Hydrotherapy involves the use of water, internally or externally, for treatment purposes. It has various physical properties that make it useful for treating wounds, reducing edema, and providing a low-impact environment for exercise. Different forms of hydrotherapy include immersion, contrast baths, whirlpools, and aquatic exercise. Proper application involves selecting the appropriate modality based on the desired effects and safety considerations.

1. PTA 200 Modalities and Procedures in Physical Therapy Hydrotherapy

2. Definition of Hydrotherapy Application of water, internally or externally, for the treatment of physical or psychological dysfunction.

3. Types of Hydrotherapy Immersion Non-Immersion

4. Primary Use of Hydrotherapy Treatment of Wounds Enhanced Environment for exercise Pain Edema Health maintenance /disease prevention

5. Physical Properties of Water High Specific Heat & Thermal Conductivity Transfers heat by Conduction and Convection Can be used as superficial heating and cooling agent

6. Physical Properties of Water Specific Heat 4 times that of air Water retains 4x as much thermal energy as an equivalent mass of air Thermal Conductivity 25 x air Water transfers thermal energy 25 x more rapidly than air ( at the same temperature )

7. Physical Properties of Water Transfers heat rapidly, efficiently Advantage of exercising patient in pool colder than patient’s body temperature. Immersion dissipates heat generated by exertion

8. Physical Properties of Water Water that is stationary transfers heat by Conduction . Moving water transfers heat by Conduction and Convection . Heating (WP) accelerated with increased agitation of water. Cooling (swimming) accelerated as patient moves more quickly through water.

9. Physical Properties of Water Buoyancy A force experienced as an upward thrust on the body in the opposite direction to the force of gravity Archimedes Principle When a body is entirely or partially immersed in a fluid at rest.. it experiences an upward thrust equal to weight of fluid it displaces. Principle used for volumetric measurements

10. Archimedes Principle Amount of fluid depends on density of body relative to density of fluid. If density of body less than density of fluid, it will displace a smaller volume of fluid (Floats) Opposite also true If density of body further decreased ( adding salt to water or air-filled objects at rest ), Body will float higher

11. Clinical Uses of Buoyancy Decrease stress and compression to body tissues ( weight-bearing surfaces ) Assist weak muscles

12. Physical Properties of Water Resistance Viscosity of water provides resistance to motion Resistance occurs against direction of motion Resistance increases proportional to… Speed Frontal area of body part in contact with water Varying resistance ( and pressure ) can be beneficial in debriding and cleansing wounds

13. Physical Properties of Water Hydrostatic Pressure Pressure exerted by fluid on body immersed in fluid. Pascal’s Law A fluid exerts equal pressure on all surfaces of a body at rest, at a given depth… This pressure increases in proportion to depth of fluid

14. Hydrostatic Pressure Water = 0.73 mmHg/cm of depth (22.4 mmHg/ft) Patient upright Pressure on distal extremities > proximal extremities Hydrostatic pressure at patient’s feet… 4 ft of water = 89.6 mmHg

15. Hydrostatic Pressure Water can have similar effect as compression devices/ bandages Helpful in decreasing edema If limb in dependent position, counteracts this effect Greatest effects of hydrostatic pressure occur in vertical position NO hydrostatic pressure effects with non-immersion hydrotherapy

16. Physiological Effects of Hydrotherapy

17. Physiological Effects Cleansing Pressure (Force = Rate of Flow) Dissolved antimicrobial agents, etc. ( Wounds ) Musculoskeletal Effects Decreases weight-bearing ( Arthritis ) 75% immersion WB 75% Increases blood flow to muscles Strengthening

18. Physiological Effects Decreased bone density loss Decreased fat loss Compared to other forms of exercise Good for obese secondary to non-weight bearing exercise Not good for general weight loss

19. Cardiovascular Effects Increased venous circulation Secondary to hydrostatic pressure, increased venous pressure Increased cardiac volume Increased cardiac output Up to 30% while upright to neck Decreases HR and Systolic BP ( cool water ) May increase in warm or hot water

20. Respiratory Effects Increases work of breathing Due to hydrostatic pressure on lungs up to 60% May need to be very careful with respiratory and/or cardiac patients Decreases exercise-induced asthma High humidity

21. Renal Effects Increases urine production Increases sodium and potassium excretion May be used to patient’s advantage with hypertension, peripheral edema

22. Psychological Effects Relaxing Warm water Invigorating Cold water

23. Clinical Uses of Hydrotherapy

24. Superficial Heating and Cooling Advantages Even contact with skin Does not need to be fastened Allows movement of heat/cold Disadvantages Extremity often in dependent position

25. Wound Care Cleansing properties facilitate Rehydration Softening and debridement of necrotic tissue Removal of wound debris Hydrostatic pressure and heat increase circulation Provides moist environment to optimize healing

26. Immersion vs. Non-Immersion Non-immersion therapy becoming more popular Concern for increased pressure on regenerating tissues by water and turbine Potential for infection in contaminated tank WP recommended for Extensive thick exudate Slough or necrotic tissue Gross purulence Dry eschar

27. Immersion versus Non-Immersion Discharge all forms of hydrotherapy when wound is clean Many antimicrobial products are cytoxic to normal tissue ( unless very diluted ) Tank and turbine must be thoroughly cleaned and disinfected

28. Non-Immersion Techniques Fluid delivered at pressure of 4-15 psi Below this bacteria not removed Above this, wound trauma may occur, or bacteria driven into wound Saline squeeze bottle, Water Pik

29. Non-Immersion Techniques Recommended for N ecrotic, nonviable tissue or debris Continue until all removed and full granulation bed present Often use both With both types, must thoroughly dry intact skin in surrounding area prevents maceration

30. Treatment of Burns Similar, but burns particularly painful when debrided Wounds sometimes less deep, sensory nerves intact Monitor patient closely often high-dose analgesics Hubbard Tank for large body surface area Chance of contamination Greater loss of sodium ( add salt ) Shower (non-immersion) in early stages After re-epithelialization, water for exercise

31. Pain Control Increased sensory stimulation to peripheral mechanoreceptors Gait Theory Cold water decreases inflammation Decreases weight-bearing, increases “ease of movement”.

