Hydrotherapy: Stanbridge University 2023 PDF

1 ©Stanbridge University 2023 Hydrotherapy Source: Bellew 2016  2 Objectives ©Stanbridge University 2023 By the end of this pre...

1 ©Stanbridge University 2023 Hydrotherapy Source: Bellew 2016  2 Objectives ©Stanbridge University 2023 By the end of this presentation, the student will be able to describe the following: Types of Hydrotherapy The physical properties of water Physiological responses and Mechanical effects of water Therapeutic benefits of hydrotherapy Components and care of a therapeutic whirlpool Benefits of aquatic exercise and water activities Benefits of hydrotherapy for wound management General technique/application, Dosage and Frequency for aquatic/hydro- therapy Indications, contraindications and precautions for aquatic/hydro- therapy  3 ©Stanbridge University 2023 Hydrotherapy Defined The use of water to facilitate healing and exercise to enable patients to achieve therapy goals Types: ▫ Aquatic or pool therapy (focus for this course) ▫ Whirlpool hydrotherapy ▫ Contrast bath  4 ©Stanbridge University 2023 Physical Properties of Water: Buoyancy Buoyancy Principle: the buoyant force on a body immersed in a fluid is equal to the weight of the fluid displaced by that object Source: Bellew 2016  5 ©Stanbridge University 2023 Physical Principles and Properties of Water Center of Buoyancy (COB)= sternum Center of Gravity (COG) anterior to sacrum Functionally COB and COG are similar Note: When a patient loses a limb, the patient will side bend toward the residual limb to maintain balance in the water.  6 ©Stanbridge University 2023 Physical Properties of Water: Buoyancy If a body part is immersed in water, the buoyant force reduces force of gravity on the body Buoyancy–assisted (BA): Vertical movement directed parallel to vertical forces of buoyancy that assist motion Buoyancy-supported (BS): Horizontal movement with vertical forces of buoyancy eliminating or minimizing the need to support an extremity against gravity Kisner 2012  7 ©Stanbridge University 2023 Physical Properties of Water: Buoyancy Buoyancy-resisted (BR): Movement directed against or perpendicular to vertical forces of buoyancy, creating drag Buoyancy- super (supra) resisted (BSR): Use of equipment increases total surface area moving through water or increasing speed of movement creating greater drag Kisner 2012  8 ©Stanbridge University 2023 Source: Bellew 2016  9 ©Stanbridge University 2023 Physical Properties of Water: Buoyancy Objects that are denser than water: less buoyant: will sink -increased bone density Objects that are less dense than water: more buoyant: will float -fully inflated lungs -obese individuals (lower specific gravity)  10 ©Stanbridge University 2023 Depth of Body- Weight bearing Neck- 10% weight-bearing Chest- 25% weight-bearing Waist- 50% weight-bearing Just above knees- 65% weight-bearing Source: Behrens 2014  11 ©Stanbridge University 2023 Hydrotherapy Exercises consider different effects of buoyance and body weight in each of these Source: Bellew 2016  12 ©Stanbridge University 2023 Physical Properties of Water: Viscosity Source: www.pikrepo.com Viscosity: Internal friction present in liquid secondary to the cohesive properties between the molecules resists the movement of an extremity through water faster the limb is moved through water → more resistance encountered Viscosity of Honey vs Water  13 ©Stanbridge University 2023 Physical Properties of Water: Hydrostatic Pressure DEF: Force that the water exerts on the body or parts Varies depending on the depth that the body part is immersed Example: body immersed in water up to the neck less hydrostatic pressure against trunk and shoulders compared to feet → more resistance exercising at greater depths  14 ©Stanbridge University 2023 Physical Properties of Water: Hydrostatic Pressure Increased pressure at greater depths may encourage venous return in a proximal direction from the LE’s May assist with increasing lymph flow and decreasing edema However: dependent position of body part may cancel this effect Also: heat + dependent position may actually encourage LE swelling  15 ©Stanbridge University 2023 Hydrostatic Pressure The larger arrows indicate higher