REPUBLIC OF UZBEKISTAN
MINISTRY OF HEALTH
THE TASHKENT MEDICAL ACADEMY
"CONFIRM"
The pro-rector on study
Prof. Teshaev O.R
____________________
«________» ___________ 2014y.
CHAIR OF FOLK MEDICINE, REHABILITOLOGY AND A PHYSICAL
CULTURE
SUBJECT: REHABILITOLOGY
FOR STUDENTS 4TH COURSES OF TREATMENT AND MEDICOPEDAGOGICAL FACULTIES
CURRICULUM
TASHKENT - 2014
1
CONTENT OF APPROACH
№
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Content
Pattern of curricular program
Working program
Study technologies
Set of exercises and activities
Test and quizzes
Control questions
General tests
Sharing materials
Glossary
Themes of abstracts
List of Aknowledgements
Foundamental conspectus
Litureture
Foreign books
Themes of course works
Annotation
About authors
Useful suggestions
Normative documentaries
Evaluation criterias
БЕТЛАР
3-21
22-41
42-185
186-191
191-198
198-202
202-203
203-213
214-218
218-219
219-221
222-259
259-260
260-261
261
262-317
318-322
2
REPUBLIC OF UZBEKISTAN MINISTRY OF HIGH AND AVERAGE
EDUCATION
REGISTRATED
REPUBLIC OF UZBEKISTAN
MINISTRY OF HIGH AND
AVERAGE
EDUCATION201_YEAR
CONFIRMED
IN
“____”
_________ORDER № “____”-
№________________
201_YEAR “___”
____
CURRICULUM OF
INTERNAL MEDICINE, GERIATRICS AND REHABILITOLOGY
Knowledge part:
500000
– health and social support
Study part:
510000
– Health
Study direction:
5510100 – Treatment work
5111000 – professional education (5510100 – treatment
work)
Tashkent - 2013
3
The technology of training is discussed and confirmed on therapeutic section CMC
of the Tashkent medical academy № ____ from _________ 2014
Curriculum made in Tashkent Medical Academy
Authors:
Nurillayeva N.M
CMS AP Head of department internal medicine and
allergology for GP in treatment faculty
Рустамова М.Т.
Professor of department internal medicine and
endocrinology for GP in treatment faculty
Гадаев А.Г.
Professor of department internal medicine and
endocrinology for GP in medical pedagogical faculty
Усманходжаева А.А. CMS AP Head of folk medicine, rehabilitation and
physical culture
Reviewers:
Alavi A.L
–Professor of department faculty, hospital therapy of
medical pedagogical faculty and department internal
medicine of stomatological faculty in TMA
Zakhidova M.Z.
-Professor of department retraining GP in institute of
doctors retraining in Tashkent
The technology of training is discussed and confirmed on therapeutic section CMC
of the Tashkent medical academy № ____ from _________ 2014
4
Introduction
«Даволаш иши» мутахассислиги бўйича «УАШ малакавий тавсифномаси»
талабларига асосан кўриб чиқилган ҳолда – Соғлиқни сақлаш биринчи
босқичида шифокор ёрдамини кўрсатиш асосий билим ва амалий
кўникмаларига кирувчи : касалликлар профилактикаси, ички касалликлари
бор беморларни эрта ва қиёсий ташхиси ва уларни режали равишда олиб
бориш кўникмаларини тўлиқ эгаллаган УАШ тайёрлаш.
The purpose and subject problem
Фанни ўқитишдан мақсад – Соғлиқни сақлаш бирламчи бўғинида асосий
билим, шифокор ёрдамини кўрсата олиш кўникмаларини: эрта ташхис,
қиёсий ташхис, профилактика ва беморларни олиб бориш тактикасини ўз
ичига олувчи умумий амалиёт шифокори квалификацион характеристикасига
«Даволаш иши» ихтисослиги талабларига жавоб берувчи УАШ тайёрлаш.
Фаниннг вазифалари:
- Профилактика ва ахоли соғлигини сақлаш учун бирламчи ёрдам
кўрсатиш бўйича билимларни эгалаш
- КШП/КВП шароитида малакали шифокор ёрдамини
кўрсата
олиш билим ва кўникмаларини ўзлаштириш
- Диспансеризация ва реабилитация ўтқазиш чора тадбирларни билим
ва кўникмаларини ўзлаштириш
Фан бўйича талабаларнинг билимига, кўникма ва малакасига
қўйиладиган талаблар
-«УАШ тайёрлаш ички касалликлар» ўқув фанини ўзлаштириш жараёнида
амалга ошириладиган масалалар доирасида бакалавр:
- УАШ амалиётида кўп учрайдиган асосий клиник синдромларни билиш.
- «УАШ малакавий тавсифномаси»да кўрсатилган ички касалликлар ташхис
мезонлари ва хавф омилларини билиш.
«УАШ
малакавий
тавсифномаси»да
кўрсатилган
ички
касалликларклиникаси ва эрта ташхисини билиш.
- УАШ тактикаси.
- Даволаш стандартлари.
- Меҳнатга лаёқатлилик экспертизаси, диспансеризацияси вареабилитацияси
асосларини билиш билиши керак;
- ҚВП/ШВП даражасида УАШ имкониятига қараб баъзи касалликларнинг
эрта ташхисини мустақил равишда тўлиқ амалга ошириши керак; фақат
айрим ҳоллардагина, яъни бемор аҳволи яхшиланмасагина бошқа соғлиқни
сақлаш ташкилотига (поликлиника, шифохона) қўшимча маслахат ва даво
олиш учун юборилади. (КВХ, 1 тоифали хизмат)
- ҚВП/ШВП шароитида имкониятига қараб УАШ ўткир ҳолатлар ва
касалликларни ажрата билиши ва уларни даволаб, лозим бўлса қўшимча
маслаҳат ва даво олиш учун мутахассис кўригига юбориши керак. (КВХ, 2
тоифали хизмат)
5
- ҚВП/ШВП шароитида УАШ беморларга адекват текшириш ва
муолажаларни малакали ва мустақил равишда амалга ошириши керак (КВХ,
3.1 тоифали хизмат).
- ҚВП/ШВП ва бошқа муассасаларга юбориш орқали керакли мувофиқ
бўлган муолажа ва текширувлар ўтказиш.(КВХ, 3.2 тоифали хизмат)
- ҚВП/ШВПга ҳар хил сабаблар туфайли мурожаат қилаётган беморлар ва
специфик хавф омилларига мойил бўлган шахсларга соғлом инсонларга
профилактик оқартув ёрдамини тақдим этиш кўникмаларига эга бўлиши
керак.
-Соғлом турмуш тарзини ташвиқот қилиш
- Бемор ва соғлом аҳолига маслахат бериш
- Аҳолининг алоҳида гуруҳларига индивидуал ёрдам кўрсатиш
- Мижозларни мустақил қабул қилиш
- Тиббиёт этикаси ва деонтологиясини сақлаш
- Беморларда клиник текшириш ўтказиш, анамнез йиғиш, тизим ва органлар
бўйича кўриш
- Қиёсий ташхис ўтказиш
- Тахминий ташхис қўйиш
- Мақсадга йўналтирилган текширувларни буюриш
- Якуний ташхисни қўйиш
- Ҳаракат режим ива пархезларни буюриш
- Рационал даволашни рецептура кўринишда белгилаш
- Зарур тиббий муолажаларни ўтказиб, шошилинч тиббий ёрдамни кўрсатиш
- Меҳнатга лаёқатлилик масаласини ҳал қилиш
- Керакли тиббий ҳужжатларни тўлдира билиш
- Қўшимча тиббий кўрикларга юбориш, ўтказиш ва шифохонага ётқизиш
масалаларини ҳал қилиш
- Қайта тиклаш ва санатор дам олишларга юбориш
- Аҳолини ижтимоий ҳимояланмаган гурухларга ва беморларга парваришни
ташкиллаштириш
- Диспансеризация ишларни ўтказиш
- Профилактик, соғломлаштириш сангигиеник ва эпидемияга қарши
тадбирларни инфекцион ва ноинфекцион касалларда қўллаш
- Қилинган ишлар аудитери
- Тиббий адабиётлар билан ишлаш
- Компьютер билан ишлаш малакаларига эга бўлиши керак.
Фаннинг ўқув режадаги бошқа фанлар билан ўзаро боғлиқлиги ва
услубий жиҳатдан узвий кетма-кетлиги
Ички касалликлар фани клиник фан ҳисобланиб, 11,12,13,14 семестрларда
ўқитилади. Дастурни амалга ошириш ўқув режасида режалаштирилган
табиий-илмий ва клиник (биология, биофизика, биохимия, нормал анатомия,
патологик анатомия, микробиология ва иммунология, умумий гигиена,
ижтимоий гигиена, соғлиқни сақлашниташкиллаштириш, тиббий техника,
фармакология, клиник фармакология, шифокор ва бемор, ички касалликлар
6
пропедевтикаси, факултет терапия, госпитал терапия, халқ тиббиёти,
реабилитология, нур ташхиси ва нур терапияси) фанлардан етарли билим ва
кўникмаларга эга бўлишлик талаб этилади.
Соғлиқни сақлаш тизимидаги ўрни
УАШ тайерлаш соғлиқни сақлаш бирламчи бўғинида асосий ахамиятга эга.
УАШ ахоли орасидаги ўрни: касалликларни эрта босқичларида аниқлаш,
профилактик
чора-тадбирларни
ўтказиш,
зарурат
бўлганда
тор
мутахассисларга юбориш, айрим касалликларни тарқалиши ва асоратларини
олдини олиш ва диспансеризация, реабилитация ўтқазиш. УАШ оилавий
шифокор бўлиши билан бирга ёши катта ва ёш болаларгача бўлган ахолига
хизмат кўрсатади хамда касалликларни олдини олиш билан шуғулланади.
Соғлиқни сақлаш тизимидаги муассасаларида тиббий реабилитация
бўлимларида олиб бориладиган даволовчи тадбирлар асосан бузилган
функцияларни кайта тиклайдиган ва компенсация киладиган махсус
усулларни беморларга индивидуал холда ишлаб чикариш, уларни асосий
мулжали тургун ногиронликни ва асоратларни бартараф килишига
каратилган. Бунда беморни хар томонлама тиббий, жисмоний, психологик,
ижтимоий ва касбий вазифаларини тулик кайта тиклаб жамиятда уз урнини
эгаллашига имкон яратади.
Фанни ўқитишда замонавий ахборот ва педагогик технологиялар
Талабаларнинг ички касалликлар фанини ўзлаштиришлари учун ўқитишнинг
илғор ва замонавий усулларидан фойдаланиш, янги информацион-педагогик
технологияларни татбиқ қилиш муҳим ахамиятга эгадир. Фанни
ўзлаштиришда дарслик, ўқув ва услубий қўлланмалар, маъруза матнлари,
тарқатма материаллар, компьютер дастурлари, электрон материаллар
фойдаланилади. Маъруза ва амалий дарсларда мос равишдаги илғор
педагогик технологиялар қўлланилади.
Асосий қисм
Фаннинг назарий машғулотлари мазмуни
6-курс талабалари учун амалий машғулотлар учун кўрсатма
Ўпка касалликларида таққослама ташҳисот, юрак қон томир касалликларида
таққослама ташҳисот,ошқозон ичак
касалликларида таққослама
ташҳисот,ревматологик касалликларида таққослама ташҳисот,сийдик
ажратиш тизими касалликларида таққослама ташҳисот
7-курс талабалари учун амалий машғулотлар учун кўрсатма
Оилавий тиббиёт асослари, юрак қон томир касалликларида таққослама
ташҳисот, упка касалликларида таққослама ташҳисот, ревматологик
касалликларида таққослама ташҳисот, ошқозон ичак касалликларида
таққослама ташҳисот, сийдик ажратиш тизими касалликларида таққослама
ташҳисот, иситмада таққослама ташхисни ўтқазиш
Ички касалликлар фани ва унинг таркибий қисмлари.
6-курс талабалари учун амалий машғулотлар учун кўрсатма
7
Ўпка касалликларида таққослама ташҳисот
Йўтал балғам ажралиши билан.
Бўлакли ва сегментар ўпка зарарланишининг таққослама ташхиси.Бўлакли
пневмония, инфильтратив ўпка сили, ўпка инфаркти. Касалхона ташқари ва
касалхона ичи пневмонияси. УАШ тактикаси. Бирламчи, иккиламчи,
училамчи профилактикаси ва диспансеризацияси.
Халқали ўпка зараланишларида таққослама ташхис: ўчоқли пневмония,
туберкулема, ўпка абсцеси, ўпка ўсмаси, ўпка эхинококи. Турли этиологияли
пневмония (бактериал, вирусли, микоаплазмали). УАШ тактикаси. Бирламчи,
иккиламчи, училамчи профилактикаси ва диспансеризацияси.
Диффуз диссеминациянинг таққослама ташхиси. Ўчоқли пневмония. Ўпка
силининг гематоген диссеминирлашган формаси. Пневмокониоз, рак
метастазлари. УАШ тактикаси. Бирламчи, иккиламчи, училамчи
профилактикаси ва диспансеризацияси.
Ўпка касалликлар билан боғлиқ кўкрак қафасидаги оғриқлар.
Қуруқ ва эксудатив плевритнинг таққослама ташхиси. Эксудатив
плевритнинг турлари. УАШ тактикаси. Бирламчи, иккиламчи, училамчи
профилактикаси ва диспансеризацияси.
Ҳансираш, нафас сиқиш.
Бронхообструкция билан кечувчи касалликларнинг таққослама ташхиси.
(бронхиал астма, ЎСОК, ўпка ўсмаси). УАШ тактикаси. Бирламчи,
иккиламчи, училамчи профилактикаси ва диспансеризацияси.
Ўпка ва юрак касалликларда ҳансирашнинг таққослама ташхиси. Ўпка
етишмовчилиги ва қон айланиш етишмовчилиги. УАШ тактикаси. Бирламчи,
иккиламчи, училамчи профилактикаси ва диспансеризацияси.
Юрак қон томир касалликларида таққослама ташҳисот
Аритмиялар.
Ритм бошловчи кўчишининг, синус тугунини заифлик синдроми.
экстрасистолия турларининг таққослама ташхиси. УАШ тактикаси.
Бирламчи, иккиламчи, училамчи профилактикаси ва диспансеризацияси.
Бўлмачалар ҳилпирашининг ва титрашининг, пароксизмал тахикардия, WPW
синдроми таққослама ташхиси. УАШ тактикаси. Бирламчи, иккиламчи,
училамчи профилактикаси ва диспансеризацияси.
Блокадаларнинг таққослама ташхиси: булмачалар аро, атриовентрикуляр,
коринчалараро. УАШ тактикаси. Бирламчи, иккиламчи, училамчи
профилактикаси ва диспансеризацияси.
Артериал гипертензия.
Буйракли АГ билан гипертония касаллигини таққослама ташхиси. Ҳавф
омиллари. ГК босқичлари, буйракли АГ турлари (паренхиматоз,
реноваскуляр). УАШ тактикаси. Бирламчи, иккиламчи, училамчи
профилактикаси ва диспансеризацияси.
Эндокрин АГ билан гипертония касаллигини таққослама ташхиси. Эндокрин
АГ турлари (феохромацитома, Кон синдроми, Иценго-Кушинг синдроми,
8
тиреотоксикоз). УАШ тактикаси. Бирламчи, иккиламчи, училамчи
профилактикаси ва диспансеризацияси.
Гемодинамик АГ билан гипертоник касалликни таққослама ташхиси.
Гемодинамик АГ турлари (атеросклероз, аорта коарктацияси, аорта клапани
етишмовчилиги, димланиш гипертензияси, тўлиқ АВ блокада). УАШ
тактикаси. Бирламчи, иккиламчи, училамчи профилактикаси ва
диспансеризацияси.
Гипертония касаллиги билан марказий артериал гипертензияни таққослама
ташхиси. Марказий АГ ни келтириб чиқарувчи сабаблар (БМЖ, арахноидит,
энцефалит, мия ўсмаси). УАШ тактикаси. Бирламчи, иккиламчи, училамчи
профилактикаси ва диспансеризацияси.
Юрак соҳасидаги оғриқлар.
ЮИК зўриқиш стенокардияни барча функционал синфлараро
оғриқ
синдромини қиёсий ташхиси. УАШ тактикаси. Бирламчи, иккиламчи,
училамчи профилактикаси ва диспансеризацияси.
ЮИК ностабил стенокардияни барча турлари (илк пайдо бўлган, ривожланиб
борувчи, спонтан, эрта инфарктан кейин, эрта операциядан кейин) оғриқ
синдромини киёсий ташхиси. УАШ тактикаси. Бирламчи, иккиламчи,
училамчи профилактикаси ва диспансеризацияси.
ЮИК стенокардия ва миокард инфарктини оғриқ синдромини қиёсий
ташхиси (клиник, лаборатор, ЭКГ). УАШ тактикаси. Бирламчи, иккиламчи,
училамчи профилактикаси ва диспансеризацияси.
Миокард инфарктинингтурли клиник вариантларини қиёсий ташхиси. УАШ
тактикаси. Бирламчи, иккиламчи, училамчи профилактикаси ва
диспансеризацияси.
Турли этиологияли миокардит ва миокардиодистрофияларнинг қиёсий
ташхиси. УАШ тактикаси. Бирламчи, иккиламчи, училамчи профилактикаси
ва диспансеризацияси.
Перикардит, аорта аневризмаси ва ЎАТЭ қиёсий ташхиси. Бирламчи,
иккиламчи, училамчи профилактикаси ва диспансеризацияси.
Кардиомегалия ва юрак шовқинлари.
Юрак чўққи турткисида эшитилувчи функционал (анемик, қон оқимининг
ўзгариши, иситмада) ва органик (митрал клапан етишмовчилиги, митрал ёриқ
стенози, митрал клапан пролапси) шовқинларнинг қиёсий ташхиси. УАШ
тактикаси. Бирламчи, иккиламчи, училамчи профилактикаси ва
диспансеризацияси.
Аорта устида эшитилувчи юрак нуқсонларидаги ( ревматик, инфекцион
эндокардит, атеросклероз) шовқинларнинг қиёсий ташхиси. УАШ тактикаси.
Туғма ва орттирилган юрак нуқсонлариниқиёсий ташхиси. Бирламчи,
иккиламчи, училамчи профилактикаси ва диспансеризацияси.Бирламчи,
иккиламчи, училамчи профилактикаси ва диспансеризацияси.
Кардиомиопатиянинг турли шакилларини (дилятацион, рестриктив,
гипертрофик, ўнг қоринча аритмоген дисплазияси) қиёсий ташхиси. УАШ
9
тактикаси. Бирламчи, иккиламчи, училамчи профилактикаси ва
диспансеризацияси.
Кардиомиопатия, юрак нуқсонлари, ЮИК, гипертония касалликларини
қиёсий ташхиси. УАШ тактикаси. Бирламчи, иккиламчи, училамчи
профилактикаси ва диспансеризацияси.
Ошқозон ичак касалликларида таққослама ташҳисот
Дисфагия
Эзофагит, рефлюкс эзофагит, склеродермиядаги дисфагия, қизилўнгач
ўсмаларини қиёсий ташхиси. УАШ тактикаси. Бирламчи, иккиламчи,
училамчи профилактикаси ва диспансеризацияси.
Қориндаги оғриқ
Гастрит ва яра касаллиги (ошқозон ва ўн икки бармоқли ичак) ни қиёсий
ташхиси. УАШ тактикаси. Бирламчи, иккиламчи, училамчи профилактикаси
ва диспансеризацияси.
Сурункали холецистит ва сурункали панкреатитни қиёсий ташхиси. УАШ
тактикаси. Бирламчи, иккиламчи, училамчи профилактикаси ва
диспансеризацияси.
Носпецифик ярали колит ва Крон касаллигини қиёсий ташхиси. УАШ
тактикаси. Бирламчи, иккиламчи, училамчи профилактикаси ва
диспансеризацияси.
Гепатомегалия
Актив ва ноактив сурункали гепатитни қиёсий ташхиси. УАШ тактикаси.
Бирламчи, иккиламчи, училамчи профилактикаси ва диспансеризацияси.
Сурункали гепатит ва жигар циррозини қиёсий ташхиси. УАШ тактикаси.
Бирламчи, иккиламчи, училамчи профилактикаси ва диспансеризацияси.
Сариқлик.
Ўт-тош касаллиги ва билиар-панкреатик соҳа ўсмалари (жигар, ўт қопи,
ошқозон ости бези ўсмалари) ни қиёсий ташхиси. УАШ тактикаси.
Бирламчи, иккиламчи, училамчи профилактикаси ва диспансеризацияси.
Ревматологик касалликларида таққослама ташҳисот
Бўғим синдроми.
Ревматизм ва ревматоид артритни қиёсий ташхиси. УАШ тактикаси.
Бирламчи, иккиламчи, училамчи профилактикаси ва диспансеризацияси.
Серонегатив спондилоартрит (реактив артрит, Бехтерев касаллиги, псориатик
артрит) ларниқиёсий ташхиси. УАШ тактикаси. Бирламчи, иккиламчи,
училамчи профилактикаси ва диспансеризацияси.
Бириктирувчи тўқиманинг диффуз касалликларини (тизимли қизил бўрича,
тизимли склеродермия) қиёсий ташхиси. УАШ тактикаси. Бирламчи,
иккиламчи, училамчи профилактикаси ва диспансеризацияси.
10
Тизимли васкулитларни (носпецифик аортоартериит, тугунли периартрит)
қиёсий ташхиси. УАШ тактикаси. Бирламчи, иккиламчи, училамчи
профилактикаси ва диспансеризацияси.
Сийдик ажратиш тизими касалликларида таққослама ташҳисот
Сийдик чўкмасини ўзгаришлари.
Пиелонефрит, гломерулонефрит ва интерстициал нефритни қиёсий ташхиси.
УАШ тактикаси. Бирламчи, иккиламчи, училамчи профилактикаси ва
диспансеризацияси.
Амилоидоз ва нефропатияларни қиёсий ташхиси. УАШ тактикаси. Бирламчи,
иккиламчи, училамчи профилактикаси ва диспансеризацияси.
Шиш синдроми.
Турли этиологияли махаллий (аллергик, қон томирли, яллиғланишли) ва
умумий (қон айланиш етишмовчилигидаги, буйракка боғлиқ, эндокрин, оч
қоринга) шишларни қиёсий ташхиси. УАШ тактикаси. Бирламчи, иккиламчи,
училамчи профилактикаси ва диспансеризацияси.
7-курс талабалари учун амалий машғулотлар учун кўрсатма
Оилавий тиббиёт асослари.
УАШ вазифалари.Ишлашнинг ўзига хос томонлари. Тиббий хужжатлар.
Беморлардан ўз уйида хабар олиш. Жамоатни жалб этиш. Врач ва
беморларнинг хуқуқлари. УАШ ишида этика ва деонтология.
Ишлашнинг ўзига ҳос томонлари. Оилада руҳий муҳит. Дин ва урф одат
муаммолари. Оилани маслаҳат қилиш.
Мулокотга алоқадор факторлар. Мулоқотдаги кийинчиликлар. Хахслараро
мулоқот. Амалий маслаҳатлар.
Маслахат бериш турлари. Маслахат бериш принциплари. Беморни ўз
соғлигига жавобгарлиги.
Профилактика турлари. Соғлом турмуш тарзини тадбиқ этиш. Озиқланиш ва
рўзғор гигиенаси. Профилактик кўрик, скрининг. Инфекцион ва
ноинфекцион касалликлар профилактикаси. Иммунизация. Дастурлар ва
тадбирлар.
Болалар, ўсмирлар, аёллар (фертил ёшдаги аёллар, хомиладорлар), эркаклар,
кексалар. Ишлаб чиқариш ва қишлоқ хўжалигидаги ишчилар. Ижтимоий
ҳимояланган инсонлар. Беморлар, оғир беморлар, ўлаётган беморлар.
Реабилитация ва диспансеризация муаммолари. Ишга лаёқатликни
экспертизаси.
Санитар оқартув. Касалланиш ва ўлимнинг асосий сабабларига таъсир этиш.
Руҳий ҳолатни мустаҳкамлаш. Экология ва касб омиллари. Беморларни
ўқитиш, “мактаблар”.
Саёҳатчига маслахат бериш. Саёхатдан кейин маслахат бериш.
Иммунизация. Иқлим ва соат ўзгаришларини алмашиниши. Чайқалиш ва тоғ
касаллиги. Йўл тиббиёт анжомларни йиғиндиси.
Тахминий ташхис. Хавфли касалликлар. Ташхисий хатоликлар. Имитатор
касалликлар. Руҳий бузилишва симуляция.
11
Юрак қон томир касалликларида таққослама ташҳисот
Кўкрак қафасидаги оғриқ.
НЦД, ЮИК стенокардия, ИККС, миокардит ва миокардиодистрофияни
таққослама ташхиси. УАШ тактикаси. Бирламчи, иккиламчи, училамчи
профилактикаси ва диспансеризацияси.
Умуртқа
кўкракқисмини
остеохондрози,қовурғааро
нервларнинг
невралгияси, кўкрак қафаси жарохати, ўраб олувчи темиратки таққослама
ташҳиси. УАШ тактикаси. Бирламчи, иккиламчи, училамчи профилактикаси
ва диспансеризацияси.
Юрак уриб кетиши.
Аритмияларни таққослама ташхиси. Синусли тахикардия, нафас аритмияси,
экстрасистолия. УАШ тактикаси. Бирламчи, иккиламчи, училамчи
профилактикаси ва диспансеризацияси.
Қон айланиш етишмовчилиги, анемия, тиреотоксикоздаги юрак уриб
кетишининг таққослама ташхиси. Бирламчи, иккиламчи, училамчи
профилактикаси ва диспансеризацияси.
Бош оғриғи.
Гипертония касаллиги ва склеротик артериал гипертензиянинг таққослама
ташхиси.
Ўпка касалликларида таққослама ташҳисот
Йўтал балғам ажралиши билан.
ЎРК, ЎРВК, ўткир бронхит ва пневмониянингтаққослама ташхиси.
Сурункали бронхит ва бронхоэктатик касалликнинг таққослама ташҳиси.
УАШ тактикаси. Бирламчи, иккиламчи, училамчи профилактикаси ва
диспансеризацияси.
Хансираш, бўғилиш.
Бронхиал астма,эмфизема, пневмосклерознинг таққослама ташҳиси. УАШ
тактикаси.Сурункали нафас етишмовчилиги. УАШ тактикаси. Бирламчи,
иккиламчи, училамчи профилактикаси ва диспансеризацияси.
Ревматологик касалликларида таққослама ташҳисот
Бўғим синдроми (артралгия, артритлар).
Ревматизм, ревматоид артрит ва инфекцион артритларнинг таққослама
ташҳиси. УАШ тактикаси. Бирламчи, иккиламчи, училамчи профилактикаси
ва диспансеризацияси.
Остеоартроз ва подагранингтаққослама ташҳиси. УАШ тактикаси.Бирламчи,
иккиламчи, училамчи профилактикаси ва диспансеризацияси.
Ошқозон ичак касалликларида таққослама ташҳисот
Диспепсия (жиғилдон қайнаши, кўнгил айниш, қайт қилиш). УАШ
тактикаси. Бирламчи, иккиламчи, училамчи профилактикаси
ва
диспансеризацияси.
12
Гастрит, дуоденит ва яра касаллигининг таққослама ташҳиси. УАШ
тактикаси. Бирламчи, иккиламчи, училамчи профилактикаси ва
диспансеризацияси.
Ўт йўллари дискинезияси ва холециститнинг таққослама ташҳиси. УАШ
тактикаси.Бирламчи,
иккиламчи,
училамчи
профилактикаси
ва
диспансеризацияси.
Постхолецистэктомик синдром ва жаррохлик амалиёти бажарилган ошқозон
касаллигини таққослама ташҳиси. УАШ тактикаси.Бирламчи, иккиламчи,
училамчи профилактикаси ва диспансеризацияси.
Қориндаги оғриқ.
Эпи-, мезо- ва гипогастрал соҳадаги оғриқлар билан кечувчи
касалликларнинг таққослама ташҳиси. УАШ тактикаси. Бирламчи,
иккиламчи, училамчи профилактикаси ва диспансеризацияси.
Диарея.
Инфекцион ва ноинфекцион этиологияли диареянингтаққослама ташҳиси.
УАШ тактикаси. Бирламчи, иккиламчи, училамчи профилактикаси ва
диспансеризацияси.
Қабзият.
Таъсирланган ичак синдроми, қариялардаги қабзият ва йўғон ичак
ўсмаларининг таққослама ташҳиси. УАШ тактикаси. Бирламчи, иккиламчи,
училамчи профилактикаси ва диспансеризацияси.
Гепатомегалия.
Ўткир гепатит, сурункали гепатит, жигарнинг алкогол касаллигини
таққослама ташҳиси. УАШ тактикаси. Бирламчи, иккиламчи, училамчи
профилактикаси ва диспансеризацияси.
Сийдик ажратиш тизими касалликларида таққослама ташҳисот
Дизурия.
Ўткир ва сурункали холециститнинг таққослама ташҳиси. УАШ
тактикаси.Цистит ва сийдик кислотали диатезнинг таққослама ташҳиси.
УАШ тактикаси. Бирламчи, иккиламчи, училамчи профилактикаси ва
диспансеризацияси.
Иситмада таққослама ташхисни ўтқазиш
Номаълум генезли иситма. Иситма турлари ва характери, иситмада
текшириш режаси. УАШ тактикаси.Бирламчи, иккиламчи, училамчи
профилактикаси ва диспансеризацияси.
Инфекцион касалликлардаги (бактериал, вирусли) иситмани таққослама
ташҳиси. УАШ тактикаси. Бирламчи, иккиламчи, училамчи профилактикаси
ва диспансеризацияси.
Амалий машғулотларни ташкил этиш бўйича кўрсатма ва тавсиялар
Амалий машғулотларда талабаларўрганиш ва ўзлаштириши, уларда
клиник
фикрлаш,
турли
гурух
касалликларини
дифференциал
диагностикасини, профилактикасини билиш, хамда кейинчалик соғликни
сақлашнинг бирламчи бўғинида ишлашларини ўрганадилар.
13
Амалий машғулотларнинг тахминий тавсия этиладиган мавзулари:
6-курс талабалари учун амалий машғулотлар учун кўрсатма
1. Оилавий тиббиёт асослари.
2. Оила билан ишлаш.
3. Мулоқот санъати.
4. Маслахат бериш.
5. УАШ ишида профилактика.
6.
Йўтал балғам ажралиши билан.
7. Ўпка касалликлар билан боғлиқ кўкрак қафасидаги оғриқлар.
8. Ҳансираш, нафас сиқиш.
9. Аритмиялар.
10.Артериал гипертензия.
11.Юрак соҳасидаги оғриқлар.
12.Кардиомегалия ва юрак шовқинлари.
13.Дисфагия.
14.Қориндаги оғриқ.
15.Гепатомегалия.
16.Сариқлик.
17.Бўғим синдроми.
18.Сийдик чўкмасини ўзгаришлари.
19.Шиш синдроми.
7-курс талабалари учун амалий машғулотлар учун кўрсатма
1.
Аҳолининг турли гуруҳлар билан ишлаш.
2.
Ҳавф омилларига таъсир қилиш.
3.
Саёҳатчилар учун тиббиёт.
4.
УАШ амалиётига таққослама ташҳисот.
5.
Кўкрак қафасидаги оғриқ..
6.
Юрак уриб кетиши.
7.
Бош оғриғи.
8.
Йўтал балғам ажралиши билан.
9.
Хансираш, бўғилиш.
10. Бўғим синдроми (артралгия, артритлар).
11. Диспепсия (жиғилдон қайнаши, кўнгил айниш, қайт
қилиш).
12. Қориндаги оғриқ.
13. Диарея.
14. Қабзият.
15. Гепатомегалия.
16. Дизурия.
17. Иситма.
Амалий машғулотларни ташкил этиш бўйича кафедра профессорўқитувчилари томонидан кўрсатма ва тавсиялар ишлаб чиқилади. Унда
талабалар асосий маъруза мавзулари бўйича олган билим ва кўникмаларини
амалий масалалар ечиш орқали янада бойитадилар. Шунингдек, дарслик ва
14
ўқув қўлланмалар асосида талабалар билимларини мустаҳкамлашга эришиш,
тарқатма материаллардан фойдаланиш, илмий мақолалар ва тезисларни чоп
этиш орқали талабалар билимини ошириш, масалалар ечиш, мавзулар бўйича
кўргазмали қуроллар тайёрлаш ва бошқалар тавсия этилади.
Лаборатория ишларини ташкил этиш бўйича кўрсатмалар
кўзда тутилмаган
Мустақил ишни ташкил этишнинг шакли ва мазмуни
Талаба мустақил ишини тайёрлашда фаннинг хусусиятларини ҳисобга олган
ҳолда қуйидаги шакллардан фойдаланиш тавсия этилади:

дарслик ва ўқув қўлланмалар бўйича фан боблари ва мавзуларини
ўрганиш;

тарқатма материаллар бўйича маърузалар қисмини ўзлаштириш;

автоматлаштирилган ўргатувчи ва назорат қилувчи тизимлар билан
ишлаш;
 махсус адабиётлар бўйича фанлар бўлимлари ёки мавзулари устида
ишлаш;
 янги техникаларни, аппаратураларни, жараёнлар ва технологияларни
ўрганиш;
 талабанинг ўқув-илмий-тадқиқот ишларини бажариш билан боғлиқ
бўлган фанлар бўлимлари ва мавзуларни чуқур ўрганиш;
 фаол ва муаммоли ўқитиш услубидан фойдаланиладиган ўқув
машғулотлари;
 масофавий (дистанцион) таълим.
Тавсия этилаётган мустақил ишларнинг мавзулари:
VI-курс талабалари учун
1. Қиёсий ташхис алгоритми
2. Қиёсий ташхисот (жадвал, схема ва слайдлар)
3. Хавф омиллари
4. Ташхис қўйишда ва даволашда янгиликлар (интернет,монографиялар,
қўлланмалар, журнал мақолалари)
5. Ташхиснинг замонавий тамойиллари
6. Хомиладорларда даволаш ва кечишнинг ўзига хос томонлари
7. Кексаларда даволаш ва кечишнинг ўзига хос томонлари
8. Асоратлар
9. УАШ тактикаси (мутахассис кўриги ва госпитализация қилиш учун
йўлланмага кўрсатмалар).
10.Ички касалликларнинг бирламчи, иккиламчи, училамчи
профилактикаси ва диспансеризацияси.
11.Стандарт даволашлар (жадвал, схема, кроссворд)
12.Дори воситаларини презентацияси
13.Беморга тавсиялар (превентив кўникмалар)
14.Тестлар (10 тадан кам эмас)
15.Карта-масалалар (2 тадан кам эмас)
16.Врач аудит ишлари
15
VII-курс талабалари учун
1. Қиёсий ташхис алгоритми
2. Қиёсий ташхисот (жадвал, схема ва слайдлар)
3. Ташхис қўйишда ва даволашда янгиликлар (интернет,монографиялар,
қўлланмалар, журнал мақолалари)
4. Хав омиллари ва эрта ташхисот
5. Скрининг дастурлар
6. УАШ тактикаси (мутахассис кўриги ва госпитализация қилиш учун
йўлланмага кўрсатмалар)
7. Стандарт даволашлар (жадвал, схема, кроссворд)
8. Реабилитация
9. Диспансеризация
10.Беморга тавсиялар (превентив кўникмалар)
11.Меҳнатга лаёқатлилик экспертизаси
12.Тестлар (10 тадан кам эмас)
13.Карта-масалалар (2 тадан кам эмас)
14.ВОП аудит ишлари
6-курс талабалари учун реабилитолгия фанидан амалий машғулотлар
учун кўрсатма
Юрак-қон томир ва нафас тизимлари касалликларидатиббий
реабилитация тадбирлари
Юрак ишемик касаллиги, миокард инфаркти, гипертония ва гипотония
касаллиги, НЦД, атеросклероз билан касалланган беморларнинг комплекс
реабилитацияси, юрак-кон томир тизимида операциялардан кейинги
реабилитация усуллари; (тикланувчи даволашнинг турли босқичларида
физиотерапия, даволовчи жисмоний тарбия ва реабилитациянинг
ноанъанавий усулларини қўллаш). Босқичларида гипоксияни йўқотувчи, қон
суюлтируви, спазмолитик, седатив, қон айланишини яхшиловчи,
микроциркуляцияни ва модда алмашувни кучайтировчи физик муолажаларни
ва жисмоний реабилитация қулланилади. Психологик ва ижтимоий
аспектларни ўрганиш.
Зотилжам, бронхит, бронхиал астма, бронхоэктатик касаллик,
эмфизема билан касалланган беморларнинг комплекс реабилитацияси
(тиқланувчи даволашнинг турли босқичларида физиотерапия, даволовчи
жисмоний тарбия ва реабилитациянинг ноанъанавий усулларини қўллаш).
Физик муолажалар ялиғланишга қарши, сўрилтирувчи, қон айланишни
яхшиловчи, бронхларни кенгайтирувчи, нафас олишни меъерловчи, седатив
16
таъсир кўрсатувчи, мода алмашинувини, буюрак усти безни фаолиятини
яхшиловчи қаратирилган.
Беморларни санатор-курорт даволаш босқичиларида йўлланма бериш,
бунда курорт турини аниқлаш ва йил фаслини белгилаш.
Овкат ҳазм килиш тизими, сийдик чиқариш йўллари ва буйрак
касалликларида, эндокрин системаси касалликлари билан касалланган
беморларнинг реабилитацияси
Гастрит, ошқозон ва ўн икки бармоқ ичак яраси касаллиги,
энтероколит, сапроғ чиқариш йўллари ва жигар касалликлари, буйракнинг
яллиғланиш жараёнлари билан касалланган, эндокрин системаси ва модда
алмашинуви (қандли диабет, метаболик синдроми, семириш, қалқонсимон
без касалликлари, подагра)
беморларнинг комплекс реабилитацияси
(тиқланувчи даволашнинг турли босқичларида физиотерапия, даволовчи
жисмоний тарбия ва реабилитациянинг ноанъанавий усулларини қўллаш).
Босқичларида: оғриқ қолдирувчи, яллиғланишга қарши, регенерацияни
кучайтирувчи,
сўрилтиручи,
ошқозон
ичак
перисталтикасини
нормалаштирувчи ва модда алмашинувини яхшиловчи, қондаги қанд
миқдорини пасайтирувчи, микроциркуляцияни яхшиловчи, тана вазнини
камайтирувчи, мода алмашинувини кучайтирувчи, яхшиловчи, седатив
таъсир этувчи, туқима трофикасини яхшиловчи физиотерапевтик
муолажаларни тавсия қилиш. . Беморларни санатор-курорт даволаш
босқичиларида йўлланма бериш, бунда курорт турини аниқлаш ва йил
фаслини белгилаш.
Нерв тизимлари, таянч-ҳаракат аппаратининг деструктив-дистрофик
касалликлари билан касалланган беморларнинг реабилитацияси.
Периферик ва марказий нерв тизимлари патологияларида (неврит,
невралгия, умуртқа поғона чурраси, инсульт,
МНС функционал
касаликларида) яллиғланишга қарши, дегидратацияни кучайтиручи, шишни
қайтарувчи, буғимлар функционал холатини яхшиловчи, сурилтирувчи,
буйрак усти бези фаолиятини яхшиловчи, седатив таъсир курсатувчи
физиотерапия, даволовчи жисмоний тарбия ва реабилитациянинг
ноанъанавий усулларини қўлланилади; таянч-ҳаракат аппаратининг
деструктив-дистрофик ва ялиғланиш касалликлари (полиартритлар, ДОА,
Бехтерев касаллиги),
билан касалланган беморларнинг комплекс
реабилитацияси;
Беморларни санатор-курорт даволаш босқичиларида йўлланма бериш, бунда
курорт турини аниқлаш ва йил фаслини белгилаш
Гинекологик касалликларда, акушерлик ва педиатрияда
учрайдиган баъзи патологик ҳолатларда реабилитация
Гинекологик яллиғланиш жараёнларида сурункали инфекция ўчоғи
санацияси, яллиғлниш сўрилиши, бузилган функцияларни тиклаш, оғриқни
қолдириш ва асоратларнинг олдини олиш мақсадида физиотерапевтик
омиллар ва реабилитация усулларини қўллаш; акушерликда кузтиладиган
баъзи патологик ҳолатларда физик омилларни профилактик мақсадда
17
қўллаш; болалар ва ўспиринларда кузатиладиган нафас системаси ва таянчҳаракат аппарати касалликларида қўлланилдиган физиотерапевтик омиллар
ва реабилитация усулларининг ўзига хослиги.
Хирургик касалликларни реабилитацияси
Травмотологияда ва умумий хирургик касалликларида комплекс
реабилитациясида: яллиғланишга қарши, бактериоцид, бактериостатик,
сўрилтирувчи,
дегидратацияни
яхшиловчи,
спазмолитик,
микроциркуляцияни ва туқима трофикасини яхшиловчи, регенерацияни
кучайтирувчи, шишишни қайтарувчи; травматологияда иммобилизация ва
иммобилизациядан сунги босқичларида контрактурани олдини олувчи, бўғим
функционал холатини яхшиловчи, асоратини олдини олувчи физиотерапия,
даволовчи жисмоний тарбия ва реабилитациянинг ноанъанавий усуллари
қўлланиши.
Ўз вақтида беморларни санатор-курорт даволаш босқичиларида йўлланма
бериш, бунда курорт турини аниқлаш ва йил фаслини белгилаш
Амалий машғулотларни ташқил этиш бўйича кўрсатма ва тавсиялар
Амалий машғулотларда талабалар
1. Беморларга ташхисига ва касаллигини даврига асосоланиб реабилитация
этапини аниклаш;
2. Беморга индивидуал реабилитация дастурни тузиш;
3. Индивидуал реабилитация дастурида патогенетик таъсир этадиган
физиотерапевтик муолажаларни тўғри танлаш ва комплекс равишда
тузиш;
4. Реабилитация этапларида даволовчи жимоний тарбияни воситаларини ва
шаклларини танлаш ватўғри тавсия килиш;
5. Даволаш ҳужжатларини расмийлаштириш;
6. Расмийлаштирилган даволовчи усулларни самарадорлигини аниқлаш;
7. Беморга санаторий турини танлаш ва санаторий шаротида реабилитация
тадбирларни аниқлаш;
8. Соғломлаштириш мақсадида физиопрофилактикмуолажаларни қўллаш
ва жисмоний тарбия усулларни тавсия килишни
ўрганадилар.
Амалий машғулотларнинг тахминий тавсия этиладиган мавзулари:
1. Юрак-қон томир ва нафас тизими касалликларида
реабилитация
усуллари.
2. Ички аъзоларни , сийдик чиқариш йўллари ва буйрак касалликлари
билан касалланган беморларнинг реабилитацияси.
3. Нерв системси, таянч-ҳаракат аппаратининг деструктив-дистрофик
касалликлари билан касалланган беморларнинг реабилитацияси.
4. Эндокрин ва модда алмашинув касалликларда реабилитация усуллари
5. Гинекологик касалликларда, акушерлик ва педиатрияда учрайдиган
баъзи патологик ҳолатларда реабилитация.
6. Жарроҳлик ва травматологик беморларнирабилитацияси
18
Амалий машғулотларни ташкил этиш бўйича кафедра профессорўқитувчилари томонидан кўрсатма ва тавсиялар ишлаб чиқилади. Унда
талабалар асосий маъруза мавзулари бўйича олган билим ва кўникмаларини
амалий масалалар ечиш орқали янада бойитадилар. Шунингдек, дарслик ва
ўқув қўлланмалар асосида талабалар билимларини мустаҳкамлашга эришиш,
тарқатма материаллардан фойдаланиш, илмий мақолалар ва тезисларни чоп
этиш орқали талабалар билимини ошириш, масалалар ечиш, мавзулар бўйича
кўргазмали қуроллар тайёрлаш ва бошқалар тавсия этилади.
Мустақил ишни ташкил этишнинг шакли ва мазмуни
Талаба мустақил ишини тайёрлашда фаннинг хусусиятларини ҳисобга олган
ҳолда қуйидаги шакллардан фойдаланиш тавсия этилади:

дарслик ва ўқув қўлланмалар бўйича фан боблари ва мавзуларини
ўрганиш;

тарқатма материаллар бўйича маърузалар қисмини ўзлаштириш;

автоматлаштирилган ўргатувчи ва назорат қилувчи тизимлар билан
ишлаш;
 махсус адабиётлар бўйича фанлар бўлимлари ёки мавзулари устида
ишлаш;
 Янги техникаларни, аппаратураларни, жараёнлар ва технологияларни
ўрганиш;
 талабанинг ўқув-илмий-тадқиқот ишларини бажариш билан боғлиқ
бўлган фанлар бўлимлари ва мавзуларни чуқур ўрганиш;
 фаол ва муаммоли ўқитиш услубидан фойдаланиладиган ўқув
машғулотлари;
 масофавий (дистанцион) таълим.
Тавсия этилаётган мустақил ишларнинг мавзулари:
1. Юрак
кон-томир
тизимидаги
операцияларидан
кейинги
реабилитацияси.
2. Болалар церебрал параличларида реабилитация усуллари.
3. Миофасциал ва умуртка-погона огрик синдромларида комплекс
реабилитация усуллари
4. Амиотрофик ён. склерозида реабилитацияни кулланиши
5. Онкологик касалликларида реабилитацияси
6. Суяк синишларида ва остеопороз касаллигида тиббий реабилитация
усуллари
7. Турли касалликлар реабилитациясида мехнат билан даволаш усулини
роли ва ахамияти
Дастурнинг информацион-услубий таъминоти
Мазкур фанни ўқитиш жараёнида таълимнинг замонавий методлари,
педагогик ва ахборот-коммуникация технологиялари қўлланилиши назарда
тутилган.
- барча мавзулар бўйича маъруза машғулотларида замонавий компьютер
технологиялари
ёрдамида
презентацион
ва
электрон
дидактик
технологияларни;
19
- фаннинг умумий ва хусусий бўлимларига тегишли мавзуларида
ўтказиладиган амалий машғулотларда ақлий ҳужум, қора қути, ўргимчак
ини, гуруҳли фикрлаш педагогик технологияларини қўллаш назарда
тутилади.
LITERATURES
Main
1
Bogolyubov V.M. "Balneology and Physiotherapy" 1 and Volume 2 M.
Medicine 1985
2.
Yuldashev K., Y. Kulikov "Physiotherapy". Tashkent. 1984
3.
Strelkova N.I. "Physical treatments in neurology", M., 1983.
Four Popov S.N. "Physical rehabilitation" Rostov-on-Don, 1999
5.
Okorokov A.N. "Treatment of diseases of the internal organs. Manual ",
Volume 2, Moscow, 2004.
6.
Epifanov V.A. "Medical rehabilitation." Moscow, 2005.
7.
Ed. Epifanov V.A. - Therapeutic physical culture. Moscow, "GEOTAR
Medicine" 2006
9.2. Auxillary
1
Bogolyubov V.M. "Handbook of sanatorium selection", M, 1992.
2.
Iasnogorodski VG "Handbook of Physical Therapy", M, 1981.
3.
Ponomarenko TN "Guide to practical training in general physiotherapy", M,
2000.
Four Yuldashev KY "Non-drug treatments" a practical guide for physicians.
5.
S.N.Babaadzhanov Directory physiotherapist. Tashkent, 1999 g.Suluyanova
6.
V.Oransky, D.S.Ilhamdzhanova Quick Reference physiotherapy. T 1992
7.
The text of lectures and tutorials.
9.3.Foreign literatures:
1. Marlis Gonzalez-Fernandez, MD, PhD, Jarrod David Friedman, MD
Physical Medicine and Rehabilitation Pocket Companion
2. Mark Harrast, MD, Jonathan Finnoff, DO Sports Medicine Study Guide and
Review for Boards
3. Wainapel, Stanley F.; Fast, Avital (Editors) Alternative Medicine and
Rehabilitation A Guide for Practitioners 2003 - Demos Medical Publishing
4. Consuelo T Lorenzo et al. Physical Medicine and Rehabilitation Medscape
Reference 2011 - WebMD
5. Sara J. Cuccurullo (Editor) Physical Medicine and Rehabilitation Board
Review 2004 - Demos Medical Publishing, 848 pp.
9.4.Internet resources:
http://www.doktor.ru
http://www. medinfo.org
http://www.restart-med.ru
http://www.sportpsy.cz
http://www.alhealth.com
http://www.docguide.com
20
http://www.healthweb.com
http://www.acsm.org
http://www.apta.org
http://www.sportsmed.org.
http://www.jphysiol.org
http://www.physsportmed.com
http://www.sportsmedicine.com
21
REPUBLIC OF UZBEKISTAN
MINISTRY OF HEALTH
THE TASHKENT MEDICAL ACADEMY
DEPARTMENT OF FOLK MEDICINE, REHABILITATION AND
PHYSICAL CULTURE
«CONFIRMED»
STUDY
PRORECTOR,
PROFESSOR TESHAEV O.R.
___________
«_____»__________2014 YEAR
HIGH EDUCATION’S
Sphere of knowledge:
700000 – “public health and social welfare”
Sphere of education:
720000 – “public health”
Major of education:
5720100- “treatment”
5140900-“profession education”
WORK PROGRAM FOR REHABILITATION
Total hours – 72 hours
Practical exercises – 36 hours
Lectures – 4 hours
Self-study – 32 hours
TASHKENT – 2014
22
Authors:
Visogortseva O.N.
Head teacher of the department of the ethnoscience,
rehabilitation and physical culture, Candidate of
Medical science
Adilov Sh.Kh.
associate professor of the department of
ethnoscience, rehabilitation and physical culture.
the
Reviewers:
Khamraev A.A
Head of TMA II GP and endocrinology
Agzamova Sh.A.
Associate professor of the department of the medical
ambulatory and rehabilitation of TashPMI.
Working programme of the subject is made on the basis of educational
programme and educational plan of the “Occupational study”, “Work of
medical treatment" major, discussed in the meeting of the research and
development council of Tashkent Medical Academy, approved by the protocol
of the meeting No.___ dated ___ ___ ___ .
23
КИРИШ
1.1.Таълим бериш мақсади ва вазифалари
Таълим бериш мақсади.
Фанни ўқитишдан мақсад – талабаларнинг реабилитология соҳасидаги,
беморларни кайта тиклаш жараёнидаги роли ва аҳамияти ҳақидаги билим
савиясини ошириш.Шифокорларнинг касбий маҳоратини яхшилашда, қайта
тиклаш дастурини комплекс асослари бўйича ўз билимларини оширишга
қаратилган бўлиб, ўз ичига физикавий усуллар, шифобахш жисмоний тарбия,
массаж, мануал терапия, рефлексотерапия, ноанаънавий усулларини олган
ҳолда, уларни касалликни муваффақиятли ва ўз вақтида даволашда, қайта
тиклашда ва олдини олишда қўллашга қаратилган.
Таълим бериш вазифалари
Турли касалликларида шифохона, шифомаскан ва амбулатор
шароитида беморларни тиббий реабилитациясида физотерапевтик усулларни,
жисмоний реабилитация воситаларни ва қўшимча ноаънавий даволовчи
тадбирларини биргаликда қўлланишини ўргатиш. Аҳолининг соғлиғини
мустаҳкамлаш, ижтимоий ва маиший шароитларга мослашишини
(адаптациясини) яхшилаш тадбирларни билиш. Реабилитациянинг мақсади
ва вазифалари: бузилган функцияларни қайта тиклайдиган ва компенсация
қиладиган махсус усулларини ишлаб чиқиш, турғун ногиронликни ва
асоратларни бартараф қилиш. Физиотерапия ва шифобахш жисмоний тарбия
усуллари касалликни даволаш вақтини қисқартиришда ва асоратларни
олдини олишда қўлланилиши долзарб масала деб ҳисобланади. Чунки
юқоридаги услубларни қўлланилиши асосий даволовчи терапиянинг
таъсирини кучайишига ва дори моддалардан кузатиладиган асоратларни
олдини олишига имконият беради. Даволаш босқичини охирги этапи
ҳисобланган санатор курорт муассасалари бемор организмининг функционал
ҳолатини тикланишига ва уларни уй шароитига мослаштиришга имкон
беради. Бу босқичда беморларни даволаш дори-дармонсиз табиий факторлар
билан амалга оширилади.
1.2.Ўқув таълими бўйича талаба билими, малакаси ва
кўникмаларига бўлган талаб.
Талаба билиши керак.
- реабилитация ҳақида тушунча, унинг аспектлари ва принципларини;
- турли касалликларни даволашда физиотерапевтик муолажаларни ва
шифобахш жисмоний тарбияни комплекс усулларда қўлланишини;
- муолажаларни танлашда умумий ва махсус кўрсатма ва
моънеликларга риоя қилишни;
-даволаш муолажалар мажмуасини тузишда асосий ва ёндош
касалликларни ҳисобга олишни, нормал ва патологик ҳолатларда физик
омилларнинг хусусиятларини ва уларнинг организмга таъсир қилиш
механизмини;
- соғломлаштириш мақсадида физиопрофилактик муолажаларни
қўллашни;
24
-беморни асосий, ёндош касалликларини, кўрсатма ва қарши
кўрсатмаларини ҳисобга олган ҳолда, касалликнинг аниқ нозологик
турларида физик муолажаларнинг оптимал мажмуасини ишлаб чиқишни;
-касалликнинг турли босқичларида шифобахш жисмоний тарбия,
рефлексотерапия, массаж, фитотерапия ва бошқа усулларини ўз вақтида
қўллаш ва уларни бир бирига мослашни, соғломлаштириш, профилактика,
санитария-гигиена тадбирларини ўтказишни;
- соғлом турмуш тарзини ташвиқот қилишни, касаллик турига қараб
физик муолажаларни патогенетик даволаш комплексини тузишни,
организмнинг жисмоний иш бажариш қобилиятини аниқлаш усулларини.
Талаба қуйидаги малакаларга эга бўлиши керак:
Даволаш, касалликнинг олдини олиш жараёнида, шунингдек ижтимоий
ва жисмоний адаптацияда реабилитацион дастурларни ўз вақтида ва тўғри
танлаш; физик муолажаларни организмга таъсир этиш механизмини, турли
касалликларда даволаш, асоратларининг олдини олиш ва организмнинг
қаршилигини ошириш мақсадида қўлланилишини, даволаш ва реабилитация
даврида тўлақон комплекс тузиб, организмни соғломлаштиришда оқилона
фойдаланишни, аҳолининг соғлиғини мустаҳкамлаш, ижтимоий ва маиший
шароитларга мослашишини (адаптациясини) яхшилаш учун тадбирларни
танлаш. Беморлар билан индивидуал машғулотлар обориш, шифокорпедагогик назоратини ўтказиш, беморлар билан индивидуал машғулотлар
олиб бориш; физиотерапевтик муолажа усулларини мустақил бажариш,
физиотерапевтик муолажаларга рецептларни аниқ ва тўғри ёзиш,
физиотерапевтик аппаратларни муолажаларга тайёрлаш, бирламчи тиббий
ёрдам кўрсатиш. Беморларга индивидуал реабилитация дастурини тузиш.
Талаба қуйидаги кўникмаларини орттириши керак.
Турли касалликлар билан хасталланган беморларга индивидуал
реабилитация дастурларни тузиш, унда организм тўқималарини физик
муолажаларга сезувчанлигини аниқлаш ва таъсир этиш соҳасини белгилаш;
даволаш терапиясининг самарадорлигини аниқлаш ва уни тартибга солиш;
беморларга ШЖТни режалаш ва тўғри тавсия қилиш; шифокор-педагогик
назоратини ўтказиш, машғулотда қўлланилаётган жисмоний юкламаларнинг
адекватлигини ва самарадорлигини баҳолаш; реабилитация босқичида
поликлиника ва шифохонада ШЖТ вазифаларини ва ҳаракат тартиботларини
аниқлаш, беморларни санатор-курорт даволаш босқичига йўлланма бериш,
бунда курорт турини аниқлаш ва йил фаслини белгилаш.
1.3.Берилган ўқув фанини ўқитишда керак бўладиган бошқа ўқув
фанлари тартиби
Дастурни амалга ошириш ўқув режасида режалаштирилган умумий
физиотерапия, шифобахш жисмоний тарбия, врач назорати, терапия,
жарроҳлик, доя-гинекология, педиатрия, травматология ва ортопедия
фанларидан етарли билим ва кўникмаларга эга бўлишлик талаб этилади.
1.4. Талабалар билиш керак бўлган амалий кўникмалар минимуми.
25
1. Турли касалликлар билан хасталланган беморларга индивидуал
реабилитация дастурларни тузиш.
2. Турли касалликларда физиотерапевтик муолажаларини тўғри тавсия
этиш. Организм тўқималарини физик муолажаларга сезувчанлигини аниқлаш
ва
таъсир
этиш
соҳасини
белгилаш,
даволаш
терапиясининг
самарадорлигини аниқлаш ва уни тартибга солиш.
3.Физиотерапевтик муолажаларга рецептларни аниқ ва тўғри ёзиш.
4.Беморларга ШЖТни режалаш ва тўғри тавсия қилиш; шифокорпедагогик назоратини ўтказиш.
5.Машғулотда
қўлланилаётган
жисмоний
юкламаларнинг
адекватлигини ва самарадорлигини баҳолаш.
6.Реабилитация босқичида поликлиника ва шифохонада ШЖТ
вазифаларини ва ҳаракат тартиботларини аниқлаш.
7.Беморларни санатор-курорт даволаш босқичига йўлланма бериш,
бунда курорт турини аниқлаш ва йил фаслини белгилаш.
1.5.Талабалар билимининг назорати
Ўқитилган материаллар бўйича талабаларнинг билимини ва
кўникмаларни ўзлаштириш даражасини баҳолаш бутун дарс ўтиш вақтида 2
босқичда олиб борилади : кунлик жорий назорат ва якуний назорат бўйича
рейтинг баллари қўйилади. Якуний назорат фан тугаши билан ўтказилади.
Талабалар билимининг назорати ҳар хил кўринишда олиб борилади : оғзаки
сўров, вазиятли масалаларни ечиш, ўргатувчи-назорат қилувчи тестларга
ёзма ёки огзаки жавоб, амалий кўникмаларни бажариш, ўқитишнинг янги
технология усуллари билан баҳолаш. Бундан ташқари талабалар мустақил иш
топширадилар ва улар кундалик жорий назоратда баҳоланади.
Фан бўйича рейтинг баллари жорий ва якуний назорат балларининг
йиғиндиси фан бўйича қайдномаларга ва талабаларнинг рейтинг
китобчаларига қўйилади.
1.6. Ўқув технологияларидан фойдаланиш
Ўқитиш жараёнида дарслик ва қўлланмалардан, интернетдан олинган
янги маълумотлардан, тарқатма материаллардан (муолажаларни ўтказиш
тартиби, жадваллар, кроссворд, баҳолаш усуллари) ўқитишнинг янги
технология усулларидан (мияга ҳужум, кичик гуруҳлар ва ҳ.з),
физиотерапевтик аппаратлардан, видеофильмлардан фойдаланилади.
2.Ўқув юқламасининг ҳажми
Меҳнат
ҳажми
72
Ўқув юкламасининг ҳажмини аудитор
машғулотлар бўйича тақсимлаш.
Ҳаммаси
Маъруза
Амалий
машғулот
40
4
36
3. Маърузалар
3.1 Маърузалар мавзу режаси
Мустақил
иш
32
26
№
Соат
Маърузанинг мавзуси
1
Реабилиталогия фани ҳақида тушунча. Реабилитология
2
аспектлари. Беморлар реабилитация қилиш принциплари ва
босқичлари.
2
Турлий хил касалликларнинг тиббий реабилитацияси
2
ҳусусиятлари. Беморни физиотерапевтик усуллар ва дори
дармон билан комплекс даволаш, бу услубларни бир бирига
тўғри келиши, кетма-кетлиги, бир вақтда олиб борилишини
тўғри ташкил этиш.
Жами4 соат
3.2.Маъруза матнларининг мазмуни.
Маъруза № 1. Реабилиталогия фани ҳақида тушунча.
Реабилитология
аспектлари.
Беморлар
реабилитация
қилиш
принциплари ва босқичлари.
Реабилитация фани ва вазифалари, турлари, реабилитация дастури
тадбирлари, босқичлари, баҳолаш мезонлари ҳақида тушунча бериш.
Тиббий тикланишнинг физиотерапевтик асослари, касалларни
даволашда тикланиш терапиясининг асосий босқичлари:
-Даволаш-функционал чиниқтирувчи.
-Функцияларни актив тиклаш босқичи.
-Этиопатогенетик ва симптоматик терапия бирлиги.
-Маълум босқичларда тикланиш тадбирларни ўтказиш.
-Тиббий тикланишнинг ҳар бир босқичларида даволаш тадбирларини
кетма-кет ўсиб борувчи интенсивликда қўллаш.
Маъруза № 2. Турлий хил касалликларнинг тиббий
реабилитацияси ҳусусиятлари. Беморни физиотерапевтик усуллар ва
дори дармон билан комплекс даволаш, бу услубларни бир бирига тўғри
келиши, кетма-кетлиги, бир вақтда олиб борилишини тўғри ташкил
этиш.
-Реабилитация воситаларини тўғри қўлланиши, турлий хил
касалликлар реабилитаициясида касаллик ривожланиш босқичларида
реабилитация комлексларни тузиш, уларни қўллаш.
-Фармакологик препаратларни ва физик муолажаларни биргаликда
қўллаш.
-Патология турига қараб, тиббий тикланиши босқичларини кетма
кетлигини бир тартибда ўтказиш.
-Тиббий тикланиш дастурларида турли усул ва воситаларни комплекс
қўллаш.
Интеграл маъруза: (горизантал интеграция).
Турлий
хил
касалликларнинг
тиббий
реабилитацияси
ҳусусиятлари. Беморни физиотерапевтик усуллар ва дори дармон билан
комплекс даволаш, бу услубларни бир бирига тўғри келиши, кетмакетлиги, бир вақтда олиб борилишини тўғри ташкил этиш.
27
Маъруза даволаш ва тиббий педагогика факултетлари 6 курс талабаларига
мўлжалланган. Маърузачилар: Неврология кафедраларнинг профессор, т.ф.д.
Рахимбаева Г.С. Халқ тиббиёти, реабилитология ва жисмоний тарбия
кафедранинг доц. Адилов Ш.К. Муддат: 11, 12 семестр.
Адабиётлар: 1,2,3,16,17,22,31,35,38.
4. Амалий машғулотлар мавзуси
Амалий
машғулот
1
2.
Мос
Соат Мавзулар номи ва уларнинг бўлимлар
келувбўйича мазмуни, фойдаланилган янги
чи
педагогик технологиялари.
маъ
руза
1,2
6
Юрак-қон
томир(юрак
ишемик
касаллиги, гипертония касаллиги, НЦД)
ва
нафас
олиш
органлари
касалликлари(зотилжам,
плеврит,
сурункали бронхит, ўпка эмфиземаси,
бронхоэктатик
касал-лиги,
бронхиал
астма)
тиббий
реабилитацияси
тадбирлари.
Юрак миокарди ва коронар тож томирларда
қон айланишини нейрогуморал бошқаришни
яхшилаш, ундаги модда алмашинуви, қисқарувчанлик, микроциркуляция, гемодинамикасини яхшилаш мақсадида физиотерапевтик муолажаларни ва ШЖТ воситаларини
қўллаш. Нафас олиш органлари касалликларининг реабилитациясида физиотерапевтик муолажаларни ва ШЖТ воситаларини
қўллаш.
Суҳбат, бахс-мунозара, ўйин дарслари,
1, 2
6
кўргазмали материялар фойдаланилади.
Ошқозон – ичак касалликлари (гастрит,
ошқозон ва ичак яраси, колит, энтерит,
энтероколит, холецистит), буйрак (сурункали пилонефрит, нефритлар) ва сийдик
йўллари
касалликлари
тиббий
реабилитацияси.
Овқат ҳазм қилиш системасининг функционал ҳолатини яхшилаш, ошқозон секрециясини меъёрлаштириш, ичаклар перисталтикасини яхшилаш. Оғрик қолдирувчи, регене-
Адабиётлар
А.1,2,3,4,6
Қ.2,5,
10,23,24
А.1,2,3,4,6
19,20
Қ.2,3,9,11,
23,24
28
3.
1, 2
6
1, 2
6
1, 2
6
4.
рацияни, сўрилиши жараёнларини кучайтирувчи таъсир кўрсатадиган физик муолажалар ва ШЖТ комплексини қўллаш. Минерал
сувларни ичиш, парафин, балчиқ, озокерит,
электроуйқу, электрофорез, магнитотерапия,
ДМВ, Соллюкс, ШЖТ, лазеротерапия, УВЧ.
“Кластер”, “Мия хужми” усулларидан
фойдаланиш.
Асаб системаси касалликларида (марказий нерв тизими касалликлари: инсульт,
переферик асаб тизими касалликлари, юз
нерви неврити, остеохондрозда). Бўғим
касалликлари (ревматоид артритлар,
подагра, псориатик артритлар, Бехтерев
касаллиги ва остеоартрозларда) касалликлар реабилитацияси.
Асаб касалликларида яллиғланишга қарши,
бошланғич даврларида асоратларининг олдини олиш, оғриқни қолдиришни камайтириш
мақсадида, марказий нерв системасининг
функционал ҳолатини яхшилаш, функциясини тиклаш. Касаллик асоратларининг олдини
олишда физиотерапевтик муолажаларни ва
ШЖТни қўланиши.
Кейс стади усули қўланилади.
Эндокрин (қандли диабет, семириш, қалқонсимон без касалликларида), юқумли
(сарамас, бруциллёз ва кўк йутал) ва
тери-таносил касалликларининг (псориаз,
аллергик тошмалар) комплекс реабилитацияси.
Модда алмашинуви (қандли диабет, метаболик синдроми, семириш, қалқонсимон без
касалликлари, подагра) бузилган беморларнинг комплекс реабилитацияси (тиқланувчи
даволашнинг турли босқичларида физиотерапия, шифобахш жисмоний тарбия ва
реабилитациянинг ноанъанавий усулларини
қўллаш). Беморларни санатор-курорт даволаш босқичиларига йўлланма бериш, бунда
курорт турини аниқлаш ва йил фаслини
белгилаш.
“Кластер”, “Мия хужми”, инсерт-усули
фойдаланилади.
А.1,2,3,4,6
17,18,20
Қ.1,2,9,11,
16,23,24
А.1,2,4,6,
19,20
Қ.2,3,9,11,
23,24
А.1,2,3,4,6
29
5.
6.
1,2
6
Травматологик (қўл-оёқ, умуртқа поғанаси ва тоз суяклари синганиши) ва жарроҳлик касалликлар (кўкрак ва қорин
бўшлиқларидаги органларнинг операциялари,
қон-томир
касалликлари)
реабилитацияси.
Травмотологияда ва умумий жарроҳлик
касалликларининг комплекс реабилитациясида: яллиғланишга қарши, бактериоцид,
бактериостатик, сурилтирувчи, дегидратацияни яхшиловчи, спазмолитик, микроциркуляцияни, тўқима трофикасини яхшиловчи
ва регенерацияни кучайтирувчи, шишишни
қайтарувчи; травматологияда иммобилизация ва иммобилизациядан кейинги босқичларида контрактурани олдини олувчи, бўғим
функционал холатини яхшиловчи, асоратини
олдини олувчи физиотерапия, шифобахш
жисмоний тарбия ва реабилитациянинг
ноанъанавий усуллари қулланилади.
“Кластер”, “Мия хужми”, инсерт-усули
фойдаланилади.
Гинекологик касалликларда (ҳомиладорлик вақти, туғуруқ ва туғуруқдан кейинги
даврлар), гинекологик касалликлар (аёл
жинсий аъзолари яллиғланиш касалликлари, климактерик синдром и генитал
инфантилизм), педиатрияда (болалар
церебрал параличи, рахит, аллергодерматозлар, бронхиал астма, ревматизм и
болалар ЛОР касаллиги) реабилитация.
Гинекологик яллиғланиш жараёнларида
сурункали инфекция ўчоғи санацияси,
яллиғланишнинг сўрилиши, бузилган функцияларни тиклаш, оғриқни қолдириш ва
асоратларнинг олдини олиш мақсадида
физиотерапевтик омиллар ва реабилитация
усулларини қўллаш; акушерликда кузатиладиган баъзи патологик ҳолатларда физик
омилларни профилактик мақсадда қўллаш;
болалар ва ўсмирларда кузатиладиган нафас
системаси ва таянч-ҳаракат аппарати
касалликларида қўлланилдиган физиотерапевтик омиллар ва реабилитация усуллари-
15,17,18
Қ.1,2,4,9,
11,12,23
А.1,2,3,4,6
11,14,15
Қ.2,9,11,14
15,17,18,
19,23,24
30
нинг ўзига хослиги.
“Кластер”, “Мия хужми”,
фойдаланилади.
инсерт-усули
5.Мустақил иш
Ма
шғу
лот
№
1.
Мос
келувчи
Маъруза
№
1, 2
Мустақил
мазмуни
ишлар
мавзуси
ва Ажратилган
соат
1.Юрак
қон-томир
тизимидаги
операцияларидан кейинги реабилитацияси.
Реабилитация босқичлари, жисмоний
реабилитациясида махсус машқларни
қўллаш, таъсир механизмлари.
2.Нафас тизими билан касалланган
Адабиёт
лар
3
А.1,2,3,4
5,6,12,21
Қ.2,5,
10,23,24
2
А.1,2,3,4
31
1, 2
1, 2
2.
3.
1, 2
1, 2
1, 2
4.
1. 2
беморларни Ўзбекситондаги санатор
давоси.
Нафас касаликларининг реабилитациясида санатор–курортга саралаш. Тоғли
курортлар. Спелеотерапия.
1.Ошқозон ичак тракти касалликларини бальнеологик даволаш.
Минерал сувлар таркиби, минерал
сувларни
қўлланилиш
усуллари,
санотор куророрт даволашдаги ўрни.
1.Умуртқа поғона касалликларида
комплекс реабилитация усуллари.
Умуртқа поғанаси касалликларида
умуртқа поғанасини чўзиш (тракцион
терапияси). Йога-асана (махсус дастлабки ҳолатда даволаш).
2.Турли касалликлар реабилитациясида меҳнат билан даволаш усулининг аҳамияти.
Меҳнат билан даволаш турлари. Юракқонтомир, таянч-ҳаракат, семизлик ва
бошқа касалликларда меҳнат билан
даволашни қўллаш.
1.Қандли диабет асоратларини комплекс реабилитацияси.
Диабетик ангиопатия ва полинейропатияда физиотерапевтик омилларни
ва ШЖТ воситаларини қўллаш.
2.Тери касалликлари билан касалланган беморларни Ўзбекситондаги
санатор давоси.
Тери касалликлари билан касалланган
беморларни санатор-курорт даволаш
босқичларига йўлланма бериш, бунда
курорт турини аниқлаш ва йил фаслини белгилаш. Иқлимли ва бальнеологик санаторийлар.
3.Гепатит касаллигида реабилитация.
Реабилитация этаплари, жисмоний
реабилитациясида махсус машқлар ва
физиотерапевтик омилларини қўллаш,
беморларни санатор-курорт даволаш
босқичларига йўлланма бериш.
5,6,12,21
Қ.2,5,9,
10,23,24
2
А.1,2,3,4
6,19,20
Қ.2,3,9,1
1,23,24
3
А.1,2,3,4
6,17,18,
20
Қ.1,2,9,
11,16,23,
24
А.1,3,5,
10,16
Қ.5,10
2
3
А.1,2,4,6
19,20
Қ.2,3,9,
11,23,24
2
А.1,2,4,6
19,20
Қ.2,3,9,
11,23,24
3
А.1,4,15,
19
Қ.4,23
32
1,2
5.
1, 2
1, 2
6.
1,2
1, 2
1.Онкологик
касалликларининг
реабилитацияси.
Онкологик касалликларида реабилитациянинг ўзига хослиги. Руҳий ва
жисмоний реабилитацияси.
2.Суяк синишларида ва остеопороз
касаллигида тиббий реабилитация
усуллари.
Реабилитация этаплари, жисмоний
реабилитациясида махсус машқлар ва
физиотерапевтик омилларини қўллаш,
таъсир механизмлари.
3.Операциялардан кейинги реабилитация босқичлари.
Реабилитация этаплари, жисмоний
реабилитациясида махсус машқлар ва
физиотерапевтик омилларини қўллаш,
таъсир механизмлари, беморларни
санатор-курорт даволаш босқичларига
йўлланма бериш.
1.Болалар церебрал параличларида
реабилитация усуллари.
Реабилитация этаплари, жисмоний
реабилитациясида махсус машқлар ва
физиотерапевтик омилларини қўллаш,
таъсир механизмлари.
2.Бепуштлик билан касалланган
беморларни Ўзбекситондаги санатор
давоси.
Санатор-курорт даволаш босқичларига
йўлланма бериш, курорт турини
аниқлаш ва йил фаслини белгилаш.
2
3
А.1,2,3,
4,617,18,
20
Қ.1,2,9,
11,16,23,
А.1,2,3,
4,6,11,14
Қ.2,9,11,
14,15,19,
23,24
3
А.1,2,3,4
6,11,12
Қ.2,9,11,
17,18,
19,23,24
2
А.1,2,3,
4,6,11,14
Қ.2,9,11,
14,15,19,
23,24
2
А.1,2,3,
4,6,11,14
Қ.2,9,11,
14,15,19,
23,24
6. Фан бўйича кўникма, малакалар ва билимларини
баҳолаш критериялари ва рейтинг назорати
Талабанинг тайёргарлик сифатини белгиловчи асосий критерияси унинг
рейтинги ҳисобланади, бу эса жорий ва якуний назорат баҳоларининг
йиғиндисидан чиқарилади.
Фан бўйича 100 балл куйидагича тақсимланади:
№
1.
2.
Назорат тури
Жорий назорат
Якуний назорат
ЖАМИ
Максимал балл
50
50
100
Коэффициент
0,5
0,5
1
Ўтиш балл
27,5
27,5
55,0
33
Амалий машғулотларни баҳолаш критерияси бўлиб, талабанинг
машғулотга тайёргарлиги ва вазифаларни, мустақил ишини бажариш сифати
баҳоларининг йиғиндисидан келиб чиқадиган жорий баҳоси ҳисобланади.
Criteria for daily assessment
No. Learning
%
1
96-100
2
91-95
Mark
Distinction
“5”
3
86-90
4
81-85
Good
“4”
Degree of the students’ knowledge
Fully expresses own opinion regarding the topic, gives
right answers to all the questions, analyses and makes a
conclusion, thinks creatively, actively participates during
the discussion of the topic. Approaches the problem
solution cases regarding the topic, answers fully and
correctly to the test. The student has broad thinking and
can exchange his thought with the teacher. Research
papers, slides, complex of the video movies are prepared
based on the more the 10 online source and up-to-date
literature.
Fully expresses own opinion regarding the topic, gives
right answers to all the questions, analyses and makes a
conclusion, thinks creatively, actively participates during
the discussion of the topic, thinks independently.
Approaches the problem solution cases regarding the
topic, answers fully and correctly to the test. The student
has broad thinking and can exchange his thought with the
teacher. Research papers, slides, complex of the video
movies are prepared based on the more the 10 online
source and up-to-date literature.
