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GBOU HPE Rostov State Medical University of the Ministry of Health of the Russian Federation

Department of Internal Medicine with the basics of general physiotherapy No. 2

Methods of medical rehabilitation for cardiovascular diseases

Candidate of Medical Sciences, Ass. Levitskaya E.S.

Characteristics of diseases of the cardiovascular system:

• CSDs are the most common socially significant diseases throughout the world and more often than others lead to disability and mortality:
• Russia ranks first in the world in terms of mortality from the most common chronic diseases - cardiovascular diseases (CVD), in particular coronary heart disease (CHD), and cerebrovascular diseases.

Shalnova S. A., Conradi A. O., Karpov Yu. A. et al. Russian Journal of Cardiology. 2012. - 5 (97) – p. 6-11

Vascular diseases of the brain in Russia: reality and prospects for solving the problem. Suslina Z.A. 10-05-2011

Mortality from CVD per 100 thousand population in the Russian Federation

Mortality in working age

Characteristics of diseases of the cardiovascular system (2):

2. A large number of young people of working age suffer from chronic and acute myocardial ischemia

3. Decreased quality of life and social activity of patients

4. Steadily progressing diseases

Possibility of influencing the course of cardiovascular diseases:

• Prevention (primary, secondary)
• Treatment (non-drug, medicinal, surgical) aimed at the cause of the disease, slowing down pathogenetic mechanisms, the development of complications, symptomatic
• Rehabilitation

Cardiac rehabilitation –

These are comprehensive (integrated) long-term programs that include a medical assessment of the patient’s functional state, physical exercise (training) prescribed based on individual exercise tolerance, modification of cardiac risk factors, patient education and counseling.

Comprehensive rehabilitation programs are designed for:

• modification of risk factors
• slowing down the structural restructuring (remodeling) of target organs
• reducing the risk of sudden death
• improved cardiovascular prognosis
• monitoring heart disease symptoms
• stabilization of the pathogenetic process of CVD development
• improving psychological and professional status

Rehabilitation phases

I. Hospital phase (Phase I) – period of inpatient treatment in the hospital

diological (cardiac surgery) department of the clinic, hospital

about an acute case of illness

II. Early post-hospital (intermediate) phase (Phase II, re-phase)

convalescence)– recovery period after discharge from cardiology

medical (cardiac surgery) hospital, lasts up to 12 weeks after

acute case of the disease. Rehabilitation is carried out in rehabilitation centers, in health care facilities at the patient’s place of residence.

III. Late post-hospital phase (post-convalescence) (Phase III)–

4-6-12 months duration after an acute case of the disease.

Long-term supervised outpatient cardiac rehabilitation programs: duration of at least 6 months after phase II

IY. Phase IY (maintenance) – long-term outpatient rehabilitation period, lasts indefinitely, ideally throughout the patient’s life

Comprehensive cardiac rehabilitation is a process that should:

Start immediately

Continue continuously

Conducted in stages

Based on the individual characteristics of the patient

Carried out in a manner acceptable to the patient and his environment

Comprehensive cardiac rehabilitation should include the following elements:

Assessment of the patient’s clinical condition

- optimization of pharmacological treatment

Physical rehabilitation – a stepwise and controlled increase in physical activity, adapted to a person’s individual capabilities

Psychosocial rehabilitation, the purpose of which is to teach the patient to help himself in stressful situations, emotional states such as fear and/or depression, and to develop the ability to psychologically adapt to the consequences of the disease;

- diagnosis and control of so-called “risk factors” for the development of CVD

- lifestyle changes

- education of patients and their relatives

- “tracking” the effects of rehabilitation programs

REHABILITATION

Correction of CVD risk factors

Increasing the “functional reserve” of the cardiovascular system

Continuous, optimal drug therapy

• Diet therapy
• Weight loss program
• Physiotherapeutic methods
• Balneotherapy, hydrotherapy, heat therapy

Medical aspect of rehabilitation

Physical aspect of rehabilitation

Psychological adaptation

Psychological aspect of rehabilitation

Non-drug prevention

Professional aspect of rehabilitation

One of the reasons for such high mortality and morbidity rates of CVS is multifactorial environment modern patient, leading to damage to the vascular endothelium

Among more than 250 known risk factors, WHO experts identified the 7 most significant:

• Arterial hypertension
• Hypercholesterolemia
• Smoking
• Obesity
• Low consumption of vegetables and fruits
• Physical inactivity
• Excessive alcohol consumption

Oganov R.G. et al., 2008 Podzolkov V.I., 2011, Shilov A.M., 2011.

Smoking is death from “pleasure”

• More and more young people and women are taking up smoking
• Smokers have a 70% higher risk of developing coronary heart disease compared to non-smokers
• 80% of high mortality can be attributed to smoking-related diseases
• The risk of developing CHD increases with the number of cigarettes smoked, duration of smoking, age at smoking initiation, and smoke inhalation

SMOKING

Release of adrenaline-like substances into the blood

Damage to the vascular endothelium and dependent organs

Effects of nicotine

Severe spasm of all blood vessels

CVD, pathology of the respiratory system, cancer, impotence

High mortality rate

Increased platelet aggregation

Common diseases of the cardiovascular system:

• Impact on metabolism in order to slow down the progression of diseases (HD - reducing the consumption of table salt, IHD - animal fats, etc.)
• Compliance with diet
• The completeness of a diet containing products of animal and plant origin
• Accounting for calorie content and chemical composition of main products and dishes
• Nutritional therapy should take into account the underlying and concomitant disease

Principles of therapeutic nutrition for ischemic heart disease (anti-atherosclerotic diet):

• Reduce your overall fat intake
• Dramatically reduce the consumption of saturated fatty acids (animal fats, butter, cream, eggs). Up to 10-15 g/day
• Increase consumption of foods enriched with polyunsaturated fatty acids (liquid vegetable oils, fish, poultry, seafood)
• Increase your intake of fiber and complex carbohydrates (vegetables, fruits). Amount of fiber in diet 35 mg/day

Principles of therapeutic nutrition for ischemic heart disease (anti-atherosclerotic diet) (2):

5. Replace butter with vegetable oil when cooking

6. Drastically reduce the consumption of foods rich in cholesterol (fatty meats, fish, caviar, butter, cheeses, chocolate, whole milk products, egg yolks)

7. Reduce the amount of sugar (no more than 40-50 g/day)

8. Limit the amount of table salt in food (up to 3-5 g/day)

Principles of therapeutic nutrition for ischemic heart disease (anti-atherosclerotic diet) (3):

HEALTHY!:

9. Seafood containing organic iodine and rich in polyunsaturated fatty acids: squid, mussels, shrimp, seaweed)

10. Products containing chromium (corn, cereals (pearl barley, buckwheat), bread, vegetables, meat)

11. Vegetarian, fruit, dairy (with skim milk) soups. Meat and fish broths are limited to 1-2 times a week.

Principles of therapeutic nutrition for

hypertension:

• Exclusion of products that stimulate the central and cardiovascular systems (strong meat and fish broths, strong tea, coffee), causing increased gas formation, bloating (for example, beans, peas, carbonated drinks)
• Reducing the content of table salt. Refusal of foods containing a lot of salt (herring, smoked meats, canned fish, pickles, etc.), not adding enough salt
• Low intake of 1-3 g salt/day
• “ideal” intake of 2-5 g of salt/day
• Moderate consumption of 8-12 g of salt/day
• High intake of more than 15 g of salt/day

Principles of therapeutic nutrition for

hypertension (2):

4. Reducing dietary intake of saturated fats and enriching the diet with unsaturated fats

5. Enrichment of the diet with foods containing magnesium and potassium

• Potassium is actively involved in the accumulation of energy in the heart muscle, has a diuretic effect, promotes the excretion of sodium (potatoes, lean meat, barley, oatmeal, millet cereals, cabbage, pumpkin, apricots, prunes, dried apricots, milk, cottage cheese, etc.)
• Magnesium – vasodilator effect, preventing vascular spasm (rye and wheat bread with bran, oatmeal, wheat, barley, buckwheat, corn, beans, peas, soybeans, beets, parsley, walnuts, almonds, raisins, etc.)

