The purpose of rehabilitation of patients is to enable them to function in an unassisted manner, in their normal living environment, after injury or illness. Patients have to relearn how to walk, after recovering from a coma or brain injury. And, patients who have received trauma to their arms or legs, need to recover the range of motion of their joints or spine. Hydrotherapy equipment an important tool within rehabilitation.
Create a safe exercise environment for patients
Hydrotherapy equipment helps physiotherapists and rehabilitation experts to create an aquatic environment that is safe to exercise in. It helps the therapists to make the most of the unique properties water has to offer:
- Reduced gravity
- Warmth, which reduces muscle tension and increases joint mobility
- Resistance to movement, slowing down all exercises
- Increase of the central blood volume, increasing the heart’s efficiency
- An unbalancing effect, strengthening the core muscles
- Strong water currents that can assist in underwater massage, but also balance and strength training
What is hydrotherapy?
The use of the beneficial effects of water goes back more than 4000 years and has been recorded in Roman, Greek, and even Egyptian civilizations. it is a known fact that Egyptian royalty bathed in water with essential oils and flowers, while the Romans had public baths for their citizens. Hippocrates, Greek physician and founder of modern medicine thinking, prescribed bathing in spring water for sickness. Other cultures with a very long history in hydrotherapy include Japan and China, where in Japan hydrotherapy was centered around Japanese hot springs or “onsen”. This was even long before the Romans invented their “Thermae” or bathing houses.
Complementary to regular physiotherapy
Formerly referred to as Hydropathy, hydrotherapy can be viewed as a specialized form if physiotherapy, which involves the use of water to reach similar improvement goals such as:
- bodily balance
- range of motion of the joints
- trunk stability and flexibility
- movement control
- walking patterns
- reduced pain sensation
Water reduces gravity
Water, compared to other methods of rehabilitation, offers lots of advantages. Because of the reduction in gravity, patients with muscle loss, or reduced muscle control are able to move their limbs against gravity, while they would remain motionless on dry land. The warm water will support blood circulation and improve the relaxation of the muscles. Therefore, the mobility of joints is improved in water, which can allow the stretching of ligaments to achieve permanent mobility improvement.
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The difference between passive and active hydrotherapy
[Passive] The therapist moves the patients’ muscles and body
Classic hydrotherapy mostly involves patients who are stationary in a bath, soaking and relaxing in the warm water. That’s what we call passive stationary exercises and immersion. Around the years 1700 – 1800, several inspired doctors who were not afraid to experiment, started to introduce several treatments for patients during their immersion. These treatments could involve the use of medicinal herbs, underwater massages, and underwater joint manipulation. Others, especially Sebastian Kneipp, introduced the concept of hot/cold treatments to increase the circulation of the body, which offered beneficial effects on the body.
In modern hydrotherapy thinking, we still regard these treatments as passive as the patient receives the treatment, instead of the patient taking an active role in their rehabilitation.
[Active] The patient can carry out exercises under the supervision of a (physio)therapist
Inactive hydrotherapy, rather than passive, patients play an active role in their own rehabilitation. This means that they carry out their own exercises, under the supervision of a therapist. The therapist can then tell the patients to carry out several exercises in the water, such as:
- walking exercises
- moving against the resistance of a countercurrent
- moving on unbalanced surfaces
- walking or running on a treadmill
- moving between parallel bars
In fact, the number of exercises and games that can be carried out in a pool is unlimited. The most striking characteristic of active hydrotherapy is that it is fun and relaxing. This has a very positive effect on the brain and the outcome of the rehabilitation program.
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Passive hydrotherapy equipment vs Active hydrotherapy equipment
Smaller baths and pools for passive hydrotherapy
Passive hydrotherapy equipment involves smaller baths and pools. As the patient is stationary, the need to accommodate a large range of motion for the patient is limited. Some of the passive hydrotherapy baths are comparable in size and shape to a normal bath, which one would use at home. These baths can come equipped with lots of functions to stimulate the body to get the blood flowing, for instance:
- underwater massage (to be applied by the therapist)
- underwater currents (whirl effects)
- bubbles and vibrations
- electro-galvanic currents through the water
The Hubbard tank. A butterfly-shaped bath for passive stationary exercises
A special case of a bath designed for passive aquatic therapy is the Hubbard tank or butterfly bath. The butterfly shape of this bath allowed the patients the full range of motion of the limbs, while at the same time, the therapist can easily reach the important muscles of the patient from all sides, for instance, to help to flex the joints or applying underwater massage.
Active hydrotherapy equipment usually offers the patients more range of motion than passive hydrotherapy equipment. Instead of a therapist performing the actions on the patients, however, the patients carry out their movements themselves.
For active hydrotherapy, we advise our clients to choose for larger hydrotherapy equipment such as a movable floor in a concrete pool or a modular pool.
Adjustable depth, essential in active hydrotherapy
When should you choose for fixed depth or variable depth? Standard concrete or modular pools have a fixed depth and are suitable to carry out active hydrotherapy. At the same time, no patient is alike. There is a large variability in patient height, as well as their diagnosis and ability to move. For instance, for children to experience an optimal exercise environment, a different depth is needed than for a basketball player. This is why the movable floor was invented as one of the most important types of hydrotherapy equipment for active hydrotherapy.
“For children to experience an optimal exercise environment, a different depth is needed than for a basketball player.”
