Hydrotherapy In NeurologyHydrotherapy In NeurologyEwa Poniecka-HanscombeEwa Poniecka-Hanscombe

ObjectivesObjectives

• To discuss physiology of immersion To discuss physiology of immersion and benefits of hydrotherapyand benefits of hydrotherapy

• Contraindications (absolute, relative), Contraindications (absolute, relative), precautionsprecautions

• Hydrotherapy in neurologyHydrotherapy in neurology

• Introduction to Halliwick, Watsu, Introduction to Halliwick, Watsu, Water specific therapy, Bad RagazWater specific therapy, Bad Ragaz

Hydrostatics & Hydrostatics & HydrodynamicsHydrodynamics

Archimedes Principle.Archimedes Principle.When the body is wholly or partially When the body is wholly or partially

immersed in a fluid at rest it experiences immersed in a fluid at rest it experiences an apparent loss of weight equal to the an apparent loss of weight equal to the weight of the fluid displaced.weight of the fluid displaced.

Floatation.Floatation.The ability of an object to float is dependent The ability of an object to float is dependent

on its relative density.on its relative density.

Physiology of immersionPhysiology of immersion

All the physiological changes All the physiological changes associated with immersion occur associated with immersion occur during during Head-Out Water Immersion Head-Out Water Immersion (HOWI) in an upright position at 35(HOWI) in an upright position at 35°°C C - this diminished during supine - this diminished during supine immersion (Hall, 1990).immersion (Hall, 1990).

1.Cardiovascular1.Cardiovascular• Central blood volume increases by 700mls,Central blood volume increases by 700mls,

• Central venous pressure increases from 3-Central venous pressure increases from 3-15mmHg15mmHg

• The heart increases in size by 30% in 6 The heart increases in size by 30% in 6 secondsseconds

2. Renal2. Renal• Urine production increases from 1ml-Urine production increases from 1ml-

7ml/min,7ml/min,

• Sodium excretion increases by 200-300%,Sodium excretion increases by 200-300%,

• Potassium & calcium are also excretedPotassium & calcium are also excreted

3.Respiratory3.Respiratory• Most lung volumes are decreasedMost lung volumes are decreased

• Decreased airway diameter,Decreased airway diameter,

• Increase in total workload of Increase in total workload of breathing,breathing,

4. Haemodilution4. Haemodilution

5. Well Being5. Well Being• Immersion is a profound suppressor Immersion is a profound suppressor

of the sympathetic nervous systemof the sympathetic nervous system

Brainstorm Benefits Brainstorm Benefits

1.Relief of pain & muscle 1.Relief of pain & muscle spasmspasm• Warmth of water,Warmth of water,• Suppression of the sympathetic nervous Suppression of the sympathetic nervous

system,system,• Reduced effect of gravityReduced effect of gravity

2. Improved strength and 2. Improved strength and enduranceendurance

• Resistance to movement (viscosity- Resistance to movement (viscosity- molecular interchange which occurs when molecular interchange which occurs when a fluid is in motion, turbulence, buoyancy),a fluid is in motion, turbulence, buoyancy),

3.Ease of movement, joint 3.Ease of movement, joint range& flexibilityrange& flexibility

• Support & assistance offered by Support & assistance offered by buoyancy and reduced effect of buoyancy and reduced effect of gravity,gravity,

44. . Reduction of oedema & Reduction of oedema & improved circulationimproved circulation

• Hydrostatic pressure, passive, active, Hydrostatic pressure, passive, active, muscle pump activitymuscle pump activity

5. Re-education of functional 5. Re-education of functional activitiesactivities

• BalanceBalance

• CoordinationCoordination

• PosturePosture

• ( Use of metacentric effect- relation ( Use of metacentric effect- relation of centre of gravity to centre of of centre of gravity to centre of buoyancy , buoyancy, resistance),buoyancy , buoyancy, resistance),

6. Improved cardiovascular 6. Improved cardiovascular fitnessfitness• Hydrostatic pressure, resistance to Hydrostatic pressure, resistance to

movementmovement

7. Feeling of well being7. Feeling of well being• Ability versus disability,Ability versus disability,• Enjoyment,Enjoyment,• Social interaction,Social interaction,• IndependenceIndependence

