AKADEMIA MEDYCZNA W GDAŃSKU

Anna Kuciejczyk

English for
Physiotherapists 2
materiały do nauki języka angielskiego
dla studentów fizjoterapii

GDAŃSK 2008
 Recenzent
mgr Hanna Żadkowska

Wydano za zgodą
Senackiej Komisji Wydawnictw
Akademii Medycznej w Gdańsku

© Copyright by Medical University of Gdańsk

ISBN 978-83-60253-31-1

Wydawca: Akademia Medyczna w Gdańsku

Zlec. KW/218/08
 CONTENTS

MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS .......................... 5

INTERVERTEBRAL DISC PROLAPSE .................................................................... 10
ARTHRITIS ............................................................................................................... 14
SCIATICA.................................................................................................................. 19
OSTEOPOROSIS ..................................................................................................... 25
SKELETAL SYSTEM DISEASES – REVISION ........................................................ 30
TENDINITIS, BURSITIS............................................................................................ 35
MULTIPLE SCLEROSIS – PATIENT’S REHABILITATION ...................................... 40
PARKINSON’S DISEASE – REHABILITATION ........................................................ 45
POST-STROKE REHABILITATION .......................................................................... 50
BRAIN INJURY REHABILITATION........................................................................... 55
PATIENT REHABILITATION – REVISION ............................................................... 60
BACK PAIN – TREATMENT METHODS .................................................................. 63
DIAGNOSTIC CRITERIA FOR MAJOR DEPRESSIVE EPISODE .......................... 68
EXAMINATION OF A JOINT MOTION ..................................................................... 72
LIMITATION OF A JOINT MOTION .......................................................................... 77
JOINT MOBILIZATION ............................................................................................. 81
SPORTS INJURIES ................................................................................................. 85
JOINT INJURIES – REVISION ................................................................................. 89
THERAPEUTIC HEAT .............................................................................................. 92
THERAPEUTIC COLD.............................................................................................. 96
GYMNASTICS ........................................................................................................ 100
PROSTHESES AND ORTHOSES .......................................................................... 105
RELAXATION TECHNIQUES ................................................................................. 109
CONTINUING PROFESSIONAL DEVELOPMENT OF A PHYSIOTHERAPIST.... 114

3
4
 MUSCULOSKELETAL AND CONNECTIVE TISSUE
DISORDERS

EXERCISE 1: Discuss in pairs.

• How often do you go to a doctor? When was the last time? What was the rea-
son?
• Have you ever visited a physiotherapist as a patient? What was your problem?
What are the most typical problems people report?
• How do physiotherapist diagnose patient’s disorders? Is it always possible to
diagnose disorders just by taking a patient’s history?

Exercise 2: Read the text and complete the gaps with proper prepositions (for,
on, by, with, through, in, to, of, to, between). Then, answer the questions below.

Musculoskeletal Disorders (MSDs)

The term refers 1)………. disorders and injuries of the muscles, tendons, ligaments,
nerves, cartilage, and spinal discs. It is not applied to injuries resulting from falls,
slips, or similar accidents. Most commonly, the term is used 2)………. disorders of
the hands, wrists, elbows, forearms, or shoulders, but also quite often a MSD can
affect other parts 3)………. the body such as the neck, back, or even the knees. Al-
though MSD is a term widely used in the United States, there are many other names
for these disorders, however. Here are some examples: Cumulative Trauma Disor-
ders (CTDs), Repetitive Strain Injuries (used by British Commonwealth countries),
Regional Musculoskeletal Disorders (used 4)………. rheumatologists), Overuse Syn-
dromes (used in sports medicine), Work-related Disorders (used by the World Health
Organization). Since there are some problems concerning etiology of certain disor-
ders, health professionals often disagree 5)………. what to call this phenomenon.
According 6)………. American statistics MSD and injuries account for about 60 per-
cent of all occupational illnesses.
MSDs include:
• Low back pain – definitely the most common MSD nowadays;
• Carpal tunnel syndrome (CTS) – probably the most well known MSD. This is a
nerve condition (damage to a nerve passing through the wrist) causing such
symptoms as pain, tingling, and numbness in one or both hands;
• Myalgia (a general term 7)……….. muscle pain);
• Tendinitis (irritation of a tendon);
• Tenosynovitis (irritation of the sheath around a tendon);
• Epicondylitis (irritation of the tendon attachments at the elbow; includes tennis
elbow and golfer’s elbow);
• Cubital tunnel syndrome (damage to a nerve passing 8)………. the elbow);
• Thoracic outlet syndrome (compression of the nerves and vessels 9)……….. the
neck and shoulder);
While they seem to have suddenly appeared in the last few decades, MSDs have
actually been around for centuries. Historically they were associated with blue-collar
jobs, however more recently, MSDs developed in white-collar jobs (for instance cleri-

5
cal workers often get “writer’s cramp”) as well as among people (including children)
who go online to use the web.
MSDs are not the same as sprains, strains, and other injuries caused 10)………. a
sudden trauma or a few days of overuse. They are also different from a localized fa-
tigue, like the sore shoulders after a week of intense weight training. These injuries,
though resembling the symptoms of a MSD, develop quickly and require only a few
days of rest for recovery. MSD symptoms are distinct 11)………. two ways. First,
MSDs involve a long latency period - months or years. Second, the symptoms persist
even after days of rest. In some extreme cases full recovery may even take years.
The biggest problem 12)………. diagnosing is the variety of conditions that fall into
the MSD category. They have many things in common, but the various kinds of
MSDs have different symptoms and methods of diagnosis. Health professionals usu-
ally depend on a patient’s reports of symptoms (e.g. a persistent pain, tingling,
numbness, aching, stiffness, or a feeling of heat in the affected area both while work-
ing and resting) and of the patient’s work and non-work activities. Quite frequently
symptoms can vary in their severity depending 13)………. the amount of exposure.
They often appear gradually and become more severe as exposure continues. Cer-
tain diagnostic tests can be done 14)………. order to determine which kind of MSD is
involved. Tests might involve, for instance, moving the wrist in particular ways or us-
ing instruments to check whether nerve function has been affected.
Treatment depends on the nature and severity of the condition. Mild cases caught
early can often be successfully treated 15)………. anti-inflammatory drugs, rest or
restricted activity, and possibly physical therapy. In the case of severe or long-lasting
disorders common methods include: prolonged rest, anti-inflammatory drugs, immo-
bilizing splints, heat or ice treatments, or physical therapy, or a combination of these.

Wordlist:
account for – stanowić
attachment – przyczep
blue-collar job – praca fizyczna
carpal tunnel syndrome – zespół cieśni nadgarstka, zespół kanału nadgarstka
writer’s cramp – kurcz pisarski
cubital tunnel syndrome – zespół ciasnoty kanału nerwu łokciowego
cumulative trauma disorder – zaburzenia wynikłe z kumulacji urazów
epicondylitis – zapalenie nadkłykcia
etiology – pochodzenie
exposure – wystawienie na działanie jakiegoś czynnika, narażenie
latency – utajenie, okres utajenia
myalgia – ból mięśniowy
numbness – drętwienie
repetitive strain injury – uraz spowodowany powtarzanym wysiłkiem
sheath – pochewka, otoczka
splint – szyna
sprain – uraz stawu z naderwaniem więzadeł bez zwichnięcia
strain – uszkodzenie powysiłkowe
tendinitis – zapalenie ścięgna
tenosynovitis – zapalenie pochewki ścięgna
thoracic outlet syndrome – zespół górnego otworu klatki piersiowej
tingling – mrowienie
white-collar job – praca za biurkiem, umysłowa

6
1. What are MSDs?
2. Which parts of the body are most commonly affected by MSDs?
3. Why are there so many terms referring to the same group of disorders?
4. Who is mostly affected with these disorders nowadays?
5. What is a carpal tunnel syndrome?
6. In what ways are MSDs different from common injuries or fatigue?
7. How can a health professional correctly diagnose a MSD?
8. What are possible ways of treatment in the case of MSDs?

EXERCISE 3: Write nouns for the following verbs.

to irritate - to ache –
to resemble - to treat –
to apply - to combine –
to disagree - to function –
to occupy - to attach –
to categorise - to immobilize –
to restrict - to prolong –
to damage - to appear –
to sprain - to persist –
to recover - to diagnose -
to expose - to injure –

EXERCISE 4: In pairs, prepare English definitions for the following terms.

symptoms health professional diagnosis wrist severe condition

fatigue recovery accident long-lasting disorder elbow

EXERCISE 5: Complete the text below with the correct words.

The risk f……………. most commonly responsible for work-related musculoskeletal

disorders i…………….. for example: work postures and movements, force of
m…………….., repetitiveness and pace of work, temperature, accompanying vibra-
tions, and the weight of the o……………… being handled at work. Actually, any body
position can c……………… discomfort and fatigue if it is maintained for
l………………. periods of time. Even a standing position – a natural body posture not
related to any h………………… hazards – can cause sore feet, general muscular
fatigue, and low b…………………. pain when a particular job involves standing for
long periods. There are generally two aspects that can c……………….. to injuries.
The first one relates to a body position. For instance, prolonged bending
f………………, backward, twisting the trunk places too much stress on the low back.
Other examples include persistent and repetitive reaching above shoulder
l………………., rotating the arms, bending the wrists. The second aspect is related to
h……………… the neck and the shoulders in a fixed position. The muscles contract
and s……………… contracted for as long as the task requires. These contracted

7
muscles squeeze the blood vessels, which restricts the f………………… of blood all
the way down to the working muscles. When the blood supply is reduced, fatigue in
the working muscles is accelerated, making them more prone to i……………….. . To
sum up, the longer a fixed or awkward body position is used, the more
l………………….. people are to develop work-related musculoskeletal disorders.

EXERCISE 6: Translate into English.

1. Większość chorób układu mięśniowo-szkieletowego rozwija się z biegiem

czasu i jest spowodowana wykonywaną pracą lub środowiskiem pracy.
2. Choroby układu mięśniowo-szkieletowego mogą być również wywołane przez
wypadki, np. złamania i zwichnięcia.
3. Choroby te zazwyczaj dotyczą pleców, szyi, ramion i kończyn górnych, rza-
dziej kończyn dolnych.
4. Problemy zdrowotne obejmują szeroki zakres dolegliwości, lekkie i silne bóle
oraz bardziej poważne choroby wymagające przerwania pracy i podjęcia lec-
zenia.
5. W przypadkach gdy choroba staje się przewlekła, leczenie i powrót do zdrowia
mogą okazać się nieskuteczne, skutkować może to trwałą niepeł-
nosprawnością i utratą pracy.

EXERCISE 7: Put the verbs in brackets in the correct forms.

1. I ………………………. (go) skiing before but last week was still a real chal-
lenge for me.
2. I can’t come out now because I ……………………….. (finish) my homework.
3. I ………………………... (wait) for ages for him to write before finally a short let-
ter arrived.
4. Can you remember what you …….…………………….. (wear) the night you
lost your wallet?
5. You’ve dropped your documents. I………………………….. (pick up / them) for
you.
6. I ………………………… (watch) my favourite talk show when the doorbell
………………………… (ring).
7. The most popular film she ………………………….. (make) so far is Total
Eclipse.
8. The talk shows ………………………… (increase) in number all the time.
9. As it …………………………. (snow) all day and night the roads around the city
were blocked.
10. We looked out of the window and saw it ……………………….. (snow) so we
stayed in.
11. I’m going home now but I…………………………… (see) you at the same time
tomorrow.
12. They ………………………….. (broadcast) this documentary on TV twice al-
ready.

8
References:
http://www.ccohs.ca/oshanswers/ergonomics/risk.html 4. 09. 2007
http://www.hermanmiller.com/hm/content/research_summaries/wp_Musculoskeletal.
pdf 4. 09. 2007
http://www.pip.gov.pl/html/pl/doc/07080604_3.pdf 4. 09. 2007
Luke Prodromou, “First Certificate Star. Practice Book”, Macmillan Heinemann,
Madrit 2003.

9
 INTERVERTEBRAL DISC PROLAPSE

EXERCISE 1: Discuss.
• Have you ever heard of a slipped disc? What happens to a person? What are the
symptoms and how are they relieved?
• Do you know anyone who suffered from a slipped disc?
• What may cause such a condition?

EXERCISE 2: Read the text and insert the missing fragments from the list.
Then, answer the questions below:

Prolapsed intervertebral disc, 1)………. is a condition, most commonly of traumatic

etiology, where the gelatinous nucleus pulposus squeezes through the annulus fibro-
sus and bulges in a posterior (or posterolateral) direction, below the posterior longi-
tudinal ligament. Due to this, 2)………. - most commonly S1, then L5, then L4. The
intervertebral disc prolapse can be divided into three regional sub-types: cervical,
thoracic (rare, accounts only for 0.2% of all disc lesions), and lumbar. The symptoms
may be divided into consequent two stages; the first stage – 3)………., and the sec-
ond one – 4)………. . The symptoms can also be categorised as mechanical (due to
changes in ligamentous and fascial structures in the lumbar spine) and neurological
(due to pressure upon the nerve root by the disc protrusion itself). Most common
clinical features of prolapsed intervertebral disc are: 5)………, inability to straighten
up: lumbar lordosis may decrease and a protective sciatic scoliosis may appear, pain
felt in leg and buttock - sciatica - may be observed after a few days, paraesthesia or
numbness in the leg or foot, urinary retention - a result of cauda equina compression
(a surgical emergency), tenderness in the midline of the lower back. Moreover, the
pain may be worsened by foot dorsiflexion and bowstringing of the popliteal nerve,
also a "crossed sciatic tension" may be observed - sciatic pain in the affected leg on
raising the unaffected leg. Diagnosis is based on various imaging techniques
6)………. (and to exclude alternative pathology, e.g. metabolic and neoplastic bone
disease): radiograph, contrast myelography scan, CT scan, NMR scan. The treat-
ment normally involves: bedrest, sometimes with traction and anti-inflammatory
drugs; reduction – is effective in 90% of cases, frequently requires epidural corticos-
teroid and local anaesthesia; surgical removal (the indications are: cauda equina
compression syndrome, persistant pain and severely limited leg raise not helped by a
conservative treatment, neurological deterioration, frequent recurrence), 7)………. .

A. back pain with very limited movement, sudden onset while lifting or stooping,
B. in which pain is also felt in the leg.
C. physical rehabilitation (isometric exercises, learning proper methods of lifting).
D. pressure symptoms appear on the root below the level of herniation
E. also called displaced, herniated or slipped disc,
F. in which pain is confined to the back
G.used in order to localise the site of the lesion

10
Wordlist:
annulus fibrosus – pierścień włóknisty
bowstringing – napinanie
brachalgia – ból ramienia
bulge – wybrzuszać się
cauda equina – ogon koński, ostatnie nerwy odchodzące od rdzenia kręgowego
compression – ucisk
confined – skoncentrowany (gdzieś: o bólu)
consequent – następujący po sobie
deterioration – pogorszenie
dorsiflexion – zgięcie grzbietowe
epidural – nadtwardówkowy
extruded – wypchnięty
facia – powięź
gelatinous – galaretowaty
impinge upon – zderzać się z czymś, uderzać w coś
longitudinal – podłużny
NMR (Nuclear Magnetic Resonance) scan – jądrowy rezonans magnetyczny
nucleus pulposus – jądro miażdżyste
paraesthesia – parestezja (uczucie mrowienia i drętwienia)
popliteal – podkolanowy
prolapse – wypadnięcie
protrusion – wystawanie
reduction – repozycja
stoop – pochylać się
traction – wyciąg
vent – otwór, kanał, ujście

1. What happens during an intervertebral disc prolapse?

2. What can the prolapse be divided into?
3. How do the symptoms stages differ from each other?
4. What are the mechanical symptoms?
5. What is the person suffering from a slipped disc likely to feel?
6. What is a „crossed sciatic tension”?
7. How is the condition of a disc prolapse diagnosed?
8. What are the ways of treatment?
9. Which discs are less likely to prolapse?

EXERCISE 3: Complete the phrases with single words on the basis of the text.
Then translate the phrases into Polish.
1. alternative ………….…………..
2. ………………………….. limited
3. traumatic ……………………….
4. frequent ………………………...
5. ………………………….features
6. imaging ………………………….
7. ……………………….. treatment
8. ………………………………spine

11
9. ………………………………..pain
10. neurological ……………………
11. neoplastic ………………………
12. ……………………………….leg
13. ………………………..…lesions
14. local …………………………….
15. ………………………………root

EXERCISE 4: Complete the text with the phrases from the box.

The condition of a prolapsed cervical disc 1)…………………………… or below the

6th cervical vertebra affecting the 6th or 7th cervical nerves. A part of the gelatinous
nucleus pulposus 2)………………………………………… in the annulus fibrosis at its
weakest - postero-lateral – part, also a part of the annulus may be displaced. There
may be a postero-lateral prolapse (a protrusion 3)……………………………… leaving
the spinal canal) or a central prolapse (when it impinges upon the spinal cord). The
first type manifests with acute neck stiffness 4)………………………………… other
straining. Later, the pain radiating over the shoulder and throughout the upper limb
may develop 5)…………………………….. paraesthesia. The other type presents
signs similar to a spinal cord compression. On examination certain neck
6)…………………………….. but movement in at least one direction, often lateral flex-
ion, is free. Slight sensory impairment in the distribution of the cervical nerves with
the corresponding 7)……………………………………… or absent may be observed.
Usually, 8)…………………………… are sufficient for the treatment of cervical disc
prolapse. These include non-steroidal anti-inflammatory drugs (if not contraindi-
cated), muscle relaxants in the case of muscle spasms, avoiding heavy lifting, a rigid
neck collar (only 9)………………………….), physiotherapy. Other possibility of treat-
ment is surgery (although it carries a significant risk) indicated for example when a
patient 10)……………………………………. brachialgia with or without neurological
disorders.

for a short term tendon reflexes depressed

suffers from a persistent or progressive movements may be limited by pain
aggravated by coughing and together with fingers
usually occurs immediately above may protrude through a vent
conservative measures impinges upon the nerve

EXERCISE 5: Ask about the underlined parts of the sentences below.

1. All these procedures are usually combined with spinal fusion.

2. Operative intervention may involve removal of the extruded disc material.
3. During the initial phase, heavy lifting must be avoided.
4. Various imaging techniques are used to localise the site of the lesion.
5. Even where it is obvious that a disc herniation has occurred, the principle of
first treatment is conservative.
6. Remissions are largely independent of treatment.

12
 7. The most common clinical feature of prolapsed intervertebral disc is back
pain with very limited movement.
8. A slight protrusion bulges against the posterior longitudinal ligament and
causes local pain in the neck.

EXERCISE 6: Work in pairs. You are a young and not very experienced physio-
therapist. Write an e-mail to a friend surgeon describing symptoms and the
physical examination results. Ask for confirmation of the diagnosis and sug-
gestion of a good treatment option.
Give your letter to another pair to be checked and corrected.

EXERCISE 7: Choose the correct option in the sentences below.

1. I promise I never see her / I will never see her again.

2. This time tomorrow we’ll fly / we’ll be flying to Greece.
3. I’m having / I’ll have an important meeting with my accountant tomorrow morn-
ing.
4. How many poems has Mickiewicz written / did Mickiewicz write?
5. I have two tickets to the theatre for tonight. Do you come / Will you come with
me?
6. Have you reminded her / Did you remind her about the seminar?
7. We don’t need to hurry. Tom drives / is going to drive us to the station.
8. It’s the first time I have ever driven / had ever driven a car.
9. They have been waiting / had been waiting for two hours before the police ar-
rived.
10. They awarded / have awarded David Linch the Oskar, I’ve just heard about it!
11. For the last few years my children went / have been going to a summer camp
in the mountains. They really enjoy it every time.
12. The roads should be repaired / have been repaired last year, but they are still
dangerous for drivers.
13. I went / have been going to school when I was seven.
14. Sorry, we have sold / have been selling the last copy of this newspaper.
15. You looked as if you have cried / had been crying.

References:
http://qjmed.oxfordjournals.org/cgi/content/abstract/16/3/157 5.07.2007
http://serwisy.gazeta.pl/zdrowie/2,51174,,,,37393508,P_MEDIMEDIA_CHOROBY.ht
ml 5.07.2007
http://www.gpnotebook.co.uk/simplepage.cfm?ID=1651179529 5.07.2007
Luke Prodromou, “First Certificate Star. Practice Book”, Macmillan Heinemann,
Madrit 2003.

13
 ARTHRITIS

EXERCISE 1: Discuss.
• Think of potential causes of problems with joints.
• What are the consequences of such problems?
• Who is most likely to suffer from such disorders?
• How can people cope with joints problems?

EXERCISE 2: Read the text and answer the questions below.

Arthritis literally means joint inflammation. It is not a single disease, it refers to a

group of more than 100 rheumatic diseases and other conditions that cause prob-
lems in joints. Two most common types of arthritis are osteoarthritis and rheumatoid
arthritis. Actually, any part of the body can become inflamed or painful from arthritis.
Some rheumatic conditions, if left undiagnosed and untreated, can result in debilitat-
ing, even life-threatening complications or may cause irreversible damage to the
joints, bones, internal organs, and skin. Arthritis can affect anyone at any age, includ-
ing children. The incidence of arthritis increases with age, but nearly three out of
every five sufferers are under 65.
Due to arthritis, some changes occur in a joint. For instance, in a healthy knee, carti-
lage protects and cushions bone surfaces that come together at the joint allowing
bones to move without friction. In an unhealthy knee, cartilage is damaged or worn
away causing pain from bones rubbing together. The most common symptom of ar-
thritis is pain. It can be continuous or intermittent, may occur after activity or exercise
but it may also happen even if someone has been resting and still for a period of
time. Pain may be concentrated in one spot or spread all over the body. Joints may
feel stiff and difficult to move (limited range of motion), daily activities, such as climb-
ing stairs may become a challenge. Other symptoms that may appear are: swelling,
inflammation, skin tenderness, fatigue, reddening and warmth around the affected
joint.
Unfortunately there is no cure for arthritis. Early diagnosis and treatment tailored to
an individual's needs are crucial in slowing or preventing damage to joints. Only a
physician (rheumatologist) can determine what type of arthritis one has. Arthritis is
diagnosed based on the overall pattern of symptoms, detailed medical history, physi-
cal exam, x-rays (to identify joint deformity and erosions) and lab tests (to identify
inflammation, infection). The goals of a treatment plan are to: decrease symptoms,
ensure slow progression of the disease, prevent or minimize joint deformities and
damage, maintain joint function, preserve mobility and range of motion.
An effective arthritis treatment regimen can help manage the disease. There are
many treatment options, patients normally are treated with more than one type of
treatment to increase its effectiveness. Most commonly doctors recommend: medica-
tions (over-the-counter, topical creams for early symptoms, anti-inflammatory drugs,
corticosteroids, disease modifiers, sleep medications), lifestyle changes (regular ex-
ercise keeps the body moving and flexible, may lessen pain, increase movement,
reduce fatigue; weight control reduces stress put on joints), heat and cold therapy
(provides short-term relief from pain and stiffness), joint protection (learning how to

14
avoid using sore and weak joints, walking with assistive devices), surgery (may be
effective in minimizing or eliminating pain when other treatment methods have failed).

Wordlist:
cushion (v.) – wyściełać
debilitaiting – osłabiający
friction – tarcie
incidence – zapadalność (na chorobę), częstość występowania
intermittent – przerywany (ból)
irreversible – nieodwracalny
lessen – zmniejszyć (intensywność)
life-thretening – zagrażający życiu
literally – dosłownie
osteoarthritis – zapalenie kości i stawów
over-the-counter drugs – leki bez recepty
pinch – szczypać, uciskać
(be) predisposed to – mieć skłonności do czegoś
progression – postępowanie (choroby)
regimen – regulamin, tryb postępowania
rheumatoid arthritis – reumatoidalne zapalenie stawów
still – nieruchomy
tailor sth to one’s needs – dostosować coś do czyichś potrzeb
tenderness – tkliwość uciskowa
topical – miejscowy
wear away – zużywać, ścierać

1. What type of disease is arthritis?

2. Which part of the body is mostly affected?
3. What may be the consequences of arthritis?
4. What happens in an affected joint?
5. What are the typical symptoms of arthritis?
6. How is arthritis diagnosed?
7. What is the aim of arthritis therapy?
8. What are the treatment options?

Now decide if the sentences below are true or false. If false, correct them using your
own words.

1. Arthritis cannot be described as a single disease. There are hundreds of types.

2. Surgery is most commonly the only way of treating arthritis.
3. Arthritis can cause functional limitations which interfere with activities of daily living.
4. Pain is caused by improper bone movements inside the joint.
5. Since arthritis is uncurable, it’s pointless to use any therapies.
6. Only elderly people are predisposed to arthritis.
7. Besides the physical limitations imposed by arthritis, living with chronic pain can
have emotional consequences.
8. Arthritis causes only minor aches and pains.
9. Arthritis can be treated by changes in your diet.
10. You may have to try several treatment options before finding the most optimal
treatment plan for you.

15
EXERCISE 3: Complete the following table with the names of two types of ar-
thritis: RA (rheumatoid arthritis), O (osteoarthritis).

Who is most likely to get the condition?

………………. – usually middle-aged and elderly people;

………………. – mostly women (75%), often begins between the age of 30 and 60,
but can develop at any age;

What is the medical definition of the condition?

………………. – an inflammatory condition (causes joint swelling) in which the im-

mune system mistakenly attacks the tissue lining and cushioning the joints;
………………. – a disease affecting joints, gets worse over time, is not inflammatory
(does not cause joint swelling);

What causes pain?

………………. – cartilage wears away and the cushioning fluid in the joint becomes
inflamed. Due to the inflammation chemicals are released, they damage the carti-
lage and the bone of the affected joint;
………………. – the cartilage that cushions the bones of the joint starts to erode,
bones of the joint start to grind or rub together;

What are the symptoms of the condition?

………………. – pain and stiffness;

………………. – pain and swelling;

EXERCISE 4: A role play. Work in pairs.

A: You are a middle-aged person suffering from severe joint problems. Since you
have difficulty with walking, you call a physiotherapist’s office and try to arrange a
home visit. Explain the problem and be polite.

B: You are a physiotherapist. A patient calls your office and wants a home visit. Ask
what the problem is and explain that you are very busy and it is really difficult for you
to leave the office. Try to reach a compromise. Remember, all your patients are very
important, you cannot lose this one!

16
EXERCISE 5: Complete the extract below with the correct words.

Mysterious pain
The location of the pain 1)………………….. not necessarily suggest the exact condi-
tion you have. The source is not always what you'd think. For instance, the pain that
truly 2)……………………. from a hip problem is often located in the thigh or groin
area. In other cases, hip pain may be a 3)………………….. of a problem elsewhere in
the body. If the pain is more in the buttocks 4)………………….. the hip, for example,
it may actually result from a 5)……………………. in the back. And, while hip pain that
travels 6)……………………. the leg may be the result of the hip joint inflammation, it
can also be a sign of sciatica (a condition usually 7)…………………… by a pinched
nerve in the back). If the pain travels below the knee, it could be a sign of disease
related 8)…………………… blood vessels or nerves. In women, pain in the hip or
upper leg may stem from several 9)……………………. causes, including tumors of
the uterus or ovaries, endometriosis (the presence of uterine tissue elsewhere in the
body), or pelvic inflammatory disease (infection in the reproductive
10)……………………….).

EXERCISE 6: Translate into English.

