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Pathogenetically, myogeloses are nonspecific mesenchymal reactions with slight inflammatory symptoms which frequently arise due to capillary hypoxemia. The exudative muscle connective tissue inhibitions which arise in the form of high-protein edema are an absolute indication for specific combination treatment, which mainly consists of the manual lymphatic drainage therapy of our school. The principles and the kinds of treatment in several stages, phases and combinations are explained and described.
A non exhaustive survey of physiotherapy methods and techniques in "soft E.N.T. treatment" is briefly described. Without using "strength or brutality" which might retard the patient's recovery, the physiotherapist should focus his efforts to regain optimal functioning of the affected structure. So, physiotherapy techniques such as relaxation, bio-feedback, massage, exercise and electrotherapy, are used for a successful treatment of headache, migraine, vertigo, peripheral facial palsy, neck, cervico-facial (awkward positioning) and temporo-mandibular joint problems. Manual lymphatic drainage in post-surgical regeneration of skin and underlying structures, an example of very soft technique suits perfectly in the context of "soft E.N.T."
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Thirty-one Japanese with essential hypertension were divided into training (n = 21) and non-training (n = 10) groups. Physical training of 10 weeks was instituted after 4 or more weeks of observation, and changes in blood pressure and serum concentrations of taurine and other amino acids were investigated. The workload in physical training was predetermined by the submaximal multistage graded exercise test on a bicycle ergometer, and the blood lactate threshold which reflects approximately 40-60% of maximal oxygen uptake was chosen. The hypertensive patients underwent bicycle ergometer training for 60 minutes, three times a week for 10 weeks. Blood pressures were significantly decreased by 14.8/6.6 mmHg in systole/diastole in the training group, but not in the non-training group. Serum concentrations of taurine and cystine were increased significantly by 26% and 287%, in the training group. Increase in serum asparagine (11%), histidine (6%) and lysine (7%) concentrations was also significant, only in the training group. Plasma norepinephrine level and whole blood and plasma volumes were significantly reduced. The change in serum taurine level was significantly negatively correlated with the change in plasma norepinephrine. In addition there was a significant positive correlation between the change in plasma norepinephrine and the change in diastolic blood pressure in the training group. Based on these results, the increase in serum taurine which is known for its antihypertensive activity could contribute, at least in part through the reduction in plasma norepinephrine level, to the antihypertensive effect of exercise.
Medical training therapy (MTT) belongs to the active methods which can be used by physiotherapists under medical prescription. This dynamic method was originally developed by O. Holten in Norway but it has become extremely popular in patients and did also convince a large number of therapists; as a consequence of its success, its prescription increased progressively and actually replaced larger parts of the passive methods used before. The aims of MTT is to work in a pain free environment and increase both muscle resistance, strength and joint mobility as well. The technique does not have any absolute contraindication, but it has to be individually adapted to each single patient. A true advantage of MTT is certainly that the active training sessions can be done in small well controlled groups of patients. As it does also apply for other types of currently used physical therapies, there are only restricted evidence-based proofs of efficacy and therefore scientifically sound studies are still needed in this field.
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The hemodynamic effects of nitroglycerin and nifedipin and the application of both substances during a long term training program in patients with angina pectoris, myocardial infarction, and myocardial dysfunction (=48) were studied. Cardiac output, heart rate, and arterial blood pressure showed no significant changes after application of nitroglycerin and nifedipin. After nitroglycerin, however, there were significant drops of pulmonary arterial pressure and right atrial pressure during rest and exercise, whereas no changes were seen after nifedipin. With the application of nitroglycerin (but not with nifedipin) prior to the daily physical training program on a bicycle ergometer, all patients with angina pectoris and myocardial dysfunction showed an increasing training effect during the long term program and their angina pectoris improved.
Self-controlled gymnastics in SADAM relaxes the masticator muscles, allows precise assessment of occlusion and helps the patient acquire occlusion-conscience. The technique is entirely patient controlled.
Forty patients participated in a study of the importance of early occupational therapy for the prognosis in stable Colles' fractures. Seventeen patients were treated by an occupational therapist 1-3 days after the injury, and the need for appliances and home-care was estimated. Twenty-three patients completed the usual treatment. Five weeks after the injury, we found significantly (p less than 0.05) better function of the hand in the 17 patients with early occupational therapy. This difference in function could not be found after 13 weeks. The rate of complications was the same in the two groups. The results indicate that contact with the occupational therapist shortly after the injury is valuable in patients with stable Colles' fractures.
