Whirlpool Baths & Hubbard Tank & Pool Therapy

WHIRLPOOL BATHS

Whirlpool Baths Is composed of a tank that can

hold water and a turbine that provides agitation and aeration in order to produce movement of the water in the tank.

Tank is usually made of stainless steel, although fiberglass and plastic tanks are also available.

Low-boy and High-boy tanks are also available to immersion of larger parts of the extremities or immersions up to the waist.

Method of Heating: Convection Superficial Heating – depth of penetration is

from 1-10mm

Use:Local (or general heat) application of moist

heat

Treatment Temperature:390C – 430C (1030F – 1100F)950F – 1000F for peripheral vascular diseases920F – 960F for open wounds

Treatment Time: 20 minutes. 30 minutes if other therapeutic

procedures are also being done.

Methods of Application Fill the tank with water to the proper level and to the

desired temperature. Whirlpool liners may be used for patients with burns, wounds, or who are infected with blood borne pathogens (human immunodeficiency virus or hepatitis-B virus)

Add disinfectant if open wounds are present. Sodium Hypochlorite (Bleach), Povidone-iodine,

Chloramine-T Standard precaution (gowns, gloves, goggles, masks)

should be applied when working in infected environment (possibility of splashing)

Assist patient in immersing body part into the tank

Methods of Application Pressure points should be

padded for patients comfort and to minimize compression of blood vessels and nerves. Keep towels out of the water.

Adjust agitator to desired position.

Turn on agitator and adjust the force, direction, depth and aeration

Monitor patient’s response and tolerance to the whirlpool

At the end of the treatment, dry and inspect the skin.

Advantages of Whirlpool Heat is applied to all surfaces of the extremity Buoyancy of water makes the performance of

exercise easier Cleansing action is beneficial for burns, open

wounds, ulcers Gentle massaging action.

Disadvantages: The process of cleaning the tanks and disinfecting it

after treating patients with infected area may be tedious.

HUBBARD TANK

EQUIPMENT :• Hubbard stainless tank or ceramics tank• 2 agitators w/c are freely movable• head rest & rubber rings for head to rest on• frame or canvas plinth• a footstool• rubber cap for women to avoid hair from

getting wet & clogging the drain• swim suits• double sheet to tie patient, if necessary• disinfectant• sterile sheets, towels or bandages

Method of Heating: Convection Superficial Heating – depth of penetration is from 1-

10mm

Use: General heat application of heat, underwater exercises

Treatment Temperature: 380C (1000F) 950F – 1000F for peripheral vascular diseases 920F – 960F for open wounds

Treatment Time: 20 minutes. 30 minutes if other therapeutic procedures

are also being done.

Method of Application Fill the tank with water to the proper

level and to the desired temperature Most commonly prescribed temperature is 36 to 39

oC (97 to 102oF)

Tubs take from 20 - 40 minutes to fill

Add disinfectant, if open wounds are present. If a disinfectant is needed, care should be

exercised as to the proper choice so as to avoid too much absorption from a large open skin area, w/c may lead to complications later.

Assist patient into the tub. If a hoist is to be used, have an aide or a therapist

assist in the transfer If no hoist available, a three-man lift may be used

in transferring a helpless patient

Arrange the head rest to the patient’s comfort & safety

If agitators are ordered, arrange height, direction & force of agitation of one or two turbines to accomplish desired purpose. Check height of the head again after turning on the

turbine, you may have to raise it again

If underwater exercises are prescribed, the agitators are not used. The therapist administers the exercises as prescribed. Maintain good alignment of the patient. Buoyancy

of water necessitates careful stabilization of the patient to insure coordinated movements.

 ***Many patients are apprehensive about being in

water. They need constant reassurance and may well be tied down with a sheet in the first treatment.

General Cleaning Procedures1. After draining water from tank, rinse the entire tank

including the openings in agitator and all the drains.

2. Wipe all areas that were in contact with water with a clean dry towel.

3. Wash the inside of the tank, outside the agitators and the drains with disinfectant diluted in warm water. Also wash agitators, thermometers and all equipment used in the treatment. Some tanks have a hose that can be used to spray tank. Allow disinfectant to stand for at least one minute.

4. Place the agitator in bucket filled with water and disinfectant, covering all openings with solutions. Turn on agitator for about 20-30 seconds. Turn off motor and remove agitator from bucket.

5. Rinse the entire tank and all equipment until all residue is removed. Following use with patients with wounds or burns, refill the tank with hot water and disinfectant and allow solutions to stand for five minutes (with or without the agitator)

6. Repeat step 4 with clean water. You may wish to rinse the tank a second time with hot water to hasten drying.

7. Wipe both the inside and the outside of the tank with a dry towel.

Precautions:

Decreased temperature sensations

Impaired cognition

Recent skin graft

Incontinence

Confusion/disorientation

Deconditioned state

Hydrophobia with full immersion.

