Hydrotherapy for Physiotherapy.pptx

This the lecture for the Physiotherapy students on Principles of Hydrotherapy

1. Hydrotherapy Dr Ira Indurkar MPTh Neuro First BPTh

2. Purpose At the end student should be able to understand the definition, principles, physiological effects, indications, contraindications, clinical applications of hydrotherapy

3. Learning Objectives S No Learning objectives Domain Level Criteria Condition 1 Explain Fluid dynamics Cognitive Must know All 2 Explain principles of hydrotherapy Cognitive & Psychomotor Must know All 3 Explain Clinical application Cognitive & psychomotor Must know All

4. Introduction What Is a fluid ? Substance that flows when subjected to a shear stress. Water exerts forces on the human body when submerged

5. Relative Motion The velocity of a body relative to a fluid influences the magnitude of the force exerted by the fluid on the body Eg static standing towards or opposite

6. Properties of water /Principles of hydrotherapy Buoyancy Hydrostatic pressure Viscosity Surface tension

7. Buoyancy It is an upward force that works opposite to gravity Archimedes principle : It states that an immersed body experiences upward thrust that is equal to the volume of liquid displaced

8. Effects of buoyancy Buoyancy provides the patient with relative weightlessness and unload the joint by reducing the force of gravity Active motion at ease Resits the movement when moved in opposite direction Amount of air in the lungs also affect buoyancy > with inflated, < deflated Body composition, obese , increased bone density Three-dimensional access

9. Hydrostatic pressure Pressure exerted by the water on the immersed objects Pascals law states that the pressure exerted by the fluid is equal on all surfaces of the object Pressure increases as immersion increases , pressure on distal limbs and more than the proximal

10. Effects Increased pressure reduces or limits effusion, and assists venous return. Induces bradycardia and centralizes peripheral blood flow Exercises are more easily performed at the surface

11. Viscosity Viscosity is friction occurring between molecules of liquid resulting in resistance to flow Resistance is proportional to the velocity of movement through liquid Viscosity acts as resistance Increasing the velocity of movement increases the resistance Increasing the surface area moving through water increases resistance

12. Surface Tension Surface of the fluid act as a membrane under tension, Force / unit length Effects Extremity moving through the surface performs more work than if kept under water Using equipment at the surface of the water increases the resistance

13. Hydromechanics Characteristics of fluid in motion- Laminar flow, turbulent flow, Drag Laminar flow smooth, streamlined eg pipes Turbulent – Irregular, chaotic eg blood flow in arteries Drag- Force exerted by a fluid stream on any obstacle in its path or felt by the object moving through it. Clinical significance Moving water – patient needs to work hard Moving with equipment increases the resistance Eg use a boot to increase knee extension

14. Thermodynamics Water temperature has an effect on the body and therefore on performance in an aquatic environment Water retains temperature 1000 times more than the air Water conducts temperature 25 times faster than air Patient moving through the water loses body temperature faster

15. Centre of Buoyancy The centre of Buoyancy is the reference point of an immersed object on which buoyant forces of fluid act In vertical position posterior devices patient leans forward, anterior buoyancy causes the patient to lean back Unilateral manual resistance patient revolves around the practitioner in a circular motion A patient with unilateral lower extremity amputation leans towards the residual side Patient sitting on the floor will experience both center of buoyancy and center of gravity

16. Precautions Fear of water : Fearful patients can experience symptoms such as muscle guarding, stress response. Orientation program and proper flotation devices can help patients Neurological disorders: Patient with ataxia may find difficulties in controlling movements, heat intolerant patients with Multiple sclerosis may fatigue Respiratory disorders : adversely affect the breathing, lung expansion can be affected due to hydrostatic pressure Cardiac Dysfunction: Angina, abnormal blood pressure, heart disease or compromised pump mechanism also requires close monitoring Small open wounds and lines: use waterproof dressing , closure of tracheostomy , clamping of lines, g tube in situ should be monitored.

17. Indications Facilitate range of motion exercises Initiate resistance training Facilitate weight bearing activities Enhance the delivery of manual techniques Provide three-dimensional access to the patient Facilitate cardiovascular exercises Initiate functional activity replication Minimise risk of injury or re injury Enhance patient relaxation

18. Contraindications Incipient cardiac failure and angina Respiratory dysfunction, vital capacity less than 1 liter Severe peripheral vascular disease Danger of bleeding or haemorrhage Severe kidney disease ( patient are unable to adjust the fluid loss during immersions) Open wounds without occlusive disease Menstruation without internal protection Water and airborne disease ( influenza, gastrointestinal infection, typhoid , cholera and poliomyelitis) Uncontrolled seizures

19. Physiological effects Lymphatic system Hydrostatic pressure on the effusion reduces edema Hydrostatic pressure and viscosity both causes increase in lymph flow and thus reduces edema Musculoskeletal effects Decreased joint loading , decrease weight bearing eg 75 % immersions decreased weight bearing by 75 percent Increased blood flow to the muscles Increased range of motion Increased strength of the muscles Good for bariatric patient

20. Cardiovascular effects Increased venous circulation Increased cardiac volume Increased cardiac output Decreased HR and systolic BP in cool water

21. Pulmonary system Increased work of breathing Due to hydrostatic pressure on lungs Decreased exercise induced Asthma Due to high humidity

22. Renal effects Increased urine production Increased sodium and potassium excretion

23. Psychological effects Relaxing- warm water Invigorating- cold water

24. Hydrotherapy types Immersive Non-immersive

25. Aquatic temperature and therapeutic exercises Aquatic immersive exercises including flexibility, strengthening, gait training and relaxation may be performed at temperature between 26C and 35 C Intense aerobic exercises performed above 80 percent Maximum HR should occur between 22 C to 26 C Duration use a maximum time of 20 minutes full immersion in patients with non compromised system

26. Special equipment for exercises Collar, rings , belts and vests Swim bars Gloves, Hand paddles and hydro tone Bells Fins , hydro- tone boots Kick boards

27. Pools for immersion hydrotherapy Traditional therapeutic pools 100feet , 25 feet wide , Depths begin at 3 to 4 feet Individual patient Pool

28. Refrences Therapeutic exercise, Carolyn Kisner , Lynn Allen Colby( Sixth edition)

29. Thank you