Physiotherapy

PHYSIOTHERAPY, physiatry, physical therapy, physical methods of treatment, is a scientific and practical discipline whose task is to study the effects of various physical agents on healthy and diseased organisms and to apply them for preventive and therapeutic purposes. Physiotherapy is a relatively young medical discipline that took shape at the end of the 19th and beginning of the 20th centuries (I International Congress on Physiotherapy in Liège in 1905), although some of its branches, such as massage, hydrotherapy, and heliotherapy, in their history date back to deep antiquity. Corresponding to the physical agents, physiotherapy includes a number of departments, namely: 1) mechanical methods of treatment - massage, therapeutic gymnastics, mechanotherapy (on apparatuses), seismotherapy, coordination gymnastics, 2) electrotherapy, 3) phototherapy (including heliotherapy), 4) X-ray therapy, 5) radiotherapy, 6) hydrotherapy, etc. All these therapeutic methods do not depend on the natural conditions of a given locality and can be carried out everywhere in appropriately equipped and apparatus-equipped institutions. Along with this, there are physical therapeutic effects that are entirely connected with one or another locality (therapeutic, resort). These include, for example, climatotherapy, thalassotherapy, etc. Since all these methods are based on the action of one or another physical agent or their combination, they of course must also be attributed to physiotherapy. However, on the other hand, they are also characterized by the fact that they belong to the so-called "natural" physical methods. This circumstance justifies their consideration also in the discipline close to physiotherapy - in balneotherapy, or, in the latest terminology, in balneology. However, it should not be forgotten that all these questions constitute an integral part of physiotherapy as the therapeutic application of physical agents, regardless of whether they are natural or artificial, obtained with the help of appropriate instruments.

In relation to the classification of the effects used in physiotherapy, in recent time there have been proposals by Vermel and Grober, which, however, have not received general recognition. Both authors proceed from the concept of energy as the active principle of each physical agent. Grober arranges various types of "physical energy" according to wavelength and places them within the range from the shortest (X-ray and radium rays) to the longest (mechanotherapy). Indeed, the author himself says: "If at present, from a strictly scientific point of view, we no longer evaluate too highly the doctrine of the energy spectrum, nevertheless this doctrine and the theory replacing it have great heuristic significance; for the goal we have set ourselves of precisely defining the content of physical therapy, we cannot yet offer anything better in its place".

Vermel builds his classification as follows: all departments of physiatry (according to the author's terminology) are divided into: simple - with one energy, complex - with two energies. More complex are the departments in which the same energies are transmitted through a material medium. In the latter case, the biological and therapeutic effect of the physico-chemical composition of the latter must be taken into account.

I. Departments based on radiant energy a) Electric rays - medical electrology b) Light rays - medical photology c) X-ray and radium rays - X-ray-, radiology

II. Departments based on mechanical energy a) Endogenous (rest, active | Medical kinesiology (theory of physiol. and ther. effect of mechanical energy) gymnastics, sport) b) Exogenous (rest, passive | therapeutic gymnastics, massage)

III. Department based on thermal energy a) Thermal energy transmitted as such (radiant) | Medical thermology b) Thermal energy transmitted through media of all 3 aggregate states

IV. Department based on two energies transmitted through water a) Radiant (thermal) - thermal | Medical hydrology discharge of water (hydriatics - theory of physiol. and therapeutic effect of water) b) Mechanical - mechanical discharge of water

