LABOUR THERAPY — the directed involvement of the patient in work with to lay down. the purpose, and also for the purpose of rehabilitation.
The most wide spread occurance was got by labor therapy at treatment of mentally sick. T. t. in psychiatry is a component of so-called therapy Wednesday, under a cut understand the directed correction of relationship of the patient with people around (personnel of medical establishment, other patients, a family) for the purpose of its more successful social rehabilitation. Promoting increase in a self-assessment of the patient, T. t. changes its relations with other people and thus promotes improvement of a condition of mentality of l of the social status — an ultimate goal of rehabilitation.
Use of work with to lay down. the purpose in psychiatry treats the end of 18 century when F. Pinel in France, in Italy, Tyyuk (Territorial election commission) in England occupations work in psychiatric-tsakh began to enter V. Chiarugi. At the beginning of 20 century in Germany of Simone (N. of Simon), carrying out the principle of not constraint of patients, organized in the clinic medical refurbishment work with mentally sick on the basis of the differentiated modes of work.
In Russia at the beginning of 19 century organized work to treatment mentally sick the first was applied by I. F. Ryul and V. F. Sabler. Intensively developed T. t. as remedy hron. mentally sick
H. N. Bazhenov, V. I. Yakovenko,
M. P. Litvinov, P. P. Kashchenko.
In the first years of the Soviet power of T. t. mentally sick began to pay much attention during the development of programs of the organization and improvement of psychiatric service of the country. Big contribution to development of the theory and practicians T. t. T. A. Geyer, D.E. Melekhov,
M. A. Dzhagarov, G. V. Zenevich
, etc. brought.
Not any involvement of the patient to work can be considered medical or useful. Herlin (Ch. Nayeg-lin, 1979) allocates the following signs of «work without therapy»: lack of payment or discrepancy to its volume of work of the patient; subordination of work only to economic needs to lay down. institutions, but not to problems of rehabilitation of patients; nedifferentsi-rovannost and long-term stability of kind of work; lack of orientation of patients on their future the prof. activity.
T. t. mentally sick should be distinguished from therapy by employment. Of t. it is aimed at the development or preservation of the prof. of skills whereas treatment by employment is connected with carrying out leisure (drawing, a molding, a burning out on a tree, etc.). From psychotherapy of T. t. the subject activity of the sick person including psikhol distinguishes. and fiziol. components to lay down. actions.
M. S. Lebedinsky and V. N. Myasi-shchev (1966) allocate several parties to lay down. impacts of work: stimulation of vital processes and increase in body resistance and identity of a disease; derivation with painful experiences; strengthening of intellectual and strong-willed qualities according to conditions and requirements of reality; increase in a mental tone of the patient, release it with feeling of the inferiority and lameness; recovery of communication of the patient with collective.
Distinguish T. t. mentally sick, carried out in hospitals and it is out-patient. In psychiatric-tsakh or nursing homes (see the House nursing home) T. t. carry out directly in a wedge, departments or in special medical and production workshops (see. Medical and production, labor workshops). It can begin with different types of employment (drawing, art embroidery, a molding, etc.), to turn into simple labor processes (e.g., assembly of details of the elementary devices) and further in their more difficult types which are carried out usually in hospital workshops (work on machines, sewing by car, etc.). The choice of activity therapy process shall be carried out taking into account specificity of symptoms (degrees of manifestation psikhopatol. disturbances and change of the personality), and also forms of a course of a disease and the accompanying somatic diseases. It is very important to consider the relation of the patient to treatment, the nature of its relationship with people around, first of all with a family.
Out-patient form T. t. carry out in activity therapy workshops at psychoneurological clinics (see the Clinic). She is appointed the patient living at home (as a rule, to mentally sick disabled people of I and II groups). For most seriously ill patients will organize work at home. Lechebnotrudovy workshops are visited also by the patients who are on treatment in day hospitals of psychoneurological clinics. In the USSR all patients working in lechebnotrudovy workshops at dispanse-rakh are provided free of charge with pharmaceuticals and food, the reward for work is given by it.
Indications to T. t. the attending physician of a hospital or clinic defines. The patients working in workshops are watched by specially trained doctor-trudoterapevt.
In the Soviet Union the wide experience of a new form of rehabilitation mentally sick in the conditions of industrial production — so-called industrial rehabilitation is accumulated. One its option provides daily, except the days off, work on production of the patients who are on treatment in psychiatric-tse, at the same time patients earn reward for the work. At other option of industrial rehabilitation mentally
the patient living at home works (most often as the worker) at the enterprise where has all rights and fulfills the duties established for the healthy people working there. At one option of industrial rehabilitation patients with frustration of mentality (hl. obr. these are patients with an alcoholism) work in workshops of the enterprise and live in factory specialized hostels. For production work of mentally sick special workshops can be also organized or separate jobs are allocated.
At all options of industrial rehabilitation the patients working mentally are under observation of medical staff.
Besides, T. t. apply in other fields of medicine. E.g., in traumatology, orthopedics, neurology of T. t. it is directed to recovery of the broken motive function and labor skills. T. t. widely use in to lay down. institutions (hospitals, sanatoria) where patients are forced to be a long time in connection with features of a current patol. process (tuberculosis of bones and joints, tuberculosis of a respiratory organs, effects of poliomyelitis, severe injuries, etc.) *
T. t. is an effective method of treatment that is connected with its features: focus from
movements, vershayemy in the course of work, the productive nature of activity of the patient, a possibility of introduction into process of work of elements of creativity. Having concentrated attention on results of work, the patient overcomes fear of pain better, carries out the set movements that increases to lay down, effect of a method more safely.
