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

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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

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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)
Risk assessments are needed.
Motor symptoms: Muscle weakness - partial
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:
<http://www.worksafebc.com/health_care_providers/Assets/PDF/hydrotherapy_application_
physiotherapy.pdf> (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:
<http://www.mssociety.org.uk/about_ms/index.html> (Accessed: 14th November 2009).

Multiple Sclerosis Organisation, (2008). Multiple Sclerosis Symptoms [Internet]. Available

from: <http://www.mult-sclerosis.org/mssymptoms.html> (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 from:
th
<http://www.cdc.gov/hrqol/methods.htm> (Accessed: 14 November 2009).

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