General physiotherapy.Physiotherapy (physis – nature) is a science about using of external environmental factors

with therapeutical aim. These factors may be natural or modificated.Physical factor may have its first action in the organism on the level of afferent nerves or

at the level of sensitive molecular groups. The reactions to factors include local physico-chemical changes in the tissues & general reactions: reflective or humoralis.

So, there are two types of reactions: specific and nonspecific.All physical factors have nonspecific action. It means the all factors may regulate two

main physiological functions of organism, & may be as adaptogenes, which help the organism to fight against different unfavorable factors.

Specific action of factors depends on its nature & differs this factor from other.Both action influence on organism together, but the main action is a specific component.

Using the dose of physical factor we try to maximize specific action and minimize nonspecific. Counterreactions for physical factors are individual. They are divided into physiological, pathological reactions (general, local) and increasing of the pathological process activity.

That is why the physiotherapeutical procedures must be prescribed individually according to the etiology & pathogenesis of the disease.

Physiotherapeutic prescription includes the individual plan of treatment.Structure of physiotherapeutic prescription:

1) The name of physical factor;2) The region of action;3) The method of treatment;4) Dose of physical factor (intensity of action);5) Duration of procedure;6) The frequency of actions;7) The number of procedures for whole course of treatment.

Classification of physical factors (by professor A.N.Obrosov):I. Electrical agents:

1) Direct current of low voltage (galvanization, electrophoresis)2) Pulsatile current with

a) Constant direction & low frequency of impulses: electrostimulation, electrodiagnostic method, diadynamotherapy;b) Alternating direction and moderate frequency of impulses: interferential current, sinusoidal modulated current (SMT);

3) Alternating current & alternating electromagnetic fields of high voltage:a) Of high frequency: darsonvalization, ultratonotherapy, inductotherapy;b) Electromagnetic field of ultrahigh frequency: UHF-therapy;c) Electromagnetic field of super high frequency: microwave therapy

4) Direct electrical current of high voltage (franklinization);II. Magnetic fields:

a) Of constant directionb) Of alternating direction & low frequency

III. Electromagnetic radiation:a) Infrared radiationb) Visible radiationc) Ultravioletd) Lasers

IV. Hydrotherapy:a) Fresh waterb) Mineral & medical watersc) Gaseous waters

V. Thermotherapy:

a) Medical mudb) Paraffinc) Ozokerited) Naftalan

VI. Mechanical energy:a) Vibrationb) Ultrasound

VII. Artificial air environment:a) Aeroions & hydroaeroionsb) Aerosols & electroaerosolsc) Barotherapy (changeable air pressure)General contraindications for the using of physical agents:

- Malignancy & suspection for malignancy, including haemoblastosis;- Hormonoactive tumors in nomen in growthstage or tumors, required surgery (masthopathy, endometriosis, ulterine myoma);- Cachexia;- Febrilis temperature of the body;- TBC (tuberculosis of lungs with abscess of stabilization of disease);- Systemic lupus erythematosus;- Acute phase of myocardial infarction;- Acute phase of stroke;- Prominent atherosclerosis (of heart & brain vessels);- Aneurysm of aorta & other large vessels;- Severe arterial hypertension with systolic pressure more than 180 mm Hg;- Complex & severe arrhythmias and disorders of myocardial conductivity;- Epilepsy with frequent seizures;- Severe deficiency of organs (heart failure II-III stages, chronic renal failure);- Presence of large metal chips near the large vessels and nerves in zone of physiotherapeutic action;- Individual intolerance to this type of energy;- Long professional contact with this type of energy.

Electrotherapy. Electrical current is the flow of charged particles, such as electrons (in metals) or ions (in

electrolytes). In solutions & in the human body, an electrical current stimulates the movement or flow of ions.

Any substance can be considered to be electrically conductive if it allows the passage of charged particles. Resistance is the opposition to the flow of charged particles, & is affected by the nature & structure of the material. Conductance is the ability to transmit charged particles & is the reciprocal of resistance. The liquor and the blood plasma have a high conductance; the less conductive tissues of body are whole blood, muscles, parenchimatosis organs. The bones, fat, fascias, tendons & other connective tissue elements cannot transmit charged particles. Dry skin, hair can be considered to be dielectrics.

Galvanization.The main physical agent is direct current of low voltage (60-80 V) & low strength (< 50

mA).Apparatus:- AGN (wall galvanization apparatus)- AGP (portable galvanization apparatus)- AGS (stomatological galvanization apparatus)- GR (galvanization of oral cavity)- “Potok”The main biophysical processes.

Galvanic current goes into the tissues throw the ostia of the oil and perspiratory glands, hair folliculs, intercellular spaces. Also the passage of charged particles in the tissues may be through the skin, if the agent has prolonged action. Sometimes it is necessary to pass current throw the mucous membranes or wounds.

Later electrical current goes, generally, through the blood or lymphatic vessels in different tissues.

Scheme of ion’s movement during galvanization.Polarization is the process of ion concentration near electrodes according their charge.

