Lecture 1 - Hydrotherapy (modalities) Flashcards
The use of water to faciltate healing and movement and to enable patients to achieve therapy goals
Hydrotherapy
What are the 4 kinds of hydrotherapy
1) Aquatic therapy
2) Whirlpool
3) Contrast Bath (going from hot to colrd)
4) Pulsed lavage
Unweighting force from water on an object immersed in water
Buoyancy
the amount of water thats displaced relates to the amount of unweighting force you have
Will a pt weight bear more or less through their LE the deeper they are in the water?
Less
KNOW: Resistance exercises can be used using principles of buoyancy
Buoyancy of an object depends on its _____
Density
* less dense items dont sink as much as more dense items
Will adipose tissue float more or less easily than bone? Why?
More easily because it has decreased density
Thickness of liquid is known as its _______
Viscosity
KNOW: w/ an object that has increased viscosity the liquid will have more cohesive forces between molecules (they want to stick together more)
If we try to move an object through a thicker liquid it will have more internal friction (trying to break those very stuck together molecules creates increased firction)
Another motion that resists that movement through the very thick liquid is drag force. The more viscis the lquid the more drag forces are going to be present (drag = resists the movement of an an object in liquid)
What resists the movement of an object (or body part) in water?
Drag forces
Will drag forces increase or decrease w/ increased viscosity?
Increase
Think throwing something trhough honey - it won’t work as well as throwing it through water aka its movement was resisted more
What force increases when the speed of movement underwater increases. This force occurs in the opposite direction of movement
Drag force
Essentially saying that w/ faster movement underwater this force works against you even more
In doing the action below the faster they move their leg the increased drag force (which will resist the movement of their leg in the water)
Will a deeply submerged object have more or less pressure on it? Why?
More
Because the water itself is exerting that pressure on it
Pressure water exerts on the immersed body or body part?
Hydrostatic pressure
The deeper you are the more water is pressing down = more hydrostatic pressure
Will the hydrostatic pressure be more on a surfer who has just fallen off a surfboard or someone 10m down in the ocean
10m down
Is there genreally more hydrostatic pressure on LE or UE? Why?
LE
because they’re deeper down
The ability of water to transfer heat
Theramodynamics
What will transfer heat better - sitting water or turbulent water. Which force is used?
Turbulent water via convextion
Properties of water in motion is known as:
Hydrodynamics
What two things can hydrodyanmics be (water in motion be)
Stream lined
Turbulent
Water in motion can be streamlined or turbulent
Explain both
* which one has a higher viscosity?
* Which one will transfer heat more affectively?
Streamlined: think of water in a stream - its all moving in one direction - no churning
Turbulent water: Its constantly churning - think white water rapids
* higher viscosity
* Transfers heat more effectively via convection (making all those tiny water bubbles)
Between what temperatures do we have cooling affects?
33-65
Between what timeratures do we have heating effects?
97-104
What temps do we want to do aquatic therapy at?
81-96 (no heating or cooling effects here - this is neutral water)
What are hemodynamic effects?
Changes in bloodflow
Submerging someone in cold water will do what do HR?
Brady
Submerging someone in warm water will do what to HR?
Tachy
Hydrostatic pressure does what to venous return?
Increases it (lots of these effects negated by gravity_
What does hydrostatic pressure do to breathing?
Makes it harder because the water is exerting that force back on your chest
KNOW: If someone is immersed up to the neck in water it can be 60% more work to breathe
Would want to watch out for this for a pt w/ COPD
* would not want to immerse their chest (may just below level of lungs to not increase the amount of work needed to breathe)
KNOW: Cold water can sitmulate urge or urination
What happens to neural conduction in cold water?
it decreases
What kind of water increases BF to the muscles the most
Moving hot water
KNOW: muscle strength will increases w/ exercise against turbulent water
KNOW: Aquatic therapy safety concerns:
Contraindications:
* Bowel/bladder incontinece
* Tracheostomy (dont want water into lungs)
* Infectious diseases
* Progressively worsening congestive heart failure
* Uncontrolled seizures
* Respiratory compromise (especially when vital capacity < 1L) - any kind of water on them will make breathing harder (hydrostatic pressure)
Precautions:
* Aspiration risk
* Catheters
* Cognitive impairments
* Tetraplegia/high level paraplegia
* Open wounds
* Skin condition/dryness
Aquatic therapy = PT in the water
KNOW: Whirlpools are passive and have little effect on function
* No longer utlize for wound debridement
What are whirlpools normally used for
Subacute/chronic sprains or strains (cold)
KNOW: Are also used ofr RA/OA to reduce pain if the water is warm
Are whirlpools used for edema? Why
Effects on edema not strong
Because limbs are in that gravity depend position - meaning even though its cold gravity will pull the edema back down
KNOW: Whirlpool clinical procedure
Initital set up:
* Choose appropriate whirlpool size
* Inspect tank for cleanliness, electrical safety
* Close drain in tank and fill w/ water at appropriate temperature
* Prior to appointment, ensure patient is in appropriate clothing to expose body part or submerge body (swimsuit)
* Inform patient of precatuions, clear of condtraindications
* Edurcate pt on purpose of whirlpool use
* Take appropriate measures prior to reatment (girth, ROM, pain etc.)