Adequately expresses own opinion regarding the topic,
gives right answers to all the questions, analyses and
makes a conclusion, thinks creatively, actively participates
during the discussion of the topic. Fills in the protocol of
the coursework results regarding the topic. Research
papers, slides, complex of the video movies are prepared
based on the more the 10 online source and up-to-date
literature.
Adequately expresses own opinion regarding the topic,
gives right answers to all the questions, analyses and
makes a conclusion, thinks creatively, actively participates
during the discussion of the topic. 15-20 one type of
animation working papers are prepared based on the more
the 8-10 online source and up-to-date literature. All the
information is provided in the full amount but delivered in
boring manner.
34
5
76-80
6
71-75
7
66-70
8
61-65
9
55-60
10
54-30
Answers are right but not full, the student corrects the
mistakes according to the additional questions of the
teacher, adequately active in discussion of the topic. The
student participates in fulfillment of the tasks given in the
lecture hall. 10-15 one type of animation working papers
are prepared based on the more the 5-8 online source and
up-to-date literature. All the information is provided in the
full amount but delivered in boring manner.
Adequately active in discussion of the topic but make
some mistakes, participates in fulfillment of the tasks
given in the lecture hall, takes necessary notes. 5-10 one
type of animation working papers are prepared based on
the more the 3-5 online source and up-to-date literature.
All the information is provided in the full amount but
delivered in boring manner.
50% of the answers are right but understands the sense of
the question. The student can fulfill the tasks but makes
couple of mistakes.
50% of the answers are right, not all the time understands
the sense of the questions, performs the task with the help
of the teacher and even though makes couple of mistakes.
Poorly written papers using the 2-3 online sources and upto-date literature. Working paper is decorated well but has
some mistakes, inconsistent, topic is not fully covered.
Complex of slides, which cover half of the topic, is
prepared on the basis of 5-10 one type animation. Stands,
banners or other informative materials are made with low
quality.
40% of the answers are right, sometimes the student is
Satisfactory confused, not all the time can understand the sense of the
question, fulfill the tasks with the help of the other
“3”
students or teacher. Some working papers prepared bases
on 2-3 online sources and up-to-date literature. Working
paper is decorated well, has some mistakes, inconsistent,
does not fully cover the topic. Complex of slides, which
cover half of the topic, is prepared on the basis of 5-10
one type animation. Stands, banners or other informative
materials are made with low quality.
The student can give right answers up to 40%, answers are
not clear, cannot perform the tasks. Home task is not done.
Unsatisfactory Working paper is poorly decorated, inconsistent, does not
“2”
cover the topic. 1-2 online sources and literature are used.
Complex of slides, which cover half of the topic, is
prepared on the basis of less than 10 one type animations.
35
Stands, banners or other informative materials are made
with low quality.
11
Participates in the practical exercises, in the uniform, has
got the notebook. Home task is not done. The student does
not perform any coursework.
30-20
Assessment criteria for Students Independent Works (SIW)
No.
Learning
%
1
86-100
2
71-85
3
55-70
4
0-54
Assessment
Degree of the students’ knowledge
Working papers with high quality prepared based on more
than 10 online sources and up to date literatures. Topics of
the working papers are fully covered, paragraphs logically
structured, in writing the paper the student demonstrated
his knowledge. Working paper is decorated well. The
Distinction
clear and well structured complex of the slides made
“5”
based on more than 30 one type of animations, up to date
information are used which cover the topic. Stands,
banners or other materials are made with high quality,
materials written logically, executed clearly and with high
quality, all information is provided in full scope.
Working papers prepared based on more than 3-5 online
sources and up to date literatures. The working papers are
well decorated, without mistakes, paragraphs logically
structured, the topic is fully covered. The clear and well
structured complex of the slides made based on more than
Good
15-20 one type of animations, up to date information are
“4”
used which cover the topic. Stands, banners or other
materials are made with high quality, materials written
logically, executed clearly and with high quality, all
information is provided in full scope but executed in a
boring manner.
Working papers prepared based on more than 2-3 online
sources and up to date literatures. The working papers are
well decorated, has some mistakes, inconsistent, the topic
Satisfactory
is partially covered. More than 10-15 one type of
“3”
animations slides prepared. Stands, banners or other
materials compose half of the materials, executed with
low quality.
Working paper is decorated poorly, has mistakes,
Unsatisfactory consistency is not followed, topic is cover partially. 1-2
“2”
online sources and literatures are used. Less than 10 one
type of animations slides prepared. Stands, banners or
36
other materials compose half of the materials, executed
with low quality.
Assessment criteria for final exam
No.
Learning
%
1
96-100
2
91-95
3
86-90
All questions of the self-study program are answered
correctly but consistency is not followed
4
81-85
All questions of the self-study program are answered
correctly but there is a minor mistake in consistency
5
76-81
All questions of the self-study program are answered
correctly but there are couple of mistake in consistency
6
71-75
7
66-70
8
61-65
9
55-60
10
54-30
11
30 and
less
Mark
Degree of the student’s knowledge
All questions of the self-study program are answered
consistently and correct
Distinction
“5”
Good
“4”
All questions of the self-study program are answered
correctly but there are some inconsistency
There are mistakes (30%) in answers. Consistency of the
answers is adjusted
There are mistakes (40%) in answers. Consistency of the
answers is breached
Satisfactory
“3”
There are mistakes in answers, 45% of the answers are
incorrect, consistency is breached in major cases.
There are mistakes in answers, 55% of the answers are
incorrect, consistency is breached in major cases.
There are mistakes in answers, more than 55% of the
answers are incorrect, consistency is breached in major
Unsatisfactory cases.
“2”
All answers are incorrect and consistency is breached in
major cases.
Реабилиталогия фанидан амалий кўникмалар рўйхати
37
1.Турли касалликлар билан хасталланган беморларга индивидуал
реабилитация дастурларни тузиш.
2.Турли касалликларда физиотерапевтик муолажаларини тўғри тавсия
этиш. Организм тўқималарини физик муолажаларга сезувчанлигини аниқлаш
ва
таъсир
этиш
соҳасини
белгилаш,
даволаш
терапиясининг
самарадорлигини аниқлаш ва уни тартибга солиш.
3.Физиотерапевтик муолажаларга рецептларни аниқ ва тўғри ёзиш.
4.Беморларга ШЖТни режалаш ва тўғри тавсия қилиш; шифокорпедагогик назоратини ўтказиш.
5.Машғулотда
қўлланилаётган
жисмоний
юкламаларнинг
адекватлигини ва самарадорлигини баҳолаш.
6.Реабилитация босқичида поликлиника ва шифохонада ШЖТ
вазифаларини ва ҳаракат тартиботларини аниқлаш.
7.Беморларни санатор-курорт даволаш босқичига йўлланма бериш,
курорт турини аниқлаш ва йил фаслини белгилаш.
Амалий кўникмаларни баҳолаш мезонлари
Жорий назоратнинг 40%ни амалий қисм ташкил қилади.
Максимал 20 баллга тенг.
Реабилитология фанидан жорий назорати бўйича ўзлаштириладиган
ҳар бир амалий кўникмалар босқичда амалга оширилади ва максимал 100
балл билан баҳоланади.
Амалий
кўникмалар
қадамма-қадам
бажарилишида
ҳатолар
қилинганда, бажарилмаган қадам ҳисобидан максимал ажаратилган баллар
олиб ташланади. Охирги қўшилган баллар суммасидан қуйидаги коэффицент
билан ҳисобланади, 20 * х/100 коэффицентга ўтказилади.
Масалан: талаба
80 балл
олса амалий кўникмани жорий
баҳолашдаги балли 16 га тенг бўлади. 16 балл ёки жорий баҳолашни 38%
ташкил этади.
Daily assessment
Theoretical part
25%
12.5 minimum
credits
Analytical part
Practical part
SIW
30%
40%
5%
15.0 minimum
20 minimum
2.5 minimum
credits
credits
credits
Текшириш тадбирлари
Ўқув машғулотини ўзлаштириш сифатини баҳолаш 2 хил назорат :
жорий ва якуний баҳолаш орқали амалга оширилади.
38
1.Жорий баҳолаш (ЖБ) - ҳар куни талабаларнинг билими ва амалий
кўникмаларни ўзлаштирилиши текширилиб борилади. Баҳолаш қуйидагича
амалга оширилади :
-соволларга оғзаки жавоб бериши;
-вазиятли масалаларни ечиш,таклифлар бериш;
-амалий кўникмаларни бажариш;
-янги усулларни қўллаб, билимни баҳолаш;
-мавзу бўйича тестларни қўллаш.
Талабаларнинг мустақил ишлари (ТМИ) – талабалар томонидан
мустақил тайёрланган ишлари (реферат, слайдлар, кроссворд, тарқатма
материал, вазиятли масала) амалий машғулотларда эшитилиб, тахлил
қилинади ва рейтинг назорати тизими асосида балларда баҳоланади.
Талабанинг мустақил иши
ЎзР Олий ва ўрта махсус таълим
Вазирлиги-нинг 21.02.2005 йил 34-сонли буйруғи ва ТТА ректори 2009
йилдаги буйруғи билан тасдиқланган «Талаба мустақил ишини ташкил
этиш, назорат қилиш ва баҳолаш тартиби тўғрисида Намунавий низом»
асосида ташкил этилади.
Ҳар бир бажарилган иш рейтинг назорати тизимига асосан балларда
баҳоланади.
2.Якуний баҳолаш (ЯБ) – амалий машғулотлар тугагач, қуйидагича олиб
борилади:.
-ЯБ га жорий баҳонинг максимал рейтинг балининг 55 фоизидан юқори
балл олган талабалар қўйилади;
-якуний баҳолаш ОСКИ шаклида олинади;
-рейтинг назорти тизимига асосан балларда баҳоланади.
3. Фан бўйича умумий рейтинг балли ЖБ ва ЯБ балларини қўшиб
олинади. Олинган баллар қайднома ва талабаларнинг рейтинг китобчасига
қўйилади.
Фан бўйича умумий рейтинг балли қуйидагича баҳоланади :
86,0 – 100,0 балл аъло
71,0 – 85,9 балл яхши
55,0 – 70,9 балл коникарли
54,9 ва ундан паст коникарсиз
Ахборот-услубий таъминланиш
Мультимедияли презентацияли маърузалар, ўқув фильмлари, янги
педагогик технологиялар, электрон китоблар.
7. LITERATURES:
1. MAIN:
1. Боголюбов В.М.«Медицинская реабилитация » Москва, 2006,3 тома.
2. Бабаджанов С.Н. «Справочник физиотерапевта», Ташкент, 1999г.
3. Епифанов В.А. «Лечебная физкультура и спортивная медицина» М., 2000.
39
4. Попов В.И. Чоговадзе В.Г. «Физическая реабилитация» Ростов наДону
2001.
5. Епифанов В.А. “Лечебная физическая культура” М. 2003.
6. Дубровский В.А. “Лечебная физкультура” М., 2004.
7. Лекционные материалы и учебно-методические разработки.
8. Рихсиева О.А. «Массаж», Т. 1996.
9. Евдокимова Т.А. Милюкова И.В. Новейший справочник“Лечебная
физкультура,” М. 2004.
10. «Медицинские основы физического воспитания и формирования здоровья
и гармоничного развития детей и подростков» проф. Назиров Ф.Г. проф.
Ахмедова Д.М. проф. Суюмов Ф.А. доц. Васильев В.Д, проф. Шайхова
Г.И. Ташкент 2003.
11. Эдвард
Т.
Хоули,
Б.
Дон-Френкс
«
Руководство
инструктораоздоровительного фитнесса» Киев 2004.
12. Бет Шоу “Йога fitТренинг для здоровья”, М. 2005.
13. Милюкова И.В. Евдокимова Т.А. “ Гимнастика для детей”, М. 2004.
14. .А. Боков С. Сергеев “ Йога для детей” М. 2004.
15. Сосин И.Н., Кариев М.Х. «Физиотерапия в хирургии, травматологии и
нейрохирургии», Ташкент, 1994г.
16. Попов С.Н. “Физическая реабилитация” Ростов на Дону, 1999г.
17. Епифанов Е.А. “Лечебная физкультура” М. 1999г.
18. Боголюбов В.М., Пономаренко Г.Н. “Общая физиотерапия” М. 1999г.
19. Дмитрев А.Е., Мариченко А.Л. “ЛФК при операциях на органах
пищеварения” 1990г.
20. Корхим М.А., Рабинович И.М. “ЛФК в домашних условиях” 1990г
21. Симулянова В.А., Солова Э.В. “Учебное пособие по лечебной
физкультуре в терапии”.
2.ANCILLARY:
1. Улащик В.С. “Домашняя физиотерапия” Минск 1993г.
2. Боголюбов В.М. “Справочник по санаторно-курортному отбору” М. 1992г
3. Выгоднер Е.Б. «Физические факторы в гастроэнтерологии» М., 1987г.
4. Добровольский В.К. «Лечебная физическая культура в хирургии», Л.,
1970г.
5. Кокосов А.Н., Стрельцова Э.В. «Лечебная физическая культура в
реабилитации больных заболеваниями легких и сердца», Л, 1981г.
6. Красильникова Р.Г. “Методы физиотерапии в медицинской практике” М.
1997г.
7. Левинсон А.Я. “Электромедицинская аппаратура” М. 1987г
8. Лобзин Ю.В., Захаров В.И. «Реабилитация и диспансеризация
инфекционных больных», Санкт-Петербург, 1994 г.
9. Муратов Н.Н. «Курорты федерации профсоюзов Узбекистана», Т., 2005 г.
10.Николаева Л.Ф., Аронов Д.М. «Реабилитация больных ишемической
болезнью сердца», М., 1988г.
11.Николова Л., Бойкиева Св. «Специальная физиотерапия», София, 1974 г.
40
12.Понамаренко Т.Н. “Руководство к практическим занятиям по общей
физиотерапии” М. 2000г.
13.Руденко Т.Л. “Физиотерапия”, Ростов на дону, 2000г.
14.Рогачева Е.И., Лаврова М.С. «Лечебная физкультура и массаж при
детских церебральных параличах», Л., 1977г.
15.Рыхсиев О.А. и др. “Массаж”, Т., 1996г
16.Стрелкова Н.И. «Физические методы лечения в неврологии», М., 1983г.
17.Стругацкий В.М. «Физические факторы в акушерстве и гинекологии»,
М.,1981г.
18.Силуянова В.А., Кавторова Н.Е. «Учебное пособие по лечебной
физкультуре в акушерстве и гинекологии», М., 1977г.
19.Умарова Х.Т., Карачевцева Т.В. «Физиотерапия в педиатрии», Ташкент,
1993г.
20.Цой Р.Д. “Справочник по рефлексотерапии” Т. 1994г.
21.Цой Р.Д. “Рефлексотерапия” Т. 1995г.
22.Цыганов А.И., Мартынюк Л.А. «Справочник по физиотерапии уха, горла
и носа», Киев, 1981 г.
23.Юлдашев К.Ю. “Немедикаментозные методы лечения” практическое
пособие для врачей, Т., 1999г.
24.Ясногородский В.Г. “Справочник по физиотерапии” М., 1981г.
25.Teylor S.B., Miller N.H. “Basic physiologic principils relatied to Group
exirsise programs” Filadelphiya 1990
26.Tehaxton L. “Phithiological and psythological effects of short term exirsise
eddiction on habitual runners.” 1992 96.
INTERNET RESOURSES:
http://www.doktor.ru
http://www. medinfo.org
http://www.restart-med.ru
http://www.mirmed.ru
http://micropolarization.narod.ru
http://skolioz.mccinet.ru
http://www.sportpsy.cz
http://www. aapmr.org
http://www.alhealth.com
http://www.docguide.com
http://www.healthweb.com
http://www.acsm.org
http://www.apta.org
http://www.sportsmed.org.
http://www.jphysiol.org
http://www.physsportmed.com
http://www.sportsmedicine.com
41
42
MINISTRY OF HEALTH OF THE REPUBLIC OF UZBEKISTAN
CENTRE OF MEDICAL EDUCATION
Tashkent Medical Academy
"APPROVED"
Pro-rector for Academic
Affairs
Prof. Teshaev O.R.
____________________
"________" ___________2014.
Department: Department of Folk Medicine, Rehabilitation and Physical
Culture
Subject: Rehabilitology
Subject: Practical exercises
"Application of physical factors and physical therapy in the rehabilitation of
patients with diseases of the cardiovascular system; ischemic heart disease,
hypertension, NSD, and respiratory system; pneumonia, pleurisy, CPD
(chronic bronchitis, bronchiectasis, emphysema), asthma "
Practical exercises
Educational technology
Tashkent-2014
43
Educational model in practical lesson
Theme № 1: "Application of physical factors and physical therapy
in the rehabilitation of patients with diseases of the cardiovascular
system; CHD hypertonia, NSD, and respiratory; pneumonia,
pleurisy, COPD ( chronic bronchitis, bronchiectasis, emphysema),
bronchial asthma.
Study time: 270 min
Number of students 8-9
Type of the classes
Exercise topics.
Structure of the training sessions
(Lesson plan )
1. Introduction
2. Theoretical part
3. Analytical part
- organizer
- tests
- situational tasks, recipe.
4. Practical skills.
Teach the skill to choose the right
treatment strategy and guidelines
physical therapy and exercise therapy
in cardiovascular diseases and
respiratory diseases.
-Indications and contraindications to
physical therapy and exercise therapy
in patients with diseases of the
cardiovascular system and respiratory
system;
-Mainstream physical therapy in
cardiovascular diseases and respiratory
diseases;
-Mechanisms of action of physical
factors and means of exercise therapy
on patients with diseases of the
cardiovascular system and respiratory
system.
Purpose of the lesson:
The student should know:
44
The graduate should be able to:
Run the practical skills to make
complex rehabilitation with the use of
physical therapy and exercise therapy
on an outpatient receiving individual
patient, based on the examination,
medical history, medical history data
and laboratory and instrumental data;
-Write the recipe on the assigned
physical factors;
-Conduct designated procedures;
-Make an exercise of physiotherapy for
patients with diseases of the
cardiovascular system, depending on
the stage of the disease.
Pedagogical objectives:
-Acquaint with the indications and
contraindications for physiotherapy
treatment and exercise therapy in patients
with cardiovascular disease (CVD) and
respiratory system;
-Clarify the concept of etiopathogenic
and symptomatic treatment using
physical factors of cardiovascular
diseases and respiratory diseases
depending on the stage of the disease;
-Teach drafting complex rehabilitation
depending on the stage of the disease;
-Teach yourself to let designated
physiotherapy;
-Teach yourself to pick up a set of
exercises and therapeutic exercises to
demonstrate their patients.
Learning outcomes
-List the indications and
contraindications for the purpose of
physiotherapy and exercise therapy in
patients with diseases of the respiratory
system and CCC;
-Called main purpose of use of
physiotherapy and exercise therapy
factors in patients with diseases of the
respiratory system and CCC;
Training Methods
Conversation, discussion,
brainstorming, demonstration, training
game.
Front, collective work groups both
oral and written;
solution case studies;
demonstration of practical skills
mastered.
Forms of educational activity
-Up complex of rehabilitation
measures, depending on the stage of
the disease;
Self-appointed spend physiotherapy;
Self-selected set of exercises of
physiotherapy and demonstrate their
patients.
45
Learning Tools
Distributing educational materials,
visual aids, videos, board-stand, photo,
text.
Methods and means of feedback.
Assessing knowledge and monitoring.
Quiz, test, presentation of results of a
learning task or solving case studies,
demonstrating the independent exercise
of practical skills.
Typical flow chart practical lesson
Stages of work
and time
(270 min)
1st stage
20 minutes
Action
Teacher
Theoretical part
Learners
Listen, write, update,
ask questions.
1.1. Checks attendance and
notebooks
20 minutes
1.2. Names theme classes, its goals,
objectives and expected learning
outcomes. . Introduces the mode of
operation in the lesson and
evaluation criteria (see guidance for
students).
25 minutes
1.3. . Gives the task for
independent work, references to
independent work. Reported
indicators and criteria for
evaluation. (Appendix 6).
25 minutes
1.4. Conducts a quiz in order to
activate the students knowledge on
the topic:
10 minutes
1.5. Break
7
46
"Stage 2"
60 minutes
30 minutes
Analytical part
Solve the test tasks,
answer questions,
2.1. Leading the discussion topics present during
of practical classes.
physiotherapy
Distributes materials of the case
patients and LH in
and introduces the algorithm
the classroom, work
analyzing the situation. Divides the independently on the
students into groups.
FT devices and
physical therapy
2.2. Assesses students' background room, work in
knowledge using new educational
groups, present the
technologies (small groups, case
results of the group
studies). (Appendix 3).
work.
Teaches proper selection of
methods of rehabilitation patients.
45 minutes
2.3 Break
3rd stage
60 minutes
20 minutes
10 minutes
The practical part.
Conduct self-esteem,
interassessment. Ask
An opinion on the subject, focusing questions. Recorded
students on the main reports on the assignment.
importance of the work done for
future professional careers.
Commends the work of groups and
individual students, summarizes
interassessment. Analyzes and
evaluates the degree of
achievement of lesson. (Appendix
5).
3.3. Gives task for independent
work, references to independent
work. Reported indicators and
criteria for evaluation. (Appendix
6).
Gives the task to prepare for the
next lesson.
47
1. Motivation
Rehabilitation aims not only to address the symptoms of the disease, how it is
achieved with drug therapy, but also to the gradual recovery of physical health,
psychological status and professional opportunities as a result of the patient. The
physical aspect of rehabilitation is provided timely and adequate mobilization of
the patient, his early appointment of individual therapeutic exercises, then the
group therapeutic physical culture (treatment gymnastics), dosed walking, as well
as special physical training, first conducted in hospitals, and then under the selfmonitoring at home.
Physical factors lead to changes in the functions of the cardiovascular system,
improve pump and contractile function of the heart in alleviating the conditions of
his work (peripheral vasodilator effect and afterload reduction, lengthening of
diastole). Improved central and peripheral parts of the oxygen-function of the
cardiovascular system is pathogenetically grounded direction in the treatment of
major clinical manifestations of the pathology of the cardiovascular system.
2. Interdisciplinary communication and Intra
Teaching the topic is based on the knowledge students the basics of biochemistry,
biophysics, anatomy, normal and pathological physiology of the cardiovascular
and respiratory systems, the etiology and pathogenesis of diseases of the
cardiovascular system and respiratory system, general physiotherapy and exercise
therapy foundations. Acquired during the course of knowledge will be used in
traversing disciplines therapy, cardiology, cardiac surgery, pulmonology,
tuberculosis, as well as GPs in their practice.
3. Contents of the lesson
3.1 Theoretical part
48
Application of physiotherapy and exercise therapy in rehabilitation of patients with
diseases of the cardiovascular system.
Combating diseases of the cardiovascular system has become the main objective of
health and medical science. A deep interest in this issue determined the prevalence
of cardiovascular diseases, their huge role in disability and mortality, which gives
not only medical but also social value. Therefore, it is important scientific
principles and rationale for the development of effective methods of treatment,
rehabilitation and prevention. At the moment the fight against diseases of the
cardiovascular system is carried out by a single coherent system:
Identify and conduct pre-disease state multidisciplinary, preventive measures.
Early diagnosis and differential complex treatment.
Rehabilitation and secondary prevention. Among various methods of preventing
and, undoubtedly have a physical meaning of factors, as they do not reveal many
of the mechanisms involved in the occurrence and development of diseases of the
cardiovascular system. Results of studies in recent years have greatly expanded the
scope of physical factors in the prevention, treatment and rehabilitation of patients
with diseases and rationale of their use as an effective drug therapies are not at all
stages of specialized cardiac care hospital, clinic, sanatorium-resort.
Physiotherapy factors constitute the basis of nature (sun, climate, mineral and fresh
water, swimming in seas, rivers and lakes, as well as preformed obtained using
special devices) factors. The primary action of physical factors on the body
through the skin, its receptor system, cardiovascular system and associated with
changes in physical and chemical processes in the skin. Electrical, thermal,
mechanical, chemical, radiation, etc. Irritation inherent physical factors, exerting
effects on the skin, cause reactions receptor system and blood vessels in the form
of changes in excitability threshold receptors and microvascular tone.Extremely
important in the mechanism of therapeutic action of physical factors is changing
the sensitivity of vascular receptors, especially highly sensitive chemoreceptors of
the carotid and aortic areas.
With receptor zones occur reflexes changing tone
of arterial and venous blood vessels, blood pressure, heart rate, irritability
vasomotor and respiratory centers.
In the treatment of diseases of the cardiovascular system using a number of
physical factors, energy absorption in tissues which is transformed into heat
(alternating fields, electromagnetic fields). Occurring at the same time heating of
tissues accompanied by vascular reactions, such as dilatation, disclosure of
dormant capillaries, accelerate blood flow in them, change platelet aggregation.
Thus, the local physical action as a preamble, is converted into a chemical trigger,
which in turn is transformed into a single neuro-reflex and humoral process,
involving the responses of various body systems.
In the treatment of diseases of the cardiovascular system using a variety of
instructional techniques:
- Local (e.g. heart area)
- Reflector, segmentar (impact on reflex zones)
49
In the practice of physiotherapy is important to correlate the physical force of the
impact factor with the initial state of functional pathological changes of the system
and its compensatory abilities. It is therefore necessary to develop optimal methods
of physiotherapy based on the severity and characteristics of the disease, the
mechanisms of action of physical factors.
CHD
The basis of CHD is myocardial hypoxia that develops in the absence of mismatch
between the demand for blood supply to the heart and its software.
Myocardial hypoxia may occur with limited blood flow as a result of violations of
indigenous duct or at sharply increased demand for it. Most frequently involved in
the development of diseases, both factors.
The primary cause of coronary heart disease are most often atherosclerosis
coronary heart arteries. Development and progression of coronary artery disease
contributes factors of intravascular thrombosis - Violations coagulation and
anticoagulation blood system.
Besides proven value changes in the functional state of damage to subcortical
structures of the brain and peripheral nervous sympathetic system in the genesis of
angina and myocardial injury.
Complexity and diversity of the pathological mechanisms of CHD cause division
its genetic, clinical, and functional characteristics that determines the difference in
prognosis and treatment approaches. Problem of physical methods in CHD is to
improve the nervous, neurohumoral and hormonal regulation of the coronary
circulation and myocardial including its metabolism, contractility and excitability.
Normalize impaired systemic and regional hemodynamics, and myocardial
microcirculation; reduce elevated blood hemocoagulation, improve metabolism
and immune reactivity in general, and ultimately improve backup capabilities
coronary circulation and myocardium. Important influence on the comorbidities
hypertension, diabetes mellitus, hyperthyroidism, hypercholesterolemia,
osteochondrosis of cervical-thoracic spine with pain and vascular syndromes,
peptic ulcer, etc.
All physiological methods currently used in the treatment of coronary heart disease
can be divided into 4 groups according to their pre-emptive action on a particular
system:
Group 1 - the central nervous system and peripheral.
Group 2 - heart
Group 3 - a systemic regional hemodynamics.
Group 4 - to disturbed metabolic processes in the body.
Physiologically CHD necessarily apply within the context of activities, including
mode with reduced nervous tension.
Preformed factors. Electrosleep - its clinical effect in patients with angina I-III of
fc manifested in the sedative, hypotensive action, increasing the threshold load,
causing angina, sinus tachycardia termination and extrasystoly.
50
Iontophoresis: With any method of application affects the central nervous system,
promoting equilibrating the nervous processes, enhance braking process rebuilds
autonomic regulation of the heart.
Conducted by three methods:
General - Vermel electrophoresis;
Reflex-segmental (electrodes are located in areas Zakharyin-Ged or collar area.
Transcardially .
On the application of electrophoresis is necessary to remember that patients with
rare and not severe angina can achieve cessation or deceleration stenocardia
attacks, and the application of electrophoresis extrasystole arrhythmia, e.g. obzidan
not yielded positive results is apparently due to the lack of a dose of the drug
administered. Dielectric alternating field to the physical methods directly affect the
central nervous system and hypothalamo-pituitary region. In CHD is the method of
exposure transcerebral UWI using this method achieved slowing angina attacks,
reduce headaches, improve sleep, lower blood pressure, increase physical
performance, decrease extrasystoles, slowing attacks of atrial fibrillation, reducing
hypercholesterolemia, and hypertriglyceridemia, hyperbetalipoproteidemia,
reducing elevated aggregation platelets.
UHF-energy action on the heart improves intracardial compensation mechanisms
of the coronary circulation, including microcirculation and intracardiac nervous
system, which regulates the functional state of the heart.
Magnetotherapy - The most pronounced effect of the action of magnetic fields is
to improve microcirculation reduce elevated platelet aggregation, enhancing the
intensity of oxidative processes and increase tissue oxygenation.
Clinical effect of magnetic fields and angina patients 1,2,3 FK reflected in a
marked deceleration of angina attacks, increased the threshold load, causing
myocardial ischemia decreases myocardial oxygen consumption. Under the
influence of the magnetic field is increased peripheral muscle blood flow, reduce
blood viscosity, increased platelet aggregation.
Balneotherapy - Doubtless takes a significant place among different treatments
of CHD. All kinds of thermal baths have, hydrostatic and specific chemical action.
Multilateral action bathrooms, especially in ischemic heart disease, is important is
their ability to expand and accelerate the peripheral capillaries in their bloodstream
that underlies the reduction in peripheral vascular resistance, elimination of tissue
hypoxia. Bath cause a redistribution of blood to the periphery, increasing venous
age to the heart, eliminate disturbance in the nervous system, humoral regulation of
the cardiovascular system, alter the rheological properties of blood. Apply bath of
natural mineral waters and artificial carbonate, sulfide, rad.
Hydrotherapy - Have varying degrees of severity mechanical, and thermal effect
hydrostatistic. By varying the temperature and mechanical stimulation can be
obtained by various haemodynamic responses and reactions of the nervous system.
Thermal procedures cause vasodilatation, lowering blood pressure, sedation, cool
and cold procedures different durations cause vasoconstriction, improving their
tone, Wake up blood pressure, a tonic effect.
51
Hydrotherapy in ischemic heart disease - and it is swimming in the pool and
contrast baths and underwater shower massage. Hydrotherapy prescribed
according to the gravity of functional disorders.
Application of modern treatment involves not only differentiated, but also
complex, aimed at compensation of myocardial ischemia through different links
regulation of the coronary circulation is provided so important taken in treatment
with the inclusion of several methods. This is especially in sanatorium conditions
typically include balneotherapy - LFC dosed walking and massage. Adding to this
complex of electrodetection or electrophoresis gives a pronounced effect.
When compiling complex of considerable importance is the sequence of
procedures, their sequencing, especially for patients with severe functional
disturbances.
Physical factors and prevention
Prophylaxis (Primary and secondary) consists of general activities, including the
first mode with decreasing voltage, the ordering of the day, regular rest, etc.
Effect of physical factors in the pre-disease stage should be aimed at removing
fallen into the functional state of the central nervous system, neuro-vascular,
hormonal, and metabolic disorders. Used for this purpose electrosleep treatment,
electrophoresis with bromine, rad, bromine, nitrogen bath, hydrotherapy, oxygen
therapy.
Physiological methods in CHD patients staged rehabilitation, rehabilitation of
patients with myocardial infarction include the following phases:
hospital
phase of recovery (convalescence) carried out in cardiac sanatoriums.
postreconvalescent phase, lasts throughout life and is held with medical
supervision.
Physiotherapy and choice of method is based on their clinical and functional and
pathophysiological features of the various phases of a heart attack. In the acute
phase of myocardial infarction physiotherapy applied limited - electric
electrophoresis heparin magnesium lower extremities massage, exercise therapy. In
the phase of recovery (4-6 weeks) complex sanatorium treatment including
adequate, motor mode, climate treatment gymnastics. For special climatic
treatment using coastal plains and forest resorts. To the mountain resorts of
patients with angina pectoris, myocardial infarction, and it is desirable not send
climatic resorts not far from the place of residence, and patients with arrhythmias
(extrasystole, flicker paroxysm of atrial flutter, patients with chronic aneurysms 23 with circulatory failure, angina pectoris 3l. k is sent to the local cardiac nursing
home. Patients with angina 4f spa treatments are contraindicated.
When choosing a method of treatment should be considered in the treatment of
hypertension, diabetes, and other comorbidities.
In the maintenance phase starts from the end of recovery and continuing
throughout life, rehabilitation tasks defined progression and prevention of acute
illness, and coronary heart disease, by maintaining and further mobilization of
52
reserve level circulation, easing the risk factors, prevention of recurrent myocardial
infarction.
Tactics use all kinds of hydrotherapy, electrotherapy and their methods depend on
the severity of disease and comorbidities.
Hypertensive heart disease.
Central to the pathogenesis and development of hypertension is generally accepted
hyperreactivity hypothalamic centers of the sympathetic nervous system with the
hypersecretion of catecholamines leads to stimulation of many subordinate,
neuroregulatory systems; vasopressin ACTH treatment, angiotensin and
aldosterone hypersecretion of catecholamines has a stimulating effect on the
power, heart rate, metabolism pressor effect on all peripheral vessels, giving an
increase in total peripheral resistance and diastolic systemological. Effect of
physical factors in hypertension disease should be directed.
Improvement of the functional state of the CNS, autonomic and humoral regulation
of the cardiovascular system, improve self-regulation processes in the circulatory
system, leading to a decrease in arterial hypertension.
Hemodynamic improvement, reduced myocardial hyperfunction, increasing its
contractile ability.
Correction of metabolic processes in the body.
Improved renal circulation.
Increase the adaptive capacity of the organism to various external influences.
All the physical therapies used to treat hypertension may be conditionally divided
into 4 groups:
Neurohemodynamic processes acting on the central nervous system.
Stimulating peripheral, pressor mechanisms (carotid sinus area, baroreceptors large
vessels, synaptic ganglia.
Improves renal blood flow and reduces renal vascular resistance.
It has an overall impact on the influence of hemodynamic link diseases.
The factors of the first group include - electric, iontophoresis, galvanizing, an
alternating magnetic field (PMP), aerosol therapy applied to patients with
hypertension to reduce the increased excitability of the nervous system and the
functional activity of the sympathetic-adrenal system, pain in the heart, improve
sleep.
Galvanization and electrophoresis carried out mainly by three methods - collar
on Vermel and transorbital by Bourguignon. Selection of medications depends on
the clinical features of the disease. AMF used by reflex-segmental method,
reducing sympathetic influence on the cardiovascular system, promote the
efficiency of the oxygen regime of the heart and blood pressure decrease due to the
reduction of elevated cardiac output.
Hypotensive action has negative ions and hydroionization.
Effective neck massage.
Factors include two groups diadynamic currents (DDT) by applying them to the
carotid sinus area, or gathering on the collar zone and in the projection of the
kidneys.
53
For group 3 factors include diathermia, ultrasound, galvanizing, CMT, AMF.
Diathermia and ultrasound performed on the kidneys. When exposed to the
projection area VMF kidney hypotensive effect is realized not only through
changes in renal hemodynamics, but reflex-humoral way through the autonomic
nervous system.
4 group of factors - include methods balneotherapy and hydrotherapy. For the
treatment of hypertensive patients used radon, carbon dioxide, sulfide, bromine,
chloride, sodium and other bath. Most often, patients used a complex combination
of electrotherapy treatment and balneotherapy complemented by physical therapy
and massage. It is important to observe more rationally interleaving procedures.
To select the approach to the treatment of hypertension in addition to staging its
clinical variant should have an accompanying diseases and complications. In such
cases, the appointment of treatment must be based on the severity and
characteristics of hypertension and related diseases.
Spa treatment.
In hypertensive 1-2 A degree carried out in spa treatment, climatic and local
cardiac sanatoriums. Choice of spa treatment determined by the type of
balneotherapy and changing climatic conditions. In particular, you should refrain
from sending to the resorts to changing climatic conditions, or in periods of sharp
fluctuations in weather reacted patients with reactions to crises and menopause. In
hypertensive 2B step without severe cerebral and coronary circulation of renal
function, when CD 2B treatment performed only in local cardiac sanatoriums.
Cardiopsychoneurosis.
syndrome of functional disorders of the cardiovascular system due to violations of
its regulation of the central nervous system.
Pathogenetic physiotherapy methods should be designed to address violations in
the higher parts of the central nervous system, along with the improvement of the
regulatory functions of subordinate divisions of the autonomic nervous system.
The choice of methods of treatment and methods of their application is based on
clinical features of different types of the disease - hypertensive, anti-hypertensive
and cardiac. In order effects on the central nervous system, on pain of cardiac
arrhythmias and lipid metabolism electrosleep apply. In severe sanitation galvanic anode collar, electrophoresis with novocaine, novokainamid, pananginum,
nicotinic acid. When the pain - Darsonvalization, massage and MSS the heart,
head. When hypertensive type of disease Recommended self-massage of limbs and
trunk by dry brush. Among the methods used hydrotherapy showers (rain,
circulatory, underwater shower - massage) dousing, dry and wet pack, coniferous,
oxygen, nitrogen bath. With the aim of therapeutic effects on the cardiovascular
system and the nervous system used hydrocolonotherapy - swimming, exercise in
pools with fresh water and mineral water.
Neurocirculatory dystonia patients used the spa treatment in spa, coastal and
lowland climate and local cardiac sanatoriums.
Atherosclerosis
54
Atherosclerosis - Is a metabolic disease, which is based on the violation and
neurohumoral regulation of lipid metabolism and protein permeability and trophics
vascular wall. A person can identify a variety of factors associated with the
disease. The most frequent combination are certain types of hyperlipidemia and
hypertension, especially if they are complemented by the neuro-emotional stress,
limited physical activity, family history.
Treatment of atherosclerosis Regardless of the period of the disease and the
preferential localization, consists of general measures, including treatment with
decreasing nervous tension.
Should recommend refusal of professional additional loads systematic recreation
etc. Smoking and alcoholic beverages are prohibited. Exceptional value is given
rationally constructed motor mode, gymnastics, including medical, and sports.
The main influences of physical methods in atherosclerosis any localization are
first in action on impaired metabolism and vascular trophics secondly, the
elimination or reduction of hemodynamic disorders in the development of reserves
in the circulatory organs.
In order to influence the nervous system and indirectly through her disturbed
metabolism and regulation of blood circulation is prescribed: neurotic syndrome in
patients with severe sleep disorders, angina, cardiac arrhythmia (extrasystoles,
sinus tachycardia, paroxysmal tachycardia), in violation of lipid and carbohydrate
metabolism - electrosleep sedative for the procedure (procedure number 81) with a
pulse frequency of 5 Hz to 20 Hz. Length procedures gradually increased from 20
to 45 minutes, the procedures are carried out within a day or 4 - 5 times a week.
The treatment course of 12-18 procedures.
With concomitant blood circulation in the vertebrobasilar system in the absence of
hypotension and tachycardia - galvanic collar on AE Shcherbakov or a collar with
aminophylline (technique number 11) in a day or two consecutive days, followed
by a day of rest. The treatment course of 12-20 procedures.
Patients with neurotic syndrome type irritable weakness appoint rain or circular
shower (Procedure number 181, 185), conifers bath temperature of 36 0 C
(procedure number 201) for 8-12 minutes every other day, 10-12 baths; mineral
baths (bromine, sodium chloride with sodium chloride content of 30 g / l (methods
№ 210,211), with concomitant obesity power shower at a pressure of 1.5-2.0 atm,
in a day, 8-10 procedures (procedure number 182) , underwater shower massage
(Procedure number 189) at a pressure of 1.5-2, 8-10 minutes, every other day, 1012 procedures.
In order to influence the metabolic processes in the liver, especially in patients
with severe metabolic disorders, with concomitant diseases of the liver and biliary
tract, diabetes and other metabolic diseases, apply drinking mineral water, has a
choleretic effect (Essentuki number 4 and 17, Smirnov, Borjomi etc.) for ¾ - 1 cup
3 times a day for 30-40 minutes before eating in the form of a heated (40-42 0 C)
electroplating the liver (the method number 21) at a current density of 0.03-0.05
mA / cm 2 laying area.
55
To reduce hypoxia prescribed oxygen therapy by inhalation of oxygen for 20-30
minutes every day, stay in an oxygen tent for 20-30 minutes every day, just 12-14
procedures.
For the treatment of atherosclerosis is widely used therapeutic exercise.
The presence of hypertension stage I or II or symptomatic hypertension without
hypertensive crisis is not a contraindication for treatment of specified physical
methods. The diagnosis of hypertension stage II B without chronic coronary
insufficiency, postinfarction cardiosclerosis and without consequences of
cerebrovascular failure, renal failure without the use of these natural treatments are
also contraindicated. They should be applied on a background of drug therapy.
The complex necessarily include physical therapy, exercise, diet. Shows massage
precordium and the reflex zones of the heart (when expressed Cardialgia) or neck
massage (with labile blood pressure, headaches, insomnia).
Staged rehabilitation of patients with coronary artery disease after surgical
treatment.
Currently, along with conservative treatment is increasingly used surgical
treatment of coronary artery disease. Indications for surgical treatment of coronary
artery disease is severe angina refractory to medical treatment, cardiac aneurysm.
Rehabilitation treatment of CHD patients after surgery involves several steps.
Stage 1 - (In the surgical clinic) during unstable clinical condition of the patient.
From the very first days after the operating period along with medical therapy he
prescribed breathing exercises massage.
Stage 2 (post in-patient) period of stabilization of the patient. At this stage, the
task maximize adaptive-compensatory processes, increasingly used by various
forms of physical therapy, and preformed natural physical factors. First of all
factors involved trainees effect on the heart-balneotherapy, massage,
electrotherapy, dosed walking. treatment gymnastics basis are: breathing exercises
and relaxation exercises with gradually increasing loads. Assigned the same
massage using classical techniques besides vibration. Electric procedures used
electrophoresis of novocaine, electrosleep. Balneotherapy in this period carried out
four-chamber baths or "dry" carbonic baths.
Stage 3 (Outpatient) at this stage the event aimed at compensation of coronary
heart failure, hemodynamic instability, the weakening of neurotic disorders and
risk factors for disease progression, complex treatment includes single, sulfide
baths, exercise, massage, electrosleep.
Spa treatment usually prescribed to patients through local cardiological
sanatorium, and a year later, and the climatic resorts and beaches where patients
underwent a comprehensive treatment using electrotherapy physiotherapists
aerotherapy, heliotherapy, UFO, swimming in the sea, swimming pool. Thus,
rehabilitation treatment of CHD patients after surgery should be based general
principles of rehabilitation of CHD patients, ie it should be phased long and
contain measures of rehabilitation and preventative action.
Hypertonic disease
56
Hypertensive heart disease - chronic pathological condition of the body,
manifested long systolodiastolic resistant hypertension, the development of which
are important genetic predisposition, a dysfunction of the central nervous and
neuroendocrine systems and membrane-receptor pathology leading to the
restructuring of vessels, heart and kidneys.
Increased blood pressure GB not be known due to reasons like for symptomatic
hypertension. In foreign nomenclature, which is based on syndromal and
symptomatic approaches to verify the diagnosis, adopted the term "hypertension",
reflecting the fact and degree of increase in blood pressure. We differentiate
between primary (essential) and secondary (symptomatic) hypertension.
GB leads to high rate of complications (strokes, heart attacks, heart failure, chronic
renal failure) and mortality. Furthermore, elevation of blood pressure associated
with development and progression of atherosclerosis, coronary heart disease, etc.
The main risk factors for the disease is considered male, menopause in women,
smoking, increased cholesterol more than 6.5 mmol / L burdened heredity. Other
risk factors include the reduction of HDL-C, LDL-C increase, microalbuminuria in
diabetes, impaired glucose tolerance, obesity, sedentary lifestyle, increased levels
of fibrinogen, reduction of endogenous tissue plasminogen activator, increased
levels of plasminogen activator inhibitor type 1, increasing the concentration of
apolipoprotein E, high values of factor VII coagulation, homocysteine, d-dimer,
CRP, estrogen deficiency, a chronic immune process in the cardiovascular system
associated with certain pathogens, low socio-economic status, ethnicity, living in
endemic geographic regions, particularly the nature of (latent aggressiveness ,
anxiety, behavior of the type "A").
Increased blood pressure is mainly due to an imbalance relations minute volume of
blood and peripheral vascular resistance.
Cardiac output is determined by the cardiac output, which depends in turn on the
myocardium and blood volume. Peripheral vascular resistance depends on the tone
of resistance arteries and the degree of vascular remodeling (narrowing of the
blood vessels as a result of hypertrophy mediointimal complex and increase the
"stiffness" walls of blood vessels).
Hemodynamic in hypertension is also due to changes in the regulation of the
cardiovascular system and kidneys, impaired physiological balance between
pressor and depressor mechanisms. The greatest value in increasing blood pressure
in hypertension attached changes circulatory regulation of the central and
sympathetic nervous system, which is closely linked to the activity of the
endocrine system, renal function and microcirculation.
Currently, the primary factor in the formation of arterial hypertension is considered
genetically determined predisposition, which is expressed in widespread violations
of ion transport system and the structure of the cytoplasmic membrane of cells.
The result is a level shift the regulation of calcium metabolism, changes in
hormone-cell relationships manifests increased activity of the hypothalamicpituitary-adrenal, renin-angiotensin-aldosterone, insular systems, etc. Calcium
overload cells enhances the contractile capacity of vascular smooth muscle 57
functional component increase peripheral resistance. In addition, excess calcium
activates cellular proto-oncogenes (growth factors), resulting in hypertrophy and
hyperplasia of smooth vascular muscle - the organic component of the peripheral
vascular resistance. Occurring with myocardial hypertrophy and increased
contractility, wall thickening and narrowing of the blood vessels are factors fixing
blood pressure high.
As a result, hypertension is the result of perversion pressosensitive relationship
between the centers of the brain, sympathetic nerves, resistive and capacitive
vessels and the heart, resulting in activation of the renin-angiotensin mechanism,
excessive secretion of aldosterone, and finally the outcome of depletion
mechanisms depressant kidney (prostaglandin E2-Din, kallikrein, bradykinin),
vessels (12-prostaglandin or prostacyclin, kallikrein-kinin and dopaminergic
system, endothelial relaxing factor) and the heart (atrial sodium uretic factor).
Meaning kidney increase in blood pressure due to their leading role in the
regulation of sodium and water homeostasis.
Important pathogenetic factors of hypertension consider tissue insulin resistance
(paired with increased sodium reabsorption, increased activity of the sympathetic
nervous system, the expression of proto-oncogenes and the weakening of
vasodilatory stimulus), increased receptor density and myocardial vascular bed and
their sensitivity to adrenergic effects due to excessive secretion of cortisol and
thyroid hormones , major change in biological rhythm neuroendocrine systems and
hence rhythms regulate the cardiovascular system. A special place in the
pathogenesis of hypertension endothelial dysfunction belongs increased synthesis
of endothelin and reduced nitric oxide synthesis.
Reconstruction of the heart and blood vessels, long periods of hypertension
determine the functioning of the circulatory system in stressful conditions that
leads to impaired relaxation and contraction of the myocardium, cerebral, coronary
and peripheral hemodynamics with the formation of complications, such as stroke,
heart attack, heart and kidney failure.
The main syndromes GB are cardialgia, cephalalgia, hypertension, cardiovascular
remodeling system, endothelial dysfunction, CNS dysfunction, neurohormonal
dysregulation, membrane receptor pathology of renal dysfunction. In clinical
practice, often isolated neurotic, cerebrovascular, cardiac syndromes and
autonomic dysfunction syndrome. In physical therapy convenient to distinguish the
following syndromes: neurotic, dysregulated neurohormonal and renal dysfunction.
The main goal of treatment of patients with essential hypertension is to restore the
balance between pressor and depressor mechanisms of regulation of blood
pressure. The main objectives of treatment are the regulation of the structure and
function of the myocardium, the modulation of tone and structure of the resistive
and large arteries, correction of the central nervous system and kidneys. These
tasks include, in turn correct the imbalance major hormonal systems (sympathetic
nervous, renin-angiotensin-aldosterone, kallikrein-kinin, prostaglandin, endothelin,
etc.), improvement of microcirculation in vasoactive areas (kidney, brain),
correction receptor relationships in the area of the carotid sinus , aortic arch,
58
centers of the brain and kidneys, including at the level of the membranes of
vascular endothelium, smooth muscle of blood vessels. The main groups of drugs
for the treatment of hypertension are neurotropic agents, acting on vascular smooth
muscle elements, antagonists of the renin-angiotensin system, diuretic.
Physiotherapy patients with essential hypertension is aimed at relief of headache
methods, reinforcing the inhibitory processes in the CNS (sedation techniques),
correction of hypertension (hypertensive methods), decreased activity sympathetic
nervous system (vegetocorrecting methods), the decrease in activity of the reninangiotensin-aldosterone system (RAAS) and the correction renal surround
mechanism of regulation of blood pressure (RAAS-modulating methods).
Physical treatment of hypertensive patients
Sedatives methods: electrosleep, total franklinization, galvanizing the brain and
segmental zones, iontophoresis sedatives, tranquilizers, antidepressants, local
darsonvalization head and neck area, bromine, conifers, nitrogen bath, aero
sedatives, hour aerotherapy.
Antihypertensive methods: transcerebral amplipulse, warm fresh water, sodium
chloride baths, carbonic baths.
Vegetocorrecting methods: transcranial electroanalgesia, galvanizing the brain and
ganglia of the sympathetic trunk, iontophoresis (adrenolytics, ganglioblockers,
cholinemimetics), low-frequency magnetic therapy (head, cervical sympathetic
ganglia, heart), UHF-therapy (carotid sinus area, solar plexus, cervical sympathetic
ganglia), infrared laser , biocontrolled aeroionotherapy.
RAAS-modulating methods: galvanizing, diadynamic, amplipulse, UHF-therapy,
low and high frequency magnetic therapy kidney area.
Contraindications to physiotherapy patients with essential hypertension is
hypertension stage III, hypertensive crisis, a sharp increase in blood pressure
without clinical signs of crisis, circulatory failure above the PA stage (for
electromagnetotherapy) and higher stage I (balneotherapy), cerebrovascular failure
(stroke) in the early stages of myocardial infarction (in the acute phase), expressed
meteolability patients, cardiac arrhythmias (atrial fibrillation, tachysystolic form,
paroxysmal tachycardia, arrythmia politopnye different origin). Spa treatment.
At the direction of the spa treatment of patients with essential hypertension is
necessary to consider not only the stage, but the clinical features of the disease,
complications and comorbidities.
Patients with slowly progressive course of stage I and II in the absence of GB
vascular crises and pronounced atherosclerosis of brain, heart, kidneys, without
severe disorders of heart rhythm and conduction, circulatory failure, not higher
stage I sent to the seaside resorts (excluding the hot season) climate of the
mountains, plains and forests. They are shown balneal resort with radon, carbon
dioxide and iodine-bromine waters.
Patients with stage II GB with stable hypertension, hypertensive crisis without,
cerebrovascular, coronary blood flow and renal function, without severe cardiac
arrhythmias and conduction, circulatory failure is not shown above stage II spa
treatment at local resorts. When NAH and HD I spa therapy, in addition to
59
treatment in a sanatorium, may be appointed as an outpatient measure. When crisis
GB stable (extracrisis) phase of the disease patients can be directed to local motels
cardiology.
In the local health centers can be assigned patients treated with NB-stage disease as
in benign and circulatory failure, the PA stage, atrial fibrillation, coronary artery
disease associated with exertional angina FC I-III, in the early period after a
hypertensive crisis, with long-term effects of cerebral and coronary circulation.
Patients with signs hypersympathicotonia recommended direct on balneal resort
with radon, carbon dioxide and iodine-bromine water and forest, seaside resorts
(excluding southern resorts in the hot season). Meteosensitive patients, women in
menopause is not recommended to be sent to the Baltic seaside resorts in late
autumn and early spring periods, as well as in regions with sharply contrasting
weather conditions.
Contraindications to the sanatorium treatment of patients with malignant course are
GB, hypertension stage III with recent myocardial infarction or stroke, circulatory
failure above stage II, severe cardiac arrhythmias and conduction, impaired kidney
function nitrogen excreting. Be aware that the WHO classification, stage III GB
differs from stage II features arteriosclerotic lesions of various organs, blood
pressure levels, the nature of the flow, presence of complications, so the question
should be sent to a spa treatment hypertensive patients with stage III can be
considered debatable. Sanatorium treatment of patients with malignant course GB
stage III contraindicated. Patients with higher GB PA stage and myocardial
infarction or stroke with severe disturbances of cardiac rhythm and conduction,
impaired renal function, it is recommended to treat only in local cardiac
sanatoriums.
Performance criteria of spa treatments are subjective and objective measures of the
patients. Given that the chronic course of illness marked changes in the health
status of patients during the spa treatment often does not happen, then the estimate
is graduation: "Improvement", "sustained improvement" and "impairment".
Improvement of the patient with essential hypertension stage I ascertain if blood
pressure, disappearance of headaches, irritability, sleep improvement, health,
improving physical and emotional stress. Sustained improvement in patients with
essential hypertension were recorded while keeping within a year of good health,
endurance physical and emotional stress. In this AD must remain on normal
numbers or have a rare short climbs. Unfavorable results of sanatorium treatment
of these patients is considered to deterioration of their health, save headaches,
increased blood pressure.
For patients with stage II GB improvement are the following features: reduction of
15-20 mmHg or normalization of blood pressure, disappearance or reduction of
circulatory failure, systolic overload of the left ventricle, headache, increased work
capacity, exercise tolerance (20% increase in the duration and rate of walks),
increased myocardial contractility, and total peripheral resistance (according
tetrapolar rheogram) .
60
Sustained improvement in patients in the long term while maintaining ascertain
within a year reduction in blood pressure or a transient increase in not requiring
long-term use of antihypertensive drugs, the achieved level of physical activity,
myocardial contractility and total peripheral resistance; absence of ECG signs of
increase of systolic left ventricular overload. Deterioration: increase in blood
pressure, circulatory failure, systolic overload of the left ventricle, increased
subjective symptoms, worsening portability physical and emotional stress,
worsening functional ability of the myocardium and increase in total peripheral
resistance (by tetrapolar rheogram). physioprophylactics. Initial
physioprophylactics HD associated with the treatment of neurosis, asthenic
conditions, neuro dystonia of hypertensive type as possible precursors of the
disease. Value has a fight with these risk factors GB as physical inactivity,
obesity, smoking.
Secondary physioprophylactics effective in stages I and II GB PAG. Taking into
account the period of aftereffect physical treatments (3-6 months). Optimal for
maintaining normal (for a particular patient) blood pressure should probably be
considered the courses of physioprophylactics 2-4 times a year (outpatient and
motels). Its objectives are to maintain a normal psycho-emotional status of the
patient, slow increase of activity of sympathetic-adrenal system, improving
cerebral circulation and inhibition of progression of hemodynamic disturbances
(central and regional hemodynamics).
Rehabilitation of patients with lung diseases.
Respiratory diseases currently occupy fourth place in the structure of diseases
leading to increased mortality and disability, and which also contribute to the
increased rate of air pollution and the extent of the use of chemical products
manufacturing, agriculture and households. As a result, under the influence of
external and internal factors has changed the nature of inflammatory diseases and
increased the number of individuals with increased bronchial reactivity. For
inflammatory diseases of the bronchopulmonary system has become more common
tendency to protracted chronic course, early accession allergic complications.
Experts identify a group of diseases, which they called
Chronic nonspecific lung diseases and attributed to him: chronic pneumonia,
chronic bronchitis, bronchiectasis, pulmonary fibrosis, emphysema, bronchial
asthma. The last 10-15 years has spread recovery of patients with COPD:
Pulmonary Clinic-rehabilitation department - health-pulmonology clinic.
Objectives and principles of rehabilitation of pulmonary patients
Function
- Achievement of regression of reversible and irreversible changes in the
stabilization of lung
- Restoration and improvement of respiratory function and CAS,
- Restoration and improvement of psychological status and disability.
Task
- The elimination of the inflammatory focus
- The improvement of bronchial patency
61
- Increase ventilation
- Inconsistency between alveolar ventilation and pulmonary blood flow,
- Drainage improvement in lung function,
- Economization of respiratory muscles by increasing their capacity and friendly.
- Activities aimed at improving the neurohormonal mechanisms of regulation of
external respiration.
Realization of these tasks may vary depending on the disease, the individual
patient, the form and extent of damage the respiratory system.
Clinico-physiological rationale for the use
of physical rehabilitation
In most cases, respiratory diseases marked bronchial obstruction. As a result of
bronchospasm and edematous inflammatory changes occur bronchoconstriction
and increases resistance to air movement on the tracheobronchial tree as when
inhaling and when exhaling. Breathing exercises and exercises with the
pronunciation of sounds on the exhale reduce reflex spasm of smooth muscles of
the bronchi and bronchioles. Vibration of the walls in the gym sound acts like
vibromassage, thereby relaxing their muscles. Increased sympathetic tone in the
classroom exercise therapy, stimulation of adrenal function, enhancement of
epinephrine, corticosteroids, has in turn, expressed antispasmodic effect.
Also contributes to the removal of bronchospasm exercises in warm water
relaxation effect. With the loss of the elastic properties of light, small bronchi
deprived own elastic support during exhalation begins to subside, which also leads
to an increase in airway resistance, but primarily on the exhale. To increase
intrabronchial pressure applied in the classroom treatment gymnastics breathing
through a straw whistle through tisnut lips (teeth), exhale through the tube into the
water, etc.
Gymnastics classes address the incoordination of the respiratory act. This is
possible thanks to the fact that the person is able to arbitrarily change the tempo,
rhythm, amplitude of respiratory movements, the value of pulmonary ventilation.
Inclusion in the program of studies of exercise-related respiratory phases become
conditional reflex exercises for
activity of the respiratory system and contributes to a patient conditional
respiratory reflex. Arbitrarily changing breathing through breathing exercises, you
can achieve a harmonious work costophrenic mechanism of breathing with great
ventilation effect and with less expenditure of energy on the work of breathing.
Under the influence of regular employment upper pectoral breath type is replaced
by more appropriate thoracicoinferior. Inflammatory diseases of the
bronchopulmonary system accompanied by the accumulation of pathological
secretions (sputum, mucus, pus) that violates the airway patency. Excretion of
pathological secretions from the respiratory tract is achieved by bronchial drainage
at different positions of the body, contributing to, the removal of secretions due to
its own weight (postural drainage). Even more effective is the combination of
postural drainage with exercise, it is advisable prior to the occupation and use of a
combination of physical treatments that stimulate expectoration.
62
Rehabilitation of patients with asthma
Bronchial asthma (BA) is one of the most common diseases and unfortunately,
there is a tendency of constant growth of this disease. So if the incidence of asthma
in the beginning of the century did not exceed 1% of the total population, it is now
the figure rose to 10%. Annually from the disease killed about 2 million people
(V.N.Sasonov 1994) BA-a chronic relapsing disease with a primary lesion of the
bronchi, which is characterized by their hyperactivity caused by specific
(immunological) and (or) non-specific (non-immunological), congenital or
acquired mechanisms and basic (mandatory) feature of which is choking and (or)
asthmatic status, due to spasm of smooth muscle bronchus, hypersecretion, and
edema of the bronchial mucosa (G.B.Fedoseev 1982) An important
pathophysiological step is smooth muscle spasm of the small bronchi and
bronchioles, mucosal edema due to a sharp In this form the main clinical
symptoms of the disease. Bronchospasm in asthma develops in two ways: 1) a
direct action of inflammatory mediators on bronchial smooth muscle (primary
bronchospasm); 2) during stimulation of the sensory endings of the vagus nerve
(secondary bronchospasm). Currently, the most common trigger factor for asthma
are respiratory infections. Significant role in the pathogenesis of asthma higher
parts of the central nervous system involvement, namely the CNS influenced
interoreceptive unconditioned reflexes arises pathological dominant, which is
converted into a conditioned reflex, this explains the recurrence of asthma attacks
and the role of emotional factors in this, which, acting through the autonomic
nervous system, also can cause choking in a patient with bronchial asthma. BAchronic disease, occurring with exacerbations, which in most cases are followed by
periods of remission. In the initial stages of the disease is its main expression
asthma expiratory type. With the progression of the disease become more
pronounced signs of respiratory function not only in the attack, but also in the
interictal period. They are to reduce the VC, expiratory volume, impaired gas
exchange, the development of respiratory failure. Frequent attacks adversely affect
the function of the cardiovascular system and can cause heart failure. AD is a
typical complication of obstructive pulmonary emphysema.
Clinico-physiological rationale for the use of funds
Physical rehabilitation and physical therapy
rehabilitation. Rehabilitation measures in asthma are aimed at maintaining disease
remission, recovery of functional activity and adaptive capabilities of the
respiratory system and other organs, and systems to ensure the normal
development of subsequent survivability of an organism. For this purpose a set of
therapeutic and remedial measures, including the organization of health-protective
and dietary regimen, the use of physical therapy, massage, physiotherapy and
pedagogical impact. Purpose of these methods is determined by the patient and the
characteristics of the disease. The main objectives of physiotherapy, treatment and
preventive measures are the effects aimed at reducing the activity of the
inflammatory process, the restoration of local and general and non-specific
immunological reactivity, improve respiratory function. In the rehabilitation of
63
patients with asthma exposure to physical factors play a leading role. Physical
education is a powerful factor in improving the impact on the patient. Things
treatment gymnastics promote adaptation of the patient, his cardiovascular system
and respiratory system to physical stress, increase its immunological reactivity
against viral and bacterial infections.
Main objectives:
Normalization tone CNS (elimination of stagnant pathological focus) and reduction
of the total strength.
Reducing spasm bronchi and bronchioles.
Development of the mechanism of complete breathing with predominant training
exhalation.
Strengthening the muscles involved in breathing.
Increased mobility of the diaphragm and chest.
Education arbitrary muscle relaxation.
Education of the patient to control his breath in order to hold them during an
asthmatic attack.
Increased functional reserves through training.
Achieving stabilization regression reversible and irreversible changes in the lung.
Means of physical rehabilitation. Form of physical therapy used in asthma:
physiotherapy, morning hygienic gymnastics, metered walking on flat terrain, light
sports, cross-country skiing. Basically gymnastics administered in between bouts at
improving the general condition of the patient. After graduating from attack to
facilitate removal of hard sputum, eliminating emerging areas of atelectasis and
pneumonia prevention shows the special breathing exercises with slow full
exhalation. Classes physiotherapy follow to start and finish a light massage face,
arms and chest, in order to apply these same exercises for relaxation of muscles of
the upper body and chest. LH course can be divided into two periods: preparatory
and training . In training period applies a broad arsenal of general development,
special breathing exercises that aim to completely remove the adverse effects of an
asthmatic attack, implement training apparatus of external respiration, improve gas
exchange, intensify metabolic processes, improve efficiency of the organism as a
whole.
In preparatory period acquaint the patient with special exercises to restore proper
breathing mechanism. Duration of 2-3 days, the pace slow exercise. In LH classes
must include the most simple, easy to perform exercises in the form of flexion,
extension, maintenance and make the final, as well as exercises on the extension of
the trunk, the slopes in the front and sides. In the training period are actively used
gymnastic items (stick, ball, etc.), gymnastic exercises on the wall. The pace is
slow and the average duration of 2-3 weeks Special exercise aimed at training and
development functions and bodies violated in connection with the disease. So in
AD mobility impaired chest and focus on static and dynamic exercises. These
exercises include:
64
Exercise with slow and complete exhalation extended because they provide a more
complete removal of air from the emphysematous alveoli stretched through
narrowed bronchioles and train the diaphragm and abdominal muscles involved in
the implementation of a full exhalation.
Exercises with the pronunciation of vowels and consonants, are designed for the
development of voluntary conscious control exhalation by the patient in order to
make it uniform, rather than intermittent, spastic. Vibration same upper respiratory
tract helps to reduce bronchospasm during exhalation.
The classes are taught patient LH decrease in breathing, which reduces excessive
ventilation. Inflating chamber, rubber and pear objects (balls, balls, etc.)
Contraindicated in patients with asthma exercise associated with straining and
breath holding. Selection of exercises and duration of physiotherapy in asthma are
highly individual character, depend on the physical fitness and dealing with disease
severity. Evaluating the effectiveness of the proposed method on the basis of
health, external respiration function and circulation: BH, VC, HR, physiological
curve. Also LH used dosed walking on flat ground, jogging, is best done in the
autumn-winter period, accustoming the body to low temperatures can apply
swimming, pre-prepare the body to cold water, so you need to start in the warm
season. Fruitfully act skiing in a quiet pace and proper breathing, their duration
increases gradually. Contraindications to gymnastics classes: fevers, pronounced
worsening inflammation, frequent attacks of breathlessness, severe pulmonary
heart disease III-st.
Rehabilitation of patients with asthma by applying preformed natural and physical
factors.
When assigning physical therapy should take into account the stage of
development and phase (active process) disease. It is now widely used in aerosol
therapy during bouts of asthma. Advantages medical electric aerosole therapy
synergistic action expressed in aerosol pharmacologic agents and electric charge,
ensure high dispersion stability and penetrating ability of medicinal aerosols. To
eliminate the bronchospasm in order to improve the conductivity of bronchial
inhalation use the following mixtures (a single inhalation) Novocain 2% -1.0
Atropine Sulfate-0, 1% -0.25 Ephedrine hydrochloride, diphenhydramine 5% 1.0% -1.0 1-Ascorbic Acid 5% -1.0% Glucose 20 -1 0
V.M.Bogolyubov offered the following mixture:
A solution of 0.5% -0.25 isadrine
Water distillated 3, 0 (by inhalation)
Adrenaline chloride solution 0.1% -1.0
Distilled water 2.0 (by inhalation)
Solution of atropine sulfate 1% -1.0
Distilled water in 4-5,0 (2 inhalations)
In order to reduce the sensitization of local airway mucosa, the following
inhalation mixtures containing antihistamines (one inhalation):
1 Diazolin - 0,05 Ephedrine chloride-0, 025 Novocaine-0, 25% -30.0
Diphenhydramine-0, 03 Adrenalin chloride 0.1% -10 cap.
65
By indications hydrocortisone may be added into the blends inhaled dose of 0,025
g per 1 ml of suspension or inhalation. Better to spend inhalation glucocorticoid
therapy with treatments - becatid, beclometh. Inhalation therapy Intaglio (mast cell
stabilizer) should be carried out by insufflation capsules using the original brand
inhaler "Spinhaler". Or by using the liquid preparation in the form of aerosol
inhalation.
To improve the trophic mucosa using extracts of medicinal herbs
(plantain, chamomile, succession, thyme, coltsfoot), vitamin supplements, some
biogenic stimulators (aloe), aromatic organic oil (sea buckthorn, peach, olive).
For the treatment of atopic asthma electrosleep form is shown, the pulse
frequency is selected individually from 2-3 to 20-25, or from 80 to 120 Hz. From
time to 15-30 minutes. 1-2 hours on a course of 10-15 procedures. Advisable to use
UHF therapy for adrenal projection area (at the level of Th-XII L-II) or inducer
cable around the body in order to increase the glucocorticoid function.
UHF therapy on interscapular region by weak thermal and thermal dose
(20 W) on the course of 10-12 procedures. Short-wave therapy-disk electrode on
the interscapular region of 10-15 min;
UHF therapy power 80-100 watts with lateral or anterior-posterior
location of the electrodes 10-15 min. on the course of 10-12 procedures.
To improve the drainage function of bronchi in the complex treatment
using CMT therapy electrodes are placed on the paravertebral level Th-4-6
vertebrae, variable mode, the duration of 3:3 s, 60-80 Hz frequency, modulation
depth of 75-100%, III-IV kind of work every 3-5 minutes. The first procedure 6-7
min., Subsequent - 10 min., A course of 10-12 procedures. To improve the actions
carried bronchial drainage CMT electrophoresis aminophylline. Electrophoresis
also use iodine, magnesium, intranasal electrophoresis on comb-Kassil use in
asthma, allergic or vasomotor rhinitis dimedrolum, novocaine, calcium chloride,
Intaglio (1 caps. 3 ml of distilled water). Turundy cotton soaked in the drug
solution in the nasal passages are found in a depth of 1-2 cm current 0.3-0.5 to 2-3
mA for 10-30 minutes. 10-12 procedures.
Treatment variable low frequency magnetic field in the discontinuous mode of the
device "Pole-1" for posterolateral thorax 30-35 mT for 10 min. a course of 8-10
treatments lead to positive results in the treatment of asthma with blood circulation
in the pulmonary and pulmonary heart disease, small changes in respiratory
function.
Ultrasound in small doses has analgesic, resorbing, vasodilator, antispasmodic,
hyposensisbilising effect, stimulates the phagocytic activity of leukocytes. Voiced
paravertebral field at Th-IV - Th-IX intensity of 0.2 W/cm2, then posterolateral
surface of the thorax during the 6th - 8th intercostal space for 2 min. only 8
minutes. 12-15 procedures. For the treatment of asthma, there is a technique to
Jurayev AD: applied to the skin 10% novocaine ointment, voiced by the projection
area of glomus (landmark at the intersection of the lines connecting the middle
third of the rectus muscle of the neck and chin) in a continuous mode, stable
method for 3 min. on both sides, on a course of 10 treatments.
66
Ultraviolet irradiation of the thorax in remission at the 4th 3-4 biodoses
fields in mild and 2-3 biodoses with average form over the course of 20 1-2
procedures. In order to carry out desensitization Aeroionotherapy negative charge
to 5-15 min. daily rate of 15-20 procedures.
In recent years, methods of treatment used helium-arsenide laser "Pattern"
paravertebrally at Th-III-V vertebrae on biologically active points of light.
Methods of treatment of low intensity helium-neon laser apparatus from "APL-1"
Light beam on the region roots of the lungs of 1.5 min. daily.
Massage
Massage is one of physiotherapy techniques prescribed for asthma. Recommended
massage since taking pats in the direction from the lower edge of the ribs to the
neck, shoulders and armpits. In the transverse direction of the spine massage is
done by intercostal space to the axilla and back.
Then rubbed the skin and mash the back muscles of the shoulder girdle in the
longitudinal and transverse directions. Complete stroking massage. Duration back
massage for 8-10 minutes. Massage anterior chest wall is conducted when the
patient lies on his back, the direction of massage movements from the bottom edge
of the costal arches collarbone, shoulders, axillary pits, carefully massaged over
the chest and the subclavian area.
Chronic bronchitis.
Chronic bronchitis is a consequence of acute bronchitis develops independently
or under the influence of exposure to infection in chronic diseases of the upper
respiratory tract, adverse climatic conditions and professional, in smokers under
the influence of volatile toxic substances in heart failure congestive lung.
Physical methods used in chronic bronchitis, acute exacerbations of the disease to
treat and to prevent the latter.
Preventive measures are designed to increase the overall resistance of the
organism, for normalization of neuro-humoral regulation systems, and to
strengthen immunogenesis compensatory functional processes in the bronchopulmonary, cardiovascular and nervous systems.
Used with these objectives in the period of remission physiotherapy methods
should be combined with tempering procedures: water and as a partial and general
wiping chest and body with subsequent applications and dousing shower by
aeroprocedures, heliotherapy, walking and sleeping outdoors, physiotherapy,
health path, as well as for rehabilitation of the upper airway in the presence of foci
of chronic infection (chronic treatment tonsillitis, sinusitis, rhinitis, etc.)
To improve the overall resistance and impact on functional reserves in the
respective systems of the body in remission appoint:
common UV-investment (since ¼ biodoses) through day 15 procedures
medicinal aerosols and electroaerosole inhalation with bronchospasmolytic and
with secretolitic funds (1% aminophylline, papaverine 2% - 1 ml chymotrypsin
chemopsin, 0.5% potassium iodide solenoschelochnyh mineral water, alkaline
mixtures);
67
iodine electrophoresis pancreatin, trypsin procedure by Vermeule; every 15 min, a
current density of 5 mA / cm2, A course of 12-15 procedures.
When treating patients in the acute stage of chronic bronchitis is advisable to apply
methods of physiotherapy, anti-inflammatory, desensitizing action in combination
with the methods of rehabilitation in the form of endobronchial inhalation therapy
(medical aerosols and electroaerosoles). In steady-state conditions in the absence
of significant signs of intoxication and fever physiotherapy methods can be
incorporated into a comprehensive treatment from the first days of the disease.
In severe inflammatory activity is recommended: electric field UHF 10-12 minutes
every other day oligotermic dosage; inductothermia on the interscapular region in
force anode current 18-200 mA for 12-25 minutes every day or every other day;
Decimeter wave (SCM) therapy with localization impact on the region roots of the
lungs every day or rectangular emitter when the generator output power from 30 to
50 watts and a gap of 3-4 cm, daily or every other day, 10-15 procedures per
treatment;
aerosol and electroaerosole - inhalation antibacterial, desensitizing,
Bronchospasmolytic and fibrinolytic agents (antibiotics, aminophylline,
Halidorum, Demerol, chymotrypsin chemopsin etc).
Inhalation of aerosols and electroaerosoles antibiotics and fibrinolytic agents
should be combined with inhaled bronchospasmolytics. Should precede the
introduction of the last inhalation of antibiotics and fibrinolytics that with
bronchospasm always penetrate to a sufficient depth in bronchopulmonary system.
The interval between these procedures should be from 20 to 40 min.
With concomitant rhinopharyngitis and tracheitis expedient to suppress
hyperreactivity mucosa of trachea and bronchi in the first stage of treatment assign
electroaerosoles alkaline mineral waters and mixtures - 4-5 first procedures, 10-15
procedures and then 1% aminophylline.
In the treatment of patients with chronic bronchitis in acute stages of low activity is
used shortwave ultraviolet radiation (wavelength 253.7 nm) combined with 1%
electroaerosole inhalations of aminophylline or alkaline solution mixtures. The
advantage of this method is that the FAC-rays, in addition to bactericidal exert
antiinflammatory and analgesic effect, increase the reduced secretory function of
the adrenal cortex, which plays a major role in the processes immunogenesis.
The method of application is also at Asthmatoid bronchitis moderate course.
At the first stage of treatment is irradiated region D 10 - L 4 erythemal doses in
increasing intensity (3 to biodoses 6-7), a day, a course of 5 treatments; directly
followed by a second stage carried electroaerosoletherapy (alkaline or alkaline
mixture of mineral water, 1% solution of aminophylline). The first two procedures
- 10-15 minutes later - 20 minutes on a course of 6-10 treatments prescribed daily.
To consolidate the sustainable effect after elimination of the inflammatory process
is advisable to use aero - and heliotherapy.
To restore, termoadaptation processes in the warm seasons apply conifers, oxygen
baths, circular and fan shower temperature 34-35 0 C for 1 day ½ - 3 min for a
total of 25-30 treatments.
68
In remission, during the warmer months climatic treatment is carried out: on the
southern coast of Crimea, in forest areas - chronic bronchitis patients with scanty
sputum release in middle and high climate - patients with chronic bronchitis with
copious sputum.
Pleurisy.
Dry pleurisy. Dry pleurisy is observed in many diseases of the lungs and other
organs and systems (with pneumonia, pulmonary suppuration, rheumatism,
systemic vasculitis, systemic lupus, etc.)
In most cases, the cause of dry pleurisy is pulmonary tuberculosis, often dry
pleurisy is the first step, "dry equivalent" ecssudative pleurisy.
Treatment of physical factors is reduced mainly to the treatment of the underlying
disease, as dry pleurisy - secondary process.
