A physical rehabilitation  in a traumatological  and orthopedics practice .

A physical rehabilitation at the surgical operations  on the organs of pectoral and abdominal cavities.

Breaks of bones are violation of their integrity because of action of external mechanical factor or pathological process. Diaphyseal (bone a body) distinguish, metaphyseal  and epiphyseal breaks.

 Accompanied functional discords: pain, parafunction, hemorrhage, crackpot mobility bones, at displacement of отломков is deformation of extremity. Surrounding soft fabrics are pulled in a pathological process, there are common and local changes in an organism.

The changes of commons show up discord of functions of organs of circulation (tachycardia, low blood pressure) of blood, digestion (constipations, проносы), selection (delay of uropoiesis or incontinence of urine), the processes of exchanges rise, general reactivity of organism goes down.

Because of protracted temporal akinesia, related to immobilization, bed mode, there can be the second changes in fabrics: muscular atrophy, corrugation and bulge of arthral bag, loss of its elasticity, diminishing of amount of synovia in emptiness of joint, dissociation, fibrotic changes of arthral cartilage, osteoporosis. It contingently the gradual fadings of afferental impulsation от иммобилизованной extremity: a functional motor denervation develops, the functional appear, and then and morphological changes in muscles, joints of the immobilized ending. Through inactivity of the immobilized ending the amount of collagen is multiplied in muscles, the decline of amount of miosin and hepatin, atrophy of muscular fibres, passes, and later are destructive changes in them. Muscles lose retractive ability and force. Gradually contraction and muscular bulges develop because of loss of muscular elasticity and its retraction.

Treatment of damages of locomotorium is built on principles:

1) the choice of method of treatment of break concernes the common state of patient, age, character and localization of damage;

2) a replicon provides renewal of length and form of ending fragment;

3) set fragments owe is in the fixed state.

One of methods of complex functional therapy is MPE, the basic mean of which are physical exercises which intensively influence on a locomotorium.

Depending on character of break of bones of endings and stage of stationary treatment of patients, the course of MPE is divided into 3 periods:

1 - immobilizations;

2 - post-immobilized;

3 - restoration.

Features of method:

1) continuity of the use during all course of treatment, the method of MPE changes depending on the period of treatment;

2) early application of MPE, that provides the improvement of the common state of patient not only, and warns the origin of complications (pneumonias, contracture, atrophy);

3) uniting treatment physical exercises with immobilization;

4) gradual increase of loading: abstention of physical exercises on intensity in a 1-t period and intensification is in a 3-th period;

5) use of active and passive physical exercises.

Contra-indications to setting of MPE:

- common difficult state of patient because of blood loss, psychical trauma, infection, concomitant diseases;

- fervescence, except for long subfebril (not higher 3,7, 5);

- danger of appearance or renewal of bleeding because of motion;

- a presence of extraneous bodies is in fabrics, placed near large vessels, nerves and other vital;

- presence of other diseases which are contra-indication to setting of medical physical education.

Period of immobilization. Lasts 30-90 days. Clinically characterized the sharp consequences of trauma, beginning of regenerative process in the damaged fabrics. Coincides with forming of primary bone callosities. On the condition of absence of contra-indications of MPE appoint from the first days of stationary treatment.

General tasks:

- increase of the common state of patient;

- improvement of function of the vitally important systems: сердечно-сосудистой, respiratory, nervous, grassy;

- increase of resistance of organism;

- warning of violations, conditioned the bed mode.

Special tasks:

- improvement of trophism of the immobilization ending;

- stimulation of consolidation of break;

- warning of muscular atrophy, parafunctions joints of the immobilized ending, prophylaxis of rigidily and contracture;

- making of necessary temporal indemnifications.

Forms of MPE:

Medical gymnastics, morning sanitary gymnastics, individual tasks for independent employments.

For the decision of general tasks appoint bracing exercises. They are executed from all initial positions which possible during immobilization. All not иммобилизованные groups of muscles, joints, must participate in implementation of exercises (table 35, fig. 10). At employment is included by static and dynamic respiratory exercises, on attention, co-ordination of motions. Obligatory are observances of principle of scattering, alternation of dynamic exercises, static tensions and weakening.

The special tasks are decided with a help:

1) exercises for the symmetric healthy ending - render assistance the improvement of blood supply and trophism in immobilization;

2) exercise in the free of immobilization joints of the damaged ending;

3) ideomotor (mental) exercises for the immobilized ending;

4) static tension of muscles of the immobilized ending. Because of implementation of these exercises there is rapprochement of wreckages of bones, the processes of regeneration are stimulated on the city of break, blood supply, trophism of the damaged ending activates. Static tension of muscles is executed because of their rhythmic by turn reduction and weakening (30-50 times after 1 minutes). For renewal of movable in joints and good weakening of muscles recommend brief tensions 1-3 with, and for renewal of force and endurance of muscles is tension for  5-7 with (C.Ì. Ataev);

5) in the case of breaks of bones of thigh or shin execute exercises with pressure on the axis of ending (on support or back of bed) and lowering of immobilized leg under bed level. This is prepare a leg to the axleloading, a supporting function is restored, tone of vessels practices;

6) from 2-3 days is a massage of the healthy ending, reflexogenic areas, free of immobilization of parts of the damaged extremity (stroking, grinding, careful mashing).

Table 35

STANDARD complex of exercises of medical gymnastics at break of humeral bone

(period of immobilization)

№	Initial position		Account			Description of exercise		Dosage (number of retry)		Pointing
1		Lying on the back		1 2	To heave up healthy hand up is inhalation I.P. it is exhalation		6-8		A rate is middle
2		Lying on the back		1 2	To squeeze the fingers of brush in a fist To straighten the fingers of brush		6-8		A rate is middle
3		Lying on the back			By turn back and pelmatic bending a foot		8-10		A rate is middle
4		Lying on the back			The by turn and simultaneous bending of feet is in knee and hip joints		6-8		A rate is middle
5		Lying on the back			Diaphragmatic breathing		1,5 minutes
6		Lying on the back, healthy hand aside		1 2	To bend a hand in an elbow joint I.P.		8-10		A rate is middle
7		Lying on the back			Bending, unbending, circular motions in radiocarpal joints		6-8		A rate is middle
8		Lying on the back			Pressure every finger of brush on the surface of tire
9		Lying on the back		1 2 3-4	To heave up a direct right foot, retain it 2-3 with I.P. It exactly for a counter-clockwise leg		6-8		A rate is middle
10		Sitting on an arm-chair, healthy hand to the shoulder		1-4 5-8	Revolved motions in a humeral joint ahead It exactly back		6-8		A rate is middle
11		Sitting on an arm-chair			Isometric tension of muscles of forearm with their next weakening		3-4		2-3 with
12		Sitting on an arm-chair		1 2-4 3	Inclination of trunk to the right I.P. Inclination of trunk to the left		8-10		A rate is middle
13		Sitting on an arm-chair		1 2	Forerake of trunk, to get a healthy hand a foot is exhalation I.P. it is inhalation		6-8		A rate is middle
14		Sitting on an arm-chair			Diaphragmatic breathing		1,5 minutes
15		Sitting on an arm-chair, healthy hand on a belt			The by turn bending of feet is in knee and hip  joints		6-8		A rate is middle
16		Sitting on an arm-chair, healthy hand on a belt			Isometric tension of muscles of shoulder with their next weakening		3-4		2-3 with
17		Sitting on an arm-chair, healthy hand on a belt		1 2	To take a healthy hand aside is inhalation I.P. it is exhalation		6-8		A rate is middle

Postimmobilization period.

