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CONTEMPORARY BALNEOLOGY IN CZECH REPUBLIC

CONTEMPORARY BALNEOLOGY IN CZECH REPUBLIC. Ivan Va ř eka, Ji ří Hn á tek. Spa Luhacovice, Co., Luhacovice, Czech Republic Department of Physiontherapy and Pain Management, Faculty of Physical Culture, Palacky University, Olomouc, Czech Republic. THE M AIN SPA RESORTS IN CZECH REPUBLIC.

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CONTEMPORARY BALNEOLOGY IN CZECH REPUBLIC

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  1. CONTEMPORARY BALNEOLOGY IN CZECH REPUBLIC Ivan Vařeka, Jiří Hnátek Spa Luhacovice, Co., Luhacovice, Czech Republic Department of Physiontherapy and Pain Management, Faculty of Physical Culture, Palacky University, Olomouc, Czech Republic

  2. THE MAIN SPA RESORTS IN CZECH REPUBLIC with prevailing diagnoses Jeseník Jáchymov Jánské lázně movement respiratory Karlovy Vary digestive neurology Františkovy lázně Poděbrady cardio-vascular gynaecology Prag Mariánské lázně urology Luhačovice respiratory BechyněBludovDubí u TeplicFrantiškovy LázněJáchymovJanské LázněJeseníkKarlova StudánkaKarlovy VaryKarvináKonstantinovy LázněLázně BělohradLázně BohdanečLázně KynžvartLázně Libverda Brno Třeboň movement Lipová - lázněLuhačoviceMariánské LázněMšené - lázněOsečnáOstrožská Nová VesPoděbradySlatinice Teplice nad BečvouToušeňTřeboňVelichovkyVelké LosinyVráž u PískuŽeleznice

  3. THE LAST 15 YEARS CHANGES privatisation modernizing (buildings, equipment) increasing in portion of self-payers and foreigners

  4. BASIC STATISTICS 2002 51 private spa facilities (18 347 beds) 17 state spa facilities (4 625 beds) 295 968 clients (8 867 less than in year 2001) 5 877 748 days of stay (137 652 less than in year 2001) 278 089 adults (41 % complex, 7 % partial, 13 % selfpayment, 39 % foreigners)

  5. SPECTRUM OF HEALTH SPA PATIENTS (CZ, 2002) Total number of beds: 22179Health care provided: 275811 patients Number of care days: 5545315

  6. SPA THERAPYTYPE PARTIAL COMPLEX HIC HIC HIC TREATMENT (PROCEDURES) ACCOMODATION + MEAL CLIENTS „SELFPAYMENT“ without HIC HIC=Health Insurance Company

  7. „THE LIST OF INDICATIONS for SPA THERAPY in ADULTS, CHILDREN and ADOLESCENTS“ the public notice of the Ministry of Health, 1997 • Contents • diagnoses (according to ICD 10) distributed into 11 main groups (and following subgroups) • indications • the duration of spa therapy ( + prolongation conditions) • the type of spa care (complex or partial) • commentary • contraindications • officialspa places for given diagnoses

  8. gives a RECOMMENDATION of spa therapy for given diagnosis (according to ICD 10) and group (according to LI 1997) SPECIALIST CONSULTANT GENERAL PRACTITIONER completes form of “PROPOSALfor SPA THERAPY” DOCTOR-AUDITOR HEALTH INSURANCE COMPANY approves form of “PROPOSALfor SPA THERAPY”

  9. TRENDS IN NUMBER OF PATIENTS 250 000 200 000 150 000 100 000 50 000 1980 1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 HIC selfpayment foreigners

  10. TRENDS IN HEALTH SPABEDS

  11. TRENDS IN HEALTH SPABEDS

  12. TRENDS IN ADULTS INDICATIONS (HIC, CZ)

  13. TRENDS IN ADULTSINDICATIONS (HIC, CZ)

  14. TRENDS IN CHILDRENINDICATIONS (CZ)

  15. TRENDS IN CHILDRENINDICATIONS (CZ)

  16. TRENDS IN ADOLESCENTSINDICATIONS (CZ)

  17. TRENDS IN ADOLESCENTSINDICATIONS (CZ)

  18. TRENDS IN PATIENTS SPECTRUM (LUHAČOVICE)

  19. TRENDS IN PATIENTS SPECTRUM (LUHAČOVICE)

  20. TRENDS IN ADULTSINDICATIONS (LUHAČOVICE)

  21. TRENDS IN CHILDRENINDICATIONS (LUHAČOVICE)

  22. THE FOREMOST TASKS increasing in portion of self-payers and foreigners maintenance of HIC payment to give the evidence-based reasons for spa treatment innovated offer accomodation & services improvement research EU funds fitness reconditioning wellness relax fun co-operation (spas, universities) • shorter programmes (weekend, max. 2 weeks) • family „packs“ • manager programme • etc., etc.

