Prof Dr Naguib Salem Professor Of Physical Therapy
Prof. Dr. Naguib Salem Professor Of Physical Therapy Faculty Of Physical Therapy Cairo University 6 th October University roma 11/01/97 1
Physical Therapy Rehabilitation Of The Vascular System roma 11/01/97 3
Mechanics Of The Blood Flow Arterial Role roma The walls of the arterioles are susceptible not only to nervous control but also influenced by chemical effects. During exercise the mean pressure rises but little because there is a fall in the peripheral resistance caused by this arterioles dilatation. 11/01/97 4
Mechanics Of The Blood Flow The resistance to the flow through a vessel depends on the length and the radius of the vessel and on the viscosity of the blood. The arterial pressure under resting condition is about 100 mm. Hg. , and the blood flow is about 100 ml. /sec. During exercise it could be raised to 4 times of the resting value. roma 11/01/97 5
Mechanics Of The Blood Flow The diameter of the vessel can be a tremendous changes in its ability to conduct blood when its flow is stream line. The diameter of the vessel is increased by double size while the pressure increases by 4 times and flow by 16 times. roma 11/01/97 6
Mechanics Of The Blood Flow roma 11/01/97 7
Mechanics Of The Blood Flow Volume Flow through the circulation is affected by: 1 -Increase of main arterial pressure. 2 -Reduction of peripheral resistance 3 -The booster action of muscular pump. roma 11/01/97 8
Mechanics Of The Blood Flow Increase of the volume flow through the circulation can be achieved by 1 - Increased force Of cardiac Contraction. 2 - A decrease in the resistance to the flow of the blood. roma 11/01/97 9
Mechanics Of The Blood Flow Increase of the volume flow through the circulation can be achieved by 3 - The peripheral pump activity represented by the effect of rhythmic contraction of the skeletal muscle contraction which surround the veins and which massage the blood back to the heart. roma 11/01/97 10
Mechanics Of The Blood Flow II-Venous Role When the subject in recumbent position, the difference of the pressure between that at the venous end of the capillaries and that at the heart is responsible for the return of the blood from the periphery to the heart. roma 11/01/97 11
Mechanics Of The Blood Flow roma If the subject is tilted into the erect posture , the venous pressure in the feet may have to exceed 90 mm. Hg. to overcome the hydrostatic column of blood between the heart and feet to provide the necessary volume flow. Above the level of the heart the extra thoracic veins collapse when their intraluminal pressure becomes subatmospheric value. 11/01/97 12
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Mechanics Of The Blood Flow During muscular exercise the return of the blood from the capillaries to the heart is secured by pumping action exerted by the rhythm of the muscles on the veins. roma 11/01/97 14
Pathology Of Arterial Diseases n Vessel Injury: The vascular endothelial layers act as a selective barrier that protects the subendothelial layer from interacting with blood cells and blood component. With repeated injuries there may be impairment of endothelial to regenerate. roma 11/01/97 15
Pathology Of Arterial Diseases n Factors Regarded As injurious agents : A- Smoking B-Immune Mechanism C- Mechanical Stress as in HYPERTENSION. roma 11/01/97 16
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Pathology Of Arterial Diseases II- Lipid Infiltration Development of ATHEROSCLEROSIS Due To: 1 - Nutrition 2 - genetic 3 - Metabolic 4 - Obesity 5 - Diabetic 6 - Production Of Triglyceride roma 11/01/97 18
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Evaluation OF Arterial Disorders Palpation of pulse. n Skin Temperature. n Skin integrity and pigmentation. n Test for reactive hyperemia. n Claudication time. n Doppler ultrasonography. n roma 11/01/97 20
Treatment of Acute arterial disease. Preventive Treatment: 1 - Diet 2 - Stop Smoking 3 - Activity. 4 - Drugs 5 - Hygiene 6 - Relive Stress * REFLEX HEATING OF THE OPPOSITE LIMB. * POSITIONING OF PATIENT WITH RAISED HEAD. n roma 11/01/97 21
Ph. Th. For Venous Ulcer Goals roma 1 - Reduction Of edema. 2 - Control of infection. 3 - Mobilization of tissue in the floor and edges of the ulcer. 4 -Mobilize stiff joints. 5 - Strength the muscles. 6 -Reduction of gait and posture problems. 11/01/97 22
METHODS # Faradic Therapy # Air Compression. n Exercise in pressure support bandage or elasticized support stocking with the limb elevated. n High elevation. n Massage in form of effleurage or deep kneeding and squeeze. n Other electrotherapy as ultra sound to soften the edema. 11/01/97 23 n roma
Treatment Of Chronic Arterial Disease n Patient with mild disease , a graduate exercise program of walking or bicycle should be initiated. roma 11/01/97 24
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Goals Of Treatment in Chronic Arterial Disease 1 - Improve exercise tolerance for ADL. n 2 - Improve vasodilatation. n 3 - Relive pain at rest. n 4 - Prevent joint contracture and muscle atrophy. n 5 - Prevent skin ulceration. n 6 - Promote healing of ulceration. n roma 11/01/97 26
Burger’s Exercise n It is the exercise to improve muscle power and maintain joint range of motion, it is a trail in an attempt to improve blood supply and venous drainage particularly if the patient is likely to be in bed for sometime. roma 11/01/97 27
Procedures Of Burger’s Exercise The routine involves 3 positional changes of posture in order that the effect of gravity on blood is felt: 1 - The patient is comfortably supported in 45 ° and limb color observed until blanching occur. 2 - The Time should be noted for the change to occur and a further 1 minuts are added. n roma 11/01/97 28
Procedures Of Burger’s Exercise 3 - The patient is then placed in a high sitting position with the limbs dependent until full filling of the superficial veins is observed , and further 3 minutes are added. roma 11/01/97 29
Procedures Of Burger’s Exercise 4 - The patient then lies completely flat (supine) if possibly for approximately 5 minutes. The time must be noted and sequence reported 4 -5 times pre session, the patient should continue the routine at home not less than 3 times per day. roma 11/01/97 30
Thank you roma 11/01/97 31
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