Begins after the removal of gipseous bandage or skeletal elongation. Clinically in this period there is the eventual forming of bone callosities. It is necessary to take into account that ending after immobilization of atrophy, motions in joints are limited.

General tasks:

- preparation of patient to rising (if there was the bed mode);

- training of vestibular vehicle;

- teaching to move on crutches;

- training of support ability of healthy extremity;

Special tasks;

- to normalize the trophism of the damaged ending (the eventual forming of bone is callosities, liquidation of muscular atrophy);

- to recover motion in the joints of the damaged ending;

- to recover and normalize the functions of the damaged ending;

- to recover a correct carriage, normalize motive habits, improve their quality.

Respiratory use, resolve exercises, on equilibrium , co-ordination of motions, static exercises, on weakening, exercises with objects, with resistance. The physical loadings increase due to multiplying the amount of exercises and their reiterations.

The removal of immobilization lets to execute active motions in all joints of the damaged extremity (fig. 11, 12).

Medical physical education at the breaks of spine.

A spine executes a protective function, resistances, motions. It is a basic axis and place of attachment of muscles of trunk, overhead, lower belt.

A trauma arises up because of falling on a buttock or falling on the chapter of difficult to the object.

 In fact injuring force operates apeak on a spine. It causes flattening one, rarer than 2-3 vertebrae. As vertebrae can not compress through resistance of hard fabrics (neurocentrums), there is the slipped disc ahead on more уплощенному lower vertebra.

 Therefore treatment is directed to on the abstinent permanent unbending of spine, creation and strengthening of strong muscular the corset which will be able to retain trauma vertebrae in correct position.

The course of medical physical education is divided into three periods (A.O. Dreving):

I period.

Task:

- increase of the psychoemotional state;

- assistance establishment of trauma vertebrae in functional initial position;

- abstinent toning up of muscles of the back;

- improvement of circulation of blood;

- prophylaxis of pneumonia;

- activation of laxation.

Features of medical gymnastics:

1) a patient executes motion hands and feet, not tearing away endings от a bed, that not to displace trauma vertebrae energetic motions;

2) execute easy motions endings and respiratory exercises.

Table 36

STANDARD complex of exercises of medical gymnastics at breaks of spine

(And period)

№	Initial position		Account		Description of exercise		Dosage (number of retry)		Pointing
1		Lying, hands along a trunk	1-2 3-4	To take hands at a side under the corner of 45, not tearing away them от a bed, to square shoulders I.P.		4-5		A rate is slow
2		Lying, hands on a belt	1-2 3-4	Back unbending feet, strongly sipping socks on itself I.P.		5-6		A rate is slow
3		Lying, feet on the width of shoulders. Hands are arcuated in joints of elbows on 90, brushes are lines	1 2-4 3	Brushes to the humeral joints I.P. To unbend hands in an elbow joint		5-6		A rate is middle
4		Lying, hands on a belt	1-2 3-4 5-8	To bend a counter-clockwise leg in a knee and talocrural joint, not tearing away a heel from a bed I.P. It exactly for a right foot.		3-4		A rate is slow
5		Lying. Hands are arcuated in the joints of elbows, elbow lifted at the level of shoulders, brushes  lines one above the second, hands downward	1-2 3-4	To divorce elbows, affect a bed, square shoulders and heaps I.P.		5-6		A rate is middle
6		Lying, hands on a belt, feet on the width of shoulders; socks on itself in the back unbending	1-4	Rotatory motions by a direct leg with the touch of plane of bed by the internal and external edge of foot		3-4		A rate is slow
7		Lying, hands are arcuated in the joints of elbows, finger to the humeral joints	1-4	Circular motions by elbows ahead – aside – downward – upwards		5-6		A rate is slow
8		Lying, hands along a trunk	1 2 3-4	To take the left arm aside with the simultaneous sinistrogyration of chapter I.P. It exactly  for a right arm		4-5		A rate is slow
9		Lying, hands are arcuated in the joints of elbows, finger in a fist	1 2	To unbend and divorce fingers I.P.		8-10		A rate is middle
10		Lying, hands are arcuated in the joints of elbows, finger in a fist	1 2	To bend a brush in a radiocarpal joint I.P.		8-10		A rate is middle

Duration of procedure in the first days 10-15 minutes Exercises execute 2-3 in a day (table 36).

II period.

Features of medical gymnastics:

1) energetic exercises for the muscles of humeral and pelvic belt;

2) for a pelvic belt there is the inadvisable complete loading, therefore motions are conducted every leg separately;

3) training of muscles of the back - extensors: does not appoint difficult exercises, and the special exercises are conducted not in full.

Main principle of leadthrough of employments is motions of not pains (table 37).

Table 37

STANDARD complex of exercises of medical gymnastics at breaks of spine

(II period)

№

Initial position

Account

Description of exercise

Dosage (number of retry)

Pointing

1

Lying, hands along a trunk

1 2 3

Hands at a side Hand up Hands downward

5-8

A rate is middle

2

Lying, hands at a side, brush in a fist

1-2 3-4

The tense bending of hands is in humeral joints, bringing brushes over to the shoulders I.P.

6-8

A rate is middle

3

Lying, hands along a trunk

1-4

Motions of direct hands at a side – upwards - downward with a simultaneous  appeal around a longitudinal axis

4-6

A rate is slow

4

Lying, hands on a belt

1-8

Imitation of motions a leg, as at wheeling

3-4  by every leg

A rate is middle

5

Lying, direct hands are dilute at a side at the level of shoulders and something retired

Small circles by hands, straining the muscles of the back and shoulder-blades

4-5

A rate is slow

6

Lying, hands on a belt

1 2 3 4-6

To bend a counter-clockwise leg in knee and hip joints To straighten in a knee-joint To lay on a bed It exactly for a right foot

4-6

A rate is middle

Exercises foot. Conduct every leg separately. During motions a foot is in the back unbending

8

Lying, hands on a belt

1-8

Imitation of motions a leg as at wheeling

for 3-4

A rate is middle

9

Lying, hands on a belt

1 2 3 4 5

To bend a leg To straighten upwards To take aside To bring a leg over To lay on a bed

for 2-3

A rate is middle

10

Lying, hands on a belt

1 2

To heave up a direct leg on 45(later on 70-80) I.P.

for 2-3

A rate is middle

11

Lying, hands on a belt

1 2

To take a direct leg on 45(later on 70-80) I.P.

for 2-3

A rate is middle

Exercise for the muscles of the back

12

Lying on a stomach, hands are arcuated in the joints of elbows, hands back in a bed

Bending of the back with levitating a breast

3-4

4-5 with on 1 saging

13

Lying and stomach, hands are arcuated in the joints of elbows, a forearm is parallel edges of bed

Insignificant raising of trunk with support on a forearm

3-4

4-5 with on 1 saging

14

Lying on a stomach

To heave up a head, to try the back of head to affect shoulders

3-4

4-5 with on 1 saging

15

Lying and stomach, hands are arcuated in the joints of elbows, a forearm is parallel edges of bed

1-2 3-4

To heave up a trunk on straighten hands with support only on a brush I.P.

