Professional Documents
Culture Documents
Word count:
Page 1 of 7
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).
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.
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.
Page 4 of 7
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.
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
Page 5 of 7
have both physiological and psychologically positive outcomes, these outcomes will now be
discussed during the critical evaluation (Cameron, 2009).
Critical Evaluation
Page 6 of 7
Bibliography
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).
Multiple Sclerosis Society, (2009). About Multiple Sclerosis [Internet]. Available from:
<http://www.mssociety.org.uk/about_ms/index.html> (Accessed: 14th 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).
Page 7 of 7