Whirlpool and Hubbard Tanks Section PDF

Whirlpool Tank  Whirlpools baths or tanks are stainless-steel tanks, which usually are utilized for immersion of all or part of the body, use agitated water to produce convective heat or cooling, massage, and gentle debridement.  The force of water agitation is controlled...

Whirlpool Tank  Whirlpools baths or tanks are stainless-steel tanks, which usually are utilized for immersion of all or part of the body, use agitated water to produce convective heat or cooling, massage, and gentle debridement.  The force of water agitation is controlled by knobs on the pump or turbine. Water direction can be controlled by changing the position of the output nozzle. Temperature may range from 36 to 41 °C. All whirlpools tanks have at least one turbine and can be stationary or mobile  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. Mechanism of action 1. Water agitation stimulates the skin surface mechanically and thermally. This stimulation of the large diameter mechanoreceptors and thermoreceptors produce analgesic effect through the "Gate control mechanism". 2. The mechanical effect of the water irrigation is used for cleaning of open wounds and removal of débris and necrotic tissues. 3. Mechanical irrigation improves peripheral circulation in cases of ulcers secondary to poor circulation. N.B.: Vigorous irrigation can destroy delicate granulation tissues. o Subcutaneous tissue temperature increases by the water temperature which results in increasing blood flow. Types of whirlpool tanks 40  The limb tank is used for immersion of one upper limb, both upper limbs, or the distal lower limb.  The lowboy and highboy tanks are used for lower limb immersion or immersion of the trunk up to the mid thoracic level.  In the lowboy tank, the patient is in the long sitting position and can perform ROM exercises with both knees.  In the highboy tank, the patient is seated in chest-high water with flexed hips and knees. Fig. high and low boy whirlpool Whirlpool Water Temperature (A) Cold whirlpool: - 0°Cto26°C (32° F to 79° F). - Can be used in place of an ice pack or a cold pack, to treat acute inflammatory conditions of the distal extremities. Low temperatures can be achieved by adding ice to the whirlpool water; however, very low temperatures should not be used on large areas due to the increased risk of tissue damage. 41  (B)Tepid water: - 26° to 33° C (79° to 92° F). - Should be used in the whirlpool if the water is being used solely as a medium for exercise. Warmer temperatures are likely to produce fatigue and colder temperatures can inhibit muscle contraction (C) Neutral warmth - 33° to 35.5° C (92° to 96° F). - Should be used for the treatment of open wounds and in patients with circulatory, sensory, or cardiac disorders. Neutral warmth may also be used to control tone in patients with neurologically based hypertonicity. (E) Hot whirlpool: - 37° to 40°C (99° to 104° F). - Is recommended for the control of pain and/or to increase soft tissue extensibility because this temperature range of whirlpool water has been shown to increase the temperature of subcutaneous tissue to within the range required to produce these effects. - 40° to 43° C (104°) to - The higher end of this temperature range is recommended for the treatment of chronic condition, such as osteoarthritis or rheumatoid arthritis in the non-acute phases, when small.areas are being treated, while the lower end of this range is recommended when large areas of the body are to be immersed. - The whirlpool temperature should not exceed 43° C (110° F) at any time because higher temperatures may cause burns. - The tank should be filled with water immediately before it is used to prevent the water temperature from changing excessively between filling and patient immersion. If an antimicrobial is being used, it should be added to the water as the whirlpool is being filled. Physiological effects of Whirlpool tank: 42  This tank combines the values of convective heat and gentle massage. The hydromassage can produce attenuation of pain and muscle spasm. By a) Producing vasodilatation. b) Improving local arterial and lymphatic circulation. c) Breaking down old adhesions after sprains or fractures. d) Cleansing and stimulating wounds (low temperature used), e) Mechanical removing of dirties, dead tissue and pus g) Causing regression of inflammatory processes, and h) Reduction of edema and effusion. Indications of whirlpool tank  Open contaminated wounds. - Contractures  Burns - Muscle spasms  degenerative arthritis -Acute musculoskeletal injuries  Skin ulceration and infection  Patients who are morbidly obese and immobilized who cannot be cleaned in another manner after immobilization or casting Contraindication of whirlpool 1. Diabetes and varicose vein 2. advanced arteriosclerosis. 3. advanced peripheral vascular disease Practical application of Whirlpool tank  Select the proper size and /or style of bath according to the size and need of the patient. 43  The whirlpool; tank is filled with water and check the water temperature by a thermometer.  If the bath is made of full stainless steel, the water temperature can be initially slightly higher than desired as the heat will rapidly radiate through the stainless steel.  The water intake holes of the agitator must be well under the water before starting the motor, as the water intake cools the motor.  Add disinfectant, to the recommended concentration for mild antiseptic and for psychological purposes (this addition is optional)  Adjust the position of patient according to the treated part, ( comfort and security) and remove all clothing from the part to be treated and as much other doming as a necessary for comfort and to prevent its saturation with water.  Place the part in the water.  In some instances of joint involvement, encourage the patient to move the part during the treatment, keeping it underwater.  