2-3

A rate is middle

16

Lying on a stomach, hands on a belt

1 2

To heave up a trunk waist-deep I.P.

4-5

A rate is middle

III period.

Physical exercises which require good co-ordination of motions and considerable power tension are executed.

 Include exercise for development of flexibility of spine (lateral inclinations and appeals of spine are in a longitudinal axis). Carry out tense arch-outs  with large amplitude and burdening.

Table 38

STANDARD complex of exercises of medical gymnastics at breaks of spine

(III period)

№	Initial position		Account			Description of exercise		Dosage (number of retry)		Pointing
				Exercise for development of flexibility of spine.
1		Lying on the back		1 2-4 3	To bend a trunk to the right I.P. To bend a trunk to the left		6-8		A rate is middle
2		Lying on the back, hands on a belt		1 2 3-4	To the right pulling out the turn of trunk counter-clockwise shoulder ahead I.P. It exactly to the left, pulling out a right shoulder. This exercise can be executed with establishment of hand in an opposite side		6-8		A rate is middle
3		Lying on the back, hands on a belt			Imitation of blow of boxer in an opposite side with the turn of trunk		5-6		A rate is middle
4		Lying on a stomach, hands are arcuated, forearm along the edge of bed, brush at the level of shoulders		1-2 3-4	To get up all fours To bend the back		5-6		A rate is middle
5		Lying on a stomach, hands are arcuated, forearm along the edge of bed, brush at the level of shoulders		1-2 3 4 5 6 7-8	To get up all fours To fish out the left arm ahead and upwards To drop the left arm To fish out a right arm ahead and upwards To drop a right arm I.P.		6-8		A rate is middle
6		Lying on a stomach, hands are arcuated, forearm along the edge of bed, brush at the level of shoulders		1-2 3-4 5 6-10	To get up all fours. To fish out a right arm ahead and to do by her large circle: downward, taking a humeral belt in motion, eyes watch after motion of brush To drop a right arm It exactly for the left arm		5-6		A rate is middle
7		Lying on a stomach, hands are arcuated, forearm along the edge of bed, brush at the level of shoulders		1-2 3-4 5-6 7-10	To get up all fours To fish out back a right foot on a bed, simultaneously dropping a right half a pelvis To get up all fours It exactly for a counter-clockwise leg		5-6		A rate is middle
					Exercises foot
8		Lying on the back, hands on a belt		1 2	To heave up direct feet on 45 (later on 70-80) I.P. To retain feet at right angles to the axis of feet		4-6		A rate is middle
9		Lying on the back, hands on a belt		1 2	To divorce direct feet at a side I.P.		6-8		A rate is middle
10		Lying on the back, hands on a belt		1 2 3 4 5 6	To heave up both legs I.P. To heave up a counter-clockwise leg I.P. To heave up a right foot I.P.		4-5		A rate is middle
11		Lying on the back, hands on a belt		1 2 3 4-6	To take a direct counter-clockwise leg aside To lead in an opposite side above a right foot I.P. It exactly for a counter-clockwise leg		5-6		A rate is middle
12		Lying on the back, hands on a belt			Crucialof motion heaved up direct feet		8-10		A rate is middle
13		Lying on the back, hands on a belt			”Bicycle”
14		Lying on the back, hands on thighs, feet something arcuated in knees, feet prop in a vertical board in the feet of bed			Easy straightening of knees. It is thus necessary to displace a trunk upwards		7-8		Support and weakening after 2 with
					Tense bending of the back
15		Lying on the back. Support by elbows in a bed, feet are arcuated, feet something placed		1-2 3-4	Levitating a trunk (pelvis) with incurving him upwards; support on the back of head, elbow, feet I.P.		6-8		A rate is middle
16		Lying on the back. Support by elbows in a bed, feet are lines		1-2 3-4	Levitating all body with support on the back of head, elbow, heels I.P.		6-8		A rate is middle
17		Lying on the back. Support by elbows in a bed, feet are lines		1-2 3-4	To heave up a trunk with support on the back of head, elbow and one leg; to the friend here to draw out horizontally on the equal knees of arcuated leg I.P.		3-4		A rate is middle
18		Lying on a stomach. Hands at a side		1-4	Circular motions by hands ahead		5-6		A rate is middle, to try that gather internal edges shoulder-blades
19		Lying on a stomach. Hands at a side and tomentous downward			Wide circular motions by direct hands ahead, at a side and downward with the simultaneous bending of trunk to the belt; dropping hands downward, to lie down on a bed		4-5		A rate is middle
20		Lying on a stomach, support on an elbow, brushes are raised to the level of shoulders, by hands ahead		1-2 3-4	To heave up a trunk waist-deep I.P.		5-6		A rate is middle
21		Lying on a stomach. Hands are raised and retired		1-2 3-4	To heave up a trunk, abandoning hands in the same position I.P.		6-8		A rate is middle
22		Lying on a stomach. Hands are arcuated in the joints of elbows, a forearm and brushes lie along the edge of bed		1 2 3-4	To heave up a direct right foot I.P. It exactly for a counter-clockwise leg		6-8		A rate is middle

Control after efficiency of medical physical education for the muscles of the back it is possible to conduct by a test: it is offered to the patient to retain a trunk in position of ''swallow”: lying on a stomach to take hands back, to heave up a head and shoulders with the simultaneous getting up of direct feet. A test is satisfactory, if a patient retains this position 2-3 minutes

For the muscles of abdominal press: lying on the back, to heave up direct feet under the corner of 45º.

 A test is positive, if a patient retains the feet of 2-3 minutes (fig. 13).

In 45-60 days after a trauma it is let a patient to get up. At getting up from the bed of patient must not sit down. In position lying on a stomach he moves on the edge of bed, drops a leg which lies on verge of bed and puts her on forgery; leaning hands, puts a friend a leg and straightened.

Gradually include exercises which are executed from initial position standing: inclination of trunk, by turn taking and bringing feet over, half squatting with the direct back, pumping-over from a heel on a sock.

The functional state of spine must be checked up through 4 messes after a trauma. At the positive results of clinical and radiological inspection a patient suggest to execute exercises from initial position standing (fig. 14).

Medical physical education at the breaks of bones of pelvis.

A pelvis executes the function of support of trunk at a seat, standing, walking. A pelvic ring is the place of attachment of large muscular arrays which set the lower endings in motion, support a trunk upended.

The breaks of bones arise up a pelvis because of compression a pelvis in lateral or front-back direction, at falling on feet. It is difficult damage. Treatment of patients requires the stay of patient on the bed mode which results in limitation of the motive mode. The forced position in a bed is reason of decline of general exchange of matters, circulation of blood, motive function, discords of other systems. General reactivity of organism which results in worsening of regenerator ability of fabrics goes down because of these changes, including by a bone.

The tasks of medical physical education it is been:

1. Influence on the common state of patient. Physical exercises promote physiological ability of organism, render assistance renewal of the affected functions of organism, there is normalization of function of pelvic organs.

2. To render assistance the best consolidation of the damaged bones.

3. To fix the special exercises muscles, which are involved at standing, walking and maintenance of pelvic ring in proof position.

With the purpose of weakening of muscles the pelvis of patient needs to lay on the back on a shield with a mattress; under knee-joints underlay a roller, due to what knee and hip joints are in slightly arcuated position, and the muscles of pelvic belt are weakened. At the break of symphysis it is necessary to put thighs parallel, at other breaks of pelvis of thigh something dilute.