In a pool with a movable floor, the therapist can easily change the depth to suit the needs of the patient. Furthermore, a movable floor enables the therapist to increase the amount of weight that is carried by the joints and the spine of the patient as patients make progress in their abilities. Therefore, to create an optimal environment for active hydrotherapy, one cannot cope without this important piece of hydrotherapy equipment.
What kind of pool suits you best?
A swimming pool is probably the most important tool of hydrotherapy equipment. But what are the differences between concrete and modular pools?
Pools are usually built out of concrete, and covered by a watertight lining and tiles to keep the water in. Modern hydrotherapy pools are usually equipped with a movable floor to be able to change the pool depth. Also, these pools can be equipped with underwater windows, to give the therapist a good view of the way patients are carrying out their exercises. As a more modern option, however, it is also possible to fit a concrete pool with underwater cameras enabling the therapist to have a full view of the exercises and to store images for registering patient’s progress.
Our clients mainly choose a concrete pool with a movable floor, because concrete is easy to form in any size or shape, available worldwide and relatively low in cost. Another factor is that many locations already have an existing pool where they would like to add a movable floor into.
As an alternative to concrete pools, many rehabilitation centers choose for a more flexible and adaptable option which is a modular pool. A modular pool is a piece of hydrotherapy equipment that can be installed in every available room, effectively turning this room into a hydrotherapy area. The modular design includes several panels, that can be bolted together on site to form the pool. All the elements arrive at the site prefabricated and within 10 days of installation time, one can have a fully functional stainless steel pool with excellent hygienic properties. Just as any concrete pool, a modular pool can be fitted with a movable floor, underwater windows, cameras, and underwater treadmills. Contrary to concrete pools however, a modular pool can also be deconstructed and restored elsewhere if necessary.
Our clients mainly choose a modular pool when there is an existing location, but no concrete pool. Another reason is often that modular pools are relatively faster to build and assembled on site.
An Underwater treadmill is essential in active hydrotherapy
The most advanced accessory on the market now is the underwater treadmill. The underwater treadmill can be integrated into the pool bottom, or even on the movable floor. When de underwater treadmill is integrated into the movable floor, this enables the patient to perform stationary walking exercises under variable gravity conditions, which opens up a very large range of treatment possibilities for the therapist. Combined with an underwater camera system for recording session data, the underwater treadmill is one of the most versatile pieces of hydrotherapy equipment.
Self-propelled underwater treadmill
In some circumstances, investing in an electrically operated underwater treadmill is just not an option. In this case, it is still well possible to perform stationary walking exercises underwater using the Pooltrack Curve. The Pooltrack curve is a piece of hydrotherapy equipment enabling patients to perform a walking kind of motion on a set of underwater rollers. This helps in muscle control and increases trunk stability.
Underwater bicycle, a home trainer in water
Another very versatile piece of hydrotherapy equipment is the underwater bicycle. This bicycle works like a water-based home trainer and uses the unique properties of water to create a speed dependent amount of resistance. If the water depth can be varied using a movable floor, the therapist can offer a large range of treatment conditions to train with the underwater bicycle.
Obstacle course, for safe balance control
With an underwater obstacle course, a very challenging underwater obstacle circuit can be created, train patients pro-active and reactive balance control abilities. The underwater obstacle course consists of several items, ranging from balance beams, to underwater hurdles, to a wiggle board and a reaching pole to imitate several scenarios that can occur in daily life.
Underwater fitness circuit, burn calories and reduce the strain on the joints
Finally, a kind of ‘underwater gym’ can be created using the Aquaback® underwater training circuit. The Aquaback® training circuit was created by Dr. Uwe Schlünz, who looked to develop a fitness circuit aimed at strengthening the back muscles in an aquatic environment. One of the big advantages of training these muscles is that the training hardly causes any muscle ache in the recovery stage, while at the same time, patients can train at quite a challenging intensity level.
Safety and water hygiene in hydrotherapy
Because of its special nature, care should be taken in selecting the proper kind of hydrotherapy equipment. In most hospitals of rehabilitation centers, there is a limited experience available with working with water or pools. Because the pools are used with patients that are susceptible to infection, special care must be taken for water hygiene. Unless the water is replaced after each patient session, a hydrotherapy pool needs to have a water treatment plant, to perform at least the following basic functions:
- disinfection with a disinfecting agent such as chlorine or bromide
- filtration, to take solid contaminants out of the water
- heating, to maintain a proper temperature for hydrotherapy
Making lifting patients easy with patient hoisting equipment
In designing an area for hydrotherapy, one should take into account the patient flow, through changing area with showers and toilets, to the pool and back to the changing area. The pool area needs special provisions such as hoisting equipment and stairs for patients to be able to enter and exit the pool in an easy manner.
The hydrotherapy room itself should be equipped with a system to maintain a stable humidity, which EWAC Medical can offer. With a large body of warm water in the room, without humidity control, the water will quickly condense on all colder surfaces such as the walls and the ceiling of the room which will quickly cause equipment malfunction.
Increase the possibilities, add a movable floor to your swimming pool
Before designing a hydrotherapy area, however, one should consider the variability of patients that will make use of the hydrotherapy equipment. Active and passive hydrotherapy requires different sets of equipment, and especially in active hydrotherapy, it is important to consider the option of a movable floor to increase the number of possible exercises and range of patients that can be treated in the pool.
EWAC Medical can take an active role in designing the hydrotherapy area in any application, based on the requirements of the customer.