Thera midterm

• Hydrotherapy


  Derived from Greek words: hydro = water, therapeia = healing
• Physical Properties of Hydrotherapy


  • Solvent
  • Surfactants
  • Saline Solution
  • Resistance
  • Hydrostatic Pressure
  • Buoyancy
  • Specific Heat and Thermal Conductivity
• Solvent


  Water (H2O) = universal solvent, Running water over wound = dissolve contaminants or necrotic material
• Debridement


  Using irrigation, Debridement is the removal of dead (necrotic) or infected skin tissue to help a wound heal
• Surfactants


  Allows water to dissolve fatty material that is hydrophobic, not used to clean wounds
• Saline Solution


  Water + salt/water soluble antimicrobials, Salt makes water alkaline (not acidic), Saline solution is not the same as dextrose (since this one is sugar)
• Resistance


  Viscosity of water provides resistance to the motion of body within it, Resistance is zero when there is no flow or motion, Resistance increases by increasing the speed of water flow or body movement, Faster water or patient = more resistance, Increase frontal area = increase resistance, Slower water or patient = less resistance, Kickboard - decrease frontal area = decrease resistance

  
• Hydrostatic Pressure


  Pressure exerted by a fluid on a body immersed in it, PASCAL'S LAW - a fluid exerts equal and inward pressure in all surfaces of body at rest in proportion to the depth of the body in the fluid, More distal = more hydrostatic pressure, Water exerts 0.73 mmHg pressure per centimeter of depth (22.4 mmHg/ft), Immersion in water can promote circulation or alleviate peripheral edema caused by venous or lymphatic insufficiency
• Buoyancy


  Force experienced as an upward thrust on the body in the opposite direction to the force of gravity, Archimedes principle - When a body is entirely or partially immersed in fluid at rest, it experiences an upward thrust equal to the weight of the fluid it displaces, Salt water has higher concentration compare to pure water
• Specific Heat and Thermal Conductivity


  Water can transfer heat by conduction and convection and therefore can be used as a superficial heating or cooling agent, Water has higher specific heat and thermal conductivity compared to air
• Physiological Effects of Hydrotherapy


  • Cleansing Effects
  • Musculoskeletal Effects
  • Cardiovascular Effects
  • Respiratory Effects
• Cleansing Effects


  Pressure to remove debris, Dissolved surfactants and antimicrobials to assists with cleansing
• Musculoskeletal Effects


  Decreased weight bearing, Strengthening, Effects on bone density loss, Less fat loss than with other forms or exercise
• Cardiovascular Effects


  Increased venous circulation, Increased cardiac volume, Increased cardiac output, Decreased HR, SBP, and rate of O2 uptake response to exercise
• Respiratory Effects


  Decreased vital capacity, Increased work of breathing, Decreased exercise-induced asthma
• Clinical Indications for Hydrotherapy


  • Wound Care
  • Acute Burn Injury
  • Edema Control
• Precautions for Hydrotherapy


  • Impaired thermal sensation in the area to be immersed
  • Alcohol ingestion
  • Limited strength, endurance, balance, ROM
  • Medications
  • Urinary incontinence
  • Fear of water
  • Respiratory problems
• Contraindication for Hydrotherapy


  • Cardiac instability
  • Confusion or impaired cognition
  • Maceration around a wound
  • Bleeding
  • Infection in the area to be immersed
  • Bowel incontinence
  • Severe epilepsy
  • Suicidal patients
• Adverse Effects of Hydrotherapy


  • Drowning
  • Burns, fainting and bleeding
  • Hyponatremia
  • Infection
  • Aggravation of edema
  • Asthma exacerbation
• Traction


  Tensional mechanical force applied to the body in a way that separates the joint surfaces and elongates surroundings soft tissues
• Effects of Traction


  Distract joint surfaces, Reduce protrusions of nuclear discal material, Stretch soft tissue, Relax muscles, Mobilize joints
• Clinical Indications for Traction


