hydrotherapy-.pptx

Hydrotherapy

1. Hydrotherapy Hydrotherapy

2. Definition of Hydrotherapy Definition of Hydrotherapy    Application of Application of water, water, internally internally or or externally, externally, for for the treatment of physical or psychological the treatment of physical or psychological dysfunction. dysfunction.

3. Types of Hydrotherapy of Hydrotherapy Types    Immersion Immersion    Non-Immersion Non-Immersion

4. Primary Use of Hydrotherapy Primary Use of Hydrotherapy    Treatment Treatment of of Wounds Wounds    Enhanced Environment Enhanced Environment for for exercise exercise    Pain Pain    Edema Edema    Health maintenance /disease prevention Health maintenance /disease prevention

5. Physical Properties of of Water Water Physical Properties    High Specific High Specific Heat Heat & Thermal & Thermal Conductivity Conductivity    Transfers Transfers heat heat by by Conduction and Convection Conduction and Convection  Can be used as superficial superficial heating and cooling agent heating and cooling agent Can be used as

6. Physical Properties of of Water Water Physical Properties    Specific Specific Heat Heat 4 times 4 times that that of of air air  Water retains retains 4x 4x as as much thermal much thermal energy energy as as an an Water equivalent mass of air r    Thermal Thermal Conductivity Conductivity 25 x 25 x air air  Water transfers transfers thermal thermal energy energy 25 x 25 x more rapidly more rapidly Water than air ( at the same temperature ) t )

7. Physical Properties of of Water Water Physical Properties    Transfers Transfers heat heat rapidly, efficiently    Advantage of Advantage of exercising patient in pool colder colder than patient’s body temperature.  Immersion dissipates heat generated by exertion

8. Physical Properties of of Water Water Physical Properties    Water that is is stationary transfers heat heat by by Conduction . .    Moving water Moving water transfers heat by by Conduction and and Convection . .  Heating (WP) accelerated with increased agitation of water.  Cooling (swimming) accelerated as patient patient moves moves more more quickly through water.

9. Physical Properties of of Water Water Physical Properties    Buoyancy Buoyancy  A force experienced as an upward thrust on the body in the opposite direction to the force of gravity    Archimedes Archimedes Principle Principle  When a body is is entirely entirely or or partially partially immersed in a fluid at rest.. • I t experiences an upward thrust equal an upward thrust equal to weight of fluid it displaces.  Principle used for volumetric volumetric m e asurements m

10. Archimedes Principle Archimedes Principle    Amount Amount of of fluid depends fluid depends on density on density of of body body relative to density of fluid.  density of of body body less than density less than density of of fluid, fluid, it it will will If displace a smaller volume of fluid (Floats) • Opposite also true  If density density of of body body further further decreased ( decreased ( adding salt I to water or air-filled objects at rest ), ), Body will float higher

11. Clinical Uses of Buoyancy Clinical Uses of Buoyancy    Decrease stress and compression to body tissues ( weight-bearing surfaces )    Assist weak muscles Assist w

12. Physical Properties of of Water Water Physical Properties    Resistance  Viscosity of of water water provides provides resistance to motion  Resistance occurs against direction of motion    Resistance increases Resistance increases proportional to…  Speed  Frontal area of body part in contact with water    Varying resistance ( Varying resistance ( and pressure and pressure ) ) can be beneficial in debriding and cleansing wounds

13. Physical Properties of of Water Water Physical Properties    Hydrostatic Hydrostatic Pressure Pressure  Pressure exerted by fluid on body immersed in fluid.    Pascal’s Pascal’s Law Law  A fluid exerts equal equal pressure on all pressure on all surfaces surfaces of of a body a body at rest, at a given depth…  This pressure increases pressure increases in proportion to depth of fluid

14. Hydrostatic Pressure    Water Water = 0.73 mmHg/cm of = 0.73 mmHg/cm of depth (22.4 mmHg/ft)    Patient Patient upright  Pressure on distal extremities Pressure on distal > proximal proximal extremities  Hydrostatic pressure at patient’s feet… Hydrostatic • 4 ft of water water = 89.6 mmHg = 89.6 mmHg

