HYDORTHERAPY Flashcards
OBJECTIVE
Discuss the role of WP in rehabilitation (#2)
Identify effects of WP on pain relief and functional activities (#6)
Demonstrate proper application of WP (#7)
Identify indications and contraindications for WP (#8)
Explain the physiologic effects of WP (#9)
Document use and response to WP based on patient care scenarios (#10)
Recognize possible adverse reactions to WP interventions (#11)
Explain factors related to treatment progression and attainment of goals based on a sample POC (#12)
Apply principles of aseptic technique, infection control and universal precautions (#14)
Identify and list potential cultural difference s during WP application (#16)
Recognizes absent or altered sensation (#19)
Recognize when interventions should not be provided due to change in patient status and communicate with the PT (#20)
FYI
can be applied externally, either by immersion of the whole body or of parts of the body in water (WP), or without immersion by spraying our pouring water onto the body and has been shown to have wide ranging therapeutic effects and benefits.
Hydrotherapy
What is Hydrotherapy used for?
- wound treatment or to provide an enhanced environment for therapeutic exercise.
- Also used occasionally to control pain or edema.
Why is the use of hydrotherapy limited in most clinical settings?
It is not very cost effective. It takes a long time to fill up the machine and clean it
What are the physical properties of water?
- relitively high specific heat and thermal conductivity
- ability to provide buoyancy
- resistance
- hydostatic pressure- the pressure exerted by a fluid on the body immersed in the fluid.
What are the possible modes of heat transfer associated with hydrotherapy?
- conduction-produced by stationary water
- convection- produced by moving water
Stationary water transfers heat by
conduction
Moving water transfers heat by
convection
According to the Archimedes’ principle, when a body is entirely or partially immersed in a fluid at rest, it experiences an ____________ equal to the weight of the fluid it _______________.
upward thrust , displaces
The density of the human body is greater than the density of water. true of false
False -The body is less dense than water.
the ratio of density of a material compared to the density of water.
Specific gravity (pg 282)
fyi
If the relative density of the body is further decreased, as with the addition of floatation devices or by adding salt to the water, the body will float even higher in the water. (See Figure 9-2, page 247)
fyi
Submersion of most of the body decreases
stress and compression on weight bearing joints, muscles and connective tissues.
fyi
Submersion may also be used to help raise weakened body parts against gravity or to assist the therapist in supporting the weight of the patient’s body during therapeutic activities.
fyi
The viscosity of water provides
resistance to the motion of a body in water.
The resistance occurs _____________ the direction of the motion of the body and ___________ in proportion to the relative speed of the body’s motion and the frontal area of the body part(s) in contact with the water. See Figure 9-3 on page 248.
against ,increases
The relative speed of motion of the body can be increased by……………….
- having the patient move faster in the water
- increasing the speed at which the water moves toward the patient.
Velocity-dependent resistance provided by water makes it a safe and effecting strengthening and conditioning medium for many patients. Why?
The resisitance of the water is zero when it is not moving, providing a safety, when moving the resistance increases making it an effective environment for training.
The variable resistance and thus pressure provided by moving water can also be beneficial for ……………..
debriding and cleansing wounds.
What is hydrostatic pressure and why is it important?
the pressure exerted by a fluid on a body immersed in the fluid.
What law is this?
a fluid exerts equal pressure on all surfaces of a body at rest at a given depth and this pressure increases in proportion to the depth of the fluid. (See figure 9-5, page 248)
Pascal’s Law
According to Pascal’s Law
hydrostatic pressure ______________ as the depth of immersion_________________.
increases, increases
an example of pascal’s law
in the vertical position, the patient will experience greater hydrostatic pressure on the feet than the cranial or proximal parts of the body.
Hydrostatic pressure can provide the same pressure exerted by certain devices, such as ………..
compression garments or ACE bandages.
Immersion in water can assist in promoting _____________ or alleviating peripheral edema caused by venous or lymphatic insufficiency.
circulation
fyi
Clinical Note: Although hydrostatic pressure can assist in promoting circulation, in some patients, the benefits may be counteracted due to the limbs being in a dependent position.
fyi
In terms of hydrostatic pressure, do you think that the effects will be the same on a patient in the vertical position (standing) as they are with a patient in a horizontal position (such as swimming)? Why or why not?
The hydrostatic pressure would be greater in the vertical position because the hydrostatic pressure increases with the depth of immersion. The horizontal position will have less hydrostatic pressure due to the fact that the limbs will be closer to the surface of the water.
There are no hydrostatic pressure effects when nonimmersion hydrotherapy techniques are utilized. True or False
true
Physiological Effects of Hydrotherapy
- Cleansing
- Musculoskeletal effects
- Cardiovascular effects
- Respiratory effects
- Renal effects
- Psychological effects
How is water used for rehabilitation purposes, i.e. how does rehab utilize water’s cleansing effects?
Water is used both as a debriding agent to remove endenous debris, such as wound exudate or necrotic tissue, and as a cleaner to remove exogenous waste, such as gravel or adhered dressing materials, and to reduce bacterial burden.
