General bases of physical rehabilitation

General bases of physical rehabilitation.

Bases of a massage .

 

 

A medical physical culture (MPE) is independent medical discipline, where facilities of physical culture are used with a medical, prophylactic and health purpose.

The basic tasks of MPE it is been:

1.     To save and support a sick organism in the best active functional state.

2.     To warn complication, which illness can cause and those, that can arise up because of the forced rest.

3.     To stimulate potential protective forces of organism in a fight against a disease.

4.     To bring over a patient to active voice in the process of convalescence.

5.     To accelerate liquidation of local anatomic and functional displays of illness.

6.     To recover the functional full value of man in a short term.

7.     To educate positive attitude of patients toward tempering of the organism ordinary natural factors.

 

Decline of force of muscles			Diminishing of mass of body		Violation of co­ordination of motions
Decline of synthesis of ATF and disconnection of oxidization and phosphorylation			Diminishing of mass of muscles		Violation of proprioreceptors sensitiveness of muscles
Decline of expenses of energy			A decline of metabolism is in muscles		Diminishing of impulsation from proprioreceptors
	hypocinesia
Decline of tone of vessels		Violation of Ca/P exchange			Violation of variety of impulsation
Diminishing of mass of myocardium		Increase of selection of calcium with urine			Violation of trophic function of the nervous system
Antrening cardiovascular system		Violation of durability of bones			Decline of reactivity, asthenia

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hypocinesia has a negative influence on a human organism (fig. 1). MPE uses the basic biological function of organism ­ motion. The central nervous system regulates the balanced activity of different organs and systems. At a disease the regulative function of CNS is multiplied. Therefore at treatment it is necessary to recover ccordinatory activity of different functions of organism. For the decision of this problem use physical exercises basis of which is motion. Operating the dosed physical loadings on an organism, we can recover the affected functions, or to perfect their co­ordination, if they changed under influencing of disease. Physical exercises operate positively not only on CNS but also on other systems and organs.

Activity of the cardiovascular system is improved: a systole volume is multiplied and frequency of cardiac reductions diminishes, and it conduces to more economic work of heart. At motions circulation of blood is improved and in area of damage, that stimulates regenerative processes.

At the correct breathing of patient and strengthening of respiratory muscles the function of the respiratory system is improved. The deep breathing is caused by multiplying pulmonary ventilation, in fact an organism uses oxygen better, reserve air is anymore used, favourable terms are created for the satiation of blood oxygen.

At implementation of physical exercises reduction of fat musculature increases reflexly ­ the peristalsis of intestine, secretory function, is improved in fact, activity of organs of digestion is improved. The general exchange of matters and power expenses of organism rises because of action of physical exercises; tone of muscles is strengthened. Physical exercises operate on a bone-joint vehicle: the trophic role of the nervous system increases, investigation of it are improvements of blood supply of bones.

To medical physical education inherent features which distinguish her от other methods of treatment. The systematic use of physical exercises with the purpose of treatment considerably promotes efficiency of medical measures, abbreviates the terms of treatment and stay of patient in a hospital, diminishes a break between clinical and functional convalescence.

MPE differs от other methods of treatment them, that this method of treatment:

–         popular and free of charge;

–         natural ­ physical exercises lie in basis;

–         promotes reactivity of organism;

–         does not have allergic reactions;

–         does not have a traumatic influence;

–         universality of influencing (bracing and selective);

–         easily measured out and studied reaction on loading;

–         it is possible protractedly or constantly to use for treatment and prophylaxis of relapses;

–         a lot of not contra­indications, but if am, temporal;

–         high emotionality of employments.

REGULAR NORMS of REFERENCES of MEDICAL PERSONNEL of MEDICINAL­ATHLETIC DISPENSARY

A 1 position is set from a calculation position of doctors of medical physical education (MPE) on:

a) 8 positions of sporting doctors, necessary in accordance with the points of ”а” and ”b” п. of 1 this section;

b) 250 thousand persons of urban population which lives on territory of activity of dispensary.

If to the dispensary for a grant proper медпомощи other medical­-preventive establishments (subdivisions) of city (city administrative district) are fastened, positions of doctors of medical physical education (MPE) are entered in his state, in obedience to operating for them a regular norm.

Position of manager by the separation of medical physical education (MPE):

–        from 3 to 7 positions of doctors of MPE ­ in place of one medical position

–        from 7,5 positions of doctors of MPE­ in place of a 0,5 position of doctor.

Position of deputy of main doctor on medical work is entered at presence of 40 doctors which conduct an ambulatory­policlinic reception.

Positions of instructors and methodists of MPE with higher education are set from a calculation a 1 position on 4 positions of doctors on sport, by a necessity in accordance with the points of ”а” and ”b” point of 1 this section.

If to the dispensary for a grant the proper help fastened other medical­-preventive establishments (subsections) of city (city administrative district) in his state can be entered position of instructors on MPE with secondary and higher education, foreseen establishments after operating for them regular norms.

Positions of instructor MPE with secondary education are set from a calculation a 1 position on a 1 position of doctor MPE or instructor on MPE with higher education, necessary in accordance with the subitems of ”а” and ”b” point 2 this sections.

Regular norms of medical personnel of departments of sporting medicine in composition the territorial medical associations of city policlinics (bridge and districts with a population over 50 thousand of persons).

а) positions of doctors of MPE are set depending on a presence in the state of positions of doctors which conduct an ambulatory reception:

от 10 to a 20 ­ 1 position

more than 20 to 40 ­ 2 positions

more than 40 additionally 0,5 positions on every followings 20 positions of doctors which conduct an ambulatory­policlinic reception.

At the calculation of positions undertake to attention position of doctors which conduct a reception in the state fastened on establishments of ambulatory­policlinics, but does not have a separation (cabinet) of rehabilitation in the composition

c) positions of methodists on MPE with higher education and instructors on MPE with secondary education a 1 position is set from a calculation on 30 positions of doctors which conduct an ambulatory­policlinic reception

Regular norms of medical personnel of separations (cabinets) of rehabilitation in composition the policlinics of cities and settlements of city type (with the amount of population there is to 100 thousand of persons)

II. Medical personnel

Positions of doctors of MPE are set at the amount of positions of doctors which conduct an ambulatory reception:

от 10 to 20­0,5 position

more than a 20­1 position

ІІ Middle medical personnel.

1.    Position of methodist MPE with higher education or instructor MPE with secondary education is set from a calculation a 1 position at presence of not меньше 15 positions of doctors on an ambulatory­policlinic reception

d) Norms of medical personnel of separations (cabinets) of rehabilitation in composition permanent establishments (independent hospitals and hospitals in composition).

e) MEdical personnel

Positions of doctors of MPE are set:

on 200 beds ­ 1 position

more than 200 beds is a 1 position and additionally 1 position on every followings 250 beds; 0,5­1 position on every neuro-traumatological, neuro­surgical, patients by poliomyelitis (infectious separation).

ІІ. Middle medical personnel.

1.    Positions of methodists of MPE with higher education or instructors of ЛФК with secondary education are set:

а) from a calculation 2 positions on 400 beds of all types, but not меньше 1 position at presence of more than 200 beds;

b) 0,5­1 position on a traumatological separation, нейротравматологическое;

c) 0,5­1 position on a neurological separation, neuro­surgical;

d) 0,5­1 position on a heart attack separation (30-­60 beds);

e) 0,5­1 position on the separation of musculosceletal tuberculosis

f)0,5­1 position on an infectious separation for patients by poliomyelitis.

 

NORMS OF CALCULATIONS OF TIME FOR IMPLEMENTATION OF PROCEDURES OF MEDICAL PHYSICAL EDUCATION

1.    For conducting of procedures of medical physical education such estimated time is fixed adults and children:

1.1.         For therapeutic patients:

Ú   in the sharp and subsharp period of disease, bed mode are 15 minutes;

Ú   in the period of convalescence or chronic form of disease at the individual method of employments are 25 minutes; at the group method of employments are 35 minutes;

Ú   For patients after conducting of surgical operations:

Ú   at the individual method of employments are 15 minutes;

Ú   at the group method of employments are 20 minutes;

1.2.         For traumatological patients, in the period of immobilization:

Ú   at the individual method of employments are 15 minutes;

Ú   at the group method of employments are 25 minutes;

Ú   at the traumas of spine and pelvis after immobilization:

individual employments are 25 minutes;

employments of groups are 35 minutes;

at the traumas of spine :

Ú   individual employments are 35 minutes;

Ú   groups are 45 minutes;

1.3.         For neurological patients:

at the individual method of employments are 30 minutes;

at the group method of employments are 45 minutes;

1.4.         For pregnant and women giving birth in family houses and womanish consultations:

at the individual method of employments are 15 minutes;

at the group method of employments are 30 minutes;

1.5.         For the children of school age (at schools):

at the individual method of employments are 30 mites;

at the group method of employments are 45 mintes;

1.6.         For the children of preschool age (in preschool establishments of children’s):

at the individual method of employments are 25 minutes;

at the group method of employments are 30 minutes

 

NOTE: Time, necessary for conducting of preparatory work, filling of document and direct conducting of procedure, is taken into account in the norms of calculations.

