IN THE PHYSICAL REHABILITATION OF PATIENTS WITH SEQUELAE OF INJURIES OF THE LOWER EXTREMITIES IN ZHITOMIR OF REHABILITATION FACILITIES

Annotation. Purpose: to study the physical properties and therapeutic effect of mechanical factors in the pathogenetic treatment in traumatology. Material: 622 patients were studied with the consequences of injuries of the lower extremities (age 18-64 years). Observations carried out since 2005 in hospitals and medical health institutions of Zhitomir. Selected physiotherapy factors that are mainly used for the physical rehabilitation of patients in trauma. Results: identified the factors that were intended to eliminate the consequences of injuries of the lower extremities. Analyzed their effect in the author's method of complex rehabilitation of patients. Performed systematization selected physiotherapy factors in a table to read and understand forms. In the medical health institutions in the city of Zhytomyr investigated and established the effectiveness of the recommendations. Conclusions: physical factors cause the body general, non-specific and specific response to each type of impact. This allows you to selectively influence the pathogenic elements of the disease. Should strictly adhere to the indications and contraindications to the use of physiotherapy factor. It is necessary to take into account age, sex, and comorbidity.

-With the help of PR specialists select from 10 groups of physical therapy factors those, which are used most frequently in traumatic treatment [5,10,12,14] ; -Systemize the selected factors in tables of visual and informative character for further their usage in certain cases of physical rehabilitation (PR) of patients, who have lower limbs' traumas [1,8,21] ; -Prove efficiency of authors' methods by results of PR of 622 patients in Zhytomyr rehabilitation centers [6, 16 ,19].
For this purpose we solved the following tasks: -Analysis of literature sources' data about mechanical factors of physical therapy, about their classifications; -Analysis of indications and counter-indications for using of these factors in PR of patients with lower limbs' traumas; -Provisioning of descriptive form of recommendations; -Researching of compliance of table data with practical application of PR in therapeutic-rehabilitation centers of Zhytomyr.Results of the researches have been recommended for wide usage in medical-rehabilitation institutions.

Results of the researches
The authors tested patients, who were rehabilitated in medical and rehabilitation-sanatorium institutions of Zhytomyr, in particular, in regional rehabilitation vertebrologic center and sanatorium-rehabilitation center "Denyshi".Contingent included: sportsmen of different age categories -6.7% and other patients.
The conducted research showed that in Zhytomyr region patients with SMS disorders make 19.1% of disabled and heavy forms of disablement (1 st and 2 nd groups) are observed exactly with SMS traumas (up to 50%).Often disablement is caused by traumas of SMS and periphery nervous system because for them long period of disease is characteristic as well as functional disorders of locomotion and nervous system [2,11,20].
Demand of patients with SMS traumatic after effects in poly-clinical rehabilitation treatment in Zhytomyr (city) is 4.1 times higher than possibility to actually satisfy it.In Zhytomyr poly clinical institutions there are no such researches; in statistic reports on health protection in Zhytomyr there are no data about it.
Increasing of patients to be rehabilitated is conditioned also by increasing of PR possibilities [1,2,4,6].For example, in Zhytomyr there is a lot of massage centers, though other methods of physical therapy are used more seldom.Analysis of patients' medical histories showed that PT (in complex of PR in after treatment period was prescribed to 483 patients or 66%, while it was practically used by only 20.3%.With physical therapy apparatuses being available at center, patients did not receive required treatment owing to absence of PR complex methodic for after effects of lower limbs' traumas.
The worked out by the authors PR methodic, in general, ensured achieving of positive results at the account of complex usage of different PR variants and their combinations with other physical therapeutic procedure, including non-traditional, for patients with after effects of lower limbs' traumas [6,7,13].
In hospitals, rehabilitation sanatorium centers the authors tested 622 patients (417 city-residents and 205 from countryside) who had after effects of lower limbs' traumas: fractures of different character -368 cases, joint traumas -96 cases, heavy open fractures -41 cases, wounds -52 cases, dislocations -21, damage of Achilles tendon -23.In hospital (immobilizing period) we tested 223 patients (53 -city residents and 170 -from countryside); in post immobilizing period -196 and 34 accordingly; in recreational period we tested 119 patients..
It was nearly impossible to examine recreational period of countryside patients, because there is no rehabilitation specialists in countryside.The authors could to examine only 38 patients, who were rehabilitated in sanatorium "Denyshi" and 19 patients in regional rehabilitation vertebrologic center.
Patients were prescribed to be treated with physical therapeutic methods in first days of immobilizing period.Only 9 patients violated regiment of treatment in hospital period that is why they were excluded from further researches.All other followed strictly doctor's recommendations.Owing to different circumstances, subjective or objective, in average there were fulfilled 86% of procedures from the required quantity.
It was more difficult to test fulfillment of rehabilitation prescriptions in other period: city residents followed strictly all terms, countryside pa6tients -only when it was possible.
And it was really a problem to test fulfillment of rehabilitation requirements in third period, because of absence of rehabilitation specialists in villages of Zhytomyr region (3 rehabilitation specialists per 93 villages); because of absence of required rehabilitation equipment in village medical centers, because of absence of PR complex methodic for all rehabilitation periods.That is why for such patients physical therapeutic prescriptions were restricted by usage of UNF or non traditional factors 9 th -10 th groups (see tables).
In tables we present examples from Zhytomyr medical-rehabilitation centers.The authors checked carefulness of fulfillment of rehabilitation prescriptions by patients in all periods as well as results of patients' rehabilitation.
Summarizing results of the researches we can conclude that patients, who regularly and carefully followed all doctors' prescriptions in process of complex PR shortened rehabilitation period by 1-3 weeks and turned to trainingcompetition process and full-fledged social life. Conclusions: -Combination of rehabilitation methods is specific for every disease, for every patient with after effects of lower limbs' traumas; -Effective result is possible only after rehabilitation by complex methodic.With it, very important is patients' knowledge about trauma, traumatic disease, terms, methods and factors of rehabilitation.It shall be assisted by visual aids and information, including information about physical therapeutic factors; -The authors' experience and results of the researches permit to recommend effective schema of rehabilitation course, which was tested in practice of rehabilitation institutions, where its effectiveness and efficiency were tested in combinations: TPC with MT (medical therapy) + PT + TM (therapeutic massage).Such rehabilitation methodic ensures required level of joint mobility and improvement of number of organism's functions.
Further works shall be devoted to studying of other components of complex PR of patients with after effects of lower limbs' traumas as well as creation of descriptive informational materials.Notes: «+» means that the mentioned method of physical therapy is to be used in the given period of rehabilitation

Table
Physical therapeutic factors for physical rehabilitation of patients with after effects of lower limbs' traumas