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Faculty of Health and Life Sciences

(Student Number 086415323)

Module: 2OP040 Semester 1: (2009/10)

Hydrotherapy Intervention & its Supporting Theory
Base for Patients with Multiple Sclerosis

Word count:

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firstly the theory base of the intervention that is hydrotherapy. 2001). highlighting the enduring and progressive physical health problems surrounding the disease. this will be shown in relation to the patient’s needs. Therefore each patient will need to be carefully assessed and any contra indications investigated (Campion. 2005). for example: the patient’s possible bad experience relating to water. Best practice will also be addressed by Page 2 of 7 . This is done by asking four core questions with an additional ten about the patient’s HRQOL. Within this environment multi disciplinary teams will be shown to play a vital part in the planning and implementation of the intervention and how this in turn relates to the patient’s needs. ultimately helping to promote independence and social inclusion. Again the HRQOL is an essential determinate or outcome analysis to the intervention of hydrotherapy. Following this introduction there will be five main topics discussed. The section entitled Critical evaluation will then look closely at a range of influences in the causation of multiple sclerosis. 2009). depression as an outcome.Introduction Whilst navigating through this assignment the reader will achieve an understand of the intervention that is hydrotherapy. its context and environment. During this process safety considerations will be reflected and contra indication considered. Following the critical evaluation a discussion will explain how the intervention itself had been assessed. why hydrotherapy was chosen and the effect hydrotherapy has on progressive physical health (multiple sclerosis). eating and transferring are important aspects of life. National Centre for Chronic Disease Prevention and Health Promotion (2005) indicate that by using a series of questions called “healthy daily measure” HRQOL can be assessed. well being and current activity limitation in conjunction with the patient’s life (National Centre for Chronic Disease Prevention and Health Promotion. and how this approach is used to aid activities of daily living (ADL). Using ADL as a tool for analysis evidence will show the needs of people that have the disease multiple sclerosis. how the treatment has progressed through time and by contrasting the two. Hydrotherapy will be shown appropriate to the client’s needs and health related quality of life (HRQOL). looking at the treatment itself. This model of assessment can be generic or adapted when looking at specific long term diseases or illness and has proven to be suitably reliable for cross cultural application (Pong. as the core reasoning is based around the following. ADL such as dressing. 1997). Stress. measurements of these activities are critical and have shown to be predictors in long term health problems (Chiaravalloti et al. bathing. pain experienced.

Multiple sclerosis is a disease that affects the central nervous system. such as. Hemiplegia.C. Penultimately a summary of analysis will be given. and Parkinson’s disease. Also its application has varied. and has been used by many cultures such as the Proto Indians. Through time it has been observed that while other forms of rehabilitation/treatment have been and gone hydrotherapy has remained. Ataxia. The rationale behind choosing the intervention hydrotherapy was based on its diversity to provide unobtrusive progress whilst stabilising the condition (multiple sclerosis). This therapy is conducted and supervised by appropriately qualified personnel. this will enable the reader to gain an overview of the assignment content. Egyptians. with a current estimated one hundred thousand having the disease. ideally in a purpose-built hydrotherapy pool” (Martin. Using the natural properties of water creates a dynamic environment in which movement that has been lost can be restored. and its ability to promote rehabilitation not only within multiple sclerosis but many other degenerative neurological diseases. waters for curing purposes and water to combat fevers have been noted. this occurs when the protective sheath which surrounds the nerves (myelin) is damaged. 2004: 3). showing the implications for future practice in conjunction with hydrotherapy and the disease multiple sclerosis. When the myelin sheath becomes damaged signals sent from neuron to neuron become weekend and confused. unlike conventional exercise (Campion. and Hindus. Multiple sclerosis is the most common neurological condition to affect the United Kingdom. “Professionals generally define hydrotherapy as a pool therapy program specifically designed for an individual in an attempt to improve neuromuscular and skeletal function.exploring the National Service Frame Work. clearly highlighting the milestones throughout. extracting the main issues from within the assignment. Multiple Sclerosis Society (2009) concludes. ultimately leading to a breakdown in communication between the brain and other parts of the body. The central nervous system comprises of the brain and spinal cord. Before the reader progresses any further it would be beneficial to gain a brief insight/definition into the disease multiple sclerosis and intervention hydrotherapy. using a subtle effortless approach with the ability to over challenge the central nervous system. Hydrotherapy Theory Base Campion (2001) believes hydrotherapy as a modality dates back to 2400 B. allowing the body to be simultaneously Page 3 of 7 . Finally a conclusion will be given pulling together all the key points. for example: hygienic installations (water for personal cleaning). 2001). Possibly the longevity of hydrotherapy as an intervention is due to water being one of only two environments available to humans.

