Physiological Effects Of Hydrotherapy PDF

Physiological Effects of Hydrotherapy Dr. Basma Ibrahim, MSc, PhD Cairo university Lecturer in Egyptian Chinese University  Content Effects Of Water On Effects Of Water On Cardiovascular...

Physiological Effects of Hydrotherapy Dr. Basma Ibrahim, MSc, PhD Cairo university Lecturer in Egyptian Chinese University  Content Effects Of Water On Effects Of Water On Cardiovascular Effects Of Water On Effects Of Water On Musculoskeletal System Respiratory System Renal Function System (Hemodynamics)  EFFECTS OF WATER ON CARDIOVASCULAR SYSTEM (HEMODYNAMICS)  Content: Effect of cold Table of water Dive reflex and Introduction and warm water temperature and Precautions on it’s cardiovascular physiological system effect  Introduction The hemodynamic effects of hydrotherapy include local changes in circulation and systemic effects on cardiac function. The water’s temperature will either increase localized circulation secondary to vasodilation or decrease localized circulation secondary to vasoconstriction Effect of cold and warm water on cardiovascular system Generally, warm water temperatures of about 95.9°F (35.5°C) will result in vasodilation. Cold water temperatures below 80.6°F (27°C) will cause vasoconstriction. Table 5-2 summarizes the physiological effects of commonly used water temperatures for hydrotherapy.  Dive reflex Immersion of the entire body except the head or immersion of only the face will result in a set of cardiovascular effects known as the (dive reflex). Shunting of These effects Peripheral Bradycardia, blood to vital include vasoconstriction organs. However, these effects are dependent on the water’s temperature  When exercising in water, Immersion in water at monitoring heart rate may Immersion in warm or body temperature has a not be an accurate reflection hot water increases heart neutral effect on heart of cardiovascular stress. rate. rate. Therefore, monitoring perceived exertion is preferred over monitoring of heart rate.  Precautions The effects on the cardiovascular To limit the effects on the system (sudden vasoconstriction, cardiovascular system, it is decrease in heart rate, and best to enter the water slowly, increase in heart volume from wetting the face and hands increased venous return) may not first, and avoid full-body be tolerated by some, particularly immersions in cold water. those with cardiovascular deficits.  Effects Of Water On The Respiratory System  Content Effect of different levels Advantages of of immersion in water hydrotherapy on Precautions on respiratory system respiratory system Effect of different levels of immersion in water on respiratory system Immersion of the whole body in water increases the work of breathing because the shift of venous blood from the peripheral to the central circulation increases the circulation in the chest cavity, and hydrostatic pressure on the chest wall increases resistance to lung expansion. Immersion in water up to the neck has been shown to decrease expiratory reserve volume by approximately 50% and to decrease vital capacity by 6% to 12%; these effects, when combined, increase the total work of breathing by approximately 60%. Advantages of hydrotherapy on the respiratory system Water-based exercise is often recommended for patients with (exercise induced asthma) because studies have shown that it is less likely to cause asthma in these individuals than exercising on dry land and that is because of Various factors including: 3) High humidity of the air inspired during water 1) The absence of pollen 2) Hydrostatic pressure on exercise, prevents drying or over the water the chest cooling of the respiratory mucosa. Precautions Patients with respiratory or cardiovascular impairments should always be carefully monitored during water- based exercise, because of the additional respiratory demand that may overload those patients and prevent or limit adaptation to the additional workload  Effects Of Water On Renal Function  Content Mechanism of the Basic effect of Advantages of effect of hydrotherapy on hydrotherapy on hydrotherapy on renal function renal function renal function  Basic effect of hydrotherapy on renal function Immersion of an individual up to the neck in water has been shown to increase urine production and excretion of urinary sodium and potassium.  Mechanism of the effect of hydrotherapy on renal function That cause increased Water immersion that cause redistribution increase urine renal blood flow and increases hydrostatic of blood volume and the production and decreased production of pressure of water on the relative central excretion of urinary antidiuretic hormone periphery hypervolemia sodium and potassium. (ADH) and aldosterone.  Advantages of hydrotherapy on renal function These renal effects can be taken advantage of to treat patients with hypervolemia, hypertension, or peripheral edema. In patients with chronic kidney disease, comparing no exercise to low- intensity water exercise twice weekly for 12 weeks was found to improve kidney and cardiorespiratory function and to decrease resting blood pressure. Effects Of Water On the Musculoskeletal System  Content Effect of buoyancy Velocity and on patients with buoyancy effect on Effect of buoyancy musculoskeletal resisted and on obese subjects injuries and assisted exercise in problems water  Effect of buoyancy on patients with musculoskeletal injuries and problems The buoyancy of water unloads weight-bearing anatomical Thus, patients in a pool may be structures and thus allows able to perform weight-bearing patients with load-sensitive joints exercises or walk unassisted to perform exercises with less with a normal gait pattern, when trauma and pain. For example, they can perform these activities at 75% immersion, weight on dry land only with the support bearing on the lower extremities of crutches. is reduced by 75%. The load-reducing effect of water buoyancy can help patients with arthritis, ligamentous instability, cartilage breakdown, or other degenerative or traumatic conditions perform and progress more rapidly with rehabilitation activities.  