HYDROTHERAPY TECHNIQUES 23-24.pdf

HYDROTHERAPY TECHNIQUES General Intervention Methods Degree in Physiotherapy USP-CEU SCHEME HYDROTHERAPY TECHNIQUES CLASSIFICATION 1.TECHNIQUES WITHOUT PRESSURE ABLUTIONS, AFFUSIONS. WRAPS, COMPRESSES, FOMENTA...

HYDROTHERAPY TECHNIQUES General Intervention Methods Degree in Physiotherapy USP-CEU SCHEME HYDROTHERAPY TECHNIQUES CLASSIFICATION 1.TECHNIQUES WITHOUT PRESSURE ABLUTIONS, AFFUSIONS. WRAPS, COMPRESSES, FOMENTATIONS BATHS HOT PACKS, PARAFFIN, PELOIDS, PARAFANGOS SAUNA, STEAM BATHS. 2. TECHNIQUES WITH PRESSURE SHOWERS, JETS, WHIRLPOOL BATH, SUBAQUATIC MASSAGE. 3. POOL THERAPY HUBBARD TANK, POOLS AND SWIMMING. 2  TECHNIQUES WITHOUT PRESSURE ABLUTIONS Application of water by a hand covered with a towel dipped in cool/cold water and wrung out prior to application. Entire body is draped except for the treatment area. Fast application to avoid cold loss. 3  TECHNIQUES WITHOUT PRESSURE ABLUTIONS LOCAL/REGIONAL/GENERAL APPLIED IN CENTRIPETAL DIRECTION. Most frequent: UPPER-BODY LOWER-BODY WHOLE-BODY 4  TECHNIQUES WITHOUT PRESSURE ABLUTIONS After ablution the body is not dried but covered with blankets for 30 minutes. Never begin this treatment with a patient feeling cold or cold feet or in a cold room. The body must be warm before and after. 5  TECHNIQUES WITHOUT PRESSURE AFFUSIONS The pouring of water in a stream on the body/segment without pressure. Water is applied using a rubber tube at 10 cm from the body surface and pointing downwards with the patient seated, leaning forward or lying down. 6  TECHNIQUES WITHOUT PRESSURE AFFUSIONS Cold (less 20ºC) for 1 minute. Hot start from neutral (34-36ºC) till 45ºC for 3-5 minutes. Alternant affusions: 38-42ºC for 1-2 minutes 10-16ºC for 20 seconds Repeated 3 times, starting by hot. 7  TECHNIQUES WITHOUT PRESSURE AFFUSIONS When the application is finished, water is removed with the hands so the skin remains wet. The application is followed by physical exercises, a massage or friction followed by rest (wrapped) for 30-60 minutes (till vasodilation reaction occurs). 8  TECHNIQUES WITHOUT PRESSURE ABLUTIONS & AFFUSIONS INDICATIONS Depend on water temperature and duration. Finish a heat treatment Stimulate blood flow to the skin (general tonic) Bedridden patients Antipyretic method: warm water and cold water every 20-30 min Insomnia and anxiety. 9  TECHNIQUES WITHOUT PRESSURE BODY WRAPS Hydrotherapy treatments in which the patient in decubitus is wrapped first in sheets and then in layers of blankets. They can be dry/wet, hot/cold, partial/total. A body wrap is formed by: A wet linen sheet in contact with the patient’s body. A linen sheet A wool/flannel blanket. 10  TECHNIQUES WITHOUT PRESSURE BODY WRAPS APPLICATION The table is covered with a blanket and 2 sheets. Patient should be naked or partially dressed lying on the sheet and is quickly wrapped in it. The sheet is tucked in snugly around the patient’s neck so that no air escapes. Patient should rest for: 30-120 minutes in cold wraps (10-20ºC) or 20-30 minutes in hot wraps (40-45ºC) (till perspiration) 11  TECHNIQUES WITHOUT PRESSURE BODY WRAPS APPLICATION After that time, unwrap the patient If he/she continues sweating, a bath should be given followed by drying and covering for a rest period of 30-60 minutes more. 12  TECHNIQUES WITHOUT PRESSURE BODY WRAPS INDICATIONS Cold wraps: fever, weakness and insomnia. Local wraps with ice: contusions, sprains, haematomas. Hot wraps: To reduce joint stiffness in chronic degenerative rheumatisms (arthritis) and chronic pain. As an antispasmodic method in renal, uterine, biliar and urinary colics. Stimulate inmune system. Contraindications: the same as cold and hot thermotherapy applications. 