Basics of physical rehabilitation. Types of training, principles of drawing up physical rehabilitati.pptx

1. Basics of physical rehabilitation.
Types of training, principles of
drawing up physical rehabilitation
programs, methods of efficiency
assessment.
Presented by
Puthenpurackal George Jobin

2. MEDICAL
REHABILITATION
Itis the foundation of the rehabilitation process. It
is aimed at restoring health, eliminating the
pathological process, preventing complications,
restoring or partially compensating for impaired
functions, combating disability, preparing the
recovering and the disabled for domestic and
workloads. The use of further types of
rehabilitation, their duration and scope depends
on its effectiveness

3. The tasks of medical rehabilitation
are
1. restoration of the patient's domestic
capabilities, ie the ability to move, self-
care and perform simple homework
2. restoration of working capacity, ie
professional skills lost by a disabled
person through the use and development
of functional capabilities of the
musculoskeletal system
3. prevention of the development of
pathological processes that cause
temporary or permanent disability, ie the
implementation of secondary prevention
measures.
There are three or four stages in medical
rehabilitation.
● specialized hospital,
● specialized rehabilitation center or
sanatorium,
● rehabilitation department of the
polyclinic.
The process of rehabilitation can be
divided as follows:
1st stage - rehabilitation therapy,
2nd stage - readaptation,
3rd - rehabilitation
Physical rehabilitation is an integral part of
medical rehabilitation. Simultaneously with
physical rehabilitation, the patient is
psychologically prepared to overcome the
difficulties associated with the disease and its
possible consequences.

4. It is the use of means and methods of physical
culture (exercise), massage and natural factors
for preventive and curative purposes in the
complex process of restoring the health,
physical condition and efficiency of patients and
the disabled. It is an integral part of medical,
socio-professional rehabilitation and is used in
all its periods and stages.
PHYSICAL
REHABILITATION

5. The means of PR are: therapeutic
physical culture, therapeutic
massage, mechanotherapy,
occupational therapy,
hydrokinesiotherapy. The purpose
of physical rehabilitation, the
sequence of application of its
forms and methods is determined
by the nature of the disease, the
general condition of the patient, the
period and stage of rehabilitation,
motor mode.

6. Exercise therapy is a
method of treatment that
uses the means and
principles of physical
culture to treat diseases
and injuries, prevent their
exacerbations and
complications, restore the
health and efficiency of
patients and the disabled.

7. ➔ Natural-biological method, which is based on the use of the main biological
function of the human body - the function of movement! (is the main stimulator of
growth, development and formation of the organism). The function of movement,
stimulating the active activity of all body systems, supports and develops them,
helping to increase the overall efficiency of the patient.
➔ Method of active functional therapy. Regular dosed exercise stimulates, trains
and adapts individual systems and the whole body of the patient to increasing
physical activity, ultimately leading to functional adaptation of the patient.
➔ The method of non-specific therapy, and the physical exercises used are non-
specific stimuli. Any exercise always involves all parts of the nervous system.
FEATURES OF THE EXERCISE METHOD

8. ➔ Method of pathogenetic therapy. Systematic use of exercise can affect the reactivity of
the body, change both the overall reaction of the patient and its local manifestation.
➔ Method of training therapy. One of the characteristic features of exercise therapy is the
process of dosed training of patients with exercise. Exercise training goes through the
entire course of therapeutic use of exercise, contributing to the therapeutic effect. There
are general and special training in exercise therapy. General training is aimed at
recovery, strengthening and general development of the patient's body, it uses various
types of general strengthening and developing exercises. The purpose of special training
is the development of functions impaired due to illness or injury. It uses all types of
physical exercises that have a direct impact on the area of the traumatic focus or
functional disorders of any affected system (breathing exercises for pleural adhesions,
exercises for joints in polyarthritis, etc.)

9. Exercise therapy is part of a comprehensive method of
treatment (there are therapeutic, surgical and orthopedic
methods of treatment, etc.) used in modern medicine.
The main feature that distinguishes exercise therapy
from all other methods of treatment is the conscious and
active participation of the patient in the treatment of
exercise. The patient, who knows what to use physical
exercises (purpose), consciously performs the prescribed
movements, sometimes by force of will forces himself to
overcome just laziness or unpleasant feelings that may
occur during exercise, especially after operations,
injuries, burns. Exercise therapy is indicated for almost
all diseases and at any age.