If treating wounds and patches of dead tissues are removed by the agitated water, then shut off the agitator occasionally to remove the pieces of tissues from (lie water to avoid stopping up the agitator).  Gentle stretching of tight structures and even hand massage may  be done by the therapist while the limb is under water, f After the treatment, inspect the part.  If massage is to be given, keep the part wrapped and wanned until it can be done.  Temperature: Water temperature is determined by the amount of the body submerged, patient health, and goals of treatment. A hand or limited portion of a limb with intact sensation may tolerate temperatures up to 45 °C. With immersion to the waist, decrease water temperature to 40-41°C. If most of the body is submerged, decrease water temperature to 38-39°C. Duration: 20-45 min. 44  General care before and after each patient may include:  Empty the tank after use, or be sure proper water recirculation is occurring (ie, agitator intake and outflow is clear).  Scrub the inside of tank with a commercial disinfectant. Rinse tub with clean water. Dry the tank.  Polish external surface of tank with a commercial stainless steel polish.  All electrical outlets should have a ground fault circuit interrupter and should be of the highest industry quality standard available. At no time should a patient or staff person who is touching or in water be allowed to switch a circuit on or off.  All electrical outlets should be positioned so that persons being treated are not easily able to turn the agitator on or off. Fig. whirlpool application for upper and lower limb Advantages: 1- It does not occupy a large space. 2- It is suitable for treatment of limbs. 45 Disadvantages: 1- Tune and effort consumption. 2 -Edema is induced if the patient does not move the part inside the bath. 46  Hubbard Tank - It is a large bath used for total boy immersion of an individual patient, and is usually made of plastic or stainless steel. - It looks like a figure of 8 or a key hole for practical use allowing the therapist treatment without having to enter the water. - The dimensions of the tank are two 240 cm long  180 cm wide  120 cm depth - Water stretcher and 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 body sling and an over head carrier. - Using one or more turbines for agitation of water. Some of them have a jet hose to be used for special hydromassge effects or to give under-water douche. Physiological effects of Hubbard tank: Same as whirlpool bath and give chance for more exercises for the body. - Active assisted, resisted and stretching exercises can be done Indications and Contra - Indications of Hubbard tank: As whirlpool bath. Practical application of Hubbard tank:  Explain the procedure of treatment lo the patient to prevent the 47  development of fear of water'  The patient should be dressed in a cotton loin cloth and halter when needed. - Ear stoppers are not recommended but the ears may be protected by using a small lamb's wool pad coated with petroleum jelly on the inner side. - The pad is held in place by the bathing cap.  The patient is lifted into the tank by means of either a hand operated hoist or an electrically powered overhead hoist.  The patient lies on a canvas stretcher which is attached to the hoist by  cables or he sits in a canvas body sung.  Lower the patient slowly in water.  The cables are detached from the sling or stretcher.  The stretcher is placed on an angle by putting the head End on a stool placed in the tank for that purpose. This is to raise the patient's head so that it is comfortably supported outside of the water.  Apply a cold compress to the patient's head and allow him to lie in the water a few minutes (adjustment period) before starting the exercises.  The patient may be given cool drinks to replace water lost in perspiration.  The tank may by used for immersion baths, but generally some form of therapeutic exercises is done active - assertive, (active resisted exercises and stretching shortened muscles)  The patient should be handled carefully when being removed form the tank.  Avoid pressure on the painful areas:  Free the head end of the submerged plinth and attach the hoist cables to it.  Lift the patient and transfer him to a dry plinth.  Move him quickly and if possible shift the body in one piece. 48  lifting the pelvic area place the hands under buttocks and lift upward.  Use a draw sheet for heavy patients.  The patient should be covered to protect the body form air drafts.  Dry the hair and cover the head with a dry towel and let the patient rest after the treatment. Fig. application of hubbard tank in different conditions Temperature. 3 6 - 41 °C Lower temperature : used for muscle re-education or active exercises. 49 Higher temperature: used for cerebral palsy children, relaxation of muscle, sedation, stretching soft tissues. The temperature of the water and the pressure of the whirling water are easily controlled. Duration: 15 -30 min. Precautions: I- The patient should not be left alone when he is in the Hubbard tank. There is a danger of accidental drowning with some patients who are too severely disabled to protect themselves. II- The following measures should be taken into consideration to prevent cross- infection: a- Patients with communicable diseases as skin rashes or cold are either not allowed into the tank or are put into the tank alone. b- Only well children or poliomyelitis patients in the subacute stage are placed together in the tank. c- Use clean water for each patient or each group of patients. Advantages of Hubbard tank: 1- Tanks are cheaper to install and maintain than other therapeutic pools' 2- The therapist does not have to enter the tank to give the treatment. 3- The tank requires a small amount of space. 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 and size of me tank. 3- The therapist can not get as close to the patient as in a pool. 50