OBJECTIVE: To evaluate the benefits of preoperative physical therapy and instruction of patients with primary coxarthrosis to be subjected to a total hip arthroplasty. SETTING: University Hospital Maastricht. DESIGN: Controlled trial. MATERIAL AND METHOD: During 14 months the effects were measured of preoperative physical therapy and instruction of 64 patients divided into two populations; one group (n = 31) received preoperative instruction and physical therapy, the other did not (n = 33). Effects were measured with the Visual Analog Scale, the Harris Hip Score and the days patients could stand, walk, climb a stair and be discharged. RESULTS: The Harris Hip Score showed a significant difference (p < 0.05) favouring the instructed group on day 14 after the operation and at the moment the patients were discharged. The other parameters showed no significant differences between the groups. Differentiation by age, gender and type of arthroplasty showed the same results. CONCLUSION: Preoperative exercise and instruction is not useful for patients who in the near future will be treated with a total hip arthroplasty for primary coxarthrosis.
Gasometric determinations of pO2, pCO2 and pH were carried out in capillary blood obtained from the upper extremities before and after 10 minutes of kinesitherapy in 30 patients with hemiplegia following stroke. The determinations were done with an acid-base equilibrium analyser Radiometer Copenhagen pH M 71 MKZ. Ten minutes of kinesitherapy caused significant changes in the pH of the blood towards alkalinization, less pronounced in the paralytic extremities. However, differences in the determinations in paralytic and non-paralytic extremities were statistically not significant. These results confirm earlier observations of the authors and point out that 10 minutes of kinesitherapy seems to be the shortest times of exercise giving significant biochemical and clinical effect.
BACKGROUND: Physical training has proven to be a valid and effective therapeutic tool capable of counteracting muscle changes that occur in chronic heart failure (CHF) patients. Nevertheless, few studies have analyzed the frequency of use of this therapy and the reasons for any reduced compliance and adherence to the prescription. The aim of this study was to quantify the frequency of the participation of CHF patients in a program of domiciliary physical training and to analyze the factors that can influence adherence to the program. METHODS: Three hundred and twenty-two consecutive CHF patients (ejection fraction 28 +/- 7%) in a stable condition with optimized medical therapy performed a cardiopulmonary test, including determination of peak oxygen consumption, at baseline and after 9 +/- 3 months. All the patients had participated in sessions of health education on the relationship between illness/physical activity. The prescription of physiotherapy was decided by the physician on the basis of each patient's clinical need assessed in the diagnostic-therapeutic management. The patient referred for physiotherapy entered a therapeutic strategy that included sessions of training on anaerobic threshold, self-management of the session, and formulation of a domiciliary physical training program. During the follow-up evaluation the patients were asked to complete a questionnaire, which investigated the relationship between several factors and the patient's adherence to the physical training program, which was objectively evaluated by the change in peak oxygen consumption recorded at the end of the training, taking into account the spontaneous variations found in the control group. RESULTS: Two hundred and eighty-two of the patients (88%) satisfied the criteria for inclusion in the study. Only 61 (22%) of them were judged to have adhered to the recommended physical training. Type of employment (chi 2 = 7.08, p < 0.02), the state of retirement (chi 2 = 8.9, p < 0.01), ischemic etiology (chi 2 = 5.91, p < 0.01), compatibility with employment (chi 2 = 15.8, p < 0.0004), availability of suitable domestic conditions (chi 2 = 14.5, p < 0.0008), the structure of the training program (chi 2 = 22.33, p < 0.0001) and a learning phase in a gym (chi 2 = 71.33, p < 0.0001) were significantly correlated at univariate analysis with the performance of the physical training. Multivariate analysis identified the structure of the training program (odds ratio 9.6, 95% confidence interval 2.8-33) and a learning phase in a gym (odds ratio 49.6, 95% confidence interval 11-210.8) as independent factors (r2 = 0.48) determining adherence to the physical training program. CONCLUSIONS: Adherence to unmonitored, recommended domiciliary physical training appears to be modest even in patients who have been in-patients in a cardiac rehabilitation center. Various factors seem to influence the adherence of the patient to this therapy, but structural factors, such as the organization and learning of the program, more strongly influenced the patient's subsequent compliance.
Physical therapy can support geriatric rehabilitation in contributing to better health status, mobility, and quality of life. However, the central focus of this contribution is not on illness-specific aspects of physical therapy but on power and stamina training. These two training methods are of special importance for geriatric rehabilitation since most patients are admitted due to related problems and these two methods do imply specific risk factors for the rehabilitation process. The spectrum of physical adaptation processes supported by power and stamina training is described and scientifically evaluated. Even in higher age groups positive training effects are possible. Adequate usage of these training methods contributes to increased competence and a minimization of risks in daily life.