Effect of buoyancy on obese subjects Buoyancy can particularly help obese patients, for whom land-based exercise places extreme stresses on weight-bearing joints. Because obese individuals have more low-density, subcutaneous fat than average weight people, they are more buoyant in water, so water- based activities reduce their joint loading even more. Therefore, it may be used to restore fitness in obese patients. Recent research has found that weight loss in obese people is similar when exercise is performed in water or on dry land if the exercise intensity, duration, and frequency are similar. Therefore water-based exercise is now recommended both for improving fitness and function of obese patients and for safer and more comfortable weight loss  Velocity and buoyancy effect on resisted and assisted exercise in water The velocity-dependent resistance provided by water can be used to increase extremity strength in patients with musculoskeletal, cardiovascular, and neurological diseases such as fibromyalgia, arthritis, heart failure, and multiple sclerosis and can maintain strength in healthy individuals. In general, aquatic training provides effects on strength similar, but not superior, to land-based training. If the direction of water flow is adjusted to be in the same direction as the patient's motion, the resistance of the water can also be used to aid the patient's motion.  Aquatic Therapy Content Precaution Disadvantage Definition Indications Contraindications Advantages s s  Definition Refer to treatments and exercises performed in water for relaxation, fitness, physical rehabilitation, and other therapeutic benefit. Indications  Aquatic therapy has wide therapeutic applications for: 1) Patient with exercise induced asthma 2) Pediatric 3) Geriatric 4) Neurological 5) Cardiopulmonary 6) Orthopedic patients 7) Postoperative conditions 8) Athletes 9) Inadequate orofacial control 10) Hypersensitive disorder 11) Pregnancy  Exercise-induced asthma: Water-based exercise including swimming is well suited to patients with exercise-induced asthma, particularly children, because the water environment reduces the incidence of asthma in these individuals while increasing their fitness Older adults specifically can use aquatic exercise because it is thought to be particularly helpful in age- related deficits and resulting in increased strength, functional mobility, balance, and quality of life. Patients with balance problems can benefit from aquatic therapy because hydrostatic pressure and buoyancy help to support the body. Hydrostatic pressure provided by deeper water can help move fluids upward, which can assist with improving circulation insufficiency in cardiopulmonary disease. A recent systematic review on the effectiveness of therapeutic pools in the management of rheumatoid arthritis concluded that there is a short-term reduction in pain and improvement in the health status of patients compared to no or other interventions. However, the long-term benefits require further studies. There are several effects of therapeutic aquatic exercises on symptoms and functions in individuals with lower limb osteoarthritis such as (significant effect on pain, physical functioning, stiffness, and quality of life). Patients with chronic low back pain have benefited from aquatic exercise programs. Aquatic exercise programs also can be beneficial for patients following total joint replacements Athletes can benefit from aquatic therapy because water becomes an environment that requires the same functional physiology used in competitive sports. Sport-specific movement patterns can be performed in water, and their intensity can be increased over time, depending on the athlete’s functional improvements on land. Patients who have inadequate orofacial control can benefit from hydrotherapy by working on lip closure and bubble blowing in water. Patients with hypersensitivity disorders can benefit from aquatic therapy by gradually immersing one extremity at a time into the pool along with performance of enjoyable activities in the pool to help decrease hypersensitivity Exercise in water may be particularly appropriate for pregnant women because it unloads the weight-bearing joints Contraindications  Contraindications content Bleeding Bowel or bladder incontinence Infectious diseases Tracheostomy Uncontrolled seizures or sever epilepsy Respiratory compromise, vital capacity less than 1 L Alcohol ingestion Cardiac instability Bleeding: immersion hydrotherapy in warm or hot water should not be applied if bleeding is in or near the area to be treated because the bleeding will be increased due to increase arterial circulation as a result of vasodilation. Bowel or bladder incontinence: if this is uncontrolled, patient cannot enter pool because of danger of cross-contamination of other tissues and other people in the pool. Infectious diseases: contraindication for aquatic therapy because of the danger of spreading infection to others in the pool. Tracheostomy: