LOW-INTENSIVE PHYSICAL THERAPY IN RUSSIA
Prof. G. Ponomarenko
St. Petersburg 02/2000
Development
of physiotherapy in the XX century has been passing in a
dialectic unity of ideas about specificity and universality
of influence of medical physical factors. At the beginning
of the century, having comparatively small range of utilized
physical factors, the doctors strove for attributing to
each of those the maximum number of medical effects, often
developing for the second time, provided prolonged application
or complex usage with the other factors. Such notions were
occasionally engendered by superficial ideas about a certain
resemblance of pathogenetic mechanisms of diseases and their
repeatability on various stages. On this basis during a
long period of time the scientists have made attempts to
create "the general theory of physiotherapy".
At the heart of the mechanism of medical effect of physical
factors, they have investigated in series conceptual aspects
of the basic sciences relating to physiotherapy - neuro-reflex
and neuro-humoral theories, adaptation, stress, information-cybernetic
theory of life organization, functional systems theory,
theory of antagonistic regulation of functions, etc.
In principle any cells of the organism may react upon the
medical physical factors. Nevertheless, the lower is the
intensity of factors, the more important highly sensitive
systems are for producing the reactions upon the organism.
Hardly reprehensible is even today a fairly widespread notion
as if the "targets" of influence of the medical
physical factors are several (epithelial, neural, immunocompetent,
endocrine, etc.) cells. However, those who have come to
believe in this, obviously do not realize it in full that
there are cells in the organism, membranes of which are
the most sensitive to the heterogeneous physical factors
and are their receptors. Physical medical factors of mechanic
and optic nature are perceived by mechano- and photoreceptors,
electromagnetic factors - by membranes of the excitable
tissues, while thermal factors influence on thermomechanosensitive
structures and are able to modulate their functional activity.
They form specific reactions, energy of which exceed the
energy of acting medical factor many times, and the reactions
develop due to the free energy - the part of the organism
inner energy which is used for biologic oxidation and for
maintaining metabolites flow to be directed through the
cell membranes. Directedness of these reactions is often
determined by the influence area, their amplitude depends
upon the intensity of the physical factor, frequency selectivity
is conditioned by the structure of sensing cells, and the
reactions are developed in the course of the medical procedure.
Considerable progress in studying molecular level of living
matter organization and cell pathology has made possible
to determine unequal character of the ways of influence
of the physical factors of various types of energy over
several organs-"targets". Today the selective
influence of low-frequency impulse currents upon several
types of neural conductors is experimentally proven, high-frequency
electromagnetic vibrations - by different cell microstructures,
optical radiation of diverse frequency - by various kinds
of chemical bonds and compounds, vibrostimulus - by several
types of mechanoreceptors, etc. Thus, more and more facts
of selective absorption of the physical factors' energy
by several kinds of sensing cells and biological structures,
which indicate the heterogeneity of medical influence of
diverse-charater physical factors, are being accumulated.
Under the effect of high-intensive physical factors of electromagnetic
and mechanic character the surplus of their energy is transformed
into heat, which fact has found an application for physiotherapy
in the form of nonspecific (caloric) influence of UHF-fields,
high-intensive ultrasound. Caloric effects are determinative
for most of high-intensive thermal factors.
According to the present-day data, the conformity of energy
type of the utilized low-intensive factor to the nature
of sensing structures of tissues-"targets" is
the necessary condition of specific medical effect, while
their high directivity to the corresponding organ-"target"
is the sufficient one. The limits of specific and non-specific
influence of each of the factors may be determined on the
basis of space-time features of their energy distribution
(table 1).
STANDARDS
OF MEDICAL EFFECT OF PHYSICAL FACTORS
Tabel (1)
where
WR - the energy of patient's responses to medical physical
factor;
WF - the energy of the influencing factor; R - patient's
reaction; v - frequency or other modulation-wave characteristics
of the factor; t - time of the medical effect development.
Modern tendencies of physiotherapy development are oriented
towards the elaboration of new techniques of medical physical
influence, the search for new effective medical physical
factors, the guarantee of high selectivity (targetness)
of their influence, the inclusion of patient biological
feedback in the devices' structure, the usage of secure
elemental basis, considerably raising electrosafety and
reducing the sizes of the manufactured devices.
Nowadays medical application of impulse currents has been
successfully realized within the methods of short-impulse
electroanalgesia. For its implementation the devices are
provided with the automatic control systems and programs
to influence on several parts of the human body.
The world reserves of physiotherapy equipment have been
enriched with the instruments, set to influence upon the
patient's extremities by low-frequency magnetic field. Antispasmodic
and hypocoagulating effect typical of such magnetic fields
enables to apply them efficaciously for correction of functional
vascular disorders.
Low-frequency ultrasonic vibrations (22 kHz), possessing
higher penetrating power in comparison with traditionally
used frequencies and giving an opportunity to remove commissures
and cicatrices effectively, are successfully used by modern
gynecology and urology. Finally, the priorities for usage
of laser emission of red and infra-red range have been determined.
The former is advisable to be applied for speeding up repair
regeneration, and the latter - proliferation.
At the same time, within the development of physiotherapeutic
equipment, particularly abroad, there emerged a tendency,
faulty for native medicine, to select the influence parameters
automatically, starting only from nosological form of disease,
and not from the patient's general condition. This fact
primitivizes the level of physician's thinking and does
not make possible to realize his creative potential and
the opportunities of complex effect of medical physical
factors.
Thus, the analysis of physiotherapy present-day condition
and its development tendencies points out that there is
an urgent need for small-sized combine-devices, enabling
to carry out techniqes combined with the automatic selection
of influence parameters. From among the available perspective
methods it is advisable to introduce the methods of biregulative
electrostimulation, laser therapy, ultrasonic therapy, haloinhalation
therapy, impulse magnetotherapy in medical institutes.
