HYDORTHERAPY Flashcards by marissa r

OBJECTIVE

Discuss the role of WP in rehabilitation (#2)
Identify effects of WP on pain relief and functional activities (#6)
Demonstrate proper application of WP (#7)
Identify indications and contraindications for WP (#8)
Explain the physiologic effects of WP (#9)
Document use and response to WP based on patient care scenarios (#10)
Recognize possible adverse reactions to WP interventions (#11)
Explain factors related to treatment progression and attainment of goals based on a sample POC (#12)
Apply principles of aseptic technique, infection control and universal precautions (#14)
Identify and list potential cultural difference s during WP application (#16)
Recognizes absent or altered sensation (#19)
Recognize when interventions should not be provided due to change in patient status and communicate with the PT (#20)

FYI

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can be applied externally, either by immersion of the whole body or of parts of the body in water (WP), or without immersion by spraying our pouring water onto the body and has been shown to have wide ranging therapeutic effects and benefits.

Hydrotherapy

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What is Hydrotherapy used for?

wound treatment or to provide an enhanced environment for therapeutic exercise.
Also used occasionally to control pain or edema.

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Why is the use of hydrotherapy limited in most clinical settings?

It is not very cost effective. It takes a long time to fill up the machine and clean it

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What are the physical properties of water?

relitively high specific heat and thermal conductivity
ability to provide buoyancy
resistance
hydostatic pressure- the pressure exerted by a fluid on the body immersed in the fluid.

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What are the possible modes of heat transfer associated with hydrotherapy?

conduction-produced by stationary water
convection- produced by moving water

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Stationary water transfers heat by

conduction

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Moving water transfers heat by

convection

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According to the Archimedes’ principle, when a body is entirely or partially immersed in a fluid at rest, it experiences an ____________ equal to the weight of the fluid it _______________.

upward thrust , displaces

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The density of the human body is greater than the density of water. true of false

False -The body is less dense than water.

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the ratio of density of a material compared to the density of water.

Specific gravity (pg 282)

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fyi

If the relative density of the body is further decreased, as with the addition of floatation devices or by adding salt to the water, the body will float even higher in the water. (See Figure 9-2, page 247)

fyi

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Submersion of most of the body decreases

stress and compression on weight bearing joints, muscles and connective tissues.

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fyi

Submersion may also be used to help raise weakened body parts against gravity or to assist the therapist in supporting the weight of the patient’s body during therapeutic activities.

fyi

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The viscosity of water provides

resistance to the motion of a body in water.

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The resistance occurs _____________ the direction of the motion of the body and ___________ in proportion to the relative speed of the body’s motion and the frontal area of the body part(s) in contact with the water. See Figure 9-3 on page 248.

against ,increases

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The relative speed of motion of the body can be increased by……………….

having the patient move faster in the water
increasing the speed at which the water moves toward the patient.

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Velocity-dependent resistance provided by water makes it a safe and effecting strengthening and conditioning medium for many patients. Why?

The resisitance of the water is zero when it is not moving, providing a safety, when moving the resistance increases making it an effective environment for training.

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The variable resistance and thus pressure provided by moving water can also be beneficial for ……………..

debriding and cleansing wounds.

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What is hydrostatic pressure and why is it important?

the pressure exerted by a fluid on a body immersed in the fluid.

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What law is this?

a fluid exerts equal pressure on all surfaces of a body at rest at a given depth and this pressure increases in proportion to the depth of the fluid. (See figure 9-5, page 248)

Pascal’s Law

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According to Pascal’s Law

hydrostatic pressure ______________ as the depth of immersion_________________.

increases, increases

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an example of pascal’s law

in the vertical position, the patient will experience greater hydrostatic pressure on the feet than the cranial or proximal parts of the body.

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Hydrostatic pressure can provide the same pressure exerted by certain devices, such as ………..

compression garments or ACE bandages.