Indications:

Decubitus ulcers

Open burns and wound

Post hip fractures

Post surgical conditions of hip

Sub acute and chronic musculoskeletal conditions of neck, shoulders and back

Rheumatoid Arthritis.

Contraindications:

Bleeding

Wound maceration

Cardiac instability

Profound epilepsy (with full immersion)

Electrical Safety:

Safety precaution must be taken with any modality that potentially exposes the patient to electrical hazard from faulty electrical conditions.

A ground fault circuit interrupter should be installed

All whirlpool turbines, tanks and motor used to lift patients should be checked for current leakage.

POOL THERAPY

Aquatic exercise

refers to the use of multidepth

immersion pools or tanks that facilitate

the application of various established

therapeutic interventions, including

stretching, strengthening, joint

mobilization, balance and gait training,

and endurance training.

Goals of Aquatic ExerciseThe specific goals include:

Facilitate range of motion (ROM) exercise Initiate resistance trainingFacilitate weight-bearing activitiesEnhance delivery of manual techniquesProvide three-dimensional access to the

patientFacilitate cardiovascular exercise Initiate functional activity replicationMinimize risk of injury or reinjured during

rehabilitationEnhance patient relaxation

Why do Aquatic Exercises?

The specific purpose of aquatic exercise is

to facilitate functional recovery by

providing an environment that augments a

patient’s and/or practitioner’s ability to

perform various therapeutic interventions.

Advantages of Aquatic Therapy

Early activity with non-weight bearing status

Reduction of joint compressive forcesWarmth of waterRelaxation of musclesGate theory mechanismsPsychological factors

Precautions Fear of Water

• Fear of water can limit the effectiveness of any immersed activity. Fearful patients often experience increased symptoms during and after immersion because of muscle guarding, stress response, and improper form with exercise.

Neurological Disorders• Ataxic patients may experience increased difficulty

controlling purposeful movements. Patients with heat-intolerant multiple sclerosis may fatigue with immersion in temperatures greater than 33C.51

Seizures• Patients with controlled epilepsy require close

monitoring during immersed treatment and must be compliant with medication prior to treatment

Cardiac Dysfunction• Patients with angina and abnormal blood

pressure also require close monitoring. For patients with cardiac disease, low-intensity aquatic exercise may result in lower cardiac demand than similar land exercise.

Small Open Wounds and Lines• Small, open wounds and tracheotomies may

be covered by waterproof dressings. Patients with intravenous lines, Hickman lines, and other open lines require proper clamping and fixation.

Contraindications

Incipient cardiac failure and unstable angina.

Respiratory dysfunction; vital capacity of less than 1 liter.

Severe peripheral vascular disease.

Danger of bleeding or hemorrhage.

Severe kidney disease: Patients are unable to adjust to fluid loss during immersion.

Open wounds, colostomy, and skin infections such as tinea pedis and ringworm.

Uncontrolled bowel or bladder: Bowel accidents require pool evacuation, chemical treatment, and possibly drainage.

Water and airborne infections or diseases: Examples include influenza, gastrointestinal infections, typhoid, cholera, and poliomyelitis.

Uncontrolled seizures: They create a safety issue for both clinician and patient if immediate removal from the pool is necessary.

BUOYANCY Definition.

o Buoyancy is the upward force that works opposite to gravity.

Properties. o Archimedes’ principle states that an immersed

body experiences upward thrust equal to the volume of liquid displaced.

Clinical Significanceo Buoyancy provides the patient with relative

weightlessness and joint unloading, allowing performance of active motion with increased ease.

o Buoyancy allows the practitioner three-dimensional access to the patient.

Hydrostatic Pressure Definition

The pressure exerted on immersed objects.

Properties

Pascal’s law states that the pressure exerted by fluid on an immersed object is equal on all surfaces of the object. As the density of water and depth of immersion increase, so does hydrostatic pressure.

Clinical Significance

Increased pressure reduces or limits effusion, assists venous return, induces bradycardia, and centralizes peripheral blood flow. The proportionality of depth and pressure allows patients to perform exercise more easily when closer to the surface.

Viscosity Definition.

Friction occurring between molecules of liquid resulting in resistance to flow.

Properties. Resistance from viscosity is proportional to the

velocity of movement through liquid.

Clinical Significance• Water’s viscosity creates resistance with all active movements.• A shorter lever arm results in increased resistance. During

manual resistance exercises stabilizing an extremity proximally require the patient to perform more work.

• Stabilizing an extremity distally requires the patient to perform less work.

• Increasing the surface area moving through water increases resistance.

Surface Tension Definition.

The surface of a fluid acts as a membrane under tension. Surface tension is measured as force per unit length.

Properties• The attraction of surface molecules is parallel to the

surface.• The resistive force of surface tension changes

proportionally to the size of the object moving through the fluid surface.

