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Good practice guide in the balneal prophylactic, therapeutic and rehabilitation treatment in elderly proposal draft presentation

Authors: O. Surdu 1, 2, V. Marin1, T. V. Surdu2, V. Rusu 1, D. Profir 1 1. Balneal and Rehabilitation Sanatorium Techirghiol 2. Ovidius University Constanta Leonardo Proyect:Thermal Baths for Active Ageing Termas de Cuntis May 4-7, 2012

1. Natural therapeutic factors: climate (relief, hydrology and vegetation), including salty mines and caves micro climate mineral/thermal waters (for bathing and drinking cure) mud/peat/clay Gases 2. geronto-prophylactic balneal cure 3. Therapeutic balneal cure in eldery 4. Rehabilitation balneal cure in eldery

5. Indication and contraindication of balneal cure in adults 6. Physiological features of aging process and modulation of thermal parameters required by application of balneal factors in elderly 7. Contraindication of balneal cure in elderly and protocol for the application of spa treatment in the elderly 8. Balneal section facilities and enforcement rules

Type of climate in Romania (Your country):
temperate continental with four distinct seasons Some parameter of climate: a. The average annual temperature: 11C (52F) in the south and 8C (46F) in the north. b. Precipitation - over 750 mm/year, on the highest mountains - much of it falling as snow. -In the south-central parts - around 600 mm/year. -In the Danube Delta, rainfall levels are very lowaround 370 mm/year .


temperate continental climate is modulated by the relief: plain climate (exciting in the summer), seaside climate (hot and humid in the summer, dry and windy in the winter); hillock and hill climate (sparing climate); mountain climate (low and high mountain with tonic/challenging properties);

Microclimate (exemples)
Salt mines and caves microclimate

temperature: 10 - 12 C air humidity 50-80% presence of aerosols of NaCl absence of vegetal allergens and pathogen microorganisms (like in a surgery room)

Mineral waters-definition and conditions (Congress at Bad Nauheim in 1912)

Def. Are natural solutions of salt separate ionic or not, in balance from its source/spring. at least one of the following conditions: to contain at least 1 g salt/l; to contain chemical elements, solid or gaseous, with scientifically proven therapeutic action; to have from its source at least 20 C; to contain micro-elements;

Mineral waters
Criteria for the classification


in salts the temperature of the water chemical composition and physical properties level of mineralization

Mineral waters
types of mineral/thermal waters :

Saline, chloro-sodic waters, alkaline, alkaline terouse, sulfatate-sodic-magnesium, carbogaseous, oligometallics, oligominerale ferruginous, arsenicale, iodurate, sulfurous, radonics/radioactive waters

Mineral waters
Ways of using:

cure, bathing cure, aerosols, lavages and gynecological applications

Exploitation and marketing of natural mineral waters

Mineral waters used/indicated in internal cure are drunk most of the time directly to the source. They can be bottled and can be marketed for food consumption, daily. By judgment nr.1.020 of September 1, 2005 have been established "Technical rules of operation and marketing of natural mineral waters" This document (including attachments) contains the elements necessary for proper management and utilization of mineral water. The label of mineral waters must contain information on chemical composition, name and location of the source. On the label can be written instructions like "stimulates digestion", "stimulate biliary secretion" or similar indications

Explotation and marketing of natural mineral waters specific rules

the source must be marked with signs, it must be paved, equipped with handrails and benches for rest. Patients receive the instuction for the balneal cure from the medical doctor of the resort. On the recipise are listed: the source of mineral water, the amount of mineral water, the rhythm and the moment of administration, depending on the type of diseases. Some mineral waters can be administrated as inhalation or/and vaginal irrigation. For this type of applications are needed adequate facilities, approved by the Ministry of Health

Therapeutic lakes
Are areas of water which have taken birth through one of the mechanisms, which can be used to bathing. Yours country? Types of lake: the sea shore lakes appeared at a river flowing into the sea; plain lakes whose chemical composition is determined by soil composition of the neighborhood; Lakes form in massive salt.