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Immersion in water can assist in promoting _____________ or alleviating peripheral edema caused by venous or lymphatic insufficiency.

circulation

fyi ## Footnote Clinical Note: Although hydrostatic pressure can assist in promoting circulation, in some patients, the benefits may be counteracted due to the limbs being in a dependent position.

fyi

In terms of hydrostatic pressure, do you think that the effects will be the same on a patient in the vertical position (standing) as they are with a patient in a horizontal position (such as swimming)? Why or why not?

The hydrostatic pressure would be greater in the vertical position because the hydrostatic pressure increases with the depth of immersion. The horizontal position will have less hydrostatic pressure due to the fact that the limbs will be closer to the surface of the water.

There are no hydrostatic pressure effects when nonimmersion hydrotherapy techniques are utilized. True or False

true

Physiological Effects of Hydrotherapy

- Cleansing - Musculoskeletal effects - Cardiovascular effects - Respiratory effects - Renal effects - Psychological effects

How is water used for rehabilitation purposes, i.e. how does rehab utilize water’s cleansing effects?

Water is used both as a debriding agent to remove endenous debris, such as wound exudate or necrotic tissue, and as a cleaner to remove exogenous waste, such as gravel or adhered dressing materials, and to reduce bacterial burden.

The buoyancy of water unloads the weight bearing anatomical structures and can thus allow patients with load sensitive joints to perform exercises with less trauma and pain. This effect can help patients with:

1. Arthritis 2. Ligamentous instability 3. Cartilage breakdown 4. Other degenerative or traumatic conditions of the articular or periarticular structures of the weight-bearing jt to progress more rapidly with rehabilitation activities

Buoyancy can also be particularly helpful for \_\_\_\_\_\_\_\_\_\_\_\_\_\_patient for whom land based exercises places such extreme stress on the weight bearing joints.

obese

Water based exercises is recommended for improving the \_\_\_\_\_\_\_\_\_\_and __________ of obese patients, but is generally not recommended for weight loss.

fitness and function

The velocity dependent resistance provided by water can also be used to provide force against which muscles can work to \_\_\_\_\_\_\_\_\_\_\_or ____________ strength.

gain or maintain

If water flow is adjusted to occur in the same direction of the patient’s motion, what will occur?

The resistance of the water can also be used to aid the pt’s motion

Cardiovascular Effects: See figure 9-6, page 250 The cardiovascular benefits of hydrotherapy are primarily a result of the effects of

hydrostatic pressure

who's law is this? When immersed in the water to the neck blood volume increase by 60% and cardiac volume increases by nearly 30%. The heart’s response to this increase in pressure with an increase in the force of cardiac contraction and an increase in stroke volume

Starling’s Law

The rate of oxygen consumption is lower when exercise is performed in water than when exercise at the same level of perceived exertion is performed on dry land. True or False

true

fyi ## Footnote Clinical Note: Because of the increase in stroke volume and cardiac output, there is a physiological basis for using exercise in water for cardiac conditioning and rehabilitation.

fyi

Please read about hydrotherapy with CHF patients. How may this information benefit you in your SPTA/PTA careers? Pg 250

This information will help guide me as a PTA when working with a CHF pt. Their hearts response to being put in water brings it close to those of healthy controls.

BE AWARE THAT HEART RATE, SPECIFICALLY TARGET HEART RATE, IS NOT THE IDEAL GUIDE FOR WATER EXERCISE INTENSITY. Therefore, what should be used as a guide to determine the patient’s exercise intensity?

Level of perceived exertion

Respiratory Effects: See figure 9-7, page 251 Immersion of the whole body in water increases the work of breathing because the shift of venous blood flow from the\_\_\_\_\_\_\_\_\_\_\_\_ to the \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_circulation increases circulation in the chest cavity, and the hydrostatic pressure on the chest wall increases the resistance to lung expansion.

peripheral to the central circulation

With full body immersion, as seen with aquatic therapy, the workload challenge to the respiratory system that occurs when exercise is performed in water can be used to improve the efficiency and strength of the \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_system.

respiratory

because this additional respiratory challenge may overload patients with respiratory or cardiovascular impairments, such patients should always be

monitored during water based exercise

Why is Water based exercises often recommended for patients with exercise induced asthma

water based exercise is less likely to cause asthma as compared to land based exercise.

