Principles of Hydrotherapy Treatment - طـبيـعي للعلاج الطبيعي والتأهـيل الطبي
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افتراضي  Principles of Hydrotherapy Treatment
كُتبَ بتاريخ: [ 09-09-2010 - 03:10 PM ]
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الصورة الرمزية Sultan AlEnad PT
Sultan AlEnad PT
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Sultan AlEnad PT غير متواجد حالياً
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قوة التقييم :

Principles of Hydrotherapy Treatment
· Principles of Treatment
· Contraindications to Pool Therapy

Strengthening muscles
Muscles are strengthened by being worked progressively against graded resistance. In the pool,
resistance may be from buoyancy, turbulence.
Movement downwards in the pool are resisted by buoyancy. Floats which may be of different
densities may be used to increase the effect of buoyancy.
This is created by movement through water and is increased if the rate of movement is
increased. The patient may move as a whole through the water–this is the principle underlying
muscle strengthening using Bad Ragaz techniques. Alternatively, the patient may be fixed and
move one limb at a time. Walking fast through water is useful for strengthening muscles and
for improving cardiovascular fitness.
Joint mobility
Relief of pain and muscle spasm by the warmth of the water and by support from buoyancy can
restore free movement of joints. Exercises for gaining mobility are generally slow, taken to the
point of limitation, held, carried a bit further and then relaxed. Full–range sweeping
movements also gain range (the speed is kept to a minimum so that the muscles are not
working against turbulence). Hold–relax and repeated contractions may be used to gain joint
movement–generally with the patient in lying (buoyancy supporting) or positioned so that
buoyancy may assist in gaining the movement.
Mobilizations–Oscillatory passive movements can be applied to joints to gain range. Fixation is
a problem and it may require two physiotherapists, one fixing and one producing the
movement, to localize the effect to the joint being treated. Patients report considerable relief
from pain following mobilization in the pool.
Coordination and balance
Patients can practice activities in standing, for example stride standing or walk standing ,
transference of weight, or arm movements. The buoyancy of the water relieves weight, for
example 90% relief is obtained if the water is over the shoulders, therefore weight–bearing
activities such as walking, stepping up and down, standing up and down can be practiced in the
pool before the patient attempts these activities on land. Components of swimming can be
practiced, for example the leg patterns of different swimming strokes may be performed while
the patient holds the pool rail. Swimming and ball games, Bad Ragaz techniques and the
Halliwick principles all help patients to regain coordination. The special value of the Halliwick
approach is to teach the patient breathing control and balance in the water, thereby enabling
him to the water–confident.
Pain relief
The general freedom of movement in a pool enables tissue fluid to flow through tissue planes,
removing metabolites and improving nutrition. These effects, together with a feeling of well–
being after physical activity, help to gain permanent reduction of pain. In some pools there is a
facility for applying a high–pressure jet of water to a painful area. The patient is standing,
sitting or lying and the physiotherapist directs the jet at the area to be treated and moves if
either in circles or to and fro for 5–10 minutes. Patients report relief of the aching which is
often associated with muscle spasm or tightness in degenerative conditions or chronic injury.
Contraindications to Pool Therapy
· Principles of Treatment

· Contraindications to Pool Therapy
1. Recent pulmonary embolus.
2. Recent CVA (within 3 weeks).
3. Gastrointestinal disorders.
4. Tracheostomy
5. Careful consideration is essential for patients with open wounds covered with a
waterproof dressing (e.g. Opsite).
6. Hypotension, hypertension.
7. Epilepsy.
8. Vertigo.
9. Low vital capacity (below 900 ml).
10. Kidney disease.
11. Diabetes.
12. Thyroid deficiency.
13. Radiotherapy in the previous 3 months.
Precautions must be taken for patients with
1. Tinea pedis or verrucas–pool therapy must be delayed until these conditions have been
cleared or special socks may be worn.
2. AIDS. Patients with this syndrome must not be treated if there are skin cuts.
3. Hydrophobia–fear of water. Breathing control must be taught.
4. Contact lenses.
5. Hearing aids.
6. Allergy to chlorine.
7. Hemophilia.
8. Severe mental retardation.
1. Falls inside and outside the pool.
2. Burns and scalds.
3. Faulty equipment.
Contagious diseases are a problem because of the proximity of patients and staff. Waterborne
diseases are typhoid, cholera, dysentery.
Precautions necessary to ensure patient and staff safety with pool therapy.
1. Water temperature should be 34–37°C (94–98°F).
2. Chlorine levels should be 1.5–3.00 parts per million.
3. Water pH level should be 7.207.8.
4. Chlorine and pH levels must be tested two or three times a day.
5. There must be a complete water turnover every 4 hours .
6. Bacteriological testing must be performed regularly.
7. Backwashing must be performed regularly.
8. Results of all tests must be recorded meticulously.
9. The floor of the pool must be on non–slip.
10. There must be handrails on both sides of steps for entry to the pool.
11. A cord to an emergency bell must be situated over the pool.
12. Hoists and other pool equipment must be tested and maintained regularly.
13. A footbath must be situated near the entry point to the pool.
14. The pool surround must have a non–slip floor and handrails.
15. Water must be mopped up so that it does not remain on the pool surround.
16. Air temperature should be 25°C (78°F).
17. The humidity level should be 55%.
18. Overshoes must be provided and worn by everyone within a designated area.
19. All staff must be trained and regularly tested in emergency and resuscitation
20. The maximum time for a physiotherapist to be in the water without a break is 2 hours.
It is recommended that physiotherapists who are treating patients in the pool regularly
should not be in the water for longer than 1.5 hours without a break.
General facilities
1. A hydrotherapy department should include rest, changing and utility areas.
2. Rest and changing areas.
3. Air temperature should be 21°C (68°–74°F).
4. There must be adequate space and privacy.
5. Wheelchair accessibility is essential in all areas.
6. There must be provision for privacy for patients and security for their valuables.
7. Showers and toilets must be available both for able and for disabled people.
8. Utility area.
9. There must be a washing machine and spin dryer for cleaning swimming costumes.
10. Buckets are essential for shoes, flippers and other equipment which must be soaked in
11. Chemicals must be stored in a secure, cool dark place with goggles and gloves which
must be worn when chemicals are being handled.
12. Storage space is essential for linen, wheelchairs, sticks and crutches.

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