Mud is one of the five elements of nature having immense impact on the human body in health as well as in sickness. The mud is made of ground/rocks of pasty consistency Substances formed in natural conditions under the influence of geological processes and which in smoothly divided state and in mixture with water are used in medical practice as mud bath or local procedures. (ISMH)


Types of mud: exemples and clasification Sapropelic mud - black, sulfurous deposits, very unctuous with very good plasticity Peat - brown organic deposits Mineral mud are formed by salts sedimentation of carbon dioxide, calcium, iron or soulphourous springs Ways of using: cold ointment, mud bath, mud wrapping/pack


Emanation of dry CO2 named mofeta (plural mofete) therapeutic used for their vasculoactive properties Emanation of SH2 named sulphatarium used for their condroprotectiv activity ex? Emanation of both: dry CO2 and SH2 used for both: vasculoactive and condroprotectiv properties ex?

Fields of pathology/prophylaxis potential beneficiaries of balneal cure

1. Neurological pathology (central/periphery) 2. Rheumatologycal diseases: osteoarthritis; inflammatory arthritis; acute, sub-acute, sub chronic or chronic steady; 3. Post traumatic pathology: shoemaker, orthopedic-surgical, sports; 4. Cardiovascular pathology (cardiac diseases; peripheralarterial/venous/lymphatic); 5. Respiratory pathology (type restrictive / obstructive/ mix); 6. Pathology of civilization (sedentariness; stress/breakdown - with important prophylactic connotations); 7. Geriatric pathology, geriatric-prophylaxis, geriatric-rehabilitation; 8. Pediatric pathology

Fields of pathology/prophylaxis potential beneficiaries of balneal cure

9. Psychiatric pathology (stress/breakdown, syndromes neurotic syndrome); 10. Digestive pathology (gastro-intestinal, biliary, hepatic); 11. Kidney and urinary pathology; 12. Metabolic pathology; 13. Gynecological pathology 14. Dermatological pathology and cosmetology 15. Pathology ORL 16. Professional-occupational pathology

General contraindications for balneal cures in adults:

Acute and chronic fever during the flare Infectious diseases - including the venereal diseases (syphilis, clap, AIDS, hepatitis acute type B, C, etc.); tuberculosis - except in cases with healing confirmed by the specialist physician; healthy carriers of pathogens including parasitic agents Cachectic states, regardless of causes; Cancer of any type, in every location or stage; Bleeding from any cause; Hematological diseases Epilepsy, psychopaths - including elitism chronic and other drug addiction;

General contraindications for balneal cures in adults:

Diseases to the limit organ failure (cardiac insufficiency, renal, hepatic and/or metabolism status unbalanced or difficult to control with therapeutic means; swinging HTA and/or with high values without therapeutically control; Disturbances of sensitivity (hypersensitivity to specific current links it was perhaps psychogenic/hypo - anesthesia emanating on the areas relatively taut) Lesions and/or skin diseases, with risk of aggravation by F. F. T. N. and/or lesions large, unsightly; areas with skin irritation, solutions of continuity; Patients who can not care for themselves; Patients recovering from serious and recent illness Pathological pregnancy in any month and normal pregnancy after three months

General rules for applying balneal treatment

Inspection of the patient before immersion in the tub. General warm procedures must not be applied secondary abundant meals (lunch), stress, physical exercises, tensed situations. It is preferred that application takes place in the morning. If the patient has two major procedures the same morning, its mandatory to have a 2 hours break between them. The physician must avoid too many procedures on medical prescription for one patient. Menstrual bleeding contraindicates any balneal procedure first 2-3 days, the following days allowing only partial applications to upper limbs.

General rules for applying balneal treatment

Draining of kidney and digestive residues. The application of cold thermotherapy will be done only on warm skin or heated before areas and begins always with the warm factor. Hot or warm applications will always be followed by a cold procedure, in order to avoid consecutive vasoplegia. When the patient finish the bath, he goes out of the tub and must be dried with a sheet, intensity of this process being correlated with the intended aim: with vigorous movements (for toning the patient) or softly (to reduce response).

General rules for applying balneal treatment

Precise application of the prescription: temperature, duration, level of immersion or application area. The assistant/therapist may add minor procedures - friction or brushing, in order to rush appearance of dermo-vascular reactions. The therapist must provide psychological support to the patient by explaining him the applied procedure and avoiding unpleasant discussion or arguing. The assistant/therapist must supervise the patient carefully meanwhile the application, in order to prevent incidents or accidents which can happen.

