WHIRLPOOL BATHS

Whirlpool Baths
Is composed of a tank that can hold water and a turbine that provides agitation and aeration in order to produce movement of the water in the tank. Tank is usually made of stainless steel, although fiberglass and plastic tanks are also available. Low-boy and High-boy tanks are also available to immersion of larger parts of the extremities or immersions up to the waist.

Method of Heating:
Convection Superficial Heating depth of penetration is from 1-10mm

Use:
Local (or general heat) application of moist heat

Treatment Temperature:
390C 430C (1030F 1100F) 950F 1000F for peripheral vascular diseases 920F 960F for open wounds

Treatment Time:
20 minutes. 30 minutes if other therapeutic procedures are also being done.

 Methods of Application
Fill the tank with water to the proper level and to the desired temperature. Whirlpool liners may be used for patients with burns, wounds, or who are infected with blood borne pathogens (human immunodeficiency virus or hepatitis-B virus) Add disinfectant if open wounds are present. Sodium Hypochlorite (Bleach), Povidone-iodine, Chloramine-T Standard precaution (gowns, gloves, goggles, masks) should be applied when working in infected environment (possibility of splashing) Assist patient in immersing body part into the tank

 Methods of Application
Pressure points should be padded for patients comfort and to minimize compression of blood vessels and nerves. Keep towels out of the water. Adjust agitator to desired position. Turn on agitator and adjust the force, direction, depth and aeration Monitor patients response and tolerance to the whirlpool At the end of the treatment, dry and inspect the skin.

Advantages of Whirlpool
Heat is applied to all surfaces of the extremity Buoyancy of water makes the performance of exercise easier Cleansing action is beneficial for burns, open wounds, ulcers Gentle massaging action.

Disadvantages:
The process of cleaning the tanks and disinfecting it after treating patients with infected area may be tedious.

HUBBARD TANK

EQUIPMENT :
Hubbard stainless tank or ceramics tank 2 agitators w/c are freely movable head rest & rubber rings for head to rest on frame or canvas plinth a footstool rubber cap for women to avoid hair from getting wet & clogging the drain swim suits double sheet to tie patient, if necessary disinfectant sterile sheets, towels or bandages

Method of Heating:
Convection Superficial Heating depth of penetration is from 1-10mm

Use:
General heat application of heat, underwater exercises

Treatment Temperature:
380C (1000F) 950F 1000F for peripheral vascular diseases 920F 960F for open wounds

Treatment Time:
20 minutes. 30 minutes if other therapeutic procedures are also being done.

Method of Application
Fill the tank with water to the proper level and to the desired temperature
Most commonly prescribed temperature is 36 to 39 oC (97 to 102oF) Tubs take from 20 - 40 minutes to fill

Add disinfectant, if open wounds are present.

If a disinfectant is needed, care should be exercised as to the proper choice so as to avoid too much absorption from a large open skin area, w/c may lead to complications later.

Assist patient into the tub.

If a hoist is to be used, have an aide or a therapist assist in the transfer If no hoist available, a three-man lift may be used in transferring a helpless patient

 Arrange the head rest to the patients comfort & safety

If agitators are ordered, arrange height, direction & force of agitation of one or two turbines to accomplish desired purpose. Check height of the head again after turning on the turbine, you may have to raise it again If underwater exercises are prescribed, the agitators are not used. The therapist administers the exercises as prescribed. Maintain good alignment of the patient. Buoyancy of water necessitates careful stabilization of the patient to insure coordinated movements.

***Many patients are apprehensive about being in water. They need constant reassurance and may well be tied down with a sheet in the first treatment.

General Cleaning Procedures

1. 2. 3. After draining water from tank, rinse the entire tank including the openings in agitator and all the drains. Wipe all areas that were in contact with water with a clean dry towel. Wash the inside of the tank, outside the agitators and the drains with disinfectant diluted in warm water. Also wash agitators, thermometers and all equipment used in the treatment. Some tanks have a hose that can be used to spray tank. Allow disinfectant to stand for at least one minute.

4.

Place the agitator in bucket filled with water and disinfectant, covering all openings with solutions. Turn on agitator for about 20-30 seconds. Turn off motor and remove agitator from bucket.

5. Rinse the entire tank and all equipment until all residue is removed. Following use with patients with wounds or burns, refill the tank with hot water and disinfectant and allow solutions to stand for five minutes (with or without the agitator) 6. Repeat step 4 with clean water. You may wish to rinse the tank a second time with hot water to hasten drying. 7. Wipe both the inside and the outside of the tank with a dry towel.

Precautions:
Decreased temperature sensations

Impaired cognition
Recent skin graft Incontinence Confusion/disorientation Deconditioned state Hydrophobia with full immersion.