Principles of therapeutic nutrition for

hypertension (3):

7. It is possible to periodically alternate a hyposodium diet with a magnesium diet, which is prescribed in the form of 3 diets for 3-4 days each day (normalization of vascular tone, blood pressure, increased diuresis, decreased cholesterol levels)

8. In case of severe hypertension, the Kempner diet (rice-compote diet) is possible for 3-4 days:

• Rice porridge + compote (6 times a day, 1 glass) – 50 g rice, 100 g sugar, 1.5 kg fresh or 240 g dried fruit
• Ingredients: 10 g protein, 0.4 g fat, 308 g carbohydrates, 1276 kcal

• Limiting salt intake:
• FC I – do not eat salty foods (up to 3g salt)
• II FC – plus do not add salt to food (up to 1.5 g of salt)
• III FC – plus products with reduced salt content and preparation without salt (less than 1.0 g of salt)

2. Limiting fluid intake:

• relevant only in extreme situations: with decompensated severe CHF, requiring intravenous administration of diuretics
• in normal situations, it is not recommended to increase the volume of fluid more than 2 l/day (minimum fluid intake is 1.5 l/day)

3. Food should be easily digestible, with sufficient vitamins and protein.

4. Reducing foods rich in fiber and cholesterol, which cause flatulence

5. Enrichment of products with potassium and magnesium salts

Principles of therapeutic nutrition for

chronic heart failure:

The goal is to facilitate the activity of the cardiovascular system, improve the pumping function of the heart, reduce the peripheral vascular resistance, improve the metabolism of the heart muscle, increase diuresis, spare the digestive organs and kidneys

Excessive accumulation of adipose tissue

Hormonal and metabolic abnormalities

Insulin resistance and hyperinsulinemia

Sodium and water retention

Increased activity of the sympathetic nervous system

Increased RAAS activity

Increased adipocytes

Release of a large number of biologically active substances that affect vascular tone, for example:

Angiotensinogen;

Angiotensin II;

Interleukins;

Prostaglandins;

Tumor necrosis factor-α;

Leptin et al.

Progression of hypertension, ischemic heart disease, increased risk of developing AMI, TIA/cerebrovascular accident

Principles of weight loss:

• Reducing the energy value of the diet and increasing physical activity. Calorie content – ​​not less than 1000 kcal/day and not more than 1500 kcal/day
• Frequent meals in small portions (5-6 times a day)
• The recommended volume of liquid is at least 1.5 liters of water
• Inclusion in the diet of foods containing large amounts of fiber, vitamins, minerals, a balanced set of proteins and amino acids.

Principles of weight loss (2):

5. It is not recommended to consume: sweet and carbonated drinks, strong tea and coffee, alcohol, fatty and fried meat, sausages, smoked meats, canned food and other products with a high content of table salt, butter, margarine, confectionery, starches and pasta, spices, herbs, sugar, cheese, sour cream, cream

6. Fight against physical inactivity - walking, light jogging, swimming

Pedometer is a means of monitoring the patient’s daily physical activity, used to combat physical inactivity

MECHANISMS OF ACTION OF FU

Stimulating

action

Trophic

action

Compensatory

action

Medicinal

action

General training

action

Therapeutic exercise (physical therapy)

is a mandatory component of physical rehabilitation programs for cardiovascular diseases

The selection of exercise therapy programs should be carried out individually, taking into account the severity of the disease, its nature, and the patient’s age

Exercise therapy modes

I. Gentle

II. Gentle-training

III. Coaching

Motor activity modes:

Strict bed rest

Bed rest

Semi-bed rest

Free mode

MODES IN SANATORIUMS:

Gentle mode

Gentle training mode

Training mode

Secondary prevention

Primary prevention

Principles of using exercise therapy:

1 - individual approach

2 - strict dosage

3 - regularity

4 - gradual increase in load

5 - continuity of selected forms and methods

6 - control of load tolerance and effectiveness

The initial rate and volume of FU is minimal for each patient, followed by a gradual increase

Before prescribing exercise therapy to patients with cardiovascular diseases, it is necessary to conduct an exercise test (bicycle ergometry or treadmill test) to assess the possible risk of complications and determine the safe volume and intensity of physical exercise

• for arterial hypertension (hypertension)
• for coronary heart disease (including stable angina and after myocardial infarction)
• for chronic heart failure
• after a stroke
• after cardiac surgery (coronary artery bypass grafting, angioplasty, replacement of heart valves and great vessels, heart transplantation, surgical remodeling of the LV, reconstructive operations on the aorta)
• after implantation of devices that support heart rhythm
• for obliterating diseases of the main and peripheral arteries

Contraindications to exercise therapy for cardiovascular diseases

• Crisis course of arterial hypertension
• Heart rhythm disturbance
• Acute stages of cardiovascular disease (myocarditis, endocarditis, unstable angina and acute myocardial infarction, etc.) and pathology of other organs and systems, until hemodynamics and clinical laboratory parameters are stabilized
• Development of an attack of severe weakness and severe shortness of breath during physical activity

Objectives of exercise therapy for diseases of the cardiovascular system:

Acceleration of recovery time after MI and other ACS, stroke, cardiac surgery, etc.

Normalization of impaired regulation of cardiac activity and vascular tone

Restoring normal adaptation to physical activity and physical performance

Increasing the effectiveness of complex therapy (drug, non-drug)

Slowing down further progression of the disease, reducing the risk of complications and premature death

Normalization of the psycho-emotional sphere and general condition

Results of regular exercise therapy sessions

• Decrease in heart rate and blood pressure at rest and during exercise
• Physical exercise tolerance increases significantly
• Collateral and peripheral circulation improves
• Improves myocardial contractility, oxygen and energy utilization by cardiomyocytes
• Increased cardiac efficiency and coronary reserve
• The secretion of catecholamines, the content of lipids and blood glucose decreases
• The activity of the blood anticoagulation system increases and the risk of thromboembolic complications decreases

FORMS of exercise therapy for diseases of the cardiovascular system

Therapeutic gymnastics procedure

Morning hygienic exercises

Independent studies

Dosed walking

Close-range tourism

Games, swimming

Exercise therapy for diseases of the cardiovascular system

General developmental exercises

Breathing exercises (static, dynamic)

Dynamic exercises for medium and small muscle groups

Weight and Resistance Exercises

Exercise therapy methods

Controlled (carried out in medical institutions)

Uncontrolled or partially controlled

(at home according to an individual plan)

Group

Individual

FU classification

By independence:

• active (performed entirely by the patient himself)
• passive (performed by a patient with impaired motor functions with the help of a healthy limb, an exercise therapy instructor or a special simulator)

According to physiological principle:

• isometric (static)
• isotonic (dynamic or locomotor)
• resistance exercises (combination of isometric and isotonic).

for certain muscle groups(muscles of the arms, legs, respiratory muscles, etc.)

Stages of physical rehabilitation after AMI:

• First stationary: up to 10-15 days in the absence of complications in the early subacute period of the disease, in the presence of complications in the acute and early subacute period - individualized length of hospital stay
• Second inpatient (inpatient rehabilitation department) – 16 days.
• Outpatient clinic (dispensary), sanatorium

Due to the early activation of patients with myocardial infarction (MI), physical rehabilitation at the inpatient stage must begin as soon as the patient’s clinical condition allows.

Physical rehabilitation measures should be carried out in the absence of the following contraindications:

• symptoms of cardiogenic shock (pallor, cold sweat, low blood pressure, etc.)
• symptoms of acute heart failure (pulmonary edema, cardiac

3. severe forms of arrhythmias (over- and ventricular tachycardia, complete

atrioventricular block, group extrasystole)

4. presence of anginal pain

5. increase in body temperature above 38 ° C

Algorithm of rehabilitation measures in patients with acute myocardial infarction at the inpatient stage

Development of AMI

No contraindications

• step-by-step mobilization on days 1-2 of AMI in the absence of pain
• FU for small muscle groups
• breathing exercises

Cardiology department

FN tests (5-13 days after the onset of AMI)

Various schemes of rehabilitation programs taking into account the severity of the condition

training small muscle groups using an expander, exercise on an exercise bike, dosed walking, therapeutic exercises, etc.

An example of step-by-step mobilization on the first day of AMI

1st stage: limited movements in bed aimed at improving

venous circulation, breathing exercises, muscle relaxation exercises. The patient is allowed to sit with support and use a razor

2nd stage: in addition to the above, the patient is allowed to sit in bed without support

3rd stage: the patient is allowed to sit in bed with his legs dangling, and then sit on a chair for a while

4th stage: walking around the ward is allowed

5th stage: special exercises to mobilize the patient begin

6th stage: the patient is allowed to walk along the corridor and climb several steps of the stairs

7th stage: Walking in outerwear and outdoors is permitted.

Algorithm of rehabilitation measures for patients with acute myocardial infarction at the outpatient stage

The goal is to maintain and develop physical performance, readapt the patient to everyday and work stress

Physical activity includes:

• therapeutic and hygienic gymnastics classes
• measured walking
• various sports games
• intensive physical training (according to indications)
• physical activity in connection with everyday household stress, subsequently, after going to work - in connection with professional responsibilities

N.B.! Individual selection of rehabilitation programs, taking into account physical and mental preparedness!

