Hydrotherapy Flashcards
hydrotherapy comes from words
“Hydro”
“Therapeia”
Physical properties of water:
Specific heat Thermal conductivity Buoyancy Resistance Hydrostatic pressure
Specific heat
Amount of energy needed to inc temp of a given weight of material by a given no of degrees
j/g/deg celsius
Thermal conductivity
Ability of material to transfer heat through conduction
cal/sec)/(deg celcius/cm
Water = specific heat: ? ; thermal conductivity: ?
Water = specific heat: 4.19 ; thermal conductivity: 0.0014
Air = specific heat: ?; thermal conductivity: ?
Air = specific heat: 1.01; thermal conductivity: 0.000057
Water: air ratio => specific heat: ? ; thermal conductivity: ?
Water: air ratio = specific heat: 4.14 ; thermal conductivity: 24.56
very cold to cold
0-18 ℃/32-64℉
Cool: acute inflammation
18-26 ℃/64-79℉
Tepid: exercise, acute inflammation if can’t tolerate cold
26-33 ℃/79-92℉
Neutral warmth: open wounds, medically-compromised pts, dec. tone
33.5-35.5 ℃/92-96℉
mild warmth: inc. mobility of burns
35.5-37℃/96-99℉
hot: pain control
37-40℃/99-104℉
very hot: inc. tissue extensibility, chronic conditions
40-43℃/104-110℉
should not be used
> 43℃/>110℉
Buoyancy
Archimedes’ principle: When a body is immersed in fluid at rest, it creates an upward thrust equal to the amount of fluid displaced
Specific gravity: density of material to density of water ratio
If specific gravity < water, it can float in water
specific gravity of water
1
specific gravity of salt water
1.024
specific gravity of ice
0.917
specific gravity of air
0.00121
specific gravity of human body
0.974
specific gravity of subcutaneous fat
0.85
someone with more subcutaneous fat will find it —- to float in water
easier
Resistance
d/t viscosity of water
Resistance to flow/thickness
Adhesion of molecules
The larger the surface area that moves against the water, the — you feel the resistance
The larger the surface area that moves against the water, the more you feel the resistance
The faster you move, the — you feel the resistance
The faster you move, the more you feel the resistanceq
Cleansing effect
Remove debris from wound
Dissolved surfactants and anti-microbials in water
musculoskeletal effects
assistive , dec weight bearing
d/t buoyancy
Strengthening (resistive)
Effects on bone density loss
It’s easier for patients to move
Places stress on bones
Prevents bone density loss
Less fat loss
cold effects
Decreases metabolism
Pain relief
Inflammation control
warm effects
Relaxes muscle
Increases flexibility
Improves circulation
Increases tissue extensibility
Cardiovascular effect
Venous circulation is inc. Compresses veins in distal extremities Hydrostatic pressure Inc cardiac volume Inc cardiac output Dec. heart rate Dec. systolic BP Dec. rate of O2 uptake (VO2)
Respiratory effects
Dec. vital capacity
Immersed at neck level: inc hydrostatic pressure
Thoracic wall has difficulty expanding
Increases circulation to chest cavity
Blood accumulates more to the heart, more to the lungs
Increases work of breathing because it needs to provide oxygen to the increased amount of blood
Inc. work of breathing
Dec. exercise-induced asthma
High humidity of air
Renal effects
Diuresis (frequent urination) Sodium and potassium excretion Increases renal blood flow Blood is focused in central body Decreases ADH which increases production of urine Beneficial for reduction of edema
Psychological effects
Warm: relaxing
Cold: energizing
Uses
Superficial heating or cooling via conduction or convection
Pain control
Reduction of WB
Thermal effects
Edema control
hydrostatic pressure
Water exercises
Can be assistive or resistive
Water gives more safety for patient
Balance is easier
Wound care
Rehydration, softening of schar and debridement of wound
Contraindications for local immersion
Maceration around wound
Excessive softening of tissue
Results to breakdown
Bleeding
Precautions for local immersion
Impaired sensation Temp factor Infection Impaired cognition Recent skin grafts (Can remove skin grafts)
Contraindications for full body immersion
Cardiac instability
(Congests heart)
Infection spread in water
(Unless pt owns pool)
Bowel incontinence
(Could assist in faster evacuation of the bowel)
Severe epilepsy
Suicidal patients
Precautions full body
Confused or disoriented
PT should be with pt in pool
Alcohol ingestion
Limited strength, endurance, balance
Medications for cv disease
Urinary incontinence
Hydrophobia
Respiratory compromise
Don’t immerse thoracic area
Adverse effects
Drowning Burning Fainting Bleeding Hyponatremia (extensive wound burn) Salt should be added in water Aggravated if water is hypotonic Infection Add antimicrobials in water and pt is the only one who uses it Aggravation of edema in UE Asthma exacerbation if humidity is not controlled
Application techniques
Whirlpool tanks
Butterfly valve:
allows air to flow
Turbine ejector:
water output with air, turbulence
Throttle:
used to move turbine left or right
Suspension bracket:
attaches turbine to tank
Why is turbulence needed?
