physiological 10.pdf

PHYSIOLOGICAL EFFECTS OF HYDROTHERAPY BY Dr.Azza Attia Associate proof. Of Physical therapy Objectives At the end of this lecture the student will be able to:  Describe the physiological effect of hydrotherapy application.  Identify the indications and contraindications for hydrotherapy applicat...

PHYSIOLOGICAL EFFECTS OF HYDROTHERAPY BY Dr.Azza Attia Associate proof. Of Physical therapy Objectives At the end of this lecture the student will be able to:  Describe the physiological effect of hydrotherapy application.  Identify the indications and contraindications for hydrotherapy application.  Enumerate the advantages and dis advantages of hydrotherapy application.  Differentiate between different types of hydrotherapy modalities. Physiological effects of Hydrotherapy 1. Cardiovascular system. 2. Pulmonary system. 3. Renal system. 4. MusculoskeletalT system. Cardiovascular system  During immersion to the chest level in room temperature, the Central F venous pressure is increased as blood displaced centrally secondary to hydrostatic pressure. If  The amount of blood displacement depends on the depth of submersion: increased level of body immersion ,increase hydrostatic pressure, increase blood shift centrally and increase central venous pressure. level F Test Leading to: 1- increase Venus return Edeng If 2-increase stroke volume(volume of __ blood pumped from the left ventricle of the heart with each beat), 6 70 100mL  Normal SV= 70-100ml StrokeVolume 3-increase cardiac output (CO = SV x HR) Heartrate (amount of the blood ejected by the heart per minute),  normal CO = 5,000ml  4- increase muscle circulation CO SUXHR I the amount of blood moved by the heart at any time Patient at risk 06 6  Cardiovascular dysfunction  Coronary artery disease mainartery totheHeart  Deep vein thrombosis DVT m  Cardiac arrhythmia(irregular heartbeats) i If  Cardiomyopathy (group of conditions that affect the structure of the heart and reduce its ability to pump blood around the body) f  angina pectoris (chest pain or discomfort due to coronary heart disease)  cardiac ischemia (Myocardial ischemia) Pulmonary system • The pulmonary blood flow increases secondary to hydrostatic pressure. • the rib cage circumference decreases to about 10% by I the effect of the hydrostatic pressure. Low • By the effect of reducing the rib cage circumference that lead to shortness of breath, rapid breathing • Vital capacity: is the maximum amount of air a person can expel from the lungs after a maximum inhalation. • Secondary to the effect of hydrostatic pressure on the to chest wall , which cause decreases in the Vital capacity by 6-9%. • decreases in the Vital capacity leads to increases the total work of breathing by 60% Patient at risk:  Cardiopulmonary dysfunction  Pulmonary dysfunction E  Respiratory distress when fluid builds up in the  Chest infection 0 tiny, elastic air sacs (alveoli) in the lungs. The fluid keeps lungs from filling with enough air, which means less oxygen reaches your bloodstream so oxygen can’t get to the body organs  Obstructive lung diseases (COPD) inflammatory lung disease that causes obstructed airflow from the lungs (Emphysema and chronic bronchitis) If as Renal system RBf CBF 1- increased renal blood flow secondary to the increase in central blood flow. formation be may 2-Improve renal function Trickey NT 3-increse sodium excretion as a result of improve renal function. 3- Increased central blood flow also causes increased diuresis (micturition) I 4- Reduce the ADH (Aldosterone) hormone level secondary to the increase in central blood flow. 0 so  Hydrotherapy with full- body immersion has been recommended as a treatment for edema in patients with nephrotic syndrome and cirrhosis that is resistant to diuretic intervention a Function of ADH(aldosterone hormone) 1. aid in the conservation of __ ‫املساعدة في حفظ الصوديوم وإفراز‬ ،‫البوتاسيوم‬ sodium and secretion of potassium, 541 I 2. increase water retention . 3. helps to increase the reabsorption of water and ions in the kidneys to maintain sufficient blood volume levels. 4. stabilizing the blood pressure Musculoskeletal system   hydrostatic pressure   blood flow to muscle .   oxygen blood supply __ Promote aerobic muscle exercise.   removal of waste products  relief muscle spasm. O   temperature of the water causes peripheral vasodilatation,  blood flow to the muscles, and an  soft tissue elasticity, which contributes to  joint ROM. Tem Per Vasodi 0 0 patients to perform exercise with less trauma and  The bouncy of water  weight bearing and allow pain on joints.  The resistance provided by water (bouncy) can be used to provide a force against muscle   muscle strength.  The bouncy of the water can be used as active assistance for weak muscle. Therapeutic uses of Hydrotherapy 2 1.Superficial heating and cooling: warm or cold water can be used clinically to heat or cooling I superficial tissues by different modalities (hot packs, ice massage). 