Methods for monitoring the effectiveness and tolerability of FU

• Clinical(survey, examination): patient’s tolerance to FU, appearance of “new” symptoms of the disease, sensations associated with deterioration of the central nervous system (dizziness, loss of consciousness, flashing “spots” before the eyes, etc.)
• Biochemical: a standard set of blood tests monitored in patients with CVD (lipid profile, blood coagulation system, etc.)
• Instrumental: all types of ECG, ABPM, stress tests, echocardiography, etc. when indicated

Types of massage for cardiovascular diseases

Classical

Relaxing

Collar zone

Scalp and forehead area

Auricles

Massage

• Increases the effectiveness of physical activity
• Improving blood and lymph circulation in the tissues and organs of the chest
• Promotes moderate expansion of peripheral vessels
• Facilitation of the work of the LA and LV, improvement of the pumping function of the heart
• Reducing congestion in the circulatory system
• Metabolic processes and oxygen utilization improve

Contraindications for massage:

Angina pectoris class IV

Fresh inflammatory processes in the heart valves and myocardium

hypertension

Physical factors are prescribed aimed at eliminating ANS dysfunction (hypersympathicotonia and hyperkinetic type of hemodynamics) and correcting the functional states of the central nervous system.

• Methods of neurotropic pulse therapy:
• Electroson(using a sedative technique with orbitomastoid application of electrodes, 10-20 procedures per course)
• Electrotranquilization(frontomastoid technique, 10-20 procedures)
• Mesodiencephalic modulation(with individual choice of shape and intensity of pulse and current 10-15 procedures)
• Low frequency pulse therapy(using DDT, SMT and interference currents, from 7-8 to 10-2 procedures)
• Magnetotherapy- on the frontal area. If there are contraindications to low-frequency pulsed currents (10-15 procedures)
• Anodic galvanization or galvanic collar according to Shcherbak(10-12 procedures)
• Drug electrophoresis(Mg2+, Ca2+, K+, papaverine, aminophylline, novocaine, no-spa, platifillin). (8-12 procedures)

Physiotherapeutic methods of treating patients

hypertension (2)

• Bioresonance therapy: Bemer therapy, PERT therapy (using an inductor in the form of a mattress, 10-15 procedures)
• Low-intensity laser radiation of the infrared range(3 points paravertebral to the cervicothoracic spine CVII-TIV, course 8-10 procedures)
• Ultrasonic exposure on the sinocarotid area (8-10 procedures)
• Aeroionotherapy(course 10-15 procedures)
• Aerophytotherapy (inhalation of essential oils of vanilla, orange, ylang-ylang, hyssop, lemon, marjoram, juniper, fennel, cypress, geranium, lavender, rosemary)
• Halotherapy(course 10-20 procedures)
• Ozone therapy(IV, 10 infusions)

Physiotherapeutic methods of treating patients with coronary artery disease

It is aimed mainly at normalizing the central mechanisms of blood circulation regulation with increasing myocardial oxygen consumption, myocardial contractility and exercise tolerance, as well as reducing vascular peripheral resistance and normalizing autonomic reactions. .

• Electroson using sedative technique
• Magnetic and laser therapy
• Drug electrophoresis
• Aeroionotherapy
• Aerophytotherapy includes inhalation of vapors of essential oils of orange, lavender, rose, mint, lemon balm, hyssop, anise, geranium, ylang-ylang, marjoram
• Ozone therapy
• Halotherapy
• Bemer and PERT therapy
• Neurotropic impulse therapy
• Magnetotherapy
• Electrophoresis

Physiotherapeutic methods of treating patients after AMI

17-23 days after the onset of acute MI, patients can be prescribed:

• Electroson using sedative technique
• central electroanalgesia
• drug electrophoresis
• low frequency magnetic field
• laser therapy (BLOCK, etc.)
• climatotherapy (aerotherapy and heliotherapy)
• balneotherapy ( carbon dioxide, sulfide, radon, oxygen, iodine-bromine baths, etc. )

Physiotherapeutic methods of treating patients after cardiac surgery

For the rehabilitation of patients with coronary artery disease after surgical correction, hardware physiotherapy methods can be used 8-10 days after surgery.

Objectives of hardware physiotherapy:

• relieving angina pain syndrome
• relief of chest pain associated with surgery
• increasing coronary, myocardial and aerobic reserves
• elimination of autonomic dysfunction, symptoms of hypersympathicotonia, to increase oxygen supply to the myocardium

Prescribed:

• Electroson using sedative technique
• Central electroanalgesia
• Anodic galvanization collar area or galvanic collar according to Shcherbak
• Novocaine electrophoresis using transcardial technique
• Low frequency magnetic therapy
• Ultratonotherapy

Reflexology

Hypertonic disease

Impaired control of basic hemodynamic parameters

Disruption of regulatory processes in the vascular center of the medulla oblongata

Tonic stimulation of the heart and blood vessels

Acupuncture stimulation of the higher centers of the g/m cortex and subcortical formations, spinal cord

• hypotensive effect
• restoration of an adequate ratio of central and peripheral hemodynamic parameters
• improvement of the function of contraction and relaxation of the left ventricular myocardium
• increasing tolerance to physical activity
• restoration of the baroreflex mechanism of self-regulation.

Reflexology

Cardiac ischemia

Disturbance of neurohumoral regulation of the heart and coronary arteries

Acupuncture stimulation aimed at regulating blood circulation and its vegetative support

• the frequency of angina attacks decreases
• anxiety level decreases
• increased tolerance to physical activity
• indicators of central and peripheral hemodynamics improve
• the contractile function of the left ventricle improves
• the reactivity of the sympathetic and activity of the cholinergic systems decreases
• Plasma renin activity is normalized
• in the presence of concomitant hypertension, blood pressure decreases

Balneotherapy, hydrotherapy, peloid therapy and heat therapy in the rehabilitation of cardiac patients

Balneotherapy

(sodium chloride, carbon dioxide, iodide-bromine, hydrogen sulfide, radon baths)

method of treatment, prevention and restoration of impaired body functions using natural or artificially prepared mineral waters

Impact on the microcirculatory bed of the skin and/or through the respiratory system (n/r, carbon dioxide vapor) and reflexively on the physiological processes of the cardiovascular system

Hydrotherapy (underwater shower-massage, contrast water baths, turpentine, oxygen and nitrogen baths

Peloid therapy

Thermal therapy (saunas, infrared cabins)

This is the external use of fresh water (tap, river, lake, well) in the form of baths, showers, douches, wraps, swimming in the pool.

Temperature and/or mechanical influences causing reflex vascular reactions

rehabilitation of cardiac patients using sauna type

dilatation of arterioles, decrease in peripheral vascular resistance, blood pressure, increase in heart rate and blood volume. The state of balance of the sympathetic and parasympathetic nervous system

a treatment method based on the use of therapeutic mud and peloid-like substances (paraffin, ozokerite, clay, naftalan, bischofite)

thermal, mechanical, chemical and biological factors of influence

Physical Aspect of Cardiac Rehabilitation is aimed at improving the adaptation processes of the cardiovascular system, increasing its fitness, endurance, and increasing the “functional reserve” of the heart muscle.

Strict monitoring of the patient’s hemodynamic status after the procedures performed

Strict continuity in any methods of cardiac rehabilitation

Timeliness of various rehabilitation methods

Keeping a patient diary (heart rate, blood pressure)

Thank you for attention!

Re habilis - restoration of ability. “adapt again” – lat. Art. 40 323 Federal Law – medical rehabilitation and sanatorium-resort treatment. 21.11.11

Treatment
– elimination of the cause
(etiopathogenetic measures).
Rehabilitation – restoration of function.
MR – medical and social activities.

Goals of medical rehabilitation

Preservation,
health promotion
Realization of health potential, management
active social, industrial
life
Reducing premature mortality,
morbidity, disability
Increased life expectancy,
improving quality of life

Objectives of medical rehabilitation

Reactivation
(function restoration)
Resocialization
Reintegration (recovery
social and psychostatus)
REHABILITANT – a person who is indicated
rehabilitation measures.

Levels of rehabilitation

Prenosological
(prevention of development
nosology).
Postnosological (measures for
outcome of the disease during the period of exacerbation or
in chronic cases).
Compensatory (prevention
decompensation due to disability
(increasing degree of disability),
strengthening reserve capabilities).

