Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
is an interdiscipline:
between Orthopedics & Traumatology (OT),
Prof. Stefan BANKOV, MD. PhD, DMSc - PRM & Orthopedics & Traumatology
COMPETENCIES IN BOTH
THEMATIC FILDS:
PRM & OT
Sofia, 2010-2017
Necessary COMPETENCES
Sofia, 2010-2017
for working in
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Competences
HOW ?
Methods, techniques
Sofia, 2010-2017
RESULTS (Evaluation)
Prof. Yvette Koleva, DM, PhD, DMSc
Quality of Care
!!!
The problem:
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
The Quality of Life
!!!
The tragedy
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
The OT Rehabilitations opinion
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
the care .
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Protocol for registration of patients data
.
ASSESSMENT & EVALUATION
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
GONIOMETRY
active & passive
Sofia, 2010-2017
Prof. Yvette Koleva, DM, PhD, DMSc
Internal rotation
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Circumduction
Sofia, 2010-2017
Prof. Yvette Koleva, DM, PhD, DMSc
Special motion
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Plantar flexion
Sofia, 2010-2017
Prof. Yvette Koleva, DM, PhD, DMSc
PALMAR FLEXION & DORSAL FLEXION OF THE HAND
Sofia, 2010-2017
Prof. Yvette Koleva, DM, PhD, DMSc
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Prof. Yvette Koleva, DM, PhD, DMSc
Inversion and eversion
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Inversion of the right foot
Prof. Yvette Koleva, DM, PhD, DMSc
Sofia, 2010-2017
Opposition
Prof. Yvette Koleva, DM, PhD, DMSc
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Scapulo-humeral rhythm
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Scapulo-humeral rhythm
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
FUNCTIONAL ANALYSIS OF ACTIVITIES
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Assessment of the stature
???
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Assessment of ADL
Functional evaluation of the patient in PRM must be based on
INTERNATIONAL CLASSIFICATION OF
FUNCTIONNING, DISABILITY AND HEALTH
(ICF, WHO, 2001)
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
HEALTH CONDITION
(alteration / disease)
ICF
Body functions Activities Participation
(and structures) (limitations) (disability)
PERSONAL
BODY FACTORS ACTI
FUNCTIONS Technical Age, sex, VITIES
PAIN assistance Poly morbidity, Operating Management PARTICI
Health culture contact contact PATION
Range Verticalization
of Motion Family
ENVIRONMENT
MUSCLE
Home Mobility
FORCE/ Leisure
WEAKNESS Transport
Employment Locomotion Social life
COORDI
Health (rates
NATION (performance Political
Services based) Transport
BALANCE (time related) activities
based) Assurance
GAIT
Family Grasp
Sensibility ADL
Friends
The holistic approach to the patient must be obligatory the complex evaluation must
include:
COGNITIVE CAPACITIES (orientation, memory, attention, compliance during rehabilitation,
conscience of necessity of preventive measures due to the principal disease);
PAIN (localization, type, intensity /verbal or visual analogue scale/; activities increasing
pain);
RANGE OF MOTION (active and passive);
MUSCLE FORCE OR MUSCLE WEAKNESS, motor deficiency;
COORDINATION (neuro-muscular coordination; static, locomotor or dynamic ataxia);
MOBILITY (necessity of technical aids, gadgets; instruments, etc.);
ENDURANCE (capacity to support extreme changes, necessity of pauses during
investigations and functional activity);
INDEPENDENCE IN ACTIVITIES OF DAILY LIVING (bathing, dressing, eating, hygiene,
Sofia, 2010-2017
contacts);
PERSONAL FACTORS (health culture, polimorbidity, age, sex).
***
Functional examination.
In clinical practice we apply the
COMPLEX REHABILITATION PRINCIPLE
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Physiotherapy, electrotherapy,
massages, ergotherapy
In different groups of diseases
Or
Synergic combination of different
physical modalities and techniques:
Complex rehabilitation programme for
every health condition
KINESI PREFORMED
(physio) MODALITIES
(electro/magneto/light/th)
therapy
ERGO
ES (occupational)
therapy
The found is always adapted diet and strict medication of the basic disease
Modalites physiques / PHYSICAL MODALITIES Lego style
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
ES MAGNETO-Therapy
KINESI-Th IONTOPHORESIS
ERGO-Th TENS
LASER DEEP
OSCILLATION
Sofia, 2010-2017
10-2017
OT REHABILITATION ALGORITHM :
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
PREFORMED MODALITIES
ANALYTIC
EXERCICES Sofia, 2010-2017
MS & MI
augmentation du
mouvement de base
Pour les muscles
paravertebraux
PIR
strech techniques
Massages
PNF
Patellar Mobilisations
Vue posterieure
(ADL)
Sitting in bed
Verticalization
Balance training
Mirror box
therapy
in amputees
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Occupational therapy
Mechanotherapy
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Passive Mechanotherapy
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM Sofia, 2010-2017
Passive Mechanotherapy
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM Sofia, 2010-2017
Passive Mechanotherapy
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM Sofia, 2010-2017
PASSIVE ACTIVE MECHANO-Therapy
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM Sofia, 2010-2017
PASSIVE ACTIVE MECHANO-Therapy
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM Sofia, 2010-2017
PASSIVE ACTIVE MECHANO-Therapy
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM Sofia, 2010-2017
PASSIVE ACTIVE MECHANO-Therapy
STRETCHING
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM Sofia, 2010-2017
MECHANO-THERAPY
ACCESSORIES
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM Sofia, 2010-2017
ctive Mechanotherapy
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM Sofia, 2010-2017
ctive Mechanotherapy
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM Sofia, 2010-2017
Medical
(LPG device)
Hubert
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
xtension therapy
CERVICAL TRACTIONS
FUNCTIONAL
ELECTROSTIMULATIONS
PHYSICAL ANALGESIA
PREFORMED PHYSICAL FACTORS
- ELECTROSTIMULATIONS
(exponential form of pulses, ti=200 msec, tp=1000 msec, Fr=0,25-0,5 Hz,
- aperiodic.