15. Hydrostatic Pressure Hydrostatic Pressure    Water Water can have similar can have similar effect as compression compression devices/ bandages  Helpful in decreasing edema  If limb in dependent limb in dependent position, counteracts this this effect effect If    Greatest effects Greatest effects of of hydrostatic hydrostatic pressure occur in vertical position  NO hydrostatic pressure effects with non-immersion hydrotherapy

16. Physiological Effects of Hydrotherapy Physiological

17. Physiological Effects    Cleansing Cleansing  Pressure (Force = Rate of Flow)  Dissolved antimicrobial agents, etc. ( Wounds Wounds ) )    Musculoskeletal Musculoskeletal Effects  Decreases weight-bearing ( weight-bearing ( Arthritis ) • 75% immersion WB 75%  Increases blood flow to muscles  Strengthening

18. Physiological Effects Physiological Effects    Decreased bone density Decreased bone density loss loss    Decreased fat Decreased fat loss loss • Compared to other forms of of exercise exercise  Good for obese secondary to non-weight obese secondary to non-weight bearing Good for exercise exercise • Not good for general general weight loss

19. Cardiovascular Effects Cardiovascular Effects    Increased venous Increased venous circulation circulation  Secondary to hydrostatic to hydrostatic pressure, pressure, increased venous increased venous pressure pressure    Increased cardiac Increased cardiac volume volume    Increased cardiac Increased cardiac output  Up to 30% while upright to neck    Decreases Decreases HR and Systolic Bp cool water water ) )  May increase in warm or increase in warm or hot hot water water

20. Respiratory Effects Respiratory Effects    Increases Increases work work of of breathing breathing  Due to hydrostatic pressure on lungs • up to 60% • May need to be very careful careful with respiratory with respiratory and/or and/or cardiac cardiac patients    Decreases Decreases exercise-induced asthma  High humidity

21. Renal Effects Effects Renal    Increases Increases urine production urine production    Increases Increases sodium and potassium excretion sodium and potassium excretion  May be used to patient’s be used to patient’s advantage with hypertension, peripheral edema

22. Psychological Effects Effects Psychological    Relaxing Relaxing  Warm water    Invigorating Invigorating  Cold water

23. Clinical Uses of Hydrotherapy

24. Superficial Heating and Cooling Superficial Heating and Cooling    Advantages  Even contact with skin Even contact with skin  Does not need to be fastened Does  Allows movement of heat/cold Allows    Disadvantages  Extremity often in dependent position Extremity

25. Wound Care Wound Care    Cleansing properties facilitate  Rehydration Rehydration  Softening and debridement of of necrotic tissue Softening and debridement  Removal of of wound debris Removal    Hydrostatic pressure and heat increase circulation circulation    Provides moist environment to optimize healing healing

26. Immersion vs. Non-Immersion Immersion vs. Non-Immersion    Non-immersion therapy becoming more popular  Concern for increased pressure on regenerating Concern for tissues by water and turbine tissues by water  Potential for for infection in contaminated tank Potential    WP recommended for  Extensive thick exudate Extensive thick exudate  Slough or necrotic tissue Slough or  Gross purulence Gross purulence  Dry eschar Dry eschar

27. Immersion versus Non-Immersion Non-Immersion Immersion versus    Discharge all forms of hydrotherapy when wound is clean wound is clean  Many antimicrobial Products are cytoxic to normal Many tissue ( unless very diluted tissue ( unless very diluted )    Tank and turbine must be thoroughly cleaned and disinfected and disinfected

28. Non-Immersion Techniques Non-Immersion Techniques    Fluid delivered at pressure of 4-15 psi  Below this bacteria not microbacterial Below this  Above this, wound trauma may occur, occur, or or bacteria Above this, wound trauma may driven into wound driven into wound  Saline squeeze bottle, Water Pik Saline squeeze bottle,