1. Artretyzm jest schorzeniem związanym z zapaleniem stawów. Towarzyszące

mu objawy to ból podczas wykonywania ruchów, uczucie sztywności, oraz
opuchlizna.
2. Istnieją dwa główne rodzaje artretyzmu: osteoartretyzm i artretyzm reu-
matyczny, będący najczęściej następstwem złamania lub uszkodzenia stawu.
3. Artretyzm niszczy tkanki stawowe i może stanowić przyczynę trwałego kalec-
twa, a nawet prowadzić do śmierci.
4. Początkowo artretyzm atakuje stawy w nadgarstkach i drobne stawy kończyn.
W późniejszych etapach rozwoju choroby dochodzi do zniekształceń w sta-
wach biodrowych, łokciowych, kolanowych, oraz w kręgosłupie.
5. Jest to choroba, w której układ immunologiczny atakuje tkankę stawów.
6. Reumatoidalne stany zapalne rozwijają się powoli i może to trwać latami.
7. Świadomość potencjalnego zagrożenia i odpowiednie wspomaganie or-
ganizmu jest bardzo ważne ze względu na skuteczną profilaktykę oraz
ochronę przed kalectwem i cierpieniem.
8. Choroba ta występuje częściej u kobiet niż u mężczyzn.

EXERCISE 7: Explain (in English!) the difference in meaning between the pairs
of sentences below.

1. Only the chairman objected to the proposal to build a new school.

The chairman objected only to the proposal to build a new school.
2. The mechanic didn’t pretend to know what had gone wrong in my car.
The mechanic pretended not to know what ha gone wrong in my car.
3. I haven’t seen Kate this morning. Have you?
I didn’t see Kate this morning. Did you?
4. He recovered from flu so quickly that he didn’t need to visit a doctor.
He recovered from flu so quickly that he needn’t have visited a doctor.

17
5. They looked silently admiring a portrait of Holbein.
They looked silently admiring a portrait of Holbein’s.
6. He didn’t promise to attend the meeting.
He promised not to attend the meeting.
7. He must have had a new lock put on the door.
He must have put a new lock on the door.
8. Sarah went to the shop only to discover how expensive the dress was.
Sarah went to the shop, only to discover that the dress was very expensive.
9. When David comes back, please tell him where I am.
If David comes back, please tell him where I am.
10. It’s snowing hard now.
It’s hardly snowing now.
11. You are now speaking like a teacher.
You are now speaking as a teacher.
12. Pam spends a lot of money on clothes.
Pam is spending a lot of money on clothes.
13. I haven’t seen John recently. Has he gone on holiday?
I haven’t seen John recently. Has he been on holiday?
14. Mary is sure to be offered the job.
Mary is sure she’ll be offered the job.
15. I regret to say that you’ll be held responsible for that.
I regret saying that you’ll be held responsible for that.

References:
B.D. Graver, „Advanced English Practice”, Oxford University Press, 1995.
http://aromabc.homestead.com/artretyzm.html 5.07.2007
http://arthritis.about.com/ 5.07.2007
http://en.wikipedia.org/wiki/Arthritis 5.07.2007
http://osteoporoza.info/Default.aspx?PageToOpen=/ChorobaSzczegoly.aspx&id=82
5.07.2007
http://www.nlm.nih.gov/medlineplus/arthritis.html 5.07.2007
http://zimmer.com.au/z/ctl/op/global/action/1/id/379/template/PC/navid/924
5.07.2007

18
 SCIATICA

EXERCISE 1: Discuss.
• Have you ever experienced pain in the lower back, radiating down the thigh or
leg? Do you think it was a sciatica? What was the cause of this pain? How did
you handle the problem?
• Do you think such a pain is a common problem among people? What are the typi-
cal causes? What should one do when a pain like this appears?

EXERCISE 2: Read the text and put the correct headings into the spaces below.
Then, answer the questions.

1. ……………………Sciatica is a general term that refers to a condition in which the

sciatic nerve (the largest one in the human body) is irritated. Sciatic nerve travels
from the lower back down the back of each leg, giving information from the brain to a
lot of muscles in legs and feet, making it possible for these muscles to work, and car-
rying sensory sensations to the brain.
2. ……………………The usual sciatica pain is localized in the low back, buttock, and
down the back of the thigh. Depending on where the sciatic nerve is affected, the
pain may also radiate to the foot or toes. It can vary from an infrequent, slight annoy-
ing pain (with a general potential to get worse) to an excruciating one that makes it
impossible for a person to walk or do their normal activities.
3. …………………… Many different things can cause sciatica. Most commonly it re-
sults from pressure on the sciatic nerve from a herniated (slipped) disc in the lumbar
spine. This condition is called a “radiculopathy” (the disc protrudes from its normal
position in the spine putting pressure on the radicular nerve – a part of the sciatic
one). Other potential causes are e.g. lumbar spinal stenosis, degenerative disc dis-
ease, isthmic spondylolisthesis, sacroiliac joint dysfunction (the last two cause sciat-
ica-like pain), but also tight muscles, arthritis, and abnormal structures in the buttock
or hip can be responsible for the nerve irritation.
4. …………………….. Sciatica occurs most frequently in people between 30 and 50
years of age. As a result of this condition, the following sensations may occur: pain in
the rear or leg that is worse when sitting, burning or tingling down the leg, weakness,
numbness or difficulty moving the leg or foot, a constant pain on one side of the rear,
low back pain (usually less severe than the leg pain that comes along). Since in most
cases sciatica pain results from inflammation, the vast majority of people who experi-
ence it get better with time (usually a few weeks or months) and find pain relief with
non-surgical treatments. Symptoms that may constitute a medical emergency (the
need for seeking immediate medical attention) include: progressive weakness in the
leg or bladder/bowel incontinence (cauda equina syndrome). Other people who
should contact their doctor if sciatica occurs are the ones who: have been diagnosed
with cancer, take steroid medications, abuse drugs, have unexplained, significantly
low weight, or HIV.
5. …………………….. It requires a diagnosis of the underlying cause of the pain.
Thus, a physical therapist should do a full assessment to figure out the cause, treat it
(help to get rid of the pain), and also teach the patient what to do to get rid of the sci-
atic pain yourself if it starts to return. Typical sciatica treatments include:

19
 • Non-surgical treatment (conservative care options) which may include one or a
combination of medical treatments (heat / ice therapy, drugs e.g. non-steroid
anti-inflammatory, epidural steroid injections) and alternative treatments (acu-
puncture, massage therapy and chiropractic manipulation - spinal adjustments).
It is most frequently in a form of exercise and stretching. The goals of such a
treatment include both relief of sciatica pain and prevention of future sciatica
problems.
• Sciatica surgery, such as microdiscectomy or lumbar laminectomy and discec-
tomy, to remove the portion of the disc that is irritating the nerve root. This sur-
gery is designed to help relieve both the pressure and inflammation and may be
recommended if the pain is severe and has not been relieved with appropriate
manual or medical treatments.
6. ……………………… When the pain is severe a short period of bed rest is usually
recommended. However, a program of physical therapy and exercise should be pur-
sued quite quickly, since inactivity is likely to make the sciatic pain worse. This is be-
cause regular movement is necessary to nourish the various structures in the low
back and encourage the strength needed to support the low back region. Most sciat-
ica exercises focus on strengthening and gentle stretching the abdominal and back
muscles. Aerobic exercise, such as walking or swimming are also good components
of recovery.
7. …………………….. A number of non-surgical spine care professionals, including
physical therapists, chiropractors, physiatrists (physical medicine and rehabilitation
specialists), pain medicine specialists, certified athletic trainers may recommend ex-
ercise as part of a sciatica treatment program. It is however important to get a diag-
nosis before starting any sciatica exercises, since the sciatica-like pain may (rarely)
be caused by other serious medical conditions, such as a tumour.

Physical therapy.
Occurrence and symptoms.
Final remarks.
Causes.
Treatment of sciatica.
The character of sciatic pain.
Introduction.

Wordlist:
alert – czujny
bladder – pęcherz
bowel – jelito
buttock – pośladek
cauda equina syndrome – zespół końskiego ogona
contiguous – przylegający, styczny
discectomy – wycięcie (operacyjne usunięcie) dysku kręgowego
epidural – nadoponowy
excruciating – rozrywający (ból)
facet joint – stawy międzywyrostkowe
herniated disc – wypadnięty dysk = slipped disc
incontinence – nietrzymanie
isthmic spondylolisthesis – kręgozmyk cieśni

20
laminectomy – laminektomia, przecięcie blaszki kręgowej w celu dotarcia do rdzenia
kręgowego
microdiscectomy – mikrodiscektomia (usunięcie przepukliny jądra miażdżystego
techniką mikrochirurgiczną)
nourish – odżywiać
numbness – drętwienie
piriformis muscle – mięsień gruszkowaty
piriformis syndrome – zespół gruszkowaty
protrude – wystawać
pursue – prowadzić (studia, sprawę), wykonywać (plan)
radicular nerve – nerw korzeniowy
radiculopathy – choroba, dysfunkcja korzonków nerwowych
rear – tył
root – korzeń
sacroiliac – krzyżowo-biodrowy
sciatica – rwa kulszowa

1. What is a sciatic nerve and what is it responsible for?

2. What kind of pain is associated with sciatica?
3. What is radiculopathy?
4. What can sciatica result from?
5. Who is most likely to suffer from sciatica?
6. What symptoms may appear?
7. Who needs to be especially alert to sciatica symptoms?
8. How is sciatica treated?
9. Why shouldn’t people with sciatica spend too much time resting in bed?
10. What is the goal of physical exercises for sciatica?

EXERCISE 3: A role-play. Work in pairs.

A: You are a patient and you suffer from a severe pain of the lower back. Describe
the problem in detail to the physiotherapist, give all the necessary information. Ask
questions about the possible ways of treatment. You work physically, have a big fam-
ily so you must be healthy very soon.

B: You are a physiotherapist. Ask a patient about the symptoms, get as much infor-
mation as possible (onset, severity, frequency, character of pain, daily routine, job,
living environment, etc.). Explain possible ways of treatment, answer the patient’s
questions. Suggest the best possible therapy.

EXERCISE 4: Match the phrases together. They have appeared in the text.

medical nerve
full sensations
sensory pain
joint spine
conservative stenosis
athletic dysfunction
sciatic irritation

21
 vast majority
gentle emergency
lumbar assessment
spinal treatment
nerve stretching
excruciating trainer

EXERCISE 5: Complete the text below with the correct prepositions from the
list.

in x4 of x4 at x2 through from
together down out

The sciatic nerve is the largest nerve ……………. the body and is composed
…………… individual nerve roots that combine to form the “sciatic nerve”. It starts
……………. the low back …………… lumbar segment 3 (L3). The sciatic nerve roots
run …………… the bony canal ……………. the spine, and …………….. each level
…………….. the lower back a pair of nerve roots exits …………….. the spine and
then comes …………… to form the large sciatic nerve that runs all the way
…………….. the back ……………. each leg. Portions …………….. the sciatic nerve
then branch …………… ……………. each leg to innervate certain parts …………..
the leg (e.g. the foot, the toes, the calf).

Now translate the text into Polish.

EXERCISE 6: Back problems that cause sciatica pain. Write the terms next to
the correct definitions.
lumbar herniated disc
lumbar spinal stenosis
degenerative disc disease
isthmic spondylolisthesis
piriformis syndrome
sacroiliac joint dysfunction

1. …………………………………. – the process itself is a natural one that occurs

with aging. A worn away, weakened disc can irritate a nerve root and cause sci-
atica. The disc undergoing the process produces an excessive amount of micro-
motion that results in an irritation.
2. ………………………………….. - this condition commonly causes sciatica due to
a narrowing of the spinal canal. It is more common in the elderly, typically results
from a combination of one or more of the following: enlarged facet joints, a bulg-
ing disc placing pressure on the nerve roots as they exit the spine, overgrowth of
soft tissue.
3. …………………………………... - the sciatic nerve can also get irritated as it runs
under the piriformis muscle in the rear. If the piriformis muscle irritates or
pinches a root that comprises the sciatic nerve, it can cause sciatica-type pain.

22
 4. …………………………………… – sometimes referred to as a slipped disk, rup-
tured disk, bulging disc, protruding disc. It occurs when the soft inner core of the
disc extrudes through the fibrous outer core of the disc and the bulge places
pressure on the contiguous nerve root as it exits the spine.
5. …………………………………… – this condition only rarely causes back pain or
sciatica pain. It occurs when a small stress fracture (most often at the fifth seg-
ment) allows the L5 vertebral body to slip forward on the S1 vertebral body. The
L5 nerve may get pinched as it exits the spine due to the combination of: disc
space collapse, the fracture, and the vertebral body slipping forward.
6. ……………………………………. – irritation of this joint at the bottom of the spine
can also irritate the L5 nerve, which lies on top of it, and cause sciatica-type
pain.

EXERCISE 7: Modal verbs. Choose the correct option.

1. There is someone at the door. This has to be / must be a postman.

2. Sarah came home early. She needn’t have worked / didn’t have to work late
this afternoon.
3. You mustn’t / can’t drive over 50 km/h across the city in Poland.
4. You drove too fast yesterday. You must have / could have caused an acci-
dent.
5. You mustn’t / don’t have to go to work today because it’s a national holiday.
6. You needn’t / mustn’t talk during the writing exam.
7. He needn’t have paid / didn’t need to pay for the meal since Iater it turned out
the company covered all the expenses.
8. When he was a young boy he could / might ride a bike.
9. You must have turned / should have turned to the left. Now, I can’t see the
right way on the map.
10. When I went to school pupils mustn’t / didn’t have to wear uniforms.

EXERCISE 8: Rewrite the sentences using the words in brackets.

1. Perhaps you would let me know tomorrow. (might)

2. Although I was extremely rude to him, I didn’t feel guilty. (may have)
3. The Conservatives are expected to win the next election. (ought to)
4. Let’s not wait any longer. It’s possible he won’t turn up at all. (may)
5. It has been impossible for me to get to the bank yet, so I haven’t got any
money. (be able)
6. It is possible he missed the train. (may)
7. Maybe he forgot to write to me? (could)
8. It was unnecessary for you to have told Mike anything. (need)
9. You are not obliged to come to this meeting. (don’t)
10. I want you visit us again one day. (must)

23
References:
B.D. Graver, „Advanced English Practice”, Oxford University Press, 1995.
„English for Medical Students and Doctors 1”, Ewa Donesch-Jeżo, WPL, Kraków,
2000.
http://medycyna.linia.pl/ischias.html 5.07.2007
http://physicaltherapy.ca/ortho/Sciatica1.html 5.07.2007
http://www.spine-health.com/topics/cd/d_sciatica/sc01.html 5.07.2007
http://zdrowie.flink.pl/rwa_kulszowa.php 5.07.2007

24
 OSTEOPOROSIS

EXERCISE 1: Discuss.

• What kind of disease is osteoporosis? Do you know anyone who suffers from
this?
• Who is most likely to suffer from osteoporosis? Why?
• What are the ways of treating osteroprosis?

EXERCISE 2: Read the text and complete the gaps with the correct words (the
first letters have been given to help you). Then decide if the sentences below
are true or false. Correct the false ones.

Osteoporosis is a silent disease of progressive bone loss associated with an in-

creased risk of fractures. It literally means "porous bone." The disease is 1)
c……………… “silent” since it often develops unnoticed over many years, with no
symptoms or discomfort, until a fracture 2) o…………….. (the most common ones
occur at the spine, wrist and hip). Osteoporotic fractures are often slow to heal and
heal poorly. Bones that are affected by osteoporosis are fragile, can break with only a
minor fall or injury that normally would not 3) c……………… a bone fracture. When a
person is young, older bones are removed (bone resorption) and replaced by new
bone (bone formation). With time, the balance between bone resorption and bone
formation shifts, so that more bone is lost than can be replaced. As a consequence,
bones become structurally 4) w…………………, thinner, and more prone to fractures.
Although the exact medical causes of osteoporosis are not always certain, there exist
various 5) f………………. that can increase the risk of developing osteoporosis and
suffering a fracture:
• Aging. Everyone loses bone with age. It starts in the mid-30s but accelerates after
50 years of age. In general, the 6) o……………….. you are, the lower your total
bone mass and the greater your risk for osteoporosis.
• Heredity, that is for instance: a family 7) h………………. of fractures, slender body
build (small bone structure), a Caucasian or Asian background, fair skin.
• Lifestyle and nutrition. Poor nutrition, low dietary intake or absorption of calcium
and vitamin D, low body weight, 8) s……………… lifestyle, smoking, alcohol
abuse have been linked to osteoporosis.
• Medications, diseases, conditions. Using, such as steroids, heparin, anticonvul-
sants, also, some thyroid problems, anorexia nervosa, inflammatory arthritis, sex
hormone deficiency, particularly estrogen deficiency, 9) b…………….. in women
(e.g. in a post menopause period) and men predispose to osteoporosis.
Osteoporosis is more common in older individuals and non-Hispanic white women,
but can occur at any age, in men as well as in women, and in all ethnic groups. When
unchecked, osteoporosis can lead to postural changes, physical abnormality (particu-
larly in the form of hunched back), and decreased mobility. Osteoporosis-related
bone fractures are 10) r………………… for considerable pain, decreased quality of
life, lost workdays, and disability. Elderly people are often likely to develop pneumo-
nia and blood clots in the leg veins that can travel to the lungs (pulmonary embolism)

25
due to prolonged bed rest after a hip fracture. In addition, once a person has experi-
enced a spine fracture due to osteoporosis, he or she is at very high risk of suffering
another such fracture in the near future (next few years).
The disease is detected and 11) d………………. by a doctor using a combination of a
complete medical history and physical examination, skeletal X-rays, bone densitome-
try (to measure BMD - bone mineral density) and specialized laboratory tests. Dual
energy x-ray absorptiometry (DXA) is one of the best current tests to measure BMD,
it is quick, painless, precise, similar to x-ray, but uses very little radiation. Other tech-
niques can also identify osteoporosis, including single photon absorptiometry (SPA),
quantitative computed tomography (QCT), radiographic absorptiometry and ultra-
sound.
The 12) g…………………. of osteoporosis treatment is the prevention of bone frac-
tures by stopping bone loss and by increasing bone density and strength. Unfortu-
nately, none of the available treatments for osteoporosis are complete cures. It is dif-
ficult to rebuild a bone that has been weakened by osteoporosis. Therefore, preven-
tion of osteoporosis is as important as treatment. The common preventive measures
are:
• Lifestyle changes: quitting smoking, 13) r……………….. alcohol intake, regular
exercises (to keep fit and decrease the risk of falls), consuming a balanced diet
with adequate calcium and vitamin D.
• Medications that stop bone loss and increase bone strength and formation.
• Estrogen or hormone replacement 14) t………………….: estrogen therapy alone
or in combination with another hormone, progestin, has been shown to decrease
the risk of osteoporosis and osteoporotic fractures in women. The side effect is,
however, an increased risk of breast cancer, stroke and blood clots.
• Treating medical conditions that can cause osteoporosis.

Wordlist:
accelerate – przyspieszać, nabierać tempa
anti-convulsants – leki przeciwdrgawkowe
background – pochodzenie
clot – skrzep
considerable – znaczny, znaczący
deficiency – niedobór
densitometry – densytometria, pomiar gęstości tkanki kostnej
density – gęstość
dual energy x-ray absorptiometry (DXA) – dwuenergetyczna wiązka rentgenowska,
absorpcjometria podwójnej energii promieniowania rentgenowskiego
embolism – zakrzepica
fragile – łamliwy, kruchy
heredity – dziedziczność
hormone replacement therapy – hormonalna terapia zastępcza
hunched back = hunchback – garb
porous – porowaty
predispose (to) – wytwarzać skłonność, predyspozycję
prone to – podatny na
pulmonary emboliom – zator płucny
quantitative computed tomography (QCT) – ilościowa tomografia komputerowa
resorption – wchłanianie się, resorpcja
single photon absorptiometry (SPA) – absorpcjometria pojedynczego fotonu

26
slender – szczupły, smukły
thyroid – tarczycowy

1. Osteoporosis is called “silent” because it never gives any symptoms.

2. The affected bones look and function the same as the healthy ones.
3. The balance between formation and resorption changes when a person gets
older.
4. Osteoporosis is caused only by the aging process.
5. A person’s ethnic group can be a risk factor for osteoporosis.
6. Heavy drinkers and smokers are in a greater risk than people who don’t use such
stimulants.
7. Osteoporosis is only common among the elderly women.
8. The disease can have impact on a person’s appearance.
9. Medical complications of osteoporosis are not usually dangerous.
10. Osteoporosis-related fractures are single episodes.
11. DXA is the same as an x-ray.
12. Treatment of osteoporosis is pointless since the disease cannot be completely
cured.

EXERCISE 3: A role-play. Work in pairs.

A: You are a 58-years-old man/woman. You are quite healthy, but your lifestyle is not
perfect (cigarettes, parties, sedentary job). You broke you leg several weeks ago, but
you don’t think this can be possibly related to osteoporosis, although your mother
had it. You just don’t believe. You meet your good friend – a physiotherapist, in a
shop.

B: You are an elderly physiotherapist. You meet a good friend in a shop. You’ve
heard that he/she broke a leg several weeks ago. Try to persuade him/her, that this
may be related to osteoporosis, say what you know about it, recommend some tests.
Ask your friend about his/her lifestyle and family history.

EXERCISE 4: Write synonyms for the following words / phrases.

a disease - a fracture –
silent - a symptom –
fragile - an injury –
to accelerate - risk –
current - slender –
sedentary – common –
mobility – considerable –
decreased - prolonged –
to detect a disease - treatment –
disease prevention -

27
EXERCISE 5: Complete the sentences below with the correct words appropri-
ate for the context.

1. Osteoporosis can be detected by ……………….. tests that measure bone density.

2. One in two white women will ……………… a bone fracture due to osteoporosis in
her lifetime.
3. After age 35, ………………… men and women will normally lose 0.3 to 0.5% of
their bone density per year as part of the ……………….. process.
4. Vitamin D helps the body ………………. calcium.
5. ……………..... of osteoporosis is as important as its treatment.
6. The …………………. of exercise for osteoporosis has mostly to do with decreasing
the risk of falls.
7. In postmenopausal women, smoking is …………………. with an increased risk of
osteoporosis.
8. There is a lot you can do throughout your life to prevent osteoporosis, slow its pro-
gression and ……………….. yourself from fractures.
9. Doctors believe that a program of moderate, regular exercise is …………………..
for the prevention and management of osteoporosis.
10. New medications exist to slow and even ………………….. the progression of os-
teoporosis.

EXERCISE 6: Writing. Your clinic is participating in a big campaign against os-

teoporosis. You have to prepare lots of advertising materials to be distributed
among our patients. Write a short paragraph concerning osteoporosis prophy-
laxis that will be included in a leaflet. Be concise and persuasive.

EXERCISE 7: Translate into English.

1. Osteoporoza nazywana jest często „cichą chorobą”, ponieważ objawy nie są

widoczne, do czasu, aż nastąpi patologiczne złamanie kości.
2. Każda kobieta, która miała złamanie po menopauzie ma dwukrotnie większą
szansę na wystąpienie następnych.
3. Wraz ze starzeniem się wszyscy są narażeni na rozwój osteoporozy– wiek jest
podstawowym czynnikiem ryzyka tej choroby.
4. Podstawowym celem leczenia osteoporozy jest uniknięcie złamań.
5. Chociaż osteoporoza nie jest bezpośrednim zagrożeniem dla życia to powik-
łania po złamaniach mogą znacznie obniżyć jakość życia chorego.
6. Osteoporoza jest chorobą atakującą kości.

EXERCISE 8: Passive voice. Rewrite the sentences using passive structures.

1. Someone turned on the light in the kitchen and opened the door.
2. An ambulance took the patient to hospital.
3. Normally the workers sweep these streets every day, but last week nobody
swept them.
4. They haven’t stamped these letters.
5. You should have taken these books back to the library.

28
 6. A car knocked him down.
7. You shouldn’t leave your wallet on the desk. You should always carry it with
you.
8. The police searched the house and found lots of illegal goods.
9. A machine could do this more easily.
10. Thick fog held up the trains.
11. Everyone looked up to him.
12. All the government members will see the president off at the airport.
13. They brought their children up in France.
14. We can’t repair the clock.
15. Candidates must not use any dictionaries.
16. Has someone posted my parcel?
17. You must keep your dog on a leash in the garden.
18. He likes people to all him ‘sir’.
19. Someone is following us.
20. You have to see it to believe it.
21. Don’t touch this sculpture.
22. You needn’t have done this.

References:
A.J. Thompson, A.V. Martinet, “A Practical English Grammar”, Oxford, 1994.
http://orthoinfo.aaos.org/brochure/thr_report.cfm?Thread_ID=13&topcategory=Wome
n 6.07.2007
http://www.medicinenet.com/osteoporosis/article.htm 6.07.2007
http://www.msd.pl/content/corporate/products/obszary/osteoporoza.html 6.07.2007
http://www.rheumatology.org/public/factsheets/osteopor_new.asp 6.07.2007

29
 SKELETAL SYSTEM DISEASES – REVISION

EXERCISE 1: Answer the questions in pairs.

• What are the functions of the skeletal system?

• What is the system composed of?
• What is the difference between the axial and appendicular skeleton?
• Give examples of 5 diseases affecting the skeletal system?
• How should people take care of their skeletal system (spine) in order to re-
duce the risk of disorders?
• Do you always remember to keep you spine in a correct position when you sit,
rest, study, etc?
• What would you do to make your patients more aware of the fact that their
spine needs to be taken care of?

EXERCISE 2: Complete the gaps with the correct words when necessary. Then
translate the extract into Polish.

Scoliosis is the 1)………….. describing a lateral (away from the middle) or sideways
curvature of 2)…………… the spine. Although the condition usually occurs in those
older than 10 years (mostly girls), there were cases 3)………… it was diagnosed in
infants. Scoliosis may result from problems not connected 4)………….. directly to
spine’s condition: one leg being shorter than another, muscle spasms, or appendici-
tis. In other cases, the curvature may result 5)……….. spine not being normal due to
e.g. birth defects, muscular dystrophy, metabolic diseases, connective tissue disor-
ders. With early screening and detection, most 6)………… children with scoliosis can
be treated to prevent more curvature. The physical examination will include a forward
bending test that will 7)………… the practitioner define the curve. There will also be a
thorough neurological exam to look for any changes in strength, sensation, or re-
flexes. The treatment is determined by the cause of the scoliosis, the size and loca-
tion of the curve, and the stage of bone growth (how close to maturation). Most cases
of adolescent idiopathic (unknown cause) scoliosis require no treatment (less than 20
degrees) but should 8)…………. checked by a doctor at regular intervals (often every
6 months). Physical therapists and orthotists (orthopedic appliance specialists)
9)…………. be helpful in explaining the treatments and ensuring a comfortable fit of
the brace to increase the compliance with the treatment plan.

EXERCISE 3: Skeletal system disorders. Match the terms to their definitions.

cast fracture sprain displaced whiplash

fissure bone mass dislocation traction bad posture

1. …………….. – an abnormal curve of the spine may result from this.

2. …………….. – following a break, this may be used to stop bones moving.