Basic duties of doctor of medical physical education

1.    Organizational work: permanent business contact with administration of hospital and all managers of separations for the improvement of raising of medical physical education (timely setting, multiplying the volume of patients, help of doctors and trained nurses and other)

2.    Medical work: inspection of patients with conducting of functional tests, setting of forms, facilities, methods of medical physical education, dosage of the physical loadings, account of efficiency.

3.    Methodical work: development of method of medical physical education is a selection of physical exercises, help an instructor in drafting of complexes, development of testimonies and contraindications to medical physical education, drafting of methodical letters, teaching a medical personnel, medicinal­pedagogical control, completing of groups for employments.

4.        Permanent work on the improvement of terms of conducting of physical education: expansion of apartments, acquisition of inventory and other

Basic duties of instructor on medical physical education:

1.        Medical work: conducting of procedures and account of efficiency.

2.        Methodical work: drafting of complexes.

3.     Organizational work: verification of morning sanitary gymnastics is in separations.

TESTIMONY AND CONTRA­INDICATION TO SETTING OF MEDICAL PHYSICAL CULTURE.

During the rehabilitation of patients medical physical education occupies one of the first places in every clinical speciality. She can be appointed practically in any period of flow of illness. Testimonies to setting of MPE are its tasks.

There are not many contra­indications to setting of medical physical education and they, as a rule, have temporal character.

There are permanent contra­indications: it is heavy irreversible making progress organic diseases of commons, at which impermissible activating both general and local physiological processes, where basic the tasks of treatment there is a facilitation of sufferings of patient, without a hope on renewal of health (malignant new formations, disease of blood, psychical diseases, making progress of cardiac and respiratory insufficiency).

Temporal conraindication:

–         sharp period of disease;

–         grave condition of patient;

–         sharp inflammatory process, which is accompanied the increase of temperature of body, increase SOY, leucocytosis (she can be applied at a subfebrile temperature, in such cases must SOY show a tendency to normalization);

–         sharp period of nonimflamatory processes (hypertensive attack, stroke);

–         making progress of disease (depending on the dynamics of process);

–         pain syndrome not depending on localization of pain;

–         bleeding or his threat, haemoptysis;

–         presence of extraneous bodies near main vessels and nervous barrels.

 

Order of setting and registration of procedures of MPE.

In default of contra­indications to setting of MPE a treating doctor appoints a patient medical physical education, about what does a record in a hospital chart, where must specify the basic task of MPE ( e.g. lengthening exhalation, to recover mobility of joints) and recommended forms of MPE (fig. 2). A medical sister carries setting of doctor in the sheet of settings. A patient heads for a doctor­specialist on medical physical education (if patient on the bed mode, then a doctor on medical physical education examines a patient in a chamber). After the inspection of patient doctor MPE gives pointing an instructor about that, what facilities, loadings, method, duration, amount of employments shown a patient. About all of it he writes down illnesses in history, and master data ­ in the magazine of account which is in the cabinet of MPE. An instructor on MPE appoints time of employments, daily does records in the notebook of account. Later conducts a report, where the amount of procedures which are conducted sick, amount of patients, specifies, percent of circumference by medical physical education of patients of hospital.

At the change of the state of patient, methods of employments doctor MPE does the proper records in a hospital chart.

 

An example of record of consultation of doctor MPE is in a hospital chart:

Date.

Consultation of doctor MPE.

Taking into account subjective (…), objective (…) information, information of additional methods of inspection (…), MPE is shown a patient on the mode (…), forms of MPE: (…), method of employments (…), place of employments (…). Concrete recommendations in relation to the method of MPE are given to the instructor (last name, initials) which will work with to the patients.

Signature.

 

Basic document of therapeutic physical training room.

1.     Magazine of account of patients, that engaged in a medical gymnastics.

2.     Card index with the filled cards of patients which treat oneself in the cabinet of MPE (form № 42).

3.     Notebook for the account of procedures and scope of patients a morning sanitary gymnastics.

4.     Plan of work on a year.

5.     Annual report: digital data and explaining message.

6.     Distributing of departments between instructors.

7.     Graph of work of instructors in therapeutic physical training room and in departments.

8.     A curriculum of employments of groups medical physical education is in the cabinet of MPE.

9.     Folder with orders, instructions and other

10. Folder with methodical materials (by complexes, reminders and other)

Except for it to the document of cabinet of MPE take also the records of doctor and instructor in hospital charts.

Equipment of cabinet of MPE.

Obligatory apartments: gymnasium and consulting room.

Except for it it is desirable to have such apartments: cabinets of механотерапии and functional diagnostics, rooms for expectation with a locker room, shower­bath, playing hall or hall of correcting gymnastics.

Obligatory a minimum of equipment (an amount depends on the sizes of cabinet of MPE and от the amount of patients).

Shells:

1.     A gymnastic stair is 2­4 rows.

2.     Gymnastic bench.

3.     Couch (with the set of rollers).

4.     To have are 4.

Objects:

1.     A ball is volley­ball are 4.

2.     Medboly

0,5 kg ­	4­6.
1 kg ­	4­6.
2 kg ­	1.

3.        A stick is gymnastic are 6

4.        Rubber ribbon is 6

5.        Dumb­bells

0,5 kg ­	4­6
1 kg ­	4­6
2 kg ­	1

What anymore it will be good inventory, so much the better. Except for transferred it is possible yet to use jump rope, maces are gymnastic, mechano-therapeutical vehicles.

 

Forms of conducting of MPE:

Choosing the form of conducting of MPE, it is needed to take into account the individual features of patient, weight and clinical flow of illness, tasks which put doctor and methodist on MPE.

Taking into account meaningfulness and frequency of application, there are such forms of medical physical education (table 1):

1.     Medical gymnastics (MG).

2.     Morning sanitary gymnastics (MSG).

3.     Individual tasks to the patients for independent employments.

4.     Pedestrian walks.

5.     Terrenkur.

6.     Playing lesson.

7.     Elements of sporting exercises.

8.     At run.

9.     Procedure of selfmassage.

Close there are sessions of work therapy and massage to the forms of medical physical education. Procedure of mechano-therapy is a variety of medical gymnastics, instead of separate form of medical physical education.

Medical gymnastics I am the major and basic form of conducting of medical physical education. Exactly for this form of MPE the special physical exercises are used with a medical purpose. By the feature of MG there is то, that she:

а) accessible all patient both on the state a health and on an equipment (all patients which do not have contra­indications to setting of MPE can attend, does not need the special equipment and apartments);

b) electoralness of action (at its application it is possible selective to influence on the certain groups of muscles, for example muscles of the back, abdominal press, hands, etc.);

в) measured out easily (if necessary it is possible to change duration of procedure, amount of exercises, rest between implementation of exercises, rate and amplitude of implementation);

г) the lack of medical gymnastics is absence of emotionality (she can be created musical accompaniment of implementation of exercises) and naturalness of motions. MG can be used on all modes of motive activity.

Morning sanitary gymnastics used with a bracing purpose. Bracing exercises promote general tone of organism of patient, excited of cortex after sleep, improve circulation of blood. On an equipment and on the state the health of MSG accessible all, emotional, natural, measured out easily, it is possible selective to influence on the certain groups of muscles; it is possible to use on all modes of motive activity.

Individual tasks for independent employments – it notoriously neat and studied a patient complex from not many simple and effective exercises at a certain disease. A patient executes these exercises independently under surveillance of medical sister. Such employments complement and considerably promote efficiency of employments a medical gymnastics. Independent employments are accessible on the state a health all patient, does not need the special equipment, selective influence on the certain groups of muscles, nevertheless them not always easily to dosage, unpresent emotionality, they not always are natural. Appointed at all modes of motive activity.

Pedestrian walks – conducted after setting of doctor in the dosed form. The exchange of matters rises in patients, increases and improved circulation of blood, breathing, there are positive emotions which distract a patient от ideas about illness. Pedestrian walks do not need the special equipment, accessible not all patient (only on the free and training modes), does not have a selective action (influence on weigh organism), natural.

Terrenkur – treatment the dosed ascent. Use for diseases cardiovascular, respiratory systems, metabolic disturbances. The route of terrenkur is marked out on areas, each of which has a home of one’s own getting up. Appointed only on the training mode, does not have a selective action (influences on weigh organism), measuring out loading is possible length of distance, rate of walking, corner of getting up, amount of stops for rest. It emotional and natural method.

Playing lesson – it natural method, causes positive emotions, tones up a neuropsychic sphere, promotes the exchange of matters, improves the function of the respiratory and cardiovascular systems. Nevertheless this form of MPE has electoralness of action, not always she can be measured out exactly.

Elements of sporting exercises in MPE use for more quick renewal of break functions of organs, prophylaxis of diseases, increase of ability to work of patients. It is possible to use swimming, weir, skiing, wheeling. It natural and emotional method, does not have a selective action, measured out badly. Appointed on the training mode of motive activity.

At run, as a form of MPE – natural, emotional, relatively measured out easily, does not need equipment, influences on weigh organism of man: cardiovascular system is perfected, respiratory systems, a transport system of oxygen is multiplied, due to a sedative action warns psychical stress; promotes firmness to the infectious diseases.