Indications:
Decubitus ulcers Open burns and wound Post hip fractures

Post surgical conditions of hip

Sub acute and chronic musculoskeletal conditions of neck, shoulders and back Rheumatoid Arthritis.

Contraindications:
Bleeding Wound maceration Cardiac instability

Profound epilepsy (with full immersion)

Electrical Safety:
Safety precaution must be taken with any modality that potentially exposes the patient to electrical hazard from faulty electrical conditions.
A ground fault circuit interrupter should be installed All whirlpool turbines, tanks and motor used to lift patients should be checked for current leakage.

POOL THERAPY

Aquatic exercise
refers to the use of multidepth immersion pools or tanks that facilitate the application of various established therapeutic interventions, including

stretching, strengthening, joint mobilization,

balance and gait training, and endurance training.

Goals of Aquatic Exercise

The specific goals include:
Facilitate range of motion (ROM) exercise Initiate resistance training Facilitate weight-bearing activities Enhance delivery of manual techniques Provide three-dimensional access to the patient Facilitate cardiovascular exercise Initiate functional activity replication Minimize risk of injury or reinjured during rehabilitation Enhance patient relaxation

Why do Aquatic Exercises?

The specific purpose of aquatic exercise is to facilitate functional recovery by providing an environment that augments a patients and/or practitioners ability to

perform various therapeutic interventions.

Advantages of Aquatic Therapy

Early activity with non-weight bearing status Reduction of joint compressive forces Warmth of water Relaxation of muscles Gate theory mechanisms Psychological factors

Precautions
Fear of Water
Fear of water can limit the effectiveness of any immersed activity. Fearful patients often experience increased symptoms during and after immersion because of muscle guarding, stress response, and improper form with exercise.

Neurological Disorders
Ataxic patients may experience increased difficulty controlling purposeful movements. Patients with heatintolerant multiple sclerosis may fatigue with immersion in temperatures greater than 33C.51

Seizures
Patients with controlled epilepsy require close monitoring during immersed treatment and must be compliant with medication prior to treatment

 Cardiac Dysfunction
Patients with angina and abnormal blood pressure also require close monitoring. For patients with cardiac disease, low-intensity aquatic exercise may result in lower cardiac demand than similar land exercise.

Small Open Wounds and Lines

Small, open wounds and tracheotomies may be covered by waterproof dressings. Patients with intravenous lines, Hickman lines, and other open lines require proper clamping and fixation.

Contraindications
Incipient cardiac failure and unstable angina.

Respiratory dysfunction; vital capacity of less than 1 liter.

Severe peripheral vascular disease.

Danger of bleeding or hemorrhage.

Severe kidney disease: Patients are unable to adjust to fluid loss during immersion.

Open wounds, colostomy, and skin infections such as tinea pedis and ringworm.

 Uncontrolled bowel or bladder: Bowel accidents require pool evacuation, chemical treatment, and possibly drainage. Water and airborne infections or diseases: Examples include influenza, gastrointestinal infections, typhoid, cholera, and poliomyelitis. Uncontrolled seizures: They create a safety issue for both clinician and patient if immediate removal from the pool is necessary.

BUOYANCY
Definition.
o Buoyancy is the upward force that works opposite to gravity.

Properties.
o Archimedes principle states that an immersed body experiences upward thrust equal to the volume of liquid displaced.

Clinical Significance
o Buoyancy provides the patient with relative weightlessness and joint unloading, allowing performance of active motion with increased ease. o Buoyancy allows the practitioner three-dimensional access to the patient.

Hydrostatic Pressure
Definition

The pressure exerted on immersed objects.

Properties

Pascals law states that the pressure exerted by fluid on an immersed object is equal on all surfaces of the object. As the density of water and depth of immersion increase, so does hydrostatic pressure.
Clinical Significance

Increased pressure reduces or limits effusion, assists venous return, induces bradycardia, and centralizes peripheral blood flow. The proportionality of depth and pressure allows patients to perform exercise more easily when closer to the surface.

Viscosity
Definition. Friction occurring between molecules of liquid resulting in resistance to flow. Properties. Resistance from viscosity is proportional to the velocity of movement through liquid. Clinical Significance
Waters viscosity creates resistance with all active movements. A shorter lever arm results in increased resistance. During manual resistance exercises stabilizing an extremity proximally require the patient to perform more work. Stabilizing an extremity distally requires the patient to perform less work. Increasing the surface area moving through water increases resistance.

Surface Tension
Definition.
The surface of a fluid acts as a membrane under tension. Surface tension is measured as force per unit length.

Properties
The attraction of surface molecules is parallel to the surface. The resistive force of surface tension changes proportionally to the size of the object moving through the fluid surface.