29. Non-Immersion Techniques    Recommended for  N ecrotic, nonviable tissue or debris • Continue until all removed and full granulation bed present present • Often use both    With both types, must thoroughly With both types, must thoroughly dry intact skin s in surrounding area  prevents maceration

30. Treatment of Burns Treatment of Burns    Similar, Similar, but but burns burns particularly particularly painful painful when when debrided debrided  Wounds sometimes sometimes less deep, less deep, sensory nerves sensory nerves intact intact Wounds    Monitor Monitor patient patient closely closely  often high-dose analgesics often high-dose analgesics    Hubbard Tank Hubbard Tank for for large body large body surface area surface area  Chance of contamination contamination Chance of  Greater loss of loss of sodium ( sodium ( add salt Greater add salt ) )    Shower Shower (non-immersion) (non-immersion) in early in early stages stages    After After re-epithelialization, re-epithelialization, water water for for exercise exercise

31. Pain Control Pain Control    Increased sensory Increased sensory stimulation to peripheral stimulation to peripheral mechanoreceptors mechanoreceptors  Gait Theory Theory Gait    Cold water Cold water decreases decreases inflammation inflammation    Decreases Decreases weight-bearing, weight-bearing, increases increases “ease “ease of movement”. of movement”.

32. Edema Control Edema Control    Hydrostatic Hydrostatic pressure pressure    Cool Cool water water  Vasoconstriction Vasoconstriction  Decreased vascular permeability permeability Decreased vascular  Hot water water increases Hot increases edema edema • Increased arterial Increased arterial blood flow, blood flow, increased vasodilation. increased vasodilation.

33. Edema Control Edema Control    Contrast Baths Contrast Baths  “ Trains” smooth muscles of “ Trains” smooth muscles of blood vessel; blood vessel; vasoconstriction/vasodilation. vasoconstriction/vasodilation.  No research to solidly support support No research to solidly

34. Contraindications, Precautions Precautions Contraindications, and Adverse Effects and Adverse Effects

35. Contraindications, Local Immersion Contraindications, Local Immersion    Maceration Maceration  Increased maceration, increased size of increased size of wound wound Increased maceration,    Bleeding Bleeding  In or near near the area the area In or

36. Precautions, Local Immersion Precautions, Local Immersion    Impaired thermal Impaired thermal sensation sensation  Check temperature of water water with thermometer with thermometer first first Check temperature of    Infection Infection  Universal Precautions Precautions Universal  Clean WP Clean WP    Confusion, Confusion, impaired cognition impaired cognition  Use constant, direct supervision direct supervision Use constant,  Temperature of water water near near body body temperature temperature Temperature of    Recent Recent Skin Grafts Skin Grafts  Direct agitator away away from graft. from graft. Direct agitator  Neutral or mild warmth (96 - (96 - 98 98 F) Neutral or mild warmth F)

37. Contraindications, Full Body Contraindications, Full Body Immersion Immersion    Cardiac Cardiac instability instability  Uncontrolled hypertension or heart failure heart failure Uncontrolled hypertension or    Infectious Infectious conditions conditions that that spread with water spread with water  UTI’s, plantar warts, tinea pedis warts, tinea pedis ( pool ( pool ) UTI’s, plantar )    Bowel Bowel or or bladder bladder incontinence incontinence  Use non-immersion techniques Use non-immersion techniques    Severe epilepsy Severe epilepsy  Increased risk of drowning drowning Increased risk of    Suicidal Suicidal patients patients  Increased risk of drowning drowning Increased risk of

38. Precautions, Full Body Immersion Precautions, Full Body Immersion    Confusion, Confusion, Disorientation Disorientation  Keep head above water Keep head above water  Constant supervision supervision Constant  Low temperature Low temperature    After After ingestion of ingestion of alcohol alcohol  Hypotensive effects Hypotensive effects  Drowning Drowning    Patients Patients with limited strength, with limited strength, endurance, endurance, balance, ROM ROM balance,  Hands-on approach required Hands-on approach required