In the case of difficult breaks of pelvis and divergence of отломков it is necessary to impose the belt of Gil'ferdinga. The belt of Gil'ferdinga is raised by a pelvis and renders assistance rapprochement of fragment; thus necessarily, that both legs were half-bent on the tires of Brauna. It renders assistance weakening of muscles of pelvic ring, facilitates implementation of exercises.

A gymnastics is begun in 3-5 days from the beginning of treatment. At the damage of organs small the pelvis of setting of medical physical education concernes the state of the damaged organs.

Engaged in a gymnastics at breaks it is divided a pelvis into three periods: two periods lying and one standing.

And a period (10-14 days) is energetic exercises for the muscles of humeral belt and trunk; very careful easy motions by feet, thighs at employments remain on a roller, motions are executed with support.

General tasks:

- increase of vital tone of patient;

- prophylaxis of complications from the side of cardiovascular, respiratory systems, gastroenteric highway;

- improvement of processes of exchanges.

Special tasks:

- improvement of circulation of blood in area of damage with the purpose of activation of processes of regeneration;

- warning of decline of force and endurance of muscles of pelvic belt and endings, to rigidity in joints.

In early terms after a trauma patients must capture the pectoral type of breathing, it is related to тем, that a diaphragm excursion at other types of breathing promotes intra-abdominal pressure, which can provoke the origin of pain syndrome, bleeding in place of trauma (table 39, 40).

II period – patients continue an energetic gymnastics for the muscles of hands and trunk; motion feet, but unsupported by a roller thighs. In this period it is let patients to lie on a stomach and execute a medical gymnastics from initial position lying on a stomach (table 41).

Task of MPE:

- strengthening of muscles of trunk, endings and pelvic belt;

- multiplying motions is in joints;

- training of supporting function of the lower endings.

III period - begins from the moment of rising.

Task of MPE:

- renewal of function of the lower endings, skills of walking, correct build;

- strengthening of muscles of trunk, pelvic belt, endings;

- renewal of supporting function of the lower endings;

- multiplying amplitude of motions is in joints, especially in hip.

FIRST PERIOD.

Table 39

I. Exercises for hands.

Execute a press for strengthening of muscles of abdominal, slanting muscles of trunk, muscles of the back and humeral belt. These exercises conduct treatments during all course.

№	Initial position		Account			Description of exercise		Dosage (number of retry)		Pointing
1		Lying on the back. Feet on a roller. Hands along a trunk		1 2 3	To take hands at a side is inhalation To lift ahead To drop downward is exhalation		3-4		To execute after 5-6 with a 1 exercise
2		Lying on the back. Hands at the side of brush are compressed in a fist		1-2 3-4	Slowly with tension to bend hands in the joints of elbows, bringing brushes over to the shoulders is exhalation. Freely to divorce hands - inhalation		4-5		A rate is slow
3		Lying on the back, hands along a trunk, elbow and brush lines, finger together		1-7 8 9-16	To heave up hands at a side - uphill with a simultaneous appeal around a longitudinal axis A cotton is in a palm With an appeal on an axis to drop hands downward		3-4		A rate is slow
4		Lying on the back, hands along a trunk		1-2 3-4 5-8	To take hands and return a chapter to the right is inhalation I.P. it is exhalation The same to the left		2-4		A rate is slow
5		Lying on the back. Hands at a side, arcuated in the joints of elbows		1-4 5-8	Circular motions by shoulders ahead Circular motions by shoulders back		3-4		5-6 with on one the circle
6		Lying on the back. Direct hands at a side		1-4 5-8	Small circular motions by hands ahead, straining the muscles of the back and shoulder-blades The same back		3-4		One the circle after 2-3 with
7		Lying on the back. Hands are arcuated in the joints of elbows, brush in a fist		1-2 3-4 5-8	Turn of trunk by a right shoulder ahead, simultaneously to fish out a right arm ahead is exhalation I.P. it is inhalation It exactly with a counter-clockwise shoulder and left arm		2-3  by every hand		Rate: 4-5 with on a 1 motion
8		Lying on the back. Hands are arcuated in the joints of elbows, впираются in a bed, finger in a fist		1-3 4-6	Bending of breast ahead with support on an elbow and shoulders are inhalation I.P. it is exhalation		3-4		Rate: one the motion after 5-6 with
9		Lying on the back. Hands are arcuated in the joints of elbows, something taken от a trunk. Feet are arcuated in knee and hip  joints, feet stand near a roller, something placed		1-2 3-4	To heave up a pelvis, впираясь in a bed a chapter, shoulders, elbows and feet I.P.		4-5		1 подъем 5-6 with
10		Lying on the back. Hands along a trunk		1-2 3-4 5-8	Rising trunks a scythe by a right shoulder ahead, a right arm stretches in the direction of counter-clockwise knee; to lean against a counter-clockwise elbow - exhalation I.P. it is inhalation The same for a counter-clockwise shoulder and left arm		2-3  by every hand		A rate is slow
11		Lying on the back. Hands along a trunk		1-2 3-4 5-8	To bend a trunk in left. The left arm slides downward, I.P. It exactly in a right side		2-3 flexion in every side		A rate is slow

Table 40

II. Exercises foot

№	Initial position		Account				Description of exercise		Dosage (number of retry)		Pointing
1		Lying on the back. Hands on thighs, feet on a roller, something dilute				Back unbending feet Later this exercise is united with bending of hands in the joints of elbows Exercise strengthens the muscles-extensors of shin		7-5		A rate is middle. To hold feet perpendicularly to the axis of feet
2		Lying on the back				Bending of fingers of leg		6		A rate is middle
3		Lying on the back				Tension of muscles of leg, not changing its position		3-4		Foot of perpendicularly to the axis of leg: tension after 15 with
4		Lying on the back		1 2 3-4		To bend a right foot in knee and hip joints, not tearing away a heel from a bed I.P. It exactly for a counter-clockwise leg		7-12  by every leg		A rate is slow
5		Lying on the back. Feet are arcuated, drag heels to the roller, feet are the feet placed on length		1-2 3-4		To divorce knees To take knees
At first this exercise is executed as a waggle of leg is in a thurl. At the break of symphysis execute the waggle of feet only, later with small resistance. Complete breeding of thigh not rotined. At weak and pains motions exercises execute  every leg separately, gradually passing to motions two feet, multiply the volume of motions. When motions will become sure and not pains, the то breeding of feet is executed with resistance.
6		Lying on the back. Feet are arcuated, heels drag to the roller			1-2 3-4 5-8	To take a counter-clockwise leg to the edge of bed. A foot does not unstuck от a bed, at motion gradually to move toe heel I.P. It exactly for a right foot		3-4 by every leg		A rate is slow
7		Lying on the back. Hands on thighs			1 2 3-4	To straighten a counter-clockwise leg in a knee-joint, a shin rises to the level of roller I.P. It exactly for a right foot		3-4  by every leg		6-7 after 15 with

SECOND PERIOD.

