This document discusses various forms of physiatrics and rehabilitation. It begins by defining physiatrics as a medical discipline that applies physical energies and natural factors in treatment and prevention. It then classifies the different forms of physiatrics, which include physiotherapy using kinetic therapy, electrotherapy, magnetotherapy, thermotherapy, cryotherapy, hydrotherapy and phototherapy. Natural factors include climatotherapy and balneology. The document provides details on evaluation methods and the primary effects of physiotherapy. It then discusses various kinetic therapies and other physical energies in more depth.

1. Physiatrics
Klinika geriatrie LF UK
a FNsP Milosrdní bratia s.r.o.

2. Introduction
 Origin of the word :
 Re- Latin prefix meaning again, back
 Habilitas – ability, sufficiency
 Rehabilitatio – restoring of previous health
condition/status
- larger sense – any therapy which purpose is
restoration of health and man’s power
- narrow sense – medical discipline, techniques for
restoration and reinforcement performance and
especially motion skills.

3. Physiatrics and rehabilitation
 Rehabilitation: complex of processes, which ensure
optimal somatic, psychical and social condition of an
individual. This condition should allow the individual to
take again an adequate position in society.
 Physiatrics: medical discipline applying physical
energies and factors of nature in treatment and
prophylaxy.
 Balneology: uses sources of natural waters and peloids
(peat and bog (sludge)). Thermal, chemical and
mechanic attributes can be used in the treatment.

4. Classification of physiatrics
Physio-therapy
/physical energies/
 Kinetic therapy
 Electro-therapy
 Magnetic-therapy
 Thermo-therapy, Cryo-
therapy
 Hydro-therapy
 Photo-therapy
Natural factors
 Climatotherapy
 Balneology

5. Evaluation
 History
 Physical examination
 Goniometry
 Evaluation of muscle
strength
 Functional assessment
(Barthel Index)
 Ergometry
- bicycle
- handle
- treadmill
 EMG

6. Effects of physiotherapy
 Primary= direct
Local impact of physical energies on tissues; the most
common effect is: HYPERAEMIA:
- increased input of energy source molecules (O2,
proteins, fats, carbohydrates), anti-inflammatory
substances
- increased output of metabolic products – especially acid
products /e.g. lactate (it causes pain)/
- increased resorption of haematomas and blood clots
- finally, the effects of physiotherapy are analgetic,
spasmolytic and anti-inflammatory ones
 Secondary: mediated by humoral and nervous
processes

7. 1. Kinetic therapy
Therapeutic physical training
Ergotherapy (occupational therapy)
Therapeutic massage

8. I. Therapeutic physical training
 method using physical motion and exercise, it’s purpose is
the same as in rehabilitation in general:
- restoring of patients to optimal functioning and achieving
functional adaptation of organism.
 exercises :
– according to intensity: exercises in vision – passive – with
the help – active motion – active motion against external
power
– according to purpose: general (conditional training ) –
special
– according to number of patients: individual – in group
– according to performance: gymnastic – practical – games
– according to type : shuttle – traction – pressure
isotonic - isometric

9. main application form of therapeutic physical
training
 introduction: warming - up exercises
 main part: general and special exercises
 final part: breathing, relaxation exercises,
instructions/education
I. Training unit
duration of a training unit: 15 – 45 min, adequate
frequency and repeating of exercises and training
units, progressive increasing of exercise load,
indications and contraindications, observation of
patient - subjective and objective status.

10. Rehabilitation after heart attack
(coronary thrombosis)
 1. phase: hospitalisation
– 0. stage – no physical activity
– 1. stage – breathing and relaxation exercises
– 2. stage – active motion of small muscle groups
– 3. stage – active motion of groups of larger
muscles, sitting with support, sitting
with legs hanging down
– 4. stage – walking on a flat ground around a bed,
in a room, in a corridor, ...
– 5. stage – walking up stairs
– 6. stage – gymnastic exercises
– 7. stage – free motion in a hospital

11. Rehabilitation after coronary
thrombosis
 2. phase: convalescence: period from
leaving the hospital to the starting work
 3. phase: postcovalescence: the period
after the hospitalisation for the rest of the
life

12. II. Occupational therapy
(ergotherapy )
 Applied especially during long-term care or long-term
hospitalisation (departments of rehabilitation,
departments of psychiatry, ...)
 occupational therapy: is defined as “the art and science
of directing man’s participation in selected tasks to
restore and enhance performance, facilitate learning of
those skills and functions essential for adaptation,
diminish or correct pathology, and to promote health.
/training of patient to service him/herself in daily
activities, activities related to his job, support aids –
wheelchair, … /
 therapy based on patient`s activity: all activities relaxing
patient (knitting, needlework, pottery, work in garden,
painting, work with PC,...)