With the exclusion of tuberculosis in the acute period of use:
exposure lamp or sollux by Minin, daily from 10 to 20 minutes;
application of paraffin temperature 50-60 0 On a daily or every other day for 2030 min for a total of 10-20 treatments.
In the absence of temperature:
calcium - or iodine electrophoresis (in the presence of pleural adhesions) with the
localization of the active electrode, respectively, localization of pleurisy, the
second on the opposite side of the chest, the current 10-20 mA; procedures are
carried out every day or every other day for 20-30 min for a total of 20-25
procedures;
in the future (a month after recovery) procedures to water quenching (pouring,
wiping soul indifferent temperature);
gymnastics with an emphasis on breathing exercises;
climatic treatment on the southern coast of the Crimea and in the dry steppe
climate.
Pericardial effusion. Treatment of exudative pleurisy held antituberculosis, antirheumatic and anti-allergic agents.
Physical methods of treatment used in combination with drugs:
therapeutic exercises (breathing exercises) during resorption effusion to avoid the
formation of massive pleural adhesions;
exposure lamp or sollux Minin daily or every other day for 20-30 minutes, with the
exclusion of pulmonary tuberculosis, after resorption of exudate;
application of paraffin temperature 50-55 0 Since every other day for 20-30 min
for a total of 20-25 treatments;
Calcium - electrophoresis;
Total UV exposure 1-2 times a week from 0.5 to 2-3 biodoses;
Applications dirt;
iodine electrophoresis in a day; current density of 0.03-0.05 mA / cm 2 , For 1520 minutes every day or every day for a total 25 treatments;
climatic treatment on the southern coast of Crimea, mountain and steppe areas.
Pneumonia.
69
Methods of physical therapy in lobar pneumonia must be used in conjunction with
the necessary medication etiologic action. Their appointment is intended to
accelerate the resorption of inflammatory infiltrates, reduce the symptoms of
intoxication, improve ventilation and circulation in them, to strengthen the
mobilization of protective, immune processes in the body of the patient.
Application of physical factors in combination with early antibiotic therapy
shortens the period of the disease and prevent complications.
When lobar pneumonia apply:
a) ultraviolet irradiation erythema doses in the chest. It can start with is not yet
finished fever period and expressed general phenomena of mild intoxication.
During this period, the procedure should be carried out in the ward. Irradiation is
carried out near the margins of the affected area easy front, rear or side with a
dosage of from 2 to 6 biodoses (mean dose 4.3), ranging from 100 to 400 cm 2 ,
Every single field. After the disappearance of erythema irradiated again on course
to 18-20 exposures. Ultraviolet irradiation of the chest does not restrict the use of
cans, mustard plasters, warming compresses;
b) electric field UHF. Capacitor plate 8-13 cm in diameter was placed in the lateral
parts of the thorax when the air gap of 3 cm and procedures performed in weak
thermal dosage. With limited unilateral processes plates are placed at the front or
rear surface of the thorax, respectively, localization of the lesion in the lung.
Duration of treatment 15 minutes, procedures are prescribed every day or two; a
course of treatment from 10 to 18-20 procedures;
c) inductothermia on the thorax. It is performed with the use of an inductor-ROM
or flat spiral coils with 3-31/2 superimposed respectively lesions in the lungs at the
strength of the anode current of 140-180 mA. Duration of treatment in 5 minutes
the first day, the second day of 10 minutes, the third day of the 15-minute
procedure is prescribed for the strength of the anode current of 140 mA, on the
fourth day - at a current of 160 mA, on the fifth day - at a current of 180 mA. 7-14
per treatment procedures.
Inductothermia to be administered in suppurative processes in the lungs
(bronchiectasis, abscesses), with tendency to hemoptysis, with cardiopulmonary
diseases, with a significant depletion of the patient. Method of treatment is shown
in protracted course of acute pneumonia after temperature reduction and
disappearance of intoxication;
g) spa treatment. Sanatorium treatment is profiled in local sanatoriums during the
recovery period, spa treatment - climatic resorts of the Southern coast of the
Crimea and in Kislovodsk after complete recovery.
Lobular pneumonia (pneumonia) - acute infectious disease of various
etiologies with the inflammatory process in the lung lobules. Depending on the
number of lobes involved in the inflammatory process, distinguish small focal, and
drain macrofocal bronchopneumonia in recent years.
Focal pneumonia can occur as an independent disease and as secondary
(hypostatic, aspiration, atelectatic, metastatic pneumonia)
70
Physical factors are applied after the acute symptoms subside and the disease is
especially useful in the protracted course and tendency to migration and relapse. At
the early stage of the disease electroaerosoles used antibiotics.
In acute focal pneumonia during the first 2-3 days of the disease are treated with
intravenous antibiotics and injections of gamma globulin influenza or serum
polyglobulin. With 3-4th day of illness intravenous antibiotics replaced twice
(during the day) the introduction of negatively charged electroaerosoles (penicillin,
streptomycin, kanamycin or Terramycin). electroaerosoles heparin in treatment of
viral pneumonia is used in the midst of disease flowing with blood
hypercoagulability. Procedures are carried out 1-2 times a day under the control of
coagulation.
Microwave therapy is only assigned when there is no failure, cardiovascular
system and suppurative processes in lungs. UHF electric field is assigned to the
same procedure as with lobar pneumonia; physiotherapy - with 2-3rd day after the
temperature.
During the recovery period, patients are encouraged to stay in local profiled
homes.
Immunostimulatory methods
Heliotherapy - therapeutic effects of solar radiation on a fully or partially naked
body of the patient. Caused by long-wavelength ultraviolet radiation enhancement
of the synthesis of melanin and migration of Langerhans cells in the dermis leads
to compensatory activation of cellular and humoral immunity. Dosage sunbathing
carried by the energy flux density of the total radiation. Depending on latitude,
time of day and year it was achieved at varying lengths of procedures based on
REET. Heliotherapy spend in the weak, moderate, intensive treatment (Annex 4);
Rates 12-24 procedures.
Contraindications to physiotherapy: HB accompanied by cardiopulmonary
failure above stage II, acute purulent inflammatory lung disease, bronchial asthma
with frequent severe attacks, spontaneous pneumothorax, pulmonary embolism,
solitary cysts larger quantity, chronic lung abscess, general contraindications to
physical treatments. Contraindications for universal sympathomimetic are:
hypertension, atherosclerosis, myocarditis, insomnia; for nonselective In -Agonists:
chronic circulatory insufficiency, arrhythmias; platifillin contraindicated in
glaucoma.
Spa treatment
Patients with chronic bronchitis in the phase of steady or unstable remission
without the expressed violations ventilation function without bronchiectasis
accompanied by copious sputum, respiratory failure is not above the stage I sent
for treatment in local motels and climate treating resorts.
Contraindications to the sanatorium treatment are chronic diffuse bronchitis,
pneumonia in the acute stage, pulmonary fibrosis, emphysema, pneumoconiosis,
accompanied by cardiopulmonary insufficiency stage II above, as well as in the
acute stage.
71
Improvement in patients with chronic obstructive bronchitis in remission, with
respiratory failure is not above the stage I ascertain the absence or reduction of
complaints, clinical, radiological and laboratory signs of remission of inflammation
in the lungs, increasing motor activity, physical performance, improving the
volume and speed performance of ERF. Sustained improvement accompanied by
the absence of complaints, clinical, radiological and laboratory signs of remission
of inflammation in the lungs (normal percentage of leukocytes, no signs of
pneumonia, lung infiltration). In contrast, the growth of weakness, the changing
nature of cough, dyspnea complaints, increased body temperature, increased
number of sputum, signs of inflammatory activity in the lungs: progressive
tachypnea, auscultatory signs of pneumonia, focal infiltration of the lung tissue,
leukocytosis, neutrophilic shift, elevated erythrocyte sedimentation rate, acute
phase proteins in the plasma - evidence of the deterioration of patients.
In patients with chronic bronchitis in stable remission phase, pulmonary heart
disease and pulmonary heart failure stage II diffuse pneumosclerosis about
improving conditions after spa treatment is judged by the reduction of dyspnea
disappearance asthma attacks, reduce the amount of sputum, clinical, radiological
and laboratory signs remission of inflammation, normalize or significantly
improved respiratory function, reduce overload of the right ventricle of the heart,
the normalization of systolic intervals, positive dynamics of blood pressure in the
pulmonary artery. Persistent lack of improvement indicate underlying disease
relapse within 6 months, reducing the number of days of disability is not less than
50%, the stabilization of the improvement in pulmonary ventilation.
Deterioration of patients with an increase in verifying dyspnea expiratory
character, appearance or increase in the number of attacks of breathlessness,
sputum, cough build-up, the changing nature of cough and sputum, fever, increase
in the quantity appears dry and moist rales, reduced ventilation, the progression of
obstructive syndrome, build-up signs of emphysema, in the analysis of lung
ventilation function - a more severe degree of impairment of ERF and the growing
signs of overload of the right ventricle of the heart, an increase in pulmonary artery
pressure (voltage buildup period, reducing the period of exile, increase voltage
relationship period to a period of exile).
Physioprophylactics
Physioprophylactics aimed at preventing relapses and reducing their severity by
reducing inflammatory manifestations (anti-methods), bronchial obstruction
(bronchodilators methods) to improve sputum of the tracheobronchial tree
(mucolytic methods), reduce the appearance of hypoxia (antihypoxic methods) and
restore immune dysfunction immunostimulatory methods).
Appendix-1
USING METHOD "CIRCLE TABLE»
Methods of performance.
To work needed:
1. Set of cards with rehabilitation assignments.
72
2. Stopwatch.
3. Plain piece of paper.
Progress:
1. Written form.
2. Students in turn pull the card with the job.
3. Every student writing answers for 5 minutes.
4. Then the teacher collects answer sheets.
5. Overall time of the game 45 minutes.
6. Answer of an each student is treated separately.
7. Answers are being discussed on a sheet with all students.
8. Achieved score takes into account when setting the "current estimates."
9. Answer sheet is set to score points in red ink.
10.The bottom of the log free teacher records on the business game.
11. Logging of the game.
List of tasks for the business game
Collection of questions: "circle table"
1. Contraindications to unobligated funds treatment gymnastics heart?
-The general plight of the patient due to blood loss, shock, infection, concomitant
diseases;
Resistant pain; risk of bleeding or bleeding in the resumption of ties with the
movements;
- The presence of foreign bodies near major blood vessels, nerves, and other vital
organs.
2. Purpose of rehabilitation.
-The concept of rehabilitation of sick and disabled people is that with the help of
co-ordination of the activities of medical, psychological, social plan maximum
number of people after major surgery, injury. severe disease should restore their
physical, psychological, social status so that. if possible, avoid disability or have
the lowest degree of disability, to be integrated into society to achieve the highest
possible social and economic independence.
3.What kinds of direction of rehabilitation do you know?
- Medical
- Physical
- Psychologic
- Professional
- Socio-economic
4. Purpose of the hospital phase:
restoration of physical and mental condition of the patient to a level at which it
could be transferred to a sanatorium for the implementation of phase II
73
rehabilitation or be prepared enough to continue treatment at home
5. Rehabilitation of patients with coronary heart disease, myocardial
infarction
There are 3 phases:
I - inpatient (hospital stage)
II - recovery (sanatorium stage)
III - maintenance (outpatient stage)
Maximum score
25-24
excellent
100% -86%
Criteria for evaluating the theoretical part
23-21 score
20-19 score
18-16 score
15-13 score
good
85% -73%
Poor
43% and less
Satisfactory
70-56%
Satisfactory
53% -46%
Appendix-2
Analytical part
4.1.Cluster, organizer
Graphic Organizer: compilation of clusters on a given topic.
Graphic organizer tool-visual presentation of the thought processes.
Cluster - (beam bunch) method mapping information - gathering ideas around a
main factor for determining the meaning and focus of the whole structure.
Rules for compiling cluster .
1.Write down everything that comes into your mind. Do not judge the quality of
ideas: just write them down.
2.Do not pay attention to spelling and other factors constraining the letter.
3.Do not stopped writing until the time runs out. If the idea of suddenly stop
coming to your mind, then paint with on paper, until you have new ideas.
4.Try to build as many links. Do not limit the number of ideas, their flow and
communication between them.
Teacher describes.
1
Introduces students to the rules for preparation of the cluster.
2.
In the center of the chalkboard or a large sheet of paper written keyword or
topic name of 1-2-words.
Student performs.
1.Write down everything that comes into your mind. Do not judge the quality of
ideas: just write them down.
2.Do not pay attention to spelling and other factors constraining the letter.
74
3.Do not stopped writing until the time runs out. If the idea of suddenly stop
coming to your mind, then paint with on paper, until you have new ideas.
4.Try to build as many links. Do not limit the number of ideas, their flow and
communication between them.
Questions to produce cluster:
1.Compose rehabilitologic event with PRS.
2. Create a rehabilitologic event with diseases of the respiratory system.
"Cluster" scheme organizer.
Rehabilitologic
events in patients
with asthma
Medication
Climatic
treatment, climate
forests, seas
Medical
rehabilitation
(Healing stage)
Physiopathogene
tic factors
Physical
rehabilitation
in outpatient
но-поликлиconditions
ловиях
Physiological
factors, traffic
police,
heliotherapy
contrast.
Sredstvai
form
treatment
gymnastic
s.
Does not lead
to secondary
complications
, return to
work
activities ..
Physiological
factors
(inhalation,
massage,
phew)
DMB on the
adrenal gland,
ultrasound
examination
Physical
rehabilitation in
sanatoria
Physical
exercises,
Means
treatment
breathing
exercises,
heliotherapy,
75
aerotherapy, D
Each group evaluates the other groups. Maximum score -15-22
Grou Clear and exact Visual
Complianc Group
Total score of 15
p
answer (5)
(graphic)
e with
Activity
Num
(5)
regulations 2.5.
ber
(2.5)
1.
2.
Maximum score
15-14
13-12 score
11-10 score
9-8 score
7-6 score
100% -86%
85% -73%
70-56%
53% -46%
43% or less
Criteria for evaluation of the analytical part: (Organizer)
Analytical part
Appendix-3
4.2. Situational tasks:
76
Task No. 1. A patient-types, 44 years. Diagnosis: Acute myocardial infarction left
ventricular posterior wall, subacute stage, day 15.
Is it possible to assign this patient physical therapy and physical therapy?
Objectives pursued in this case, physical therapy and exercise therapy.
Contraindications to physical therapy and exercise therapy for this pathology.
Which factors FT can be used in this condition at this stage.
Make an exemplary complex LH given patient. At what height should be performed
HR exercise. Duration of classes, the number of repetitions.
Standard response : During this period, physical therapy prescribed limited,
treatment gymnastics appointed with 3-5 days of the disease. Tasks of TrE:
improving the correlation function of the CNS, activation of noncardiac factors,
cardiorespiratory adaptation to increasing stress, improvement of mental and
emotional status of the patient. Contraindications to CFT and gymnastics are
complicated course of the disease, angina at rest, cardiac aneurysm and vascular
disease for unstable. Of CFT at this stage shows electric, GAI with bromine,
oxygen. The complex LH should include breathing exercises, dynamic and static
exercises for medium and small muscle groups, walking at a slow pace, walking
along the corridor, the development of a single span. Heart rate at 50% of the
maximum tolerated. Estimated lesson time 20 minutes. The number of repetitions
6-8 times.
Task No. 2. Patient X-new, 60 years. Diagnosis: Hypertensive heart disease stage
II. Stage II degree. CHD, exertional angina FC II.
Is it possible to assign this patient physical therapy and physical therapy?
Objectives pursued in this case, physical therapy and exercise therapy.
What state under these pathologies are contraindications to physical therapy and
physical therapy?
FT What factors can be used for this diagnosis?
Make an exemplary complex LH given patient. At what height should be performed
HR exercise. Valid digits AD when the physical load Duration of classes, the
number of repetitions.
Standard answer: This patient must assign FT and gymnastics. Task lowering
blood pressure, normalization of state of the CNS, improving the function of the
central and peripheral hemodynamics, increased exercise tolerance, normalization
of lipid and carbohydrate metabolism, activation of anticoagulatory system.
Contraindications: unstable blood pressure, hypertension III degree, posthypertensive crisis, unstable angina, signs of stress and ischemic ECG. In the
complex FT include: electric, iontophoresis with sedative or hypotensive drugs,
magnetic AMF on collar area or region of the heart, darsonvalization, head
massage and neck area, total franklinization. The complex LH include respiratory,
general developmental exercises are special relaxation exercises on development of
balance, coordination, walking, swimming. Valid digits BP 170/100 mm Hg, heart
rate at the height of the load 75% of the maximum tolerated. Estimated lesson time
20-30 min, the number of repetitions 8-10.
77
Task No. 3. Sick T-fishing for 25 years. Diagnosis: Cardiopsychoneurosis mixed
type. Pulse 88 beats per minute, blood pressure 130/85 mm Hg mm Hg
Is it possible to assign this patient physical therapy and physical therapy?
Goals and objectives of physiotherapy and exercise therapy at this diagnosis.
Assign complex FT-treatment of this patient.
Make an exemplary complex LH.
Contraindications to physical therapy and exercise therapy of attached pathology.
Standard answer: This patient must assign FT and gymnastics. Task lowering
blood pressure, normalization of state of the CNS, improving the function of the
central and peripheral hemodynamics, increased exercise tolerance, normalization
of mental and emotional status, activation anticoagulatory system. In the complex
FT include: electric, iontophoresis with sedative or hypotensive drugs, magnetic
AMF on collar area or region of the heart, Darsonvalization, head massage and
neck area, total Franklinization, circular and douches, bubble baths or conifers. BH
complex: respiratory, general developmental exercises are special relaxation
exercises on development of balance, coordination, walking, swimming, exercise
at the gym. Contraindications: common to physical therapy, the development of
tachycardia, severe general weakness, shortness of breath.
Task No. 4. Patient A s 25 years. Diagnosis: Right-sided pneumonia. 5 days of
illness.
1 Is it possible to assign this patient physical therapy and physical therapy?
2. Goals and objectives of physiotherapy and exercise therapy at this diagnosis.
3. Assign complex FT-treatment this patient.
Four Make an exemplary complex LH.
5 (number) Contraindications to physical therapy and exercise therapy of attached
pathology.
Standard answer: This patient must assign FT and gymnastics. Task normalize
the mechanics of breathing (breathing slowing and deepening), accelerate the
resorption of the pathological focus in the lung, improve drainage function of
bronchi, the state CCC, nervous, digestive and other systems, prevention of
atelectasis, thrombus formation, etc. In the complex FT include: UHF or
inductothermia on lung area, magnetic AMF on the chest area sollux, chest
massage. BH complex: breathing exercises, physical exercises for small and
medium muscle groups of the upper and lower extremities, draining position.
Contraindications: severe intoxication, fever, respiratory failure, tachycardia (heart
rate over 100 in 1 min.)
Appendix-3
4.3 Tests
1 Physiotherapy may be nominated in:
a) of hypertension stage II, atherosclerosis, coronary artery disease, atrial
fibrillation, tachysystolic form H II degree;
b) Stage II of hypertension, hypertensive crisis; of hypertension stage II, atrial
arrhythmia (rare);
78
c) of hypertension stage II atherosclerotic cardiosclerosis, atrioventicular blockade
III degree;
g) of hypertension stage II, stage III circulatory failure.
2. Physiotherapy is contraindicated in:
a) Stage I of hypertension, atherosclerotic cardiosclerosis, atrial fibrillation
resistant forms of circulatory failure in stage I;
b) Stage II of hypertension, myocardial infarction (heart attack two years ago),
circulatory failure in stage I;
c) of hypertension stage I, paroxysmal ventricular tachycardia;
d) of hypertension stage II atherosclerotic cardiosclerosis, right bundle branch
block.
3.
With hypertension stage I complained of irritability, poor sleep patients
show physical treatment:
a) local darsonvalization on left front chest;
b) total franklinization;
c) amplipulse on neck area;
d) hydrogen sulfide baths;
e) power shower.
4. The sharp decline in blood pressure and even the development of
orthostatic collapse (with a single procedure) is possible if:
a) laser therapy on the projection of the aortic arch;
b) on the carotid sinus diadynamic zone;
c) decimeter wave therapy collar region;
d) electrophoresis vasodilators transorbital;
e) total franklinization.
5.
Physiotherapy CHD patients is not indicated for.
A) stable angina functional class III;
b) FC IV angina;
c) unstable angina;
d) stable angina FC III, circulatory failure PA stage (H PA);
e) stable angina FC III, atrial fibrillation normosistolic form, I stage.
6.
Laser therapy can be administered to patients with stable coronary
heart disease angina:
a) Only FC I-II;
b) FC I-III;
c) I-IV FC;
d) III FC with frequent attacks of angina at rest.
79
7.
Low-frequency magnetic therapy indicated in patients with stable
coronary heart disease angina:
a) Only FC I-II;
b) I-III of FC;
c) I-IV FC;
d) II with FC II degree atrioventricular block;
e) III FC, circulatory insufficiency stage III.
8.
In CHD with stable angina FC III, H PA stage may be carried out:
a) common hydrogen sulfide baths;
b) general radon baths;
c) general carbonic baths;
d) of dry carbon dioxide baths.
9.
In the acute phase of focal pneumonia during bacterial aggression (onethird days of illness) when you cough with phlegm, increase in body
temperature to 38 ° C is optimal physical treatment:
a) intraorganic electrophoresis of AB drugs
b) electrophoresis antibiotics transverse procedure;
c) Electrophoresis of antibiotics in the longitudinal methodology;
d) antibiotic heat and humid inhalation.
10. Select the most efficient combination of physical methods of treatment
of a patient with acute pneumonia, pneumosclerosis NAM I step on the stage
of morphological recovery (10-20th days of illness) in the presence of an
inflammatory infiltrate in the lungs, with a rare bit of cough and sputum
a) low intensity UHF therapy (nonthermal doses) on the area of infiltration and
alkaline inhalations;
b) high-frequency magnetic therapy to the area of infiltration and inhalation
mucolytics;
c) the electric field in the UHF subthermal doses and mud baths;
d) low-frequency magnetic therapy and alkaline inhalations;
e) the electric field in the UHF thermal and inhalation doses of mucolytics.
11. Inhalation therapy for patients with chronic diseases of the bronchi
used aerosols:
a) atomized;
b) the coarse;
c) low-dispersion;
d) high and Coarse.
12. Ultrasound therapy is contraindicated in:
a) step of pneumonia morphological recovery (10-20th day of the disease);
b) pneumosclerosis;
80
c) bronchiectasis;
d) exacerbation of chronic bronchitis in the subacute stage respiratory failure stage
II;
e) exacerbation of asthma moderate flow, I NAM stage.
13.
Choose the best method of treatment for patients with chronic
bronchitis resort with pneumosclerosis in remission:
a) inhalation of sea water;
b) galotherapy;
c) the inhaled mucolytics;
d) mud pack on the chest;
e) an electric field in the UHF thermal dose.
Fourteen During exacerbation of atopic asthma pathogenic origin should be
considered the following method of physiotherapy:
a) endonasal electrophoresis with Intalum;
b) Aeroionotherapy;
c) UHF-therapy at the root of the lung;
d) galvanization chest horizontally;
e) amplipulse paravertebrally.
15. In bronchial asthma, with one current and Dishormonal hypoadrenia
pathogenetic treatment is:
a) ultrasound therapy in the thoracic paravertebral;
b) high-frequency magnetic therapy on the adrenal glands;
c) galotherapy;
d) high-frequency magnetic therapy on the thymus;
d) electrophoresis Intalum (endonasal).
Appendix-3
4.4 Cookbook by physical factors
1. Darsonval
darsonvalization in the neck PP 4-6 T3-5 min N10-15. daily
2. Electrophoresis
Electrophoresis on Shcherbak neck area. NaBr solution. Current 10-15 mA.
Exposure 20-25 min. Course of 10 treatments.
3. UHF
UHF region of the maxillary sinus, the emitter is at an angle, gap 3-4cm,
oligothermic dose (40W). Exposure 5-7 min. Course of 6-8 treatments.
4. Aerosoletherapy
Heat and humid inhalation with Tashkent mineral water. Water temperature 38-42
about
C. On one inhalation of 50 - 100 ml. mineral water .. Duration 5 - 10 min.
daily course of 12 treatments.
81
Infrared
Infrared irradiation lamp sollux on chest area. Distance from the unit 50-100 cm
intensity - to the feeling of pleasant warmth. 20-30 min duration. . daily course of
10-15 procedures. Visible radiation
6.Laser therapy
Laser therapy of chronic tonsillitis. PM 0.5-3.0 mW duration of 1-10 minutes. .
daily rate of 6-10 treatments.
Maximum
score 2515
15-14excellent
100% -86%
criteria for evaluating the test, situational problems.
13-12 score
11-10 score 9-8 score
7-6 score
14-12-well
85% -73%
11-7satisfactory
70-56%
6-4unsatisfactory
53% -46%
3 or less - bad
43% or less
Appendix-4.
The practical part
5.1 Implementation of practical skills. (Step by step)
Perform practical skills - to make complex rehabilitation measures using physical
therapy and exercise therapy on an outpatient receiving individual patient, based
on the examination, medical history, medical history data and laboratory and
instrumental data;
-Write the recipe on the assigned physical factors;
-Conduct designated procedures;
-Make an exercise of physiotherapy for patients with diseases of the cardiovascular
system and respiratory system, depending on the stage of the disease.
Drafting complex rehabilitation measures step by step
Indications: diseases of the cardiovascular system
Purpose: rehabilitation
Necessary equipment and methods: stethoscope, sphygmomanometer, stopwatch
necessary clinical and laboratory equipment, physical therapy aids, exercise
equipment, laboratory findings (ECG EhoKS, complete blood count, coagulation,
blood chemistry), sample Martin
Steps for:
No. Stages of
Failed
to
execute
step
Follow
all
steps
(20point)
82
1.
2.
3.
4.
5.
6.
Evaluation of the clinical condition of the patient
(complaints, anamnesis morbi, anamnesis vitae, status
presens, data clinical and laboratory studies
Appointment rational physiotherapy:
to determine whether a given patient contraindications to
physiotherapy
in the absence of contraindications for physiotherapy
selection of major groups of physical factors on
syndromic pathogenetic principle
selection of specific physiotherapy treatments to the
patient in accordance with the rules of the compatibility
of physical factors
Sequencing of physiotherapy appointment at their
complex
registration sheet assignments (writing prescriptions for
physiotherapy)
Totals
0
3
0
3
0
3
0
3
0
3
0
5
20
Assessment of the adequacy of physical activity for patients with various
diseases during the procedure of physiotherapy
Purpose: learn to assess the adequacy of physical activity for patients with
various diseases of the SSA during physiotherapy sessions (LH)
Indications: Assessment of the adequacy of physical activity for patients with
diseases of hypertension
Necessary equipment and methods: stethoscope, sphygmomanometer, stopwatch
No. Stages of
1.
Interrogation of the patient in order to identify possible
complaints before the LH
2.
Measurement of blood pressure, heart rate calculation,
BH patient to load
Failed to Follow
execute all
step
steps
(20point)
0
2.
0
2.
83
3.
4.
5.
6.
7.
8.
9.
Counting heart rate for 10 seconds in the patient by the
end of the introductory part of LH, identifying
complaints and external signs of fatigue
Counting heart rate for 10 seconds in a patient
complaints and identify external signs of fatigue during
the main part of LH
Counting heart rate for 10 seconds in a patient
complaints and identify external signs of fatigue in the
final part of LH
Measurement of blood pressure, heart rate calculation,
BH, identifying complaints and external signs of fatigue
in a patient after 5 min after LH
Storing the data in the medical and control card
Draw the physiological load curve
Making a conclusion
Totals
0
2.
0
2.
0
3
0
3
0
0
0
0
2.
2.
2.
20
Criteria for evaluation of practical skill
100% -86%
85% -71%
70% -55%
54% -37%
36% less
40-34.4excellent
34-28.4-well
28-22satisfactory
21.6-14.8
unsatisfactory
14.4 and less
bad
6. Forms of control knowledge
- Oral;
- Written;
- Decision of situational problems;
- Demonstration of practical skills mastered.
Appendix- 5.
1
In assessing students' knowledge of Rehabilitation accounted following
approximate criteria
84
Criteria for the assessment of knowledge, skills and abilities of students
Criteria of the current control
Unsatisfacto
rily
Poor
100% -86% 85% -71%
70-55%
54% -37%
36% o
less
Theoretical part
20-19
points
18-17 points
16-15 points
14-13 points
12
points
2.
Analytical part
organiser
15-14
points
13-12 points
11-10 points
9-8 points
7-6
points
3
Test
15-14
points
13-12 points
11-10 points
9-8 points
7-6
points
4
The practical part
40-35 score 35-30 score
30-25 score
25-15
points
1714
score
Evaluation
Excellent
№
Adoption in %
1
Nu Performa
m nce in%
be
r
Evaluatio
n
Satisfactory
Level of knowledge and skills
85
1.
96-100%
2. 91-95%
3.
86-90%
Excellent Student independent. Has a general concept on the
"5"
subject of rehabilitology. Applies in practice, with the
matter, said confidently, has fine views. Full correct
answer to the questions on the classification of
electrotherapy, mechanisms of action of continuous
and pulsed currents (galvanization, iontophoresis,
diadynamic, electric, electric pulp test, amplipulse),
application techniques, indications and contraindications. Summarizes and makes decisions, think
creatively, independently analyzes. Situational
problems are solved correctly, with a creative
approach, with full justification response.
Actively and creatively involved in interactive games,
right to make informed decisions and summarizes and
analyzes.
Recipes writes is true, with the best indication of dose
exposure to physical factors. The synopsis on the
subject there.
Excellent Full correct answer to the questions on the
"5"
classification of electrotherapy, mechanisms of action
of continuous and pulsed currents (galvanization,
iontophoresis, diadynamic, electric, electric pulp test,
amplipulse), application techniques, indications and
contra-indications. Summarizes and makes decisions,
think creatively, independently analyzes. Situational
problems are solved correctly, with a creative
approach, with full justification response.
Actively and creatively involved in interactive games,
right to make informed decisions and summarizes and
analyzes.
Recipes writes is true, with the best indication of dose
exposure to physical factors.
Excellent The questions posed by the classification action
"5"
mechanisms examined (light therapy, aerosol therapy,
barotherapy), physical factors (FF), methods of
application, indications and contra-indications to
appoint highlights enough, but there are 1-2 in reply.
Applies in practice, with the matter, said confidently,
has fine views. Situational problems are solved
correctly, but the justification answer sufficiently.
Actively involved in interactive games, correct
decisions.
Recipes writes is true, with the best indication of dose
exposure to physical factors, but there are 2-3
86
Fo
ur
81-85%
Average
"4"
5.
76-80%
Average
"4"
6.
71-75%
Average
"4"
grammatical errors.
Questions posed by products electrotherapy,
mechanisms of action of continuous and pulsed
currents (galvanization, iontophoresis, diadynamic,
electric, electric pulp test, amplipulse), application
techniques, indications and contraindications to fully
covered, but there are 2-3 inaccuracies, errors.
Applies in practice, with the matter, said confidently,
has fine views. Situational problems are solved
correctly, but the justification answer sufficiently.
Inaccuracies in solving situational problems. Actively
involved in interactive games, correct decisions.
Recipes writes is true, with the best indication of dose
exposure to physical factors, but there are 2-3
grammatical errors, inaccuracies in dose.
Correct but incomplete coverage of the issue. The
student knows the classification of electrotherapy,
mechanisms of action of continuous and pulsed
currents (galvanization, iontophoresis, diadynamic,
electric, electric pulp test, amplipulse), methods of
application, indications and contra-indications, but
not fully versed in the mechanisms of action of
physical factors. With the matter, said confidently,
has fine views. Actively involved in interactive
games. Situational problem gives partial solutions.
Recipes written specifying the dose exposure to
physical factors, but there are 3-4 grammatical errors,
inaccuracies in dose.
Correct but incomplete coverage of the issue. The
student knows the classification of electrotherapy,
mechanisms of action of continuous and pulsed
currents (galvanization, iontophoresis, diadynamic,
electric, electric pulp test, amplipulse), methods of
application, indications and contra-indications, but
not fully versed in the mechanisms of action of
physical factors, incomplete lists contraindications to
CFT in this pathology. With the matter, said
confidently, has fine views. Actively involved in
interactive games. Situational problem gives partial
solutions.
Recipes written specifying the dose exposure to
physical factors, but there are 3-4 grammatical errors,
inaccuracies in dose.
87
7.
78
89
10
.
66-70%
Satisfacto The correct answer to half the questions posed. The
ry
student knows the classification of continuous and
"3"
pulsed currents (galvanization, iontophoresis,
diadynamic, electric, electric pulp test, amplipulse)
but poorly versed in the mechanisms of action of
physical factors, incomplete lists contraindications to
CFT in this pathology. With the matter, said
uncertainly, has accurate representations only on
specific issues theme. Situational problems are solved
correctly, but there is no justification response.
Student passive when discussing CDS.
Recipes are written with an inaccurate indication of
dose exposure to physical factors, there are
grammatical errors.
65-61% Satisfacto The correct answer to half the questions posed. The
ry
student knows the classification of continuous and
"3"
pulsed currents (galvanization, iontophoresis,
diadynamic, electric, electric pulp test, amplipulse)
but poorly versed in the mechanisms of action of
physical factors, incomplete lists contraindications to
CFT in this pathology. With the matter, said
uncertainly, has accurate representations only on
specific issues theme. Situational problems are solved
correctly, but there is no justification response.
Student passive when discussing CDS.
Recipes are written with an inaccurate indication of
dose exposure to physical factors, there are
grammatical errors.
55-60% Satisfacto The correct answer to half the questions posed. The
ry
student knows the classification of continuous and
"3"
pulsed currents (galvanization, iontophoresis,
diadynamic, electric, electric pulp test, amplipulse)
but poorly versed in the mechanisms of action of
physical factors can not enumerate contraindications
to CFT in this pathology. Poor seized with the matter,
said uncertainly, has exact representation only on
specific issues theme. Student is very passive when
discussing CDS.
Recipes are written with an inaccurate indication of
dose exposure to physical factors, there are
grammatical errors.
40-54% Unsatisfa Lighting 1/10 of the questions at the wrong approach.
ctorily Student does not know the physical factors
"2"
(galvanization, iontophoresis, diadynamic, electric,
88
11 30-40 %
.
electric pulp test, amplipulse). Practically does not
understand the mechanisms of action of physical
factors, does not understand the indications and
contraindications to the appointment of FT in this
pathology.
All recipes are written with blunders.
Unsatisfa Questions not answers. Does not know the physical
ctorily factors (galvanization, iontophoresis, diadynamic,
"2"
electric, electric pulp test, amplipulse) and their
mechanisms of action. Is not able to prescribe
physical factors on the topic.
For the presence of students in the classroom, in
proper form, with a notebook has.
7. Chronological map classes
Stages classes
Form
INSPECTION
Attendance checks
and notebooks
Explanation theme.
Introductory word
teacher (justification
themes).
Theoretical part
Analytical part
Time - 270
mins
30min
Break
30min
10
minutes
Verbal response.
30min
Discussion of
"cluster", to solve the
tests.
60 min
Provide students with
visual aids (tables,
posters, logical and
didactic structure, slides,
videos, diagrams) and
giving explanations to
them.
The practical part
The acquisition of
practical skills
30 min
45 min
60 min
89
Conclusion teacher
Evaluates on points.
Gives the task for
homework
30 min
8. Control questions:
Appendix-6
1 Name, for what purpose are assigned physical factors in diseases of the
cardiovascular system.
2. What are the physical factors that have a sedative effect.
3. What are the physical factors that have a hypotensive effect.
Four What are the physical factors that have antiplatelet effect.
5. What is the benchmark for dosing of physical activity among patients with
CVD?
6. What physical factors contribute to improve the oxygenation of the blood?
7. Which functional tests carried out in patients with CVD with a view to
dispensing of physical activity?
8 What is the main form of exercise therapy given to patients with cardiac disease
in the hospital.
9. What are the physical factors that prescribed for asthma with the aim of
pathogenetic therapy indicate the area of impact.
10. What are the physical factors that improve the drainage function of bronchi.
11. What are special exercises for bronchitis.
12. Name the special breathing exercises.
13. Specify the starting position of PH in patients with abscess of the lower lobe of
the right lung.
14 Name the physical factor that is assigned when the purpose of ARI and
virusocidal bactericidal action.
Appendix-7
9. List of recommended literature.
9.1. Main
1
Bogolyubov V.M. "Balneology and Physiotherapy" 1 and Volume 2 M.
Medicine 1985
2.
Yuldashev K., Y. Kulikov "Physiotherapy". Tashkent. 1984
3.
Strelkova N.I. "Physical treatments in neurology", M., 1983.
Four Popov S.N. "Physical rehabilitation" Rostov-on-Don, 1999
5.
Okorokov A.N. "Treatment of diseases of the internal organs. Manual ",
Volume 2, Moscow, 2004.
6.
Epifanov V.A. "Medical rehabilitation." Moscow, 2005.
90
7.
Ed. Epifanov V.A. - Therapeutic physical culture. Moscow, "GEOTAR
Medicine" 2006
9.2. Auxillary
1
Bogolyubov V.M. "Handbook of sanatorium selection", M, 1992.
2.
Iasnogorodski VG "Handbook of Physical Therapy", M, 1981.
3.
Ponomarenko TN "Guide to practical training in general physiotherapy", M,
2000.
Four Yuldashev KY "Non-drug treatments" a practical guide for physicians.
5.
S.N.Babaadzhanov Directory physiotherapist. Tashkent, 1999 g.Suluyanova
6.
V.Oransky, D.S.Ilhamdzhanova Quick Reference physiotherapy. T 1992
7.
The text of lectures and tutorials.
9.3.Foreign literatures:
6. Marlis Gonzalez-Fernandez, MD, PhD, Jarrod David Friedman, MD
Physical Medicine and Rehabilitation Pocket Companion
7. Mark Harrast, MD, Jonathan Finnoff, DO Sports Medicine Study Guide and
Review for Boards
8. Wainapel, Stanley F.; Fast, Avital (Editors) Alternative Medicine and
Rehabilitation A Guide for Practitioners 2003 - Demos Medical Publishing
9. Consuelo T Lorenzo et al. Physical Medicine and Rehabilitation Medscape
Reference 2011 - WebMD
10.Sara J. Cuccurullo (Editor) Physical Medicine and Rehabilitation Board
Review 2004 - Demos Medical Publishing, 848 pp.
9.4.Internet resources:
http://www.doktor.ru
http://www. medinfo.org
http://www.restart-med.ru
http://www.sportpsy.cz
http://www.alhealth.com
http://www.docguide.com
http://www.healthweb.com
http://www.acsm.org
http://www.apta.org
http://www.sportsmed.org.
http://www.jphysiol.org
http://www.physsportmed.com
http://www.sportsmedicine.com
91
92
MINISTRY OF HEALTH OF THE REPUBLIC OF UZBEKISTAN
CENTRE FOR MEDICAL EDUCATION
Tashkent Medical Academy
"APPROVED"
Pro-rector for Academic Affairs
Prof. Teshaev O.R.
____________________
"________" ___________ 2014
Department: Department of Folk Medicine, Rehabilitation and Physical
Education
Subject: Rehabilitology
Theme of the practical lesson
"Application of physical factors and physical therapy in the rehabilitation of
patients with diseases of the gastrointestinal tract
(Gastritis, gastric and intestinal,
colitis, enteritis, cholecystitis), urinary tract and kidneys"
Practical lesson
Educationaltechnology
93
Tashkent - 2014
EDUCATIONAL TECHNOLOGY OF THE PRACTICAL LESSON
Theme №2:"Application of physical factors and exercise therapy in
rehabilitation of patients with diseases of the gastrointestinal tract
(Gastritis, gastric and intestinal,
colitis, enteritis, cholecystitis), urinary tract and kidneys."
Study time: 270 min
Number of students 8-10
Type of lesson
Exercise topics.
Structure of the training sessions
Lesson plan
1. Introduction
2. Theoretical part
3. Analytical part
- chart
- tests
- situational tasks and recipes.
4. Practical skills.
Purpose of the lesson:
The graduate should know:
The graduate should be able to:
teach the skill to choose the right treatment
strategy and guidelines physical therapy and
exercise therapy with application of physical
factors and physical therapy in the
rehabilitation of patients with diseases of the
gastrointestinal tract, urinary tract and
kidneys.
-Indications and contraindications to physical
therapy and exercise therapy in patients with
diseases of the gastrointestinal tract, urinary
tract and kidneys;
-The main directions of physiotherapy
treatment for diseases of the gastrointestinal
tract, urinary tract and kidneys;
-Mechanisms of action of physical factors
and means of exercise therapy on patients
with diseases of the gastrointestinal tract,
urinary tract and kidneys.
Perform practical skills - to make complex
rehabilitation measures using physical
therapy and exercise therapy on an outpatient
receiving individual patient, based on the
examination, medical history, medical history
data and laboratory and instrumental data;
94
-Write the recipe on the assigned physical
factors;
-Conduct designated procedures;
-Make an exercise of physiotherapy for
patients with diseases of the gastrointestinal
tract, urinary tract and kidneys.
Pedagogical objectives:
-Acquaint with the indications and contraindications
for physiotherapy treatment and exercise therapy in
patients with diseases of the gastrointestinal tract,
urinary tract and kidneys.
- To reveal the concept of etiopatogenetic and
symptomatic treatment using physical factors of the
gastrointestinal tract, urinary tract and kidneys
according to the stage of disease;
-Teach drafting complex rehabilitation depending on
the stage of the disease;
-Teach yourself to let designated physiotherapy;
-Teach yourself to pick up a set of exercises and
therapeutic exercises to demonstrate their patients.
Training Methods
Forms of educational activity
Learning Tools
Methods and feedback means
Learning outcomes
-List the indications and contraindications for
the purpose of physiotherapy and exercise
therapy in patients with diseases of the
gastrointestinal tract, urinary tract and
kidneys.
-Called main purpose of use of
physiotherapy and exercise therapy factors in
patients with diseases of the gastrointestinal
tract, urinary tract and kidneys.
-Up complex of rehabilitation measures,
depending on the stage of the disease;
Self-appointed spend physiotherapy;
Self-selected set of exercises of
physiotherapy and demonstrate their patients.
Conversation, discussion, brainstorming,
demonstration, training game.
Front, collective work groups, "Learning
Together".
Distributing educational materials, visual
aids, videos, board-stand, photo, text.
Quiz, test, presentation of results of a
learning task or solving case studies,
demonstrating the independent exercise of
practical skills.
Typical flow chart of lesson
Stages of work and time
Action
95
270 minutes
Teacher
1st stage
Theoretical part
20 minutes
1.1. Checks attendance and notebooks
20 minutes
1.2. Names the classes theme, its goals,
objectives and expected learning
outcomes. Introduces the mode of
operation in the lesson and evaluation
criteria (see guidance for students).
25 minutes
Learners
Listen, write,
update, ask questions.
1.3. . Gives the task for
independent work, references to
independent work. Reported indicators
and criteria for evaluation. (Appendix 6)
1.4. Conducts a quiz to identify
students' knowledge on the topic:
25 minutes
1.5. Break
10 minutes
Stage 2
60 minutes
Analytical part
2.1. Leading the discussion
topics of practical classes.
Distributes materials of the case
and introduces the algorithm analyzing
the situation. Divides the students into
groups.
30 minutes
2.2. Assesses students'
background knowledge using new
educational technologies (small groups,
case studies). (Appendix 3)
Teaches proper selection of
methods of rehabilitation patients.
Solve the test
tasks, answer questions,
present during
physiotherapy patients
and TrE in the
classroom, work
independently on the FT
devices and physical
therapy room, work in
groups, present the
results of the group
work.
45 minutes
2.3 Break
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3rd stage
60 minutes
20 minutes
10 minutes
The practical part.
3.1. Makes own opinion on the
subject, focusing students on the main,
according to the importance of the work
done for future professional careers.
Conduct selfesteem, interassessment.
Ask questions.
Recorded assignment.
Commends the work of groups
and individual students, summarizes
interassessment. Analyzes and evaluates
the degree of achievement of lesson.
(Appendix 5)
3.3. Distributes tasks for
independent work, references to
independent work. Reported indicators
and criteria for evaluation. (Appendix 6)
Gives the task to prepare for the
next lesson.
1. Motivation
Diseases of the digestive, urinary tract and kidneys are very common. They are
characterized by a chronic relapsing course, a tendency to progression and occurrence of
complications, often cause temporary or permanent disability (disability). Recognizes the
importance of all spa and physiotherapy factors in the treatment and prevention of diseases of the
digestive tract, AIM, and kidneys. Application of physical factors contribute to the normalization
of the neuroendocrine regulation, improve the trophic affected tissues, increase the body's
sensitivity to drugs (medication that reduces patient load), a positive effect on the psychological
status of the patient. Ability to navigate among individuals and resort factors and prepare a
comprehensive treatment using them is necessary for each GP.
2. Interdisciplinary and intradisciplinary communication
Teaching the topic is based on the knowledge students the basics of biochemistry, biophysics,
anatomy, normal and pathological physiology of the digestive and urinary systems, etiology and
pathogenesis of diseases of the gastrointestinal tract, and kidneys IMP total physiotherapy and
exercise therapy foundations. Acquired during the course of knowledge will be used in
traversing disciplines therapy, gastroenterology, nephrology, urology, and GPs in their practice.
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3. Contents of the lesson
3.1. Theoretical part
Diseases of the digestive
Diseases of the digestive system are very common. Onset of the disease in the majority of
cases occur in preschool age, with a greater role played by risk factors predominate functional
disorders increases with age frequency of inflammatory diseases. The system of staged treatment
of children becomes important application of physical factors that have a positive impact on the
secretory-motor function, repair processes in the affected organs, the activity of the autonomic
and central nervous system.
REHABILITATION OF PATIENTS WITH DISEASES OF THE URINARY ORGANS
Pyelonephritis - nonspecific inflammatory process of the kidneys, her pelvis and calyces, flowing mainly affecting the
interstitial tissue of the kidney.
The main etiologic factor in the development of pyelonephritis is an infection. However, for an inflammatory process requires
additional conditions that contribute to its development. The most common causative agents of disease are Escherichia coli,
Proteus vulgaris, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus, fecal coli and Streptococcus the adjustable
bases. Proteus and Pseudomonas aeruginosa occur more frequently as the other flora suppressed antibacterial drugs. Flora and its
sensitivity to antibiotics in the treatment of change, which makes it necessary to repeat urine culture and antibiogram.
Action etiological factor depends on a massive importation of microbial virulence and infection status of the organism.
Additional terms and conditions that contribute to the development of pyelonephritis, are a violation of the passage of urine,
venous stasis in the urinary organs, as well as co-morbidities.
Pathways of infection in the kidney are important in the pathogenesis of pyelonephritis. It is now believed that an infectious
agent may enter the kidney: 1) hematogenous route from a distant hidden hearth (tonsillitis, sinusitis, stomatitis, boil, infected
wound, etc.); 2) urogenital way - from the bladder to the kidney (due to vesicoureteral reflux and renal pelvis); 3) rising by - on
the wall of the ureter in subadventitial layer by interstitial tissue; 4) lymphogenous way.
Lymphatics kidneys perform afferent (abductor) function, they are manifold, in which output from a kidney infection. Stasis
of urine, trauma and other causes that violate lymph from the urinary tract, primarily from the kidney, cause infection delay than
favorable conditions for its development in the interstitial tissue of the kidney. Renal tissue ischemia plays an important role in
the development of pyelonephritis.
Pathogenesis of pyelonephritis appears chain stages: 1) penetration of infection into the kidney interstitium, which is preceded
by venous stasis and swelling of the interstitial tissue; 2) renal ischemia due to which the fore hypoxia promotes the death of
tubular epithelium; 3) the formation of inflammatory lesions in the kidney.
In the development of pyelonephritis plays the role of venous stasis. If you violate the passage of urine becomes essential
venous stasis resulting from compression of the renal pelvis stretched veins in the renal hilum. This stasis causes swelling of the
interstitial tissue and accompanied by an increase in capillary permeability. The latter in turn facilitates the penetration of
microbes from the bloodstream into the interstitial tissue and the development of inflammation in her plots. Causes of venous
stasis may be different - occlusion urinary tract disorders and urodynamics urinogenic extraurine character.
Development of the inflammatory process and its course is largely dependent on the general state of the organism, its ability
to resist infection. Favorable basis for rapid and malignant course of pyelonephritis create beriberi, depletion, areactive condition.
The clinical picture of pyelonephritis is very diverse. It may be absent or mild specific symptoms of urinary tract.
Acute pyelonephritis. If acute pyelonephritis is not preceded by a disease of the urinary system, it can be primary. In
such cases, the infection gets into the kidney through hematogenous of purulent focus in the body. Secondary acute
pyelonephritis develops due to diseases of the urinary system: with nephrolithiasis as a consequence of urinary tract obstruction
after renal colic; the presence of urinary reflexes; in violation of the outflow of urine associated with a disease of the bladder,
prostate and urethra.
There are two clinical forms of acute pyelonephritis: serous pyelonephritis and interstitial purulent pyelonephritis. The latter
includes apostematous (blotchy) nephritis, kidney abscess and bacteremia. In a separate clinical entity isolated necrosis of the
renal papillae - a serious complication of acute pyelonephritis caused by circulatory disorder (ischemia and hypoxia) Malpighian
pyramids and the renal papilla.
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Picture of acute pyelonephritis different prevalence of primary and general scarcity of local symptoms of infection.
Interstitial serous pyelonephritis characterized acute onset. In the early days of the disease point temperature to 38-39 ° C. Signs
of intoxication expressed mild. Headache, joint pain, malaise, anorexia, occasional constipation, nausea (in children - vomiting,
diarrhea) - the most frequent symptoms. Local signs fuzzy.
Chronic pyelonephritis may develop as a result of the transition process in acute chronic disease. Possible
hematogenous and urinogenic pathways of infection. In chronic pyelonephritis in the early stages of the disease is the
predominant damage of the duct system, and only in the terminal period of the process involves the glomerular apparatus of the
kidney. This is due to early decline of renal concentrating ability and later disorder glomerular filtration.
For chronic pyelonephritis different symptoms of poverty. Patients sometimes there is a decrease in performance, fatigue,
vague pain in the lumbar region in combination with low grade fever.
In patients with pyelonephritis are the following syndromes: inflammation of renal pelvis system, hemodynamic and
metabolic disorders; asthenoneurotic and immune dysfunction.
Physical methods of treatment of patients with pyelonephritis aimed at relief of inflammation (anti-inflammatory methods),
increased reparative regeneration (reparative and regenerative methods), improving microcirculation and metabolism in the
kidney (vasodilators methods), activation of glomerular filtration rate and urine output (diuretics methods) and correction of
immunity disorders (immostimulating Methods).
Physical methods of treatment of patients with pyelonephritis
Anti-inflammatory Methods:
UHF-therapy, UHF-therapy, iontophoresis uroseptics
1
.
Reparative and regenerative methods: infrared laser therapy, ultrasound therapy 1 .
Vasodilators methods: osocerite therapy, peloidotherapy, infrared irradiation 1 , Electroplating,
low-frequency
magnetic therapy.
Diuretic methods:
high-frequency magnetic therapy, pulsed magnetic therapy, drinking mineral water with organic
, Interferential, sodium chloride baths.
Immunomodulatory methods: SF-the irradiation doses in suberitemic1, heliotherapy, thalassotherapy, LOC, radon
baths.
Contraindications: hyperthermia, general intoxication, the presence of radiopaque stones in the kidney (more than 0.5
cm), hypertension, micro-and gross hematuria, chronic renal failure, chronic circulatory insufficiency higher than I degree, tumor
formation and cystic kidney nephroptosis, urgent conditions (renal colic ), kidney abscess, tuberculosis of the kidney.
Substance
1
Spa treatment
Patients with chronic pyelonephritis without exacerbation without violating nitrogen excreting renal function with IBC develops
in violation of the mineral (water and salt) exchange in the kidneys. Changes contribute to the formation of stones ugly matches,
prevents the outflow of urine electrolyte composition changes hypertension is directed to balneotherapy and climate treatment
resorts.
Improvement in patients with chronic pyelonephritis without exacerbation ascertain reduction of general weakness, pain,
dysuria disappearance, normalization of body temperature, a decrease in leukocyturia (less than 20 in the field of view),
proteinuria (at least 1 g / day), nitrogen excreting preservation of renal function, lower power bacteriuria, reduce anemia and
normalization of blood analysis.
Contraindications to the sanatorium treatment are chronic kidney disease (chronic glomerulonephritis, primary and secondary
chronic pyelonephritis) with pronounced symptoms of kidney failure, high blood pressure or neuroretinitis, sclerosis with
symptoms of severe kidney chronic renal failure, kidney disease, accompanied by hydronephrosis stage II and above, and
polycystic kidney cysts (multiple, large solitary) with symptoms of chronic renal failure, nephrotic syndrome with severe edema
and severe symptoms of chronic renal failure, macroscopic hematuria of any origin.
Physioprophylaxis Physioprophylactic objectives are to prevent further development of chronic pyelonephritis and its
exacerbations, as well as the formation of kidney stones by preventing inflammation (reparative and regenerative methods);
recovery of renal function and urinary tract (diuretics methods) and correction of immunity (immune-boosting methods).
Acute glomerulonephritis (AGN) - an acute infectious-allergic diffuse renal disease, mainly affecting the glomeruli,
which develop proliferative exudative changes.
At the origin of AGN clearly traced the role of infection. Significance of
p-hemolytic streptococcus group A. Most often precede the development of AGN acute tonsillitis or acute pharyngitis, skin
pustular disease. In recent years, increased the role of viral infection - influenza, hepatitis B virus Sometimes AGN develops after
vaccination.
The emergence of the disease contributes to the body hypothermia, especially in humid conditions. In response to a foreign
antigen generated antibody, which combine with the antigen and the complement, immune complexes are formed. At first, they
circulate in the blood. Some neutrophils destroyed others enter the bloodstream to the kidneys, which are deposited on the outer
side of the basement membrane, and glomerular mesangial partially.
Immune complexes were captured on a basal membrane in the form of individual clumps. Factor that directly affects the
glomeruli, is a complement. It places deposition of immune complexes and complement rush neutrophils, releasing lysosomal
enzymes, enhancing endothelial damage and basement membrane. The release of serotonin from platelets contributes to
coagulation, resulting in fibrin deposition on the basal membrane.
99
Listed as macrophage reaction proliferation of endothelial and mesangial cells that contribute to the elimination of immune
complexes from the body. In the presence of young lymphoid cells having trophic function physiological regeneration occurs
nephron, including the basal membrane.
Clinical syndromes: edematous, hypertensive, pain, asthenia, acute renal failure, congestive heart failure.
Chronic glomerulonephritis CGN) - a group of diseases of different origin and morphological manifestations,
characterized by lesions of the glomerular apparatus of the kidney and the development of glomerulosclerosis and renal
failure.
CGN may precede the development of infectious disease, hypothermia or vaccination, but half of the patients a clear
connection with any etiologic factor can not be established. CGN developed as a primary chronic disease and is not the outcome
of the acute process. Two variants of the glomerular lesions. The first is similar to that described in AGN: in response to the
introduction of different antigens into an organism produces antibodies in the blood form immune complexes which enter the
bloodstream and in the glomeruli have a damaging effect on the structure of the nephron. The second scenario is more common
CGN: in response to the introduction of different antigens into an organism produces antibodies tropic to the basement
membrane, which are fixed to its surface. Membrane damage occurs, the modified membrane antigen produced autoantibodies.
Complement is deposited on the membrane localization zone at the autoantigen-autoantibody complex. Then the migration of
neutrophils to the basement membrane. With the destruction of neutrophils allocated lysosomal enzymes, reinforcing membrane
damage. Simultaneously, the activation of the coagulation system that leads to the deposition of fibrin in an area of the antigen
and antibody.
Platelets seating in membrane damage, isolated vasoactive substances. This strengthens the processes of inflammation.
Regeneration of the basement membrane is not due to inferiority and lack of trophic cells (defect young subpopulation of Tlymphocytes).
In the progression of CGN also participate nonimmune factors: damaging effect on proteinuria glomeruli and tubules,
reducing the synthesis of prostaglandins (impairs renal hemodynamics), hypertension (accelerating the development of renal
failure), nephrotoxic hyperlipidemia.
Prolonged inflammation, the current waves, ultimately leads to sclerosis, hyalinosis, emptying the glomeruli and chronic renal
failure.
Main syndromes in CGN: edematous, hypertensive, anemic, pain, asthenia, chronic renal failure, congestive heart failure,
nephrotic, urinary, renal dysfunction (filtration, reabsorption, excretory, nitrogen excreting).
Principles of treatment: strict bed rest for 1-2 weeks. to the normalization of blood pressure and eliminate edema in patients
AGN; a diet rich in potassium (rice, potatoes) with the restriction of protein and salt, edema - fluid. In early disease fluid intake
should be limited. After stepping swelling amount of fluids you drink should be 300-500 ml more urine volume.
When streptococcal infection within 1-2 weeks shows antibiotics (penicillin, ampicillin). Prescribe drugs that improve blood
circulation in the kidney and blood rheology (heparin, trental), immunosuppressants (prednisone).
Symptomatic therapy is aimed at addressing the major symptoms of the disease - edema and hypertension. To this end
assigned antihypertensives and diuretics.
In remission patients receive chimes. Symptomatic therapy, which includes diuretics and antihypertensive drugs, treatment of
chronic renal failure. In CGN with isolated urinary syndrome active treatment is not carried out.
Based on the etiopathogenesis and clinical picture of the disease, it is advisable to allocate the following syndromes:
inflammatory, degenerative, hypertensive, edematous and hypercoagulable.
Physical methods of treatment used to reduce inflammation in the glomerular apparatus of the kidneys and blood vessels (antiinflammatory and reparative and regenerative methods), correction of immune dysfunction (immune correcting methods), reduce
glomerular ischemia and kidney tissues (vasodilators and antihypoxic methods), reducing coagulation potential (hypocoagulating
methods); reducing edema (dehydrating diuretics and methods).
Physical methods for the treatment of patients with chronic glomerulonephritis
Anti methods: UHF-therapy, UHF-therapy, iontophoresis with uroantiseptics.
Immunostimulatory methods: SF-irradiation (suberythematous dose), heliotherapy.
Immunosuppressive methods: transcerebral UHF-therapy, high-frequency therapy on the adrenal
glands, UHF-
therapy on the adrenal glands, iontophoresis calcium Demerol.
Reparative and regenerative methods:
infrared laser therapy, ultrasound therapy, iontophoresis vitamin C
peloidotherapy.
Vasodilators methods: paraffin, osoceriteotherapy, infrared irradiation.
Diuretic methods: iontophoresis antispasmodics, amplipulse, high-frequency
magnetic therapy, treatment of drinking
mineral water.
Dehydrating methods: infrared sauna, sauna.
hypocoagulating methods: iontophoresis anticoagulants and antiplatelet, low-frequency magnetic therapy.
Antihypoxic method: oxygen-barotherapy.
Cystitis - inflammation of the bladder mucosa, accompanied by a breach of its function. Predisposing factors for the
occurrence of inflammation in the bladder are urodynamics of lower urinary tract, the barrier function of the mucosal
epithelium of the bladder, blood flow in the bladder wall, reducing the overall reactivity.
In the etiology of infectious cystitis play a role (Escherichia coli, Streptococcus, Proteus, Chlamydia, Staphylococcus,
adenovirus, herpes, gonococcus, trichomonas), chemical, toxic, drug, radiation and other factors. Penetration of infection into the
bladder can occur upward, downward, and lymph through hematogenous.
100
Cystitis is much more common in women, due to the rising infection through the lumen of the urethra. In men, infection of
the bladder can be observed in inflammatory processes in the prostate gland, seminal vesicles, epididymis and the urethra.
Downward path of infection in the bladder usually occurs when the inflammatory process in the kidneys (chronic
pyelonephritis, pyonephrosis). Cystitis with long existing chronic pyelonephritis is mainly observed during the active phase of
pyelonephritis, with concomitant bacteriuria. It is also possible lymphogenous path of infection with inflammation in the genitals
because of the direct relationship between lymphatic bladder, ovaries, uterus.
Cystitis are classified according to pathogenetic principle (primary, secondary), etiology (infectious - specific and nonspecific, chemical, thermal, toxic, medicinal, nutritional, neurogenic, radiation, involutional, postoperative); depending on the
course - acute and chronic cystitis (chronic cystitis in most cases is secondary), prevalence of inflammation (focal or diffuse) and
the nature of the morphological changes: acute - on catarrhal, hemorrhagic, granulating, fibrinous, ulcerative, and gangrenous
abscess, chronic cystitis - by catarrhal, ulcerative, polypoid, cystic, encrusting and necrotizing interstitial.
Acute endocystitis characterized by edema and hyperemia of the bladder mucosa, while the protracted inflammation involving the submucosal and muscular layers with the formation of purulent infiltration, ulceration of the mucosa, the advent of
limited areas of necrosis. For chronic cystitis is characterized by loss of all layers of the bladder wall, the appearance of bleeding
granulation, cysts, microabscesses and ulcers on the mucosa. In marked fibrosis occur wrinkling bladder wall, reducing its
volume.
The clinical course is characterized by the presence of pyuria cystitis and terminal hematuria. Acute cystitis is rarely
accompanied by phenomena of intoxication and fever. Fever indicates involvement in the inflammatory process of the overlying
urinary tract and the development of complications. Patients concerned about frequent painful urination. Constant impulses from
inflamed bladder mucosa causes tonic contraction of the detrusor and increased intravesical pressure. In connection with the
involvement of inflammatory bladder neck pain irradiating to the crotch, the anus and the penis head. Acute cystitis suprapubic
pain remains and is the act of urination due to increased sensitivity of the inflamed mucosa.
Main syndromes acute cystitis: inflammation, pain, disuric, dismetabolic.
Treatment of acute cystitis include compliance with bed rest, diet with the exception of sharp, irritating food and drink copious
alkaline. Spend pharmacotherapy - with antibiotics, nitrofurane derivatives drugs nalidixic acid, sulfonamides, antispasmodics
(Nospanum, Analginum, papaverine, belladonna in candlelight).
Treatment of chronic cystitis is aimed at eliminating violations reservoir function of the bladder, bioenergetic processes
intensification of its walls, creating a maximum concentration of antimicrobial drugs in inflammation; topically administered
antiseptic solutions. Antibacterial drugs are prescribed and uroantiseptic long, full normalization of urine and disappearance of
previously inoculated pathogens. It is mandatory appointment immunomodulators - pentoxyl, metacyl, drugs aloe, vitamins A,
Bi, Bg, E. When catarrhal and hemorrhagic cystitis shown instillation of oil solutions (synthomycin emulsion, sea buckthorn oil,
rosehip), with granular cystitis - installation of 0.25% solution of silver nitrate, 2-3% solution Collargol, diotsida solution.
Physical methods of treatment prescribed since the early days of the disease and is used for relief of the inflammatory (antiinflammatory methods) and dysuric (myorelaxing methods) syndromes achieve analgesia (analgesic methods) and restore urinary
tract urodynamics (diuretics methods).
Physical methods for the treatment of patients with cystitis.
Anti methods: UHF, microwave therapy, electrophoresis of furadonin, erythromycin, an infrared laser therapy, ultrasound
therapy, interstitial electrophoresis antibiotics.
Myorelaxing methods: vibration, thermal, infrared irradiation, peloidotherapy.
Methods of analgesia: SF-irradiation erythemal doses, diadynamic.
Diuretic methods: amplipulse, amplipulsephoresis with gangleron, sitting baths, drinking mineral water treatment.
Contraindications: the presence of micro-and gross hematuria, acute period when a feverish state.
Spa treatment
Patients with chronic cystitis in remission, with complications in the form of urinary incontinence, detrusor hyperreflexia and
hypertonus sent for balneotherapy and mud-cure resorts subtropical, steppe, forest climates, as well as in marine climate of the
southern latitudes: Krainka Zheleznovodsk, Truskavets, Pyatigorsk, Staraya Russa. An important component of recreational
therapy is the application of therapeutic physical culture - path, therapeutic exercises that strengthen the muscles of the perineum
and the anterior abdominal wall.
Contraindications are active inflammatory process, hemorrhagic, ulcerative cystitis, leukoplakia, a condition requiring surgery
(urethral stricture, bladder neck sclerosis, diverticula, stones), benign prostatic hyperplasia.
Physioprophylaxis
Physioprophylaxis exacerbations of chronic cystitis is aimed at improving immunity (immune-boosting methods) and increased
diuresis (diuretics methods).
PROSTATITIS
Prostatitis - infectious and inflammatory diseases of the prostate with a primary lesion of glandular and connective tissue
of the organ. Chronic prostatitis is characterized by a prolonged course with a tendency to recur, accompanied by a variety of
disorders of the prostate, sexual dysfunction and urinary disorders.
101
Most often sick men of 25-45 years old.
In nonspecific (banal) prostatitis pathogen infection is opportunistic and pathogenic microflora. Confounding factors of
nonspecific infectious prostatitis may be stagnant (congestive) phenomenon. Joining both specific and nonspecific infection on a
background of stagnation in the prostate is the most common cause of prostatitis now.
In the mechanisms of prostate development are two major ways: urinogenic (ascending or descending - purulent
pyelonephritis) and hematogenous (if foci of chronic infection). The presence of disease in adjacent organs (proctitis,
thrombophlebitis hemorrhoidal veins, etc.) can contribute to prostate infection through a developed network of veins or pelvic
fascia plate.
In the mechanism of the development of prostate specific value have predisposing factors: anatomical and physiological
changes in the structure and function of the prostate gland due to an illness, venous congestion and lymphostasis in the pelvic
organs, immune deficiency, the presence of local and general infection, dysrhythmia sexuality, etc.
Prostatitis classified by etiology (infectious - specific and nonspecific; congestive - stagnant and mixed).
On the basis of a post mortem (catarrhal, follicular, and parenchymal abscess of the prostate, which can be a complication of
prostatitis, dystrophic, fibrocystic, granulomatous and sclerosis of the prostate gland, which is the outcome of chronic prostatitis).
The clinical course - acute, chronic, Pathogenesis - hematogenous, uretrogenic, canalicular, calculous, allergic, endocrine.
Main syndromes: asthenoneurotic, intoxication, pain
(Pain in the perineum, sometimes radiating along the spermatic cord in the lumbosacral region, burning in the urethra, anus)
prostatorhea - copious involuntary leakage of prostate secretion, disuric (violations of the frequency and nature of urination,
painful urination), sexual disorders (disorders erectile function) and reproductive disorders (infertility, changes in the number and
motility).
Treatment of patients with prostatitis performed on an outpatient basis and in most cases conservative. In the complex
treatment of prostate observe two principles: readjustment of foci of infection (antibiotic therapy) and improve blood circulation
to the prostate gland (prostate massage, physiotherapy, physical therapy).
During the course of antibiotic therapy is essential purpose of optimum doses and methods of administration of drugs based
on their pharmacokinetics in the body of the patient. Are optimal doses of antibiotics at which their concentration in the blood 23 times exceeds the minimum inhibitory concentration of the pathogen.
Chronic prostatitis in most cases occurs on the basis of immunodeficiency, so against the backdrop of the required destination
immune correcting antibiotic drugs (likopid, diuciphonum, ridostin, neovir, thymus preparations) and vitamins.
Physical treatments aimed at relief of inflammation (anti-inflammatory methods) and the reduction of pain (analgesic
methods), cupping stagnation and reduction of sclerotic changes in the future (defibrosing methods) and increase immunity
(immune-boosting methods).
Physical methods of treatment prostatitis
Anti methods: UHF, microwave, ultrasound therapy 1, Phonophoresis antibiotics IR laser.
Methods of analgesia: diadinamo-, SMC-therapy, analgesics electrophoresis 2 UV irradiation erythemal doses.
Defibrosing methods: electrophoresis of enzymes, potassium iodide, prostate massage, magnet, Mud, SMT-therapy bath
sulfide, microclysters.
Immunostimulatory methods: electrophoresis immunomodulators, air baths, thalassotherapy.
Contraindications to physiotherapy: Benign prostatic hyperplasia stage III prostate cancers.
Spa treatment
Patients with chronic prostatitis (vesiculitis) tubercular etiology in remission with limited infiltration, without urethral stricture
routed to the climatic-, spa-and mud-cure resorts of the Black Sea coast of the Caucasus, the Crimea.
Disappearance of pain in the sacral region, above the pubis, perineum, dysuria, improving general, normalization of blood and
urine, prostatic secretion (disappearance or reduction of the number of leukocytes, increase of lecithin granules, reducing the
number of macrophages), reduced edema, pain prostate cancer during rectal examination and improvement of sexual function
indicate normalization of patients. Stable maintenance of the achieved level of performance without reducing potency, absence of
pain and dysuria in normal urine analysis, a small number of cells in the prostate secretion showed no changes in the initial state
of the patient, and the preservation of pain in the sacrum, perineum, suprapubic, dysuria, sexual disorders function; no changes in
laboratory parameters, in particular urine and prostatic secretions, or increase the number of leukocytes - about its deterioration.
Contraindications are malignant tumors of the prostate, benign prostatic hyperplasia stage III.
Physioprophylaxis
Physioprophylaxis exacerbations of chronic prostatitis is the application of methods for facilitating the resolution of stagnation in
the pelvic area and the methods that have immunostimulatory effects.
Benign prostatic hyperplasia
Benign prostatic hyperplasia
(BPH) - process characterized by hyperplasia of the glands and the stroma of the
prostate.
Source hyperplastic process in BPH are paraurethral glands.
102
In the pathogenesis of BPH is dominated by hormonal disorders at the level of cancer, and at the level of the hypothalamicpituitary relationships. The main importance is the ratio of sex hormones - androgens and estrogens, as well as determining their
level of pituitary hormones - luteinizing hormone and follicle-stimulating hormone, prolactin. Growth of epithelial cells of the
prostate associated with the level of androgens and development of stromal hyperplasia of estrogen depends on the contents, but
in both cases the expected synergistic effect of androgens to estrogens. In prostate cells, testosterone is metabolized by the
enzyme 5a-reductase inhibitor in an active form - dihydrotestosterone (DHT). Most of DHT in combination with androgen
receptor protein activates cell DNA, resulting in the growth and differentiation of cancer cells. Smaller part under the influence of
5a-reductase turns into 5CC-androstenediol, which acts as a beta-adrenoceptor blocker prostate and coordinate work so detrusor
and sphincter. Increased synthesis of androgen receptor complex causes a decrease in the formation and activation of adrenergic
androstenediol prostate, which manifests itself in inappropriate coordination of detrusor and sphincter.
In the pathogenesis of BPH has a definite value violation lymphoid cell link that is evident in the number of T-and Blymphocytes. BPH growth strengthens circulatory disorders of the prostate gland that promotes stagnant inflammation. In this
regard, frequent comorbidities in BPH are chronic prostatitis and chronic pyelonephritis secondary.
Thus, hormonal disorders underlying BPH leads to a compensatory hyperplasia of the stromal and epithelial tissue and the
subsequent development of immunological, inflammatory and trophic disorders.
Hyperplastic prostate tissue causes deformation of the prostatic urethra, ejaculatory ducts, causes cystic expansion of the
seminal vesicles or atrophy. Depending on the direction of tumor growth distinguish intra-and BPH subvesical forms that are
clinically differ in severity urinary disorders. Growth towards the rectum does not interfere with the function of the sphincter, the
growth of the center leads to a narrowing of the lumen of the urethra, the pressure on the bladder neck, which leads to poor
circulation, inflammation, edema of all layers of the bladder wall. Clinically, in this case expressed in symptoms of bladder outlet
obstruction, there is macro-or microscopic hematuria.
By histomorphological grounds are 4 forms of BPH: glandular (adenoma), fibrous (fibroadenoma), myoma (adenomyoma)
and mixed.
Clinical classification is based on the morphofunctional state of the bladder, upper urinary tract and kidneys depending on the
stage of the disease.
Stage I is characterized by a compensatory hypertrophy of the detrusor, ensures complete evacuation of urine from the
bladder, i.e. absence of the symptoms of residual urine. Renal dysfunction and upper urinary tract are absent. The core is dysuria
syndrome - a violation of the frequency and duration of urination.
II stage is characterized by degenerative changes in the detrusor and the appearance due to its lack of contractility of the
symptoms of residual urine (from 100-200 to 1000 ml). There is disruption of transport urine level of the renal pelvis and ureter
and their subsequent expansion and decreased kidney function (compensated stage renal disease). Saved dysuria syndrome
(having urgent need to urinate, frequent urination, or its delay, pain).
III stage - paradox ischuria. Characteristic function of the detrusor decompensation, expansion of the upper urinary tract,
renal pelvis and calyces and renal failure progression to end stage with signs of uremia. Bladder distended and packed with
chronic urinary retention observed her involuntary discharge (night and then day) in case of overcoming the accumulated urine
resistance cystic sphincter (paradoxical ischuria).
Thus, one can distinguish BPH number of pathogenetic and clinical syndromes: hormonal disorders
(abnormal correlation of female and male sex hormones), hyperplasia, circulatory disorders (venous congestion in the pelvic
organs), inflammation (various options stromal inflammatory changes), urinary disorders (disuric) and chronic renal failure.
Of fundamental importance is the division of obstructive symptoms in the (mechanical component) associated with
compression of the urethra hyperplastic prostate tissue, and irritative (dynamic component) arising from breach of an alphaadrenergic receptors of the bladder neck, prostatic urethra and prostate.
Tactics of treatment of BPH patients depends on the relationship of three main components: degree of prostate enlargement,
the severity of irritative, obstructive and objective signs and symptoms of bladder outlet obstruction. Treatment includes three
directions: surgical treatment, conservative therapy and alternative (hardware thermal) methods.
Surgical treatment: open prostatectomy, transurethral endosurgical treatment (TURP), transurethral electrovaporization,
transurethral electroincision, endoscopic laser surgery (laser ablation, vaporization, coagulation) and cryoablation of the prostate.
Hardware thermal methods used for BPH using endourological manipulation based urological surgical departments. Most
devices for thermotherapy are a source of electromagnetic radiation in the decimeter and centimeter waves provide local heating
tissue to 45 - 85 ° C and necrotic. Apply as transurethral and transrectal method.
Conservative treatment of BPH shown in concomitant diseases and complications that are contraindication to surgery prostatectomy.
Leading trend of drug therapy for BPH is a hormonal therapy - the use of progestins, anti-oestrogenic and anti-androgenic
effects. Also hormonal drugs, to reduce the appearance of obstructive component used 5a-reductase inhibitor (Proscar,
permikson) blocks the conversion of testosterone to the active form (DHT) in prostate tissue to prevent further iron proliferative
responses. For relief of dynamic disturbances in severe disorders of urination due to increased smooth muscle tone and usedblockers (alfuzosin, prazosin, etc.), reducing muscle tone of the bladder, urethra and prostate. Possibly a combined application
5a-reductase inhibitors and adrenolytics, which is especially effective in treating patients with stage I BPH.
Physical methods of treatment used to correct hormonal violations (hormone correcting methods) and for the relief of
stagnation in the prostate (trophostimulating methods). disuric syndrome is caused by mechanical keep urine from leaking or
impaired autonomic effects on smooth muscle of the bladder, urethra and prostate, i.e. is secondary. In connection with this
relief dizuricheskih events possible while reducing obstruction (due to reducing the size of the prostate or its removal) or, in the
case of dynamic dominance violations when restoring coordinated work of the detrusor and sphincter (due to the normalization of
relations sympathetic and parasympathetic influences).
