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HYDROTHERAPY

HYDROTHERAPY. Aila Nica J. Bandong, PTRP Instructor Department of Physical Therapy Clinical Supervisor CTS- Pediatric Section College of Allied Medical Professions. Learning Objectives. At the end of the lecture, the students should be able to: Define hydrotherapy

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HYDROTHERAPY

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  1. HYDROTHERAPY Aila Nica J. Bandong, PTRP Instructor Department of Physical Therapy Clinical Supervisor CTS- Pediatric Section College of Allied Medical Professions

  2. Learning Objectives At the end of the lecture, the students should be able to: • Define hydrotherapy • Identify the chemical, physical, and thermal properties of water • Enumerate the therapeutic effects of hydrotherapy • Identify the factors that affect thermal effects of water • Differentiate the types of water immersion modalities • Identify the parts of a whirlpool bath • Enumerate the indications, contraindications, and precautions/guidelines for the use of the modalities • Identify common additives in whirlpool therapy • Use clinical decision making skill in choosing appropriate water immersion modality • Learn how to operate a high-buoy tank • Apply evidence regarding use of water immersion modalities in practice

  3. Chemical Properties of Water

  4. CHEMICAL PROPERTIES • Pure water is a polar molecule consisting of 2 molecules of Hydrogen and 1 molecule of Oxygen

  5. Physical Properties of Water

  6. CONSTANTS • freezing point: 0 degree Celsius • boiling point: 100 degrees Celsius • density: at 0 degree Celsius- .999868 at 4 degrees Celsius- 1.0000 • pH: 7 • specific heat: 1.00

  7. FORCES EXISTING IN WATER • buoyancy • hydrostatic pressure • cohesion • viscosity • surface tension

  8. Buoyancy • upward force exerted on an immersed object OPPOSITE to gravity Archimedes’ Principle: a body immersed in a liquid experiences an upward force equal to the weight of the displaced liquid • affected by postural alignment, surface area, weight of bones in relation to muscle and fat, and vital capacity

  9. Hydrostatic Pressure • ratio of magnitude of force per surface area Pascal’s Law: pressure exerted by water is equal in all parts of the object • tends to increase as depth and density increases

  10. Cohesion • force between same molecules • tendency to attract each other

  11. Viscosity • friction between molecules • property of water that resists motion within it • leads to resistance to flow • FLUIDITY • Dependent on: • speed/velocity of movement of liquid • shape of the body

  12. Surface Tension • surface of liquid acts as a membrane under tension • increased attractive forces on the surface

  13. HYDROMECHANICS • laminar flow • All molecules are parallel • turbulent flow • Molecules are erratic/not parallel • drag • Cumulative effect of turbulence and fluid viscosity

  14. Thermal Properties of Water

  15. SPECIFIC HEAT • amount of heat (calories) needed to raise the temperature if 1 gram of substance by 1 degree Celsius • 1 calorie • high specific heat prevents sudden changes in temperature

  16. THERMAL CONDUCTIVITY • ability of a substance to conduct heat • water: 0.6

  17. METHODS OF HEAT TRANSFER CONDUCTION CONVECTION RADIATION EVAPORATION

  18. Conduction Exchange of thermal energy between bodies in contact with each other

  19. Convection Heat transfer by mass motion of water when the heated fluid is caused to move away from the source of heat, carrying energy with it

  20. Radiation Exchange of electromagnetic energy due to difference in temperature between the skin and surrounding environment

  21. Evaporation Occurs through loss of fluid from sweating and by the pulmonary system during exhalation

  22. Hydrotherapy is... the use of water as a therapeutic agent

  23. Therapeutic Effects of Water

  24. THERAPEUTIC EFFECTS • Thermal • Mechanical Cold application Heat application Agitation

  25. COLD APPLICATION • increased cardiac tone • peripheral vasoconstriction • increased blood viscosity • decreased HR • longer diastole • decreased vasodilator metabolites • decreased blood flow

  26. HEAT APPLICATION • vasodilation of arteries and arterioles • increased capillary permeability • release of vasoactive agents • increased metabolism (Van’t Hoff’s Law) • increased blood flow • increased tissue extensibility • increased HR • increased RR

  27. FACTORS AFFECTING THERMAL EFFECTS • temperature difference between water and skin • method of heat transfer • thermal conductivity of the structure • rate of rise in initial temperature • surface area covered • duration of exposure • weight, age, and general condition of the patient