Table 1.

Forms of MPE

 

 

Facilities of medical physical education – it то, what we aiming operate on the organism of man with a medical purpose. To facilities MPE behave:

–         physical exercises;

–         modes of motive activity;

–         initial positions;

–         factors of tempering;

–         massage and adopting a selfmassage.

Physical exercises, which use in medical physical education are the specially organized motions for achieving a medical and health effect. They are divided on:

–         gymnastic;

–         sporting­applied;

–         playing;

–         labours.

Physical drills influence not only on the different systems of organism but also on separate muscular groups, educate such elements of motion, as amplitude, force, speed. They are classified on anatomic signs:

–         for mimic muscles;

–         for the muscles of neck;

–         for the muscles of overhead extremities;

–         for the muscles of overhead extremities and humeral belt;

–                  for the muscles of the back;

–         for the muscles of abdominal there is a press;

–         for the muscles of pelvis;

–         for the muscles of the lower endings.

 

In relation to loading:

–         without loading: used for operating on separate parts of body, joints, muscles; for training nervous, cardiovascular, respiratiory systems, for the increase of exchange of matters, movable of spine, acceleration of regenerative processes;

–         with loading: for strengthening of action of exercises on an organism and for the increase of emotionality of employments. They are divided on:

а) exercises with shells (gymnastic sticks, dumb­bells, expanders, maces);

б) exercises on shells and vehicles (exercises on a gymnastic wall, gymnastic bench, mechano-therapeutical vehicles, etc.);

In grain muscular reduction:

–         dynamic (isotonic): a muscle works in the isotonic mode, I.e. there is changing of periods of reduction and weakening of muscles, here is motion in joints;

–         static (isometric): tension passes in a muscle without motion in a joint. Such exercises are conducted in immobilized extremities. At isometric exercises rest of the damaged bones is not violated, nevertheless supported in tone nervous and muscular systems of immobilized extremity, normal circulation of blood is provided in muscles and periosteum.

On complication:

–         simple;

–         difficult.

On activity:

–         active: exercises which are executed most sick at volitional effort. They can be executed in the facilitated terms. For this purpose use the special sliding planes which diminish force of friction in the moment of active motion. Possible other variant, when create the dosed resistance in the moment of implementation of active motion, thus this resistance can be on the different stages of motion: at first, in the middle, in the end. Active exercises operate on the nervous system, and it promotes general activity of patient; a patient controls feelings which arise up because of motion; here take place displacement of tendons, and it warns formation of connections; at active motions increased capilarization muscles, blood supply of muscles, involved in implementation of exercise, so surrounding fabrics is improved in fact.

–         passive: exercises which are executed without volitional effort of patient by an instructor, here is not active reduction of muscles. Such exercises appoint then, when patient not in possibility to execute them. Passive motions improve крово­ and lymph circulation, stimulate the origin of active motions because of the reflex influencing of efferental impulsation, support elasticity of copula­tendon vehicle, warn formation of not mobility in joints.

Ideomotornye of exercise it is the parcel of impulses to contracting muscles. At renewal of motions in an idea the ordinary stereotype of processes of excitation and braking is saved in CNS. It supports the functional movable of ending.

On influence on an organism:

–         bracing: directed on making healthy and strengthening of all organism;

–         special: operate selective on ту or other part of musculosceletal vehicle.

In grain exercises:

–         on a stretch;

–         on equilibrium;

–         correcting;

–         on co­ordination;

–         on weakening;

–         reflex;

–         respiratory, divided on:

а) dynamic, that team up with motions of hands, humeral belt, trunk;

б) static ­ carried out only through a diaphragm and intercostal muscles;

в) special ­ use for a prophylaxis and fight against pulmonary complications.

Sporting­applied exercises:

–         walking (ordinary, complicated, dosed);

–         at run;

–         climbing and crawl;

–         rowing;

–         swimming;

–         wheeling;

–         skiing.

Games:

–         in place;

–         not mobile;

–         mobile;

–         sporting.

 

In MPE use table tennis, badminton, bowling­alley, gorodkis, relay races.

Labour. It is a method of active renewal of the functions and ability to work affected in the process of illness by work.

Appoint at the diseases of musculosceletal vehicle, neurological, psychical discords. Use such types of work, making of flowers, wickerwork of baskets, works in a garden, on a vegetable garden.

By work therapy restored or improved muscular force and movable in joints, circulation of blood and trophism of the damaged organs or systems of organism is normalized; in a patient attention, hope, develops on recovering.

Select 5 modes of labours ( Третяков С.В., 1981):

0 is the mode of temporal failure to attend a patient separation of work therapy;

1 is the chamber mode: a patient is engaged in work therapy in a chamber;

2 is student’s mode: a patient studies the recommended type of work;

3 is the mode of brief working day: on medical shows a brief working day is given a patient on 1 h., additional interruptions are in work;

4 is the mode of complete working day with limitation of type of works;

5 is the mode of complete working day.

 

Description of the modes of motive activity it is presented in table 7.

Table 7

MODES OF MOTIVE ACTIVITY

 

 

 

Procedure of medical physical education can be conducted:

1.     By an individual method: conducted in the case of the difficult state of patient, when he is on the bed mode. Advantage of this method is in том, that it is possible easily to measure out the physical loading, exercises are executed very exactly. But during conducting of individual employment there is not emotionality, and it gradually depresses a patient and in an eventual result removed on a medical process.

2.     By a group method: procedure of MPE is conducted with the certain group of patients. Making groups for conducting of procedures, it is necessary, that patients were with an identical disease (for example pneumonia, pleurisy), if it is possible, in the identical stage of flow of illness, patients had identical trained approximately, were identical age, floor. In the case when there is not the special methodical pointing in relation to a disease and patients have identical functional possibilities approximately, in groups patients can attend with different pathology. During conducting of employments a group method high emotionality is created, nevertheless heavier to dosage loading for a concrete patient and to trace exactness of implementation of exercises.

3.     By an independent method: a patient work at home and comes in a consulting MPE room for consultations. This method is applied then, when a patient caot regularly visit medical establishment (on the state a health, residence far from medical establishment, duration of course of treatment). The independent method of employments is appointed in том case, when a patient is taught and high­quality executes the necessary complex of physical exercises, correctly and expressly measures out loading, conducts self­control.

Preparation to procedure of medical physical education.

An instructor must be in a sporting suit and dressing­gown, well to know the contingent of patients, that will come on employment.

An apartment, where procedure is conducted, must be ventilated, before it to conduct the moist cleaning up, it is necessary to check up the good condition of gymnastic objects and shells. During conducting of procedure in a chamber it is necessary to turn off radio transmitters, television sets, extraneous persons must go out from a chamber.

A patient must know the value of medical physical education for his convalescence and before employment to empty an intestine and urinary bladder, clean out nasal motion; to tune in to implementation of physical exercises; changed clothes in a sporting suit and change in a comfortable shoe; in good time to come in the cabinet of MPE; if necessary, a patient before employment must in good time adopt medicines.

Patients must engage in light gymnasia by an area not меньше 40 m², where not less two gymnastic step­ladders must be, coverage – clean and dry, in good condition inventory. Rooms for an individual gymnastics must be equipped a necessary inventory, to have an area not less 16­-20 m².

Medical gymnastics it is the dominant form of MPE and decides the special tasks of treatment of certain disease. She must be conducted correctly, it is needed in fact:

–         to provide the systematic, purposeful operating both on the organism of patient and on the damaged system;

–         to attain the expressed clinical effect;

–         to propagandize permanent employments physical exercises.

A doctor must be able to conduct engaged in a medical gymnastics in order that:

а) to teach an instructor;

б) if necessary to control his work;

в) to provide medical control;

г) together with an instructor to develop the most effective methods of MG;

д) to conduct procedures heavy patients and at the danger of complications.

Before to conduct procedure of MG, an instructor must teach patients rhythmic, smooth, even implementation of physical exercises, adjusting of breathing, arbitrary change of his rhythm, frequencies, depths, to the concerted association of exercises with inhalation and exhalation, to the arbitrary weakening of all body or separate muscular groups, self­control and adjusting of the mental condition.

During conducting of procedure of MG an instructor owes:

1.        To name exercise.

2.        To name initial position.

3.        To tell and show implementation of exercise in an association with breathing.

4.        To ask or understood the technician of implementation of exercise.

5.        To give a command to beginning of implementation of exercise.

6.        To give a command to completion of implementation of exercise.

Procedure of MG consists of 3th sections: introductory, basic, final.

Introductory section counted on preparation of organism of patient to the next physical loadings. This part of employment promotes the general exchange of matters, moderately warms up an organism, attracts attention and regulates the emotional state. Respiratory and bracing physical drills are executed for all groups of muscles. An accent is done on those muscles which will have most loading in basic part of employment. Exercises in this part must not be difficult, patients must know them. Duration of introductory section 5-­10 min.

