Evaluation to improve the physiotherapy treatment efficiency of patients with osteoarthritis of the hip joints Osteoarthritis of lower limb

is the most widespread in the world. This disease can cause pain, or distortion of the joints. Anatomy and physiology of the hip. The hip joint (articulatio Cox) connects the rim of the lower extremity lower extremity free. The pond comes a deep acetabulum and the pel ic bone of the femoral head. Degenerative changes. !egeneration is a result of cell aging and ad erse changes in its interior, following a number of summari"ing the physical and biochemical factors disrupting their functions. These changes lead to damage to the anatomical structure of the pond, an impaired function and pain. These changes may be accompanied by a secondary inflammation of syno ial membrane, which explains the more commonly used last name instead of the pre ious osteoarthritis osteoarthrosis . Treatment and rehabilitation. Electrotherapy. #ach current in sensory tolerance to the analgesic effect. T#$% currents. T#$% (Transcutaneus #lectrical $er e %timulation) is a special type of electrical stimulation uses low&fre'uency pulsed currents mainly to treat pain. T#$% is a nonin asi e method, introduced in ()*+ by the Canadian ,onald -el"a. and /all0s. The 1riton 2atric. currents T#$% stimulation pulses applied rectangular, triangular, unipolar or bipolar, and also arranged, pac.ages0. Commonly used are asymmetrical biphasic pulses. Clinically significant importance are two types of T#$%, called. con entional (high&fre'uency, 34&T#$%) acupuncture and T#$% (low&fre'uency, 54&T#$%) There are also burst T#$% (explosi e), 1rief 6ntense T#$% (hiperstimulati e) or modulate. 6n con entional T#$% applies a high fre'uency (+7&877 3") and low current, the patient felt mild within 8+&97 mA. The proposed treatment time aries from 97 minutes to se eral hours a day. Analgesic effect after the application of con entional T#$% appears 'uic.ly, but it does not last long: 97&*7 min. Apply this type of therapy in acute pain. T#$% at low fre'uencies ((&(7 3") is also called acupuncture. Apply current abo e the threshold of tolerance. The treatment time should not exceed ;+ minutes. Analgesic effect in this case appears late, but it lasts longer, e en up to 8;7 min. The mechanism of action in ol es acti ation of descending antynocept. This therapy is used in the fight against chronic pain. 2hysiotherapists ha e a choice of two&or stimulation with fourele.trod. Commercially a ailable electrodes are of different si"e and shape, must be easy to fix. They should not be smaller than ;x8 cm, not to cause burns. Often used ele.trtrody coal or special hypoallergenic materials. Trabert currents. <ery popular because of its analgesic efficacy gained so.=Trabert currents= are often labeled as the =>, (>ltra ,ei" & ultra&stimulants & in ?erman) or= 8&+ #lectricity =(name deri ed from the definition of power: 8 ms pulse @ pause + ms). Currents of =>,= gained its *9

rightful place in electrotreatment since the publication +7 years ago (in ()+A) by !r. 3. Trabert their experimental wor. on the currents analgesics. Trabert currents are the most .nown and used, mostly due to the fact that many, especially newer electrotherapy de ices, it has in its composition. The indications for the use of those currents are especially osteoarthritis. -easure current Trabert is multifaceted, is a potent bodBcowym, leading to reduced impact of pain, especially a few hours after the procedure. This effect is more noticeable in the daily repetition of treatments, especially when near the area of pain will be applied on the negati e electrode (cathode). Action Trabert currents in this case consists of a strong inhibitory influence conduction of pain impulses in the area called. ner e roots. Another important factor in the biological action of >, is the current wea.ness of sympathetic acti ity (sympathetic) and relaxing effect on the spastic (which are in constant oltage) spinal muscles. 