The new technologies in physical and rehabilitation medicine

Fizikalna medicina primjenjuje fizikalne agense u prevenciji, liječenju i rehabilitaciji bolesnika, dok je rehabilitacija proces kojim se pomaže osobi da postigne maksimum fizičke, psihičke, društvene, profesionalne, rekreativne i edukacijske osposobljenosti u odnosu na fiziološko ili anatomsko oštećenje, ograničenja okoline, te želje i životne planove. U fizikalnoj medicini propisuje se fizikalna terapija, koja koristi razne oblike energije, u svrhu prevencije, liječenja i rehabilitacije bolesnika. Prema vrsti fizikalnog agensa fizikalna terapija može se podijeliti na pet velikih cjelina. Tu spadaju mehanoterapija, uključujući i kineziterapiju, termoterapija, elektroterapija, fototerapija, te prirodni čimbenici. Zbog dokazane učinkovitosti, apsolutnu prednost u izboru fizikalnih procedura ima kineziterapija, a “klasične” metode elektroterapije gube svoju važnost, većinom zbog činjenice da se njihova primjena koristi na iskustvenoj bazi, a vrlo je malo dobro dizajniranih istraživanja sa znanstveno potvrđenim rezultatima temeljenim na dokazima. Ipak razvojem tehnologije dolaze novi, tehnološki napredni uređaji, kao što su ekstrakorporalni udarni val i laseri velike snage. Indikacije za ekstrakorporalni udarni val su tendinopatije s i bez kalcifikata, pseudoartroze, avaskularne nekroze kostiju i kalcificirajući miozitisi, te miofascijalni sindromi s trigger točkama. Indikacije za primjenu lasera velike snage su vertebralni i vertebrogeni sindromi, radikulopatije, tendinopatije, lezije mišića, kontrakture, artritisi i artropatije, lezije hrskavice, analgetsko djelovanje po bolnim točkama te aplikacija na tkiva s oslabljenom aktivnosti metabolizma (dekubitusi). Kod navedenih procedura insistira se na potvrdi učinkovitosti kvantitativnim mjerama radi podizanja kakvoće rada i poboljšanja ishoda liječenja i rehabilitacije.Physical medicine applies physical agents in the prevention, treatment and the rehabilitation of patients, whereas rehabilitation is a process which enables a person to achieve the maximum in physical, psychological, social, professional, recreational and educational ability with regard to the physiological or the anatomical damage, environment limitations, personal desires and life plans. In physical medicine, physical therapy is prescribed, which applies various forms of energy, for the purpose of patient prevention, healing and rehabilitation. With reference to the type of the physical agent, physical therapy can be divided into five large groups. These include mechanotherapy (including kinesitherapy), thermoterapy, electrotherapy, phototherapy, and natural factors. Because of its proved effectiveness, kinesitherapy has absolute priority in the choice of physical procedures, while classical methods of electrotherapy tend to lose their importance mainly because of the fact that their application is used on the empirical basis. Furthermore, there is a relatively low incidence of well designed research studies showing scientifically significant proofs in evidence based medicine. Nevertheless, with the development of technology, new, technologically advanced devices have appeared, such as extracorporeal shock wave therapy (ESWT) and high intensity laser therapy (HILT). Indications for the ESWT are the tendinitis with and without calcifications, pseudarthrosis, bone avascular necrosis and calcifying myositisis, as well as myofascial syndromes with trigger points. Indications for the application of HILT are vertebral and vertebrogen syndromes, radiculopathies, tendinopathies, lesions of the muscles, contractures, arthritis and arthropathies, cartilage lesions, analgesic impact on painful trigger points and the application on the tissue with weakened metabolism activity (pressure and trophic ulcers). With the procedures mentioned above, one should insist upon the proof of their respective effectiveness by applying quantitative measures, for the purpose of increasing the quality of work and improving the outcome of treatment and rehabilitation