  23. THE SPA TREATMENT OF THE RESPIRATORY TRACT

  24. various „pulmonary“ diagnoses from benign chronic laryngopharyngitis through bronchial asthma, chronic bronchitis and chronic obstructive pulmonary disease to S/P pulmonary carcinoma OP frequently in combination with other diseases of various severity (e.g. ASHD, HTN, DM) and invariably together with movement system function disorders primary functional (later structural

  25. AIMS of the SPA THERAPY breathing function improvement airway deliverance mucosa regeneration EDUCATION home selftherapy instructions functional improvement of the other organs and systems (including movement system)

  26. SPA THERAPY METHODS of the respiratory tract elements of the whole medical rehabilitation KINESIOTHERAPY + DRAINAGE TECHNIQUES THE BASIC METHOD in SPA THERAPY SCOPE TOO MANUAL TECHNIQUES – massage & musculosceletal medicineas preparation for kinesiotherapy Balneotherapy – INHALATION & climatic therapy, change of daily stereotype Physical Therapy– e.g. shortwave, IR- ray, CO2 baths + other watertherapy procedures (e.g. Kneipp, Priesnitz) Education

  27. „FUNCTIONAL DISORDERS“ due to respiratory diseases - BREATHING STEREOTYPE alteration (short and superficial) - „REFLEX“ CHANGES („petrificated“) blockade of AO and upper cervical column rib blockade breathing resistance increase spasms & TPs in upper trapezius and scaleni; HAZ C3-4, Th3-10 do not cover the muscle spasms!!! - faulty POSTURE (typical Th hyperkyphosis with „chin forward“)

  28. RESPIRATORY PHYSIOTHERAPY set of drainage and breathing techniques (Smolíková) musculosceletal techniques – „reflex changes“ release kinesiotherapy techniques based on posture correction (Brügger principle)a posture activation (diaphragma, abdominal and pelvic floor muscules, deep cervical flexors) + other spec. techniques fitness kinesiotherapy + endurance training (very important but overlooked despite very bad fitness status) nordic walking

  29. DRAINAGE TECHNIQUES Chevaillier – slow INS, INS pause, slow long active EXS, step/by/step form TV to IRV autodrainage (AD) active cycle of breathing techniques (ACBT) breathing control (BC) flutter relaxed rest breathing PEP mask thorax elasticity exercise (TEE) slow maximal INSP, short passive EXSP postural drainage? classic method but outdated forced exspiration technique & huffing (FET) percussion drainage

  30. NEBULA INHALATION in scope of spa treatment traditional method of spa treatment MINERAL WATER (in particular) aerosol = droplets 0,1-10 m reach to bronchi and bronchioli alcalic mineral waters ( Na+ and HCO3-); salty waters (Na+ and Cl-); mixed Effects (depending on temperature and agent): mucolytic, secretalytic, trofic, hyposensitive REGENERATION of bronchial mucosa OTHER AGENTS - mucolytics, secretolytics, detergents (N-acetylcystein) - antiflogistics - (10 % CaCl2+ Panthenol+Vincentka; corticoids) - bronchodilatantia - (beta2-mimetics, atropine) - antibiotics (neomycin)

  31. Types of the individual inhalation devices • jet (nozzle) type • - basic type • stream of compressed air flows through jet and disperses liguid ellevating in capillary • ultrasound type • 2,5 MHz, concave crystal focused on surface of dispersed liquid • droplets 0,5-5 m, 10x higher density as jet type • electro aerosol • equal charge prevents fusion of droplets, minus has better effect; • technically difficult • vibrate aerosol • - 100 Hz;, better intrudes into paranasal caves

  32. Factors influencing the nebula effect • - droplets size - 1-5 m is optimum for distal airways – the smaller ones (steam) are not cought and go off; the bigger (spray) stay in nasopharynx) • - electric charge – minus is better • - nebula density – optimum 15-25 mg/l • - nebula amount – 5-12 l/min • - inhalation duration – depends on inhalated substance • inhalation frequency and amount – optimum daily!!! • NEBULA TEMPERATURE • HYPOTHERMIC (22-33 OC) - decreasing hyperaemia, anti-inflammatory effect, danger of spasm in sensitive patients!!! • ISOTHERMIC (34-38 OC) mucosa calm – the most frequent • HYPERTHERMIC (39-44 OC) - mucosa hyperaemia, in chronic diseases and/or mucousa atrophy

  33. Main effects of inhalation • (depending on agent) • airways humidizing • mucus liquefy • bronchial muscles relaxation • mucosa swelling alleviation (due to blood-flow reduction) • airways epithelium regeneration • airways inflammation suppression • treatment of chronic infections

  34. General rules of inhalation treatment rough cleaning before inhalation throat (gargling) and nose (rinsing) instruction of due breathing by inhalation after 4-6 of normal breathing cycles one deep inspiration follows with short apnoic pause check the patient during the first inhalations central antitusics in case of torpid cough mucolytics prior to bronchodilatantia bronchodilatantia prior to antibiotics

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