* Skin inspection
* Patient to end whirlpool (assist if needed - provide pt w/ a way to contact you [supervision if necessary])
* Adjust turbine assembly and turn on - can direct the current toward the treatment area or indirect (if to sensitive use indirect)
* Treatment time 10-30 minutes
KNOW: Following treatment
* Inspect skin
* Re-test
* Provide patient w/ towel and assist w/ exiting the whirlpool
* Document details of treatment and response
* Drain tank and disinfect
Whirlpool Precaustions:
* Malignancies (especiialy w/ heat)
* Sensory Impairments
* Hypersensitivity to cold
* Pulmonary disease
* Cardiac insufficiency (were putting body in an environment thats going to alter BF so dont want this)
* Unstable BP
* Impaired circulation
* Edema (we don’t want to put a swollen limb into a warm whirlpool)
* Acute fibril Episode (if someone has a very)
Acute inflammation
* Theraml regulation impairment
* RA
* MS
* Impaired cognitiion
* Fear of water
NOTE: Whirlpools can be hot or cold
Whirlpool Contraindications:
* Bowel / Bladder Incontince
* Intoxication
* Uncontrolled Epilespy
* Danger of hemorrhaging (again were changing that BF)
* Recent post-op surgical incision (want it to be fully closed)
* Skin Ulcers (venous insufficiecy, edema, lymphedema) - already areas of body w/ lots of fluid - wont help
* Skin conditions / infection
* Tissue Flaps
* Skin graphs (want them to heal)
DVT or other thrombosis (BF/Pressure chaging = bad here - dont want them getting knocked lose)
Cyclic immersion of body or body part into hot then cold water
Contrast bath
What is a typical cycle patttern for contrast bath
repeated how many times?
How long is one of these cyclles (hot+cold)
How long does treatment last
3:1 or 4:1 (hot:cold)
1-5 minutes cycles
Repeated 5-7 times
total time = 20-30 minutes
Biggest indication for contrast bath. Why?
Edema
Theroy is that this creates a vascular pumping because you’re altearning between warming (vasodilation = increased BF) and then cold (vasoconsitrction = decreased BF) creating a pumping effect
HOWEVER - theres not a lot of strong evidence that this helps edema
* theres a superficial BF change but it doesnt really get to the heart of edema
* this is priamrily because you’re still in that independent position so its not doing much
* Force of gravity is much graeter than that pumping effect (negates it)
Contrast bath clinical procedure
* Obtain 2 containers of appropriate size
(Hot = 100-111 [slightly lower than theraputic level] cold = 50-66)
Prepare pt:
* educate on purpose / contraindications
* Take pre- measures
* Skin inspection
Position patient and containers in appropriate position
* Quickly move body or limb between containers
Instruction pt and set timer approperly
* 3-4 min hot 1 min cold
* 5-7 cycles or total time = 20-30 mintes
Place body/limb in hot container and begin treatment
End treatment
* Provide towel
Assess patient response
* Skin check, post measure
Documentation:
Aquatic therapy:
* Water temp
* SOAP note information
* Means of entry/exit (how were they able to get in and out of the pool - qualifies the nesesity for this) - goal for aquatic therapy is to get these people on land and to fucntion on land - if they need a lift to get in and out then this is good for them and they wouldnt be able to do dry land
Whirlpool
* Type of whirlpool - was it just a limb or body
* Treatment area
* Agitation (mild, moderate, full)
* Duration - how long
* Active/Passive - was the person exercising in pool?
* Pt response - skin checks / post measurements etc… how did the pt respond
Who benefits from aquatic therapy:
* RA
* Chronic Low back pain
* Fibromyalgia
* Postoperative orthopedics
* OA
* Children w/ cerebral palsy