13  TECHNIQUES WITHOUT PRESSURE COMPRESSES AND FOMENTATIONS Local application on the body surface using a folded cloth dipped in water. Hot or cold. Fomentation: When a poultice or herbal medicine is used apart from the water. 14  TECHNIQUES WITHOUT PRESSURE COMPRESSES AND FOMENTATIONS Compresses are made of linen / cotton / flannel They are wet beforehand and wrung out and then folded in several layers before application. There are different forms and sizes. Over the wet cloth, there is a dry towel and then a woollen blanket to adjust the compress to the body. The patient will rest in decubitus. 15  TECHNIQUES WITHOUT PRESSURE COMPRESSES AND FOMENTATIONS Cold compresses (10-20ºC) are applied for 15-60 minutes. When the compress gets hot, it should be changed or wet in cold water every 10 minutes. Cold water or ice can be used. local cryotherapy method Hot compresses (40-45ºC), they are less wrung out and should be covered the same as cold compresses. superficial thermotherapy agent Contraindications: the same as cold and hot thermotherapy. 16  TECHNIQUES WITHOUT PRESSURE WHOLE BODY-BATHS Immersion are performed in bathtubs, tanks or pools with the patient immersed to the neck. Bathtub: thermal actions are predominant. Tanks/Pool immersions, mechanical and thermal actions are predominant. Spa bathtubs: thermal and hydrokinetic factors are present. 17  TECHNIQUES WITHOUT PRESSURE REGIONAL BATHS Half baths: This is one in which the patient sits waist-deep in hot water so that the upper body is entirely out of the water. Three-quarter baths: In which the patient sits chest/nipple-deep. 18  TECHNIQUES WITHOUT PRESSURE REGIONAL BATHS Sitz baths: Warm bath used for cleansing or healing purposes. Patient sits in the bath and water covers only the hips and buttocks. Hemorrhoid surgery Episiotomy Sciatica Dysmenorrhea Kidney stone pain 19  TECHNIQUES WITHOUT PRESSURE PARTIAL BATHS HAND OR FOOT baths. VERY HOT HOT COLD CONTRAST BATHS 37-44ºC 11-20ºC 20  TECHNIQUES WITHOUT PRESSURE HOT BATHS Temperature: 37-40ºC total baths Up to 45ºC partial baths Superficial thermal agents Duration: 5-20 minutes. Procedure: Start with 37ºC and increase 1ºC per minute till 40-45ºC. After the bath, patient will be dryed and rest for 1 h. 21  TECHNIQUES WITHOUT PRESSURE COLD BATHS Temperature: 11-20 ºC total baths Sensitivity: hotter temperatures Body part introduced slowly and progressively Duration: variable 10-20 seconds: Total baths 30 seconds: Partial baths short applications. 15-20 min: reduce pain, muscle spasm, edema. 22  TECHNIQUES WITHOUT PRESSURE TYPES OF COLD BATHS GENERAL BATHS, which reduce body temperature faster in hyperthermia or heat stroke, and are also used during a sauna to reverse vasodilation of skin after a heat treatment. PARTIAL BATHS: hand baths, foot baths and sitz baths (haemorrhoids). 23  TECHNIQUES WITHOUT PRESSURE CONTRAST BATHS They combine immersions in both hot and cold water, and are mainly used to treat extremities. Two tubs are needed: ✓one with hot water (37-44ºC) ✓another with cold water (11-20ºC). Patient should place his/her extremities in the tubs alternatively 24  TECHNIQUES WITHOUT PRESSURE CONTRAST BATHS Procedure: 1) Start with the hot tub for 7-10 minutes. 