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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

Physical Principles of Water


Archemedes 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

Physical Principles of Water


Buoyancy
The quality of being able to float, as on
water
The upward force exerted upon an
immersed or floating body by a liquid

Physical Principles of Water


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

Physical Principles of Water


Buoyancy

Exerts the greatest effects on


longer lever arms

Physical Principles of Water


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 peoples bodies are floating?

Physical Principles of Water


Buoyancy

A person with fully

inflated lungs will float


Once that air is
expelled, the person
will sink

Physical Principles of Water


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.

Physical Principles of Water


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

Physical Principles of Water


Relative Density
without the lungs fully inflated
The relative density of the human
body is between 1.050 and 1.084

Physical Principles of Water


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

Physical Principles of Water


Relative Density
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

Physical Principles of Water


Relative Density
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

Physical Principles of Water


Hydrostatic Pressure
The pressure of a liquid

Physical Principles of Water


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

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

Clinical Significance
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

Clinical Significance
Relative Density
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

Clinical Significance
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

Resistance to Movement in Water


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

Check this out

Resistance to Movement in Water


Viscosity
Internal friction, or the resistance to relative
movement within the liquid
Viscosity decreases as temperature increases

its easier to move in warmer water and more difficult to move


in cooler water.

Resistance to Movement in Water


Viscosity
Air is less viscous than
water
There is more

resistance to movement
in water than on land

Resistance to Movement in Water


Viscosity
The greater the cohesion
The greater the viscosity
The more difficult it will be to move within it

Resistance to Movement in Water


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

Resistance to Movement in Water


Turbulence
Fluid flow in which the
velocity constantly
changes in magnitude
and direction

Resistance to Movement in Water


Turbulence
Movement parallel to
turbulent flow will be
easier than
perpendicular to it

Resistance to Movement in Water


Direction of movement
Against gravity = with buoyancy
Easy to move in the water

Resistance to Movement in Water


Direction of movement
Against buoyancy = with gravity
Difficult movement in the water

Resistance to Movement in Water


Drag
Larger surface areas will encounter greater
resistance to movement in the water
drag

Less drag

Resistance to Movement in Water


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

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

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

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

Hydrotherapy Equipment
Turbines
Adjustable
Height
Air intake
Turbulence
Angle for turbulent flow

Hydrotherapy Equipment
Patient Supports
Transfers
Lifts
Gurneys
Ramps and submersible
wheelchairs (aquatic
pool)

Hydrotherapy Equipment
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????

Hydrotherapy Equipment
Extremity tanks
Stainless steel or
fiberglass
Mobile or fixed
Small areas of the
body
Hands, feet, elbows,
ankles

Hydrotherapy Equipment
high boy
Stainless steel or fiberglass
Mobile or fixed
Knees, hips (?), backs (?)

Hydrotherapy Equipment
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

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

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

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