation reaction is not yet a disease, but there are disturbances in well-being and sleep. In patients with malignant tumors, accelerated tumor growth is observed. The presence of such deviations is dangerous because, against their background, a breakdown in the adaptive potential and the development of a stress response can easily occur. At the same time, with properly selected therapy, this reaction can be translated into a more favorable reaction for the body.

This therapy is called activation therapy. This is a purposeful and controlled challenge and maintenance of the necessary adaptive reaction in the body.

Carrying out such therapy is possible only with the use of low-intensity physical factors, such as EHF-therapy, general magnetotherapy, thin-layer mud applications, etc., as well as Eleutherococcus tincture or plantain juice. The choice of the first dose depends on the nosological form and the state of the body at the time of treatment. The smallest dose should be chosen for angina pectoris, hypertension, etc. For acute and chronic inflammations - the first dose is the middle or upper therapeutic dose.

Some physiotherapy methods allow you to "deliver" medicinal substances directly to the problem area (most often electrophoresis is used for this). Others improve, correct blood characteristics (). Laser therapy and other techniques activate the protective, restorative functions of the body at the cellular level. Perhaps a local effect on the problem area or biologically active points using. Procedures using special equipment are complemented by manual therapy, massage.

• neurological disorders;
• pathological mental states;
• sports, industrial, domestic injuries;
• violations of the work of internal organs.

Methods of influence, the duration of the physiotherapy course and the composition of the accompanying treatment plan should be determined by the attending physician.

Rehabilitation using physiotherapy techniques

Rehabilitation is the final phase of treatment, in which the disturbed functions of the body are restored to the maximum extent. Physiotherapy in the composition provides:

• reduction of recovery time after an illness or injury;
• strengthening the action of medicines prescribed by a doctor, increased efficiency;
• longer remission;
• rapid relief of negative symptoms;
• general improvement in health;
• the ability to controllably and safely increase the load or therapeutic effect without the risk of complications.

Physiotherapeutic procedures reduce pain, relieve swelling and inflammation, improve emotional state, normalize sleep and wakefulness, appetite. They are carried out in courses, gradually increasing the intensity of action with each subsequent procedure. It is possible to use several techniques simultaneously to speed up and improve the results of rehabilitation.

Physiotherapy in prevention

The restorative, healing effect of physiotherapeutic procedures improves the preventive effect. As part of prevention, the Panacea Medical Center recommends the use of physiotherapy in the following cases:

For elderly patients. To improve general health indicators, maintain remission of chronic diseases, strengthen immunity and central nervous system. Physiotherapy for the elderly provides prevention of OPD diseases, helps to maintain physical activity. If the body is weakened, it increases resistance to infections and viruses. Periodic implementation of a course of physiotherapeutic procedures prevents the development of "age-related" diseases, improves mental and psychological state.

At risk of recurrence of a chronic disease. With the use of prolonged remission of a number of chronic diseases. These can be systemic diseases, dysfunctions of internal organs, neuralgic, psychiatric diseases, etc. In the prevention of relapse, such methods are especially effective for the elderly: they help maintain normal health indicators and good health. Periodic repetition of a course of physiotherapy procedures reduces the risk of relapse for patients with alcohol dependence, helping to normalize the work of the central nervous system and reduce the manifestations of alcoholism-related diseases of the internal organs.