30
 3. …………….. – the force used to pull bones back into alignment / their ana-
tomical position.
4. …………….. – a break in a bone.
5. ……………. – a drastic shift of two bone ends out of their normal position.
6. ……………. – this injury is the partial tearing of a ligament.
7. ……………. – people lose this as they grow older.
8. ……………. – with this kind of break bones are forced from their anatomical
position.
9. ……………. – a crack in the surface of a bone.
10. ……………. – the injury (usually due to a car accident) in which the neck is
suddenly forced forward and then backward.

EXERCISE 4: Sciatica exercises.

A. Below there are pictures presenting exercises recommended for sciat-
ica. Match them to proper descriptions.

…………….. - Start by lying on the back with the knees bent, then slowly raise the
buttocks from the floor. Hold bridge for about 10 seconds, then slowly lower to start-
ing position.

……………. - While lying on the back on the floor, with knees bent and arms at sides,
tighten the stomach muscles and slowly raise alternate legs 5-10 cm from the floor.
Try to ‘march’ for 30 seconds.

31
……………… - While lying flat on the stomach, raise one leg behind with the knee
slightly bent and no arch in the back or neck. Hold for abut 10 seconds, then slowly
lower to starting position.

……………… - While kneeling on hands and knees, raise one leg or with the knee
slightly bent keeping neck and back straight. Hold for a while, then slowly lower to
starting position.

…………….. - While lying on the back on the floor, slowly raise one leg while lower-
ing the opposite arm.

…………….. - While lying on the back on the floor, with knees bent tighten lower
stomach muscles and buttocks to flatten the back.

……………… - Lying face down, with elbows straight and arms stretched above the
head, raise one arm and the opposite leg 5-10 cm off the floor. Hold for 5-10 sec-
onds, then slowly lower to starting position.

……………… - While kneeling on hands and knees, raise one leg straightened or
with the knee slightly bent and no arch in the back or neck and also raise the oppo-
site arm.

B. Now prepare instructions for the following exercises (6).

32
EXERCISE 5: Word-building. Change the words in brackets to complete the
sentences.

1. Don’t be ……………….. . I can’t do all of this by myself! (reason)

2. The hotel requires check ……………… to be done by tomorrow. (pay)
3. The professor gave an ………………. lecture to the students. (impress)
4. Don’t be so ………………, we’ve only been waiting for 30 minutes. (patient)
5. I’m sorry, but these complications seemed ……………. in this case. (avoid)
6. The boss was angry because I had behaved ……………….. . (responsible)
7. Unfortunately sir, our disease is ……………….. . (cure)
8. Tim, don’t tell lies, it’s very ………………. . (honesty)
9. Last summer my cousin was bitten by a ………………. snake. (poison)
10. I asked many people but they were rather …………… . (help)
11. I was …………….. by my friends to participate in this contest. (courage)
12. Our teacher is quite ………………., we usually know what to expect. (predict)
13. The soldiers always do what they are ordered, they are …………….. . (obey)
14. You won’t be paid much as an ……………….. worker. (skill)

EXERCISE 6: Paraphrase the sentences.

I won't be able to clean my room in less than two hours.
I will need...............................................................................................
I don't cook as well as my grandmother.
My grandmother........................................
The yellow plums are less expensive than the red ones.
The yellow plums ...............................................................
I can't see you before nine in the evening.
Nine................................................................
Nowadays I don't have as much free time as I used to.
I used to have ....................................................................
I'm a poor swimmer, but Tom is much worse.
Tom is..................................................................
She sings better than anyone else.
She is ...............................................
My brother didn't work hard enough to graduate.
My brother worked ..................................................
My car is cheaper than the others.
Mine.................................................
My father couldn't afford to buy the fridge.
The fridge.......................................................
Miss Thronton is the best teacher they've got.
They haven't got.........................................
They arrived too late to get a good seat.
They didn't .................................................
You studied too little to pass the exam.
You didn’t .........................................................
If you are concentrated, you won’t make so many mistakes.
The ………………………………………………
If you study more, you will get better grades.
The ………………………………………………

33
References:
A. Pohl, “Test Your Professional English. Medical”, Penquin English, Harlow, 2002.
http://www.virtualbonecentre.com/diseases.asp?did=316 6.07.2007
M. Misztal, “Tests in English. Word-formation”, WSiP SA, Warszawa 1998.
http://www.spine-health.com/topics/cd/d_sciatica/sc01.html 5.07.2007

34
 TENDINITIS, BURSITIS

EXERCISE 1: Ask your partner the following questions.

• Have you ever had problems with your tendons?
• What happened? How did you deal with the problem?
Discuss:
• What situations may result in tendinitis? Who is likely to suffer from it?
• What is the treatment like?
• What may be the consequences of a tendon injury?

EXERCISE 2: Read the text and complete the gaps with the correct sentences
from the list below. There is one extra sentence which you do not need to use.
Then answer the questions.

Tendons are the tough cords of tissue that attach muscles to bones and assist mus-
cles while moving bones. Tendinitis, also called tendonitis, means that the tendon is
inflamed (there is an increased blood flow through the area with warmth, swelling,
pain and loss of function). 1)……. . Depending on where it happens, it may have a
special name, such as tennis elbow. Injuries (most often a repetitive, minor injury of
the affected area) and overuse (the tendon is unaccustomed to the new level of de-
mand e.g. while new physical activity) are common causes of tendinitis. When a ten-
don has too much weight put through it, is used too much, or is stretched too much,
tendinitis can develop. 2)……. . The symptoms can be noticed quite soon: pain and
tenderness near the joint, the action of pulling the muscle becomes irritating, the
normal smooth gliding motion of the tendon is impaired.
Bursitis is an inflamed condition of a bursa – a small sac that acts as a cushion or
pad between moving structures (bones, muscles, tendons or skin). 3)……. . In bursi-
tis, their gliding capabilities are lost, they get more and more irritated, swollen, the
movement becomes painful. Bursitis usually results from a repetitive movement (for
example in people who rest on their elbows for long periods or bend their elbows fre-
quently and repetitively), due to prolonged and excessive pressure (for example,
kneeling longer than is usual), or after a traumatic injury. 4)…… . Both tendinitis and
bursitis can be recurrent or chronic in some cases, however, they are usually tempo-
rary conditions, particularly if treated early. Longer-term problems may often result
from failure to rest the inflamed limb or the joint, at least temporarily.
Diagnosis of tendonitis and bursitis requires a medical history and careful physical
examination (this can reveal tenderness and pain when the muscle to which the ten-
don is attached is working against resistance). 5)…… . Other tests which may be
useful in the detection of these conditions (blood tests, MRI, ultrasound) are gener-
ally not required.
Treatment of tendinitis and bursitis is based on the underlying cause. In overuse or
injury, reduction of the causing force or stress is mandatory. Splints or braces for the
affected part are a means of achieving rest and reduction of stress on the part, espe-
cially in the hand and wrist area. 6)…… . Other options include ultrasound (most
commonly administered by a physical therapist), physical therapy – stretching exer-

35
cises, steroid injections and surgery. A potentially serious complication of tendonitis
is rupture of a tendon (the most common is tear of the Achilles tendon in the lower
calf), which usually requires surgical intervention to repair. Prevention involves warm-
ing up and stretching prior to strenuous exercise, applying proper strengthening
techniques to help using muscles in a safe, more efficient manner, taking breaks dur-
ing repetitive tasks to relieve pressure, using joints protection (e.g. protective cush-
ions during prolonged kneeling).

A. Treatments, particularly ice, may help to reduce inflammation and pain, medicines
relieve pain and decrease swelling.
B. Also certain systemic inflammatory conditions (for example rheumatoid arthritis)
may make people susceptible to developing bursitis.
C. Certain diseases, such as rheumatoid arthritis, thyroid disorders, diabetes also
can cause it.
D. X-rays do not show bursae or tendons, but may be useful in excluding other bone
or joint problems.
E. It usually occurs in the shoulders, knees, elbows, hips, heels or wrists.
F. Both disorders affect mostly athletes.
G. Bursae decrease friction between two surfaces that move in different directions.

Wordlist:
brace – aparat podtrzymujący, korekcyjny
bursa, (pl.) bursae – kaletka
bursitis – zapalenie kaletki
calf – łydka
cast – opatrunek unieruchamiający
cord – sznurek
cushion – poduszeczka
demand – wymóg
friction – tarcie
gliding – przesuwanie, ślizganie
wedge – klin
impaired – zakłócony
mandatory – obowiązkowy, konieczny
manner – sposób
muszle imbalance – brak równowagi mięśniowej
recurrent – nawracający
rupture – przerwanie, rozerwanie
sac – worek
splint – szyna
strenuous – wymagające wysiłku,
suscepyible to – podatny na
tear – przerwanie, rozerwanie
tendinitis – zapalenie ścięgna
thyroid disorder – choroba tarczycy
tough – twardy, mocny
unaccustomed – nieprzyzwyczajony

36
1. What condition can be described as a tendinitis?
2. What are the typical causes of tendinitis?
3. What are the symptoms?
4. What are bursae?
5. What are they responsible for?
6. What may bursitis result from?
7. How are tendinitis and bursitis diagnosed?
8. What are the ways of treatment?
9. Why is prevention important and how is it carried out?

EXERCISE 3: Finish the sentences on the basis of the text.

1. Tendinitis is diagnosed …………………………

2. Tendinitis is usually caused by ………………….
3. In order to prevent tendonitis and bursitis …………………..
4. Prolonged and excessive pressure …………………………..
5. It is not usually required to diagnose…………………………………
6. Tendinitis develops when ……………………….
7. Rupture of a tendon ……………………………..
8. Bursa is …………………………………………

EXERCISE 4: Fill in the gaps with the correct words.

Achilles tendonitis
Achilles tendonitis is a 1)……………….. of irritation and inflammation of the large
tendon in the 2)……………….. of the ankle. Achilles tendonitis is a common overuse
injury 3)…………………… pain and swelling. Furthermore, Achilles tendonitis can
4)…………………… to small tears within the tendon, and make it susceptible to rup-
ture. As people 5)……………………, tendons, like other tissues in the body, become
less flexible, more rigid, and more susceptible to 6)…………………. Therefore, mid-
dle-age recreational athletes are most 7)………………….. to Achilles tendonitis.
Achilles tendonitis can develop into a chronic problem if treatment is not initiated at
once. Over time, inflammation can lead to degenerative 8)…………………… within
the tendon, and may even contribute to a higher chance of the tendon rupture. The
9)………………….. treatment of Achilles tendonitis is prevention. Stretching the
Achilles tendon before exercise, even at the start of the day, will help to maintain
flexibility in the 10)……………….. joint. The treatment methods of Achilles tendonitis
include: rest (it will allow the inflammation to subside), immobilization (either a re-
movable walking boot, or sometimes even a cast, can allow the inflamed tissue to
cool down quickly), heel wedge (when inserted into the 11)…………………… mini-
mizes the stress on the Achilles tendon), ice therapy (can help stimulate blood flow to
the area, and relieve the pain), anti-inflammatory medications, physical therapy (by
formulating a stretching and rehabilitation 12)…………………… to work on flexibility
of the Achilles tendon).

37
EXERCISE 5: Writing. Your boss has sent you to attend a lecture on treatment
and prevention of tendinitis. Write a short note – a report from this event, give
your opinion about it.

EXERCISE 6: Put the parts of the sentences together.

1. The preferable method of heating is… … cause of tendinitis is overuse.

2. Ice can be used to reduce the inflam- … an injection of cortisone may be con-
mation … sidered.
3. Stretching and strengthening are very … helpful to address any areas of mus-
… cle imbalance.
4. Splints or braces for the affected part … improved by the medications that will
are … decrease pain and swelling.
5. The most common … … that is usually associated with biceps
tendonitis.
6. Achilles tendonitis treatment can be … … is painful and irritating.
7. If the symptoms of bursitis are persis- … the bursa can return to its usual state
tent, … and perform its usual function.
8. By minimizing inflammation and swell- … in a warm shower or bath for 10 to 15
ing, … minutes.
9. Patients with infected bursitis will need … antibiotic treatment, and may require
… surgical drainage of the bursa.
10. Movement of an inflamed bursa … … a means of achieving rest and reduc-
tion of stress on the part.

EXERCISE 7: Reported speech statements and negatives. Rewrite the sen-

tences using reported speech structures.

1. ‘I have something to show you,’ I said to her.

2. ‘Our team has never won this contest,’ said Steve.
3. ‘I’m going away tomorrow, mother,’ he said.
4. ‘I’ve been in London for a month but so far I haven’t had time to visit the Tower,’
said Mike.
5. ‘It isn’t so cloudy today as it was yesterday,’ I remarked.
6. ‘I couldn’t get into the house because I had lost my key, so I had to break a win-
dow,’ he said.
7. ‘They should put the traffic lights here, otherwise there’ll be more accidents,’ he
said.
8. ‘If you leave home at five, you should be here by nine,’ he said to me.
9. ‘Shut the door, Paul,’ she said.
10. ‘Don’t watch late-night horror movies,’ I warned them.

38
11. ‘Open the safe!’ the thieves ordered the bank clerk.
12. ‘Could you translate this for me, please?’ I asked the official.
13. ‘When you are driving always look in your driving mirror before turning right,’ said
my instructor.
14. ‘Listen to me for a short moment at least!’ she said angrily to her son.
15. ‘She left home yesterday at 7 a.m. and nobody has met her ever since’ the police
reported.

References:
A.J. Thompson, A.V. Martinet, “A Practical English Grammar”, Oxford, 1994.
http://patients.uptodate.com/topic.asp?file=bone_joi/6721 6.07.2007
http://physicaltherapy.ca/ortho/Bursitis1.html 6.07.2007
http://physicaltherapy.ca/ortho/Tendinitis1.html 6.07.2007
http://orthopedics.about.com/cs/ankleproblems/a/achilles.htm 6.07.2007
http://orthopedics.about.com/cs/sportsmedicine/a/blbursitis.htm 6.07.2007
http://orthopedics.about.com/cs/sportsmedicine/a/tendinitis.htm 6.07.2007
http://www.emedica.pl/szczeg_choroby.php3?nr=145&typ=1&nazwa=mi%C3%84%C
2%99%C4%B9%C2%9Bnie%20i%20%C4%B9%C2%9Bci%C3%84%C2%99gna
6.07.2007
http://www.nlm.nih.gov/medlineplus/tendinitis.html 6.07.2007
http://www.rheumatology.org/public/factsheets/tendonitis_new.asp? 6.07.2007

39
 MULTIPLE SCLEROSIS – PATIENT’S REHABILITATION

EXERCISE 1: Discuss in pairs.

• What would you tell your friend who is going to study physiotherapy at the
MUG? What are the good and bad aspects of the studies here? Do you rec-
ommend studying physiotherapy or not? Why (not)?

EXERCISE 2: Read the text and complete the gaps with the correct words from
the box. Then decide if the sentences below are true or false. Correct the false
ones.

assess impairments reduce possibly incurable

various pauses initial occur mildly
brain transfer

Multiple sclerosis (MS) is an autoimmune, progressive, life-long, chronic and unfortu-

nately 1)………………… disease of the central nervous system. It affects mainly
young women (between 20 and 50), and is quite an unpredictable condition that can
range from being relatively benign to being totally disabling. Some people with MS
may be 2)……………. affected while others may lose their ability to write, speak, or
walk. Due to multiple areas of inflammation and scarring (sclerosis) in the central
nervous system, communication between the 3)………………. and other parts of the
body is disrupted.
Symptoms of MS vary from mild to severe. Exacerbations and remissions are com-
mon - an attack is followed by a period of recovery. Sometimes symptoms are pro-
gressive and may appear in 4)…………….. combinations, depending on the area of
the nervous system affected. Usually the initial manifestations of MS are: tingling and
numbness in the face, hand and feet, vision problems. As the disease gets worse,
the following symptoms develop: paresthesia, shaky movements, walking problems,
bowel and bladder control problems, fatigue, loss of sensation, speech problems,
tremor, hearing loss. About half of all people with MS experience cognitive
5)………………. causing difficulties with any of the following: concentration, attention,
memory.
A rehabilitation program for people with MS is designed to meet the needs of the in-
dividual patient. It depends on the type and severity of the symptoms and the amount
of impairment. Active involvement of both the patient and their family is crucial to the
success of the program. The goal of MS rehabilitation is enabling the patient to return
to 6)……………… the highest level of function and independence, as well as improv-
ing the overall quality of life - physically, emotionally, and socially. Rehabilitation can
be conducted on an inpatient or outpatient basis. The rehabilitation team includes
many skilled professionals, such as: neurologists, physiatrists, internists and other
specialists, nurses, dietitians, physical therapists, occupational therapists,
speech/language therapists. The program is normally based on four key points (may
include all or a combination of some of them):
• Physical therapy. A primary goal of physiotherapy is to help prevent physical
complications that may 7)………………, such as contractures (abnormal short-

40
 ening of muscles) or bedsores if a patient is immobile. It usually consists of al-
ternating exercise with periods of rest for the best results. Also, during exercises
patients should always have time to "cool off" since heat can make MS symp-
toms worse. The exercises may only be needed occasionally (as symptoms
flare), or daily (to reduce constant symptoms). After an 8)………………. training
program at the therapist's office, patients can continue the therapy at home ei-
ther alone or with an assistant (progress is monitored during occasional office
visits). Most commonly physiotherapy program includes: stretching and
strenghtening exercises to increase the range of motion, gentle aerobic exer-
cises, aquatic (water) exercises, balance control exercises (also teaching how to
fall safely).
• Occupational therapy. This may help with activities such as getting dressed,
brushing teeth, eating, cooking, or any other task that patients are having diffi-
culty completing. An occupational therapist will 9)……………… the living envi-
ronment to see whether any assistive devices (e.g. a cane, a wheelchair) are
needed. Then he/she will provide a patient with: help to obtain such devices,
training on how to use such devices, instructions concerning 10)………………
from a wheelchair to a bed, a car, etc.
• Speech therapy. Since MS can cause problems in speech, speech patterns, and
with swallowing, such therapy may help patients to: reduce long
11)……………… in sentences or within words, reduce slurring of words (may
result from weakened coordination of the tongue, lips, cheeks, and mouth mus-
cles), reduce nasal sound (when facial muscles become too relaxed), help im-
prove speech patterns and generally oral communication, cope with swallowing
problems (by changing the type of food eaten by a patient).
• Cognitive retraining. Many people with MS develop some kind of cognitive im-
pairment (usually slowed thinking, reasoning, remembering, or concentrating).
The therapy helps to 12)…………… cognitive disability by: enabling the patient
to identify the impairment, training the patient how to be well-organised (using a
computer, a notebook), informing about professional help that can be provided
when certain conditions affecting cognitive abilities (depression, stress) are no-
ticed.

Wordlist:
autoimmune – autoagresyjny
bedsore – odleżyna
benign – łagodny
cane – laska (also: a stick)
cognitive impairment – upośledzenie percepcyjne
contracture – przykurcz
disabling – zniedołężniająca (choroba)
enabling – umożliwienie
exacerbation – pogorszenie się (stanu chorego)
flare (up) – o objawach: natężać się
incurable – nieuleczalna (choroba)
involvment – zaangażowanie
multiple sclerosis – stwardnienie rozsiane
paresthesia – parestezja, samoistnie występujące wrażenie czuciowe
progressive – postępujący

41
reasoning – kojarzenie, sprawność umysłowa
remission – remisja, ustąpienie choroby
scarring – bliznowacenie
sclerosis – stwardnienie
slur – zlewać ze sobą słowa
swallowing – przełykanie
tremor – drżenie

1. The patient’s condition gets worse with time.

2. All the patients develop the same MS symptoms.
3. After an attack patients normally feel better.
4. Vision disturbances usually appear as final MS symptoms.
5. Cognitive impairments are rare among the MS patients.
6. The aim of rehabilitation is to give patients possibility to be as independent as
possible.
7. Rehabilitation can only be performed in a hospital.
8. The rehabilitation team consists of few professionals.
9. Physical therapy does not have to be very regular.
10. Breaks between exercises are not necessary.
11. Speech therapy is to teach patients how to speak more clearly.
12. Nothing can be done about cognitive impairments.

EXERCISE 3: A role-play. Work in pairs.

A: You are a physiotherapist. A young man / woman talks to you about his / her
mother suffering from MS. He / she wants to know all about the therapy, since he /
she cares about the mother very much. Try to calm him / her down.

B: Your mother (72) suffers from MS, the symptoms are quire severe (problems with
moving, speaking). Talk to a physiotherapist about a therapy for her. You are very
worried, you love your mother very much, but she is a difficult person (she is very
sensitive, doesn’t like strangers, is rather lazy, can be unfriendly, failure makes her
demotivated). Ask for help.

EXERCISE 4: For the words below write the ones with an opposite meaning.

constant - weakened –
occasionally - reduce –
skilled - relaxed (muscles) –
independence - improve –
success - chronic –
active - incurable –
benign - initial –
severe (condition) - recovery –

42
EXERCISE 5: Complete the sentences with words form the text.

1. His condition was e……………………… by the cold and damp weather.

2. The period when an illness is less severe and symptoms resolve is called a
r…………………. .
3. Rheumatoid arthritis is thought to be an a………………….. disease, the pa-
tient’s own cells are attacked by autoantibodies.
4. When a disease affects person’s c………………… abilities, they have prob-
lems with mental processes, perception, reasoning and memory.
5. I was advised by a d…………………… to reduce unnecessary carbohydrates
in my diet.
6. MS is a d………………….. disease since it makes the person impossible to do
some normal activities.
7. I…………………….. have to stay in hospital all the time during treatment, they
do not go home unless the doctor permits.
8. She has muscle c………………….. in the lower limbs – this is the result of a
rehabilitation program she underwent too late.
9. Physical limitations, problems with performing daily activities, speech difficul-
ties and slowed thinking – these are the most common d………………….. of
MS patients.
10. She has made only a partial r………………….. – her condition improved only
to some extent.

EXERCISE 6: Translate into Polish.

1. The research presented only limited evidence for shot-term improvements in

symptoms and disability and thus it was not treated seriously by the authori-
ties.
2. Rehabilitation goal is to help people improve cognitive function if they have
any cognitive impairment, such as difficulty remembering, caused by MS.
3. Multiple sclerosis rehabilitation takes a multidisciplinary team approach to pro-
viding care to MS patients.
4. Therapists recommend appropriate adaptive equipment or techniques based
on the expected course of each patient’s disease.
5. Regardless of what caused the disability, rehabilitation specialists work to re-
store maximum function and quality of life for the patient – both at home and in
the community.

EXERCISE 7: Put the words in order to make sentences.

1. upon specific programs needs depend rehabilitation patients’

2. the occupational need therapy depends one’s personal for symptoms on
3. speech may be pauses interrupted or long rhythm by between
words syllables normal
4. you life rehabilitation may help more live a productive
5. team the regularly rehabilitation discuss meets to goals progress pa-
tients’ and

43
EXERCISE 8: Reported speech questions. Rewrite the sentences using the re-
ported speech structures.

1. ‘Why does the price go up so often?’ she wondered.

2. ‘Does the train stop at Brighton?’ asked Bob.
3. ‘How long have you been here?’ said Pat.
4. ‘Did you play for your school team?’ asked Brandon.
5. ‘What is your new house like?’ I asked them.
6. ‘Why do you think it can be dangerous?’ he asked her.
7. ‘Would you like me to go with you?’ I said.
8. ‘Why should I go there?’ asked Chris.
9. ‘Who are you writing this letter to? asked Sarah.
10. ‘Do you still love Jane?’ I asked my brother.
11. ‘Would you like to say anything else?’ the lawyer asked his client.
12. ‘Have you copied the documents yet?’ the boss asked his secretary.
13. ‘How shall I help you?’ asked the clerk.
14. ‘Will I see you tomorrow at eight?’ I asked my friend.
15. ‘When are you going to tell me the truth?’ Brian asked his wife.

References:
http://physicaltherapy.ca/neuro/MS.html 6.07.2007
http://www.bchealthguide.org/kbase/as/ty7186/actionset.htm 6.07.2007
http://www.cochrane.org/reviews/en/ab006036.html 6.07.2007
http://www.healthsystem.virginia.edu/UVAHealth/adult_pmr/index.cfm 6.07.2007
http://www.healthsystem.virginia.edu/uvahealth/adult_pmr/multscle.cfm 6.07.2007
http://www.parknicollet.com/Rehab/services/physicalTherapy/multipleSclerosisRehab
.cfm 6.07.2007

44
 PARKINSON’S DISEASE – REHABILITATION

EXERCISE 1: Discuss.
• What do you know about Parkinson’s disease, its symptoms, ways of treatment?
• Who are mostly the patients?
• Do you find it easy to work with people who are very ill, suffer greatly because of
their illnesses, problems? Does it make you stressed? How do you cope with this
stress?

EXERCISE 2: Read the text and compete the gaps with the correct words.

Parkinson's Disease is a chronic, slowly progressing, neurological disorder resulting

1)........................ a lack of the chemical dopamine in the brain. Dopamine normally
sends signals that allow smooth, coordinated function of the body's muscles and
movement. The disease affects nerve cells, or neurons (located in a part of the brain
– substantia nigra - that produces dopamine) so that they die or do not
2)........................ properly. When approximately 80% of the dopamine-producing
cells are damaged, the symptoms of Parkinson disease appear. Parkinson’s disease
affects both men (more often) and women. It shows no social, ethnic, economic or
geographic boundaries. Although the incidence of Parkinson's increases
3)......................... age, it is not part of normal aging. Only 0.5 percent of people 65
and older have Parkinson's.
Symptoms are many and can be different for each person. The loss of dopamine
production in the brain causes: trembling of hands, arms, legs, jaw and face; slow-
ness of movement; rigidity (stiffness); difficulty with balance and coordination. As
symptoms 4)........................ worse, people with the disease may have trouble walk-
ing, writing, talking or doing simple tasks. They may also have problems such as de-
pression, insomnia, stiff facial expression, muffled speech. The clinical picture of the
disease can be so varied that absolute clinical diagnosis may not always be
5).......................... Nevertheless, the presence of at least two of three motor signs -
tremors, bradykinesia (extreme slowness of movement) and rigidity - is usually used.
Persistence of these signs for several years may clarify and specify the diagnosis.
There is no cure for Parkinson's disease. However, there are many medicines that
help alleviate the symptoms and help delay the progression of the disease. Also pa-
tients are recommended to 6)........................... physical and occupational therapy.
Rehabilitation therapy enhances the lives of people with Parkinson's disease by in-
creasing the safety and efficiency of their movement strategies, thereby improving
their ability to function in everyday life 7).......................... It helps increase the pa-
tient’s endurance, strength, general fitness and energy level and also elevate their
mood and decrease anxiety. Moreover, this kind of therapy helps people maintain
their independence and self-respect (allowing people to enjoy their meals, reducing
speech 8).............................).
Physical therapy might help with the disease symptoms although neurological dam-
age cannot be reversed. The goal is to improve people’s independence and quality of
life by improving movement and function, relieving pain, and preventing problems
(risk of falls). Therapy usually includes learning about new movement techniques,
strategies, and equipment. A physical therapist performs stretching or manipulative

45
exercises with a patient or can teach exercises to strengthen and loosen muscles.
Many of 9).......................... exercises can be performed at home. Physical therapy
can be helpful in establishing an exercise program before significant rigidity, lack of
coordination, loss of conditioning, or weakness occurs. It helps with: balance prob-
lems, lack of coordination, fatigue, pain, gait, immobility, weakness. Treatment often
can be completed in one to three office visits. The first appointment includes an
evaluation and recommendations for exercises. The following appointments
10)........................... the patient’s progress, review and expand the home program.
Occupational therapy can help people with Parkinson’s disease stay active in daily
life. By improving their skills, showing the patients different ways to complete tasks,
or introducing new equipment, an occupational therapist can help them perform eve-
ryday activities with 11)........................ ease and satisfaction. An occupational thera-
pist might also recommend making changes to their home or workplace to promote
more independence. Occupational therapy can be especially beneficial when the dis-
ease’s symptoms make it difficult for a person to take care of themselves (e.g. dress-
ing, bathing, eating, etc).
Apart form pharmacological, physio and occupational therapy, there are other inter-
ventions that can prolong the quality of life 12).......................... individuals afflicted
with this disease. They include: speech therapy, psychosocial adjustment counseling,
dietary counseling, support groups, therapeutic recreation activities, and very impor-
tant – regular physical exercises performed individually at home (to improve mobility).