Basic section make exercises which have the special and common operating on the organism of patient. The task of this section is liquidation of discords, caused a disease, complete renewal of functions or forming of compensate mechanisms, activation of common and local circulation of blood and exchange of matters, improvement of breathing, liquidation of the stagnant phenomena, increase of functional possibilities of organism. Exercises of this section depend on the features of method of MPE at certain diseases. The special exercises are alternated with bracing exercises. It is necessary to adhere to principle of dispersion of loading. In a basic period, loading is maximal, duration 6­-20, sometimes 40 minutes.

Final section provides effective completion of employment, renewal of the initial state of organism. Bracing and respiratory exercises which team up with exercises on weakening are executed. Duration от 3 to 6­8 min.

An instructor must not execute exercise together with by patients. He must look after patients, by correct implementation of exercises and at a necessity to correct failings and run­time errors exercises. It can be:

–         tension at implementation of exercises;

–         shallow breathing, brief delays of breathing,

–         it is correct to unite the lack of ability inhalation and exhalation with certain parts of exercise;

–         bad co­ordination of motions, their unclear implementation.

Skills of the correct breathing are produced at implementation of respiratory exercises: deep breathing at peace, inhalation at implementation of exercise, where a thorax and long exhalation broadens at its narrowing, looking of patient after breathing at peace and at implementation of physical exercises.

From the first employments of MG an instructor must teach patients arbitrarily to weaken muscles. It is necessary for this purpose:

1.        To execute the special physical exercises at the weakened muscles (complete weakening in initial position sitting on an arm­chair and lying on the back; throw of ball and weakening; physical drills which are alternated with weakening of muscles; joggle extremities at the weakened muscles);

2.        Necessarily to weaken muscles in a pause after implementation of every physical exercise;

3.        Self­control at implementation of physical exercises and weakening of those muscles which are not involved in loading.

Technique of the main special physical exercises on weakening of muscles:

An instructor offers to the patient from initial position standing on inhalation to heave up hand up, then during exhalation to drop them and fully to weaken muscles. At first he this exercise shows on itself, offers to the patient to walk up and palpate biceps in the weakened state and to loosen the weakened hand from a side aside. After implementation of exercise a patient an instructor checks up the degree of weakening, loosening a hand. If a hand is easily loosened is weakening complete.

It is offered to the patient to be weakened in initial position lying on the back. The degree of weakening is checked up by an instructor, sticking a brush between a floor and lumbar lordosis patient. At the complete weakening moving forward a brush is not succeeded.

 

Medical control an instructor and doctor carries out during procedure of medical physical education. Measure HELL, count up frequency of pulse, breathing, look after the signs of fatigue. These indexes are added to the system of co­ordinates, where on abscise axis mark time through each 3 minutes, and for y­axes ­ HELL, pulse, breathing through each of 3 minutes of procedure. Connecting the graphic indexes of pressure separately, pulse and breathing get the physiological curve of procedure of medical physical education. She must be:

­ protuberant form;

–         the peak of loading must take place in second third of basic part of employment and answer a maximally possible pulse;

–         synchronousness of change of indexes of pressure, pulse, breathing;

–         at the end of procedure these parameters are near to initial.

During employments it is necessary to heed a medical gymnastics after a patient and take into account the complex reaction of organism on the physical loading:

1.     Change of arterial pressure (systole, diastole and pulse).

2.     Change of frequency, rhythm, tension, filling of pulse.

3.     Character of motions (rightness of implementation of physical exercises, co­ordination).

4.     Sweatiness.

5.     Color of person (hyperemia, pallor, cyanosys of lips).

6.     Mien, attention.

7.     Feel of patient (at questioning).

Loading is adequate, if:

а) complaints are absent in a patient, there are not the sharply expressed signs of fatigue;

b) on the nosedive of loading a pulse is multiplied:

–         at the bed mode on 8 after 1 minutes

–         at to chamber ­ on 16 after 1 minutes

–         at to free ­ on 24 after 1 minutes

–         at training ­ after a formula 180 is age of patient.

c) increase systole HELL on 40 mm. Hg. item, increase or decline of diastole HELL on 10 mm. Hg. ; pulse pressure must be increased;

d) becoming more frequent of breathing on 6­8 respiratory motions;

e) breathing and pressure must change synchronously with a pulse;

f) all indexes are restored after 3­5 minutes.

The important condition of correct treatment of patient is a choice of adequate, dosed remedy. Procedure of medical physical education also must be measured out depending on weight of flowing of illness, stage, age, floor, physical preparedness of patient. It can be done, taking into account such factors:

1.     Size and amount of the muscles involved in implementation of exercises. Mali of group of muscles is required by less efforts for implementation of certain motion, in fact and loading will be insignificant, and vice versa, for the greater loading it is needed to involve the large groups of muscles.

2.     Amount of reiterations of exercises. At the multiple reiteration of exercise the dose of loading increases and vice versa.

3.     Rate of implementation of exercises. He is chosen depending on the common state of patient and size of the involved muscular groups. Multiplying a rate, we achieve growth of the physical loading.

4.     Rhythmic implementation of exercises diminishes loading, in fact at rhythmic reduction and weakening of muscles for patients motive habits are quick produced, which results in more economy use of energy, necessary for realization of certain motions. The rhythm of implementation of exercises improves haemo- and lympho- circulation, that is an important factor for diminishing of loading.

5.     Amplitude of motions. The volume of motion increases because of prepotent reduction a muscle, means and the dose of the physical loading is multiplied. Therefore, to get the small loading, especially on the early stages of treatment, it is needed to begin to execute exercises with small amplitude, gradually extending her at convalescence of patient.

6.     Amount and duration of periods of rest at implementation of exercises. At an increase them ­ loading diminishes vice versa.

7.     Simplicity and complication of exercises ­ they depend on an amount and type of the involved muscular groups and от co­ordination of motions at implementation of exercise. Difficult exercises create the large loading, in fact for their implementation it is necessary greater tension of efforts and attention, which conduces to the rapid fatigue. Procedure of MPE is begun always from simple exercises with the gradual passing to difficult.

8.     Implementation of exercises, burdened objects (medical ball, dumb­bells, maces, expander, rubber ribbon) ­ at their application it is necessary to make more efforts, means loading increases.

9.     Initial position, which depends on character of disease, executable physical exercise. Initial position from which begin to execute exercise will play a considerable role for correct implementation of exercise. For diminishing of the physical loading it is expedient to execute exercise from simple initial position (for example sitting on an arm­chair, leaning back on the back; lying on the back) and vice versa, for multiplying the physical loading it is needed to execute exercises from the complicated or special initial positions.

10. Respiratory exercises: use as a mean of decline of the physical loading. What more respiratory exercises are in procedure of MG, the less loading.

11. Emotionality during conducting of procedure of MG: emotional employments are easier carried sick, give the best results, positive emotions take off or considerably diminish crushed of patient, which is conditioned diseases, and it promotes the effect of both medical physical education and medicinal treatment. Not emotional procedures cause the rapid fatigue of patients and diminish a desire to be engaged in a medical physical culture.

Determination of functional possibilities of organism.

Conducting tests with the physical loading, determine functional ability of organism at the physical loading and degree of his insufficiency; adaptive and compensate functional possibilities; fitness of patient to the different types of activity; adequacy of reaction on different in grain, intensities, to the volume physical loadings during employments of MPE.

Choosing a functional test, it is necessary to take into account age and floor of patient; degree of physical trained; character of disease; degree of violation of functions of the damaged organ or system; presence of concomitant diseases; stage of physical rehabilitation.

To define functional possibilities we can:

а) to explore the functions of organism on the whole, separate functional systems or organs in the conditions of rest. It lets to show functional and structural changes which characterize the degree of functional insufficiency, compensate and adaptive possibilities. The got functional parameters are compared to the proper theoretical or standard sizes taking into account age, floor, scales ;

б) to explore the functions of organism on the whole, separate functional systems or organs in the conditions of the standard or dosed physical loading.

Use 2 types of tests:

I.                      Tests, where the indexes of the cardiorespiratory system are determined after the standard physical loading. Here tests belong with squat, running, by jumps. Here take into account changes and terms of renewal of frequency of pulse, pressures, breathing. A basic task of tests on renewal is determination of reaction of the cardiovascular system on the physical loading. Most standardized is a test Martin. More detailed than see section ”Sporting medicine”, theme: ”Functional tests”.

II.                   Submaximal tests, where the indexes of the cardiovascular and respiratory systems get directly during loading and during the renewed period.

For conducting of necessary researches and providing of safety of patient during conducting of tests is needed: stadiometr, couch, medical weight, stop­watch, tonometer, electrocardiograph, lung­tester, defibrillator, simplest pulmotor, complete set for first medical care: set for intubation, syringes, анты is unrhythmical facilities, nitroglycerine, papaverine, aminophylline, adrenalin, strophanthin, solution of glucose, isotonic solution of chloride of sodium.

By absolute contra­indications to conducting

submaximal tests am:

Ø     carried less than 3 months back heart attack of myocard;

Ø     frequent attacks of cardiac angina;

Ø     insufficiency of circulation of blood II б ­ III, sharp myocardial ischemia, intensifying of chronic coronal insufficiency, threat of thromboembolic complications, shortages are hearts which are accompanied the overloads of myocard, atrio-ventricular blockade of II­-III st.;

Ø     violation of conductivity;

Ø     disease, where physical activity must be limited: sharp infectious diseases, myocarditises, pneumonias, malignant new formations, disease of blood.

