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Aila Nica J. Bandong, PTRPInstructor
Department of Physical TherapyClinical Supervisor
CTS- Pediatric SectionCollege of Allied Medical Professions
Learning ObjectivesAt the end of the lecture, the students should be able to:Define hydrotherapyIdentify the chemical, physical, and thermal properties of
waterEnumerate the therapeutic effects of hydrotherapyIdentify the factors that affect thermal effects of waterDifferentiate the types of water immersion modalitiesIdentify the parts of a whirlpool bathEnumerate the indications, contraindications, and
precautions/guidelines for the use of the modalitiesIdentify common additives in whirlpool therapyUse clinical decision making skill in choosing appropriate
water immersion modalityLearn how to operate a high-buoy tankApply evidence regarding use of water immersion
modalities in practice
CHEMICAL PROPERTIESPure water is a
polar molecule consisting of 2 molecules of Hydrogen and 1 molecule of Oxygen
CONSTANTSfreezing point: 0 degree Celsiusboiling point: 100 degrees Celsiusdensity:
at 0 degree Celsius- .999868
at 4 degrees Celsius- 1.0000pH: 7specific heat: 1.00
FORCES EXISTING IN WATER
buoyancy hydrostatic pressure cohesion viscosity surface tension
Buoyancyupward force exerted on an immersed object
OPPOSITE to gravity
Archimedes’ Principle: a body immersed in a liquid experiences an upward force equal to the weight of the displaced liquid
affected by postural alignment, surface area, weight of bones in relation to muscle and fat, and vital capacity
Hydrostatic Pressure ratio of magnitude of force per surface area
Pascal’s Law: pressure exerted by water is equal in all parts of the object
tends to increase as depth and density increases
Cohesion force between same molecules
tendency to attract each other
Viscosity friction between molecules property of water that resists motion within it leads to resistance to flow
FLUIDITY
Dependent on:
• speed/velocity of movement of liquid
• shape of the body
Surface Tension surface of liquid acts as a membrane under tension
increased attractive forces on the surface
HYDROMECHANICS laminar flow
All molecules are parallel turbulent flow
Molecules are erratic/not parallel drag
Cumulative effect of turbulence and fluid viscosity
SPECIFIC HEAT amount of heat (calories) needed to raise the temperature if 1 gram of substance by 1 degree Celsius
1 calorie high specific heat prevents sudden changes in temperature
THERMAL CONDUCTIVITY ability of a substance to conduct heat
water: 0.6
METHODS OF HEAT TRANSFER
CONDUCTION
EVAPORATION
CONVECTION
RADIATION
Conduction
Exchange of thermal energy between bodies in contact with each other
Convection
Heat transfer by mass motion of water when the heated fluid is caused to move away from the source of heat, carrying energy with it
Radiation
Exchange of electromagnetic energy due to difference in temperature between the skin and surrounding environment
Evaporation
Occurs through loss of fluid from sweating and by the pulmonary system during exhalation
the use of water as a therapeutic agent
THERAPEUTIC EFFECTS Thermal
Mechanical
Cold application
Heat application
Agitation
COLD APPLICATIONincreased cardiac toneperipheral vasoconstrictionincreased blood viscositydecreased HRlonger diastoledecreased vasodilator metabolitesdecreased blood flow
HEAT APPLICATIONvasodilation of arteries and arteriolesincreased capillary permeabilityrelease of vasoactive agentsincreased metabolism (Van’t Hoff’s Law)increased blood flowincreased tissue extensibilityincreased HRincreased RR
FACTORS AFFECTING THERMAL EFFECTStemperature difference between water and
skinmethod of heat transferthermal conductivity of the structurerate of rise in initial temperaturesurface area coveredduration of exposureweight, age, and general condition of the
patient
AGITATIONdebridementanalgesiafacilitation of exercisemuscle relaxation
Modalities
WATER IMMERSION MODALITIES
Whirlpool bath
Hubbard tank
Pool/Aquatic Therapy
Parts Agitator/ Turbine ejector/ Aerator Water thermometer Hot and cold water mixing valve Temperature gauge Gravity drain Seat
Motor Pump/Turbine Motor
Thermometer
Steel Tank
Turbine Engine/Motor
Switch
Suspension Bracket
Throttle
Butterfly Knob
Drive Shaft
Breather Tube
Objectives for usestimulation of circulationpromotion of muscle relaxation and pain relief
debridementfacilitation of exercise
Indicationswound care:
decubitus ulcers, sub-acute or chronic soft tissue injury, burns
arthritislimited ROM
muscle spasmmuscle
weaknesspost fracturestension, anxiety,
or other psychological problems
Contraindicationspatient with
cardiac dysfunctionpatient with