Wordlist:
adjustment – przystosowanie
afflicted (with) – dotknięty (chorobą)
alleviate – złagodzić
ankiety – niepokój
approximately – w przybliżeniu
boundary – granica, ograniczenie
bradykinesia – spowolnienie ruchowe
counselling – poradnictwo
elevate – podnieść
enhance – poprawić
facial – twarzowy
gait – chód
incidence – zapadalność (np. na chorobę), częstość występowania
insomnia – bezsenność
muffled – niewyraźne, przytłumione (dźwięki)
persistence – utrzymywanie się (np. symptomów)
reverse – odwrócić, cofnąć
rigidity – sztywność
substantia nigra – substancja czarna
trembling – drżenie

46
EXERCISE 3: Answer the questions on the basis of the text.

1. What changes appear in the brain of a person with Parkinson’s disease?

2. Is Parkinson’s disease more common in men than in women?
3. What are the symptoms of the disease?
4. How is the disease diagnosed?
5. What is the aim of physical therapy?
6. What is the role of a physiotherapist?
7. How often should a patient meet a physiotherapist?
8. What are the benefits of the physical therapy?
9. What are the other elements of Parkinson’s disease treatment?

EXERCISE 4: Work in pairs. What would you say to a Parkinson’s disease pa-
tient who:
• has severe symptoms but doesn’t want to attend sessions?
• doesn’t want to leave home because he/she is ashamed of what other people
think of him/her?
• has serious problems with completing even the simplest tasks properly?
• doesn’t seem to understand your instructions although nobody ever has prob-
lem with this?
• wants to leave the country for a year or two to travel?
• ignores the therapy because he/she believes medicine will soon find a cure for
the disease?

EXERCISE 5: Translate the phrases in brackets to complete the text.

Exercise For People With Parkinson’s Disease

Exercise benefits (zarówno fizyczne jak i psychologiczne) 1…………………………….
…………………… well-being of people with Parkinson’s disease. Because Parkin-
son’s disease affects (zdolność ruchu danej osoby) 2…………………………….
………………., exercise helps to keep muscles strong and (poprawić giętkość) 3…….
……………………… and mobility. Exercise does not stop the disease from progress-
ing; however, it improves balance, helping people (przezwyciężyć problemy zwi-
ązane z chodzeniem) 4………………………………….. and strengthen the muscles
that aid in swallowing and speaking. Also, exercise can prevent some of the
(wtórnym, długotrwałym komplikacjom) 5……………………………………………….. of
Parkinson’s disease such as stiffening of the joints. Patients also receive the emo-
tional satisfaction of feeling (że czegoś dokonali) 6………………………………….
………………...
Check with your doctor (przez rozpoczęciem) 7………………………………any exer-
cise program. Your doctor might make recommendations about:
• The types of exercise (najlepiej dopasowanych) 8………………………….to
you and those that you should avoid
• The intensity of the workout (how hard you should be working)
• The duration of your workout and any (ograniczenia fizyczne) 9………………
…………………………

47
 • Referrals to other professionals, such as a physical therapist, who can help
you (stworzyć twój osobisty program ćwiczeń) 10…………………………………
…………………………
The type of exercise that works best for you depends on your (objawów, poziomu
kondycji fizycznej I ogólnego stanu zdrowia) 11………...…………………………………
………………… . Generally, exercises that (rozciągają kończyny) 12………………….
thorough the full range of motion are encouraged. For patients whose illness limits
their ability to exercise, (skierowanie do fizjoterapeuty) 13……….
…………………….. can help by designing an exercise program that you can do. The
final (przestroga, środek ostrożności) 14…………………………, when you begin ex-
ercising, is to go slowly.

EXERCISE 6: Match the words to make phrases from the text in Exercise 2.

social exercises
facial counseling
stretching progressing
clinical boundaries
improve expression
dietary independence
alleviate disorder
neurological strategy
movement symptoms
slowly picture

EXERCISE 7: Rearrange the letters in the words in bold to complete the sen-
tences below.

Many Parkinson's 1) asttiepn are encouraged to perform 2) egrrula exercise to help.

Here are some 3) stpi for them:
• Exercise when you are well 4) esrtde and move most 5) reefyl.
• Wear loose, comfortable 6) tcgohlin and shoes with good support.
• Include adequate rest periods in your exercise program or 7) eividd your pro-
gram into shorter 8) isesossn.
• Move slowly through each exercise and 9) vdoai bouncing motions.
• Maintain normal 10) reabgnthi throughout exercises.

EXERCISE 8: Conditionals. Put the verbs in brackets into the correct form.

1. If you (hear) from Jake could you please let me know?

2. If Steve (refuse) to help, we (have to) manage without him.
3. If he (be) a poor man he (not stay) at the Ritz.
4. If I (see) a tiger walking across the Central Park I (climb) the nearest tree.
5. If she (not be) so shy, she (enjoy) parties.
6. They speak Polish to her. If they (speak) English her English (improve).
7. I don’t have a map. If I (have) I (direct) you.
8. If he (not take) his gloves off he (not get) frost bitten last weekend.

48
 9. If he (tell) me earlier he was a vegetarian I (prepare) something more suitable.
10. If it (not rain) all the time we (enjoy) the visit more, yet we were bored.
11. If the examiner (read) the passage slower, the candidates (understand) it, but
they didn’t.
12. If he is such a good swimmer, he (save) the boy from drowning.
13. If he (report) to the doctor earlier he (be) healthy now.
14. Her father (be) worried if she (not get) home before midnight.
15. If she had taken a taxi she (not miss) the plane.

References:
A.J. Thompson, A.V. Martinet, “A Practical English Grammar”, Oxford, 1994.
http://www.baptist-health.com/rehab_institute/general/parkinsons/ 6.07.2007
http://www.clevelandclinic.org/health/health-info/docs/2200/2223.asp?index=9200
6.07.2007
http://www.clevelandclinic.org/health/health-info/docs/2300/2323.asp?index=9383
6.07.2007
http://www.ext.colostate.edu/PUBS/CONSUMER/10234.html 6.07.2007
http://www.nlm.nih.gov/medlineplus/parkinsonsdisease.html 6.07.2007
http://www.nym.org/services/neuro/parkinrehab.html 6.07.2007
http://www.parkinson.org/NETCOMMUNITY/Page.aspx?&pid=225&srcid=229
6.07.2007
http://www.umm.edu/parkinsons/rehab.html 6.07.2007

49
 POST-STROKE REHABILITATION

EXERCISE 1: A role-play. Work in pairs. Two physiotherapists meet outside a

rehabilitation clinic. You both share the same office (surgery) in the clinic.

A: You are having a very difficult and complicated rehabilitation session these days.
The patient needs it badly and he has to meet you very often, before you go for a
short holiday next week. Ask and persuade your friend to change his/her schedule so
that you could meet the patient tomorrow (Tuesday) at 2 pm.

B: Your friend wants to ask you a favour (changing your schedule for tomorrow after-
noon), but this a problem for you. At 2 p.m. you have got a patient that can meet you
only on Tuesdays. Is it possible to find a solution?

EXERCISE 2: Read the text below and put the fragments in the correct order.
Then answer the questions.

A. As the patient begins to improve and build up strength, movements and more
complicated exercises are introduced to encourage both sides of the body to work
together. Some physical therapists may use such therapeutic methods as electro-
therapy (TENS) that encourages brain reorganization and recovery of function, and
hydrotherapy (for repeated movement practice if a patient is weak).
Occupational therapy is also an important element of rahabilitation aiming at reducing
problems with performing everyday activities.

B. The symptoms include: sudden numbness, weakness, or paralysis of the face,

arm or leg (especially on one side of the body), sudden confusion, trouble speaking
or understanding speech, sudden trouble walking, dizziness, loss of balance or coor-
dination, sudden trouble seeing in one or both eyes, severe headache. People can
be affected in different ways, they often have a combination of symptoms.
Rehabilitation after stroke is a long process, ending only when it no longer produces
any positive effect.

C. Stroke is the one of the most common causes of death nowadays. It is also the
single most common cause of severe disability. It happens when blood flow to the
brain stops. As a result, within minutes, brain cells begin to die because they stop
getting the oxygen and nutrients they need to function. There are two kinds of stroke.
The most common kind of stroke, called ischemic stroke, is caused by a blood clot
that blocks or plugs a blood vessel in the brain.

D. Quite often stroke patients find it hard to control their emotions. Feelings of anger,
despair, frustration and grief, dramatic mood swings and sudden outbursts are all
normal - can be due to the damage the stroke has caused to their brain. Helping to
understand, and cope with, these symptoms and feelings is an important part of re-
habilitation. Sometimes a psychologist or psychiatrist can be asked for expert advice.

50
E. Most of the 75% of patients who survive the first month after a stroke will require
specialised rehabilitation. The goal is to make the patient as independent and pro-
ductive as possible by improving physical abilities (often relearning the skills that
have been lost) and condition. A successful rehabilitation depends on the following
factors: how early it began, the extent of the brain injury, the patient’s attitude, the
rehabilitation team's skills, and the cooperation of family and friends.
Rehabilitative physical therapy begins normally in hospital after the patient's medical
condition has been stabilized, often within 24 to 48 hours after the stroke.

F. The other kind, called hemorrhagic stroke, is caused by a blood vessel that breaks
and bleeds into the brain. A stroke is sometimes called a "brain attack" since it is very
serious - just like a heart attack. Because the brain controls everything that the body
and mind does, damage to the brain can affect both body functions (moving, swal-
lowing, breathing, seeing, etc) and mental functions (thinking, speaking learning, un-
derstanding, etc.). The symptoms of a stroke can last for a short time or for a longer
time leading to long-term disabilities.

G. The initial steps involve promoting independent movement since many patients
are paralyzed or seriously weakened. Patients are prompted to change positions in
bed and to engage in passive or active range-of-motion exercises (with or without a
therapist’s active assistance) to strengthen their stroke-impaired limbs. Progressively
the tasks are more complex and demanding (sitting up and transferring between the
bed and a chair, standing, bearing their own weight, walking, with or without assis-
tance, bathing, dressing). Treatment for weak or paralysed limbs starts with small
guided movements and performing simple exercises.

H. A range of techniques is used and suited to different situations and disabilities.

These may include for example, learning to eat or dress with one hand, using mem-
ory aids such as lists or a diary, practising physical or mental skills through crafts and
board games.
Since a stroke frequently affects communication skills (causing aphasia - difficulty
using and understanding spoken and written language, dysarthria - when a stroke
affects the muscles in the face, making it difficult to form words, dyspraxia - the per-
son may find it hard to speak or understand conversation) speech and language
therapy are recommended and necessary to assess each patients’s difficulties and
develop appropriate techniques.

1_____, 2_____, 3_____, 4_____, 5_____, 6_____, 7_____, 8_____

Wordlist:
aphasia – afazja
clot – skrzep
craft – rękodzieło, rzemiosło
demanding – wymagający
despair – rozpacz
dizziness – zawroty głowy
dysarthria – dyzartria, upośledzenie wymowy
dyspraxia – dyspraksja, utrudnienie czynności ruchowej wywołane przez ból

51
extent – stopień, zasięg
grief – żal
hemorrhagic – krwotoczny
ischemic – niedokrwienny
outburst – wybuch (np. emocji)
plug (v.) – zaczopować, zalepić
prompt (v.) – zachęcić

1. What happens during a stroke?

2. What are the two types of a stroke called and what are they caused by?
3. What are the symptoms of a stroke?
4. What does the success of rehabilitation depend on?
5. What does the initial rehabilitation stage concentrate on?
6. When are more complicated exercises introduced?
7. How can occupational therapy help people after a stroke?
8. What are the problems with emotions caused by?

EXERCISE 3: Discuss in pairs.

• How could you cope with patients who have emotional problems (suddenly start
to cry during exercises, get nervous without a reason)?
• Post-stroke rehabilitation is often a very long and tiring process for both the pa-
tient and the physiotherapist. What qualities could help the physiotherapist deal
with problematic issues (demotivated patients who give up because of no results,
tiring sessions due to no positive contact with patients, being surrounded by suf-
fering and unhappy people all the time)?

EXERCISE 4: Complete the passage with the correct words / phrases form the
box.

independence recovery being practise focus

motivated positive quality good diet sleep
achieve healthy talking

Helping rehabilitation

Unfortunately, however natural it is to feel depressed and anxious, negative feelings

will get in the way of progress. It’s important for the person to 1)………………. on
what they want to 2)…………………… and stay 3)…………………. Here are some
tips.
• 4)………………….. the tasks therapists have taught you between therapy ses-
sions – but don’t exhaust yourself.
• Understand why each task has been set. This will help keep you
5)…………………... Remember that 6)………………… can be gradual and
even when progress is slow it is worth persevering.
• Don’t push people away. 7)…………………. to others, or even just
8)………………..... with other people if you have difficulty communicating, can
stop you becoming isolated and withdrawn.

52
 • Stay 9)…………………….. Plenty of 10)…………………, a 11)…………………
and regular physical exercise are all important to your rehabilitation.
• Don’t despair if you don’t fully regain your previous abilities. Enjoy the best
12)………………… of life and 13)……………………… that you can.

EXERCISE 5: Correct the mistakes in the sentences below.

1. Effective rehabilitation rely on a coordinate, multidisciplinary team approach.

2. When the patient discharging from a rehabilitation program, the general practitio-
ner's role become vital.
3. It is strongly recommending that a rehabilitation assessment is undertook within
24–48 hours of admission to a stroke unit.
4. Once the patient's condition stabilises medical, there is less needs for the facilities
of the hospital.
5. The focus of the rehabilitation program moves to improve function and independ-
ence, and preparing the stroke survivor and his or her carers for life after dis-
charged.
6. Rehabilitation only be successful if the team, patient and carers cooperated to set
interdisciplinary goal.
7. A neuropsychologist is an important membership of a specialised stroke rehabili-
tated team, as cognitive deficits common.
8. There are a strong consensus among rehabilitation experts that the most impor-
tant elements in any rehabilitation program is carefully directed, well-focus, repeti-
tive practice.
9. The same kind of practice used by all people when they learning a new skill, such
as play the piano or pitch a baseball.
10. Stroke survivor frequently have a variety of pain chronic syndromes resulting from
stroke-inducing damage to the nervous system.

EXERCISE 6: Translate into English.

1. Udar mózgu to szybko rozwijające się zaburzenia funkcji mózgu, które są wy-
wołane uszkodzeniem naczyniowym.
2. Najczęstszymi objawami udaru są: jednostronne osłabienie albo drętwienie
kończyn, zaburzenia w rozumieniu mowy lub niemożność wypowiadania słów,
zaburzenia widzenia, bardzo silne zawroty głowy, zaburzenia połykania.
3. Udar mózgu jest chorobą ludzi starszych. Zachorowalność wzrasta drama-
tycznie wraz z wiekiem.
4. Po przebytym udarze nawroty następują bardzo często.
5. Niestety, wciąż z powodu udaru mózgu kilkanaście procent osób umiera na
udar niedokrwienny w ciągu pierwszego miesiąca, a na udar krwotoczny aż
30-40%.
6. Bardzo ważne jest leczenie czynników ryzyka udaru: nadciśnienia, hiperlipi-
demii i cukrzycy, obniżenie wagi ciała, zaprzestanie palenia papierosów, ogra-
niczenie picia alkoholu.

53
EXERCISE 7: Unreal past. Put the verbs in brackets into the correct form or fin-
ish the sentences.

1. Tom and Jenny are very tired. It’s high time we (leave).
2. He walks as if he (have) wooden legs.
3. If only he (know) then that the disease was actually curable!
4. If only I (keep) my mouth shut! Now it’s too late.
5. He always talks as if he (give) a public speech.
6. I’d rather you (not go) to this party alone.
7. I’d prefer you (leave) these books at home.
8. You told me what to do. If only I (take) your advice seriously!
9. Can I tell Tom about it? I’d rather you (keep) it for yourself.
10. Can I read this article? I’d prefer you (clean) your room first.
11. I’m sorry I haven’t got a car. I wish ………………………
12. I’m sorry I haven’t booked a seat. I wish …………………..
13. It’s a pity you are busy tomorrow. I wish …………………….
14. I’m sorry you told Jake about it. I wish ………………………..
15. It’s a pity you are going home tonight . I wish…………………….

References:
A.J. Thompson, A.V. Martinet, “A Practical English Grammar”, Oxford, 1994.
http://www.americanheart.org/presenter.jhtml?identifier=4713 6.07.2007
http://www.mja.com.au/public/issues/177_08_211002/pol10119_fm.html 6.07.2007
http://www.ninds.nih.gov/disorders/stroke/poststrokerehab.htm 6.07.2007
http://www.ninds.nih.gov/disorders/stroke/stroke_needtoknow.htm#knowstoke
6.07.2007
http://www.nlm.nih.gov/medlineplus/stroke.html 6.07.2007
http://www.stroke.org.uk/information/ 6.07.2007
http://www.zdrowie.med.pl/udar/udar01.html 11.09.2007

54
 BRAIN INJURY REHABILITATION

EXERCISE 1: Your clinic is going to organize a conference on rehabilitation

techniques next month. You and your friend are responsible for arranging the
‘technical ‘aspects of the conference. Work in pairs and make decisions on the
folowing:
• the venue (location) of the conference
• the length (number of days)
• the number of people you expect
• the accommodation for the conference members
• the equipment needed during lectures (presentations) and practical sessions
(workshops)
• additional attractions for the guests
• meals / coffee breaks during the conference (restaurants – transport to and
from?)

EXERCISE 2: Read the text and write headings for the paragraphs. Then decide
if the sentences below are true or false.

1……………………………………..
There are three main types of brain injuries: traumatic, acquired and congenital. They
can vary from mild to severe but all of them are serious medical conditions. Acquired
brain injuries are ones that have occurred after birth, congenital – were present be-
fore birth, traumatic (TBI – the most common ones) – are caused by a traumatic
event such as a car accident, fall or physical violence. All brain injuries are unique,
the type of injury the brain receives may affect just one functional area, various ar-
eas, or all areas of the brain.

2……………………………………..
A traumatic brain injury occurs when an outside force impacts the head hard enough
so that the brain moves within the skull or the force causes the skull to break and it
directly hurts the brain. TBI may produce a diminished or altered state of conscious-
ness, which results in impaired cognitive abilities, disturbed physical, behavioral or
emotional functioning. These impairments may be either temporary or permanent.

3…………………………………….
Symptoms of TBIs can include, but are not limited to: spinal fluid coming out of the
ears or nose, loss of consciousness, dilated or unequal size of pupils, vision
changes, dizziness, balance problems, respiratory failure, coma, paralysis, difficulty
with moving body parts, weakness, poor coordination, vomiting, headache, ringing in
the ears, or changes in ability to hear, difficulty with thinking skills, memory problems,
inappropriate emotional responses, difficulty with speaking.

55
4……………………………………
Rehabilitation involves two essential processes: restoration of functions that can be
restored and learning how to do things differently when functions cannot be restored
to pre-injury level. Physical therapy results depend on the age of the individual, the
severity of the injury, and the amount of time that they were unconscious. Some of
these changes may get better with time. Rehabilitation programs should be individu-
alized, catering for each person's unique needs since no two brain injuries are ex-
actly alike. Apart from neurophysical aspects, also cultural, social and economic
backgrounds must always be taken into consideration when planning a person's re-
habilitation program. The program typically involves:

5…………………………………….
Physical therapy – the person’s ability to move the body is evaluated and treated. A
therapist focuses on improving physical function by addressing muscle strength, en-
durance, flexibility, balance, and coordination. Training frequently involves assistive
devices such as canes or walkers. Also treatments of heat, cold, and water are ap-
plied to assist with pain relief and muscle movement.

6……………………………………..
Occupational therapy – the goal is to prevent, reduce, or overcome physical, emo-
tional challenges by means of purposeful activities to ensure the highest level of in-
dependent functioning in everyday life. Areas covered by occupational therapy in-
clude for example: feeding, bathing, dressing, toileting, mobilizing the body on and off
the toilet (bed, chair, bathtub), driving, homemaking, using medical equipment at
home.

7……………………………………...
Speech therapy - focuses on the muscles in the face, mouth, and throat. A person’s
ability to express oneself is evaluated. If the person is unable to verbalize, alternative
forms of communication are introduced.

8………………………………………
Other members of a rehabilitation team include: rehabilitation nurses, neuropsy-
chologists, recreational therapists, social workers.

Wordlist:
acquired – nabyty
altered – zmieniony
bathtub – wanna
cane – laska
cater – przen. wyjść na przeciw oczekiwaniom
coma – śpiączka
dilated – rozszerzone
diminish – zmniejszyć, zredukować, uszczuplić
homemaking – prowadzenie gospodarstwa domowego
impact – uderzać
pupil – źrenica
recreational therapist – terapeuta rekreacyjny
social worker – pracownik socjalny
unequal – nierówny

56
venue – miejsce (np. konferencji)
violence – przemoc
walker – chodzik

1. No matter the type, all brain injuries are serious.

2. Acquired and congenital brain injuries are related to the moment of birth.
3. There are no two identical brain injuries.
4. Brain injuries affect only some parts of the brain.
5. In TBIs, the skull always hurts the brain.
6. It is possible that cognitive and physical impairments will only last for some time.
7. BIs may affect hearing abilities.
8. Rehabilitation sometimes involves learning the abilities you have once been good
at.
9. Rehabilitation programs are similar to all patients.
10. Physical therapy mostly involves muscle training.
11. Speech therapy can help even if the patient can’t speak at all.

EXERCISE 3: On the basis of the text, make questions for the following an-
swers.

1. The patient’s state, age and the severity of injury.

2. Then it directly hurts the brain.
3. Three: traumatic, congenital and acquired.
4. Cultural, social, econiomic and neurophysical.
5. For example a car accident.
6. For some time or permanently.
7. Assistive devices.
8. For example dressing, eating, bathing.
9. To decrease the pain.
10. Alternative forms of communication.

EXERCISE 4: Complete the phrases on the basis of the text.

1. r…………………….. therapist
2. a……………………. devices
3. s……………………. of the injury
4. i…………………….. e……………………. response
5. d……………………. state of c……………………….
6. b……………………. problems
7. a……………………. brain injuries
8. f…………………….. area
9. economic b…………………………
10. respiratory f…………………………
11. spinal ………………………………
12. n……………………. aspects

57
EXERCISE 5: Ask abort the underlined parts of the sentences.

1. A direct force to the head can also break the skull and directly hurt the
brain.
2. A person with a suspected brain injury should contact a physician immedi-
ately.
3. An acquired brain injury commonly results in a change in neuronal activity.
4. Acquired brain injury takes place at the cellular level within the brain.
5. The person with a brain injury and his or her family should always be the
most important members of the treatment team.
6. After a brain injury, people may have to relearn how to do these types of
tasks.
7. Vocational evaluation and training may also be a component of this type of
program.
8. Brain recovery follows patterns of brain development.
9. Basic skills must be strengthened before more complex skills are added.
10. There may be a poor fit between the needs of children with TBI, and typical
school educational programs.

EXERCISE 6: Writing. Write an invitation to a conference from Exercise 1, to be

published in a medical journal. Decide which information should be included.

EXERCISE 7: Translate into English.

1. Uraz mózgu jest najczęściej skutkiem silnego uderzenia w głowę.

2. W rezultacie dochodzi do uszkodzenia komórek nerwowych i połączeń między
nimi oraz do krwawienia powstałego w wyniku uszkodzenia naczyń krwionoś-
nych.
3. Typowe objawy to: krótkotrwała utrata przytomności, bóle i zawroty głowy,
nudności, wymioty, zaburzenia widzenia i słuchu, dezorientacja, nieadekwatne
reakcje emocjonalne, problemy z pamięcią i koncentracją.
4. W przypadku poważniejszych urazów mogą pojawić się drgawki, długotrwała
utrata przytomności lub stan śpiączki.
5. Po przewiezieniu do szpitala, około połowa pacjentów z poważnym urazem
mózgu wymaga interwencji chirurgicznej.
6. Wielu pacjentów wymaga długotrwałej rehabilitacji i nigdy nie powraca do sta-
nu sprzed wypadku.

EXERCISE 8: Gerund and infinitive.

A: What is the difference in meaning?

1. I regret to say that I can’t help you tonight.
I regret saying such offensive words to you.
2. I remember switching off the radio yesterday.
I always remember to switch off the radio when I leave house.
3. I’d like to assist you with the patient.
I like assisting you with your patients.

58
4. It started to rain again.
It started raining again.
5. Don’t forget to feed the animals before you go out.
I won’t forget riding a camel in Egypt last year.

B: Put the verbs in brackets into the gerund or (to) infinitive.

1. I’d rather (take) the train now.
2. I promise I won’t forget (switch) off the light.
3. She often puts off (start) her duties until 10.a.m.
4. When in our office never smoke without (ask) for permission first.
5. Do you mind (talk) to this client for a moment?
6. Have you finished (write) the report? The boss is waiting.
7. I watched a man (repair) the car just in front of my house.
8. Bob suggested (buy) the tickets in advance.
9. He wanted her (confess) the whole truth.
10. He agreed (lend) me some money.

References:
„English for Medical Students and Doctors 2”, Ewa Donesch-Jeżo, WPL, Kraków,
2001.
http://www.biausa.org/Pages/treatment_and_rehab.html 6.07.2007
http://www.biausa.org/Pages/types_of_brain_injury.html 6.07.2007
http://physicaltherapy.ca/neuro/TBI.html 6.07.2007
http://portalwiedzy.onet.pl/7093,,,,,,,489839,tematyczne.html 11.09.2007
http://www.headinjury.com/rehabcognitive.html 6.07.2007
http://www.mja.com.au/public/issues/178_06_170303/kha11095_fm.html 6.07.2007

59
 PATIENT REHABILITATION – REVISION

EXERCISE 1: Answer the questions in pairs.

• How would you define ‘rehabilitation’?

• When do people need rehabilitation?
• What is important for the rehabilitation process to be effective?
• How to motivate rehabilitated patients when the process does not bring imme-
diate effects?
• What are the differences between carrying out a rehabilitation program with a
child and an adult?
• What makes a good rehabilitation specialist?

EXERCISE 2: Complete the sentences with the correct words form the box.

disability x2 adapt tools reverse

severity reach achieve restore
designed degree quality other
family treatment complications

What does rehabilitation involve?

