Hydrotherapy & Compression Flashcards
What are the 4 physical properties of water?
High Specific Heat
Thermal Conductivity
Hydrostatic Pressure
Buoyancy/Resistance
What are the possible modes of heat transfer associated with hydrotherapy?
Conduction & Convection
How is heat transferred in stationary water?
By Conduction
How is heat tranferred in moving water?
By Convection
What is buoyancy?
A force experienced as an upward thrust on the body opposite to the force of gravity.
Per Archimedes’ Principle:
When a body is entirely or partially immersed in a fluid at rest, it experiences an _________________ equal to the weight of the weight of the fluid it displaces
Upward Thrust
Which has a higher density: the human body or water?
Water
What is Specific Gravity?
The ratio of density of a material compared to the density of water.
What does submersion of most of the body do to weight bearing joints , muscles and connective tissues?
It decreases stress and compression
What does the viscosity of water do to the motion of a body?
It provides resistance to motion.
What direction does resistance occur in relationship to the motion of the body in water?
Resistance occurs against the direction of the motion
How is resistance affected relative to the speed of a body’s motion in water?
Resistance increases in proportion to the speed.
In addition to the benefits of exercising in water, what other benefit(s) can be derived from the variable resistance and pressure of moving water?
It is good for debriding and cleansing wounds.
According to Pascal, does hydrostatic pressure increase or decrease as the depth of immersion increases?
Pressure increases as depth increases.
There are no hydrostatic pressure effects when nonimmersion hydrotherapy techniques are used. True or False?
True
List 6 psysiological effects of water that result from its physical properties:
Cleansing Musculoskeletal Effects Cardiovascular Effects Respiratory Effects Renal Effects Psychological Effects
Can immersion in water assist in alleviating peripheral edema caused by venous or lymphatic insufficiency?
Yes
Compare the effects of hydrostatic pressure on a vertical (standing) patient vs a horizontal (swimming) patient?
Pressure will be greater on the feet of the vertical patient.
List types of conditions which can progress more rapidly during rehabilitation when buoyancy is used to unload weight-bearing anatomical structures.
Arthritis
Ligamentous Instability
Cartilage Breakdown
Degenerative or traumatic conditions of the articular or periarticular structures of the weight-bearing joints
What property(ies) of water can be used to provide force against which muscles can work to gain or maintain strength
Velocity dependent resistance
What happens when water flow is adjusted to occur in the same direction of the patient’s motion?
Resistance is decreased - the water flow can actually be used to assist the patient’s movement.
The cardiovascular benefits of hydrotherapy are primarily a result of the effects of what?
Hydrostatic Pressure
How does hydrostatic pressure benefit cardiovascular therapy?
The pressure displaces venous blood proximally
This increases Cardiac Volume
Which increases Stroke Volume and Cardiac Output
What is Starling’s Law?
The strength of the heart’s systolic contraction is directly proportional to its diastolic expansion
This means that under normal physiological conditions, the Right Atrium pumps all of the blood returned to it without any blood backing up into the veins.
Is the rate of oxygen consumption lower or higher when exercise is performed in water than when exercise at the same level of perceived exertion is performed on dry land?
It is lower
Should Target Heart Rate be used as the gauge for water exercise intensity? Why?
No. Heart rate to exercise is “blunted” in water. The LEVEL OF PERCEIVED EXERTION should be the guide for exercise intensity in water.
Why does immersion of the whole body in water increase breathing work?
Because the venous blood flow from peripheral to central circulation increases circulation in the chest cavity - the hydrostatic pressure on the chest wall increases the resistance to lung expansion.
What kind of conditions/impairments should be carefully monitored during water based exercise?
Respiratory and/or cardiovascular impairments.
The additional respiratory challenge of exercising in water may overload patients with these conditions.
Is water based exercise more or less likely than land based exercise to aggravate asthma?
Less likely
What renal effects can be seen in individuals immersed up to the neck in water?
Increased urine production
Urinary Sodium & Potassium excretion
What type of patients may benefit from immersion in warm water?
Individuals with CHF
Patients who need a calming environment
Overstimulated or agitated patients
What type of patients may benefit from immersion in cold water?
Patients who can benefit from the stimulation of the cold water -
Patients who are generally less active or less responsive
What type of symptoms/conditions would suggest using a contrast bath?
Chronic Edema
Subacute Trauma
Inflammatory conditions such as sprains, strains, or tendonitis
Hyperalgesia
Hypersensitivity caused by reflex sympathetic dystrophy or other conditions
What are the benefits of a contrast bath?
It is used to achieve the benefits of heat, including decreasing pain, increasing flexibility, while avoiding the risk of increased edema
What direction should the turbine be directed to control pain or to remove tightly adhered wound debris?
It should be turned toward the affected area
When should the turbine in a WP be directed away from the involved area?
If the area is hypersensitive
If granulation tissue is present
Recent skin grafts
Clinically, what is the general use of Whirlpools?
Exercise or pain control in limited areas of the body.
They are sometimes used for wound care as well.
What are the 7 things that should be included in hydrotherapy documentation?
- Type of hydrotherapy used
- Patient position / activity
- Water Temp
- Treatment time
- Outcome/response to treatment
- Fluid pressure, if applicable
- Any water additives used
What are the contraindications for local immersion hydrotherapy?