Table 41

Exercises foot

№	Initial position				Account								Description of exercise				Dosage (number of retry)				Pointing
1		Lying on the back, hands on thighs				1 2 3-4 5-8				To straighten a right foot To take a right foot aside I.P. It exactly for a counter-clockwise leg				3-4  by every leg				Rate 4-5 with on one the motion
2		Lying on the back, hands on thighs				1 2 3 4 5-8				To bend a right foot in a knee and hip joint To straighten a leg To lift up To drop a leg It exactly for a counter-clockwise leg				5-6 for every leg				Rate 5-6 with for every leg
3		Lying on the back. Hands on thighs, feet lines, feet are dilute on the width of shoulders, feet on itself								Appeal of all leg on a longitudinal axis. Feet during an extorsion affect a bed an external edge, at a turn deep into by an internal edge. Feet remain direct and not distracted от a bed				5-6				Rate of turn 3-4 with
4		Lying on the back				1 2 3 4 5 6-10				To heave up an arcuated counter-clockwise leg To straighten in a knee-joint To take aside To lead To put into initial position It exactly for a right foot				3-4 by every leg				A rate is middle
5		Lying on the back				1-3 4-6 7-10				To heave up a direct right foot I.P. It exactly for a counter-clockwise leg				5-6 by every leg				A rate is middle
6		Lying on the back, hands on thighs, feet are something separated				1-2 3-4				To heave up both direct legs I.P.				3-4				Rate 3-4 with on a 1 motion
7		Lying on the back, hands on thighs, feet are something of separated				1 2 3 4 5-8				To take a counter-clockwise leg to the left To take a counter-clockwise leg to the right, on decussatio with a right foot To take to the left I.P. It exactly for a right foot				2-3				A rate is middle
8		Lying on the back, hands on thighs, feet of separated				1 2 3-4				To bend feet in knee and hip joints To pull at knees on a stomach I.P.				3-4				A rate is middle
9		Lying on the back, hands on thighs, feet are something of separated				1 2 3-4 5 6				To bend feet in knee and hip joints To pull at knees on a stomach To divorce straighten feet at a side To take feet To put on a bed				2-3				Rate: 4-5 with on all motions
		Taking into account the site of fracture, common state of patient, in 3-5 weeks it is settled to lie on a stomach. Because does not yet recommend to sit down, a turn on a stomach is executed because at the breaks of spine: a patient lies on verge of bed, by a hand which from an edge grasps at the main end of bed and rolled on a stomach. Hand that near the middle of bed must be extracted along a body.
10		Lying on a stomach. Hands are arcuated in the joints of elbows, forearm and brush parallel edges of bed, feet lines, feet at right angles to the axis of leg, socks prop in a bed					1-2 3-4 5-6			To strain and straighten knee-joints To strain all leg I.P.				5-8				A rate is middle
11		It exactly					1 2 3-4			To heave up a direct right foot upwards I.P. It exactly for a counter-clockwise leg				4-5 by every leg				A rate is middle. Breathing and rest after of every motion
12			It exactly					1-2 3-4			To heave up two legs upwards I.P.				3-4				A rate is middle. Breathing and rest after of every motion
13				It exactly					1 2 3-4			To take a counter-clockwise leg I.P. To take a right foot				3-4				Rate 2-3 with on a 1 motion
14				Lying on a stomach with support on a forearm and brush					1 2			To heave up a pelvis I.P.				4-5				Rate 5 with on 1 a way up
15				Lying on a stomach. Hands are arcuated in elbows, a forearm is parallel to the edge of bed, brushes a little under shoulders level					1-4 5-8			Complete raising a pelvis: at bending in knee and hip joints trunk of replace back, a breast did not almost unstuck от a bed, hands are unbended in the joints of elbows I.P.

Patients with the break of pelvis are in bed от 3 weeks (breaks without displacement and one-sided) to 2-3 months (breaks with displacement and bilateral).

After rising of patients with them conduct a medical gymnastics standing, continue a gymnastics lying. Give exercise on strengthening of muscles feet, shins, all leg, squat and inclinations of trunk.

Success of treatment of surgical patients depends not only on the technique of implementation of operation but also from preoperative preparation of patient, flowing of postoperative period.

Expectation of operation, fear for its consequences unfavorably influence on the mental condition of patient. It results in loosening protective forces of organism.

Hypodynamia, conditioned the stay of patient in station to the operation, after an operation assistance the decline of general vital tone of patient is rendered limitation of motive activity. Hereupon cardiovascular function worse, respiratory, grassy, endocrine and other systems. Anaesthetizing anesthesia also predetermines functional discords of organism. Unfavorably influences on patient and trauma because of operation - from there strong irritants operate on CNS.

 In an early postoperative period there is pain in a postoperative wound which results in the superficial pectoral type of breathing. Therefore there can be stagnation in lights, a sputum which heavily clears one's the throat through pain and decline of tussive reflex accumulates in respiratory tracts.

Considerable changes take place in a gastroenteric highway. A relaxation is slowed, gasification increases, which are caused by pain. It can cause an enteroplegia with the proper consequences. There can be an anuria. Activity of ductless and exchange of matters glands rises.

Because of surgical interference there is insufficiency of oxidizing processes on the severe bed mode. Coverage of power expenses is here carried out due to not comfortable for an organism anaerobic reactions. Application of physical exercises, activating the aerobic phase of exchange, diminishes inferiority of oxidizing processes.

The mechanisms of trophic action of physical exercises are used for stimulation of regeneration and regeneration hypertrophy of fabrics, damaged during operative interference. Activation of regeneration of the damaged skin, hypoderm, aponeurosis, fascias and muscles provided the improvement of circulation of blood and dosed functional irritations at the proper selection of physical exercises.

Choosing physical exercises it is necessary to take into account operating of contracting muscles on aponeurosis which is their case. In first case of reduction direct the muscle of stomach renders assistance weakening of his aponeurosis, in to the second, at reduction external slanting the muscle of stomach  aponeurosis functionally will play the role of tendon and sipping are loadings, which positively operates on his regeneration.

Very well physical exercises influence on the regeneration of the fabrics of stomach, intestine, liver, gall-bladder and other organs damaged during an operation.

Setting of norms of functions, conditioned medical application of physical exercises after operative interference on the organs of pectoral and abdominal emptiness behaves foremost to the organs of breathing. The special respiratory exercises and conscious adjusting of breathing mechanism are given by possibility in an early postoperative period to recover the affected mechanism of breathing, considerably to improve pulmonary ventilation, recover the draining function of bronchial tubes. Most effective these actions at the operative cuts of lower half of abdominal wall and at renewal of functions of intestine. Under influence of direct irritation of receptors of intestine by exercises, that is mixed and carry out the massage of loops of bowels, due to the mechanism of reflexes of viscero-motors activates and normalized peristalsis, flatulence and atony of intestine diminishes, the output of gastric content is accelerated in an intestine, going of gases is improved, that diminishes flatulence, renders assistance the normal defecating.

Physical exercises render assistance: thermoregulation, normalizations of homoeostasis, to renewal of tone of muscles of abdominal press, participating of front abdominal wall in the act of breathing, cough, to the language and other

MPE is an effective method in the holiatry of surgical patients in to перед- and postoperative periods.

Medical physical education is divided into  periods:

1. Preoperative (for the planned patients)

2. Early postoperative:

a) from the first clock after an operation to the seat;

b) rising;

c) taking out all stitches.

3. Late postoperative - to excerption from permanent establishment.

4. Remote postoperative - to convalescences.

Task of postoperative gymnastics:

1. Psychotherapy influence, creation of positive emotional background for preoperative preparation, confidence in positive investigation of operative interference, distraction от the unpleasant experiencing.