Necessary equipment for section/department of balneotherapy and surveillance measures (microbiological and biochemical) of therapeutic resource

Tub dimension must be between 80x175 cm and 100x190 cm and the volume of used water is between 180 - 220 l. Minimal area allocated for a tub is 8 m2 , and for the shower is 2-3 m2. Drainage system and filling valves must be dimensioned in order to allow filling, respectively drainage of the tub in 3-5 minutes. Scottish shower, massage shower, etc) is minimum 3-4 m2 by room , and for Scottish shower is necessary a distance of 3-3.5 m between the nozzle and the patient.

Necessary equipment for section/department of balneotherapy and surveillance measures (microbiological and biochemical) of therapeutic resource

The mud packing room must has an optimum surface of 4 m2, height of 2.5 to 3.5 m, must contain beds with dimensions between 80x175 cm and 100x190 cm, with a height of 70 to 80 cm. Balneotherapic rooms must have the floor coated with non-slippery materials, be provided with adequate drainage system, wooden grills and naturally illuminated. Fluorescent lamps provide most proper artificial light, which allow the therapist to see dermo-vascular reaction. The walls must be covered by tiles up to the ceiling or at least up to a height of 2 m from the floor.

Necessary equipment for section/department of balneotherapy and surveillance measures (microbiological and biochemical) of therapeutic resource

Ventilation of the rooms must ensure vapor removal during application, so that humidity in the air doesnt exceed 75%. Optimum temperature in the baths rooms/chambers is 22C to 24C, and in the corridors and waiting rooms 20C to 22C. It is appropriate to have ambient thermometers in every room, for better monitoring of thermal comfort necessary during the procedures. Duration of a warm bath is 20-30 minutes, after this resting is necessary for 1-2 hours. For time monitoring every room must have a signalizing clock or an hourglass with sand.

Necessary equipment for section/department of balneotherapy and surveillance measures (microbiological and biochemical) of therapeutic resource

Sweating and resting shall be carried out in the hotel room and when hydrothermotherapy is applied in specialized outpatient must exist specially designed spaces: rooms for resting and/or sweating, where the patient get fluids for hydration: mineral water, tea. Special attention must be paid to surveillance of surface/source of mineral water, to protection of perimeter in accordance with the existing laws, checking periodically microbiological and biochemical parameters. Personnel involved in this activity will carry out periodically a medical exam, according to valid epidemiological and working protection normative. Special attention will be paid to self control rhythmically realised by the owner of the base.

Physiological features of aging process and modulation of thermal parameters required by application of balneal factors in elderly

The therapeutically objectives in elder locomotors rehabilitation in balneal resort are:

The maintaining / regaining of articular mobility; The maintaining / regaining of muscular force and resistance; The maintaining / correction of body posture and alignment; The maintaining / correction of motor coordination and control and equilibrium.

The therapeutically objectives in elder rehabilitation in balneal resort in pathology of:


tract Cardiovascular aparat Digestive tract Kidney and urinary tract Neurological periphery and central Posttraumatic sequels

Therapeutic objectives followed in balneal treatment in elderly are:

The decrease/control of pain; Prevention of loss/recover of joint mobility; Prevention of loss/recover of muscular force and resistance; In case of neurological squeals, the kinetic program aims are: recover of the muscular tonus decrease in muscular hypertonia and increase in muscular hypotonia; prevention of axial deviations; recover the balance between agonist / antagonists, synergistic / stabilizers, and also between the physiological alternation contraction / relaxation; the re-establishment of body equilibrium, voluntary motor control, walking and abilities.

Contraindications and/or limits for balneal cures in elderly

Painful ischemic heart disease (especially angina at rest), myocardial infarct, cardiac arrhythmia (except possibly chronic atrial fibrillation with average rate, well tolerated), Severe high blood pressure, uncontrolled / difficult to control treatment Clinical cerebral atherosclerosis, dementia syndromes Sphincter disorders (bladder and / or anal)

Parameter modulation of kinetics and hydrokinetotherapy clinically motivated prescriptions, may allow 3-rd age and even 4-th age patients to do efficient balneal and physical treatments, not only with the purpose of training/stimulating the organisms adaptability, with the delay of global decrease of performance / maladjustment phenomena characteristic for senescence - thus gerontoprophilaxis but also with the purpose of treating ailments and/or chronic dysfunctions gerontorehabilitation, both aspects leading finally to the same objective the improvement of life quality.