Inflammatory syndrome in BPH is considered as a manifestation of comorbidities - chronic prostatitis or pyelonephritis - and
requires the use of anti-inflammatory treatments, except for the use of physical factors with strong proliferative effect (highelectromagnetotherapy).
103
Physical methods for the treatment of patients with BPH. hormone correcting methods:
transcranial UHF therapy, transrectal oxyprogesterone phonophoresis.
Immunomodulatory methods: aero, thalassotherapy.
trophostimulating method: massage of the prostate
Contraindications to the sanatorium treatment are malignant tumors of the prostate and benign prostatic hyperplasia stage IIIII.
Physioprophylaxis
Physioprophylaxis BPH is aimed at stabilizing the neuroendocrine processes at the level of the hypothalamic-pituitary system,
improve blood circulation and limfottoka in the pelvic organs, training vegetative maintenance of organ systems, including the
genitourinary system, increase nonspecific resistance and prevention of postoperative complications.
The leading role played by the methods recreational therapy and therapeutic physical culture: air and sun baths, sea bathing,
hygienic gymnastics, dosed walking.
Appendices
USING METHOD "WHO CAN FASTER, WHO CAN MORE»
Methods of carrying out.
To work needed:
1. Set of cards with rehabilitation tasks.
2. Stopwatch.
3. Plain piece of paper.
Progress:
1. The game is in written form.
2. Students in turn pull the card with the task.
3. Every student writes down his answers on a task for 5 minutes.
4. Then the teacher collects answer sheets.
5. Overall time of the game - 45 minutes.
6. Every answer of an each student is treated separately.
7. Answers are being discussed on a sheet with all students.
8. Collected score is being taken into account when current marking.
9. The answer sheet is marked with a score point with red ink.
10. The free bottom of the log is for teacher's records on the case game.
11. Logs of the games are being saved.
List of tasks for the case game
Collection of questions: "Who can faster, who can better"
1 Give an explanation of the concept of Rehabilitology: The term "rehabilitation" is derived
from the Latin word «habilis» - ability, «rehabilis» - recovery ability
2. Task of rehabilitation? Elimination of the consequences of the disease. End its goals - the
restoration of independence and disability, quality of life rehabilitant, as well as possible,
reducing the limitations of its activity, increased reserves for active participation in the life, the
creation of conditions for the beneficial effects of the environment and the risk factors.
3.What main task of medical and social rehabilitation? By "medical and social
rehabilitation" means the restoration of physical, psychological and social status of people who
have lost these abilities as a result of illness or injury.
4. Stages of rehabilitation process:
stationary
104
polyclinic
sanatorium
Maximum score 25-24
excellent
100% -86%
Criteria for evaluating the theoretical part
23-21 score
20-19 score
18-16 score
good
Satisfactory
Unsatisfactorily
85% -73%
70-56%
53% -46%
15-13 score
Poor
43% or less
Appendix No.2
Four Analytical part
4.1. Structure and logic "pyramid" diagram
Terms of drawing diagrams.
1. Write down everything that comes into your mind. Do not judge the quality of ideas: just write
them down.
2.Do not pay attention to spelling and other factors constraining the letter.
3.Do not stopped writing until the time runs out. If the idea of suddenly stop coming to your
mind, then paint with on paper, until you have new ideas.
4. Try to create as many links as possible. Do not limit the number of ideas, their flow and
communication between them.
5.
Teacher is explaining.
1. Introduces students with the rules of the diagram construction
2. In the center of the chalkboard or a large sheet of paper written keyword or topic name of 1-2words.
Student performs.
1.In the process of compiling the Cascade can move the components and elements of the system
scheme - it allows us to rethink certain provisions.
2.If you find yourself at a dead end, developing an idea, go back to level 1-2 up and see if you
missed something important and you can not do anything differently.
3.You used to write from left to right. Try to build a stage from right to left.
4.For this place is not the main idea of the left and right edge of the sheet.
Collection of questions
1.Create a rehabilitologic event in diseases of the digestive tract.
2.Create a rehabilitologic event in diseases of the urinary and kidney.
"Cascade" circuit diagram.
105
Diseases of the urinary
tract
Pyelonephritis
Inflammation,
hemodynamic,
metabolic change, pain
asthenoneurotic
Glomerulonephritis
Swelling, pain,
hypertension, anemia,
astenoneurotic, chronic
renal failure, heart failure.
urolithiasis
Pain, dysuria,
hypertension, ARF
astenoneurotic
Rehabilitation
- Anti- UHF UHF
electrophoresis preparations
- Reparative regenerative
method infrared laser UTT
- Vasodilator osocerite
peloidotherapy infrared
illuminator galvanizing
- Diuretics TDC bath
- Immunostimulating SF
heliotherapy talossotherapy
LFK, diet, herbal medicine
- Anti- UHF UHF
electrophoresis preparations
uroantiseptics
-Immunostimulatory SF
heliotherapy
-Immunosuppressive UHF
UHF electrophoresis
Regenerative-laser UTT
peloidotherapy LFC diet,
herbal medicine.
-Miorelaxation and
antispasmodics: bath infrared illuminator
Myostimulating method
DDT Amplipulse
- Diuretics TDC
- Vessels dilating
galvanization galvanization
paraffin
- Urolytics, exercise, diet,
herbal medicine
106
Group
Number
Each group evaluates the other groups. Maximum score -15-22
Clear and exact Visual
Compliance Group Activity Total score of 15
answer (5)
(graphic)
with
(2.5)
(5)
regulations
(2.5)
1.
2.
Criteria for evaluation of the analytical part: (chart)
Maximum score
15-14
13-12 score
11-10 score
9-8 score
7-6 score
100% -86%
85% -73%
70-56%
53% -46%
43% or less
Analytical part
Appendix-3
4.2. Situational tasks:
Task No. 1. Patient D Male, 35 years old.
Diagnosis: Peptic ulcer bulb 12 duodenal ulcer in acute stage of abating.
1. Is it possible to assign this patient physical therapy and physical therapy?
2. Objectives pursued in this case, physical therapy and exercise therapy.
3. Contraindications to physical therapy and exercise therapy for this pathology.
4. Which factors FT can be used in this condition at this stage.
5. Make an exemplary complex TrE given patient.
Standard answer: This patient must assign FT and gymnastics. Tasks: impact on
neurohumoral regulation of digestive processes, improve blood circulation in the
abdomen and pelvis, strengthening the abdominals, increased intra-abdominal pressure,
stimulation of the motor function of the digestive system, a positive impact on the neuropsychic sphere patient, increasing emotional tone. Contraindications: severe pain,
vomiting, bleeding, penetrating ulcer. Of CFT at this stage shows electric, iontophoresis
with antispasmodics, magnetic therapy, laser. The complex TrE should include breathing
exercises, restorative and special exercises for the abdominals.
Task No. 2. Patient H, 48 years old.
Diagnosis: Chronic non-calculous cholecystitis in the acute stage. Chronic pancreatitis
1. Is it possible to assign this patient physical therapy and physical therapy?
2. Objectives pursued in this case, physical therapy and exercise therapy.
3. Contraindications to physical therapy and exercise therapy for this pathology.
4. Which factors FT can be used in this condition at this stage.
5. Make an exemplary complex TrE given patient.
Standard answer: This patient must assign FT and gymnastics. Task impact on
neurohumoral regulation of digestive processes, improve blood circulation in the
107
abdomen and pelvis, strengthening the abdominals, increased intra-abdominal pressure,
stimulation of the motor function of the digestive system, improve bowel function, a
positive impact on the neuro-psychic sphere patient, increasing emotional tone.
Contraindications: severe pain, uncontrollable or frequent vomiting, hyperbilirubinemia,
increased ALT and AST levels. Of CFT at this stage shows: drinking mineral water,
magnet on the right hypochondrium, iontophoresis with antispasmodics, laser therapy.
The complex TrE should include breathing exercises, restorative and special exercises for
the abdominal muscles, walking. Original left lateral decubitus prescribed to improve the
outflow of bile.
Task No. 3. Patient Sh, 38 years old.
Diagnosis: Chronic bilateral pyelonephritis under partial remission.
1. Is it possible to assign this patient physical therapy and physical therapy?
2. Objectives pursued in this case, physical therapy and exercise therapy.
3. Contraindications to physical therapy and exercise therapy for this pathology.
4. Which factors FT can be used in this condition at this stage.
5. Make an exemplary complex TrE given patient.
Standard answer: This patient must assign FT and gymnastics. Task improving blood
supply to the kidneys, increased sensitivity to drug therapy, removal of smooth muscle
spasm of the renal pelvis and ureter, a positive impact on the neuro-psychic sphere
patient, increasing emotional tone. Of CFT at this stage shows: drink plenty of mineral
water iontophoresis on the kidneys (with furadonin, erythromycin, calcium chloride),
magnetic, thermal treatments (diathermy, therapeutic mud, diatermomud, osocerite and
paraffin baths). Contraindications: high arterial hypertension, severe anemia, acute period
of the disease, chronic renal failure. The complex TrE should include breathing exercises,
restorative and special exercises for the abdominals and lower extremities.
Task No. 4. Patient P., 45 years. Diagnosis: Chronic prostatitis.
1. Is it possible to assign this patient physical therapy and physical therapy?
2. Objectives pursued in this case, physical therapy and exercise therapy.
3. Contraindications to physical therapy and exercise therapy for this pathology.
4. Which factors FT can be used in this condition at this stage.
5. Make an exemplary complex TrE given patient.
Standard answer: This patient must assign FT and gymnastics. Task reduction of the
inflammatory process in the prostate, improving regional blood flow, reproductive
function, positive impact on the neuro-psychic sphere patient, increasing emotional tone.
Contraindications: acute pain, fever, acute urinary retention. Of CFT at this stage shows:
Microwave inductothermy, osocerite trousers, RAS therapy, rising shower. The complex
TrE should include breathing exercises, restorative and special exercises for the
abdominals, pelvic floor and lower limbs, walking, bike
Appendix-3
4.3 Tests.
1.Which electroplating method used in gastric ulcer
A. * endonasal galvanizing
B. Method C. Vermeulen collar, galvanizing by Shcherbak
D. locally-cross method
2.What electrophoresis method used in hyperacid gastritis.
A. * No-spa
B. novocaine
C. diphenhydramine
D. niacin
108
3. Factors normalize peristalsis.
A. * CMT
B. UFO
C. laser therapy
D. franklinization
5. Physical factors used in acute hepatitis.
A. * magnetotherapy
B. microwave
C. electrophoresis
D. electrosleep
6. What fizioterapeutic method can not be applied in cholelithiasis.
A. * DDT
B. paraffin
C. mud
D. Darsonval
7. When used for drinking mineral water in diseases hyperacid gastritis?
A. * warm water before eating 40-45 minutes
B. cold water for 10-15 minutes before meals
C. warm water after a meal
D. while eating cold water
8. Effective method in inflammation of the prostate gland.
A. *ultrasound
B. Franklin method
C. darsonvalization
D. UV
9. What is the physical method used for active treatment of pyelonephritis with antiinflammatory and diuretic effect?
A. low frequency magnetic.
B. sodium chloride bath.
C. intraorganic furadonin electrophoresis.
D. Diadynamic therapy.
10. Resorts in Uzbekistan are useful in chronic pyelonephritis.
A. * Sitorai Khosa
B. Chimen
C. Chortoq
D. "Botanics"
Appendix-3
4.4 Cookbook by physical factors
1 Electrophoresis: 2% novocaine solution on the stomach ma 01/08/10, T-20 min, N 5-7 through
the day.
Methodology Electrodes 300 cm 2 epigastric surface zone technique transverse 9 (anode)
electrode arrangement with the rear of the lower segment of the breast after 10 minutes the
109
current is reduced to 0 by changing the polarity of the electrode to increase the current sense of
vibration. Indications: spasms of smooth muscles and sphincter hypertonicity of n.vagus, ulcers
and 12 duodenal ulcer gastric phase of scarring
2. Epigastric area UHF microwave therapy, d 100 beams 100mm pin, P-10-15 W, T-10-12 min
N 10 12 every day.
Methodology 100 mm irradiator on the contacted epigastric area,
Indications: gastric ulcer and duodenal ulcer
3. Electrosleep. 3.5 Hz 2-3 procedures. 10Hz 3-7 t 30-50min, N8-10 daily.
Methodology patient lying on the couch, the electrodes fixed orbital mammilary hydrophile
electrode pads in the eyes closed (wetted pads 38-39% water) eye electrodes cathode (-) in the
mastoid anode ( ).
Indications: peptic ulcer and duodenal ulcers, eczema, dermatitis
Contraindications: glaucoma, cataracts.
Four Treatment paraffin-osocerite.
Paraffin application on the liver area. Temperature 50-54 about C, duration 30-60 minutes on a
course of 15-20 procedures. Every day or every other day
Methodology osocerite tortilla temperature 50-60 about C on the stomach duration of 30-60
minutes on a course of 10 - 15 procedures. Every day or every other day
Maximum
score 2515
15-14excellent
100% -86%
criteria for evaluating the test, situational problems.
13-12 score
11-10 score
9-8 score
7-6 score
14-12-well
85% -73%
11-7satisfactory
70-56%
6-4-deficient
3 or less bad
53% -46%
43% or less
Appendix-4.
5.The practical part
5.1 Implementation of practical skills (the steps)
Targetteach students to use Sustainable Integrated physiotherapeutic treatment methods in
practice.
Indications: teach and perform on their own choose physiotherapy physical factors used
procedures in the pathogenetic treatment urinary tract diseases.
Necessary equipment : Account CFT shells.
No. Stages of
Failed to
execute
Follow
all steps
110
step
1.
Evaluation of the clinical condition of the patient
(complaints, anamnesis morbi, anamnesis vitae,
status presents, data clinical and laboratory studies
Appointment rational physiotherapy:
Evaluation
2.
3.
4.
5.
6.
Excellent
Average
0
Satisfactory
to determine whether a given patient
contraindications to physiotherapy
in the absence of contraindications for physiotherapy
selection of major groups of physical factors on
syndromic pathogenetic principle
selection of specific physiotherapy treatments to the
patient in accordance with the rules of the
compatibility of physical factors
Sequencing of physiotherapy appointment at their
complex
registration sheet assignments (writing prescriptions
for physiotherapy)
TOTAL
(20point)
3
Unsatisfactori Poor
0
3
0
3
0
3
0
3
0
5
20
Assessment of the adequacy of physical activity for patients with various diseases during
the procedure of physiotherapy
Purpose: learn to assess the adequacy of physical activity for patients with various diseases
during physiotherapy sessions (TrE)
Indications: learn to assess the adequacy of physical activity for patients with chronic gastritis.
Necessary equipment : Account physiotherapists Rockets.
111
№ Mark
Adoption in %
1
.
Theoretical part
2 Analytical part
.
3
.
organiser
Test
4 The practical part
excelent
good
average
unsatisfy
poor
100% -86%
85% -71%
70-55%
54% -37%
36%
18-17 points
16-15 points
14-13 points
15-14 points
13-12 points
11-10 points
9-8 points
15-14 points
13-12 points
11-10 points
9-8 points
40-35 score
35-30 score
30-25 score
20-19
points
25-15
points
Failed to
execute
step
1.
0
Follow
all steps
(20point)
2.
0
2.
0
2.
0
2.
0
3
0
3
0
0
0
0
2.
2.
2.
20
2.
3.
4.
5.
6.
7.
8.
9.
poin
7-6
poin
7-6
poin
1714
scor
No. Stages of
Interrogation of the patient in order to identify possible
complaints before the TrE
Measurement of blood pressure, heart rate calculation, BH patient
to load
Counting heart rate for 10 seconds in the patient by the end of the
introductory part of TrE, identifying complaints and external
signs of fatigue
Counting heart rate for 10 seconds in a patient complaints and
identify external signs of fatigue during the main part of TrE
Counting heart rate for 10 seconds in a patient complaints and
identify external signs of fatigue in the final part of TrE
Measurement of blood pressure, heart rate calculation, BH,
identifying complaints and external signs of fatigue in a patient
after 5 min after TrE
Storing the data in the medical and control card
Draw the physiological load curve
Making a conclusion
Totals
(12
112
Criteria for evaluation of practical skill
100% -86%
85% -71%
70%-55%
54% -37%
36% less
40-34.4-
34-28.4-well
28-22-
21.6-14.8
14.4 and less
satisfactory
unsatisfactory
bad
excellent
6. Forms of knowledge control, skills and abilities
- Oral
-Written
Solution case studies
Demonstration of practical skills mastered.
Criteria for the assessment of knowledge, skills and abilities of students
Appendix-5.
1. In assessing students' knowledge of Rehabilitation accounted following
approximate criteria
Criteria of the current control
Nu Performa
Evaluatio Level of knowledge and skills
m
n
nce in%
be
r
113
1.
96-100%
Excellent Student independent. Has an overall concept on the
"5"
subject Rehabilitation. Applies in practice, with the
matter, said confidently, has fine views. Full correct
answer to the questions on the classification of
electrotherapy, mechanisms of action of continuous
and pulsed currents (galvanization, iontophoresis,
diadynamic, electric, electric pulp test, amplipulse),
application techniques, indications and contraindications. Summarizes and makes decisions, think
creatively, independently analyzes. Situational
problems are solved correctly, with a creative
approach, with full justification response.
Actively and creatively involved in interactive games,
right to make informed decisions and summarizes and
analyzes.
Recipes writes is true, with the best indication of dose
exposure to physical factors. The synopsis on the
subject there.
2. 91-95%
Excellent Full correct answer to the questions on the
"5"
classification of electrotherapy, mechanisms of action
of continuous and pulsed currents (galvanization,
iontophoresis, diadynamic, electric, electric pulp test,
amplipulse), application techniques, indications and
contra-indications. Summarizes and makes decisions,
think creatively, independently analyzes. Situational
problems are solved correctly, with a creative
approach, with full justification response.
Actively and creatively involved in interactive games,
right to make informed decisions and summarizes and
114
analyzes.
Recipes writes is true, with the best indication of dose
exposure to physical factors.
3.
86-90%
Excellent The questions posed by the classification action
"5"
mechanisms examined (light therapy, aerosol therapy,
barotherapy), physical factors (FF), methods of
application, indications and contra-indications to
appoint highlights enough, but there are 1-2 in reply.
Applies in practice, with the matter, said confidently,
has fine views. Situational problems are solved
correctly, but the justification answer sufficiently.
Actively involved in interactive games, correct
decisions.
Recipes writes is true, with the best indication of dose
exposure to physical factors, but there are 2-3
grammatical errors.
4.
81-85%
Average
Questions posed by products electrotherapy,
"4"
mechanisms of action of continuous and pulsed
currents (galvanization, iontophoresis, diadynamic,
electric, electric pulp test, amplipulse), application
techniques, indications and contraindications to fully
covered, but there are 2-3 inaccuracies, errors.
Applies in practice, with the matter, said confidently,
has fine views. Situational problems are solved
correctly, but the justification answer sufficiently.
Inaccuracies in solving situational problems. Actively
involved in interactive games, correct decisions.
115
Recipes writes is true, with the best indication of dose
exposure to physical factors, but there are 2-3
grammatical errors, inaccuracies in dose.
5.
76-80%
Average
Correct but incomplete coverage of the issue. The
"4"
student knows the classification of electrotherapy,
mechanisms of action of continuous and pulsed
currents (galvanization, iontophoresis, diadynamic,
electric, electric pulp test, amplipulse), methods of
application, indications and contra-indications, but
not fully versed in the mechanisms of action of
physical factors. With the matter, said confidently,
has fine views. Actively involved in interactive
games. Situational problem gives partial solutions.
Recipes written specifying the dose exposure to
physical factors, but there are 3-4 grammatical errors,
inaccuracies in dose.
6.
71-75%
Average
Correct but incomplete coverage of the issue. The
"4"
student knows the classification of electrotherapy,
mechanisms of action of continuous and pulsed
currents (galvanization, iontophoresis, diadynamic,
electric, electric pulp test, amplipulse), methods of
application, indications and contra-indications, but
not fully versed in the mechanisms of action of
physical factors, incomplete lists contraindications to
CFT in this pathology. With the matter, said
confidently, has fine views. Actively involved in
interactive games. Situational problem gives partial
solutions.
Recipes written specifying the dose exposure to
116
physical factors, but there are 3-4 grammatical errors,
inaccuracies in dose.
7.
66-70%
Satisfacto The correct answer to half the questions posed. The
ry
student knows the classification of continuous and
"3"
pulsed currents (galvanization, iontophoresis,
diadynamic, electric, electric pulp test, amplipulse)
but poorly versed in the mechanisms of action of
physical factors, incomplete lists contraindications to
CFT in this pathology. With the matter, said
uncertainly, has accurate representations only on
specific issues theme. Situational problems are solved
correctly, but there is no justification response.
Student passive when discussing CDS.
Recipes are written with an inaccurate indication of
dose exposure to physical factors, there are
grammatical errors.
78
.
65-61% Satisfacto The correct answer to half the questions posed. The
ry
student knows the classification of continuous and
"3"
pulsed currents (galvanization, iontophoresis,
diadynamic, electric, electric pulp test, amplipulse)
but poorly versed in the mechanisms of action of
physical factors, incomplete lists contraindications to
CFT in this pathology. With the matter, said
uncertainly, has accurate representations only on
specific issues theme. Situational problems are solved
correctly, but there is no justification response.
Student passive when discussing CDS.
Recipes are written with an inaccurate indication of
dose exposure to physical factors, there are
117
grammatical errors.
89
55-60% Satisfacto The correct answer to half the questions posed. The
.
ry
student knows the classification of continuous and
"3"
pulsed currents (galvanization, iontophoresis,
diadynamic, electric, electric pulp test, amplipulse)
but poorly versed in the mechanisms of action of
physical factors can not enumerate contraindications
to CFT in this pathology. Poor seized with the matter,
said uncertainly, has exact representation only on
specific issues theme. Student is very passive when
discussing CDS.
Recipes are written with an inaccurate indication of
dose exposure to physical factors, there are
grammatical errors.
10 40-54%
Unsatisfa Lighting 1/10 of the questions at the wrong approach.
.
ctorily
Student does not know the physical factors
"2"
(galvanization, iontophoresis, diadynamic, electric,
electric pulp test, amplipulse). Practically does not
understand the mechanisms of action of physical
factors, does not understand the indications and
contraindications to the appointment of FT in this
pathology.
All recipes are written with blunders.
11 30-40 %
Unsatisfa Questions not answers. Does not know the physical
.
ctorily
factors (galvanization, iontophoresis, diadynamic,
"2"
electric, electric pulp test, amplipulse) and their
mechanisms of action. Is not able to prescribe
physical factors on the topic.
For the presence of students in the classroom, in
118
proper form, with a notebook.
7. Chronological map classes
Stages classes
Form
Time 270 min
1
Check
Attendance and notebooks
check
10min
2
Explanation theme.
10min
3
Introductory word teacher
(justification themes).
Theoretical part
Verbal response.
30min
4
Analytical part
Talk "chart", to solve the
tests.
60 mins
5
Provide students with visual
aids (tables, posters, logical
and didactic structure,
slides, videos, diagrams) and
giving explanations to them.
The practical part
Implementation of
practical skills
Conclusion teacher
Evaluates on points. Gives
the task for homework
6
7
40 mins
Break
10 minutes
45 mins
40 mins
25 mins
119
Appendix-6
8. Control questions:
1. What purpose has the rehabilitation treatment for complex diseases digestive tract.
2. Methods of rehabilitation and their advantage in diseases of chronic gastritis.
3.What know means of physical rehabilitation in diseases of the urinary tract.
4. Purpose - application of natural factors.
5.What contraindication in UHF in diseases of urinary tract.
6. Possible treatment methods with electric therapy in chronic nephritis.
Appendix-7
9. List of recommended literature.
9.1. General
"Medical rehabilitation" ed. Bogolyubov V.M. - Book I, II, III 3th ed. rev. et al.-M.: 2010.416s., Fig.
"Medical rehabilitation" ed. Bogolyubov V.M. M-2007 3-volume edition
Ponomarenko G.M. "Private physiotherapy» Medical M. 2007 698s.
"Medical rehabilitation" ed. V.A. Yepifanova Moscow 2005. 400c
Bogolyubov V.M. "Methods and techniques of physiotherapy" M. 2001 s.280
Ushakov A.A. "Practical Guide to Physical Therapy" by M. 1996 250c.
Epifanov V.A. "Therapeutic physical culture" M. 2003 s.674
Dubrovsky V.A. "Therapeutic exercises", M. 2004. pp. 450
Dubrovsky V.I. "Therapeutic physical training (kinesitherapy)": Textbook. for university
students. - 2nd ed., with ter.-M., 2001.-608 p.: ill.
Physical rehabilitation: under the general editorship. prof. S.N. Popova Ed. 3rd. - Rostov-onDon, 2005.-608 pp.
The text of lectures and tutorials.
120
9.2. Foreign literature:
Marlis Gonzalez-Fernandez, MD, PhD, Jarrod David Friedman, MD Physical Medicine and
Rehabilitation Pocket Companion
Mark Harrast, MD, Jonathan Finnoff, DO Sports Medicine Study Guide and Review for Boards
Wainapel, Stanley F.; Fast, Avital (Editors) Alternative Medicine and Rehabilitation
A Guide for Practitioners 2003 - Demos Medical Publishing
Consuelo T Lorenzo et al. Physical Medicine and Rehabilitation Medscape Reference
2011 - WebMD
Sara J. Cuccurullo (Editor) Physical Medicine and Rehabilitation Board Review
2004 - Demos Medical Publishing, 848 pp.
9.3.Internet resources:
1.
2.
3.
4.
5.
6.
7.
www.tma.uz
www.ziyonet.uz
www.kimdao.ru
www.doktor.ru,
www. medinfo. home.ml.org
http://www.restart-med.ru
http://www.mirmed.ru
121
MINISTRY OF HEALTH OF THE REPUBLIC OF UZBEKISTAN
CENTRE FOR MEDICAL EDUCATION
Tashkent Medical Academy
"APPROVED"
Pro-rector for Academic Affairs
Prof. Teshaev O.R.
____________________
"________" ___________2014.
Department: Department of Folk Medicine, Rehabilitation and Physical Education
Subject: Rehabilitology
Theme: Practical lesson
“Application of physical factors and physical therapy in the rehabilitation of
patients with diseases of the nervous system (neuritis of the facial nerve,
stroke, low back pain), rheumatologic patients (arthritis and ostearthroses)."
Practical lesson
Educational technology
122
Tashkent-2014
EDUCATIONAL TECHNOLOGY OF THE PRACTICAL LESSON
Theme №3"Application of physical factors and physical therapy in the
rehabilitation of patients with diseases of the nervous system (neuritis of the
facial nerve, stroke, low back pain), rheumatologic patients (artrites and
osteartrosis)."
Study time: 270 mins
Type of lesson
Structure of the training sessions
(Lesson plan)
The aim of the
classes
Number of students 8-12
Exercise topics.
1. Introduction
2. Theoretical part
3. Analytical part
- chart
- tests
- situational tasks and recipes.
4. Practical skills.
Form a knowledge-indications and contraindications
physiotherapy treatment and exercise therapy in patie
with diseases of the nervous system and rheumatolog
patients;
-Teach the skill to choose the right treatment strategy
and the main directions of physiotherapy treatment fo
diseases of the nervous system and the musculoskelet
system;
-Teach drafting complex rehabilitation depending on
the stage of the disease;
-To give an idea about the etiopathogenic and
symptomatic treatment using physical factors of
diseases of the nervous system and the musculoskelet
system, depending on the stage of the disease.
123
The student should know:
The graduate should be able to:
Pedagogical objectives:
-Acquaint with the indications and
contraindications for physiotherapy treatment and
exercise therapy in patients with diseases of the
nervous system and rheumatologic patients;
- To reveal the concept of etiopatogenetic and
symptomatic treatment using physical factors of
the gastrointestinal tract, urinary tract and kidneys
according to the stage of disease;
-Teach drafting complex rehabilitation depending
on the stage of the disease;
-Teach yourself to let designated physiotherapy;
-Teach yourself to pick up a set of exercises and
therapeutic exercises to demonstrate their patients.
- Indications and contraindications to physical therapy
and exercise therapy in patients with nervous system
and rheumatologic patients;
-The main directions of physiotherapy treatment for
diseases of the nervous system and rheumatologic
patients;
-Mechanisms of action of physical factors and means
exercise therapy on patients with diseases of the
nervous system and rheumatologic patients.
Perform practical skills - to make complex
rehabilitation measures using physical therapy and
exercise therapy on an outpatient receiving individual
patient, based on the examination, medical history,
medical history data and laboratory and instrumental
data;
-Write the recipe on the assigned physical factors;
-Conduct designated procedures;
-Make an exercise of physiotherapy for patients with
diseases of the nervous system and rheumatologic
patients.
Learning outcomes
-List the indications and contraindications for the
purpose of physiotherapy and exercise therapy in
patients with diseases of the nervous system and
rheumatologic patients;
-Called main purpose of use of physiotherapy and
exercise therapy factors in patients with diseases of th
nervous system and rheumatologic patients;
-Up complex of rehabilitation measures, depending o
the stage of the disease;
Self-appointed spend physiotherapy;
Self-selected set of exercises of physiotherapy and
demonstrate their patients.
124
Training Methods
Forms of educational activity
Conversation, discussion, brainstorming, demonstrati
Front, collective work groups, "Learning Together".
Learning Tools
Distributing educational materials, visual aids, videos
board-stand, photo, text.
Methods and feedback means
Assessing knowledge and monitoring.
Quiz, test, presentation of results of a learning task or
solving case studies, demonstrating the independent
exercise of practical skills.
Typical flow chart of lesson
Stages of work and
time of 6 hours
270 minutes
Stage 1
Action
Teacher
Theoretical part
20 minutes
1.1. Checks attendance and notebooks
20 minutes
1.2. Names the classes theme, its
goals, objectives and expected
learning outcomes. Introduces the
mode of operation in the lesson and
evaluation criteria (see guidance for
students).
25 minutes
1.3 Gives task for independent work,
references to independent work.
Reported indicators and criteria for
evaluation. (Appendix 6)
25 minutes
Learners
Listen, write, update, ask
questions.
1.4. Conducts a quiz in order to
activate the students knowledge on
the topic:
1.5. Break
10 minutes
Stage 2
60 Minutes
Analytical part
Solve the test tasks, answer
questions, present during
2.1. Leading the discussion topics of physiotherapy patients and LH
practical classes.
in the classroom, work
Distributes materials of the case and
independently on the FT
introduces the algorithm analyzing the devices and physical therapy
situation. Divides the students into
room, work in groups, present
groups.
the results of the group work.
30 Minut
2.2. Assesses students' background
125
knowledge using new educational
technologies (small groups, case
studies). (Appendix 3)
Teaches proper selection of methods
of rehabilitation patients.
45 minutes
2.3 Break
Stage 3
60 Minutes
The practical part.
3.1 implementation of the practice
session.
3.2.Makes opinion on the subject,
focusing students on the main,
according to the importance of the
work done for future professional
careers.
Conduct self-esteem,
interassessment. Ask
questions. Recorded
assignment.
20 minutes
Commends the work of groups and
individual students, summarizes
interassessment. Analyzes and
evaluates the degree of achievement
of lesson. (5 - application).
10 minutes
3.4.Gives task for independent work,
references to independent work.
Reported indicators and criteria for
evaluation. (Appendix 6)
Gives the task to prepare for the next
lesson.
1. Motivation
Neurology and rheumatology - it is the field of medicine, where physical factors are very
widely used. Preformed natural and physical factors are used in the initial forms of the disease
with the purpose of delaying its progression, as well as during the recovery period after vascular
accidents, cranial trauma, injuries and diseases of the spinal cord and peripheral nerves
extremities, peripheral nervous system diseases, arthritis, arthrosis, etc. etc. Ability to navigate
among individuals and resort factors and prepare a comprehensive treatment using them is
necessary for each GP.
126
2. Interdisciplinary and intradisciplinary communication
Teaching the topic is based on the knowledge students the basics of biochemistry, biophysics,
anatomy, normal and pathological physiology of the nervous system (NS) and musculoskeletal
(ODA), the etiology and pathogenesis of diseases of the National Assembly and the DDA,
general physiotherapy and exercise therapy foundations. Acquired during the course of
knowledge will be used in traversing disciplines therapy, neurology, neurosurgery,
rheumatology, and GPs in their practice.
3. Contents of the lesson
3.1. Theoretical part
A list of the issues on this topic :
Etiopathogenesis, clinical features and treatment with physical factors of diseases of the
nervous system (cerebral arteriosclerosis, stroke, traumatic brain injury, cerebral palsy,
poliomyelitis, neuritis of the facial nerve, trigeminal neuralgia, lumbodynia).
 Etiological, pathogenetic and symptomatic treatment with physical factors of diseases of the
musculoskeletal system (rheumatism, rheumatoid arthritis, osteoarthritis deforming,
osteochondrosis, ankylosing spondylitis, scoliosis).
 Physical factors are used at different stages of the disease: acute, subacute, remission.

The achievements of modern neuroscience in the diagnosis and treatment of acute
cerebrovascular implemented in medical practice as a system of rapid phase of stroke care, can
significantly improve the outcome of the disease. The real challenge is to achieve housEchold
"independence" is not less than 70% patients, survivors of stroke.
The first condition for solving this problem - fast hospitalization of patients in specialized
chambers (blocks) of intensive therapy in vascular neurology wards. The second important
condition - the development and improvement of services neurorehabilitation in all stages of
stroke care. To refer to the basic principles of neurorehabilitation: early start, continuity,
continuity, multidisciplinary organization principle.
Isolated stationary phases of outpatient and inpatient neurorehabilitation.
Strategy of rehabilitation therapy is the elimination or reduction of pathological changes
forming permanent neurological syndromes. True restoration of brain functions is only possible
in the first 6 months. post-stroke, it is ensured "disinhibition" functionally inactive nerve cells,
including in the area "ischemic penumbra" and caused the disappearance of edema, improving
metabolism and neuronal activity synapse reduction. Another recovery mechanism is
compensation that is provided by the presence of multilateral anatomical connections between
the various divisions of the nervous system and the plasticity of the nervous centers.
127
Early rehabilitation in acute stroke.
The purpose of rehabilitation of patients after cerebral stroke; - Not only pathophysiological
improvement, but also the improvement of functional abilities, social and domestic activity.
Since the degree of self-service is mainly determined by the motor deficit, the most important
aspect is neurorehabilitation motor rehabilitation, which should include the following areas:
drug therapy, treatment position, kinetic therapy, vibration massage, physiotherapy,
acupuncture, biofeedback techniques based on biofeedback.
These methods are directed to:
restore proper system start-up and reflex afferent
activities
developing amplitude and accuracy of active movements;
struggle with increased muscle tone and alignment of its asymmetry;
prevention of contractures and pain;
improving autonomic and sensory motor acts software;
a focus on consistency and correctness of the "inclusion" of muscles in a particular motor act.
■
•
•
■
■
■
Treatment includes the provision; stacking paralyzed limbs at the same level in the horizontal
plane at the patient in a healthy side, which provides a uniform gravitational load on the limb;
position on the paralyzed side; laying in a position opposite position Wernicke-Mann; position
without a pillow on my stomach; pronation with reliance on the forearm and hand; limit time
spent on the back.
Despite its simplicity, corrective posture (treatment position) contribute to: reduce severe
spasticity, increased sensitivity, reduction of pathological activity with tonic neck and labyrinth
reflexes, muscle tone alignment asymmetry and restoration of the body schema. Treatment
provision prevents the development of contractures, pain and pathological settings in the limbs
and trunk.
Kinesotherapy. Basis of early motor rehabilitation is developmentally valid
kinesotherapy. Playback methods kinesotherapy formation sequence of movements of the child,
and domestic skills training using physiological synergy allows the patient to re-pass the
developmental process of becoming motility. Developmentally kinesotherapy solves problems
caused by physiological modeling of hierarchical control of motor function of the nervous
system. Of the numerous methods kinesotherapy currently used: reflex system Feldenkrais
exercises and coordination Gymnastics "Balance". The choice is justified as sufficient
effectiveness of these procedures, and the simplicity of their execution, which allows to attract
ballroom classes with relatives and caregivers.
Passive movements and massage should be administered as early as possible, since the day
when the patient regained consciousness. In this early recovery period ( first period) position
correction should continue, and massage techniques to perform surface (light stroking) in the
affected limb muscles (flexors and pronator hand flexors and adductors feet), which usually
occurs toning. For the rest of the limbs massage may be more profound than stroking, rubbing
and apply kneading slack. Massage combined with the slow, carefully conducted passive
movements. If the patient has not yet appeared increased muscle tone, non-rigidity / contracture,
the passive and active movement to start with the distal parts of the limbs. When there are
increased muscle tone, stiffness and synkineses movements appropriate to start with the large
joints of the limbs.
Breathing exercises are used as special exercises that help normalize blood circulation; as a
means of reducing the general and special load procedure LH and massage; Patients learning
proper breathing rational, voluntary regulation of breathing during muscular activity and
decrease muscle tension.
Exercises in arbitrary relaxation of skeletal muscles are used as special that can help reduce
muscle tension, and as a means of extending the range of motor skills, abilities and qualities.
128
These exercises have a clear inhibitory effect on the CNS. Work motor apparatus entirely
subordinated CNS: excitation of the motor centers causes muscle contraction and tonic tension
and brake centers causes muscle relaxation. Completeness of muscle relaxation is directly
proportional to the depth of established inhibitory process.
Main tasks of TrE: prevention of contractures by reducing muscle tone and control
synkineses.
Special exercises with movement disorders (Early recovery period).
1. Exercises for the upper limbs. Restoration of movement in hand with hemiparesis is slower
than in the lower extremities, and not always hand function recovered completely. When
hemiparesis and disturbed function of the deltoid muscle, and with it reduced its firming joint
role; when transferring the patient in sitting and standing there is a danger of stretching the joint
capsule under the weight of hanging limbs and going of the humeral head from the acetabulum
(subluxation of the joint). This may be accompanied by pain in area of the joint, periarticular
muscle tension, which hinders movement. Methodology strengthen the shoulder joint: initial
posture lying on the healthy side, folded hands, twisting the fingers so that the finger affected
arm I was on top of one finger healthy. Methodist, standing in the face of the patient, puts his
right hand around the shoulder joint, fixing, so the joint. Elbow of the affected arm in a bent arm
he holds the left hand in order to gently press without pain head of the humerus to the glenoid
cavity. This is a position with the installation which produces Methodist left hand slowly and
smoothly 5-20 movements of small amplitude. After executing these movements the patient's
arm is fixed (At Original sitting or standing). The same exercise for the hands and performed
in the late period of recovery, often arise when contractures and increased muscle tone (posture
Wernicke-Mann). In these cases, the hand gradually moved away from the body (to the
horizontal level) and Methodist produces these exercises, fixing the humeral head in the glenoid
cavity. Exercise in the abduction of the shoulder forward, up and away: initial posture lying on
the healthy side. One hand holds the Methodist bent elbow to the forearm in pronation position,
the palm of the other hand holds the brush in the patient unbent position and finger III devotes
one finger to the side. Bringing the head to shoulder glenoid cavity, as in the previous exercise,
the patient's hand is raised up, assign it to the side and back.
Exercise unbending arm at the elbow diverting it to the side: initial posture supine. Methodist
with one hand holding the outside of the elbow, the other supports the brush, but so that one
finger is superimposed on its rear surface, and the other - on the palmar surface; 1 finger of the
affected arm by pressing the brush practitioner is put aside.
Supination and pronation of the forearm Methodist holds while straightening the fingers and
wrist with one hand while the other hand supports the patient's elbow.
Lightweight raise and lower hands using good hand, pinch and block (a block device) is used
with the advent of the initial paralyzed arm, even subtle, voluntary movements.
I first exercise conducted once a day (under the control of a practitioner), and further two times
(the second time the patient performs the exercise for you). If during passive exercises for the
hand of the affected arm brush Methodist keeps one hand in extension, and I finger retracted,
then the exercises for the lower extremity foot Methodist gives normal (physiological) position
or holds it in extension-These measures are essential to prevent synkineses in the hands and feet.
In a number of exercises for upper limb patient should fix the affected brush healthy.
2. Exercises for the lower extremities. The most common exercises to restore movement
of the lower extremity:
- Rotation of the hip; adduction and abduction of the thigh;
- Passive flexion of the knee (thigh when unbent) to an initial lying on its side;
- Passive flexion and extension of the knee;
- Passive motion in the ankle joint;
- Raise and lower legs using his good hand, pinch and block (the latter is advisable to start as
soon as the foot appear notable voluntary movements).
129
Even with bedrest each procedure should start with exercises for healthy limbs, and then
rotate them with active exercises for the paretic limbs and breathing exercises, including rest
periods. At first, the special exercises for paretic arm and legs is recommended only alleviate the
situation and assist in their implementation. With increased muscle rigidity active exercises
should be combined with massage, passive movements and muscle relaxation exercises.
Active exercises should not cause pain. They operate in a slow and quiet pace without forcing
the range of motion. Impact mainly on upper limb extensors, flexors, leg and foot dorsal flexors,
to prevent the formation of normal hemiplegic contractures. As smoothing neurological
symptoms should gradually prepare the patient for getting up, changing his position in bed: turns
on its side with the return to supine position, translating into a sitting position. This is done
during procedures LH, and at other times with the help of staff. To teach the patient to a sitting
position in bed should be from the moment appear as arbitrary motion in the hip joint, but with
the general condition and during the time after stroke. For the first time a sitting position easier,
providing focus
The clinical picture of stroke allocate 4 periods: precursors during acute period (10 - 15 days
to 4 weeks depending on the severity), the recovery period (from 4-6 weeks to 12 months) and
residual, characterized by the presence of persistent sequelae.
The aim of physiotherapy is full (or partial) restoration of damaged central nervous
system function and return the patient to actively work and everyday life.
Physical methods of treatment used to reduce cerebrospinal fluid dynamics (decongestants
methods), blood rheology (hypocoagulating methods), metabolism of nervous tissue (enzyme
stimulating methods), cortical functions (methods psychostimulant) bioelectrogenesis brain
(trophostimulant methods) prevent progression of motor disorders (neurostimulant methods ).
Physical methods for the treatment of patients with ischemic
Psychostimulant methods: long aerotherapy, oxygen baths, chromotherapy nonselective.
Tonic method: therapeutic massage.
trophostimulant methods: diadynamic, amplipulse, electrical, local darsonvalization.
neurostimulant method: neuroelektrostimulyatsiya.
enzyme stimulating methods: infrared laser, transcerebrally UHF-therapy.
hypocoagulant method: low-frequency magnetic therapy.
Contraindications: acute illness, impairment of consciousness, psyche (reactive psychosis)
and cortical functions (aphasia, agnosia), expressed paralysis, extrapyramidal (hyperkinesis) and
cerebellar (ataxia) disorders, inability to look after themselves, a violation of the pelvic organs,
cardiovascular and respiratory failure decompensation.
Spa treatment
In local motels direct patients with transient ischemia, without repeated crises, with
hypertension stage I-II in 3-4 months after the attack, with transient ischemic attacks, cerebral
angiodistonicheskimi crises occurring organic with focal symptoms, resolved within days, not 2
weeks before the development of the disease, the effects of intracerebral hemorrhage
(hemorrhagic stroke) not earlier 4-6 months with the possibility of self-service and selfmovement without compromising intelligence, aphasia, and do not require surgical intervention,
with the consequences of stenosis or occlusion of cerebral major arteries of the cerebral arteries (
cerebral infarction) during the recovery period is not previously 4-6 months with the possibility
of self-service and
Contraindications to the sanatorium treatment are severe stroke with loss of motor function,
diseases of the nervous system with mental disorders.Improving the condition of patients
130
suffering from the effects of cerebral circulation in patients with self-service, without the
expressed intellectual-mental disorders ascertain to improve the overall condition, hemodynamic
stabilization, normalization and improvement of sleep restoration cranial nerve function, muscle
strength buildup previously affected limbs 1-2 points , increasing the tempo of active movements
in them, normalize muscle tone, recovery coordination, gait improvement, rehabilitation or
substantial decrease in the intensity of sensitivity disorders, vegetative-vascular reactions as
intellectual-mental disorders (for REG, SPL D, EEG). Sustained improvement characterized by
the persistence or tendency to further restoration of disturbed brain function, hemodynamic
stabilization. Deterioration observed during exacerbation of the underlying disease
(hypertension, arteriosclerosis, rheumatism), deepening signs of focal brain lesions, cerebral
symptoms accession, repeated violations of cerebral circulation, the growth of intellectualmental disorders. According to REG, ultrasonography - the deterioration of cerebral circulation;
by EchoEG - increase intraventricular hypertension; EEG - pathological lesions of brain activity;
changes in blood clotting properties.
Physioprophylaxis
Physioprophylaxis aimed at preventing the development of stroke and their recurrence, the
adaptation of patients with sequelae of cerebrovascular events in daily life and work through the
treatment of hypertension (antihypertensives, diuretics and vasodilators methods),
atherosclerosis, ischemic heart disease (cardiac, vasodilators and hypocoagulating methods ),
prevention of metabolic disorders (diabetes, obesity); correction of metabolic disorders
(immune-boosting methods), functional disorders of the central nervous system (sedative, tonic,
and psychostimulant psychorelaxing methods), recovery of motor and motor functions
(trophostimulant, neurostimulant, enzyme stimulating methods).
Encephalopathy gradually progressive organic brain tissue changes due to chronic cerebral vascular insufficiency
caused by various cardiovascular diseases - hypertension, atherosclerosis, rheumatism, etc.
Isolated atherosclerotic in origin, and other forms of hypertensive encephalopathy.
Encephalopathy occurring in various diseases, has much in common both in the nature of clinical
manifestations, and within, but some of its features still depend on the etiological factor.
In the pathogenesis of the disease are important factors such as arterial hyper-and hypotension,
ischemic heart disease, arrhythmias (paroxysmal, atrial, sinus), chronic circulatory failure and
respiratory disorders rheological properties of blood (hypercoagulability), fat and carbohydrate
metabolism, expressed osteochondrosis whiplash, developmental abnormalities of the cervical
vertebrae, functional disorders of the autonomic nervous system. These factors lead to a breach
of cerebral hemodynamics (chronic cerebral circulatory insufficiency, hypoxia and metabolic
disorders in the nervous tissue, and prolonged their availability - destructive processes and death
of nerve cells, which in turn leads to a more profound functional disturbances of the autonomic
and cortical processes nervous system).
For the initial period of the disease is characterized by pseudoneurostenic syndrome:
emotional instability, irritability, memory loss, headache, dizziness, sleep disturbances, tinnitus
and other symptoms. There are often increased vascular reactivity, blood pressure instability,
especially in hypertension, which is characterized in that stage carryover increase blood pressure.
Signs of organic lesions of the nervous system thus usually do not reveal. Fundus retinal artery
narrowing note. Operability of patients in this stage of the disease persists. Treatment and
preventive measures can contribute to stable compensation.In an unfavorable course of the
disease, especially when exposed to various exogenous factors, clinical symptoms become more
severe. Fatigue, headache, dizziness, sleep disturbances are stubborn; often arise fainting.
Enhanced emotional instability. Neurological examination revealed structurally unstable organic
symptoms: cranial asymmetry of innervation of the tendon reflexes, muscle tone, fuzzy
pyramidal signs, etc. Notes vegetovascular lability often occur cerebral vascular crises, after
which enhanced organic symptoms ("traces"). Often changes mind - appear self-doubt, a
tendency to hypochondriacal condition, phobia, explosiveness, egocentrism, slabodushie
compounded by memory disorders, particularly in the current events. Changes in the fundus
become more significant and are in the nature of atherosclerotic or hypertensive angiosclerosis.
Ability to work is reduced. When pronounced vascular encephalopathy in connection with the
increase of the morphological changes of brain tissue clinical picture becomes more severe.
Progressive decline in memory and attention narrows the range of interests and gradually
developed dementia. Course of the disease is aggravated by repeated crises and cerebral stroke.
In the neurological status during this period marked distinct organic symptoms:In an unfavorable
course of the disease, especially when exposed to various exogenous factors, clinical symptoms
become more severe. Fatigue, headache, dizziness, sleep disturbances are stubborn; often arise
fainting. Enhanced emotional instability. Neurological examination revealed structurally
unstable organic symptoms: cranial asymmetry of innervation of the tendon reflexes, muscle
tone, fuzzy pyramidal signs, etc. Notes vegetovascular lability often occur cerebral vascular
131
crises, after which enhanced organic symptoms ("traces"). Often changes mind - appear selfdoubt, a tendency to hypochondriacal condition, phobia, explosiveness, egocentrism, slabodushie
compounded by memory disorders, particularly in the current events. Changes in the fundus
become more significant and are in the nature of atherosclerotic or hypertensive angiosclerosis.
Ability to work is reduced. When pronounced vascular encephalopathy in connection with the
increase of the morphological changes of brain tissue clinical picture becomes more severe.
Progressive decline in memory and attention narrows the range of interests and gradually
developed dementia. Course of the disease is aggravated by repeated crises and cerebral stroke.
In the neurological status during this period marked distinct organic symptoms: cranial nerve
supply failure, nystagmus, signs of pyramidal insufficiency, sometimes speech disorders, paresis,
sensory disturbances and pelvic disorders. Often there is a pseudobulbar syndrome - dysphonia,
dysarthria and dysphagia, combined with symptoms of oral automatism, increased mandibular
and pharyngeal reflex violent weeping and laughter. Pseudobulbar syndrome is caused by
multiple small focal changes in the white matter of both hemispheres of the brain or brain stem,
destroying supranuclear fibers on both sides. With the defeat of the basal ganglia there are
various extrapyramidal symptoms, which can reach the degree of parkinsonism. For
parkinsonism, sometimes when developing vascular encephalopathy, characterized by signs of
destruction and other systems, in particular pyramidal. Fundus at this stage say gross changes:
atherosclerosis - retinal vascular sclerosis, sometimes symptoms of copper and silver wire; with
hypertension - hypertensive retinopathy angiosclerosis and the phenomenon of crossing
arteriovenous (symptom Salus I-II-III), a phenomenon Gvista sometimes hemorrhage.
Main syndromes: encephalopathy, DYSCIRCULATORY and metabolic disorders.
Treatment is aimed at correcting violations general hemodynamics and microcirculation. Used
antihypertensives (pentalgin, hexon, Inderal, obzidan etc.), vasodilators (aminophylline,
papaverine, stugeron, Cavintonum, sermion, redergin, Teonikol, kordafen, korinfar
pentoxifylline), anticoagulants (aspirin, chimes, doksikum), nootropics ( piracetam, Pyritinol,
aminalon, gammalon, Phenibutum), antioxidants (vitamin E, Aevitum, vitamin C, pyridoxine,
hydroxy butyrate sodium, folic acid) and correction functions of the central and autonomic
nervous system tranquilizers (seduksen, fenozepam) and vegetokorrektorami (Belloidum,
Bellataminalum, Bellaspon). Shall adjust metabolic disorders by normalizing metabolic
disorders, reducing energy needs of the brain and increase its resistance to hypoxia.
Physical methods of treatment used to improve cerebral blood flow (vasodilators and
antispasmodics methods), stimulation of brain bioelectrical activity (toning methods) and
activation of its trophics (trophostimulant methods) and metabolism (enzyme stimulating
methods), reduction hypercoagulable (hypocoagulating methods).
Physical methods for the treatment of patients with circulatory encephalopathy
Vasodilators methods: transcerebrally electrotherapy, iontophoresis of vasodilators and
cerebral circulatory stimulant, aromatic baths.
Toning methods:
therapeutic massage, contrast baths, showers, whirlpool baths,
thalassotherapy 1 .
trophostimulant methods: diadynamic, amplipulse, electrical, local darsonvalization.
enzyme stimulating methods: infrared laser, transcerebrally UHF-therapy 1 , Iontophoresis
stimulants metabolism, air baths.
hypocoagulant method: low-frequency magnetic therapy.
Contraindications: pronounced cerebral arteriosclerosis with mental disorders, hypertension
stage 111, senile dementia, Alzheimer's disease.
Spa treatment
Patients with circulatory encephalopathy without cerebrovascular and expressed
psychopathological disorders (including in combination with hypertension stage I-II) directed to
climate-treating and balneal resort.
Physioprophylaxis aims to improve hemodynamics and microcirculation (vasodilators
methods), correction of metabolic and trophic disorders (catabolic trophostimulant and methods),
the restoration of the central and peripheral nervous system and the immune (immune-boosting
methods).
TRAUMATIC BRAIN DISEASE
Acute traumatic brain damage are divided into two groups: closed and open. Closed
head injury include concussion (concussion), bruise (contusion), compression (compression) and
a fracture of the skull base and vault in the pathogenesis of blunt trauma distinguish primary,
direct mechanical effect of a traumatic impact on the nerve cells and secondary - the impact on
the brain of different factors , under the influence of injury arising. Hydrodynamic forces
generated by hitting the skull and microwave wave rushes from the lateral ventricles to the III
ventricle and then through the water of the brain (Sylvian aqueduct) to the IV ventricle, have a
great impact on a relatively fixed parts of the brain (the hypothalamic-pituitary region and
brainstem) .
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Direct tissue trauma brain function violates centers that regulate breathing and cardiovascular
activity, alters the functional properties of the reticular formation of the brain that plays an
important role in maintaining wakefulness. Neurodynamic disorders (interneurons traumatic
asinapsy) increase impulses damaged tissues of the receptor formations meninges. Huge role
Vascular disturbances: after brief spasm occur phlebarteriectasia stasis followed by an increase
in their permeability. Along with a number of vascular rupture and hemorrhage produced by
diapedesis. Simultaneously observed a sharp increase in venous pressure, venous stasis, that
along with choroidal plexus traumatization increases the production of cerebrospinal fluid and
may lead to acute hydrocephalus. Important to increase the permeability of the blood-brain
barrier. When an injury skull enhanced transition of various biologically active compounds of
molecules through the wall of cerebral and meningeal vessels. Certain role in the pathogenesis of
barrier disorders in acute trauma plays accumulation of acetylcholine in the cerebrospinal fluid.
Trauma is also a stressor causing stress reaction in the body. In its early period of increased
allocation of pituitary growth hormone, which stimulates mineralocorticoid formation in the
adrenal cortex, thus increasing the vascular permeability. Found that glucocorticoid (second)
phase of injury in severe cases may be missing. These processes lead to a change in state of
colloidal proteins, changes in pH towards acidosis and brain edema formation. These
pathogenetic links cause cerebral manifestations, combined with local, which are caused by
direct damage to certain areas of the brain.
Pathological disorders are divided into primary and secondary. The primary concern cracks
and fractures, contusion foci of softening of the brain tissue, primary necrosis and bleeding, to
the secondary - edema and brain swelling, late hemorrhage, brain replacement by scar tissue,
degenerative changes, and infectious complications. In the late period of the original can be
detected cysts brain fusion shells, hydrocephalus. Open skull injury are accompanied by the bone
structure of the skull, meninges with the introduction of debris into the substance of the brain,
which leads to liquorrhea and bleeding (external and internal) and deep structural changes of the
brain.
The clinical picture of open head injuries are the leading cerebral syndromes (disturbance of
consciousness, vital functions), breach liquorodynamics (CSF hypotension), cerebrovascular
accident (subdural, epidural, subarachnoidal) and intracerebral hemorrhage (hematoma).
Long-term consequences of brain injury may occur asthenic disorders (asthenia option
traumatic encephalopathy), irritability (an explosive version), euphoria and a significant decrease
in criticism (euphoric version), apathy and aspontaneity (apathetic version).
Traumatic epilepsy is not an independent one traumatic encephalopathy, as epileptiform
seizures may occur in different variants of traumatic encephalopathy.
Asthenia in traumatic encephalopathy has several features.
These include fatigue,
accompanied by excessive irritability and explosiveness that occurs in an insignificant occasion
tearfulness, hypersensitivity, characterized by intolerance loud noises and bright lights. Marked
autonomic lability, expressed in the variability of pulse rate and breathing with little exertion,
excessive sweating, severe flushing of the skin, are replaced by pallor, etc. Observed persistent
headaches, dizziness. Asthenic conditions and accompanying disorders can become stronger or
weaker.
Deterioration is usually associated with certain physical illnesses, infections, intoxication, as
well as trauma and fatigue.
Main syndromes: vegetodistonic (disturbance of cerebral hemodynamics), hypertensionhydrocephalic (microdynamic violations), and astenodepressing psychoorganic.
Physical treatments aimed at improving cerebral hemodynamics (vasodilators,
hypocoagulating methods), metabolic activation of the nervous tissue and its functional
properties (enzyme stimulating methods), correction of the effects of trauma (psychostimulant
methods), improving body tone (tonic methods) and reduction of elevated CSF pressure
(diuretics Methods).
Physical methods of treatment of patients with acute brain injuries
Vasodilators methods: galvanization and iontophoresis of vasodilators and cerebral
circulatory stimulants.
enzyme stimulating methods:
iontophoresis stimulants metabolism, air baths,
transcerebrally UHF-therapy, infrared laser therapy 2 .
Diuretic methods: low intensity UHF-therapy, sodium chloride baths.
hypocoagulant method: LOC.
psychostimulant method: oxygen baths.
Contraindications: the acute phase of injury requiring emergency hematoma, impaired
consciousness, mental disorders, in violation liquorodynamics
decompensated, severe
autonomic dysfunction, seizures.
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Spa treatment
Patients with sequelae of closed (2 months) and open (after 5 months) brain injury in asthenic,
vascular, hypothalamic syndromes without pronounced intracranial hypertension is not
accompanied by a sharp disturbances in the motor area, preventing self-care and independent
movement, seizures and mental disorders directed to balneotherapy and mud-cure resorts.
Contraindications to the sanatorium treatment effects are severe cranial trauma with significant
fallout of motor functions with seizures, mental disorders.
Improving the condition of patients with closed consequences (4 months) and open (6 months)
in brain injury rehabilitation period ascertain the termination or significant reduction in the
intensity of headaches, dizzy spells, impaired coordination of movements, normalization of sleep
and adequacy of emotional reactions, sensitivity, recovery cranial nerve function, reflexes,
sensitivity, intellectual-mental disorders, there are no signs of intracranial hypertension
according EchoEG, skull radiography and ophthalmoscopy and normalization of brain activity
by EEG; sustained improvement - for headaches of moderate intensity, short duration, no more
than once a month, with a trend towards further normalization of motor-reflex Deterioration of
patients with an increase in fixed brain symptoms (headache, dizziness, nausea), ataxia,
intellectual-mental disorders, vegetative-vascular disorders accession syncope, general and focal
epileptic seizures and signs of intracranial hypertension rise according EchoEG, craniography
and ophthalmoscopy.
Physioprophylaxis
Physioprophylaxis aimed at preventing further progression of the clinical syndromes of
injury by improving cerebral hemodynamics (vasodilators and hypocoagulating methods)
liquorodynamics (diuretics and immunocorrecting methods); improving metabolism of nervous
tissue, increase its resistance to hypoxia (enzyme stimulating methods);
restore function of the central and autonomic nervous system with correction astenodepressing
syndrome (psychostimulant and toning methods).
Peripheral nervous system disorders
Prosoponeuralgia - defeat pairs of cranial nerves V - the most common of all types of
neuralgia.
In the etiology of trigeminal neuralgia attach great importance to the narrowing of bone holes,
where the nerve branch. Often the cause of SARS are neuralgia, rheumatism, malaria, and
various inflammatory diseases of the paranasal cavities of the nose, teeth. Trigeminal neuralgia
major clinical picture is a brief attack (from a few seconds to a few minutes) is extremely intense
pain. They are often localized in a single branch. Irradiation of pain observed in all the branches
and even in the neck, arms, neck, but never the pain does not go to the opposite side. Twinges of
pain may be accompanied by a reflex contraction of facial and masticatory muscles in the form
of tonic convulsions corresponding half of the face. Along with this marked autonomic
disorders: hyperemia half of the face, conjunctival redness, lacrimation, salivation.
Neuritis (neuropathy) of the facial nerve - defeat VII cranial nerves (mimic muscles
paralysis, Bell's palsy), occurs most often after exposure to cold, the flu and other infections.
Have a congenital anomaly of the facial value (fallopian) canal, abscess, venous stasis. Bell's
palsy is often secondary - in inflammatory processes of the middle ear and temporal bone, skull
trauma, especially with a fractured at the base of the processes in the brain membranes and
inflammatory tumors in the cerebellopontine angle. Facial paralysis can be caused by pontine
form of polio or encephalitis caused by the Coxsackie virus.
The clinical picture is characterized by paralysis or paresis of the facial muscles corresponding
to half of the face - the patient can not collect on the forehead creases, frown, close eyes, eye slit
while yawning (lagophthalmos). When you try to close the eye-rolling eyeball watching up and
broad band of sclera - symptom of Bell. On the side of paralysis dramatically lowered the angle
134
of the mouth, the patient can not "downturned" teeth, cheeks inflate - free air is available. Liquid
food is poured out of the corner of his mouth. Especially often visible facial asymmetry with a
smile and laugh. With the defeat of the facial nerve above a discharge tympani (chorda tympani)
facial paralysis is accompanied by disorder of taste on the front half of the relevant language.
The defeat of the stapes nerve (n. stapedius) characterized hyperacusia. Localization process
above a discharge greater petrosal nerve gives sharp violation of tearing and eye dryness. The
localization process in a cranked ganglion can develop symptom Gunta - rash herpetic vesicles
on the anterior surface of the ear, the external auditory canal, tympanic cavity in the back of the
palate and the front half of the tongue.
Bell's palsy is combined with pain and decreased sensitivity in their respective fields. The
defeat of the facial nerve in the cerebellopontine angle involving violations VIII couples
cerebellar disorders on the side of the hearth and pyramidal symptoms on the opposite side.
The clinical picture of trigeminal nerve and facial nerve neuropathy pain isolated,
inflammatory, metabolic, degenerative and neuropathic syndromes.
In therapy neuropathy (neuralgia) include anti-inflammatory (antibiotics, corticosteroids),
immunosuppressive, diuretics, antisense drugs vitamins B1, B6 and B 12 Providing reparative
and regenerative effect on the nerve, as well as metabolic and trophostimulant effects, analgesic
agents (Analginum, ibuprofen, indomethacin, diclofenac), mediators (neostigmine, nevalin,
galantamine), substances that improve the conductivity of impulses along nerve fibers.
Physical methods of treatment used to relieve pain (analgesic and anesthetic techniques), relief
of inflammation and edema (antiexudativ and decongestants, reparative and regenerative
methods), improvement of microcirculation (vasodilators methods) and metabolism
(hypocoagulating methods), improving the function of the neuromuscular fibers ( neurostimulant
methods).
Physical methods for the treatment of patients with diseases and injuries of the cranial nerves
Methods
of analgesia: transcranial electroanalgesia, diadynamic, CMT therapy for nerve exit
points 1 , short-impulse of electroanalgesia.
Anesthetic methods: iontophoresis anesthetics, floating on the nerves exit points 1 , Local
cryotherapy.
Antiexudativ methods: low intensity UHF-therapy1, MWSS-therapy.
Reparative and regenerative methods: infrared laser therapy, ultrasound therapy.
Vasodilators methods: iontophoresis of vasodilators ultratontherapy, red laser, paraffin 1 .
trophostimulant methods: therapeutic massage, local darsonvalization.
Miostimulant method: myoelectrostimulation2.
neurostimulant method: bioregulating electrostimulation.
Methods of analgesia:
Contraindications: trigeminal neuralgia and neuritis (neuropathy) of the facial nerve, acute
illness or injury, expressed vegetovascular, trophic and motor disturbances.
Spa treatment
Patients with trigeminal neuralgia with occasional bouts, neuritis and neuropathy (ischemic
and infectious origin) of the facial nerve in the early and late periods, including contracture, 2
months and later onset of the disease and sent to climate-treating balneal resort.
Contraindications to the sanatorium treatment are diseases and injuries of the cranial
nerves in the acute stage of the disease, as well as accompanied by severe disturbances in the
motor area (contractures) cranial nerves.
Physioprophylaxis
Physioprophylaxis aimed at preventing recurrence of the pathological process by increasing
microcirculation and metabolism of nervous tissue (vasodilators, trophostimulant methods),
restoration of function of the neuromuscular apparatus (neurostimulant methods).
Osteochondrosis
Osteochondrosis - it is primarily a disease of the intervertebral disc.
135
Intervertebral discs consist of the nucleus pulposus (the jelly-like substance) and more dense
fibrous ring, holding the nucleus in the center of the disk and perform the functions of the case.
When osteochondrosis various reasons (malnutrition disk microtrauma unfavorable staticdynamic load, etc.) and cracking occur separation of fibrous ring. It loses its ability to effectively
carry out its function. Initially, the movement occurs intradisc nucleusthen protrusion
(protrusion) of the disk, and even loss (prolapse) of the individual elements of the nucleus
outside of the ring, formed a herniated disc. While the surrounding tissue (spinal roots, vessels
and structures arise even spine radicular, musculo-tonic, neuro, spinal, vascular and visceral
disorders.
In clinical picture of osteochondrosis isolated reflex muscular-tonic, radicular, compressionradicular, vascular and neuro syndromes.
Treatment of patients with neurological manifestations of osteochondrosis requires the exclusion
of the stator dynamic loads for 7-10 days, the use of analgesics, non-steroidal anti-inflammatory
drugs (Voltaren, indomethacin, Celebrex, diclofenac) used vasodilators, reinforcing regional
blood flow and microcirculation (Trental, Teonikol , solkoseril, Actovegin, Nikoverin,
nikoshpan), dehydrating agents (Lasix, veroshpiron, Uregei, hydrochlorothiazide), muscle
relaxants (baclofen, lidocaine), anticholinergics (neostigmine, Nivalin, oksazil), adjuvants,
regenerative and reparative processes in the nerve fibers ( milgamma, vitamins B), drugs that
improve the exchange of connective tissue, prescribe medication therapeutic blockade
Physical methods for the treatment of patients with signs of osteochondrosis or osteoarthritis
of the spine are aimed at pain relief (analgesic methods); improvement of regional blood flow
and microcirculation in lumbar motion segments (vasodilators, hypocoagulating methods),
reduction dystrophy (trophostimulant methods) fibrodestruction (defibrosing, fibromodulating
methods), reduction of motor disorders (methods, corrective locomotor dysfunction) and the
removal of metabolic disorders (enzyme stimulating methods) .
Physical methods for the treatment of patients with neurological manifestations of
osteochondrosis
Methods of analgesia: diadynamic (Fig. 7.5), amplipulse, iontophoresis dipyrone, SFirradiation
erythema doses, transcranial electroanalgesia, radon, nitrogen, sodium chloride baths
1-3
.
Anesthetic methods: fluctuorisation, iontophoresis with anesthetics.
Vasodilators methods: 1-3
infrared irradiation, iontophoresis vasodilator drugs (vasodilators), red
laser, local barotherapy
.
Enzimostiuliruyuschie methods: inductothermy, vibrovakuumtherapy, oxygen, air baths 2 - 3 .
trophostimulant methods: therapeutic1 massage,
sismotherapy, showers, underwater massage,
thalassotherapy, electrodream therapy - 2 .
Defibrosing methods: iontophoresis defibrosing drugs phonophoresis defibrosing drugs,
turpentine, radon baths.
Fibromodulating methods: peloidotherapy, osocerite therapy, paraffin.
Methods of correction of locomotor dysfunction: hydrogen sulfide, whirlpool baths.
Myorelaxing methods: sismotherapy, warm, fresh, iodide-bromine baths 2.3 .
Rehabilitation in diseases of the musculoskeletal system.
Rheumatoid arthritis (RA) - a chronic autoimmune connective tissue inflammation, mainly
affecting the joints of the type of erosive and destructive progressive polyarthritis.
Etiology and pathogenesis of rheumatoid arthritis are still unknown, although the etiological
factors suggest the following: genetic (in patients with RA established a hereditary
predisposition to a breach of immunological reactivity) and infectious agents (Epstein-Barr
virus). In recent years, discusses the role of mycobacteria in the development of RA. They
express proteins stressors that can cause arthritis. RA risk factors include age older 45 years,
female gender, family history, concomitant diseases (congenital defects of bones and joints,
nasopharyngeal infection).
The pathogenesis of RA are autoimmune processes, which contributes to the emergence of a
deficit of T-suppressor function of lymphocytes. One of the etiological factors causing the
development of the immune response. Joint damage begins with inflammation of the synovial
membrane - synovitis, then acquiring proliferative character with damage cartilage and bone pannus. Intensity and type of clinical inflammatory immune response is determined by genes.
Damage to the immune complexes joint tissue leading to further autoantibody forming and
chronic inflammatory process. In the pathogenesis of RA cytokines play a huge role. They are
136
advantageously produced by immune system cells, bone marrow, fibroblasts, monocytes,
platelets, macrophages.
Of great importance in the pathogenesis of RA has also endothelial cells, which regulate the
processes of blood coagulation and platelet aggregation, vascular tone, immunoinflammatory
reactions synthesized cytokines are involved in all phases of acute and chronic inflammation.
Under the influence of an autoimmune inflammatory process formed granulation tissue
originating from the inflamed synovium is composed of fibroblasts, lymphocytes, macrophages,
and is rich in blood vessels. Pannus penetrates the cartilage from the synovial tissue and destroys
it by affecting enzymes induced cytokine production inside the pannus. Gradually, the cartilage
is replaced by granulation tissue, it disappears, and develops ankylosis. Chronic inflammation of
the periarticular tissue, joint capsule, ligaments, tendons leads to joint deformity, subluxation,
contracture.
It is now believed that autoimmune processes play a key role in the early stages of RA, and in
the later stages are set to non-immune mechanisms, i.e. ability to pannus growth, invasion and
destruction of articular cartilage.
Distinguish the following clinical and anatomical forms of RA. Articular form (Most
common) appears mainly characterized by progressive joint disease. RA with systemic
manifestations - in this form, in addition to typical articular syndrome, marked the defeat of the
internal organs. Mixed form includes RA develops in patients with other rheumatic diseases,
often osteoarthrosis or rheumatism.
Nature of the disease, the intensity of pain in RA is largely dependent on the degree of activity
of the process. She is currently divided into 3 degrees. The first (lowest) level of activity is
diagnosed when persistent, emerging only when moving, pain in the joints accompanied by
morning stiffness lasting no more than 1 hour Exudative changes in the joints are absent or
negligible. Mild laboratory indices of inflammation. ESR increased to 20 mm / h Moderate
gammaglobulinemia, rheumatoid factor can be detected only at low dilutions (1:3, 1:8). The
second (middle) level of activity is characterized by persistent persistent pain in the joints,
accompanied by morning stiffness. The latter can be reduced to the evening. In joints distinct
exudative changes on the background of proliferative processes. There are significant changes in
the blood. ESR increased to 40 mm / h, expressed gammaglobulinemia (22-23%). Rheumatoid
factor detected in the blood at high dilution it (1:81; 1:64). The third (highest) level of activity
manifested intense constant pain in the joints, followed by stiffness throughout the day. Exhibit
clinical manifestations viscerites (pleurisy, myocarditis, neuritis). Expressed exudative changes
in the joints and sharp inflammatory reaction of the blood with high titers of RF. Remission in
RA is diagnosed in the absence of joint pain and stiffness. Movement of the joints due to a
limited proliferative processes in the joints and periarticular tissues after previous exacerbations.
Laboratory tests for inflammation does not give abnormalities. By the nature of the flow of the
RA is divided into fast and slow progressing and without appreciable progression. There are 3
degrees of functional insufficiency of the musculoskeletal system: professional capacity when I
somewhat limited, with II degree - lost at the III degree - lost the ability to self-service.
The earliest signs of RA are morning stiffness in the joints, joint swelling lasting more than
1.5 months, symmetrical lesions joints of the hands; rapid regional muscle atrophy, subcutaneous
regional presence of nodules increased content of a-and y-globulin serum, the presence of
immunoglobulin in the serum, the presence of RF or phagocytes in the serum or synovial serum
concentration increased cytological enzymes lymphocytes acid phosphatase and alkaline
phosphatase
in neutrophils expressed cell count in the synovial fluid (more than 12,000 cells per
1 mm 3 ), Histologically detectable changes: enhanced proliferation of synovial cells coverts,
hypertrophy of the villi, necrotic foci.
In the later stages of the disease reveal long subfebrile total weight loss, increased erythrocyte
sedimentation rate, radiographically detectable subchondral osteoporosis, marginal usuration
epiphyses, persistent inflammatory changes in the joints with the development of their
deformation and contractures. Complexity and poorly understood mechanisms of development of
RA, many systems involved in the formation of pathological processes cause difficulties in the
treatment of RA.
Main syndromes: immunopathological, inflammation, pain.
Along with the widely used medication for the physical therapy, tasks which depend on the stage
of the pathological process, the degree of dysfunction of the musculoskeletal system and the state
of cardio-respiratory system. It is based on the principle of pathogenetic treatment.
In RA, as well as in many diseases of the musculoskeletal system, joint function
can be maintained or enhanced only through exercise. Physiotherapy and exercise therapy in
diseases of the musculoskeletal system are very important.
Physical factors are applied in rheumatoid arthritis.
In appointing PT must adhere to the following principles:
 FT must be treated on a background of drug therapy, cancellation medicines,
especially basis, is unacceptable;
137




PT should be administered to the extent that pathological activity and its process
stage, concomitant diseases, age and general condition;
in selecting the optimal treatment should be considered FT FT compatibility
procedures, the possibility of their combination, tolerance;
in the next few hours after the procedure undesirable prolonged walking,
cooling of the body;
PT treatment, the recommended activity is high, and has been successfully
applied at lower activity levels.
Treatment of patients with RA is aimed at identifying and addressing the causes contributing
to the aggravation and progression of the disease. This should take into account the activity of
the process, the clinical form of the disease, the degree of adaptive systems, comorbidity and age
of the patient. Patients with RA appoint a diet with balanced composition of amino acids,
sulfonamides prolonged action, and nitrofurane of aminochinoline, gold drugs, sulfasalazine,
salazopiridazine, metronidazole, intestopan, quinidine, Nicodin, ascorbic acid and Ascorutinum.
Assign also anti-malarial drugs that inhibit the release of lysosomal enzymes, the production of
superoxide radicals, leukocyte chemotaxis. In periods of acute RA are treated with non-steroidal
anti-inflammatory drugs (NSAIDs) - Voltaren (diclofenac sodium), acetylsalicylic acid,
kapoxen, piroxicam. Swelling of the joints and stiffness reduce antihistamines
(diphenhydramine, diprazil, tavegil). For stimulation of the immune system are used
antioxidants: tocopherol, retinol, rutin, vitamin C, and aminocaproic acid, herbal adaptogens
(lemongrass, Siberian ginseng, golden root), dibazolum, insulin. To remove small immune
complexes is advisable to use immunoglobulin gamma-globulin dry plasma.
Physical methods of treatment used to reduce the activity of the pathological process,
weakening and disappearance in the tissues of the joints inflammation (anti-inflammatory and
reparative and regenerative methods), relieve pain (analgesic methods), correction of immune
dysfunction (immunosuppressive methods) to improve the exchange of connective tissue and
epiphyseal cartilage and improved locomotor function (fibromodulating methods).