Rehabilitation is the process of helping a person 1)………………….. the highest level
of function, independence, and 2)………………….. of life possible. Rehabilitation
does not 3)…………………… or undo the damage resulting form a disease or
trauma, but rather helps 4)…………………. the person to optimal health, functioning,
and well-being. Rehabilitate in 5)………………… words means to make able. The
goal of rehabilitation is to help the patient 6)……………………. the highest level of
function by preventing complications, reducing 7)………………….., and improving
their independence.
Each rehabilitation program is different since it is 8)……………….. to meet each per-
son's specific needs. Most commonly, however, 9)……………….. components for
rehabilitation programs include:
• treating the disease and preventing 10)……………………
• treating the 11)………………….. and improving function
• providing adaptive 12)…………………. and altering the environment
• teaching the patient and family and helping them 13)………………….. to life-
style changes
The success of rehabilitation depends on many factors, such as:
• the nature and 14)…………………… of the disease, disorder, or injury
• the type and 15)…………………. of any resulting impairments and disabilities
• the overall health of the patient
• 16)……………………… support

60
EXERCISE 3: Areas covered in rehabilitation programs. Complete the table us-
ing the proper terms listed below.

family support physical care socialization skills

communication skills self-care skills (ADL) respiratory exercises
psychological counseling mobility skills cognitive skills
vocational training pain management

Patient’s need: Example:

Feeding, bathing, dressing, toileting.

Nutritional needs, medication, and skin care

Walking, transfers, and self-propelling a wheelchair.

Breathing treatments and exercises to promote lung

function.
Speech, writing, and alternative methods of communi-
cation.
Memory, judgment, concentration, problem solving,
and organizational skills.
Interacting with other people at home and within the
community.
Work-related skills.
Medications and alternative methods of managing
pain.
Identifying problems and solutions with thinking, emo-
tional, and behavioral issues.
Patient and family education, training about the condi-
tion, medical care, and adaptive techniques.

EXERCISE 4: A role-play ‘First day at work’. Work in pairs.

A: This is your first day at work as a physiotherapist. Ask your boss about your du-
ties, responsibilities, ask detailed questions to make sure you understand everything
precisely. Ask who your patients are, what problems they mostly come with, who else
the clinic employs, etc.
B: You are a manager of a rehabilitation clinic. A new employee starts working today.
Answer his/her questions about the scope of duties and responsibilities. Make sure
he/she understands everything. Finally, ask some questions to check if he/she re-
members what you have just said.

61
EXERCISE 5: Translate into Polish.

What are the possible effects of disability on the patient’s family?

Family members are affected by the patient's disability, and frequently become co-
managers of the patient's care. They may experience many changes due to the pa-
tient's disability. Family members often join the patient in a period of grief caused by
a loss of function. Severe injuries, chronic diseases, or disabilities may mean a
change in family roles. For example, a housewife may need to return to work and
become the breadwinner after her husband's become disabled; a son may need to
adjust his work schedule to help care for an elderly parent. These changes can
cause stress and conflict within the family. Financial problems occurring due to medi-
cal bills or unemployment add more stress on the family. Changes in living arrange-
ments, childcare issues, and community re-entry may pose new problems for the pa-
tient and family.
By cooperating with the rehabilitation team, the patient and family can help reduce
some of the adverse effects of disability. This can be accomplished by:
• identifying the adverse effects of disability within the family
• working together on realistic problems’ solutions
• participating in family education and counselling sessions
• planning for patient’s discharge and community re-entry.

EXERCISE 6: Paraphrase the sentences.

1. The boss is not to be disturbed. On no account …………..

2. He’s an extremely dangerous driver. He……………………
3. I think you should go to the party. If ………………………..
4. I believe you two haven’t met before. I don’t ………………
5. I’d prefer us to go to the cinema. I’d rather ………………..
6. He didn’t revise for the exam so He failed it. If ……………
7. Rihanna is the singer I admire most of all. There is ……...
8. We had hardly arrived home when it started to rain. No sooner …………….
9. I wanted to take my son for a walk but the rain put me off. I was
…………………….
10. Remind me to buy some apples. Don’t …………….
11. I don’t find those old songs very interesting any more. I’m no longer ………….
12. If you forget your ID you cannot go in. Unless…………………..
13. He is thought to be intelligent. People think………………………
14. There are some biscuits in that box. That box. ………………….
15. Is there necessarily a motive for crime? Does …………………..

References:
http://www.healthsystem.virginia.edu/uvahealth/adult_pmr/ 6.07.2007
M. Misztal, ‘Tests in English. Structural conversion,’ WSiP, Warszawa1997

62
 BACK PAIN – TREATMENT METHODS

EXERCISE 1: Discuss in pairs:

• Have you ever experienced back pain? What was it caused by?
• What did you do to relieve the pain?
• When should people consult a doctor for back pain?

EXERCISE 2: Read the text below and insert the missing headings from the list.
Then answer the questions.

Hot or cold packs (or both)

Surgery
Physical therapy and exercise
Complementary and alternative treatments
Medications
Cortisone injections

Back pain can range from a dull, constant ache to a sudden, sharp pain that makes it
hard to move. It can start quickly if you fall or lift something too heavy (acute back
pain – lasts less than 6 weeks), or it can get worse slowly and last longer (more than
3 months – chronic back pain). Although anyone can suffer from it, there are several
risk factors: getting older, poor physical fitness, being overweight, some diseases
and conditions (arthritis, cancer, scoliosis, spinal stenosis, kidney stones, infections,
endometriosis, herniated disc, pregnancy), job (hard physical activities, office jobs),
smoking. Back pain may also be caused by tense muscles, stress, injuries from
sprains, fractures, accidents, and falls. People should seek doctor’s advice if they
feel pain together with: numbness or tingling, urinating problems, or fever.
Treatment depends on back pain type. Acute back pain usually doesn’t require any
treatment except for rest, however, some analgesic drugs are frequently used.
Chronic back pain is less common, but more methods are normally used to treat it:
1)………………………………– they can soothe sore, stiff backs. They may relieve
pain but do not fix the cause of it.
2)………………………………– analgesic drugs, topical analgesic creams, ointments
to be rubbed onto the skin, muscle relaxants, nonsteroidal anti-inflammatory drugs
(reduce pain and swelling. Also antidepressants and narcotics can be prescribed for
a short period of time with close doctor’s supervision.
3)………………………………– given into the space around the spinal cord (epidural
space). They help decrease inflammation around the nerve roots.
4)………………………………– various techniques can be applied (heat, ice, ultra-
sound, electrical stimulation, and muscle release techniques) to the back muscles
and soft tissues in order to reduce pain. Specific exercises are recommended to in-
crease flexibility, strengthen back and abdominal muscles, improve posture and pre-
vent pain from recurring.
5)………………………………– the most common are: professional spinal manipula-
tion, transcutaneous electrical nerve stimulation (TENS), acupuncture, acupressure –
they are normally used when the above methods do not relieve back pain.

63
6)………………………………– it is usually reserved for pain caused by spinal prob-
lems (herniated disc, spinal stenosis, vertebral fracture, degenerative disc disease).
There are different procedures, e.g. laminectomy and laminotomy (they involve re-
moving part of a vertebra), fusion (joining two vertebrae to eliminate painful move-
ment). Rarely, when back pain is caused by a tumour or a nerve root problem sur-
gery is needed right away to ease the pain and prevent more problems.

Wordlist:
ache – ból
analgesic – przeciwbólowy
dull – tępy
endometriosis – gruczolistość, endometrioza
fusion – zespolenie, połączenie
ointment – maść
scoliosis – skolioza
rub – pocierać
seek – szukać
soothe – złagodzić
sore – bolący
stenosis – zwężenie

1. What is the difference between chronic and acute back pain?

2. Describe people who are most likely to suffer from back pain?
3. Which symptoms should be alarming to people?
4. How is an acute back pain treated?
5. Why are cold and hot packs not as effective as e.g. surgery?
6. Which of the drugs prescribed must be taken under a doctor’s supervision? Why?
7. What are the effects of cortisone injections?
8. In what ways does physical therapy help with back pain?
9. When do people usually turn to alternative methods of treatment?
10. What surgical procedures help with back pain and what do they involve?

EXERCISE 3: A. Match the words in the columns below to make phrases from
the text.

chronic disc
herniated overweight
strengthen stones
vertebral back pain
complementary muscles
being drugs
kidney relaxants
tense space
improve treatment
epidural posture
muscle fracture
analgesic abdominal muscles

64
B: Now complete the sentences below with the phrases from A.

1. The patient was examined and the doctor confirmed what he suspected from
the beginning, the back pain and difficulty walking and moving around was
caused by a …………………………… .
2. I have never had any problems with my urinary system! I’m shocked to have
………………………………………diagnosed!
3. Physiotherapist may recommend you plenty of exercises to ………………your
……………………. .
4. Relax, breathe deeply and don’t think about your problems for a while. This
will help to relax your ……………………….. .
5. Injections are sometimes given within the ………………………………… - the
region around the spinal cord.
6. …………………………………,or obesity, is a risk factor for many diseases,
such as diabetes, and various heart disorders.
7. Your belly needs regular exercising. Let’s do something to
……………………… your ……………………………. a bit.
8. Broken bones within the spine are not as common as broken legs or arms, but
yesterday we had a patient with a……………………………………… .
9. Apart from conventional methods (drugs, surgery) more and more people
nowadays use ……………………………………….. to speed up recovery proc-
ess.
10. She had been suffering from …………………………….. for about two months
before she decided to seek for help.
11. Pain-killing agents are formally referred to as ………………………………….
12. When the muscles are tense for too long ………………………………… should
be administered.

EXERCISE 4: Complete the tips on back pain prevention with the correct verbs.

Preventing back pain

You may be able to 1)…………………… back pain by improving your physical condi-
tion and learning and practicing proper body mechanics. In order to keep your back
healthy and strong:
• 2)…………………. . Regular low-impact aerobic activities can increase
strength and endurance in your back and allow your muscles to function bet-
ter. Try walking and swimming first.
• 3)………………….. muscle strength and flexibility. Abdominal and back
muscle exercises help condition these muscles so that they work together like
a natural corset for your back.
• 4)………………….. smoking. Smokers have reduced oxygen levels in their
spinal tissues, which can prolong the healing process.
• 5)…………………... a healthy weight. Being overweight puts strain on your
back muscles.
In addition, use proper body mechanics:
• 6)…………………… smart. Maintain a neutral pelvic position. If you must
stand for long periods of time, try to place one of your feet on a low footstool to
take some of the load off your lower back.

65
 • 7)…………………… smart. Choose a seat with good lower back support, try
placing a pillow in the small of your back to maintain its normal curve. It’s best
to 8)…………………… your knees at hips level.
• 9)…………………… smart. Let your legs do the work. Move straight up and
down. Keep your back straight and 10)……………………. only at the knees.
11)……………………. the load close to your body. Avoid lifting and twisting at
the same time.
• 12)…………………... smart. Use medium-firm mattress and pillows for sup-
port and comfortable, natural position.

EXERCISE 5: A role-play. Work in pairs.

A: You are a physiotherapist. The patient suffers form back pain. Take the patient’s
history, ask about all details related to the causes. Instruct the patient on the preven-
tive measures concerning back pain. Make sure that the patient understands your
advice.
B: You are a patient. You suffer from back pain. This may be somehow related to
your lifestyle. Give the physiotherapist all the information he/she needs. Ask how to
prevent back pain.

EXERCISE 6: Translate into English.

Kręgosłup piersiowy jest narażony na działanie dużych sił ściskających, szczególnie

kiedy jest nadmiernie wygięty ku tyłowi, co następuje w sytuacji gdy się garbimy. Je-
śli garbienie się wejdzie w nawyk i staje się ustawiczne, następuje zmiana kształtu
kręgów - ulegają spłaszczeniu. Jeśli kręgosłup nie zostanie poddany rehabilitacji,
odkształcenia kręgów utrwalą się i nie pomogą żadne ćwiczenia. Dolegliwości bólo-
we wynikają m.in. z wadliwej postawy siedzącej. Winne są jej np. niewygodne szkol-
ne ławki i biurka w domach, przy których uczniowie godzinami garbią się nad książ-
kami. Ból może być bardzo dotkliwy i jest reakcją mięśni na nadmierne obciążenie.
Należy kontrolować i korygować postawę ciała, szczególnie w pozycji siedzącej. Bi-
urka i stoły, przy których pracujemy powinny być na tyle wysokie, by nie trzeba było
się nad nimi pochylać. Krzesła powinny być profilowane w taki sposób by dawały
oparcie miednicy i całemu kręgosłupowi.

EXERCISE 7: Gerund and infinitive. Complete using the correct verbs (‘to’
Infinitive or gerund forms)

1. This room will look very nice once you have finished ………………….it.
2. You should stop ………………….. about the exam, otherwise I leave.
3. The film was so funny she couldn’t help ………………………..
4. The secretary asked if he would mind …………………… for a while.
5. The student pretended not …………………….. the teacher’s question.
6. I offered …………………. him, he couldn’t lift the box by himself.
7. No teacher would profess ………………….. all the answers.
8. I invited them ………………. to our party.
9. I wish you wouldn’t keep ……………………. me the same all the time.

66
 10. The best way ………………….. a language is to practice
………………………… it as often as it is possible.
11. When you have finished that book, tell me if it’s worth
……………………, please.
12. He didn’t admit ………………….the invitation, although I knew he had.

References:
B.D. Graver, „Advanced English Practice”, Oxford University Press, 1995.
http://fitness-cafe.net/bole-plecow 12.09.2007
http://health.howstuffworks.com/how-to-relieve-back-pain4.htm 7.07.2007
http://www.mayoclinic.com/health/back-pain/DS00171/DSECTION=5 7.07.2007
http://www.mayoclinic.com/health/back-pain/DS00171/DSECTION=6 7.07.2007
http://www.niams.nih.gov/hi/topics/pain/ff_backpain.htm 7.07.2007
http://www.ninds.nih.gov/disorders/backpain/backpain.htm 7.07.2007

67
 DIAGNOSTIC CRITERIA FOR MAJOR DEPRESSIVE
EPISODE

EXERCISE 1: Discuss.
• What makes you sad, depressed?
• How often do you feel depressed?
• In what way(s) do you cope with bad mood?
• In what way(s) can patient’s depression affect rehabilitation process? What might
be the consequences?

EXERCISE 2: Read the text and complete the gaps with the correct verbs. Then
answer the questions.

Major depressive disorder (MDD) is also called major depression, clinical depression,
or unipolar depression (relates to mood representing only one extreme pole – the
depressed one). It can 1)…………… different people in different ways. However,
most people will either have depressed mood or experience a general loss of interest
in activities they once enjoyed (or a combination of both). In addition, other physical
and mental symptoms 2)……………. frequently appear: fatigue, difficulty with mem-
ory and concentration, feelings of helplessness and hopelessness, headaches, body
aches, and thoughts of suicide. Depression normally strikes people between the
ages of 25 and 44, although it can affect any person at any age. In adults, major de-
pressive disorder affects twice as many women as men. The course of the illness
tends to vary. Some people experience attacks of depression separated by years
between episodes (they usually last 6-9 months) in which there 3)……………. no
symptoms. Others may have periods of several episodes. It often happens that even
if major depression goes untreated, it will run its course and leave by itself. Doctors
tend to attribute it to the body’s tendency to correct abnormal situations.
The development of major depressive disorder may 4)………….. related to certain
medical illnesses, such as cancer, stroke, diabetes, and myocardial infarction. As
many as 20-25% of people suffering from these diseases are likely to develop major
depressive disorder sometime during the presence of their medical illness. This defi-
nitely makes the whole situation worse (the prognosis 5)…………… usually less posi-
tive) since managing or treating a medical condition can be more difficult if a person
is also clinically depressed.
For many rehabilitation patients, depression is a common medical problem that af-
fects recovery. Depressed in-patients tend to use the rehabilitation program less ef-
fectively, 6)…………… less progress, and have an increased length of stay. After
discharge, depressed patients tend to stay at home all the time, do not become in-
volved in recreational activities, have very poor social life. They are also less likely to
successfully complete rehabilitation programs or to use recommended adaptive de-
vices. Unfortunately, MDD is often overlooked by healthcare providers and inappro-
priately (or inadequately) diagnosed (usually due to lack of time, knowledge, or skill).
Thus, rehabilitation specialists 7)………….. recognize the symptoms of depression
and provide the necessary treatment for these patients as part of the overall treat-
ment plan.

68
Below 8)……………. the diagnostic criteria for major depressive episode:
1. Depressed mood most of the day, nearly every day, indicated by either self-
observation (subjective report) or observation made by others. Children and
adolescents may become irritable.
2. Markedly diminished interest or pleasure in all, or most activities (self-observed
or observed by others).
3. A considerable loss or gain of weight (e.g., a change of more than 5% of body
weight in a month when not dieting), decrease or increase in appetite nearly
every day.
4. Insomnia or hypersomnia (sleeping more than usual) nearly every day.
5. Behavioral changes - psychomotor agitation or retardation (particularly observ-
able by others).
6. Feeling of fatigue or loss of energy nearly every day.
7. Feelings of worthlessness, inappropriate or excessive guilt (not related to being
ill).
8. Reduced ability to think or concentrate, indecisiveness (either by subjective re-
port or as observed by others).
9. Recurrent thoughts of death (not just fear of dying) or suicide (with or without a
plan), a suicide attempt.
• To diagnose MDD, the presence of five (or more) of the above symptoms is re-
quired during the same 2-week period and this must represent a significant
change from previous functioning; one of the symptoms must be (1) or (2).
• The list does not concern symptoms that 9)…………. clearly due to a general
medical condition (e.g. hyperthyroidism), delusions or hallucinations, direct
physiological effects of a substance (e.g., alcohol, drug abuse, medication), or a
normal grief over the death of a loved one.
• The symptoms 10)…………. great distress or difficulty in functioning at home,
work, and other areas of everyday life.

Wordlist:
adolescent – osoba w wieku dojrzewania
attribute (to) – przypisywać coś
agitation – pobudzenie
course – przebieg (choroby)
delusions – omamy, złudzenia
diminish – zmniejszać
discharge – wyjście (pacjenta) ze szpitala
distress – zmartwienie, rozpacz
grief – żal
guilt – wina
helplessness – bezsilność
hopelessness – uczucie beznadziejności
hyperthyroidism – nadczynność tarczycy
indecisiveness – niezdecydowanie
in-patient – pacjent w szpitalu
major depressive disorder – depresja
markedly – znacznie
myocardial infarction – zawał mięśnia sercowego
pole – biegun

69
retardation – opóźnienie
strike – uderzać
suicide – samobójstwo
unipolar – jednobiegunowy

1. Who is most likely to suffer from depression?

2. What can the course of illness be like?
3. When is depression likely to develop?
4. What is the impact of depression on a rehabilitation process?
5. Why is depression not always correctly diagnosed?
6. What feelings may accompany people suffering from depression?
7. How long should the symptoms last to indicate depression?

EXERCISE 3: Work in pairs. On the basis of the diagnostic criteria from the
text:

A: ask your partner questions that would normally be used while diagnosing MDD.
B: answer your friend questions. You can’t answer just YES / NO.

EXERCISE 4: Change the words in the phrases below to make them correct. All
of them appeared in the text in Ex. 2.

clinical infarction clinical ………………………….

abnormal devices abnormal ……………………….
adaptive changes adaptive ………………………...
rehabilitation condition rehabilitation ……………………
increases situations increases ……………………….
medical diagnosed medical …………………………
depressed depression depressed ………………………
myocardial program myocardial ………………………
recreational activities recreational …………………….
inappropriately mood inappropriately …………………
social length social ……………………………
behavioral life behavioral ………………………

EXERCISE 5: Translate the extract into Polish.

Latest research results indicate that in adults, major depressive disorder affects twice
as many women as men. For both genders it is most common in those who are 25-
44 years of age, and least common for those over the age of 65. In children, how-
ever, clinical depression affects girls and boys at about the same rate. What is more,
within an entire lifetime, major depression will affect 10%-25% of women and 5%-
12% of men. At any one point in time, 5%-9% of women and 2%-3% of men are likely
to be clinically depressed. Although it has been observed that major depression can
occur at any age, the average age for developing the illness seems to be in a per-
son's mid-20's. However, the average age of onset of the condition appears to be

70
decreasing. The people whose a parent or sibling (brother, sister) has had major de-
pression may be 1.5 to 3 times more likely to develop this condition than others.

EXERCISE 6: Rewrite the sentences below using the word given.

1. I had seen the film before. time

That wasn’t the …………………………………………….. the film.
2. She returned the money to the safe yesterday. back
Yesterday she …………………………… the safe.
3. As a result of walking five kilometers. He was very tired. so
He had walked …………………………….. very tired.
4. Could you tell me which person has influenced you most? greatest
Who……………………………………… influence on you?
5. When did you start to learn Spanish? been
How ……………………………………… Spanish?
6. London is not an easy city to move about in. difficult
It…………………………………………… in London.
7. Londoners used to pride themselves on their transport system. proud
Londoners………………………………… system.
8. I bought a video camera because I wanted to record the sunset. that
I bought a video camera ………………………. record the sunset.
9. You should change your bad habits. high
It’s …………………………………………your bad habits.
10. I have no more letters to write today. writing
I …………………………………………… letters for today.

References:
http://findarticles.com/p/articles/mi_m0825/is_4_71/ai_n15970793 6.07.2007
http://findarticles.com/p/articles/mi_m3225/is_1_61/ai_59426928 6.07.2007
http://www.allaboutdepression.com/dia_03.html#1 6.07.2007
http://www.healthyplace.com/communities/bipolar/diagnosis_major_depression.asp
6.07.2007
http://www.healthyplace.com/Communities/Depression/major_depression.asp
6.07.2007
http://www.redorbit.com/news/health/309230/major_depression_in_rehabilitation_car
e/index.html?source=r_health 6.07.2007
L. Prodromou, “First Certificate Star. Student’s Book”, Macmillan Heinemann, Madrid
2003.

71
 EXAMINATION OF A JOINT MOTION

EXERCISE 1: Answer the questions in pairs.

• What are joints and what is their function in the body?
• Do you know any disorders affecting joints? What are their symptoms and how
are they treated?
• Who is most likely to suffer from joint disorders?

EXERCISE 2: Read the text and answer the questions below.

The initial stage of joint examination is history taking. Patient should be asked not
only about joint symptoms but also systemic and extra-articular ones. This is due to
the fact that many manifestations, such as fever, chills, malaise, weight loss, muco-
cutaneous symptoms (rash, eye irritation or pain, photosensitivity), cardiopulmonary
and gastrointestinal symptoms may be also associated with joint disorders. The most
common symptom of joint disorders is pain. The history should include the location
(also superficial or deep), severity, character (aching, burning, prickling, stabbing),
and factors that aggravate or relieve pain. It must be determined whether pain is wor-
se upon first moving a joint or after prolonged use when it is present during the day.
Other joint symptoms may include: stiffness (a fixed limitation of joint motion - the
examiner must be able to separate an inability to move a joint from reluctance to
move a joint because of pain), fatigue (weakness, desire to rest that reflects exhaus-
tion), instability (weakness of the ligaments or other structures that stabilize the joint
– most common in the knee joint).
During physical examination each involved joint is inspected and palpated, and the
range of motion is estimated. First, joints are put in the rest position, observed for
erythema, swelling, deformity, skin abrasions or punctures, then they are compared
with their uninvolved (not affected) opposites. Joints are gently palpated, to note the
presence of warmth, tenderness, soft masses, bulges, bony enlargements, joint effu-
sion.
The next step is to determine, measure and record the joint’s range of motion (ROM).
Active range of motion is the maximum range through which the patient can move
the joint, any limitation normally results from weakness, pain, stiffness or mechanical
abnormalities. Passive range of motion is the maximum range through which the ex-
aminer can move the joint, passive limitation usually reflects mechanical abnormali-
ties (e.g., deformities, swelling, scarring) rather than weakness or pain. Both motions
are compared to the accepted ROM for that joint, and any limitation in range (e.g.
due to muscle contracture; capsule restriction) is noted. All motions of a joint are
measured from defined zero starting point positions. The degrees of motion of a joint
are added in the direction the joint moves from the zero starting position. During the
ROM assessment crepitus is also noted. This is a palpable or audible grinding pro-
duced by joint motion, caused by rough articular cartilage or tendons – may help to
determine which structures are involved. Proper evaluation of joint ROM and muscle
strength (volition) are essential to successful patient management. Success in these
evaluations is based on use of accepted measuring methods. The ROM limitations
must be carefully noted so that during testing the patient or examiner does not try to
move the joint past the limitation. Also, it is important to grade muscles on the ability

72
to move the joint through the entire ROM available, not the average range. In order to
obtain the best results the joints should be ranged slowly and smoothly. Examiners
should avoid grasping the extremities too tightly.
Different joints are examined in a different way. Below there are two examples:
• The hip joint’s examination begins with gait evaluation. A limp frequently sug-
gests hip arthritis, may also result from pain, leg shortening, flexion contracture,
or muscle weakness. Patient can easily demonstrate loss of internal rotation (of-
ten due to hip osteoarthritis or any hip synovitis), flexion, extension, or abduc-
tion. When the examiner places one hand on the patient's iliac crest he/she de-
tects pelvic movement that might be mistaken for hip movement. To identify flex-
ion contracture the patient must attempt leg extension with the opposite hip
maximally flexed to stabilize the pelvis. The situation when pain accompanies
passive range of motion (assessed by internal and external rotation with the pa-
tient in a supine position and the hip and knee flexed to 90°) suggests intra-
articular origin.
• In the elbow, the examiner should attempt a full 180° extension. Such an exten-
sion is possible with nonarthritic or extra-articular lesions, when it is limited, ar-
thritis is suspected. The joint and the area around are inspected for swellings.
The joint motion is not limited when there is swelling of the olecranon bursa, this
may result from infection, trauma, gout and rheumatoid arthritis.

Wordlist:
abduction – odwiedzenie
abrasion – otarcie
articular – stawowy
audible – słyszalny
bony enlargements – przerosty kostne
bulge – wybrzuszenie
bursa – torebka
contracture – przykurcz
capsule – torebka (stawowa)
cardiopulmonary – sercowo-płucny
contrlateral – leżący naprzeciwko
crepitus – trzeszczenie
desie – pragnienie, chęć
deviation – odchylenie
distract – rozluźnić (staw)
effusion – wysięk, wylew
erythema – rumień
estimate – oszacować
eversion – wynicowanie
exhaustion – wyczerpanie
extension – rozprostowanie
extra-articular – pozastawowe
extremities – kończyny
flexion – zgięcie
gastrointestinal – żołądkowo-jelitowy
gout – skaza moczanowa
grasp – chwycić
grinding – zgrzytanie

73
iliac crest – grzebień biodrowy
inversion – odwrócenie
limp – utykanie
malaise – złe samopoczucie
mucocutaneous – śluzowo-skórny
occluded – zablokowane
olecranon – wyrstek łokciowy
photosensitivity – światłowstręt
prickling – piekący
proceed (to) – przejść (do)
puncture – ukłucie
range – zakres
reluctance – niechęć, niemoc, opór
restriction – ograniczenie
rough – szorstki
scar – blizna
severity – ciężkość (o chorobie)
stabbing – kłujący
superficial – powierzchwny
supine – wyprostowany
synovitis – zapalenie błony maziowej
volition – wola
warmth – ciepło

1. What is history taking?

2. Why should the questions concern not only the joint symptoms?
3. What should be specified as far as pain is concerned?
4. What other joint symptoms may be reported?
5. What can the inspection and palpation of a joint reveal?
6. What is the difference between the active and passive range of motion?
7. How is ROM determined?
8. What is crepitus?
9. What should the examiner remember about while assessing ROM?
10. When is patient’s gait examined?
11. What can a limp result from?
12. What situation may suggest elbow arthritis?