Allows for the assistive or resistive functions of the water
hubbard dimensions
full body
6ftx8ftx4ft
425-700 gallons
extremity dimensions
distal extremity
15’x28-32’x18-25’
10-45 gallons
high boy dimensions
mid-thoracic; doesn’t allow full LE ext.
20-24” x 36-48” x 28” x
60-105 gallons
low boy dimensions
mid thoracic; allows full LE ext
24’ x 28’ x 18’
75-105 gallons
typical duration of hydroptherapy immersion
20-30 min
contrast bath temperatures
warm: 38-43 deg
cold water: 13-18 deg
technique of contrast bath
hot for 3-4 mins
cold for 1-2 mins
lasts 20-30 mins total
last immersion for acute to subacute: cold
for subacute to chronic: warm
usually ends c warm
Exercise pool uses
Optimizes functions
Allows full body immersion
Swimming pools: 100 ft long x 25 feet wide x 8 feet depth
Sloping bottom
exercise pool common temps
Temp: 26-36 deg, common = tepid
Warm: 34-36 deg for low intensity exercises
Cool: 26-29 deg for more intense exercises
non-immersion irrigation devices pressure
4-5 psi
non-immersion irrigation device uses
Sprays water to open wound
pressure : 4-5 psi
Pulsatile irrigation device delivers fluid at controlled pressure + Removes contaminated fluid
PULSED LAVAGE
room temp and relative humidity for safety
A room temperature of 25-30 deg c relative humidity of 50% is ideal
Infection control safety
Appropriate cleaning protocol Use clean water Drain and clean tank and turbines after each use Commonly contaminated areas Bottom of pool Overflow pipes Agitators Thermometer Edges Drainage
documentation
Hydrotherapy using x temp x duration x exercise done x body part to rationale
goals for aquatic exercise
Facilitation of ROM exercise Initiate resistance training Facilitate weight bearing Enhance delivery of manual techniques Easy access of body parts of pt Facilitate CV endurance exercise Initiate functional replication Minimize risk of injury or re-injury Enhance relaxation
Precautions aquatic exercise
Hydrophobia Neurological disorders Difficulty controlling movements Fatigability Seizures Must be controlled seizures Cardiac dysfunction Angina or abnormal BP Low intensity exercises Small open wounds and lines Must be covered
contraindications aquatic exercise
Incipient cardiac failure or unstable angina Respiratory dysfunction Severe peripheral vascular disease Danger of bleeding or hemorrhage Severe kidney disease (fluid loss) Open wounds, colonoscopy, skin infections Uncontrolled bladder or bowel Water and airborne infections Uncontrolled seizures
Surface tension
Greater surface equals greater resistance
Surface acts as membrane under tension
exercises at surface are – difficult than exercises under
more
hydronamics
Laminar flow
slow
Turbulent flow
fast
Drag
When a person thrusts forward, there is an opposition called drag
rate of temp change is dependent on
mass and specific heat
specific heat
amount of heat required ot raise the temp of 1 gram of substance by 1 deg
center of buoyancy at vertical position
sternum
non-buoyant devices
gloves
hand paddles
hydro-tone bells
hydro-tone boots
used for resistance
ROM is easier in water thru
reduction of joint compression
dampening pain
