WK9-Hydrotherapy and Compression Flashcards
List some of the physical properties of water.
High specific heat and thermal conductivity.
Buoyancy: upward thrust against gravity.
Resistance: when motion applied downward
Hydrostatic Pressure: equal pressure exerted on your body from all directions under water.
List the physiological effects of hydrotherapy.
Cleansing, MSK, CV, Respiratory, Renal, Psychological
What are the cleansing effects of hydrotherapy.
Mostly referring to whirlpool
softens materials, such as scars or wounds allowing for debridement of wounds, antimicrobials may be additive
What are the MSK effects of hydrotherapy ?
- Buoyancy decreases weight bearing
- Resistance provides force for strengthening
- Hydrostatic pressure increases resting muscle blood flow by 100-225% during immersion of the body up to the neck.
What are the cardiovascular effects of hydrotherapy ?
Enhanced venous return as blood is displaced proximally from extremities by hydrostatic pressure
central blood volume increases 60%, cardiac volume by 30% leading to a 30% increase in cardiac output
This results in a slower HR, therefore, RPE should be used to assess effort level.
What are the respiratory effects of hydrotherapy ?
Increased work of breathing due to chest wall compression, increased circulation in chest cavity, it becomes harder to get air in
What are the renal effects of hydrotherapy ?
increased urine production from increased renal blood flow, increased central blood volume, decreased ADH and aldosterone
increased Na and K excretion in cold water.
What should you inform patients of doing before getting into a pool ?
Empty their bladder
Describe the advantages and disadvantages of hydrotherapy for: heating and cooling
advantages: perfect contact with skin, allows movement
disadvantages: dependent position ( upright immersion) may aggravate edema.
What are the common uses of water exercise ?
increase circulation, muscle strength, joint viscoelasticity, flexibility, ROM, ambulation, coordination, CV conditioning, psychological well being. Leads to decreased pain, muscle spasm, and stiffness.
How does hydrotherapy aid edema control ?
Hydrostatic pressure results in increased circulation and renal control, cold water may also vasoconstrict vessels leading to decreased vascular permeability
AVOID HOT WATER IMMERSION WITH EDEMA.
What are the benefits of hydrotherapy for wound care ?
accelerates wound healing, facilitates rehydration, softening, and debridement, may improve circulation
What is the general range of temperatures that is appropriate for multiple common disorders?
79-90 F
What temperature of water is recommended for patients that would benefit from analgesia, vasodilation, relaxation, and improved connective tissue mobility ?
96.2-98.2 F
What temperature of water is recommended for patients with spasticity, MS, or longer immersion times to avoid fatigue and overheating ?
86-94 F
What are the contraindications for local and full body immersion for hydrotherapy ?
local: maceration around a wound, bleeding
full body: cardiac instability, infectious conditions that may spread through the water, bowel and incontinence, severe epilepsy, suicidality
What are the contraindications and precautions for negative pressure wound therapy ?
contraindications: necrotic tissue, untreated osteomyelitis, malignancy in the wound, untreated malnutrition, exposed vessels, nerves, or organs, non-enteric and unexplored fistulas, exposed anastomotic sites
precautions: anticoagulant therapy, difficult hemostasis, confusion/disorientation
What are some precautions for local immersion and full body immersion in hot water ?
local: impaired thermal sensation locally, infection, impaired mentation, recent skin grafts
full body: pregnancy, MS, poor thermal regulation
What are some precautions for full body immersion of any temperature ?
confusion, disorientation, alcohol ingestion, limited strength, ROM, balance, endurance, urinary incontinence, medications, fear of water, respiratory issues.
What are the effects of compression?
improves venous and lymphatic circulation
limits the shape and size of tissue
increases tissue temperature
Reduces edema
Prevents DVTs through increased blood flow
Which is better for the control of venous and lymphatic circulation, static or intermittent compression ? Why ?
Intermittent, because it ‘milks’ fluids from proximal to distal vessels, it is more like a pump which mimics the bodies natural pump
How does an increase in tissue temperature aid scar formation ?
May increase activity of temperature sensitive collagenases
What are the clinical indications for external compression ?
Edema control, DVT prevention, VI ulcers, residual limb shaping post amp, control of hypertrophic scarring
What are some different causes of edema ?
Imbalance between hydrostatic and osmotic pressure inside and outside of vessels, venous or lymphatic obstruction, increased capillary permeability, immobility, pregnancy
When should you not treat with compression ?
When patients edema is due to systemic causes, typically indicates CHF, and compression may worsen situation.
What are some contraindications to compression therapy ?
ABI <.8
heart failure or pulmonary edema
Recent or acute DVT
obstructed lympathic or venous return
Severe PAD
acute local skin infection
hypoproteinemia
acute trauma/fracture
arterial revascularization
What are some common precautions to compression?
impaired sensation/mentation
uncontrolled HTN
Cancer
Stroke/ Cerebrovascular Insufficiency
Over superficial peripheral nerves that may be easily compressed.
What is the range of compression for DVT prevention ?
16-18 mmHg worn for 24h/day
What is the range of compression for scar tissue control ?
20-30 mmHg
What is the range of compression for edema control ?
30-40 mmHg
