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Ministry of Public Health of Ukraine
M. Gorky Donetsk national medical university
STUDY GUIDE
“Physical rehabilitation and sports medicine ”
(for the 3-rd year students of stomatological faculty)
Approved on the meeting of
academic council of Donetsk
national medical university
____№__ from ________2012
Donetsk 2012
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Study guide for practical classes on physical rehabilitation and sports medicine (for the 3-rd year students of stomatological faculty)
/Ed. by V.M. Socrut.- Donetsk, 2008.- с.
Authors Socrut V.M., Povazhna O.S, Zubenko I.V., Peklun I.V.
Proposed guidelines for practical classes are designed for independent work of students and facilitate learning-skills in the study module, "Physical Rehabilitation and Sports Medicine" (for the 3-rd year students of stomatological faculty)
Reviewers :
Surzhanskiy S.K. - M.D., professor, chief of stomatology department of internship and postgraduation education faculty
Basiy R.V. – candidate of medical science, associate professor of human anatomy department, chief of educational-methodological cabinet
Parkhomenko T.S. - candidate of medical science, associate professor of internal medicine № 2 department
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Content
1. The general fundamentals of sports medicine. Medical supervision during physical training and sports .... ... ... ... ... ... ... ... ... ... ... . ... ... 3
2. The general principles of physical rehabilitation. Remedial gymnastics in the system of physical rehabilitation. Basis of therapeutic massage ...8
3. Remedial gymnastics in odontogenic inflammatory processes of the jaw-facial area ... ... ... ... ... ... ... ... ... ... . ... ... ... ... ..... ... ... ... ... ... ... ... ... 14
4. Remedial gymnastics for bone fractures of maxillofacial region, contracture and joint rigidity... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... .... 19
5. Remedial gymnastics in pre-and postoperative period for nonunion lips and palate, facial and trigeminal neuritis... ... ... ... ... ... ... ... ... ... ...... .. 23
6. Means of restoration during health-improving training and in the modern sport (for self-study)
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^ . Medical ensuring of the rational use of physical training methods for the harmonious development of man strengthens his health, increases the efficiency of exercises to improve efficiency and creative longevity. Conducting of sports selection, the study of diseases associated with sports increases sporting performance.
To meet the challenges of doctor's control, every person engaged in physical culture and sports should undergo medical examination. Proper evaluation of physical development of man leads to the proper selection of kinesitherapy methods for diseases and injuries of jaw-facial area, indications and contraindications to this treatment method and purpose of physical culture.
General purpose: to be able to assess the level of physical development, human functional state on physical culture and sports or for exercise prescription at the dental pathology, be able to determine the overall physical performance of persons engaged in physical culture and sports, or undergo physical rehabilitation.
To realize the general purpose you should be able to:
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knowledge - skills:
• Know the purpose, objectives and characteristics of medical control for health and sports training
• Assess changes in the functional state of organs and systems in various pathological conditions (department of pathological physiology)
• Identify anthropometric indices by appropriate external signs (skin, posture, etc.).
• Explain some indices of physical development, stomatoscopic data, methods / department of propaedeutic therapy, department of children diseases /.
• To carry out functional tests with breath holding (Stange's test, Gencha’s test), stress and breathing tests, tests with the change of body position in space (orthostatic, clinostatic).
• Be able to take indices of cardiovascular and respiratory systems’ function / department of propaedeutic therapy, department of children diseases /.
• Master the method of performance of test for determination of physical efficiency (Harvard step test PWC170)
• Be able to take indices of cardiovascular and respiratory systems’ function / department of propaedeutic therapy, department of children diseases /.
• Interpret the results about possibility of physical culture and sports.
Explain some functional indices of cardiovascular system/ department of propaedeutic therapy, department of children diseases /.
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TASKS FOR CONTROL OF INITIAL LEVEL OF KNOWLEDGE AND SKILLS
Task 1
For the distribution of children for medical groups for physical culture development of the child. What is the main indicator of physical development of children and Teenagers?
A. Height
B. Body weight
C. Circumference of chest
D. Lung capacity
E. Muscular strength
Etalon answer: A
Task 2
During the medical examination of the 1 st year students at the department of physical education the anthropometric indexes were evaluated considering sigma deviations. What evaluation method was applied?
A. Standards
B. Correlations
C. Index
D. Profiles
E. Pertsentil
Etalon answer: A
Task 3
During the medical examination of children at the department of physical education function of the respiratory system were studied. The peculiarities of the respiratory system functioning during exercise in children compared with adults include:
A. Increased breathing by the expense of frequency
B. Less effective compensation of functions
C. Fastest restoration of breath after loads
D. Increased breathing by the expense of depth
Task 4
In the experiment the stimulation of the parasympathetic function of nervous vagus was conducted. What effects can be observed?
A. Reduction of heart rate
B. Increase of heart rate
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E. Adaptogens, energytropic.
Task 6
Athlete T., 19 years old first takes part in the European Championships of gymnastics. He feels a great responsibility that is accompanied by high excitation. Athlete is prescribed to take baths before bedtime to calm and relaxation.
Which baths by the temperature conditions correspond to this purpose?
A. Warm
B. Indifferent
C. Cool
D. Hot
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for the work of students on self-study topic
"METHODS OF RESTORATION WHEN FITNESS TRAINING AND IN MODERN SPORTS"
At the beginning of work the initial level of students’ knowledge and skills is controlled. For that purpose it is necessary to solve the tests of initial knowledge and skills. Answers are compared to the etalon answers. If necessary the initial level of knowledge and skills can be improved with the given sources of information. Then, for the realization of the training purposes it is necessary to learn literature, graph of logical structure according to the theoretical questions which help the implementation of targeted activities. At the end of class students solve to test tasks.