32. Edema Control Hydrostatic pressure Cool water Vasoconstriction Decreased vascular permeability Hot water increases edema Increased arterial blood flow, increased vasodilation.

33. Edema Control Contrast Baths “ Trains” smooth muscles of blood vessel; vasoconstriction/vasodilation. No research to solidly support

34. Contraindications, Precautions and Adverse Effects

35. Contraindications, Local Immersion Maceration Increased maceration, increased size of wound Bleeding In or near the area

36. Precautions, Local Immersion Impaired thermal sensation Check temperature of water with thermometer first Infection Universal Precautions Clean WP Confusion, impaired cognition Use constant, direct supervision Temperature of water near body temperature Recent Skin Grafts Direct agitator away from graft. Neutral or mild warmth (96 - 98 0 F)

37. Contraindications, Full Body Immersion Cardiac instability Uncontrolled hypertension or heart failure Infectious conditions that spread with water UTI’s, plantar warts, tinea pedis ( pool ) Bowel or bladder incontinence Use non-immersion techniques Severe epilepsy Increased risk of drowning Suicidal patients Increased risk of drowning

38. Precautions, Full Body Immersion Confusion, Disorientation Keep head above water Constant supervision Low temperature After ingestion of alcohol Hypotensive effects Drowning Patients with limited strength, endurance, balance, ROM Hands-on approach required

39. Precautions, Full Body Immersion Patients on medications Physician clearance sometimes required Patients with fear of water Patients with respiratory problems Watch for signs of respiratory distress, especially in hot or very warm water

40. Precautions, Full Body Immersion Patients that are Pregnant 1st trimester ( maternal hyperthermia ) Use normal water temperature Can be very good therapeutic intervention Patients with MS Temperature >88 0 F may cause increase fatigue, weakness. Patients with poor thermal regulation Elderly, infants

41. Precautions, Non-Immersion Hydrotherapy Maceration Ineffectiveness Drowning

42. Adverse Effects of Hydrotherapy Burns, Fainting, Bleeding Check with thermometer, and gloved hand Hypotension Immersion in warm/hot water, hypertension medications Hyponatremia ( burns ) Increased edema Use of hot water Dependent positioning

43. Application of Hydrotherapy

44. Application, General Rules Assess problem and set goals of treatment Determine if most appropriate treatment Make sure no contraindications Select appropriate form of hydrotherapy Whirlpool Hubbard Tank Contrast bath Non-immersion device Pool Explain the procedure, purpose, sensations Apply appropriate form of hydrotherapy Assess outcome Document

45. Selection of Hydrotherapy Base decision on Desired effects Size of area to be treated Allowance for safety, control of infection Cost-effectiveness

46. Whirlpool Tanks Low-Boy High-Boy Extremity Hubbard Tank

47. Whirlpool Turbine Agitator Adjustable height, direction, aeration. Should be grounded Do NOT run without water in tank.

48. Low-Boy

49. Hubbard Tank

50. Extremity Tank

51. Temperature Range Cold (32-79 0 F) Acute inflammation Tepid (79-92 0 F) Exercise Acute inflammation if cold not tolerated Neutral warmth (92-96 0 F) Open wound Medically compromised patients Decrease tone

52. Temperature Range Mild warmth (96-98 0 ) Increase mobility Burn Hot (99-104 0 ) Pain, Increase ROM Increase soft tissue extensibility Very Hot (104-110 0 ) Limited body area Chronic conditions DO NOT use WP at temperatures > 110 0 F !!

53. Hubbard Tank 8 feet long x 6 feet wide, 4 feet deep 425 gallons water Turbines, stretcher, hoist Expensive secondary to amount of water, time to clean

54. Contrast Bath Alternate immersion (distal) First warm/hot water, then cool/cold water Uses Decrease edema Pain relief Decrease sensitivity (desensitize)

55. Application, Non-Immersion Irrigation PulsaVac: Lab

56. Application, Pool Temperature 79 - 97 0 Never below 65 0 Impairs muscles ability to contract

57. Cleaning, WP/Hubbard Tank Wear gloves, goggles, gown Drain tank Rinse with clean water Scrub tank with brush and detergent and rinse again Disinfect Tank

58. Disinfecting the Tank Levels of disinfection Low level Intact skin 70-90% ethyl alcohol, sodium hypochloride bleach germicidal solution Intermediate Level 70-90% ethyl alcohol phenolic germicidal detergent High Level Chlorine-based products Can corrode tank

59. Disinfecting the Tank Change disinfectant periodically to decrease risk of resistant strains Fill tank Add solution ( hot water ) expose all inside surfaces x 10 minutes Clean and disinfect turbine, bucket with water/detergent x 5 minutes bucket with disinfectant x 10 minutes

60. Disinfecting the Tank Drain tank Rinse with clean water Dry thoroughly with towels Culture tank, turbines, drains, and water supply periodically

61. Aquatic Exercise

62. Aquatic Exercise Uses Increase circulation Increase muscle strength Increase joint ROM, flexibility Improve ambulation Improve coordination Increase cardiovascular, respiratory conditioning Decrease pain, spasm Decrease weight-bearing on joints Relaxation/ psychological well-being

63. Types of Aquatic Exercise Swimming Running ( with or without vest ) Walking Cycling Stretching Underwater treadmill or parallel bars, etc.

68. The End