Maceration around a wound
Bleeding
What are the precautions for local immersion hydrotherapy?
- Impaired thermal sensation in the area to be immersed
- Infection in the area to be immersed
- Confusion or impaired cognition
- Recent skin grafts
What are the adverse effects of hydrotherapy?
- Burns
- Fainting
- Hyponatremia (salt loss) - pt w/extensive burns
- Infection
- Aggravation of edema
- Bleeding
- Drowning
What are the precautions for full body immersion in Hot or Very Warm water?
- Pregnancy
- Multiple Sclerosis
- Poor Thermal Regulation
What are the contraindications for full body immersion hydrotherapy?
- Cardiac instability
- Infectious conditions that may be spread by water
- Bowel incontinence
- Severe epilepsy
- Suicidal patients
What are the precuations for the use of full body immersion hydrotherapy?
- Confusion or disorientation
- Alcohol ingestion by the patient
- Limited strength, endurance, balance or ROM
- Medications
- Urinary Incontinence
- Fear of Water
- Respiratory Problems
What WP temperature setting is most appropriate for treating acute inflammation?
Cold: 32-79 F
OR if not tolerated, 79-92 (Tepid)
What WP temperature setting is most appropriate for therapeutic exercise?
Tepid: 79-92 F
What WP temperature setting is most appropriate for treating open wounds?
Neutral: 92-96 F
What WP temperature setting is most appropriate for medically compromised patients?
Neutral: 92-96 F
What WP temperature setting is most appropriate for treating decreased tone?
Neutral: 92-96 F
What WP temperature setting is most appropriate for increasing mobility in burn patients?
Mild Warmth: 96-98 F
What WP temperature setting is most appropriate for pain control?
Hot: 99-104 F
What WP temperature setting is most appropriate for increasing soft tissue extensibility?
Very Hot: 104-110 F
What WP temperature setting is most appropriate for treating chronic conditions?
Very Hot: 104-110 F
Can Very Hot temperatures (104-110 F) be used for whole body immersion hydrotherapy?
No. It should be used only when treating a limited body area.
What is an Autograft?
A skin graft using the patient’s own skin.
What is an Allograft?
A skin graft using another person’s skin.
What is a Xenograft?
A graft of tissue transplanted between animals of different species
What is a Cultured Graft?
Made from the patient’s own skin cells, in combination with a medical fabric that dissolves after grafting to the wound.
What is a Biosynthetic Dressing?
Gels, solutions or semi-permeable sheets derived from a natural source
What is compression?
A mechanical force that increases external pressure on the body or a body part.
What are the therapeutic effects of external compression?
- Improves venous and lymphatic circulation
- Limits the shape and size of tissue
- Increases tissue temperature
What are the clinical indications for the use of external compression?
- Edema
- Lymphedema
- Prevention of DVT
- Venous Stasis Ulcers
- Residual Limb Shaping after Amputation
- Control of Hypertrophic Scarring
What are the contraindications for compression?
- Acute trauma or fracture
- Heart Failure or Pulmonary Edema
- Acute Infection
- Recent or acute DVT, Thrombophlebitis or pulmonary emobolism
- Arterial Revascularization
- Lymphatic or Venous Obstruction
- Peripheral arterial disease or ulcers due to sever arterial insufficiency
- Hypoproteinemia
What are the precautions for compression?
- Impaired sensation
- Uncontrolled Hypertension
- Impaired Mentation
- Cancer
- Stroke or cerebrovascular insufficiency
- Superficial peripheral nerves
What is the appropriate pressure for upper extremity compression?
30-60 mm Hg
What is the appropriate pressure for lower extremity compression?
40-80 mm Hg
What is the standard compression treatment time?
2 to 3 hours
What inflation/deflation ratio is most appropriate for treating edema?
3:1
Specifically:
80-100 sec Inflation : 25-35 sec Deflation
What inflation/deflation ratio is most appropriate for DVT prevention?
3:1
Specifically:
80-100 sec Inflation : 25-35 sec Deflation
What inflation/deflation ratio is most appropriate for treating a venous stasis ulcer?
3:1
Specifically:
80-100 sec Inflation : 25-35 sec Deflation
What inflation/deflation ratio is most appropriate for residual limb reduction?
4:1
Specifically:
40-60 sec Inflation : 10-15 sec Deflation
What are the possible adverse reactions to compression?
- Aggravating a condition that is causing edema
2. Impairing circulation with too much pressure
What can be done to minimize the probability of adverse reactions to compression?
When edema in an extremity has fluid accumulation at the proximal end of the extremity, it should be mobilized using massage.
To avoid adverse circulatory effects, the patient should be monitored for changes in BP or edema - especially during the first application. Treatment parameters can also be adjusted.
How much pressure is recommended to control scar tissue formation using compression?
20-30 mm Hg
Usually compression garments or elastic bandages.
How long should compression garments be worn?
24/7 except when bathing.
What 6 things should be included in documentation of compression treatment?
- Type of compression device
- Area of body being treated
- Inflation and deflation times
- Compression or inflation pressure
- Total treatment time
- Patient’s response to treatment
What type of sensation testing is most appropriate prior to applying intermittent pneumatic compression?
Pressure test
What patient assessments should be completed AFTER compression treatment?
Blood Pressure
Girth Measurement
Skin Integrity