hydrostatic pressure (Deeper water) Source: Bellew 2016  16 ©Stanbridge University 2023 Physical Properties of Water: Hydrodynamics Turbulent water creates more resistance to movement Therefore: exercising in turbulent Source: www.pikist.com water will provide more resistance compared to exercise in water that is at rest ▫ Frontal resistance: resistance of initiation of movement ▫ Greater the surface area the greater the resistance  17 ©Stanbridge University 2023 Physical Properties of Water: Hydrodynamics Laminar flow: Horizontal flow of water passing over a body part in motion ▫ More irregular the flow, the greater the drag Drag: pull from behind inhibiting forward motion ***Energy requirements in an aquatic environment have been reported to be 33% to 42% greater than compared to land exercises Source: Behrens 2014  18 ©Stanbridge University Hydrodynamics 2023 Laminar (streamline) flow Turbulent flow Michlovitz’s (Bellow) Fig. 5.4  19 ©Stanbridge University 2023 Physiological Effects of Water Effect on: Hemodynamics Respiratory System Renal System Neurological System Muscular System  20 ©Stanbridge University 2023 Hemodynamics: Cardiac Function Dive Reflex: cardiovascular effects that occur when most of the body is immersed (head/face out of water) Bradycardia Peripheral vasoconstriction Shunting of blood to vital organs →Depends on temperature of the water: Warm or Hot Water: Increases heart rate Water at Body Temperature: Neutral effect on HR  21 ©Stanbridge University 2023 Respiratory and Renal Systems Respiratory System: Hydrostatic pressure against chest: inhibits lung expansion Increased circulation to center of body inhibits lung expansion Lower maximal oxygen uptake vs. land-based exercise  22 ©Stanbridge University 2023 Respiratory and Renal Systems Renal Function: Increased urine output Increased sodium excretion Increased potassium excretion * Empty bladder prior to Source: www.pixnio.com entering pool*  23 ©Stanbridge University 2023 Neurological System Warm Water: relaxing Cold Water: stimulating or invigorating  24 ©Stanbridge University 2023 Muscular System Increased muscular blood flow (warm water) Relaxation of muscle spasms (warm water, agitation of water→ increased sensory stimulation of water against skin, resulting in analgesia and breaking of pain-spasm cycle) Increased strength: exercising in water against turbulence/resistance Stimulation effects: cold water Analgesia: cold or warm-hot water  25 ©Stanbridge University 2023 Physical Properties of Water: Thermodynamics / Heat Transfer Physiological effects of hydrotherapy depend on the following: 1. Temperature of the water 2. Amount of the body that is immersed 3. Whether person is at rest or moving  26 ©Stanbridge University 2023 Physical Properties of Water: Thermodynamics / Heat Transfer Heat Transfer from water to tissues: Body and Water at rest: convection + some conduction Patient moving in water (or) when water moves across the skin’s surface: convection Water creates heat loss 25x faster than air  27 ©Stanbridge University 2023 Aquatic Therapy and Water Temp Flexibility, strengthening, gait training and relaxation may be performed in temperatures between 78.8-91.4 °F Chronic pain and muscle spasm 94°F or greater Cardiovascular training and aerobic exercise for non- compromised cardiopulmonary systems should be between 78.8-91.4 °F Intense aerobic training >80% HRmax should be performed in lower temperatures to minimize risk of heat illness  28 ©Stanbridge University 2023 Aquatic Therapy and Exercise Kisner pg 295 Special populations Rheumatoid arthritis- higher temps: 104°F- 110°F Spasticity- lower temps up to 20-45 min: 92 °-96 °F Multiple Sclerosis- lower temp, limited time 81-83 °F  29 ©Stanbridge University 2023 Hydrotherapy: Pool/Aquatic Therapy General technique/application 1. Choose appropriate water temperature 2. Review medications, precautions, contraindications 3. Safety, clothing, shoes (slippery surfaces), changing areas 4. Transfers, assistance Levels: ramps, stairs, lifts, ladders 5. Fear of water, expectations 6. Equipment: floats, paddles, vests, flippers, weights, treadmill, etc.  30 ©Stanbridge University 2023 Progression of Exercise Exercises in the water can