Relative contra­indications to conducting of tests it is been:

Ø     vibratile arrhythmia;

Ø     early or groups extrasystoles;

Ø     blockade of legs of bunch of Gisa, syndrome of premature excitation of ventricles (WPW);

Ø     arterial pressure more than 200/100 mm.Hg.;

Ø     pulmonary insufficiency with diminishing of LC to 50 %;

Ø     table of contents of haemoglobin in blood less 60 %;

The different types of loadings draw on researches depending on a purpose:

–         permanent ­ for determination of physical ability to work of healthy people;

–         continuously increasing ­ during short time his power is increased to the threshold level or to the waiver of work;

–         increasing, intermittent­ his power is increased with short interruptions for rest;

–         increasing, continuous ­ his power is increased at a stretch for rest.

For determination of tolerance to the physical loadings rarer increasing, more frequent irregular loading. The inspected execute work under control ECG and arterial pressure. Every loading lasts 3­6 minutes, periods of rest 3­10 minutes. Duration of rest depends on the state of inspected and volume of researches.

The committee of experts of WHO(1971) recommends at bicycle ergometer for children and women to begin loading with 150 (25 Wt) and multiply every next loading on 150 (25 Wt); for men ­ with 300 (50 Wt) and to increase followings on 300 (50 Wt). For sportsmen there is the initial loading of 600 (100 Wt), and to multiply the next loadings on 600 (100Wt).

Depending on the state inspected power of loading and rate of his growth can change. In patients initial loading reduced ­ 60­120 (10­20 Wt).

Method of conducting of bicycle ergometry test of PWC₁₇₀ it is described in a section ”Sporting medicine”, a theme is ”Physical ability to work”.

Using the table of R. Shephard (1969) can be defined submaximal loading level for a test on steps (table 2). In a table indicated amount of gettings up on a double step after 1 minutes during 4 minutes. It answers 75 % maximal consumption of oxygen for the persons of different floor, mass, age. The estimation of results is conducted on a pulse, which measure after loading.

Table 2

Submaximal loadings for steppe­test and their estimation for the persons of different age, floor and mass of body

 

 

Note: in brackets puls is indicated for 1 minute.

Above every column a pulse which answers middle physical ability of men or women of certain age­old group is marked in brackets. If a pulse at inspected differs less, than on 10 per/ minutes от the middle index resulted in handles is physical ability him considered satisfactory, when pulse on 10 and more shots less average ­ physical ability is higher от middle, and when pulse on 10 and more shots exceed an average is physical ability low.

Executed work for the set time at steppe­test it is possible to expect after the formula of W = BW *H *T * 1,33, where W is loading, ВW is mass of body (kg), Н is a height of step (m), Т is an amount of gettings up after 1 minutes, 1,33 is a coefficient which takes into account physical expenses on an ascent from a step, which are made by 1/3 expenses up grade.

If necessary it is possible to conduct special functional тесы:

1.     For research of the vegetative nervous system are orthostatic and clinorthostatic tests ( it is described in a section ”Sporting medicine”, a theme is the ”Functional tests”).

2. Spirografichkie tests, which include the estimation of pulmonary ventilation (table  3), estimation of possibilities of adaptations of vehicle of the external breathing (LC, tests to Barbell, Genchi,), determination of character of violations of vehicle of the external breathing (obstructive, and the mixed changes), on indexes, which characterize bronchial ability (correlation between inhalation and exhalation) to travel cross­country, index of Tifno­votchala.

Indexes of the external breathing.

1.     Frequency of breathing of puls 16-­20 after 1 minute.

2.     Respiratory volume to 500–800 ml.

3.     Minute volume of breathing of MAUDE of 5-­8 l/min.

4.        Vital capacity of lights of LC in male 3,5-­4,5 l.

for the women of 2,5-­3,5 л.

5.Reserve volume of inhalation of 45­-55% LC.

6.        Forced vital capacity of lights of FLC in male 2,5-3,5;

for the women of 1,8­–2,5.

7.       Test of Tifno 70% LC.

8.       Maximal ventilation of lights of 70­120 l/min.

9.       Coefficient of respiratory backlogs of KDR = LC/MOD higher 8.

10.   Index of rate of movement of air of PSDV = MVL/LC 16-­20.

11.   Minute absorption of oxygen of MPO₂ 200-­350 мл.

12.   Coefficient of the use of oxygen of KIO₂ =MPR/MOD*100 35-­45 ml.

13.   Pnevmotakhometriya on видохе in male 4­8 l/sec

for the women of 3­6 l/sec.

14.   Delay of breathing on inhalation ­ 40sec

on exhalation ­30sec.

Table 3

Maximum norms and gradations of deviation from the norm of breathing indexes

 

 

3. Standard complexes of medical gymnastics with the dosed physical loading ­ used in patients at cardiovascular diseases (table 4). Estimate to on:

а) degrees of drawing on reserve of heart (РС)

РС = pula max. ­ pula of rest

Pula max. for patients 190 is evened is age.

б) reactions HELL is systole and pulse pressure must not go down;

в) dynamics of ECG: displacement of segment of ST and violation of rhythm and conductivity. At ischemic displacement of ST on 2 мм and it is anymore necessary immediately to halt loading, even when an attack of стенокардии yet is not.

                                                                                

Table 4

Complexes of medical gymnastics with the dosed physical loading

 

 

4.     Tests for determination of violations of motions in joints and degree of change of force of muscles at the diseases of musculosceletal vehicle (table 5, 6). These tests can be used for diagnostics of the functional state of organism and for control after efficiency employments of MPE.

а) the angular measurings of amplitude of motions in joints conduct a goniometer. The volume of motions is determined in degrees on the scale of goniometer. Amplitude of motion is a difference between the maximally possible bending and unbending in a joint.

                                                    

                                 

Table 5

Measuring of amplitude of motions is in joints

 

 

Table 6

Functionally is a motive test (Keitel W. et al., 1971)

 

 

At the performance of objective № 13­19 a patient can stick to hands for the back of arm­chair.

 

Massage is dosed mechanical operating on the bare body of man which is conducted the hand of masseur or special vehicles by the special receptions.

There is both a general reaction of organism at a massage and local in the area of operating on organs and fabrics because of mechanical irritation. The general reaction of organism takes place because of difficult associate reflex neurohymoral and neuroendocrinal processes which are regulated the higher departments of CNS. Irritants от receptors, which are in a skin, tendons, bags of joints, connections, muscles, walls of vessels (angioreceptors), internal organs (interoreceptors) on sensible ways passed in the central nervous system and achieve a cortex. Formed in CNS the proper reactions render assistance normalization of regulative and co­ordinating function, stimulations of regenerative processes. The general reaction of organism on a massage depends on the functional state of higher departments of CNS, от the functional state of the receptor field which gets a massage, от the clinical display of illness, от a dose, method of massage.

At the action of massage gistamin, acethylcholin appears in a skin. It is тканевие hormones which take part in the transmission of nervous impulses, in adjusting of vascular tone. Annoying the nervous system, they can give begaew reflexes. So, a basic mechanism of action of massage on an organism is a process of co­operation of nervous and hymoral factors. Except for it, a massage yet has the direct mechanical operating on the massed fabrics.

Influence on a skin. A skin forms the external cover of body of man, protects it from the harmful influencing. It is the enormous receptor field (area of skin of the grown man of 1,5-­1,6 m²), that is peripheral part of skin analyzers. She takes part in the exchange of matters, in adjusting of water and thermal exchange (80% heats, which produced in an organism, gives oneself up through a skin). Through days through a skin selected near 0,5-­0,6 l waters, with different is then selected salt, suckling acid, products of nitrous exchange. A skin is rich in the vessels of bloods. Consider that the one third of blood is in a skin. Changing the road clearance of vessels at reduction or weakening of skin muscles in reply to a nervous impulse, a skin takes part in adjusting of circulation of blood, here increased or diminishes influxes of blood to the internal organs.

A skin has 2 layers:

1.        External is an epidermis. The mews of epidermis роговеют and exfoliate. An epidermis does not have bloody vessels, therefore his feeds carried out a lymph and plasma of blood, which act after the cracks of intertissues from the layers of derma.

2.     Deep layer ­ actually skin, or derm which makes basis of skin; here are fibroblast, collagenic, elastic and reticularis fibres. In the deep layer of skin there are the stopped up glands of sweats, greasy, follicles of hairs, blood and lymphatic vessels, vegetative nervous fibres, taurus Meysnera ­ perceive a tactile irritation, taurus Fatera ­ Pachini is sense of pressure, taurus Ruffini is a thermal irritation, retorts of Krauze are cjld receptors irritations. All skiervous completions are related to central nervous system.

Under influencing of massage from a skin destroy the dead mews of epidermis, and together with them and microorganisms which are on the surface of skin. It renders assistance the improvement of a skin breathing, the secretory function of glands of sweats and greasy, their initial openings, is multiplied, in fact from an organism the products of disintegration are anymore selected. Due to a massage крово­ and lymph circulation is accelerated, venous stagnation diminishes, blood supply of skin, and and its feed is improved, resistance rises to the mechanical and temperature influencing of external environment. A massage improves the processes of exchange in the massed area, and because a skin takes part in all processes of exchanges of organism, a general exchange increases.

