Physical therapy and rehabilitation

What is physical therapy and rehabilitation?

Physical therapy and rehabilitation is a specialty that aims to improve the quality of life and functional status of people after brain, spinal cord, nerves, bone, joint, muscle, ligament diseases or injuries. Physical therapy and rehabilitation is responsible for the non-operative treatment of musculoskeletal diseases. It does this through methods such as exercise, medication, physical therapy, orthotics prescribing, injections. Physical therapy refers to the treatment of diseases with the use of physical phenomena such as heat (hot-cold), sound (ultrasound), light (laser), water (hydrotherapy), electromagnetism (TENS, magnetic field treatments), force ( traction , massage). The history of physical therapy is as old as medicine.

Goals of physical therapy

Although it varies from patient to patient, physical therapy applications can be done for the following purposes:

  • Ensuring that the joints can move at their normal range of motion
  • muscle strengthening
  • Providing joint stability
  • Providing muscle flexibility
  • Ensuring independence in activities of daily living
  • Restoring functional skills lost due to any disease
  • Increasing walking distance and mobility
  • Improving overall health, helping a person realize their maximum potential

Benefits of physical therapy

Although it varies according to the purpose of treatment, physical therapy can provide the following benefits:

  • Reduction in pain, decreased need for pain medication
  • Eliminate or delay the need for surgery
  • Increasing movement and functionality
  • Post-injury treatment
  • Returning to normal life after surgery
  • Treatment of strokes due to stroke, brain injury or spinal cord injury
  • Preventing falls, improving balance
  • Treatment of age-related problems such as muscle wasting, joint stiffness, osteoporosis

Devices used in physical therapy

Some devices used in physical therapy

Electrotherapy: It provides benefits such as reducing pain and preventing muscle wasting, according to the principle of stimulating nerves or muscles with electrical currents given by electrodes placed on the skin.

Ultrasound: Using sound waves, effects such as heating effect in deep tissues, increase in cell membrane permeability, modulation of the activity of immune system cells can be achieved. It can help deliver certain drugs through the skin (phonophoresis).

Shortwave diathermy: Deep tissues can be heated by using electromagnetic waves at specially selected frequencies.

Microwave diathermy: Its working principle is similar to short wave diathermy, the wavelengths used are different.

Magnetic field therapy: It is accepted that it provides healing in tissues with magnetism.

Laser: Low-power lasers, also called cold lasers, can have pain-relieving, wound-healing, and cell metabolism-increasing effects. It is used for wounds on the skin surface and problems such as near-surface enthesitis and epicondylitis.

Traction: The stress on the discs between the spine bones can be reduced by applying mechanical pulling force with special devices in lumbar and neck hernia.

Water treatments (hydrotherapy): Water has been used for therapeutic purposes throughout history, it is one of the oldest physical therapy applications. In addition to passive treatments such as hot baths and whirlpool baths, there are also water treatments in the treatment pools where the patient participates actively by exercising. The buoyancy of the water reduces the load on the joints and makes people with muscle weakness feel more comfortable than on land.

Hot and cold treatments: Perhaps the most widely used physical therapy methods are hot and cold applications. Cold application reduces edema, inflammation and pain. Muscle stiffness, called spasticity, can also be reduced by cold therapy. Hot therapy stretches muscles and ligaments, relieves muscle spasm, reduces pain, increases circulation. Tools such as coldpack, hotpack, infrared can be used.

Orthoses and prostheses: Orthoses are assistive devices worn on the arm, leg or body of the person. It can be used to protect joints or increase function. Prostheses are devices used to replace the lost limb.

Devices to assist walking: Devices such as a cane, tripod, canadian, and walker can facilitate walking.

Methods used in physical therapy

Massage: It can be done with different techniques such as scar tissue massage, deep tissue massage, lymphedema massage, for purposes such as opening joint restriction, increasing circulation, solving muscle spasm, relieving pain.

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Taping techniques: Taping techniques such as kinesiotape can be applied for purposes such as correction of posture disorder, treatment of muscle-induced pain.

Manual therapy: Joints and muscles are examined using the hands and treatment is performed with various force application techniques.