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Graph of logical structure of the theme: ^
  
Physical factors
  
Antioxidant
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B. Increased tone of gastrointestinal tract sphincters
C. Weakening of intestinal motility
D. Increased atrial contractions
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1. Нормальная физиология /Под ред. проф. В.И. Филимонова.-К.: Здоровье, 1994.-С.25-53
2. А.В. Мазурин, И.М. Воронцов. Пропедевтика детских болезней. - М.: Медицина, 1985.-С.67-79
3. Василенко В.Х. Пропедевтика внутренних болезней.- М.: Медицина, 1989.-С.155-271
4. Соціальна медицина та охорона здоров”я /Під ред. Вороненко Ю.В., Москаленка В.Ф. - Тернопіль: Укр. мед. книга, 2000. - С.247-269
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1. Definition of sports medicine as clinical discipline. Basic directions of sports medicine. Notion of doctor’s control. Purpose and tasks of doctor’s control.
2. Methods of complex doctor’s examination of athletes and sportsmen, kinds of doctor’s examination
3. Definition of term «physical development». Factors which determine physical development of human. Methods of examination and assessment of physical development and state of musculoskeletal system.
4. Notion about functional tests and their significance in functional diagnostics. Kinds of functional tests.
5. Methodics of tests (20 squatting during 30 sec, 15-seconds running on the spot with maximum speed, 3 minutes running on the spot with speed 180 steps for minute, Letunov’s etc.).
6. Types of cardiovascular system reactions on physical loads.
7. Methodics of tests PWC170, Harvard step-test.
8. Criteria of tolerance threshold to physical loads.
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BASIC:
1. Лікувальна фізкульура та спортивна медицина /Клапчук В.В., Дзяк Г.В., Муравов І.В. та ін.; за ред. В.В. Клапчука, І.В. Дзяка. - К,: Здоров,я, 1995. - С.30-45
2. Лечебная физкультура и врачебный контроль / Под ред. В.К. Епифанова, Г.А. Апанасенко. -М.: Медицина, 1990. - С. 10-28
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Graph of logical structure of the theme
ADDITIONAL
1. Детская спортивная медицина / Под ред. СБ. Тихвинского, СВ. Хрущева -М: Медицина, 1980.-С. 144-165
2. Физическое развитие детей и подростков /Апанасенко Г.Л. - К.: Здоров,я, 1985. – 80 с.
3. А.В. Чоговадзе, М.М. Круглый. Врачебный контроль в физическом воспитании и спорте. М.: Медицина, 1977 - С.3-75.
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Task 1
18 years old student has hypersthenic constitution, height is below average, straight and square shoulders, broad chest, dull epigastric angle, there is overbalance of the transverse dimensions of the body over lengthwise, short limbs, broad hands with short fingers, short thick neck, heavy skeleton, strong elastic skin. What are the main features of hypersthenic constitution?
A. Overbalance of transverse dimensions of the body over the longitudinal
B. Low height, short limbs, short fingers
C. Square shoulders. Broad chest
D. "Heavy skeleton"
E. "Heavy skeleton", square shoulders, wide chest
Task 2
Sportsman on athletics has height 180 cm (deviation from the average is +
+1.2 &), body mass differs on +1.0 &, the circumference of the chest +1&, LVC on +1.5&, carpal dynamometry of the right hand on +1.3 &, left on +1.0 &, deadlift dynamometry on +0.75 &. What level of physical development of an athlete according to the method of standards?
A. High
B. Above average
C. Average C
D. Below average
E. Low
Task 3
Sportsman on athletics had flu. During Martine’s test decrease of diastolic blood pressure to "0" was found. To which pathological reaction is it typical?
A. Normotonic
B. Hypertonic
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Task 1
Team of oarsmen participats in the championship of the country. Each sportsman applied for participation in several distances, which demands considerable endurance. Along with changes in diet, the use of vitamins was increased.
What is the daily requirement for vitamin C during work on endurance of sportsmen?
A. 100-150 mg.
B. 150-200 mg.
C 200-250 mg.
D 250-300 mg.
E. more than 300 mg.
Task 2
Sportsman O., is preparing to participate in the Olympic Games in running on 30 km. Currently there is intensive training for 2-3 workout a day. Athlete complains of a sense of pain in right hypochondrium after the end of running.
What group of pharmacological agents should be prescribed to the sportsman in this case?
A. Coenzymes, nootropic
B. Energytropic, adaptogens
S. Adaptogens, coenzymes
D. Antioxidants hepatropic
E. Energytropic, coenzymes
Task 3
Sportsman B., football player complains of pain in muscle of calf that appears after training during the last month.
What physiotherapeutic procedure should be prescribed to the sportman?
A. General bath, massage of limbs
B. Hydromassage, amplipulse therapy
C. Diadynamic therapy, electrosleep
Д. Local decompression, massage of limbs
Е. Pediluvium, amplipulse therapy
Task 4
21 years old sportsman Z. was diagnosed chronic overstrain. The ECG revealed myocardial dystrophy of the I-II degree.
What groups of pharmacological medicines should be prescribed?
A. Coenzymes
B. Preparations of plastic effect, energytropic
C. Antioxidants, coenzymes
D. Stimulators of hematopoiesis
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Task 1
4th year student D, master of sports of athletics, is preparing for the competitions in the running for 1500 m. Trainings are held 1-2 times each day.
What is the average amount of proteins in food should be in nutrition of athlete at this time?
A. 50-70 grams.
B. 70-100 grams.
C 80-150 grams.
D 100-170 grams.
E. 150-200 grams.
Etalon answer: D.
