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8/10/2019 Hydrotherapy Lecture...
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Dr. Laxmikant Bakane
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At the end of the lecture, we should be able to
learn:Define hydrotherapyIdentify the physical and thermal properties ofwaterEnumerate the therapeutic effects ofhydrotherapyIdentify the factors that affect thermal effectsof waterDifferentiate the types of water immersionmodalitiesIdentify the parts of a whirlpool bathEnumerate the indications, contraindications, andprecautions/guidelines for the use of themodalities
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Hydrotherapyincorporates water as ahealing tool
Hydrothermaltreatments includewater temperature toaid the healing process
Water allows movementsand exercises to be done
while limiting theeffects of gravity andpressure on weak areasof the body
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Physical Therapy Increase range of motion Strengthen muscles
Reduces pressure on painful/weak joints/muscles Useful especially for people with chronic
pain and decreased bone density whereland based exercises would cause pain orinjury.
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Physical Properties of Water allow it to be avaluable tool in Physical Therapy Buoyancy; water counteracts gravity and helps to
support the weight of the patient in a controlledfashion as the patient is immersed
Viscosity : resists movement by means of friction,allowing strengthening and conditioning of aninjury, while reducing the risk of further injurydue to loss of balance
Hydrostatic pressure : produces forcesperpendicular to body surfaces at every point,increasing kinesthetic (body motion or position)and proprioceptive (posture self-regulating)awareness in some patients.
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Thermal
Mechanical
Cold applicationHeat application
Agitation
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Increased cardiac tonePeripheral vasoconstrictionIncreased blood viscosityDecreased HRLonger diastoleDecreased vasodilator metabolitesDecreased blood flow
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Vasodilation of arteries and arteriolesIncreased capillary permeability
Release of vasoactive agentsIncreased metabolism (Vant Hoffs Law) Increased blood flowIncreased tissue extensibilityIncreased HRIncreased RR
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DebridementAnalgesiaFacilitation of exercise
Muscle relaxation
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Temperature difference between waterand skinMethod of heat transferThermal conductivity of the structureRate of rise in initial temperature
Surface area coveredDuration of exposureWeight, age, and general condition of thepatient
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freezing point: 0 degree Celsiusboiling point: 100 degrees Celsiusdensity:
at 0 degree Celsius- .999868at 4 degrees Celsius- 1.0000pH: 7specific heat: 1.00
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Buoyancy
Hydrostatic Pressure Cohesion Viscosity Surface Tension
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Upward force exerted on an immersed objectOPPOSITE to gravity
Archimedes Principle: a body immersed in aliquid experiences an upward force equal tothe weight of the displaced liquid
Affected by postural alignment, surface area,weight of bones in relation to muscle and fat,and vital capacity
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Resistance
Viscosity of water provides resistance to motion Resistance occurs against direction of motionResistance increases proportional to Speed
Frontal area of body part in contact with waterVarying resistance ( and pressure ) can bebeneficial in debriding and cleansing wounds
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Water molecules are cohesive; they havethe tendency to attract each other.
This results in
An increase in viscosity of the medium, ascompared to that of air, And an increase in resistance to range ofmotion.
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Friction between molecules Property of water that resists motionwithin it leads to resistance to flow
Dependent on:
speed/velocity of movement ofliquid
shape of the body
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Surface of liquid acts as a membraneunder tension
Increased attractive forces on the
surface
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Laminar flow-All molecules are parallel Turbulent flow-Molecules are erratic/not parallel Drag-Cumulative effect of turbulence and
fluid viscosity
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High Specific Heat & Thermal ConductivityTransfers heat by Conduction and Convection Can be used as superficial heating and
cooling agent.Amount of heat (calories) needed to raise thetemperature of 1 gram of substance by 1degree Celsius High specific heat prevents sudden changesin temperature
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Specific Heat 4 times that of air Water retains 4x as much thermal energy
as an equivalent mass of airThermal Conductivity 25 x air Water transfers thermal energy 25 x more
rapidly than air ( at the same temperature )Transfers heat rapidly, efficientlyAdvantage of exercising patient in poolcolder than patients body temperature.
Immersion dissipates heat generated byexertion
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Water that is stationary transfers heat byConduction .Moving water transfers heat by Conduction andConvection. Heating (WP) accelerated with increased agitation of
water. Cooling (swimming)accelerated as patient moves more
quickly through water.
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Exchange of thermal energy betweenbodies in contact with each other
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Heat transfer by mass motion of water
when the heated fluid is caused to moveaway from the source of heat, carryingenergy with it.
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Exchange of electromagnetic energy dueto difference in temperature between theskin and surrounding environment
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Occurs through loss of fluid fromsweating and by the pulmonary systemduring exhalation.
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Cleansing Pressure (Force = Rate of Flow) Dissolved antimicrobial agents, etc. ( Wounds )Musculoskeletal Effects Decreases weight-bearing ( Arthritis )
75% immersion WB 75% Increases blood flow to muscles Strengthening
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Decreased bone density lossDecreased fat loss
Compared to other forms of exercise
Good for obese secondary to non-weightbearing exerciseNot good for general weight loss
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Increased venous circulation Secondary to hydrostatic pressure, increased venous
pressureIncreased cardiac volumeIncreased cardiac output Up to 30% while upright to neckDecreases HR and Systolic BP ( cool water )
May increase in warm or hot water
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Increases urine productionIncreases sodium and potassium excretion May be used to patients advantage with hypertension,
peripheral edema
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Relaxing Warm waterInvigorating Cold water
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Advantages Even contact with skin Does not need to be fastened
Allows movement of heat/coldDisadvantages Extremity often in dependent position
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Cleansing properties facilitate Rehydration Softening and debridement of necrotic tissue Removal of wound debrisHydrostatic pressure and heat increasecirculationProvides moist environment to optimize
healing
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Increased sensory stimulation to peripheralmechanoreceptors Gait TheoryCold water decreases inflammationDecreases weight- bearing, increases easeof movement.