10. Contraindications to the appointment of
exercise therapy:
lack of contact with the patient due to his serious condition or mental disorders; acute
period of the disease and its progressive course; increasing circulatory failure; sinus
tachycardia (more than 100 beats per 1 min) and bradycardia (less than 50 beats per 1
min); frequent attacks of paroxysmal tachycardia or atrial fibrillation; extrasystole with
a frequency of extrasystoles over 1:10; negative ECG dynamics, indicating deterioration
of blood circulation in the coronary vessels; atrioventricular block II-III degree; arterial
hypertension (more than 220/120 mm Hg) on the background of a satisfactory
condition of the patient: arterial hypotension (less than 12.0 / 6.7 kPa, or 90/50 mm
Hg); frequent hyper- or hypotensive crises; threat of bleeding and thromboembolism;
anemia with the number of erythrocytes up to 2.6-3-1012 / l, increase in ESR over 20-25
mm / h, normal leukocytosis.

11. There are four main
mechanisms of therapeutic
effect of exercise on the
patient's body:
➔ Tonic
➔ Trophic effect
➔ The formation of
compensation
➔ Normalization of
functions
Story for illustration purposes only

12. TONIC EFFECT
There is an increase in blood and lymph
circulation, coronary circulation; myocardial
contractility; increased lung ventilation;
activation of motor-evacuatory and acid-forming
function of the gastrointestinal tract; increasing
the excitability and lability of nerve cells, which
increases the strength and balance of nervous
processes, stimulation of hematopoiesis;
fibrinolytic activity of blood; stimulation of the
adrenal cortex; increasing the level of insulin
activity, enhancing metabolism; increase the
blood supply to working muscles.
The tonic effect of exercise is greater
the more muscles are involved in
motor activity and the higher the
muscular effort. People who engage in
exercise, have positive emotions,
create a good mood and confidence in
a speedy recovery

13. TROPHIC ACTION
Trophic action. There is an increase in
the processes of regeneration and
repair; acceleration of resorption of
inflammatory exudate, transudate;
strengthening of redox processes
without obligatory change of blood
supply due to adaptive-trophic
influence of the nervous system;
prevention of atrophic and
degenerative processes; restructuring
of the primary callus; increase calcium
deposition in the bones.

14. FORMATION OF
COMPENSATION
Formation of compensations. It is noted inclusion of extracardiac
circulatory factors (muscle pump, suction action of the thoracic and
abdominal cavities, body position; increased alveolar ventilation due
to healthy areas change in the type of breathing after surgery on the
organs of the thoracic or abdominal cavities; walking on crutches,
prostheses during immobilization and after amputation depending on
the nature of the disease, compensation can be temporary or
permanent, the former occurring during the illness and disappearing
after recovery, and the latter in the case of irreversible loss or
limitation of function

15. NORMALISATION OF FUNCTION
Restoration of the anatomical integrity of the organ or tissues, the
absence after treatment of signs of the disease is not evidence of
functional recovery of the patient. Normalization of functions occurs
under the influence of constantly increasing physical activity, as a
result of which regulatory processes in the body are gradually
improved, temporary compensations are eliminated, motor-visceral
connections and motor qualities of a person are restored. At the same
time normalization of: contractile function of heart, pressor and
depressor systems is noted; pulmonary volumes, bronchial patency,
ventilation; drainage function of the biliary system; strength, muscle
tone, range of motion in the joints; physical fitness; psycho-emotional
state.

16. Classification of physical exercises
Quotes for illustration purposes only
respiratory,
corrective, to relax
muscles, to stretch
muscles, to balance,
rhythmic, using
gymnastic objects
and devices.
By the nature of
muscle contraction:
➔ dynamic
(isotonic
contraction)
➔ static
(isometric
contraction).
By degree of
activity:
➔ Active
➔ passive
➔ active-
passive
By anatomical
feature:
➔ for small (brush,
foot, face),
➔ middle (neck,
forearms, shins,
thighs),
➔ large (limbs,
torso) muscle
groups
By the nature of
the exercises:

17. BREATHING EXERCISES
It is grouped as follows: "local" (to
increase the volume of ventilation
function of individual parts of the lungs),
with resistance to breathing (to strengthen
the respiratory muscles), those that
increase the mobility of the chest and
diaphragm, with the reproduction of
sounds (to facilitate exhalation) , drainage,
with dosed respiratory arrest and with
voluntary control of respiration. They can
be performed in dynamic and static
modes, using or excluding the movements
of the limbs and torso. Unlike calm normal
breathing, which should be optimal in
frequency and depth, breathing exercises
can have the task of hyper-and
hypoventilation of the lungs.

