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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

HYDROTHERAPY

Aila Nica J. Bandong, PTRP

Instructor

Department of Physical Therapy

Clinical Supervisor

CTS- Pediatric Section

College of Allied Medical Professions

learning objectives
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
chemical properties
CHEMICAL PROPERTIES
  • Pure water is a polar molecule consisting of 2 molecules of Hydrogen and 1 molecule of Oxygen
constants
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
forces existing in water
FORCES EXISTING IN WATER
  • buoyancy
  • hydrostatic pressure
  • cohesion
  • viscosity
  • surface tension
buoyancy
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
hydrostatic pressure
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
cohesion
Cohesion
  • force between same molecules
  • tendency to attract each other
viscosity
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
surface tension
Surface Tension
  • surface of liquid acts as a membrane under tension
  • increased attractive forces on the surface
hydromechanics
HYDROMECHANICS
  • laminar flow
    • All molecules are parallel
  • turbulent flow
    • Molecules are erratic/not parallel
  • drag
    • Cumulative effect of turbulence and fluid viscosity
specific heat
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
thermal conductivity
THERMAL CONDUCTIVITY
  • ability of a substance to conduct heat
  • water: 0.6
methods of heat transfer
METHODS OF HEAT TRANSFER

CONDUCTION

CONVECTION

RADIATION

EVAPORATION

conduction
Conduction

Exchange of thermal energy between bodies in contact with each other

convection
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

radiation
Radiation

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

evaporation
Evaporation

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

hydrotherapy is

Hydrotherapy is...

the use of water as a therapeutic agent

therapeutic effects
THERAPEUTIC EFFECTS
  • Thermal
  • Mechanical

Cold application

Heat application

Agitation

cold application
COLD APPLICATION
  • increased cardiac tone
  • peripheral vasoconstriction
  • increased blood viscosity
  • decreased HR
  • longer diastole
  • decreased vasodilator metabolites
  • decreased blood flow
heat application
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
factors affecting thermal effects
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
agitation
AGITATION
  • debridement
  • analgesia
  • facilitation of exercise
  • muscle relaxation
water immersion modalities
WATER IMMERSION MODALITIES
  • Whirlpool bath
  • Hubbard tank
  • Pool/Aquatic Therapy
parts
Parts
  • Agitator/ Turbine ejector/ Aerator
  • Water thermometer
  • Hot and cold water mixing valve
  • Temperature gauge
  • Gravity drain
  • Seat
parts of a whirlpool bath
Parts of a Whirlpool Bath

Motor Pump/Turbine Motor

Thermometer

Steel Tank

components of the turbine
Components of the Turbine

Switch

Turbine Engine/Motor

Suspension Bracket

Throttle

Butterfly Knob

Drive Shaft

Breather Tube

objectives for use
Objectives for use
  • stimulation of circulation
  • promotion of muscle relaxation and pain relief
  • debridement
  • facilitation of exercise
indications
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
contraindications
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
additives
Additives
  • wounds:

- povidone iodine

- saline solution

- antibacterial agents

- sodium hypochlorite

  • dry skin:

- bath oil

  • burn patients:

- 4% solution Lidocaine

types of whirlpool bath
TYPES OF WHIRLPOOL BATH

According to shape:

  • Low buoy tank
  • High buoy tank
  • Extremity tank

According to mobility:

  • Movable
  • Fixed
low buoy
LOW BUOY
  • Dimensions

width: 24 inches

length: 52 – 66 inches

depth: 18 inches

high buoy
HIGH BUOY
  • Dimensions

width: 20 – 24 inches

length: 36 – 48 inches

depth: 28 inches

extremity tank
EXTREMITY TANK
  • also called UPPER EXTREMITY TANK
  • Dimensions

width: 15 inches

length: 28 – 32 inches

depth: 18 – 25 inches

dosage
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

clinical decision making
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
hubbard tank
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

dosage1
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
additional equipment
ADDITIONAL EQUIPMENT
  • Walk trough
  • Adjustable seat
  • Motorized chair lift
  • Hydrostretcher with hydraulic lift
contrast baths
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
sitz bath
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
guidelines to treatment
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
guidelines to treatment1
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
evidence in practice
Evidence in Practice

A 25-year old male suffered from Colle’s fracture 2 months ago. Patient reported falling on outstretched arm after making a “lay-up” during a basketball game. He was put on plaster cast for 6 weeks during which no therapeutic intervention was provided. Upon medical consult 2 weeks ago, he was advised by his doctor to seek physical therapy for management of complications following prolonged immobilization specifically limitation of motion. Referral letter included whirlpool bath as part of management.

evidence in practice1
Evidence in Practice
  • Clinical Question:

Will use of whirlpool bath improve range of motion post-Colle’s fracture?

  • Search Strategy:
    • In which database will you search? Why?
    • What keywords will you use? Limits?
    • What types of articles will you look for? Why?
thank you for listening

Thank you for Listening!

Do you have any questions?

references
References

Balicanta, R. E. (2004). Lecture notes on water immersion modalities for PT 156: Physical agents I.

Hayes, K. W. (1993). Manual for physical agents (4th Ed). Connecticut: Appleton and Lange.

Hecox, B., Mehreteab, T. A., and Weisberg, J. (1994). Physical agents: A comprehensive text for physical therapists. Connecticut: Appleton and Lange.

Kisner, C. and Colby, L. A. (2002). Therapeutic exercise: Foundations and techniques (4th Ed). Philadelphia: F. A. Davis Company.

Michlovitz, S. L. (1996). Thermal agents in rehabilitation (3rd Ed). Philadelphia: F. A. Davis Company.

Sussman, C. (1998). Whirlpool in wound care. Collaborative practice manual for physical therapists and nurses. (no place): Aspen Publishers.

Pictures retrieved June 21, 2008 from the following websites: www.hospimedicaintl.com, www.theratek.com, www.medicaloutfitters.net, www.mtstjosephhome.com, www.lakeeriemed.com, www.wannatowel.netkennel.com, www.ecu.edu, www.lifetecinc.com, www.advantagemedical.com, www.cchosp.com.