Distinguish the functional labor therapy directed to recovery of the functions of an organism broken in connection with a disease, and production, preparing the patient for work and helping to recover professional opportunities of the patient.
The main indications to use of functional T. t. disorders of motive function of preferential upper extremities (restriction of amplitude of movements in joints, decrease in force and a tone of muscles, a lack of coordination of movements) after injuries, operative measures, inflammatory processes, diseases of peripheral nerves, etc. serve.
General technique of use of functional T. t. is defined by the nature of the disturbances which are observed at the patient and it is based on exact biomechanical analysis of the carried-out labor operations (see the Biomechanic). For functional T. t. carrying out various labor operations — from elementary labor processes with the facilitated loading (kartonazhny works, winding of threads, production of products from foam rubber, a gauze, etc.) before the movements developing thin coordination by fingers can be offered to the patient (work on the typewriter, a molding, weaving, knitting, etc.). The choice of specific work depends on localization of disturbances of mobility, weight of defeat, age, sex, the general condition of the patient. For performance of labor operation to the patient with the deformed joints of fingers and lack of full manual capture suggest to use the working tool with the handle changed as appropriate or the supplied nozzle, special, convenient for capture, or the fixing belt.
In the period of an immobilization of an extremity after an injury and as soon as possible after it to the patient suggest to carry out the facilitated labor operations by preferential unimpaired hand and due to the movements in joints of the affected extremity, to-rye were not exposed to an immobilization. Further, 3 — 4 months later after an injury, apply increase in volume of movements in the injured extremity and performance of the work demanding bigger muscular effort.
An important role is played by T. t. at effects of a pseudorheumatism (see) with defeat of a brush, fingers, humeral, elbow joints.
T. t. it can be shown at the motive frustration caused by pathology of a peripheral nervous system, napr, traumatic plexites (see), defeats of trunks of peripheral nerves, and defeats of c. N of page — the central and flaccid paralyzes (see Paralyses, paresis), parkinsonism (see), hyperkinesias (see), an ataxy (see) owing to the postponed neuroinfections, disturbances of cerebral circulation, craniocereberal injuries, and also cerebral palsy. In these cases strictly differentiated selection of labor operations according to harakterokhm disturbances of the movement, their depth and volume, preferential localization is necessary. Because at patients with defeats of a nervous system the exhaustion, in the course of T quickly develops. t. it is necessary to dose an exercise stress carefully.
Production T. t. promotes development in the sick compensatory processes, recovery which are temporarily lost and formation of new working skills. Indications to use of production T. t. and forms of its carrying out are close to those at functional T. t. In addition to purely to lay down. is more whole, production T. t. matters for the subsequent employment of disabled people.
T. t. apply in combination with massage (see) and means of LFK (see. The physiotherapy exercises) — to lay down. gymnastics and correction by situation. Lech. the gymnastics is appointed more often before involvement of the patient to labor therapy for the purpose of preparation of the motive device of extremities and an organism in general to more considerable functional load, and correction situation — after T. t.
Feature of use of T. t. at children's age for recovery temporarily lost or lagging behind in development (owing to defeat of the central or peripheral nervous system) motive functions its purposeful game character is.
T. t. it is contraindicated at an aggravation of a basic disease, malignant new growths, the general serious condition of the patient, tendency to bleedings.
See also Rehabilitation. Bibliography: Gellerstein S. G.,
Recovery labor therapy, in system of work evakogospitaly, Chelyabinsk, 1943; Gellerstein S. G. and Tsfasman I. L. Principles and methods of labor therapy mentally sick, M., 1964; r e l and about in with to and y M. Ya. Labor therapy mentally sick, M., 1966; Zaporozhets A. Century and Rubenstein of S. Ya. Metodik of recovery work therapy at wounds of upper extremities, M., 1942; M. M Boars. Rehabilitation mentally sick, L., 1978; To and p t e l and A. F N. Recovery treatment (physiotherapy exercises, massage and work therapy) at injuries and deformations of a musculoskeletal system, M., 1969; To and p t e-
a lean A. F. and Lasskaya L. A. Labor therapy in traumatology and orthopedics, M. 1979; Clinical and orga-
nizatsionny bases of rehabilitation mentally sick, under the editorship of M. M. Kabanov and K. Weise, M., 1980; Kruglova L. I. Recovery of working ability of patients with schizophrenia in the conditions of industrial production, L., 1981;
Melekhov D. E. Clinical bases of the forecast of working capacity at schizophrenia, M., 1963; The organization and practice of labor therapy in psychiatry and neurology, under the editorship of B. B. Malakhov, etc., L., 1982; R at and N about in and F. S. Effektivnost of labor therapy at mental diseases, L., 1971; X in and l and in and c -
to and y T. Ya. and Malakhov B. B. Labor therapy and pharmacological treatment of patients with schizophrenia in out-patient conditions, L., 1975; Yudint. I. Sketches of history of domestic psychiatry, M., 1951; Panteleev D. Work therapy at psikhichn of a zabolyavaniye, in book: Work therapy, under the editorship of St. Bankova, page 258, Sofia, 1979; Haerlin C. Beschaftigungstherapie nach Akutstadium, in book: Beschaftigungstherapie, Grundlagen und Praxis, hrsg. v. G. Jentschura u. H. W. Janz, Bd 2, S. 46, Stuttgart, 1979; Harlfinger H. Milieutherapie, Ar-beitstherapie und Beschaftigungstherapie als Basis der Rehabilitation psychisch Kran-ker, in book: IV Intern. Symp. fiir Rehabilitation psychisch Kranker, S. 220, Leningrad, 1974; Paul G. L. a. Lentz R. J. Psychosocial treatment of chronic mental patients, Cambridge — L., 1977.
M. M. Kabanov. A. F. Kaptelin „