2.Wound care: Hydrotherapy can be used to accelerate the healing of wounds by the following: - Facilitate the rehydration us - Softening of necrotic tissues Deadcell - Improve circulation. - Cleaning west products Therapeutic uses of Hydrotherapy 3. Water exercise: Various types of exercise including swimming, running with or without a vest , walking, cycling can be used under water Therapeutic uses of Hydrotherapy 4. Pain control: Hydrotherapy is thought to control pain by providing a high level of sensory stimulation to gate the transmission of pain sensations at the spinal cord. sensory stimulation by: Using hot water Using cold water Using Turbulent water e Therapeutic uses of Hydrotherapy 5.Edema control: Water immersion reduces peripheral edema due to the hydrostatic pressure of water. e rural a O IT There are special apparatus for under water exercises. (A) Fixed apparatus:  1- Hand rail:, it should be attached all around the pool at the level of the surface of the water.  A second rail placed lower down is very useful, especially for exercises in which the patient is in the side lying position and holding onto the rail. (the lower rail should be approximately 45 cm below the surface of the water) e Hand rail Surface g below rail 4C em surface  2-Parallel bars: it is extremely valuable to have parallel bars in the pool. So that gait activities and other exercises can be given to patient . 5s  3- Under water lighting: It is much easier for the physiotherapist to observe the movement if there is under water lighting. F  4- Steps: Steps in the pool should have a hand rail on both sides 5-Mechanical overhead lift: For severally disabled patients (B) Semi-fixed apparatus  1- Submerged plinths: especially for the subject who is severely paralyzed or who is in a lot of pain.  2- Sub merged stool: They must be sufficiently weighted, so that they remain stable on the floor of the pool 6 5 C) Movable Apparatus (Buoyancy Aids) 1- swim discs for the upper limb a 2- Balls and Floating toys: for children training 3-Aqua noodles with different length. Managing Pool therapy  The pool should have a built-in filtration, and chlorinating system. m ventilation, which does not allow  Adequate room is condensation to accumulate on the walls or windows.  There should be a regular maintenance schedule for cleaning at least weekly and tests for water chlorine 0 and pH levels should be performed twice a day. 0 0  There should be shower facilities for cleansing before therapy (36 C) and for cooling down after therapy (30 C to 32 C).  adequate space for patients to rest after therapy for 20 IS minutes and fluid replenishment should be available. Wks  Adequate staffing in the pool depends on the condition of the patient population being treated, and there should be one person present to help the patient a outside the pool 36 30 Contraindications to Hydrotherapy Cardiac dysfunction Infectious diseases Vomiting Urinary infections Suprapubic catheter Severe burns if altered or impaired thermal sensation Contraindications  Severe peripheral vascular disease Bleeding disorders (hemorrhage) Impaired/decreased thermal sensation Bowel or bladder incontinence Respiratory dysfunction Epilepsy E Advantages of hydrotherapy  Free movement with less     risk of injury Decreases weight bearing on joints. Buoyancy may assist weak muscles to allow increased performance of active exercise Has the ability to affect all major body systems. Water can be used in different form and temperature EE Disadvantages of hydrotherapy  Slippery environment with increased risk of falls outside pool  Risk of infection  Difficulty stabilizing or isolating body parts during In exercise  Risk of drowning: suffocate in water, inhale water. Method of heat transfer 3 Methods Conduction • energy is transferred by the direct contact of molecules, not by the movement of the material Example: putting your hand on a stove burner. • Ex: hot Packs Con • Paraffin bath Method of heat transfer Radiation Ei energy is transferred by electromagnetic radiation Example: heat felt when standing away from a large fire. Ex : Infrared- shortwave- microwave Convection 5,3 s energy is transferred by the mass motion of groups of molecules resulting in transport and mixing of properties Ex: Whirlpool tank Hubbard Tank Whirlpool tank: ‫حمامات أو خزانات الدوامة عبارة عن خزانات من الفوالذ املقاوم للصدأ تُستخدم‬ ‫ وتستخدم املاء املثار إلنتاج الحرارة أو التبريد‬،‫لغمر الجسم بالكامل أو جزء منه‬ .‫ والتنضير اللطيف‬،‫ والتدليك‬،‫بالحمل الحراري‬ Whirlpool baths or tanks are stainless steel tanks which are utilized for immersion of all or part of body, use agitated water to produce convective heat or cooling, massage, and gentle debridement Water for the tank can be agitated by turbines which mix air and water. The body part is submerged and can be actively moved during the treatment Types of whirlpool tanks: E According to shape: Lowboy tank Highboy tank 3 Extremity tank 7 According to mobility: Movable Fixed whirlpool tanks Movable For inpatient treatment (weight, wheels, breaks, drainage) fixed For outpatient treatment (weight, drainage) LOW BOY Shape • In the lowboy tank, patient is in the long sitting position and can perform ROM exercises with both knees and ankle • Dimensions width: 24 inches 0 length: 52 – 66 inches depth: 18 inches 1 56 HIGH BOY • In the highboy tank, l patient is seated in chest-high water with flexed hips and knees. • Dimensions width: 20 – 24 inches length: 36 – 48 inches depth: 28-30 inches so EXTREMITY TANK • also called upper or lower extremity tank. • Dimensions width: 