2) 1 minute in the cold tub 3) 4 minutes in the hot bath. This is repeated for 30 minutes usually finishing with the hot bath. Changes should be done quickly. 25  TECHNIQUES WITHOUT PRESSURE CONTRAST BATH’S EFFECTS The baths cause dilatation and constriction of the blood vessels of the skin surface stimulating local blood flow in the treated extremity. They also stimulate the contra-lateral extremity circulatory system leaving the patient feeling both relaxed and invigorated (Passive Vascular Exercise). 26  TECHNIQUES WITHOUT PRESSURE CONTRAST BATH’S INDICATIONS ✓ Subacute phases of peripheral joint arthritis and sprains to reduce swelling and to increase local blood flow. ✓ Inflexible stumps after amputation. ✓ In the early states of peripheral vascular diseases (Raynaud) Disease or intermittent claudication with a greater spasmodic component. ✓ Reflex Sympathetic Dystrophy 27 TECHNIQUES WITH PRESSURE SHOWERS JETS WHIRLPOOL BATH SUBAQUATIC MASSAGE. 28  TECHNIQUES WITH PRESSURE SHOWERS AND PRESSURE JETS Streams of water directed upon one or more parts of the body. Whole body A part of the body. Showers/Douches are stream of water from a showerhead full of holes which provides numerous streams. Pressure jets refer to a unique stream of water without the need of a showerhead. 29  TECHNIQUES WITH PRESSURE SHOWERS AND PRESSURE JETS Mechanical and thermal effects Effect depends on: Area of the body treated. Water temperature. How hard the spray hits the body. Treatment duration. The mechanical stimulation of the stream stimulates skin receptors that are sensitive to pressure. Effects: ▪ Sedative ▪ Adhesions release ▪ Analgesic ▪ Increased blood flow ▪ Muscle relaxation ▪ Lymphatic and venous drainage 30  TECHNIQUES WITH PRESSURE SHOWER CLASSIFICATIONS SHAPE BODY AREA WATER TEMPERATURE PRESSURE SPECIAL SHOWERS 31  SHOWERS CLASSIFICATION SHAPE IN WHICH WATER IS PROJECTED OVER THE BODY SPRAY/NEEDLE/CIRCULAR SHOWER RAIN SHOWER FAN SHOWER FILIFORM SHOWER 32  SHOWERS CLASSIFICATION BODY AREA IN WHICH WATER IS APPIED TOTAL-BODY SHOWER PARTIAL-BODY SHOWER ABDOMINAL SHOWER ARM SHOWER 33  SHOWERS CLASSIFICATION WATER TEMPERATURE COLD COOLED HOT VERY HOT WARM NEUTRAL CONTRAST/SCOTTISH SHOWER 38-40ºC 20-25ºC 34  SHOWERS CLASSIFICATION PRESSURE CLASSIFICATIONS Affusions (no pressure) to filiform shower (6-12 atm) SPECIAL SHOWERS Vichy shower-massage Subaquatic shower 35  TECHNIQUES WITH PRESSURE GENERAL PRESSURE JETS/PERCUSSION SHOWERS A very strong spray of water, applied with a hose to the posterior aspect of a patient’s body in a perpendicular way to the body surface. ✓ Position of patient: standing ✓ Jet Pressure: 1-3 atm ✓ Distance: 3 – 4 m ✓ Temperature: Hot jets 37-40ºC Cold jets 20-25ºC ✓ Duration depends on patient tolerance and indications. Normally 2 to 5 minutes. https://www.youtube.com/watch?v=Hg71O-8HnuQ&t=10s 36  TECHNIQUES WITH PRESSURE COLD DOUCHE This is a single stream of water under pressure used/applied at a distance of 2-3 m from the patient. The temperature may be regulated and they can be general/local. Followed by rubbing. It is a powerful stimulant and useful for its tonic effect after the hot-air bath and circular douche. Indications: Anemia, insomnia, headaches, acne, chronic constipation, malnutrition, intoxication 