respiratory dysfunction
patient with decreased thermal sensation
severe peripheral vascular disease
bleeding or hemorrhage
acute Rheumatoid arthritis
fevermalignanciesuncontrolled boweldermatologic
conditions, infections
Additiveswounds:
- povidone iodine
- saline solution
- antibacterial agents
- sodium hypochlorite
dry skin:
- bath oil
burn patients:
- 4% solution Lidocaine
TYPES OF WHIRLPOOL BATHAccording to shape:
Low buoy tank
High buoy tank
Extremity tank
According to mobility:
Movable
Fixed
LOW BUOYDimensions
width: 24 inches
length: 52 – 66 inches
depth: 18 inches
HIGH BUOYDimensions
width: 20 – 24 inches
length: 36 – 48 inches
depth: 28 inches
EXTREMITY TANKalso called UPPER EXTREMITY TANK
Dimensions
width: 15 inches
length: 28 – 32 inches
depth: 18 – 25 inches
DOSAGETemperature:
39.9 – 46.1 degrees Celsius or103 – 115 degrees Farenheit
Duration:20 minutes if used as heating modality15 minutes if used as cooling modality5 – 20 minutes if used for debridement10 – 20 minutes if used for exercise
Clinical Decision-makingimmersion of LE can be done using high
and low buoy tanksHigh buoy tank requires the patient to be
able to flex both hip and knee but does not allow full extension (adult)
Low buoy tank allows full-motion exercises of the knee
Both high and low buoy tanks can be fitted with hydraulic chair lift
HUBBARD TANKDimensions
length: 7 feet 2 inches
upper wing width: 6 feet
middle wing width: 35 inches
lower wing width: 4 feet 2 inches
depth: 22 inches
insets: 15 inches
DOSAGETemperature:
32.2 – 38.8 degrees Celsius
90 – 102 degrees Farenheit
(in the clinics)36.1 – 38 degrees Celsius
97 – 100 degrees Farenheit
Duration:20 minutes
Ambient temperature25.5 degrees Celsius
50% humidity
ADDITIONAL EQUIPMENTWalk troughAdjustable seatMotorized chair liftHydrostretcher with hydraulic lift
Contrast BathsAlternately immersing extremity in hot and
cold bathAka “vascular exercise”IndicationsArthritis, joint sprains, s/p amputation, musculo- tendinous strainsTemperatureHot: 38-44 degrees CelsiusCold: 10-18 degrees Celsius
Treatment Duration30 minutes
Warm whirlpool: 10 minutes
Cold whirlpool: 1 minuteWarm whirlpool: 4
minutesCold whirlpool: 1 minute
Sitz BathWater only covers the pelvic regionHotIncreases circulation in the pelvic area enhance
tissue healing and reduce painTemperature: 40.5- 46 .C or 105-115 .F for 2-10
minutesIndications: hysterectomy, hemorrhoidectomy,
chronic pelvic inflammatory disease
ColdIncreases tone of smooth muscles reduce uterine
bleedingTemperature: 17-24 .C or 25-75 .F for 2-10 minutes
Guidelines to Treatmentdetermine objectives for using the modalityselect appropriate temperatureinspect the area to be treatedexplain procedure ad operation to the
patientposition the patient comfortablymonitor vital signsadjust level of agitation accordinglyturn agitator off after treatment
Guidelines to Treatmentdon’t allow finger or loose bandage to clog
the openingscheck for any breakage in the wiringsensure that the motor is securely fasteneddon’t allow the patient to operate the
machinedon’t direct agitation to the area that
could be further damagedcontrol ventilation and humidity of
surrounding area
Evidence in PracticeA 25-year old male suffered from Colle’s fracture 2
months ago. Patient reported falling on outstretched arm after making a “lay-up” during a basketball game. He was put on plaster cast for 6 weeks during which no therapeutic intervention was provided. Upon medical consult 2 weeks ago, he was advised by his doctor to seek physical therapy for management of complications following prolonged immobilization specifically limitation of motion. Referral letter included whirlpool bath as part of management.
Evidence in PracticeClinical Question:Will use of whirlpool bath improve range of
motion post-Colle’s fracture?
Search Strategy:In which database will you search? Why?What keywords will you use? Limits?What types of articles will you look for?
Why?
Do you have any questions?
ReferencesBalicanta, R. E. (2004). Lecture notes on water immersion modalities for
PT 156: Physical agents I.Hayes, K. W. (1993). Manual for physical agents (4th Ed). Connecticut:
Appleton and Lange.Hecox, B., Mehreteab, T. A., and Weisberg, J. (1994). Physical agents: A
comprehensive text for physical therapists. Connecticut: Appleton and Lange.
Kisner, C. and Colby, L. A. (2002). Therapeutic exercise: Foundations and techniques (4th Ed). Philadelphia: F. A. Davis Company.
Michlovitz, S. L. (1996). Thermal agents in rehabilitation (3rd 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, www.cchosp.com.
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