Hydrotherapy Intervention Essay

Faculty of Health and Life Sciences

(Student Number 086415323) Module: 2OP040 Semester 1: (2009/10)

Hydrotherapy Intervention & its Supporting Theory Base for Patients with Multiple Sclerosis

Word count:

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Introduction Whilst navigating through this assignment the reader will achieve an understand of the intervention that is hydrotherapy, and how this approach is used to aid activities of daily living (ADL), ultimately helping to promote independence and social inclusion. Using ADL as a tool for analysis evidence will show the needs of people that have the disease multiple sclerosis, highlighting the enduring and progressive physical health problems surrounding the disease. ADL such as dressing, bathing, eating and transferring are important aspects of life, measurements of these activities are critical and have shown to be predictors in long term health problems (Chiaravalloti et al, 2009). Following this introduction there will be five main topics discussed; firstly the theory base of the intervention that is hydrotherapy, looking at the treatment itself, its context and environment. Within this environment multi disciplinary teams will be shown to play a vital part in the planning and implementation of the intervention and how this in turn relates to the patient’s needs. During this process safety considerations will be reflected and contra indication considered, for example: the patient’s possible bad experience relating to water. Therefore each patient will need to be carefully assessed and any contra indications investigated (Campion, 2001). The section entitled Critical evaluation will then look closely at a range of influences in the causation of multiple sclerosis, why hydrotherapy was chosen and the effect hydrotherapy has on progressive physical health (multiple sclerosis). Hydrotherapy will be shown appropriate to the client’s needs and health related quality of life (HRQOL). National Centre for Chronic Disease Prevention and Health Promotion (2005) indicate that by using a series of questions called “healthy daily measure” HRQOL can be assessed. This is done by asking four core questions with an additional ten about the patient’s HRQOL. This model of assessment can be generic or adapted when looking at specific long term diseases or illness and has proven to be suitably reliable for cross cultural application (Pong, 1997). Again the HRQOL is an essential determinate or outcome analysis to the intervention of hydrotherapy, as the core reasoning is based around the following; pain experienced, depression as an outcome, Stress, well being and current activity limitation in conjunction with the patient’s life (National Centre for Chronic Disease Prevention and Health Promotion, 2005). Following the critical evaluation a discussion will explain how the intervention itself had been assessed; this will be shown in relation to the patient’s needs, how the treatment has progressed through time and by contrasting the two. Best practice will also be addressed by Page 2 of 7

exploring the National Service Frame Work. Penultimately a summary of analysis will be given, extracting the main issues from within the assignment, showing the implications for future practice in conjunction with hydrotherapy and the disease multiple sclerosis. Finally a conclusion will be given pulling together all the key points; this will enable the reader to gain an overview of the assignment content, clearly highlighting the milestones throughout. Before the reader progresses any further it would be beneficial to gain a brief insight/definition into the disease multiple sclerosis and intervention hydrotherapy. Multiple Sclerosis Society (2009) concludes, Multiple sclerosis is a disease that affects the central nervous system, this occurs when the protective sheath which surrounds the nerves (myelin) is damaged. The central nervous system comprises of the brain and spinal cord. When the myelin sheath becomes damaged signals sent from neuron to neuron become weekend and confused, ultimately leading to a breakdown in communication between the brain and other parts of the body. Multiple sclerosis is the most common neurological condition to affect the United Kingdom, with a current estimated one hundred thousand having the disease. “Professionals generally define hydrotherapy as a pool therapy program specifically designed for an individual in an attempt to improve neuromuscular and skeletal function. This therapy is conducted and supervised by appropriately qualified personnel, ideally in a purpose-built hydrotherapy pool” (Martin, 2004: 3). The rationale behind choosing the intervention hydrotherapy was based on its diversity to provide unobtrusive progress whilst stabilising the condition (multiple sclerosis), and its ability to promote rehabilitation not only within multiple sclerosis but many other degenerative neurological diseases, such as, Ataxia, Hemiplegia, and Parkinson’s disease. Using the natural properties of water creates a dynamic environment in which movement that has been lost can be restored, using a subtle effortless approach with the ability to over challenge the central nervous system, unlike conventional exercise (Campion, 2001).

Hydrotherapy Theory Base Campion (2001) believes hydrotherapy as a modality dates back to 2400 B.C. and has been used by many cultures such as the Proto Indians, Egyptians, and Hindus. Also its application has varied, for example: hygienic installations (water for personal cleaning), waters for curing purposes and water to combat fevers have been noted. Through time it has been observed that while other forms of rehabilitation/treatment have been and gone hydrotherapy has remained. Possibly the longevity of hydrotherapy as an intervention is due to water being one of only two environments available to humans, allowing the body to be simultaneously Page 3 of 7

subjected to gravity (downwards force) and buoyancy (upwards force), contributing to a truly three dimensional form of rehabilitation. Although, through time advances were largely empirical a greater understanding is now evident, with physiotherapist becoming more interested and skilled in the manipulation of non weight bearing exercise (Campion, 2001).

