Hydrotherapy on Movable Platform - Power of Versatility

in Clinical Application

Ms. Rosana Lam, SPT UNITED CHRISTIAN HOSPITAL

HYDROTHERAPY WORKING GROUP, PTCOC

8 MAY 2014

Water – Power of Versatility

Fall

Risk

Strain on joints

Muscle Hypertone

Hyper-reflexia

Oedema Pain

Proprioceptive & Exteroceptive

feedback

Soft tissue

suppleness

Balance restoration

Weight bearing Gait facilitation

Relief therapist MHO loading

Warm Water is Ideal Therapy Enviro-nment

Hydrotherapy Pathologies

Reference: Becker (2009) Aquatic Therapy: Scientific Foundations and Clinical Rehabilitation Applications. American Academy of Physical Medicine and Rehabilitation 1: 859-872

Chronic Disease

Neurological Pathologies

Obesity

Paediatric Pathologies

Degenerative Disease

Soft Tissue Injuries

Sport Injuries

Quality & Effective Patient Service

H2O Unique physical

properties

Physio-therapist

skills Pool

Design Equipment

Safety measures

PTCOC Hydro-therapy

WG

Water Unique Physical

Properties

Physical Properties of Water

Viscosity Drag Force

Turbulence Velocity

Buoyancy

Thermo-dynamics

Hydrostatic Pressure

Density Specific gravity

Surface tension

Body weight off-loaded with increasing immersion depth

Hydrostatic Pressure The water braces my

back and knees so I can stand upright

in the Pool !!! Neck – 0 mmHg

Ankle – 110 mmHg

Waist – 36 mmHg

Hydrostatic pressure Central Blood Volume & Cardiac Output

Upright Standing Upright standing in water

Hydrostatic pressure Central Blood Volume & Cardiac Output

Upright Standing Upright standing in water

Hydrostatic pressure Central Blood Volume & Cardiac Output

Upright Standing Upright standing in water

Turbulent & Drag Force

Physiological Effect of Hydrotherapy

Patient

Blood Pressure

Heart Rate

Blood Flow to Muscles

Extero-ceptive & Proprio-ceptive

feedback

Cardiac Output

Efficiency

Breathing Workload

Pain Sensation

Quality & Effective Patient Service

H2O Unique physical

properties

Pool Design

Equipment Safety

measures

Physio-therapist

skills PTCOC Hydro-therapy

WG

Overseas Corporate Scholarship Program for Physiotherapists in Hydrotherapy

17-28/8/2013: Minneapolis 5 Structured

modules

13-16/8/2013: Las Vegas

Conference & Workshop

USA

Variety of Hydrotherapy Techniques

Water Yoga Water Ai Chi

Aqua

Soft tissue

Stretch

Task Typed Activites

Progression

of Rx

BackHab

Joint

Mobilization

Stretching

Aqua Soft Tissue Stretch

Water Yoga

Water Ai Chi

POH

AHNH

Progression of Rx

• 4 Wall concept

Stretching of Tight Tissues

Back Adductors

Hamstrings

Hip Rotators Stretch

Neck

Neck Extension

Joint Mobilization

Neck Rotation

Joint Mobilization Thoracic Spine

Put on Clothes

Task Typed Activities (Functional Training)

Task Typed Activities (Functional Training)

Carry a weighted cup / Bucket

BackHab

BackHab Study Proposal: Use of BackHab in Rx of simple Low Back Pain (LBP) Inclusion Criteria: • At least 10 min. LBP free

each day Exclusion Criteria: • Contraindication • No neurology • Red / Yellow flag • Unable to follow command • Poor adherance to

program • Injury on duty(IOD)

UCH

LBP patient

Baseline Ax

Hydro Group Land Rx Group

Final Ax (Post 4/52)

Evaluation (Post 4/52)

UCH C

ou

rse:

