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The main form of application of medical physical culture is the procedure of therapeutic exercises (LH), it is conducted in individual and group order. Gradual increase in physical activity is achieved by changing the starting position (lying, sitting, standing, side lying, on all fours, etc.), selection of exercises, complications of exercise, increase the amplitude of movements, degree of force tension, tempo exercises and breathing exercises.
Exercise should consistently cover different muscle groups. The exercise is performed rhythmically, in a relaxed, medium tempo. Each exercise is repeated on 5-8-12. The number of exercises in the 5-12 and more complex. Each procedure LH consists of three sections: introductory, main and final.
In this introductory section uses a simple exercise, mainly for small and medium-sized muscle groups, walking, breathing exercises. The introductory part is 15-20% of the time. Exercises help of getting over work, preparing for the main part of the study.
The main section consists of General developmental and special exercises. Can be used walking, games, application exercises, exercises with objects, projectiles, etc. over time the primary partition is 65-70% of the time.
The final section characterized by a decrease in General physiological load through the use of breathing exercises, walking, relaxation exercises, etc. the Final section takes 10-20% of the time. Breathing exercises in LH is used for training of correct breathing, reduced physical activity, as well as special effects on the respiratory system. It is especially important to use breathing exercises in the early postoperative period, diseases of the cardiorespiratory system, etc. All breathing exercises are performed freely, without any effort. In lung diseases, exhalation should to be lengthened.
In proceedings of LH great practical importance is the dosage of physical activity. It is necessary that it was adequate to the patient's condition, caused a moderate the excitability of the functional systems of the body, as a rule, was not accompanied by increased pain, would not cause pronounced fatigue and deterioration of General health of the patient.
Using all the above methods, it is possible to optimally adjust the physical load.
Schematically, the load is divided into three categories:
I - load, without limitation, resolution running, jumping and other complex and General developmental (obstavlennyh) exercises;
II - the load limitation, with the exception of running, jumping, exercises with a strong force and difficult coordination in relation to exercises at a ratio of breathing exercises 1:3 and 1:4;
III - weak load, using basic gymnastic exercises, mainly in the initial position (I. p.) lying, sitting, at a ratio of breathing exercises 1:1 or 1:2.
Distinguish three methods of procedures of medical gymnastics: individual, group and consultative (or self).
Individual method is used in surgical patients in the early postoperative period, severe patients with limited motor abilities (paralysis, spinal fracture, in traction, etc.).
The group method is used in the peer group of disease patients. When selecting groups stem from clinical entities, and in conducting lessons based on the functional status of patients.
Advisory (self) method is recommended when the patient is discharged from hospital, and at home it will carry out sessions of physical therapy (usually in the form of medical gymnastics). Usually the patient is taught the complex LH in the hospital, and at discharge he was given a set of exercises of medical gymnastics for the hands.
Morning hygienic gymnastics has a great health value. It is conducted after a night's sleep, at home or in sanatorium-resort treatment in combination with air bath and gidroprotsedury.
Dosed walking (walking) are a natural form of movement. Walking has a moderate effect on cardiorespiratory system, recovering useful in diseases of the cardiovascular and respiratory system, neuroses, etc. Walks are used in hospitals, but particularly common in Spa treatment. The load during walking is controlled by pace, terrain, value range, length of stride. A favorable factor is the fact that the walk is held outdoors (Park, square, garden, resort area, etc.)
Dosed climbing (path) is a type of walk. In contrast to the dosed walking on flat terrain, routes of health paths pass using rough terrain in the conditions of sanatorium-resort zone. The value of physical activity depends on the route length (usually 500, 1500, 3000 m), terrain, pace, number of stops. The path is shown in diseases of the cardiorespiratory system, neurosis, endocrine diseases, obesity, etc.
Near tourism usually consists of Hiking within 1-3 days and is considered as a method of training the whole body. Near tourism applied in sanatorium-resort treatment, and also on tourist centers. Walking can be on boats, bikes, horses, etc. Change a variety of terrain, sun and air baths - all this has a positive effect on the psyche of patients.
Movement modes (mode of motion). In the organization of the treatment process in hospitals motor mode is one of the important factors.
Passive mode (physical inactivity) adversely affects the recovery of patients.
Active mode (when the relevant medical evidence) contributes to the development of positive emotions, strengthening of metabolic processes, tissue regeneration, improve cardiovascular system, etc. When assigned to active mode should be based on the characteristics and course of the disease, age, profession, and household conditions, state of fitness, etc.
The rest (sparing) is designed for individuals exhausted, weak, weary, with symptoms of asthenia, after undergoing complex surgical interventions, cardiovascular disease, etc. Designated patient LH must meet the clinical course of the disease, the functional state of the patient and his adaptation to physical loads.
Mode I, bed (rest mode) is divided into two phases: A - mode strict bed, observing the rest mode; B - bed mode lightweight (advanced) with a gradual extension of motor activity of the patient (turning, sitting, etc.).
