Physical Agents in Rehabilitation - FLUIDOTHERAPY PDF

Physical Agents in Rehabilitation FLUIDOTHERAPY FLUIDOTHERAPY Learning outcomes The student should be able to: 1. Describe the principles of fluidotherapy 2. Explain the physiological effects of fluidotherapy 3. Explain the therapeutic effects of fluidotherapy 4. Outline the appli...

Physical Agents in Rehabilitation FLUIDOTHERAPY FLUIDOTHERAPY Learning outcomes The student should be able to: 1. Describe the principles of fluidotherapy 2. Explain the physiological effects of fluidotherapy 3. Explain the therapeutic effects of fluidotherapy 4. Outline the applications of fluidotherapy  5. Explain the contraindications to fluidotherapy 6. Outline the Advantages and disadvantages of fluidotherapy 7. Given a patient case demonstrate the safe and effective application of fluidotherapy. FLUIDOTHERPAPY Superficial heating modality To fluidize - To cause finely divided particles to acquire the characteristics of fluid Heat transmitted by forced convection - forced movement of heated air contd The unit Contains cellulose particles, a heating element and an air compressor. Warm air is forced through the particles which become suspended. Temp. of tank: 46.1- 50.6 deg C Particles have low specific heat capacity and low thermal conductivity Varying degrees of agitation can be used  continued Size of unit Varies to accommodate hands, feet or back For back, patient lies on a net. The body part is introduced into tank through a sleeve which fits around proximal portion of limb. contd Number of openings vary Limb is free to move during therapy. Therapist can assist with exercise. Fluidotherapy Fluidotherapy  Controls Time Temperature Air speed Pulse time Preheat timer Clock “Press to change mode” “Increase”, “decrease” arrows  Treatment time Adjustable from 1- 99 minutes Default is 20 minutes Temperature Adjustable from 31.1- 54 deg C Default temperature is 46.1 deg C Air speed Adjustable from 0-100 Default is 50  Pulse time Pulses the medium “on and off” Adjustable from off to 6 seconds Default 5 secs Pre-heat timer Pre-heats the medium Unit will pulse until pre-heat temp is reached or for 90 minutes Clock Procedure Instruct patient to wash hands and remove jewelry Assess patient Check skin. If there are open wounds cover if necessary Check thermal sensation Check other contraindications Explain what is to be done and why Insert part into sleeve and close sleeve over proximal portion of limb Procedure continued Set timer – 20 minutes Set temperature Set blower speed (agitation) Instruct patient to exercise if this is desired At end of treatment loosen sleeve, remove particles and inspect skin Assess treatment effectiveness Physiological Effects Heat production. Increased tissue temperature Increased blood flow- 6-fold increase Increased metabolism- 4-fold increase Increased extensibility of collagen Relaxation of muscle Mechanical stimulation of skin  Findings from research 1. Fluidotherapy at 47.78 deg C for 20 minutes resulted in: Temperature rise of 9 deg in joint capsule of thumb, 0.5 cm below skin Temperature rise of 5.2 deg C in flexor hallucis brevis (Borrell, 1980) These were higher than temperature increases produced by paraffin  2. 20 minutes of fluidotherapy (48 degC) applied 5 times per week for 3 weeks produced significant reduction in swelling of the hand and significant improvement in ADL in a group of 30 persons with stroke (Sang Woo Han, 2017). Indications Promotion of tissue healing Desensitization of skin after injury Chronic oedema Adhesions Muscle spasm Pain relief- counter-irritation through mechanoreceptor stimulation Contraindications and precautions Severe circulatory obstruction Impaired sensation Dermatological conditions Recent strong analgesia Bleeding disorders Acute inflammation Over malignancies Lack of comprehension Maintenance of unit Clean inlet filters at the end of each week Refill with cellulose as necessary Inspect sleeves and repair Launder sleeves each week with anti-bacterial detergent Advantages Unit is convenient and easy to operate Heat is distributed over entire limb area Free limb movement is possible Very little pressure is applied to treated area Therapist can mobilize limb Can be used for limb with bandage, cast, splint Temperature constant throughout session No plumbing required, no towels necessary Varying sized units Minimal maintenance Disadvantages Relatively expensive to purchase Existing units do not allow for treatment of hips and shoulders Spilling of particles will make floor slippery Units are relatively large. Much floor space needed to accommodate units and chairs Videos https://www.youtube.com/watch?v=IKIJE2WVquE https://www.youtube.com/watch?v=2mWvPludnio Case study The patient is a 38 year old construction worker who had his right hand crushed under a heavy weight while at work 3 months ago. He suffered fractures to his 2nd, 3rd and 4th proximal phalanges and to his 2nd and 3rd metacarpals and he dislocated the MP joint of his thumb. His hand was immobilized in a splint for 6 weeks. He is unable to return to work due to significant loss of function. Examination reveals decreased ROM of flexion, extension and opposition of the thumb, decreased ROM of flexion and extension of 2nd, 3rd and 4th MP joints; weakness of intrinsic muscles and pain with closing  1. Can the patient be helped with therapeutic heat? 2. What stage of the injury-healing continuum is he in? 3. What are the specific goals to be achieved? 4. What are the proper application procedures?