Task 2
Athlete T., master of sports of international class in swimming is preparing to responsible competition. To speed up the relevant processes and prevent fatigue, along with other drugs the athlete takes riboksyn.
Which group of pharmacological agents is riboksyn?
A. Coenzymes
B. Plastic effect
C. Energytropici substance
D. Adaptogens
E. Antioxidants
Etalon Answer:B
Task 3
Male 34 y.o.has been jogging. He runs at a distance of 8.6 km. Periodically takes a bath with water temperature 37-38o C.
Which regime does the water temperature correspond in this case?
A. Warm
B. Indifferent
C. Cool
D. Hot
Etalon answers: A.
Sources of information for improvement of initial level of knowledge and skills
1. Гігієна харчування з основами нутріціалогії /В.І. Ципріян та ін. Навч. посібник. - К.: Здоровья, 1999.-С. 118-127.
2. Фармакологія: Підручник / І.С. Чекман, Н.О. Горчакова, В.А. Туманов та ін.: За ред. І.С. Челкмана. - К.: Вища школа, 2001. - 598с
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Graph of logical structure of the theme: «GENERAL FUNDAMENTALS OF SPORTS MEDICINE, MEDICAL SUPERVISION DURING PHYSICAL TRAINING AND SPORTS»
Hypotonic
Hypertonic
Distonic
With stage increase
Гіперт
Exercise performance
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C. Asthenic
Д. Distonic
Е. Stage-like
Task 4
To determine the adaptation to exercise the patient was asked to perform a standard test (20 squattings in 30 s). After the load increase in heart rate was 110%, Systolic ABP does not significantly change, diastolic pressure increased on 10 mm Hg, pulse pressure decreased, recovery time lasted 3 min 40s
Which type of reaction of the cardiovascular system on the physical activity changes correspond?
A. Normotonic
B. Hypertonic
C. Asthenic
D. Dystonic
E. Stage-like
Task 5
57 y.o. teacher of high school engaged in athletic exercises during 5 months. At the time of medical examination there are any complaints. Objectively: increase in muscle strength is determined, the total weight is increased on 5%, the reaction of the cardiovascular system on trial with 20 squats in 30 s – variant of normotonic reastion, recovery time decreased on 25 sec. Indicators of general efficiency (test PWC) have not changed.
What are the indications for continued patient athletic gymnastics?
A. The increase in muscle strength indices
B. The increase in total weight
C. No reduction in general efficiency
D. Reduced recovery time after exercise
E. Reduced recovery time after physical activity, no reduction in general efficiency
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to the work of students in the practice
At the beginning of the study control of initial level of students' knowledge is conducted. After that, students measure the basic anthropometric parameters and determine the level of physical development using standard method. Then students conduct functional tests with breath holding (Stange's test, Genche’s test), loading and breathing tests, tests with the change of body position in space (orthostatic, clinostatic). The estimation of reaction types of the cardiovascular system to the standard exercise Then students calculate indices of physical performance and aerobic capacity of the body using special tables and enter in the card (form №067 u)
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exercises with their successful application as part of a complex rehabilitation program to restore and maintain health. Kinesitherapy (treatment movements) or physiotherapy (exercise) – is a branch of rehabilitation, which is studying the mechanisms of therapeutic action on the body of movements with preventive, curative and rehabilitative purposes.
Physiotherapy, as part of medical rehabilitation, often has syndrome, pathogenetic nature. Actions carried out by physical factors in certain areas - zones of organs’ projection with account of reflex mechanisms of factor’s action. Therapeutic effects are achieved through actions on central and autonomic nervous system, hormonal disorders, correction of immune status and metabolism. Local recovery processes are optimized, adaptation in a whole organism in various pathological conditions develops that helps to considere physiotherapy as adaptive treatment.
The basic principle of adaptive nutrition of sportsmen is balanced digestion compliance with respect to the initial state of the body, certain sports and intensity of activities, including the distribution of energy values after the main types of nutrients, which greatly varies depending on the phase of preparation for sporting events; rational value of mineral substances; balance amount of basic nutrients, vitamins and microelements depending on antropo-morphometric, physiological and metabolic characteristics of a sportsman, the state of his digestive organs, tastes and habits.
To realize the general purpose you need:
Specific objectives: The baseline of initial level of
knowledge - skills:
1. Be able to determine the features of nutrition considering orientation of recreational and sports training
1. Explain energy and plastic expenditure of the organism during significant physical activity (dep. of hygiene, ecology and life safety)
2. Be able to apply the necessary pharmacological agents during t training for sport
2. Explain mechanisms of pharmacological agents’ effects on restoration of metabolic processes (energy and plastic substances) (dep. pharmacology)
3. Be able to identify physical factors that are needed to accelerate restoring of human efficiency
3. Explain changes in the metabolism, reparative under the influence of natural or preformed factors (dep. of physical therapy and remedial gymnastics)
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THEME METHODS OF RESTORATION WHEN FITNESS TRAINING AND IN MODERN SPORTS"
for self-learning
Actuality of the theme: Methods of efficiency restoration of the person that is engaged in physical education or sports are not less important than loads. Otherwise, neglecting of restorative methods, absence of stimulation of restorative processes every time with loads prevent achievement of the main purpose of physical exercises - health-improvement.
It means that increase of organism efficiency as a result of improvement of functions’ regulation and expansion of adaptive possibilities does not happen
^ : To be able to determine the necessary means for recovery of physical efficiency during recreation or sports training
Pedagogical restorative facilities are directed to control physical efficiency and course of recovery processes by rationally organized muscle activity on the basis of accounting quantitative characteristics of the loading and rest. Pedagogical restorative facilities include rational distribution of loads in the macro-, meso and microcycles, creation of clear rhythm and mode of training process, the rational construction of educational and training sessions, using different means and methods of training, including non-traditional ones, rational observance of the sequence of exercises, alternating loads for orientation; individualization of the training process, adequate intervals of rest, exercises for recreation, relaxation and restore of breathing, corrective exercises for the spine and foot, days of preventive rest.
