hydrotherapy - mcccbehrensb/documents/hydro14.pdf · hydrotherapy aquatics and whirlpools ......
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Hydrotherapy
Aquatics and Whirlpools
History of Hydrotherapy Usage
• One of the oldest forms of heat application
• Initially used for relaxation
History of Hydrotherapy
• “ordinary containers are not as therapeutic as clinical containers such as whirlpools and Hubbard Tanks with agitating turbines”
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Physical Principles of Water
• Archemede’s Principle (buoyancy)
– A body which is fully or partially immersed in a liquid experiences an upward thrust equal to the weight of the liquid it displaces
• check this out…
Physical Principles of Water
• Buoyancy
– The quality of being able to float, as on water
– The upward force exerted upon an immersed or floating body by a liquid
Physical Principles of Water
• Buoyancy
– The upward thrust acting in the opposite direction to the force of gravity
• Exerts a stronger upward thrust as the submerged part nears the
surface of the water
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Physical Principles of Water
• Buoyancy • Exerts the greatest effects on
longer lever arms
Physical Principles of Water
• Buoyancy
– The amount of air in the lungs has a distinct impact on the overall density of the human body and its ability to float or sink
What part of these people’s bodies are floating?
Physical Principles of Water
• Buoyancy • A person with fully
inflated lungs will float
• Once that air is
expelled, the person
will sink
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Physical Principles of Water
• Relative Density is equal to the ratio of the mass of a given volume of a substance to the mass of the same volume of water
– a.k.a. Specific Gravity
The weight density of a material is the weight of a given volume unit of the material divided by that volume unit. An example is that a 1 cubic foot volume of water weighs
62.4 pounds. The density of water is then 62.4 pounds per cubic foot.
Physical Principles of Water
• Relative Density
– with the lungs fully inflated
• The relative density of the human body is between 0.95 and
0.974
– A body with a relative density less than one will float
Physical Principles of Water
• Relative Density
– without the lungs fully inflated
• The relative density of the human body is between 1.050 and 1.084
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Physical Principles of Water
– A body with a relative density greater than one will sink
– A body with a relative density equal to one will float just below the surface of the water
Physical Principles of Water
• Relative Density
– When a body is floating, the ratio of the submerged parts to those not submerged will be:
• 0.95 to 0.05 or
• 0.974 to 0.26
Physical Principles of Water
• Relative Density
– If the submerged portion of the body exceeds 0.05, then the amount of water displaced by the remainder will be insufficient to support the weight of the body.
• The pelvis and legs will sink
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Physical Principles of Water
• Hydrostatic Pressure
– The pressure of a liquid
Physical Principles of Water
– The molecules of a liquid thrust upon each part of the surface area of an immersed object or liquid
– The pressure will increase with increased depth in the liquid
Clinical Significance
• Buoyancy
– Reduces the stresses on immersed weight bearing joints
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Clinical Significance
– Provides an additional source of resistance for exercise training in the water if the part is moved downward against buoyancy
Clinical Significance
– The center of buoyancy (COB) will lie in a vertical line, if the COB falls outside of the BOS then the body will shift to try to maintain an upright position
Clinical Significance
• Relative Density
– Floating versus not floating
– Floating requires NO physical effort,
• Can dispel fears about the water
– The body will easily be supported by the water
– It will be easier to maintain an upright posture in water
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Clinical Significance
• Hydrostatic pressure – Pressure will be experienced as a
body is immersed in water
– Chest expansion will be more difficult • If the vital capacity is less than 1500cc
– Use floatation devices and extreme caution
– Edema reduction will be enhanced by external pressure
Resistance to Movement in Water
• Surface tension
– The force exerted between the surface molecules of a liquid manifesting itself as an “elastic skin” at the surface of the liquid
Resistance to Movement in Water
• Cohesion
– The attractive force exerted by each molecule on those surrounding it that are of the same type of matter
– Check this out
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Resistance to Movement in Water
• Viscosity
– Internal friction, or the resistance to relative movement within the liquid
– Viscosity decreases as temperature increases
– it’s easier to move in warmer water and more difficult to move
in cooler water….
