hydrotherapy lecture

8/10/2019 Hydrotherapy Lecture...

1/76

Dr. Laxmikant Bakane


2/76

At the end of the lecture, we should be able to

learn:Define hydrotherapyIdentify the physical and thermal properties ofwaterEnumerate the therapeutic effects ofhydrotherapyIdentify the factors that affect thermal effectsof waterDifferentiate the types of water immersionmodalitiesIdentify the parts of a whirlpool bathEnumerate the indications, contraindications, andprecautions/guidelines for the use of themodalities


3/76


4/76

Hydrotherapyincorporates water as ahealing tool

Hydrothermaltreatments includewater temperature toaid the healing process

Water allows movementsand exercises to be done

while limiting theeffects of gravity andpressure on weak areasof the body


5/76


6/76

Physical Therapy Increase range of motion Strengthen muscles

Reduces pressure on painful/weak joints/muscles Useful especially for people with chronic

pain and decreased bone density whereland based exercises would cause pain orinjury.


7/76

Physical Properties of Water allow it to be avaluable tool in Physical Therapy Buoyancy; water counteracts gravity and helps to

support the weight of the patient in a controlledfashion as the patient is immersed

Viscosity : resists movement by means of friction,allowing strengthening and conditioning of aninjury, while reducing the risk of further injurydue to loss of balance

Hydrostatic pressure : produces forcesperpendicular to body surfaces at every point,increasing kinesthetic (body motion or position)and proprioceptive (posture self-regulating)awareness in some patients.


8/76


9/76

Thermal

Mechanical

Cold applicationHeat application

Agitation


10/76

Increased cardiac tonePeripheral vasoconstrictionIncreased blood viscosityDecreased HRLonger diastoleDecreased vasodilator metabolitesDecreased blood flow


11/76

Vasodilation of arteries and arteriolesIncreased capillary permeability

Release of vasoactive agentsIncreased metabolism (Vant Hoffs Law) Increased blood flowIncreased tissue extensibilityIncreased HRIncreased RR


12/76

DebridementAnalgesiaFacilitation of exercise

Muscle relaxation


13/76

Temperature difference between waterand skinMethod of heat transferThermal conductivity of the structureRate of rise in initial temperature

Surface area coveredDuration of exposureWeight, age, and general condition of thepatient


14/76


15/76

freezing point: 0 degree Celsiusboiling point: 100 degrees Celsiusdensity:

at 0 degree Celsius- .999868at 4 degrees Celsius- 1.0000pH: 7specific heat: 1.00


16/76

Buoyancy

Hydrostatic Pressure Cohesion Viscosity Surface Tension


17/76

Upward force exerted on an immersed objectOPPOSITE to gravity

Archimedes Principle: a body immersed in aliquid experiences an upward force equal tothe weight of the displaced liquid

Affected by postural alignment, surface area,weight of bones in relation to muscle and fat,and vital capacity


18/76


19/76

Resistance

Viscosity of water provides resistance to motion Resistance occurs against direction of motionResistance increases proportional to Speed

Frontal area of body part in contact with waterVarying resistance ( and pressure ) can bebeneficial in debriding and cleansing wounds


20/76


21/76


22/76

Water molecules are cohesive; they havethe tendency to attract each other.

This results in

An increase in viscosity of the medium, ascompared to that of air, And an increase in resistance to range ofmotion.


23/76

Friction between molecules Property of water that resists motionwithin it leads to resistance to flow

Dependent on:

speed/velocity of movement ofliquid

shape of the body


24/76


25/76

Surface of liquid acts as a membraneunder tension

Increased attractive forces on the

surface


26/76

Laminar flow-All molecules are parallel Turbulent flow-Molecules are erratic/not parallel Drag-Cumulative effect of turbulence and

fluid viscosity


27/76


28/76

High Specific Heat & Thermal ConductivityTransfers heat by Conduction and Convection Can be used as superficial heating and

cooling agent.Amount of heat (calories) needed to raise thetemperature of 1 gram of substance by 1degree Celsius High specific heat prevents sudden changesin temperature


29/76

Specific Heat 4 times that of air Water retains 4x as much thermal energy

as an equivalent mass of airThermal Conductivity 25 x air Water transfers thermal energy 25 x more

rapidly than air ( at the same temperature )Transfers heat rapidly, efficientlyAdvantage of exercising patient in poolcolder than patients body temperature.