The buoyancy of water unloads the weight bearing anatomical structures and can thus allow patients with load sensitive joints to perform exercises with less trauma and pain. This effect can help patients with:
- Arthritis
- Ligamentous instability
- Cartilage breakdown
- Other degenerative or traumatic conditions of the articular or periarticular structures of the weight-bearing jt to progress more rapidly with rehabilitation activities
Buoyancy can also be particularly helpful for ______________patient for whom land based exercises places such extreme stress on the weight bearing joints.
obese
Water based exercises is recommended for improving the __________and __________ of obese patients, but is generally not recommended for weight loss.
fitness and function
The velocity dependent resistance provided by water can also be used to provide force against which muscles can work to ___________or ____________ strength.
gain or maintain
If water flow is adjusted to occur in the same direction of the patient’s motion, what will occur?
The resistance of the water can also be used to aid the pt’s motion
Cardiovascular Effects:
See figure 9-6, page 250
The cardiovascular benefits of hydrotherapy are primarily a result of the effects of
hydrostatic pressure
who’s law is this?
When immersed in the water to the neck blood volume increase by 60% and cardiac volume increases by nearly 30%. The heart’s response to this increase in pressure with an increase in the force of cardiac contraction and an increase in stroke volume
Starling’s Law
The rate of oxygen consumption is lower when exercise is performed in water than when exercise at the same level of perceived exertion is performed on dry land. True or False
true
fyi
Clinical Note: Because of the increase in stroke volume and cardiac output, there is a physiological basis for using exercise in water for cardiac conditioning and rehabilitation.
fyi
Please read about hydrotherapy with CHF patients. How may this information benefit you in your SPTA/PTA careers? Pg 250
This information will help guide me as a PTA when working with a CHF pt. Their hearts response to being put in water brings it close to those of healthy controls.
BE AWARE THAT HEART RATE, SPECIFICALLY TARGET HEART RATE, IS NOT THE IDEAL GUIDE FOR WATER EXERCISE INTENSITY. Therefore, what should be used as a guide to determine the patient’s exercise intensity?
Level of perceived exertion
Respiratory Effects:
See figure 9-7, page 251
Immersion of the whole body in water increases the work of breathing because the shift of venous blood flow from the____________ to the _______________circulation increases circulation in the chest cavity, and the hydrostatic pressure on the chest wall increases the resistance to lung expansion.
peripheral to the central circulation
With full body immersion, as seen with aquatic therapy, the workload challenge to the respiratory system that occurs when exercise is performed in water can be used to improve the efficiency and strength of the __________________system.
respiratory
because this additional respiratory challenge may overload patients with respiratory or cardiovascular impairments, such patients should always be
monitored during water based exercise
Why is Water based exercises often recommended for patients with exercise induced asthma
water based exercise is less likely to cause asthma as compared to land based exercise.
Immersion of an individual up to the neck in water has been shown to increase __________ production and ___________sodium and potassium excretion.
urinary , urinary
What type of patients may benefit from immersion in warm water?
Warm water can be used clinically to provide a comforting and calming environment for overstimulated and agitated pt’s
What type of patients may benefit from immersion in cold water?
The invigorating effects of cold water can be used to facilitate more active exercise participation by those who are generally less active or responsive.
Contrast Bath:
See figure 9-14, page 269
What does a contrast bath consist of and what are the benefits?
Immersing an area, generally distal extremity, first in warm or hot water then in cool or cold water. Contrast bath have been shown to cause fluctuations in blood flow over 20 min tx.
What type of patients may benefit applying a contrast bath?
Pts with chronic edema; subacute trauma; inflammatory conditions such as sprains, strains, or tendonitis; or hyperalgesia or hypersensitivity caused by reflex sympathetic dystrophy or other conditions.
fyi
Whirlpool is composed of a tank that can hold water and a turbine that provides agitation and aeration to move the water in the tank.
See figure 9-14, page 266
fyi
The turbine may be directed towards the involved or affected area to apply maximum force, as may be desired to control pain or to remove tightly adhered ____________(as often seen with road rash).
control pain,wound debris
When should the turbine be directed away from the involved area?
When there is a skin graft, granulation tissue, and hypersensitivity.
fyi
Most turbines also allow the clinician to open or close the aeration valve to further modify the pressure of the water flow.
fyi
Clinically, what is the general use of WPs?
For exercise to pain control in limited areas of the body, such as leg and foot or arm and hand.
Documentation of hydrotherapy treatment should include:
- Type of hydrotherapy used
- pt’s position and/or activities
- Water temp
- Duration of tx
- Outcome of or response to tx
- Fluid pressure, of applicable
- Water additives, if applicable
Contraindications and Precautions for Hydrotherapy***
- Macerations around a wound
- bleeding
Local Immersion Precautions:
- Impaired thermal sensation
- infection in the area to be immersed
- Confusion of impaired cognition
- Recent skin graft
Adverse Effects of Hydrotherapy
- Drowning
- Burns, fainting, bleeding
- hypothermia
- infection
- Aggravation of edema
- Asthma exacerbation
Note: For written examination purposes, also know the precautions and contraindications associated with full body immersion.