Psychological restorative measures. Rehabilitation tactic requires identification vegetative tone form, signs of changes in emotional and cognitive field of motivation. Test on an alternative basis that specifies the shape of psychogeny and dysneurotic syndrome (with predominant CNS excitation on the background of sympatotony with a sense of panic or, conversely, a predominance of inhibitory processes in the CNS with vagotony, depression and anxiety) was specially developed with thai purpose by prof. Sokrut V.M. and as. Karlova I.V. Detection by this test of psychogeny (depressive or hysterical) defines differentiated sedative or tonic treatment tactics.
The fundamental basis of recovery system is adaptive kinesitherapy that is effectively applied on all stages of restorative treatment, thus affecting as separate pathogenetic chain of disease, as the whole body. Knowledge of general principles of kinesitherapy, mechanisms of its therapeutic effect, makes it possible to choose the right means, forms and methods of treatment
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At the end of the study students solve tests. During sum up the analysis of fulfilled work is made.
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Actuality of the theme: One of the most important methods of prevention and treatment of diseases and injuries of jaw-facial region is remedial gymnastics. This method allows for both general and local effect, thereby providing prevention of various complications, and in addition accelerates the processes of restoration of disturbed functions etc. Remedial gymnastics should be considered as a method of pathogenetic therapy, since the application of its methods, along with the general reaction of the body, the physiological mechanisms involved in the pathological process are included.
Influence of remedial gymnastics is not reduced to functional changes, because the improvement of the function improves the structure of organ and vice versa. Successful use of remedial gymnastics is possible only with proper selection of means, forms and methods of exercise, taking into account the relevant mechanisms of therapeutic effect of exercise at each stage of treatment. One of the important methods of kinesitherapy is a massage, as a technical effect on the tissue of organism using special techniques that performed by hands or machines with health care or hygienic purpose is widely used in dentistry. Features of the impact of massage on different phases of the pathological process permit to use this method to increase the effectiveness of treatment. All of the foresaid makes massage an effective method of treatment for various dental diseases.
^ To master the principles of choice of means, forms and methods of remedial gymnastics for various diseases and injuries.
To realize the general purpose you need:
Specific objectives: The baseline of initial level of
knowledge - skills:
1. Identify indications and contraindications to the use of remedial gymnastics
1. Interpret the patient’s state by the signs of main and associated diseases. / department of internal medicine /
2. Identify patient’s regime of motor activity
2. Assess severity of the patient’s state by clinical and functional parameters. / department of internal medicine /.
3. Define purpose of remedial gymnastics in accordance with motor activity and clinical data
3. Interpret pathogenetic changes in the specific disease or injury. / department of pathologic physiology, department of internal medicine /
4. Explain choice of method and dosage when prescribing massage at different pathology
4. Evaluate the data of change the functional state of organs and systems
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TASKS FOR CONTROL OF INITIAL LEVEL OF KNOWLEDGE AND SKILLS
Task 1
The patient complains of significant pain and redness of the left buccal region, the last three days the temperature was 37,2-37,3 oC. In the blood there is slight leukocytosis, and increased ESR. The abscess of buccal region is diagnosed.
Which period of illness corresponds the patient's condition?
A. Acute
B. Subacute
C. Period of the disease involution (primary recovery)
D. Period of full recovery
Etalon Answer: B
Task 2
51 y.o. Patient D., suffers from essential hypertension of II st., ABP is 160/100 mm Hg, recurrent hypertensive crisis. Patient turned to the dentist with a diagnosis of periodontitis on the background of hypertension.
What are the main pathogenetic changes typical for essential hypertension?
A. The formation of foci of pathological excitation
B. Violation of cortical-visceral relations
C. Violation of the vasomotor center
D. Violation of the pressor renal system
E. Violation of the relationship between the nervous, renal, hormonal and cardiovascular systems
Etalon Answer: E
Task 3
The patient is in the department with diagnosis of acuteglossitis areata exfoliativa, concomitant diagnosis is rheumatism I-II st. activity N2a. After treatment patient feels better. Physician’s examination found that crackling in the lungs disappeared, edema of lower extremities, the liver was reduced to the edge of the right hypochondrium, intestinal bloating, and intestinal disorders disappeared.
What changes in the patient's condition indicate a decrease in circulatory failure?
A. Satisfactory health, elimination of intestinal disorders
B. Reducing the number of wheezing in the lungs
C. The disappearance of edema of lower extremities
D. Reduction of liver, disappearance of edema of lower extremities
E. Reduction of the liver, the disappearance of wheezing in the lungs and edema of lower extremities
Etalon Answer: E
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Task 1
A patient diagnosed neuritis of facial nerve on the right. Paralyzed side face is slack, violation of eyelids blinking, palpebral fissure is not closed, mouth is skewed to the left. The synkinesis appeared. Synkinesis is:
А. Conjugate movements
В. Conjugate strain
S. Motor skills
D. Reducing the range of motions
E. Increasing the range of motions
Task 2
3 y.o. patient has been admitted to the maxillofacial department yesterday regarding congenital nonunion palate. Language was unintelligible. There is jaw deformation, violation of chewing function, facial expressions flaccid. The body temperature is 38 °C. Complaints of sore throat.
Determine regimen of motor activity of the patient.