Clinical Significance• An extremity that moves through the surface

performs more work than if kept under water.• Using equipment at the surface of the water

increases the resistance.

Hydromechanics Definition

Hydromechanics comprise the physical properties and characteristics of fluid in motion.

Components of Flow Motiono Laminar flow. Movement where all molecules

move parallel to each other, typically slow movement.

o Turbulent flow. Movement where molecules do not move parallel to each other, typically faster movements.

o Drag. The cumulative effects of turbulence and fluid viscosity acting on an object in motion.

Clinical Significance of DragAs the speed of movement through

water increases, resistance to motion increases.

Moving water past the patient requires the patient to work harder to maintain his/her position in pool.

Application of equipment (glove/paddle/boot) increases drag and resistance as the patient moves the extremity through water.

Special equipment for aquatic exercise:Collars, Rings, Belts, and Vests

Equipment designed to assist with patient positioning by providing buoyancy assistance can be applied to the neck, extremities, or trunk. Inflatable cervical collars are used for the supine patient to support the neck and maintain the head out of the water.

Swim BarsBuoyant dumbbells

(swim bars) are available in short and long lengths. They are useful for supporting the upper body or trunk in upright positions and the lower extremities in the supine or prone positions. Patients can balance (seated or standing) on long swim bars in deep water to challenge balance, proprioception, and trunk strength.

Gloves, Hand Paddles,

Fins and Boots

Resistance to upper and

lower extremity movements is

achieved by applying webbed

gloves or progressively larger

paddles to the hands and

boots/fins on the leg and feet.

These devices are not buoyant

and, therefore, only resist

motion in the direction of

movement.

Kickboards

Used to provide

buoyancy in the prone or

supine positions, create

resistance to walking

patterns in shallow water

when held vertically, or used

to challenge seated,

kneeling, or standing

balance in the deep water.

Exercise Equipment

Assistive devices• Floatation cuffs• Pull buoys• Vests and belts• Kickboards• Water

dumbbells

Resistive devices

• Water shoes• Fins• Boots• Webbed gloves• Paddles• Bells

Aquatic Therapy TechniquesAi Chi: a combination of deep breathing and slow broad

movements of the arms, legs and torso using concepts of T’ai Chi, Shiatsu and Qigong. Performs standing in shoulder-depth water with an ideal pool temp of 88F to 96F

Ai Chi Ne: (pronounced Eye Chee Knee) is a partner stretching program. It involves breathing techniques to increase relaxation and therefore enhance the stretch abilities.

BackHab: a program that the individual can do on his own. It is an aquatic walking program using various strides to accomplish a variety of benefits. It is excellent for gait re-training.

Bad Ragaz Ring Method: a method of muscle re-education utilizing specific patterns of resistance, endurance, elongation, relaxation, ROM and tonal reduction.

The Burdenko Method: used for athletic training and as a therapeutic methods for people with disabilities. Concept includes integrating land and water therapy, using a vertical position, focusing on the whole body and homework.

Feldenkrais: uses gentle movement and directed attention to improve movement and enhance human functioning. This method aims to increase ease and ROM, improve flexibility and coordination and encourage the individual to rediscover innate capacity for graceful efficient movement.

Halliwick: an approach to teaching people with physical and/or learning difficulties to participate in water activities, to move independently in water and to swim.

Lyu Ki Dou: various hands-on healing modalities along with Ai Chi, Tai Chi and Qi Gong.

Massage: water massage used for soft tissue manipulation and body mobilization techniques in water.

Proprioceptive Neuromuscular Facilitation (PNF): exercises consist of spiral and diagonal patterns and must incorporate three components of motion: flexion or extension, adduction or abduction and rotation.

Water Pilates: Pilates exercises adapted for the pool. This body conditioning program is designed to improved strength, flexibility and range of motion (ROM) and also encourages musculoskeletal alignment.

Unpredictable Command Technique (UCT): has a goal of progressing the clients so that two or more motor movements are done simultaneously.

Wassertanzen: a dynamic movement therapy that includes work below the water surface with the aid of nose clips. Wassertanzen means “water dance”

Water Yoga: performed in warm, waist-to-chest depth water to develop strength and static balance simultaneously.

Watsu: (water + shiatsu) is cradling, one-on-one program that is experienced in a very warm water (approx 94F) pool. It is for pain reduction, increase ROM, increased circulation, psychological problems, relaxation and reduction of stress.

Yogalates: combines Yoga, Pilates, Ai Chi. The objectives are increase body awareness, strength, ROM , relaxation and inward focus.

Exercise Session Format

Start with 10 to 15 minutes and increase in 5-minute intervals

Use deep breathing to increase vital capacity

Use GRADUAL progressive overloadWork on balanceWork on strengthWork on flexibilityLonger cool down