MONOPOLAR currents.
Sofia, 2010-2017
Preformed physical modalities
for anti-pain effect
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
PHYSICAL
ANALGESIA
Sofia, 2010-2017
- Intelect 340 Combo Electrotherapy Unit (Intelect, Chattanooga group, 2004), programme
TENS ( , 40%,
20-400 msec., 1-250 Hz), 15-20 m,
15 - 20 min., XV e.
Light
Amplification
by
Stimulated
Emission Intense
highly directional
of
beam of light
Radiation
Prof. Yvette Koleva, DM, PhD, DMSc Sofia, 2010-2017
- LASER - He-Ne, 5-10 mW/cm2, D = 1,5 cm, 3 min. , 6 fields per die, XV procedures
Devices
Physiolaser in any configuration between 635 to 904 nm:
from 50 mW/ 785 nm up to terrific 500 mW/810 nm or 90 W/904 nm.
New: 200 mW/685 nm (red).
Sofia, 2010-2017
DEEP
OSCILLATION
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
BASIC INDICATIONS:
SN & SM conditions,
Pain relief;
TRAUMATOLOGY,
SURGERY.
FFECTS OF
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
DEEP OSCILLATION
Anti-inflammatory effect;
Stimulation of micro-circulation;
Oedema reduction;
Tissue regeneration;
Pain relief;
Contra fibrosis .
DEEP OSCILLATION
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
DEEP OSCILLATION
Evident
,
,
Sofia, 2010-2017
(
)
DEEP OSCILLATION
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
DEEP OSCILLATION
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
DEEP OSCILLATION
( )
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Shock wave therapy
Shockwave is an acoustic wave which carries high energy to painful spots and
myoskeletal tissues with subacute, subchronic and chronic conditions.
The energy promotes regeneration and reparative processes of the
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Acoustic waves with high energy peak used in Shockwave therapy interact with
tissue causing overall medical effects of accelerated tissue repair and cell
growth, analgesia and mobility restoration. All the processes mentioned in this
section are typically employed simultaneously and are used to treat chronic,
sub-acute and acute (advanced users only) conditions.
New Blood Vessel Formation Reversal of Chronic Inflammation
Nutrient blood flow is necessary to start and maintain the repair processes Chronic inflammation occurs when the inflammatory response is not completely halted. It can
of damaged tissue structure. The application of acoustic waves creates damage healthy tissue and results in chronic pain. Mast cells are one of the key components of
capillary microruptures in tendon and bone. Due to microruptures the the inflammatory process. Their activity may be increased by using pervasive acoustic waves.
expression of growth factors such as eNOS, VEGF, PCNS and BMP is Mast cell activation is followed by the production of chemokines and cytokines. These pro-
significantly increased. inflammatory compounds first enhance the inflammatory process and in the next step help
As a result of these processes arterioles are remodeled, stimulated to grow restore normal healing and regenerative processes.
and new ones are formed. The new blood vessels improve blood supply
and oxygenation of the treated area and support faster healing of both the
tendon and the bone.
Scientific support Stimulation of Collagen Production
Biological Mechanism of Musculoskeletal Shockwaves The production of a sufficient amount of collagen is a necessary precondition for the
repair processes of the damaged myoskeletal and ligamentous structures. Shockwave
therapy accelerates procollagen synthesis. The therapy forces the newly created collagen
fibers into a longitudinal structure which makes the newly formed tendon fibers more
dense and stiff and creates a firmer structure.
Shock wave therapy
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
INDICATIONS in OT practice:
tennis elbow
shoulder tendonitis
heel, achilles and knee trauma
degenerative disorders
SOURCE: http://www.shockwave-therapy.co.uk
In some cases
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Drug therapy
Infiltration therapy
etc.
Sofia, 2010-2017
Meso therapy
Infiltration therapy
Michel Pistor (19242003) performed clinical research and founded the
field of mesotherapy. Multi-national research in intradermal therapy culminated with Pistor's work from 1948 to
1952 in human mesotherapy treatments.
The French press coined the term Mesotherapy in 1958.
The French Acadmie Nationale de Mdecine recognized Mesotherapy as a Specialty of Medicine in 1987.