The two environments mentioned earlier, land and water, have many different physical properties, for example: both have specific heat, thermal conductivity and external forces (gravity and hydrostatic pressure respectively). Most pertinent to hydrotherapy is the waters specific and thermal heat conductivity qualities. Waters specific heat is four times that of air and thermal conductivity twenty five times greater than air. This means water retains four times the amount of thermal energy as an equivalent amount of air, allowing water to subsequently transfer thermal energy twenty five times faster. Therefore if the water temperature is maintained lower than that of the patients, heat created during exercise will be thermally transferred away from the body, thus allowing the patient to maintain a core temperature. Furthermore using the buoyancy (hydrostatic pressure) of water decreases both stress and compression on load bearing joints within the patient’s body, in turn strengthening connecting muscle and tissue (Cameron, 2009). This will be looked at in more detail in relation to multiple sclerosis during the critical evaluation.

Hydrotherapy Association of Chartered Physiotherapists (2006) indicates that the role of multi disciplinary teams is vital when implementing a hydrotherapy programme. Treatment plans are discussed with the physiotherapist and the patient but also involve other pool professionals, for example: the physiotherapist may have a number of assistants depending on how advanced the disease (multiple sclerosis) has become.

Consideration by the

physiotherapist is not only given to the treatment but to the planning and surrounding elements involved; some of these considerations/contraindications have been listed below with examples of how this relates to patients with multiple sclerosis.

Considerations/Contraindications

Patient with Multiple Sclerosis

Entry and Exit into the pool (use of hoist)

Motor symptoms: Muscle weakness - partial

Risk assessments are needed.

or mild paralysis, Loss of muscle tone causing stiffness, pain and restricting free movement of affected limbs and Wasting of muscles due to lack of use.

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Depth of water - Risk assessments is Visual symptoms: such as blurred vision needed.

Sensory symptoms: Loss of awareness of location

of

body

parts

(Proprioceptive

Dysfunction). Co ordination and balance symptoms: Loss of

coordination

and

Abnormal

balance

function in the inner ear. Length of treatment time

Fatigue in relation to the patients muscle tone and range of movement.

Starting positions

Slow limb position response.

Goal setting and progression

As in all rehabilitation setting achievable smaller goals with progression to achieve the overall target, consideration of the patient’s cognitive

symptoms,

for

example:

depression, mood swings and anxiety. Use of buoyancy aids

Wasting of muscles due to lack of use.

Information adapted from: (Multiple Sclerosis Society, 2009).

Hydrotherapy Association of Chartered Physiotherapists (2006) agreed by expert opinion that the following contraindications would rule out absolutely any form of hydrotherapy; “acute vomiting or diarrhoea, medical instability following an acute episode (e.g. CVA, DVT, PE, status asthmatics), Proven chlorine/bromine allergy, Resting angina, Shortness of breath at rest, Uncontrolled cardiac failure/paroxysmal and Weight in excess of the evacuation limit” (Hydrotherapy Association of Chartered Physiotherapists, 2006: 24).

To conclude hydrotherapy and its theory base the physiological effects will now be discussed. As described previously water has the ability to cool or heat whilst using hydrostatic pressure to stabilise. The heating and or cooling of water allows modifications to take place within the human body. These changes within the body can be hemodynamic (increased blood flow or circulation), neuromuscular (increased synapse between neurons and motor neurons), metabolic (greater function of amino acids, carbohydrates and lipids i.e. fats) and soft tissue flexion and extension. In short the use of heated water induces increased nerve conduction speed and reduces the latency of sensory and motor responses. Therefore it can be concluded that for some multiple sclerosis patient’s hydrotherapy can

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have both physiological and psychologically positive outcomes, these outcomes will now be discussed during the critical evaluation (Cameron, 2009).

Critical Evaluation

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Bibliography Dr. Craig, W, Martin, (2004). Hydrotherapy: Review on the effectiveness of its application in physiotherapy and occupational therapy [Internet]. Available from: (Accessed: 14th November 2009).

Dr. Lam Tai Pong, (1997). What is Health Related Quality of Life? [Internet]. Available from: <sunzi1.lib.hku.hk/hkjo/view/23/2302034.pdf> (Accessed: 14th November 2009).

Hydrotherapy Association of Chartered Physiotherapists, (2006). Guidance on Good Practice in Hydrotherapy. London: Halliwick.

Margaret, R, Campion, (2001). Hydrotherapy: Principals and Practice. Oxford: Butterworth-Heinemann. Michelle, H, Cameron, (2009). Physical Agents in Rehabilitation: From Research to Practice. 3rd Edition, Oregon: Saunders Elsevier.

Multiple Sclerosis Society, (2009). About Multiple Sclerosis [Internet]. Available from: (Accessed: 14th November 2009).

Multiple Sclerosis Organisation, (2008). Multiple Sclerosis Symptoms [Internet]. Available from: (24th November 2009).

Nancy, Chiaravalloti. John, DeLuca. Elizabeth G, Goering. Yael, Goverover, (2009). The Relationship among Performance of Instrumental Activities of Daily Living, self-report of quality of life, and self-awareness of functional status in individuals with multiple sclerosis. Rehabilitation Psychology, 54 (1): 60-8.

National Centre for Chronic Disease Prevention and Health Promotion, (2005). Health Related

Quality

of

Life:

Methods

and

Measures

[Internet].

Available

th

(Accessed: 14 November 2009).

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