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
Physical Principles of Water Archemede s Principle 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
Physical Principles of Water Buoyancy The quality of being able to float, as on water The upward force exerted upon an immersed or floating body by a liquid
Physical Principles of Water 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
Physical Principles of Water Buoyancy Exerts the greatest effects on longer lever arms
Physical Principles of Water 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
Physical Principles of Water Buoyancy A person with fully inflated lungs will float Once that air is expelled, the person will sink
Physical Principles of Water 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
Physical Principles of Water Relative Density with the lungs fully inflated The relative density of the human body is between 0.95 and 0.974 A body with a relative density less than one will float
Physical Principles of Water Relative Density without the lungs fully inflated The relative density of the human body is between 1.050 and 1.084
Physical Principles of Water 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
Physical Principles of 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 0.974 to 0.26
Physical Principles of Water 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
Physical Principles of Water Hydrostatic Pressure The pressure of a liquid
Physical Principles of Water 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
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
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
Resistance to Movement in Water Surface tension The force exerted between the surface molecules of a liquid manifesting itself as an elastic skin at the surface of the liquid
Resistance to Movement in Water Cohesion The attractive force exerted by each molecule on those surrounding it that are of the same type of matter Check this out
Resistance to Movement in Water 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.
Resistance to Movement in Water Viscosity Air is less viscous than water There is more resistance to movement in water than on land
Resistance to Movement in Water Viscosity The greater the cohesion The greater the viscosity The more difficult it will be to move within it
Resistance to Movement in Water 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
Resistance to Movement in Water Turbulence Fluid flow in which the velocity constantly changes in magnitude and direction
Resistance to Movement in Water Turbulence Movement parallel to turbulent flow will be easier
Resistance to Movement in Water Turbulence Movement perpendicular to turbulent flow will be difficult
Resistance to Movement in Water Direction of movement Against gravity = with buoyancy Easy to move in the water
Resistance to Movement in Water Direction of movement Against buoyancy = with gravity Difficult movement in the water
Resistance to Movement in Water Drag Larger surface areas will encounter greater resistance to movement in the water drag Less drag
Resistance to Movement in Water 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
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
Hydrotherapy Removal from cold water Peripheral vasodilation Eyrthema Decreased blood pressure
Hydrotherapy Hot water immersion (98-104 o F) Local application Sedative effect Relief of muscle guarding or spasm
Hydrotherapy Hot water immersion (98-104 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)
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)
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
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
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
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
Precautions to Hydro/Aquatics High blood pressure Control length of exposure and temperature of the water Fear of water Monitor closely Use flotation devices