METHODS OF MEDICAL REHABILITATION

1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
Physical rehabilitation methods
Mechanical methods of rehabilitation (mechanotherapy,
kinesitherapy).
Massage
Traditional methods of treatment (herbal medicine,
manual therapy, occupational therapy)
Psychotherapy
Speech therapy assistance
Physiotherapy
Reconstructive therapy
Prosthetic and orthopedic care (prostheses, orthoses,
orthopedic shoes)
Spa treatment
Technical means of rehabilitation
Information and advice on issues
medical rehabilitation

Modern rehabilitation technologies

Costume "Adele"

Aspects of rehabilitation

Medical
Physical
(basic)
Psychological
Professional
Socio-economic
Pedagogical

Medical aspect

Solve medical, treatment and diagnostic,
treatment and prophylactic issues.
Goal: eliminating the threat to life,
prevention of complications, exacerbations,
disability.
Objectives: restoration, mitigation,
stabilization of the defective function,
mental status, functional
reserves, increasing sanogenetic
possibilities, the patient's adaptation to
new conditions within the framework of the disease!

Physical aspect

includes all questions related to the application:
-physical factors
- exercise therapy products
-kinesitherapy
-ergotherapy
-manual and reflexology
The main importance of using physical resources
rehabilitation is an increase in physical
performance of patients.
Neglect of the physical aspect
may lead to adverse consequences -
prolongation of bed rest, hospital stay
treatment and temporary disability of patients.

Main objectives of physical rehabilitation

Acceleration
recovery processes
Hazard Prevention and Reduction
disability
It is impossible to provide functional
recovery without considering
the body's natural desire for
movement (kinesophilia).
Consequently, the means of physical
rehabilitation are the main link
rehabilitation process.

Exercise therapy as a method of physical rehabilitation

Two directions of using exercise therapy funds in
rehabilitation system:
- for the purpose of restoring motor skills
functions
- to maintain fitness
body
Systematic use of exercise therapy:
-strengthens the musculoskeletal system;
-improves cardiovascular activity
respiratory systems and organs;
- mobilizes compensatory mechanisms;
- accelerates functional adaptability;
-reduces the time of clinical and
functional recovery;

ERGOTHERAPY is a section of rehabilitation medicine that studies methods and means aimed at restoring people’s motor activity

Occupational therapy is an element of physical
aspect of rehabilitation and represents
active method of restoration or compensation
lost functions with the help of intelligent work,
aimed at creating a useful product,
including:
locomotor;
neuro-reflex;
psycho-emotional;
intelligent components.

An occupational therapist (home therapist) is a specialist who helps people achieve their maximum level of functioning and independence in

Tasks of an occupational therapist
o Teaching the patient self-care skills
o Daily living skills training
o Development of fine motor skills
Occupational therapy helps
restoration of physical performance,
have favorable psychological
impact on the patient.

Goals and objectives of occupational therapy

Therapeutic training
Psychotherapeutic
Educational
Occupational therapy is carried out during
recovery and can last no more than 23 months.
The goal of occupational therapy (especially when
myocardial infarction or stroke) not
is learning a new profession.

Psychological aspect Psychotherapy is a system of rehabilitation effects on the human psyche

The need for psychotherapy in the process
rehabilitation is due to:
The inevitability of occurrence in the process for a long time
developing disease damage
psycho-emotional sphere of the patient (crises,
depression, neurosis).
Into the structure of the disease during its development
mechanisms of the higher nervous system are involved
activities (psycho-vegetative disorders).
Psychotherapy is an effective tool
involvement in the rehabilitation process
patient, whose active participation is extremely
necessary for the formation of mechanisms
self-rehabilitation in social and
professionally.

The ultimate goal of any rehabilitation program is to restore the patient’s personal and social status.

Almost half of the cases are mental
changes and mental factors are
reason preventing return
sick to work after a number of illnesses
(myocardial infarction, stroke, traumatic brain injury).

Depression, “going into illness,” fear of physical
tension, confidence that the return to
work will cause harm to the heart, may cause recurrence
myocardial infarction.
These mental changes can become irresistible
obstacle to restoration of working capacity and
solving employment issues and will lead to “no”
efforts of a cardiologist and rehabilitation specialist!

TASKS OF MENTAL REHABILITATION

Acceleration
normal process
psychological adaptation to
changed as a result of illness
(trauma) life situation;
Prevention and treatment of developing
pathological mental changes.
The main methods are various
psychotherapeutic influences and
pharmacotherapy.

When conducting psychotherapeutic interventions, a number of rules must be observed:

Mandatory
future orientation
professional activity.
Correct selection of methods, taking into account
rehabilitated functions.
Early start, gentle load,
its gradual increase
duration.

Psychotherapy
Individual
Group
Family
Combined (I+G (S))

Individual psychotherapy

Group psychotherapy

Socio-economic aspect

Social rehabilitation is a set of measures
aimed at increasing the level
functional abilities in everyday life and society,
restoration of destroyed or lost
disabled public relations and relations
due to health or physical impairment
defect.
Social methods of influence are aimed at:
organization of an appropriate lifestyle;
eliminating the impact of social factors,
interfering with successful rehabilitation;
restoration or strengthening of social
connections.

The purpose of social rehabilitation:

RE-SOCIALIZATION
- restoration of the social status of the individual
-abilities for everyday, professional and
social activities
- ensuring social adaptation in conditions
environment and society
- achievement of independence and material
independence

Methods of social rehabilitation

Social and household
adaptation(training
self-service, adaptation to
family, apartment, training
use of technical means);
Social-environmental
rehabilitation (psychotherapy,
psychocorrection, assistance in
solving personal problems,
legal advice
questions);

Professional aspect

Prevention of disability
includes various elements:
-correct work ability examination (ITU)
-rational employment
- systematic differentiated
drug treatment of underlying
diseases (injuries)
-implementation of a program aimed at
increase in physical and mental
patient tolerance.
Restoration of working capacity is
the most striking criterion of effectiveness
rehabilitation!

Vocational rehabilitation methods

Career guidance
Psychological
correction
Training (retraining)
Creation of a special workplace
disabled person
Professional production
adaptation

Pedagogical aspect

These are educational, developmental and
educational in nature, aimed at
so that the disabled person gains social experience,
mastered the necessary skills and abilities
on self-service and self-sufficiency,
social norms of behavior.
The pedagogical aspect includes:
-correctional pedagogy
-education of children and adults with disabilities,
complicating the learning process
-organization of educational courses and schools
for the sick, disabled and their relatives.

PRINCIPLES OF REHABILITATION

Basic principles of rehabilitation 1. The principle of comprehensiveness of MR

This is the widest possible use of different methods
medical and other nature.
To implement this principle, the following are used:
methods of psychological rehabilitation
physical rehabilitation methods
drug rehabilitation
reconstructive surgery
occupational therapy
school for the patient and relatives
The complex nature of rehabilitation is manifested as follows:
way that rehabilitation activities should
not only doctors, but also others
specialists: sociologists, psychologists, teachers,
representatives of social security authorities,
trade union representatives, lawyers, etc.

2. An early start of rehabilitation measures is possible.

The basis of this principle is that
individual medical activities
rehabilitation should begin early
days (and sometimes hours) of illness or received
injuries after stabilization of vital signs
functions.
If a person is at risk of disability -
rehabilitation activities become her
prevention.
If the disability develops, they become
the first stage in the fight against it.
The principle of early onset of MR is applicable both for
patients with acute and chronic
pathology.

3. The principle of phasing

Involves providing rehabilitation services
helping a person in several stages, at
over a fairly long period
time
The patient, moving from the acute phase of the disease to
subacute and then to chronic,
must receive consistently
appropriate rehabilitation assistance:
In a specialized inpatient department;
Stationary mono- or multidisciplinary
rehabilitation center;
In the rehabilitation department of an outpatient clinic;
At home;
In a sanatorium, etc.

4. Individuality of rehabilitation measures.

In each specific case, they take into account
characteristics of the rehabilitator (his potential and
prognosis) in medical, professional,
socially, domestically and depending on
for this purpose an individual program is drawn up
rehabilitation.

5. Continuity of rehabilitation.

“The provision on
continuity of rehabilitation: medical
rehabilitation should begin during the process
treatment, professional rehabilitation
should begin immediately after completion
medical; a person must start working
immediately upon completion of the course
vocational rehabilitation. Otherwise
case, the patient gets used to retirement, suffers
his psyche, and practice shows that
involve him in rehabilitation at a later date
It’s very difficult after treatment.”
S. N. Zorina (1970)

6. consistency.

This is a strict sequence of procedures and
activities that contribute
maximum elimination
disabling consequences and
further integration of the rehabilitator into
society.

7. continuity.

Continuity must be respected as
individual stages of medical
rehabilitation (inpatient,
outpatient, home, sanatorium),
and in all aspects of everything
rehabilitation process
(medical, medical-professional,
professional, social
rehabilitation).

8. Active participation of the patient

is the basis for successful implementation
individual rehabilitation program and
achieving the set goal.
To do this you need:
-explaining goals and objectives to the rehabilitator
rehabilitation program, its essence.
- positive attitude towards work,
recovery, return to family and
society.
-understanding by patients that rehabilitation is
a long process and depends on mutual
trust of all its participants.