Under influencing of massage in a skin active histamine-lice matters appear physiological is causes a vasodilating effect which results in the redistribution of blood. Next to local influence on a skin through a peripheral nervous vehicle there is the reflex influencing on weigh organism.

Operating on muscles.

Muscles are active part of motive vehicle of man. All skeletal muscles consist of striated muscular fabric. Their reduction takes place at volitional effort of man. Therefore these muscles name an arbitrary musculature.

The muscular cells of internal organs are formed due to fat muscular fabric. Reduction of fat musculature does not submit wills of man, therefore she is named by voluntary.

Blood supply of muscles, as a rule, passes from a few arteries. With venous blood the products of exchange belong on veins. The well developed lymphatic vessels have muscles and closely associated with the nervous system. Motive and sensible nervous fibres fit for every muscle. They carry in a muscle nervous impulses from a head and spinal cord, cause his reduction. On sensible nervous fibres which have the completions in muscles and tendons, signals go about the state of muscles in a spinal and head cord. Under influencing of massage in muscles anymore acts oxygen and nutritives, the products of disintegration hatch quick. It conduces to the increase of elasticity of muscular fibres and retractive function, deceleration of muscular atrophy, and also to diminishing of hypotrophy of muscles, if she is developed. A massage is rendered by an assistance the increase of ability to work of muscles, accelerates renewal of ability to work after the physical loadings (fig. 3).

 

Mechanical action

Mechano-receptors (sensors of force, speeds, acceleration)

Proprioretseptory (muscular spindles, receptors of joints)

Skin-visceral reflexes (change activity of internal organs)

Lemnisc and spinothalamic ways

Segmental reflexes

Specific and unspecific kernels of thalamus, internal knee body, kernels of barrel of brain, hypothalamus.

Somatosensornya bark of large hemispheres of brain.

 

General answer for an action

 

Fig. 3 is Influencing of massage on mechano- and proprioreceptors.

Operating on joints. Joint that is intemmitent, cavernous, mobile connection. In every joint there are surfaces of joints of uniting bones, joint bag which surrounds the surfaces of joints of bones, joint emptiness which is into a bag between bones. Joints are simple, difficult, complex, combined. Under the action of massage blood supply of joint and periarticularis fabrics is improved, elasticity, durability of ligaments vehicle and mobility, is multiplied in a joint, resorbtion of joint exudation and pathologic deposits is accelerated in periarticularis fabrics.

Action on circulatory and lymphatic systems. The vessels of bloods divide by arteries, arterioles, capillaries and veins. On arteries blood flows от a heart to fabrics. Arteries on the current of blood gradually divide by less vessels and in the end transform at arterioles. The last in same queue disintegrate on the system of capillaries. Their walls are characterized the high feeling, due to what in capillaries an exchange passes by matters between blood and fabrics. Shallow veins which gradually meet and increased begin от capillaries.

The system of circulation of blood provides continuous circulation of blood, this is provide a transport function: to fabrics nutritives and oxygen are delivered and the products of exchange and carbon dioxide perch. Except for it, transporting hormones, enzymes and other matters, she unites an organism in one whole and carries out the hymoral adjusting of functions.

The lymphatic system is part of the vascular system. It is the ramified system of vessels with the knots placed on their motion. A lymph moves in the direction of large veins of neck, where it disembogues in blood. The lymphatic system together with veins provides suction from fabrics of water with the matters dissolved in her, and also colloid solutions of albuminous matters, emulsions of fats, bacteria, products of disintegration of mews which caot be sucked in in of the circulatory system capillaries. Speed of haemo- and lymph- circulation increases under influencing of massage, especially in capillaries. There is expansion of functionings capillaries, the unfunctionings capillaries of reserves open up. It renders assistance more active providing with of organs oxygen and nutritives, to more quick conclusion from the organism of products of disintegration, liquidation of the stagnant phenomena passes, the edemata of different origin resolve.

At abstinent expansion of vessels on periphery blood от internal organs is redistributed to the surface of skin and muscles, which improves work of left auricle and left ventricle of heart.

At implementation of receptions of massages there is the direct and reflex operating on local and common circulation of blood. Rhythmic motions of massages facilitate motion of blood on arteries and accelerate the outflow of venous blood (fig. 4)

Operating of massage on the nervous system. The nervous system regulates activity of all organs and systems of human organism, provides his connection as whole with an external environment. Yet I.P. Pavlov specified that the central nervous system can operate on organs triply:

1-      starting action, causes or stops the function of organ (reduction a muscle, secretion of gland);

2-      vascular­motive, changes the width of road clearance of vessels, regulating influxes of blood to the organ;

3-      trophic action, promotes or reduces the exchange of matters, and with it and the use of nutritives and oxygen.

The central nervous system perceives afferent (sensible) information, which arises up at annoying specific receptors and in reply to it forms the proper efferent impulses which cause change in activity of certain organs and systems of organism.

A massage, as irritant, foremost operates on the peripheral nervous system, and through the bark of large hemispheres on CNS. Conducting the different receptions of massages, it is possible to change the functional state of bark of main brain, promote or reduce general nervous excited, influence on reflexes, improve trophism of fabrics, and also activity of different internal organs. A massage influences also on the peripheral nervous system. This action shows up in the improvement of conductivity of nerves, weakening or disappearance of pain, the process of regeneration at the damage of nerve is accelerated, in warning of development of the second changes in muscles and joints on the side of damage of nerve.

Operating on the exchange of matters. A massage causes changes in the oxidation-reduction processes, influencing on the general exchange of matters. Under influencing of massage urinary excretion is multiplied, secreting of nitrous organic matters is thus multiplied: urea, urinary acid; from mineral matters ­ chlorous sodium, inorganic phosphorus.

Under influencing of massage the amount of haemoglobin, red corpuscles and leucocytes is multiplied.

Contra­indication to setting of massage:

1. sharp inflammatory process;

2. sharp states of fevers;

3.     haemorrhagic, bleeding or threat of their origin;

4.     disease of blood;

5.     festerings processes of different localization;

6.     disease of skin (eczema, deprive, dear pouring out, furunculosis, etc.);

7.     mycotic diseases of nails, to hair part of chapter;

8.     sharp inflammation, thrombosis, considerable varicose expansion of veins with trophic discords;

9.     endarteritis, complicated trophic violations, gangrene;

10. aneurysm of vessels;

11. inflammation of lymphatic knots;

12. disease of the vegetative nervous system in the period of intensifying;

13. active form of tuberculosis;

14. of high qualities and malignant tumours of dear localization;

15. psychical diseases with considerable excitation;

16. sharp cardiovascular, hepatic, kidney insufficiency;

17. pain syndrome.

Classification of massage and his kinds.

A massage can be general ­ in this case масируют all body, and local ­ when масируют certain part of body.

After character of conducting of procedures distinguish a hand and vehicle massage. Last divide on hydromassage, vibromassage, vacuum, pneumomassage, baromassage, synocardialis, jar massage.

Depending on the purpose of massage and от facilities which operate on the surface of body, a massage is divided into sanitary, medical, sporting, segmentary-reflex, cosmetic.

Sanitary massage it can be local and general. He is used as a mean of care of body, with a prophylactic purpose for safety and strengthening of health, increase of ability to work.

Medical massage – used as an effective method of treatment and prophylaxis of diseases. In a medical massage 4 select basic reception: stroking, grinding, fulling, vibration. Can be used in different modifications, has the testimonies and contra­indications.

Sporting massage used in athletic practice in different periods of athletic activity. In the period of trainings use with the purpose of strengthening and increase of physical ability to work, more quick renewal of sportsman; after competitions ­ for the removal of fatigue and more quick recreation.

Segmentary-­reflex massage – is based on the use of features of segmentar structure of body: annoying skin receptors of certain areas causes skin-vasceral reflexes of internal organs which innervating by those segments of spinal cord.

Cosmetic massage – used for the care of skin with the purpose of warning its senescence, at the cosmetic failings, diseases. It can be prophylactic, medical, plastic.

On the physiological operating on an organism a massage can be restorative and calming (fig. 5).

To the basic receptions of hand massage А.Ф.Вербов (1966) attributes:

1)     stroking, 2) grinding, 3) fulling, 4) vibration.

 

		Receptions of massages
Stroking		Grinding		Fulling				Vibration
		Restorative action
	Calming action

 

At implementation of massage it is necessary to toe such lines:

1.     Adopting a massage is carried out on motion of lymphatic vessels from periphery to the center (hands of mass from a brush to the elbow joint, then from an elbow joint to the armpit cavity, feet – from a foot to the knee a joint and to the inguinal area, pelvic­coccyx and lumbar areas of mass to the inguinal knots; back – from a spine in sides; neck – from a hair cover downward to the subclavicular knots; thorax – from a breastbone in sides to the cavities of arm­pits; direct muscles of stomach ­ from top to bottom; slanting muscles of stomach ­ from a top to the bottom (fig. 6).