2. Improvement of higher mechanisms of regulators of CNS.

3. Common strengthening of organism, increase of force and endurance.

4. Activation of circulation of blood and breathing, liquidation of the stagnant phenomena and hypoxia.

5. To prepare the operating field: increase of local circulation of blood, lymph-circulation, exchange of matters, strengthening of muscles, increase of elasticity of skin.

6. Education of skills of adjusting of mental condition and breathing.

7. Loosening influence of the pathological phenomena.

8. To teach physical and respiratory drills which will be executed in the first days after an operation.

Testimonies to setting of preoperative gymnastics:

Hernia. Chronic cholecystitis. Appendicism. Ulcerous illness to the stomach and duodenum bowels. Partial intestinal impassability at glutineus illness. Bronchiectatic illness. Diverticulum, burns of gullet.

Contra-indication to setting of preoperative gymnastics:

Threat of origin of bleeding or perforation.

High temperature of body.

Grave common condition.

Festerings processes.

Intoxication.

Features of method:

1. Moderation of the physical loadings.

2. Simplicity and availability is implementation of physical and respiratory drills from simple initial positions: lying, sitting.

3. Use at to basic medical and morning sanitary gymnastics.

4. Implementation of bracing and special physical exercises for:

a) activations of circulation of blood and laxation;

b) normalizations of function of the damaged organ;

c) preparations of the operating field.

Main principle is not to overload and not overstrain a patient.

What quick rational preparation will begin to the operation - the best and greater effect от the use of physical exercises will be in a postoperative period.

A preoperative gymnastics is conducted in the cabinet of MPE of policlinic, later than hospital (table 42, 43).

Table 42

STANDARD complex of exercises of medical gymnastics in preoperative period

№	Initial position		Account			Description of exercise		Dosage (number of retry)		Pointing
1		Sitting is a right arm on a breast, counter-clockwise on a stomach			Quiet not forced breathing		4-6		On inhalation a thorax and stomach rise, on exhalation go down
2		Sitting, leaning back on the back of arm-chair, hands on thighs			Clench and unlocking fingers		8-10		A rate is slow
3		Sitting, hands on a belt		1 2-4 3	To heave up a right sock and counter-clockwise heel I.P. To heave up a counter-clockwise sock and right heel		8-10		A rate is slow. Breathing is arbitrary
4		Sitting are brushes to the shoulders		1-4 5-8	Appeal in humeral joints ahead Appeal in humeral joints back		For 4		Breathing is arbitrary
5		Sitting. Hands are lower		1 2	Returning hands upwards to divorce hands at a side is inhalation I.P. it is exhalation		4-6		A rate is slow
6		Sitting. Hands on a belt		1 2 3-4	To fish out a counter-clockwise leg ahead, not tearing away feet от a floor I.P. It exactly for a right foot		For 4		A rate is middle
7		Sitting. Supported arm-chairs on the back, hands on a thorax on each side			Quiet abdominal type of breathing, on exhalation vigorously to pull in an abdominal wall, it is soft to conduct spitting		4-6
8		Sitting on verge of arm-chair, hand on a belt		1 2 3-4	Turn of trunk to the right with the simultaneous taking of right arm aside is inhalation I.P. it is exhalation It exactly to the left		For 4		A rate is slow
9		Sitting. Supported arm-chairs on the back, hands are lower		1-2 3-4 5-8	Brace a counter-clockwise knee hands, slowly to pin against a stomach is exhalation I.P. it is inhalation The same for a right knee		For 4		A rate is slow
10		Sitting. Supported arm-chairs on the back, hands on a thorax on each side			Quiet abdominal type of breathing, on exhalation vigorously to pull in an abdominal wall, it is soft to conduct spitting		4-6		A rate is slow
11		Sitting. Hands are lower		1 2 3-4	Inclination of trunk to the right is exhalation I.P. it is inhalation The same to the left		For 4		A rate is slow
12		Sitting. To bend hands in cubital joints		1-4 5-8	Appeal brushes after a hour-hand Anticlockwise		For 4		A rate is middle
13		Sitting. Leg on a leg		1-4 5-8	Appeal of feet after a hour-hand Anticlockwise		For 8		Tepm middle
14		Sitting. Supported on the back of arm-chair. Right arm on a breast, counter-clockwise on a stomach			Complete quiet breathing		4-6		Exhalation with general relaxation

At operations concerning the chronic festerings diseases of lights in a preoperative period it is necessary to use drainage exercises which render assistance the delete of festering sputum. Initial position for draining must be such, that an area of patient of lung was higher draining bronchial tube. Then a sputum will get in a main bronchial tube, from there to branching of trachea. Here most sensitiveness of tussive reflex. It causes an energetic cough with discharge of sputum.

Drainage exercises:

a) for the overhead stake of right lung:

initial position sitting on an arm-chair; to incline a trunk with a simultaneous sinistrogyration, to heave up a right arm - inhalation. Through 30 with with appearance of cough on exhalation, coughing, to incline a trunk ahead, getting the fingers of hands of floor. Coughing, in such position to stay too long on a few seconds. A methodist presently presses synchronously with tussive shoves on overhead part of thorax.

b) for the middle stake of lung:

initial position sitting on a couch, a main end is lower on 20-30(. In a slow rate fully to unbend a trunk back. A methodist carries out easy pressure on the middle surface of thorax. Breathing out and coughing, a patient returns a trunk to the left and ahead. Rising from a couch, to lean forward, getting the hands of foot. During a forerake a sputum is selected. During coughing a methodist presses in the area of middle fate (anterolateral surface of thorax) synchronously with tussive shoves. A phase of rest of 0,5-1 and reiteration of exercise is 3-4 times after it.

c) for the front segments of middle stake of right lung:

Initial position lying on the back with the lower main end of bed (couches) on 40 see To divorce hands at a side, inhalation and on exhalation to the right half of thorax to pull up a right foot, arcuated in knee and hip joints. A patient remains in this position to 30 with and coughs.

d) for the lower stake of right lung:

1. initial position lying on left, the main end of bed is lower. A right arm on inspiration goes up, on expiration with coughing of patient of push synchronously with a cough on the lateral and lower  departments of thorax. A methodist presently  carries out the easy pattering in the posterior-anterior department of thorax between shoulder-blades;

2. initial position lying on left, the main end of bed is lower. To divorce hands at a side is inhalation. On exhalation, coughing to pull up a right foot, arcuated in knee and hip joints, to the thorax;

3. initial position sitting on an arm-chair or standing. On exhalation slowly to incline a trunk ahead, getting a right arm the sock of counter-clockwise leg.

e) at to bilateral damage bronchial tubes:

initial position support standing on knees. From this position on exhalation to drop overhead part of trunk, bending hands, and to heave up a pelvis as possible higher (imitation of creeping). At the end of exhalation is coughing. To go back into initial position - inhalation.

For multiplying diaphragm mobility, increases of tone of muscles abdominal press and intercostal muscles:

initial position sitting on an arm-chair, feet lines, feet affect a floor. To heave up hand up is inhalation; on slow exhalation to do a forerake, coughing, to affect tiptoes hands.

For the best effect the described exercises can be executed with objects (sacs with sand 1,5-2 kg, dumb-bell, mace).