Clinical Significance
An extremity that moves through the surface performs more work than if kept under water. Using equipment at the surface of the water increases the resistance.

Hydromechanics
Definition Hydromechanics comprise the physical properties and characteristics of fluid in motion. Components of Flow Motion o Laminar flow. Movement where all molecules move parallel to each other, typically slow movement. o Turbulent flow. Movement where molecules do not move parallel to each other, typically faster movements. o Drag. The cumulative effects of turbulence and fluid viscosity acting on an object in motion.

Clinical Significance of Drag

As the speed of movement through water increases, resistance to motion increases. Moving water past the patient requires the patient to work harder to maintain his/her position in pool. Application of equipment (glove/paddle/boot) increases drag and resistance as the patient moves the extremity through water.

Special equipment for aquatic exercise:

Collars, Rings, Belts, and Vests
Equipment designed to assist with patient positioning by providing buoyancy assistance can be applied to the neck, extremities, or trunk. Inflatable cervical collars are used for the supine patient to support the neck and maintain the head out of the water.

Swim Bars
Buoyant dumbbells (swim bars) are available in short and long lengths. They are useful for supporting the upper body or trunk in upright positions and the lower extremities in the supine or prone positions. Patients can balance (seated or standing) on long swim bars in deep water to challenge balance, proprioception, and trunk strength.

Gloves, Hand Paddles, Fins and Boots

Resistance to upper and lower extremity movements is achieved by applying webbed gloves or progressively larger paddles to the hands and boots/fins on the leg and feet. These devices are not buoyant and,

therefore, only resist motion in the

direction of movement.

Kickboards
Used to provide buoyancy in the prone or supine positions, create resistance to walking patterns in shallow water when held

vertically, or used to challenge

seated, kneeling, or standing balance in the deep water.

Exercise Equipment
Resistive Assistive devices devices Water shoes Floatation cuffs Fins Pull buoys Boots Vests and belts Webbed gloves Kickboards Paddles Water dumbbells Bells

Aquatic Therapy Techniques

Ai Chi:

a combination of deep breathing and slow broad movements of the arms, legs and torso using concepts of Tai Chi, Shiatsu and Qigong. Performs standing in shoulder-depth water with an ideal pool temp of 88F to 96F (pronounced Eye Chee Knee) is a partner stretching program. It involves breathing techniques to increase relaxation and therefore enhance the stretch abilities. a program that the individual can do on his own. It is an aquatic walking program using various strides to accomplish a variety of benefits. It is excellent for gait re-training. a method of muscle re-education utilizing specific patterns of resistance, endurance, elongation, relaxation, ROM and tonal reduction.

Ai Chi Ne:

BackHab:

Bad Ragaz Ring Method:

The Burdenko Method: used for athletic training and as a therapeutic methods for people with disabilities. Concept includes integrating land and water therapy, using a vertical position, focusing on the whole body and homework.
Feldenkrais: uses gentle movement and directed attention to improve movement and enhance human functioning. This method aims to increase ease and ROM, improve flexibility and coordination and encourage the individual to rediscover innate capacity for graceful efficient movement.

Halliwick: an approach to teaching people with physical and/or learning difficulties to participate in water activities, to move independently in water and to swim.
Lyu Ki Dou: various hands-on healing modalities along with Ai Chi, Tai Chi and Qi Gong. Massage: water massage used for soft tissue manipulation and body mobilization techniques in water.

Proprioceptive Neuromuscular Facilitation (PNF): exercises consist of spiral and diagonal patterns and must incorporate three components of motion: flexion or extension, adduction or abduction and rotation. Water Pilates: Pilates exercises adapted for the pool. This body conditioning program is designed to improved strength, flexibility and range of motion (ROM) and also encourages musculoskeletal alignment. Unpredictable Command Technique (UCT): has a goal of progressing the clients so that two or more motor movements are done simultaneously. Wassertanzen: a dynamic movement therapy that includes work below the water surface with the aid of nose clips. Wassertanzen means water dance

Water Yoga: performed in warm, waist-to-chest depth water to develop strength and static balance simultaneously.

Watsu: (water + shiatsu) is cradling, one-on-one program that is experienced in a very warm water (approx 94F) pool. It is for pain reduction, increase ROM, increased circulation, psychological problems, relaxation and reduction of stress.
Yogalates: combines Yoga, Pilates, Ai Chi. The objectives are increase body awareness, strength, ROM , relaxation and inward focus.

Exercise Session Format

Start with 10 to 15 minutes and increase in 5-minute intervals Use deep breathing to increase vital capacity Use GRADUAL progressive overload Work on balance Work on strength Work on flexibility Longer cool down