  28. AGITATION • debridement • analgesia • facilitation of exercise • muscle relaxation

  29. Modalities

  30. WATER IMMERSION MODALITIES • Whirlpool bath • Hubbard tank • Pool/Aquatic Therapy

  31. Parts • Agitator/ Turbine ejector/ Aerator • Water thermometer • Hot and cold water mixing valve • Temperature gauge • Gravity drain • Seat

  32. Parts of a Whirlpool Bath Motor Pump/Turbine Motor Thermometer Steel Tank

  33. Components of the Turbine Switch Turbine Engine/Motor Suspension Bracket Throttle Butterfly Knob Drive Shaft Breather Tube

  34. Objectives for use • stimulation of circulation • promotion of muscle relaxation and pain relief • debridement • facilitation of exercise

  35. Indications • wound care: decubitus ulcers, sub-acute or chronic soft tissue injury, burns • arthritis • limited ROM • muscle spasm • muscle weakness • post fractures • tension, anxiety, or other psychological problems

  36. Contraindications • patient with cardiac dysfunction • patient with respiratory dysfunction • patient with decreased thermal sensation • severe peripheral vascular disease • bleeding or hemorrhage • acute Rheumatoid arthritis • fever • malignancies • uncontrolled bowel • dermatologic conditions, infections

  37. Additives • wounds: - povidone iodine - saline solution - antibacterial agents - sodium hypochlorite • dry skin: - bath oil • burn patients: - 4% solution Lidocaine

  38. TYPES OF WHIRLPOOL BATH According to shape: • Low buoy tank • High buoy tank • Extremity tank According to mobility: • Movable • Fixed

  39. LOW BUOY • Dimensions width: 24 inches length: 52 – 66 inches depth: 18 inches

  40. HIGH BUOY • Dimensions width: 20 – 24 inches length: 36 – 48 inches depth: 28 inches

  41. EXTREMITY TANK • also called UPPER EXTREMITY TANK • Dimensions width: 15 inches length: 28 – 32 inches depth: 18 – 25 inches

  42. DOSAGE • Temperature: 39.9 – 46.1 degrees Celsius or 103 – 115 degrees Farenheit • Duration: 20 minutes if used as heating modality 15 minutes if used as cooling modality 5 – 20 minutes if used for debridement 10 – 20 minutes if used for exercise

  43. Clinical Decision-making • immersion of LE can be done using high and low buoy tanks • High buoy tank requires the patient to be able to flex both hip and knee but does not allow full extension (adult) • Low buoy tank allows full-motion exercises of the knee • Both high and low buoy tanks can be fitted with hydraulic chair lift

  44. HUBBARD TANK • Dimensions length: 7 feet 2 inches upper wing width: 6 feet middle wing width: 35 inches lower wing width: 4 feet 2 inches depth: 22 inches insets: 15 inches

  45. DOSAGE • Temperature: 32.2 – 38.8 degrees Celsius 90 – 102 degrees Farenheit (in the clinics) 36.1 – 38 degrees Celsius 97 – 100 degrees Farenheit • Duration: • 20 minutes • Ambient temperature • 25.5 degrees Celsius • 50% humidity

  46. ADDITIONAL EQUIPMENT • Walk trough • Adjustable seat • Motorized chair lift • Hydrostretcher with hydraulic lift

  47. Contrast Baths • Alternately immersing extremity in hot and cold bath • Aka “vascular exercise” Indications • Arthritis, joint sprains, s/p amputation, musculo- tendinous strains Temperature • Hot: 38-44 degrees Celsius • Cold: 10-18 degrees Celsius • Treatment Duration • 30 minutes • Warm whirlpool: 10 minutes • Cold whirlpool: 1 minute • Warm whirlpool: 4 minutes • Cold whirlpool: 1 minute

  48. Sitz Bath • Water only covers the pelvic region Hot • Increases circulation in the pelvic area  enhance tissue healing and reduce pain • Temperature: 40.5- 46 ̊C or 105-115 ̊F for 2-10 minutes • Indications: hysterectomy, hemorrhoidectomy, chronic pelvic inflammatory disease Cold • Increases tone of smooth muscles  reduce uterine bleeding • Temperature: 17-24 ̊C or 25-75 ̊F for 2-10 minutes

  49. Guidelines to Treatment • determine objectives for using the modality • select appropriate temperature • inspect the area to be treated • explain procedure ad operation to the patient • position the patient comfortably • monitor vital signs • adjust level of agitation accordingly • turn agitator off after treatment

  50. Guidelines to Treatment • don’t allow finger or loose bandage to clog the openings • check for any breakage in the wirings • ensure that the motor is securely fastened • don’t allow the patient to operate the machine • don’t direct agitation to the area that could be further damaged • control ventilation and humidity of surrounding area

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