Hydrotherapy - MCCCbehrensb/documents/Hydro14.pdf · Hydrotherapy Aquatics and Whirlpools ... Aquatic Therapy Equipment ... Hubbard Tank –Fixed –Whole body immersion

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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”

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Physical Principles of Water

• 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

http://www-personal.umich.edu/~lpt/archimedes.htm

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• 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

http://www.pbs.org/wgbh/nova/lasalle/buoybasics.html

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• 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

0.974

– A body with a relative density less than one will float



– without the lungs fully inflated

• The relative density of the human body is between 1.050 and 1.084

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– 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



– 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



– 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

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• 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

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– Provides an additional source of resistance for exercise training in the water if the part is moved downward against buoyancy


– 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



– 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

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• 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


• Cohesion

– The attractive force exerted by each molecule on those surrounding it that are of the same type of matter

– Check this out

http://packerpedia.wiki.packer.edu/D_Cohesion,+Adhesion+&+Surface+Tension

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• 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

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• 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

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• 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

http://swimright23.webs.com/dragandresistance.htm

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• 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

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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 (55-65oF)

– Vasoconstriction

– Increased muscle tone

– Increased heart rate

– Increased blood pressure

– Involuntary shivering

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Hydrotherapy

• Removal from cold water

– Peripheral vasodilation

– Eyrthema

– Decreased blood pressure

Hydrotherapy

• Hot water immersion (98-104oF)

– Local application • Sedative effect

• Relief of muscle guarding or spasm

Hydrotherapy • Hot water immersion (98-104oF)

– Large body surface immersion

• Increased

– body temperature

– Circulatory rate

– Metabolic rate

– Oxygen consumption

– Heat elimination

– Heart rate

– (10bpm for every 1oF above

basal body temperature)

Hubbard Tank

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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


• Turbines

– Adjustable

• Height

• Air intake

• Turbulence

• Angle for turbulent flow


• Patient Supports

– Transfers

• Lifts

• Gurneys

• Ramps and submersible wheelchairs (aquatic

pool)

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• 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????


• Extremity tanks

– Stainless steel or fiberglass

– Mobile or fixed

– Small areas of the body

• Hands, feet, elbows,

ankles

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• “high boy”

– Stainless steel or fiberglass

– Mobile or fixed

• Knees, hips (?), backs (?)


• “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

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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

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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

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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

Hydrotherapy - MCCCbehrensb/documents/Hydro14.pdf · Hydrotherapy Aquatics and Whirlpools ... Aquatic Therapy Equipment ... Hubbard Tank –Fixed –Whole body immersion

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