EXERCISE 3: Put the activities under the following headings.

Active range Passive range

Inspection Palpation of motion of motion
examination examination

1. Examine each major joint and muscle group in turn.

2. Look for scars, rashes, or other lesions.
3. Ask the patient to move each joint through a full range of motion.
4. Gently move patient’s joint through its full range of motion.

74
 5. Look for asymmetry, deformity, or atrophy.
6. Ask the patient to relax and allow you to support the extremity to be examined.
7. Identify any areas of tenderness.
8. Always compare with the other side.
9. Proceed to passive range of motion if abnormalities are found.
10. Identify any areas of deformity.

EXERCISE 4: Put the stages of joint examination in the correct order.

Accessory Joint Motion Examination Technique
ˆ Repeat technique on involved joint
ˆ Place hands as close as possible to joint
ˆ Apply technique to contralateral joint
ˆ Stabilize proximal segment
ˆ Record findings
ˆ Place the joint in its resting position and distract the joint
ˆ Explain the technique to the patient
ˆ Apply glide force parallel to joint surface
ˆ Compare to noninjured joint
ˆ Position the patient comfortably

EXERCISE 5: Below there are some tests used for joints examination. Work in
pairs and try to follow the instructions with your partner.

Allen Test (Radial/Ulnar Arteries)

1. Ask the patient to make a tight fist.

2. Compress both the ulnar and radial arteries to stop blood flowing to the hand.
3. Ask the patient to open the hand.
4. Release pressure on the ulnar side. The hand should "pink" up in a few sec-
onds unless the ulnar artery is occluded.
5. Repeat the process for the radial artery as indicated.

Halen's Test (Median Nerve)

1. Ask the patient to press the backs of the hands together with the wrists fully
flexed (backward praying).
2. Have the patient hold this position for 60 seconds and then comment on how
the hands feel.
3. Pain, tingling, or other abnormal sensations in the thumb, index, or middle fin-
gers strongly suggest carpal tunnel syndrome.

Ballotable Patella (Major Knee Effusion)

1. Ask the patient to lie supine on the exam table with leg muscles relaxed.
2. Press the patella downward and quickly release it.
3. If the patella visibly rebounds, a large knee effusion (excess fluid in the knee)
is present.

75
EXERCISE 6: During an examination joints are checked in various ways. In
pairs, look below and check if you can demonstrate the following movements
of the joints from the list.

• Fingers – flexion/extension; abduction/adduction

• Wrist – flexion/extension; radial/ulnar deviation
• Elbow – flexion/extension
• Shoulder – flexion/extension; internal/external rotation; abduction/adduction
• Knee – flexion/extension
• Ankle – flexion (plantarflexion) /extension (dorsiflexion)
• Foot – inversion/eversion
• Toes – flexion/extension

EXERCISE 7: Translate the following sentences into Polish.

1. Test position is the position in which the part (and joint) is placed by the exam-
iner. The patient is asked to hold that position, if possible.
2. A contracture causes an almost complete loss of ROM of a joint.
3. A child's muscle strength can be tested up to grade 3 (fair) without much diffi-
culty. In higher grades, success depends on the child's cooperation and un-
derstanding.
4. Joint instability can have a marked effect on muscle examination.
5. Pressure is the force applied by the examiner's hand to determine the strength
of the muscle holding the joint in the test position.
6. Pressure must be applied gradually in testing patients whose degree of
strength is above grade 3 (fair).

References:
http://medinfo.ufl.edu/year1/bcs/clist/extrem.html 6.07.2007
http://www.merck.com/mmpe/sec04/ch031/ch031a.html 6.07.2007
http://www.oandp.org/jpo/library/1993_02_049.asp 6.07.2007

76
 LIMITATION OF A JOINT MOTION

EXERCISE 1: A role-play. Work in pairs. Change roles.

A: You are a physical therapist. Your patient has a problem with a knee / a hip joint.
Take a detailed history and carry out physical examination. Recommend some treat-
ment.

B: You are a patient and you suffer from a severe pain in your knee / hip joint. Talk to
the physical therapist, answer all the questions in detail, let him / her examine you
and ask for help.

EXERCISE 2: Read the text below and complete the questions below with
proper words. Then answer the questions.

As it was stated in the previous unit, the range of motion (ROM) is the full amount of
motion that can occur at a joint. ROM is affected by the shape and size of the joints,
the flexibility of the muscles, ligaments, blood vessels, and nerves. When a joint does
not move fully and easily in its normal manner it is considered to have a limited range
of motion. In other words, limited range of motion is a reduction in the normal dis-
tance and direction through which a joint can move. This may limit an ability to per-
form certain functional activities. For example, if the shoulder has a decreased (lim-
ited) ROM a person may not be able to reach overhead to grab an object from a
shelf, in the case of a knee with a decreased ROM a person may walk with a limp.
Joint’s mobility / flexibility is normally affected by the following groups of factors:
• Internal: the type of joint (not all joints are equally flexible), bony structures which
limit movement, the internal joint’s resistance, the elasticity of muscle tissue (tis-
sues after injuries are not very elastic), the elasticity of tendons, ligaments, and
the surrounding skin (e.g. limited by contractures), muscles’ ability to contract and
relax (in order to achieve the greatest range of movement);
• External: temperature (in a warm place flexibility increases), the time of day (in
the morning flexibility is the worst), age, sex (women tend to be more flexible), the
joint’s condition (injured joints are less flexible than healthy ones), overall fitness,
the restrictions caused by any clothing or equipment, muscle mass around a joint
(heavily developed muscles limit the range of joint movement – excess fatty tis-
sue imposes a similar restriction).
Moreover, there are other factors, such as: swelling, pain, inflammation (bursitis,
tendinitis), infection, spasticity of the muscles, injuries (fracture, dislocation), disease
(arthritis), physical disability. Actually, limited range of motion may be identified by
the health care provider during an examination for other conditions, and the affected
person may not even be aware of its presence.
In order to maintain normal ROM, it is recommended that joints are moved through
their available range quite often. Unfortunately, normal daily activities do not take
joints through their full range of motion. A person that is immobile due to an injury or
illness, may lose some of their joints' normal ROM. Physical therapists help to pre-
vent this from happening by helping patients, even if they are just after an injury (still

77
in the ICU), to continue to move all of their joints. They recommend the so-called
range of motion exercises. These exercises are gentle stretching exercises moving
each joint as far as possible in all directions. However, there are cases, medical con-
ditions for which they are not good and can actually cause an injury. Thus, it is impor-
tant for the exercises to be recommended only after a full assessment. A physical
therapist should demonstrate and teach a patient the appropriate ROM exercises, so
that the therapy could safely be continued at home.

Wordlist:
assessment – ocena
grab – chwycić
impose – powodować, narzucać
resistance – opór
spasticity – spastyczność

1. What generally affects the __________ of a joint motion?

2. How __________ a limited range of motion be defined?
3. What happens when a ___________ has a limited range of a joint motion?
4. Which two ___________ of factors determine / affect joint’s flexibility?
5. What is the ___________ between joint mobility and temperature?
6. When can limited ROM be ___________?
7. What is the ___________ of ROM exercises?
8. What is the ___________ of demonstrating the activities by the physiotherapist?

EXERCISE 3: Writing. Work in groups of 3 or 4 and follow the task.

Steve, your 11-years-old nephew, who lives in England has recently had an accident.
Now he has problems with moving his knee properly. He is depressed and very much
afraid of attending physical therapy sessions. Write an e-mail to Steve (max. 50
words), encourage him to participate in the sessions and cheer him up generally.

EXERCISE 4: Below there are normal ranges of joint motion. Complete them
with the words from the box. Then, follow the instructions and check your
range of a joint motion.

swing chin radius midline

right arm up biceps
finger sternum

Neck
Flexion: 70-90 degrees. Touch 1)………………… with chin.
Extension: 55 degrees. Try to point up with 2)…………………...
Lateral bending: 35 degrees. Bring ear close to shoulder.
Rotation: 70 degrees left & right. Turn head to the left, then 3)………………….

Shoulder
Abduction: 180 degrees. Bring 4)………………… up sideways.

78
Adduction: 45 degrees. Bring arm toward the 5)…………………….. of the body.
Horizontal extension: 45 degrees. Swing arm horizontally backward.
Horizontal flexion: 130 degrees. 6)………………….. arm horizontally forward.
Vertical extension: 60 degrees. Raise arm straight backward.
Vertical flexion: 180 degrees. Raise arm straight forward.

Elbow
Flexion: 150 degrees. Bring lower arm to the 7)………………………...
Extension: 180 degrees. Straighten out lower arm.
Supination: 90 degrees. Turn lower arm so palm of hand faces 8)…………………….
Pronation: 90 degrees. Turn lower arm so palm faces down.

Wrist
Flexion: 80-90 degrees. Bend wrist so palm nears forearm.
Extension: 70 degrees. Bend wrist in opposite direction.
Radial deviation: 20 degrees. Bend wrist so thumb nears 9)…………………….
Ulnar deviation: 30-50 degrees. Bend wrist so little 10)…………………… nears ulna.

EXERCISE 5: In pairs, explain in English what is the difference between the

terms in each pair.

TREATMENT CURE
THERAPIST DOCTOR
HOSPITAL SURGERY
NURSE NURSERY
REHABILITATION DOING EXERCISES
PASSIVE EXERCISES ACTIVE EXERCISES
QUALIFICATIONS EXPERIENCE

EXERCISE 6: Wordbuilding. Change the words in bold to complete the sen-

tences.

Depending on the type of joint involved and its present

condition, the bone structure of a particular joint places
very ………………. limits on flexibility. This is a common NOTICE
way in which age can be a factor …………….. flexibility LIMIT
since older joints tend not to be as healthy as younger
ones.
Muscle mass can be a factor when the muscle is so
…………….. developed that it interferes with the ability to HEAVY
take the adjacent joints through their complete range of
motion. Excess fatty tissue imposes a similar …………...... RESTRICT
The …………….. of "flexibility" work should involve per- MAJOR
forming exercises designed to reduce the internal

79
………………. offered by soft ……………… tissues. Most RESIST, CONNECT
stretching exercises attempt to accomplish this goal and
can be performed by almost anyone, …………….. of age REGARD
or gender.

References:
http://arthritis.about.com/od/exercise/g/rangeofmotion.htm 7.07.2007
http://physicaltherapy.ca/ortho/ROM1.html 7.07.2007
http://www.bsu.edu/web/ykwon/pep294/lab2/rom_lab.html 7.07.2007
http://www.cmcrossroads.com/bradapp/docs/rec/stretching/stretching_3.html#IDX84
7.07.2007
http://www.cmcrossroads.com/bradapp/docs/rec/stretching/stretching_8.html#SEC85
7.07.2007
http://www.nlm.nih.gov/medlineplus/ency/article/003173.htm 7.07.2007
http://www.nlm.nih.gov/medlineplus/ency/imagepages/9530.htm 7.07.2007

80
 JOINT MOBILIZATION

EXERCISE 1: A role-play. Work in pairs.

A: You are a physical therapist. You need to buy some necessary equipment for your
surgery (a new electrical examination couch, a tilt table, an electrotherapy unit, a
wheelchair). Talk to a sales representative of a leading company producing physio-
therapy devices. Negotiate good prices. Remember, you don’t have a lot of money.

B: You are a sales representative of a well-known company producing physiotherapy

equipment. Your regular client, a physical therapist, wants some new things for his /
her surgery. Offer different equipment in different prices (your company produces
both expensive and cheaper products). Try to sell as much as possible.

EXERCISE 2: Read the text and complete the gaps with the correct sentences.
There is one extra sentence. Then answer the questions below.

Joint mobilization is often mistaken for a technique called manipulation since both
techniques treat musculoskeletal dysfunctions and fall under the category of manual
therapy. 1)………. This is done by quick movements that occur beyond the available
joint range of motion. A sound resembling a pop or click (similar to cracking one's
knuckles) often accompanies the procedure, this is the result of the release of pres-
sure in the joint. Manipulation is done to increase the joint limited range of motion
and to break adhesions that disrupt joint movement. Manipulation usually has a tem-
porary effect.
Mobilization, a common hands-on manual technique performed by physical thera-
pists is a gentle and safe alternative to joint manipulation. This is done when a bone,
or a joint, is moved in order to release painful tension, stiffness, chronic pain and re-
store normal joint function (movement, power and range of motion) including also the
surrounding soft tissue (e.g. muscle, ligaments, fascia). It involves small, very pre-
cise, passive movements, within or to the limit of a joint's normal range of motion
usually applied as a series of gentle stretches in a smooth, rhythmic way to an indi-
vidual joint. 2)………. ‘Grade one’ mobilization is used for very sensitive or acute pa-
tients to initiate more normal movement; ‘grade two” is applied with slightly more
pressure for pain relief; ‘grade three’ both relieves pain and gently improves the
range of motion of stiff joints; ‘grade four’ is administered for stretching tight tissues
(relieving tension) and restoring ROM in chronically damaged joints.
Joint mobilization is performed to improve flexibility / mobility in areas that currently
have a limited ROM due to any type of stiffness, strain, injury, tightness, paralysis or
chronic pain. 3)………. It is very important that the physical therapist performs a con-
sultation before starting the joint mobilization (or manipulation) therapy. During such
a consultation the therapist should assess the blood, nerve supply, bone and mus-
cles in the afflicted area. 4)……….
Mobilization is considered safer than manipulation because it is done slowly and the
patient has the opportunity to stop the procedure if it becomes uncomfortable for any
reason. The technique is especially effective with arthritic joints. 5)………. Therapists

81
often choose mobilization when a patient has a severe muscle spasm and must un-
dergo relaxation and stretching.
Neither mobilization nor manipulation techniques should be applied in the following
circumstances: severe osteoarthritis or osteoporosis, malignant lesions in the af-
fected area, bleeding in a joint, total joint replacements, dysfunction with the blood-
flow within the affected area, a full diagnosis has not been reached yet. 6)……….
Since the procedures are to be performed very precisely, the therapist must undergo
professional training, be experienced and very careful when dealing with patients’
joints.

A. Possible complications (more often associated with manipulation) include: frac-

ture, dislocation, muscle or tendon injury, torn ligament, nerve damage.
B. Neither of them should be performed without prior preparation.
C. Frequently, after the mobilization portion of the therapy has been completed,
therapists recommend (as a preventative measure) some complimentary treatments -
such as certain strengthening and stretching exercises.
D. Joint manipulation is performed by chiropractors, it involves twisting a joint (usu-
ally in the neck or back) to the end of range, then giving a sudden thrust.
E. Also it is used in the case of elderly patients, as their bones are often more brittle,
fragile and osteoporosis does not always show up on x-ray unless quite advanced.
F. This is necessary in order to decide if joint mobilization (or manipulation) is safe in
a given situation and for a given patient and to reduce the risk of complications.
G. Mobilization may be administered by a practitioner in various gradations or de-
grees of pressure.

Wordlist:
adhesion – zlep
brittle – łamliwy
complimentary – uzupełniający
crack – pęknięcie, pękać
fragile – kruchy
knuckle – staw śródręczno-paliczkowy, kostka ręki
manipulation – manipulacja, czynność manualna
mobilization – uruchomienie, uwolnienie
pop – pęknięcie, wystrzał, trzask
preventive measures – środki zapobiegawcze
thrust – popchnięcie

1. When is manipulation used and by whom?

2. What kind of movements are involved in manipulation?
3. How long do the manipulation effects last?
4. When is joint mobilization performed?
5. What kind of movements does mobilization involve?
6. What is the difference between various grades in mobilization?
7. What must the therapist do prior to the application of either technique?
8. Why is mobilization considered safer than manipulation?
9. What are the contraindications to these procedures?
10. Which technique is more likely to develop complications?
11.

82
EXERCISE 3: Group the following characteristics under the following headings.

• Quick movement
• Small movements
• Typical technique used by Physical Therapists
• Movements beyond joint ROM
• Can be stopped when painful
• Movements within joint ROM
• Sudden thrust
• Gives a sound effect
• Various degrees of pressure
• High energy
• Unable to stop once started
• Gentle stretches
• Typical technique used by Chiropractors

MOBILIZATION MANIPULATION

EXERCISE 4: Writing. In groups of 3-4 follow the task below.

There are two places (clinics) providing physiotherapy treatment in the town you work
and live in. You are employed in the one that is smaller but has a long tradition. The
National Health Fund has decided to close one of them. Write a short letter (max 100
words) in which you present the profound benefits your clinic brings to the commu-
nity, list its wide range of services, mention the team of professional specialists em-
ployed there, etc. Be persuasive.

EXERCISE 5: Discuss in pairs.

YOUR LIFE
• Do you consider yourself a happy person?
• What are 5 most important things in your life?
• Have you ever achieved anything you really wanted very much? What was
it? How much time did it take to achieve this?
• Is there anything you want to achieve in future?
• What will your life be like in 10 years time?

EXERCISE 6: Ask about the underlined parts of the sentences below.

1. This procedure is often accompanied by a pop or click.

83
 2. Movements are applied at various locations on each of the affected verte-
brae, and at various angles.
3. Mobilization is safer because it is done slowly and the patient has the op-
portunity to stop the procedure if it becomes uncomfortable.
4. This kind of therapy is especially effective with arthritic joints.
5. Physical therapists perform a full assessment of the blood and nerve supply
in the affected area.
6. In order to prevent the pain from returning a short time after the spinal manipula-
tion, other treatments need to be performed.
7. The long bone is attached or joined to another bone by a joint.
8. A clinician must know what is the total range of joint motion.
9. The other common mobilization technique is called oscillatory mobilization.

References:
http://en.wikipedia.org/wiki/Joint_manipulation 7.07.2007
http://health.enotes.com/nursing-encyclopedia/joint-mobilization-manipulation
7.07.2007
http://physicaltherapy.ca/ortho/Jointmobilization1.html 7.07.2007
http://physicaltherapy.ca/ortho/SpinalManipulation.html 7.07.2007
http://www.massagetherapy101.com/massage-techniques/joint-mobilization.aspx
7.07.2007
http://www.sigafoospt.com/Education/Mobilization.htm 7.07.2007
http://www.spineuniverse.com/displayarticle.php/article1692.html 7.07.2007

84
 SPORTS INJURIES

EXERCISE 1: Discuss in pairs.

• In which sports are injuries most common? Why? What kind of injuries are they?
How can they be prevented?
• Would you like to deal with sportspeople in your future career? What are the ad-
vantages and disadvantages of such a job?
• Why is proper nutrition considered so important for sportspeople?
• Have you ever suffered from an injury that resulted from sports activity or exer-
cise? What happened? What was the treatment like?
• What do you think will change in the future as far as sports injury treatment is
concerned? Share your suggestions / predictions with a partner. Think about:
decline/increased need for surgery, improved rehabilitation techniques, new im-
aging methods, better diagnostic methods, tissue engineering, gene therapy,
etc.

EXERCISE 2: Read the text below and decide whether the statements below are
true or false. Correct the false ones.

Injuries seem to be inevitable for people participating in physical, sporting activities.

Their nature may vary according to the factor they resulted from: an acute episode of
trauma (fractured bones), overuse (due to repeated episodes of microtrauma). Gen-
erally, the causation of sports injuries may involve intrinsic factors (directly connected
with the sportsperson) and the extrinsic ones (those derived from external forces).
Among the intrinsic factors there are for example: age, sex, body composition and
weight, muscle power (stiffness, weakness), poor joint flexibility, congenital joint hy-
perlaxity, malalignment (e.g. leg length discrepancy, varus – club foot). The extrinsic
factors include: training methods and competition (sudden changes in training meth-
ods, poorly designed training techniques, violent play), old, poor or unsuitable
equipment, surfaces on which the sportspeople train, environmental aspects (cold
weather – reduced elasticity, hot, humid weather – heat stroke, poor light). Each
sport has its own group of injuries that are, to a greater or lesser extent, specific to
that sport itself. Prevention of sports injuries should be based on such elements as:
adequate warm up before training, correct stretching and strengthening exercises to
achieve a muscle power balance, correct use of equipment (also safety equipment),
etc.
Managing a sports injury is not merely treating the injured part, but also eliminating
the undelying cause (e.g. poor equipment). The first step in dealing with sports inju-
ries is, however, to discover the sporting cause of it. This frequently requires a good
knowledge of the sport – a health provider should able to obtain a full sporting his-
tory. Fortunately, patients are in most cases able to provide the reasons for their inju-
ries. Also, liaison with the coach may be invaluable. In order to make a proper diag-
nosis, appropriate investigations (mostly ultrasound and x-ray) should be made. The
rehabilitation process may cause various problems. In many cases, sports injuries
are caused by premature return to competition before the athlete is ready. Reha-

85
biliatition must not be perceived as a loss of time, but more positively, it should be
treated as an opportunity to correct the existing deficiencies.
Sports injuries are normally treated with: rest (that irritates sportspeople most), anal-
gesic agents (e.g. non-steroidal anti-inflammatory gels, injections), surgical proce-
dures (when the conservative measures have not solved the problem). All of these
are usually combined with physiotherapy. Various stretching techniques are applied
and the process of rehabilitation needs to be supervised. Also other methods of
treatment are commonly used: massage, strapping, strengthening techniques with
manipulation and mobilisations, ultrasound, electrotherapy, laser therapy. Physio-
therapists not only work with patients, they also constantly consult with doctors and
coaches, exchange information on the rehabilitation process and the patient’s pro-
gress.
To summarise, managing sports injuries involves: an assessment of why the injury
occurred, treatment combined with maintaining overall fitness, and a gradual struc-
tured rehabilitation programme that requires team work (cooperation of the patient,
doctor, physiotherapist and a coach).

Wordlist:
causation – czynniki sprawcze
club foot – szpotawa stopa
coach – trener
derive from – pochodzić z
discrepancy – różnica
extrinsic – zewnętrzny, związany z zewnętrznymi czynnikami
varus – szpotawy
friction – tarcie
heat stroke – udar słoneczny
humid – parny i wilgotny (o pogodzie)
hyperlaxity = hypermobility – nadmierna ruchomość stawów
inevitable – nieunikniony
intrinsic – cechujący czyjąś naturę, wewnętrzyny
invaluable – bezcenny, nieoceniony
liaison – kontakt
malailignment – nieprawidłowe ułożenie w linii
merely – jedynie
permature – przedwczesny
strapping – bandażowanie, umocowanie przylepcem

1. It is difficult to avoid sports injuries.

2. Both intrinsic and extrinsic factors are exlusively related to an athlete.
3. The type of weather has great impact on athletes’ mood and condition.
4. Each athlete may suffer from all possible kinds of sports injuries.
5. Athletes are not normally able to provide information on the injury cause.
6. Rehabilitation is a long process so athletes quickly get impatient.
7. Taking a sporting history – talking to a patient and a coach – is always enough to
make a proper diagnosis.
8. Surgical treatment is normally recommended when other methods are ineffective.
9. Physiotherapists do not tend to monitor the patients’ progress.
10. Team work in managing sports injuries is necessary.

86
EXERCISE 3: Put the stages of managing a sporting injury in the correct order.

........ Formulating a treatment plan appropriate to an injury (rest, drugs,

physiotherapy, surgery)
........ Maintenance of general fitness (of uninjured parts)
........ Rehabilitation - gradual, structured regimen
........ First aid procedures
........ Accessory investigations (to confirm the initial diagnosis)
........ Examination (of an athlete and equipment)
........ Prevention strategies (general fitness, training regimen, equipment use)
......... Making a diagnosis
......... RICE - Rest (an injured part), Ice (pain relief, prevention of bleeding),
Compression (to reduce swelling), Elevation (of an injured part)
......... Correction of a poor training programme
......... History taking to establish cause(s) of an injury
......... Sport specific fitness exercises
......... Making an initial diagnosis

EXERCISE 4: A role-play. Work in pairs.

A: You are a physiotherapist. Take a sporting history and carry out a physical exami-
nation of a sportsperson. Be precise and get as many details a as possible.

B: You are an athlete. You come to a physiotherapist with an injury of a leg / muscle /
arm (the choice is yours). Report in detail what has happened, answer all questions
and follow instructions during a physical examination.

EXERCISE 5: Below there are several common tips concerning injury preven-
tion given by sports therapists. Complete them using the correct words from
the box.

tendinitis moderate softest uphill level modify

twisting warm-up pulse land absorption

Tips for Preventing Injuries

• Avoid 1)_____________ knees by keeping feet as flat as possible during

stretches.
• When jumping, 2)_____________ with your knees bent.

87
 • Do 3)____________stretches before activity; not just before vigorous ac-
tivities like running, but also before less vigorous ones such as golf.
• Don't overdo.
• Cool down following vigorous sports. For example, after a race, walk or
walk/jog for five minutes so your 4)_____________ comes down gradually.
• Wear properly fitting shoes that provide shock 5)______________ and
stability.
• Use the 6)____________ exercise surface available, and avoid running on
hard surfaces like asphalt and concrete. Run on flat surfaces. Running
7)____________ may increase the stress on the Achilles tendon and the
leg itself.
• Don't pack a week's worth of activity into a day or two. Try to maintain a
8)____________ level of activity throughout the week.
• Learn to do your sport right. Using proper form can reduce your risk of
‘overuse’ injuries such as 9)____________ and stress fractures.
• Accept your body's limits. You may not be able to perform at the same
level you did 10 or 20 years ago. 10)____________ activities as neces-
sary.
• Increase your exercise 11)____________ gradually.

EXERCISE 6: Translate into English.

1. Sporadyczne uprawianie sportu wiąże się z większym ryzykiem doznania

urazu.
2. Po urazie wskazany jest natychmiastowy zimny okład i poruszanie kon-
tuzjowanym palcem.
3. Jeśli ruch kontuzjowanym palcem jest niemożliwy należy udać się do leka-
rza specjalisty i wykonać zdjęcie radiologiczne.
4. Najczęstszym urazem stawu kolanowego doznawanym podczas gry w ko-
szykówkę jest uszkodzenie więzadła.
5. W przypadku, gdy osoba doświadczyła wcześniejszych skręceń lekarz
może zalecić grę w opatrunku typu taping lub w ortezie.
6. Należy sobie zdawać sprawę z tego, iż zmiana uprawianego sportu wiąże
się z innym, specjalistycznym treningiem w celu uniknięcia kontuzji.

References:
A. Kuciejczyk, „Materiały z języka angielskiego dla Wydziału Lekarskiego – zajęcia
fakultatywne”, AMG 2006.
http://bmj.bmjjournals.com/cgi/content/full/308/6940/1356 2.12.2007
http://en.wikipedia.org/wiki/Sports_injuries 2.12.2007
http://sportsmedicine.about.com/cs/ankle/a/ankle2.htm 2.12.2007
http://sportsmedicine.about.com/cs/overtraining/a/aa062499a.htm 2.12.2007
http://sportsmedicine.about.com/od/paininjury1/a/overuse.htm?once=true&
2.12.2007
http://www.niams.nih.gov/hi/topics/sports_injuries/SportsInjuries.htm#ra_12#ra_12
2.02.2008
http://www.rehasport.pl/koszykowka.php 2.12.2007

88
 JOINT INJURIES – REVISION

EXERCISE 1: Answer the questions in pairs.

• Have you ever been on a diet? Were you happy with the results?
• What is a balanced diet? Do you have a good diet?
• What is anorexia? Do you know anybody who has any eating disorders? Why
are they so common nowadays (especially among young girls)?
• In what way can physiotherapists educate patients about healthy lifestyle?
What arguments can they use?