6t must be noted that muscle spasticity is the reason for the se erity of pain in the diseased area, which creates a .ind of closed circle: muscular tensionC painC muscular tensionC pain and so pre enting the exit of the loop. -uscle tension hinders the flow of blood to the patient space, as well as remo ing waste products, which often leads to worsening of the disease process. 6f you stop this icious circle Trabert currents can initiate the process leading to a cure with the additional use of other treatment methods such as medication, manual therapy or rehabilitation. The third important feature of the therapy is the introduction of these currents in muscle tremor with a fre'uency of (;9 3" stimulus fre'uency compatible with them current. 6t is said in this case a stimulating massage shoc. (impuls), causing muscle relaxation. Evaluarea pentru a mbunti eficiena tratamentului de fizioterapie de pacieni cu osteoartrita a articulaiilor oldului Osteoartrita membrului inferior este cea mai rDspEndita afectiune din lume. Aceasta boala poate pro oca durere, sau denaturarea articulaiilor. Anatomia si fi"iologia a oldului.Articulaia oldului (articulaia Cox) este formata din membrul inferior liber ce se articulea"a prin capului femural cu acetabul osul pel ian . Modificri degenerative !egenerarea este un re"ultat al imbatranirii celulare ce duce la modificDri nefa orabile, datorita unui numDr ridicat de factorilor fi"ici i biochimici ce duc la perturbare a funciilor sale. Aceste modificDri duc la deteriorarea structurii anatomice a soldului, la disfunciea sa i durere. Aceste modificDri pot fi Fnsoite de o inflamaie secundarD a membranei sino iale, de aceea se explicD numele mai frec ent utili"atin ultimul timp de osteoartro"D, osteoartrita Tratament i reabilitare. Electroterapie. 4iecare curent de toleranD sen"orialD are un efect analge"ic. Curenii T#$%. T#$% (stimularea electrica ner oasa Transcutaneus) este un tip special de stimulare electricD ce folosete cureni de joasD frec enD sub forma de impulsuri, Fn principal pentru a trata durerea. T#$% este o metoda nein a"i a, introdusa Fn ()*+ de cDtre canadianul ,onald -el"a. i de /all. 1ritanicul 2atric. introduce curenti T#$% prin impulsuri de stimulare aplicate dreptunghiular, triunghiular, unipolar sau bipolar, i, de asemenea, aranjate, pachete =. 4rec ent utili"ate sunt impulsuri asimetrice bifa"ice. 6mportanD semnificati D clinic
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sunt douD tipuri decurenti T#$%, numite con enionale (de FnaltD frec enD, 34&T#$%), acupunctura i T#$% de frec enD joasD (54&, T#$%) $u sunt, de asemenea, s&au nDpustit T#$% (explo"i e), T#$% %curt intens (hiperstimulati e) sau modulea"a. Gn T#$% con enional se aplicD o frec enD FnaltD (+&87 3") de curent redus, pacientul simite o uoarD furnicatura Fn termen de 8+&97 mA. Timpul tratamentului propus aria"D de la 97 minute la mai multe ore pe "i. #fectul analge"ic, dupD aplicare a T#$% con enionale efectul apare rapid, dar nu durea"D mult timp, in jur de 97&*7 min. Acest tip de terapie se aplica in ca"ul durerii acute. Curentul T#$% aplicat la frec ene joase ((&(7 3") este numit acupunctura. Acest tip de curentse aplica peste pragul de toleranD. Timpul tratamentului nu trebuie sD depDeascD ;+ de minute. #fectul analge"ic, Fn acest ca" apare tar"iu, dar durea"a mai mult, chiar i pEnD la 8;7 min. -ecanismul de aciune implicD acti area curentului in sens descrescator. Aceasta terapie este folosita in lupta impotri a durerii cronice. 