  • Spinal disc bulge or herniation
  • Spinal nerve root compression
  • Joint hypomobility
  • Subacute inflammation
  • Muscle spasm
• Contraindication for Traction


  • Where motion is contraindicated
  • Acute injury of inflammation
  • Joint hypermobility
  • Peripheralization of symptoms with traction
  • Uncontrolled hypertension
• Precautions for Traction


  • Structural diseases or conditions affecting tissues in the area to be treated
  • When pressure of the belts may be hazardous
  • Displaced annular fragment
  • Medial disc protrusion
  • When severe pain fully resolves with traction
  • Claustrophobia
  • Inability to tolerate prone or supine position
  • Disorientation
  • Temporomandibular joint problems
  • Dentures
• Tractive Force


  Upper Cervical: 10-15 lbs, Mid-Low Cervical: 35-50 lbs, Male: 1/4 body weight (kg), Female: 1/5 body weight (kg)

  
• Compression


  Inward-directed mechanical force that increases external pressure on the body or a body part, Improve fluid balance and circulation or modify scar tissue
• Edema


  Edema is caused by increased fluid trap in the body tissue, Increasing extravascular hydrostatic pressure, Promotes circulation
• Grading of Edema


  Grade 1+ = most distal joints, Grade 2+ = less distal joints, Grade 3+ = proximal joints, Grade 1+ = bumalik right after pindutin, Grade 2+ = nawala yung lubog in LESS THAN 30 secs, Grade 3+ = nawala yung lubog in MORE THAN 30 secs
• Contraindication for Compression


  • Heart failure or pulmonary Edema
  • Recent or acute DVT, thrombophlebitis, pulmonary embolism
  • Obstructed lymphatic or venous return
  • Severe peripheral arterial disease
  • Acute local skin infections (e.g. cellulitis)
• Precautions for Compression


  Impaired sensation or mentation, Uncontrolled HTN, Cancer, Superficial peripheral nerves
• Parameters for Compression


  Edema, DVT prevention, venous stasis ulcer: Inflation 80-100/Deflation 25-50 (3:1), 30-60 secs UE, 40-80 secs LE, 2-3 hrs treatment time, Residual Limb reduction (amputee): Inflation 40-60/Deflation 10-15 (4:1)
• Extracorporeal Shockwave Therapy (ESWT)


  Also known as shockwave therapy, Effective method for treatment of urinary stones, Beneficial in fracture healing, Most research has focused on upper and lower extremity tendinopathies, fasciopathies, and soft tissue conditions
• Effects of ESWT


  Promote neovascularization at the tendon-bone junction, Stimulate proliferation of tenocytes and osteoprogenitor differentiation, Increase leukocyte (WBC) infiltration, Amplify growth factor and protein synthesis to stimulate collagen synthesis and tissue remodeling
• Indications for ESWT


  • Upper extremity/Lower extremity tendinopathy
  • Greater trochanteric pain syndrome
  • Medial tibial stress syndrome
  • Patellar tendinopathy
  • Adhesive capsulitis
  • Nonunion of long bone fractures
  • Avascular necrosis of femoral head
  • Osteoarthritis of the knee
• Contraindications for ESWT


  • Pregnancy
  • Over major blood vessels and nerves
  • Open wounds
  • Joint infections
  • Epiphysis
  • Blood clot
  • Infection
  • Cancerous tissues
  • Compromised mental status
• Effleurage


  Applied centripetally, one direction or with variations, Used to apply lubricant (lotion/oil), Relieve muscle spasm, Increase blood flow, Stimulates lymph flow, Increase skin mobility
• Petrissage


  Rhythmic and cyclic lifting of tissue followed by kneading, Preferred by patients in their 30s, Specially used in gastrocnemius muscles
• Effects of Massage


  • Relieve muscle spasm
  • Increase blood flow
  • Stimulates lymph flow
  • Increase skin mobility
• Gate control theory


  How massage relieves muscle spasm
• Spasm is compensation from pain