The positive ions move toward the cathode (negative), where they pick up electrons, & the negative ions move toward the anode (positive), when they give up electrons. “Current flow is considered to be from the anode to the cathode, that is, opposite to the direction of electron flow.

After this process of electrolysis on the electrodes there is a great amount of acid & alkaline, that is why this method needs cloth padding between electrodes & skin.

In the body ions are concentrated near cell membranes, because of their increased resistance. The ions are concentrated near membranes so generating polarization zones and field inside tissues. The polarization potential reaches to maximum (200-500 mV) in 25-30 min after action beginning. It is diminished after turning off an electrical current.

Diffusion is the ion movement from the place of their large concentration to the small concentration. Osmos – is a movement of water from the place of small ion’s concentration to the place of their large concentration. So, physiological diffusion and osmos in human tissues are intensificated due to electrical current.

The main physiological reactions and their medical effects.The physiological reactions due to direct electrical current are based on the ion excitation

theory. According to this theory for excitation the quantitive correlation between ions K+ and Na+

and Ca2+ and Mg2+ is very important. Mobility of ions mainly depends on their hydrate cover size, i.e. connected dipole-molecules of water. Bivalent ions with a great hydrate cover move slower than monovalent ions. Because of all enumerated ions have a positive charge they move from the anode to the cathode. In a certain time the relative prevalence of more mobile ions K +

and Na+ will be under the cathode. The concentration of less mobile ions Mg2+ and Ca2+ will be higher inversely under the anode.

The concentration of an enumerated ions and their concentration have a great significance for excitative processes. The electrotonus is an excitability changes in the electrical current at the moment of electrical chain backing up the membrane penetrance of tissue is increased, and their electrical resistance is decreased under the cathode.

This change of excitability under the cathode is called catelectrotonus. The anelectrotonus is a decreasing of membrane under the anode and increasing of membrane resistance. These particularities o excitability changes under the cathode and anode are used in a direct electrical current application. The anode is an active electrode to decrease the excitability of tissue. To increase the excitability of tissue it is necessary to use cathode.

The direct electrical current is transferred to the tissue by means of electrode, applicated on the skin. The great part of voltage appears in the skin due to high skin resistance. On this skin region the patient feels slight burning, creeping sensation, which are connected with irritation of sensitive nervous fibers. Edema and skin hyperemia are observed under the electrodes. These changes are not connected with thermal effect of electrical current. Because of an electrical current, used in galvanization, has so insignifical strength, so the mechanism of hyperemia is neuroreflective. Due to local reflective-segmentative reactions the vessels are dilated. Through the appropriate skin regions it is possible to influence on internal organs. The changes in the organs will be the same – increasing membrane penetrance, intensification of diffusion & osmos. The direct electrical current may be used to influence on central nervous system. In the brain & spinal cord the high-laid centers have positive charge and the low-laid – negative charge. This condition is called physiological anelectrotonus, it is necessary for normal activity of nervous system. It may be increased by means of direct electrical current. The positive electrode is

located in the forehead zone, and the negative electrode – in the interscapularis region. This action improves coordinative and regulative functions of brain, which is useful at cortico-visceralis diseases.

As a result of direct electrical current influence the stimulation of macrofages system is observed, which increases an effectivity of protective reactions.

The main indications for this method:1) Inflammative processes (without purulence) in the stage of resolution2) Diseases & traumas of peripheral nervous system3) Degenerative-dysthrophic diseases of the musculo-sceletal system4) Dyskinesias of internal organs5) Functional disorders of central nervous system.The main contraindications for this method:1) Acute stages of inflammation, a purulence;2) Injured skin (abrasions, scratches);3) Acute & subacute eczema, other dermatitis in the region of electrodes application;4) Praesence of skin irritative symptoms after procedure;5) Acutist pain syndrome because of trauma of peripheral nervous fibers.Dosage depends on:1) Density of electrical current (0,01-0,1 mA for 1 cm2 of electrode cloth padding)2) Patient’s sensation (slight tingling, burning sensation)3) Duration of procedure (from 15 to 30 minutes)4) Frequency of procedures (every day or about day)5) Duration of treatment course 910-15 procedures, possibly to 30).Drug electrophoresis (iontophoresis).Electrophoresis of medicines (iontophoresis) is the transcutaneous delivery of ions into

the body to therapeutic purposes using an electrical current. Iontophoresis is an alternative to oral or parenteral (e.g, needle injection) methods of drug delivery. This method is called electropharmacological because of combination of medication’s & electrical current’s effects.

But medication & galvanic current’s effects is not simply summarized in this method. This factors together increase effects of each other. Responsive reaction firstly depends on pharmacological characteristics of drug.

The rate of transcutaneous drug movement in electrical field of direct current is near 1 cm/hour. So, during the procedure drug goes not so deeply & is concentrated in skin, & partly in subcutaneous fat.