Physical methods for the treatment of patients with rheumatoid arthritis
Anti
methods: low intensity UHF-therapy to the area of the joints 1 , UHF-therapy area adrenal
2
, Hydrocortisone phonophoresis.
Methods of analgesia: SF-irradiation in erythemal doses1, transcranial electroanalgesia,
iontophoresis analgesics.
Immunosuppressive methods: aerocryotherapy, iontophoresis immunosuppressants, nitrogen
bath, an infrared laser.
Fibromodulating methods: peloidotherapy, radon baths, hydrogen sulfide baths1, Iodidebromine baths, whirlpool baths.
Contraindications to physiotherapy are RA with systemic lesions (viscerites), thyrotoxicosis,
severe dystonia.
Spa treatment
Patients suffering from the effects of rheumatic fever not previously 8-10 months after the acute
and subacute effects of the heart, and with symptoms of cardiac insufficiency stage I patients
with RA primarily joint and combined forms in the inactive phase, with minimum and average
activity of the process at self-service and self-directed movement on balneal resort with nitrogenhydrogen sulfide thermal waters and mud-cure resorts.
Contraindications to the sanatorium treatment are septic forms of RA and systemic
involvement - visceritis. If the patient completed a course of hormone therapy in the community,
in the direction of his sanatorium recommended not earlier than 3-4 months after the treatment.
If the patient is receiving maintenance doses of steroid hormones, it can be routed to the spa
treatment. Radon baths are contraindicated in patients with a high degree of activity of
rheumatoid process expressed exudative manifestations in joints, with circulatory failure above
stage I, CHD, angina voltage IV FC, leukopenia, hypothyroidism, poor tolerance of radon
mineral water, occupational exposure to ionizing radiation, benign tumors, vascular dysfunction.
Improvement in patients seen at the resort reduction or disappearance of pain, improvement of
the support function (walking without a cane), an increase in muscle strength (25 % According
dynamometer), muscle tone (25%), increase range of motion in the joint by 25%, reduction or
disappearance of stiffness, sensitivity to palpation, pain for 9-12 months, increase joint range of
motion for a quarter of the original, reducing the amount inflamed joints, no tendency to
decrease motor activity for 6-9 months. Deterioration characterized by the inability to move
without additional funds, decreased muscle tone and strength, decreased range of motion, severe
138
tenderness to palpation, violation of the form of the joint, increasing the number of inflamed
joints, stiffness buildup, swelling, crepitus.
Physioprophylaxis
Physioprophylaxis aimed at preventing exacerbations of the disease and further progression of
joint damage (immune-boosting methods), improving metabolism in the connective tissue and
cartilage of epiphyseal (fibromodulating methods), improved locomotor function (correction
methods locomotor dysfunction).
Ankylosing spondylitis (Ankylosing spondylitis, spondylitis disease Shtryumpellya-Marie) a chronic systemic inflammatory disease of the spine and peripheral (synovial) joints
belonging to the group of seronegative spondyloarthritis.
Etiology and pathogenesis of Ankylosing spondylitis (BB) are similar to rheumatoid arthritis.
Is essential in the development of chronic inflammation of the urogenital organs of the
gastrointestinal tract, chronic tonsillitis. Foci of infection sensitize the body, weaken the
immune system, and the process of developing an autoimmune disease. Among the factors that
contributed to the disease, often acting spinal column injury, contusion of the spinal cord, as well
as hypothermia. Essential in causing the disease attached to the presence of patients with
ankylosing spondylitis and relatives histocompatibility antigen - HLA.
Collagen damage due to circulating blood antigen - antibody, which during passage through
the vascular wall are retained on the basal membrane of cells, which includes collagen. By the
antigen - antibody joins complement, which causes additional damage collagen. Process is
exacerbated by the fact that flock here neutrophils and other inflammatory cells. By fagocyting
complexes, they then often break down, releasing their lysosomal enzymes. Last to hydrolytic
cleavage of proteins, nucleic acids and thereby create conditions for the emergence of new
autoantigens. It creates a kind of vicious circle, which explains the systematic destruction and
duration of the disease. Violated intercellular interactions in the area of inflammation. A
characteristic feature of the pathological process in the BB is the tendency to rapid ossification of
the ligamentous apparatus and the fibrous ring of the intervertebral discs, causing the spine
acquires a shape similar to a bamboo stick. Primary inflammation localized in sacrovertebral
articulation and is accompanied by autoimmune processes, similar to those in RA. Slowly rising
by affected joints of the lumbar, thoracic and cervical spine. In the peripheral joints may develop
synovitis, periarticular edema, fibrosis of the synovium, capsule with a penchant for ossification
ankylose. Patients often affects the cartilage, fibrous tissue tendons and intervertebral discs.
Simultaneously there is an inflammation in the surrounding cartilage of this periosteum and
bone. Bone defect arises
(Erosion) of the anterior spine to seal the surrounding tissue, forming square vertebrae of extraarticular lesions are more common anterior uveitis, iritis and iridocyclitis, at least - keratitis.
BB clinically manifested by pain in the sacroiliac region and other parts of the spine. With the
defeat marked thoracic chest pain type intercostal neuralgia. Gradually developing spine
immobility, broken posture of the patient and his gait. Isolated central form of disease involving
only the spine (kyphosis and rigid) rhisomyelating (except spine affected shoulder and hip
joints), peripheral (added knee, elbow and ankle joints), Scandinavian (small joints of the hands
and feet), and visceral lesion with additional internal organs (heart, blood vessels, eyes, kidneys).
By the nature of the flow is divided into BB slowly progressing, slowly progressing with periods
of exacerbation, rapidly progressive forms and septic option.
In blood, Bechterew's disease reveals increased ESR, which does not correlate with the
activity of the autoimmune process, and is apparently due to a large concentration of abnormal
globulins. At the same time, tests for rheumatoid factor and antinuclear antibodies at the disease
negative. A large number of detected C-reactive protein. According to clinical and laboratory
parameters, there are three degrees of activity - low, medium, high. The level of activity depends
on the bone growths, destruction of articular bone damage muscular system, subluxations.
Main syndromes: inflammation, pain, persistent defiguration and joint deformity, allergic.
Treatment of patients with BB reorganization aimed at foci of infection, relief of pain and
inflammation of joints, reducing their swelling and reduction sensitization. Used for the
treatment of pyrosolone drugs, indomethacin, ibuprofen, Voltaren, ketoprofen, naproxen, aspirin,
Analginum, if necessary - corticosteroids, in some cases - immunosuppressants and cytostatics.
Physical methods of treatment used for pain relief (analgesic methods), effects of
inflammation and swelling of the joints (anti-methods), exchange gain of connective tissue and
barriers to the development of ossification (fibromodulating methods), reduction immune
response (immunosuppressive methods), the voltage decreases skeletal muscle (posture
correction methods) and reduce or eliminate contractures (defibrosing methods).
139
Physical methods for the treatment of patients with Bechterew's disease
Methods of analgesia: 2 SF-irradiation erythema doses 1 Transcranial electroanalgesia
electrophoresis analgesics .
Anti methods: low intensity UHF-therapy
to the area of the joints 1 , UHF-therapy area adrenal
hydrocortisone phonophoresis 2 .
Fibromodulating
methods: peloidotherapy, radon baths 1 , Iodide-bromine baths, whirlpool
2
baths , Paraffin, osocerite therapy.
Immunosuppressive
methods: aerocryotherapy, iontophoresis immunosuppressants, nitrogen
bath 2 .
Methods of correction of posture: autoreklinatsiya spinal traction therapy, underwater spine
traction, static spine relaxation massage.
Defibrosing methods: iontophoresis (phonophoresis) defibrosing drugs.
Contraindications: diseases of the cardiovascular system and kidneys, thyrotoxicosis, severe
dystonia, purulent processes.
Spa treatment
Patients with ankylosing spondylitis provided independent movement of the patient and the
activity of the process is not above Grade II and inflammatory spondylopathies sent for
balneotherapy and mud-cure resorts.
Contraindications to the sanatorium treatment are severe joint deformity secondary synovitis
with the loss of the possibility of independent movement.
Physioprophylaxis
Physioprophylaxis aimed at stimulating immunity (immune-boosting methods), improving the
functional properties of the affected joint (fibromodulating methods), the reduction of stress in
skeletal muscle (posture correction methods), reduction or elimination of contractures
(defibrosing methods).
Appendix-1
Analytical part
USING "attack to brain"
Methods of performance.
To work needed:
1. Set of cards with rehabilitation tasks.
Protocol with a list of groups of students.
Stopwatch.
Action:
The game is performed in oral form.
Students take turns pulling a card with a question first task complexity.
Every student writes down his answers on a task for 1 minutes.
After each answer, the teacher puts score in the protocol.
5. Overall time of the game - 45 minutes.
List of tasks for the business game
"Attack to brain":
Name, for what purpose are assigned physical factors in diseases of the National Assembly.
What are the physical factors that have a sedative effect.
What are the physical factors that have a hypotensive effect.
What are the physical factors that have antiplatelet effect.
What are the physical factors used for electrical stimulation.
140
What are the physical factors that have an analgesic effect.
List the tasks TrE with neuritis of the facial nerve.
List the tasks TrE in cerebral stroke.
List the tasks TrE spinal osteochondrosis.
Special exercises with neuritis of the facial nerve.
Special techniques and medicines electrophoresis with neuritis of the facial nerve.
Special techniques of electrophoresis and drugs for trigeminal neuralgia.
Name, for what purpose are assigned physical factors in rheumatologic diseases.
Physical factor used for the purpose of pathogenetic therapy in RA and Ankylosing spondylitis.
Special exercises in RA small joints of hands.
Special exercises at DOA knee.
Maximum score 25-24
excellent
100% -86%
evaluation criteria of the theoretically
23-21 score
20-19 score
18-16 score
good
Satisfactory
Unsatisfactorily
85% -73%
70%-56%
53% -46%
15-13 score
Poor
43% or less
Appendix-2
4. Analytical part
4.1. Structure and logic "pyramid" diagram
Drafting structural logic diagram
Terms drawing pyramid.
1. Write down everything that comes into your mind. Do not judge the quality of ideas: just write
them down.
2.Do not pay attention to spelling and other factors constraining the letter.
3.Do not stopped writing until the time runs out. If the idea of suddenly stop coming to your
mind, then paint with on paper, until you have new ideas.
4. Try to create as many links as possible. Do not limit the number of ideas, their flow and
communication between them.
Teacher is explaining.
1.
Introduces students with the rules of the diagram construction
2.
In the center of the chalkboard or a large sheet of paper written keyword or topic name of
1-2-words.
Student performs.
1. Write down everything that comes into your mind. Do not judge the quality of ideas: just write
them down.
2.Do not pay attention to spelling and other factors constraining the letter.
3.Do not stopped writing until the time runs out. If the idea of suddenly stop coming to your
mind, then paint with on paper, until you have new ideas.
4. Try to create as many links as possible. Do not limit the number of ideas, their flow and
communication between them
PYRAMIDE SCHEME
REHABILITATION
recover of dysfunction, prevention of secondary
complications and complete recover
141
Basic principles of
rehabilitation after stroke
:
From a neurological rehabilitation
department continues rehabilitation
centers

In the rehabilitation process
should actively take part patients
and relatives of patients

ACTIV
E
PASSIVE
QUESTION-ANSWER
REHABILITATI
ON AFTER
STROKE
PAIN KILLERS
ANABOLIC HORMONES
PUT ON FIXED BANDAGE FOR PATIENTS
CAME WITH SHOULDER TRAUM
Each group evaluates the other groups. Maximum score score -15
142
group
No.
Clear and exact
answer (5)
Visual
(graphic)
(5)
Reglament
(2.5)
Group Activity
(2.5)
Total score of 15
1.
2.
Criteria for evaluation of the analytical part: (diagram).
Maximum score
15-14
13-12 score
11-10 score
9-8 score
7-6 score
100% -86%
85% -73%
70%-56%
53% -46%
43% or less
Analytical part
Appendix-3
4.2 Situational tasks:
Task No. 1. Patient B s, 42 years old. Diagnosis: Osteochondrosis of the cervical spine.
Trigeminal nerve on the right, the third day.
Is it possible to assign this patient physical therapy and physical therapy?
Objectives pursued in this case, physical therapy and exercise therapy.
Contraindications to physical therapy and exercise therapy for this pathology.
Which factors FT can be used in this condition at this stage.
Make an exemplary complex LH given patient.
Standard answer: This patient must assign FT and gymnastics. Task relief of pain attack, antiinflammatory therapy, preventing new attacks, strengthening the body, establishing sleep,
appetite. Contraindications: tendency to nosebleeds, detachment of the retina, acute suppurative
processes in the paranasal sinuses, middle ear, cerebrovascular accident. In the combined therapy
should include physical factors: solljuks lamp, UHF, DDT or SMT-phoresis novocaine
procedure Bergonie half mask, RAS therapy or hydrocortisone phonophoresis exit site of the
trigeminal nerve, massage. LH complex consists of breathing exercises, exercises for facial
muscles, neck and shoulder girdle.
Task No. 2. A newly-patient, 63 years old. Diagnosis: GB Stage III. The consequences of acute
stroke (1 month) with right gemisindromom.
Is it possible to assign this patient physical therapy and physical therapy?
Objectives pursued in this case, physical therapy and exercise therapy.
Contraindications to physical therapy and exercise therapy for this pathology.
Which factors FT can be used in this condition at this stage.
Make an exemplary complex LH given patient.
Standard answer: This patient must assign FT and gymnastics. Task lowering blood pressure,
improving the state of the central nervous system, activation of blood anticoagulation system,
reducing pathological tone, reduction in the degree of paresis, eliminating perverse friendly
143
movements, reconstruction and the formation of the most important motor skills.
Contraindications: unstable blood pressure, high hypertension, arrhythmias, dyspnea, ischemic
ECG changes, angina. In the combined therapy should include physical factors: electric, CMT,
electrophoresis of iodine, bromine or neostigmine for ophthalmic or neck-occipital technique,
magnetic therapy, hydrotherapy, mud (osocerite-paraffin) applications. LH complex consists of
breathing exercises, exercise to reduce elevated tone, to increase muscle strength exercises for
the muscles and joints healthy and diseased limb exercises for the formation of motor skills.
Task No. 3. Patient P Male, 27 years old. Diagnosis: Ankylosing spondylitis, a form of the
central activity II, FNS II.
Is it possible to assign this patient physical therapy and physical therapy?
Objectives pursued in this case, physical therapy and exercise therapy.
Contraindications to physical therapy and exercise therapy for this pathology.
Which factors FT can be used in this condition at this stage.
Make an exemplary complex LH given patient.
Standard answer: This patient must assign FT and gymnastics. Task reduction of inflammatory
activity, the stimulation of the adrenal glands, reducing pain and muscle stiffness, increased the
mobility of the spine, ankylose prevention, improved psycho-emotional state of the patient.
Contraindications: high degree of inflammatory activity, high erythrocyte sedimentation rate. In
the combined therapy should include physical factors: DMV on the adrenal region, DDT or
SMT-phoresis with non-steroidal anti-inflammatory drugs, phonophoresis with hydrocortisone
mganitotherapy, laser therapy. LH complex consists of breathing exercises, bracing, exercises for
all parts of the spine, upper and lower extremities.
Task No. 4. Patient W., 32 years. Diagnosis: Rheumatoid arthritis, arthritic form polyarthritis.
Activity I. X-ray stage II. FNS II.
Is it possible to assign this patient physical therapy and physical therapy?
Objectives pursued in this case, physical therapy and exercise therapy.
Contraindications to physical therapy and exercise therapy for this pathology.
Which factors FT can be used in this condition at this stage.
Make an exemplary complex LH given patient.
Standard answer: This patient must assign FT and gymnastics. Task reduction of inflammatory
activity, the stimulation of the adrenal glands, reducing pain, increasing mobility of the affected
joints, prevention ankylose, improved psycho-emotional state of the patient. Contraindications:
high degree of inflammatory activity, high erythrocyte sedimentation rate, fever, exudative
phenomena expressed in the joints, severe pain, anemia Article III. In the combined therapy
should include physical factors: DMV area on adrenal SMT-phoresis Dimexidum, UV radiation
in a pattern erythema doses, UHF, magnet on the affected joints, paraffin-osocerite applications.
LH complex consists of breathing exercises, bracing, special exercises for the affected joints.
Appendix-3
4.3. Tests
1. Which method is used for galvanizing neuritis of the facial nerve?
A. * half mask Bergonie
B. galvanic collar on Shcherbak
C. Method of Bourguignon
D. method by Vermel
2. In the acute phase of trigeminal neuralgia patient is contraindicated:
A. Laser.
B. Magnetic.
144
C. Cryotherapy.
D.
fluctuorisation.
E.
Local darsonvalization .
3. Factors decreasing the swelling and pain in soft tissue injuries?
A. * UHF
B. Massage
C. TrE
D. Franklin method
4. When DDT
A. * stop the pain with neuritis
B. stop the pain in fractures
C. stop the pain in luxations
D. Stop the pain of kidney colic
5. Which method is particularly effective in rheumatoid arthritis?
A. * UHF
B. Massage
C. CMT
D. paraffin
6. In inflammatory diseases of the joints in the phase of reparative regeneration effectively
destination:
A medium-wave ultraviolet irradiation erythema doses on the joint.
B. UHF-therapy on the joint.
C. High-frequency magnetic therapy on the adrenal glands.
D. Low-intensity microwave therapy (non-thermal dose).
E. Ultrasound therapy joints.
7. Methods used in acute sciatica?
A. * magnetotherapy
B. massage
C. osocerite
D. mineral bath
8. Medicines used in osteoarterosis?
A. * painkillers
B. antiarrhythmics
C. glycosides
D. diuretics
9. Clinic disease osteoarthritis
* A big pain in the joints and in walking time in vertebral column
B. pain in distal hand phalanges
C. pain at rest
D. "Morning stiffness"
10. Observed in osteoarthritis:
A. * degeneration of joints
B. deformation of joints
145
C. Port inflammation. tissue of joints
D. strengthening movement
\
Appendix-3
4.4 Cookbook by physical factors
1. Darsonvalisation on neck pain area darsonvalization area and irradtating pain in carpal-ray
surface. PP-5-3-4.T 5 min 10 N6-daily.
Indication: anti-inflammatory, pain-killing, spasmolytic.
2.Magnetotherapy.Impulse magnetotherapy on cervical part of the spine and joints Yip-1-3-1
ventilator T-2 area 12 min N 6-8 day.
Methodology Inductors N and S on the skin surface, the contact technique. Two sides of the
cervical spine with paravertebral region alternating every 1-3 Pulses with cervical spinal
inductor. Thereafter inductor act on the shoulder joint, outer front and back surfaces.
Indication: When sciatica neck, periarthritis.
3.Electrophoresis of Bergonie on the front half mask zone with 2% procaine, electrode is being
located on front zone and collar area. Nam Tok and LW 2-3 min., Pole 1.5 min. will change. CP
and DP 3 min. 5-8 daily routines.
Indications: used in trigeminal neuropathy and facial nerve.
4.Hydrotherapy
1. Full rubbing . Water temperature 34 about C., and then reducing the temperature to 1 -2
until 22-20 about C. After a day or daily rate of 15-30 procedures.
about
C
2. Wrapping. Temperature 30 - 25 about C, nude patient wrapped wet sheets. 10-60 min
duration. After a day or daily rate of 15-20 procedures.
3.Stream douche (Charcot), water temperature from 35-32 about C until 20-15 about C. Pressure
of from 1.5 to 2.5 -2 -3 atm. Duration 2-5 min. In the course of 15-20 procedures.
4. Baths: appointed by the water temperature, water chemistry, sequence of application, duration,
intensity, treatment course.
Maximum
score of 15
15-14excellent
100% -86%
criteria for evaluating the test, situational problems.
13-12 score
11-10 score
9-8 score
7-6 score
14-12 score
85% -73%
11-7satisfactory
70%-56%
6-4-unsatisfactory 3 or less - bad
53% -46%
43% or less
146
Appendix-4.
5.The practical part
5.1 Implementation of practical skills (the steps)
Objective Perform practical skills - to make complex rehabilitation measures using physical
therapy and exercise therapy on an outpatient receiving individual patient, based on the
examination, medical history, medical history data and laboratory and instrumental data;
Indications: teach and perform on his own physiological factors used to select physical
procedures for pathogenic neuritis of the facial nerve.
Necessary equipment : physiotherapy equipment.
#
Stages of
Failed to
execute
step
1.
Evaluation of the clinical condition of the patient (complaints,
anamnesis morbi, anamnesis vitae, status presents, data clinical
and laboratory studies
Appointment rational physiotherapy:
to determine whether a given patient contraindications to
physiotherapy
in the absence of contraindications for physiotherapy selection of
major groups of physical factors on syndromic pathogenetic
principle
selection of specific physiotherapy treatments to the patient in
accordance with the rules of the compatibility of physical factors
Sequencing of physiotherapy appointment at their complex
registration sheet assignments (writing prescriptions for
physiotherapy)
TOTAL
0
Follow
all steps
(20point)
3.
0
3.
0
3.
0
3.
0
0
3.
5.
2.
3.
4.
5.
6.
20.
Assessment of the adequacy of physical activity for patients with various diseases during
the procedure of physiotherapy
Objective learn to assess the adequacy of physical activity for patients with various diseases
during physiotherapy sessions (LH)
Indications: learn to assess the adequacy of physical activity for patients with alimentary
obesity.
Necessary equipment : Account physiotherapists Rockets.
# of
Stages of
Items
Failed to
execute
Follow
all steps
147
step
1.
2.
3.
4.
5.
6.
7.
8.
9.
Interrogation of the patient in order to identify possible
complaints before the LH
Measurement of blood pressure, heart rate calculation, BH
patient to load
Counting heart rate for 10 seconds in the patient by the end of the
introductory part of LH, identifying complaints and external
signs of fatigue
Counting heart rate for 10 seconds in a patient complaints and
identify external signs of fatigue during the main part of LH
Counting heart rate for 10 seconds in a patient complaints and
identify external signs of fatigue in the final part of LH
Measurement of blood pressure, heart rate calculation, BH,
identifying complaints and external signs of fatigue in a patient
after 5 min after LH
Storing the data in the medical and control card
Draw the physiological load curve
Making a conclusion
Total
Evaluation
Excellent
Average
100% No. Adoption in %
85% -71%
86%
-19
18-17
100%Theoretical
-86%
85% -71%
70%-55%
1.
part
Points
points
2.
Analytical part34-28.4-well
15-14
13-12
40-34.428-22excellent
satisfactory
Satisfactory
70-55%
0
(20point)
2.
0
2.
0
2.
0
2.
0
3.
0
3.
0
0
0
0
2.
2.
2.
20.
Unsatisfactorily Poor
36% or
54% -37%
less
16-15
54% -37%
14-13 points36% or12less
points
points
11-10
7-6less 21.6-14.8 9-8 points 14.4 and
unsatisfactory
bad
Criteria for assessment of practical skills
6. 6. Forms of knowledge control, skills and abilities
- Oral;
- Written;
- Decision of situational problems;
- Demonstration of practical skills mastered.
Appendix-5.
6.1. Criteria under evaluation knowledge, skills and abilities of students
148
organiser
points
15-14
3.
TESTS
points
40-35
4
The practical part
points
Criteria for current estimate
No
.
1.
Performanc Evaluation
e in%
96-100%
Excellent
5
2.
91-95%
Excellent
"5"
3.
86-90%
Excellent
"5"
4.
81-85%
Average
"4"
points
13-12
points
35-30
points
points
11-10
points
30-25
points
9-8 points
25-15
points
points
7-6
points
14 points
Student's knowledge level
Student independent. Has an overall concept on the subject
Rehabilitation. Applies in practice, with the matter, said
confidently, has fine views. Full correct answer to the
questions on the classification of electrotherapy, mechanisms
of action of continuous and pulsed currents (galvanization,
iontophoresis, diadynamic, electric, electric pulp test,
amplipulse), application techniques, indications and contraindications. Summarizes and makes decisions, think creatively,
independently analyzes. Situational problems are solved
correctly, with a creative approach, with full justification
response.
Actively and creatively involved in interactive games, right to
make informed decisions and summarizes and analyzes.
Recipes writes is true, with the best indication of dose
exposure to physical factors. The synopsis on the subject
there.
Full correct answer to the questions on the classification of
electrotherapy, mechanisms of action of continuous and pulsed
currents (galvanization, iontophoresis, diadynamic, electric,
electric pulp test, amplipulse), application techniques,
indications and contra-indications. Summarizes and makes
decisions, think creatively, independently analyzes. Situational
problems are solved correctly, with a creative approach, with
full justification response.
Actively and creatively involved in interactive games, right to
make informed decisions and summarizes and analyzes.
Recipes writes is true, with the best indication of dose
exposure to physical factors.
Questions posed by products electrotherapy, mechanisms of
action of continuous and pulsed currents (galvanization,
iontophoresis, diadynamic, electric, electric pulp test,
amplipulse), application techniques, indications and
contraindications to fully covered, but there are 1-2 errors in
the response. Applies in practice, with the matter, said
confidently, has fine views. Situational problems are solved
correctly, but the justification answer sufficiently.
Actively involved in interactive games, correct decisions.
Recipes writes is true, with the best indication of dose
exposure to physical factors, but there are 2-3 grammatical
errors.
Questions posed by products electrotherapy, mechanisms of
action of continuous and pulsed currents (galvanization,
iontophoresis, diadynamic, electric, electric pulp test,
149
5.
76-80%
Average
"4"
6.
71-75%
Average
"4"
7.
Seventy
Satisfactor
y
"3"
78.
65-61%
Satisfactori
ly
"3"
amplipulse), application techniques, indications and
contraindications to fully covered, but there are 2-3
inaccuracies, errors. Applies in practice, with the matter, said
confidently, has fine views. Situational problems are solved
correctly, but the justification answer sufficiently. Inaccuracies
in solving situational problems. Actively involved in
interactive games, correct decisions.
Recipes writes is true, with the best indication of dose
exposure to physical factors, but there are 2-3 grammatical
errors, inaccuracies in dose.
Correct but incomplete coverage of the issue. The student
knows the classification of electrotherapy, mechanisms of
action of continuous and pulsed currents (galvanization,
iontophoresis, diadynamic, electric, electric pulp test,
amplipulse), methods of application, indications and contraindications, but not fully versed in the mechanisms of action of
physical factors. With the matter, said confidently, has fine
views. Actively involved in interactive games. Situational
problem gives partial solutions.
Recipes written specifying the dose exposure to physical
factors, but there are 3-4 grammatical errors, inaccuracies in
dose.
Correct but incomplete coverage of the issue. The student
knows the classification of electrotherapy, mechanisms of
action of continuous and pulsed currents (galvanization,
iontophoresis, diadynamic, electric, electric pulp test,
amplipulse), methods of application, indications and contraindications, but not fully versed in the mechanisms of action of
physical factors, incomplete lists contraindications to PT in
this pathology. With the matter, said confidently, has fine
views. Actively involved in interactive games. Situational
problem gives partial solutions.
Recipes written specifying the dose exposure to physical
factors, but there are 3-4 grammatical errors, inaccuracies in
dose.
The correct answer to half the questions posed. The student
knows the classification of continuous and pulsed currents
(galvanization, iontophoresis, diadynamic, electric, electric
pulp test, amplipulse) but poorly versed in the mechanisms of
action of physical factors, incomplete lists contraindications to
PT in this pathology. With the matter, said uncertainly, has
accurate representations only on specific issues theme.
Situational problems are solved correctly, but there is no
justification response. Student passive when discussing CDS.
Recipes are written with an inaccurate indication of dose
exposure to physical factors, there are grammatical errors.
Correct answer to the third set of questions. The student knows
the classification of continuous and pulsed currents
(galvanization, iontophoresis, diadynamic, electric, electric
pulp test, amplipulse) but poorly versed in the mechanisms of
action of physical factors, incomplete lists contraindications to
150
89
55-60%
Satisfactor
y
"3"
10.
40-54%
Unsatisfact
orily
"2"
11.
30-40 %
Unsatisfact
orily
"2"
PT in this pathology. With the matter, said uncertainly, has
accurate representations only on specific issues theme.
Situational problems are solved correctly, but there is no
justification response. Student passive when discussing CDS.
Recipes are written with an inaccurate indication of dose
exposure to physical factors, there are grammatical errors.
The correct answer is 1/4 of the questions. The student knows
the classification of continuous and pulsed currents
(galvanization, iontophoresis, diadynamic, electric, electric
pulp test, amplipulse) but poorly versed in the mechanisms of
action of physical factors nemozhet lists contraindications to
PT in this pathology. Poor seized with the matter, said
uncertainly, has exact representation only on specific issues
theme. Student is very passive when discussing CDS.
Recipes are written with an inaccurate indication of dose
exposure to physical factors, there are grammatical errors.
Lighting 1/10 of the questions at the wrong approach. Student
does not know the physical factors (galvanization,
iontophoresis, diadynamic, electric, electric pulp test,
amplipulse). Practically does not understand the mechanisms
of action of physical factors, does not understand the
indications and contraindications to the appointment of FT in
this pathology.
All recipes are written with blunders.
Questions not answers. Does not know the physical factors
(galvanization, iontophoresis, diadynamic, electric, electric
pulp test, amplipulse) and their mechanisms of action. Is not
able to prescribe physical factors on the topic.
For the presence of students in the classroom, in proper form,
with a notebook.
7. Chronological map of the lesson
151
Stages classes
Form
Time 270 min
Testing
Attendance and notebooks
check
Explanation theme.
30 mins
Verbal answer.
30 mins
Discussion of "cluster", to
solve the tests.
60 mins
Provide students with visual
aids (tables, posters, logical
and didactic structure, slides,
videos, diagrams) and giving
explanations to them.
The practical part
Implementation of
practical skills
Conclusion teacher
Evaluates on points. Gives
the task for homework
30 mins
Introductory word teacher
(justification themes).
Theoretical part
Analytical part
30 mins
Break
10 minutes
45 mins
60 mins
30 mins
Appendices
8. Control questions:
Questions on survival knowledge:
1. Etiopathogenesis, clinical treatment of diseases of the nervous system (cerebral
arteriosclerosis, stroke, traumatic brain injury, cerebral palsy, poliomyelitis, neuritis of the facial
nerve, trigeminal neuralgia, lumbodynia);
2. Etiopathogenesis, clinical features, treatment of rheumatic diseases (rheumatism, rheumatoid
arthritis, osteoarthritis deforming, osteochondrosis, ankylosing spondylitis).
3. Heat hydrotherapy: characteristic physiological action, indications, contraindications,
techniques.
4. Resort factors, classification resorts. Indications and contraindications for sanatorium
treatment.
5. Forms and means of physical therapy.
Appendix No.7.
9. List of recommended literature.
9.1. "Medical rehabilitation" ed. Bogolyubov V.M. - Book I, II, III Izd.3 e-2. "Medical
rehabilitation" ed. Bogolyubov V.M. M-2007 3-volume edition
3. Ponomarenko G.M. "Private physiotherapy» Medical M. 2007 698s.
152
1.
2.
3.
4.
5.
6.
"Medical rehabilitation" ed. V.A. Yepifanova Moscow 2005. 400
Bogolyubov V.M. "Methods and techniques of physiotherapy" M. 2001 s.280
Ushakov A.A. "Practical Guide to Physical Therapy" by M. 1996 250c.
Epifanov V.A. "Treatment Physical therapy" M. 2003 p.674
Dubrovsky V.A. "Exercising" M. With 2004. 450
Dubrovsky V.I. "Therapeutic physical training (kinesitherapy)": Textbook. for stud.
Textbook. institutions. - 2nd ed., with ter.-M., 2001.-608 p.: ill.
7. Physical rehabilitation: under the general editorship. prof. Popova S.N. Ed. 3rd. - Rostovon-Don, 2005.-608 pp.
9.2. Auxillary
11. Marlis Gonzalez-Fernandez, MD, PhD, Jarrod David Friedman, MD Physical Medicine
and Rehabilitation Pocket Companion
12. Mark Harrast, MD, Jonathan Finnoff, DO Sports Medicine Study Guide and Review for
Boards
13. Wainapel, Stanley F.; Fast, Avital (Editors) Alternative Medicine and Rehabilitation A
Guide for Practitioners 2003 - Demos Medical Publishing
14. Consuelo T Lorenzo et al. Physical Medicine and Rehabilitation Medscape Reference
2011 – WebMD
15. Sara J. Cuccurullo (Editor) Physical Medicine and Rehabilitation Board Review 2004 Demos Medical Publishing, 848 pp.
9.3. Internet Sources
http://www.lib.uiowa.edu/hardin/md/index.html , http://dir.rusmedserv.c ,
http://www.medlinks.ru / , http://www.kosmix.com/ , http://www.medpoisk.ru/ ,
http://www.tripdatabase.com/ , h ttp :/ / www.klinrek.ru / cgi-bin / mbook ,
http://www.intute.ac.uk/medicine/
http://elibrary.ru http://www.freebooks4doctors.com/ http://www.medscape.com/
http://www.meducation.net/ http://www.thecochranelibrary.com
153
MINISTRY OF HEALTH OF THE REPUBLIC OF UZBEKISTAN
CENTRE FOR MEDICAL EDUCATION
Tashkent Medical Academy
"APPROVED"
Pro-rector for
Academic Affairs
Prof. Teshaev
O.R.
____________________
"________"
___________2014.
Department: Department of Folk Medicine, Rehabilitation and Physical Education
Subject: Rehabilitology
Theme of the practical lesson
Application of physical factors and exercise therapy in rehabilitation of patients with
endocrine (diabetes, obesity, thyroid disease) and mental illness (neurasthenia, hysteria,
psychasthenia)
Practical lesson
Educational technology
TASHKENT-2014
154
EDUCATIONAL TECHNOLOGY OF THE PRACTICAL LESSON
Theme № 4 “Application of physical factors and exercise therapy in rehabilitation of
patients with endocrine (diabetes, obesity, thyroid diseases) and mental disorders
(neurasthenia, hysteria, psychasthenia.) Comprehensive rehabilitation of patients with skin
and infectious diseases (psoriasis, allergic rash)”.
155
Study time: 270 minutes
Type of lesson
Structure of the training session
(lesson plan)
Purpose of the lesson:
The graduate should know:
The graduate should be able to:
Pedagogical objectives:
Pedagogical objectives:
- To generate knowledge of
indications and contraindications for
physiotherapy treatment and exercise
therapy in patients with endocrine
and mental illness, as well as skin
and infectious diseases;
- Teach the skill to choose the right
treatment strategy and the main
directions of physiotherapy treatment
with endocrine, psychiatric, skin and
infectious diseases;
-Teach
drafting
complex
rehabilitation depending on the stage
of the disease;
-Teach yourself to let designated
physiotherapy;
-Teach yourself to pick up a set of
exercises and therapeutic exercises to
demonstrate their patients.
Number of students: 8-12
Exercise topics.
1. Introduction
2. Theoretical part
3. Analytical part
- organizer
- tests
- situational tasks, recipe.
4. Practical skills.
Teach the skill to choose the right treatment strategy and
guidelines physical therapy and exercise therapy
- Methods of research and diagnostics
And Communications basis establishing the relationship
between the ballroom;
- Indications and contraindications to physical therapy and
exercise therapy in patients with endocrine, psychiatric, skin and
infectious diseases;
-Make recipe on the physical factors and recommend physical
factors despite physiological effect;
-Indications and contraindications, physiotherapy treatment
for diabetes, obesity and disease thyroid iron
-Value stages of rehabilitation exercise therapy in diseases
neurasthenia, hysteria, psychasthenia
Self-holding of physiotherapy and exercise therapy
manipulation
Despite actions rehabilitations conduct symptomatic
patogenetic treatment.
-Up complex of rehabilitation measures, depending on the
stage of the disease (brucellosis and pertussis)
Learning outcomes
- Formed knowledge of indications and contraindications for
physiotherapy treatment and exercise therapy in patients with
endocrine and mental illness, as well as skin and infectious
diseases;
-Called main purpose of use of physiotherapy and exercise
therapy factors in patients with endocrine diseases, mental health,
skin and infectious pathologies;
-Up complex of rehabilitation measures, depending on the stage of
the disease;
Self-appointed spend physiotherapy;
Self-selected set of exercises and medical gymnastics show.
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Flow chart of practical classes
Stages of work
and time
(270 minutes)
1st stage
Action
Teacher
Learners
Theoretical part
20 minutes 1.1. Checks attendance and notebooks
20 minutes 1.2. 1. Tells subject classes, its goals, objectives and expected
learning outcomes. Introduces the mode of operation in the
lesson and evaluation criteria (application number 6)
Listen, write,
update and answer
questions.
1.3. . Gives the task for independent work, references to
25 minutes
independent work. Reported indicators and criteria for
evaluation (application № .7)
1.4. Out by the "who is the fastest who is more" in order to
25 minutes
strengthen the student's knowledge on the subject.
(appendix No.1)
10 minutes
Stage 2
80 minutes
10 minutes
45 minutes
3rd stage
60 Minutes
20 minutes
10 minutes
11.5.Break
Analytical part
2.1. Leading the discussion topics of practical classes.
Distributes materials of the case and introduces the algorithm
analyzing the situation. Divides the students into groups.
Appendix 2
2.2. Assesses students' background knowledge using new
pedagogical techniques (tests and case studies, the drugs)
(Appendix 3)
2.3 Break
The practical part.
3.1. Acquisition of practical skill (application number 4)
3.2. An opinion on the subject, focusing students on the main
reports on the importance of the work done for future
professional careers.
3.3. Commends the work of groups and individual students,
summarizes interassessment. Analyzes and evaluates the
degree of achievement of lesson. (Appendix 5).
3.4. Gives the task for independent work, references to
independent work. Reported indicators and criteria for
evaluation. (Appendix 6)
answer questions
work in groups,
present the results
of the group work.
Perform practical
skills
Conduct selfesteem,
interassessment.
Ask questions.
Recorded
assignment.
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1. Motivation
Physical factors and means of physical therapy is widely used in endocrinology,
dermatology, infectious diseases, and practice in the treatment of neuroses. They promote rapid
recovery, a complete restoration of disturbed functions, which significantly reduces the time of
hospitalization and temporary disability, extend the period of remission. Ability to navigate
among individuals and resort factors and prepare a comprehensive treatment using them is
necessary for each GP.
2. Interdisciplinary communication and Intra
Teaching the topic is based on the knowledge students the basics of biochemistry,
biophysics, anatomy, normal and pathological physiology of the endocrine system, skin,
microbiology, epidemiology, etiology and pathogenesis of endocrine, psychiatric, skin and
infectious diseases, general physiotherapy and basic gymnastics. Acquired during the course of
knowledge will be used in traversing disciplines therapy, psychiatry, dermatology, infectious
diseases, as well as GPs in their practice.
3. Contents of the lesson
3.1. Theoretical part
Neuroses and neurotic states
Neurasthenia - functional disorders of the nervous system characterized by impaired psychoemotional and vegetative sphere.
The basis of neurasthenia is three-breaking mechanism of higher nervous activity: weakening of
internal inhibition and enhancement of excitation (hypersthenia), diffuse inhibition in the
cerebral cortex and the weakening of the excitation (hyposthenia), abnormal lability of the
excitation process with simultaneous weakness of the inhibitory process.
In the most common form hypersthenic dominated emotional disturbances. Patients with
irritable, unconstrained, are angry. Their mood is extremely choppy. In addition, marked sleep
disturbances (poor sleep, often waking up), and headaches. In contrast, when hyposthenic form a
sharp decrease in performance, fatigue, memory loss, low mood. Patients with long sleep;
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restless sleep; get up in the morning, "broken", often complain of headaches. For all forms of
neurasthenia characteristic autonomic vascular disorders.
Main syndromes: hypersthenic (neurasthenic) hyposthenic (astenodepressive) and
Vegetovascular.
In the treatment of patients suffering from neurasthenia used vitamins (A, B, C, E), adaptogens
(Eleutherococcus), sedatives (bromine, valerian, motherwort, peony), sleep disorders - imovan,
dokarmin, radedorm, stimulators (biosed, peloidodistillate) vegetative "Harmonizer"
(Belloidum).
Physical methods of treatment used to restore the functions of the CNS, the normalization of
inhibitory processes - excitation (sedative, tonic, psychostimulant, psychorelaxing methods),
restoring the functions of the autonomic nervous system (vegetocorrecting methods).
Physical methods for the treatment of patients suffering from neurasthenia
Sedatives methods: electrodream therapy, franklinization, iontophoresis sedatives, aero,
nitrogen, iodine-bromine baths 1 .
psychorelaxing methods: vibratory relaxation, alpha massage, audiovisual relaxation.
Toning methods: shower, whirlpool baths, massage therapy 2 .
Psychostimulant methods: Hour aerotherapy, oxygen baths 3 .
Vegetocorrecting methods: endonasal galvanization, iontophoresis sedative and vasodilator
drugs.
Contraindications: psychopathy, psychosis, severe hypochondriac depression, obsessivecompulsive and other psychotic condition severe autonomic dysfunction.
Spa treatment
Patients with neurasthenia (hyper-and hyposthenic form) in the absence of severe hypochondria
and depression, severe good general state of health, increase of mental and emotional status of
the patient, hypochondria and reduce the severity of autonomic dysfunction.
Contraindications to the sanatorium treatment are intrusive and other psychopathic condition of
psychopathy, psychosis, severe depression hypochondriac.
Physioprevention
Physioprevention aimed at preventing the progression of functional disorders of the nervous
system through the normalization of the processes of excitation and inhibition in the central
nervous system (sedative and tonic methods) and correction of autonomic dysfunction
(vegetocorrecting methods).
HYSTERIA
Hysteria - A functional disorder of the nervous system, characterized by Breaks in the behavior
of pseudoorganic sensomotor disturbances.
Hysteria is based on three main criteria: clinical, personality and originality pathogenic conflict.
Patients hysterical neurosis characterized by high sensitivity and impressionable, suggestible and
suggestion, an unstable mood.
They tend to attract the attention of others, which is a
manifestation of one of the major trends of hysterical personality.
For patients suffering from hysteria characterized by movement disorders: seizures, paralysis and
paresis, astasia-abasia, hyperkinesis, contracture, blepharospasm, aphonia and mutism. Sensory
impairments and disorders of sensation: hysterical blindness, deafness, loss of smell, taste and
sensory disturbances in the form of hypoesthesia, hyperesthesia and paresthesia. Among the
vegetative-somatic manifestations should include cardiac disorders, respiratory, gastrointestinal,
autonomic, and sexual dysfunction.
Leading syndrome in the clinical picture - neurotic (asthenoneurotic).
Treatment of patients with hysteria include sedatives (bromine, motherwort tincture, peony,
passion flower, valerian root), tranquilizers (phenazepam nozepam, relanium) with autonomic
dysfunction - autonomic harmonizers (Belloidum, Bellataminalum, Bellaspon), insomnia eunoktin, radedorm) .
159
Physical methods aimed at restoring the inhibition and excitation processes in the cerebral
cortex and the improvement of mental and emotional state patient (sedatives, psychorelaxing
methods).
Physical methods for the treatment of patients with hysteria
Sedatives methods: franklinization transcranial electroanalgesia, electrodream therapy,
iontophoresis tranquilizers, conifers, nitrogen, iodine-bromine baths, therapeutic massage.
psychorelaxing methods: vibratory relaxation, alpha massage, audiovisual relaxation.
Contraindications: frequent hysterical attacks, psychopatisation personality expressed
autonomic dysfunction, negative attitude towards physiotherapy.
Spa treatment
Patients with hysteria directed to climate treating resorts: Arkhangelsk, Marfino, Zvenigorod,
Solnechnogorsk, Kislovodsk, Sochi, Gelendzhik, Anapa, Zelenogorsk Svetlahorsk.
Improvement in patients ascertain the restoration of mental and emotional state of the patient,
reducing the excitation processes in the cerebral cortex.
Contraindications to the sanatorium treatment are frequent hysterical attacks and psychopathic
personality deviation.
Physioprevention
Physioprevention conducted to prevent progression of functional disorders of the central nervous
system and psychopatisation person through the normalization process of excitation and
inhibition in the cortex (sedative methods).
Obsessive-compulsive disorder
Obsessive-compulsive disorder functional disorder of the nervous system characterized by impairments in emotion and will.
The clinical picture is always available common neurotic symptoms: irritability, fatigue,
difficulty concentrating, sleep disturbances. These symptoms can be significantly expressed and
act in obsessional neurosis as collateral asthenic syndrome. Patients obsessional neurosis often
show signs of increased excitability of the nervous system. Dominate the clinical picture of
neurosis are a variety of obsessive-compulsive disorder: fears (phobias), thoughts, ideas,
memories, doubts, obsessions, movements and actions (pulse, rituals).
Syndromes are leading astenodepressive and asthenoneurotic.
psychorelaxing methods: vibratory, audiovisual relaxation.
psychostimulating method: iontophoresis psychostimulants.
Contraindications to physiotherapy, sanatorium treatment and Physioprevention similar to those
in neurasthenia.
NEUROALLERGODERMATOSES
Neuroallergodermatoses - A group of chronic itching dermatoses, which are based on
hereditary constitutional dysregulation of the immune response. They occur mainly increase the
reactivity of the immune system, disorders of the trophic function of the autonomic nervous
system and the central nervous system hyperexcitability. To neuroallergodermatoses include
itching, hives, eczema, dermatitis, pruritus and atopic dermatitis.
Neuroallergodermatoses are allergic reactions caused by the interaction of allergens with IgE,
fixed on the membranes of basophils and mast cells (type I allergic reaction), or damage to the
membranes of basophils, mast cells and platelets circulating immune complexes (CIC) in the
area of inflammation - reaction 111 type.
Atopic dermatitis and eczema IgE interact with Langerhans cells, provoking the development of
cytotoxic delayed-type hypersensitivity reactions, - IV type allergic reactions.
The basis of the mechanism of development of neurogenic neuroallergodermatoses lie
Functional disorders of the CNS, which leads to an imbalance neurotrophic autonomic function,
often to improve its parasympathetic activity.
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On the background of these allergic and neurogenic factors occur an increase in permeability of
microvasculature and interstitial edema formation in response to the release of vasoactive
substances due to perverse reaction to compromise the immune system due to imbalance or
neurotrophic activity of the autonomic nervous system.
Isolation of vasoactive substances (histamine, serotonin, bradykinin, substance P), along with
increased microvascular permeability provokes excitement receptor apparatus of the skin,
especially the free nerve endings, which manifests itself in the sensation of itching. For example,
intradermal administration of the solution of low concentration of histamine causes itching, and
high concentration - is accompanied by pain. Allergic reactions in the skin cause the
development of local immune inflammation.
Virtually all patients neuroallergodermatoses characteristic syndrome, pruritus, with
prolonged duration of disease associated neurasthenic syndrome. For most clinical entities
neuroallergodermatoses except pruritus syndrome characterized by a skin rash or exanthema,
urticaria characterized by the presence of elements (urticaria), microvesicles (eczema and atopic
dermatitis), scaly red patches (abortive form of eczema - eczematid) lichenificating papules
(neurodermatitis atopic dermatitis), urticaria of papulovesicles or papules (scrapie). In most
forms of itching dermatoses in patients with syndromes are local immune inflammation and
rheological disorders microvasculature. Due to immune inflammation and circulatory hypoxia in
areas of inflammation of the skin develops tissue hypoxia, oxidized metabolites accumulate
activated lipid peroxidation (LPO). Besides immune inflammation, due to an imbalance in the
autonomic regulation neuroallergodermatoses syndrome may develop angioedema.
Treatment of patients with neuroallergodermatoses involves the use of sedatives, tranquilizers,
anxiolytics - for correction of functional disorders of the CNS. For relief of immune
inflammation used antihistamines, detoxifying agents (sodium thiosulfate), vitamins (C, P A, E,
RR) angioprotectors and immunomodulators, in severe cases - glucocorticosteroids. Recently
successfully and with high efficiency antihypoxants administered, particularly linseed oil. Local
therapy: Applications antipruritic agents in the form of solutions, mashes, powders, creams,
ointments. The dosage form is administered according to the process steps: when shown lotion
soak and wet-drying bandage at subsiding inflammation pass on creams, ointments, in the final
stages of paste used with anti-inflammatory agents and permitting.
Physical treatments may reduce excitation in the cerebral cortex (sedative methods) constrict
blood vessels (vasoconstrictor methods), reduced immunity (immunocorrecting methods),
activate the endocrine system (hormone stimulating methods), reduce blood viscosity
(rheocorrective methods), the manifestations of hypoxia (and antihypoxic antioxidant methods);
local effect reduces itching (antipruritic, astringent methods), relieves inflammation (antiinflammatory methods).
Physical treatments neuroallergodermatoses
Sedatives methods: electrodream therapy, total franklinization.
Vasoconstrictor methods: UHF-therapy paravertebral sympathetic nodes.
Antipruritic methods: local darsonvalization electrophoresis antihistamines, bubble baths.
Decongestants methods: electroplating, low intensity UHF-therapy.
Immunocorrecting methods: infrared laser, LOC, EHF-therapy, hypoxic.
Hormone stimulating methods: MWSS-therapy field adrenal RF magneto area adrenal
transcerebral UHF electrotherapy.
Rheocorrective methods: red laser and chromotherapy, low-magnetic therapy.
Antihypoxic methods: hypobaric hypoxic red chromotherapy.
Antioxidant Methods: red laser and chromotherapy, permanent magnet therapy, hydrogen
sulfide baths.
Contraindications: malignant neoplasms of the skin, bullous dermatoses, cutaneous porphyria,
systemic lupus erythematosus, skin diseases in the acute stage. Please observe the general
contraindications. Private contraindication to the use of hypobaric hypoxia is a pathology in
otolaryngology distortionary patency of the auditory tube, frontal and maxillary sinuses.
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Spa treatment
Neurodermatitis patients, scrapie, eczema (seborrheic true and in the chronic stage with winter
form), lichen planus, neuroallergodermatoses climate treating sent to mountain resorts and
balneal resort with radon water and hydrogen sulfide.
Physioprevention
Physioprevention secondary, is to prevent the recurrence of acute immune inflammation. Apply
immunostimulatory methods, spa therapy and balneal mountain resorts.
Psoriasis (Psoriasis) - a genetically determined chronic immune-dermatosis caused by
polygenic autosomal dominant hereditary factors with incomplete penetrance.
The pathogenesis of the disease is a genetic predisposition to a breach of the normal process of
keratinocyte differentiation, which manifests itself in the inability of keratinocytes of spinous
layer of the epidermis to transform normal cells in the granular layer. Intercellular contacts in
psoriatic plaque weakened cells of the stratum corneum - corneocytes - not fully mature horny
weakly coupled to each other and form flakes easily detached. Moreover, the ripening altered
corneocytes (paraceratic cells) is initiated the production of autoantibodies that are fixed together
to the complement on the membranes of these cells and induce an immune inflammation, leading
to the appearance of papules of epidermal. Causes that provoke exacerbation are
neuropsychological injuries, infections (especially streptococcal) disease, the pathology of the
endocrine system and metabolism, immunodeficiency states. Immune system response in
psoriasis manifests itself in the growth ratio T-helpers/T-supressors, a general decline in the
number of T-lymphocytes, increasing the content of the CEC in the blood.
The disease is characterized by a rash of scaly papules abundantly appearing due to enhanced
proliferation of keratinocytes in the basal layer of the epidermis and the further breakdown of the
processes of keratinocyte differentiation spinous layer.
Distinguish the following clinical types of psoriasis: vulgar psoriasis, psoriatic arthritis, psoriatic
erythroderma and pustular psoriasis (generalized or limited psoriasis of palms and soles). For
most variants of the psoriasis is characterized by syndrome of differentiation and
hyperproliferation of keratinocytes - parakeratosis; in generalized forms - a syndrome of
systemic immune reaction (Civray). Visually skin psoriasis vulgaris syndrome manifested
exanthema (miliary, lenticular and numular papules). Psoriatic arthritis first develops an
inflammatory infiltration, and then there is degeneration of periarticular tissues and becomes the
main artralgic syndrome.
Total therapy is indicated for disease progression. Used most often "Hungarian scheme," the
essence of which is to appoint a "shock" (ten-fold relative to the daily needs) doses of folic acid
on the background of usual doses of vitamin B 12 ascorbic acid and some modifications scheme
- calcium gluconate. Applying the "Hungarian scheme" with parakeratosis gives a soft cytostatic
effect, which may be due to substrate inhibition of nucleic acid synthesis shock doses of folic
acid. Assign as immunomodulators, interferon, adaptogens. In cases of severe psoriasis torpid
widespread use immunosuppressants, cytostatics, nonsteroidal anti-inflammatory drugs
(NSAIDs) and corticosteroids.
Local therapy in the acute period includes exfoliating and anti-inflammatory ointments,
stationary and regressive periods - tar ointment in increasing concentrations. A high effect of
using ointments containing cholecalciferol - Vitamin D3 (E.g., ointment "Psorkutan").
Physical methods for the treatment of psoriasis are aimed at reducing the proliferative activity of
the epidermis, correction of immune disorders and rheological (rheocorrective permitting,
immunocorrecting methods), correction of hormonal disorders (hormone correcting methods),
inhibition of the synthesis of ceratoblasts (cytostatic, keratolytic methods), a decrease of
excitation in the cerebral cortex ( sedatives methods).
Physical methods for the treatment of psoriasis
162
Immunocorrecting methods: infrared laser, LOC, EHF-therapy, hypoxic 1 UV irradiation in the
medium wave range suberithemaldoses.
hormone correcting methods: RF magnetic therapy on the adrenal region, transcerebrally UHF
electrotherapy 1 .
Rheocorrective methods: red-la-zero and chromotherapy; intravenous blood irradiation,
transcutaneous blood irradiation; LF megnetotherapy 1 .
Allow method: tar baths.
Cytostatic method: PUVA-therapy.
Keratolytic method: alkaline bath.
Sedatives methods: electrodream therapy, franklinization 1 .
Fibromodulating methods: ultrasound therapy, paraffin and osocerite therapy, radon, hydrogen
sulfide baths 1 .
Immunocorrecting methods
Contraindication to SF and PUVA therapy is the spring-summer form of psoriasis. Should
also be considered contraindications for physiotherapy at neuroallergodermatoses.
Spa treatment
Psoriasis patients with limited and extensive in the autumn-winter and spring-summer forms a
regressive step guide on climate and balneal resort. Spa treatment includes radon and hydrogen
sulfide baths. Heliotherapy and balneotherapy spend on balneal resorts and mixed: Argman, Hot
Key, Sergievskie Mineral Waters Khilovo, Belokuriha, Pyatigorsk, Tshaltubo, naphthalene.
Physioprevention
Physioprevention psoriasis secondary, is to prevent the recurrence of deterioration, increase
non-specific resistance (immune-boosting methods, treatment for mountain and sea climate and
balneal resort).
Using physical factors endocrine disorders and metabolic disease.
Diabetes mellitus (DM) - a heterogeneous disorder characterized by chronic hyperglycemia due
bar absolute or relative insulin deficiency, which develops as a result of the impact of genetic or
exogenous factors. The basis of the disease is the absolute and relative insulin deficiency.
Absolute failure due to a decrease in insulin production IN Cells of the pancreatic islets of
Langerhans as a result of degenerative or necrotic Breaks under the influence of disturbing
factors or impaired insulin synthesis, leading to incretion hormone with reduced biological
activity.
Absolute insulin deficiency contribute to autoimmune processes (violation immunogenesis
system, leading to the development of processes autoimmunoaggression with electoral defeat
AT cells), viral infection 1 Inflammatory disease, fibrosis or calcification of the pancreas,
circulatory Breaks (atherosclerosis), neoplastic processes, manifestations of amyloidosis,
hemochromatosis, mental and physical trauma, intoxication, insolation, synthesis IN Abnormal
insulin cells with altered structure and activity.
Immunovirusnaya theory SD (risk of disease associated with gene features 6th human
chromosome determining specific histocompatibility antigens, that are part of the human major
histocompatibility system - antigens HLA, DR-3, DR-4 increases the likelihood of diabetes,
antigens and HLA, B -7, DR-2 reduces the risk of disease.
Tampering IN Virus-cell or other damaging factor may be a signal for triggering an immune
autoaggression, the appearance of antibodies to pancreatic islet cells, activated T-lymphocytes of
insulitis (lymphocytic infiltration of the islets of Langerhans), progressive IN Cell insufficiency
with decreasing incretion insulin.
Distinguish 5 stages of IDDM: I - a genetic predisposition to diabetes; II - the initiation of
immune processes; III - the stage of active immunological processes, IV - decreased secretion of
insulin-stimulated glucose; V - clinically overt diabetes.
163
Absolute insulin deficiency is the cause of diabetes is only 10% of patients. In most cases the
occurrence of the disease occurs even at normal and elevated concentrations of endogenous
insulin in the blood. Reason for the development of metabolic disorders in these cases is the
relative insulin deficiency, which is based on reducing the sensitivity of insulin-dependent
tissues to the action of endogenous insulin - insulin resistance fabric.
Despite the role of genetic factors (family, ethnic) in the occurrence of diabetes with relative
insulin deficiency, genetic determinants of the disease is not found (loci 11th and 19th
chromosomes where genes are insulin and insulin receptors).
Tissue insulin resistance contribute to: obesity, advanced age, hyperglycemia, increasing the
concentration contrainsular hormones (cortisol, growth hormone, epinephrine), resulting in a
reduced number and reduced affinity of insulin receptors on the cell surface, the appearance of
autoantibodies to the insulin receptor. Hyperglycemia entails Breaks in protein and fat
metabolism, which is associated with multiple disabilities functioning of the central and
autonomic nervous system, cardiovascular system, etc., violations organotrophic (liver) and
decreased immunity. All of these disorders have their pathogenetic path of development and
progress, but the foundation of this process is the pathology of polyvalent carbohydrate
metabolism. Insulin is produced by cleavage of proinsulin from the so-called C-peptide content
in the blood reflect the true production of the hormone. It allows utilization of glucose into cells
of tissues by maintaining its level in the blood within 3 - 6 mmol / l. Hormone secretion
stimulated by gastrin, secretin, cholecystokinin, vasoactive intestinal polypeptide and
somatostatin inhibited, formed in the D-cells of the pancreas. The sensitivity of insulin receptors
affect growth hormone, corticosteroids, estrogens, progestins, parathyroid hormone. In response
to a decrease in tissue glucose utilization and increased production of cells of the pancreas
glucagon degradation enhancing insulin.
Viral infection accompanied by the development of insulitis, followed by destruction [3-cells and
the formation of antibodies to them, are found in more than half of patients with diabetes type 1.
In diabetes type 2 relative insulin deficiency due to a decrease in the number of receptors to him
and postreceptor glucose metabolic disorders resulting from the deficiency of intracellular
enzymes, develops on the background of unbroken hormone secretion. Resistance to insulin
leads to increased secretion - insulinism and further reducing the number of receptors. When
activated hyperinsulism - lipogenesis, contributes to obesity, which is thus a risk factor and
diabetes type 2, and its early manifestation.
At inadequate insulin therapy in patients with diabetes type 1, the formation of tissue insulin
resistance to endogenous and exogenous insulin. Individuals suffering from diabetes type 2,
under the influence of metabolic disorders, chronic pancreatitis, atherosclerosis occurs
destruction of p-cells, leading to reduced production of endogenous insulin.
Due to absolute or relative insulin deficiency impaired glucose transport across the cell
membrane, which causes the activation of compensatory processes that mobilize additional
sources of energy from the combustion of fats and proteins. As a result, activated glycogenolysis,
lipolysis, protein catabolism. In the blood, increasing the concentration of glucose, non-esterified
fatty acids, nitrogenous wastes. Hyperglycemia causes glycosuria, polyuria, dehydration.
Activation of p-oxidation of fatty acids leads to an increase in the content of cells of acetylcoenzyme A starting material of synthesis of the acetone and acetoacetic acid. Increasing
concentrations fraught with development of metabolic acidosis and general intoxication. The
main factors determining the prognosis of the patient, are the severity and rate of progression of
microvascular complications (a kind of systemic vasculitis, leading to the eventual defeat of the
walls of blood vessels of the kidneys, eyes, heart, limbs) and macroangiopathy (atherosclerosis
of the coronary, cerebral and peripheral arterial trunk).
Main syndromes: syndrome, metabolic disorders, hyperglycemic, and asthenic.
Therapy for patients with diabetes include diet approach in qualitative and quantitative terms, the
physiological and individualization depending on body weight, the nature of work.
164
Excluded digestible carbohydrates. The ratio of fats, carbohydrates and proteins - 30-35%: 50—
60 % : 10-15% respectively. Fractional meal (5-6 times a day, at intervals of no more than 3-4
h), the distribution of portions depending on the mode of the day and the nature of drug
treatment, eating foods rich in dietary fiber.
Mainstay medication for the treatment of NIDDM (with no effect on diet) are sulfonylureas,
which stimulate the synthesis of endogenous insulin IN Cells and reduced tissue insulin
resistance. Used mostly second-generation drugs: glibenclamide, gliclazide, glipizide and
gliquidone. Biguanides reduce tissue insulin resistance, reduce the absorption of carbohydrates in
the intestine, improving lipid metabolism: buformin and metformin.
-Glucosidase inhibitors and the brush border of the intestinal epithelium, delaying cleavage of
polysaccharides in the small intestine and thus reduce postprandial hyperglycemia: acarbose.
Benzoic acid derivatives, slowing the absorption of glucose: repaglipid. Insulin, which is shown
in diabetic ketoacidosis and diabetic coma, IDDM (Type 1), joined with NIDDM absolute
insulin deficiency ("insulin dependent" NIDDM), severe trauma, infection, surgery.
Also surgical treatment is being used: transplantation of cultures of islet cells, pancreas
transplantation. Methods of immunologic correction - autoimmunoaggression suppression
processes in the initial phase of the disease, when there occurred the destruction of most of the
B- cells.
Physical methods of treatment of patients with diabetes are aimed at correcting neurohumoral
dysregulation of the endocrine system (vegetocorrecting methods), strengthening of the
excretory function of the pancreas (insulinstimulating methods), correction of carbohydrate and
fat metabolism (enzyme stimulating methods) and cupping astenoneurotic conditions (sedative
methods).
Physical methods of treatment of patients with diabetes
Vegetocorrecting methods: transcranial electroanalgesia, galvanizing the brain and segmental
zones transcerebral UHF-therapy, heliotherapy.
Insulinstimulating methods: drinking water treatment chloride-sulfate sodium-calciummagnesium water. enzyme stimulating methods: oxygen, ozone, air, contrast baths,
thalassotherapy.
Sedatives methods: electrodream therapy, iontophoresis sedatives, long aerotherapy.
Contraindications: severe diabetes complicated by encephalopathy, retinopathy,
nephroangiosclerosis with renal failure or exhaustion, with the development of macrovascular
expressed trophic disorders, decompensated diabetes, accompanied by severe hyperglycemia
(above 9 mmol / l), ketoacidosis and weight loss, and labile form of diabetes with a tendency
toward ketoacidosis and hypoglycemic conditions.
Contraindicated impact currents and high-frequency fields to the lumbar region, as they can
cause stimulation of the adrenal cortex functions. Not shown are the intense heat and light
treatments. The number of procedures should be limited to avoid overloading the patient.
Spa treatment
Diabetic patients in the state of compensation or subcompensation (hyperglycemia not above 9
mmol / l) type 1 (insulin-dependent) mild to moderate severity without tendency to ketoacidosis
and hypoglycemic conditions and type 2 (non-insulin) mild to moderate in severity steady state
without compensation tendency to acidosis sent to balneal resort (only in motels with specialized
departments), where, along with drinking water and other natural healing factors they are
assigned a health food, and if necessary - insulinocorrecting drugs. Diabetic patients can be
treated at the resorts: Berezivski Mineral Waters, Borjomi, Hot Key, Essentuki, Zheleznovodsk,
Karachi, Staraya Russa, Truskavets, Theodosia, Poltava, as well as local (suburban) sanatoriums
for patients with metabolic disorders, gastrointestinal diseases.
Physioprevention
165
Physioprevention aimed at correcting the neurohumoral dysregulation of the endocrine system
(vegetocorrecting methods), strengthening of the excretory function of the pancreas
(insulinstimulating methods), correction of carbohydrate and fat metabolism (enzyme
stimulating methods) and cupping astenoneurotic conditions (sedative methods).
Obesity - metabolic disease characterized by excessive accumulation of fat in the areas of its
physiological deposits.
Obesity as a disease of the endocrine system has many causes, and its development and
manifestations (symptoms) are determined by a combination of the relationship and
interdependence of various reasons, chief among which are genetic defects that cause insulin
resistance and determine the development of the patient so-called metabolic syndrome
(syndrome X) having and single pathogenesis including hypertension, atherosclerosis and
diabetes. Are also important causes of stress, low physical activity, as well as reducing the
sensitivity of regulatory hormones of the hypothalamus to peripheral hormones in elderly
patients, the nature of food intake, which promotes overeating and a violation of the basic
ingredients of food intake. Based on these reasons, a constellation isolated primary and
secondary obesity. Primary obesity is not a consequence of any disease and is a serious problem
for complications and high mortality. In contrast, secondary obesity occurs as a comorbidity in
organic diseases CNS, mental illness, some endocrine disorders such as Cushing's cider,
insulinoma, etc. It is rare. Patients are seen in the corresponding specialists.
Since obesity is a consequence of a breach of the normal mechanisms of regulation of the
content of fat in the body, its pathogenesis is very complicated and involves a lot of factors that
are often closely intertwined. Defects in the leptin receptor gene itself and adipose tissue leading
to reduction in the number or sensitivity of the leptin receptor saturation in the center in the
hypothalamus or reducing adipose hormone-sensitive lipase by lipolytic enzymes, such as
growth hormone, catecholamines, glucagon. As a result, patients diminishes lipolysis, and
increases adipogenesis. It should be noted that the decrease in sensitivity due to leptin also
increased activity and age of the hypothalamus, which occurs in patients after 60 years.
Plays a significant role as the nature of food intake. Overeating satiety center is adapted to the
higher levels of glucose, insulin and leptin in the blood, reducing its sensitivity to this hormone
and thus insufficient braking occurs hunger center, which leads to using large amounts of food.
Reducing the sensitivity of the satiety center can also occur as a result of stress, neurosis type
neurasthenia, various psycho-emotional factors (feelings of loneliness, sadness, emotions
detainees). Nature of food intake by the fact that in the use of protein-rich food at its disposal the
body expends a lot of energy (food thermogenesis), and foods rich in fat, requires virtually no
energy costs for disposal and stimulates lipogenesis in adipocytes.
Another factor is physical inactivity, leading to reduced physical thermogenesis and lipolysis,
decrease and increase lipogenesis. Obesity is often seen with age (age obesity). Older people are
age disorders of hypothalamic regulatory centers associated with an increase in their activity and
reduced sensitivity of the satiety center to dentin, as well as reducing the so-called adaptive
thermogenesis, which leads to a decrease in activity IN -Adrenergic receptors, reducing the
number of thyroid hormones, in particular T3 and reverse T3. In this situation, those prone to
obesity, adaptive thermogenesis and reduced lipogenesis intensity exceeds the intensity of
lipolysis, ie elderly sensitivity to leptin satiety center is reduced by reducing the sensitivity of its
receptors in the heart of saturation.
Classification of obesity is performed by the distribution of fat. On this basis, isolated trunk
(android, visceroabdominal, central, top, apple) and peripheral (gynoid, glyuteofemoralnoe,
bottom, pear-shaped) obesity. Age adults secrete obesity and obesity throughout life, and
morphologically - hypertrophic and hyperplastic obesity. The most common is the classification
of obesity, which is isolated by two main types of obesity - android and gynoid. Android type is
characterized by an uneven distribution of excess fat located in the upper half of the body
(abdomen, face, internal organs). In appearance it is often called apple and by the distribution of
fat it is like obesity in Cushing's syndrome. Gynoid type is characterized by a uniform
166
distribution of fat with its predominance in the hips and buttocks. This is called peripheral
obesity, or pear-shaped. Android obesity is characterized by an increase in the volume of fat cells
without increasing their number and called hypertrophic and gynoid - in most cases begins in
childhood and is characterized by hyperplasia of fat cells increase their volume and called
hyperplastic.
Diagnose the type of obesity and its power to determine the conduct of so-called body mass
index (BMI), which is the quotient of the actual body weight (kg) by the square of height (m 2 )
Patient. A BMI less than 18.5 indicate malnutrition, 18.5-24.9 - the normal ratio of weight to
height, 25-29.9 - improved nutrition, 30-34,9 - about obesity I level, 35-39 , 9 - II degree of
obesity, more than 40 - about obesity III level.
Treatment of patients with obesity include low-calorie diet, physical activity, drug therapy. 4
using drugs pharmacological groups:
• reducing food intake: serotonergic (miridik, floksatim) and catecholaminergic (miridik);
increasing energy expenditure (miridik);
reducing absorption of nutrients (Xenical or orlistat);
biguanides (siofor, metformin glyukofaks).
Treatment trunk obesity and metabolic syndrome is carried out in accordance with the plan of
treatment of the underlying disease. For this purpose, the treatment regimen include centrally
acting agents - amphetamine derivatives (Fepranon, dizopimon) and drugs that increase energy
expenditure (L-thyroxine).
Physical methods used in complex pathogenetic therapy of obese patients, taking into account
the main syndrome disease. When metabolic disorders in the pathogenesis of obesity primarily
use corrective methods. Their main activities are therapeutic correction of central mechanisms of
regulation of fat metabolism, increase thermogenesis and contractile motor function of the
intestine. These are methods of central or common exposure. Along with these methods using
the local exposure areas of adipose tissue, i.e. methods of activating exBreak or corrective
adipostat, adipocytes in the adipose tissue. Thus, based on a combination of various components
of the syndrome, they occur at the local level, a number of new syndromes that require
correction of physical therapies. Based on the syndromic pathogenetic treatment of patients with
obesity targets of therapeutic physical factors are how the body as a whole (general methods of
action), and hypertrophic adipose tissue sections (methods local effects).
It is known that important links in the pathogenesis of obesity are a violation of the
neuroendocrine regulation of lipolysis of eating disorders, which contribute to the formation and
colonohypokinetic dysmetabolic syndrome bowel syndrome. In the presence of these syndromes
mainly use techniques correcting lipid metabolism, increase the intensity of lipolysis by
increasing energy expenditure (increase contractile thermogenesis) and activating the motor
function of the intestine (stimulating the excretion of fats coming from food and prevent their
absorption). Sedentary lifestyle leads to the formation dyscirculatory syndrome that correcting
methods to stimulate local blood flow, and violation adipostat adipose tissue leads to the need for
direct effects on adipocytes methods local lipolytic effects.
Comprehensive treatment program constitute methods of correction of metabolic abnormalities
syndrome (enzyme stimulating methods), correction of the central mechanisms adipostasis
(hormone correcting methods) hormone correcting methods: transcranial electroanalgesia,
transcerebrally UHF-therapy 1 , Microwave therapy of thyroid 2 , Carbon dioxide, radon baths.
Methods for enhancing contractile thermogenesis: electromyostimulation, contrasting, air baths
and sea bathing 1 , Scottish shower, vacuum gradient massage, baths, wet packs.
colonokynetic methods: colonoscopy hydrotherapy, enemas and mineral water.
Lipocorrecting methods: vibrovacuum therapy, endermotherapy, segmental barotherapy.
Vasoactive methods: power shower, circular, Scottish shower.
Contraindications: endocrine obesity organic genesis.
Spa treatment
167
Patients with primary alimentary-constitutional obesity I-III degree without cardiac
decompensation events sent to climate treating balneotherapy and spa resorts: Anapa,
Gelendzhik, Yeisk Zelenogorsk Kabardinka Leningrad resort area of Sochi, southern coast of
Crimea, Berdyansk, Gagra, Liepaja, Picunda Simeiz, Sukhumi, Acapulco, Albena, Albufeira,
Alicante, Anzio, Arcachon, Atlantic City, Biarritz, Brighton, Varadero, Viareggio, Graal-Müritz,
Up-Ville-sur-Mer, Dubrovnik, Cannes, Capri, Corfu, Costa Brava.
Contraindication to the sanatorium treatment is secondary obesity: hypothalamic-pituitary,
cerebral, endocrine (organic origin) and any form of obesity IV degree circulatory failure above
stage II.
Improvement in patients ascertain reduction of body weight, shortness of breath when walking,
to improve glucose tolerance and deterioration - to weight gain, poor general health, strengthen
breathlessness when walking, reduced urine output, appearance pastosion or edema in the lower
extremities and increased blood pressure.
Physioprevention
Physioprevention obesity is aimed at reducing body weight (lipocorrecting methods), correction
of metabolic syndrome disorders (enzyme stimulating methods).
Hypothyroidism (Myxedema) - a disease based on the reduction of the thyroid gland (TG), due
to its degenerative Breaks, impaired biosynthesis of thyroid hormones, reducing their biological
activity.
Isolated primary hypothyroidism, when the pathological process directly affects the thyroid,
secondary - tertiary and pituitary resulting from any infringement thyreotropic hypothalamic
regulation of pituitary function. Hypothyroidism can be congenital and acquired disease. Occurs
in women more often than men.
Primary hypothyroidism can be caused by various pathological processes. Violations of fetal
development, leading to aplasia or hypoplasia of the thyroid gland, give the clinical picture of
congenital hypothyroidism flowing without goiter.
By hypothyroidism can lead iodine deficiency in the environment.
The primary cause of the so-called spontaneous (primary) hypothyroidism is autoimmune
thyroiditis, leading to a decrease in the volume of functioning thyroid tissue. Often irreversible
hypothyroid state are the result of thyroidectomy or a result of receiving a large dose of
inadequately radioactive iodine. Transient form of primary hypothyroidism are often associated
with antithyroid drugs overdose in the treatment of diffuse toxic goiter. In rare cases, transient
hypothyroidism can be caused by long-term administration of iodine preparations, for example,
about asthma.
Cause of congenital primary hypothyroidism might be defective enzyme systems of thyroid
hormones, thyroid aplasia and hypoplasia. A characteristic feature of primary hypothyroidism is
the so-called mucosal edema - extra-cellularity accumulation in different organs and tissues
(skin, skeletal muscle, myocardium) mucopolysaccharides enhancing hydrophilicity tissues. This
was the reason for designation of primary hypothyroidism term "myxedema." At primary
hypothyroidism is characterized by reducing the levels of T3 T4 increase the level of thyroid
stimulating hormone (TSH), may increase cholesterol levels. The most reliable method for
diagnosing both clinical and preclinical forms of hypothyroidism is a test with thyrotropin.
Inadequate increase in TSH in response to thyrotropin reliably indicates primary
hypothyroidism.
In all forms of primary hypothyroidism in response to lower levels of thyroid hormones in the
blood is amplified thyreotropic anterior pituitary function. TSH in serum of patients in the tens
and even hundreds of times may exceed the level determined in the blood of healthy people.
Observed hyperplasia and hypertrophy of existing thyroid tissue, which creates favorable
conditions for the formation of tumors, colloid cysts, or further progression of autoimmune
thyroiditis.
168
Secondary hypothyroidism is caused by pathological processes leading to destructive Breaks in
pituitary cells producing TSH. Most often secondary hypothyroidism is a consequence of
neoplastic processes (chromophobe pituitary adenoma, craniopharyngioma) or vascular
disorders, impair the blood supply to the anterior pituitary.