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Hydrostatic pressureCool water Vasoconstriction
Decreased vascular permeability Hot water increases edema
Increased arterial blood flow, increased vasodilation.
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Contrast Baths Trains smooth muscles of blood vessel;
vasoconstriction/vasodilation. No research to solidly support
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Whirlpool bath
Hubbard tank
Pool/Aquatic Therapy
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Agitator/ Turbine ejector/Aerator
Water thermometer Hot and cold water mixing valve Temperature gauge
Gravity drain Seat
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Motor Pump/Turbine Motor
Thermometer
Steel Tank
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TurbineEngine/Motor
Switch
Suspension Bracket
Throttle
Butterfly Knob
Drive Shaft
Breather Tube
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Stimulation of circulationPromotion of muscle relaxation and pain
reliefDebridementFacilitation of exercise
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According to shape:
Low buoy tank
High buoy tank
Extremity tank
According tomobility:
Movable
Fixed
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Dimensions
width: 24 incheslength: 52 66 inchesdepth: 18 inches
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Dimensions
width: 20 24 incheslength: 36 48 inchesdepth: 28 inches
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also called UPPER EXTREMITY TANK
Dimensions
width: 15 inches
length: 28 32 inchesdepth: 18 25 inches
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Temperature:39.9 46.1 degrees Celsius or
103 115 degrees FarenheitDuration:20 minutes if used as heating modality
15 minutes if used as cooling modality5 20 minutes if used for debridement10 20 minutes if used for exercise
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Immersion of LE can be done using highand low buoy tanksHigh buoy tank requires the patient tobe able to flex both hip and knee butdoes not allow full extension (adult)Low buoy tank allows full-motionexercises of the kneeBoth high and low buoy tanks can befitted with hydraulic chair lift
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Dimensions
length: 7 feet 2 inches
upper wing width: 6 feetmiddle wing width: 35 incheslower wing width: 4 feet 2 depth: 22 inchesinsets: 15 inches
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Temperature :32.2 38.8 degrees Celsius
90 102 degrees Farenheit
(in the clinics)36.1 38 degrees Celsius97 100 degrees Farenheit
Duration:20 minutes
Ambienttemperature
25.5 degrees Celsius50% humidity
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Alternately immersing extremity in hot andcold bathAka vascular exercise
Indications
Arthritis, joint sprains,s/p amputation, musculo-tendinous strains
TemperatureHot: 38-44 degrees CelsiusCold: 10-18 degrees Celsius
Treatment Duration
30 minutesWarm whirlpool: 10minutesCold whirlpool: 1 minute
Warm whirlpool: 4 minutesCold whirlpool: 1 minute
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Uses Decrease edema Pain relief Decrease sensitivity (desensitize)
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Water only covers the pelvic regionHot
Increases circulation in the pelvic area enhancetissue healing and reduce pain Temperature: 40.5- 46
C or 105-115
F for 2-10 minutes Indications: hysterectomy, hemorrhoidectomy, chronic
pelvic inflammatory diseaseCold
Increases tone of smooth muscles reduceuterine bleeding Temperature: 17-24 C or 25-75 F for 2-10 minutes
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Cold (32-790
F) Acute inflammationTepid (79-92 0 F) Exercise
Acute inflammation if cold not toleratedNeutral warmth (92-96 0 F) Open wound Medically compromised patients
Decrease tone
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Mild warmth (96-980) Increase mobility
BurnHot (99-104 0)
Pain, Increase ROM Increase soft tissue extensibilityVery Hot (104-1100)
Limited body area Chronic conditionsDO NOT use WP at temperatures > 110 0 F !!
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Assess problem and set goals of treatmentDetermine if most appropriate treatmentMake sure no contraindicationsSelect appropriate form of hydrotherapy Whirlpool
Hubbard Tank Contrast bath Non-immersion device Pool
Explain the procedure, purpose, sensationsApply appropriate form of hydrotherapyAssess outcomeDocument
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Determine objectives for using the modalitySelect appropriate temperature
Inspect the area to be treated
Explain procedure and operation to the patient
Position the patient comfortably
Monitor vital signs
Adjust level of agitation accordingly
Turn agitator off after treatment
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Dont allow finger or loose bandage to clog the
openings
Check for any breakage in the wirings
Ensure that the motor is securely fastenedDont allow the patient to operate the machine
Dont direct agitation to the area that could be
further damagedControl ventilation and humidity of surrounding area
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Base decision on Desired effects Size of area to be treated Allowance for safety, control of infection Cost-effectiveness
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Balicanta, R. E. (2004). Lecture notes on water immersion modalitiesfor PT 156: Physical agents I.Hayes, K. W. (1993). Manual for physical agents (4 th Ed).Connecticut: Appleton and Lange.
Hecox, B., Mehreteab, T. A., and Weisberg, J. (1994). Physicalagents: A comprehensive text for physical therapists.Connecticut: Appleton and Lange.
Kisner, C. and Colby, L. A. (2002). Therapeutic exercise: Foundationsand techniques (4 th Ed). Philadelphia: F. A. Davis Company.Michlovitz, S. L. (1996). Thermal agents in rehabilitation (3 rd 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