Stages and organizational issues of medical rehabilitation

Rehabilitation can be carried out at any stage of the disease or functional impairment, regardless of the location of the subject

Stages of medical rehabilitation

Stage 1 – intensive care unit:
carried out in the acute period in the presence of rehabilitation
potential and absence of contraindications.
Stage 2 – in stationary conditions of a medical organization
(rehabilitation centers, rehabilitation departments, etc.):
carried out in early recovery, late
rehabilitation and period of residual symptoms of the disease
diseases in the presence of rehabilitation potential,
no contraindications, for patients requiring
ongoing care for chronic illness.
Stage 3 – in medical rehabilitation departments (offices)
organizations providing outpatient care
assistance: carried out regardless of the recovery period,
in the presence of rehabilitation potential, absence
contraindications, patients capable of
self-care, with chronic disease and
its residual effects.

Stages of MR

Hospital stage
Outpatient stage
Sanatorium-resort stage
Hospitals
A program is being drawn up
rehabilitation, rehabilitation
increasing
efficiency,
reducing deadlines
treatment
Polyclinic,
medical centers,
city ​​sanatoriums
Aimed at regeneration
and compensation
impaired functions,
reactivity correction
body
Sanatoriums,
dispensaries, homes
recreation
Provides
warning
relapses. Consolidation
remission, increase
adaptation reserves
body

Multidisciplinary rehabilitation team

Multidisciplinary team (MDB)

brings together specialists providing
assistance in the treatment and rehabilitation of patients
and working as one team
(team) with clear coordination and
coordination of actions, which
provides a targeted approach to
implementation of rehabilitation tasks.
Proposed by the WHO Regional Office for
European countries.

The work of the MDB includes:

A joint
inspection and assessment
patient's condition, degree of impairment
functions
Creating an adequate environment
for the patient depending on his
special needs
Joint discussion of the condition
patients at least once a week
Collaborative goal setting
rehabilitation and patient management plan.

Specialists involved in rehabilitation (MDB team)

Medical specialists (neurologists, orthopedists,
therapists, etc.)
Rehabilitologist
Rehabilitation nurse
Physiotherapist
Psychologist, psychotherapist
Physical therapy specialist
Subspecialists (ophthalmologists,
otolaryngologists, audiologists, speech therapists,
urologists)
Social worker
Other specialists (nutritionist, occupational therapist)

Nurse-mandatory member of the MCH

Should know:
-basics of therapeutic
physical education and
massage;
-methods of occupational therapy;
-control methods
adequacy
loads,
specific to
diseases;
-methods of small
psychotherapy.

Rehabilitation MDB

Must be assembled at least twice - when
formation of a rehabilitation program and
upon completion at this stage
rehabilitation.
If complications and signs occur
the inadequacy of the CSBM program may
be called at any time.
Not only the composition of the MDB is important, but also
distribution of functional
responsibilities and close cooperation
all members of the brigade!

Progress of the discussion

In
time for discussion with the attending physician
reports basic clinical,
laboratory, instrumental
data.
Other members of the CSBM complement,

Description of the presentation by individual slides:

1 slide

Slide description:

MINISTRY OF EDUCATION AND SCIENCE OF THE RUSSIAN FEDERATION St. Petersburg State Budgetary Professional Educational Institution “Medical College No. 9” Methods of medical rehabilitation for cardiovascular diseases Teacher Ryzhikova L.I. St. Petersburg 2017

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Characteristics of diseases of the cardiovascular system: CSDs are the most common socially significant diseases throughout the world and more often than others lead to disability and mortality: Russia is the first place in the world in mortality from the most common CNDs - cardiovascular diseases (CVDs), in particular coronary heart disease (CHD), cerebrovascular diseases. 56.5% 32.3% Shalnova S. A., Conradi A. O., Karpov Yu. A. et al. Russian Journal of Cardiology. 2012. - 5 (97) – p. 6-11

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Possibilities of influencing the course of cardiovascular diseases: Prevention (primary, secondary) Treatment (non-drug, medicinal, surgical) aimed at the cause of the disease, slowing down pathogenetic mechanisms, development of complications, symptomatic Rehabilitation

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Cardiac rehabilitation is a comprehensive (integrated) long-term program that includes a medical assessment of the patient’s functional state, physical exercises (training) prescribed based on individual exercise tolerance, modification of cardiac risk factors, patient education and counseling.

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Comprehensive rehabilitation programs are designed to: modify risk factors slow down the structural restructuring (remodeling) of target organs reduce the risk of sudden death improve cardiovascular prognosis control the symptoms of heart disease stabilize the pathogenetic process of CVD development improve psychological and professional status

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Phases of rehabilitation: I. Hospital phase (Phase I) – a period of inpatient treatment in the cardiology (cardiac surgery) department of a clinic or hospital for an acute case of the disease II. Early post-hospital (intermediate) phase (Phase II, convalescence phase) – the period of recovery after discharge from a cardiology (cardiac surgery) hospital, lasts up to 12 weeks after an acute case of the disease. Rehabilitation is carried out in rehabilitation centers, in health care facilities at the patient’s place of residence. III. Late post-hospital phase (post-convalescence) (Phase III) – 4-6-12 months duration after an acute case of the disease. Long-term supervised outpatient cardiac rehabilitation programs: duration of at least 6 months after Phase II IY. Phase IY (maintenance) – long-term outpatient rehabilitation period, lasts indefinitely, ideally throughout the patient’s life

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Slide description:

Comprehensive cardiac rehabilitation is a process that should: - begin immediately - continue continuously - be carried out in stages - be based on the individual characteristics of the patient - be carried out in a manner acceptable to the patient and his environment

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Slide description:

Comprehensive cardiac rehabilitation should include the following elements: - assessment of the patient’s clinical condition - optimization of pharmacological treatment - physical rehabilitation - a stepwise and controlled increase in physical activity, adapted to the individual’s capabilities - psychosocial rehabilitation, the purpose of which is to teach the patient to help himself in stressful situations, emotional states , such as fear and/or depression, develop the ability to psychologically adapt to the consequences of the disease; - diagnosis and control of so-called “risk factors” for the development of CVD - lifestyle changes - education of patients and their relatives - “monitoring” of the effects of rehabilitation programs

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Slide description:

REHABILITATION Correction of CVD risk factors Increasing the “functional reserve” of the cardiovascular system Continuous, optimal drug therapy Diet therapy Weight reduction program Physical activity Physiotherapeutic methods Balneotherapy, hydrotherapy, heat therapy Medical aspect of rehabilitation Physical aspect of rehabilitation Psychological adaptation Psychological aspect of rehabilitation Non-drug prevention Professional aspect of rehabilitation

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Slide description:

* MECHANISMS OF ACTION OF FU Stimulating effect Trophic effect Compensatory effect Therapeutic effect General training effect Therapeutic exercise (physical therapy) is a mandatory component of physical rehabilitation programs for cardiovascular diseases. The selection of exercise therapy programs should be carried out individually, taking into account the severity of the disease, its nature, and the patient’s age

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Slide description:

Exercise therapy modes I. Gentle II. Gentle-training III. Training Modes of physical activity: - strict bed rest - bed rest - semi-bed rest - free mode MODES IN SANATORIA: - Gentle mode - Gentle training mode - Training mode * Secondary prevention Primary prevention

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Principles of using exercise therapy: 1 - individual approach 2 - strict dosage 3 - regularity 4 - gradual increase in load 5 - continuity of selected forms and methods 6 - control of load tolerance and effectiveness

Slide 13

Slide description:

The initial rate and volume of exercise is minimal for each patient, followed by a gradual increase. Before prescribing exercise therapy to patients with cardiovascular diseases, it is necessary to conduct a physical load test (bicycle ergometry or treadmill test) to assess the possible risk of complications and determine the safe volume and intensity of physical exercise

Slide 14

Slide description:

Therapeutic exercise is recommended as a mandatory component of rehabilitation and secondary prevention programs: for arterial hypertension (hypertension) for coronary heart disease (including stable angina and after myocardial infarction) for chronic heart failure after a stroke after cardiac surgery ( coronary artery bypass grafting, angioplasty, prosthetics of heart valves and great vessels, heart transplantation, surgical remodeling of the LV, reconstructive operations on the aorta) after implantation of devices that maintain heart rhythm in occlusive diseases of the great and peripheral arteries

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Contraindications to exercise therapy for cardiovascular diseases! Crisis course of arterial hypertension Heart rhythm disturbances Acute stages of cardiovascular disease (myocarditis, endocarditis, unstable angina and acute myocardial infarction, etc.) and pathology of other organs and systems, until hemodynamics and clinical laboratory parameters are stabilized Development of an attack of severe weakness and severe shortness of breath during physical activity load