Immersion of an individual up to the neck in water has been shown to increase __________ production and \_\_\_\_\_\_\_\_\_\_\_sodium and potassium excretion.

urinary , urinary

What type of patients may benefit from immersion in warm water?

Warm water can be used clinically to provide a comforting and calming environment for overstimulated and agitated pt’s

What type of patients may benefit from immersion in cold water?

The invigorating effects of cold water can be used to facilitate more active exercise participation by those who are generally less active or responsive.

Contrast Bath: See figure 9-14, page 269 What does a contrast bath consist of and what are the benefits?

Immersing an area, generally distal extremity, first in warm or hot water then in cool or cold water. Contrast bath have been shown to cause fluctuations in blood flow over 20 min tx.

What type of patients may benefit applying a contrast bath?

Pts with chronic edema; subacute trauma; inflammatory conditions such as sprains, strains, or tendonitis; or hyperalgesia or hypersensitivity caused by reflex sympathetic dystrophy or other conditions.

fyi Whirlpool is composed of a tank that can hold water and a turbine that provides agitation and aeration to move the water in the tank. See figure 9-14, page 266

fyi

The turbine may be directed towards the involved or affected area to apply maximum force, as may be desired to control pain or to remove tightly adhered \_\_\_\_\_\_\_\_\_\_\_\_(as often seen with road rash).

control pain,wound debris

When should the turbine be directed away from the involved area?

When there is a skin graft, granulation tissue, and hypersensitivity.

fyi Most turbines also allow the clinician to open or close the aeration valve to further modify the pressure of the water flow.

fyi

Clinically, what is the general use of WPs?

For exercise to pain control in limited areas of the body, such as leg and foot or arm and hand.

Documentation of hydrotherapy treatment should include:

1. Type of hydrotherapy used 2. pt’s position and/or activities 3. Water temp 4. Duration of tx 5. Outcome of or response to tx 6. Fluid pressure, of applicable 7. Water additives, if applicable

Contraindications and Precautions for Hydrotherapy\*\*\*

- Macerations around a wound - bleeding

Local Immersion Precautions:

1. Impaired thermal sensation 2. infection in the area to be immersed 3. Confusion of impaired cognition 4. Recent skin graft

Adverse Effects of Hydrotherapy

1. Drowning 2. Burns, fainting, bleeding 3. hypothermia 4. infection 5. Aggravation of edema 6. Asthma exacerbation

Note: For written examination purposes, also know the precautions and contraindications associated with full body immersion. CONTRAS

1. Pregnancy 2. Multiple sclerosis 3. Poor thermal regulation

Note: For written examination purposes, also know the precautions and contraindications associated with full body immersion. PRECAUTIONS

1. cardiac instability 2. infectious conditions that may be spread by water 3. bowel incontinence 4. severe epilepsy 5. suicidal pt’s

Whirlpool Water Temperature Please know the temperature ranges, sensation and clinical application for WP skill comp testing as listed on page 267, Table 9-5 for

1. cool, 2. tepid, 3. neutral, 4. hot, 5. very hot

Neutral water temp

92-96 F

Cold whirlpool temp

32-79 F

Tepid water temp

79-92 F

Hot water temp

99-104 F

Very hot temp

104-110 F

Cold whirlpool 32-79 F can be used in place of

an ice pack, to treat acute inflammatory conditions of the distal extremities.

Tepid water 79-92 F should be used in the whirlpool if

the water is being used soley as a medium for exercise.

Neutral water 92-96 F should be used for tx of......