Content mode: stay in bed more often in the supine or half-sitting. With an overall satisfactory condition allowed active slow and turning in bed, for short periods (2-3 times a day for 5-30 min) stay in bed in the sitting position, active eating and active toilet. Morning gymnastics and LH in bed depending on medical indications. Compulsory ventilation and wet cleaning of the chamber several times a day.
Mode II, polupostelny (ward). The content of the regime: the transition into the sitting position on the bed with drooping feet or in a chair (2-4 times a day for 10-30 minutes). A few days later - the transition to a standing position and walking around the ward followed by rest in the sitting position or lying down. In this period the patient independently change position in bed, chair, toilet and eating. The walk alternates with leisure in a chair (in the chair). Morning gymnastics, hygienic gymnastics - according to individual indications.
Mode III, free (coaching). Content mode: free walking on the office. Walking the stairs from the 1st to 3rd floors with the rest. Walk on air for 15-30 min with rest. Morning exercises and physical therapy are used for medical reasons.
In the conditions of sanatorium-resort treatment of patients with diseases of cardiovascular system, respiratory system, and digestion using three kinds of modes - sparing, sparing-training and coaching. Driving mode should be set individually depending on the patient's personality, peculiarities of his character and disease. Mode movements should include specific activities. Individual mode of motion and rest is determined by the attending physician in each individual case depending on medical indications, profile and geographical location of the resort, as well as the season and to provide consistency in the application of the various elements of physical therapy throughout the day, combined with all the other curative factors of this resort. Properly designed and precisely executed movements, the regime itself is a powerful factor in the treatment of patients in the resorts and sanatoriums.
The world health organization (who) in rehabilitation patients distinguishes two periods: the hospital, and follow-up.
One characteristic of exercise therapy is a process dosed workout. Training in physical therapy permeates the whole period of application of physical exercises for therapeutic purposes, while other treatments are often powerless to ensure the functional recovery of the affected systems. In medical physical culture distinguish the General and special training.
General training aims at healing, strengthening and overall development of the patient's body, there are used various kinds of General developmental and educational exercise.
The special training aims at the development of the functions disturbed due to illness or injury. It use the kinds of physical exercises that have a direct impact on an area of injury or functional disorder in one or another of the affected system (breathing exercises in pulmonary diseases, exercises for injuries and diseases of the joints, etc.).
Exercise at equilibrium is used to Refine coordination, improve the disturbed functions of the vestibular apparatus, etc.
Reflex exercises are exercises that train remote from a muscle injury, for example, the use of exercises for the shoulder girdle will have a reflex effect on the muscles of the lower limb, or motion in one lower limb causes vascular changes other extremity.
Breathing exercises occupy an important place in the conduct of LH. All breathing exercises are tentatively subdivided into dynamic and static. Dynamic breathing exercise is a combination of movement and breathing; static - without movement; with the active respiratory exercises, physical therapy Methodist compresses the rib cage on exhalation of the patient (so-called activation of respiration). Breathing exercises are of breath-hold and active (long) expiration.
Treatment status is a method of fixing by adhesive plaster (paresis of the facial nerve) of the affected muscles, as well as giving them the physiological position with an elastic bandage (clubfoot), splint, roller (for paralysis) under the mouse, a box (for paralysis) foot (feet), etc. Treatment status are used in the early stages of the disease, it aims at the elimination of the pathological positions in the joints or muscles (e.g., facial muscles when facial nerve paresis), prevent contractures and pathological synkinesia and synergies. Correction bandage, splint, etc. should be short, from 15-30 min to 1.5-3 hours, as long correction can lead to increased spasm of the muscles, especially in patients with paralysis (stroke), injuries of the musculoskeletal system and other diseases.
Simulators. A form of physical therapy sessions patients are at the gym and block devices (see Fig. Block trainers). They are designed to develop strength, endurance of muscles, develop joints, that is, to increase mobility in the joint (joints).
Used exercise in the gym affect certain (separate) groups of muscles and joints. Furthermore, the performance of these exercises requires a certain initial position. Classes at the gym (and lighter duty vehicles) contribute to the development of major movements in the joints and strengthen muscles. Properly organized training on simulators should not cause pain. Block devices and various adaptations for the exercise therapy is particularly important in the restoration of function of the hand, fingers, large joints, etc. (see Fig. Block trainers).
In recent years simulators are widely used in the rehabilitation of athletes with the consequences of injuries and diseases of the musculoskeletal system, and after operations. But classes at the gym should start not earlier than after 2-3 weeks of treatment and in combination with cryomassage.
In an early start of training (for example, after meniscectomy) may decline (slow) regeneration of cartilage, increase in synovitis (effusion of joint), limitation of movement, cause some pain, especially if the burden falls on the lower limb. Excluded such exercises in squats, jumping, etc. for 4-6 months. Initially, therapeutic exercises, massage, running (combined with walking) in water.
In obesity, osteochondrosis classes at the gym, using the sauna (sauna), diet, walking and running produce a significant positive result.
Exercise at the gym, sparing the spine (I. p. lying, half-sitting, etc.) in combination with segmental-reflex massage, cryomassage shown for scoliosis I and II, art (Calino), it is useful and swimming breaststroke way.
