Hydrotherapy. History of Hydrotherapy Usage. History of Hydrotherapy 8/26/2014. Aquatics and Whirlpools

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1 Hydrotherapy Aquatics and Whirlpools History of Hydrotherapy Usage One of the oldest forms of heat application Initially used for relaxation History of Hydrotherapy ordinary containers are not as therapeutic as clinical containers such as whirlpools and Hubbard Tanks with agitating turbines 1

2 Archemede s Principle (buoyancy) A body which is fully or partially immersed in a liquid experiences an upward thrust equal to the weight of the liquid it displaces check this out Buoyancy The quality of being able to float, as on water The upward force exerted upon an immersed or floating body by a liquid Buoyancy The upward thrust acting in the opposite direction to the force of gravity Exerts a stronger upward thrust as the submerged part nears the surface of the water 2

3 Buoyancy Exerts the greatest effects on longer lever arms Buoyancy The amount of air in the lungs has a distinct impact on the overall density of the human body and its ability to float or sink What part of these people s bodies are floating? Buoyancy A person with fully inflated lungs will float Once that air is expelled, the person will sink 3

4 Relative Density is equal to the ratio of the mass of a given volume of a substance to the mass of the same volume of water a.k.a. Specific Gravity The weight density of a material is the weight of a given volume unit of the material divided by that volume unit. An example is that a 1 cubic foot volume of water weighs 62.4 pounds. The density of water is then 62.4 pounds per cubic foot. Relative Density with the lungs fully inflated The relative density of the human body is between 0.95 and A body with a relative density less than one will float Relative Density without the lungs fully inflated The relative density of the human body is between and

5 A body with a relative density greater than one will sink A body with a relative density equal to one will float just below the surface of the water Relative Density When a body is floating, the ratio of the submerged parts to those not submerged will be: 0.95 to 0.05 or to 0.26 Relative Density If the submerged portion of the body exceeds 0.05, then the amount of water displaced by the remainder will be insufficient to support the weight of the body. The pelvis and legs will sink 5

6 Hydrostatic Pressure The pressure of a liquid The molecules of a liquid thrust upon each part of the surface area of an immersed object or liquid The pressure will increase with increased depth in the liquid Clinical Significance Buoyancy Reduces the stresses on immersed weight bearing joints 6

7 Clinical Significance Provides an additional source of resistance for exercise training in the water if the part is moved downward against buoyancy Clinical Significance The center of buoyancy (COB) will lie in a vertical line, if the COB falls outside of the BOS then the body will shift to try to maintain an upright position Clinical Significance Relative Density Floating versus not floating Floating requires NO physical effort, Can dispel fears about the water The body will easily be supported by the water It will be easier to maintain an upright posture in water 7

8 Clinical Significance Hydrostatic pressure Pressure will be experienced as a body is immersed in water Chest expansion will be more difficult If the vital capacity is less than 1500cc Use floatation devices and extreme caution Edema reduction will be enhanced by external pressure Surface tension The force exerted between the surface molecules of a liquid manifesting itself as an elastic skin at the surface of the liquid Cohesion The attractive force exerted by each molecule on those surrounding it that are of the same type of matter Check this out 8

9 Viscosity Internal friction, or the resistance to relative movement within the liquid Viscosity decreases as temperature increases it s easier to move in warmer water and more difficult to move in cooler water. Viscosity Air is less viscous than water There is more resistance to movement in water than on land Viscosity The greater the cohesion The greater the viscosity The more difficult it will be to move within it 9

10 Agitation Adds air to the water Will decrease the resistance to movement in the water due to the reduction in the viscosity of the water Turbulence Fluid flow in which the velocity constantly changes in magnitude and direction Turbulence Movement parallel to turbulent flow will be easier than perpendicular to it 10

11 Direction of movement Against gravity = with buoyancy Easy to move in the water Direction of movement Against buoyancy = with gravity Difficult movement in the water Drag Larger surface areas will encounter greater resistance to movement in the water drag Less drag 11

12 Speed of movement Quick movements will encounter more resistance to movement unless: The part is streamlined to decrease drag Quick reversals of direction will create resistance to movement Aquatic Therapy Equipment Therapeutic Exercise Equipment Treadmills Bicycles Ploughs Sleds Stair climbers Parachutes Ski simulators Influencing Factors: Therapy Water temperature Difference between skin and water temperature Extent of immersion in the water Duration of treatment Weight, age, general condition of the patient Movement of the patient Fear of water or ability to swim 12

13 Aquatic Therapy Pools Variable depths Availability of devices To increase surface area To increase effects of buoyancy Availability of classes Aquatic Therapy Pools Therapeutic water temperatures Cooler to prevent fatigue Warmer to promote relaxation and mobility Hydrotherapy Cold water immersion (55-65 o F) Vasoconstriction Increased muscle tone Increased heart rate Increased blood pressure Involuntary shivering 13

14 Hydrotherapy Removal from cold water Peripheral vasodilation Eyrthema Decreased blood pressure Hydrotherapy Hot water immersion ( o F) Local application Sedative effect Relief of muscle guarding or spasm Hydrotherapy Hot water immersion ( o F) Large body surface immersion Increased body temperature Circulatory rate Metabolic rate Oxygen consumption Heat elimination Heart rate (10bpm for every 1 o F above basal body temperature) Hubbard Tank 14

15 Hydrotherapy Equipment Components Tanks Sealed, durable, cleanable, appropriately sized for the application Have water mixing valves with temperature gauges Have some form of water drainage system Hydrotherapy Equipment Turbines Adjustable Height Air intake Turbulence Angle for turbulent flow Hydrotherapy Equipment Patient Supports Transfers Lifts Gurneys Ramps and submersible wheelchairs (aquatic pool) 15

16 Hydrotherapy Equipment Patient supports For transfers Seats (Submersible) Swivel chairs (Submersible) Hydro Treatment Area Floor Non-slip Beveled with a central drain for leakage or emergencies CLEAN Electrical system GFI outlets, usually above the floor Electrical storms???? Hydrotherapy Equipment Extremity tanks Stainless steel or fiberglass Mobile or fixed Small areas of the body Hands, feet, elbows, ankles 16

17 Hydrotherapy Equipment high boy Stainless steel or fiberglass Mobile or fixed Knees, hips (?), backs (?) Hydrotherapy Equipment low boy Stainless steel Fixed Knees, hips (?), entire LE Hubbard Tank Fixed Whole body immersion Shaped like an angel May have a central trough and parallel bars for ambulation 17

18 Patient Preparation Appropriately attired Clean Prepared for treatment No Dressings External catheters IV in upper extremity Patient Preparation Prepared for treatment If indicated Vital signs Monitored and stable Transfer strategy has been planned out in advance Care of Equipment Cleaning Before immersion Tank Turbine (inside and outside) Support devices in the water Support devices outside of the water Floor is DRY 18

19 Care of Equipment Additives for the prevention of foam For cleaning For the prevention of the spread of disease Indications for any form of Hydrotherapy Non-specific debridement Decrease muscle guarding Increase ROM Decrease hyper-sensitivity Decrease pain Promote relaxation Promote gravity free, buoyancy rich environment for therapeutic exercise Contraindications for Hydrotherapy Full body immersion Stoma External catheter Vital capacity less than 1500cc Fear of drowning and a tracheotomy 19

20 Precautions to Hydro/Aquatics Hypertension (high blood pressure) Control length of exposure and temperature of the water Fear of water Monitor closely Use flotation devices 20