Tertiary hypothyroidism is the result of damage to the hypothalamus departments responsible for
the production of TSH. Secondary and tertiary forms of hypothyroidism are usually combined
with impaired gonadotropic rarely adrenocorticotropic pituitary function. However, there are
cases of isolated violations production of thyroid-stimulating hormone-releasing factor by the
hypothalamus.
Lowering of thyroid function is an indispensable component of the pathogenesis of
hypothyroidism. That low level of thyroid hormones in the blood is responsible for the metabolic
Breaks and Breaks in tissues and organs that are common to all forms of hypothyroidism.
Complaints of progressive weakness, memory loss, drowsiness, slow speech, deepening of the
voice, dry skin, swelling of tissues, pain in the joints. For hypothyroidism is characterized by a
kind of "tight" swelling of the face, hips, legs, areas of alopecia on the scalp. Patients with
hypothyroidism have pains in muscles, increased duration of tendon reflexes, bradycardia,
increase in heart size, and constipation.
Symptoms of hypothyroidism associated with Breaks in the functional state of the central
nervous system are the most permanent. Celebrating mental retardation patients response to
external stimuli. Tracking lethargy, drowsiness, reduced ability to concentrate. Hypothyroid
coma - extreme weighting hypothyroidism.
Main syndromes: neuroendocrine dysfunction and neurasthenic.
The aim of therapy in patients with hypothyroidism is to achieve a euthyroid state through the
selection of thyroid hormone (L-thyroxine) or other thyroid preparations (Thyreotom,
triiodothyronine).
Physical methods for the treatment of patients with hypothyroidism and potentiate the action of
thyreoidin aim to stimulate thyroid function (thyreostimulating methods), stimulation of tissue
metabolism (enzyme stimulating methods) and correction of neuroendocrine dysfunction
(hormone correcting methods).
Physical methods for the treatment of patients with hypothyroidism
Thyroid-stimulating methods: bromine baths, lower intensity MWSS-thyroid therapy.
enzyme stimulating methods: oxygen baths, ozone baths, vibrovacuum therapy, air, contrast
baths, thalassotherapy 1 .
hormone correcting methods: transcranial electroanalgesia, carbonic, radon baths, transcerebral
UHF therapy, low-frequency transcerebral electrotherapy 2 .
Thyroid-stimulating techniques
Spa treatment
Patients with mild forms of hypothyroidism, accompanied thyrogenous obesity and degenerative
Breaks in the joints, and is directed to climate treating balneotherapy spa resorts: Zelenogorsk
resort area Leningrad, Arkhangelsk, Yangantau, Varzi-Yatchi, Krainka, Darasun, Essentuki,
Zheleznovodsk, Kislovodsk, Anzio, Saratoga Springs, Biarritz, Bad Brambach, Bad Soden, Bad
Kisseingen, Bad Elster Bad Ems.
Contraindication to the sanatorium treatment of hypothyroidism is moderate and severe forms.
Ascertain improvement in patients with a decrease in the overall weakness, lethargy, coldness,
paresthesia, dry skin, the disappearance of pastose face, extremities, constipation, improve
efficiency, normalization of sleep, improved ECG (increase voltage, normalized wave 7),
normalize blood pressure, improve SOE performance, reduce hypercholesterolemia and
hypertrigliperidemia and deterioration - with an increase in the overall weakness, reduced work
capacity, strengthening skin dryness, constipation, or pastosion edema of the face and
169
extremities, reducing voltage ECG peaks in systolic blood pressure, anemia (normo- or
hyperchromic).
Physioprevention
Physioprevention aimed at preventing astenoneurotic syndrome (sedative methods) and
correction of neuroendocrine dysfunction (hormone correcting methods).
4. Analytical part
Appendix-2
New pedagogical and technological methods used in the course of employment:
Technology training to address problematic situations during workshops
4.1. model of learning technologies
topic number 4, 175 minutes
Number of students: no more than 10 people
Application of physical factors and exercise therapy in
topic
rehabilitation of patients with endocrine (diabetes, obesity,
thyroid disease) and mental illness (neurasthenia, hysteria,
psychasthenia.) Comprehensive rehabilitation of patients with
skin and infectious diseases (psoriasis, allergic rash)
1. Subject of the case
Practical lesson plan
2. Carry out the "Quiz" to catalyze knowledge. Enclosure 1
3. Clearly show the problem-solving and decision (Appendix 2).
4. Group decision "case study"
5. Make a presentation and discussion of results
6. Discuss the problem
7. The final conclusion. Commends the work of groups and
individual students, summarizes interassessment.
Purpose of the study: Give an idea of the students on the correct preparation of rehabilitation
pedagogical tasks:
Outcomes of the educational process:
 provides a basis for self-examination of the  read the contents of the case in advance, preparing
contents of the case
written;
 methods of influence on the basis of  determines the exact sequence of situations in
pathological processes
physiotherapy;
 learn to identify the problem, helps to  in dealing with problem situations applies theoretical
compare, analyze, synthesize;
knowledge;
 Prize in addressing explain the sequence of  clarifies the problem, finds the answer to solve the
precise movements;
problem;
 creates conditions for solving the problem  displays the final inference.
tasks;
 helps to infer
"Case studies", "Quiz", "situational problem",
Methods and techniques of training
"discussion"
Markers, paper, board, chalk
Learning Tools:
Work individually and in groups
Forms of educational activity
170
Venue lessons, equipment
Assessing knowledge and monitoring
Audience, equipped with technical means
Interpreting control, question-answer, self-control,
assessed by the rating system
Appendix -1
USING METHOD "WHO CAN FASTER, WHO CAN MORE»
Methods of carrying out.
To work needed:
1. A set of cards with the tasks for rehabilitation.
2. Stopwatch.
3. Blank piece of paper.
Progress:
1. Game conducted in writing.
2. Students take turns pulling a card with the job.
3. Each student in writing within 5 minutes responding to the task.
4. The teacher will collect the answer sheets.
5. Total time of 45 minutes of the game.
6. Answer each student is treated separately.
7. Answers on a sheet are discussed with all students.
8. Students' responses are estimated as follows:
9. Recruit students score accounted for billing "ongoing evaluation".
10. On the answer sheet is set to score points in red ink.
11. In the lower part of the magazine free teacher records on the business game.
12. Minutes saved games.
List of tasks for the business game
"Who can faster, who can better"
1 - job
Sheet expert in work groups
1st group
1.
comprehensive treatment is used in rehabilitation - thyroid disease diabetes, obesity.
2.
comprehensive treatment is used in the rehabilitation of neurasthenia, hysteria,
psychasthenia
Type problematic
situation
Filling a table "problem situation"
Problem situations
Way out
2nd group
1. comprehensive treatment is used in the rehabilitation of fever, brucellosis, and pertussis
2. comprehensive treatment used in the rehabilitation of Dermatology and Venereal
Diseases
fill the table "problem situation"
Type problematic situation
Problem situations
Way out
171
Evaluation and testimony at work with case
For work performed in the Auditorium
Group list
Group asset
max. 5 points
Information in the
form of visual aids
Answers given
correctly and
completely
max. 5 points
Total
max. 15
points
1
2
Evaluation criteria
50-48 score - excellent, 46 - 38 points - well, 34 - 36 points - 34-32 satisfactory unsatisfactory,
and less than 31
Appendix-3
4.2. Case studies:
Task No. 1. Patient B s, 42 years old. Diagnosis: Obesity II degree.
Is it possible to assign this patient physical therapy and physical therapy?
Objectives pursued in this case, physical therapy and exercise therapy.
Contraindications to physical therapy and exercise therapy for this pathology.
Which factors FT can be used in this condition at this stage.
Make an exemplary complex LH given patient.
Standard answer: This patient must assign FT and gymnastics. Task stimulate the
metabolism, weight loss, improvement of cardiorespiratory system, increase exercise tolerance,
improved psycho-emotional status of the patient. Contraindications: comorbidities,
contraindications to the CFT and gymnastics, and hypertensive diencephalic crises. In the
combined therapy should include physical factors: electric, contrast bath, power shower, CMT
on the abdominal muscles, massage. LH complex consists of exercises in the gym, exercises for
large muscles and abdominal muscles, running, walking, breathing exercises.
Task No. 2. Patient D-ing, 53 years old. Diagnosis: Type II diabetes are overweight,
moderate, under subcompensation. Diabetic neuropathy of the lower extremities.
1. Is it possible to assign this patient physical therapy and physical therapy?
2. Objectives pursued in this case, physical therapy and exercise therapy.
3. Contraindications to physical therapy and exercise therapy for this pathology.
4. Which factors FT can be used in this condition at this stage.
5. Make an exemplary complex LH given patient.
Standard answer: This patient must assign FT and gymnastics. Task reduction of
hyperglycemia, weight loss, improvement of cardiorespiratory system, increased exercise
tolerance, improved psycho-emotional status of the patient. Contraindications: hyperglycemia
within 16.6 mmol / l and above, the presence in urine of acetone, features precomatose state high
hypertension ECG signs of ischemia. In the combined therapy should include physical factors:
electric, electrophoresis of neostigmine on the area of the lower extremities, darsonvalization,
actinothermal bath, magnetic therapy, massage. LH complex consists of exercises for large
muscles and abdominal muscles, walking, breathing exercises.
Task No. 3. Patient K-wa, 38 years old, suffering from neurasthenia (hypersthenic
form).
1.
2.
3.
4.
5.
172
1.
2.
3.
4.
5.
Is it possible to assign this patient physical therapy and physical therapy?
Objectives pursued in this case, physical therapy and exercise therapy.
Contraindications to physical therapy and exercise therapy for this pathology.
Which factors FT can be used in this condition at this stage.
Make an exemplary complex LH given patient.
Standard answer: This patient must assign complex FT and gymnastics. Task
improvement of higher nervous activity, normalization of sleep, the improvement of
cardiorespiratory system, increased exercise tolerance, improved psycho-emotional status of the
patient. Contraindications: comorbidities, contraindications to the CFT and gymnastics,
autonomic paroxysms. In the combined therapy should include physical factors: electric, sulfide,
pine baths, hydroaeroionotherapy collar on Shcherbak with sodium bromide, neck massage. LH
complex consists of breathing, restorative exercises, relaxation exercises, walk.
Task No. 4. Patient M-wa, 35 years old. Diagnosis: Psoriasis in the acute stage.
1. Is it possible to assign this patient physical therapy and physical therapy?
2. Objectives pursued in this case, physical therapy and exercise therapy.
3. Contraindications to physical therapy and exercise therapy for this pathology.
4. Which factors FT can be used in this condition at this stage.
5. Make an exemplary complex LH given patient.
Standard answer: This patient must assign complex FT and gymnastics. Task decrease
inflammation in the skin, stimulating the glucocorticoid function of the adrenal glands, reducing
itching, faster healing of the affected areas, normalization of sleep, improved psycho-emotional
status of the patient. Contraindications: comorbidities, contraindications to the CFT and
gymnastics. In the combined therapy should include physical factors: DMV area on the adrenal
glands, electric, sulfide, pine baths, hydroaeroionotherapy collar on Shcherbak with sodium
bromide, UV radiation lesions, laser therapy, magnetic. LH complex consists of breathing,
restorative exercises, relaxation exercises, walk
4.3 Tests
1 What type of bath used in obese patients to lose weight?
A. *sauna
B. Russian bath
C. Bukhara bath
D. japanese bath
2.What of these activities reduces blood sugar?
A. * electrosleep
B. total galvanizing
C. franklinization
D. magnetotherapy.
3.What drugs do not enter by electrophoresis in diabetes?
A. Insulin *
B. Niacin
C. Neostigmine
D. Antibiotics
4. How the electroplating method is being used in inflammation of the facial nerve?
A. * mask Bergonie
B. galvanizing method Shcherbaka
C. Method by Bourguignon
D Vermeulen method
173
5. Pathogenetic physiotherapy Addison's disease
A. * DMW of suprarenal glands
B. electrosleep
C. electrophoresis method Bourguignon
D. UFO in the abdomen
6. Which collagenous diseases are not allowed to physiotherapy
A. * SLE
B. Ankylosing spondylitis
C. systemic scleroderma
D. Rheumatoid arthritis
7. Pathogenetic physiotherapy in obesity:
A. approved facility. CMT
B. UHF
C. laser.
D. electrophoresis
8. What natural factors are not used in thyrotoxicosis
A. * heliotherapy
B. aerotherapy
C. thalassotherapy
D. balneotherapy
9. LFK contraindication for patients with diabetes
A. hyperglycemic coma
B. predisposition to hemorrhage
C. Hypertensive emergency
D. bronchial status
10. The main goal of rehabilitation.
A. early start
B. individual approach
C. Integrated
D. all of the answers correct.
4.4 Prescriptions on physical factors
1 Microwave. 1 Irradiator is projected on the kidneys at a distance of 3-4 cm oligotermicheskaya
dosage 40W. exposition of 10 minutes Every day - 8-10 procedures.
2. SCM. Recipe. UHF-therapy on the affected joint. Pin D-100mm beam, each session 1-4 field
P-7-30 N 10-15 minutes every day.
Recommendation: professional, traumatic for gout and arthritis are recommended.
Notes: with lesions 4 or more joints, treatment carried on throughout the day,
receptors on the second day of the following joints or max. 3 if the joints of which only one of
them is irradiated.
3. Electrosleep
Electrosleep frequency - 1 Hz 100-150 5-7mA Time - 30-60 minutes, N 15-30 daily 4-5 times a
week
4. US therapy
Right leg and waist - labile paravertebral therapy. The intensity of 0.2-0.3 W / cm. Duration 5-7
minutes, Mode - non-stop in a day or every day
Criteria for assessing the practical skills and test
Maximum score 14-12 points
2515
15-14
- 13-12 - good
11-10 points
11-7 satisfactorily
9-8 points
6-4 - unsatisfactory
7-6 points
3 or less - Poor
174
excellent
100-86%
85-73%
70-56%
53-46%
43% or less
175
AppendiX-4.
5. The practical part
5.1 Implementation of practical skills. (Step by step)
Purpose:teach students to use complex treatment methods in physiotherapy practice.
Indications: teach yourself to perform and choose physiotherapy factors, physical procedures
used in the treatment of pathogenic diseases of the endocrine system.
Necessary equipment : Account CFT shells.
No
.
##
1.
2.
3.
4.
5.
6.
Stages of
Evaluation of the clinical condition of the patient (complaints, anamnesis
morbi, anamnesis vitae, status presents, data clinical and laboratory studies
Appointment rational physiotherapy:
to determine whether a given patient contraindications to physiotherapy
in the absence of contraindications for physiotherapy selection of major
groups of physical factors on syndromic pathogenetic principle
selection of specific physiotherapy treatments to the patient in accordance
with the rules of the compatibility of physical factors
Sequencing of physiotherapy appointment at their complex
registration sheet assignments (writing prescriptions for physiotherapy)
Failed to
execute
step
0
Follow a
steps (20
point)
3
0
0
3
3
0
3
0
0
3
5
Totals
20
Assessment of the adequacy of physical activity for patients with various diseases during
the procedure of physiotherapy
Purpose: learn to assess the adequacy of physical activity for patients with various diseases
during physiotherapy sessions (LH)
Indications: learn to assess the adequacy of physical activity for patients with obesity
Necessary equipment: Account physiotherapists Rockets.
No.
##
Stages of
Failed to
Follow a
execute step steps (20
point)
1.
Interrogation of the patient in order to identify possible complaints before
the LH
0
2.
2.
Measurement of blood pressure, heart rate calculation, BH patient to load
0
2.
3.
Counting heart rate for 10 seconds in the patient by the end of the
introductory part of LH, identifying complaints and external signs of
fatigue
0
2.
176
4.
Counting heart rate for 10 seconds in a patient complaints and identify
external signs of fatigue during the main part of LH
0
2.
5.
Counting heart rate for 10 seconds in a patient complaints and identify
external signs of fatigue in the final part of LH
0
3
6.
Measurement of blood pressure, heart rate calculation, BH, identifying
complaints and external signs of fatigue in a patient after 5 min after LH
0
3
7.
Storing the data in the medical and control card
0
2.
8.
Draw the physiological load curve
0
2.
9.
Making a conclusion
0
2.
Totals
0
20
6. Method to verify knowledge and experience
- Actively participate in discussions
- Answers written results
- To solve the problem, tests and Case Studies
- practical skills
Appendix 5
6.1. Criteria for evaluation of practical skill
N
o.
Evaluation
excellent
good
Satisfactory
unsatisfactorily
Poor
Digestion in%
100% 86%
25-24
points
15-14
points
15-14
points
40-35
points
85% 71%
23-22
points
1312
points
13-12
points
35-30
points
70-55%
54% -37%
36% and
less
21-19 points
18-17 points
15 points
11-10 points
9-8 points
11-10 points
9-8 points
1.
Theoretical part
2.
Case Study
3.
Test
4
The practical part
30-25 points
25-15 points
7-6
points
7-6
points
14 points
177
In assessing students' knowledge of Rehabilitation accounted following approximate
criteria
No.
1.
Performance
in%
96-100%
Evaluation
91-95%
Excellent
"5"
2.
Excellent
"5"
3.
86-90%
Excellent
"5"
4.
81-85%
Average
"4"
5.
76-80%
Average
Level of knowledge and skills
Student independent. Has a general concept on the subject
Rehabilitation. Applies in practice, with the matter, said confidently,
has fine views. Full correct answer to the questions on the
classification of electrotherapy, mechanisms of action of continuous
and pulsed currents (galvanization, iontophoresis, diadynamic, electr
electric pulp test, amplipulse), application techniques, indications and
contra-indications. Summarizes and makes decisions, think creatively
independently analyzes. Situational problems are solved correctly,
with a creative approach, with full justification response.
Actively and creatively involved in interactive games, right to make
informed decisions and summarizes and analyzes.
Recipes writes is true, with the best indication of dose exposure to
physical factors. The synopsis on the subject there.
Full correct answer to the questions on the classification of
electrotherapy, mechanisms of action of continuous and pulsed
currents (galvanization, iontophoresis, diadynamic, electric, electric
pulp test, amplipulse), application techniques, indications and contraindications. Summarizes and makes decisions, think creatively,
independently analyzes. Situational problems are solved correctly,
with a creative approach, with full justification response.
Actively and creatively involved in interactive games, right to make
informed decisions and summarizes and analyzes.
Recipes writes is true, with the best indication of dose exposure to
physical factors.
The questions posed by the classification action mechanisms examin
(light therapy, aerosol therapy, barotherapy), physical factors (FF),
methods of application, indications and contra-indications to appoint
highlights enough, but there are 1-2 in reply. Applies in practice, with
the matter, said confidently, has fine views. Situational problems are
solved correctly, but the justification answer sufficiently.
Actively involved in interactive games, correct decisions.
Recipes writes is true, with the best indication of dose exposure to
physical factors, but there are 2-3 grammatical errors.
Questions posed by products electrotherapy, mechanisms of action o
continuous and pulsed currents (galvanization, iontophoresis,
diadynamic, electric, electric pulp test, amplipulse), application
techniques, indications and contraindications to fully covered, but
there are 2-3 inaccuracies, errors. Applies in practice, with the matter
said confidently, has fine views. Situational problems are solved
correctly, but the justification answer sufficiently. Inaccuracies in
solving situational problems. Actively involved in interactive games,
correct decisions.
Recipes writes is true, with the best indication of dose exposure to
physical factors, but there are 2-3 grammatical errors, inaccuracies in
dose.
Correct but incomplete coverage of the issue. The student knows the
178
"4"
6.
71-75%
Average
"4"
7.
66-70%
Satisfactory
"3"
765-61%
Satisfactory
"3"
855-60%
Satisfactory
"3"
8
9
classification of electrotherapy, mechanisms of action of continuous
and pulsed currents (galvanization, iontophoresis, diadynamic, electr
electric pulp test, amplipulse), methods of application, indications an
contra-indications, but not fully versed in the mechanisms of action o
physical factors. With the matter, said confidently, has fine views.
Actively involved in interactive games. Situational problem gives
partial solutions.
Recipes written specifying the dose exposure to physical factors, but
there are 3-4 grammatical errors, inaccuracies in dose.
Correct but incomplete coverage of the issue. The student knows the
classification of electrotherapy, mechanisms of action of continuous
and pulsed currents (galvanization, iontophoresis, diadynamic, electr
electric pulp test, amplipulse), methods of application, indications an
contra-indications, but not fully versed in the mechanisms of action o
physical factors, incomplete lists contraindications to CFT in this
pathology. With the matter, said confidently, has fine views. Actively
involved in interactive games. Situational problem gives partial
solutions.
Recipes written specifying the dose exposure to physical factors, but
there are 3-4 grammatical errors, inaccuracies in dose.
The correct answer to half the questions posed. The student knows t
classification of continuous and pulsed currents (galvanizatio
iontophoresis, diadynamic, electric, electric pulp test, amplipulse) b
poorly versed in the mechanisms of action of physical facto
incomplete lists contraindications to CFT in this pathology. With t
matter, said uncertainly, has accurate representations only on speci
issues theme. Situational problems are solved correctly, but there is
justification response. Student passive when discussing CDS.
Recipes are written with an inaccurate indication of dose exposure to
physical factors, there are grammatical errors.
The correct answer to half the questions posed. The student knows t
classification of continuous and pulsed currents (galvanizatio
iontophoresis, diadynamic, electric, electric pulp test, amplipulse) b
poorly versed in the mechanisms of action of physical facto
incomplete lists contraindications to CFT in this pathology. With t
matter, said uncertainly, has accurate representations only on speci
issues theme. Situational problems are solved correctly, but there is
justification response. Student passive when discussing CDS.
Recipes are written with an inaccurate indication of dose exposure
physical factors, there are grammatical errors.
The correct answer to half the questions posed. The student knows t
classification of continuous and pulsed currents (galvanizatio
iontophoresis, diadynamic, electric, electric pulp test, amplipulse) b
poorly versed in the mechanisms of action of physical factors can n
list contraindications to CFT in this pathology. Poor seized with t
matter, said uncertainly, has exact representation only on speci
179
10.
11.
40-54%
30-40 %
Unsatisfacto
rily
"2"
Unsatisfacto
rily
"2"
issues theme. Student is very passive when discussing CDS.
Recipes are written with an inaccurate indication of dose exposure
physical factors, there are grammatical errors.
Lighting 1/10 of the questions at the wrong approach. Student does n
know the physical factors (galvanization, iontophoresis, diadynamic,
electric, electric pulp test, amplipulse). Practically does not understan
the mechanisms of action of physical factors, does not understand the
indications and contraindications to the appointment of FT in this
pathology.
All recipes are written with blunders.
Questions not answers. Does not know the physical factors
(galvanization, iontophoresis, diadynamic, electric, electric pulp test,
amplipulse) and their mechanisms of action. Is not able to prescribe
physical factors on the topic.
For the presence of students in the classroom, in proper form, with
notebook has.
7. Chronological map lessons
N
o.
Step classes
Form
1.
INSPECTION
2.
Teacher
Attendance checks and
notebooks
Notes to the topics
3.
Theoretical part
4
Analytical part
5.
6.
Show student visual aids (slides,
presentations, videos, etc.), as well
as notes
The practical part.
7.
Conclusion
Discussion
Respond orally
Discuss "Case stage"
Decides to challenge the test
Time
270
minutes
30 minutes
Break
30 minutes
10
minutes
30 minutes
80
minutes
10 minutes
Perform practical skills
60 Minutes
Based on the score set
homework, independent work
30 minutes
45
minutes
180
8. Test Questions
1 Ethiopathogenesis, clinics, treatment of endocrine disorders (obesity, diabetes mellitus,
thyroid pathology);
2. Ethiopathogenesis, clinics, treatment of psychic disorders (neurastenia, hysteria,
psychasthenia, obsessional neurosis).
3. Ethiopathogenesis, clinics, treatment of skin disorders (psoriasis, atopic dermatitis,
urtica).
4. Ethiopathogenesis, clinics, treatment of skin disorders
5. Hydrotherapy characteristic, physiological effects, indications, contraindications, methods.
6. Resort factors, classification of spas. Indications and contraindications to sanatoriumresort treatment.
7. Forms and means of exercise therapy
Suggested Reading.
9.1 Common
1. Bogolyubov V.M. "Balneology and Physiotherapy" 1 and Volume 2 M. Medicine 1985
2. Yuldashev K., Y. Kulikov "Physiotherapy". T. 1984.
3. Strelkova N.I. "Physical treatments in neurology", M., 1983.
4. Popov S.N. "Physical rehabilitation" Rostov-on-Don, 1999
5. Okorokov A.N. "Treatment of diseases of the internal organs. Manual ", Volume 2, Moscow,
2004.
6. Pasinkov S.M "Physiotherapy", M., Medicine, 1969.
7. Epifanov V.A. Handbook of medical physical culture. M, 1987.
9.2 Additional
8. Bogolyubov V.M. "Handbook of sanatorium selection", M, 1992.
9. Iasnogorodski V.G. "Handbook of Physical Therapy", M, 1981.
10. Ponomarenko T.N. "Guide to practical training in general physiotherapy", M, 2000.
11. Yuldashev K.Y. "Non-drug treatments" a practical guide for physicians.
12. Sosin I.N. "Physiotherapeutic directory", Kiev, 1973.
1. Marlis Gonzalez-Fernandez, MD, PhD, Jarrod David Friedman, MD Physical Medicine
and Rehabilitation Pocket Companion
2. Mark Harrast, MD, Jonathan Finnoff, DO Sports Medicine Study Guide and Review for
Boards
3. Wainapel, Stanley F.; Fast, Avital (Editors) Alternative Medicine and Rehabilitation A
Guide for Practitioners 2003 - Demos Medical Publishing
4. Consuelo T Lorenzo et al. Physical Medicine and Rehabilitation Medscape Reference
2011 – WebMD
5. Sara J. Cuccurullo (Editor) Physical Medicine and Rehabilitation Board Review 2004 Demos Medical Publishing, 848 pp.
10. Internet sources:
1. www.tma.uz
181
2.
3.
4.
5.
6.
7.
8.
www.ziyonet.uz
www.kimdao.ru
www.doktor.ru,
www. medinfo. home.ml.org
http://www.restart-med.ru
http://www.mirmed.ru
www.wikipedia.com
182
MINISTRY OF HEALTH OF THE REPUBLIC OF UZBEKISTAN
CENTRE FOR MEDICAL EDUCATION
Tashkent Medical Academy
"APPROVED"
Pro-rector for
Academic Affairs
Prof. Teshaev
O.R.
____________________
"________"
___________2014.
Department: Department of Folk Medicine, Rehabilitation and Physical
Education
Subject: Rehabilitology
Practical exercises
Application of physical factors and physical therapy in the
rehabilitation of surgical patients (during surgery thoracic
and abdominal cavities and disease) and trauma (fracture of
extremities, spine and pelvis)
Practical lesson
Educational technology
183
EDUCATIONAL TECHNOLOGY of the PRACTICAL ACTIVITIES
THEME №5“Application of physical factors and physical therapy in the rehabilitation of
surgical patients (during surgery thoracic and abdominal cavities and disease) and trauma
(fracture of extremities, spine and pelvis)”
Study time: 270 minutes
Type of lesson
Structure of the training
session (lesson plan)
Purpose of the lesson:
The student should know:
The graduate should be able
to:
Number of students: 8-12
Exercise topics.
1 INTRODUCTION
2. Theoretical part
3. Analytical part
- organiser
- tests
- situational tasks and recipes.
4. Practical skills.
Teach the skill to choose the right treatment strategy and guidelines
physical therapy and exercise therapy
- Methods of research and diagnostics
And Communications basis establishing the relationship between
the ballroom;
-Make rehabilitologic event with trauma disease
-Make recipe on the physical factors and recommend physical
factors despite physiological effect;
Indications and contraindications, physiotherapy treatment in
surgical diseases
Value stages of rehabilitation exercise therapy during surgery
thoracic and abdominal and vascular disease
Self-holding of physiotherapy and exercise therapy manipulation
Despite actions rehabilitations symptomatic pathogenetic treatment.
-Up complex of rehabilitation measures, depending on the stage of
184
Pedagogical objectives:
-Teach students reabilitologic
event be correctly and clearly
in trauma and surgical disease
- Teach the skill to choose the
right treatment strategy and the
main
directions
of
physiotherapy
-Teach
drafting
complex
rehabilitation depending on the
stage of the disease;
-Teach
yourself
to
let
designated physiotherapy;
-Teach yourself to pick up a
set of exercises and therapeutic
exercises to demonstrate their
patients.
the disease
Learning outcomes
-Students will learn the correct sequence of events reabilitologic in
surgical patients (during surgery thoracic and abdominal cavities and
disease) and trauma (fracture of extremities, spine and pelvis)
-Student applies in practice pathogenetic physiotherapy treatment
-Student learns to write recipes on the assigned physical factors;
-Up complex of rehabilitation measures, depending on the stage of the
disease;
Self-appointed spend physiotherapy;
Self-selected set of exercises and medical gymnastics show.
Training Methods
Conversation, discussion, brainstorming, demonstration, training
game, video method, practical method, work books,
Forms of educational activity
collective work in groups ("think in", "think - work in pairs - an
exchange of views")
Learning Tools
Location of
equipment
the
Department of Folk Medicine, Rehabilitation, Physical Education,
Department of Medical Rehabilitation and physiotherapy, physical
therapy rooms;
Distributing educational materials, visual aids, videos, board-stand,
photo, text, flipchart, models, diagrams, texts
visual aids, tables, logical-didactic scheme, physiotherapy
lesson,
equipment, clinical material (case patients).
Assessing knowledge
monitoring
Stages of work
and time
270 minutes
and
Recitation: Quiz, written poll: Testing
Action
Teacher
Learners
185
Stage 1
Theoretical part
20 minutes 1.1. Checks attendance and notebooks
20 minutes 1.2. 1. 1.2. Names the classes theme, its goals, objectives and
expected learning outcomes. . Introduces the mode of
operation in the lesson and evaluation criteria (application
number 6)
25 minutes 1.3. . Gives the task for independent work, references to
independent work. Reported indicators and criteria for
evaluation (Annex № .7)
25 minutes 1.4. Conducting the quick poll/question-answer/"who is
FASTER, MORE" in order to enhance the students '
knowledge on the topic. (Appendix No.1)
10 minutes 11.5. Break
Stage 2
Analytical part
80 minutes 2.1. Chart distributes the "what" and introduces the algorithm
of analyzing the situation. Divides the students into groups.
10 minutes
45 minutes
3rd stage
60 Minutes
20 minutos
10 minutes
2.2. Evaluating the source of students ' knowledge with the
use of new educational technologies (tests and situational
tasks, preparations) (3)
2.3 Break
The practical part
3.1. implementation of practical skill (annex # 4)
3.2. An opinion on the subject, focusing students on the main
reports on the importance of the work done for future
professional careers.
3.3. Commends the work of groups and individual students,
summarizes interassessment. Analyzes and evaluates the
degree of achievement of lesson.
3.4. Gives the task for independent work, references to
independent work. Reported indicators and criteria for
evaluation. (Appendix 6)
Listen, write,
update, ask
questions.
Answer questions.
work in groups,
present the results
of the group work.
Implementation of
practical skills
Conduct selfesteem,
interassessment.
Ask questions.
Recorded
assignment.
186
1. Motivation
Physical factors and means of physical therapy is widely used in surgery and
traumatology. Every year, the FT is becoming more widely used in the preoperative and early
postoperative periods, when complications and consequences of injuries and surgeries, while it
owns a leading position. They promote rapid healing, prevention of complications in the healing
process, more complete recovery of disturbed functions, which significantly reduces the time of
hospitalization and temporary disability. Ability to navigate among individuals and resort factors
and prepare a comprehensive treatment using them is necessary for each GP.
2. Interdisciplinary and intradisciplinary
communication
Teaching the topic is based on the knowledge students the basics of biochemistry,
biophysics, anatomy, normal and pathological physiology, etiology and pathogenesis of surgical
diseases, general surgery, traumatology, physiotherapy and total bases LFK. Acquired during the
course of knowledge will be used in traversing disciplines therapy, surgical disease, trauma, as
well as GPs in their practice.
3. Contents of the lesson
3.1. Theoretical part
Combat damage to the abdomen and pelvis.
Of all the wounds 2-6%, of all those killed about 25%,
Classification
1. Open neognestrelnye gunshot injuries:
- Non-penetrating wounds without damaging the internal organs;
- Penetrating injury with damage of parenchymal organs, hollow organs, hollow
and solid organ, retroperitoneal organs, spine;
- Thoraco-abdominal injuries.
2. Closed injuries of the abdomen:
- Bruising of the abdominal wall;
- Closed hollow organ damage;
- Closed solid organ injury;
- Closed damage hollow and solid organ;
- Closed kidney damage.
187
In modern warfare, we should expect a significant severe wounds and closed
injuries of the abdomen. Increase the number of closed injuries, combines,
"whined. multiple and combined injuries. Especially difficult will flow "ball"
injury - multiplicity; most diverse localization of ports (often on the back), onetime heavy damage to various organs due to sudden changes of direction the ball,
more extensive ruptures organs, increasing the number of thoraco-abdominal
injuries. Difficulties to diagnose injuries represent swept elements - low profile
inlets as yes the abdominal wall and the abdominal organs. DIAGNOSIS closed
injuries BELLY damage hollow organs - pain at rest and try n ..tspai.chi, dry
tongue, rapid pulse, wooden belly, lack of motility, lack of hepatic dullness, with
X-rays - gas below the diaphragm or in the sides of at lateroposition
Solid organ damage - symptoms of blood loss, symptoms of fluid accumulation in
the abdominal cavity. Closed injuries of the kidneys - hematuria, blurred contours
podvzyushno-psoas hematoma due to the X-ray
necessarily performed intravenous urography to exclude flowing
contrast in the perirenal fat (then shown lumbotomy).
Closed injuries of the pancreas - retroperitoneal hematoma,
girdle pain in the upper abdomen, increased
diastase.
Closed injuries of the retroperitoneal part of a duodenum pain in the upper abdomen and in the lumbar region, the signs
emerging retroperitoneal phlegmon may be signs of high
intestinal obstruction.
DIAGNOSIS OF OPEN ABDOMINAL INJURY
Absolute signs of penetrating wounds 1. loss of bowel or omentum;
2. discharge from the wound feces, bile, urine;
3. symptoms of peritonitis.
The essential features of penetrating wounds:
dry tongue, rapid pulse, delayed stool and gas, lack of peristalsis,
muscular defense, the positive symptoms of peritoneal irritation,
disappearance of hepatic dullness, shortening percussion sound in shelving
places.
SPECIAL DIAGNOSTIC TECHNIQUES
- Comparison of the input and output of wounds in Exit Wounds;
- Finger study rectum (blood indicates penetrating injuries to the colon);
- Determination of the loss of blood;
- X-ray;
- Celiocentesis;
- Diagnostic laparotomy (minilaparotomy in critically ill patients with multiple
injuries, when you need to reliably exclude bleeding in the stomach or damage to
the hollow organs of the abdomen);
- The dynamic observation
188
TREATMENT FOR stages of medical evacuation of wounded from battle damage
BELLY battlefield, BMP:
- Bandages large immobilization (fallen bodies do not reduce a);
- Analgesics;
- Quick takeaway.
First medical aid (WFP):
For the wounded of the first group - the state average weight: fixing bandages,
antibiotics and tetanus toxoid, with clear evidence of penetrating wound morphine, the primary evacuation
Omo.
The second group - wounded in serious condition to prepare for evacuation should
be performed: procaine blockade (perirenal, vagosympathetic inside pelvic), pour
intravenously polyglukin, enter the heart, analgesics.
Skilled surgical care (HMO)
The faster operated wounded with penetrating wound to the abdomen, the
better chance of a favorable outcome.
Triage:
The first group - the wounded with the symptoms of the ongoing
intra-abdominal bleeding, wounded, with obvious signs of damage
hollow organs - immediate surgery.
Vtooaya group - with no clear signs of internal bleeding, but "
shock II-III degree. Patients requiring dynamic monitoring
- Operation on the testimony of 1-2 hours.
The third group - inoperable wounded - after antishock
therapy pressure does not rise - conservative treatment in the hospital
department.
The fourth group - may be towed:
bruising of the abdominal wall, in the GLR, kidney-bruising .v urological hospital;
non-penetrating wounds without damaging the organs of the abdomen - in general.
Surgical Hospital.
Laparotomy in HMO C features):
- Under general anesthesia;
- Only midline laparotomy;
- The search for the source of bleeding and stop bleeding;
- Full audit of the abdominal cavity (opening bruising under visceral peritoneum,
the revision of the stomach wall Okay, finding pairs of wounds on hollow organs);
- Stitching wounds colon, stomach, small bowel resection with anastomosis "side
to side> resection of the colon leading to excretion and removing bowel into the
wound of the abdominal wall (shotgun), suturing wounds of the rectum with
imposing unnatural anus:
- Laundering and drying of the abdomen;
- The introduction of novocaine into the root of the small intestine (may be
mikroirrigator);
189
- Drainage of the subphrenic space left after the removal of the spleen, right, after
mending the wounds of the liver (the drainage in this case is derived from
posterior-axillary line), lateral drainage channels and pelvis through an incision in
the iliac region after operations on hollow organs:
- Laparotomic suturing wounds;
- Stretching the anus (under anesthesia);
- Suturing the stomach into the sheets. Evacuation contraindicated 7-12 days.
Postoperative complications
In 2/3 of all the operated.
Mortality from the experience of the Great Patriotic War - | 50%, after
laparotomy - 10%.
Complications early - shock, intestinal paresis, peritonitis.
Complications later - festering wounds eventeratsiya (10%), pneumonia (25%),
fistulas, adhesive disease, ventral hernia-specialized surgery:
(Hospitals for the wounded in the chest, abdomen, pelvis) shameful operations and
treatment of peritonitis, abscesses limited opening of the abdominal cavity, and
closure treatment of intestinal fistula, recovery operations on the gastro-intestinal
tract. COMBAT Open pelvic injuries (gunshot),
- Soft tissue injuries.;.
- Wounds of soft tissue and bone;
- Wounds of soft tissue and bone for internal injuries - injuries intraperitoneal
bladder and rectum damage extraperitoneal bladder and rectum. Closed fractures:
edge,
pelvic ring fractures without broken, broken in violation of the integrity of the
pelvic ring (the front half rings, half rings back, vertical, diagonal). Breaks the
pubic joint, breaks the sacroiliac joint. Diagnosis of closed fractures of the pelvis:
- Palpation of the pelvic ring;
- Palpation of the pelvis through the rectum in women - through the vagina;
- A symptom of "sticky heel> fracture front half rings. In fractures of the pelvis
always do finger study rectal and urine output (if he can not help). Signs of
intraperitoneal bladder injury: can not urinate during catheterization or no urine
can be a lot at once, cystography.
Primakovextraperitoneal bladder injuries: can not urinate, urinary catheterization in
small, it bloody, and over time can be uroplania crotch, thighs, scrotum,
cystography.
Signs of damage perineum urethra: can not urinate, blood in the external opening
of the urethra, a catheter (rezinovyy!) does not pass into the bladder, the bladder
may be full, cystography! Symptoms of rectal injury in closed fracture of the
pelvic bones, blood vials in the rectum, recent signs of pelvic cellulitis. Diagnosis
of open pelvic injuries:
- Examination of the wound, to determine the direction of the wound channel
- Palpation - diagnosis of fracture;
- Finger study rectum (fractures, pelvic inflammation of the peritoneum - the pain);
190
- Diagnosis vnebryushnnnyh direct bowel injury, degeneration of feces and gas
from the wound, palpation of bone fragments and blood in the rectum;
- Diagnosis of intraperitoneal rectal injury:
signs of peritonitis;
Diagnosis of intraperitoneal bladder injuries, lack of urine catheterization or her
very much signs of accumulation of fluid in the abdominal cavity;
- Diagnosis of bladder lesions vnebryushichnyh:
outflow of urine sludge wounds, lack of urination, during catheterization
blood. Cystography.
Staged treatment of the wounded from the battle damage pelvic phase of first aid
(self-help, mutual aid, assist medical orderly, paramedic BMP):
- Bandage on the wound;
- Transportation of the shield with the roller under your knees;
- Analgesics of syringe-tube, stage of the first medical aid (WFP):
- Correction of dressings;
- Puncture of the bladder;
- Stop the bleeding (tamponade wound suturing the skin over it!)
- Treatment of severe shock;
- The introduction of antibiotics;
- The introduction of tetanus toxoid;
- Transportation of the shield with the roller under your knees. Step qualified
surgical assistance: Sort:
- Wounded with ongoing bleeding;
- The victim in a state of shock;
- Wounded on intra-and extraperitoneal rectal injury and bladder, but no signs of
shock,
- Wounded with closed and open pelvic injuries, the integrity of the internal organs
in case of damage of the perineum, the bony part of the urethra and genitalia;
- Bruises and superficial-v. soft tissue wounds;
- Moribund.
Surgery for gunshot wounds of the pelvis - pchssechenie wound excision
devitalized tissue, removal of foreign bodies and svobodnolezhashih
Bone fragments, stop bleeding (can u ligation
the internal iliac artery), drainage of the wound.
If the damage of the rectum - certainly overlaps
preternatural anus.
Intraperitoneal bladder injury-laparotomy.
suturing wounds bladder DIL hub catgut suture
impositionsuprapubic fistula draining the bladder through the urethra
rubber catheter.
Intraperitoneal rectal injuries - laparoscopic ~ tomy, audit
abdomen, suturing wounds of the rectum, the imposition
unnatural anus, drainage of the abdominal cavity,
suturing wounds of the abdominal wall.
191
When vnebryushnnnyh injuries bladder - extraperitoneal exposure
bladder suturing wounds front or side of the wall (for
possible), drain fat okolopuzyrnoy on Buyal'skiy,
impositionnadlobko ^ Vågå fistula with the introduction of a catheter into the
bladder
Peltzer type.
With injuries perineal urethra - the imposition of suprapubic
fistula drainage okolopuzyrnoy fiber on Buyal'skiy, introduction to
rubber bladder catheter.
Primary suture and plastic urethral injuries were gunshot
shown.
Stage specialized surgical care:
- Clarification of the nature of injury (X-ray, urography, urethra-cystography,
cystoscopy);
- Treatment of ascending infection of the urinary tract;
- Opening and drainage streaks, phlegmon, abscess, the treatment of osteomyelitis
of the pelvis;
- Plastic urethral scar its structure;
- Closure of the suprapubic fistula, unnatural anus;
- Treatment confusions pelvis special techniques (skeletal traction, reposition
hammock, etc.)
4. Analytical part
Appendix No.1
USING METHOD "You know?»
Methods of performance.
To work needed:
1.
1. Set of cards with rehabilitation tasks.
2.
Stopwatch.
3.
Plain piece of paper.
Progress:
192
1.
2.
3.
4.
5.
6.
7.
The game is in written form.
2. Students in turn pull the card with the task.
3. Every student writes down his answers on a task for 5 minutes.
4. Then the teacher collects answer sheets.
5. Overall time of the game - 45 minutes.
6. Every answer of an each student is treated separately.
7. Answers are being discussed on a sheet with all students.
Criteria for evaluating the theoretical part
Maximum score
14-12 score
2515
15-14-excellent 13-12 score
100% -86%
85% -71%
11-10 score
11-7 satisfactorily
70-56%
9-8 score
6-4-unsatisfactorily
53% -46%
7 6ball
3 or less - bad
43% or less
Enclosure 2
4.1 logical diagram“What”.
Contraindications.
Hemorrhagic,
traumatic and
painful shocks.
Bleeding and
bleeding
tendency.
Foreign bodies
in the vicinity of
large vessels and
nerves
Reabitologiidemocratic event
with traumarelated disease
What?
What?
-Muscle
hypertrophy
-Muscle
contraction
Sheathe the problem
at the turn of the
extremities
Ossal bonds
reposition
Lack
reposition
parts of the
bones
What?
Tasks LFC 1-degree pelvic fracture
1) reduction of
external respiration
2) improve the process
of metabolism
3) adapt the organism
to grow physical load
What
Improve emotional posture Ballroom
Increasethat tone muscles
3.
Types of therapeutic rehabilitation
193
Medical
Physical
APPENDIX 3
4.2. Case studies:
Task No. 1. Patient P-va, 22 years old. Diagnosis: Lactation mastitis, stage of infiltration.
3. Assign treatment complex consisting of 3 factors physiotherapy.
4. Contraindications to CFT and gymnastics.
5. Make a set of LH.
Standard answer: The complex FT must include: UHF RAS, UV-irradiation of the breast.
Contraindications. stage abscess, fever, severe general condition of the patient. LH complex
consists of breathing exercises, bracing and exercises on the distal parts of the limbs.
Task No. 2. Patient X Male, 36 years old. Diagnosis: 6-7 ribs fractured left. List the
methods of rehabilitation of the patient and make the complex treatment.
Standard answer: The complex rehabilitation of this patient should include physical
factors and means of physical therapy. Consider the following complex treatment:
13. Microwave therapy to the affected half of the thorax.
14. Procaine or calcium electrophoresis fracture site.
15. UV radiation on the affected area.
16. LFK (LH procedures using special breathing exercises: in resistance exercise,
diaphragmatic breathing).
Task No. 3. Patient K-wa, 56 years old. Diagnosis: Adhesive disease.
3. Assign physical treatments (3).
4. Make a set of gymnastics.
Standard answer: The complex rehabilitation of this patient must include physical factors
and means of LFC. Consider the following complex treatment: Inductothermy abdomen, iodine
(or procaine) electrophoresis abdominal (transverse technique), RAS therapy localization region
of adhesions.
Complex physical therapy consists of breathing exercises (diaphragmatic breathing),
bracing and abdominal muscles, as well as walk.
Task No. 4. Patient R., 24 years old, was operated on for ulcer 12 duodenal ulcer. Day
3 after operation. Complaints of cough, low-grade fever, weakness, sweating. Your tactics for
the appointment of LFK and FT? What special exercises should be taught to the patient?
Standard answer: LH is necessary to appoint the first day after surgery. In the 1st day
breathing breast, using patient instructor doing exercises for the distal portions of the upper and
lower extremities, rotary motion in the hip joint. 3-4 days connected general tonic and special
exercises (pelvic separation from bed, diaphragmatic breathing, inflating balloons). CFT is given
after normalization of body temperature: magnet therapy, laser therapy on postoperative suture
region, electrosleep.
194
Appendix-3
4.3 Tests
1. Factors of decrease pain and swelling of soft tissue injury?
A. * UHF
B. Massage
C. LFK
D. method of Franklinization
2. What method of treatment is contraindicated in fractures?
A. * CMT
B. UHF
C. Electrophoresis
D. treatment with magnesium
3. which method is not used in the trophic wound?
A. * osocerite
B. ultra violet rays
C. Method Franklinization
D. Treatment with a laser
4. Which method is not used in the burn for fast healing of skin
A. * ultra violet rays
B. Treatment with magnesium
C. Treatment with a laser
D. method Franklinization
5. Show Index assesses the effectiveness of therapeutic gymnastics at pereudi before surgery and
after surgery
* A static load to the anterior abdominal wall
B. angle measurement
C. goniometrics
D. Test by Letunov
6.What medication is not administered in electrophoresis with broken bones?
A. * Nospanum
B. Wax
C. solution of calcium chloride
D. novocaine
7, What is the procedure is not used for indoor head fracture?
A. * absent
B.elektroson
C. darsonval
D. IRT
8, Which method is not used in the trophic wound?
A. * osocerite
B.UFA
C. Franklin Method
D. laser treatment
9.How physiotherapy can be used when the disease rumen
1 *Ultrasound
2 electrosleep
3 franklinization
4 ultraviolet
10. What sense is in clinic - outpatient rehabilitation?
195
A treatment of infectious focus
B. Restore the ability to work *
C. To increase resistance to vibration Weather
D. Cures the disease
Appendix-3
4.4 Cookbook on physical factors
1.Magnetotherapy
In trophic wound cavity impulse magnetotherapy ENT-3-4, 4-5 IVL, T=6-12 min, N8-10 every
day
Methodics: Inductors apparatus Amit-01 N and S reel sterile wipes and applies to wound
Recommendation: trophic wound is being cleansed with necrotic tissue
2. MICROWAVE on the affected joint DMW-therapy.D-beam 100 mm contact, each
session 1-4 poly r-7-30: N10-15 each day
recommendation. Can be recommended for professional, traumatic, gout arthritis.
Note: while 4 or more lesions joint bottom during change decimeter wave; the first day
of the two joints with the second day in two or three joints max if one of them is irradiated to one
side, to thyroid gland
3. DMW therapy P 120mvt/sm2 n-6min. N -10-20 a day
Methodology exposer unit daisy puts skin in the region share one share 1st day, 2 nd day to
another
Recommendation: during exacerbation yazvi stomach disorder secretory and motor
functions of the stomach, hepatobiliary system function disorder in determining symptom by
Nische also to enhance immunity
Not used in hyperthyroidism, vascular disorder
4. Pulse magnet therapy in the heart of the wound, int-3-4-5 4, IVL, t 6-12 m, N8-10
every day
Methodology Inductors apparatus Amit-01 N and S reel sterile drape and imposes to
wounds
Recommendation: trophico wounds treated by necrotic tissue
196
APPENDIX 4
5.1Prakticheskie skills (step development)
Objectiveteach students to use complex treatment methods in physiotherapy practice.
Indications: teach and perform on their own physiological factors used to select physical
procedures in pathogenetic treatment of postoperative period of shoulders fracture
Necessary equipment: Account CFT physioequipment
#
Stages of
of
Ite
ms
1. Evaluation of the clinical condition of the patient
(complaints, anamnesis morbi, anamnesis vitae, status
presents, data clinical and laboratory studies
Appointment rational physiotherapy:
2.
to determine whether a given patient contraindications to
physiotherapy
3. in the absence of contraindications for physiotherapy
selection of major groups of physical factors on syndromic
pathogenetic principle
4. selection of specific physiotherapy treatments to the
patient in accordance with the rules of the compatibility of
physical factors
5. Sequencing of physiotherapy appointment at their
complex
6. registration sheet assignments (writing prescriptions for
physiotherapy)
TOTAL
Failed to
execute
step
Follow all
steps (20point)
0
3.
0
3.
0
3.
0
3.
0
3.
0
5.
20.
Assessment of the adequacy of physical activity for patients with various diseases during
the procedure of physiotherapy
Objective learn to assess the adequacy of physical activity for patients with various diseases
during physiotherapy sessions (LH)
Indications: learn to assess the adequacy of physical activity for patients with surgical
intervention pereudi spinal column
Necessary equipment : Account LFK, Rockets
197
#
Stages of
Failed to
execute
step
Follow all
steps (20point)
1.
Interrogation of the patient in order to identify possible complaints
before the LH
0
2.
2.
Measurement of blood pressure, heart rate calculation, BH patient to
load
Counting heart rate for 10 seconds in the patient by the end of the
introductory part of LH, identifying complaints and external signs of
fatigue
Counting heart rate for 10 seconds in a patient complaints and identify
external signs of fatigue during the main part of LH
0
2.
0
2.
0
2.
5.
Counting heart rate for 10 seconds in a patient complaints and identify
external signs of fatigue in the final part of LH
0
3.
6.
0
3.
7.
Measurement of blood pressure, heart rate calculation, BH, identifying
complaints and external signs of fatigue in a patient after 5 min after
LH
Storing the data in the medical and control card
0
2.
8.
Draw the physiological load curve
0
2.
9.
Making a conclusion
0
2.
Total
0
20.
3.
4.
criteria for assessing practical skill
100% -86%
40-34, 4- perfect
85% -71%
34-28.4
score
70-55%
28-22 satisfactorily
54% -37%
21.6-14.8 unsatisfactorily
36% or less
14.4 or less - bad
6. Way to verify knowledge and experience
- Actively participate in discussions
- Answers written results
-Solve test and task case stages
- Practical skills
Appendix-5.
6.1 Assessment of practical skills
N
o.
Evaluation
excellent
good
satisfactorily
unsatisfactorily
poorly
Adoption in %
100% 86%
25-24
points
15-14
85% 71%
23-22
points
1312
70-55%
54% -37%
36% or
less
21-19 points
18-17 points
15 points
11-10 points
9-8 points
7-6
1.
Theoretical part
2.
The analytical
198
part diagram
points
points
3.
Test
15-14
points
13-12
points
F
o
ur
The practical part
40-35
points
35-30
points
points
11-10 points
30-25 points
9-8 points
7-6
points
25-15 points
14 points
In assessing students' knowledge of Rehabilitation accounted following approximate
criteria
No Performa
.
nce in%
1. 96-100%
91-95%
2.
3.
86-90%
Evaluation
Student's knowledge level
Excellent
"5"
Student independent. Has an overall concept on the subject
Rehabilitation. Applies in practice, with the matter, said
confidently, has fine views. Full correct answer to the
questions on the classification of electrotherapy, mechanisms
of action of continuous and pulsed currents (galvanization,
iontophoresis, diadynamic, electric, electric pulp test,
amplipulse), application techniques, indications and contraindications. Summarizes and makes decisions, think
creatively, independently analyzes. Situational problems are
solved correctly, with a creative approach, with full
justification response.
Actively and creatively involved in interactive games, right to
make informed decisions and summarizes and analyzes.
Recipes writes is true, with the best indication of dose
exposure to physical factors. The synopsis on the subject
there.
Full correct answer to the questions on the classification of
electrotherapy, mechanisms of action of continuous and
pulsed currents (galvanization, iontophoresis, diadynamic,
electric, electric pulp test, amplipulse), application
techniques, indications and contra-indications. Summarizes
and makes decisions, think creatively, independently
analyzes. Situational problems are solved correctly, with a
creative approach, with full justification response.
Actively and creatively involved in interactive games, right to
make informed decisions and summarizes and analyzes.
Recipes writes is true, with the best indication of dose
exposure to physical factors.
Questions posed by products electrotherapy, mechanisms of
action of continuous and pulsed currents (galvanization,
iontophoresis, diadynamic, electric, electric pulp test,
amplipulse), application techniques, indications and
contraindications to fully covered, but there are 1-2 errors in
Excellent
"5"
Excellent
"5"
199
Fo
ur
81-85%
Average
"4"
5.
76-80%
Average
"4"
6.
71-75%
Average
"4"
the response. Applies in practice, with the matter, said
confidently, has fine views. Situational problems are solved
correctly, but the justification answer sufficiently.
Actively involved in interactive games, correct decisions.
Recipes writes is true, with the best indication of dose
exposure to physical factors, but there are 2-3 grammatical
errors.
Questions posed by products electrotherapy, mechanisms of
action of continuous and pulsed currents (galvanization,
iontophoresis, diadynamic, electric, electric pulp test,
amplipulse), application techniques, indications and
contraindications to fully covered, but there are 2-3
inaccuracies, errors. Applies in practice, with the matter, said
confidently, has fine views. Situational problems are solved
correctly, but the justification answer sufficiently.
Inaccuracies in solving situational problems. Actively
involved in interactive games, correct decisions.
Recipes writes is true, with the best indication of dose
exposure to physical factors, but there are 2-3 grammatical
errors, inaccuracies in dose.
Correct but incomplete coverage of the issue. The student
knows the classification of electrotherapy, mechanisms of
action of continuous and pulsed currents (galvanization,
iontophoresis, diadynamic, electric, electric pulp test,
amplipulse), methods of application, indications and contraindications, but not fully versed in the mechanisms of action
of physical factors. With the matter, said confidently, has fine
views. Actively involved in interactive games. Situational
problem gives partial solutions.
Recipes written specifying the dose exposure to physical
factors, but there are 3-4 grammatical errors, inaccuracies in
dose.
Correct but incomplete coverage of the issue. The student
knows the classification of electrotherapy, mechanisms of
action of continuous and pulsed currents (galvanization,
iontophoresis, diadynamic, electric, electric pulp test,
amplipulse), methods of application, indications and contraindications, but not fully versed in the mechanisms of action
of physical factors, incomplete lists contraindications to CFT
in this pathology. With the matter, said confidently, has fine
views. Actively involved in interactive games. Situational
problem gives partial solutions.
Recipes written specifying the dose exposure to physical
factors, but there are 3-4 grammatical errors, inaccuracies in
dose.
200
7.
66-70%
Satisfactory
"3"
8
657
61%
Satisfactory
"3"
9
558
60%
Satisfactory
"3"
10.
40-54%
11. 30-40%
unsatisfactorily
"2"
unsatisfactorily
"2"
The correct answer to half the questions posed. The student
knows the classification of continuous and pulsed currents
(galvanization, iontophoresis, diadynamic, electric, electric
pulp test, amplipulse) but poorly versed in the mechanisms of
action of physical factors, incomplete lists contraindications
to CFT in this pathology. With the matter, said uncertainly,
has accurate representations only on specific issues theme.
Situational problems are solved correctly, but there is no
justification response. Student passive when discussing CDS.
Recipes are written with an inaccurate indication of dose
exposure to physical factors, there are grammatical errors.
Correct answer to the third set of questions. The student
knows the classification of continuous and pulsed currents
(galvanization, iontophoresis, diadynamic, electric, electric
pulp test, amplipulse) but poorly versed in the mechanisms of
action of physical factors, incomplete lists contraindications
to CFT in this pathology. With the matter, said uncertainly,
has accurate representations only on specific issues theme.
Situational problems are solved correctly, but there is no
justification response. Student passive when discussing CDS.
Recipes are written with an inaccurate indication of dose
exposure to physical factors, there are grammatical errors.
The correct answer is 1/4 of the questions. The
student knows the classification of permanent and pulse
current
(galvanization,
medicinal
electrophoresis,
electrosleep, diadynamic, electroodontodiagnosis, amplipulse
therapy), but poorly versed in the mechanisms of action of
physical factors, may not list contraindications to the use of
FT in this pathology. Poor seized with the matter, said
uncertainly, has exact representation only on specific issues
theme. Student is very passive when discussing CDS.
Recipes are written with an inaccurate indication of dose
exposure to physical factors, there are grammatical errors.
Lighting 1/10 of the questions at the wrong approach. Student
does not know the physical factors (galvanization,
iontophoresis, diadynamic, electric, electric pulp test,
amplipulse). Practically does not understand the mechanisms
of action of physical factors, does not understand the
indications and contraindications to the appointment of FT in
this pathology.
All recipes are written with blunders.
Questions not answers. Does not know the physical factors
(galvanization, iontophoresis, diadynamic, electric, electric
201
pulp test, amplipulse) and their mechanisms of action. Is not
able to prescribe physical factors on the topic.
For the presence of students in the classroom, in proper form,
with a notebook.
7. Flow chart classes
N
o.
Step classes
Form
1.
Check
2.
Introduction to the teacher
Attendance and notebooks
check
Notes to the topics
3.
Theoretical part
4.
Analytical part
5.
6.
Show student shows evident ways
(slides, presentations, videos, etc),
and their notes
The practical part
7.
Conclusion
Discussion
Respond orally
Discuss Any chart»
Decides to challenge the test
Implementation of practical
skills
Score point, set the home
setting, independent work
Time
270
minutes
30 minutes
Break
30 minutes
10
minutes
30 minutes
80
minutes
10 minutes
45
minutes
60 Minutes
30 Minutes
8. Test Questions
1. Etiopathogenesis, clinical picture, treatment of surgical diseases (abscess subcutaneous
tissue, hidradenitis, axillary infiltrates, laktacionnyj mastitis, appendicitis, diseases of
operated stomach, adhesive disease, trophic ulcer);
2. Etiopathogenesis, clinical picture, treatment of soft tissue and bone injuries (sprains,
traumatic haematoma, thermal burns, wounds, bruises, broken bones).
3. Continuous and impulse currents: characteristic physiological action, indications,
contraindications, techniques.
202
4. Electromagnetic fields of various characteristics (magnetic therapy, inductothermy, UHF,
microwave therapy): characteristic physiological action, indications, contraindications,
techniques.
5. Heat hydrotherapy: characteristic physiological action, indications, contraindications,
techniques.
6. Forms and means of physical therapy.
9. Suggested Reading.
Main
4. Bogolyubov V.M. "Balneology and Physiotherapy" 1 and Volume 2 M. Medicine 1985
5. Yuldashev K., Y. Kulikov "Physiotherapy". T. 1984.
6. Sosin I.n. Kariyev, M. H. "Physiotherapy in surgery, Traumatology and Neurosurgery,
London, 1994.
7. Popov S.N. "Physical rehabilitation", Rostov-on-Don, 1999.
8. V.k. Dobrovolsky "Therapeutic physical culture in surgery", l., 1970.
9. Stepsons S.m. "Physiotherapy", m, medicine, 1969.
10. Epifanov V.A. Handbook of medical physical culture. M, 1987.
11. Babadzhanov S.n. "Physiotherapist", Tashkent, in 1999.
Additional
 Bogolyubov V.M. "Handbook of sanatorium selection", M, 1992.
 Iasnogorodski VG "Handbook of Physical Therapy", M, 1981.
 Ponomarenko TN "Guide to practical training in general physiotherapy", M, 2000.
 Yuldashev KY "Non-drug therapies, a practical handbook for doctors, Tashkent, in 1999.
 Sosin I.n. "Physiotherapy directory», Kiev, 1973.
Orange I.e., Il′hamdžanova D.s. The "short guide to physiotherapy», Tashkent, 1992.
Foreign literature:
6. Marlis Gonzalez-Fernandez, MD, PhD, Jarrod David Friedman, MDPhysical
Medicine and Rehabilitation Pocket Companion
7. Mark Harrast MD, Jonathan Finnoff, DOSports MedicineStudy Guide and Review for
Boards
8. Wainapel, Stanley F.; Fast, Avital (Editors), Alternative Medicine and RehabilitationA
Guide for Practitioners 2003-Demos Medical Publishing
9. Consuelo T Lorenzo et al. Physical Medicine and Rehabilitation Medscape Reference
2011 – WebMD
10. Sara J. Cuccurullo (Editor)Physical Medicine and Rehabilitation Board Review2004Demos Medical Publishing, 848 pp.
10. Internet sources:
1.
2.
3.
4.
5.
www.tma.uz
www.zionet.uz
www.kimdao.ru
www.doktor.ru,
www. medinfo. home.ml.org
203
6. http://www.restart-med.ru
7. http://www.mirmed.ru
REPUBLIC UZBEKISTAN MINISTRY of HEALTH
CENTER of DEVELOPMENT of THE MEDICAL EDUCATION
TASHKENT MEDICAL ACADEMY
"Approved by"
The pro-rector on study
Prof. Teshaev
O.R.
____________________
«________»
___________ 2014.
Chair: National medicine, in rehabilitology, a physical education
Subject: Rehabilitology
Theme of practical employment
Application of physical factors and MRT in rehabilitation of patients with
gynecologic diseases (at pregnancy, sorts, after a sort) gynecologic diseases (at
an inflammation of female genitals, climacteric a syndrome, genital
infantility) and in pediatrics (NCD, CCP, rickets, allergodematitis, a
bronchial asthma, rheumatism, children's LOR diseases).
Practical employment
204
Educational and methodical guide
PEDAGOGIC TECHNOLOGY THE PRACTICAL OF EMPLOYMENT
Theme №6”Application of physical factors and MPT in rehabilitation of patients with
gynecologic diseases (at pregnancy, sorts, after a sort) gynecologic diseases (at an
inflammation of female genitals, climacteric a syndrome, генитальном infantility) and in
pediatrics (NCD, CCP, a rickets, allergodematitis, a bronchial asthma, rheumatism,
children's LOR diseases)”.
Technological card of practical employment
Time: 270 minutes
The employment form
Structure of educational
employment (the
employment plan)
The purpose of educational
employment:
Quantities of students: 8-12
Practical employment on subjects.
1. Introduction
2. Theoretical part
3. An analytical part
- Organizer
- Tests
- Situational Cases, the recipe.
4. Practical skills.
To train in ability correctly to choose tactics of treatment and the basic
directions of physiotherapeutic treatment and MRT at gynecologic
diseases (at pregnancy, sorts, after a sort) gynecologic diseases (at an
inflammation of female genitals, climacteric a syndrome, genital
infantility) and in pediatrics (NCD, CCP, a rickets, allergodematitis, a
bronchial asthma, rheumatism, children's LOR diseases).
205
The student should know:
The student should be able:
Pedagogical Cases:
- To train students to make
rehabilitation action correctly
and it is accurate
– To train in ability correctly to
choose tactics of treatment and
the
basic
directions
of
physiotherapeutic treatment
– To train in drawing up of a
complex
of
rehabilitation
actions depending on a disease
stage;
– To learn to release
independently the appointed
physiotherapeutic procedures;
– To learn to
select
independently a complex of
exercises
of
medical
gymnastics and to show to
their patients.
Training methods
Forms of educational activity
Tutorials
- Research and diagnostics methods
- Communication bases an establishment the relation with patients;
- Indications and contra-indications to appointment of
physiotherapeutic treatment and MRT at gynecologic patients and at
children with various diseases;
- Will make the recipe on physical factors and to recommend
physical factors looking physiological action;
- Indications and contra-indications, physiotherapeutic treatment at
pediatrics
- Value of stages of rehabilitation MRT at children's LOR diseases
- Independent carrying out physiotherapeutic and MRT
manipulations
- Looking to actions of rehabilitations to spend symptomatic,
pathogenic treatment.
- Make a complex of rehabilitation actions depending on a disease
stage
Results of educational activity:
- Students study will correctly make sequence rehabilitation action
at gynecologic disease (at pregnancy, sorts, after a sort) gynecologic
diseases (at an inflammation of female genitals, climacteric a syndrome,
genital infantility) and in pediatrics (NCD, CCP, a rickets,
allergodematitis, a bronchial asthma, rheumatism, children's LOR
diseases).
- The student applies in practice patogenic physical therapeutic
treatments
- The student studies to write a compounding on the appointed physical
factors;
– Make a complex of rehabilitation actions depending on a disease
stage;
– Independently carry out the appointed physiotherapeutic procedures;
– Independently select a complex of exercises of medical
gymnastics and show.
Conversation, discussion, brain storm, the demonstration, training
game. pinboard, the case study to work with books, the scheme, video
clips
Collective work in groups («it is thought in a place», «to think - to
work as steams - an exchange opinion»)
Distributing teaching materials, visual materials, video films,
board-stand, photo, the text.
Board-stand, flipchart, video films, models, the scheme, texts
206
Visual aids, tables, logic and didactic schemes, physiotherapeutic
Place of carrying out of
equipment, a clinical material (thematic patients).
employment, equipment
Oral interrogation: blitz-interrogation; written interrogation: the
Estimation of knowledge and
test
monitoring
Technological card of practical employment
Stages of work
and time
(270 minutes)
1-stage.
Action
The training
Theoretical part
20 minutes
1.1. Checks attendance and writing-books
20 minutes
1.2. 1. Informs an employment theme, its purpose, Cases and planned
results of educational activity. Acquaints with an operating mode on
employment and criteria of an estimation of results (the appendix №6)
25 minutes
Trainees
Listen, write
down, specify,
answer questions.
1.3. Gives the task for independent work, the list of the literature for
independent work. Informs indicators and criteria of its estimation (the
appendix №.7)
1.4. "PIG IN A POKE" on purposespends a method to make active
knowledge trained on a theme. (The appendix №.1)
25 minutes
11.5. Change
10 minutes
2-stage.
Analytical part
80 minutes
2.1. Supervises over discussion of a theme of practical employment.
Distributes materials of a case and acquaints with aTrEorithm, analysis of
the situation. Divides students into groups.(The appendix №2)
10 minutes
2.2. Spends an estimation of initial knowledge of students with use of new
pedagogical technologies (tests and situational Cases, preparations) (3appendix)
Answer questions
Work in groups,
present results of
group work.
2.3. Change
207
45 minutes
3-stage.
Practical part.
60 minutes
3.1. take practical skill (the appendix №4)
3.2. Does the conclusion on a theme, concentrates attention of students to
the main thing, informs on importance of the done work for the future
professional work.
20 minutes
Carry out practical
skills
Spend a self3.3. Estimates activity of groups and separate students, sums up mark. estimation,
Analyzes and estimates degree of achievement of the purpose of autoassessment.
educational employment. (5 appendix).
Ask questions.
Write down the
task.
1. Motivation
Physical factors and means MRT are widely applied in gynecology and pediatrics.
Modern scientific researches and practical operational experience show necessity of
reasonable restriction of medicamentous loading on an organism of the woman to the child
without lengthening of terms and decrease in an end result of treatment. It has especially great
value not only for the prevention of allergic and other collateral negative influences of medicines
on an organism of the woman, but also concerning protection of a fruit from influence of
unnecessary and harmful substances. Advantage of PT in pediatrics is painlessness of
procedures, active influence of energy of factors (thermal, radiant, electric, mechanical) on own
potential jet possibilities, high efficiency at smaller dosages owing to big regeneratory and
compensatory possibilities at children. Ability to be guided among physical and resort factors
and to make complex treatment with their application it is necessary for each general
practitioner.
2. Intersubject and intrasubject communications
Teaching of the given theme is based on knowledge students of bases of biochemistry,
biophysics, anatomy, normal and pathological physiology, an etiology and pathogenesis of
gynecologic diseases, obstetrics, pediatrics, the general physiotherapy and bases MRT. The
knowledge received during employment will be used at passage of disciplines by them therapy,
pediatrics, obstetrics and gynecology, and also GP in the practical activities.
3. The employment maintenance
3.1. Atheoretical part
208
4. An analytical part
The appendix №1
USE of THE METHOD "PIG IN A POKE"
Carrying out technique.
For work it is necessary:
1. Set of cards with tasks on rehabilitation.
2. The report with the list of students of group.
3. Stop watch.
Game course:
1. Game spend orally.
2. Students by turns extend a card with the taskwith a question of the first degree of
complexity.
3. Each student within 1 minute orally answers the task.
4. After each answer the teacher exposes a point in the report.
5. The general time of carrying out of game of 45 minutes
6. Answers of students are estimated as follows:
As much as possible – 1 point
«5» - 0,8 points
«4» - 0,6 points
«3» - 0,4 points
«2» - 0 points
7. The point typed by students is considered at exhibiting of "a current estimation».
8. In the bottom free part of magazine the teacher makes entry about carrying out of business
game.
9. Game reports remain.
The list of tasks for carrying out of business game
"Pig in a poke":
1. Name, physical factors are for what purpose appointed at chronic inflammatory diseases of
female sexual system.
2. Name the physical factors, having anti-inflammatory an effect.
3. Name the physical factors rendering sedative effect.
4. Name the physical factors rendering antiaggregant effect.
5. Name the physical factors rendering bactericidal effect.
6. List Cases MRT at chronic inflammatory diseases of female sexual system.
7. List Cases MRT at a climacteric syndrome.
8. List Cases MRT at CCP.
9. Special exercises at chronic inflammatory diseases of female sexual system.
10. List advantages of application of PT in pediatrics.
11. Special techniques and medical products of electrophoresis at chronic inflammatory diseases
of female sexual system.
12. Special techniques and medical products of electrophoresis.
209
13. Name, physical factors are for what purpose appointed at CCP.
14. The physical factor applied for the purpose of pathogenetic therapy in gestosis.
15. Special exercises at a bronchial asthma at children.
16. What hydropathic procedures are applied at a climacteric syndrome.
17. List contra-indications to of PT and MRT at pregnant women.
18. From what age it is possible to appoint microwave therapy to children?
Criteria of an estimation of theorethic part
Maximal
14-12 point
point 15
15-14 it is 13-12 it is good
excellent
100 %-86 % 85 %-73 %
11-10 point
11-7
it
satisfactory
70-56 %
9-8 point
is 6-4 it is
satisfactory
53 %-46 %
7-6 point
not 3 and it is less bad
43 % and are less
The appendix - 2.
4.1 Logic diagram "What".
Primaryor the basic
Frustration management of menstrual dysfunctions
Primary changes in hypothalamus and hypophysis systems
What
In the anamnesis inflammatory diseases of a brain stem
It is observed at endocrine infringement
The basic clinical situation
What
Physiotherapeutic effect
What
Low-frequency mediocre electrostimulation of hypothalamus and hypophysis systems
The basic clinical situation
What
Vegetative vascular, exchange and trophic disturbances
The basic clinical situation
What
Endonasal galvanization
The basic clinical situation
What
Physiotherapeutic effect
What
Galvanization of head and cervical area
210
Group
№
Each group estimates other groups.
High-grade performance on all points
15 points
The correct and
Evidence
To
Activity of
clear answer (5)
(5)
correspond
group
regulations
(2,5)
(2,5)
Total 15 points
1.
2.
Criteria of estimation in the analytical part:
Maximum
13-12 points
11-10 points
15 points
100-86 %
85 %-73 %
70-56 %
9-8 points
53 %-46 %
7-6 points
43 % and less
Appendix No.3
211
4.2. Situational Cases:
Case № 1 Patient R-va, 29 years. The diagnosis: Chronic bilaterial salpingophoritis in a
stage of a calming down aggravation.
1. Whether it is possible for this patient to appoint physiotherapy and MRT?
2. The Cases pursued in this case by physiotherapy and MRT.
3. Contra-indications to an administration of physical therapy and MRT at the given
pathology.
4. What of PT can be used factors at this disease at the given stage.
5. Make approximate complex TRE of the given patient.
The answer standard. It is necessary for this patient to appoint of PT and MRT. Cases:
reduction of inflammatory reaction, desensibilization of an organism, strengthening of activity of
medicinal substances, reduction superfluous proliferation of connective tissue, activization of
local blood circulation, liquidation of again arising changes of activity nervous, endocrine,
cardiovascular systems, the general strengthening of an organism, restoration of work capacity of
the woman. Contra-indications: the expressed aggravation of an inflammation, a heat, presence
of purulent processes before opening of the purulent centre and outflow creation. From of PT at
the given stage are shown: СВЧ, индуктотермия, electrophoresis, osocerite application, US
therapy with lidase. It is necessary to include respiratory exercises In complex TRE, common
and special exercises for abdominal tension muscles, bottom, walking, a bike-simulator.
Case № 2. Patient Sh-va, 52 years. The diagnosis: the Climacteric syndrome. Adiposity
of I degree. АГ I degrees.
1. Whether it is possible for this patient to appoint physiotherapy and MRT?
2. The Cases pursued in this case by physiotherapy and MRT.
3. Contra-indications to an administration of physical therapy and MRT at the given
pathology.
4. What of PT can be used factors at this disease at the given stage.
5. Make approximate complex TRE of the given patient.
The answer standard. It is necessary for this patient to appoint of PT and MRT. Cases:
normalisation of nervous, endocrine, cardiovascular systems’ activity, the general strengthening
of an organism, struggle with hypodynamia, decrease in weight of a body, improvement of a
psycho-emotional condition of the patient. Contra-indications: myoma in uterus, uteral bleeding,
high АГ, stenocardia attacks, ischemic changes on the electrocardiograms expressed arrhythmia.
From of PT at the given stage are shown: an electrodream, darsonvalization on neck
zones, franklinisation, HAE, bromine-electrophoresis a collar on Scherbak, circular or a shower.
It is necessary to include respiratory exercises in complex TRE, common health-improvement
and special exercises for abdominal tension muscles, coxae and a bottom and the bottom
extremities, walking, a velosimulator.
Case № 3. Patient N-va, 8 months the Diagnosis: the Rickets of I degree.
1. Whether it is possible for this patient to appoint physiotherapy and MRT?
2. The Cases pursued in this case by physiotherapy and MRT.
3. Contra-indications to an administration of physical therapy and MRT at the given
pathology.
