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CONTEMPORARY BALNEOLOGY IN CZECH REPUBLIC
Ivan Vareka, Jirí Hnátek
Spa Luhacovice, Co., Luhacovice, Czech
Republic Department of Physiontherapy and Pain
Management, Faculty of Physical Culture, Palacky
University, Olomouc, Czech Republic
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THE MAIN SPA RESORTS IN CZECH REPUBLIC
with prevailing diagnoses
Jeseník
Jáchymov
Jánské lázne
movement
respiratory
Karlovy Vary
digestive
neurology
Františkovy lázne
Podebrady
cardio-vascular
gynaecology
Prag
Mariánské lázne
urology
Luhacovice
respiratory
BechyneBludovDubí u TeplicFrantiškovy
LázneJáchymovJanské LázneJeseníkKarlova
StudánkaKarlovy VaryKarvináKonstantinovy
LázneLázne BelohradLázne BohdanecLázne
KynžvartLázne Libverda
Brno
Trebon
movement
Lipová - lázneLuhacoviceMariánské LázneMšené -
lázneOsecnáOstrožská Nová VesPodebradySlatinic
e
Teplice nad BecvouToušenTrebonVelichovkyVelké
LosinyVráž u PískuŽeleznice
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THE LAST 15 YEARS CHANGES
privatisation
modernizing (buildings, equipment)
increasing in portion of self-payers and
foreigners
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BASIC STATISTICS 2002
51 private spa facilities (18 347 beds)
17 state spa facilities (4 625 beds)
295 968 clients (8 867 less than in year 2001)
5 877 748 days of stay (137 652 less than in year
2001)
278 089 adults (41 complex, 7 partial, 13
selfpayment, 39 foreigners)
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SPECTRUM OF HEALTH SPA PATIENTS (CZ, 2002)
Total number of beds 22 179 Health care
provided 275 811 patients Number of care days
5 545 315
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SPA THERAPY TYPE
COMPLEX
PARTIAL
HIC
HIC
HIC
TREATMENT (PROCEDURES)
ACCOMODATION MEAL
CLIENTS SELFPAYMENT without HIC
HIC Health Insurance Company
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THE LIST OF INDICATIONS for SPA THERAPY in
ADULTS, CHILDREN and ADOLESCENTS the public
notice of the Ministry of Health, 1997

• Contents
• diagnoses (according to ICD 10) distributed into
  11 main groups (and following subgroups)
• indications
• the duration of spa therapy ( prolongation
  conditions)
• the type of spa care (complex or partial)
• commentary
• contraindications
• official spa places for given diagnoses

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gives a RECOMMENDATION of spa therapy for given
diagnosis (according to ICD 10) and group
(according to LI 1997)
SPECIALIST CONSULTANT
GENERAL PRACTITIONER
completes form of PROPOSAL for SPA THERAPY
DOCTOR-AUDITOR HEALTH INSURANCE COMPANY
approves form of PROPOSAL for SPA THERAPY
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TRENDS IN NUMBER OF PATIENTS
250 000
200 000
150 000
100 000
50 000
1980
1985
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
HIC
selfpayment
foreigners
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TRENDS IN HEALTH SPA BEDS
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TRENDS IN HEALTH SPA BEDS
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TRENDS IN ADULTS INDICATIONS (HIC, CZ)
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TRENDS IN ADULTS INDICATIONS (HIC, CZ)
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TRENDS IN CHILDREN INDICATIONS (CZ)
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TRENDS IN CHILDREN INDICATIONS (CZ)
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TRENDS IN ADOLESCENTS INDICATIONS (CZ)
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TRENDS IN ADOLESCENTS INDICATIONS (CZ)
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TRENDS IN PATIENTS SPECTRUM (LUHACOVICE)
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TRENDS IN PATIENTS SPECTRUM (LUHACOVICE)
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TRENDS IN ADULTS INDICATIONS (LUHACOVICE)
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TRENDS IN CHILDREN INDICATIONS (LUHACOVICE)
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THE FOREMOST TASKS
increasing in portion of self-payers and
foreigners
maintenance of HIC payment
to give the evidence-based reasons for spa
treatment
innovated offer
accomodation services improvement
research
EU funds
fitness reconditioning
wellness relax
fun
co-operation (spas, universities)

• shorter programmes (weekend, max. 2 weeks)
• family packs
• manager programme
• etc., etc.