16 slide

Slide description:

Objectives of exercise therapy for diseases of the cardiovascular system: - acceleration of recovery time after MI and other acute coronary syndromes, stroke, cardiac surgery, etc. - normalization of impaired regulation of cardiac activity, vascular tone - restoration of normal adaptation to physical activity and physical performance - increasing the effectiveness of complex therapy (drug, non-drug) - slowing down further progression of the disease, reducing the risk of complications and premature death - normalization of the psycho-emotional sphere, general condition *

Slide 17

Slide description:

Results of regular exercise therapy: Reduced heart rate and blood pressure at rest and during exercise. Significantly increases tolerance to physical activity. Improves collateral and peripheral circulation. Improves myocardial contractility, utilization of oxygen and energy by cardiomyocytes. Increases the efficiency of cardiac activity and coronary reserve. Decreases the secretion of catecholamines, the content of lipids and blood glucose increases. activity of the blood anticoagulant system and reduces the risk of thromboembolic complications

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FORMS of exercise therapy for diseases of the cardiovascular system Therapeutic gymnastics procedure Morning hygienic gymnastics Independent exercises Dosed walking Close-range tourism Games, swimming

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Exercise therapy for diseases of the cardiovascular system General developmental exercises Breathing exercises (static, dynamic) Dynamic exercises for medium and small muscle groups Exercises with weights and resistance

20 slide

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Methods of exercise therapy Controlled (carried out in medical institutions) Uncontrolled or partially controlled (at home according to an individual plan) - group - individual

21 slides

Slide description:

Stages of physical rehabilitation after AMI: First inpatient: up to 10-15 days in the absence of complications in the early subacute period of the disease, in the presence of complications in the acute and early subacute period - individualized length of stay in the hospital Second inpatient (inpatient rehabilitation department) - 16 days. Outpatient clinic (dispensary), sanatorium

22 slide

Slide description:

Due to the early activation of patients with myocardial infarction (MI), physical rehabilitation at the inpatient stage must begin as soon as the patient’s clinical condition allows. Physical rehabilitation measures should be carried out in the absence of the following contraindications: symptoms of cardiogenic shock (pallor, cold sweat, low blood pressure, etc.) symptoms of acute heart failure (pulmonary edema, cardiac asthma) 3. severe forms of arrhythmias (over- and ventricular tachycardia, complete atrioventricular block, group extrasystole) 4. presence of anginal pain 5. increase in body temperature above 38 ° C

Slide 23

Slide description:

Algorithm of rehabilitation measures in patients with acute myocardial infarction at the inpatient stage Development of AMI BIT No contraindications step-by-step mobilization on days 1-2 AMI in the absence of pain syndrome FU on small muscle groups breathing exercises Cardiology department Tests with physical exercise (5-13 days after the onset of AMI) Various schemes of rehabilitation programs taking into account the severity of the condition: training small muscle groups using an expander, exercise on an exercise bike, dosed walking, therapeutic exercises, etc. Tests with physical function before discharge Recommendations for drug and non-drug rehabilitation

24 slide

Slide description:

An example of step-by-step mobilization on the first day of AMI. Stage 1: limited movements in bed aimed at improving venous circulation, breathing exercises, muscle relaxation exercises. The patient is allowed to sit down with support, use a razor Stage 2: in addition to the above, the patient is allowed to sit in bed without support Stage 3: the patient is allowed to sit in bed with his legs dangling, and then sit for a while on a chair Stage 4: walking is allowed in the ward Stage 5: special exercises begin to mobilize the patient Stage 6: the patient is allowed to walk along the corridor and climb several steps of the stairs Stage 7: walks in outerwear and outside the room are allowed.

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Algorithm of rehabilitation measures in patients with acute myocardial infarction at the outpatient stage. The goal is to maintain and develop physical performance, readapt the patient to everyday and work stress. Physical activity includes: therapeutic and hygienic gymnastics, exercise therapy, dosed walking, various sports games, intensive physical training ( according to indications) physical activity in connection with everyday household stress, subsequently, after going to work - in connection with professional responsibilities N.B.! Individual selection of rehabilitation programs, taking into account physical and mental preparedness!

26 slide

Slide description:

Methods for monitoring the effectiveness and tolerability of FU Clinical (survey, examination): tolerability of FU by patients, the appearance of “new” symptoms of the disease, sensations associated with the deterioration of the central nervous system (dizziness, loss of consciousness, flashing “spots” before the eyes, etc.) Biochemical : a standard set of blood tests monitored in patients with CVD (lipidogram, blood coagulation system, etc.) Instrumental: all types of ECG, ABPM, stress tests, echocardiography, etc. when indicated

Slide 27

Slide description:

Types of massage for cardiovascular diseases Classic Relaxing Collar area Scalp and forehead area Ears

28 slide

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Massage Increases the effectiveness of physical exercise Improves blood and lymph circulation in the tissues and organs of the chest Promotes moderate expansion of peripheral vessels Facilitates the work of the left and left ventricles, improves the pumping function of the heart Reduces congestion in the circulatory system Improves metabolic processes and oxygen utilization

Slide 29

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Contraindications for massage!: - ACS - angina pectoris class IV - fresh inflammatory processes in the heart valves and myocardium

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Physiotherapeutic methods of treating patients with hypertension Prescribe physical factors aimed at eliminating dysfunction of the ANS (hypersympathicotonia and hyperkinetic type of hemodynamics) and correcting the functional states of the central nervous system. Methods of neurotropic pulse therapy: Electrosleep (using a sedative technique with orbitomastoid application of electrodes, 10-20 procedures per course) Electrotranquilizer (frontomastoid technique, 10-20 procedures) Mesodiencephalic modulation (with individual choice of the shape and intensity of the pulse and current 10-15 procedures) Low-frequency pulse therapy (using DDT, SMT and interference currents, from 7-8 to 10-2 procedures) Magnetic therapy - on the frontal area. In case of contraindications to low-frequency pulse currents (10-15 procedures) Anodic galvanization or galvanic collar according to Shcherbak (10-12 procedures) Medicinal electrophoresis (Mg2+, Ca2+, K+, papaverine, aminophylline, novocaine, no-shpa, platiphylline). (8-12 procedures)

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Physiotherapeutic methods of treating patients with hypertension (2) Bioresonance therapy: Bemer therapy, PERT therapy (using an inductor in the form of a mattress, 10-15 procedures) Low-intensity infrared laser radiation (at 3 points paravertebral on the cervicothoracic spine CVII- TIV, course 8-10 procedures) Ultrasound treatment of the sinocarotid area (8-10 procedures) Aeroionotherapy (course 10-15 procedures) Aerophytotherapy (inhalation of vapors of essential oils of vanilla, orange, ylang-ylang, hyssop, lemon, marjoram, juniper, fennel , cypress, geranium, lavender, rosemary) Halotherapy (course of 10-20 procedures) Ozone therapy (iv, 10 infusions)

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Slide description:

Physiotherapeutic methods of treating patients with coronary heart disease are aimed mainly at normalizing the central mechanisms of blood circulation regulation with increasing myocardial oxygen consumption, myocardial contractility and tolerance to physical activity, as well as reducing vascular peripheral resistance and normalizing autonomic reactions. . Electrosleep using sedative methods Magneto- and laser therapy Medicinal electrophoresis Aeroion therapy Aerophytotherapy includes inhalation of vapors of essential oils of orange, lavender, rose, mint, lemon balm, hyssop, anise, geranium, ylang-ylang, marjoram Ozone therapy Halotherapy Bemer and PERT therapy Neurotropic pulse therapy Magnetotherapy Electrophoresis

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Slide description:

Physiotherapeutic methods of treating patients after cardiac surgery For the rehabilitation of patients with coronary artery disease after surgical correction, hardware physiotherapy methods can be used 8-10 days after surgery. The objectives of instrumental physiotherapy are: relieving anginal pain syndrome, relieving chest pain associated with surgery, increasing coronary, myocardial and aerobic reserves, eliminating autonomic dysfunction, hypersympathicotonia, to increase oxygen supply to the myocardium. Prescribed: Electrosleep using a sedative technique Central electroanalgesia Anodal galvanization of the collar zone or galvanic collar according to Shcherbak Electrophoresis of novocaine using the transcardial technique Low-frequency magnetic therapy Ultratonotherapy

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Reflexology Hypertensive disease Impaired control of basic hemodynamic parameters Disruption of regulatory processes in the vascular center of the medulla oblongata Tonic stimulation of the heart and blood vessels Acupuncture stimulation of the higher centers of the cortex g/m and subcortical formations, spinal cord hypotensive effect restoration of an adequate ratio of parameters of central and peripheral hemodynamics improvement of contraction function and relaxation of the left ventricular myocardium, increased tolerance to physical activity, restoration of the baroreflex mechanism of self-regulation.