4. What of PT can be used factors at this disease at the given stage.
5. Make approximate complex TRE of the given patient.
The answer standard. It is necessary for this patient to appoint of PT and MRT. Cases:
stimulation of an exchange of vitamin D, phosphor-calcium exchange, immunologic processes,
improvement of a condition of nervous system and the loco-impellent device, strengthening of
muscular system, correct development of a statics and a motility. Contra-indications: the period
of a heat of disease, presence of fresh crises, infringement of integrity of a skin, pyodermia,
acute infectious diseases, sharp inflammatory processes, heart diseases with the phenomena of
decompensation, an acute anemia.
212
From of PT at the given stage are shown: the general UV-irradiation, calciumelectrophoresis by a technique of Vermelja, douche, coniferous baths, application paraffinosocerite application on extremities, massage. It is necessary to include respiratory exercises in
complex TRE, common health-improvement and special exercises for muscles of a back, an
abdominal tension, the bottom and top extremities, exercises on coordination and balance.
Case № 4. Patient D., 8 years. The diagnosis: the Chronic tonsillitis, the compensated
stage.
1. Whether it is possible for this patient to appoint physiotherapy and MRT?
2. The Cases pursued in this case by physiotherapy and MRT.
3. Contra-indications to an administration of physical therapy and MRT at the given
pathology.
4. What of PT can be used factors at this disease at the given stage.
5. Make approximate complex TRE to the given patient.
The answer standard. It is necessary for this patient to appoint of PT and MRT. Cases:
achievement anti-inflammatory, anaesthetising, bactericidal lytic effects, stimulation
immunologic processes, the general strengthening of an organism, improvement of the loonyemotional of a condition of the patient. Contra-indications: the aggravation of disease
accompanied by a heat and the general grave condition of the child, paratonsillar abscess.
From of PT at the given stage are shown: the UPh irradiation on tonsillar area, UV
therapy on tonsillar area, lymph nodules in a dosage, inhalation: alkali, with mineral waters,
broths of medicative herbs; US-THERAPY on tonsillar area. It is necessary to include
respiratory exercises In complex TRE, exercises, game lessons.
213
Appendix №3
4.3 Tests
1. What factors are used at mastopathy
A. *electrophoresis with CU
B. UHF
C. Treatment about magnesium
D. DDC
2. What procedures are not used at a wound a uterus neck
A. * tamponade
B. UFA
C. darsonvale
D. Laser therapy
3. What physiotherapeutic treatment are applied at second half of pregnancy?
A. * electrodream
B. A beam bath
C. Ultra-violet beams
D. Massage
4. What methods are not used at hemorrhoids
A. * osokerite
B. darsonvale
C. Treatment with the laser
D. Spray shower
5. Show an indicator an estimation of efficiency medical gymnastics at pregnancy and after
patrimonial period
A.
*myomonomeasurement muscles of a forward belly wall and a small basin
B.
goniomeasurement
C.
angle measurement
D.
caliper measurement
6. What method of galvanization are used at vasomotor rhinitis
А collar galvanization by Scherbak
В galvanization by Vermel
С half-mask by Bergonier
D.*by Kassel endonasally
7. What physical factors are used at the central ear illness
A.* A pulse current
B. An alternating current
C. A constant invariable current
D. Treatments with magnesium
E. Treatments with the laser
8. What methods are used at external an otitis
A. Ultra-violet beams
B. *sollux
C. Treatments with a magnet
D. СВЧ
E. Laser therapy
9. What factors it is applied at a rickets
А.UHF
B. HAE
214
C. Inhalation
D.USD
10. Specify an aspect of rehabilitation
A. physiotherapy.
B. treatment massage.
C. physical culture
D. MRI
Appendix №4
4.4 Collection of recipes about physical factors
1.Osocerite application.
Osocerite application – in trousers shape t040С-48С. Duration of 20 minutes. Every day 8-10
procedure
2 Mud application.
Applications in the form of "Trousers". Thickness of dirt - 5-6 cm, temperature 38-400С, every
day or every other day 15-20 minutes. One course of 12-18 treatments
Appendix №5
4.4 Collection of recipes about physical factors
1. Osocerite application.
Osocerite application – in trousers shape t040С-48С. Duration of 20 minutes. Every day 8-10
procedure
2 Mud application.
Applications in the form of " trousers". Dirt of 5-6 cm, temperature 38-400С, every day or every
other day 15-20 minutes. One course of 12-18 of treatment.
3. Электрофарез to operatein an irradiation zone pains with local anesthetic substances
(novocaine, lidocaine, trimecaine, dicain) and spasmolytic (nicotine, eufillin) I-0,01-0,03 ma \see
Т-20-30 minute N15 every day.
The recommendation: anti-inflammatory, spasmolitic, a pain satisfying actions, area
иннервации С5-С7 roots and in the centre condensed forward a ladder figurative muscles
4. A pulse magnetotherapy in an area of trophic wounds, int-3-4, IVL 4-5, т 6-12
mines, N8-10 every day
Technique: inductor device AMIT-01 N and S to reel up to a sterile napkin and imposes
in area of wounds
The recommendation: trophic wounds cleared from necrotic fabrics
Criteria of an estimation situational Cases
13-12 points
11-10 points
9-8 points
Maximum
points 15
15-14-perfectly
14-12-well
11-7-well
6-4-not well
100 %-86 %
85 %-73 %
70-56 %
53 %-46 %
7-6 points
3 and less
Badly
43 % and less
215
The appendix-4
5.Practical skills (step-by-step development)
The purpose: will learn students to application complex treatment by physiotherapeutic
methods in practice.
The indication: to learn on their own to carry out and choose physiofactors applied physical
procedures at pathogenetic treatment of infertility disease.
Necessary equipment: office of PT, physiotherapeutic devices
№
Performance stages
Could not
execute a
stage
Has
executed
all stages
(20-point)
1.
Estimation of a clinical condition of the patient (the complaint,
anamnesis morbi, anamnesis vitae, status presents, the data of
clinic and laboratory researches
Appointment of rational physiotherapy:
Definition of presence at the given patient of contraindications to physiotherapy
In case of absence of contra-indications to physiotreatment
allocation of the basic groups of physical factors by a
syndrome-pathogenetic principle
Choice of concrete physiotherapeutic procedures for the given
patient according to rules of compatibility of physical factors
Definition of sequence of carrying out physioprocedures at
their complex appointment
Registration of sheet appointments (a writing of recipes on
physioprocedures)
Total
0
3
0
3
0
3
0
3
0
3
0
5
2.
3.
4.
5.
6.
20
Estimation of adequacy of physical activity for patients with various diseases during
procedure of medical gymnastics
The purpose: to learn to estimate adequacy of physical activity for patients with various
diseases during employment by medical gymnastics (THE TRE)
The indication: to learn to estimate adequacy of physical activity for patients at 1ой a pregnancy
trimester.
Necessary equipment: TrE room, shells.
№
Performance stages
Could not
execute a
stage
1.
Interrogation of the patient for the purpose of revealing of possible
complaints prior to the beginning the TRE
Measurement the AP, calculation of HR, BrR at the patient to loading
0
Has
executed
all stages
(20-point)
2
0
2
2.
216
3.
4.
5.
6.
7.
8.
9.
Calculation HR for 10 seconds at the patient by the end of prologue the
TRE, revealing of complaints and external signs of exhaustion
Calculation HR for 10 seconds at the patient, revealing of complaints and
external signs of exhaustion during the basic part the TRE
Calculation HR for 10 seconds at the patient, revealing of complaints and
external signs of exhaustion in final part the TRE
Measurement the AP, calculation HR, BrR, revealing of complaints and
external signs of exhaustion at the patient through 5 mines after
termination the TRE
Entering of the received data in a medical-control card
To draw a physiological curve of loading
To issue a conclusion
Total
0
2
0
2
0
3
0
3
0
0
0
0
2
2
2
20
Criteria of an estimation practical skill
100 %-86 %
85 %-71 %
70-55 %
54 %-37 %
40-34,4-perfect
34-28,4-well
28-22 it is
satisfactory
21,6-14,8 it is
unsatisfactory
36 % and are
less
14,4 and it is less
bad
6. checks knowledge and experience
- Actively to participate in discussion
- Answers of written results
- To solve the test ы and Cases of Cases-stages
- Practical skills
Appendix №6
6.1мери estimations practical skill
№
Estimation
Points in %
1
2
Theoretical part
Analyticalpart of the
diagramm
3
4
The test
Practical part
Perfectly
Well
100 %-86 % 85 %-71 %
25-24
23-22
points
points
1514points
13 12
points
15-14
13-12
points
points
40-35
35-30
points
points
Well
Unsatisfactorily
Badly
70-55 %
54 %-37 %
36 % and are
less
21-19 points
18-17 points
15 points
11-10 points
9-8 points
7-6 points
11-10 points
9-8 points
30-25 points
25-15 points
7-6
points
14 points
At an estimation of knowledge of students on rehabilitology following approximate criteria
are considered now
217
9. Suggested Reading.
Main
12. Bogolyubov V.M. "Balneology and Physiotherapy" 1 and Volume 2 M. Medicine 1985
13. Yuldashev K., Y. Kulikov "Physiotherapy". T. 1984.
14. Sosin I.n. Kariyev, M. H. "Physiotherapy in surgery, Traumatology and Neurosurgery,
London, 1994.
15. Popov S.N. "Physical rehabilitation", Rostov-on-Don, 1999.
16. V.k. Dobrovolsky "Therapeutic physical culture in surgery", l., 1970.
17. Stepsons S.m. "Physiotherapy", m, medicine, 1969.
18. Epifanov V.A. Handbook of medical physical culture. M, 1987.
19. Babadzhanov S.n. "Physiotherapist", Tashkent, in 1999.
Additional
 Bogolyubov V.M. "Handbook of sanatorium selection", M, 1992.
 Iasnogorodski VG "Handbook of Physical Therapy", M, 1981.
 Ponomarenko TN "Guide to practical training in general physiotherapy", M, 2000.
 Yuldashev KY "Non-drug therapies, a practical handbook for doctors, Tashkent, in 1999.
 Sosin I.n. "Physiotherapy directory», Kiev, 1973.
Orange I.e., Il′hamdžanova D.s. The "short guide to physiotherapy», Tashkent, 1992.
Foreign literature:
11. Marlis Gonzalez-Fernandez, MD, PhD, Jarrod David Friedman, MDPhysical
Medicine and Rehabilitation Pocket Companion
12. Mark Harrast MD, Jonathan Finnoff, DOSports MedicineStudy Guide and Review for
Boards
13. Wainapel, Stanley F.; Fast, Avital (Editors), Alternative Medicine and RehabilitationA
Guide for Practitioners 2003-Demos Medical Publishing
14. Consuelo T Lorenzo et al. Physical Medicine and Rehabilitation Medscape Reference
2011 – WebMD
15. Sara J. Cuccurullo (Editor)Physical Medicine and Rehabilitation Board Review2004Demos Medical Publishing, 848 pp.
10. Internet sources:
8. www.tma.uz
9. www.zionet.uz
10.www.kimdao.ru
11.www.doktor.ru,
12.www. medinfo. home.ml.org
13.http://www.restart-med.ru
14.http://www.mirmed.ru
218
QUESTIONS LIST FOR THE FINAL CONTROL ON "REHABILITATION"
SUBJECT
1.
Define the term "rehabilitation", call the main aspects of rehabilitation.
Rehabilitation potential, rehabilitation prognosis.
2.
Contents of medical aspects of rehabilitation.
3.
Content of the physical aspects of rehabilitation.
4.
Content of the psychological aspect of rehabilitation.
5.
Content of the social and professional aspects of rehabilitation.
6.
List the basic principles of rehabilitation.
7.
Principles destination of physioprocedures.
8.
List the physical factors that have a sedative effect.
9.
List the physical factors, which have anti-inflammatory effects.
10. List the physical factors that have trophic effects.
11. List the physical factors that have bactericidal and bacteriostatic action.
12. List motor modes in a hospital and the main tasks therapeutic exercise these
modes.
13. List propulsion modes for sanatorium stage of treatment and physical
therapy for the basic tasks of these modes.
14. Terms of combining physical factors. Give examples of the combined
physiotherapy and incongruous.
15. List the physical factors that have an analgesic effect.
16. List the physical factors that have immunostimulatory effects.
17. Which of the activities is a program of rehabilitation of patients with
myocardial infarction, at a stationary stage?
18. Which of the activities is a program of rehabilitation of patients with
myocardial infarction at a polyclinic stage?
19. Which of the activities is a program of rehabilitation of patients with
myocardial infarction at a sanatorium stage?
20. Medical rehabilitation program content IHD effort angina FC II-III.
21. Contents of physical rehabilitation program IHD effort angina FC II-III.
22. Content of the program of medical rehabilitation of patients with bronchial
asthma.
23. Contents of physical rehabilitation program in patients with bronchial
asthma.
24. Which of the activities is a program of rehabilitation of patients with
pneumonia at a stationary stage?
25. Which of the activities is a rehabilitation program for patients with
pneumonia polyclinic stage?
26. Which of the activities is a rehabilitation program for patients with
pneumonia sanatorium stage?
27. Content of the program of medical rehabilitation of patients with duodenal
ulcer on the stationary phase.
28. Content of the program of medical rehabilitation of patients with duodenal
ulcer on the sanatorium stage.
219
29. Content of the program of medical rehabilitation of patients with chronic
hepatitis.
30. Content of the program of medical rehabilitation of patients with ankylosing
spondylitis.
31. Content of the program of physical rehabilitation of patients with ankylosing
spondylitis.
32. Content of the program of medical rehabilitation of patients with rheumatoid
arthritis, articular form.
33. Contents of physical rehabilitation program for patients with rheumatoid
arthritis, articular form.
34. Content of the program of medical rehabilitation patients osreoarthrosis
joints.
35. Content of the program of physical rehabilitation patients osreoarthrosis of
the joints.
36. Content of the program of rehabilitation of patients with spinal
osteochondrosis.
37. Which of the activities program is the rehabilitation of patients after stroke,
on the stationary phase?
38. Which of the activities is a program of rehabilitation of patients after stroke,
at a polyclinic stage?
39. Which of the activities is a program of rehabilitation of patients after stroke,
at a sanatorium stage?
40. Content of the program of medical rehabilitation of patients with trigeminal
neuralgia.
41. Content of the program of medical rehabilitation of patients with facial nerve
neuritis.
42. Content of the program of physical rehabilitation of patients with facial
nerve neuritis.
43. Content of the program of medical rehabilitation of patients with diabetes.
44. Content of the program of physical rehabilitation of patients with diabetes.
45. Content of the program of medical rehabilitation of patients with obesity.
46. Content of the program of physical rehabilitation of patients with obesity.
47. Which of the activities is a program of rehabilitation of patients who
received broken limbs, in the period of immobilization.
48. Which of the activities is a program of rehabilitation of patients who
received limb fractures in postimmobilization period.
49. Which of the activities program is the rehabilitation of patients who
underwent surgery on the organs of the thoracic cavity on the stationary phase?
50. Which of the activities program is the rehabilitation of patients who
underwent surgery on the organs of the thoracic cavity, at a polyclinic stage?
51. Which of the activities program is the rehabilitation of patients who
underwent surgery on the organs of the thoracic cavity at a sanatorium stage?
52. Which of the activities program is the rehabilitation of patients who
underwent surgery for abdominal organs, on the stationary phase?
220
53. Which of the activities program is the rehabilitation of patients who
underwent surgery for abdominal organs, at a polyclinic stage?
54. Which of the activities program is the rehabilitation of patients who
underwent surgery on the abdominal organs, for sanatorium-resort stage?
55. Content of the program of medical rehabilitation of patients suffering from
infertility.
56. Content of the program of medical rehabilitation patients climacteric
syndrome.
57. Content of the program of medical rehabilitation of patients with skin
diseases (psoriasis, atopic dermatitis, allergodermia) on the stationary phase.
58. Content of the program of medical rehabilitation of patients with skin
diseases (psoriasis, atopic dermatitis, allergodermia) at health resort stage
59. Content of the program of medical rehabilitation of patients with scoliosis.
60. Content of the program of physical rehabilitation of patients with scoliosis.
61. Content of the program of medical rehabilitation of patients with diseases of
ENT organs.
62. List contraindications to physical therapy.
63. Classification of physical factors, depending on their nature and syndromic
pathogenetic.
64. Features of the program of rehabilitation of the cancer diseases.
65. Content of the program of medical rehabilitation of patients with chronic
pyelonephritis at a stationary stage.
66.
Content of the program of medical rehabilitation of patients with chronic
pyelonephritis sanatorium stage.
67. List contraindications to physical therapy.
TEST QUESTIONS
Nu
mb
er
1
2
3
4
5
6
7
8
9
10
11
12
13
Tests
Rehabilitation - is:
Aspects of rehabilitation:
In the medical aspect of rehabilitation does not include:
In the physical aspect of rehabilitation include:
In the social aspect of rehabilitation does not include:
In the professional aspect of rehabilitation does not include:
The basic principles of the rehabilitation process does not apply:
The stationary phase of the rehabilitation of patients with myocardial infarction, do
not apply:
Physical rehabilitation of patients after myocardial infarction, hospitalization begins:
The first stage of activity physical rehabilitation of patients after myocardial
infarction, do not use the exercise:
Specify contraindications to physical therapy for diseases of the cardiovascular
system:
Inductothermy contraindicated for the treatment of:
Physiobalneofactors used in IHD patients have an effect:
221
14.
15
16
17
18
19.
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
The most effective anti-inflammatory effect in bronchitis in children affects:
For effects on renal hemodynamics in hypertension using:
Diagnosis: Pneumonia lower lobe of the right lung. Pick a draining position:
In the second phase of rehabilitation of patients with myocardial infarction (8-16
week) in terms of local cardiological sanatoriums, rehabilitation departments of
hospitals and clinics can be assigned:
A comprehensive recreational therapy hypertensive patient Phase II may include the
following treatments:
In arterial hypertension for primary influence on neuro-and hemodynamic processes
in the CNS using:
Diagnosis: Bronchial asthma remission. What tools are used in therapeutic exercise?
In occupational lung diseases shows the assignment of inhalation:
Diagnosis: CHD. Acute myocardial infarction without Q wave without complications.
Determine the severity of the patient's functional class and exercise therapy
appointment time:
Diagnosis: Chronic obstructive bronchitis in acute stage of abating. In order to
restore drainage function of bronchi not assigned exercises:
Obstructive bronchitis appropriate use of methods of physiotherapy, bronchodilators
have expectorant effects. It does not include:
appropriate use of
methods of physiotherapy, possessing expectorant bronchodilator effects. These
include
Of physiotherapy most broad indications in gastroenterology have:
Diagnosis: Chronic cholecystitis. Pick a starting position that promotes drainage of
the gallbladder:
Indication for lavage (irrigation) bowel disease are the following:
Patients with peptic ulcer 12 duodenal ulcer in partial remission can be sent to a
sanatorium:
Spa treatment is not indicated in patients with chronic gastritis:
With obesity grade I-II shows gidrobalneotherapy:
In the primary stage of chronic pyelonephritis in subsiding exacerbation does not
apply:
In order to prevent exacerbations of chronic pyelonephritis in remission or minimal
activity apply:
The number and order of reception of mineral water in diseases of the stomach
depends on:
Of these factors, the greatest analgesic effect in chronic gastritis with pain syndrome
have:
Among the methods of recreational therapy of peptic ulcer leading place:
Spa treatment at local health centers ill after viral hepatitis is contraindicated in case
of:
Diagnosis: Type II diabetes subcompensation stage. The range of physiotherapy
exercises are not included:
Diagnosis: Diabetes mellitus type II compensation stage. Define the problem of
physical rehabilitation:
In diabetes of moderate severity and microangiopathies impractical to appoint:
Thyrotoxicosis treatment currents should not be prescribed on the region:
Patient 38 years old, a year after thyroid surgery suffering hypothyroidism,
arthropathy advisable to appoint:
In a patient with chronic colitis after balneoprocedures noted increased abdominal
pain, diarrhea, increased pain on palpation, strengthening dysbiosis, the recent
222
43
44
45.
46
47
48
49
50
51
52
53
54
55
56
57
58
59
50
61
62
63
64
65
66
67
68
69
70
71
aggravation of 2.5 months ago. The reaction can be regarded as:
Urolithiasis to stimulate locomotor activity ureters apply:
Indication for the use of physical factors on the projection area of the kidney with
curative intent is:
In diabetes of moderate severity and microangiopathies in complex rehabilitation
include:
In subacute thyroiditis and drug allergy appoint:
Rehabilitation program for the patient with duodenal ulcer include:
Diagnosis: Rheumatoid arthritis articular form, activity II, for a slowly progressive.
What form of exercise therapy is recommended?
Patients with osteochondrosis pronounced sympathetic syndrome are encouraged to
nominate:
Trigeminal neuralgia in the acute stage does not apply physiotherapy following
factors:
Diagnosis: Post-traumatic arthritis of the temporomandibular joint. Define the
problem therapeutic exercise:
Patients with systemic sclerosis with pronounced proliferative phenomena in
periarticular tissues is not assigned:
Diagnosis: Scoliosis. Specify the kinds of the exercises:
After transient ischemic attack patients with cerebral atherosclerosis may be directed
to the resorts on the following dates:
Diagnosis: Status after TBI, concussion (6 month). Какие
exercise is not recommended for use in complex medical gymnastics?
In psoriasis in the progressive stage of the disease is most appropriate destination:
One of the most effective types of balneotherapy with atopic dermatitis in remission
are:
In the initial stages of deforming osteoarthritis, synovitis in the absence of
phenomena, the following physical factors:
Patients with osteoarthritis are not shown the following resorts:
Neuritis of the facial nerve with initial signs of contracture, optimal exposure
technique DC is:
Neuritis of the peroneal nerve, accompanied by paresis of the foot, provides the
greatest effect:
In order to improve cerebral circulation in parkinsonism not apply the following
physical factors:
What aspect of rehabilitation is not included in the program of rehabilitation of
patients with ankylosing spondylitis?
To stimulate private glucocorticoid function of the adrenal cortex in patients with
ankylosing spondylitis assigned the following physical factors:
Traumatic neuritis of the ulnar nerve from the first days of the disease, apply the
following physiotherapy treatments:
Of physical treatments for migraine (vasospastic form) inappropriate use:
When frozen shoulder in the acute period is not prescribed physiotherapy following
factors:
To stimulate weak muscles, improve the trophic metabolism in progressive muscular
dystrophy prescribe physiotherapy following factors:
When rheumatic nervous system (chorea) with the aim of sedation is used:
Pronounced analgesic effect in osteochondrosis has combination of physical factors:
Which of the physical treatments for cerebral palsy are aimed at strengthening weak
muscles:
223
72
73
74
75
76
77
78
79
80
81
82
83
84
85
85
87
88
89
90
91
92
93
94
95
96
97
98
99
10
0
10
1
10
2
10
3
10
4
10
5
10
6
10
7
Optimal physical therapy appointments of gynecological patients is:
During exacerbation of chronic salpingooforhitis caused by inflammation,
electrophoresis shows:
Diagnosis: Bilateral adnexitis. Subacute stage. Specify means therapeutic exercise:
Patients with uterine myoma and mastopathy chest compressions:
Diagnosis: Pregnancy 14 weeks. Things therapeutic exercise cease:
From infancy children used physical factor:
Specify the earliest date of application of ultrasound children:
Safety during physical therapy in pediatrics does not include:
In juvenile bleeding on the background of reduced hormonal activity advisable to
appoint:
In the 2nd trimester of pregnancy exercise is recommended to perform from the
initial position:
The group of anti-physical treatments for children with respiratory diseases are:
In the treatment of scoliosis in children do not use:
When traumatic muscular torticollis newborns do not prescribe:
Children suffering from rickets, used for therapeutic purposes:
Children with spastic constipation do not apply:
For the prevention of exacerbations of rheumatic children do not prescribe:
What physical factors are shown for pregnant women with SARS:
Indications for use:
What physical factors are shown at Lactostasis:
Diagnosis: premenstrual syndrome. Physical therapy includes:
In order to prevent adhesions in the pelvis in the postoperative period is assigned:
Specify the physical factors used in step 2 to rehabilitation after surgery for ectopic
pregnancy:
Diagnosis: climacteric syndrome. Complex physical therapy includes:
In the treatment of children is not permissible purpose in one day:
What a welcome massage accelerates callus formation?
Functional method of rehabilitation in surgery and traumatology is:
Diagnosis: Bones of the right forearm injury. Early postimmobilization period. The
complex consists of physical therapy exercise:
In the medical-rehabilitation complex patients operated on the stomach, the first
stage should include:
Physiotherapy object infiltration step rise is not:
Task of physiotherapy in the postoperative period is not:
Diagnosis: postinjection infiltrate the gluteal region. In order to infiltrate resorption
apply:
Diagnosis: Варикозное расширение вен нижних конечностей. The objectives of the
therapeutic exercise does not include:
In the treatment of soft tissue injuries, fractures and dislocations are distinguished
periods:
Specify the physical factors with antiecssudative action:
During the period of immobilization for injuries in the affected limb in the complex
physical therapy exercises include:
Ideomotor exercises and static muscle tension in immobilized limb used to:
224
10
8
10
9
11
0
18
5
11
2
11
3
11
4
11
5
11
6
11
7
11
8
11
9
12
0
12
1
General objectives of physical therapy in postimmobilization-term period does not
apply:
To stimulate peristalsis in the early postoperative abdominal exercises are used:
In order bactericidal effect in wounds and trophic ulcers are recommended:
In the postoperative period to prevent disease with a view to resolution therapy
should establish:
therapeutic exercise form in the early postoperative period after appendectomy:
Physical factors that are assigned to the stage of infiltration at carbunculosis:
Erysipelas shown everything except:
Physical factors recommended in the early postoperative period after appendectomy:
Physical treatments paraproctitis in the preoperative period:
Physical factors that are assigned in the postoperative period in hidroadenitis:
Purulent pleurisy of physical therapy does not apply:
Specify the sanatorium, which is recommended for patients with dumping syndrome:
Special exercises during immobilization in fractures of limbs:
Specify the physical factors that have a bactericidal effect
CASE PROBLEM
1.Solve the situational problem:
A patient-types, 44 years. Diagnosis: acute myocardial infarction with Q wave left
ventricular posterior wall, subacute stage, the 15th day of illness.
1.
What aspects should be included in the program of rehabilitation of the
patient?
2.
Objectives pursued by the appointment of physiotherapy and exercise
therapy.
3.
What factors can be assigned to physical therapy and at what stage?
2.Solve the situational problem:
A patient-types, 44 years. Diagnosis: acute myocardial infarction with Q wave left
ventricular posterior wall, subacute stage, the 15th day of illness.
1.
Determine the severity and functional class motoring.
2.
Make a rough set of physiotherapy patient.
3.
Height at which the heart rate should be performed exercise?
3. Solve situational problem:
A patient B., 58 years old, Clinical diagnosis :
225
Ref.: Hypertensive heart disease stage III. Hypertension II degree. Risk IV (very
high). CHD. Exertional angina FC II.
Sop.: Obesity II degree.
1.
What aspects should be included in the patient's rehabilitation program?
2.
Objectives pursued by the appointment of therapeutic exercise.
3.
Make a rough set of physiotherapy patient.
4. Solve situational problem:
A patient Islands B., 58 years old, Clinical diagnosis :
Ref.: Hypertensive heart disease stage III. Hypertension II degree. Risk IV (very
high). CHD. Exertional angina FC II.
Sop.: Obesity II degree.
1.
Objectives pursued by the appointment of physiotherapy.
2.
What factors can be assigned to physical therapy?
3.
What sanatorium recommend?
5. Solve situational problem.
Patient Bv M., 63 years old, Clinical diagnosis : Osteochondrosis of the
lumbosacral spine with reflex pain. Osteoarthritis of the knee.
Sop.: Obesity II degree (BMI 30 kg / m ²). Chronic cholecystitis without stones in
remission.
1.
What aspects should be included in the patient's rehabilitation program?
2.
Objectives pursued by the appointment of therapeutic exercise.
3.
Make a rough set of physiotherapy patient.
6. Solve situational problem.
Patient M., 63 years old, Clinical diagnosis : Osteochondrosis of the lumbosacral
spine with reflex pain. Osteoarthritis of the knee.
Sop.: Obesity II degree (BMI 30 kg / m ²). Chronic cholecystitis without stones in
remission.
1.
Objectives pursued by the appointment of physiotherapy.
2.
What factors can be assigned to physical therapy?
3.
What sanatorium recommend?
7. Solve situational problem:
Patient K in B., 31 years old, Clinical diagnosis : Chronic obstructive bronchitis
in the acute stage.
1.
What aspects should be included in the program of rehabilitation of the
patient?
2.
Objectives pursued by the appointment of therapeutic exercise.
3.
Make a rough set of physiotherapy patient.
8. Solve situational problem:
Patient K in B., 31 years old, Clinical diagnosis : Chronic obstructive bronchitis
in the acute stage.
1.
Objectives pursued by the appointment of physiotherapy.
2.
What factors can be assigned to physical therapy?
3.
What sanatorium recommend?
9. Solve situational problem:
226
Patient K-va A., 40 years old, Clinical diagnosis : Distal reflux esophagitis.
Axial hiatal hernia. Catarrhal gastro. Chronic cholecystitis in the acute stage.
1.
What aspects should be included in the patient's rehabilitation program?
2.
Objectives pursued by the appointment of therapeutic exercise.
3.
Make a rough set of physiotherapy patient.
10. Solve situational problem:
Patient K-va A., 40 years old, Clinical diagnosis : Distal reflux esophagitis.
Axial hiatal hernia. Catarrhal gastro. Chronic cholecystitis in the acute stage.
1.
Objectives pursued by the appointment of physiotherapy.
2.
What factors can be assigned to physical therapy?
3.
What sanatorium recommend?
11 Solve situational problem:
On a patient-VI, 28 years old, clinical diagnosis: Хроническийпростатит.
Urethritis.
Sop.: Obesity I degree High myopia. Myopic chorioretinal dystrophy.
1.
What aspects should be included in the program of rehabilitation of the
patient?
2.
Objectives pursued by the appointment of therapeutic exercise.
3.
Make a rough set of physiotherapy patient.
12 Solve situational problem:
On a patient-VI, 28 years old, clinical diagnosis: Хроническийпростатит.
Urethritis.
Sop.: Obesity I degree High myopia. Myopic chorioretinal dystrophy.
1.
Objectives pursued by the appointment of physiotherapy.
2.
What factors can be assigned to physical therapy?
3.
What sanatorium recommend?
13 Solve the situational problem:
Patient SE va T., 51 years old, clinical diagnosis: Type II diabetes mellitus in
moderate stage subcompensation.
Complications.: Diabetic macro-and microangiopathy. Diabetic neuropathy of the
lower extremities. Diabetic retinopathy.
1.
What aspects should be included in the patient's rehabilitation program?
2.
Objectives pursued by the appointment of therapeutic exercise.
3.
Make a rough set of physiotherapy patient.
14. Solve the situational problem:
Patient SE va T., 51 years old, clinical diagnosis: Type II diabetes mellitus in
moderate stage subcompensation.
Complications.: Diabetic macro-and microangiopathy. Diabetic neuropathy of the
lower extremities. Diabetic retinopathy.
1.
Objectives pursued by the appointment of physiotherapy.
2.
What factors can be assigned to physical therapy?
3.
What sanatorium recommend?
227
15 Solve the situational problem:
Patient-W in M., 60 years old, clinical diagnosis: Hypertensive heart disease
stage III. Of ischemic stroke in the middle cerebral artery on the right.
Hypertension II degree. Risk IV (very high).
Donkey.: Article II encephalopathy.
1.
What aspects should be included in the program of rehabilitation of the
patient?
2.
Objectives pursued by the appointment of therapeutic exercise.
3.
Make a rough set of physiotherapy patient.
16. Solve the situational problem:
Patient-W in M., 60 years old, clinical diagnosis: Hypertensive heart disease
stage III. Of ischemic stroke in the middle cerebral artery on the right.
Hypertension II degree. Risk IV (very high).
Donkey.: Article II encephalopathy.
1.
Objectives pursued by the appointment of physiotherapy.
2.
What factors can be assigned to physical therapy?
3.
What sanatorium recommend?
17. Solve the situational problem:
Patient Y in S., 20 years old, clinical diagnosis: Ankylosing spondylitis
(Bechterew's disease) central form, slowly progressive course. Activity I. X-ray
stage II-III. FTS 0.
1.
What aspects should be included in the program of rehabilitation of the
patient?
2.
Objectives pursued by the appointment of therapeutic exercise.
3.
Make a rough set of physiotherapy patient.
18 Solve the situational problem:
Patient Y in S., 20 years old, clinical diagnosis: Ankylosing spondylitis
(Bechterew's disease) central form, slowly progressive course. Activity I. X-ray
stage II-III. FTS 0.
1.
Objectives pursued by the appointment of physiotherapy.
2.
What factors can be assigned to physical therapy?
3.
What sanatorium recommend?
19. Solve the situational problem:
Patients with Island Z., 50 years old, clinical diagnosis: Double-sided pneumonia
in the stage of resolution.
Sop.: Acute facial nerve neuropathy right.
1.
What aspects should be included in the patient's rehabilitation program?
2.
Objectives pursued by the appointment of therapeutic exercise.
3.
Make a rough set of physiotherapy patient.
20 Solve the situational problem:
228
Patients with Island Z., 50 years old, clinical diagnosis: Double-sided pneumonia
in the stage of resolution.
Sop.: Acute facial nerve neuropathy right.
1.
Objectives pursued by the appointment of physiotherapy.
2.
What factors can be assigned to physical therapy?
3.
What sanatorium recommend?
ВЫПОЛНЕНИЕ ПРАКТИЧЕСКИХ НАВЫКОВ
1.
Pathogenetically justified the appointment of physiotherapy in hypertensive
whiteness stage II hypertension 2 degrees.
2.
Pathogenetically justified the appointment of physiotherapy treatments in
CHD, angina FC II.
3.
Pathogenetically justified the appointment of physiotherapy in bronchial
asthma.
4.
Pathogenetically justified the appointment of physiotherapy in duodenal
ulcer patients in acute stage of subsiding.
5.
Pathogenetically justified the appointment of physiotherapy treatments for
rheumatoid arthritis, articular form, arthritis, activity I.
6.
Pathogenetically justified the appointment of physiotherapy treatments for
osteoarthritis of the knee.
7.
Pathogenetically justified the appointment of physiotherapy treatments in
ankylosing spondylitis, a central form.
8.
Pathogenetically justified the appointment of physiotherapy treatments in
spinal osteochondrosis with reflex pain.
9.
Pathogenetically justified the appointment of physiotherapy in chronic
pyelonephritis under partial remission.
10. Pathogenetically justified the appointment of physiotherapy treatments in
diabetes mellitus type II moderate complicated with diabetic microangiopathy and
polyneuropathy.
11. Pathogenetically justified the appointment of physiotherapy in chronic
adnexitis.
12. Pathogenetically justified the appointment of physiotherapy in chronic
tonsillitis.
13. Pathogenetically justified the appointment of physiotherapy in chronic
prostatitis.
14. Pathogenetically justified the appointment of physiotherapy in fractures in
postimmobilization period.
15. Pathogenetically justified the appointment of physiotherapy after opening
mastitis suppurative focus.
16. Perform the iontophoresis in chronic gastroduodenitis.
17. Perform the UHF-therapy for frozen shoulder.
18. Perform the electrodream therapy of insomnia.
19. Carry out the procedure at darsonvalisation with dystonia.
229
20. Perform the magnetic therapy for varicose veins of the lower extremities.
21. Perform the ultraphonophoresis for osteoarthritis of the knee.
22. Perform the UV irradiation in acute rhinitis.
23. Perform the LHE baths in chronic pyelonephritis.
24. Perform the paraffin-osocerite applications in rheumatoid arthritis with a
lesion of the small joints of the hands.
25. Show special exercises for the patient with rheumatoid arthritis, affecting the
small joints of the hands.
26. Show special exercises for scoliosis patients.
27. Show special exercises for patients with cervical osteochondrosis.
28. Show special exercises for patients with osteoarthritis of the knee.
29. Show special exercises for patients with facial nerve paresis.
30. Show special exercises for patients who are on bedrest.
31. Show special exercises for patients with fractures of the forearm bones in the
period of immobilization.
32. Show special exercises for patients with fractures of the forearm bones in
postimmobilization period.
33. Show special exercises for patients with bronchial asthma.
34. Show special exercises for the patient flatfoot.
35. Show special exercises for patients with obesity.
36. Show special exercises for patients with chronic atopic colitis.
37. Referral to a spa treatment of a patient with COPD.
38. Referral to a spa treatment of a patient with rheumatoid arthritis.
39. Referral to a spa treatment of the patient with chronic pyelonephritis.
40. Referral to a spa treatment of the patient with chronic gastritis.
Write a prescription for physical therapy procedures ARRANGEMENT in such
pathology
1. Write out a prescription for UHF therapy in nasopharyngitis.
2. Write out a prescription for electrophoresis at duodenal ulcer.
3. Write out a prescription for phonophoresis in osteoarthritis of the knee.
4. Write out a prescription for darsonvalization in hypertension.
5. Write out a prescription for UHF-therapy for Ankylosing spondylitis.
6. Write out a prescription for UV-therapy for ARI.
7. Write the recipe on paraffin-ozocerite baths with osteochondrosis of the
lumbosacral spine.
8. Write out a prescription for mineral baths in rheumatoid arthritis.
9. Write out a prescription for UV-therapy for psoriasis.
10. Write out a prescription for aerosol with pharyngitis.
11 Write out a prescription for iontophoresis procedure in ankylosing spondylitis.
12 Write out a prescription for UHF therapy for right of shoulder periarthritis.
13 Write the recipe on paraffin-ozocerite applications osteoarthritis of the knee.
14. Write out a prescription for electrophoresis in hypertension.
15 Write out a prescription for the Charcot douche procedures for obesity.
230
16. Write out a prescription for UHF-therapy at the right-lower lobe pneumonia.
17th Write out a prescription for phonophoresis with reactive arthritis of the knee.
18 Write out a prescription for Diadynamic osteochondrosis of the lumbosacral
spine with radicular pain syndrome.
19. Write out a prescription for elektrodream therapy with nocturnal enuresis.
20 Write out a prescription for Darsonvalization in diabetes complicated by
diabetic microangiopathy and polyneuropathy of the lower extremities.
21 Write the recipe with magnetic therapy trophic ulcers.
22 Write out a prescription for the procedure infrared radiation for left otitis media.
23 Write out a prescription for ultraviolet irradiation procedure with rickets.
24 Write out a prescription for ultraviolet irradiation procedure with shingles.
25 Write out a prescription for laser therapy procedures in the cracks of the nipple.
26 Write out a prescription for a procedure at galvanizing asthenoneurotic
syndrome.
27. Write out a prescription for ultrasound therapy procedures for operations in the
late postoperative period.
28. Write out a prescription for a procedure in chronic bronchitis.
29. Write out a prescription for a procedure mineral baths in chronic
pyelonephritis.
30. Write out a prescription for a procedure circular douche with asthenia of CNS.
231
“KLASTER” ORGANIZERSCHEME.
REABILITATION
IN BRONCHIAL
ASTHMA
232
“ step” diagram scheme
diseases of urinary tract
Pielonefritis
Glomerulonefritis
Nephrolitiasis
reabilitation
233
pyramide scheme
ИНСУЛТДАН
КЕЙИНГИРЕАБИЛИТАЦИЯНИНГ
н
АСОСИЙ ПРИ ЦИПЛАРИ:
RECOVER
MOVEMENT:
REABILITATIO
N AFTER
STROKE
RECOVER
SPEECH
RECOVER OF PSCHOLOGICAL AND SOCIAL ADAPTATION
INCREASING OF LIMB TONUS:
PAINKILLERS
IN 15-20% CASES
JOINT INJURIES
RECOVER OF
INJURED TISSUE
TROFICS
FIXED BANDAGE TO PATIENTS WITH
SHOULDER TRAUM
234
4.1 logical diagram“What”.
Contraindications.
Hemorrhagic,
traumatic and
painful shocks.
Bleeding and
bleeding
tendency.
Foreign bodies
in the vicinity of
large vessels and
nerves
Reabitologiidemocratic event
with traumarelated disease
What?
What?
-Muscle
hypertrophy
-Muscle
contraction
Sheathe the problem
at the turn of the
extremities
Ossal bonds
reposition
Lack
reposition
parts of the
bones
What?
Tasks LFC 1-degree pelvic fracture
1) reduction of
external respiration
2) improve the process
of metabolism
3) adapt the organism
to grow physical load
What
Improve emotional posture Ballroom
Increasethat tone muscles
3.
Types of therapeutic rehabilitation
Medical
Physical
235
Exercises which doing in uteroflexion
236
ГЛОССАРИЙ
Реабилитация – бу касалликлар, жароҳатлар ёки жисмоний, кимёвий ва
маиший омиллар таъсирида ўзгарган саломатлик ва функционал ҳолатларни,
ҳамда меҳнатга қобилиятини тиклашдир.
Реабилитация мақсади – бемор ва ногиронларни маиший ва меҳнат
фаолиятига, жамиятга эрта ва эффективли қайтариш; инсоннинг шахсий
хусусиятларини тиклаш.
Реабилитацион натижа (прогноз) – бу беморнинг индивидуал заҳиралар ва
компенсатор имкониятларини, касалликнинг характери ва кечишини ҳисобга
олиб режалаштирилган вақт давомида белгиланган реабилитация мақсадига
Реабилитацион зарурлик – агар жароҳатланиш ёки касалланиш натижасида
функционал қобилиятларнинг қисқа ёки узоқ вақт бўзулиш ҳавфи
тўғилганда, ташқи муҳитнинг негатив омиллари таъсирида бемор ҳолатининг
ёмонлашиши ёки узоқ вақт чегараланиш хавфи кузатилганда керак бўлади.
Реабилитацион қобилият – беморнинг соматик ва рухий ҳолатининг
стабиллиги, тавсия этиладиган реабилитацион даволашга ёндошиш бўйича
кучли қизиқишдир.
Реабилитацион ёндошиш – бу касаллик асоратини енгишга, ҳаёт тарзини
ўзгартиришга, ҳавфли омилларнинг камайишига ёрдам берувчи ҳар хил
турларини
қўшиб
шифокорлик,
ҳамширалик
физиотерапевтик,
эрготерапевтик, логопедик, диетологик ва психотерапевтик таъминлаш билан
ўзаро алоқага кирувчи тиббий, педагогик, касбий ва ижтимоий характердаги
тадбирлар комплексини қўллашдир.
Тиббий реабилитация - тиббий реабилитациянинг асосий вазифаси
организм турли система-ларининг ва таянч-ҳаракат аппаратининг
функционал имкониятларини мукаммал тиклаш, ҳамда кундалик ҳаёт ва
меҳнат шароитларига компенса-тор мослашишни ривожлантириш бўлиб
ҳисобланади.
Жисмоний реабилитация – жисмоний имконият ва ақлий қобилиятини
тиклаш ёки компенсациялаш, организмнинг функционал ҳолатини ошириш
ва яхшилаш, жисмоний тарбия воситалари ва усуллари, спорт элементлари,
спорт бўйича тайёргарлиги, массаж, физиотерапия ва табиат омиллари
ёрдамида одам организмининг жисмоний қобилиятини, руҳий эмоционал
мустахкамлигини ва мослашувчи заҳираларинияхшилаш бўйича тадбирлар
тизимидир.
Руҳий реабилитацияда асосий эътибор бемор руҳий ҳолатининг
коррекциясига, шунингдек унинг даволанишга, шифокор тавсияларига,
реабилитация тадбирларини бажаришга тўғри ёндошишни шакллантиришга
қаратилган. Бу йўналишда беморларга касаллик натижасида ўзгарган ҳаётий
фаолиятга руҳий мослашиш учун зарурий шароитни яратиш керак.
Касбий (меҳнат) реабилитацияда меҳнатга тиклаш (жойлаштириш), касбий
ўқитиш ва қайта ўқитиш, беморларнинг меҳнатга қобилиятини аниқлаш
саволлари хал қилинади ёки кўрилади.
237
Ижтимоий-иқтисодий реабилитацияда асосий эътибор шикастланган
беморга иқтисодий мустақиллик ва ижтимоий мукаммалликни қайтаришга
қаратилади. Бу вазифалар фақат тиббий муассасалар томонидангина эмас,
балки ижтимоий таъминот органлари томонидан ҳам ҳал этилиши зарур.
Физиотерапия - табиатнинг бир тармоғи бўлиб, табиий ва одам ҳосил
қиладиган физик омилларининг физиологик ва даволаш таъсирларини
ўргатади, уларнинг касалликни олдини олиш ва даволаш учун янги
усулларни, шунингдек даволаб-тиклаш усулларини ҳам ишлаб чиқаради, шу
билан бир қаторда уларни ҳаётга тадбиқ этади.
Шифобахш жисмоний тарбия – бу жисмоний тарбия восита-ларини
касалликни даволаш, олдини олиш ва беморларни реабилитацияси мақсадида
қўллашдир.
Гальванизация − даволаш мақсадида доимий токнинг паст кучланишли (80
вольтгача) ва кичик кучли ток (50 миллиампергача) қўлланилади.
Электрофорез − организмга доимий ток ва у билан бирга организмга
кирувчи дори моддасининг унча кўп бўлмаган миқдорининг биргаликда ёки
бир вақтдаги таъсири тушунилади.
Диадинамотерапия − 2 хил яримсинусоидал шаклдаги импульс токлари
қўлланилади, яъни частотаси 50 Гц (бир тактли узлуксиз) ва 100 Гц (икки
тактли узлуксиз). Бу токлар Бернар томонидан даволаш амалиётида қўллаш
учун таклиф қилинган, шунинг учун Бернар токлари ҳам деб аталади.
Синусоидал модулланган токлар − товушли частотасига эга бўлган (5000
Гц) модулланган синусоидал токлар билан таъсир кўрсатилади, у тери орқали
яхши ўтади ва чуқур жойлашган тўқималарга таъсир кўрсатади. Бу хилда ток
кучсиз қўзғатувчи таъсир этганлиги учун унинг 10-150 Гц атрофидаги паст
частотали, яъни мушаклар биотокларининг частотасига яқин келадиган
частотали модуляциясидан кенг фойдаланилади.
Электруйку − организмга паст частотали тўғри бурчакли импульс токлари
билан таъсир этилади.
УЮЧ-терапия − даволаш мақсадида ультра юқори частотали ўзгарувчан
электр майдонидан фойдаланилади. Ультра юқори частотали электр майдони
узлук-сиз ва импульсли режимда қўлланилади. Импульсли режимда электр
майдо-нининг кучли импульс сериялари ва улар ўртасидаги пауза алмашиниб
туради.
Микротулкин терапия − даволаш мақсадида ўта юқори частотали
электромагнит тебранишлари қўлланилади. Тебранишларнинг тўлқин
узунлиги 1 метрдан 1 ммгача, тебра-ниш частотаси 300 дан 30000 мГц гача.
Бунда узунлиги 1 мм – 1 см келади-ган тўлқинлар (сантиметрли - СМТ) ва 10
см – 1 м келадиган тўлқинлар (дицеметрли - ДМТ) дан фойдаланилади.
Магнитотерапия − организмга паст частотали ўзгарувчан магнит майдони
ва доимий магнит майдони таъсирига асосланган физиотерапевтик усул
магнитотерапия деб аталади.
Франклинизация − бу юқори кучланишли (50-60 кВ гача) доимий электр
майдони билан даволашдир. Ҳосил бўлган майдонда, электр зарядларининг
238
жойини ўзгартириши ҳисобига, ҳаводаги газли молекулаларнинг
парчаланиши ҳосил бўлади.
Дарсонвализация − юқори кучланишли (20 кВ гача), кичик кучли (0,015 –
0,02 мА) ва юқори частотали (110 кГц) импульс токлар билан даволаш
усулидир. Бу ток турини биринчи марта француз олими Д.Арсонваль таклиф
қилган.
Индуктотермия − бу юқори частотали магнит майдони билан даволашдир.
Индукто – тўплаш, термо – иссиқлик,яъни иссиқликни тўплаш маъносини
билдиради.
Ултратовуштерапия - даволаш амалиётида бошқа физиотерапевтик
муолажалар билан бир қаторда ультратовуш билан даволаш ҳам кенг
қўлланилади. Ультратовушлар физик муҳитда механик тебранишлар ҳосил
бўлиши билан характерланади. Физиотерапия амалиётида ультратовушлар
800-900 кГ частотаси кўринишида қўлланилади. Тиббий даволаш амалиётида
эса 800-3000 кГ равишда қўлланилиши мумкин. Даволаш жараёнида ультра
товушларнинг организм ичига кириши уларнинг частоталарига боғлиқдир.
Ултрафонофорез - ултратовуш тарқалиб кетмаслиги учун муолажани ҳар
доим ёғли муҳитда ўтказилиши шарт. Бу усул ёрдамида организмга дори
моддалари ( мазь, гель) киргизилади.
Ёруғлик билан даволаш − тиббиёт амалиётида касалликларни даволаш ва
олдини олиш мақсадида инфрақизил, қизил (кўринувчи) ва ультрабинафша
нурлари кенг қўлланилади. Ёруғлик оқимида уларнинг тўлқин узунлиги ҳар
хилдир, яъни инфрақизил нурларники 400 мкм – 760 нм, кўринувчи
нурларники 760 нм – 400 нмгача, ультрабинафша нурларники 400 нм – 180
нмгача.
Лазеротерапия – бу монохроматик (оптик спектрда бир тўлқин узунлиги
бўлган диаазон бўлади), когерент (нурланиш электромагнит тембраниш
частотали билан мос тушади) инфра кизил нурлар.
Гидротерапия – чучук сувнинг махсус усуллар ёрдамида даволаш,
касалликнинг олдини олиш ва тиббий реабилитация мақсадида
қўлланилишига сув билан даволаш дейилади. Сувнинг махсус усуллар
ёрдамида даволаш, касалликнинг олдини олиш ва тиббий реабилитация
мақсадида қўлланилишига сув билан даволаш дейилади.
Гидроаэроионотерапия - бу узида мусбат ёки манфий электр зарядларини
тутувчи камбинирланган хаво молекулалари хамда сув молекулаларини
(гидроаэроионлар)
даво
максадида
куллаш
усулидир.Хавонинг
ионизациялашуви қуёш радиацияси космик нурлар, электр зарядлар, ердаги
радиоактив воситалар, хаво массаларининг фаол харакатлари натижасида,
хамда дарё, денгиз ва океанларнинг қирғоқларидаги сув бугланишлари
таъсири остида юзага келади.
Аэротерапия бу ўзида мусбат ёки манфий электр зарядларини тутувчи
атмосфера хавосининг заррачаларини (аэроионлар) даво мақсадида қўллаш
усулидир.
239
Аэрозолтерапия – дори моддаларини ингаляция усули ёрдамида организмга
юборишдир.
Баротерапия − баротерапия усули ёрдамида барометрик босимнинг 1
атмосферадан паст бўлган манфий босими ва 1 атмосферагача бўлган
босимлар билан даволаш жараёнида қўлланилади. Баротерапия маҳаллий ва
умумий усулларда ўтказилади.
Бальнеотерапия минерал сувнинг махсус усуллар ёрдамида даволаш,
касалликнинг олдини олиш ва тиббий реабилитация мақсадида
қўлланилишига сув билан даволаш дейилади.
Талассотерапия денгиз сувнинг махсус усуллар ёрдамида даволаш,
касалликнинг олдини олиш ва тиббий реабилитация мақсадида
қўлланилишига сув билан даволаш дейилади.
Псаммотерапия – ҳар хил усуллар ёрдамида кум билан даволаш.
Пелоидотерапия − даволаш мақсадида ил, торфли, сапропелли, сопкали
балчиқлардан фойдаланилади
Спелеотерапия – табиий ғорларда даволаниш.
Галотерапия – сунъий ҳосил қилинган ғорларда даволаниш.
Сунъий физик омиллари – физиотерапевтик аппаратлар ёрдамида физик
омилларни ҳосил килиш.
Табиий физик омиллари – табиат омиллари: сув, ҳаво, қуёш нури, иқлим,
қум, лой, балчиқ ва бошқалар.
Массаж – бу касалликни даволаш ва олдини олиш усулидир. У билан тана
юзасига ёки баъзи органларга махсус усуллар билан таъсир тилади. массаж
асосан қўл билан қилинади, лекин махсус асбоблар ёрдамида аппарат билан
ҳам ўтказилади.
Механотерапия –бунда тиббий асбоблар, аппаратлар ва тренажерлардан
фойдаланилади. Тиббий асбоблар – оғизни ва лабларни кенгайтирувчи,
аппаратлар – ортопедик мосламалар, ёрдамчи мосламалар ва Жом аппарати,
тренажерлар – велоэргометр, велотренажер, югурувчи йўлка, “эшкак эшиш”,
куч талаб қилувчи тренажерлар, “чигиритка” тренажери ва ҳ.з.
Мехнаттерапия – беморнинг эмоционал руҳий ҳолатларига оид саволларни
хал қилиш учун қўлланилади. Меҳнат билан даволаш шифохона ва уй
шароитларида олиб борилади. Шифохонада, айниқса асаб касалликлари,
травматология, ревматология ва бошқа бўлимларда муҳим аҳамиятга эга.
Асаб касалликлари бўлимида беморларнинг ўзига-ўзи хизматини тиклаш,
травматологияда – меҳнат стендларидан фойдаланиб, беморни ҳаёт
фаолиятида зарур меҳнат-ларга ўргатиш. Уй шароитида мева ва
сабзавотларни тозалаш, ҳамирли овқат қилиш, тугиш, бичиш машқлари, боғ
ва полизларда меъёрли ишлаш.
Эрталабки гигиеник гимнастика – 15 – 20 минут давомида бажарилади,
қўллашдан
мақсад
организмнинг
умумий
тонусини
кўтариш,
тетиклаштириш. Шакл якка, кичик гуруҳ, гуруҳ ҳолида ўтказилади.
Даволовчи гимнастика – шифохонада ўткзиладиган шаклларнинг асосийси
бўлиб ҳисобланади. Муолажа 3 қисмдан иборатдир (кириш қисми, асосий
240
қисми, тугалланиш қисми). Даволовчи гимнастика муолажасини амалга
ошириш учун ҳар бир система касаллигига, ҳар бир касалликка алоҳида
гимнастик машқлар комплекси тузилади ва якка, кичик гуруҳ, гуруҳ ҳолида
ўтказилади.
Терренкур – ҳар хил кўтарилиб тушиш бурчагига, масофа узунлигига эга
бўлган махсус тайёрланган йўлка. Бу шакл асосан санатория-курортларда,
диспан-серларда қўлланилади. Юрак-қон томир касалликларида, нафас
органлари, ошқозон-ичак йўли, таянч-ҳаракат аппарати касалликлари ва
модда алмашинуви бузилиши бор беморларга тавсия этилади.
Уйинли дарс – шифохонадан ташқарида ўйин воситаларидан фойдаланган
ҳолда ўйинли дарслар амалга оширилади. Бу билан беморлар организмини
ўсиб борувчи жисмоний юкламаларга мослаштириб борилади.
Яқин туризм асосан санатория-курортларда, тоғли шароитда қўлланилиб,
беморларга кунига кўп эмас, кам эмас ўрта ҳисобда 15 кмгача юриш тавсия
этилади.
Амалий спорт машқлари – бу машқлар ёрдамида юкламаларга мослаштириш, ошириб бориш, қон ва лимфа айланишлари, модда алмашинувининг яхшиланиши амалга оширилади. Уларга қуйидагилар киради : юриш,
югуриш, ўтирган ва турган ҳолатларда эшкак эшиш, сузиш, чанғи ва конки
учиш, велосипед ҳайдаш.
Санаторий − бу курортдаги даволаш-профилактик муассаса булиб,бунда
табиат омилларидан, диетотерапиядан, физиодаволаш, шжт ва шу каби
белгиланган тартиблардан кенг фойдаланилади.
Курорт − табиий даволаш омилларига, минерал манбаларига, шифо-бахш
балчиқ қатламларига, мақбул иқлимга, шунингдек беморларнинг даволаниши
ва дам олиши учун мўлжалланган бальнеотехник, гидротехник
иншоатларига, санаторияларига эга бўлган жойдир.
РЕФЕРАТ МАВЗУЛАРИ
1.Юрак қон-томир тизимидаги операцияларидан кейинги реабилитацияси.
Реабилитация босқичлари, жисмоний реабилитациясида махсус машқларни
қўллаш, таъсир механизмлари.
2.Нафас тизими билан касалланган беморларни Ўзбекситондаги санатор
давоси.
Нафас касаликларининг реабилитация-сида санатор–курортга
саралаш.
Тоғли курортлар. Спелеотерапия.
3.Ошқозон ичак тракти касаллик-ларини бальнеологик даволаш.
Минерал сувлар таркиби, минерал сувларни қўлланилиш усуллари, санотор
куророрт даволашдаги ўрни.
4.Умуртқа поғона касалликларида комплекс реабилитация усуллари.
Умуртқа поғанаси касалликларида умуртқа поғанасини чўзиш (тракцион
терапияси). Йога-асана (махсус даст-лабки ҳолатда даволаш).
5.Турли касалликлар реабилитация-сида меҳнат билан даволаш усулининг аҳамияти.
241
Меҳнат билан даволаш турлари. Юрак-қонтомир, таянч-ҳаракат, семизлик ва
бошқа касалликларда меҳнат билан даволашни қўллаш.
6.Қандли диабет асоратларини ком-плекс реабилитацияси.
Диабетик ангиопатия ва полинейро-патияда физиотерапевтик омилларни ва
ШЖТ воситаларини қўллаш.
7.Тери касалликлари билан касал-ланган беморларни Ўзбекситондаги
санатор давоси.
Тери касалликлари билан касалланган беморларни санатор-курорт даволаш
босқичларига йўлланма бериш, бунда курорт турини аниқлаш ва йил фаслини белгилаш. Иқлимли ва бальнео-логик санаторийлар.
8.Гепатит касаллигида реабилита-ция.
Реабилитация этаплари, жисмоний реабилитациясида махсус машқлар ва
физиотерапевтик омилларини қўллаш, беморларни санатор-курорт даволаш
босқичларига йўлланма бериш.
9.Онкологик касалликларининг реабилитацияси.
Онкологик касалликларида реабили-тациянинг ўзига хослиги. Руҳий ва
жисмоний реабилитацияси.
2.Суяк синишларида ва остеопороз касаллигида тиббий реабилитация
усуллари.
Реабилитация этаплари, жисмоний реабилитациясида махсус машқлар ва
физиотерапевтик омилларини қўллаш, таъсир механизмлари.
10.Операциялардан кейинги реаби-литация босқичлари.
Реабилитация этаплари, жисмоний реабилитациясида махсус машқлар ва
физиотерапевтик омилларини қўллаш, таъсир механизмлари, беморларни
санатор-курорт даволаш босқичларига йўлланма бериш.
11.Болалар церебрал параличларида реабилитация усуллари.
Реабилитация этаплари, жисмоний реабилитациясида махсус машқлар ва
физиотерапевтик омилларини қўллаш, таъсир механизмлари.
12.Бепуштлик билан касалланган беморларни Ўзбекситондаги санатор
давоси.
Санатор-курорт даволаш босқичларига йўлланма бериш, курорт турини
аниқлаш ва йил фаслини белгилаш.
АДАБИЁТЛАР РЎЙХАТИ
1.
2.
3.
4.
5.
6.
7.
Асосий:
Боголюбов В.М. «Медицинская реабилитация » Москва, 2006,3 тома.
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2000.
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Дубровский В.А. “Лечебная физкультура” М., 2004.
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242
8. Рихсиева О.А. «Массаж», Т. 1996.
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здоровья и гармоничного развития детей и подростков» проф. Назиров
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Т.
Хоули,
Б.
Дон-Френкс
«
Руководство
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12.Бет Шоу “Йога fitТренинг для здоровья”, М. 2005.
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17.Епифанов Е.А. “Лечебная физкультура” М. 1999г.
18.Боголюбов В.М., Пономаренко Г.Н. “Общая физиотерапия” М. 1999г.
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20.Корхим М.А., Рабинович И.М. “ЛФК в домашних условиях” 1990г
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Қўшимча:
1. Улащик В.С. “Домашняя физиотерапия” Минск 1993г.
2. Боголюбов В.М. “Справочник по санаторно-курортному отбору” М.
1992г
3. Выгоднер Е.Б. «Физические факторы в гастроэнтерологии» М., 1987г.
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1970г.
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реабилитации больных заболеваниями легких и сердца», Л, 1981г.
6. Красильникова Р.Г. “Методы физиотерапии в медицинской практике”
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7. Левинсон А.Я. “Электромедицинская аппаратура” М. 1987г
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10.Николаева Л.Ф., Аронов Д.М. «Реабилитация больных ишемической
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физиотерапии” М. 2000г.
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13.Руденко Т.Л. “Физиотерапия”, Ростов на дону, 2000г.
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15.Рыхсиев О.А. и др. “Массаж”, Т., 1996г
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Ташкент, 1993г.
20.Цой Р.Д. “Справочник по рефлексотерапии” Т. 1994г.
21.Цой Р.Д. “Рефлексотерапия” Т. 1995г.
22.Цыганов А.И., Мартынюк Л.А. «Справочник по физиотерапии уха,
горла и носа», Киев, 1981 г.
23.Юлдашев К.Ю. “Немедикаментозные методы лечения” практическое
пособие для врачей, Т., 1999г.
24.Ясногородский В.Г. “Справочник по физиотерапии” М., 1981г.
25.Teylor S.B., Miller N.H. “Basic physiologic principils relatied to Group
exirsise programs” Filadelphiya 1990
26.Tehaxton L. “Phithiological and psythological effects of short term exirsise
eddiction on habitual runners.” 1992 96.
Интернет сайтлари:
http://www.doktor.ru
http://www. medinfo.org
http://www.restart-med.ru
http://www.mirmed.ru
http://micropolarization.narod.ru
http://skolioz.mccinet.ru
http://www.sportpsy.cz
http://www. aapmr.org
http://www.alhealth.com
http://www.docguide.com
http://www.healthweb.com
http://www.acsm.org
http://www.apta.org
http://www.sportsmed.org.
http://www.jphysiol.org
http://www.physsportmed.com
http://www.sportsmedicine.com
244
THE NATIONAL PROGRAM
ON SHOTS
(It is confirmed by the Law of Republic Uzbekistan from 29 ugust 1997 y.)
General provisions
The republic Uzbekistan carries out constructionyandyy the societies, the
rights providing observance and freedom of the person, spiritual updating of a
society, formation of the socially-focused market economy,in the world
community.
Y the purpose and motive power of transformations realised in republic is
the person,y development and y, creation of conditions and effective mechanisms
of realisation of interests of the person, change of the become obsolete stereotypes
of thinking and behaviour. The important condition of development of Uzbekistan
is formation of perfect system shots on a basis yyheritages of the people and
universal values, achievements of modern culture, economy, a science, technics
and y.
Nationalonshots corresponds to positions of the Law of Republic Uzbekistan
"About education", it is developed on the basis of the analysisexperience,
proceeding from world achievements in an education system and it is focused on
formationgenerations of shots with high general and professional culture, creative
and social activity, ability independently to be guided in the political life, capable
to put and solve a problem by prospect.
y provides realisation of national model preparation shots, creation social
and economic, legal, psiholoyo-pedayoyicheskih and other conditions for
formation of comprehensively developed person, adaptation to a life in a modern
changing society,a choice anddevelopment educational and professional y,
education y, understanding the civil responsibility,and a family.
1. Problems and preconditionssystem transformations preparation shots
1.1.a level of development
Finding by Republic Uzbekistan yy the sovereignty, a choicea
wayanddevelopments have causedof structure and maintenances preparation shots,
have caused acceptance of some measures: Law introduction "About education"
(1992 y.); introduction of new curricula, y, textbooks, working outy maintenance;
realisation of certification and accreditation of educational institutions; creation of
new types of educational institutions.
In sphereeducations the network
kindergartens and complexes "a
kindergarten - school" develops. It is created more than 800on training of children
to foreign languages, y, to graphic and musical art, bases computer y.
The network of schools and general educational educational institutionstype
develops. 238 lycées and 136function. "Economic education", "Rural school",
"Rehabilitation of children with deviations in development" andare realised target
programm "y ", " ".
In republic comprehensive schools work over 435 thousand teachers from
which 73 percent have higher education.
245
It is begunprofessionally-tehnicheskoyo educations taking into account
territorial features of formation of a labour market, first of all in a countryside. In
this system 442 educational institutions, including - 209 vocational schools, 180
professional lycées and 53 business schools with the generalpupils 221 thousand
person nowadays function. In educational institutionsy educations work now about
20 thousand teachers and the qualified experts.
In republic 258 educational institutionsy educations withpupils of 197
thousand persons operate. In them works about 16 thousand teachers and
engineering-pedayoyicheskih workers.
The system of the higher school of Uzbekistan includes 58 higher
educational institutions, including 16 universities, 12 from which are created for
first twoy developments of Uzbekistan and 42 institutes withstudents of 164
thousand persons. In high schools of 52 percent of the doctor and candidates of
sciences work 18,5 thousand teachers, from them. In higher education
decentralisation andpreparation shots is spent, the network of educational
institutions extends, receives development a university education. It is begunshots
in new branches of knowledge, higher school transition onsystem is carried out.
Take rootmethods of an estimation of level of knowledge of entrants and
students on the basis of testing and yy the control.
According to increased requirements to quality scientific and scientificallypedayoyicheskih top skills shots it is carried outshots in postgraduate study and
doctoral studies. The Higher certifying commission is created. In republic it is
trained about 4 thousand post-graduate students, from them of 69 percent - in
systemeducations and 31 percent - in scientific research institutes. 8 percent make
of an aggregate number scientific and scientifically-pedayoyicheskih shots of the
doctor of sciences and candidates of sciences - 37 percent.
In system of improvement of professional skill and preparation shots 23
institutes, 16 faculties, 4 centres and 14 courses of improvement of qualification
function.
It is spent purposefula policy on support of presented children and studying
youth. The special centres and funds on revealing of talented young men and girls,
assistance rendering, creation of conditions for development of their abilities and
talents,training and training of capable youth in leaders foreign educational and
centres of science are created.
International contacts in science and education sphere extend.
Nevertheless, spent transformations have not provided conformity of growth
of quality preparation shots to requirements socially -country development.
1.2. Lacks and problems
preparation shots it is necessary to carry its discrepancy to requirements of
the democratic and market transformations, insufficient financially - technical and
information base to number of the most essential lacks of operating systemprocess,
shortage highly skilled yy shots, the qualitative uchebno-methodical, scientific
literature and didactic materials, absenceinteractions andy between an education
system, a science and manufacture.
246
The problem of maintenance of close interrelation between structure, the
maintenance of training and educational processes, their stages, that is - a
problemsystemseducations is not resolved. The existing education system does not
meet the requirements, which are shown toshots in developed democratic y.
The educational system, educations and preparation shots is not connected
with spent to lives, in a society reforms, mismatches requirements of carried out
transformations.
There is unsatisfactory a conditioneducation and education. Coverage of
children by preschool centres makes 25 percent fromnumbers. Exists defined
between levelchildren who have come to school from preschool institutions and a
family.
, the training, developing froma spectrum of lacksprocess of training and
education techniques at schools andeducational institutions leads to that at pupils
the independent thinking does not develop, is absentto the considered, realised
decision-making.
The pupils who have studied 9-11 classes, do not know what to do further,
they do not have self-trust. Only 10 percent of graduates of high school arrive in
higher educational institutions. The eleven-year general secondary education, at
obligatory nine-year, is not scientifically proved, does not provide due vocational
counselling and a practical orientation of training, formationthinking, skills of
labour activity.about 100 thousand graduates of base school remain not claimed in
sphere of manufacture andy educations.
As a result of absence of continuity between general educational and
professionalin an existing education system at graduates base and high school
necessary vocational counselling and skills of labour activity is not formed. Young
men and girls experience serious difficulties in a choicethe ways, corresponding to
their abilities, desires, creative and labour bents.
Educational process is guided by pupils with an average level of knowledge,
training mechanisms on individual educational y, especially presented youth are
poorly used. Educational programm were not completely released yet from, in
them it is not taken awayplaces to the sciences training to bases of morals and
spirituality, giving economic, legal and aesthetic knowledge.
Transition from technical training colleges to educational institutionstype
has declarative character. Actually training in them is carried out on out-of-date
material base and uchebno-methodical maintenance, the teaching personnel, done
not pass corresponding y.
The single-level higher education does not consider in full requirement of a
labour market, structural changes in manufacture and positive international
experience. There is sufficient independence of educational institutions inuchebnovospitatelnoyo no process, they are badly adapted for changing conditions of the
marketwork.
Have not joined properly in process preparation shots of establishment of a
science, manufacture and public institutes. Working out and introduction
mechanismseducational standards, functionscertifications and accreditations of
247
educational institutions are not defined, the system of an estimation of level of
knowledge trained does not provide objectivity and efficiency.
The prestigeeducations and the social status of teachers, tutors and
instructors, scientific and scientifically - yy shots decreases. Is absentin the field of
educationaland preparation shots, schemes yy financings of an education system
and preparation shots are unfinished.
Vital issue is weakthe most part of teachers, yy and tutors, their low
educational and professional level, essential shortage qualified yy shots is felt. In a
preschool education fromnumbers of tutors and yy only 20 percent have higher
education. schools teachers makes 93 percent, however separate areas of
maintenance with them within 77-80 percent, and on some disciplines - to 50
percent.
There is "ageing" scientific and scientifically-pedayoyicheskih shots. In
higher educational institutions of republic the quantity of doctors of sciences till 40
years makes0,9 percent from their general number, and at the age from 50 years
and above - 79 percent. Middle age of the doctors of sciences confirmed in a
scientific degree makes 50 years, and candidates of sciences - 36 years.
1.3. Reforming preconditions
The major preconditionssystem transformations preparation shots are:
dynamical advancement of republic on a construction wayyandyy societies;
realisation of radical changes in a national economy, consecutive
transformation of an economy of republic from mainly raw orientation on
release of competitive end production, expansioncountry potential;
the statement of a priority of interests of the person and education into social
policy;
growthconsciousness, formation of patriotism, feelingfor the fatherland, respect
toto national cultural-historical traditions and an intellectual heritage of the
people;
y Uzbekistan in the world community, consolidation of positions and authority
of republic on the world.
2. The purpose, problems and stages of realisation national programm
2.1. The purpose and problems
The purpose present programm - radical reforming of the education sphere,
full refusal of it, creation of National system preparation highly-skilled personnel
at level developed democratic y, meeting the requirements high spirituality and
morals.
Purpose realisation provides the decision of following problems:
education system reforming according to the Republic Uzbekistan Law
"About education", its maintenancedevelopments asuchebno-scientificallyproizvodstvennoyo a complex on a basisandeducational institutions, formation
of the competitive environment in a sphere of education and preparation shots;
coordination of an education system and preparation shots with
transformations spent in a society, constructionyy;
248
maintenance of establishments of system preparation shots highly skilled
experts, increase of prestige andthe status yy activity;
y structures and maintenances preparation shots, proceeding their
prospectsanddevelopments of the country, requirements of a society, modern
achievements of a science, culture, technics and y;
y structures and maintenances preparation shots, proceeding from
prospectsanddevelopments of the country, requirements of a society, modern
achievements of a science, culture, technics and y;
working out and introduction of effective forms and methods spirituallyeducation trained and educational work;
introduction of objective system of an estimation of quality of education and
preparation shots, certification and accreditation of educational institutions;
creation of the standard, material and information base providing demanded
level and quality of education,functioning anddevelopments,
systems
preparation shots in new social and economic conditions;
maintenance effectiveeducations, sciences and manufactures, working out of
mechanisms of formation of requirements y, and also the orderstructures, the
enterprises andon quantity and qualityshots;
working out and introduction in practice of real mechanisms of attraction of
off-budget means, including foreign investments, into systemeducations and
preparation shots;
development cooperation in area preparation shots.
2.2. Realisation stages programm
The purposes and problems National programm are realised stage by stage:
The first stage (1997-2001 yy.) - creation of legal personnel, scientificallymethodical, financially-material conditions for its reforming and development on
the basis of preservationpotential of existing system preparation shots.
At this stage it is necessary:
to make structural reorganisation and radical updating of the maintenance of
an education system according to the Law "About education";
preparation and to raise qualification yy and scientifically - yy shots to
level,to modern requirements;
to create and introducethe educational standards defining necessary
requirements to qualityand qualification trained, their cultural and spirituallymoral level;
to develop and introduce new generation of uchebno-methodical
complexes,andmaintenanceprocess;
preparation necessary material, uchebno - methodical and personnel base
fory,educations;
to improve mechanisms of attraction of off-budget means in education
andshots, to create the competitive environment in sphere educational y,
having provided, along with y, developmenteducational institutions;
249
to develop and entersystem of an estimation of activity of educational
institutions, systemqualities preparation shots and requirements for them;
to expand and strengthen international contacts, to develop and carry out real
measures on assistance international donorand funds inshots, and also to
attraction of foreign investments into a republic education sphere;
to carry outrealisations National programm onshots.
At the given stage reception of children in school since six-seven years will
be carried out, taking into consideration their physical and intellectual
development. It is carried out intensivey numbers of student's places with
necessary material conditions and security yy shots.
On a basisperformancea stage directions of realisation National programm
are specified.
The second stage (2001-2005 yy.) - full-scale realisation National
programm, its updating with the accountexperience of performance, development
of a labour market and real social and economic conditions.
Full transition to an obligatory general average and an average special, to
vocational training, and also to the differentiated training, proceeding from abilities
and possibilities of pupils is carried out.
Completion of educational institutions speciallyqualified yy is provided with
shots, the competitive environment of their activity is formed.
Strengthening of material and information base of educational institutions
proceeds, teaching and educational process is provided with the high-quality
educational literature and front lines yy y. System informationeducations is carried
out.
Mechanisms of formation of the market educationalwill to the full be
involved.
The third stage (2005 and the subsequent y) - perfection and the further
development of system preparation shots on the basis of the analysis and
generalisationexperience, according to prospects socially -country developments.
The further strengthening of resource, personnel and information base of the
educational institutions, full satisfaction uchebno-vospitatelnoyo process by the
newest uchebno-methodical complexes and front lines yyis spent.
Formation and development of national (elite) higher educational
institutions, consolidation of forms of independence and self-management of
professional educational institutions is carried out.
Informationthe process, full coverage of systemeducations by the computer
information networks having an exit in world information networks is provided.
3. National model preparation shots
The basic components of National model preparation shots are:
the person -the subject and object of system preparation shots, the consumer
and the manufacturer educational y;
y and a society -preparation and the demands of shots which are carrying
outof activity and the control over functioning of an education system and
preparation of shots;
250
continuous education - a basis preparation the qualified competitive shots,
including all kinds of education,educational standards, structure and the
functioning environment;
a science - the manufacturer and the consumer of highly skilled experts, the
developer advanced yy and information y;
manufacture - the basic customer defining requirement for shots, and also
requirements to quality and their level y, the participant of financing and is
material-tehnicheskoyo system maintenance preparation shots.
Y and a society provide an openness andsystem functioningeducations and
preparation shots.
Performance by Republic Uzbekistan internationaland conventions in the
field of human rights, education, the rights of the child, the accounty experience in
sphere preparation shots also is one of factors of its development.