Immersion dissipates heat generated byexertion


30/76

Water that is stationary transfers heat byConduction .Moving water transfers heat by Conduction andConvection. Heating (WP) accelerated with increased agitation of

water. Cooling (swimming)accelerated as patient moves more

quickly through water.


31/76


32/76

Exchange of thermal energy betweenbodies in contact with each other


33/76

Heat transfer by mass motion of water

when the heated fluid is caused to moveaway from the source of heat, carryingenergy with it.


34/76

Exchange of electromagnetic energy dueto difference in temperature between theskin and surrounding environment


35/76

Occurs through loss of fluid fromsweating and by the pulmonary systemduring exhalation.


36/76


37/76

Cleansing Pressure (Force = Rate of Flow) Dissolved antimicrobial agents, etc. ( Wounds )Musculoskeletal Effects Decreases weight-bearing ( Arthritis )

75% immersion WB 75% Increases blood flow to muscles Strengthening


38/76

Decreased bone density lossDecreased fat loss

Compared to other forms of exercise

Good for obese secondary to non-weightbearing exerciseNot good for general weight loss


39/76

Increased venous circulation Secondary to hydrostatic pressure, increased venous

pressureIncreased cardiac volumeIncreased cardiac output Up to 30% while upright to neckDecreases HR and Systolic BP ( cool water )

May increase in warm or hot water


40/76


41/76

Increases urine productionIncreases sodium and potassium excretion May be used to patients advantage with hypertension,

peripheral edema


42/76

Relaxing Warm waterInvigorating Cold water


43/76


44/76

Advantages Even contact with skin Does not need to be fastened

Allows movement of heat/coldDisadvantages Extremity often in dependent position


45/76

Cleansing properties facilitate Rehydration Softening and debridement of necrotic tissue Removal of wound debrisHydrostatic pressure and heat increasecirculationProvides moist environment to optimize

healing


46/76

Increased sensory stimulation to peripheralmechanoreceptors Gait TheoryCold water decreases inflammationDecreases weightbearing, increases easeof movement.


47/76

Hydrostatic pressureCool water Vasoconstriction

Decreased vascular permeability Hot water increases edema

Increased arterial blood flow, increased vasodilation.


48/76

Contrast Baths Trains smooth muscles of blood vessel;

vasoconstriction/vasodilation. No research to solidly support


49/76


50/76

Whirlpool bath

Hubbard tank

Pool/Aquatic Therapy


51/76

Agitator/ Turbine ejector/Aerator

Water thermometer Hot and cold water mixing valve Temperature gauge

Gravity drain Seat


52/76

Motor Pump/Turbine Motor

Thermometer

Steel Tank


53/76

TurbineEngine/Motor

Switch

Suspension Bracket

Throttle

Butterfly Knob

Drive Shaft

Breather Tube


54/76

Stimulation of circulationPromotion of muscle relaxation and pain

reliefDebridementFacilitation of exercise


55/76


56/76


57/76


58/76

According to shape:

Low buoy tank

High buoy tank

Extremity tank

According tomobility:

Movable

Fixed


59/76

Dimensions

width: 24 incheslength: 52 66 inchesdepth: 18 inches


60/76

Dimensions

width: 20 24 incheslength: 36 48 inchesdepth: 28 inches


61/76

also called UPPER EXTREMITY TANK

Dimensions

width: 15 inches

length: 28 32 inchesdepth: 18 25 inches


62/76

Temperature:39.9 46.1 degrees Celsius or

103 115 degrees FarenheitDuration:20 minutes if used as heating modality

15 minutes if used as cooling modality5 20 minutes if used for debridement10 20 minutes if used for exercise


63/76

Immersion of LE can be done using highand low buoy tanksHigh buoy tank requires the patient tobe able to flex both hip and knee butdoes not allow full extension (adult)Low buoy tank allows full-motionexercises of the kneeBoth high and low buoy tanks can befitted with hydraulic chair lift