36 slide

Slide description:

Reflexology Coronary heart disease Impaired neurohumoral regulation of the heart and coronary arteries Acupuncture stimulation aimed at regulating blood circulation and its autonomic support decreases the frequency of angina attacks decreases the level of anxiety increases tolerance to physical stress improves central and peripheral hemodynamics improves the contractile function of the left ventricle decreases sympathetic reactivity and activity cholinergic systems, plasma renin activity is normalized; in the presence of concomitant hypertension, blood pressure decreases

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Balneotherapy, hydrotherapy, peloid therapy and heat therapy in the rehabilitation of cardiac patients Balneotherapy (sodium chloride, carbon dioxide, iodide-bromine, hydrogen sulfide, radon baths) is a method of treatment, prevention and restoration of impaired body functions with natural or artificially prepared mineral waters Impact on the microcirculatory bed of the skin and/or through the respiratory system system (n/r, carbon dioxide vapor) and reflexively on the physiological processes of the cardiovascular system Hydrotherapy (underwater shower-massage, contrast water baths, turpentine, oxygen and nitrogen baths Peloid therapy Heat treatment (saunas, infrared cabins) is the external use of fresh water (tap, river , lake, well) in the form of baths, showers, douches, wraps, swimming in the pool. Temperature and/or mechanical effects causing reflex vascular reactions, sauna-type rehabilitation of cardiac patients, dilation of arterioles, decrease in BPSS, blood pressure, increase in heart rate and VO. balance of the sympathetic and parasympathetic nervous system, a treatment method based on the use of therapeutic mud and peloid-like substances (paraffin, ozokerite, clay, naphthalan, bischofite) thermal, mechanical, chemical and biological factors of influence

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The physical aspect of cardiac rehabilitation is aimed at improving the adaptation processes of the cardiovascular system, increasing its fitness, endurance, and increasing the “functional reserve” of the heart muscle. Strict monitoring of the patient’s hemodynamic state after the procedures performed Strict continuity in any methods of cardiac rehabilitation Timeliness of various rehabilitation methods Keeping a patient diary (heart rate, blood pressure) It is recommended that all types of physical rehabilitation (PH, dosed walking, training of small muscle groups, training on a bicycle ergometer) be carried out before meals or 1-1.5 hours after eating.

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Slide 2

Rehabilitation in medicine (Latin rehabilitatio - restoration) is a set of medical, pedagogical, professional and legal measures aimed at restoring (or compensating) impaired body functions and the working capacity of sick and disabled people. Rehabilitation as a process of helping the disabled has a long history. It arose and is developing as a response of society to the socio-economic and moral damage caused to it by the process of disability of the population, and the goal of rehabilitation is to find means of restoring the quantity and quality of health, restoring or compensating for lost functions, restoring or adapting to their loss.

For many years, specialists of various specialties in many medical institutions have created their own narrowly focused rehabilitation programs for neurological, cardiological, traumatological and other pathologies. Due to the disunity of representatives of this area of ​​medicine, for a long time a unified regulatory framework, knowledge base and training programs for specialists in rehabilitation problems were not formed.

Slide 3

The accumulated knowledge, specially developed methods, and most importantly, the urgent need for the comprehensive implementation of programs aimed at preserving the health of a healthy person served as the basis for the creation of an independent scientific and practical direction in medicine - restorative medicine. Regenerative medicine is currently understood as a system of scientific knowledge and practical activities aimed at preserving and restoring a person’s functional reserves, reduced as a result of the adverse effects of environmental factors and activities, or as a result of illness - at the stage of recovery (remission). Regenerative medicine, as a science, studies the patterns of processes of preserving and restoring human functional reserves through dynamic assessment and correction of health status at all stages of prevention.

Structurally, restorative medicine combines two main areas of activity and corresponding structures in the system of medical institutions: 1. Health improvement or preservation, restoration and strengthening of the health of healthy or practically healthy people, as well as persons with reversible functional disorders or pre-morbid disorders. The object of restorative and health-improving measures in this direction is the reduced functional reserves of the body, and the goal is the elimination of functional disorders and the restoration of health. 2.Medical rehabilitation of sick people and disabled people. A distinctive feature of individuals in this contingent is the presence of somatic diseases and irreversible morphological changes in organs and tissues. Rehabilitation treatment in this case is aimed at increasing functional reserves, compensating for impaired functions, secondary prevention of diseases and their complications, restoring reduced work functions and returning to capacity.

Slide 5

Corrective technologies of restorative medicine include: Impact on the body with natural and preformed physical factors (physiotherapy, balneotherapy, balneology). Therapeutic exercise and massage. Therapeutic and health nutrition. Homeopathic methods. Traditional medicine methods. Psychotherapeutic methods. Bioenergy information technologies. Other non-drug treatment and prophylactic technologies. Physiotherapy is a field of clinical medicine that studies the healing properties of natural and artificially created physical factors and develops methods of using them for the treatment and prevention of diseases, as well as for medical rehabilitation.

Slide 6

Balneotherapy (from Latin balneum - bath, dripping) is a set of treatment, prevention and rehabilitation methods based on the use of mineral waters or therapeutic mud. Resortology (resort + Greek logos doctrine) is a field of medicine that studies the effects of natural healing factors on the human body and develops methods and organizational forms of their use for therapeutic and preventive purposes both at resorts and in non-resort institutions. Physiotherapy is a method of treatment, prevention and rehabilitation based on the use of physical exercises (gymnastics, applied sports exercises, sports games). Massage (from the French massage) is a set of techniques of mechanical dosed influence on any areas of the surface of the human body, performed using special devices or by hand for therapeutic or prophylactic purposes. Therapeutic nutrition (syn. diet therapy, from the Greek diaeta - diet) is a method of treatment and prevention of diseases based on the use of specially developed (in terms of quantity, chemical composition, calorie content and cooking methods) food rations (diets) and a specific diet. Homeopathy is a special way of treating acute and chronic diseases using specially prepared medicines containing very small doses of original medicinal raw materials of natural origin. Homeopathy is distinguished from official medicine (allopathy) by its strictly individual approach to the patient and the idea of ​​any disease as the suffering of the whole organism as a whole.

Slide 7

The word "homeopathy" literally means "disease-like". This name was given to the new method of treatment about two hundred years ago by the creator of homeopathy - a famous doctor and pharmacist of his time, professor at the University of Leipzig, Christian Friedrich Samuel Hahnemann (1755 - 1843). Conducting various experiments with medicinal plants and minerals, in 1796 Hahnemann formulated the basic law of homeopathy: like is cured by like, i.e. In case of illness, the medicine that causes symptoms similar to this disease in a healthy person helps. Traditional medicine includes practical experience in methods and means of treatment, accumulated by society and passed on from generation to generation. Traditional medicine has a deep history and is based on centuries of experience of the people. Currently (according to various sources), traditional medicine includes: acupuncture, homeopathy, manual therapy, traditional diagnostics, traditional healing systems, herbal medicine and treatment with other means of natural origin, as well as bioenergy-information therapy.

Slide 8

Naturotherapy is a broad concept used for a multidisciplinary approach to health problems using natural remedies (apitherapy, herbal medicine, hirudotherapy and other methods approved for use by the Russian Ministry of Health). apitherapy is a method of natural therapy that involves using honey bees and their metabolic products for medicinal purposes. herbal medicine is a method of treating diseases using herbal medicines containing complexes of biologically active substances. aromatherapy is the use of plant extracts in the form of essences or essential oils to treat diseases by effectively influencing the patient’s emotions and mood. hirudotherapy is the therapeutic use of medicinal leeches.

Slide 9

Psychotherapy (from the Greek psyche - soul + therapeia - treatment) is the field of application of psychological methods and means to solve various forms of psychological problems, treat mental disorders and psychosomatic diseases. Bioenergy informatics (from Latin bios - life, informatio - information, explanation and Greek energeia - energy) is a scientific direction that studies information and energy interactions in nature and society. Bioenergy informatics is based on a synthesis of natural, humanitarian and philosophical sciences, as well as on modern and ancient esoteric knowledge of mankind. In terms of worldview, bioenergy informatics is based on the evolutionary priority of interactions in the Universe over material-energy interactions. Bioenergy informatics as a scientific field has been formed in recent decades (since the 1970s) in a number of countries (Russia, USA, England, Japan). Bioenergy information therapy is a method of treating a person using a torsion field. The torsion field affects every cell of the body, thereby affecting the entire body as a whole. Recovery occurs through the restoration of the natural activity of the body.

Slide 10

Thank you for attention!!!