37  TECHNIQUES WITH PRESSURE NEEDLE/SPRAY/CIRCULAR SHOWER Water is projected horizontally against the body in very fine sprays from many jets arranged at different heights using an upright system of tubes connected to a control panel. There is a sharp stimulus to the skin from these innumerable jets of small caliber (needles) → allows higher pressures. ✓ Duration: 1 -2 minutes ✓ Temperature: no more than 40ºC 38  TECHNIQUES WITH PRESSURE RAIN SHOWER The rosette is an apparatus behind the head of the patient and at a moderate angle to strike the back of the neck and shoulders. These douche also use small sprays not as fine as the spray douche. ✓ Pressure: don’t need to be very important (not harm head) ✓ Temperature: neutral to hot ✓ Duration: 2 to 4 minutes 39  TECHNIQUES WITH PRESSURE SCOTTISH SHOWER Applied by one operator using 2 hoses (one hand for hot water and the other for cold water) to change temperature. It is not applicable to the head or the anterior chest, but may be applied to: ▪ spine ▪ posterior thorax ▪ abdomen ▪ lower extremities 12 minutes: 3 cycles starting with: 1. Hot applications (38-40ºC) (1-3 minutes). 2. Cold applications (20-25ºC) for ¼ or 1/6 40  TECHNIQUES WITH PRESSURE SCOTTISH SHOWER EFFECTS/INDICATIONS A strong general stimulus. Insomnia, stress and depression, to stimulate blood flow to skin, and as a general tonic. To prevent muscle soreness after exercise and to speed recovery after vigorous exercise. Very hard to tolerate. https://www.youtube.com/watch?v=hr1hAq7tnsQ 41  TECHNIQUES WITH PRESSURE SWISS SHOWER It has multiple showerheads mounted on the shower wall at different levels and on all sides of the patient. The entire body is sprayed from head to toe. Swiss showers may have outlets in all four corners of a shower stall with 8-16 streams of water coming from each outlet. 42  TECHNIQUES WITH PRESSURE FAN SHOWER A fan-shaped stream Usually cool or cold Used to finish a treatment. ✓ Duration: 10 seconds ✓ Temperature: 25.6 - 26.7ºC. 43  TECHNIQUES WITH PRESSURE FILIFORM SHOWER It is an extremely small douche applied at high pressure. Duration: 30 seconds to 2 minutes. Acting as a skin counterirritant and stimulant. Useful in sciatica and neuralgias. It is mainly used for skin lichen lesions, acne, pruritus and burns. 44  TECHNIQUES WITH PRESSURE AIX DOUCHE/MASSAGE DOUCHE A combination of the douche with vigorous massage individual chambers. It requires the services of 2 operators, both provided with a flexible tube or hose, carrying water at different pressures. Combination of a massage with a thermal sulphurous water application (with temperature variations from cold to very hot water) at the same time. 45  TECHNIQUES WITH PRESSURE VICHY SHOWER It is a metal arm with 5-7 shower heads that run parallel and at a distance of 60-80 cm to a cushioned treatment table where the patient is lying down. Massage applied by 1-2 persons. Tempertaure: cold / warm / hot and contrast temperatures are used. A general shower at 37ºC is recommended before. Duration: 35-40 min. followed by a rest of 40 min. https://www.youtube.com/watch?v=I4I0zL8HTXw&t=13s 46  TECHNIQUES WITH PRESSURE SUBAQUATIC JETS The patient, inside a hot bath-tub, receives a water pressure jet. Jet temperature: hot or cold, being 1-2ºC hotter than the bath-tub water temperature. The massage applied with the jet can be general or local, manual or automatic. 