Therapeutic exercises: It is one of the most important components of physical therapy. In general, active treatments with the participation of the patient are more successful in recovery, and exercise applications are at the forefront of these treatments. Treatment is performed with specially designed exercises for purposes such as normalizing joint movements, strengthening muscles, increasing balance and coordination, and increasing heart-lung capacity. Exercises can be performed without any tools or with simple tools such as various weights, bands, springs, exercise balls, exercise dough, balance board, shoulder wheel, pinball table, parallel bar. High technology such as robotic devices using computer-assisted augmented or virtual reality can be utilized.

Injections: Dry needling, trigger point injections, intra-articular injections, injections to the structures around the joint, injections for spinal problems can be applied.

Patient education: Patient education is required to ensure the permanence of the results obtained with physical therapy. This training includes explaining the disease, preventive approaches and self-administered treatment methods.

Robotic physical therapy and new technologies

Physical therapy and rehabilitation is a rapidly changing and developing field where new technologies are used intensively. Information on exercise physiology, the recovery process of nerve tissue after injury, and the plasticity of the brain is increasing day by day and state-of-the-art technology is being adapted for better rehabilitation methods. Robotic physical therapy and robotic rehabilitation are prominent applications in this sense.

Hand-arm robot: Hand-arm robots are used extensively to improve the weakness and loss of function in the hand and arm in stroke, brain injury, spinal cord injury patients at the neck level. With robotic systems, the movements that the patient needs to do are performed with the help of the machine with the same quality and plenty of repetition. With various visual feedback methods, movements can be matched for different purposes and the learning speed can be increased with the motivation of the patient.

A walking robot is used in the rehabilitation of stroke, brain injury, spinal cord injury, and many neurological or orthopedic diseases that impair walking.

Walking robot / Non-gravity walking robot – band: A walking robot is used in the rehabilitation of stroke, brain injury, spinal cord injury, many neurological or orthopedic diseases that impair walking. Patients who cannot stand alone are lifted up with the help of these devices and walking simulation is performed. In addition to its side benefits such as blood circulation, prevention of osteoporosis and bowel movements, walking exercises send sensory signals to the brain about walking, stimulating the nerve circuits related to walking and increasing plasticity.

Isokinetic testing and exercise system – Cybex: There are many advantages of isokinetic exercises in muscle strengthening exercises. Special devices are required for this exercise, which moves at a constant angular velocity regardless of the force exerted by the muscle. The isokinetic test and exercise system (Cybex) provides both detailed and objective evaluation of muscle strength and controlled exercise for performance improvement. Professional athletes maximize their potential with isokinetic exercise systems.

Computerized balance training platform: Wearable technologies are used to measure and record body position and movement with high accuracy. The computerized balance platform offers new possibilities in the treatment of balance disorders by being integrated into the virtual or augmented reality environment.

Neuromodulation in physical therapy and rehabilitation

The excitability of various areas of the brain can be regulated by methods such as the transcranial direct current stimulation technique. Thus, the effectiveness of neurorehabilitation can be increased.

Neuromodulation is another area where high technology is used and rapidly developed in the treatment and rehabilitation of diseases related to brain and spinal cord injury. In neuromodulation, the excitability of nerve cells can be increased or decreased. Some of the problems encountered in stroke, brain damage and spinal cord injuries are caused by the suppression of the related nerve tissue, some of the nervous tissue being overstimulated, and some problems are caused by the imbalances between the excitation status of various nerve tissues. The excitability of various areas of the brain is regulated by methods such as transcranial magnetic stimulation, and stimulation techniques with transcranial direct current. These techniques increase the plasticity of the brain and strengthen the effect of other rehabilitation methods under appropriate conditions.

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The three stages of health: prevention, treatment, rehabilitation

Physiotherapy and rehabilitation deals with a very broad area of ​​health. Health services can be divided into 3 parts. Health services, called primary prevention, include the prevention of diseases before they occur. Vaccination activities, healthy diet and exercise, and reducing the risk of many diseases can be given as examples. Secondary protection covers the treatment services received when applying to a health institution when sick. Tertiary protection, on the other hand, covers the reduction of disability of people who do not fully recover from the disease, namely rehabilitation. Primary protection is mostly covered by family physicians and community health centres, and secondary protection is mostly covered by specialties (internal medicine, general surgery, etc.).