18. According to the general
kinematic characteristics of the
exercise are divided into cyclic
and acyclic. Locomotor cyclic
exercises: running and walking,
skating and skiing, swimming,
cycling. These exercises are
repeated repetition of
stereotypical cycles of
movements. Acyclic Exercises
involve abrupt changes in motor
activity (games, jumps,
gymnastic exercises, etc.) with a
sharp change in its power

19. FORMS OF EXERCISE
THERAPY
➔ Therapeutic gymnastics
➔ Morning hygienic gymnastics
Individual tasks for
independent classes
➔ Occupational therapy
➔ Mechanotherapy
➔ Mass forms of physical culture:
walks, excursions, short-
distance tourism.
➔ Gymnastics in water

20. The main form of therapeutic exercise is therapeutic
gymnastics. It solves special treatment and treatment-
and-prophylactic tasks. It is based on the procedure of
therapeutic gymnastics. It consists of three parts.
Introductory, the task of which is the gradual preparation
of the patient's body for the load in the main part. It can
last 12-15% of the total time of the therapeutic gymnastics
procedure. The main part includes physical exercises and
starting positions, as well as perform treatment tasks,
have a general and special effect on the body. It takes 60-
80% of the time of the whole lesson. The final part of
therapeutic gymnastics involves reducing physical
activity and bringing the patient's body to its original
position. The duration of the final part is 12-15% of the
total class time.

21. Methods of physical therapy classes
Physical therapy classes of most forms are conducted
individually, in small groups / 2-4 patients / and in groups / 5
or more patients / methods. When characterizing physical
activity it is necessary to be guided by the following methods:
1. Choice of starting position: lying, sitting, standing and their
options.
2.Characteristics of muscle groups included in the work / by
anatomical feature or by their size.
3. Amplitude of movement / small average and full.
4. Pace / slow, medium, fast.
5. Force tension.

22. 6. The ratio of general developmental and
breathing exercises
7. Use of gymnastic tools when performing
physical exercises
8. Inclusion of rest breaks
9. Alternation of heavy and light exercises.
10. The number of repetitions of each
exercise / at least 5 times.
11. Emotional decoration of the procedure.
12. The time during which the procedure is
performed, training.

23. 3. The principle of gradualness is especially important when dosing physical
activity for all their indicators: volume, intensity, number of exercises,
number of repetitions, complexity of exercises both within one lesson and
throughout the rehabilitation process.
4. Systematic - the basis of treatment and rehabilitation training during the
rehabilitation process, which lasts for several months and sometimes years.
Only through the systematic use of various means of rehabilitation, it is
possible to provide sufficient, optimal for each patient, which will increase
the functional state of his body.
5. Cyclicality. Alternation of work and rest with observance of an optimum
interval (rest between two exercises or between two employment). If the next
session falls on the phase of supercompensation, the effects of training are
summed up and functionality is increased to a new, more advanced level.

24. Pedagogical principles of medical and
restorative training
Exercise has a positive effect in rehabilitation, when they are,
firstly, adequate to the capabilities of the patient or disabled, and
secondly, have a training effect and increase the adaptive
capacity of the patient. In the process of medical and restorative
training it is important to adhere to the following physiologically
sound pedagogical principles:
1. Individual approach to the patient. During the preparation of
rehabilitation programs it is necessary to take into account the
age, sex and profession of the patient, his motor experience, the
nature and extent of the pathological process and functionality.
2. Consciousness. Only conscious and active participation of the
patient in the rehabilitation process creates the necessary
psycho-emotional background and psychological mood of the
rehabilitated, which increases the effectiveness of rehabilitation
measures

25. 6. Systematic impact (or alternation), ie sequential alternation
of starting positions and exercises for different muscle groups.
7. Novelty and diversity in the selection and application of
exercise, ie 10-15% of exercise should be updated, and 85-90%
repeated to consolidate the success of treatment.
8. Moderation of exposure to physical rehabilitation means that
physical activity should be moderate, possibly longer, or
fragmented, which will achieve the adequacy of the patient's
condition

26. Period in exercise therapy called the time period, which characterizes the anatomical and
functional state of the damaged organ and the body as a whole.
I period (introductory) - gentle - characterized by severe anatomical and functional
disorders of the damaged organ, the corresponding system and the body in general, the
symptoms inherent in this disease or injury, forced decrease in motor activity, in particular
immobilization. Tasks of this period: improvement of the patient's neuropsychological
condition, prevention of complications, stimulation of trophic and compensatory processes,
training of self-care skills.
II period (main) - functional -characterized by improvement of the clinical condition of the
patient, restoration of anatomical integrity of an organ or tissues at the same time essential
disturbance of their function. Thus, in the case of a bone fracture with the formation of a
callus, the morphological defect is eliminated, immobilization is removed, but muscle
strength is reduced and movements in the joints are limited. The main tasks of the period:
restoration of functions of the damaged organ and systems of an organism, preparation for
increase in physical activities and change of a motor mode.

