Hydrodynamics and Aquatic therapy Flashcards
Properties that support aquatic therapy
buoyancy, hydrostatic pressure, viscosity, and surface tension have a direct effect on the body in an aquatic environment
buoyancy
is the upward force that works opposite to gravity. Clinical significance is buoyancy provides the person with relative weightlessness and joint unloading, allowing performance of active motion with increase ease.
what is hydrostatic pressure
is the pressure exerted on immersed objects. Pascal’s law states that the pressure exerted by fluid is equal on all surfaces. as the depth increases so does the pressure
clinical significance of increased pressure
Assist VR, induces bradycardia and centralizes peripheral blood flow. The proportionality of depth and pressure allows you to perform exercise more easily when closer to surface
what is viscosity
Friction occuring between molecules of liquid resulting in resistance to flow- resistance is proportional to velocity of movement. Shorter lever arm results in increased resistance, increases SA in water increases resistance
physiological effects of exercise in water
increase blood supply, heat is evolved- temperature rises. there is an increased metabolism in the muscles resulting in a greater demand for oxygen and increased CO2 production. ROM is maintained or increased, and muscle power increases
Therapeutic effects
relieve pain and muscle, gain relaxation, maintain or increase ROM, re-educate paralysed muscles, strengthen weak muscles- develop endurance and power, improve circulation, improve confidence, warmth of water block nociception by acting on thermal receptors and mechanoreceptors
contraindications
cardiovascular disease, cardiopulmonary disease, diabetic, balance disorder, history of CVA/ epilepsy, incontinence, cold/influenza, fever, skin condition, contaginous disease, hepatitis, tracheotomy, UTI, open wounds, surgery,
Different stages to working with amputee
pre-operative, amputation surgery, acute post surgical, pre-prosthetic, prosthetic prescription, prosthetic training, community integration, vocational rehab, follow uo
stage of working with amputee- pre operative
Ax ROM and muscle power
stage of working with amputee- acute post- op
wound care, discharge planning, post-op chest physio, transfer practice, specific exercise to improve strength and exercise tolerance, maintain ROM
stage of working with amputee- pre prosthetic rehab
set patients goals, early walking aids can be used to help decide on patients suitability for prosthetic limb, exercise therapy to prepare the limb for a prosthesis
stage of working with amputee- prosthetic training
education around donning and doffing prosthetic, skin integrity and weight bearing, gait rehab program
Recommendations for early amputee rehab
Early walking aids as an assessment and treatment, physio is aware that level of amputation/ pre-existing medical conditions, impact of level of amputation
what is phantom limb pain
pain that is localised in the region of the removed body pard. It is poorly understood clinical phenomenon. described as crushing, toe twisting, hot iron, burning, tingling, cramping, shocking, shooting P and N. 3 theories- peripheral, central and spinal theories
Phantom sensation
is universal and doesn’t correlate with pain reports. Three types of phantom sensation- kinetic (movement), kinesthetic (size, shape, position), exterorecptive (touch pressure, temperature, itch, vibration)
peripheral theories
remaining nerves in the stump grow to form neuromas, which generate impulses- these impulses are perceived as pain in the limb. One theory says taht cooling of the nerve endings increases the rate of firing of the nerve impulses, which are perceived by the patient as phantom limb pain
central theories
Melzack proposed that the body is represented in the brain by a matrix of neurons. Sensory experiences create a unique neuromatrix, which is imprinted on the brain. When the limb is removed, the neuromatrix tries to reorganise, but the neurosignature remains due to the chronic pain experienced prior to the amputation. This causes phantom limb pain after amputation.
spinal theories
when peripheral nerves are cut during amputation, there is a loss of sensory input from the area below the level of amputation. the reduction in neurochemicals alters the pain pathway in the dorsal horn
PLP- central adaptation treatment options
mental imagery, graded motor imagery, anti-neuropathic medication, physical exercise, prosthetic use, acupuncture/TENS, self massage, education
PLP- peripheral sensitisation adaptation treatment options
irritant management, education, prosthetic, ensure good alingment and fitting, scar management, self massage, TENs
PLP- psychological and social factors
Education
Sleep hygiene
Acupuncture
Physical exercise
Relaxation techniques
CBT
Referral for formal mental health/social support
PLP= MSK factors treatment options
joint ROM/muscular
Maintenance of control and function of the limb by working segmental stabilisers as well as global mobilisers.
Trigger points/myofascial release
Neural mobilisation
Chronic pain
the patient finds themselves in a vicious cycle of pain, which not solely due to disease. a person who has pain on movement avoids pain. Natural reaction= rest, this leads to secondary stiffness and weakness, worsening the symptoms that the individual is trying to avoid. Other issues then arise, which may include financial hardship and strained relationships, side effects from medications and lack of sleep.
Biopsychosocial model of pain
The approach holds that the experience of pain is determined by the interaction between biological, psychological and social factors.
Treating pain- pain neuroscience education-
Teaches patients way to rethink their pain, increase pain thresholds during exercise, decrease fear related to movement and decreased brain activity in brain regions associated with pain.
pain neuroscience education- central sensitisation
Chronic pain is seen as not being caused by dysfunctional tissues but brain plasticity leading to hyper-excitability of the CNS known as central sensitisation. It can be defined as increased responsiveness of nociceptors in the CNS to either normal or sub-threshold afferent input, resulting in- hypersensitivity to stimuli, responsiveness to non-noxious stimuli, increased pain response evoked by stimuli outside area of injury
pain neuroscience education- delivery
Simple pictures, examples, booklets, metaphors, drawings, workbook with reading, neurophysiology
pain neuroscience education- content of sessions
Neurophysiolgy of pain- nociceptive pathways- neurons- synapses- action potential- spinal inhibition and facilitation- peripheral sensitisation- central sensitisation- plasticity of the NS
pain neuroscience education- Chronic pain management
Education, TENS, exercise, assistive devices, assistive devices, manual therapy,