3.1. The person
Y the policy in area preparation shots provides formation of versatily
developed person -through systemthe educations, inseparably linked with
intellectual and spiritually-moral education of the person. Here one ofconstitutional
laws- the right to education, display of creative abilities, intellectual development,
professional work is realised.
The law "About education" provides compulsion of receptiony
andy,educations, and also the right and ample opportunities of a choice of forms
and kinds of education and professional preparation, continuous improvement of
professional skill, if necessary, - corresponding y.
Persons, as to the consumer educational y, througheducational standards,a
quality education and professional y. Thus the person is obliged to fulfil the
requirements which have been put in pawn ineducational standards. The person as
the manufacturer educational y, having received a corresponding skill level,
participates in transfer of knowledge and experience in process of education,
activity to spheremanufactures, sciences, cultures and y.
3.2.and a society
Y and a society actfunctioning and system developments preparation shots,
co-ordinators of activity of educational institutions onhighly skilled competitive
experts.
a society
Realisation of the rightson education, a choiceways and improvement of
professional skill;
Receptiony y,y,educations, with the option of a direction of training in the
academic lycée or professional college;
The reception rightandeducations on basey or on a platno-contract basis;
Financingeducational institutions;
Developmentmanagements in the decision of problems on maintenance of
conditions for study, a life and rest of the trained;
Social support of participantsprocess;
251
Reception of education by persons within a state of health and deviations in
development.
3.3. Continuous education
Continuous education is a system basis preparation shots, the priority sphere
providing social and economic development of Republic Uzbekistan, satisfying
economic, social, scientific and technical and cultural requirements of the person, a
society and y.
Continuous education creates necessary conditions of formation creative,
socially active, spirituallypersons and advancing preparation highly skilled
competitive shots.
3.3.1. Creation and development principleseducations
Functioning principleseducations:
educations - prime characterdevelopments, prestigiousness of
knowledge, erudition andintelligence;
education democratisation - expansion of independence of
educational institutions in a choice of methods of training and
education, transition to a yosudarstvenno-public control system of
education;
y educations - disclosing of abilities of the person and
satisfactionvarious educational requirements, maintenance national
and universal values,relations of the person, a society and
environment;
y educations - formation at trained aesthetically yy outlooks, high
spirituality, culture andthinking;
the national orientation of education consisting iny unity with
national history, national traditions and customs, preservation
andcultures of the people of Uzbekistan, an education recognition the
major tooldevelopments, respect for history and culturethe people;
indissolubility of training and education, an orientationprocess on
formation of comprehensively developed person;
revealing of the presented youth, creation of conditions forreceptions
of fundamental and special knowledge at the highest level educations.
3.3.2. Reforming directionseducations
Reforms in sphereprovide educations:
cardinal improvementeducation system potential, increase of
prestigiousness of a trade of the tutor, the teacher, the teacher andthe
worker;
development of various kindsandeducational institutions;
structural reorganisation of an education system, a basic change
educational and professionaltaking into account modern world
achievements of education, a science, technics and y, economy and
cultures;
transition maintenance to an obligatory general average and an
average special, to vocational training;
252
creation of educational institutionstype, as centres y,educations,with a
science and manufacture;
y,and improvement of professional skill of shots, including
administrative, by new trades and the specialities connected with wide
developmenty, structural transformations to economy, expansion of
scales of foreign investments, business development,andbusiness;
development of spiritual and moral qualities trained at all levels and
steps of education on the basis of principles of national independence
and a priority yyheritages of the people and universal values;
perfection of a control system by education, development of
formsmanagements,educational institutions;
working out and realisation of measures on strengthening of a role of
a family, parents, public y, ,and the international funds in education
reception, and also spiritually-moral, intellectual and physical training
of children and youth;
creation and introduction of system of an objective estimation of
qualityprocess and preparation shots;
formation of mechanisms of maintenance of an education system
financial, material andresources;
creation and development in practice of real mechanismsy educations
with a science and manufacture;
expansion and development of cooperation with foreign both
international educational and scientific y;
creationand yy conditions for reception of education by persons of
not radical nationality on the native language in their placesresiding;
perfection y, y, yy and mediko-yiyienicheskoyo education and
education trained on all educational levels.
3.3.3. System and kindseducations
System functioningeducations is provided on a basiseducational standards,
continuity educationaly level and includes following kinds of education:
a preschool education;
the general secondary education;
an average special, vocational training;
higher education;
education;
improvement of professional skill andshots;
nonscholastic adult education.
Distinctive feature of National model preparation shots is introduction, as
independent steps,yandy y,educations which provide continuity of transition from
general educational to professional educational y.
General educational programm cover: preschool, initial (I-IV classes), the
general secondary education (I-IX classes), an average special, vocational training.
253
Professional educational programm include an average special, professional,
the higher (a bachelor degree, y) and education, improvement of professional skill
andshots.
Preschool education
The preschool education provides formation of the healthy, developed
person of the child, clearing upto the doctrine,to regular training. It is carried out
till six-seven years inandpreschool institutions and in a family.educations actively
participate in realisation of the purpose and problems , public andy, the
international funds.
For developmenteducations should be carried out:
Priorityqualified personnel - tutors and yy;
Search
and
introduction
effective
psiholoyo-pedayoyicheskih
techniqueseducations;
y, psiholoyo-pedayoyicheskoe and methodical maintenanceeducation of
children;
Working out and manufacture of modern uchebno-methodical grants and
technical attributes,and y;
Creation of conditions for spiritually-nravstvennoyo education of preschool
children on a basis yy cultural-istoricheskoyo heritages of the people and universal
values;
Choice possibility for various kinds of preschool centres, reception qualified
consultingon all questionseducations;
Working out of mechanisms of support and development of a network of
preschool educational and improving establishments.
The general secondary education
The general secondary education, with term of training of 9 years (I-IX
school classes), is obligatory. It includes an elementary education (I-IV classes)
and provides reception of regular knowledge on bases of sciences, develops
requirement for mastering by knowledge, forms base educational, scientific and
common cultural knowledge, spiritually - moral qualities on the basis of national
and universal cultural wealth, labour skills, the creative thinking, the realised
relation to world around and a trade choice.
On endy educations the certificate yy the sample with instructions of
educational disciplines and estimations on them stands out.
For formation of new structure and the maintenancey educations it is
necessary:
To develop and introducethe educational standards providing qualitative
general secondary education within the limits of I-IX of classes of school, with the
accountcommunications with the subsequent educationalin the academic lycées
and professional colleges;
preparation shots highly skilled yy;
To develop a network of educational institutions according to yy andfeatures
of territories, requirements of the person, a society and y;
254
To introduce the differentiated approach to training according to abilities
and possibilities y;
To create front lines yytraining, modern uchebno-methodical complexes and
didactic maintenance uchebno-vospitatelnoyo process;
To create a network of the centres of vocational counselling and psiholoyo yy consultations trained.
Average special, vocational training
The obligatory average special, vocational training with term of training
three y, on basey educations, is an independent kind in systemeducations. The
directiony,educations - the academic lycée or professional college gets out pupils
voluntary.
The academic lycée gives the average vocational education according tothe
educational standard, provides intensive intellectual development, y, the profile,
differentiated, professionally focused training taking into account possibilities and
interests of pupils.
In the academic lycées the trained have possibility on the selected works
them to a training direction (y, technical, y, etc.) to raise level of knowledge and to
generate the special professional skills directed onstudying of sciences for the
purpose of continuation of training in concrete higher educational institution, or
their realisation in labour activity.
The professional college gives an average special, vocational training in
frameworksyythe standard; providesdevelopment of professional bents, skills of
pupils, finding of one or several specialities by the chosen trades.
Professional colleges on the of equipment, to selection yyy structure,training
process are educational institutionsthe type, giving possibility of mastering of one
and more modern trades and acquisitionstheoretical knowledge on subject matters.
Training in the academic lycées and professional colleges
providesknowledge and acquisition by pupils of the chosen specialities. To
graduates of the academic lycées and professional colleges diplomas yy the
sample, granting the right to training continuation at following steps of education,
or employment by labour activity on the got specialities and trades stand out.
Forand developmentsy,educations it is necessary:
To develop and introduce standard base of functioning of the academic
lycées and professional colleges;
To carry outand y, including abroad, qualified yy shots with attraction of
experts of the higher educational institutions, manufactures, sciences and cultures;
To develop and introducestandardsy,educations;
To develop educational and professional programm, uchebno-methodical
complexes for educational institutionsy,educations;
To develop and introduce specialised programm for acquisition of skills of
labour activity by pupils of the academic lycées;
To develop the list of specialities and the trades, the qualified requirements
to experts,in professional colleges;
255
To provide creation and rational placing of educational institutions of
systemy,educations with the accountand yy conditions of territories and local
requirements for expertsa profile, to carry out the maximum coverage trained
without their separation from a family;
To strengthen material and information base of the academic lycées and
professional colleges.
Higher education
The higher education is based on basey,educations and has two steps: a
bachelor degree and y.
The enrolment of students in the higher educational institutions is carried out
on basey and on a platno-contract basis.
Bachelor degree - base higher education with fundamental and applied
knowledge in a direction of specialities, with duration of training not less than four
years.
On termination of baccalaureate programm to graduates, ony certifications,
degree "bachelor" by a trade is awarded and the diploma yy the sample who grants
the right to be engaged in professional work stands out.
y - higher education with fundamental and applied knowledge on a concrete
speciality with duration of training not less than two years on the basis of a
bachelor degree.
Endprogramm is qualifyingcertification with degree award "y".the diploma
yy the sample, granting the right to be engaged in professional work stands out.
Forand developments of two-level systemeducations it is necessary:
To develop and introduceeducational standards for a bachelor degree and y;
preparation professorial shots for the higher educational institutions,
including in leaders foreign educational and centres of science;
To spend structural transformations of the higher educational institutions;
To improve management, to expand independence of the higher educational
institutions, to enter public management in forms of councils of founders, trustees,
the public supervisory boards;
To develop and enter into practice effective mechanismseducations with a
science and manufacture;
To develop and masterand means of an individualization of training, selfeducation, systemeducations;
To intensify training of students with use new yy and information y,
modular system preparation;
To providean education orientation on a basis yyandheritages of the people
and universal values.
Poslevuzovskg education
Poslevuzovskg education is directed on maintenance of requirements of a
society in scientific and scientifically-pedayoyicheskih top skills shots, satisfaction
of creative obrazovatelno-professional interests of the person.
Poslevuzovskg education can be received in higher educational institutions
and research establishments (postgraduate study, , doctoral studies, competition).
256
Steps (postgraduate, doctor's)educations come to the end with dissertation
protection. By resultsy certifications, are awarded scientific degrees, accordingly,
the candidate of sciences and the doctor of sciences, with delivery of diplomas yy
the sample.
Actions for support and developmentinclude educations:
System perfection preparation and certifications scientific and scientificallypedayoyicheskih top skills shots according to the Law "About education" and
prospectsandcountry developments;
Priorityscientifically-pedayoyicheskih shots of the top skills for
systemeducation and scientific shots in the field of front lines yy y;
Creation of conditions for preparation scientific and scientificallypedayoyicheskih top skills shots in priority directions in the advanced educational
institutions and centres of science of the developed countries;
ycooperation with the developed countries in the field of a science,and
educations.
Improvement of professional skill andshots
Improvement of professional skill andshots are directed on updating anda
professional knowledge and skills of experts. By results of training in educational
institutions of improvement of professional skill and preparation shots the
certificate or the certificate yy the sample stand out.
Forand developments of system of improvement of professional skill and
preparation shots it is necessary:
To generate structure and the maintenance of activity of system of
improvement of professional skill and preparation shots and management of it;
To provideand acquisition by highly-skilled personnel of teachers-experts;
To create standard base of system of improvement of professional skill and
preparation the shots, providing formation of the competitive environment in this
sphere and its effective activity;
To develop and enter into practice systemcertifications and accreditations of
educational institutions of improvement of professional skill and preparation shots;
To promote creation and developmentandthe educational institutions
providing operativeand improvement of professional skill of shots and experts
according to requirements yy and yy sec of economy,and establishments of various
patterns of ownership;
To develop, create and master in practice front linesand the equipmenty, and
also simulators difficult, high technologyprocesses.
Nonscholastic adult education
For satisfaction of individual obrazovatelno-developing requirements of
children and teenagers,themtime and resty, public y, and alsolegal and physical
persons, create out-of-schoolandeducational institutions cultural-esteticheskoyo, y,
y,anddirections.
For the decision of problems of development, structure and maintenance
perfectioneducations should be carried out:
257
Expansion of a network of establishments and kinds obrazovatelnodeveloping y;
Working outand the methodical materials based on national yy values and
consideringworld experience;
Perfection available, revival national and introduction of new kinds and
formspupils, including is sports - mass and fizkulturno-improving actions,
children's tourism, national crafts.
3.4. A science in system preparation shots
The national model preparation shots includes, in quality it is essentialan
element, a science, as sphere, in which:
new fundamental and applied knowledge of laws of development of the
nature and a society are formed, the scientific results necessary for
distribution, studying and use in system preparation shots concentrate;
it is carried outscientific and yy top skills shots;
the infrastructure scientifically-issledovatelskoyo process maintenance
preparation shots is created, databases on various fields of knowledge for use
in educational information networks are formed;
occursa domestic science in world, the international exchange of scientific
achievements and shots for the decision of actual problems of a modern
science andis carried out.
For yy science inclusions in system preparation shots it is necessary:
to develop measures on maintenance of communication of a science with
educational practice, by formation and realisation of target innovative projects
on creation and development of front lines yy y;
to realise the mechanismintroductions in uchebno - educational process of
results of scientific researches through creation of experimental platforms for
introduction of front lines information and yy y;
to spend research works on maintenanceperformance National programm
onshots;
to raise quality preparation top skills shots, in every possible way to support
scientific creativity of youth;
to raise prestige and the social status of scientists, on the basis of realisation
of modern approaches to an estimation of level research and scientificallypedayoyicheskoj works in educational institutions, results of scientific
researches andworkings out;
to make activea domestic science in the international scientific community, to
develop an exchange of scientific achievements and scientists, including with
a view of perfection of an education sphere and preparation shots;
to develop system of moral and material stimulus of activity in the field of a
science and y, to found special awards andfor scientific achievements of
students and young scientists, to increase number of nominal grants,constantly
operating exhibitions and expositions scientifically-tehnicheskoyo youth
creativity.
3.5. Manufacture in system preparation shots
258
Requirements of manufacture form directions, level and system scales
preparation shots, define the purpose, problems and the maintenance professional
preparation,the qualified requirements, cause a choice adequateand education
forms. Manufacture, finally, estimates quality and competitiveness of shots.
Functions and manufacture problems in system preparation shots are defined
by that it:
forms requirement for expertslevel and qualification;
promotes systemeducations by granting available inthe order of the
material, financial, personnel and other resources necessary for
training, improvement of professional skill and preparation shots;
participates in financing target preparation both separate experts and
y, and educational institutions of various types and levels as the
founder, the trustee, the donor, the sponsor;
developswith science and education in various forms (time creative
collectives, uchebno-research-and-production complexes, the centres,
technoparks, technopolises).
Strengthening of a role of manufacture in system preparation shots is
provided by:
preparation highly-skilled personnel on the basis of connection of
training with productive work at the enterprises, including in the
course of an industrial practice;
usespotential of the enterprises inshots and in carrying out joint
scientifically-tehnoloyicheskih workings out;
education trained (labour, moral and physical) in labour collectives;
realisation preparation, preparation and improvements of professional
skill of shots in new directions of development of technics andtaking
into account requirements of manufacture;
attractionpotential of the higher educational institutions and
scientificfor the decision economic andmanufacture problems;
y improvements of professional skill yy shots in the field of front
linesit is direct on manufacture;
attraction of highly-skilled personnel of manufacture in educational
process and yy activity;
maintenance trained by workplaces for industrial practice passage;
equipmenteducational institutions the modern equipment, equipment
and the tool.
4. The basic directions of development
Systems preparation shots
Formation and system development preparation shots includes following
priority directions:
4.1. Maintenance of a continuity of education
Construction of the new continuous and successive education system
including a preschool, general average and an average special, vocational training
259
is carried out. The two-level systemy the educations, providingbachelors andtakes
root.
Postgraduate study and doctoral studies activity develops. Competitive
educational institutions on improvement of professional skill and preparation shots
are created.
It is spentand re-structuring of educational institutions. It is carried
outdevelopments and system effectiveness estimationseducations.
It is provided preparation and preparation yy shots for systemeducations.
4.2. y,and improvement of professional skill yy and scientificallypedayoyicheskih shots
The system of improvement of professional skill and preparation yy the
shots, providing high quality and a stable development of education is created y.
Maintenance of their professional qualities at competitive level is provided
advancingand improvement of professional skill yy shots.
In the higher educational institutions special faculties onhighly skilled
teachers, and in republic areas - the special centres on improvement of professional
skill and preparation teachers and experts fory andy,educations are created.
4.3. Maintenance reformingprocess
The maintenance of the education includingy, training and education of
shots on the basis of principles of national independence, a support onspiritual both
a mental potential of the people and universal values is reformed on a
basiseducational standards. The special attention is given to the person y, to
development ata cult of education and knowledge, to activity, formation of
independence, feelingand advantages.
It is spent purposefula policy on increase of authority, responsibility and
professionalism yy shots. Forms and training methods take rootyy y, new
educational programm. 4.4. Spiritually-moral education and educational work
Are developed and take root effectiveand yy forms and means spirituallynravstvennoyo educationthe generations based onnational cultural - historical
traditions, customs of the people and universal values. The priority of education
anddevelopments of the person is provided. The educational work covering all
population of the country for the purpose of increase by general and yy of culture
is improved.
Close interaction of educational institutions with parents, a family,
committees, the public centre " ", public y, funds on formation of the creative,
active person, the independence of Uzbekistan betrayed to principles and capable
to bring the real contribution insocieties is carried out.
4.5. Presented children and talented youth
Are created y, psiholoyo-pedayoyicheskie andrevealing and training
conditions, the republican databank andpresented children and youth is formed.
Attraction of the best yy and scientists for working out special educationalandyy y,
themparticipations in teaching and educational process is provided. Elite
educational institutions, as the centres on studying of sciences and technics, a
policy and economy, culture and art are created. Purposeful activity on the general
260
and professionalpresented children and talented youth abroad is carried out. The
pupil of the academic lycées first of all presented and talented, gives possibility to
show and develop the natural abilities, to realise special talents,the knowledge of
concrete fields of knowledge and narrow directions of scientific disciplines.
4.6. Management of an education system
It is carried outy structural changes and dynamics of developmentandsystem
educational institutionseducations and preparation shots. The competence
spheremanagements of education of all levels according to the Law "About
education" is defined. The is standard-legal base of education develops. Expansion
of the rights and independence of educational institutions in financially - economic
activities andy process is provided. According to the order established by Office
Min of Republic Uzbekistan, certification and accreditation of educational
institutions is spent. Onthe right to realisation of educational activity is given to
accreditation.
The effective systemmanagements of educational institutions by creation
trustee and the supervisory boards including representatives oryanizatsy - founders,
localthe authorities, business y, public y, funds and sponsors takes root.
4.7. Formation of the monitoring system of qualityeducations
The service of certification of qualitythe educations, independent
frommanagements of education is created y. Are developedthe educational
standards meeting perspective requirementsandof development of the country. The
systemestimations of activity of educational institutions, qualities yy, professorskopedayoyicheskih shots, and also knowledge trained is entered. Developquality
assurance forms preparation shots. The systemcertifications of graduates of
educational institutions is improved.
4.8. Education system financing
The financing system is improved, entered(fromand off-budget sources)
system of a financing of education and preparation shots, develops self-financing
of educational institutions, attraction private, and also foreign investments into an
education sphere is stimulated. The mechanism of granting of educational credits
forrepublics withtheir systemy is formed. The role of donors and sponsors in
system material supporteducations and preparation shots amplifies.
The increase in incomes of educational institutions at the expense of paid
educational y, enterprise, advisory, expert, publishing, industrial, scientific
andactivity according to authorised problems is provided.
4.9. Material support
Creation of a network of the academic lycées, professional colleges and their
placing is carried out, starting withand yy featuresy. The maximum coverage
trained without a separation from a family is carried out.
Measures on major repairs existing and to building of new educational
institutions with maintenance of their equipment according to standard
requirements and taking into account level of modern technics andare taken.
Creation of specialised manufactures on equipment of teaching and
educational establishments by the necessary equipment, stock, accessories,
261
technical,and didactic tutorials is supported. The computerisation and
informationprocess at all levels is made.
4.10. Creationspaces of educational system
The supply with informationprocess on the basis of modern information y, a
computerisation and computer networks develops. The role of mass media in
educational process raises, intellectualization educationalTV and radio is provided.
The publishing base of science and education develops, the steady system of
maintenance educational, uchebno-methodical, scientific, encyclopaedic and
reference books is formed.
4.11. Development of the market educational
The competitive market educationalby developmentin an education sphere
and preparation shots is formed. Developmentandeducational institutions is
provided, the competitive environment in an education sphere and preparation
shots is created, carried outy the market educational y. The system paid consulting
and additional (not provided by the cores educational y) educationaldevelops.
4.12. Maintenance socialandsupport in an education sphere
It is realiseda policy on increase of prestige andthe status yy activity.
Necessary conditions for study, improvement and rest trained and yy are created.
Educational institutions andpublic health services take necessary measures
for preservation and strengthening of health of children and studying youth.
Conditions for realisation of an improving orientation uchebno-vospitatelnoyo
process, introduction of normsa way of life are provided. Oryanizatsionnomethodical approaches for increase mediko-yiyienicheskoj cultures trained, growth
and fizkulturno-sports activity and leveldevelopments are improved. The adaptive
environment for children havingpossibilities of health and a deviation in
development is created. 4.13. Development of forms of communication of a
science with educational process
The advanced applied scientific researches in area yy and educations,
scientifically-methodical workings out forand maintenance of quality of education
according toeducational standards are carried out. From sphere fundamental and
applied science participation of scientific shots is stimulated in educational
process, communication yyy and scientifically -processes is provided. Scientific
and technical creativity of youth is in every possible way supported.
4.14. Developmentmanufactures and education systems
Creation and development of industrial practice complexes (centres), their
equipment by the modern equipment, equipment and the tool is stimulated. The
industrial potential of the enterprises inshots and carrying out joint scientificallytehnoloyicheskih workings out is effectively used. It is supportedshots on
manufacture, regular improvement of professional skill yy shots in the field of
front linesdirectly on manufacture is carried out.
4.15. The international cooperation in an education sphere and
preparation shots
The international legal base of cooperation in area preparation shots is
created, priority directionscooperation are realised, the international educational
262
structures develop, the exchange scientifically-pedayoyicheskimi shots, students
and pupils extends. The basis forrecognitions of national documents on education
is created. Activity interested min and departments, Republic Uzbekistan
embassies abroad on wide attraction of direct and indirect foreign investments into
sphere preparation shots is stirred up.
5.measures on realisation National programm
With a view of realisation National programm it is necessary:
To develop system of decisions and actions, with reflexion of concrete
mechanisms and measures of their realisation, terms, executors,andmaintenance of
realisation of directions and stages National programm;
To define functions and problemsand public institutes on performance
National programm;
To involve the qualified foreign experts for participation in working out of
concrete directions National programm;
To co-ordinate activityandstructures, and also participation internationalin
performance National programm;
To carry outand the analysis of a course of performance National programm
and on this basis to correct its separate positions and actions;
To conduct wide explanatory work under basic approaches and substantive
provisions National programm, with attraction of mass media, carrying out min
and conferences on questions of realisation and functioning of national model
preparation shots;
Actively include in process of realisation of the purposes and problems
National programm publicand the centres, republic various strata of society;
Regularly to shine a course of realisation National programm in mass media.
The Republican commission on realisation National programm onshots, with
putting on on it of functionsand coordination of all actions and actions is created,
including on:
To working out of the general requirements shown toto educational
standards for corresponding kindsof education;
To working outeducational standards andnecessary documents fory
educations;
To working outeducational standards for systemy,educations, programm
formations of a network of the academic lycées and professional colleges;
To realisation of measures on maintenancecoverage of the pupils having the
general secondary education, the academic lycées and professional Total, with the
account y, yy features and requirements for shotsy, to creation of their material
base;
To creation and maintenance of effective activity of educational institutions
for preparation and improvements of professional skill of teachers and yy the shots
working in the academic lycées and professional colleges;
To reforming of system of the higher educational institutions according to
requirements National programm, to working out and introduction
correspondingeducational standards;
263
To perfection of activity of preschool obrazovatelno-educational
establishments, increase of responsibility of a family, and publicin education and
preschoolchildren;
To maintenance of educational institutions with necessary textbooks and the
literature, attraction to this work of large educational, highly skilled experts,
development of publishing base of educational and scientific sphere;
To creation and activity maintenancey fund for the purpose of assistance to
improvement of professional skill andprofessorsko-pedayoyicheskih shots in
leading educational institutions of the developed countries;
To creation of necessary conditions forstudying of foreign languages in
systemeducations, to introduction of the accelerated methods of their studying, the
edition of dictionaries and reference books onlanguage;
y offers on strengthening of social protection and support of teachers and yy
sphere shotseducations, to revision of system of stimulation and payment of their
work;
Creation independent frommanagements of educationservices on
certification and accreditation of educational institutions, definition of qualifying
requirements to quality preparation shots, and alsoand coordination of actions
according to quality preparation shots;
To formation and system developmenteducation maintenance, to its
inclusion in a world information network, to definition of problems in a sphere of
education, facing to mass media;
y supply and demand studying in areaeducations, to formationthe market
educationalandwork, and alsoin sphere preparation shots.
Ў TO AND WITH ABOUT AND IN L AND WITH AND AND AND
Ў miny
5720100 - ABOUT WITH AT AND WITH IN
AND WITH AND AND
WITH AND AND AT TO
Government educational standards
y educations of Uzbekistan
REQUIREMENTS
To the necessary maintenance and level
264
y the doctor of the general practice in a direction
5720100 - Medical business
The edition official
Minand y
y Republic Uzbekistan educations
THE FOREWORD
1 IT IS DEVELOPED AND BROUGHT:
2 APPROVED AND PUT INTO EFFECT Order Min
Andy Republic Uzbekistan educations № __________ from «_______» _______
200 __
The information on introduction in action (cancellation)the standard and change
to it in Republic Uzbekistan territory is published in the index published“»
The exclusive rightthe standard in territory of Uzbekistan belongs .
The maintenance
1 General characteristic of a direction 5720100 - Medical business...........
2 Requirements to leveldoctors of the general practice in a direction 5720100 Medical business
3 Maintenances and components educational programm
4 Estimation and quality assurance preparation doctors of the general practice
5 Notes.............................................................................................
6 Appendix.......................................................................................
1. A general characteristic of a direction 5720100 - Medical business
1.1 Direction is brought ineducational standardseducations of Uzbekistan,the
educational
standardeducations,
the
Qualifier
of
directions
and
specialitieseducations.
1.2 Standard duration of training in a direction 5720100 - Medical business at the
internal form of training - 7 years. The academic degree - "Bachelor", the doctor of
the general practice ().
1.3 Bachelor should be y:
ion direction on posts,
Subject to replacement by persons with higher education, according to the National
qualifier of a trade and posts;
265
Specialities in limitsbachelor degree directions;
ducations in
To system preparation and improvements of professional skill. 1.4 Characteristic
of sphere and objects of professional work of the doctor of the general practice in a
direction 5720100 - Medical business
1.4.1 Place of a direction of education in the field of a science, technics and
Spheres of service 5720100 - Medical business - a direction in the field of the
public health services, including set of knowledge, abilities, skills and the relations
necessary in a trade of the doctor, used for improvement of professional skill,
medicine development as a whole.
1.4.2 Objects of professional work
Objects of professional work of the doctor of the general practice in a direction
5720100 - Medical business is the population irrespective of a sex, age,position
and character of disease, and also factors surroundingthe environments influencing
health. Primary activity of the doctor - public health care,y a way of life and
preventive maintenance of diseases. Rendering of the preventive, medical and
palliative help is spent in interests of a family and a society in cooperation with
expertsdirections of system of public health services. Social, cultural features of a
life of patients are thus considered physical, y. The doctor should improve
constantly the knowledge and skills for rendering of the effective qualified medical
aid comprehensible and safe for the patient.
1.4.3 Kinds of professional work
-medical aid at levela link
Public health services ();
- Rendering of the medical aid based on the individual
The approach to the patient and ininterests;
- The decision medical,and social problems
The patient;
- The all-round approach to rendering medical y;
- Coordination of granting of the help to the patient andto a family together with
y y.
Medical aid should be under construction taking into account cultural traditions of
a society and medical ethics.
The doctor of the general practice in a direction 5720100 - Medical business
according to fundamental, and specialcan carry out following kinds of the
professional
Activity:
- The treatment-and-prophylactic: working out and carrying out improving,
sanitary-yiyienicheskih, the preventive actions directed on the prevention of risk
factors and the dangerous reasons, the person operating on health, the prevention
and preventive maintenance of diseases, carrying out epidemic and actions; - fast
and urgent medical aid:and rendering of urgent medical aid ona stage;
- Medical-diaynosticheskaja: clinical and laboratory-toolit is wide ѐ diseases; a
direction on consultation to experts andy to their recommendations;
266
- Rehabilitation: restoration of professional and physical activity andthe status of
the patient;
- Socially-medical: together withsocial protection and
Services of mercy renderingto the population with the account sociallyyiyienicheskih, mediko-demoyraficheskih and socially-psiholoyicheskih factors;
- Scientifically-educational: participation iny a way of life in mass media;
- Oryanizatsionno-methodical: participation in carrying out of the analysis of the
basic indicators of activity of treatment-and-prophylactic and improving
establishments, in audit and planning medical y,improvement of quality of
rendering of medical aid.
1.4.4 Possibilities of professional adaptation
The doctor of the general practice (bachelor) on a speciality 5720100 - Medical
business can adapt for following kinds of professional work:
-tool service;
The doctor of the general practice can work when due hereunder in educational
institutionsandy,educations, and also at courses of improvement of qualification
and preparation shots.
5720152 - Experts y, and also related directions (speciality) of the education,
defined by the representativemanagements lasting not less than two years.
2 Requirements to levelbachelors in a direction 5720100 - Medical business
2.1 General qualifying requirements
The bachelor should:
sciences, pressing questions flowingpoliticians; capable to be independent to
analyze social problems and processes;
entifically to prove the
Position concerning spiritual national and universal values to have an active
position on the basis of idea of national independence;
nature and a society, to own knowledge of society development, to be able to use
legal and ethical standards,the relation of the person to the person, a society, to
environment to be able to consider them in professional work;
able to make the proved independent decisions in the professional work;
basisthe work;
life, to own
skillsself-improvement.
2.2 Professional qualifying requirements
should know:
267
Public health services;
rp conditions demanding rendering of the urgent help;
ciples of
functioning ;
withand works in a command;
of disease, sequence of carrying outsurvey,
standardsand differentsialno-diaynosticheskie criteria of diseases at level ;
patient in dynamics;
arrow experts,inspections and treatments;
should be able:
apply skills of consultation to creation of confidential relations with the patient;
diseases;
h most often meet at levela link;
conditions;
tool methods of inspection existing at level ;
methods;
al
aid
of
the
patients
demandingandleaving;
institutions;
and looking after persons;
own skillsworks in establishment, command work with the personnel,
conducting the documentation and carrying out of audit of quality of medical aid;
of data of demonstrative medicine in practice.
268
should:
treatment in a hospital;
institutions, forrendering assistance to patients;
the personnel of establishment for the effective joint
Activity;
nning of tactics of conducting;
ordinate actions for health strengthening, preventive maintenance, treatment,
leaving, rehabilitation and the palliative help;
importance of interrelation between medical institutions
andsociety social protection;
health;
ems of the patient, to reckonwith belief;
researches and the fundamental statistics (disease, prevalence,value etc.);
reading);
2.3 Requirements shown to knowledge, to skills, on educational
2.3.1 Requirements on the blockand social and economic disciplines
should:
-Ati declaration),and work
principlesy a site ()/YVP aspublic health services link (orders Min), financing , a
role and problems of the doctor of the general practice in public health services
system;
-and the concept: y, min health, indicators of
influence of various factors on y, an estimation of requirements of public health
services, health protection of the patient and a society;
protection at level - conversations with the population in (about , a tuberculosis,
virus
y, contraceptions, etc.);
lems of public health services - sec
cooperation: preventive maintenancea traumatism, traumas and accidents among
teenagers (conversation at schools); carrying out of preventive actions in
269
(vaccination, y); the distribution control diseases; the prevention of distribution of
the infections transferred sexual by;
chronic diseases -a diabetes, an asthma, adiposity;
sultation (consultation of difficult patients, principles and styles of
mutual relation "doctor-patient", management of time of consultations, ethics
questions, confidentiality, methods, principles and skillsdialogue);
ring of the anamnesis, survey of the patient, to
appoint laboratory and tool researches, to interpret their data;
-patient card,to conduct the medical documentation in ;
arches, a pyramid of
levels ; to use demonstrative medicine in practice, to be able to spend independent
information search on the Internet;
improvement of quality of medical aid, carrying outaudit in .
Requirements on the blockand social and economic disciplines are defined by the
document “Requirements to the necessary
To the maintenance and levelbachelors on the block “Y and social and economic
disciplines”, confirmed order Minandy educations.
2.3.2 Requirements on the block of natural-science disciplines should know within
the limits of the speciality.
2.3.3 Requirements on the block disciplines
Course of the general
The doctor of the general practice should:
The nobility:
- The basic laws yy conditions and mechanisms
Developments;
-anddiseases;
-y yy process;
- Valuethe approach in studying yy process;
- Bases of judicial medical examination;
To know:
- About the mechanism of medical products and their influence onthe person;
- About processesadaptations y;
To be able:
- To use instructions on rational use
Medical products;
- To examine various kinds;
- To make medical papers on medicolegal process;
- To make out recipes.
- a preventive course.
The doctor of the general practice should:
270
To know: - about influence of the social, physical and natural reasons on a
structure,
Development and function y;
- Aboutthe changes occurring in human
In a caseaccidents and at extreme situations;
To be able:
- To make the planned schedule, the instruction on carrying out
Preventive inoculations to children and adults, ;
- To spend routine inspections of womenage and
Improvement of women with revealed y;
-Advise for choice contraceptive means for the prevention of undesirable
pregnancy;
- To spend supervision of pregnant women for the purpose of the prevention parent
and death rates;
- To spend sexual education among teenagers, to train them yy
Sexual mutual relations, to use of contraceptive means;
- To spendgrowth and development of healthy children till 5 years;
-Participate in planning, management, public health services financing on a
yosudarstvenno-legal basis;
- To apply the basic directive documents of system of public health services;
-napravljatna medical-commission of experts ()to instructions on delivery of sicklists, being based on examination
Time invalidity;
- To analyze the basic indicators of a state of health of the population and
Activity of treatment-and-prophylactic establishments;
- To fill and to conduct basic documents (y polyclinics).
Therapeutic course
The doctor of the general practice should:
The nobility:
- y, risk factors, clinic and y, the basic laboratory-tool indicators of the most
widespread
Diseases;
- Features of a current of illness depending on an age, sex and a trade;
-basestreatments and principles
y prescriptions of medicines;
- Indications, contra-indications, collateral actions, interactions of medical
products;
- Methods of supervision of patients in dynamics;
To be able:
- To apply skills of consultation;
- rehabilitation and supervision of patients with chronic diseases;
- To carry out preventive maintenance of socially significant diseases,
Transferred sexual by (VICH/SPID, a narcotism, y); -to conduct the medical
documentation;
271
- To render the first help ona stage;
- To work with the medical literature, to use the information, to have
Skills of work with the computer.
y a course
The doctor of the general practice should:
The nobility:
- Clinic, y, complications of diseases,
-Features of a current of illness depending on an age, sex and a trade y;
- Indications and contra-indications to operation;
-methods of treatment,
To be able:
- To directon consultation to the expert or to a hospital;
- To spend processing and simple wounds in the conditions of ;
- To spend care of postoperative patients;
- To render first aid and transportation of patients at dislocations and
Crises;
-Render fastmedical aid at urgent conditions.
Course of protection of motherhood and the childhood
The doctor of the general practice should:
The nobility:
-growth anddevelopments of children till 5 years;
-Bases yy feedings anda food of children till 2th years;
-Clinic, y, the basic laboratory-tool indicators, complications most ѐ children's
illnesses;
-Clinic, y, the basic indicators laboratory-instrumentaloyo inspections, possible
complications of diseases in yy;
- Principles of leaving and treatment of childrento demonstrative medicine;
To be able:
- To conduct supervision of sick children;
- To spend routine inspections;
- To spend vaccination of children;
-Render fastthe help at urgent conditions;
-Spend dynamic supervision over the pregnant woman, in due time to reveal
complications and to direct on consultation to the expert or to a hospital;
- To advise women for choice contraceptive means;
- To conduct supervision over chronic patients;
- To spend routine inspections;-spendon early revealing of a cancer of a neck of a
uterus and a mammary gland cancer;
-Render first aid ona stage at urgent conditions.
2.3.4 Requirements on the block of special disciplines
Course of special disciplines
The doctor of the general practice should:
To know:
272
- About environment andthe principles influencing the person, the cores social,
economic, cultural, family
The reasons and the factors influencing development of illness;
- About functional changesy at y;
- About the basic scientifically-methodical problems of medical system, degree of
development and interrelation with related fields;
- About measures on decrease in distribution of the basic illnesses;
- About carrying out of examination of time work capacity;
- About clinical signs and the cores clinical, laboratory, tool indicators most ѐ
illnesses, a choice of tactics of conducting patients;
-About featuresandthe periods, yy and yy pregnancy currents, conductingprocess,
indications to y;
- About rendering of urgent medical aid ona stage
And ways urgent y;
- Abouty a way of life and preventive maintenance of diseases;
- About consultation of patients and skillsdialogue;
Skills of care ѐ, children sick and aged.
On the block of special disciplines
The doctor of the general practice should:
- To possess the basic necessary knowledge, abilities, skills and
To generate the due relation to those medical sciences and clinical disciplines
which underlie the general medical practice;
- It is effective and safe to give all-round and continuous
The help to patients irrespective of an age, sex and disease;
- To render the preventive, medical and palliative help taking into account interests
of a family and a society, and also physical, y, cultural aspects of a life of the
patient;
-Should keep in contact withdirections of activity of public health services,
rationally using available resources;
- Should bear responsibility for ѐ professional development.
2.3.5 Requirements on
On the doctor of the general practice solves the finished
The professional problem demanding application of knowledge on all blocks of
disciplines. The doctor of the general practice on :
- Carries out practical skills on models, phantoms or ѐ;
- Solves situational problems;
- Carries out the analysis of the given laboratory-tool researches.
2.3.6 Requirements to qualifying practice
Qualifying practice
The doctor of the general practice should seize skills:
- Consultations;
- Findings-out of complaints and gathering of the anamnesis, revealing of risk
factors;
- Survey of the patient;
273
-Carrying out of laboratory and tool methods of research;
Conversation-carrying out about rational a food and not medicamentous treatment;
Should be able:
- To appoint medicinal therapy;
- To fill the medical documentation in a polyclinic;
- To define time invalidity of the patient;
-Directon consultation to the expert ory;
-Carry out medical inspections of invalids andthe population;
- methods of sanitary-educational work;
- To conducty a way of life;
-Be able to work with ѐ, children sick and aged and to look after them.
3 Maintenances and components educational programm
3.1 Educationalpreparation doctors of the general practice on
To direction 5720100 - Medical business it is calculated on term of training of 7
years at the internal form of training with following distribution of time:
Theoretical training, including flowing, intermediate andcertification of 278 weeks
Qualifying experts of 22 weeks
y 2 weeks
Y certification of 2 weeks
Vacation of 56 weeks
y 360 weeks
3.2 Maximum ѐ educationalthe student in a week makes
54 hours, from them educationaltill 36 o'clock, other ѐ
Hours it is allocated foreducations - 22 hours. 3.3 ѐ educational programm,
including the intermediate
Andcertification for 7 years of training, is made by 16966 hours.
3.4 At development educational programm self-education of students on some
question or problemscourses for ѐtime should be provided.
3.5 the Necessary maintenance educational programm in a direction 5720100 Medical business
3.5.1and social and economic disciplines
The necessary maintenance of the given disciplines is defined by the document
“Requirements to the necessary maintenance and level
Bachelors on the block “Y and social and economic disciplines”, confirmed .
3.5.2 Mathematical and natural-science disciplines
Matematiko-communicative course
3.5.2.1 Computer science and information y: in the modern world and their
application medicine areas; modern medical y.
3.5.2.2 Iatrotechnics and new medicalmedical devices, a structure and principles of
work of devices; lacks modern medical y, used in preventive maintenance, y,
treatment and the rehabilitation, new communicative y, applied at rendering of the
medical
The help, an electronic card y, videoconferences;
Natural-science course
274
3.5.2.3 Medicaland y:
Influence of hereditary factors on illness development, studying of risk factors.
Degree of influence of factors of environment on development of diseases.
Influenceon illness development; medical andthe parties y,bases of results
y;
3.5.2.4 Biophysics:
Influence of fluctuation and vibration on y, biophysical abilities
Liquid and fabrics, the physical factors influencing on y, optical devices,and laser
optics, electronic devices and equipment, radioactive devices and spectroscopic
devices, , maynitno-bioloyicheskie measure measurements, weight;
3.5.2.5chemistry:
Chemical processes inand medicine, the organic law of chemical interactions,
physical and chemistry, its value forthe person;
3.5.2.6chemistry:
Methodsy andresearches
y, environment influence onthe person, interrelation
The chemical natureconnections withenvironment; 3.5.2.7chemistry:
The physical and chemical processes occurring in live y, them
Value inand the nature, interaction of parts as the basic quality of ability to live, the
squirrel, y, , enzymes, min, y, biochemical structure vodno-solevoyo an exchange,
biochemical fabrics and liquids, norm and y, modern methods of the analysis;
3.5.2.8 Latin language and bases mediko-pharmaceutical miny:
Valuelanguage
in
medical
miny
anatomo-yistoloyicheskoj,
clinical,
pharmaceutical, a lexicon,
Applied in medicine;
3.5.2.9 Human anatomy:
The formbodies, and development y, y, y, y, y, y, y; the social, physical, natural
factors influencing developmenty, conformityto a floor and age;
3.5.2.10 Yy, y, y:
Fabrics and y, cage ability to live, microscopic and
Submicroscopic structure of someand systems, blood cages,, urinogenital system,
y, bases human y, methodsin yy, light and electronic microscopy;
3.5.2.11 Normal y:
Structurey and laws of work of cages, fabrics, y,bases of functions y, adaptation
bases
yto environment; methods of check of functions
y and the basicindicators;
3.5.2.12 y,and y:
Ability to live and structure y, distribution and
The international classification of activators,bases
Activators of infectious diseases, immunity, the immune status bothy and yythe
status,
conditions, y, methods of special preventive maintenance, a vaccine;
3.5.2.13 History of medicine:
275
History of medicine and ѐ founders,in medicine, an oath
Y, role in medicine development, a role of national traditions in public health
services, modern medicine, regionalUzbekistan, uch•nye-physicians of
Uzbekistan.
3.5.3 disciplines
Course of the general
3.5.3.1y:
The basic laws and mechanisms of development of illnesses,and y,
influenceenvironment on development of illnesses, interrelation of local and
general changes y, a role hereditary y, revealing immune y,(infringement
y blood circulations, infringement of growth and fabric development, a
metabolism,
y), functional changesand systems at y,
y features in system mother-placenta-fruit, age features y, main principles of
modelling of diseases;
3.5.3.2anatomy. Sec a course:
y anatomy - the basic methods of studying
(Macroscopical and yy), the generaly;fabrics, damage and , blood circulation
change, an inflammation of immune system,and processes, privatey diseasesand
sheaves, y, the anamnesis,diseases; studying of consequences of disease in process
kliniko-patoloyoanatomicheskoyo the analysis, medical errors, filling of the
certificate on death.
3.5.3.3 Forensic medicine. Legal bases of activity of the doctor:
Medical examination at ѐ traumas, ѐ ѐy conditions y, medical examination at
emergencies with a lethal outcome; mechanical damages, examination of material
evidences, documentation registration; the rights and duties of medical workers
and patients; public health services organic laws; yrazhdansko-administrativnye,
rules of law, the crimes, concerning profession of a physician; differentiation of
errors in medical aid rendering, examination kinds.
3.5.3.4 y:
Medical products, influence mechanisms onthe person,
The general(pharmacokinetics, ), bases y, private(the list of the vital medical
products), the mechanism of action, the indication and contra-indication to
application, by-effects, poisonings with medical products, forms and methods of a
writing of recipes at variousconditions;
3.5.3.5 Yy with y, Y:
yy the characteristic of objects of environment (air,
Solar radiation, water, soil),aspects of medicine,
Interaction of the person with environment, yy requirements;
Education of teenagers, conditions of training and a food of children and teenagers;
yy work, principles yy in hospital, actual problems yy, concept about sanitary
inspection, bases yy on military objects,diseases and applicationirradiations in
treatment of various diseases; interrelationy and environment, is natural-natural,
socially-yiyienicheskie the disease reasons, secondary preventive maintenance of
276
disease. The Medical-protecting mode in medical preventive establishment,
improving actions. 3.5.3.6 Public health and management of public health services.
Biostatistics:
Indicators of health of the population: them socially-yiyienicheskoe value and
Studying methods, the medical statistics, health protection of mother and ѐ; ethics
of the doctor and medical y; medical aid renderingand to countrymen; structure
sanitary-epidemioloyicheskoj services, bases of medical statistics, methods of
statistical check and value of an estimation of indicators of health; registration of a
package of medical service, market y, elementsy, rendering of medical service in
Production, systempublic health services, the general concepts about
administrative process. Health and public health services as socialy. Public health
services reforms.
The economic concept of public health services. Business factors,
The population influencing health. The economic analysis of the market.
3.5.3.7 y:
Strengthening of health of the population, methods and ways of improvement of
the population, improvement mechanisms; methods sanitary-educational
The work directed on introduction of normsof a way of life. A conformity
estimation ѐ actions.
3.5.3.8 y, :
The mechanism of development, the reason yy process, a basis of disinfection,
sterilisation, sec, deratization; the herbs growing in territory Uzbekistan, used in
quality
and sec means; the means applied to inoculations, means yy,
y,developmentsprocess, distribution of various kinds of infectious diseases, their
terms, specific preventive actions for the prevention of infectious diseases,
preventive maintenance of infections to military establishments; working out of the
public actions influencing the mechanism of infectious diseases andof infection;
ways of distribution of infections: air, water, air-drop, intestinal, through blood;
working out of actions in a mode.
Therapeutic course
3.5.3.9 Doctor and the patient:
Skills and consultation kinds, skillsdialogue,
Renderingthe help to the patient;
3.5.3.10 Propaedeutics of internal illnesses:
Anamnesis gathering, finding-out of complaints, survey of patients (, ,
), symptoms and syndromes widely ѐ diseases internal y; laboratory and tool
methods of inspection y.
3.5.3.11 Internal illnesses. National medicine: y, y, clinic, variants of a current of
illness, a consequence,
y, differential Diagnosis diseases; y, preventive maintenance, rehabilitation,
prophylactic medical examination; Methods of treatment of national medicine: y,
y, acupressure, manipulation, herbal medicine, etc.
3.5.3.12 Phthisiology:
Clinic, early and comparative Diagnosis, y, y,
277
y risk, semiresistant ѐ, consequences of a tuberculosis,
Modern treatment; prophylactic medical examination, preventive maintenance ѐy
andforms ѐ, rendering of the first help to pregnant women, children and peopleage,
a current ѐ at patients with VICH/SPID, . Preventive maintenance, examination of
time invalidity.
3.5.3.13 Medical control, physiotherapy exercises and physiotherapy:
The medical control, instructions on employment by physiotherapy exercises and
Sports, rehabilitation of patients and physical training in the complex
Treatment, action of physical factors onthe person, a place and a physiotherapy
role in treatment of diseases internal y,value in rehabilitations of patients,
sanatorium treatment.
3.5.3.14 y:
Clinic illnesses, functional and laboratory methods of inspection; estimation
methods yy the status; the treatment, supporting therapy, prophylactic medical
examination, preventive maintenance; a current
illnesses at pregnant, elderly patients;and first aid in ѐ cases.
3.5.3.15 Yy and field therapy. Laboratory business:
Clinic, early y, differential Diagnosis illnesses of blood; yy an estimation methoda role punctures; modern treatment, preventive maintenance, a current yy diseases
at pregnant women, children, elderly patients; y, donor service questions,
interpretation of results laboratory-instrumentalnoyo inspections.
3.5.3.16 Professional illnesses:
Clinic, early y, comparative Diagnosis, treatment is wide
ѐ occupational diseases, employment at
Professional illnesses and their preventive maintenance, medical labour
examination, medical documents.
3.5.3.17 Clinical y:
kliniko-farmakoloyicheskaja The characteristic of the basicmedical products,
pharmacotherapy and medical products, treatment in out-patient-polyclinic
conditions, methods of an estimation of efficiency of medical products, the data
card of medical products.
3.5.3.18 Infectious diseases. Children's infectious diseases:
y, y, clinic, the laboratory-tool analysis, differential Diagnosis, treatment,
supervision, prophylactic medical examination of children and adults with
infectious diseases; timely specific and nonspecific preventive maintenance of
infectious diseases; complications, first aid; children's infections at adults.
3.5.3.19 Dermatovenereal illnesses, AIDS:
y, y, y, clinic,and treatment,
Prophylactic medical examination, preventive maintenance of dermatovenereal
diseases, VICH/SPID, acts, social aspects.
3.5.3.20 Nervous illnesses:
Clinical and diseases of nervous system, treatment ѐ and ѐ diseases of the central
and peripheral nervous system; the basic symptoms, clinic, methods Diagnosis,
278
differential Diagnosis, consequences and treatment; urgent and first medical
assistance.
3.5.3.21 Psychiatry and y. Medical y:
The basic laws of mental activity y;norms and y; psychiatry bases,methods y,
treatment principles, rehabilitation and examination; psychosomatic illnesses,
psychotherapy, preventive maintenance,service, socially-medical bases y;the help
to patients.
3.5.3.22 Beamand therapy:
Ultrasonic, yy, it is computer-tomoyraficheskaja,
and jaderno-maynitnoresonantillnesses; beam therapy of malignant and good-quality new growths.
3.5.3.23 Medical y:
Social directions,risk,pregnant women, clinic of hereditary diseases,and the
biochemical analysis.
3.5.3.24 Clinical yy:
yy the anamnesis; skin and provocative tests.
Clinical
and
tool
inspection,
y,
clinic,
treatment,
preventive
maintenancediseases.and pregnancy. A diet of pregnant and feeding women.
3.5.3.25a course
Operativewithanatomy: the form, a structure, interpositionand fabrics in a human
body depending on a sex, age and a constitution. Mechanical influence and
restorationand fabrics.
3.5.3.26 Generalwith bases y:
, antiseptics, bases y;patients to
To inspection; methodsandinspections; treatmentѐ,to operation, kinds of
operations,
Nonspecificdiseasesfabrics, first aid at bleedings.
3.5.3.27illnesses:
Clinic, laboratory-toolmost ѐdiseases, treatment and complications;
Urgent y, methods of a clinical estimation of diseasescages, miny spaces,arteries
and veins; differential Diagnosis, treatment, rehabilitation, preventive maintenance
and prophylactic medical examination; renderingthe help to pregnant women;
bases y, urgent actions in case of emergency, the urgent help in a hospital, a
polyclinic, houses, conducting the basic medical documentation.
3.5.3.28 y:
Clinic, y, differential Diagnosis, principles yy treatments of diseases and damages
of the central and peripheral nervous system, rendering of the first help in extreme
conditions.
3.5.3.29 Nursery y:
Clinic, y, differential Diagnosis, treatment principles
Children with ѐ and the got orthopedic diseases.
3.5.3.30 y:
Clinic, y, differential Diagnosis, rendering of the first
Medical aidthe patient.
3.5.3.31and orthopedy, . A nursery y:
279
Traumatism (houses, on transport, on manufacture), kinds of a traumatism,
Clinic, differential Diagnosis, treatment; crises (ѐ and
ѐ), renderingthe help and transportation;
Restoration of labour activity; social rehabilitation, prosthetics.
3.5.3.32 y. A nursery y:
y, clinicdiseases, methodsdangerous (malignant) and harmless (good-quality) new
growths, differential Diagnosis; value , kinds
Treatments, prophylactic medical examination, rehabilitation, work capacity
revealing.
3.5.3.33and resuscitation:
Modern methods and anaesthesia kinds, carrying out principlesanaesthesia, clinic
andthe basicsyndromes in critical situations; the general questions of intensive
therapy and resuscitation.
3.5.3.34 yy, y:
Clinic, methods y, differential Diagnosis, treatment most ѐ ear diseases, y, a nose.
Value infectiousin development of diseases -y, rendering of the fast
The urgent help in case of emergency; preventive maintenance of diseases of an
oral cavity, agefeatures, clinic widely
ѐ diseases,and consequences, indications to
Consultations of the expert, methodstreatments and prosthetics
3.5.3.35 y:
Age sight, anatomy, y, optical correction of sight; clinic, y, differential Diagnosis,
complications; ѐ and ѐ diseasessight, treatment, rehabilitation and preventive
maintenance; the fast urgent help at
Difficult defeats, work capacity examination.
Course of protection of motherhood and the childhood
3.5.3.36 Obstetrics and yy:
y andconditions in pregnancy,
Sorts and after sorts; methods of research of a condition of a fruit,y; clinic and
treatment most ѐ yy diseases;andchildbirth; consultation bases on contraception
methods.
3.5.3.37 Pediatrics:
anatomo-fizioloyicheskie Features of children;growth and development of children
till 5 years, factors and the reasons influencing growth of children, feature of
consultation of teenagers; clinic, y, differential Diagnosis the most widespread
diseases of children, treatment, principlessupervision; questions of vaccination of
children.
3.5.4 Special disciplines
3.5.4.1 Internal illnesses, y:
Preventive maintenance and public health care,y a way of life, risk factors,the
population. Clinic, y, differentialoften met syndromes, the differentiated therapy at
them, rational pharmacotherapy, tactics in concrete clinical situations in
conditionspublic health services link. Primary and secondary preventive
maintenance in various agethe population and at pregnant women. Rehabilitation,
280
prophylactic medical examination and urgent conditions at therapeutic diseases,
rendering of the urgent help at emergency conditions ona stage. The general
approaches in conditions experts. Indications to out-patient treatment, y, to a
direction in specialised medical institutions, consultations of narrow experts. The
differentiated plan of inspection of patients withinternal y, interpretation of results
of laboratory-tool researches in polyclinic and hospital conditions. Statement y,y
Diagnosis. Examination of time invalidity; bases of health protection of personsage
according to Republic Uzbekistan laws. The international bases of classification of
personsage and aged. The general laws and the ageing theory.parametres of age
norms. Basesa food of personsage and aged. Clinical,andbases of a current of
illnesses at personsage and aged. Bases of interpretation of results of laboratory
and tool researches in y. Ways of leaving in house conditions for personsage.
3.5.4.2 y: the mechanisminfluences of physiotherapeutic procedures onthe person;
a physiotherapeutic orientationrestoration, a wayuses of physiotherapeutic actions
and medical products; a choice of sanatoria and resorts, registration of the medical
documentation; observance of rules of technical safety and work principles ; use of
physiotherapeutic actions in the improving purposes; the mechanism
Influences of physical exercises, indications and contra-indications to ; kinds and
means of improving physical training.
3.5.4.3illnesses:
Clinic, y, and differentialsharpdiseases, tactics at them, rational pharmacotherapy,
treatment of the most widespreaddiseases in conditionspublic health services link,
conductingthe period,complications and their preventive maintenance, the first
medical aid at bleedings, damages,diseasesfabrics. The general approaches in
conditions experts.
3.5.4.4 Medicine of accident:
Application of necessary practical skills at rendering of the primary
Medical aid by the victim in natural cataclysms and accidents, rendering of
professional specialised medical aid and transportation.
3.5.4.5 Urgent conditions. The first help:
y and clinic at urgent conditions. Anaesthesia, resuscitation and intensive therapy
of patients in the period and in a hospital in critical situations.
3.5.4.6 Obstetrics and yy:
Consultation on planning of a family and protectionhealth. y, supervision of
pregnant women withpregnancy, atdiseases, preventive maintenance and
earlycomplications, conductingthe period, and postnatal contraception, the
emergency help at complications, consultation; testing and preventive maintenance
of the infections transferred sexual ѐ, including VICH/SPID; preventive
maintenance , consultation and realisation of contraception the help ona stage, and
treatment most often met yy diseases; rehabilitation in out-patient and house
conditions after transferred yy diseases and operations, rational pharmacotherapy,
urgent conditions in obstetrics and yy. The general approaches in conditions
experts.
3.5.4.7 y:
281
leaving and the primary help to newborns, resuscitation at in a maternity hall;
principles yy feedings at joint stay of newborns with mothers; supervision over
newborns with variousand their rehabilitation. An estimation of a state of health of
children and care of children of all age; physical and psychomotor development of
children with calculation and food correction; preventive maintenance of diseases,
safe vaccination; differentialand rational pharmacotherapy of most often met
diseasesage; the urgent help at emergency conditions; prophylactic medical
examination and rehabilitation of childrenrisk and with various diseases.
3.5.5 Industrial practice
Fastening of theoretical and practical knowledge of students at mastering
disciplines; knowledgey, given in /Y, possession of skills of work of the doctor of
the general practice in conditionspublic health services link, gathering of the basic
and minor complaints of patients, careful survey of patients, gathering and
objective
data,
appointmentthe
plan
laboratory-instrumentalnoyo
inspections,interpretation of results of laboratory-tool researches, possession of
methodsuchebno-informative activity and its control. Indications to a direction on
consultation to narrow experts, indications to out-patient treatment, indications to
hospitalisation, statementDiagnosis, a choice of tactics at concrete clinical
situations,filling of the medical documentation in the conditions of a polyclinic,
first aid and a hospital, examination of time invalidity, tactics of conducting
patients at an out-patient stage, primary and secondary preventive maintenance,
prophylactic medical examination and rehabilitation of patients, the decision of
questionsvalues (position in a family, a society, on work, physical inability
registration etc.)
3.5.6
Themes yy are developed by letting out chairs taking into account requirements of
the customer of shots and modern achievements of a science, technics and
medicine. Themes yy are developed on disciplines y, yy courses and a course of
protection of motherhood and the childhood. it is spent for the purpose of revealing
of level of knowledge and the skills received at a stageof education after endof a
course and at graduates during timey of certification. Volume yy chairs
preparation define the doctor of the general practice.
3.5.7 Realization educational programm
Educationalpreparation doctors of the general practice in a direction 5720100 Medical business it should be realised in accredited on the given direction
preparation the higher educational institutions with usey training, informationand
modern means of training. Mastering by students of foreign languages, teaching of
foreign languages by teachers, and also creation forconditions should be priority
atbachelors. Qualifying experts are spent in educational institutions, clinics, the
medical centres and scientific research institute. During training the student hands
overcertifications (at socially-yumanitarnomu course and a foreign language)
and.certification surrenders right after endprocess on correspondingto courses.
4 Estimation and quality assurance preparation
282
4.1 Quality assurance preparation shots in bachelor degree directions should
include: the internal control which is carried out by the higher educational
institution. The internal control is spent on the basis of Position aboutto the
monitoring system,the representativey managements of higher education;y the
control includingcertification for disciplines and according toby the educational
standard; the yosudarstvenno-public control which is carried out by the
representativey of management by higher education, publicand consumers of shots
in the established
Order; the external control which is carried out by Management of quality
assurance preparation of shots, certifications yy shots and educational institutions
atthe centre of testing of Office Min when due hereunder. A quality
estimationshots carries out consumers of shots in the course of their labour activity.
4.2 Higher educational institution bears full responsibility for:
- Observance of requirementsthe standard and quality preparation
The bachelors, provided by Position aboutcertifications and accreditations of the
higher educational institutions;
- Conformity professorsko-prepodavatelskoyo structure and uchebnovspomoyatelnoyo the personnel to qualifying requirements;
- Securityyy a course the necessary uchebno-methodical literature providedof a
course, and also
Materials for self-education and preparation;
- Material supportprocess.
5 Notes
The right is given to 5.1 Higher educational institution:
- To change volume of the hours which are taken away on developmentof a
material for blocks of courses - within 5 %, and for the courses entering into the
block, - within 10 %, without excessy volumestudents at maintenance miny
maintenances,this standard;
- To establish necessaryteaching of separate sections y, social and economic,
mathematical and natural-science disciplines according to a block profile courses;
- To correct the maintenance of courses taking into account achievements of a
science, technics and y;
5.2 Knowledge yythe standard is one
From
conditionsselection
professorsko-prepodavatelskoyo
structure
in
corresponding directioneducations. The appendix
Structureeducational programm in a direction 5720100 - Medical business № items
The name of blocks of disciplines andcourses
The general ѐin hours 1 2 3
1.00and social and economic disciplines 1704
2.00 Mathematical and natural-science disciplines 2952
Matematiko-communicative course 252
2.01 Computer science and information180
2.02 Iatrotechnics and new medical72
Natural-science course 2700
283
2.03 Medicaland270
2.04 Biophysics 180
2.05chemistry 144
2.06chemistry 180
2.07chemistry 324
2.08 Latin language and bases mediko-pharmaceutical miny 144
2.09 Human anatomy 450
2.10 Yy, y,324
2.11 Normal324 2.12 y,and324
2.13 History of medicine 36
3.00 disciplines 8316
Course of the general990
3.01y 270
3.02anatomy. Sec a course 306
3.03 Forensic medicine. Legal bases of activity of the doctor 144
3.04270
Mediko-preventive course 756
3.05 Yy with y,234
3.06 Public health and management of public health services. Biostatistics 378
3.0736
3.08 y, 108
Therapeutic course 3438
3.09 Doctor and the patient 72
3.10 Propaedeutics of internal illnesses 306
3.11 Internal illnesses. National medicine 558
3.12 Phthisiology 216
3.13 Medical control, physiotherapy exercises and physiotherapy 126
3.14198
3.15 Yy and field therapy. Laboratory business 270
3.16 Professional illnesses 90
3.17 Clinical234
3.18 Infectious diseases. Children's infectious diseases. 342
3.19 Dermatovenereal illnesses, AIDS 216
3.20 Nervous illnesses 252
3.21 Psychiatry and y. Medical306
3.22 Beamand therapy 108
3.23 Medical72
3.24 Clinical yy 72
a course 2160
3.25 Operativewithanatomy 198
3.26 Generalwith bases216
3.27illnesses 468
3.28108
3.29 Nursery162
284
3.30162 3.31and orthopedy, . A nursery216
3.32 y. A nursery162
3.33and resuscitation 72
3.34 yy,234
3.35162
Course of protection of motherhood and the childhood 972
3.36 Obstetrics and yy 342
3.37 Pediatrics 630
4.00 Special disciplines 1818
Disciplines of the doctor of the general practice 1818
4.01 Internal illnesses,828
4.0272
4.03illnesses 252
4.04 Medicine of accident 72
4.05 Urgent conditions. The first help 144
4.06 Obstetrics and yy 360
4.0790
5.00 Additional disciplines 450
5.01 Military y,and450
6.00 Disciplines for choice 322
6.01 Disciplines for choice 322
15562
Qualifying practice 1188
108
certification 108
16966
data
UDC _________At _________
CONSTRUCTION DEPARTMENT _________
Keywords:
Medical business, the doctor of the general practice
Ключевые слова:
Лечебное дело, врач общей практики
285
№
1.
Progress mark
in %
96-100% excellent «5»
2.
91-95%
3.
86-90%
Level of knowledge of student
Full correct answer to questions about the tasks
of sports medicine and medical monitoring for
exercise and sports, athletes survey scheme , physical
development, learning methods , evaluation and
correction of physical development . Summarizes and
makes decisions , think creatively , independently
analyzes . Situational problems are solved correctly ,
with a creative approach , with full justification
response.
Actively and creatively involved in interactive games
, right to make informed decisions and summarizes and
analyzes .
Actively involved in the development of practical
skills and properly performing.
CDS prepared high quality (abstract, slides , banner,
video ) with no less than 10 online sources and literature
in recent years.
2 . 91-95 % complete correct answer to questions
about the tasks of sports medicine and medical
monitoring for exercise and sports, athletes survey
scheme , physical development, learning methods ,
evaluation and correction of physical development .
Summarizes and makes decisions , think creatively ,
independently analyzes . Situational problems are solved
correctly , with a creative approach , with full
justification response.
Actively and creatively involved in interactive games
, right to make informed decisions and summarizes and
analyzes .
Actively involved in the development of practical
skills and properly performing.
CDS prepared high quality (abstract, slides , banner,
video ) with no less than 10 online sources and literature
in recent years.
Excellent «5»
"5" The questions about the tasks of sports
medicine and medical monitoring for exercise and
sports, athletes survey scheme , physical development,
learning methods , evaluation and correction of
physical development lit enough , but there are 1-2
errors in the response. Applies in practice , with the
matter , said confidently , has fine views. Situational
286
problems are solved correctly , but the justification
answer sufficiently.
Actively involved in interactive games , correct
decisions . Actively involved in the development of
practical skills , but there are 2-3 mistakes in their
implementation .
CDS prepared high quality (abstract, slides , banner,
video ) with no less than 10 online sources and literature
in recent years.
4.
81-85%
Good «4»
The questions about the tasks of sports medicine
and medical monitoring for exercise and sports,
athletes survey scheme , physical development,
learning methods , evaluation and correction of
physical development is fully covered , but there are 23 inaccuracies, errors . Applies in practice , with the
matter , said confidently , has fine views. Situational
problems are solved correctly , but the justification
answer sufficiently. Inaccuracies in solving situational
problems .
Actively involved in interactive games , correct
decisions .
Actively involved in the development of practical
skills , but there are 2-3 mistakes in their
implementation .
CDS prepared high quality (abstract, slides , banner,
video ) with no less than 10 online sources and literature
in recent years.
5.
76-80%
Good
Correct , but incomplete coverage of the issue .
Student knows about the problems of sports medicine
and medical monitoring for exercise and sports, athletes
survey scheme , physical development (RF ) , learning
methods , evaluation and correction of physical
development but fully understands the methods of
assessing risk factors . With the matter , said confidently
, has fine views. Actively involved in interactive games .
Situational problem gives partial solutions .
Actively involved in the development of practical
skills , but there are 3-4 mistakes in their
implementation .
CPC prepared good quality (abstract, slides) using at
least 5-8 online sources and literature in recent years.
«4»
287
6.
71-75%
Good
«4»
7.
66-70%
8.
61-65%
Satisfactory
«3»
Correct , but incomplete coverage of the issue .
Student knows about the problems of sports medicine
and medical monitoring for exercise and sports,
athletes survey scheme , physical development, but
incomplete lists methods of examination, evaluation
and correction of physical development . With the
matter , said confidently , has fine views. Actively
involved in interactive games . Situational problem
gives partial solutions .
Actively involved in the development of practical
skills , but there are 3-4 mistakes in their
implementation .
CPC prepared good quality (abstract, slides) using at
least 3-5 online sources and literature in recent years.
on the correct answer half of the questions .
Student knows about the problems of sports medicine
and medical monitoring for exercise and sports,
athletes survey scheme , physical development, but
poorly versed in the methods of examination,
evaluation and correction of physical development .
With the matter , said uncertainly , has accurate
representations only on specific issues theme.
Situational problems are solved correctly , but there is
no justification response. Passive when discussing
CDS. Passive during the development of practical
skills , makes mistakes when they are executed .
correct answer half of the questions . Student
knows about the problems of sports medicine and
medical monitoring for exercise and sports, athletes
survey scheme , physical development, but poorly
versed in the methods of examination, evaluation and
correction of physical development . With the matter
, said uncertainly , has accurate representations only
on specific issues theme. Situational problems are
solved correctly , but there is no justification
response.
Passive during the development of practical skills ,
makes mistakes when they are executed .
CPC prepared satisfactorily designed (abstract,
slides) using at least 2-3 online sources and literature
288
in recent years. Passive when discussing CDS.
9.
55-60%
10. 31-54%
correct answer to 40 % of the questions . Student
knows about the problems of sports medicine and
medical monitoring for exercise and sports, athletes
survey scheme , physical development, but poorly
versed in the methods of examination, evaluation and
correction of physical development . With the matter ,
said uncertainly , has accurate representations only on
specific issues theme. Situational problems are solved
correctly , but there is no justification response.
Passive during the development of practical skills ,
makes mistakes when they are executed .
CPC prepared satisfactorily designed (abstract,
slides) using at least 2-3 online sources and literature
in recent years. The abstract mistakes , broken logical
sequence of topics subject was not disclosed .
Improper design of slides and posters. Passive when
discussing CDS.
dissatisfaction
«2»
11. 20-30%
less than 40% coverage of the issues in the wrong
approach. Student does not know about the problems of
sports medicine and medical monitoring for exercise and
sports, athletes survey scheme , physical development.
Practically versed in the methods of examination,
evaluation and correction of physical development .
Homework is not satisfied.
Passive during the development of practical skills ,
making numerous mistakes in their implementation .
CDS performed with numerous errors , using only 12 online sources and literature, poorly framed , the
student can not present their work . Passive when
discussing CDS.
dissatisfaction "2" is present on the student practical training in the
«2»
proper form , there is a workbook . Questions not
answers. Do not know about the problems of sports
medicine and medical monitoring for exercise and
sports, athletes survey scheme , physical development.
Not involved in the development of practical skills.
Homework is not satisfied. CDS is not prepared .
Passive in class . Violates discipline prevents conduct
289
classes .
ТМИ текшириш мезонлари
№
1.
Ўзлаштириш %
86 - 100
2.
71 - 85
3.
55 - 70
Баҳолаш
Талабанинг билим даражаси
Аъло «5» 10 та манбадан ошиқ бўлган интернет ва охирги
йиллар адабиётлари маълумотларидан фойдаланиб
ёзилган юқори сифатли рефератлар. Мавзуси тўлиқ
ва ҳар томонлама очиб кўрсатилган рефератлар,
матни мантиқий кетма-кетликда ёзилган, рефератни
тайёрлашда талаба эрудитлигини, билимларининг
чуқурлилигини ва саводхон эканлигини намойиш
этди.
Реферат чиройли
расмийлаштирилган.
Мавзуни тўлиқ очиб берувчи 30 дан ортиқ
анимацияли,
замонавий
маълумотлардан
фойдаланган, аниқ ва чиройли слайдлар мажмуаси
тайёрланган. Стендлар, баннерлар ёки ламинация
қилинган материаллар юқори савияда тайёрланган,
материаллар мантиқан тўғри ёзилган, сифатли, аниқ
ва
чиройли
расмийлаштирилган,
барча
маълумотларни тўлиқ ҳажмда кўрсатиб беради.
Яхши
3-5 та манбали интернет ва охирги йиллар
«4»
адабиётлари маълумотларидан фойдаланиб ёзилган
рефератлар. Реферат чиройли расмийлаштирилган,
хатосиз, мантиқан тўғри ёзилган, мавзу тўлиқ очиб
берилган. Мавзуни очиб берувчи 15-20 та бир
турдаги анимацияли, замонавий маълумотлардан
фойдаланган, бир кўринишда расмийлаштирилган
слайдлар
мажмуаси
тайёрланган.
Стендлар,
баннерлар ёки ламинация қилинган материаллар
юқори савияда тайёрланган, барча маълумотларни
тўлиқ ҳажмда кўрсатиб беради, бироқ зерикарли
расмийлаштирилган.
Қониқар 2-3 та манбали интернет ва охирги йиллар
ли «3»
адабиётлари
маълумотларидан
фойдаланиб
қониқарли ёзилган рефератлар. Реферат чиройли
расмийлаштирилган, бироқ хатолари бор, кетмакетликка риоя қилинмаган ҳолда, мавзу ярим чала
очиб берилган. Мавзунинг ярим мазмунини очган
290
4.
0 - 54
10-15 та бир хил турдаги анимацияли, монтон
расмийлаштирилган
слайдлар
мажмуаси
тайёрланган. Стендлар, баннерлар ёки ламинация
қилинган материаллар маълумотларнинг яримиини
ўз
ичида
мужассамлаб,
сифатсиз
расмийлаштирилган.
Қониқар- Реферат ёмон расмийлаштирилган, хатолари бор,
сиз «2»
кетма-кетликка риоя қилинмаган ҳолда, мавзунинг
мазмунини яримидан кам қисмини очиб берган. 1-2
та интернет ва адабиётлар маълумотларидан
фойдаланилган. Мавзунинг яримидан кам қисмини
очган 10 дан кам бир хил турдаги анимацияли,
монтон расмийлаштирилган слайдлар мажмуаси
тайёрланган. Стендлар, баннерлар ёки ламинация
қилинган материаллар кам маълумотларни ўз ичида
мужассамлаб, сифатсиз расмийлаштирилган.
Якуний назорат
№ Ўзлаштириш
%
1.
96-100
2.
91-95
3.
86-90
4.
81-85
5.
76-80
6.
71-75
Баҳо
Аъло «5»
Яхши «4»
Талабанинг билим даражаси
Ўргатувчи назорат қилувчи дастур ҳамма
саволларига тўғри, аниқ, кетма-кетликка риоя
қилган ҳолда жавоблар берилган.
Ўргатувчи назорат қилувчи дастур ҳамма
саволларига жавоблар тўғри, аммо кетма-кет
жавоб беришда тўғирланган ҳоллари кузатилди.
Ўргатувчи назорат қилувчи дастур ҳамма
саволларига жавоблар тўғри, аммо кетмакетликка риоя қилинмаган.
Ўргатувчи назорат қилувчи дастур ҳамма
саволларига жавоблар тўғри, аммо кетмакетликда 1 та аҳамиятсиз хато бор.
Ўргатувчи назорат қилувчи дастур ҳамма
саволларига жавоблар тўғри, аммо кетмакетликда 1-2 та хато бор.
Ўргатувчи назорат қилувчи дастур саволларига
жавоб беришда хатолар бор(30%). Жавоблар
кетма-кетлигида бир неча тўғирланган ҳоллари
кузатилди.
291
7.
66-70
8.
61-65
9.
55-60
10 54 -30
11 30 ва
ундан
кам
Ўргатувчи назорат қилувчи дастур саволларига
жавоб беришда хатолар бор(40%). Жавоблар
кетма-кетлиги бузилган.
Ўргатувчи назорат қилувчи дастур саволларига
Қониқарли жавоб беришда хатолар бор, 45% жавоблар
«3»
нотўғри ёзилган ҳамда кетма-кетлик бузилган.
Ўргатувчи назорат қилувчи дастур саволларига
жавоб беришда хатолар бор, 55% жавоблар
нотўғри ёзилган ҳамда кетма-кетлик кўп
ҳолларда бузилган.
Ўргатувчи назорат қилувчи дастур саволларига
Қонижавоб беришда хатолар бор, 55%дан кўп
қарсиз
жавоблар нотўғри ёзилган ҳамда кетма-кетлик
«2»
кўп ҳолларда бузилган.
Ўргатувчи назорат қилувчи дастур ҳамма
саволларига жавоблар нотўғри ёзилган ҳамда
кетма-кетлик кўп ҳолларда бузилган.
292