be made more challenging (progressed) in the following ways: 1. Increasing the surface area of the moving body part 2. Exercising against turbulence 3. Exercising against buoyancy 4. Increasing the speed at which the body part is moving 5. Increased rate of change in direction of moving body part 6. Increasing the depth at which you are exercising the moving part (or exercising just at the surface- surface tension)  31 ©Stanbridge University 2023 Hydrotherapy: Outcomes Measure Effect on Impairments: ✓ Pain ✓ Joint ROM ✓ Strength ✓ Edema ✓ Balance & coordination ✓ Assessment of Function (i.e. Functional Independence Measure, Oswestry Low Back Pain Disability Questionnaire, etc.)  32 ©Stanbridge University 2023 Hydrotherapy Aquatic Therapy Documentation Water temperature Duration of tx. Goals of pool therapy Exercises/Movements performed Assistive equipment used Patients' tolerance/response to tx. including vital signs Means of entry/exit Any adverse reactions Post-pool therapy changes in impairments/functional limitations  33 ©Stanbridge University 2023 Hydrotherapy- Evidence I Neto et al, Hydrotherapy on exercise capacity, muscle strength and quality of life in patients with heart failure: A meta-analysis. International Journal of Cardiology, 2015; 198: 216-219 ▫ Hydrotherapy can increase exercise capacity in patients with heart failure I Al-Qubaeissy et al, The effectiveness of hydrotherapy on the Management of Rheumatoid arthritis: A systematic review. 2012, Musculoskelet. Care ▫ Some evidence to suggest hydrotherapy can reduce pain and improve the health status of patient’s with RA  34 ©Stanbridge University 2023 Clinical Controversy! High cost of resources: more expensive than land-based programs Does chronic nature of some conditions justify long- term aquatic programs? Can patient’s do just as well with land-based programs? What is the optimal number of sessions per week? When do you D/C from PT and progress to community-based aquatic programs?  35 ©Stanbridge University 2023 Whirlpool Hydrotherapy Use of water agitated by and attached electric motor Use had decreased because of infection concerns and expense of use Force of running water (turbine, faucet or pulsed lavage) can: ✓ Debride loose necrotic tissue ✓ Cleanse wound of contaminants ✓ Softening effect may facilitated debridement However: ✓ May damage new granulation tissue ✓ May cause maceration of intact skin  36 ©Stanbridge University 2023 Whirlpool Hydrotherapy: Indications Indications: ▫ Debridement or preparation for debridement of wounds ▫ Stage III or IV Chronic pressure ulcers with less than 50% necrotic tissue ▫ Cleaning wounds containing excess exudate, loose debris or foreign bodies, or localized infection ▫ Venous and Arterial ulcers  37 ©Stanbridge University 2023 Chronic Pressure Ulcers Stage III Pressure Ulcer Hydrotherapy Whirlpool treatment for wound care Source: Pierson and Fairchild 2018  38 ©Stanbridge University 2023 Whirlpool Hydrotherapy Precautions Contraindications Healing wounds with Split or full thickness grafts granulation tissue IV line Edematous extremities Colostomy Sensitivity or allergies to Incontinent additives in water Fever Catheter Seizure disorders Tracheostomy  39 ©Stanbridge University 2023 Whirlpool Hydrotherapy Source: Bellew 2016  40 ©Stanbridge University 2023 Hydrotherapy: Hubbard Tanks Large, full body immersion tank (basically body size whirlpool) Source: Behrens 2014  41 ©Stanbridge University 2023 Hydrotherapy: Whirlpool Turbine Source: Bellew 2016  42 ©Stanbridge University 2023 Hydrotherapy: Whirlpools General technique/application: 1. Explain process, review precautions, contraindications, medical status, etc. 2. Temperature: 92-96o F wound 3. PVD: no >1oC (T°C x9/5+32) over their skin temperature 4. Cardiovascular or Pulmonary disease: 96-98oF 5. Inspect for skin Temp, edema, open lesions, color, muscle spasm, sensation 6. Position comfortably (use padding, pillows); may need straps to stabilize position 7. Don’t leave unattended 8. Some whirlpools may require lifts; consider transfer status  43 ©Stanbridge University 2023 Hydrotherapy: Whirlpools Dosage: 20 minutes if using for heating benefits ✓ always consider medical diagnosis ✓ wound