A. Strict bed rest
B. Bed rest
C. Half-bed rest
D. General
Task 3
4 y.o. child was made uranostaphyloplasty. Patient is on outpatient treatment for 1 month. Condition is satisfactory. Breath during speaking is violated. Identify key objectives for the remedial exercise to the child in that period.
A. Restoration phonation and articulation
V. Training of expiration
C. Improving the drainage function of bronchi
D. Elimination of stagnation in the small circle of blood circulation
E. Correction of posture
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to the work of students in the practice
At the beginning of the study control of initial level of students' knowledge is conducted. After that, students solve situational tasks. According to clinical and functional data students define the physical activity regime and appropriate common tasks of remedial gymnastics. Selects forms and methods of their conduction, develop procedures for the scheme of remedial gymnastics. Form the set of exercises for gymnastics.
Further analysis and correction of independent work with some theoretical calculations is done. At the end of class students solve tests, sum up is made.
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Graph of logical structure of the theme: ^
Morning and treatment exercises, individual tasks. Massage
PhR in pre- and postoperative period
Treatment by positions, breathing exercises, for upper and lower extremities, for nasal breathing
Bed rest
Development of functions of palato- throaty muscular complex, restoration of movement in temporomandibular jointу in corpore
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Task 4
45 y.o. patient, after clinical examination arthrosis of the left temporomandibular joints, FN0-1 was diagnosed. In the complex treatment massage of the lesion area is prescribed. After the procedure there is pronounced hyperemia of the skin. What is it connected with?
A. With constriction of arteries and veins
B. With vasodilatation
C. With vasoconstriction
D. With dilatationof the arteries and constriction of veins
E. With vasoconstriction of microvasculature
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1. Нормальна фізіологія /Кол. авторів за ред. проф.В.І.Філімонова.-К.: Здоров'я, 1994.-С.25-33
2. Патологічна фізіологія /Н.М. Зайко, Ю.В. Биць, А.В. Отоман та ін. під ред. Н.М. Зайко, Ю.В. Биця. - К.: Лотос, 1996. - С.395-453
3. Василенко В.Х. Пропедевтика внутренних болезней, - М.: Медицина, 1989. - С155-271
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1. General contraindications to the use of remedial gymnastics
2. Classification of physical exercises
3. Characteristics of activity regimes that are used during treatment and physical rehabilitation
4. Mechanisms of treatment effect of remedial gymnastics
5. Objectives of remedial gymnastics for appropriate regimes, or periods of treatment
6. The main forms of exercises
7. Methods of holding of the procedures of remedial gymnastics
8. Indications and contraindications to the use of therapeutic massage
9. Dosage and method of procedures
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BASIC:
1. Лікувальна фізкультура та спортивна медицина /Клапчук В.В., Дзяк Г.В. Муравов І.В., та ін.: за ред. В.В. Клапчука, І.В.Дзяка. -К.: Здоров'я, 1995. - С.30-45, С.269-285
2. Лечебная физкультура и врачебный контроль. / Под ред. В.А. Епифанова, Г.А. Апанасенко,- М.: Медицина, 1990. - С. 10-28
3. Графологічна структура теми .
ADDITIONAL:
1 .ЛФК в системе медицинской реабилитации. Руководство для врачей
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Граф логічної структури теми: ^
Adaptation to physical loads, preparation to labor activity
Group gymnastic
Morning and treatment exercises, individual tasks. Therapeutic walking
Individual gymnastic
Methodics
Contraindications
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Task 3
Boy 6 years, 10 days ago underwent uranostafyloplasty because of congenital nonunion hard and soft palate. Condition is satisfactory. Sutures are removed. No complications.
Define the period of recovery treatment of the patient.
A. The first
B. The second
C. The third
^
Робутовський Т.Г. Хірургічна стоматологія. - М.1990 - С.267-310
Василенко В.Х.. Пропедевтика внутренних болезней.- М.: Медицина, 1989.-С.155-271
Нормальная физиология /Под ред. проф. В.И. Филимонова.-К.: Здоровье, 1994.-С.25-53
Бернадський Ю.І. Травматологія і відбудовна хірургія щелепно-лицьової області.-К.:Вища школа, 1985.- С.141-200.
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1. . Indications and contraindications to the use of remedial gymnastics before and after uranostafyloplasty, neuritis of facial and trigeminal nerves.
2. The task of remedial gymnastics in such cases.
3. Mechanisms of therapeutic effect of physical exercise.
4. Features of remedial gymnastics techniques before and after surgery on maxillofacial region.
^
BASIC:
1. Лікувальна фізкульура та спортивна медицина /Клапчук В.В., Дзяк Г.В., Муравов І.В. та ін.; за ред. В.В. Клапчука, І.В. Дзяка. - К,: Здоров,я, 1995. - С.247-253.
2. Лечебная физическая культура / Под ред. В.К. Епифанова, -М.: Медицина, 2001. - С. 359-362
3. Графлогічна структура теми
ADDITIONAL:
1. Каптелин А.Ф. Лечебная физкультура в системе медицинской реабилитации.- М. 1995.-С.358-369
2. Дудко Д.В. Лікувальна фізкультура в стоматології.-К.:Здоров’я, 1982.- С.54-66
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physical rehabilitation increases the effectiveness of therapy.
General purpose : to determine the tactics for remedial gymnastics use before and after uranostafyloplasty, at neuritis of facial and trigeminal nerves.