15 inches length: 28 – 32 inches depth: 18 – 25 inches Physiological Effects: The whirlpool bath combined the effects of convective heat and gentle massage e The hydromassage has the following effects • Relieve of pain by mechanical stimuli which stimulate gate mechanism for pain inhibition • Mechanical removing of dirties, dead tissue and pus. • Improve local arterial and lymphatic circulation . • Decrease muscle spasm by breaking the pain vicious cycle. • Cleaning and stimulating wound healing. • Improve the recovery time. • Reduction of edema and effusion (by increase fluid dynamics). Indications – Contraindications Indications • Open wound for debridement Contraindications •  Active bleeding  Skin allergy  Varicose veins  Advanced arteriosclerosis  Peripheral vascular disease • • • • • • • purposes Acute or chronic pain and swelling After removal of cast (post fractures) Plantar fasciitis Tendinitis Hand and fingers arthritis or rheumatoid arthritis Joint stiffness Tennis elbow Sprain or strain Tendinitis 0 Advantage and disadvantage of whirlpool Advantages: •It does not occupy a large space. • It is suitable for treatment of limbs. Disadvantages: 1- Time and effort consumption. 2- not suitable for large joints exercises. 3-they need to be cleaned often. 4-Expensive secondary to amount of water. Hubbard Tank Hubbard Tank 0 It is a large bath used for total body immersion of an individual patient, and is usually made of plastic or stainless steel. It looks like a figure of 8 or T shape for practical use allowing the therapist treatment without having to enter the water. - The dimensions of the tank are 2 m long., 1.5 m wide and 60 cm deep. Hubbard Tank (T Shape) (figure of 8 shape) Accessories for Hubbard Tank over head carrier may be used to convey non – ambulatory patient into in and out of the tank.  It can be transported into hydrotherapy tank in a seated position by using a I body sling and an over head carrier. Using one or more turbines for agitation of water for hydro massage effects body sling for partially handicapped patients Physiological Effects: • Same as whirlpool bath and give chance for more exercises for the body. • Active assisted, resisted and stretching exercises can be done Advantage and disadvantage of Hubbard tank • Advantages of Hubbard tank: • 1- Tanks are cheaper to install and maintain • • • • • than other therapeutic pool. 2- The therapist does not have to enter the tank to give the treatment. Disadvantages: 1- Tanks do not have the buoyancy of a pool because of the small volume of water. 2- The number of exercises are limited by the depth of the tank. 3- The therapist can not get as close to the patient as in a pool E Contrast Bath If Contrast Bath 8 8  it is alternate immersions of the body part in hot (40-45°C) and cold (1520°C) water.  warm submersion for 3-4 min and 00 follow with cold submersion for 1 min. 0 The cycle is repeated 3-4 times, with total treatment time 15-30 min.  The injured body part is repeatedly moved between the warm and cold water. to  Contrast therapy causes a local “pumping effect” due to a cycle of vasoconstriction and vasodilation, therefore facilitating the removal of edema. 15 30min Physiological effects • The hot water causes vasodilation, or the widening of the blood vessels, while the cold 0 water causes vasoconstriction, which is when the blood vessels tighten • A contrast bath alternates between these two processes in order to create a pumping action in the area receiving the treatment. • this pumping action increases blood flow and helps to drain excess fluids out of a swollen joint or muscle. therapeutic effects: • Marked vasodilatation occurs immediately • Increase of deeper circulation occurs reflexively. • The skin temperature increases rapidly. • considerable Sensory stimulation as cutaneous hot and cold receptors are alternately activated. • reduce the risk of undesirable clotting by significantly reducing platelet stickiness and aggregation in individuals with risk factors for ischemic heart disease. • helpful in the treatments of infections because the rapid change in temperate increase white blood cell activity. F et • Contrast baths may also increase the elasticity of the ligaments , which may help those with arthritis improve their range of motion. • help fractures to heal better by consensual reflex. is a reflex action in which stimulation of one body part results in a response in another part. E • Alternate vasodilatation and vasoconstriction accelerating recovery in the muscles from strenuous exercise. 5T • Marked sedative effect (pain relief) as Benefits for Athletes • Provides short effective recovery post- exercise. • Reduces muscle swelling and muscle spasms. • Reduce the risk for repetitive strain injuries. • Reduces soft tissue swelling and joint stiffness. • Reduces fatigue – lowers the risk of injury. • Effective in aiding pain relief. • Promotes better circulation. EE Contrast bath for Athletes Indications: • Post-traumatic swelling and edema • Neuropathic pain • Chronic inflammation • Excessive sweating • Chronic sprains and contusions • chronic rheumatologic disease Contra-indications: • Advanced peripheral vascular disease. • Arterial diseases . E • Diabetes • Malignancy • Acute conditions (inflammation- pain)