13. III. Therapeutic massage
 A system of manual movements affecting on a
patient`s body = mechanotherapy
 is derived from principles of Swedish Ling`s
massage, which includes 5 movements:
stroking, friction, kneading, percussion,
compression (vibration)
 Manual massage: classic, sport, reflex, visceral
 other types of massage: water-massage,
acupuncture

14. III. Therapeutic massage
 indications:
• soft tissue injuries with pain, spasm and muscle
tension
• articular pain, some musculoskeletal disorders
• visceral massage – constipation
 conditions: adequate temperature, 3 hours after meal at
the earliest, muscle relaxation before the massage
 contraindications: infection, inflammatory disease of
muscle, cachexia, purulent skin diseases, febrile and
other serious clinical states

15. 2. Electrotherapy
 uses beneficial effects of various types of
electric current
• enhances blood perfusion of tissues
– hyperaemia (without any cardiovascular loading)
• releases tension of striated and smooth muscle,
strengthens muscles
• analgetic and anti-inflammatory effect

16. Electro-therapy
Frequency Type of current
Frequency 0 Direct current iontophoresis
F to 1 kHz
Alternating current
Low frequency
electrostimulation
Dia-dynamic currents
F to 100 kHz Middle frequency Interferrential currents
F over 100 kHz 0,8-3MHz USG
3-30MHz Short wave dia-thermy
300MHz do 3GHz Ultra-short dia-thermy

17. Low frequency electric current
 For clinical fields:
 Cardioversion
 Defibrilation
 Cardiostimulation
 Electro-shocks
 Coagulation,
cauterization
 For physiotherapy
Electrogymnastics
 Träberts currents – improve
cappilarisation and tissue nutrition,
in peripheral circulation (neuralgias,
ischemic syndrome of limbs,
healing wounds)
 TENS – Transcutaneous
Electrical Nerve Stimulation –
analgetic effect, (muscle pain and
joint pain)
 Dia - dynamic currents

18. Interferential currents
 Discovered by Mr. Nemec
 Combination of 2 electric circles - bipolar method
1st circle has constant frequency, 2nd circle has fluctuating
frequency
 Tetrapolar method – combination of 2 bipolar circles in 1
place of tissue
 Patient feels something like pins and needles
 Strict contra-indication: metallic parts

19. Magneto-therapy
 Also for patient with clothes and with plaster, titan parts
 Strict contra-indication: pacemaker, IUD..
 Patient does not feel anything

20. Ultrasound- sonotherapy or
acustic therapy
 High frequency
current changed for
mechanical and
termic energy
 Effects: germicide
(when the size of
microbial body is the
same as wave length)
 Relaxing, analgetic

21. Photo-therapy
 INFRA – RED
 Analgesic, spasmolytic
effect
 Soaking of tissues in
depth of 2 cm
 Mainly at home
 source:
SOLUX, sun

22. Photo-therapy
 linear polarised light –
BIOPTRON LAMP
 I: bed-sores, operating
wounds, not well-
healing wounds,
eczemas,
 CI: in this time not
confirmed, pregnancy,
contact lenses

23. Ultra-violet radiation
 From 400nm up to X - ray
 In tissues penetrate to depth up to 1 mm, it means in skin to
epidermis, in the eye to cornea
Direct effects: immunity improvement, inactivation of viruses,
anti-rachitic profylaxy, improvement of rheologic
characteristics of blood
Be aware of: Skin cancer, cataract
Source: sun, lamps

24. Cryo-therapy
Temperatures les than 10 degrees
 Long history – Kneipp, Priessnitz ( 17th, 18 th
century|
 Effect: vasoconstriction, analgesic effect,
 General and local

25. hall from - 20 to – 50
degrees C (-4 to -58F)
chamber from -120 to -160
degrees C (-184 to -256 F)
Entrance after general
warming, with shoes,
gloves, covered mouth, ears
Always in motion

26. Thermo-therapy
White Wax – temperature tolerance higher than
water, about 55 to 60 degrees
Parafango - wax and soil/mud