debridement: 5-20 min. Responses to whirlpool/modifications ✓ Dependent position of extremity: edema ✓ Use towel/padding: don’t constrict circulatory or lymphatic systems ✓ Normal: Pink, wrinkled skin, mild perspiration  44 ©Stanbridge University 2023 Whirlpool Cleaning Must be drained & cleaned after each treatment Spray or squirt disinfectant in tank Let set 5 min Wash with wet cloth Rinse with water Wipe outside of tank with stainless steel cleaner Source: Behrens 2014 Material Safety Data Sheet- used for all cleaners and disinfectants  45 ©Stanbridge University 2023 Turbine Disinfecting Turbine in bucket One full squirt of disinfectant to each gallon of water (read bottle) Set turbine to lowest speed Fill bucket to cover lowest air hole on turbine Run x 5 min or greater Empty dirty water from bucket and refill with clean water Run for turbine for another 5 min  46 ©Stanbridge University 2023 Whirlpool Effectiveness Affects Inflammatory phase of wound Warm water vasodilation of superficial vessels Increase in O2 and Nutrients to area; removal of waste Fluid shifts into interstitial space and increases edema Softening and loosening of necrotic tissue Cleaning and removal of wound exudate Mechanical effects of whirlpool stimulate granulation of tissue Sedation an analgesia are induced by warm water  47 ©Stanbridge University 2023 Hydrotherapy: Pulsed Lavage Pulsed Lavage with Suction (PLWS) Description: deliver wound irrigation under pressure -controlled pressure of pulsations of irrigants into the wounds (saline, tap water) Source: Bellew 2016  48 ©Stanbridge University 2023 Hydrotherapy: Pulsed Lavage Purpose and Effects: modality for the irrigation and debridement of open wounds. Goals: decrease bacteria and infection in the wound and promote granulation and epithelialization Indications: wounds caused by arterial insufficiency, venous insufficiency, diabetes, pressure, small burns, surgery, trauma Source: Bellew 2016  49 ©Stanbridge University 2023 Hydrotherapy: Pulsed Lavage ▫ Precautions: bleeding wounds, facial tissues, near sensitive tissues (major blood vessels and nerves); patients taking anticoagulants: potential for hemorrhage; insensate patients ▫ Contraindications: on or near recent tissue grafts, flaps, or surgical procedures (consult surgeon), exposed vessels, nerves, tendons, joint capsules, bone, wounds that extend into body cavities (use extra caution with deep tunneling wounds) ▫ Dosage: 15-30 minutes; 4-15 psi; daily- 3x/week ▫ Responses/modifications: if painful: decrease psi, get Rx. for pain meds, use topical lidocaine prior to treatment  50 ©Stanbridge University 2023 Contrast Baths Source: www.rtpr.com Source: www.123RF.com  51 ©Stanbridge University 2023 Hydrotherapy: Contrast Baths ▫ Description: Alternating immersion in hot and cold baths ▫ Purpose and Effects: Vascular pumping through alternating vasodilation and vasoconstriction: may help stimulate local circulation (however, limited to superficial vasculature only) ▫ Indications: pain relief, desensitization- specifically CPRS, DOMS ▫ Precautions, Contraindications: based on the effects of heat, cold, and water; patients who have precautions or contraindications for the use of heat, cold, or water should not receive contrast baths Studies: contrast baths can INCREASE edema (avoid use in acute stage of injuries)  52 ©Stanbridge University 2023 Contrast Bath Technique: 2 tubs or whirlpools: Cold tub: 55°-65oF Hot tub: 100°-110oF Hot: Cold water ratio at 3’:1’ or 4’:2’ RA patients: start with 6’ and 4’ then alternate at a ratio of 3’:1’ (or 4’:2’) Dosage: Total treatment time 25-30 minutes Last immersion: hot water for chronic condition Last immersion: cold water for edema Responses to contrast baths/modifications: Normal: pink, wrinkled skin  53 ©Stanbridge University 2023 Objectives At this point, the student will be able to describe the following: The physical properties of water Therapeutic benefits of hydrotherapy Components and care of a whirlpool Benefits of aquatic exercise and water activities Benefits of hydrotherapy for wound management Physical properties of water and how they can be beneficial, assistive and challenging for a patient Components of a therapeutic whirlpool