Caution should be used exercise in the gym (block devices) to patients with diseases of the joints (arthritis, polyarthritis, etc.), they are especially contraindicated in coxarthrosis. In any case the lessons should be with small loads, small voltage and in combination with cryomassage joint (joints), frequent recurrence (2-3 times a day), but short (10-15 min).
Pain syndrome, reflex contractures, increased blood pressure, myocardial infarction, gastric ulcer and duodenal ulcer in the acute stage, thrombophlebitis, aortic aneurysm, myocarditis, valvular heart disease, acute infectious diseases, angina at rest, pregnancy, myopia (more than 3 units), diabetes mellitus, obliterating endothermic are contraindications to the exercises!
In diseases of the cardiovascular and pulmonary systems as well as unwanted exercise at the gym, thus, shows a more cyclical activities (running, skiing, Biking, etc.).
When assigning patient physical therapy in the clinic (or WFM, clinic, at home) should take into account its motor activity (fitness) in everyday life, his profession, age, gender. In the table the Expenditure during some household and training loads is presented in household energy demands and training loads.
The expenditure during some household and training loads
|Activity||Power consumption for 1 kg|
carpenter and metalworker
an agricultural worker
sitting in the lab (practice session)
standing in the lab (practice session)
Donning and removing shoes and clothes
lying down (without sleeping)
110 steps in 1 min
Running at a speed of
Cycling at a speed of 10-12 km/h
Swimming at a speed of 50 m/min
In a state of relative physical rest (sitting and standing) the average consumption of a person is about 1-1. 25 kcal/min. This value varies depending on the growth, body weight, gender and environment (temperature).
It is known that to maintain health, maintaining high physical performance and normal course of oxidative-metabolism people need to consume on locomotor activity approximately 1200-2000 kcal per day above basal metabolism, which is usually 1600-1800 kcal.
But the energy value of the diet of most people exceeds energy expenditure, leading to metabolic disorders and obesity, diabetes, deterioration of activity of the cardiorespiratory system, gastrointestinal tract and other organs.
The degree of intensity of physical activity, their volume must correspond to the mode of physical activity prescribed by your doctor: sparing mode sparing-training and coaching.
When testing patients before discharge from hospital to determine the tolerance to physical exercise. At independent performance of physical exercises (walking, running, breathing and General exercises, swimming etc.) also need to know the reaction of the body.
When calculating the energy expenditure during therapeutic exercise should take into account the achievable ratio under load heart rate with energy consumption (see tab. The estimated expenditure with metered loads and Calculation of energy expenditure via heart rate).
The estimated expenditure with metered loads
|Form of physical therapy||Energy expenditures, with a body weight of 70 kg, kcal/h|
Morning hygienic gymnastics, 15 min
Physiotherapy, 30 min (coaching mode)
|up to 150|
Recreational gymnastics, 60 min (coaching mode)
|up to 300|
Therapeutic gymnastics in the pool, 25-30 min
Health path (walking with the angle of elevation of 15В° and a speed of 2 km/h), 60 min
Calculation of energy expenditure (kcal/min) heart rate (Buskirik A., 1960)
When sanatorium treatment physical activity for patients with cardiovascular diseases is: when sparing mode is 4-5 h, with gentle-coaching - 5-7 h, when the coaching mode, 6-8 h
Some kind of physical activity the patient is monitored for heart rate during preliminary testing on a Bicycle Ergometer (or treadmill, step test), where is determined by its tolerance to physical load. The test allows to judge about the functional state of the cardiorespiratory system, which largely depends on the patient tolerance of physical activity.
Achieved when the threshold exercise heart rate, electrocardiographic findings, blood pressure provide baseline data for dosing physical exercise (gymnastics, walking, running, games and other physical activities).
Because the threshold pulse is fixed at the appearance of adverse (pathological) changes in the ECG, when the physical stress in everyday and professional activity (work), as well as carrying out coaching physical exercise not to allow such changes of the heart.
Must comply with the principle of gradual increase of physical exertion with the purpose of adapting it to the cardiorespiratory system.
Monitoring the reactions of the cardiorespiratory system of patients on physical activity allows you to select appropriate physical activity and assess their effectiveness in complex rehabilitation, often of a cyclical nature (dosed walking, walking skiing, running, swimming, etc.).
In cardiovascular diseases numerical control (especially telemetry) allows to avoid overload, and at the same time to maintain the desired coaching effect of physical activity.
For the expansion of motor mode to patients with diseases of cardiovascular system (during the transition from bed rest to ward, and then into a coaching mode) use the tilt test and the Romberg test to assess the response of the cardiovascular system to physical load.
In patients with injuries and diseases of the musculoskeletal system, as well as in surgical patients in the postoperative period the efficacy of therapy is estimated by the control of the state of the neuromuscular system (muscle tone, dynamometry, pneumatonometry, etc.).
Academician of the Russian Academy of Natural Sciences,
IANPO and the New York Academy of Sciences,
Doctor of Medical Sciences, Professor,
A.V. Dubrovskaya, pediatrician
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