How many types of rehabilitation are there?

Rehabilitation in congenital diseases such as spina bifida (born with a sac in the waist), brain hemorrhage, spinal cord injury, nervous system diseases such as Parkinson’s disease, multiple sclerosis (MS), after surgery for orthopedic problems such as anterior cruciate ligament rupture or fractures, heart attack It is applied in order to return to normal life after treatment, in lung diseases such as COPD, with cancer treatment or to increase the quality of life and functional independence of the person after treatment. These subjects are examples of pediatric rehabilitation, neurological rehabilitation, orthopedic rehabilitation, cardiac rehabilitation, pulmonary rehabilitation, and cancer rehabilitation, respectively. In addition to these, balance rehabilitation in the treatment of balance disorders, hand tendon, Hand rehabilitation after vascular and nerve injuries repair surgeries, sportive rehabilitation after sportive injuries, geriatric rehabilitation for old age-specific problems, pelvic floor rehabilitation for women’s health and urinary incontinence problems, amputee rehabilitation for amputee patients. Burn patients, diabetic ulcers and the care of various wounds are also special topics in the rehabilitation field. Thus, we see that rehabilitation covers all age groups and many diseases. The care of various wounds is also a special issue that falls within the field of rehabilitation. Thus, we see that rehabilitation covers all age groups and many diseases. The care of various wounds is also a special issue that falls within the field of rehabilitation. Thus, we see that rehabilitation covers all age groups and many diseases.

Amputee rehabilitation is an ongoing process from pre-amputation to permanent prosthesis use.

An example of rehabilitation: rehabilitation of stroke patient

In addition to the fact that rehabilitation is such a wide-ranging subject, each sub-title is almost a separate world. Let’s talk about rehabilitation of stroke patient as an example. Let’s consider how to rehabilitate a patient who developed a stroke after a stroke, which means vascular occlusion or damage to the brain due to bleeding. This person may have impaired swallowing function. Evaluation of swallowing, if it is impaired, nutritional solutions should be produced accordingly. In which consistency the food can be swallowed, whether it can be swallowed or whether it should be fed with a tube from the stomach, the physical therapy and rehabilitation specialist decides. Speech and comprehension disorders may develop in some of the paralyzed patients. Speech therapists start early treatment for this condition called aphasia. Monitoring the vital signs of the patient during his stay in the service, Rehabilitation nurses are responsible for preventing bedsores by changing positions, regulating toilet habits, wound care, if any, observing general hygiene rules, and administering medication. The patient is evaluated in terms of urinary problems, constipation, sexual function problems, necessary tests and treatments are planned by the specialist doctor.

The patient’s mobility is evaluated. Joint range of motion, muscle strength, sensation and balance are examined. The exercises to be done are determined. Physiotherapists perform the exercises. In this patient, physical therapy methods can be used in the treatment of complaints such as shoulder pain, joint stiffness, and muscle weakness. The physical therapy and rehabilitation physician makes the treatment plan and the physical therapy technicians implement it. In terms of the benefit of robotic rehabilitation in restoring hand and arm movements, the patient is examined and treatment is arranged. Muscle stiffness, called spasticity, is evaluated, and if necessary, botox injections are administered by a specialist physician. Specific therapy to increase the patient’s skills in daily life activities and return to professional life is performed by the occupational therapist. The specialist doctor prescribes the assistive devices that will facilitate the patient’s walking and prevent joint restriction, and the orthotic technician applies it. The diet of the patient is regulated by the dietitian. In terms of psychiatric problems, a psychiatrist is consulted. If there are additional problems such as diabetes, high blood pressure, heart disease, the opinions of the relevant doctors are sought. The social worker contributes to the return of the patient to social and business life.

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rehabilitation team

As can be seen, the treatment of a stroke patient requires the efforts of many healthcare professionals on very different issues. The concept of rehabilitation team arises from this need. The physician who evaluates the patient holistically, coordinates all this effort towards the goal of recovery, and is the interlocutor in front of the patient is a physical therapy and rehabilitation specialist. This situation is similar in traumatic brain injury and spinal cord injury. In neurological diseases such as multiple sclerosis and Parkinson’s disease, the diagnosis and the regulation of drug treatments are made by a neurologist. However, in today’s conditions, there is no definite improvement with drug treatment in many such neurological diseases, and rehabilitation approaches are needed to increase the patient’s quality of life and to ensure functional independence.