EXERCISE 2: In the texts below complete the gaps with the correct words.

Ankle sprains

Ankle sprains are one of the most c…………... sports injuries (particularly in
a………………. that require running, jumping and change of direction, such as bas-
ketball). The ankle j……………… has three bones that are precisely shaped to inter-
lock and give stability. Strong bands of connective tissue called l………………… rein-
force the joint and help hold the bones together. These ligaments prevent too much
m……………….. of the joint. A sudden movement or twist, often when the foot rolls
in, can overstretch the supporting ligaments, causing ligament tears and bleeding
around the joint. A person feels a……………….. pain when trying to move it and
when walking, This is known as an ankle sprain. Suggestions for immediate
t………………… of an ankle sprain include: resting the injured part, icepacks every
two hours, bandaging the joint firmly, r………………. the ankle above the heart level,
avoiding exercise, heat and alcohol, and massage in the first 48 hours, as these can
all exacerbate swelling. Physiotherapy provides r………………….. and support by:
exercise programs (trampoline, wobble board) to improve mobility of the joint and to
strengthen the muscles surrounding the ankle, suggesting protective
d………………… (ankle braces) to improve support during exercises.

Joint dislocation

A dislocated joint is a joint that ……………………. out of place. It occurs when the
ends of bones are ……………………. from their normal positions. The most common
causes are a …………………., fall, or other trauma to the joint. In some
……………….., dislocations are caused by a disease (e.g. rheumatoid arthritis) or a
………………... ligament. When a joint is dislocated, it no longer functions properly. A
severe dislocation can cause ………………. of the muscles, ligaments and tendons
that support the joint. Joint dislocation symptoms are the ……………… : intense pain,
swelling, immobility of the affected joint. Proper treatment requires an
………………… doctor’s examination. Common treatment options include: medica-
tion to reduce the pain and swelling, surgical intervention when ………………… liga-
ments need to be repaired and ………………...

89
 slips forced blow cases defective tearing
following immediate stretched tightened

EXERCISE 3: Change the words in bold to complete the sentences.

1. For a good specialist theory and practice are …………….. SEPARATE

2. You need to ………………. these knives, they are all blunt. SHARP
3. For the sake of ………………., let’s discuss this in Polish. SIMPLE
4. I have two dogs, Miu and Chic, and they are gray and black, ………………….
RESPECT.
5. He ……………… renounced any knowledge of the illegal affairs. PUBLIC
6. It was with great …………………. that I accepted your kind invitation. PLEASE
7. ……………….. all of his films were a success. PRACTICE
8. She always behaves well in my ……………… PRESENT.
9. What’s the ………………….. of your going to Spain this year? LIKE
10. “Cogito ergo sum” was the famous motto of the …………………… LIGHT
11. The boss was accused of ……………… treatment of his staff. HUMAN
12. We can’t smoke here, the barrels contain highly ………………… materials.
FLAME
13. The book got ……………. reviews. FAVOUR
14. We’re very sorry, the misunderstanding was caused by ……..……………. IN-
FORM.
15. The ……………… rate in Germany rose to five per cent last year. EMPLOY

EXERCISE 4: Explain the following terms in English.

joint appointment group therapy ROM

passive movements examination joint mobilization
professional qualifications good patient-therapist relationship
rehabilitation program

EXERCISE 5: Match the idioms below to their meanings and then complete the
sentences below.

to bury the hatchet - negative attitude because of jealousy

to tie the knot -
the apple of sb’s eye -
to whet sb’s appetite -
sour grapes -
to turn sb’s stomach -
to make sb keen to experience more of sth
to cause sb to feel sick/disgusted
to get married
to forget old quarrels
sb one is most fond of

The way he was eating peanuts and talking at the same time really …………………..!
Kim said my earrings made me look silly, but it was just……………….. – I know she
would like to have them.
After five years of living together they finally …………………… .
I only read the back of the book but it was enough to ………………….. .

90
My friend thinks her son can do nothing wrong – he is ……………………. .
After years of constant arguments they decided to …………………… .

EXERCISE 6: Choose the correct option.

1. If I were you, I wouldn't interfere on / in his business.

2. That river rose / has risen five feet since yesterday.
3. I recommend that he come / comes on time for the interview.
4. He'll never / ever get a promotion, however hardly / hard he tries.
5. Very little / few scientists come up with complete / completely new answers
to the world's problems.
6. Did you take my car key by / for mistake?
7. He was please / pleased to hear such a fine musician play / plays his favor-
ite piece of music.
8. The leading runner was two miles farther / further ahead.
9. Complaining about faulty goods or bad service is / are never easy.
10. Our last two days in Florida were slightly / slight spoiled with / by the
weather.

References:
http://a4esl.org/q/j/vm/ed-cm.html 2.02.2008
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Ankle_sprains?Open
Document 7.07.2007
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Knee_injuries?OpenD
ocument 7.07.2007
http://www.mamashealth.com/bodyparts/jointdis.asp 7.07.2007
http://www.mamashealth.com/bodyparts/jointrep.asp 7.07.2007
J. Milton, V. Evans, “A Good Turn f Phrase. Advanced Idiom Practice”, Express Pub-
lishing, 1998.

91
 THERAPEUTIC HEAT

EXERCISE 1: Answer these questions in pairs

• What is a normal body temperature?

• Does the high temperature outside have any impact on your mood, general condi-
tion, motivation to work/study?
• What temeperature outside is the best for you?
• What’s highest temperature you have ever experienced? When and where was
it? How did you feel?
• What do you know about therapeutic effects of heat?

EXERCISE 2: Read the text and put the parts of the text in the correct order.
Then answer the questions below.

A. This method is especially effective as pain relief in arthritic conditions of small

joints. Quite a common method is also a moist air cabinet in which air saturated with
water vapour (at a controlled temperature) is blown over a person’s body. This is
most often used in the case of back muscle spasms. Other convective heating tech-
niques include water-based exercise and spa therapy (balneotherapy).
In the conversion heat transfer, one energy form is changed into another (e.g. from
sound, light to heat). The shorter the wavelengths the deeper tissues are penetrated
and greater therapeutic effect is achieved. Usual treatment time is 20-30 minutes.

B. Heat therapy is contraindicated in the following conditions: open wounds (fluido-

therapy, paraffin baths), just after a surgery (hydrotherapy), photosensitivity (radiant
heat), multiple sclerosis, pregnancy, diabetes, cardiovascular disorders (hydrother-
apy – especially total immersion), swelling, or bruising.

C. Heat therapy involves the application of heat to the body for pain relief and health
generally. Heat provokes faster blood flow, increases the extensibility (ability to
stretch) of collagen fibers, decreases joint stiffness, reduces contractures, pain, and
muscle spasms.

D. Also, heat is applied for inflammation and injuries (both acute and chronic), such
as sprains, strains, back pain, whiplash, and arthritis. It can assist in removal of oe-
dema and waste products from areas of injury. The application of heat may be super-
ficial (hot packs, infrared heat, paraffin baths, hydrotherapy) or deep (electrodia-
thermy, ultrasound). The extent of the physiologic response to heat depends on: the
tissue temperature (usually 40-45°C), how long and how much the tissue tempera-
ture increases, and how much of the body is being treated.

E. A hot pack consists of a cotton bag with silicate gel inside. It is placed in a hot wa-
ter tank to absorb hot water and then is applied on the skin over layers of towels for
20-30 minutes. For temperature regulation and control towel thickness is intentionally
increased, the heat flow reduces and the temperature rise slows down.

92
F. Convective heat transfer involves moving the heating medium (fluid, air) around
the body / body parts. In fluidotherapy, thermostatically controlled warm air is blown
into a bed of uniform round solids (e.g. glass beads) to make a semifluid mixture. A
given body part is immersed and superficially heated (usually the temperature ranges
between 45.6 and 47.8°C).

G. The heat transmission can be divided into 3 types: conduction (contact with
warmed substances such as hot packs, compresses), convection (heat produced by
movement of the transferring heating medium, air or fluid e.g. fluidotherapy, whirpool,
hot air bath), conversion (superficial radiation e.g. infrared lamps; deep penetration -
heat is produced as energy from high frequency currents e.g. ultrasound).
In a conductive heat transfer, there is direct contact between the heat source (not
moving) and the target tissues. This includes: hot water baths, hot packs, rubber hot
water bottles, electric heating pads, warm compresses. Patients may use these tech-
niques without assistance, at home. Possible complications that may occur are
burns, difficulty in application to certain body regions, the effect of skin-drying, shock
hazard (e.g. if the electric heating pad is not insulated properly when moist), and im-
paired vascular supply (e.g. packs are too heavy to be applied on a given body part).

H. The radiant energy source is positioned between 40 and 60 cm from the treatment
site and the intensity is controlled by the light source, distance, and quality/type of a
reflector used. The therapy is most frequently used for muscle spasms related to
skeletal disorders and rheumatic joints.

1_____, 2_____, 3_____, 4_____, 5_____, 6_____, 7_____, 8_____

Wordlist:
bead – kulka, paciorek
bruising – siniak
conduction – przewodzenie
convection – konwekcja, przenoszenie ciepła w płynach i gazach drogą ruchu
cząstek nagrzanych
conversion – przetwarzanie, przekształcenie
extensibility – rozciągliwość
fluidotherapy – fluidotherapia (rodzaj leczenia ciepłem)
infrared – podczerwone
insulate – izolować, oddzielić, odosobnić
moist – wilgotny
oedema – obrzęk
saturate – nasycać
semifluid – półpłynny
silicate – krzemian
skin-drying – wysychanie skóry
vapour – para wodna
whiplash – uraz z szarpnięcia
whirpool – wir

93
 1. What is heat therapy?
2. In what way(s) does heat affect the body?
3. What do these effects depend on?
4. Which two methods of heat application can be distinguished?
5. How do conduction, conversion and convection differ from each other?
6. What complications may appear with the conductive heat transfer techniques?
7. What are hot packs and how are they applied?
8. What does fluidotherapy involve?
9. Which method(s) help with muscle spasms in the back?
10. How long does a conversion heat transfer session usually last?
11. Who should avoid heat therapy?

EXERCISE 3: Choose the correct versions in the text below.

Other forms of heat therapy

Paraffin bath is a form at / of conductive heating. Such baths are typically / particu-
larly useful for people suffering from / at contractures due to rheumatoid arthritis,
burns, and progressive / progress systemic sclerosis. Paraffin usually is applied at /
to the hands, arms, and foot / feet. Paraffin wax is melt / melted and mixed with
fluid / liquid paraffin. For therapeutic / therapy use, the paraffin bath is maintained
at the melt / melting point of 51.7-54.4°C in a thermostatically controlling / con-
trolled insulated container.
In the dip method, the hand or foot / feet is placed in the fluid / liquid paraffin bath
and withdrawn when a thin layer / level of warm solid paraffin forms / form, be-
comes adherent, and covers / discovers the skin. The dip / dipping procedure
should be repeated / reappeared until a thick paraffin glove / sleeve is formed. The
heat can be retained by wrapping / covering with towels for 20 minutes; then, the
cool solid paraffin glove / sleeve is peeled away and the paraffin is recycled / cy-
cled. The dip / dipping method allows for a mild / severe heat application because
only a limited amount of heat is available on / for transfer to the skin.

EXERCISE 4: In the text in Ex. 2, find adjectives used to describe the following
nouns.

wounds - mixture –
disorders - solids –
method - heat transfer –
joints - gel –
condition - vascular supply –
blood flow - complications –
injuries - compresses –
application - heating pad –
substances - contact –
radiation - penetration –

94
EXERCISE 5: Follow the task and act out a conversation in pairs.

A: Przyjechał/a do Ciebie kuzyn/ka z Kanady, który/a również studiuje fizjoterapię na

Akademii Medycznej i nigdy nie był/a w Polsce. Zaplanujcie wspólne spędzenie
weekendu. Gość interesuje się historią Twojego miasta i lubi zwiedzać zabytki. Chce
poznać potrawy tradycyjnej kuchni polskiej. Zaproponuj, co możecie zwiedzić i jak
tam dojedziecie. Zaoferuj wspólny obiad w dobrej restauracji oraz atrakcyjne spę-
dzenie wieczoru z Twoimi przyjaciółmi, którzy chcą poznać kuzyna/kę. Dowiedz się,
czy to nie będzie zbyt męczące i czy Twój gość chciałby spędzić ten czas w inny
sposób.

B:Jesteś studentem/ką fizjoterapii na Akademii Medycznej i mieszkasz w Kanadzie.

Przyjechałeś/aś na kilka dni do Polski w odwiedziny do kuzyna/ki. Zaplanujcie wspól-
ne spędzenie weekendu. Interesujesz się historią miasta i lubisz zwiedzać zabytki.
Chcesz poznać potrawy tradycyjnej kuchni polskiej. Dowiedz się, gdzie możecie
pójść i ile czasu to zajmie. Wyraź chęć poznania przyjaciół gospodyni/gospodarza,
aby dowiedzieć się więcej o swoich polskich rówieśnikach. Chętnie spędzisz wieczór
w pubie lub dyskotece, jeśli będzie tam miła atmosfera.

EXERCISE 6: Translate the sentences into English.

1. Ciepłolecznictwo czyli leczenie ciepłem polega na dostarczeniu do organizmu

energii cieplnej, głównie drogą przewodzenia i przenoszenia.
2. Proces przekazywania ciepła może odbywać się w drodze: kondukcji, konwekcji
i radiacji.
3. Wskazania do stosowania ciepła obejmują przede wszystkim przewlekłe stany
zapalne o różnej etiologii.
4. Pod wpływem działania ciepła napięcie ścian naczyń krwionośnych obniża się,
następuje ich rozszerzenie i zwiększenie szybkości przepływu krwi.
5. Rozszerzenie naczyń krwionośnych skóry wpływa na zwiększenie przepływu
krwi przez tkanki, co jest szeroko wykorzystywane w leczeniu wielu schorzeń i
stanów zapalnych.
6. Działanie ciepła obniża napięcie mięśni szkieletowych i gładkich oraz wpływa na
zmniejszenie napięcia powierzchniowego.

References:
http://en.wikipedia.org/wiki/Heat_therapy 7.07.2007
http://www.chinmed.com/praktyka/prakt_art/termoterapia.htm 3.02.2008
http://www.emedicine.com/pmr/topic201.htm 7.07.2007
http://www.merck.com/mmhe/sec01/ch007/ch007b.html 7.07.2007
http://www.sportsinjurybulletin.com/archive/heat-therapy-ultrasound.html 7.07.2007
http://www.thebodyworker.com/hydrotherapyheat.htm 7.07.2007
http://www.thermacare.com/heattherapy.jsp 7.07.2007

95
 THERAPEUTIC COLD

EXERCISE 1: Answer the questions in pairs.

• Do you feel less comfortable when it’s cold or hot? Why?
• What is the lowest temperature you have experienced? When was it? How did
you feel then?
• What is your body’s reaction to cold?
• Have you ever tried cryotherapy? If yes, where and how did you like it? If not,
would you like to try? Why (not)?
• Where can people receive cryotherapy in Poland?

EXERCISE 2: Read the text and answer the questions below.

Cryotherapy most commonly describes low temperatures used locally or generally in

medical therapy. The term covers various techniques, such as cryosurgery (applying
extreme cold in order to destroy diseased or abnormal tissue, especially in the skin),
cryogenic chamber therapy (placing a person in a chamber cooled with liquid nitro-
gen to a temperature of –110 C for a short duration), ice pack therapy (applying a
plastic bag filled with ice to treat pain conditions), cold immersion, ice massage,
cryokinetics (cooling during exercise), cold whirlpool baths, cryotherapy-compression
units, vapocoolant spray, ice towels, ice massage, gel packs, refrigerant gases.
Physiological effects of cryotherapy depend on the method and duration of its appli-
cation. They include: decreased local metabolism and enzymatic activity, vasocon-
striction, reduced swelling/edema, decreased hemorrhage, reduced muscle effi-
ciency, hyperemia, analgesia resulting from an impaired neuromuscular transmis-
sion. The most common indications for cold therapy are: reducing pain, muscle
spasm, acute inflammatory reaction, swelling, muscle spasticity, hemorrhage, blister-
ing, treating burns, joint motion disturbances (e.g. in the knee). On the other hand,
cryotherapy should not be used by people with: vascular impairments, hypertension,
rheumatoid arthritis, cold allergy, peptic ulcers, ischemic conditions.
Cold therapy techniques have traditionally been used to destroy various kinds of skin
tumours, precancerous skin moles, nodules, unwanted freckles, in children they have
been used in the treatment for retinoblastoma (retina cancer). Currently, it is also
used for prostate, liver and cervical cancer (especially if surgery cannot be used).
For optimal results in cases of trauma, such as superficial burns, cold should be ap-
plied immediately before a significant edema and hemorrhage occur. Therapeutic
cold is usually applied for 5-20 minutes, followed by a rest period of 30 minutes. In
the case of acute sprains/strains and postoperative care, application of cold is rec-
ommended for the first 24-48 hours. For treatment of deeper tissues or for prolonged
periods of cold application, physician evaluation/prescription is essential to avoid
complications.
Application of ice or immediate cooling of soft tissues damaged by an injury helps to
limit the level of swelling and the amount of blood leaking out.
The stages of ice applications are commonly referred to as RICE:

96
 • Ice – should be applied as soon after the injury as possible, before the swelling
appears. Ice should not be applied directly to the skin. It is recommended to
wrap the ice in a damp cloth (a dry cloth does not transmit cold effectively).
• Compression – after ice, a compression bandage helps to minimize the swell-
ing to the tissues.
• Elevation – the injured part should be elevated to help limit blood flow and pre-
vent use of muscles to injured part.
• Rest – the injured part should rest as much as possible to allow the healing of
damaged tissues.
The therapist while applying cold therapy is always obliged to avoid such negative
consequences as tissue damage and abnormally low body temperature (hypother-
mia).

Wordlist:
analgesia – zniesienie czucia bólu
blistering – powsawanie pryszczy, pęcherzy
cervical cancer – rak szyjki macicy
cryogenic chamber – komora kriogeniczna
cryokinetics – kriokinetyka, połączenie krioterapii i kinezyterapii
cryosurgery – kriochirurgia
cryotherapy – krioterapia, leczenie zimnem
damp – mokry, wilgotny
elevate – wznieść, unieść
freckles – piegi
hyperemia – przekrwienie
ice pack – woreczek z lodem
immersion – zanurzenie
impingement – nerve ~ – uszkodzenie, ucisk/cieśń nerwów
ischemic - niedokrwienny
leak out – wyciekać
mole – znamię
neuromuscular transmission – transmisja nerwowo-mięśniowa
nitrogen – azot
nodule – guzek
muscle spasticity – spastyczność, kurczowość mięśni
peptic ulcer – wrzód trawienny
precancerous – przednowotworowy
refrigerant gas – gaz chłodzący
retina – siatkówka
retinoblastoma – nabłoniak nerwowy z rozetkami prawdziwymi, glejak siatkówki
vapocoolant spray – spray pary chłodzącej
vascular – naczyniowy
vasoconstriction – zwężenie naczyń krwionośnych
whirpool bath – kąpiel wirowa

1. What is cryotherapy?
2. What does the cryogenic chamber therapy involve?
3. Give examples of physiological effects of cryotherapy?
4. When is cryotherapy applied?

97
 5. Who should not undergo cryotherapy treatment?
6. Which skin changes can receive cryotherapy treatment?
7. How long should cold be applied to the body?
8. What is RICE? Name the stages.

EXERCISE 3: Complete the text with the correct words. The first letters have
been already given to help you.

Contraindications of using ice

• Check a person's general s………………… to ice – some people find the ap-
plication of cold immediately p………………….
• Do not use ice on injuries in the chest r………………… as in some instances
this may cause a reaction in the muscles, bringing about angina pain, possibly
from the constriction of c…………………... arteries.
• Always check s………………….. sensitivity before applying ice – if a person
cannot feel touch before applying ice it may i………………… other
p……………….. such as nerve impingement. In such i……………….. ice
would only serve to mask this and complicate the problem.
• Do not a………………… cold to someone with high blood pressure as vaso-
constriction will i…………………… the pressure within the vessels.

EXERCISE 4: Put the phrases above into the correct space in the chart below.

COLD VS. HEAT THERAPY

Cold Both Heat

1. tissue metabolism increases

2. tissue metabolism decreases
3. muscle spasticity decreases
4. has analgesic effect
5. after application muscles return to their normal temperature much slower
6. after application muscles relatively quickly return to their normal tempera-
ture
7. blood flow increases
8. the tendency to bleed increases
9. the tendency to bleed decreases
10. joint stiffness is decreased
11. joint stiffness increases
12. formation of edema is facilitated
13. formation of edema is decreased

98
EXERCISE 5: A role-play.

A: You are going to open a cryotherapy centre in your city. You need a permission of
other people living in the building. Talk to their representative.

B: You are a group representative. A cryotherapy center is going to open in the build-
ing you live. The people are afraid of noise, substances used in therapies (such as
liquid nitrogen), low temperatures in the building, crowds of patients. Talk to the cen-
tre manager.

EXERCISE 6: Put the words in order to make correct sentences:

1. special to preparation is no needed cryotherapy undergo

2. the any of treatment out abdomen to be carried carefully needs
3. relieve application spasms cold may of help muscle
4. problems any potential identified bleeding are tests usually advance in
by blood
5. disease cryotherapy treat can only at single a site
6. cannot it treat cancer that spread has to other of the body parts
7. the long-term of examined therapy effectiveness is still being

References:

http://www.sigafoospt.com/Education/Cold%20Therapy.htm 7.07.2007
http://www.emedicine.com/pmr/topic201.htm 7.07.2007
http://www.grucox.com/cryotherapy.html 7.07.2007
http://www.merck.com/mmhe/sec01/ch007/ch007b.html 7.07.2007
http://www.brianmac.co.uk/cryo.htm 7.07.2007
http://en.wikipedia.org/wiki/Cryotherapy 7.07.2007
http://www.radiologyinfo.org/en/info.cfm?pg=cryo&bhcp=1 7.07.2007

99
 GYMNASTICS

EXERCISE 1: Discuss in pairs.

• Do you do regular exercises? If not, would you like to start? Do you consider
yourself an active person?
• Do you think physical education is an important subject or just a waste of time?
Do you think it should be compulsory every year? Why (not)?
• A lot of people do not exercise due to lack of time. What kind of activity would be
good for them?
• How can you find some time for physical activities several times a week? Give
your suggestions.
• What are the advantages and disadvantages of group exercises, such as aero-
bics?
• Should people who do exercises be supervised? When (not)?

EXERCISE 2: Read the text and write questions for the answers below.

Therapeutic Gymnastics

Therapeutic / remedial gymnastics are sets of sport tools (exercises) intended for
prophylaxis, treatment and rehabilitation. Exercises are specially designed to accel-
erate recovery from diseases or injuries and to sustain improved health by personally
involving the patient in the therapeutic process. Patients’ awareness that recovery to
a large extent depends on their personal effort is as important as correct and regular
exercise sessions. The goals of therapeutic gymnastics are: faster recovery, main-
taining achieved physical fitness and the restoration of the ability to work. Patients
are provided with different physical exercises depending on their disorders and a
general condition. Therapeutic sessions are always carried out under an instructor’s
supervision (a specially trained instructor, or a physiotherapist) and are conducted
either individually or in groups. Gymnastics is frequently recommended in the case of
arthritic diseases (for the improvement or restoration of the joint function), after a
trauma, for the restoration of function in central and peripheral paralysis, etc.
Remedial gymnastics differs from professional sports activities though both of them
use physical exercises. Each has, however, its own extent and the goal. Precise
dosage of physical exercises according to the specific diagnosis and other individual
features of each person is the main peculiarity of remedial gymnastics.
Gymnastics sessions are conducted in the form of:
• Group exercises – for patients with similar disorders, handicaps, e.g.
spinal problems, obesity, or lymphatic swelling.
• Individual exercises – for patients with motor skill problems, neuromus-
cular problems, or bad posture, under the leadership of a rehabilitation
worker or with the help of machines. An inseparable part of the therapy is
the rehabilitant's active participation, involvement, and co-operation during
exercises.

100
 • Water gymnastics is suitable for those who find usual gymnastics difficult.
Water makes one feel light and it is easier to perform exercises. Resistance of
water to movements gives even within a short period of time a good physical
load. It is commonly prescribed for motor skills problems, post-accident
situations, nerve problems and overall organism relaxation. In addition,
water strengthens the body and stimulates metabolism.
The techniques used in therapeutic gymnastics include: passive exercising (position-
ing, splint, traction), active muscle contraction, active assisted movements, free ac-
tive movement, or active isometric exercise. An important part of the therapy is also
fitness exercise, strengthening, correct breathing training, correct body position train-
ing, correct sitting position training, correct standing position, correct walking and
correct motoric stereotypes during daily activities.

Wordlist:
dosage – dawkowanie
extent – stopień, zakres
load – obciążenie
peculiarity – osobliwość
remedial – leczniczy, zaradczy, naprawczy
resistance – opór
splint – szyna
sustain – utrzymać, podtrzymać
tool – narzędzie
traction – wyciąg

1. Prophylaxis, rehabilitation, and treatment.

2. Faster recovery, restoration of the ability to work.
3. Either individually or in groups.
4. For arthritic diseases, after traumas, to restore functions.
5. They are different in extent and goals.
6. For patients with similar disorders.
7. For those for whom usual gymnastics is difficult.
8. It strengthens the body and stimulates metabolism.
9. Passive, active, and corrective exercises.
10. The rehabilitant's active participation, involvement, and co-operation during
exercises.

EXERCISE 3: Vocabulary practice.

A: Match the words to make phrases.

individual participation
therapeutic recovery
peripheral process
general paralysis
joint function
personal condition
precise dosage
accelerate contraction
breathing effort

101
 active load
physical posture
muscle training
bad features

B: Complete the sentences with the above phrases.

1. The exercises are specially designed to ………………….. the ……………….

process. Thanks to them you will get better sooner than you expect.
2. ……………………… can be long and tiring for the patient, but it usually brings
god results.
3. Patient’s …………………… is necessary for the a therapy to be successful.
4. Due to ………………………, the patient was not able to move his extremities.
5. As a result of a degenerative disorder this ……………………… was impaired.
6. Frequently, the therapist’s ……………….…… in the exercises is not needed.
7. ………………………… is typical of a lot of school children nowadays.
8. Rehabilitation process in the case of once active and now severely disabled pa-
tients characterizes with both emotional and …………………………….
9. These exercises are to provoke and improve …………………………. force.
10. ………………………. is often a part of the therapy since in some patients respi-
ratory problems develop.

EXERCISE 4: Work in pairs. Give instructions to your partner to perform the

following activities.

102
EXERCISE 5: Read the text for about 1 minute, then cover it and in pairs, try to
say as much as you remember. Then, translate the text into Polish.

Individual therapeutic gymnastics (ITG) represents a special type of kinesitherapy,

since it uses motion for the recovery or reparation of patients’ kinetic capacities. It is
carried out either individually, or in groups for patients with the same type of disorder.
Individual therapeutic/remedial gymnastics sessions are performed by a physiothera-
pist, who individually treats the patient. The aims are to maintain or restore physical
motor capacities, as well as to develop functional motor adaptation of the organism.
Exercises are specially chosen for the disabled body parts, a training involves work-
ing on basic motor stereotypes, improving the activity of weakened muscles, stiff
joints and nerve system. The main part of the exercise program is aimed at the af-
flicted part, for example the neck spine, lumbar region, or focused on the main prob-
lem, e.g. respiratory exercises. During the final part of the session, the intensity of the
exercises decreases, and thus, relaxing exercises and exercises for muscle exten-
sion are used.