To realize the general purpose you need:
^
knowledge - skills:
1. Identify indications and contraindications to remedial gymnastics appointments before and after reconstructive and plastic surgery on the maxillofacial area, at neuritis of facial and trigeminal nerve
1. Interpret the clinical data of main disease (department of dental surgery)
2. Define activity regime
2. Interpret the severity of the patient’s state (department of propaedeutic therapy, therapeutic dentistry)
3. State the objectives, methods and techniques of remedial gymnastics for a particular activity regime
3. Interpret etiopathogenetical mechanisms of disease and functional disorders (department of pathological physiology)
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TASKS FOR CONTROL OF INITIAL LEVEL OF KNOWLEDGE AND SKILLS
Task 1
The patient complains of mouth curvature, the prolapsusof the right angle. Clinically, left side of face is flaccid, violation of eyelids blinking. Identify the most likely diagnosis.
A. Neuritis of the 1 branch of the trigeminal nerve on the left
B. Neuritis of the 2 branch of the trigeminal nerve on the right
C. Left facial nerve neuritis
D. Right facial nerve neuritis
Task 2
The boy 6 years old, was admitted to the maxillofacial department with a diagnosis of congenital nonunion of alveolar bone of the hard and soft palate. Obscure language of the patient, with a strong nasal tinge. The internal organs pathology was not found. Determine the severity of the patient.
A. Heavy
B. Moderate
C. Satisfactory
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Под ред. Каптелина А.Ф., Лебедевой И.П. - М.: Медицина, 1995.-С. 77-68.
2. Фізичні фактори в медичній реабілітації: Підручник для студентів та лікарів / За заг.ред. В.М. Сокрута, В.М. Казакова. Донецьк, 2008. С. 220-236.
3. Лікувальна фізкультура в санаторно-курортних закладах / За ред.Фесенко Л.І. – Київ, 2005.- С. 14-63.
4. Дубровский В.И., Дубровський Н.М. Практичний посібник по масажу.- М. 1993, С.23-45.
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Task 1
45 y.o. patient is treated on the fracture of the mandible, concomitant – exacerbation of endogenous asthma, moderate stage DN I. Along with this there is a worsening of chronic thrombophlebitis, complaints of periodic attacks of breathlessness, dyspnea during walking with an average pace.
Objective: large number of dry rales over the lungs, on the left leg over the course of v. saphena magna there is red skin, oedema and pain on palpation. Tests with breath holding are decreased, reactions on orthostatic test are increased.
What are the contraindications to the use of remedial gymnastics?
A. Exacerbation of chronic thrombophlebitis
B. Aggravation of asthma
S. Respiratory failure
D. Shortness of breath on exertion
E. Deterioration of functional tests
Task 2
30 y.o. patient B., two days ago was made two-jan splintage on traumatic fracture of the mandible in the region of the right angle. The patient's condition is satisfactory, soft tissue oedema and pain sensation in the area of fracture reduced. The internal organs pathology was not found. Patient was prescribed remedial gymnastics.
What objectives of the remedial gymnastics are the leading ones currently?
A. Tonic, trophic
B. Tonic, compensatory
C. Trophic, compensatory
D. Trophic, normalizing
E. Tonic, normalizing
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Task 3
Patient B., 37 years old with a diagnosis of abscess of maxillofacial area soft tissue was performed surgery. On the third day of treatment remedial gymnastics, open ward.
What forms of exercise are indicated to the patient?
A. Morning exercises, graduated walking
B. Morning exercises, remedial gymnastics
C. Remedial gymnastics, graduated walking
D. Morning and remedial gymnastics, individual tasks
E Graduated walking, individual tasks, morning gymnastics
Task 4
2 years old boy diagnosed congenital defect of lips, uranostafyloplasty was made. In the complex treatment massage was prescribed.
What are the physiological effects of massage treatments
A. Reduction of muscle blood flow
B. Deformation of muscles and ligaments
C. Reduced activity of the sympathetic system
D. Reducing lymphoperfusion
E. Compression of nociceptive
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to the work of students in the practice
At the beginning of the study control of initial level of students' knowledge is conducted. After that, students solve situational tasks. According to clinical and functional data students define the physical activity regime and appropriate common tasks of remedial gymnastics. Selects forms and methods of their conduction, develop procedures for the scheme of remedial gymnastics. Form the set of exercises for gymnastics. Independent work in massage rooms, hydrotherapy: studying of devices, technique of massage procedures, methods for different pathology.
Further analysis and correction of independent work with some theoretical calculations is done. At the end of class students solve tests, sum up is made.
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Actuality. In the prevention and treatment of odontogenic inflammatory processes physical factors that reinforce the basic nervous processes and the entire human body have significant importance. Improved inhibitory and exciting processes of the cerebral cortex, autonomic functions and systems play an important
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What forms of remedial gymnastics should be prescribed to the patient at this stage of treatment?
A. The morning hygienic gymnastics
B. Morning and remedial gymnastics
C. Remedial gymnastics and individual tasks
D. Morning gymnastics, walks
E. Morning, remedial gymnastics, health path
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to the work of students in the practice
At the beginning of the study control of initial level of students' knowledge is conducted.
After that, students solve situational tasks. According to clinical and functional data students define the physical activity regime and appropriate common tasks of remedial gymnastics. Selects forms and methods of their conduction, develop procedures for the scheme of remedial gymnastics. Form the set of exercises for gymnastics.
Further analysis and correction of independent work with some theoretical calculations is done. At the end of class students solve tests, sum up is made.
^
Actuality. One of the urgent issues of modern dentistry is rehabilitation of sick children with congenital pathology of nonunion lip and palate. If not provided skilled care, the patient having secondary deformation of the jaws, teeth, develop pathological changes in the nasopharynx, bronchi, lungs. Exercise, as part of rehabilitation therapy, increasing the compensatory abilities of the body, trains the respiratory function and speech. Proper organization of the activity regime in pre-and postoperative period, special exercises increase the effectiveness of surgical treatment.