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THE SPA TREATMENT OF THE RESPIRATORY TRACT
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various pulmonary diagnoses from benign chronic
laryngopharyngitis through bronchial asthma,
chronic bronchitis and chronic obstructive
pulmonary disease to S/P pulmonary carcinoma OP
frequently in combination with other diseases of
various severity (e.g. ASHD, HTN, DM) and
invariably together with
movement system function disorders
primary
functional (later structural
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AIMS of the SPA THERAPY
breathing function improvement
airway deliverance
mucosa regeneration
EDUCATION home selftherapy instructions
functional improvement of the other organs and
systems (including movement system)
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SPA THERAPY METHODS of the respiratory
tract elements of the whole medical
rehabilitation KINESIOTHERAPY DRAINAGE
TECHNIQUES THE BASIC METHOD in SPA THERAPY SCOPE
TOO MANUAL TECHNIQUES massage musculosceletal
medicine as preparation for kinesiotherapy Balneot
herapy INHALATION climatic therapy, change of
daily stereotype Physical Therapy e.g.
shortwave, IR- ray, CO2 baths other water
therapy procedures (e.g. Kneipp,
Priesnitz) Education
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FUNCTIONAL DISORDERS due to respiratory
diseases - BREATHING STEREOTYPE alteration
(short and superficial) - REFLEX CHANGES
(petrificated)
blockade of AO and upper cervical column
rib blockade
breathing resistance increase spasms TPs in
upper trapezius and scaleni
HAZ C3-4, Th3-10 do not cover the muscle
spasms!!!
- faulty POSTURE (typical Th
hyperkyphosis with chin forward)
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RESPIRATORY PHYSIOTHERAPY
set of drainage and breathing techniques
(Smolíková)
musculosceletal techniques reflex changes
release
kinesiotherapy techniques based on posture
correction (Brügger principle) a posture
activation (diaphragma, abdominal and pelvic
floor muscules, deep cervical flexors) other
spec. techniques
fitness kinesiotherapy endurance training (very
important but overlooked despite very bad fitness
status)
nordic walking
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DRAINAGE TECHNIQUES
Chevaillier slow INS, INS pause, slow long
active EXS, step/by/step form TV to IRV
autodrainage (AD)
active cycle of breathing techniques (ACBT)
breathing control (BC)
flutter
relaxed rest breathing
PEP mask
thorax elasticity exercise (TEE)
slow maximal INSP, short passive EXSP
postural drainage?
classic method but outdated
forced exspiration technique huffing (FET)
percussion drainage
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NEBULA INHALATION in scope of spa
treatment traditional method of spa
treatment MINERAL WATER (in particular) aerosol
droplets 0,1-10 ?m reach to bronchi and
bronchioli alcalic mineral waters ( Na and
HCO3-) salty waters (Na and Cl-)
mixed Effects (depending on temperature and
agent) mucolytic, secretalytic, trofic,
hyposensitive REGENERATION of bronchial
mucosa OTHER AGENTS - mucolytics, secretolytics,
detergents (N-acetylcystein) - antiflogistics -
(10 CaCl2 PanthenolVincentka corticoids) -
bronchodilatantia - (beta2-mimetics, atropine) -
antibiotics (neomycin)
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• Types of the individual inhalation devices
• jet (nozzle) type
• - basic type
• stream of compressed air flows through jet and
  disperses liguid ellevating in capillary
• ultrasound type
• 2,5 MHz, concave crystal focused on surface of
  dispersed liquid
• droplets 0,5-5 ?m, 10x higher density as jet
  type
• electro aerosol
• equal charge prevents fusion of droplets, minus
  has better effect
• technically difficult
• vibrate aerosol
• - 100 Hz, better intrudes into paranasal caves

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

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

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