EXERCISE 6: Fill in the missing part of the sentence using the word in bold.
Use two to five words.

1. He took ten minutes to fix the missing part.

HIM It ………………………… to fix the missing part.
2. It's the nicest present I've ever been given.
SUCH I've …………………………………………… nice present.
3. Perhaps Mike and Bob went the wrong way and got lost.
MAY Mike and Bob…..……………………………the wrong way and got lost.
4. I'm sure they didn't plan this.
HAVE They ……………………………………… this.
5. It was wrong of you to insult Barbara.
HAVE You………………………………………… Barbara.
6. She felt happy after getting the results.
MOOD She …………………………………… after getting the results.
7. You should remove this old furniture.
RID You should ……………………………………………… this old furniture.
8. The school closes for the holidays on December 21st.
BREAKS The ………………………………………the holidays on December 21st.
9. The detective is going to investigate the theft.
LOOK The detective …………………………………………………… the theft.
10. I don't want to lend my cousin any more money.
RATHER I ……………………………………………my cousin any more money.
11. There aren't any apples left.
NO There …………………………………… left.
12. I'm sure Steve knew all the details.
KNOWN Steve ……………………………………… all the details.
13. The plane left the ground at 11 o'clock sharp.
TOOK The ……………………………………………… at 11 o'clock sharp.
14. He guarded the luggage while I asked for information.
EYE He ……………………… the luggage while I asked for information.

103
References:
http://en.wikipedia.org/wiki/Aerobic_gymnastics 8.07.2007
http://en.wikipedia.org/wiki/Gymnastics#Aerobic_gymnastics 8.07.2007
http://www.ilizarov.ru/project/lfk.htm 8.07.2007
http://www.karlovyvary.cz/static/lazenstvi_3_6.asp?LangId=2&Kol=3 8.07.2007
http://www.laine.ee/en/services/treat/gymnastics.html 8.07.2007
http://www.spaestland.no/e_beskrivelse.php 8.07.2007
http://www.sunflowers-agency.com/treatment-methods/therapeutic-remedial-
gymnastics.php 8.07.2007
http://www.viimsispa.ee/eng/index.phtml?directlink=healt_services.php 8.07.2007

104
 PROSTHESES AND ORTHOSES

EXERCISE 1: Do you agree or not? Give arguments for and against.

• It does not matter what you eat or do, your appearance and weight depends
only on genes.
• Disabled people should live in special communities, their life would be easier
then.
• Men are better doctors and women are better nurses.
• Genetic and medical research should be limited.

EXERCISE 2: Read the text below and complete the gaps with the correct
words.

Prostheses (singular: prosthesis) are devices (medically referred to as artificial ex-

tensions) that substitute for any removed or missing 1)……………….. of the human
body. The field of making prostheses is 2)………………… prosthetics. The function
of prostheses is to make the person feel as if the body part has never been removed.
Thus, they are meant to make people 3)……………… as independently as possible.
Prostheses are typically used to replace parts lost due to an injury (traumatic de-
fects), disease, missing from birth (congenital defects) or to supplement defective
4)……………….. parts. While there are many different types of prostheses, those
most commonly needed are the ones for breasts, legs, feet, arms, hands, and hip
joints. Also wigs used for people with temporary 5)………………… loss (i.e. due to
chemotherapy) are considered prostheses.
Artificial limbs replace missing extremities and their types largely depend on the ex-
tent of an amputation or loss and the location of the missing limb. Amputations are
carried out 6)……………….. to industrial, vehicular, and war accidents (in developing
countries, such as in Africa), whereas in Europe and North America disease is the
leading cause (mostly infections, cancer, and circulatory diseases).
There are four main 7)…………………. of artificial limbs: transtibial (replaces a leg
missing below the knee), transfemoral (replaces a leg missing above the knee),
transradial (replaces an arm missing below the elbow), transhumeral (replaces an
arm missing above the elbow).
Recently, there 8)……………….. been numerous significant advancements in artifi-
cial limbs. Due to new materials, such as plastics and carbon fibre, artificial limbs
9)……………….. now stronger, lighter, look much more realistic, and the amount of
extra energy necessary to operate the limb is limited.
Orthoses (singular: orthosis) are devices applied externally 10)…………………. a
part of the body (usually foot, knee, hip, back, chest, wrist, arm, neck) to make it
straight (reduce deformity), improve function, provide mechanical support, better po-
sitioning, relieve pressure on a given body part, control a weak or diseased part (pre-
vent deformity), and assist the musculo-neuro-skeletal 11)………………… . The word
is derived from ortho, meaning straight. The field of making orthoses is called orthot-
ics. Sciences 12)…………………. as materials engineering, gait analysis, anatomy,
physiology, and psychology contribute to the process of producing othoses to make

105
13)…………………. the orthosis fits and is comfortable. The most common appli-
ances include: braces, supportive collars, shoe inserts, lumbar support corsets,
trusses, splints, spinal supports and spinal jackets, footwear, stockings, and wigs.
Foot orthoses, for example, allow the muscles, tendons and bones of the
14)………………… and lower legs to function at their highest potential. They are
meant to decrease pain, not only in the foot, but in other parts of the body such as
the knee, hip and lower back. They can also provide / increase stability in an unsta-
ble joint, minimise stress forces, 15)……………….. a deformed foot from developing
additional problems, and thus improve overall quality of life. Foot orthoses take vari-
ous forms and are constructed of various materials. They can be for example: rigid
(firm material – to control foot function), soft (soft, compressible materials – to absorb
shock, improve balance), and semirigid (soft and rigid materials – to treat athlets).
They are 16)……………… by different people: those who walk or stand excessively
in their job, active sportspeople, overweight people, older people who developed ar-
thritis in their feet, children with foot deformities.

Wordlist:
advancement – postęp
artificial – sztuczny
braces – szelki, ogólna potoczna nazwa aparatów ortodontycznych
carbon fibre – włókno węglowe
collar – kołnierz
compressible – ściśliwy
corset – gorset
extension – przedłużenie
extent – stopień, zakres
footwear – obuwie
gait – chód
industrial – przemysłowy
insert – wkładka
orthosis – orteza
orthotics – protetyka
prosthesis – proteza
prosthetics – protetyka
rigid – sztywny
semirigid – półsztywny
spinal jacket – gorset wspierający kręgosłup
splint – szyna
stockings – terapeutyczne rajstopy uciskowe, przeciwżylakowe
substitute for – zastąpić
supplement – wspomagać, uzupełniać
transfemoral prosthesis – proteza uda
transhumeral prosthesis – proteza ramienia
transradial prosthesis – proteza przedramienia
transtibial prosthesis – proteza goleni
truss – pas przepuklinowy
vehicular – kołowy
wig – peruka

106
EXERCISE 3: Write answers for the following questions.

1. What is the medical term referring to prostheses?

2. What is their function?
3. What do prostheses usually replace?
4. When are amputations necessary?
5. What are the main types of artificial limbs?
6. What is the function of orthoses?
7. What sciences contribute to the process of producing orthoses?
8. What are the functions of foot orthoses?
9. Who uses foot orthoses?

EXERCISE 4: Work in pairs.

A: You have a patient who has lost his leg and is beginning his / her rehabilitation
process. He / she is asking questions about a prosthesis he/ she is going to wear.
Answer the questions and calm the patient down.

B: You have lost your leg recently due to an accident and you are going to have a
prosthesis. You are depressed and afraid. Talk to your physiotherapist, ask about
things you want to know.

EXERCISE 5: FOR OR AGAINST. Discuss in groups.

• Advantages and disadvantages of alternative medicine.
• Advantages and disadvantages of being famous.
• Advantages and disadvantages of buying online.

EXERCISE 6: Translate into English.

1. Chirurgia i technika amputowania kończyny stale rozwijają się.

2. Dobór rodzaju protezy zależy od oczekiwań klienta ale przede wszystkim od
jego budżetu.
3. Protezy kończyn dolnych można podzielić ze względu na poziom amputacji,
np. na: protezy goleni (dla amputacji poniżej kolana) i protezy udowe (dla am-
putacji powyżej kolana).
4. Pacjent po amputacji powinien oczekiwać od specjalisty cierpliwej i nieskrę-
powanej rozmowy rozpoznającej istotne potrzeby życiowe i wynikające z nich
oczekiwania wobec ortezy czy protezy.
5. Podstawowym zadaniem protez jest przywracanie maksymalnych zdolności
czynnościowych oraz dążenie do maksymalnie wiernego odtworzenia natural-
nego wyglądu zewnętrznego brakującej części ciała.

107
EXERCISE 7: Complete the passage with the correct words.

Use of prostheses – breast

A breast prosthesis or breast form is usually m……………….. of silicon gel. It is worn
i………………… your bra and closely copies the natural contours of the breast. At-
tachable breast forms have special adhesive strips which allow s…………………..
absorption to avoid overheating.
Prostheses come in different s…………….. and shapes as well as different degrees
of firmness.
Breast prostheses h…………….. restore your body image after surgery. In most
normal clothes it is i……………… to tell that a woman is wearing a prosthesis. Breast
prostheses also help to maintain good p………………. and balance, particularly for
women who h………………. larger breasts.
You should be able to wear a normal bra with a prosthesis or a bra specially
d…………………. to hold a prosthesis.
Some women are worried about w………………. a prosthesis while swimming either
because of appearance or for fear the prosthesis may fall out. Mastectomy swimwear
(which is specially designed to h……………… a prosthesis securely) is also avail-
able. Prices for prostheses vary, but those made from foam g……………….. are less
expensive than those made from silicon.

References:
http://en.wikipedia.org/wiki/Artificial_Limbs 8.07.2007
http://en.wikipedia.org/wiki/Craniofacial_prosthesis 8.07.2007
http://en.wikipedia.org/wiki/Orthosis 8.07.2007
http://en.wikipedia.org/wiki/Orthotics#Custom_.2F_Prefabricated 8.07.2007
http://www.breasthealth.com.au/careafter/useofprostheses.html 8.07.2007
http://www.cancer.org/docroot/MIT/content/MIT_7_2X_Prostheses.asp?sitearea=MIT
8.07.2007
http://www.doctoronline.nhs.uk/masterwebsite1Asp/targetpages/specialts/rehab/ortho
tic.asp 8.07.2007
http://www.protezynogi.republika.pl/index.html 3.02.2008
http://www.slspo.com/prosthetic.html 8.07.2007
http://www.sol.nu/pol/aest_p.html 3.02.2008

108
 RELAXATION TECHNIQUES

EXERCISE 1: Discuss in pairs.

• In what way do you relax: after a tiring day at the university, after a stressful
event, in order to forget about problems, at the weekend?
• How do you behave when you are stressed?
• How much time do you usually need to relax?
• Do you remember the most stressful recent situation?
• Which aspects can be stressful in a job of a physiotherapist?

EXERCISE 2: Read the text below and answer the questions.

Calm your stress

Whenever we encounter a stressful situation, a series of hormonal and biochemical
changes take place in our body. They turn it into the ‘alarm mode’ - the heart rate
increases, adrenaline rushes through the blood stream, the digestive and immune
systems temporarily shut down. People stay high alert as long as the stressors con-
tinue and afterwards they experience exhaustion and burn out. Stress cannot be
avoided but there exist certain means that can help to return to a state of balance
and regulation, provide stress relief and thus you can enjoy a better quality of life.
The ability to relax is extremely important these days when everyday life can often be
tense, stressful, both mentally and physically.
Relaxation does not merely mean a peace of mind or enjoying nice pastime activities.
This is a process that decreases negative effects of life’s challenges on one’s body
and mind. The benefits of relaxation strategies include: reducing muscle tension,
slowing breathing rate, lowering blood pressure, improving concentration, more en-
ergy, greater ability to handle problems, more efficiency in daily situations, fewer
emotional symptoms (headaches, back pain) and responses (anger, and frustration)
Exploring and learning basic relaxation strategies is not difficult. Below there are few
examples of the most common methods.
Deep breathing. This is a simple but effective relaxation method. A person concen-
trates on deep breathing and this allows the rest of their body to relax itself. Deep
breathing is a great way to get everything into synchrony. Thus, relaxation breathing
constitutes an important part of yoga and martial arts. To use the technique, take a
number of deep breaths and relax your body further with each breath. This technique
works well in conjunction with other methods, such as Progressive Muscular Relaxa-
tion, relaxation imagery and meditation.
Progressive Muscular Relaxation (PMR). This technique is useful for tense mus-
cles. A person has to concentrate on slowly tensing and then relaxing each muscle
group. The procedure is as follows: first you tense up a given group of muscles (nor-
mally you go from your toes to the neck and head) so that they are as tightly con-
tracted as possible. Then you hold them in a state of extreme tension for a few sec-
onds and relax the muscles to their previous state. Finally, consciously try to relax
the muscles even further so that you are as relaxed as possible. Thanks to this tech-
nique a person becomes more aware of their physical sensations (especially the dif-

109
ference between the muscle tension and relaxation). For maximum relaxation PMR
can be combined with other methods (deep breathing, imagery).
Visualization (guided imagery). This method is concerned with forming mental im-
ages. A person is supposed to take a visual, imaginary journey to a calming, peaceful
place or situation. One should also use as many senses as possible (smells, sights,
sounds, textures), close his / her eyes, sit in a quiet and comfortable position, loosen
tight clothing.
Other relaxation techniques, although not described above may also appear effective
and useful, depending on one’s specific needs, condition, preference. These include,
for example: yoga, music / sound therapy, meditation, hypnosis, massage, and hy-
drotherapy.

Wordlist:
alert – czujny
backyard – podwórko
burn out – wypalenie
casses – głaskać
consciously – świadomie
contracted – skurczony
encounter – napotkać
exhale – wydychać
exhaustion – wyczerpanie, zmęczenie
imagery – obrazowość, podobizna
in conjunction with – w połączeniu z
inhale – wdychać
marital arts – sztuki walki
merely – tylko, wyłącznie
mode – tryb
progressive – postępujący
sink – zanurzyć
stressor – czynnik stresogenny
swell – rozkołys, ruch falujący
swing – huśtać się, kołysać się
texture – struktura, faktura (materiału)

1. What happens in the body in a stressful situation?

2. How do people feel when stress disappears?
3. What are the advantages of relaxation?
4. What is the relationship between yoga and the deep breathing technique?
5. What should a person do to relax muscles with the PMR technique?
6. What kind of information can this method provide to a person?
7. When will the visualization technique bring best results?
8. Is it possible to combine several relaxation techniques at the same time? Think
of possible combinations.

110
EXERCISE 3: Complete the phrases from the text.

………………………. position
………………………. arts
physical …………………………..
………………………. situation
……………………….. strategies
tightly ……………………………
……………………….. images
tight ……………………………
……………………….. therapy
……………………….. changes
previous …………………………..
handle …………………………..
………………………... place
common …………………………..

EXERCISE 4: Complete the gaps with the correct words from the box. Then, in
pairs try to follow the instructions and relax.

exhale inhale cycle breath back let

slow middle asleep

Deep Breathing
1. Lie on your ………………...
2. Slowly relax your body.
3. Begin to …………………. slowly through your nose. Fill the lower part of your
chest first, then the …………….. and top part of your chest and lungs. Be sure
to do this slowly, over 8–10 seconds.
4. Hold your …………………. for a second or two.
5. Then quietly and easily relax and ………………… the air out.
6. Wait a few seconds and repeat this ………………….
7. If you find yourself getting dizzy, then you are overdoing it. ………………….
down.
8. You can also imagine yourself in a peaceful situation such as on a warm, gen-
tle ocean. Imagine that you rise on the gentle swells of the water as you inhale
and sink down into the waves as you ………………….
9. You can continue this breathing technique for as long as you like until you fall
…………………...

particularly backyard eyes return favourite

sounds boring sensations

Guided Imagery
1. Lie on your back with your ……………….. closed.
2. Imagine yourself in a ………………., peaceful place. The place may be on a
sunny beach with the ocean breezes caressing you, swinging in a hammock in

111
 the mountains or in your own ……………….. Any place that you find peaceful
and relaxing is OK.
3. Imagine you are there. See and feel your surroundings, hear the peaceful
…………………., smell the flowers, fell the warmth of the sun and any other
…………………. that you find. Relax and enjoy it.
4. You can …………………… to this place any night you need to. As you use this
place more and more you will find it easier to fall asleep.
5. Some patients find it useful to visualize something ……………….. This may be
a ………………….. boring teacher or lecturer, co-worker or friend.

EXERCISE 5: Act out the dialogue in pairs.

A:
You are a psychologist. You have an elderly patient who has recently developed hy-
pertension. He / she gets too excited and nervous while watching sport on TV and
has problems with calming down. Try to teach him / her some relaxation techniques.
Try to reach a compromise.
B:
You are an elderly person. You have recently developed hypertension. You love
watching sport on TV although it makes you nervous and your doctor asked you to
relax and calm down. You go to a psychologist to learn some relaxation methods but
you do not believe it will help you. Try to reach a compromise.

EXERCISE 6: Translate the extract into Polish.

Affirmations
Anxiety symptoms are due to a complex interplay between the mind and body. Your
state of emotional and physical health is determined in part by the thousands of men-
tal messages you send yourself each day with your thoughts. For example, if fear of
public places triggers your anxiety symptoms, the mind will send a constant stream of
messages to you reinforcing your beliefs about the dangers and mishaps that can
occur in public places. The fright triggers muscle tension and shallow breathing. Simi-
larly, if you constantly criticize the way you look, your lack of self-love may be re-
flected in your body. For example, your shoulders will slump and you may have a dull
and lackluster countenance.
Affirmations provide a method to change these negative belief systems to thoughts
that preserve peace and calm. Positive statements replace the anxiety inducing mes-
sages with thoughts that make you feel good.
Using affirmations may create a feeling of emotional peace by changing your nega-
tive beliefs about your body and health into positive beliefs, it also helps promote
self-esteem and self-confidence and also helps to reduce anxiety.

EXERCISE 7: Wordbuilding. In each space below put an adjective made from

the word in brackets.

1. a………………………… dress (fashion)

2. a ………………………… place (peace)

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 3. an ………………………… film (entertain)
4. a ………………………… child (spoil)
5. an………………………… lecture (interest)
6. a ………………………… chair (comfort)
7. an ………………………… film (educate)
8. a ………………………… book (bore)
9. a ………………………… body (die)
10. a ………………………… athlete (muscle)
11. a ………………………… painting (value)
12. an ………………………… chapter (introduce)
13. a ………………………… business (profit)
14. a……………………………exercises (respiration)
15. ……………………………. problems (urine)
16. a…………………………… action (therapy)
17. a……………………………condition (circulation)
18. a ………………………… district (reside)
19. a ………………………… disorder (digest)
20. an………………………… holiday (forget)

References:
http://www.healthy.net/scr/Article.asp?Id=1205&xcntr=1 8.07.2007
http://www.helpguide.org/mental/stress_relief_meditation_yoga_relaxation.htm
8.07.2007
http://www.mayoclinic.com/health/relaxation-technique/SR00007 8.07.2007
http://www.mind-energy.net/archives/191-Top-5-healthy-relaxation-techniques.html
8.07.2007
http://www.mindtools.com/stress/RelaxationTechniques/PhysicalTechniques.htm
8.07.2007
http://www.umm.edu/sleep/relax_tech.html 8.07.2007

113
 CONTINUING PROFESSIONAL DEVELOPMENT
OF A PHYSIOTHERAPIST

EXERCISE 1: Discuss.

• What do you think of a statement: ‘We learn through all our lives’? Do you
think it is true?
• Can you think of any skills that can be lost / forgotten when not practiced?
• In which professions (not medical) do people have to constantly develop their
professional skills? What happens if they do not do this?
• Do physiotherapists have to develop their skills constantly? How can they do
this?

EXERCISE 2: Read the text below and decide if the sentences below are true or
false.

No matter what stage in a career the person is - applying for a degree programme,
starting out as a newly qualified physiotherapist, looking into post-qualifying educa-
tion, thinking of coming to work as a physiotherapist in the UK or returning to work
after a career break – the broad field of continuing professional development will sat-
isfy all needs. Physiotherapists, as other medical professionals, have to develop and
practise their skills constantly. Being in touch with recent discoveries, newest treat-
ment methods and techniques supporting therapies, knowing most modern equip-
ment available for patients with various musculoskeletal problems – all of these quali-
ties make each physiotherapist a really professional and well-trained specialist.
Medicine and other similar sciences have rapidly developed during last 100 years
and the process is still continuing. Thus, being familiar with modern physiotherapy
methods and constantly introduced modifications takes a lot of time effort, and unfor-
tunately is quite expensive. One has to remember that patients, not scientific degrees
or a number of diplomas and certificates build good or bad reputation of a specialist;
the more satisfied patients are form the received treatment, the more favourable
opinion of a physiotherapist will spread among their relatives and friends – other po-
tential patients. On the other hand, patients appreciate and trust specialists using
modern techniques, familiar with up-to-date therapeutic strategies, well-informed and
well-trained, applying their knowledge effectively, using the acquired skills in practi-
cal, not only theoretical manner. Nowadays, people have access to various sources
of information giving them chance to learn about their health problems and locomotor
dysfunctions in detail. Thus, they normally look for good specialists, they ask ques-
tions about a physiotherapist’s experience, qualifications and professional educa-
tional background. At the same time, people know numerous stories from the media
about medical care providers, who made mistakes due to lack of experience, proper
qualifications or simply carelessness. They will not risk their health and money with-
out being sure that the person who is going to treat them has all the appropriate
qualities of a good specialist and good reputation in the professional society.
Continuing education / development of a physiotherapist is concerned with keeping
up with the changes and modern trends, broadening the range of skills and abilities

114
to use new therapies on patients and treat more and more complicated disorders and
dysfunctions. Thus, physiotherapists have to read scientific journals and magazines
(some of them are available only in English), attend professional conferences, semi-
nars, symposia (where they can listen to lectures and take part in practical sessions)
to receive information, exchange opinions with other specialists, get to know authori-
ties on physiotherapy. Special postgraduate training courses, workshops on physio-
therapy are frequently organized by medical universities and other institutions. They
are normally related to a specific kind of treatment / therapy or are meant to upgrade
already learnt skills / methods. Modern physiotherapists should also use the internet
– they can visit websites connected with their profession, exchange information with
other practitioners from abroad, become members of various professional organiza-
tions and societies.

Wordlist:
acquired - nabyty
broaden - rozszerzać
continuing education – kształcenie ustawiczne
favourable - pochlebny
in touch with – w kontakcie z
keep up with – nadążać, być na bieżąco
rapidly – prędko, gwałtownie
upgrade – podnieść, uaktualnić (umiejętności)
workshops – warsztaty

1. The idea of continuing professional development concerns only those who want
to work at the medical university after their studies.
2. Once you’ve studied the subject, you don’t have to learn any more.
3. There’s a lot of progress and fast development within the branch of physiother-
apy nowadays.
4. Physiotherapists should only concentrate on a very specific kind of treatment,
otherwise they will never be fully professional.
5. It takes time, money, and energy to learn new things, but not in physiotherapy.
6. The certificates and diplomas of a physiotherapist are the only aspects deter-
mining his / her reputation.
7. Nowadays, patients are often well-informed about their problems and possible
treatment methods even before meeting a specialist.
8. Patients frequently rely on their friends’ opinions concerning specialists.
9. The best conferences and professional journals on physiotherapy are in English.
10. Internet is a rich source of information, but not for physiotherapists.

EXERCISE 3: Match the words in the columns below to make phrases that ap-
peared in the text.

modern courses
continuing dysfunction
supporting education
professional developed
satisfied discoveries
rapidly therapies

115
 scientific trends
recent professionals
locomotor patients
proper development
postgraduate qualifications
medical degree

Work in pairs. Explain in English the above terms. Do not use the words from
the phrases in your definitions.

EXERCISE 4: A role-play. Work in pairs.

A: You are interested in a postgraduate course. You have seen an advert of one in a
professional journals. Call the information to ask for further details: time, duration (no.
of hours), location, accommodation, cost, type of sessions, people in charge, regis-
tration procedure, entry requirements, etc.

B: You work in a professional development center and provide information on various

courses. A physiotherapist calls and asks for information concerning the advert be-
low. Answer the questions and recommend the course.

Postgraduate Course in Neurological Physiotherapy

Full-time and part-time (50 h, sessions organised during the week / at week-
ends), commencing on 20th June

This is a flexible course for continuing professional development for physio-

therapists with an interest in managing neurologically impaired patients. To en-
rol you must 1) have a physiotherapy diploma, 2) have at least 1,000 hours of
clinical experience in physiotherapy management of neurological dysfunctions,
3) satisfy the admissions team of the ability to complete the programme of
study (a short interview). International applicants additionally need one of the
following English qualifications:
• TOEFL (Test of English as a Foreign Language) score of 600/250 or above
• IELTS (International English Language Testing System) score of 7.0 or above
• Cambridge Certificate of Proficiency in English at grade C or above
The course is modular, and most modules are available on an individual basis.
Each module carries a number of credit points. You get the postgraduate di-
ploma at 120 credits. You gain credit points by completing all core modules and
the option modules of your choice. Specialist modules help you to evaluate
critically available evidence and integrate approaches to managing neurological
dysfunction. Some modules explore core health issues across a range of
healthcare areas.

We promote a student-led approach with • seminars • workshops • student-led

discussion and presentation • keynote lectures • problem-based, clinically-
based and online learning.
To get further information call: 876 8547 978, PDC 78 Slim Road, Brighton, UK

116
EXERCISE 5: Ask about the underlined parts of the sentences below.

1. These standards apply to all physiotherapists.

2. The document includes 22 paragraphs.
3. Patients are given relevant information about the proposed physiotherapy
procedure.
4. Information concerning patients is treated in the strictest confidence.
5. Information relating to treatment options is based on the best available evi-
dence.
6. A treatment plan is formulated in partnership with the patient.
7. Patients who receive physiotherapy have records which include information
associated with each episode of care.

EXERCISE 6: Translate into Polish.

1. Physiotherapists communicate effectively with health professionals and other

relevant professionals to provide an effective and efficient service to the patient.
2. Recognition of the patient as an individual is central to all aspects of the physio-
therapeutic relationship and is demonstrated at all times.
3. Following information gathering and assessment, analysis will be undertaken in
order to formulate a treatment plan.
4. The treatment plan is constantly evaluated to ensure that it is effective and rele-
vant to the patient's changing circumstances and health status.
5. The term patient is used in formal documents as a term referring to individuals
and groups of individuals who can benefit from physiotherapy intervention in-
cluding those who may be called clients or users.
6. These standards apply to all physiotherapists, whether newly qualified of highly
specialist, in direct or indirect contact with patients.

References:
http://www.csp.org.uk/director/careersandlearning.cfm 8.07.2007
http://www.csp.org.uk/director/careersandlearning.cfm 8.07.2007
http://www.physio-
europe.org/index.php?action=81&PHYSIOEUROPE=3037d890d9a2b05dd123a0a44
6f62b38 8.07.2007
http://www2.shu.ac.uk/prospectus/op_pglookup1.cfm?id_num=HSC058&CurrTab=1
8.07.2007

117