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Slide 2

Organization of activities of the ITU Bureau

For many years, specialists of various specialties in many medical institutions have created their own narrowly focused rehabilitation programs for neurological, cardiological, traumatological and other pathologies. Due to the disunity of representatives of this area of ​​medicine, for a long time a unified regulatory framework, knowledge base and training programs for specialists in rehabilitation problems were not formed.

ITU Bureau specialists

Doctors of various specialties. Social work specialists. Psychologists.

The accumulated knowledge, specially developed methods, and most importantly, the urgent need for the comprehensive implementation of programs aimed at preserving the health of a healthy person served as the basis for the creation of an independent scientific and practical direction in medicine - restorative medicine. Regenerative medicine is currently understood as a system of scientific knowledge and practical activities aimed at preserving and restoring a person’s functional reserves, reduced as a result of the adverse effects of environmental factors and activities, or as a result of illness - at the stage of recovery (remission). Regenerative medicine, as a science, studies the patterns of processes of preserving and restoring human functional reserves through dynamic assessment and correction of health status at all stages of prevention.

A system of medical, psychological, pedagogical, socio-economic measures aimed at eliminating or possibly more fully compensating for acute respiratory distress caused by health problems with persistent impairment of body functions.

Slide 5

The purpose of rehabilitation.

Restoration of health, ability to work, personal and social status of disabled people, their achievement of material and social independence, integration (or reintegration) into normal living conditions of society.

Slide 6

Factors that determine specific rehabilitation objectives

Features of the disease. The nature and degree of impaired functions. Limitation of life activity. Social insufficiency of a disabled person.

Slide 7

Rehabilitation activities

Medical rehabilitation. Rehabilitation therapy. Reconstructive surgery. Prosthetics. Orthotics. Vocational rehabilitation. Professional guidance. Professional education. Employment. Professional and industrial adaptation. Social rehabilitation. social-environmental orientation. Social and everyday adaptation. Psychological aspects are implemented in each group.

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Elements of the rehabilitation system for disabled people

Scientific views, ideas, ideas. Legislative and regulatory framework in the field of rehabilitation. Scientific and scientific-technical developments. A set of measures, means, techniques and methods of rehabilitation. Rehabilitation programs for people with disabilities at different levels from federal to IPR. Rehabilitation institutions. Rehabilitation industry. Public and human rights organizations of disabled people. Information support on problems of disability and people with disabilities.

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Stages of rehabilitation

1. restorative treatment (restoration of biological and medical status). Restoration or compensation of disturbances in the anatomical and functional integrity of the body. 2. Socialization or resocialization (restoration of individual personal status). Formation and development, restoration or compensation of social skills and functions, normal activities and social-role attitudes of the individual. 3. Social integration or reintegration (restoration of social status). Assistance to disabled people and creation of appropriate conditions for their inclusion or return to normal living conditions with the opportunity to occupy a normal position in society in accordance with their gender, age, level of education, together and on an equal basis with other members of society.

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Medical rehabilitation (restorative treatment)

A set of therapeutic measures aimed at restoring impaired or lost functions and health of sick and disabled people.

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Purpose of medical rehabilitation

Elimination or mitigation of the consequences of illness, injury or injury until full or partial restoration or compensation of disturbances in the mental, physiological and anatomical state of the patient.

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Methods and means of medical rehabilitation

Drug treatment – ​​maintenance and replacement therapy. Surgical rehabilitation treatment – ​​reconstructive and plastic surgery. Physical methods of treatment - FTL. Therapeutic gymnastics - exercise therapy. Mechanotherapy. Massage. Psychotherapy. Traditional and folk methods of treatment. Social and psychological methods of treatment. Prosthetic and orthopedic care. Providing disabled people with TSR and training to use them.

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Physical methods of treatment - FTL.

Electrotherapy – galvanization, electrophoresis, electrosleep, electrical stimulation, UHF, microwave, etc. Light therapy – IR, UV, ultrasound. Balneotherapy – baths, showers, douses, mineral waters. Thermal therapy – paraffin, ozokerite, applications, baths. Inhalations. Laser therapy. And etc.

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Social and psychological methods of treatment.

Occupational therapy: General strengthening (tonic); Restorative; Professional (restoration of old and formation of new professional skills and qualities). Occupational therapy. Medium therapy. Speech rehabilitation therapy.

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Prosthetic and orthopedic care.

A complex of restorative, conservative and surgical treatment. Supplying sick and disabled people with prosthetic and orthopedic products and training in their use.

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Prosthetic and orthopedic products.

Prostheses are devices that replace a part of a limb or other part of the body and serve to compensate for an anatomical and functional defect (cosmetic and functional prostheses). Orthoses are devices worn on a segment of the musculoskeletal system to fix it and restore impaired functions (splint, bandage, corset, splint, reclinator, obturator). Orthopedic shoes are special shoes designed to correct anatomical and functional disorders of the lower extremities.

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Technical means of rehabilitation

Technical devices that promote restoration, compensation, development of impaired functions, as well as maintaining the residual functional capacity of the body.

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Types of TSR

Aids to facilitate movement (crutches, canes, walkers, chairs). Dialysis therapy products (hemodialysis and peritoneal dialysis machines). Exercise bikes and bicycle ergometers. Hearing aids, incl. implantable. Anti-decubitus drugs. Colostomy bags and urinals. Devices for administering food through a stoma. Other.

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dialysis

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Anti-decubitus medications

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Types of medical rehabilitation

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Rehabilitation institutions

Medical rehabilitation centers (hospitals, clinics, rehabilitation treatment departments). Sanatoriums and sanatoriums-resorts. Health resorts. Hospitals and aftercare departments. Prosthetic and orthopedic enterprises. Hospitals and nursing departments. Dispensaries. Commercial rehabilitation centers. Other institutions in which rehabilitation is an additional type of assistance (health centers, special educational institutions for the disabled, boarding homes, etc.)

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Vocational rehabilitation

A system of state and public measures aimed at the return or inclusion of a disabled person in socially useful work in accordance with his state of health, ability to work, personal inclinations and desires.

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Vocational rehabilitation measures

MSE (medical labor examination). Professional guidance. Preparing disabled people for professional work. Preparation of production for the use of the labor of disabled people. Measures to ensure employment (labor integration) of disabled people. Dynamic observation and control over the rationality of employment and determination of the success of social and labor adaptation. Measures for social and labor adaptation (fixation) of disabled people at work.

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Career guidance

The goal is to assist disabled people in professional self-determination and the correct use of their working abilities and capabilities, taking into account the interests of the disabled person and the needs of the labor market. System of measures: Professional selection. Medical professional consultation. Professional selection. Professional propaganda. Professional information. Professional education and enlightenment. Correction of professional interests.

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Groups of vocational guidance institutions for people with disabilities

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Professional selection

A set of methods for studying the biopsychosocial status of a disabled person to formulate recommendations for a disabled person about possible directions for his future professional development. activities that are most appropriate to the state of health, ability to work, prof. interests, inclinations and desires.

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Elements of the prof. selection

Medical aspect (medical professional consultation). Psychophysiological aspect (vocational selection). Psychological aspect. Technical (ergonomic) aspect. Social aspect. Socio-economic aspect.

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Medical aspect (medical professional consultation)

definition of honey indications and contraindications for continuation of prof. activities, available nature, conditions, regimes, forms of labor organization, professions and types of work.

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Psychophysiological aspect (vocational selection).

Assessing the suitability of a disabled person to perform work in professions indicated to him due to health reasons.

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Socio-economic aspect.

Taking into account the state and dynamics of the labor market.

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Requirements for the profession

Harmlessness and safety for disabled people. The disabled person must be fit to work in the chosen profession. Compliance with the inclinations and desires of the disabled person. Compliance with the level of training of a disabled person, his experience and knowledge, prospects for professional growth. Real job opportunities.

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Factors contraindicated for a disabled person Prof. activities or previous profession in general. Shown working conditions (severity and tension, regime, organization, hygiene factors; necessary restrictions. Special requirements for labor protection and safety. Necessary working devices and special requirements for organizational, technical and ergonomic adaptation of the workplace. List of exemplary professions and types labor.

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Measures to prepare disabled people for professional work

General education and labor training. Vocational training and retraining. Providing disabled people with technical means of adaptation to work and training in how to use them. Restoration of previous and formation of new professionally significant psychophysiological qualities and abilities. Formation of a positive attitude toward prof. training and work.

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Criteria for choosing a method of vocational training

Level of knowledge required for prof. training. The ability of a person with a disability to learn. The ability to concentrate and be prepared for neuro-emotional stress. Motivation for retraining. Ability to handle academic workloads, co-teaching and living with other students. Psychological compatibility. Social behavior. Motivation to achieve results.

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