1. open wounds, and in 2. pt’s with circulatory, sensory, or cardiac disorders. 3. Neutral water can also be used to control tone in pt’s with neurologically based hypertonicity.

Hot water 99-104 F is recommended for the control of

1. pain and/or to 2. increase soft tissue extensibility because this temp range of whirlpool water has been shown to increase the temp of subcutaneous tissue to within the range required to produce these effects.

Very hot 104-110 F to tx chronic conditions, such as

1. osteoarthritis or 2. RA in the nonacute phases in small areas of the body 3. (for larger areas it is recommended to use 99-104 F)

Whirlpool Skill Comp Testing Hints:

* Monitor vitals signs as deemed necessary What conditions may warrant you to assess vitals? * Select appropriate temperature range\*\*\* You will be given a treatment situation (i.e. pain control, acute inflammation, etc) * Verbalize and demonstrate skin check What are you looking for? * Verbalize need to clean treatment area Know WP cleaning procedure on Blackboard

An upward force on an object immersed in a fluid that is equal to the weight of the fluid it displaces, enabling it to float or to apperar lighter

Byoyancy

Exercises where the distal extremity is stationary on a stable support. When performed in a pool, the distal extremity is supported on the botton or side of the pool

closed-chain exercise

Alternating immersion in hot and cold water

Contrast baths

swelling that results from accumulation of fluid in the interstitial space

Edema

A large, stainless steel whrilpool designed for immersion of the entire body that is used primarily for the treatment of patients with extensive burn wounds

Hubbard tank

The pressure exerted by a fluid on a body immersed in the fluid. It increases with increased depth of immersion

hydrostatic pressure

The therapeutic use of water.

Hydrotherapy

exercises where the distal extremity is free to move. These exercises can can be performed in a pool if the distal extremtiy is not touching the side or bottom of the pool.

open-chain exercises

force per unit area, generally measured in pounds per square inch (psi)

Pressure

a force counter to the direction of movement. In relation to the body's movement i wate is proportional to the relative speed of the body and water's motion and to the frontal areas of the body part in contact with the water

resistance

the ratio of the dinsity of a material to the density of water.

specific gravity

the amount of energy required to raise the temp of a given weight of a material by a given number of derees, usually expressed in J/g/ degrees C

specific heat

The rate at which a material trasfers heat by conduction, usually expressed in (cal/sec)(cm2 x degrees C/cm)

thermal conductivity

the thickness or resistance to flow of a liquid, caused by friction between the molecules of the liquid. A more vicous liquid is thick and pours slowly. Water, a liquid with a relatively low viscosity, pours quickly and easily

Viscosity

The establishment and growth of microoraganisms in a wound.

Colonization

removal of foreign material or dead, damaged, or infected tissue from a wound to expose healthy tissue

Dibridement

Dead tissue or a scab that forms on a wound

Eschar

Wound fluid composed of serum, fibrin, and whit blood cells.

exudate

tissue composed of new blood vessels, connective tissue, fibroblasts, and inflammatory cells that fills an open wound when it starts to heal; typically appears deep pink or red with an irregular, berrylike surface

granulation tissue

Establishment and growth of microorganisms causing disease. With this, there are more microorganisms or more pathological microorganisms than with colonization.

Infection

softening of tissues from excessive soaking in liquid

Dead tissue

necrotic tissue

the application of continuous or intermittent subatmospheric-pressure vacuum suction to an open wound to promote wound healing; aslo known as vacuum-assisted wound closure

negative pressure wound therapy

Infection acquired in a hospital

nosocomial infection

nonimmersion pulstile irrigation, often used to clean and debride wounds and therby promote wound healing

Pulsed lavage

pus; opaque wound fluid that is thicker than exudate and contains whit blodd cells, tissue debris, and microorganisms.

necrotic tissue in the process of separating from viable, living tissue

slough

HYDORTHERAPY Flashcards

(101 cards)