8 s

ess

ion

s

Rx f

req

uen

cy:

twic

e w

eekly

Variety of Hydrotherapy Techniques

Towel Dance

Circuit Training

Plyometric

Training

Controlled Weight Bearing Training

Respiratory

Muscle

Training

Cardio-

Vascular

Fitness

Deep Water

Running

Plyometric Training

Respiratory Muscle Training

Towel Dance

Sea Snake

Cursive Writing

Spaghetti Wraps

Flag Shaking

Cardiovascular Training

Side Step / Side Jump with a Box

Circuit Training

Deep Water Running

Hydrotherapy Session for NWB PWB Ambulation

UCH

Variety of Hydrotherapy Techniques

Watsu Bad Ragaz

Motor Planning

Vestibular

Training

Sensory Integration

Spatial

Orientation Halliwick

Muscle

Tone

Modulation

Vestibular Training Sensory Stimulation

Sensory Integration Approach

Tactile Stimulation & Education of Shape / Colour

Tactile Stimulation

Motor Planning

Spatial Orientation & Bilateral Hand Coordination

Sensory Integration Approach

Spatial Orientation & Bilateral Hand Coordination

Sensory Integration Approach

Modulation of Muscle Tone

Relaxation by Watsu Dance

Clinical Application of Skills

Clinical Application of Skills

Clinical Application of Skills

• Paediatrics

Sensory

Integration

Approach

• Halliwick

• Respiratory

Muscle Training

• Cardiovascular

Fitness Training

• Deep Water

Running

• BackHab

• Water Ai Chi

• Functional

training

• Plyometric

training

• Water Yoga

Quality & Effective Patient Service

H2O Unique physical

properties

Physio-therapist

skills

PTCOC Hydro-therapy

WG

Pool Design Equipment

Safety measures

Equipment Augmentative

Communication Household Toys

Polyspot turbulence in Water Ai Chi

Pool Design driven by Clinical Need

• Very frail balance patients

• Using weight-bearing programs e.g. post-op

• Wide range of heights: infants to children to adults

• Facilitate therapist using various Rx techniques

• Wide range of pathologies: Ortho, Rheum, Sport, Neuro, Paed, Cardiac rehab, Pulmonary rehab

Modernized Pool Design Feature

• Depth vary:

– 40 cm to 180 cm

• Sufficient horizontal surface for Group activites

– 9 m x 7 m surface area

• Sloping part for axial load variation

• Moving belt on floor to challenge the cardiovascular function in joint unload environment

Modernized Pool Design Feature

• Movable Working Platform in both

–Vertical axis

–Horizontal axis

Pool with adjustable floor height with underwater Treadmill

Modernized Pool Design Feature

Modernized Pool Design Feature

Quality & Effective Patient Service

H2O Unique physical

properties

Physio-therapist

skills

Pool Design

Equipment Safety

measures

PTCOC Hydrotherapy

WG

Hydrotherapy Working Group Members

HKEC

Mr. Eric TONG,

PTI, PYNEH

HKWC

Mr. Louis TSOI,

PT I, MMRC

KCC

Mr. Man CHUNG,

SPT, QEH

KEC

Ms. Rosana LAM,

SPT, UCH

NTWC

Ms. Angela LEE,

PT I, POH

KWC

Mr. Jimmy YUEN, SPT,

PMH

NTEC

Mr. Johnson PANG, PT I,

PWH

Established since

21 Nov 2013

HA PT I/C

Since 21 Nov 2013

Terms of Reference

• Develop & review hydrotherapy service guidelines and protocols

• Develop & review operational & facility standard

• Recommend training and development program of PT to support the hydrotherapy service

• Facilitate knowledge & experience sharing to raise PT competence

Way ahead

• Review Hydrotherapy Management Guidelines (PTCOC 2006)

• Establish communication channel between PTCOC, HAHO and hydrotherapy service providers on hardware and service outcome

• Conduct sharing sessions – PT Staff forum, CCTP, HA Convention

• Recommend training program(s) to IAAHS & T&D, PTCOC

Key Messages to Optimize Versatility of hydrotherapy

Knowledge Skill

Practice

Appropriate Pool

Equipment

HA Support

CQI

THANK YOU