Table 43

STANDARD complex of exercises of medical gymnastics for patients with a festering process in lights

№	Initial position		Account		Description of exercise			Dosage (number of retry)		Pointing
1		Sitting, hands are lower				Ordinary walking	2 minutes		A rate is middle
2		Sitting, hands are lower		1-2 3-4		Walking with motion of hands Hands at a side - inhalation To drop hands is exhalation	2 minutes		Motions of hands on exhalation in a slow rate
3		Standing, hands on thighs		1-4 5-8		Walking on socks Walking on heels	2 minutes		A rate is middle. To watch after a carriage
4		Standing, hands are lower		1-2 3-5		Walking with motion of hands Hands for a chapter are inhalation To drop hands - exhalation	1 minutes		A rate is middle
5		Standing, one hand on a stomach, second on a breast				Complete quiet breathing with the lengthened exhalation and spitting	4-5		To control the hands of motion a breast and stomach.
6		Standing, feet on the width of shoulders, hands before a breast		1 2 3-4		A turn of trunk is to the right with breeding of hands is inhalation I.P. it is exhalation The same to the left	For 4-6 in every side		A rate is slow
7		Standing, hands on a belt		1-2 3-5		To rise on socks is inhalation The slow squat is exhalation	4-6		A rate is slow. With pauses for rest
8		Standing, brushes on the lateral surface of thorax				Pectoral breathing with spitting on exhalation	4-6		On exhalation to squeeze a thorax
9		Standing, hands are lower, finger compressed in a fist		1 2		Right arm upwards, counter-clockwise back Left arm upwards, right back	8-10		A rate is middle, hands lines, not to detain breathing
10		Standing, hands are lower. There is a gymnastic stick in hands		1 2 3-4		Hand up, right foot back on a sock - inhalation I.P. it is exhalation The same for a counter-clockwise leg	For 4 by every leg		A rate is middle
11		Standing, hands with gymnastic ardent before itself		1 2 3-4		To incline a corps ahead with the simultaneous raising of counter-clockwise leg and capture by a stick for a knee, to cough I.P. It exactly for a right foot	For 4 by every leg		A rate is middle. Bending of corps of -expiration, straightening of -insparetion
12		Standing, hands with gymnastic ardent above a chapter		1 2 3-4		To incline a corps to the right I.P. The same to the left	For 6  in every side		A rate is middle. Breathing is arbitrary
13		Standing with medical ball weighing 2 kg				Throwing of medical ball on a circle, veering	1 minutes		With pauses for rest
14		Standing with medical ball weighing 2 kg				Transmission of medical ball from a chapter through a side	2 minutes		With pauses for rest
15		Standing, feet on the width of shoulders. Hands on a breast				Complete quiet breathing with spitting	4-5		With the lengthened exhalation
16		Standing, hands on a belt		1 2-4 3		To walk up socks I.P. To walk up heels	8-10		A rate is middle
17		Standing, brushes to the shoulders		1 2-3		To take elbows at a side is inhalation I.P. it is exhalation	4-5		A rate is middle
18		Standing, hands are lower				To weaken the overhead endings and humeral belt	2-3		Relaxation to combine with exhalation
19		Standing, one hand on a breast, second on a stomach				Deep complete breathing	4-5		Hands controlling raising of breast and stomach

Task of postoperative gymnastics.

1. Normalization of psychical and nervous processes of higher mechanisms of regulators of CNS.

2. Activation of breathing, circulations of blood, digestion, liquidation of the stagnant phenomena (in lights, lower endings, spoiling).

3. Acceleration of scarring of postoperative wound, assistance forming of valuable scar.

4. Increase of functional possibilities of organism, force, endurance.

5. Preparation to rising, works, employments by a physical culture and sport.

6. Normalization of carriage.

7. Facilitation of alteration of organism, diminishing of pathological rejections, conditioned operative interference.

Contra-indications to setting of MPE.

Grave common condition at a sepsis, peritonitis, after the considerable loss of blood.

Threat of bleeding.

Sharp thrombophlebitis

Postoperative pneumonia is a show to setting of simple physical drills, even at a temperature to 38,5 P.

Simple gymnastic, and especially respiratory exercises can be appointed after an operation through 2 ÷ at the local anaesthetizing and through 4 ÷ - at general.

Features of method.

1. Simplicity and availability is implementation of rational bracing and special physical drills at first from initial position lying on the back, later sitting and standing.

2. Large value of respiratory exercises in the first days after an operation.

3. Gradual, but permanent complication of method and multiplying the physical loading every day (if the state of patient is improved).

4. Preparation of patient to the seat, rising, work, engaged in a physical culture and sport.

Priyomy of fixing of thorax in area of postoperative wound for the best spitting of sputum

In a postoperative period execute  respiratory and special physical drills (table 44, 45, 46).

Respiratory:

1. Deep, and after diminishing of pain is the deep breathing at peace.

2. Deep, and more late deep breathing with motions of hands which extend a thorax.

3. Blowing on the suspended objects: rubber marble, thread-papers, blowing of letters of notebook, books, inflation of marbles of rubbers.

4. Pronunciation of sounds, compositions on exhalation.

Physical drills:

1. For the operating field (for example, after appendectomy is bending and uplift of right foot, thrusting out and involvement of front abdominal wall).

2. For the acceleration of circulation of blood in the respiratory departments of feet with the purpose of prophylaxis of thrombophlebitis.

3. For strengthening of laxation, liquidation of atony.

4. For normalization of uropoiesis.

5. Corrective of exercise for the improvement of carriage.

6. For the stretch of connections.

Preparation to rising consists in:

a) increase of force and endurance at implementation of bracing physical drills without objects and with gymnastic ardent, by dumb-bells, medical ball;

b) strengthening of ligamental vehicle feet, muscles of feet, muscular corset (mainly the extensors  backs);

c) improvement of co-ordination of motions and equilibrium;

d) adaptations of circulation of blood to the change of position of body;

During the leadthrough of medical gymnastics use auxiliary receptions: pinning of wound a hand at implementation of physical exercises; implementation of physical drills with arcuated feet - the muscles of abdominal wall are not strained.

In an early period after an operation on a thorax carry out careful pressure on a front abdominal wall is renders assistance discharge and spitting of sputum, normalizes a breathing rhythm.

Diaphragmalis breathing the overcoming of resistance of hands of instructor

Table 44

STANDARD complex of exercises of postoperative gymnastics

(after an operation on a stomach, biliary  bubble on 2-8 day after an operation)

№

Initial position

Account

Description of exercise

Dosage (number of retry)

Pointing

1

Lying, hands along a trunk

Quiet breathing with the lengthened exhalation

4-5

Without strenuous

2

Lying, hands along a trunk

1 2

At the same time to squeeze fingers in a fist and heave up socks I.P.

8-10

A rate is middle. Breathing is arbitrary

3

Lying, hands along a trunk

1 2 3-4

To bend a counter-clockwise leg in knee and hip joints, not tearing away a foot от a bed I.P. The same by a right foot

For 2-3

A rate is slow

4

Lying, feet are half-bent

The quiet breathing is primary due to the muscles of stomach

4-5

A rate is middle

5

Lying, feet on the width of shoulders

1 2-4 3

To return feet deep into I.P. To return feet outside

4-6

A rate is middle. Feet are lines, breathing  arbitrary

6

Lying, впереться elbows on a bed

1 2

To bend in the pectoral department of spine is inhalation I.P.- exhalation

4-5

A rate is slow

7

Lying, hands along a trunk

1 2

To bend hands in elbows and brushes I.P.