4i"ioterapeuti au posibilitatea de a alege stimularea cu douD sau cu patru electro"i. #lectro"ii disponibi Fn comer sunt de diferite dimensiuni si forme. !imensiunea lor nu trebuie sD fie mai micD de ;x8 cm, pentru a nu pro oaca arsuri. Adesea sunt folositi pentru electroliti cDrbuni sau materiale speciale hipoalergenice. urenii Trabert sunt foarte populari datoritD eficacitDii sale analge"ice. =Curenii Trabert= sunt adesea etichetati ca =>, (>ltra ,ei" & ultra&stimulatoare) sau=#lectricitate 8&+ =(nume deri at din definiia de putere: 8 ms. Curenti puls @ pau"D + ms). Curentii,,>,H au castigat locul cu enit Fn terapia electrica acum +7 de ani (Fn ()+A) cand !r. 3. Trabert prin munca si experimenteleefectuate au do edit efectul analge"ic prin cureni. Cureni Trabert sunt cei mai cunoscuti si folositi in electroterapie, datorita aparitiilor multiplelor dispo"iti e ce ii contin. 6ndicaiile de utili"are a acestor cureni sunt deosebiti in osteoartrita. 2uterea curentului Trabert este complexD, ceea ce duce la un impact redus de durere, mai ales la cate a ore dupa procedura. Acest efect este mai e ident Fn repetarea de "i cu "i a tratamentului, mai ales atunci cEnd Fn apropiere de "ona de durere, or fi aplicate pe electrodul negati (catod). Actiunea curenilor Trabert, Fn acest ca" constD Fntr&o conducere puternicD influenD de inhibare a impulsurilor de durere Fn "ona numitD. ner oase rDdDcini. >n alt factor important Fn aciunea biologicD a >, este slDbiciunea actualD a acti itDii de simpatic (simpatic) si efect relaxant asupra spasticitatii (care se aflD Fn tensiune constantD) muchilor spinali. Trebuie sD se constate cD spasticitate muscularD este moti ul pentru se eritatea durerii Fn "ona bolna a care creea"D un fel de cerc Fnchis: tensiune muscularaC durereC tensiune muscularaC durere. Tensiunea musculara FmpiedicD fluxul de sEnge in tesutul muscular, precum i eliminarea deeurilor, care de multe ori duce la agra area procesului de boala. !acD acesti cureni Trabert opresc acest cerc icios poate iniia procesul care duce la o cura cu utili"area suplimentarD a altor metode de tratament, cum ar fi medicamente, terapie manualD sau de reabilitare. Cea de a treia caracteristicD importantD a acestei terapii este introducerea acestor cureni Fn tesuturile musculare, cu o frec enD de (;9 3" frec enD de stimulare compatibil tensiunea acesteia. %e spune Fn acest ca",ca un oc de masaj de stimulare (6mpuls), pro oca relaxarea muscularD.
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http:@@journal.rsw.edu.pl@index.php@I3%@article@download@87(8J878(()J9A+A&K8@(+9

Didynamic urrents 6t is basically a ariation of sinusoidal currents. %inusoidal currents are alternating low fre'uency currents, ha ing fre'uency of +7 3" and pulse duration of (7 msec, pro iding (77 stimuli @ sec. Physiological Effects: The main effect is pain relief through: * Pain masking (increase of the stimulation threshold): 1y !4 current, stimulation of the sensory ner es may not always cause excitation but it can be altered. * Vasodilatation and hyperemia: !ue to release of histamine in the tissues. The same can occur in deeper structures by reflex acti ity. * Muscle fibers stimulation: !idynamic current stimulates the muscle fibers, causing muscle contraction. C2 and 52 currents stimulate increase blood flow to the muscle and reduce edema. * Stimulation of vibration sense: This leads to central mas.ing of pain sensation. Indications: !idynamic stimulation causes relief of pain and edema in the following conditions: & %oft tissue injury (sprains, strain, contusion and epicondylitis). & Ioint disorders (post&immobili"ation and arthritis). & Circulatory disorders (,aynaud0s disease and migraine). & 2eripheral ner e disorders (neuralgia and sciatic neuritis). Contraindications: * Open skin: The current tends to concentrate at this pointL small bro.en areas can be insulated by <aseline. * ony areas: 6t may produce burn. M !oss of sensation: 6t can produce burn. * Skin lesions: #c"ema fungi can be irritated and made worse. * "nfections: 6t may cause spreading of infection.
