Hydrotherapy

Question 1

Physics of Hydrotherapy

Answer 1

• Buoyancy (Partially unweighted environment)
• Viscosity (Provides resistance to movement)
• Hydrostatic Pressure (Water will compress, this may improve lymph and venous return
• Heat Transfer (More extensive coverage for thermo/cryotherapy)
• Mechanical (1. Cleaning 2. Sensory stimulus (pain relief)

Question 2

Physiological effects of Hydrotherapy

Answer 2

• Hemodynamics
• Pulomonary Effects
• Renal Effects
• Muscle Effects
• Psychological
• Mechanical Cleaning

Question 3

Hemodynamic Effects

Answer 3

Water temps > 35.5C (~96 F) cause vasoDilation

Water temps <27C (~80 F) cause vasoConstriction

Hydrostatic pressure increases venous return and central venous pressure, and potentially BP

With warm and hot water, HR will increase, cold water HR may decrease

For exercise monitoring, perceived exertion will be more accurate gauge of intensity than will HR

HR is not something we can monitor in water due to HR being effected by the temperature of the water.

Question 4

Pulmonary Effects

Answer 4

• Lung expansion will be inhibited by the hydrostatic pressure of water on the chest wall as well as increased venous return
• Oxygen uptake will be decreased as a result

Question 5

Renal Effects

Answer 5

• Diuresis, Natriuresis and kaliuresis increases
• Greater effect in cold water

Question 6

Muscle Effects

Answer 6

Water above 36C has a relaxing and analgesic effect that may combat spasm

Warm water will also increase muscle blood flow, increasing oxygen delivery and waste removal

Agitated water (whirlpool) can have analgesic effect through sensory stimulation, aiding muscle relaxation

Cold water tends to be stimulating (Good for patient with hypotonicity, get the muscle activated)

Question 7

Psychological Effects

Answer 7

Neutral or warm water is relaxing

Cold water facilitates active exercise

Water is often enjoyable

Some patients have a significant fear of water

Question 8

Mechanical Cleaning Effects

Answer 8

Agitation of water can assist with cleansing wounds as well as debridement

Can facilitate debridement of necrotic tissue

Historically used whirlpools, no longer recommended

Damage to granulated tissue

Risk of infection

Cost of clean

Now use pulsed lavage with suction

Question 9

Indications for Hydrotherapy

Answer 9

Exercise (Strength, ROM, functional training, general conditioning, balance, etc.)

Cryotherapy

Thermotherapy

Pain Control (related to heat/cold or water sensation)

Wound Care – cleaning and debridement (mostly pulsed lavage with suction)

Question 10

Lower limb loading during aquatic weight bearing

Think of Paul

Answer 10

• Neck Level (~10%)
• Nipple Level (~25%)
• Navel level (~50%)

Question 11

Contraindications for Aquatic Therapy

Answer 11

Bowel or bladder incontinence

Tracheostomy

Infectious Disease

Decompensated Congestive Heart Failure (Don’t have medication that can compensate for what’s going on)

Uncontrolled Seizure Activity

Pulmonary Vital Capacity <1L

Fear of Water

Question 12

Precautions for Aquatic Therapy

Answer 12

Indwelling Catheters (must have proper clamping and fixation)

Cardiovascular Problems (monitor vitals closely)

Cognitive Impairment

Spinal Cord Injury (may have difficulty thermoregulating); Very good therapy but be cautious!

Renal Disease (may be unable to compensate for fluid loss)

Wounds (must be covered with waterproof dressing); Better to wait until skin is intact

Dry skin conditions, chemical sensitivities (can be exacerbated)

Pregnancy (First Trimester)

Multiple Sclerosis (Not above 88 F); Respond very poorly in hot environments

Question 13

Treatment Considerations - Hydro

Answer 13

Consider available equipment, and how adaptable it may be (Access, depth ranges, temperature, any other available toys, supervision)

Pool are wildly expensive and require high levels of maintenance and safety regulation

Newer technologies are helping to reduce cost and increase availability

Question 14

Clinical Application of Hydrotherapy at Different Temperature

Answer 14

• Cold (50F): Inflammation Acute
• Cool (67F): Decrease spasticity
• Tepid (80F): Theraputic Exercise
• Neutral (92F): Circulatory Disorders, Manual Techniques for Relaxation
• Warm (94F): Open Wounds, Debridements
• Hot (100F): Arthritis, ROM
• Very Hot (110): Pain Reduction

Question 15

Duration of Treatment

Answer 15

Depends on patient case and functional level

Like most other treatments, start with less and make progress

General rules for elderly and cardio patients:
Start with ~10 minutes and work up as tolerated

Question 16

Delegation to assistants

Answer 16

Depends on medical complexity and need for ongoing assessment

Question 17

Documentation

Answer 17

Type of hydrotherapy, any relevant parameters (water temp, duration, entry/exit means, assistive devices used, exercises performed), patient response/tolerance including vitals, and potential pre-post measures

Why you will change or keep doing what you are doing after

Question 18

Ice Baths

Answer 18

Used for pain relief/metabolic effects after acute injury (or exercise performance)

Not great for swelling (consider the dependent position required to rest an appendage position required to rest an appendage in a bath)

For recovery, slight effects over control group, about the same as other interventions like active recovery, compression, contract baths

Question 19

Contrast Bath

Answer 19

Alternately immersing between warm/hot (80-104 F) and cool/cold (55-67F)

Inducing vasodilation/vasoconstriction in an attempt to decrease edema

Little to no research regarding efficacy on edema, some on recovery (muscle soreness)

People who did a contrast bath found had better recovery than controls after 6 hours.