Loss of muscle tone causing stiffness. in turn strengthening connecting muscle and tissue (Cameron. Consideration by the physiotherapist is not only given to the treatment but to the planning and surrounding elements involved. Considerations/Contraindications Patient with Multiple Sclerosis Entry and Exit into the pool (use of hoist) Motor symptoms: Muscle weakness . Furthermore using the buoyancy (hydrostatic pressure) of water decreases both stress and compression on load bearing joints within the patient’s body. thus allowing the patient to maintain a core temperature. for example: the physiotherapist may have a number of assistants depending on how advanced the disease (multiple sclerosis) has become. 2001). with physiotherapist becoming more interested and skilled in the manipulation of non weight bearing exercise (Campion. thermal conductivity and external forces (gravity and hydrostatic pressure respectively). land and water. have many different physical properties. some of these considerations/contraindications have been listed below with examples of how this relates to patients with multiple sclerosis. contributing to a truly three dimensional form of rehabilitation. Treatment plans are discussed with the physiotherapist and the patient but also involve other pool professionals. Therefore if the water temperature is maintained lower than that of the patients. Hydrotherapy Association of Chartered Physiotherapists (2006) indicates that the role of multi disciplinary teams is vital when implementing a hydrotherapy programme. This means water retains four times the amount of thermal energy as an equivalent amount of air. through time advances were largely empirical a greater understanding is now evident. pain and restricting free movement of affected limbs and Wasting of muscles due to lack of use. heat created during exercise will be thermally transferred away from the body. for example: both have specific heat.partial Risk assessments are needed. Waters specific heat is four times that of air and thermal conductivity twenty five times greater than air. 2009). allowing water to subsequently transfer thermal energy twenty five times faster.subjected to gravity (downwards force) and buoyancy (upwards force). This will be looked at in more detail in relation to multiple sclerosis during the critical evaluation. or mild paralysis. (Continue next page) Page 4 of 7 . Although. The two environments mentioned earlier. Most pertinent to hydrotherapy is the waters specific and thermal heat conductivity qualities.

carbohydrates and lipids i. consideration of the patient’s cognitive symptoms. medical instability following an acute episode (e. The heating and or cooling of water allows modifications to take place within the human body. Starting positions Slow limb position response. 2009). DVT. These changes within the body can be hemodynamic (increased blood flow or circulation). Resting angina. fats) and soft tissue flexion and extension. Hydrotherapy Association of Chartered Physiotherapists (2006) agreed by expert opinion that the following contraindications would rule out absolutely any form of hydrotherapy. Proven chlorine/bromine allergy. Goal setting and progression As in all rehabilitation setting achievable smaller goals with progression to achieve the overall target. Uncontrolled cardiac failure/paroxysmal and Weight in excess of the evacuation limit” (Hydrotherapy Association of Chartered Physiotherapists. Information adapted from: (Multiple Sclerosis Society. Sensory symptoms: Loss of awareness of location of body parts (Proprioceptive Dysfunction). metabolic (greater function of amino acids. Use of buoyancy aids Wasting of muscles due to lack of use. status asthmatics).g. To conclude hydrotherapy and its theory base the physiological effects will now be discussed. for example: depression. In short the use of heated water induces increased nerve conduction speed and reduces the latency of sensory and motor responses. mood swings and anxiety.Risk assessments is Visual symptoms: such as blurred vision needed. Shortness of breath at rest.Depth of water . PE. As described previously water has the ability to cool or heat whilst using hydrostatic pressure to stabilise.e. Co ordination and balance symptoms: Loss of coordination and Abnormal balance function in the inner ear. CVA. “acute vomiting or diarrhoea. neuromuscular (increased synapse between neurons and motor neurons). 2006: 24). Therefore it can be concluded that for some multiple sclerosis patient’s hydrotherapy can Page 5 of 7 . Length of treatment time Fatigue in relation to the patients muscle tone and range of movement.

these outcomes will now be discussed during the critical evaluation (Cameron. 2009). Critical Evaluation Page 6 of 7 .have both physiological and psychologically positive outcomes.

54 (1): 60-8. Campion. Michelle. Multiple Sclerosis Organisation. Lam Tai Pong. (2009). Martin. The Relationship among Performance of Instrumental Activities of Daily Living.gov/hrqol/methods. self-report of quality of life. Multiple Sclerosis Symptoms [Internet]. London: Halliwick. Chiaravalloti. and self-awareness of functional status in individuals with multiple sclerosis. Page 7 of 7 . (2009). About Multiple Sclerosis [Internet].lib. Available from: th <http://www. (2008).html> (Accessed: 14th November 2009). (2004). (2005).html> (24th November 2009). What is Health Related Quality of Life? [Internet].cdc. Hydrotherapy: Review on the effectiveness of its application in physiotherapy and occupational therapy [Internet]. Multiple Sclerosis Society. Elizabeth G. Cameron. Available from: <http://www. (2009). (1997). Available from: <http://www. (2001). Hydrotherapy Association of Chartered Physiotherapists.htm> (Accessed: 14 November 2009).pdf> (Accessed: 14th November 2009). John. Rehabilitation Psychology. DeLuca.Bibliography Dr. Goverover.worksafebc. Nancy. Oregon: Saunders Elsevier. W. Craig. Margaret.mssociety.uk/about_ms/index. National Centre for Chronic Disease Prevention and Health Promotion. Available from: <sunzi1. R.pdf> (Accessed: 14th November 2009).mult-sclerosis. Yael. Health Related Quality of Life: Methods and Measures [Internet]. Physical Agents in Rehabilitation: From Research to Practice. Dr. Hydrotherapy: Principals and Practice.hku. H. Guidance on Good Practice in Hydrotherapy.com/health_care_providers/Assets/PDF/hydrotherapy_application_ physiotherapy.org. Oxford: Butterworth-Heinemann.hk/hkjo/view/23/2302034. (2006). Available from: <http://www. 3rd Edition. Goering.org/mssymptoms.