Popular throughout European countries and South America, mesotherapy is practiced by approximately 18,000
Sofia, 2010-2017
physicians worldwide
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
http://mi-medicalinnovation.com/img/cms/20_MIMedicalInnovation_schematechniquemesotherapieAng.jpg
Infiltration therapy
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
mesotherapy
before the procedure (respective pre-formed modality )
REDUCTION OF PAIN
Padua L, I Aprile, F Cecchi, et al.
Pain in postsurgical Orthopedic Rehabilitation: A multicenter study.
Pain Medicine, 13, 2012, 769-776.
Mesotherapy & Pain
Sofia, 2010-2017
Sofia, 2010-2017
Meso therapy
Prolo therapy
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Nerve blocks
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Occupational therapy
Environment adaptations
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
HOME ADAPTATION
Sofia, 2010-2017
OCCUPATIONAL THERAPY
Adapting the environment for ADL
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM Sofia, 2010-2017
ADL
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM Sofia, 2010-2017
ADL
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM Sofia, 2010-2017
Occupational therapy
TECHNICAL AIDS
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Brace
Walker boot
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Shoulder brace
Arm sling
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Prof. Yvette Koleva, DM, PhD, DM
Sofia, 2010-2017
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Controlled active
flexor splint
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Synergistic splint
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Differential tendon-
gliding splints
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Controlled passive extensor splint
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Immediate controlled active motion splint
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
CNS
SENSORY INPUT
MOTOR OUTPUT
Sofia, 2010-2017
oxygen transport
Sofia, 2010-2017
"Light Operated Mouse And Keyboard
LOMAK
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
SPECIAL KEYBOARDS
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
You can think about a lot of things, that one can do with
computers.
Ancient Egypt
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Otto-bock
C-leg
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
PARALYMPICS
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
MYO-ELECTRIC ROBOTIZED PROSTHESIS
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Fig. 3. Rolled dielectric elastomer acting as a bicep on a full-size human skeletal
muscle. Field-activated polymers operate at high voltage and low current. Further
development of lightweight and efficient voltage conversion and driving circuitry is
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
required for operation off of batteries. High voltage must be isolated from the user.
However, the potential danger of high voltage can be greatly reduced by limiting the
available current. For example, operation of 100 W actuators at 5000 V (a typical
maximum for dielectric elastomers) would require just 20 mA a nonlethal amount.
Sofia, 2010-2017
prosthetic hand
yo electric
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Michelangelo Hands of God (Creation)
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Otto-bock
MICHELANGELO HAND Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Michelangelo hand
the grip types
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
FORTIS exoskeleton
http://www.lockheedmartin.com/us/pr
oducts/exoskeleton/fortis.html
http://aerospace.firetrench.com/2014/08/u-s-navy-to-test-and-evaluate-lockheed-martin-industrial-exoskeletons/
Pain relief;
Increase of range of motion;
Prevention of complications;
Increase of muscle force;
Decrease of muscle weakness;
Training of neuro-muscular coordination;
Restoration of scapulo-humeral and pelvi-femoral rhythm;
Balance and gait training;
Psycho-emotional effects;
Amelioration of autonomy of patients in every day activities;
Sofia, 2010-2017
Resocialization of patients;
Amelioration of quality of life of patients.
OT Rehabilitation
PROs & CONTRAs
PROs
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
CONTRAs
Lack of sufficient evidence (we are in the era of EB medicine & EB rehabilitation);
Necessity of interdisciplinary team (OT surgeon, radiologist, PRM specialist, etc).
Sofia, 2010-2017
GROUPS OF REFLECTORY CONNECTIONS
PROPRIO-VISCERAL
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
(zones of Mackenzie)
CUTANEOUS-
VISCERAL
(zones of Head) MOTOR-VISCERAL
(zones of Mackenzie)
PERIOSTAL-VISCERAL
(zones of Vogler-Krauss)
REFLECTORY
CONNECTIONS
SUBCUTANEOUS-
CONNECTIVE TISSUE-
VISCERAL
(zones of Leube-Dicke)
Sofia, 2010-2017
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Conclusions
COMPLEX ALGORITHM OF
OT MANAGEMENT
patient education.
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Physical modalities:
one or two pre-formed modalities;
one cryo- agent.;
one or two kinesitherapeutic procedures
/incl. passive & active exercises, mechano-therapy, stretching
techniques, post isometric relaxation, analytic exercises.
Sofia, 2010-2017
Rehabilitation a la carte
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
Sofia, 2010-2017
The Rationale:
Prof. Yvette Koleva, DM, PhD, DMSc, FEBPRM
rehabilitation strategy
OT rehabilitation is obligatory
in these cases.
Sofia, 2010-2017
General practitioner
Specialists in OT, Radiology; PRM
Ergotherapist
Phisiotherapist
Kinesitherapist
Nutricioniste
Psychologist,
Sociologist
Nurse.
PRM doctor
PATIENT
Physiotherapist
Ergo therapist
OT REHABILITATION
in OT cases
ICF
MODERN DEVICES
Quality of OT rehab
Quality of life of OT patients