Hydrotherapy in Physiotherapy by Gagan.pptx

“Comprehensive presentation on Hydrotherapy in Physiotherapy explains the basics of hydrotherapy, including its methods, effects, and clinical applications in physiotherapy practice.”

1. Hydrotherapy Gagan MPT in Cardiopulmonary 1 st year

2. Hydrotherapy : Hydro means “Water” and therapy means “Therapeutic intervention used for healing”. It refers to use of water( in multidepth immersion pools, or tanks) that establish therapeutic interventions including stretching, strengthening, joint mobilization,balance training and endurance training.

3. Physical properties of water Solvent : Water is a universal solvent and can dissolve many chemical compounds while not reacting with them. Therefore water running over the body, or over an open wound, will remove some contaminants or necrotic material by dissolving them. Resistance : The viscosity of water provides resistance to the motion of a body within it. This resistance occurs against the direction of the motion of the body and increases in proportion to the relative speed of the motion and the frontal area of the body parts in contact with the water.

4. CONTINUED Hydrostatic pressure : It is the pressure exerted by a fluid on a body immersed in it. Buoyancy : Buoyancy is a force experienced as an upward thrust on the body in the opposite direction to the force of gravity. Specific Heat and Thermal Conductivity:   Specific heat  of a substance at any temperature is defined as the quantity of heat required to raise the temperature of unit mass of that substance by one degree.  Thermal conductivity refers to a material’s intrinsic ability to transfer or conduct heat. 

5. Therapeutic effects for hydrotherapy Facilitates Range of motion(ROM) exercise. Initiates resistance training. Facilitates weight bearing exercises. Enhance delivery of manual techniques. Provides 3 dimensional access to patient. Facilitates Cardiovascular exercises. Initiates functional activities replication. Minimize risk of injury or re injury during rehabiliation process.

6. Physiological effects of hydrotherapy Cleansing effects : Pressure to remove debris : It cleans the dead debris from skin by its hydrostatic pressure. Dissolved surfactants and antimicrobials to assist with cleaning : Products such as surfactant, anti microbials can be added to water to enhance its cleansing effects. Surfactants such as soap and detergent reduces the adhesion of the debris on the skin and anti microbials reduces the microbe count in water, thus on the wound surface reduces chances of infection. Musculoskeleton : Decreased weight bearing : The buoyancy is property of water which unloads the weight bearing joints of the body which joints are sensitive to bear weight.

7. CONTINUED For eg : 75% immersion, weight bearing on the lower extremities is reduced by 75%; thus patients in a pool may be able to perform weight-bearing exercises or walk unassisted with a normal gait pattern. Effects on bone density loss : Buoyancy can particularly help obese patients, for whom land-based exercise places extreme stresses on weight-bearing joints. Because obese individuals have more low- bone density and subcutaneous fat than average weight people, they are more buoyant in water. Strengthening : The velocity-dependent resistance provided by water can be used to provide a force against which muscles can work to gain or maintain strength.

8. CONTINUED Cardiovascular : Increased venous circulation : The cardiovascular effects of hydrotherapy are primarily a result of hydrostatic pressure. Hydrostatic pressure exerted on the distal extremities when the person is upright and immersed in water displaces venous blood proximally from the extremities. This enhances venous return by shifting blood from the periphery to the trunk vessels and then to the thorax and the heart.

9. CONTINUED Increased cardiac volume : Central venous pressure increases with immersion to the chest and continues to increase until the body is fully immersed .With immersion to the neck, central blood volume increases by approximately 60%, and cardiac volume increases by nearly 30%. Increased cardiac output : The increase in cardiac volume increases right atrial pressure by14 to 18 mm Hg, to which the heart responds, according to Starling's law, with an increase in contraction force and stroke volume.30 This results in approximately 30% increased cardiac output over baseline in response to upright immersion up to the neck

10. CONTINUED Respiratory : Increased work of breathing : Immersion of the whole body in water increases the work of breathing because the shift of venous blood from the peripheral to the central circulation increases the circulation in the chest cavity, and hydrostatic pressure on the chest wall increases resistance to lung expansion. Decreased vital capacity : Immersion in water up to the neck has been shown to decrease expiratory reserve volume by approximately 50% and to decrease vital capacity by 6% to 12%; these effects, when combined, increase the total work of breathing by approximately 60%.

11. continued Decreased exercise-induced asthma : Water-based exercise is often recommended for patients with exercise induced asthma because studies have shown that it is less likely to cause asthma in these individuals than exercising on dry land.

12. Renal : Diuresis and Increase sodium and potassium excretion : These effects are the result increased renal blood flow and decreased production of antidiuretic hormone (ADH) and aldosterone . Psychological : Relaxing or invigorating, depending on temperature : people who bathe or exercise in water, water immersion can be invigorating or relaxing. Variations in these psychological effects appear to depend primarily on the temperature of the water. Soaking in warm water is generally relaxing, whereas most people find that immersion in cold water is invigorating and energizing.

13. Clinical indications for hydrotherapy Fibromyalgia : Research article in 2024 suggests that Aquatic Therapy is better than Land Based Therapy for reducing pain intensity and improving sleep quality after 6 weeks of follow-up. Aquatic Therapy may be a good treatment option for women with fibromyalgia when two therapeutic exercise programmes , with 60-min sessions, were undertaken three times per week for 12 weeks. Sessions were carried out in groups by a trained physiotherapist by S. Rivas Neiraa, A.Pasqual Marquesb, R. Fernández Cervantesa, M.T. Seoane Pilladoc , J. Vivas Costaa .