2.     Lymphatic knots of not mass.

3.     Position of body at implementation of massage must be such, that tension of muscles was not.

4.     Mass by clean hands on a clean body.

5.     A masseur must constantly watch after the hands: for the night to wash warm water, to oil cream, shortly cut nails, save hands от damages.

6.     Adopting a massage must not cause feelings of pains.

7.     Mass near extremities, then distant.

8.     Beginning a massage is better from the dystal departments of body, to strengthen haemo- and lymph- circulation.

 

Sanitary bases of massage.

An apartment, where procedure of massage is conducted, must be light (luminosity of 120 ­- 150), dry, it is good to be ventilated. Temperature of air from +20 to +22С. In conducting of procedure of massage it must be quietly, must not be extraneous persons. A massage is conducted on the special couch. Its height makes 60-­80 see, length 185 -­ 200 see, width 50­-60 see. On a couch there must be a roller by the diameter of 25-­30 see. A roller is needed in order that at procedure of massage to give physiological position the lower endings for the best weakening of muscles (table 9).

In a massage cabinet there must be a closet for storage of clean sheets, dressing­gowns, towels, talc, washed, devices of massages, vehicles, other adaptations which are used during a massage; washstand with warm and cold water, two arm­chairs, writing desk with a registration magazine, carafe for a drinking­water, glass, screen. The presence of medicine chest is obligatory, where must be cotton wool, alcoholyc solution of iodine, sterile bandages, sparadrap, vaseline, disinfectant ointment, liquid ammonia, valerianic drops, powders, elastic bandage.

Before procedure of massage a patient must take warm shower, or to dry oneself a moist towel. For the greater effect of massage it is necessary to attain the complete weakening of muscles of the massed area of body. Such state comes on the average physiological position, when the joints of endings are arcuated under a certain corner. Quality of implementation of massage to a great extent is determined position of masseur in relation to a patient.

A masseur owes well to know an anatomy, topography of muscles, vessels, nerves; physiological action of separate receptions of massage, to conduct a diagnostic palpation inspection, quite to own a technique and method of massage. A masseur must always watch after the hands. They must be without scratches, cracks and callosities. At the fat skin of hands a masseur can use creams “Tomato”, “Viktoriya”, at a dry skin use creams “Velours”, “Peachy”, “Nectar”. Well such composition softens the skin of hands: glycerin 25g, liquid ammonia 2,5g, spirit of wine 96( ­ 5g).

Clothes must be lights, to free, not to forge motions. On hands there must not be objects which can injure the skin of patient. During a massage not to speak, breathe rhythmically, freely, in good time to change position of body.

Except for basic receptions there are different their variants are auxiliary receptions. Application auxiliary receptions are conditioned the anatomo-physiological features of the massed area of body, age, reason of patient, character and stage of disease. During conducting of procedure of massage all receptions are used, as a rule. Dollinger J. wrote, that ’’massage receptions, as separate tone of musics, never long sound one by one, but pass one in the second, meeting in a chord”.

Stroking. It is manipulations, where the hand of masseur freely slides on a skin with the different degree of pressure. At this reception a skin must not be displaced. It is needed to begin stroking and conclude procedure of massage; he is conducted in transition от one reception of massage to other.

Physiological action: a skin clears up от the dead mews of epidermis, tailings of secret of glands of sweats and greasy. A skin breathing and secretory function of skin is improved. The exchange of matters increases, skin-muscular tone rises, opening of capillaries of reserves passes. At stroking the ways of outflow of blood and lymph are freed, it renders assistance diminishing of edema, to more quick delete of products of exchange. This reception of massage operates calming or restorative on the central nervous system (depends on a method and dosage). Using stroking  in area of reflexogenic areas, we can attain a reflex therapeutic action on pathologic changed action of fabrics and internal organs.

Stroking is conducted:

by palm’s surface of eventual phalanx of finger (on the limited areas ­ at massaging of fingers, interdrupaceous muscles);

by palm’s surface of finger­tips (on face, joints);

by a back surface eventual and middle, or eventual, middle and basic phalanxes of arcuated in a fist fingers;

by the supporting surface of palm (back);

Stroking can be executed one or two hands.

Stroking is executed two hands:

separately simultaneously (one hand follows after the second);

at the same time (one hand is laid on on other);

separately gradually (both one or other hand);

 

Stroking can be conducted along, broadwise, zigzag, helicifom, колообразно (table 8).

The basic receptions of stroking it is been:

 

Auxiliary receptions of stroking:

stroking;

cruciform;

Table 8

Types of stroking

 

 

Methodical pointing.

1.     Poglaizhuvanie carry out at the maximally weakened muscles of the massed area and near­by parts of body.

2.     Can be carried out independently and in a complex with other receptions of massage.

3.     It is begun this reception and conclude a massage.

4.     Stroking is executed in transition от one reception of massage to other.

5.     During procedure of massage optionally to do all types of stroking.

6.     Stroking is conducted slowly and rhythmically.

7.     The planar superficial stroking can be carried out both after and against the current of lymph.

8.     At edemata, the lymphostasis stroking is begun from proximal areas.

9.     Stroking of muscles is carried out on motion of their fibres from a dystal department or tendom to proximal.

10. On different areas bodies are pressed with different force. Pressure must be large in the places of projection of large vessels, on the areas of considerable layer of fatty fabric, muscles, less ­ where appearances of bones, points of pains, promoted sensitiveness, are.

11. Stroking is preparatory procedure of the massed area to the next receptions of massages.

Grinding. It is displacement, movement, stretch of fabrics in various directions. Unlike stroking, here the hand of masseur does not slide on a skin is a skin of change together with a massage hand. Motions of massages can be both on motion of current of lymph and blood and in opposite direction. Direction of motions of massages is determined configuration, anatomic structure of joints, tendom, muscles.

Physiological action. Because of displacement and the stretch of fabrics takes place annoying receptors which are caused by expansion of vessels and acceleration of blood stream. To the massed fabrics acts anymore to oxygen and nutritives, quick destroy the products of exchange. Due to grinding the movable of fabrics is multiplied, scars, connections, stretch, a retractive function and tone of muscles increases. Conducting the energetic grinding in the places of nervous completions or on motion of nervous barrels, the declines of excited of nerves and diminishing of pain arrive at at neuritises, neuralgias.

Grindings conduct:

1)  by palm’s surface of eventual phalanx of one finger (large, indicatory, middle), or palm’s surface of 2­3 fingers (in the places of output of nerves, in area of bags of joints, at muscular consolidations);

2)  by palm’s area of tenor or hypotenor;

3)  by the elbow edge of brush;

4)  by a fist;

5)  by appearances of bones of phalanxes of fingers, arcuated in a fist;

Grinding can be done longitudinally or transversal, by one or two hands.

Basic receptions of grinding:

Rectilineal – execute the eventual phalanxes of one or a few fingers.

Circle – execute the eventual phalanxes of fingers with support on І finger, or on basis of palm. It is possible to conduct palm’s surface of half­bent fingers or one finger; with burdening; by one or two hands; by turns.

Spiral – execute basis of palm or elbow edge of brush, arcuated in a fist.

Auxiliary receptions of grinding:

Grableobraznoe – conduct appearances of bones of middle phalanxes of fingers, compressed in a fist. It is possible to execute rectilineal, spiral.

Sawing– both hands pin the elbow edge of brushes or hands against the massed area and conduct grinding in opposite directions (one hand on itself, second – от itself). Hands must be parallel between itself and athwart to length to the muscle. Distance between the hands of masseur of 1­3 see. Between brushes must arise up roller from the massed fabric. Brushes have to move it, instead of to slide on the surface of skin. When this reception is conducted the radial edges of brushes ­ he is named crossing.

Shadings – conduct the pillows of eventual phalanxes – ІІ – ІІІ or ІІ – the V fingers. Fingers are lines, maximally unbended. They are placed under the corner of 30( to the massed surface. Pressing on short forward motions, displacing fabrics, hands move in certain direction both longitudinally and transversal.

Planing it is position of hands as well as at shading. It is immersed short forward motions at fabric and to rapid pressure conduct a stretch and displacement of fabrics.

Schiptseobraznoe – execute eventual phalanxes І – ІІ, or І – ІІІ fingers. Fingers are placed as tongs. Motions are rectilineal or circular. Use for the massage of tendons, shallow muscular groups, auricle, nose.

Methodical pointing.

1.     Grinding prepares the massed fabrics to fulling.

2.     Motions at grinding are conducted in various directions, regardless of current of lymph.

3.     Grindings conduct slower what stroking.

4.     To influence stronger on fabric, it is necessary to multiply a corner between the fingers of masseur and massed surface or conduct a reception with burdening.

5.     Grindings alternated with stroking.

Mashing. It is a reception, where a masseur takes, draws off, displaces, stretches, squeezes, squeezes.

Physiological action. Because of mashing haemo- and lymph- circulation is multiplied in muscles. It renders assistance activation of oxidation-reduction processes, diminishes, or quite disappears, muscular fatigue, ability to work of muscles, their tone, is multiplied. Mashing is a passive gymnastics for muscles.