CONTRAS
- Pregnancy
- Multiple sclerosis
- Poor thermal regulation
Note: For written examination purposes, also know the precautions and contraindications associated with full body immersion.
PRECAUTIONS
- cardiac instability
- infectious conditions that may be spread by water
- bowel incontinence
- severe epilepsy
- suicidal pt’s
Whirlpool Water Temperature
Please know the temperature ranges, sensation and clinical application for WP skill comp testing as listed on page 267, Table 9-5
for
- cool,
- tepid,
- neutral,
- hot,
- very hot
Neutral water temp
92-96 F
Cold whirlpool temp
32-79 F
Tepid water temp
79-92 F
Hot water temp
99-104 F
Very hot temp
104-110 F
Cold whirlpool 32-79 F can be used in place of
an ice pack, to treat acute inflammatory conditions of the distal extremities.
Tepid water 79-92 F should be used in the whirlpool if
the water is being used soley as a medium for exercise.
Neutral water 92-96 F should be used for tx of……
- open wounds, and in
- pt’s with circulatory, sensory, or cardiac disorders.
- Neutral water can also be used to control tone in pt’s with neurologically based hypertonicity.
Hot water 99-104 F is recommended for the control of
- pain and/or to
- increase soft tissue extensibility
because this temp range of whirlpool water has been shown to increase the temp of subcutaneous tissue to within the range required to produce these effects.
Very hot 104-110 F to tx chronic conditions, such as
- osteoarthritis or
- RA in the nonacute phases in small areas of the body
- (for larger areas it is recommended to use 99-104 F)
Whirlpool Skill Comp Testing Hints:
- Monitor vitals signs as deemed necessary
What conditions may warrant you to assess vitals?
- Select appropriate temperature range***
You will be given a treatment situation (i.e. pain control, acute inflammation, etc)
- Verbalize and demonstrate skin check
What are you looking for?
- Verbalize need to clean treatment area
Know WP cleaning procedure
on Blackboard
An upward force on an object immersed in a fluid that is equal to the weight of the fluid it displaces, enabling it to float or to apperar lighter
Byoyancy
Exercises where the distal extremity is stationary on a stable support. When performed in a pool, the distal extremity is supported on the botton or side of the pool
closed-chain exercise
Alternating immersion in hot and cold water
Contrast baths
swelling that results from accumulation of fluid in the interstitial space
Edema
A large, stainless steel whrilpool designed for immersion of the entire body that is used primarily for the treatment of patients with extensive burn wounds
Hubbard tank
The pressure exerted by a fluid on a body immersed in the fluid. It increases with increased depth of immersion
hydrostatic pressure
The therapeutic use of water.
Hydrotherapy
exercises where the distal extremity is free to move. These exercises can can be performed in a pool if the distal extremtiy is not touching the side or bottom of the pool.
open-chain exercises
force per unit area, generally measured in pounds per square inch (psi)
Pressure
a force counter to the direction of movement. In relation to the body’s movement i wate is proportional to the relative speed of the body and water’s motion and to the frontal areas of the body part in contact with the water
resistance
the ratio of the dinsity of a material to the density of water.
specific gravity
the amount of energy required to raise the temp of a given weight of a material by a given number of derees, usually expressed in J/g/ degrees C
specific heat
The rate at which a material trasfers heat by conduction, usually expressed in (cal/sec)(cm2 x degrees C/cm)
thermal conductivity
the thickness or resistance to flow of a liquid, caused by friction between the molecules of the liquid. A more vicous liquid is thick and pours slowly. Water, a liquid with a relatively low viscosity, pours quickly and easily
Viscosity
The establishment and growth of microoraganisms in a wound.
Colonization
removal of foreign material or dead, damaged, or infected tissue from a wound to expose healthy tissue
Dibridement
Dead tissue or a scab that forms on a wound
Eschar
Wound fluid composed of serum, fibrin, and whit blood cells.
exudate
tissue composed of new blood vessels, connective tissue, fibroblasts, and inflammatory cells that fills an open wound when it starts to heal; typically appears deep pink or red with an irregular, berrylike surface
granulation tissue
Establishment and growth of microorganisms causing disease. With this, there are more microorganisms or more pathological microorganisms than with colonization.
Infection
softening of tissues from excessive soaking in liquid
Dead tissue
necrotic tissue
the application of continuous or intermittent subatmospheric-pressure vacuum suction to an open wound to promote wound healing; aslo known as vacuum-assisted wound closure
negative pressure wound therapy
Infection acquired in a hospital
nosocomial infection
nonimmersion pulstile irrigation, often used to clean and debride wounds and therby promote wound healing
Pulsed lavage
pus; opaque wound fluid that is thicker than exudate and contains whit blodd cells, tissue debris, and microorganisms.
necrotic tissue in the process of separating from viable, living tissue
slough