64/76

Dimensions

length: 7 feet 2 inches

upper wing width: 6 feetmiddle wing width: 35 incheslower wing width: 4 feet 2 depth: 22 inchesinsets: 15 inches


65/76

Temperature :32.2 38.8 degrees Celsius

90 102 degrees Farenheit

(in the clinics)36.1 38 degrees Celsius97 100 degrees Farenheit

Duration:20 minutes

Ambienttemperature

25.5 degrees Celsius50% humidity


66/76

Alternately immersing extremity in hot andcold bathAka vascular exercise

Indications

Arthritis, joint sprains,s/p amputation, musculo-tendinous strains

TemperatureHot: 38-44 degrees CelsiusCold: 10-18 degrees Celsius

Treatment Duration

30 minutesWarm whirlpool: 10minutesCold whirlpool: 1 minute

Warm whirlpool: 4 minutesCold whirlpool: 1 minute


67/76

Uses Decrease edema Pain relief Decrease sensitivity (desensitize)


68/76

Water only covers the pelvic regionHot

Increases circulation in the pelvic area enhancetissue healing and reduce pain Temperature: 40.5- 46

C or 105-115

F for 2-10 minutes Indications: hysterectomy, hemorrhoidectomy, chronic

pelvic inflammatory diseaseCold

Increases tone of smooth muscles reduceuterine bleeding Temperature: 17-24 C or 25-75 F for 2-10 minutes


69/76

Cold (32-790

F) Acute inflammationTepid (79-92 0 F) Exercise

Acute inflammation if cold not toleratedNeutral warmth (92-96 0 F) Open wound Medically compromised patients

Decrease tone


70/76

Mild warmth (96-980) Increase mobility

BurnHot (99-104 0)

Pain, Increase ROM Increase soft tissue extensibilityVery Hot (104-1100)

Limited body area Chronic conditionsDO NOT use WP at temperatures > 110 0 F !!


71/76

Assess problem and set goals of treatmentDetermine if most appropriate treatmentMake sure no contraindicationsSelect appropriate form of hydrotherapy Whirlpool

Hubbard Tank Contrast bath Non-immersion device Pool

Explain the procedure, purpose, sensationsApply appropriate form of hydrotherapyAssess outcomeDocument


72/76

Determine objectives for using the modalitySelect appropriate temperature

Inspect the area to be treated

Explain procedure and operation to the patient

Position the patient comfortably

Monitor vital signs

Adjust level of agitation accordingly

Turn agitator off after treatment


73/76

Dont allow finger or loose bandage to clog the

openings

Check for any breakage in the wirings

Ensure that the motor is securely fastenedDont allow the patient to operate the machine

Dont direct agitation to the area that could be

further damagedControl ventilation and humidity of surrounding area


74/76

Base decision on Desired effects Size of area to be treated Allowance for safety, control of infection Cost-effectiveness


75/76


76/76

Balicanta, R. E. (2004). Lecture notes on water immersion modalitiesfor PT 156: Physical agents I.Hayes, K. W. (1993). Manual for physical agents (4 th Ed).Connecticut: Appleton and Lange.

Hecox, B., Mehreteab, T. A., and Weisberg, J. (1994). Physicalagents: A comprehensive text for physical therapists.Connecticut: Appleton and Lange.

Kisner, C. and Colby, L. A. (2002). Therapeutic exercise: Foundationsand techniques (4 th Ed). Philadelphia: F. A. Davis Company.Michlovitz, S. L. (1996). Thermal agents in rehabilitation (3 rd Ed).

Philadelphia: F. A. Davis Company.Sussman, C. (1998). Whirlpool in wound care. Collaborative practice

manual for physical therapists and nurses. (no place): Aspen

Publishers. Pictures retrieved June 21, 2008 from the following websites:www.hospimedicaintl.com, www.theratek.com,www.medicaloutfitters.net, www.mtstjosephhome.com,www.lakeeriemed.com, www.wannatowel.netkennel.com,www ecu edu www lifetecinc com www advantagemedical com

hydrotherapy lecture

Documents