contraindication because of respiratory concerns. Uncontrolled seizures or sever epilepsy: contraindication because of danger of having a seizure while in the pool. Respiratory compromise, vital capacity less than 1 L: contraindication if immersion is likely to exacerbate symptoms Alcohol ingestion: full-body water immersion should be avoided if the patient has ingested alcohol because the impairment of judgment and cognitive functions that occurs with intoxication and the hypotensive effects of alcohol ingestion can increase the risk of drowning. Cardiac instability: Full-body immersion is contraindicated in patients with cardiac instability such as uncontrolled hypertension or heart failure because the heart in such circumstances may be unable to adapt sufficiently in response to the changes in circulation produced by hydrotherapy to maintain cardiac homeostasis. Precautions  Precautions content 1) Patients who are fearful of water 2) Patients with neurological involvement 3) Patients with controlled epilepsy 4) Anyone with problems affecting the cardiovascular system 5) History of aspiration. 6) Catheters 7) Cognitive impairments 8) Tetraplegia or high paraplegia 9) Open wounds 10) Dry skin or skin rashes 11) Impaired thermal sensation in the area to be immersed in case of immersion of body part 12) Poor thermal regulation in case of full body immersion Patients who are fearful of water may experience increased symptoms, such as muscle guarding or losing their balance. So, a gradual orientation to the water, including the use of flotation devices or starting slowly in shallow water to build confidence, may be needed. Patients with neurological involvement, such as those with multiple sclerosis, may fatigue quickly when exercising in water greater than (33°c). Patients with controlled epilepsy may need to be monitored for medication before treatment and responses during treatment. Anyone with problems affecting the cardiovascular system, such as high or low blood pressure or history of angina or heart disease, will require close monitoring during treatment Precautions must be taken if patient has a history of aspiration. Catheters: patients with indwelling catheters require proper clamping and fixation Cognitive impairments: concerns with safety when entering and leaving pool. Must be monitored closely while in pool. Tetraplegia or high paraplegia: monitor patient and temperature of water and air to prevent heat prostration and hypothermia. Open wounds: must be covered with waterproof dressing to prevent infection and maceration of wound tissue. Dry skin or skin rashes: time in pool may exacerbate dryness Impaired thermal sensation in the area to be immersed in case of immersion of body part: as there is increased risk of burns. To minimize this, so always use a thermometer and your hand to check the temperature of the Water to be used for hydrotherapy before the patient enters. Poor thermal regulation in case of full body immersion: because thermal regulation is frequently impaired in elderly adults and in infants, warm or hot water hydrotherapy should be limited to small areas in these individuals. A general rule to follow is patients should be free of bowel and bladder accidents for at least 5 days before pool therapy.  General Advantages Aquatic therapy can be used to (promote relaxation, improve circulation, restore mobility, strengthen muscles, provide gait training with less stress on weight-bearing joints, stimulate the vestibular system, facilitate sleep, increase one’s capacity for stress, and improve psychological state)  Advantages for specific condition Early aquatic therapy was as effective as land-based therapy in improving function in adults in the early postoperative period without increasing risk of wound- related adverse effects. Hydrotherapy is often combined with movement (exercise) for therapeutic effects. Slow rhythmical movements combined with rotary-type motions may decrease spasticity of muscles. The temperature and buoyancy of water combined with decreased body weight and joint compression and the psychological effects of participating in an enjoyable activity can reduce pain and muscle spasms and increase range of motion (ROM). Repetitive exercises in water and swimming strokes can improve coordination, and the warmth of the water can increase blood supply to the musculoskeletal tissues. Turbulence of the water and the speed of movement can facilitate exercises used to increase ROM and strength of the involved extremity and can help to maintain ROM and strength of noninvolved extremities. Kicking exercises in water can stimulate venous return Balance in chest-deep water is easier and recovery from disturbed balance can facilitate head righting and trunk control. Pregnant women who participated in a 1-hour water exercise program three times weekly for 6 weeks had less physical discomfort, greater mobility, and improved body image and health- promoting behaviors than control subjects who did not exercise. Pregnant women who exercise in water can controls peripheral edema; and causes less elevation of heart rate, blood pressure, and body temperature than similar exercise performed on dry land. The buoyancy of water helps alleviate age-related aches and pains during exercise and helps support people who have poor balance on land, while working against the resistance of water also helps increase strength. Cost Building & maintaining a rehabilitation pool Space & personnel Thermoregulation Impact on core body temperature May impact tolerance for participation in heat