Musculoskeletal problems are related to physical therapy

Injection / needle treatment of the joint and the structures around the joint are among the treatments applied by the physical therapy and rehabilitation specialist.

Let’s open a little more about the non-surgical treatment of musculoskeletal problems. Spinal problems such as waist, back, neck pain, joint pain such as shoulder, hip, knee, foot, muscle pain, osteoporosis, joint calcification (osteoarthritis), rheumatic diseases (rheumatoid arthritis, ankylosing spondylitis, etc.) physical therapy and Rehabilitation falls under his specialty. The physical therapy and rehabilitation physician is responsible for diagnosing spine and joint pains and arranging their non-operative treatment. Low back pain can have many causes. Diagnosis with examination and examination methods, planning and implementation of the most appropriate treatment may seem simple at first glance, but when it is detailed, it requires a lot of book knowledge.

Why is the physical therapy and rehabilitation branch little known?

As we gave examples above, although it is a branch that concerns almost everyone, the awareness of physical therapy and rehabilitation in our country is less than other specialties. This may be due to the fact that physical therapy and rehabilitation is not an organ specific specialization. For example, organs such as eye diseases, otolaryngology, dermatology and cardiology can be understood by looking directly at their names. However, the area of ​​interest of physical therapy and rehabilitation cannot be summed up in a single word or sentence. Patients often refer to an orthopedic specialist when their knee aches, neurosurgery when their back aches, and neurology when their neck hurts. However, in these cases, the first thing to be consulted is a physical therapy and rehabilitation specialist.

Historical development and names of physical therapy and rehabilitation

The fact that physiotherapy and rehabilitation is not well known among the public may also be due to the historical transformations of the field of expertise. Although physical therapy practices are very old, it is relatively new in the world as a field of specialization. Rehabilitation approaches have developed especially after the Second World War. Although it is accepted that “physical medicine and rehabilitation” is the correct expression as a specialty of medical education, the expression “physical therapy and rehabilitation” has become widespread and more known in our country. Physical therapy and rehabilitation specialist doctor is called Physiatrist in English and this is translated into our language as Physiatrist. Unfortunately, the word physiatrist is not known to most of the people. As a result, the expressions of physical therapy and rehabilitation specialist or physical therapist are used more among the people.

Positive developments in our country in recent years

In recent years, our country has made rapid progress in the training of other members of the rehabilitation team. Until recently, the numbers of physiotherapists, occupational therapists, rehabilitation nurses, speech therapists, orthotics and prosthesis technicians and social workers were insufficient in our country. Therefore, it was difficult to provide a quality rehabilitation service. The number of trained and experienced health workers is increasing, private hospitals are opened for physical therapy and rehabilitation, so patient treatments are more effective. Successes in the treatment of patients also reflect positively on the perception of physical therapy and rehabilitation in the society.

How to become a physical therapy and rehabilitation specialist?

A physical therapy and rehabilitation specialist is trained in our country with 4 years of specialization training, after 6 years of medical education. During the specialization training, an intensive training and practice is made about the diseases and treatments mentioned above. This training also includes methods such as interventional procedures such as joint injections, evaluation of musculoskeletal diseases with ultrasonography, examination of nerves and muscles with electroneuromyography. In our country, physical therapy and rehabilitation specialists can also become Rheumatology (rheumatic diseases) or Algology (pain science) specialists with 3-year subspecialty training.

Knowing physical therapy and rehabilitation is essential for everyone

As a result, having basic knowledge about physical therapy and rehabilitation improves public health. Knowing when to consult a physical therapy and rehabilitation specialist will make a difference for your health. It can be a problem that everyone experiences very often, such as low back pain, or a serious illness that you never thought existed until it happened, but once it happens, it can radically change your life. Whatever the problem, physical therapy and rehabilitation is with you as a patient-oriented specialty that evaluates the patient as a whole and aims to make real gains in his life.

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