This method has a number of specialities & advantages in comparison to other methods of drugs delivery:

1) Gives a possibility to make a superficial pathological region a high concentration of drug, to make a local effect;2) Drugs delivered by iontophoresis give adverse reactions rarely in comparison to drugs delivered orally & parenterally;3) This method is not painful, doesn’t give skin deformation, disturbances of the microcirculation; the irritation of gastro-intestinal tract mucous is absent;4) The ions of drug delivered by iontophoresis show their maximal activity;5) Drugs act in the tissues, changed by galvanic current; in these conditions their effect is more significant even in small concentration.Some drugs are electrically neutral, so they lose their activity in electrical field. To

choose the due drug for electrophoresis the doctor should use special list of medications permitted for this method. This list includes information about recommended concentrations of drugs, active ion, and polarity of the delivery electrode. The substances which have complex & different ion composition are delivered from both electrodes.

The medications not dissolved in the water or in the spirits are delivered with dimethylsulfoxide (DMSO). DMSO is the universal dissolver. For the ferment electrophoresis (lidasa, tripsin) buffers are used.

Nowadays the small concentration of medications (up to 5%) is used. The study about ionic reflections, developed by A.E.Scherbut, explains the mechanism of the electrophoresis action on the organs & systems. According to this study, skin receptors are irritated by drug’s ions & direct current. Locally the ions influence through the vegetative nervous tracts on internal organs. That is why the electrodes should be laid on the skin regions connected by vegetative innervation with internal organs.

Using electrophoresis it is possible to make a high concentration of drug directly in the place of damage, laid superficially, not to saturate the whole body.

The method of drug elimination from blood using galvanic current is called “intratissue electrophoresis”. It is used in internal diseases. In the beginning the drug is delivered in blood circulation (usually intravenously). Then galvanization of appropriate organ or tissue begins. The electrodes are placed transversely, so the pathological area is located between the electrodes. During this procedure the elimination of drug from blood, flowed through the damaged organ or tissue, takes place.

Indications depend on pharmacological characteristics of medication & indications to galvanization.

Contraindications are the same to galvanization. The additional contraindication for this method is an idiocratic reaction to drug.

Medical application to direct alternating current.Electrical current stimulates the body’s tissue. The main responsive reaction is known to

occur when alternating direct current is applied – a muscle contraction. On every impulse the muscle answers with contraction. The standard lability is the greatest amount of impulses accompanied by muscle contractions (by N.E.Vvedensky). The sceletal muscle can response with individual contractions on frequency of impulses up to 100 per second. The titanic contraction of muscle occurs at higher frequency of impulses.

Alternating current, used in physiotherapy, is divided according to the shape of impulse into: rectangular, triangular, exponential, semisinusoidal; according to the frequency of impulses, to the duration of each impulse in ms.

Electrodiagnostics & electrostimulation. Electrodiagnostics is the investigation of stimulation neuro-muscular apparatus by the

irritation with electrical current.Electrostimulation – is the influence with the electrical current on neuro-muscular

apparatus. During these methods direct alternating electrical current of low voltage (60-80 V) & low strength (up to 50 mA), of the impulses of different shape & duration is used.

Apparatus:- Universal electroimpulsator (UE);- Sinusoidal low-frequency alternating modulated current;- “Tonus”- “Amplipulse”- “Stimule”.The main biophysical processes are the same in galvanization. Due to quick increasing of

current’s strength the processes of diffusion & osmos cannot make a progress in the compensation of ionic concentration in tissues.

These disturbances are more significant than those from galvanic current of the same strength.

The main physiological reactions & their medical effect.Alternating electrical current has prominent irritative effect. The responsive reaction on it

is muscle fiber’s contraction. The muscle contraction under the cathode occurs at the less strength of currentthan under the anode.

Electrodiagnostics is used for determination the degree of severity of neuro-muscular disorders. The slight disorders are accompanied by quantitive changes; the threshold of current strength is increased. The severe stages are aacompanied by the degenerative reaction with quantitive change of contraction. The contraction becomes sluggish, vermiform. The stimulation of muscle activity with alternating electrical current disturbs the progress of degeneration, keeps the muscle by the period of reinnervation. This method also hastens regeneration of damaged nervous fibers.

The main indications:1. Primary athrophy of muscles due to peripheral nerves damages; flaccid paralysis and paresis;2. Secondary athrophy of muscles due to prolonged immobilizations, jaunt’s diseases;3. Myopathic paralysis & paresis;4. Paralysis & paresis of larynx muscles;5. Hypomotoric dyskinesias of internal organs.The contraindication for using is spastic paralysis and paresis.Dosage – during electrodiagnostics we receive the findings about functional lability of

muscle due to its minimal, but visible contraction. It helps to determine the electrical current parameters for electrostimulation, so the dose is determinated according to the results of electrodiagnostics. The procedure of muscle electrostimulation is dosed by:

1) The electrical current strength (up to 50 mA);2) The shape, frequency & duration of impulses;3) The duration of procedure (from 5 to 25 min);4) The frequency of procedure (every day or about day);5) Amount of procedures for course of treatment (from 10 to 25). This amount may be limited because of irritating effect of electrical current on the skin.

P.S. The electrodiagnostic of nonstriated muscles is impossible. That is why the dose of electrical current is determinated empirically, it is indicated in physiotherapeutic guides.