2 Ceerrf students had the opportunity to attend a traineeship in Israel, et more precisely in Tel-Aviv.
This experience abroad is an opportunity to discover new techniques, rehab philosophies, … and this is a bath we encourage within our institute.
They share their findings.
As part of our first K3 traineeship, Mr. Evelinger and Mr. Cérioli gave us the chance to be able to do this traineeship in Israel, more precisely in Tel Aviv and its surroundings.
This allowed us to discover a completely different vision of physiotherapy, whether in techniques, in relation to patients or in training.
We were, during this period, managed by a physiotherapist, Mickael Bismuth, French who immigrated to Israel after his diploma. He is now the head of respiratory physiotherapy for all of the maccabi centers in Israel.
What is maccabi?
In Israel, each citizen is part of a “koupat holim”, each contributes to the “bitouah leoumi” for their health and is associated with a center such as maccabi or klallit. These centers, bring together several medical and paramedical professionals, a very large part of the consultations are carried out in these koupat holim
We have noticed several differences between Israeli and French healthcare systems. In Israel, there is a sort of “prioritization” of patients in order to manage them more efficiently. This is determined using a questionnaire completed on this device (photo).
However, the physiotherapist has an opinion to give on his patient based on his investment in rehabilitation and the evolution of his pathology.
For home visits, the physiotherapist begins with an assessment session and fixes the course of his rehabilitation.
Outside these Maccabi, it is possible to make an appointment as a liberal and the price of the consultations is not regulated. The reimbursement is partial by his fund and the consultation is around 300 shekels (equivalent to 80 euros).
The majority of our traineeship was focused on respiratory physiotherapy.
Due to the diversity of culture in this country, we were able to meet unknown or rare diseases in France.
How is respiratory physiotherapy practiced?
Respiratory physiotherapy allows, thanks to specific physiotherapy techniques, to unclog the upper airways and evacuate bronchial secretions.
It is indicated in case of obstructive respiratory pathologies with children as well as with adults.
It can be used for babies with bronchiolitis or for adults with chronic obstructive pulmonary disease (COPD).
Cluttering of the upper and lower airways, carried out at the start of the secretory phase, may be combined with drug treatment, making it possible to avoid secondary lung infection and its complications, while shortening the healing time.
Our traineeship tutor explained to us the role of physiotherapy in lung diseases. We are there to unclutter the patient to prevent the buildup of secretions.
Naturally, we have two ways to expectorate secretions: using the eyelashes, and air movement.
In physiotherapy we are interested in air movements, because we have no action on eyelashes.
The goal is to create a motor behind the mucus to facilitate its ascent.
For this, there are two methods: by diffusion or with resistance.
- Diffusion, bring in a laminar way (in order to play with the different pressures of the pipe) some air in the collaterals so that the air goes from a healthy bronchiole to a congested bronchiole and will thus allow the ascent of the secretions
This is based on a physical phenomenon which is that air goes from P + to P-
We use a breathing aid (called mechael in Israel and cough assist in France).
- Resistance: during expiration, the air goes in the freeest possible part, so if we put a resistance at the level of the mouth, the air will go in the least blocked pipe, the one where secretion lies. Air will therefore pass to the obstructed bronchiole and thus allow the secretions to rise.
In the decluttering strategy, we first need to remove the proximal secretions and then the distal secretions to free up the passage (for example : a fire in a room, people closest to the exit door must exit first). So, we play on the flows.
- ELTGOL :
Or Total Slow Open Glottal Expiration in lateral decubitus, is an active technique mainly addressing distal blockages.
Its interest also lies in the possibility of targeting one region rather than another.
The patient is in DL (on the side to be drained), and from a normal inspiration, exhales slowly until the VR, the glottis open.
he can be helped by the therapist, who positions himself behind: one hand against the supra-lateral costal grill, the other hand exerts an infra-lateral abdominal pressure.
- Our daily agenda was set according to patient demand. In general, we were in the morning in an outpatient clinic in the maccabi center for orthopedic rehabilitation with pathologies such as ankle sprains, knee prosthesis …
Here is the maccabi center and its technical platform :
The afternoon was mainly spent on home-care visits to mainly children whom we took care of after school.
We encountered pathologies such as tracheomalacia, Cystic Fibrosis, Canavan, Ulrich’s Myopathy, Duschenes ALS disease, Family dysautonomia
We were able to visit a particular center during this internship.
This center allows patients, after a consultation in a holim koupates to continue their rehabilitation and to be able to borrow medical equipment (crutch …) for free.
There is a physiotherapy service for respiratory, urological, neurological, cardiac and balneotherapy.
In addition, several doctors and occupational therapists in this center coordinate the progress of the sessions with the physiotherapist.
Finally during this traineeship we were able to participate in a conference on electrotherapy and ultrasound.
An English physiotherapist came to introduce us to his new devices and explained the benefits of electrotherapy to the patient.