27. Hydro-therapy

28. Hydro-therapy, balneo-therapy
1. Clear water
2. With addition agents
3. With mechanical effects
A. Hypotermic
A. Izotermic
B. Hypertermic
I. Full bath
II. Half bath
III. Bath for sitting
IV. partial

29. Hydro-therapy, balneo-therapy
 Under water massage –„a lá
Vichy“, Aix les Bains“
 whirlpool
 Bubble bath - air, oxygen or
carbon dioxide
 Sub- aqual massage - Hubbard
bath

30. Hydrotherapy
 Water application on human
body under high pressure
 Mechanical and termal
effect
 Water or steam
 As a rain, needles
(injection), flapper, mist
 Cold, warm, alternate
(scottish)

32.  Peloid – fango/mud/sludge
organic /anorganic
 Curative salts ang gases

33. Natural mineral water
• Contains:
gas (1g /l CO2 alebo or sulphuretted hydrogen)
or solid parts (1g/l)
From normal water differentiates by total
mineralisation, at first ionic parts, biologically
and farmacologically active parts, osmotic
pressure and natural temperature (cca 20
degrees C in place of spring)

34. Climatotherapy
Utilization of different
meteorological
conditions and
specific features of
climate for
therapeutical and
prophylactic purposes

35. Classification of climatotherapy
 aerotherapy
 heliotherapy
 thalassotherapy
 cave therapy
 mountain therapy

36. Indications
 The patient should be able to undergo
the treatment
 The selected organ system, which will be
cured, should be still able to reflect the
stimuli of the climate

37.  Enhancement of organism
 Improvement of:
- body temperature regulation
- immunity
- cortex activity
- physical and mental efficiency
The goal of
climatotherapy

38. Aerotherapy
 Utilization of fresh air in open-air places
 the base of climatotherapy, also called natural
oxygenotherapy
 Application: sleep and stay on the sea-coast, in
mountains …
 Fresh air stimulates and irritates skin receptors or
nerve endings and upon this the organism adapts
on these stimuli, the result is decrease in negative
and undesired reaction of regulating mechanisms

39. Heliotherapy
 Utilization of radiation: from sun - direct,
from sky – dispersed, from surface of
various objects -reflected
 Uses all kinds of light spectrum:
- UV radiation
- Visible part
- IR part

40. Indications
 hardiness (getting resistant to cold) – healthy
people
 enhancement of skin function
 prophylaxy of rachitis
 morbus Bechterev
 Skin diseases – psoriasis, alopecia areata
(baldness), ulcer of calf (ulcus cruris),
 Tuberculosis

41. Thalasso-therapy
• Utilization of coastal specific factors (fresh sea -
water, wind, sea - water inhalation and
gargalization )
• Inhalation -1 mg salts in 1 m3 of sea water –
prevailing NaCl, MgCl, MgSO4, CaSO4 , K2SO4 ,
MgBr2 , ozone, oxygen, iones, less of CO2 ,
iodine
• Hydro-aero-ionization of air
• Utilization of mechanical and termal water
qualities
• Training of termo-receptors – getting resistant to
cold

42. Thalassotherapy
 Recovery - minimum 14 days
 Prophylaxy – minimum 20 days
 Treatment – 30+ days
Increase in non- specific resistance: decreased
imunological reactivity

43. Cave therapy
 Therapeutical method,
using the specific and
unique properties of
environment of the
underground space of
karst caves to treat
the chronic and
allergic respiratory
disorders
 The basic treating
factor of
speleotherapy is the
cave aerosol.

44. Karst Cave Aerosol
 The basic proven factor of speleotherapeutic effectivity is
the aerosol
 Composition of the Karst Cave Aerosol:
• High constant relative humidity and low constant
temperature
•High content of calcium and magnesium
•High ionization rate and high electronegative charge
•Sterile environment- the absence of bacteria, mould or
fungi and aggressive allergens
•Absence of environmental pollution – organic and
anorganic

45. Indications
 Repeated, chronic obstructive and non-obstructive bronchitis
 Chronic and persistent cough after acute respiratory disease, or
asthmatic origin
 Repeated, chronic sinusitis
 Repeated, chronic upper respiratory tract infections
 Repeated bronchitis in the allergic person
 Allergic rhinitis, pollinosis
 Asthma bronchiale
 Dermorespiratory syndrome
 Frequent respiratory diseases in children
 Children from ecologically polluted areas
 Children of the families with severe allergic disposition and disease

46. Thank you for your attention!
Thank you for your attention!