Diseases of the peripheral nervous system are very common in dental practice. They are characterized by chronic course, a tendency to progression and complications that are often the cause of temporary and sustained disability. Kinesitherapy can replace or supplement many treatments, including pharmacological, and trends in chronic disease in most cases can act as an independent method of treatment. The choice of optimal methods of kinesitherapy for patients with facial and trigeminal neuritis, depending on the phase and period
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BASIC:
1. Лікувальна фізкульура та спортивна медицина /Клапчук В.В., Дзяк Г.В., Муравов І.В. та ін.; за ред. В.В. Клапчука, І.В. Дзяка. - К,: Здоров,я, 1995. - С.235-243.
2. Лечебная физическая культура / Под ред. В.К. Епифанова, -М.: Медицина, 2001. - С. 549-555
3. Графлогічна структура теми
ADDITIONAL
1. Каптелин А.Ф. Лечебная физкультура в системе медицинской реабилитации.- М. 1995.-С.358-369
2. Дудко Д.В. Лікувальна фізкультура в стоматології.-К.:Здоров’я, 1982.- С.39-54
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Task 1
65 y.o. patient was delivered to the department with diagnosis of traumatic branch fracture of the mandible in the left corner. Patient has essential hypertension of the 2 st., diabetes mellitus in compensation phase. ABP is 160/90 mmHg, heart rate is 90 per min., The temperature is 38.2°C. At the time of injury loss of consciousness was absent. What are the contraindications for remedial gymnastics.
A. Diabetes mellitus
B. Systolic blood pressure 160 mm Hg
C. Heart rate above 90 per minute
D. Temperature 38.2°
E. Damage of the skin
Task 2
Patient 20 years old, an athlete in gymnastics is treated on a fracture of the mandible in the right corner. Fixation of fragments by one jaw splinting was made. Patient is stays at the department during 5 days. Patient feels well. Identify the activity regime to the patient.
A. Strict bed rest
B. Bed rest
C. Half bed rest
D. General
Task 3
23 y.o. patient with an open fracture of the mandible in the right corner was immobilized of bone fragments by the method of two-jan splinting. The patient is being treated during 15 days. Reaction to physical load with 20 squattings is normotonic.
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role in the treatment of patients with abscesses and phlegmon of maxillo-facial region.
Kinesitherapy can replace or supplement many treatments, including pharmacological. It is intended to accelerate wound healing, increase resistance. Systematic physical exercises, myogymnastics help to speed up rehabilitation of patients.
^ to determine the tactics of remedial gymnastics use at odontogenic inflammatory processes of maxillofacial area.
To realize the general purpose you need:
Specific objectives: The baseline of initial level of
knowledge - skills:
1. Identify indications and contraindications to remedial gymnastics appointments
1. Interpret the clinical data of main disease (department of therapeutic and surgical dentistry)
2. Define activity regime
2. Interpret the severity of the patient’s state (department of propaedeutic therapy, therapeutic dentistry)
3. State the objectives, methods and techniques of remedial gymnastics for a particular activity regime
3. Explain the etiopathogenetical mechanisms of diseases and functional disorders (department of pathological physiology)
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TASKS FOR CONTROL OF INITIAL LEVEL OF KNOWLEDGE AND SKILLS
Task 1
The patient developed purulent periostitis of jaw. There is inflammatory contracture of jaws. A surgical intervention was made. On the 3rd day the patient is examined by remedial gymnastics doctor. What are the clinical signs of inflammation.
A. Increased body temperature up to 37.5 °C
B. The local decrease of temperature
C. Worsening of sleep
D. Pale skin
E. Crepitation during movement in the joint
Task 2
The patient with odontogenic phlegmon of the chin was made disclosure phlegmon. After 2 days during the Martin’s test the decrease of diastolic blood pressure to 10 was found. To which kind of of the cardiovascular system is it typical?
A. Normotonic
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B. Hypertonic
C. Asthenic
D. Dystonic
E. Stepped
Task 3
The patient stays in hospital because of the the hyoid abscess on the right side. The abscess has been revealed a week ago. The patient's condition improved. Discharges from the wound are absent, the wound is filled with granulation. Determine the severity of the patient.
A. Heavy
B. Moderately severe
C. Satisfactory
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Боровський Є.В. Терапевтична стоматологія. - М.1988.- С.65-95
Василенко В.Х.. Пропедевтика внутренних болезней.- М.: Медицина, 1989.-С.155-271
Нормальная физиология /Под ред. проф. В.И. Филимонова.-К.: Здоровье, 1994.-С.25-53
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1. Indications and contraindications to the use of remedial gymnastics at odontogenic inflammatory processes of maxillofacial area.
2. Tasks of remedial gymnastics.
3. Mechanisms of therapeutic effect of physical exercises.
4. Features of remedial gymnastics techniques at abscesses, phlegmon, osteomyelitis, etc.
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BASIC:
1. Лікувальна фізкульура та спортивна медицина /Клапчук В.В., Дзяк Г.В., Муравов І.В. та ін.; за ред. В.В. Клапчука, І.В. Дзяка. - К,: Здоров,я, 1995. - С.243-247
2. Лечебная физическая культура / Под ред. В.К. Епифанова, -М.: Медицина, 2001. - С. 536-549
3. Граф логічної структури теми
ADDITIONAL
1. Каптелин А.Ф. Лечебная физкультура в системе медицинской реабилитации.- М. 1995.-С.358-369
2. Дудко Д.В. Лікувальна фізкультура в стоматології.-К.:Здоров’я, 1982.- С.28-39
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Graph of logical structure of the theme: «PHYSICAL REHABILITATION FOR BONE FRACTURES OF MAXILLOFACIAL REGION, CONTRACTURE AND JOINT RIGIDITY»
Morning and Remedial gymnastics, individual tasks
Treatment by position, breathing exercises, movements in big joints, general health-improving exercises
Conservative treatment
of fractures
Increase of emotional tone, improve of breathing mechanics, stepped preparation for everyday physical loads
Bed rest
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A. Violation of fixation
B. Post-traumatic osteomyelitis
C. Soft tissues infection
D. Formation of joint contractures
E. Formation of "false" joint
Task 2
30 y.o. patient was admitted to the department of maxillofacial surgery with a diagnosis of an open fracture of the mandible, face soft tissue damage. During surgical treatment of damaged tissue the patient lost consciousness. Determine the severity of the patient.
