Hydrotherapy Past Paper PDF

 Swelling & Improved Circulation The picture can't be display ed. • How many crepe bandages does hydrostatic pressure produce?  Range of Movement & Flexibility • Buoyancy assists movement • postural tone assists pain‐free movement Increasing Muscle Strength 1. DIRECTION OF MOVEMENT  Buoyanc...

 Swelling & Improved Circulation The picture can't be display ed. • How many crepe bandages does hydrostatic pressure produce?  Range of Movement & Flexibility • Buoyancy assists movement • postural tone assists pain‐free movement Increasing Muscle Strength 1. DIRECTION OF MOVEMENT  Buoyancy assisted movement  Buoyancy eliminated movement  Buoyancy resisted movement Increasing Muscle Strength 2. ALTERATION OF TURBULENCE  Speed of movement  Streamlining (or surface area) Increasing Muscle Strength 3. CHANGE DENSITY OF LIMB  Men or women  Weights  Floats Density changes the ability to float or the persons symmetry Improve Postural Control Standing ‐ correct posture Facilitation of Head Righting & Balance Reactions • Head righting • Head righting in ring • Balance when walking Balance • • • • • • • Static (eyes open, closed) Balance board On step to make it more difficult Dynamic Bend down to get object Turbulence Fear (put ring on them ‐ not safety device) Over‐riding fact is that many of these things can be achieved more easily in water than on land ‐ but we must progress to land Self-efficacy and motivation Balance in Older Adults • “The Effect of Land & Aquatic Exercise on Balance Scores in Older Adults.” Journal of Geriatric Physical Therapy Vol 26, 2003 • “A Water‐based program that includes perturbation exercises to improve stepping responses in older adults: study protocol for a randomized controlled cross‐over trial.” BMC Geriatrics 2008, 8:19 Why do “land” balance activities in the pool? Improve balance for land function Putting on shoes & socks Co‐ordination & Movement Initiation Without the Fear of Falling Re‐education of Function • Bed mobility • Sit to stand, posture • Walking ‐ speed, different surfaces (slopes, steps), change direction, endurance, bare feet • Balance ‐ static, dynamic, functional reach • ADL (reaching toes, putting trousers on, bathing, toilet hygiene, doing up bra) Bed mobility Rolling in a ring Roll on plinth in pool Sit to stand • Sit to stand with less body weight than on land – increase endurance, strength Walking Getting up from ground Carries over to land?? Changes in Sensory Input • • • • Visual Vestibular Proprioceptive Tactile Decrease Neurological Muscle Tone • • • • Easier positioning of heavy adults Can maintain sustained stretch Can do multiple stretches at same time Warmth & relaxation help  tone Improve fitness Relaxation, Improved Psychological Well Being & Motivation Conditions Treated in Aquatic What evidence is there and what measures do we use? • Growing evidence • More than some “traditional” physiotherapy treatment • The same measures that we use on land Patients requiring rehabilitation who can be treated in the Hydrotherapy Pool • • • • • • Orthopaedic Spinal Arthritic Sports Injuries Neurological Cardiac • • • • • • Oncology Chronic Pain Respiratory Psychiatric Ageing Disabled Obesity Orthopaedic 1. Compacted fractures, stress fractures 2. Post-plaster mobilisations 3. Dislocations 4. Muscle and tendon injuries 5. Joint reconstructions, arthroscopies Impacted # humerus Patient able to achieve only small amount of movement on land due to pain but able to move pain free in the pool several days after #. Joint Replacements • • • • • • • Day 4‐5 Waterproof dressing Pain‐free movement Gait retraining Functional activities Cardiovascular Crutch walking exercise Total Hip or Knee Replacement Surgery Rahmann, A., Brauer, S., & Nitz, J. (2009), A Specific Inpatient Aquatic Physiotherapy Program Improves Strength After Total Hip or Knee Replacement Surgery: A Randomized Controlled Trial. Arch Phys Med Rehabil Vol 90, May 2009 Gill, S., McBurney, H., & Schulz, L. (2009), Land‐Based Versus Pool‐Based Exercise for People Awaiting Joint Replacement Surgery of the Hip or Knee: Results of a Randomized Controlled Trial. Arch Phys Med Rehabil Vol 90, March 2009 Hinman, R., Heywood, S. & Day, A.,(2007) Aquatic Physical Therapy for Hip and Knee Osteoarthritis: Results of a Single‐Blind randomized Controlled Trial. Physical Therapy Volume 87 Number 1 January 2007 Spinal Conditions 1. Acute back pain 2. Disc injuries with referred pain 3. Osteoporosis, crush fractures 4. Chronic back pain: spinal stenosis 5. Post laminectomies The best way to treat backs? Rest vs early mobility Spine : “The key thing is to encourage