I. In the action of tempered water) V. Departments, in the basis of which lie both energies and physicochemical composition of the medium 1. Radiant (thermal), mechanical and physicochemical composition of water-balneology 2. Radiant (thermal), mechanical and physicochemical composition of air-medical climatology 3. Radiant (thermal), mechanical and physicochemical composition of food-dietetics According to Goldscheider, the main task of Physiotherapy is to stimulate the natural protective and regulatory processes in the organism. Physiotherapy reveals the reaction of the organism to physical irritations. At the same time, it affects the pathological process physically and directly. It is highly probable that by physical means it is possible to exert a direct influence on a number of physiological processes, and on the other hand, every external influence also acts as an irritant. Thus, a combination of direct and reactive action is repeatedly observed. Physiotherapy acts mainly as exercise of regulation in disorders caused by physical influences. The site of application of Physiotherapy is mainly the skin, the role of which in the implementation of Physiotherapy is very significant. In recent years, this question has been studied from different sides, and at present it appears as follows. Physical irritation applied to the skin (mechanical, electrical, light, etc.), on the one hand, causes changes in the skin and in the nerve endings embedded in it, the products of which, entering the circulatory system, in turn cause changes in the internal organs (circulation, metabolism, etc.) and in the nervous system (mainly in the autonomic), and on the other hand, irritation of the nerve endings in the skin causes the same phenomena in the internal organs reflexively. Thus, at present there exist a number of theories explaining the mechanism of action of physiotherapeutic procedures, and each of them, without contradicting the others, covers only part of the phenomena. The reflex theory, which already has considerable historical standing, has only recently come to the center of attention and at present mainly permeates our physiotherapeutic concepts. Professor A. E. Shcherbak paid special attention to the doctrine of the reflex action of physiotherapeutic procedures (he proposed galvanic and mud collars, Ca-iontophoresis as a vegetative cutaneous-muscular reflex). For theoretical explanations of the therapeutic action of light-see Phototherapy. In the USSR after the October Revolution, Physiotherapy received completely exceptional development. The practical significance of specialized physiotherapeutic assistance and the place it should occupy in our health care system are reflected in the 'Basic Principles of the Second Five-Year Plan for Health Care in the USSR' as follows: 'by the end of the five-year plan, the proportion of the use of physiotherapy in medical institutions must significantly increase. The methods of using electricity, sun, air, heat should take precedence. Physioprevention and physiotherapy are opening up a wide field of activity. Physiotherapy, together with rationally organized diet, shortens the period of a patient's stay in the hospital, gives maximum restoration of strength and finally should to a large extent serve as a means in localities for curing from resort-mania and reducing the mass tendency to resorts.' We already have 20 institutes and many times more physiotherapy departments. The state of physiotherapeutic assistance in numerical terms is as follows (according to S. I. Makarenko): physiotherapy installations are available in 19.4% of urban hospitals in the USSR. In the RSFSR and Ukrainian SSR, one fifth of all urban hospitals have physiotherapy installations. In the other republics, this percentage sharply drops, reaching 5% in the Turkmen SSR. In urban outpatient clinics, the percentage of physiotherapy installations ranges from 38.9 (RSFSR) to 10 (in the Turkmen SSR), amounting to 32.4 for the entire USSR. Of course, all these figures are very insufficient. Physiotherapeutic assistance is particularly weak in rural areas. However, compared to the prerevolutionary period, when physiotherapeutic assistance was generally accessible only to the propertied classes, significant successes have undoubtedly been achieved in this regard.- In connection with the development of resort business in our Union and on bases completely different from capitalist countries, the role and place of Physiotherapy on resorts have been reconsidered. In this question, one should proceed from the main task of any therapy, including therapy at a resort, i.e., the quickest and most stable restoration of the patient's working capacity. Therefore, the application of any therapy at resorts, such as drug therapy, psychotherapy, diet therapy, surgical intervention and in particular Physiotherapy, as a rule finds its justification only in combination with the corresponding therapeutic factors of a given resort. Such a combination is based on the idea that either this therapy contributes to the greater effectiveness of treatment purely by resort factors, or conversely, the results of its implementation with the simultaneous use of resort means will be better and more complete than if the same therapy (e.g., physical) were conducted without simultaneous combination with resort possibilities or even in the conditions of the patient's normal environment of residence. From this point of view, Physiotherapy at a resort can either serve as an auxiliary, additional method to resort treatment (in the narrow sense of the word) or even become the main therapy, '65 68 S for which resort treatment in turn will be auxiliary. However, in both cases, Physiotherapy is applied in combination with resort therapeutic means, it does not therefore exclude the simultaneous use of resort methods and finds full justification for wide application with the aim of increasing the effectiveness of resort treatment and the quickest restoration of working capacity. The application of Physiotherapy is not limited only to the time of the patient's stay at the resort. It should also take place in the period of preparation for resort treatment and in the post-resort period. Following this path, on the one hand, it is possible to increase the effectiveness of the patient's stay at the resort, and on the other-to consolidate the results of resort treatment. It should be further recognized that the existing organization of physiotherapeutic assistance at resorts at present appears insufficiently coordinated with the needs and demands of the corresponding resorts both in quantitative and qualitative aspects. In the modern classification of medical disciplines (incidentally very imperfect and needing a fundamental revision), Physiotherapy occupies a special place, similar to surgery. Just as surgery, since its methods are used by clinical disciplines, penetrates almost all clinics, so the practical interests of Physiotherapy bring it closer to all other departments of clinical medicine. In other respects, Physiotherapy, like surgery, along with clinical disciplines, uses a number of sciences, such as: anatomy, physiology, general pathology, physics, chemistry, etc. If the circle of practical tasks of Physiotherapy includes only the treatment of diseases and the study of the action of physical agents, and the study of the pathological processes themselves (pathology) constitutes the subject of other special clinical disciplines, it is not difficult to imagine (which has already often happened) that this or that clinician, mastering physiotherapeutic techniques, can himself, without the help of a specialist-physiotherapist, conduct this therapy in his narrowly specialized field, provided he has the necessary equipment at his disposal. The profile of the practical physician-physiotherapist is determined, on the one hand, by knowledge, theoretical and practical, of the action of physical agents on the healthy and diseased organism and their application for preventive and therapeutic purposes, and on the other-by sufficient familiarity with a certain clinical discipline. Training of physicians-physiotherapists should be carried out in special institutes. Abroad, Physiotherapy by no means occupies a place on faculties commensurate with its due place. 'In Western European countries, the level of teaching physiotherapy is not too high,' says Grober. However, if the teaching of Physiotherapy in medical faculties in Western Europe stands at an insufficiently high level, then in the numerous courses for physicians, its individual branches are taught to physicians sufficiently fully and widely. In our country since 1926, Physiotherapy has been introduced into the teaching curriculum in medical faculties as a compulsory discipline. Balneology and resortology are included in the program. In courses for physicians, Physiotherapy in our country is set up much better: there are professorial chairs on an equal footing with others, special physiotherapy institutes, clinical bases, etc. Before the revolution, we had one Moscow Society of Physiotherapists; after the revolution, the Leningrad Society (in 1923) and special sections in a number of cities arose. In 1925, the I All-Union Congress of Physiotherapists was convened in Leningrad, at which the unification of all physiotherapists of the USSR took place, in 1927-the II Congress in Moscow, in 1935-the III Congress in Kharkov. In 1926, the first issue of the specialized journal 'Physiotherapy' was published, which has now merged with the journal 'Resort and Sanatorium Affairs.' During this period, several guides to Physiotherapy have been published. The number of works published from our scientific physiotherapeutic institutions is very significant. Many works by Soviet authors have also been published in foreign journals.

At the international congresses of actinology that took place during this time in Paris in 1929 and on physiotherapy in Liège in 1930, Soviet physiotherapists delivered programmatic reports.