39. Precautions, Full Body Immersion Precautions, Full Body Immersion    Patients Patients on medications on medications  Physician clearance sometimes required required Physician clearance sometimes    Patients Patients with fear with fear of of water water    Patients Patients with respiratory with respiratory problems problems  Watch for signs signs of of respiratory distress, especially respiratory distress, especially in in Watch for hot or very warm water hot or very warm water

40. Precautions, Full Body Immersion Precautions, Full Body Immersion    Patients Patients that that are Pregnant are Pregnant  1st trimester ( maternal ( maternal hyperthermia 1st trimester hyperthermia ) )  Use normal water water temperature temperature Use normal  Can be very good therapeutic intervention intervention Can be very good therapeutic    Patients Patients with MS with MS  Temperature >88 F may Temperature >88 F may cause increase fatigue, cause increase fatigue, weakness. weakness.    Patients Patients with poor with poor thermal thermal regulation regulation  Elderly, infants Elderly, infants

41. Precautions, Non-Immersion Hydrotherapy Precautions, Non-Immersion Hydrotherapy    Maceration Maceration    Ineffectiveness Ineffectiveness    Drowning Drowning

42. Adverse Effects of Hydrotherapy of Hydrotherapy Adverse Effects    Burns, Burns, Fainting, Fainting, Bleeding Bleeding  Check with thermometer, and gloved hand Check with thermometer, and gloved hand    Hypotension Hypotension  Immersion in warm/hot water, hypertension water, hypertension Immersion in warm/hot medications medications    Hyponatremia ( Hyponatremia ( burns burns ) )    Increased edema Increased edema  Use of hot hot water water Use of  Dependent positioning positioning Dependent

43. Application of Hydrotherapy Hydrotherapy Application of

44. Application, General Rules General Rules Application,    Assess problem and set Assess problem and set goals goals of of treatment treatment    Determine if Determine if most appropriate treatment most appropriate treatment    Make sure no contraindications Make sure no contraindications    Select appropriate form of Select appropriate form of hydrotherapy hydrotherapy  Whirlpool Hubbard Tank Whirlpool Hubbard Tank   Contrast bath Non-immersion device bath Non-immersion device Contrast   Pool Pool    Explain the procedure, Explain the procedure, purpose, purpose, sensations sensations    Apply Apply appropriate form of hydrotherapy appropriate form of hydrotherapy    Assess outcome Assess outcome    Document Document

45. Selection of Hydrotherapy Selection of Hydrotherapy    Base decision on Base decision on  Desired effects Desired effects  Size of area to be treated area to be treated Size of  Allowance for safety, safety, control control of of infection infection Allowance for  Cost-effectiveness Cost-effectiveness

46. Whirlpool Whirlpool    Tanks Tanks  Low-Boy Low-Boy  High-Boy High-Boy  Extremity Extremity  Hubbard Tank Hubbard Tank

47. Whirlpool Whirlpool    Turbine Turbine  Agitator Agitator • Adjustable height, Adjustable height, direction, direction, aeration. aeration. • Should be grounded Should be grounded • Do NOT run without Do NOT run without water water in tank. in tank.

48. Low-Boy Low-Boy

49. Hubbard Tank Hubbard Tank

50. Extremity Tank Tank Extremity

51. Temperature Range Temperature Range    Cold Cold (32-79 (32-79 F) F)  Acute inflammation Acute inflammation    Tepid Tepid (79-92 (79-92 F) F)  Exercise Exercise  Acute inflammation if cold not cold not tolerated tolerated Acute inflammation if    Neutral Neutral warmth warmth (92-96 (92-96 F) F)  Open wound Open wound  Medically compromised patients compromised patients Medically  Decrease tone Decrease tone

52. Temperature Range Temperature Range    Mild warmth Mild warmth (96-98 (96-98 ) )  Increase mobility Increase mobility  Burn Burn    Hot Hot (99-104 (99-104 ) )  Pain, Pain,  Increase ROM Increase ROM  Increase soft tissue extensibility tissue extensibility Increase soft    Very Hot Very Hot (104-110 (104-110 ) )  Limited body area area Limited body  Chronic conditions conditions Chronic    DO NOT DO NOT use WP use WP at at temperatures temperatures > 110 > 110 F F !! !!