A. General severe
B. Moderately severe
C. Severe with CNS dysfunction
D. Mild
Task 3
The patient in postimmobilization period developed rigidity of temporomandibular joint. The doctor determined the latent trigger points. What are the mechanisms of trigger points.
A. Muscle hypertonia
B. Hypotonia of muscle
C. Osteomalacia
D. Myomalacia
E. Local increase of tactile sensitivity
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Робутовський Т.Г. Хірургічна стоматологія. - М.1990 - С.246-310
Василенко В.Х.. Пропедевтика внутренних болезней.- М.: Медицина, 1989.-С.155-271
Нормальная физиология /Под ред. проф. В.И. Филимонова.-К.: Здоровье, 1994.-С.25-53
Бернадський Ю.І. Травматологія і відбудовна хірургія щелепно-лицьової області.-К.:Вища школа, 1985.- С.83-92.
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1. Indications and contraindications to the use of remedial gymnastics for fractures, tight mobility and contractures of the joints.
2. The task of remedial gymnastics in these cases.
3. Mechanisms of therapeutic effect of physical exercises.
4. Features of gymnastics techniques for fractures, joint contractures.
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Graph of logical structure of the theme: ^
Morning and remedial gymnastics individual, special with loads and resistance
Active and passive mechanotherapy, exercises for neck muscles, upper extremities, mimic muscles
PhR of abscess and phlegmon
Complete restoration of broken functions, adaptation to everyday and occupational physical loads
General
health-improving
breathing
exercises for
mastication and mimic muscles’
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Task 1
The patient is in hospital with an abscess over the hyoid region. Objectively there is submandibular oedema on the left. Severe pain does not allows to carry out acts of swallowing and chewing. The disclosure of abscess was made. After a day condition improved. What are the contraindications to remedial gymnastics appointment to improve tissue regeneration in the wound.
A. Essential hypertension of the 2 st
B. Osteoarthritis deformans, the active phase
C. Hypothyroidism
D. Hypotension
E. Fever 38oC
Task 2
48 y.o. patient in a day after surgery on the parotid gland abscess notes paresis of mimic muscles on the left half face, face asymmetry. On examination - oedema of soft facial tissue on the left, facial asymmetry, flatness of nasolabial folds, constriction of face on the right. Heart rate 78 beats per minute, blood pressure 120/80 mmHg What is the activity regime for the patient?
A. Strict bed rest
B. Bed rest
C. Half bed rest
D. General
Task 3
The patient stays in hospital because of the phlegmon in the canine fossa. Two days ago, the disclosure of phlegmon was made. Body temperature is normal, no discharge from the wound. After the test with 20 squatting for 30 s increase in heart rate was 110%, Systolic ABP does not significantly change, diastolic pressure increased on 15 mm Hg, pulse pressure decreased, recovery time lasted 4 min. What forms of remedial exercises can be prescribed in this case?
A. Morning hygienic gymnastics
B. Morning and remedial gymnastics, individual assignments
C. Remedial gymnastics and individual assignments
D. Morning gymnastics and individual assignments
E. Morning, remedial gymnastics, health path
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to the work of students in the practice
At the beginning of the study control of initial level of students' knowledge is conducted. After that, every student get tasks that include short extract from the case report, on the basis of which prescription of remedial gymnastics for appropriate activity regime is made, the scheme of remedial gymnastics is developed.
Further analysis and correction of independent work with some theoretical calculations is done.
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At the end of class students solve tests, sum up is made.
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Actuality. Fractures of the jaws belong to the most common injuries of maxillofacial region. They constitute over 15% of fractures of the body. Of all injuries facial skeleton over 85% are fractures of the mandible. Dysfunction of the nervous system are possible at the injuries of the jaws. Prolonged immobilization causes complications such as contracture, stiffness of temporomandibular joint mobility, speech and eating defects. With the purpose of fast restoration of function, accelerating regeneration in the complex treatment the remedial gymnastics prescribed in the early stages.
^ determine tactics of remedial gymnastics use for bone fractures of maxillofacial region, stiffness and contractures of the joints.
To realize the general purpose you need:
Specific objectives: The baseline of initial level of
knowledge - skills:
1. Identify indications and contraindications for remedial gymnastics prescription at fractures, stiffness and contractures of joints
1. Interpret the clinical data of the main disease (department of dental surgery)
2. Define activity regime
2. Determine the severity of the patient’s state (department of propaedeutic therapy, therapeutic dentistry)
3. State the objectives, methods and techniques of remedial gymnastics for particular activity regime
3. Explain the etiopathogenetical mechanisms of disease and functional disorder (department of pathological physiology)
DETERMINATION AND ENSURING OF THE INITIAL LEVEL OF KNOWLEDGE AND SKILLS
TASKS FOR CONTROL OF INITIAL LEVEL OF KNOWLEDGE AND SKILLS
Task 1
A patient has a fracture of the mandible in the right angle and multiple abrasions of face. Two-jan splinting and treatment of soft tissues of face was made. What are the most likely complications of the patient’s state for the next 2-4 days?.
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