Absolute ContraindicationAbsolute Contraindication

• Uncontrolled cardiac failure,Uncontrolled cardiac failure,

• Resting Angina,Resting Angina,

• Short of breath at rest,Short of breath at rest,

• Medically unstable (CVA, DVT, PE),Medically unstable (CVA, DVT, PE),

• Acute Vomiting or diarrhoea,Acute Vomiting or diarrhoea,

• Chlorine sensitivity,Chlorine sensitivity,

• Severe urinary tract infectionSevere urinary tract infection

Relative ContraindicationsRelative Contraindications

• Open infected wounds,Open infected wounds,

• Poorly controlled epilepsy,Poorly controlled epilepsy,

• Unstable diabetes,Unstable diabetes,

• Radiotherapy,Radiotherapy,

PrecautionsPrecautions

• Blood pressure,Blood pressure,

• Epilepsy,Epilepsy,

• Haemophilia,Haemophilia,

• Friable skin,Friable skin,

• Impaired Impaired sensation,sensation,

• MRSA,MRSA,

• Invasive TubesInvasive Tubes

• Behavioural Behavioural problems,problems,

• Fear of water,Fear of water,

• Gross Obesity,Gross Obesity,

• Incontinence,Incontinence,

• Hearing Aids,Hearing Aids,

• Grommets,Grommets,

• Contact lenses,Contact lenses,

WatsuWatsu

• WatWater Shiater Shiatsusu

• Aquatic shiatsu,Aquatic shiatsu,

• Started at School of Shiatsu &Massage at Started at School of Shiatsu &Massage at Harbin Hot Springs (Northern California),Harbin Hot Springs (Northern California),

• Developed by Harold Dull in 1980,Developed by Harold Dull in 1980,

• Aquatic bodywork form using stretches Aquatic bodywork form using stretches and principles of Zen Schiatsu while and principles of Zen Schiatsu while floating people in water (an effective floating people in water (an effective way of mobilising ‘Chi’ life force through way of mobilising ‘Chi’ life force through the meridians, lines of energy in the the meridians, lines of energy in the body)body)

2 Principles of Watsu2 Principles of Watsu

StretchingStretching

- Ancient technique Ancient technique of opening of opening channels through channels through which our Chi which our Chi energy flows,energy flows,

- Strengthen Strengthen muscles and muscles and increases flexibilityincreases flexibility

Zen ShiatsuZen Shiatsu

- Connecting with Connecting with breath,breath,

- Zen (meditation),Zen (meditation),

- Shiatsu (finger Shiatsu (finger pressure),pressure),

Halliwick Halliwick concept is an approach of teaching people with physical concept is an approach of teaching people with physical and/or learning difficulties to participate in water activities, and/or learning difficulties to participate in water activities, to move independently in water, and to swim to move independently in water, and to swim

Halliwick- The 10 Points Halliwick- The 10 Points ProgrammeProgramme

• Mental adjustmentMental adjustment• Disengagement Disengagement • Transversal (formerly vertical) rotation Transversal (formerly vertical) rotation

controlcontrol• Saggital rotation controlSaggital rotation control• Longitudinal (formerly lateral) rotation Longitudinal (formerly lateral) rotation

controlcontrol• Combined rotation controlCombined rotation control• Up thrustUp thrust• Balance in stillnessBalance in stillness• Turbulent glidingTurbulent gliding• Simple Progression and a basic strokeSimple Progression and a basic stroke

Water Specific TherapyWater Specific Therapy

• Developed 1974 in Bad Ragaz, Switzerland,Developed 1974 in Bad Ragaz, Switzerland,• Based on Halliwick Concept as a motor Based on Halliwick Concept as a motor

learning program for individual neurological, learning program for individual neurological, orthopaedic and rheumatologic treatment,orthopaedic and rheumatologic treatment,

• Utilises water as a problem solving Utilises water as a problem solving environmentenvironment

• Hydrodynamic effectsHydrodynamic effects• Reactive treatmentReactive treatment• Promoting both active movement and Promoting both active movement and

relaxation for efficient movement,relaxation for efficient movement,

Bad RagazBad Ragaz• Bad Ragaz is a method of muscle re-education utilizingBad Ragaz is a method of muscle re-education utilizing specific patterns of resistance, endurance, elongation, specific patterns of resistance, endurance, elongation,

relaxation, range of motion and tonal reduction. relaxation, range of motion and tonal reduction.

• The therapist uses the physical properties of water to interact The therapist uses the physical properties of water to interact with the patient creating progressive passive to active, with the patient creating progressive passive to active, isometric, isokinetic, and isotonic exercises. This technique isometric, isokinetic, and isotonic exercises. This technique incorporates the fundamentals of PNF incorporates the fundamentals of PNF

• The client is verbally, visually, and/or tactilely instructed in a The client is verbally, visually, and/or tactilely instructed in a series of movement or relaxation patterns while positioned series of movement or relaxation patterns while positioned horizontally and supported by rings or floats in the water horizontally and supported by rings or floats in the water

• Exercises consist of spiral and diagonal patterns and must Exercises consist of spiral and diagonal patterns and must incorporate three components of motion: flexion or incorporate three components of motion: flexion or extension, adduction or abduction, and rotation extension, adduction or abduction, and rotation