53. Hubbard Tank Hubbard Tank    8 feet 8 feet long x long x 6 feet 6 feet wide, wide, 4 feet 4 feet deep deep    425 gallons 425 gallons water water    Turbines, Turbines, stretcher, stretcher, hoist hoist    Expensive secondary Expensive secondary to amount to amount of of water, water, time to time to clean clean

54. Contrast Bath Contrast Bath    Alternate immersion (distal) Alternate immersion (distal)  First warm/hot water, then cool/cold water water, then cool/cold water First warm/hot    Uses Uses  Decrease edema Decrease edema  Pain relief Pain relief  Decrease sensitivity (desensitize) (desensitize) Decrease sensitivity

55. Application, Non-Immersion Irrigation Application, Non-Immersion Irrigation    PulsaVac: PulsaVac: Lab Lab

56. Application, Pool Application, Pool    Temperature 79 - Temperature 79 - 97 97  Never below 65 below 65 Never • Impairs Impairs muscles muscles ability ability to contract to contract

57. Cleaning, WP/Hubbard Tank Cleaning, WP/Hubbard Tank    Wear Wear gloves, gloves, goggles, goggles, gown gown    Drain tank Drain tank    Rinse with clean water Rinse with clean water    Scrub tank Scrub tank with brush and detergent with brush and detergent and rinse and rinse again again    Disinfect Tank Disinfect Tank

58. Disinfecting the Tank Disinfecting the Tank    Levels Levels of of disinfection disinfection  Low level Low level • Intact skin Intact skin • 70-90% ethyl 70-90% ethyl alcohol, alcohol, • sodium hypochloride bleach sodium hypochloride bleach • germicidal germicidal solution solution  Intermediate Level Intermediate Level • 70-90% ethyl 70-90% ethyl alcohol alcohol • phenolic phenolic germicidal germicidal detergent detergent  High Level High Level • Chlorine-based products Chlorine-based products • Can corrode tank Can corrode tank

59. Disinfecting the Tank Disinfecting the Tank    Change disinfectant Change disinfectant periodically periodically to decrease to decrease risk of resistant strains risk of resistant strains    Fill Fill tank tank    Add solution ( Add solution ( hot hot water water ) )  expose all inside surfaces inside surfaces x x 10 minutes 10 minutes expose all    Clean and disinfect Clean and disinfect turbine, turbine,  bucket with water/detergent with water/detergent x x 5 minutes 5 minutes bucket  bucket with disinfectant with disinfectant x x 10 minutes 10 minutes bucket

60. Disinfecting the Tank Disinfecting the Tank    Drain tank Drain tank    Rinse with clean water Rinse with clean water    Dry Dry thoroughly thoroughly with towels with towels    Culture tank, turbines, drains, Culture tank, turbines, drains, and water and water supply supply periodically periodically

61. Aquatic Exercise Aquatic Exercise

62. Aquatic Exercise Aquatic Exercise    Uses Uses  Increase circulation Increase circulation  Increase muscle strength Increase muscle strength  Increase joint ROM, flexibility ROM, flexibility Increase joint  Improve ambulation Improve ambulation  Improve coordination Improve coordination  Increase cardiovascular, respiratory conditioning Increase cardiovascular, respiratory conditioning  Decrease pain, spasm spasm Decrease pain,  Decrease weight-bearing on joints Decrease weight-bearing on joints  Relaxation/ psychological psychological well-being well-being Relaxation/

63. Types of Aquatic Exercise of Aquatic Exercise Types    Swimming Swimming    Running ( Running ( with or with or without without vest vest ) )    Walking Walking    Cycling Cycling    Stretching Stretching    Underwater Underwater treadmill treadmill or or parallel parallel bars, etc. bars, etc.

64. The End The End