Resistance to Movement in Water
• Viscosity
– Air is less viscous than water
• There is more resistance to movement
in water than on land
Resistance to Movement in Water
• Viscosity
– The greater the cohesion
– The greater the viscosity
• The more difficult it will be to move within it
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Resistance to Movement in Water
• Agitation
– Adds air to the water
• Will decrease the resistance to movement in the water due to the reduction in the viscosity of the water
Resistance to Movement in Water
• Turbulence
– Fluid flow in which the velocity constantly changes in magnitude and direction
Resistance to Movement in Water
• Turbulence
– Movement parallel to turbulent flow will be easier than perpendicular to it
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Resistance to Movement in Water
• Direction of movement
– Against gravity = with buoyancy
• Easy to move in the water
Resistance to Movement in Water
• Direction of movement
– Against buoyancy = with gravity
• Difficult movement in the water
Resistance to Movement in Water
• Drag
– Larger surface areas will encounter greater resistance to movement in the water
drag Less drag
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Resistance to Movement in Water
• Speed of movement
– Quick movements will encounter more resistance to movement unless:
• The part is streamlined to decrease drag
– Quick reversals of direction will create resistance to movement
Aquatic Therapy Equipment
• Therapeutic Exercise Equipment – Treadmills
– Bicycles
– Ploughs
– Sleds
– Stair climbers
– Parachutes
– Ski simulators
Influencing Factors: Therapy
• Water temperature
• Difference between skin and water temperature
• Extent of immersion in the water
• Duration of treatment
• Weight, age, general condition of the patient
• Movement of the patient
• Fear of water or ability to swim
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Aquatic Therapy Pools
• Variable depths
• Availability of devices
– To increase surface area
– To increase effects of buoyancy
• Availability of “classes”
Aquatic Therapy Pools
• Therapeutic water temperatures
– Cooler to prevent fatigue
– Warmer to promote relaxation and mobility
Hydrotherapy
• Cold water immersion (55-65oF)
– Vasoconstriction
– Increased muscle tone
– Increased heart rate
– Increased blood pressure
– Involuntary shivering
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Hydrotherapy
• Removal from cold water
– Peripheral vasodilation
– Eyrthema
– Decreased blood pressure
Hydrotherapy
• Hot water immersion (98-104oF)
– Local application • Sedative effect
• Relief of muscle guarding or spasm
Hydrotherapy • Hot water immersion (98-104oF)
– Large body surface immersion
• Increased
– body temperature
– Circulatory rate
– Metabolic rate
– Oxygen consumption
– Heat elimination
– Heart rate
– (10bpm for every 1oF above
basal body temperature)
Hubbard Tank
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Hydrotherapy Equipment
• Components
– Tanks
• Sealed, durable, cleanable, appropriately sized for the application
• Have water mixing valves with temperature gauges
• Have some form of water drainage system
Hydrotherapy Equipment
• Turbines
– Adjustable
• Height
• Air intake
• Turbulence
• Angle for turbulent flow
Hydrotherapy Equipment
• Patient Supports
– Transfers
• Lifts
• Gurneys
• Ramps and submersible wheelchairs (aquatic
pool)
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Hydrotherapy Equipment
• Patient supports
– For transfers
• Seats
– (Submersible)
• Swivel chairs
– (Submersible)
Hydro Treatment Area
• Floor
– Non-slip
– Beveled with a central drain for leakage or emergencies
– CLEAN
– Electrical system
• GFI outlets, usually above the floor
– Electrical storms????
Hydrotherapy Equipment
• Extremity tanks
– Stainless steel or fiberglass
– Mobile or fixed
– Small areas of the body
• Hands, feet, elbows,
ankles
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Hydrotherapy Equipment
• “high boy”
– Stainless steel or fiberglass
– Mobile or fixed
• Knees, hips (?), backs (?)
Hydrotherapy Equipment
• “low boy”
– Stainless steel
• Fixed
• Knees, hips (?), entire LE
Hubbard Tank
– Fixed – Whole body
immersion
– Shaped like an “angel”
– May have a central trough and parallel
bars for ambulation
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Patient Preparation
• Appropriately attired
– Clean
– Prepared for treatment
• No
– Dressings
– External catheters
– IV in upper extremity
Patient Preparation
• Prepared for treatment
– If indicated
• Vital signs
– Monitored and stable
• Transfer strategy has been
planned out in advance
Care of Equipment
• Cleaning
– Before immersion
• Tank
• Turbine (inside and outside)
• Support devices in the water
• Support devices outside of the water
• Floor is DRY
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Care of Equipment
• Additives
– for the prevention of foam
– For cleaning
– For the prevention of the spread of disease
Indications for any form of Hydrotherapy
• Non-specific debridement
• Decrease muscle guarding
• Increase ROM
• Decrease hyper-sensitivity
• Decrease pain
• Promote relaxation
• Promote gravity free, buoyancy rich environment for therapeutic exercise
Contraindications for Hydrotherapy
• Full body immersion
– Stoma
– External catheter
– Vital capacity less
than 1500cc
– Fear of drowning
and a tracheotomy
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Precautions to Hydro/Aquatics
• Hypertension (high blood pressure)
– Control length of exposure and temperature of the water
• Fear of water
– Monitor closely
– Use flotation devices