During mashing there is annoying the receptors of muscles, tendons, connection, bags of joints, fascia. The state of the central nervous system and neuro-muscular vehicle changes hereupon. The excited of CNS and tone of muscles goes down at the slow rate of mashing, and vice versa ­ they rise at rapid, superficial and short at times reception mashing.

Mashing is conducted:

1)       by palm’s surface of eventual phalanx І­ІІ, І­ІІ­ІІІ fingers;

2)       by all fingers;

3)       by appearances of bones of middle phalanxes of fingers, compressed in a fist;

Mashing can be conducted one or two hands in various directions.

Mashing is continuous and uneven.

Adopting mashing is conducted in three stages:

1.     A brush is densely put on the massed muscle (from one the sides there is a large finger a muscle, from other ­ ІІ are the V fingers). Muscle it is wrung out a brush aside ІІ ­ the V fingers.

2.     Seize and squeeze a muscle between fingers and displace him toward a large finger.

3.     By basis of brush a muscle is pinned against a bone bed and return into previous place.

A transition from one stage to other must be gradual, smooth, without stops.

Ordinary mashing. Execute one hand. Take the massed muscle, lift, squeeze between fingers, gradually moving up on his length.

 

Ring in transversal direction. Execute two hands. A masseur puts both brushes across motion of мышечных fibres. Large fingers are from one the sides to the muscle, other ­ from the second; the elbows of masseur are dilute in sides. In the case of the one-directional mashing a muscle is displaced toward large fingers, at different-directional one hand change muscle on itself, other ­ from itself, moving up gradually on length to the muscle.

Mashing two hands is in longitudinal direction. Take a muscle two hands from different sides. Large fingers from above to the muscle, handing over from below. It is pressed large fingers, wring out a muscle; ІІ ­ the V fingers are squeeze a muscle from below. Motions on length must a muscle be soft, gradual.

Uneven mashing execute because and continuous, but hands move with a shove, rhythmically, squeezing fabrics.

Auxiliary receptions of mashing.

Pressing out. Massed a muscle is deeply taken, defer upwards and skip between large and ІІ, or large and handing over fingers. It is possible to execute one or two hands.

Fulling. The surfaces of palms’s are take the massed surface from two sides. Brushes place parallel, fingers at to it lines. Motions are conducted in opposite directions. Apply on endings.

Rolling. Press in the depth of fabrics the elbow edge of brush of one hand, the second hand is take fabrics, roll from above the first and mash between hands. Rolling can be conducted on separate fingers, fist. Apply for the massage of stomach, lateral surfaces of the back.

Displacement. The fabrics taken a fold move short rhythmic motions from a bone bed in longitudinal or transversal directions. Conduct the backs on muscles, in the case of changes of scars of skin, at paralyses, paresises.

Pinching. Execute large and index fingers, one or two hands. A muscle is taken, pull up upwards, pull and release. Necessarily combined with stroking. Apply in the case of deep scars.

Stretch. Execute the large fingers of hands, І і ІІ by fingers. They are laid from two sides of the massed area, press or grasp fabrics and stretch in opposite directions. Use at presence of scars, connections, corrugation, at muscular contarture, diseases of nervous barrels.

Pressure. Execute irregularly the ends of large and index fingers in the places of output of nerves, on the muscles of person.

Methodical pointing.

1.     Muscles must be weakened and to occupy physiological position.

2.     Mashing is conducted in various directions, slowly, fluently, without jerks, to 50­-60 motions for a minute.

3.     A reception must be begun from the place of transition a muscle at tendon, at first to conduct the easy superficial mashing and gradually to pass to more energetic deep.

4.     After mashing it is necessary to conduct stroking.

Vibration. It is a grant the massed surface of hesitating motions by the hand of masseur.

Physiological action. A vibration causes the proper reactions of organism on the type of skin-visceral, moto-visceral and viscero0visceral reflexes (М.Р. Mogendovich, 1963).

A vibration is conducted:

1)       by palm’s surface of eventual phalanx of one finger (point vibration);

2)       by palm’s surface І і ІІ fingers;

3)       by palm’s surface І, ІІ and ІІІ fingers or ІІ and ІІІ fingers, І і all handing over of fingers;

4)       by a palm;

5)       by a fist;

6)       by the elbow edge of brush.

A vibration can be continuous and irregular.

During a continuous vibration the hands of masseur, not torn away from the massed surface, carry out rhythmic, different amplitude hesitating motions. If a hand here moves along the massed area is a instable vibration, when a hand does not move ­ stable.

During an uneven vibration after every touch to the massed surface the hand of masseur is torn away from a skin, I.e. short, rapid, rhythmic shots are executed. These shots can be executed one or two hands. A brush moves only in a radiocarpal joint. After implementation of blow of her immediately tear away from the massed area.

Auxiliary receptions of vibration.

Concussion. Execute hands or tags І і ІІ fingers which are placed from two sides of the massed segment. A masseur conducts rapid hesitating rhythmic motions in horizontal or vertical direction, as at sifting of flour through a sieve. It is possible to conduct on a stomach, thorax, larynx.

Shaking off. Execute on endings. A masseur takes the brush of patient both hands, and by hesitating motions in vertical direction, executes rhythmic, with small amplitude of shaking off. Muscles of ending must be maximally weakened.

Пунктирование. Execute palm’s surface of ends of index and middle fingers. Motions similar to work on a printing­press. Conduct in the places of output of nerves, in the sites of fracture, on small muscles, tendon.

Deck­house. Execute the elbow edge of brush. A brush is in middle position between pronation and supenation. Fingers are dilute and weakened. Hands in the joints of elbows are arcuated at right angles. Hands move quickly, rhythmically, motions only in a лучезапястном joint. Strike the little finger of the right and left arm in the distance 2­3 see at a speed of 250 -­ 300 after 1 min.

Popleskivanie. Executed palm’s surface of brush, finger a little arcuated; it is possible to conduct a fist. Brushes bend and unbended in a radiocarpal joint. An air pillow appears between a palm and skin.

Methodical pointing.

1.     A vibration must not be pain.

2.     Intensity, force of action during a continuous vibration depends on a corner between the brush of masseur and massed surface, what corner nearer to 90, the more so strong action.

3.     Execution of receptions of shocks time in one area must not exceed 10 seconds.

4.     An irregular vibration is forbidden to conduct thighs on an internal surface, popliteal pit, places of projection of internal organs.

 

 

Table 9

NORMS OF CALCULATIONS OF TIME IN CONDITIONAL UNITS ON IMPLEMENTATION OF PROCEDURES OF MASSAGES

(in obedience to the order of Ministry of health of Ukraine

от “31” 12 1992 y. № 211)

 

 

NOTE:

1.       For one conditional massage unit there is the accepted massage procedure (direct conducting of massage), on implementation of which 10 is needed min.

2.       Time of transitions (moves) for implementation of procedures of massages outside a cabinet taken into account in the conditions of units of massages after actual costs.

Areas of Zakhar’ina ­ Geda and their value in determination of area of massage.

Organism of man ­ one whole. Diseases, which arises up in an organism it is needed to examine as illness of all organism, instead of local process.

A spinal cord in the process of development acquires a segmentary structure. Every spinal nerve of innervating is a certain area of skin of the proper segment (dermatome). Dermatome are skin areas which engulf a body от a middle line behind to the middle line ahead. Connection a segment is a spinal nerve ­ dermatome remains unchanging.

Irritation from internal organs passed through likable and parasympathetic nervous systems (table 10).

 

Table 10

Physiological action of sympathetic and parasympathetic nerves

 

 

The areas of transmission are designated on spinal segments which innervating them. Therefore according to the output of nerves distinguish such segments of spinal cord:

8 neck (With₁ – With₈);

12 breasts (D₁ – D₁₂);

5 lumbar (L₁–L₅);

5 coccyges (S₁ – S₅);

Table 11

Segmentary innervation of internal organs

(from data of different authors)

 

 

These reflex changes can arise up at the diseases of internal organs:

а) on a skin (viscero-cutanes reflex of Zagar’ina ­ Geda) as hypertension in dermatome, that answer the segments of spinal cord;

b) in muscles (viscero-­motor reflex of Makenzi, 1921): tonic long tensions of transversely striated muscles of body;

c) in hypodermic connecting fabric (Leube I Dicke,1948);

d) in vessels (viscero-­motor  reflex): at coronarospasm on left of thorax look after expressed and long dermographism;

e) in periostal fabric (viscero-periostal reflex of Foglera­krausa (Wogler I Kraus, 1955)): origin of the limited rolle-like bulges on ribs at the diseases of the cardiovascular system;

f) there can be local changes of temperature of skin in the projection area of sick organ, sweat production, conductivity of skin rises.

 

Because of operating of massage on certain segments there are the proper reflex reactions in an organism: circulation of blood is improved, there are changes of cellular metabolism. It renders assistance normalization of intercommunications in sick fabrics and organs, which is positively removed on the flow of illness.

Use stroking, grinding of eventual phalanxes of fingers, mashing, vibration palm’s surface. A considerable place is taken auxiliary receptions: shading, planing, displacement, squeezing.