Rehabilitation: Clinicians in physical medicine and rehabilitation frequently prescribe modalities that use physical energy to produce therapeutic effects. These modalities include thermotherapy (i.e. heat and cold), electrotherapy (eg, transcutaneous electrical stimulators, iontophoresis, neuromuscular electrical stimulators, biofeedback), light therapy (eg, ultraviolet radiation, laser), massage/mobilization, manipulation, traction, hydrotherapy, aquatic-based physical therapy (PT), and acupuncture.
Hydrotherapy is a therapeutic modality that uses water in any of its states to treat disease and functional disability. Hydrotherapy specifically is designed to improve neuromuscular, skeletal, and proprioceptive function in patients with acute, sub-acute, and chronic disabilities. Hydrotherapy also is used for long-term maintenance. Hydrotherapy is a useful adjunct to or a viable substitute for traditional PT treatment. Ideally, the patient progresses to an independent exercise program designed to maintain and improve health and fitness at an appropriate level. Therapists, physicians, and other members of the healthcare team interact to determine what level is appropriate and to design the program.
No water exercises are safe without instruction from a qualified therapist. Participants in hydrotherapy activities can be injured during any exercise, simply because the exercise protocols are performed in water. When underlying pathological conditions are not acknowledged, participants enter programs unaware of their abilities and limitations. Participants entering programs without the direction of qualified professionals are not likely to reach their maximal functional potential.
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Wound Care:Physical therapy encompasses a broad area of treatments and interventions, including wound management for patients. Some of the wound care procedures assist with cleaning of the wound bed, promote healing, management of resulting scar and debridement. Debridement is the manual removal of nonviable tissue using instruments. Therapists can also use hydrotherapy procedures to debride and prepare the wound for manual debridement.
Two types of hydrotherapy procedures can be done to assist with debridement and cleansing of a patient’s wound: whirlpool and pulsatile lavage:
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Whirlpool effects can cause softening of necrotic or dead tissue and improve healing by increasing circulation, which brings nutrients to the area.
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Pulsatile lavage cleanses with debridement with use of a water pick suction device. It also causes a negative pressure to remove necrotic tissue to reduce infection and enhance healing.
All treatments of hydrotherapy and manual debridement require a physician’s order. A thorough physical therapy evaluation must be completed prior to treatment since there are contraindications and precautions to treatment of wounds. Patients vary from slow healing wounds, diabetic ulcers, status post-surgery with an open wound, peripheral vascular disease with an open wound, burns, skin grafts, wounds caused by motor vehicle accidents and more.