27. III period (final) - training -characterized by the completion of the recovery process,
recovery of functions, but the ability to withstand the strain of life is still insufficient.
Patients have residual effects of the disease: decreased strength, endurance, speed,
ability to tolerate physical activity in full.
The main tasks of the period: education of confidence in complete recovery and full
return to work, increase of functional ability and physical qualities of an organism, its
training to physical loadings of industrial and household character; restoration of
working capacity or improvement of functions of replacement and adaptation of the
patient to the living conditions changed by illness or injury.

28. General requirements for
the methodology of
exercise classes
The technique involves the use of exercises of low, moderate,
high and maximum intensity, depending on the motor mode,
the period of use of exercise therapy at the stages of
rehabilitation.
➔ Low-intensity exercises include movements of small
muscle groups, performed mainly at a slow pace, static
breathing exercises and muscle relaxation exercises.
Physiological changes in the performance of these
exercises are insignificant.
➔ In exercises of moderate intensity involve the work of
medium and large muscle groups of the limbs, torso,
use dynamic breathing exercises, walking at a slow and
medium pace, sedentary games. The physiological
parameters of the cardiovascular and respiratory
systems are restored to normal after 5-7 minutes.

29. ➔ High intensity exercises force to work a large number of
muscle groups and they are performed at a medium and
fast pace. These are, first of all, gymnastic exercises on
devices, with medical balls, fast walking, running, motor
and sports games, etc. After performing these exercises,
the duration of the recovery period in terms of heart rate,
blood pressure, pulmonary ventilation is more than 10
minutes.
➔ Exercises of maximum intensity characterized by the
simultaneous work of a large number of muscles, which is
performed at a rapid pace, which causes significant
changes in the cardiovascular and respiratory systems,
metabolism. These exercises are mainly used in the
rehabilitation of athletes.

30. Motor modes
The appointment and use of various
forms of exercise therapy and other
means of physical rehabilitation are
closely related to the motor regime,
which regulates the motor activity of
the patient during treatment in the
hospital and post-hospital
rehabilitation periods. It is prescribed
by a doctor and varies depending on
the course of the disease, the stage of
treatment, the body's response to the
factors included in the content of a
particular motor regime. At the
inpatient stage of treatment, these
regimens are divided into: bed, ward
and free

31. Extended bed rest involves periodic changes in the
patient's position in bed. He is well versed in body turns
in bed, which he began to teach in the previous mode,
sitting in bed with a pillow or on the back of a functional
bed. At the end of the regime, the patient sits in bed with
his legs down, which is a stage of preparation for getting
out of bed. Sitting in bed begins with one to three
minutes and gradually reaches 15-20 minutes or more.
Gradually, patients master the household skills of self-
care / eating, washing, shaving for menPositive response
to functional tests indicating improvement. condition of
the patient, allow to transfer it to the next - ward mode.
BED MODE
strict bed and extended bed. Strict bed rest is
intended to provide the patient with physical and
mental peace. The patient is always in a supine
position or abdomen, lying with the head raised. He
is not allowed to turn around on 1 5 his own and
perform movements in large joints. Meals, toilets
are carried out with the help of staff. In this mode,
the patient is taught to turn to the side. At the end
of the mode allow movements in small and partially
in medium joints. When adapting to this regime, the
improvement of the patient's condition is
transferred to the extended bed rest.

32. CHAMBER MODE/SEMI BED MODE
Chamber mode or semi-bed is characterized
by the fact that the patient is in bed half the
day, and half out of bed sitting in a chair,
walking around the room, eating at the table,
using the toilet, which is in the ward unit
Gradually decreases the time spent in bed
chamber, and at the end of the regime - exit to
the corridor. In this mode, patients adapt to
walking, the training process of the whole
organism and its individual systems begins.
Adaptation of patients to this mode allows
you to transfer them to. next-free, mode

33. Free mode:
encourages patients to significantly
expand the amount of household
activities and increase physical
activity during physical therapy. The
main at this stage of treatment is to
continue the process of training the
body to prepare some patients to
stay at home or spa, and the second
part to perform production tasks. In
this mode, patients are prescribed
almost all forms of physical therapy
depending on the disease.