47  TECHNIQUES WITH PRESSURE TUBS WITH JETS / JACUZZIS / HOT TUBS-SPAS Small pools containing jets of water or air or both, big enough for more than one person (40ºC) They also contain equipment that heats and recirculates the bath water. Water is not drained out at the end of the bath but treated with chemicals to disinfect it. Indications/contraindications are the same as for hot baths. 48  TECHNIQUES WITH PRESSURE TYPES WHIRLPOOL (AREA) Whole body whirlpools: Burns and pressure sores. Arm/Leg whirlpools indications: to relieve joint stiffness and muscle spasm in arm/leg, to make exercise easier and to relieve pain. posttraumatic pain, cleansing wounds, scar tissue contractures from burns, wounds or adhesions, acute trauma, swelling and muscle spasm. 49  TECHNIQUES WITH PRESSURE TYPES WHIRLPOOL (TEMPERATURE) Very cold and cold: Acute inflammatory conditions of distal extremities. Combined with exercises. 5-15 minutes. Tepid: to perform exercises and in acute conditions. Neutral: open wounds and circulatory, sensory or cardiac disorders and to control muscle tone. Mild warmth: Burns once epithelialization has begun. 50  TECHNIQUES WITH PRESSURE TYPES WHIRLPOOL (TEMPERATURE) Hot and very hot: control pain and increase soft extensibility in chronic conditions and to remove necrotic tissue. 20 minutes, necrotic tissue (5-20 min). Combined with exercises: 10-30 minutes. ❖ Cardiovascular illnesses: no more 38ºC. 51  TECHNIQUES WITH PRESSURE WHIRLPOOL Wound treatment indications Delay primary wound closures: dog bites. Venous stasis ulcers. Skin grafts and skin flaps. Opened pain lesions (ischemic ulcers, burns). 52  TECHNIQUES WITH PRESSURE WHIRLPOOL Wound treatment: to remove necrotic tissue, to stimulate granulation tissue formation, to soften tissues, to stimulate blood circulation over the affected area to increase tissue oxygen and nutrients, to produce an analgesic and a calming effect over the injured and surrounding tissues to clean the wound using germicidal agents. 53  TECHNIQUES WITH PRESSURE WHIRLPOOL PROCEDURE When the treatment is completed, the limb is removed from the water, dried and inspected. The operator should cover the limb with a towel. In the case of treating an open wound, a clean, pressurized rinse is recommended to remove bacteria, both tanks and turbines being drained and cleaned after use. 54  HUBBARD TANKS To facilitate the mobilization in water. Individual treatment Full body immersion Sizes and forms: clover, butterfly, keyhole, figure-of- eight. With a hoist and turbine for turbulences Stainless steel or ceramic 55  HUBBARD TANKS RHEUMATOID ARTHRITIS in exarcebation phase. BURNS OPEN WOUNDS INCONTINENCE 56  BIBLIOGRAPHY Cameron MH. Physical Agents in Rehabilitation: From Research to Practice. Elsevier, 2012. · Bélanger AY. Evidence-Based Guide to Therapetic Physical Agents. Elsevier Churchill Livingstone 2002. · Cole AJ, Becker BE. Comprehensive Aquatic Therapy. 3rd edition, USA. Washington State University Publishing, Pullman WA. 2011. Brody LT, Geigle PR. Aquatic Exercise for Rehabilitation and Training. Champaign, IL, USA. Human Kinetics Publishers. 2009. Güeita J, Alonso M, Rodríguez C. Terapia acuática: Abordajes desde la fisioterapia y la terapia ocupacional. Elsevier. España. 2015. Pérez-Fernández, Mª Reyes. Principios de hidroterapia y balneoterapia. Madrid: McGraw-Hill Interamericana de España. 2005 57