14. Continued Edema control (Peripheral vascular disorder) : A Research article done in October 2024 suggests that when Individually tailored physical training, combined with hydrotherapy as a heat therapy were conducted six days a week, from Monday to Saturday, for a total duration of 21 days (3 weeks). The water pressure during the treatments ranged from 2.5 to 3.5kPa, and the water temperature was maintained at approximately 39 ◦C through out 20 min treatment, has a beneficial effect on improving peripheral blood flow assessed by impedance plethysmography , as well as patients’ tolerance to physical exercise (increased walking distance) by Joanna Kapusta , Anna Kapusta , Mateusz Babicki and Robert Irzma nski

15. CONTINUED Osteoarthritis : This meta analysis conducted in Dec 2023, which concluded that A total of six randomized controlled trials were included for data extraction and meta-analysis. The present study revealed that there were significant differences between the two groups regarding the pain intensity at 1 week (WMD = − 0.429; 95% CI: −0.679 to −0.179; P=0.001), 4 week (WMD = −0.308; 95% CI: −0.587 to − 0.030; P =0.030) and 8 week (WMD = −0.724; 95% CI: − 1.099 to −0.348, P<0.001). Furthermore, hydrotherapy was associated with improved outcome of the Western Ontario and McMaster Universities Arthritis index at 1 week (WMD = −3.314; 95% CI: −6.484 to − 0.145, P= 0.040), 4 week (WMD = − 3.630; 95% CI: −6.893 to −0.366, P=0.029) and 8 week (WMD = −3.775; 95% CI: − 7.315 to −0.235; P= 0.037) weighted mean differences (WMDs). No serious adverse events were observed in all patients who received hydrotherapy. Hydrotherapy is efficacious and safe for reducing pain and improving functional status in individuals with knee OA, without increasing the risk of adverse effects. This met analysis was conducted by Changjiang Lei, MD, Haiting Chen, MM, Su Zhen, MM, Qingyun Pan, MM, Jing Xu , MB, Yuan , MB, Yang Liu, MM

16. CONTINUED Parkinson Patients : A meta analysis was conducted on Dec, 2023 which suggests that Long-term effects of hydrotherapy on balance function All five included studies used BBS Berg Balance Scale to follow balance function in patients with PD. The effect of the hydrotherapy group on balance function improvement could be maintained for a longer period compared to the control group (SMD=0.69; 95% CI=0.21, 1.17; p=0.005; I 2  =44%). Long-term effects of hydrotherapy on motor function

17. CONTINUED Long-term effects of hydrotherapy on motor function Four studies of balance function in PD patients were followed. There was no significant difference in the maintenance of motor function in PD patients in the hydrotherapy group compared to the control group. (SMD=0.06; 95% CI=-0.33, 0.44; p=0.77; I 2  =0%). Long-term effects of hydrotherapy on mobility Four of the included studiesassessed the mobility of PD patients by TUG at follow-up. The results showed no difference in the maintenance of mobility in PD patients in the hydrotherapy group compared to the control group (SMD=−0.53; 95% CI=−1.13, 0.08; p=0.09; I 2  =63%).

18. CONTINUED Wound care : A Research article has been published in July 2024 which suggests that on the application of hydro pressure techniques on ulcer wound on diabetic patient The results of statistical hypothesis testing show that there is a difference between the values of the biofilm observation sheet before hydro pressure is performed and after hydro pressure is performed on diabetic ulcer patients. By looking at descriptive statistics before and after using the Hydro Pressure technique as a wound wash, there is a decrease in the average value. The hydro pressure technique is able to reduce the average value of biofilm in the wound healing process.

19. Bio film, which consists of microorganisms clinging to the wound's inner surface, can lead to prolonged infections and hinder healing. Hydro pressure techniques offer a non-pharmacological approach to addressing this issue. So it can be concluded that the use of hydro pressure is effective as a wound washer fluid for diabetic ulcer wound biofilms by authors Naziyah Naziyah , Mohamed Saifulaman Mohamed Said , Faridah Mohd Said , Rizki Hidayat

20. clinical contraindications for hydrotherapy Incipient cardiac failure and unstable angina.  Severe peripheral vascular diseases. Danger of bleeding and or haemorrhage. Severe kidney disease.(Patient are unable to adjust their fluid loss during immersion). Open wounds without occlusive dressings,colostomy and skin infections such as, tinea pedis, and ringworm.

21. Precautions for hydrotherapy Fear of water : It can reduce the effectiveness of any immersed activity . It can increase symptoms of patient due to muscle guarding and stress response. Neurological disorders : such as ataxic patient, Multiple sclerosis (heat intolerant) patients. Respiratory disorders : Water immersion may adversely affect breathing pattern of patient due to hydrostatic pressure of water w.r.t chest wall of patient, it tends to inhibit chest expansion of patient. Cardiac dysfunction such as angina, arterial blood pressure compromized pump mechanism etc.

22. Pools used for hydrotherapy Traditional therapeutic pool Individual patient pool

23. Special equipments used in hydrotherapy Cervical collar Flotation rings Hand paddles Buoyancy belts

24. Swim bars

25. Swim bars

26. Therapeutic pool care and safety Therapeutic pools require regular care and cleaning to avoid Pseudomonas aeruginosa (an infection causing folliculitis). Cleaning should occur at least twice weekly, and chlorine and pH level tests should be done twice daily. All walking surfaces near and around the pool should be slip-resistant and free of barriers. Water splashses should be dried immediately to prevent slips and falls. Safety rules and regulations are a must, as are emergency procedures, and should be posted and observed by all involved in therapeutic pool use. Life preservers should be readily available and at least one staff member who is CPR certified should be present at all times.

27. References : Carolyn Kisner , John Borstad and Lynn Allen Colby and Michelle H. Cameron

28. Thank you