34. At the outpatient or sanatorium-resort stages of treatment, patients are prescribed:
gentle, gentle-training and training regimes.
➔ Gentle mode involves training of all body systems, stimulation of metabolic
processes, further mastery of household skills, improving physical performance.
In the first days after discharge of patients from the hospital, their motor activity
decreases slightly, and then gradually increases due to an increase in the
number of exercises, their complications.
➔ Gently training the regime provides for full adaptation of patients to domestic
loads and industrial practice. Exercise in this mode increases significantly and
allows patients to begin to perform production tasks. Help this purpose of almost
all forms of therapeutic exercise.
➔ Training mode acts until the full adaptation of man to domestic and industrial
loads. At their choice, patients begin to engage in one of the sports, but can not
participate in competitions. The time spent in each of the modes of the clinic and
sanatorium is determined individually, depending on the age of the patient,
illness, differences in physical performance and profession of the patient.
Switching from mode to mode depends on the adaptation of patients to the
previous one, which 1 6 is determined by functional tests.

35. The effectiveness of exercise
therapy
In the process of using exercise therapy in the complex treatment of
patients should determine its effectiveness to control the correctness of
the selection of physical exercises and the appropriateness of the chosen
technique, to quickly make adjustments to the lessons and course of
exercise therapy. Methods of studying the effectiveness of exercise
therapy depend on the nature of the disease, surgery, injury. A generally
accepted rule is to determine the physiological load curve during exercise
classes. There are the following types of control: express control, current
and stage control.

36. ➔ Express control used to assess the effectiveness of one lesson
(urgent effect). To do this, study the direct reaction of the patient to
exercise. Medical and pedagogical observations are performed, heart
rate, respiration and blood pressure are determined before, during
and after classes. The obtained data make it possible to construct a
physiological load curve, which with a correctly planned lesson
gradually increases in the introductory part, reaches its maximum in
the middle of the main part and decreases in the final part of the
lesson. During rapid control, it is recommended to use
radiotelemetric research methods (teleelectrocardiograph,
electrocardiograph, etc.), which are especially important in
cardiovascular pathology

37. Current control spend during all period of treatment not less than once in 7-10
days, and also at change of a motor mode. It provides an opportunity to make
timely adjustments to the method of training, physical rehabilitation program. Use
clinical data, results of functional tests, indicators of instrumental research methods,
anthropometry.
Stage control carried out to assess the course of treatment in general (cumulative
effect), for which before the start of exercise classes and when leaving the hospital
in-depth examination of the patient. Anthropometric measurements are used and,
depending on the nature of the pathology, functional tests and special research
methods are performed, which indicate the state of a particular system:
cardiovascular, respiratory, nervous, musculoskeletal, and others. Thus, to
determine the functional state of the cardiovascular system used dynamic tests with
different physical activities: squats, walking, running, jumping, exercises on an
ergometer, treadmill, climbing stairs. According to the reaction of heart rate, blood
pressure, recovery time of these indicators after exercise, a conclusion is made
about the functional state of the cardiovascular system and an assessment of
physical performance at present.

38. Individual rehabilitation
program
is a set of optimal for the patient, disabled person rehabilitation measures,
including certain types, forms, volumes, terms and procedure for their
implementation, aimed at restoring or compensating for impaired or lost body
functions, recovery, compensation of the patient or disabled person to
perform certain types activities. To compile it, it is necessary to take into
account the whole set of changes (morphological, physiological,
psychological) and follow the rules that provide: partnership of doctor,
rehabilitologist and patient; determination of the patient's rehabilitation
potential, especially his motor abilities; versatility of actions, ie the account of
all parties of rehabilitation for each patient; complexity of treatment and
rehabilitation measures; stepwise (transient) actions performed (gradual
appointment of restorative measures taking into account the dynamics of the
functional state of the patient).

39. The scheme of appointment of means of PR in
complex treatment of patients:
1. Diagnosis and basic clinical, functional data.
2. The treatment period for the appointment of PR.
3. Indications and contraindications to the appointment of PR.
4. Clinical and physiological justification for the appointment of PR
(based on physiological mechanisms of therapeutic action of
exercise): special tasks that can be solved by means of exercise
therapy; general tasks.
5. Means of exercise therapy: Motor mode; Exercise; Tempering
tools
6. Forms of exercise.

40. 7. Methods of physical exercise.
8. Dosage of physical activity.
9. Features of the use of physical exercises (special exercises).
10. Methods and criteria for determining the effectiveness of the
cumulative effect of exercise therapy

41. THANK YOU!