gradual mobilization within the limits of pain and early return to appropriate activity/work.” Acute Back Pain • Fusions • Laminectomies • Crush fractures ‐ osteoporosis CONCLUSION: • Although both the aquatic and land interventions produced significant increases in overall spinal height, the aquatic intervention produced greater pain relief and centralization response in subjects with low back pain and signs of nerve root compression. • The researchers did a comprehensive search of PubMed, the Cochrane Library, Embase & Cumulative Index to Nursing & Allied Health from their inceptions to November 2016 for randomized controlled trials, which used therapeutic aquatic exercise for low back pain. • Eight trials involving 331 patients were included in the meta‐analysis. Conclusion: Aquatic exercise can statistically significantly reduce pain and increase physical function in patients with low back pain. Further high‐quality investigations on a larger scale are required to confirm the results. Sporting Injuries! • ACL repairs • Stress fractures • Soft tissue injuries • Post game recovery • Fitness during recovery from injury A dancer does the splits with the assistance of buoyancy! Arthritic Conditions Osteoarthritis Rheumatoid arthritis Ankylosing spondylitis Fibromyalgia Arthritic conditions affect all ages Water exercise is beneficial for patients of all ages but children especially want to move and play in water and so exercise their joints very easily. Systematic review and meta‐analysis comparing land and aquatic exercise for people with hip or knee arthritis on function, mobility and other health outcomes. Batterham, S, Heywood, S etal. BMC Musculoskelet Disord. 2011; 12: 123. 10 randomised, controlled clinical trials that compared land to aquatic exercise for adults with arthritis were included. Conclusion Overall, aquatic and land based exercises appeared to result in comparable outcomes for participants. On the other hand aquatic exercise appears neither more nor less effective than land based exercise. For people who have significant mobility or function limitations and are unable to exercise on land, this is extremely important. Unusual variants of Arthritis Weight loss patients /Morbidly Obese • All screening data apply • Ensure that facility has resources to cater for patients needs including seating and the ability to rescue patient from the pool • Be aware of limitations of hoist eg maximum load • Identify Occupational Health and Safety risks For children Other Conditions • Psychiatric Conditions ‐ Relaxation ‐ Activity therapy ‐ Compensation neurosis • Ageing disabled • Cardiac rehabilitation • Cancer care Oncology Neurological Conditions 1. Cerebrovascular accidents 2. Parkinson's disease 3. Multiple sclerosis 4. Spinal cord injuries and disease 5. Motor Neurone Disease 6. Cerebral Palsy (Botox & Baclofen pumps) Parkinsons Disease ‐ stride length Aquatic Physiotherapy Assess Diagnose Measure Treat Re‐assess Evaluate of outcomes Physiotherapists working in water should work to the same acceptable clinical standards and practices as land based physiotherapists Aquatic Physiotherapy Individual Treatment Group Treatment Class Prescribed Exercise Programs (PEP) or “Self Care” Individual Treatment: • Assessment, measure, reassessment, evaluation of outcomes • At this point make decision as to best possible treatment • Time as for initial or standard land based assessment and treatment plus pre‐screening • Charge for initial or standard land based treatment plus Pool Use fees Group Treatment: • Patients may be grouped for a number of reasons: Pool availability, condition, cost or insurer • Most would have had an initial assessment and follow up treatment (land or water) • All should have measurable outcomes • Participants will have progressed to needing no hands on • Will have individualized exercise program • Have exercise supervision, progression, correction etc Class • Usually grouped by condition eg arthritis, antenatal, backs • “Follow the leader” • Often no outcomes/measures • Often no progression ie: doing the same thing 6 months later • Can be run by a range of exercise professionals • Usually lower fee • Patients will take as the cheaper option Prescribed Exercise Program: • Patients will often progress on to self management and carry out their exercise program unsupervised. • Should have individual program (not generic ‘back program’). • Should be reviewed at intervals if problems recurs or does not continue to improve. • Should be noted that physio is not present. Hydrotherapy Aquatic physiotherapy Water exercise Family support Swimming, fitness