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M Thrombosis. M Cardiac pace ma.ers. Dosage: * "ntensity: 6t should be increased gradually until definite ibration or pric.ling sensation occurs. * #uration: $ot more than (8 minutesL each type for 9 minutes. * $re%uency: !aily or e ery other day for (8 sessions.

urenti Dinamici Acestia sunt Fn esenD o ariatie de cureni sinusoidali. Cureni sinusoidali sunt curenti alternati i de joasD frec enD, a End frec ena de +7 3" i durata impulsului de (7 ms, oferind (77 stimuli @ sec. 2rincipalul efect este ameliorarea durerii prin: & durere de mascare (creterea pragului de stimulare): prin df curent, stimularea ner ilor sen"oriali nu poate pro oca Fntotdeauna excitare, dar aceasta poate fi modificata. & asodilataie i hiperemia datoritD eliberarii de histaminD Fn esuturi.acelai lucru se poate produce Fn structurile profunde prin acti itatea reflexD. & stimularea fibrelor musculare: curentul didynamic stimulea"D fibrele musculare, pro ocEnd contracia muscularD. cureni cp i lp stimula creterea fluxului sanguin la ni elul muschiului si a reduce edemul. &stimularea prin ibraii: Acest lucru duce la mascarea centrala al sen"atia de durere. 6ndicatii: %timularea prin curentii diadinamici pro oacD reducerea durerii i edemului, Fn urmDtoarele condiii: & prejudiciul esutului moale (entorse, tulpina, contu"ii i epicondilita). & tulburDri comune (post&imobili"are i artrita). & tulburDri circulatorii (boala raynaud i migrenD). & tulburDri ner oase periferice (ne ralgii sciatice si ne rita). ontraindicaiile aplicarii curentilor continui: & pielea deschisa la culoare: curentul tinde sD se concentre"e pe aceste locuriL "onele mici rupte pot fi i"olate cu aselinD. &pe "onele osoase, acestia pot produce arsuri. &le"iunile cutanate: ciuperci ec"ema poate fi iritat i a fDcut mai rDu. &infecii: aceasta poate pro oca rDspEndirea infeciei. & trombo"D. & factorii ce duc la marirea ritmului cardiac Dozaj! & aloare: ar fi crescutD treptat pEnD la ibraii determinatD sau FnepDturi apare.
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& durata: nu mai mult de (8 minuteL fiecare tip de 9 minute. & frec enta: "ilnic sau la doua "ile, timp de (8 sesiuni.

http:@@www..au.edu.sa@4iles@77+97;;@4iles@A999;NAN!idynamic.doc
Evaluare (. Care sunt formele clasice de curent diadinamic (dupa 1ernardt): a. curent monofa"at b. curent difazat c. curent ritm sincopat d. curent scurta perioada e. curent gal anic 8. 4ormele deri ate de curent diadinamic sunt: a. curent medie perioada b. curent monomodulat c. curent dimodulat d. curent sfert de unda e. curent ritm sincopat 9. #fectele curentului diadinamic forma monofa"at sunt: a. excitomotor b. creste tonusul muscular c. actioneaza ca un masaj electric profund d. are actiune asodilatatoare e. mioanalge"ic ;. #fectele curentului diadinamic farma lunga perioada sunt: a. excitator b. miorela"ant c. decongestionant d. reali"ea"a gimnastica musculara e. actioneaza ca un masaj profund intens +. !in terapia impulsurilor de joasa frec enta fac parte: a. curentii diadinamici b. curentii interferentiali c. curenti Trabert d. curenti 5educ e. curenti neofaradici