6-8

A rate is middle. Breathing is arbitrary

8

Lying, feet and hands are arcuated, by the feet die on a bed

1 2

To raise a pelvis - inhalation I.P. it is exhalation

3-4

A rate is slow. Without strenuous

9

Lying, hands along a trunk

1 2 3-4

A turn of trunk is to the right through a hand is exhalation I.P. it is inhalation The same to the left

2-3  in every side

A rate is slow. Without strain

10

Lying, brushes to the shoulders

1-4 5-8

Revolved motions in humeral joints ahead The same back

4-6 in every side

A rate is middle. Breathing is arbitrary

11

Lying, hands along a trunk

1 2-4 3

Turn of chapter to the right I.P. Sinistrogyration of chapter

For 5 In each side

A rate is middle. Breathing is arbitrary

12

Lying, hands along a trunk

Quiet complete breathing

1 minutes

Table 45

STANDARD complex of exercises of postoperative gymnastics

(3-5 days after an operation)

№	Initial position		Account			Description of exercise		Dosage (number of retry)		Pointing
1		Lying on the back, hands along a trunk		1 2	Hands at a side - inhalation I.P. it is exhalation		4-5		A rate is slow
2		Lying on the back, hands along a trunk		1 2 3-4	To bend a right foot in a knee and hip joint, not tearing away a foot от a bed is exhalation I.P. it is inhalation The same for a counter-clockwise leg		3-4		A rate is slow
3		Lying on the back, hands along a trunk		1 2	At the same time to bend hands in elbows and feet in talocrural joints I.P.		8-10		A rate is middle, breathing is arbitrary
4		Lying, and later standing. Feet on the width of foot			Quiet pectoral breathing		4-5		Exhalation is longer for inhalation
5		Lying, hands and feet are arcuated		1 2	Hand back elbows and feet to raise a pelvis - inhalation I.P. it is exhalation		4-5		A rate is slow, not to detain breathing
6		Lying, and later standing. Feet on the width of foot		1 2 3 4 5	To return toward an operating wound (e.g. after appendectomy): to bend a counter-clockwise leg, die by her and to return a right arm on a right side to bend a right foot, balk the left arm ahead and by the elbow of right arm, to sit down Die hands in the edge of bed, to get up Standing to divorce shoulders - inhalation To weaken shoulders - exhalation		4-5		A rate is slow, with stopping and rest for a right side, then sitting
7		Standing, feet on the width of shoulders, hands on a belt		1 2 3-4	Hands at a side, turn of trunk to the right is exhalation I.P. it is exhalation The same to the left		3-4 in every side		A rate is slow
8		Sitting on an arm-chair, brush to the shoulders		1 2	To divorce elbows at a side, to bend is inhalation I.P. it is exhalation		4-5		A rate is slow
9		Sitting on an arm-chair, hands are lower			Clench and unclenching of fingers of hands with a next joggle brushes		8-10		A rate is middle
10		Lying, hands along a body			Complete quiet breathing		4-6		Transition at position lying quietly with support on hands

Table 46

STANDARD complex of exercises of postoperative gymnastics

(10-14 day after an operation)

№

Initial position

Account

Description of exercise

Dosage (number of retry)

Pointing

1

Standing near an arm-chair sideways

Walking in place with support by a hand on the back of arm-chair

30 with

To watch after a carriage

2

Standing, feet on the width of shoulders, hands are lower

1 2

To divorce hands at a side is inhalation I.P. it is exhalation

4-5

A rate is middle

3

Standing, hands on thighs

Walking on a hall with the high raising of thigh

30 with

A rate is slow, breathing is arbitrary

4

Standing, hands to the shoulders

1-4 5-8

Turns in humeral joints ahead The same back

For 4-6

A rate is middle, not to detain breathing

5

Standing, hands on a belt

1 2

To take elbows back, to try to take shoulder-blades - inhalation I.P. it is exhalation

4-5

A rate is middle

6

Standing, feet on the width of shoulders, hands are lower

1 2

Forerake of trunk is exhalation To bend back is inhalation

4-6

Exhalation is lengthened with spitting

7

Standing with the printed ball

Shifting of the printed ball from one hand in other with taking of the extracted hand aside

3 by every hand

Breathing is arbitrary

8

Standing, one hand on a breast, second on a stomach

Quiet complete breathing with spitting on exhalation

4-5

Expiration, hands are controlled by motions of breast and stomach

9

Standing a person to the partner

Throws of the printed ball from a breast  to the partner

30 with

Breathing is arbitrary

10

Standing, hands are lower

1-3 4-7

Walking in place Inhalation Exhalation

25 with

To watch after a carriage

11

Sitting, counter-clockwise leg on right one

1-4 5-8 9-16

Revolved motions by a counter-clockwise foot after a hour-hand Anticlockwise The same for a right foot

For 4 in every side

A rate is middle, amplitude of maximally

12

Sitting, hands are lower

Clench and unclenching of fingers with a next joggle brushes

8-10

A rate is middle

13

Sitting, one hand on a stomach, second on a breast

Quiet complete breathing

4-5

Hands are controlled by motions of breast and stomach

Method of medical physical education at operations on the organs of pectoral and abdominal emptiness something differs (table 47).

Table 47

Features of method of MPE at operations on organs:
to the pectoral cavity	to the abdominal region
preoperative period
To train the abdominal type of breathing	To train the pectoral type of breathing. Breathing must be rare and deep
early postoperative period
To employments begin in the first clock after an operation, when the action of anesthesia is closed - execute respiratory exercises, spitting. Use the abdominal type of breathing Execute motion the fingers of radiocarpal, joints of elbows, talocrural, to neck department of spine (turns of head, in genicular та thurls)	To employments begin the next day Use the pectoral type of breathing The same except for motions in knee and hip joints
Exercises repeat 5-8 in shallow joints, in middle and large – 4-6. On 2-3 days for all joints and arm, but
limit motions in a humeral joint on the side of operative interference (incomplete amplitude by an arcuated in an elbow joint hand) The rate of implementation of exercises is slow, exercises for a trunk	limit loading on the muscles of abdominal press execute with incomplete amplitude of motion feet, footsteps from bed does not tear away
Position sitting entered:
operations on lights and heart is 7-th day	appendectomy is 1-st day, operation on an occasion keels – 4-5 day, resection to the stomach 4-7 day
Position standing entered:
operation on lights - 7-10 day, on a heart - 8-14 day	appendectomy – 2-6 day, on an occasion keels – 8-10 day, resections to the stomach – 6-8 day, cholecystectomy – 7-12 day
Late postoperative period
Exercises for all muscular groups, amplitude is gradually multiplied to complete. Employments are conducted in the cabinet of MPE. Use exercises with objects (gymnastic sticks, dumb-bells, medical ball) and on shells (gymnastic wall, bench), exercise on renewal of correct carriage, different types of walking. Exercises repeat 10-12 times. Duration of employments to 20-25 minutes Main task:
strengthening of muscles of trunk, renewal of movable in a humeral joint on the operated side.	strengthening of muscles of stomach, to warn formation of connections, acceleration of regeneration of fabric in place of cut