CLINICAL LEARNING DISABILITIES
Using hydrotherapy: maximising benefits Philip Boulter RNMH, RMN, Ls Deputy Director of Nursing Services, Lifecare NHS Trust. Caterham.
People with a learning disability are increasingly using hydrotherapy for exercise, socialising, and the release of tension and energy. For those with a physical dis ability, it offers an opportunityfor independent activity from which tlxy may beprecluded outside the hydrotherapy pool. The author discusses guidelines for staff involved in hydrotherapy sessions before examining in detail the benefits this form of treatment has to offer.
Using water as therapy can promote relaxation, improve circulation and restore mobility, as well as being an enjoyable activity.
Hydrotherapy is a commonly used term, but its specialised nature is rarely understood. The use of water as a therapy includes several different types of treatment, such as packs, baths and douches. The most important and widely used hydrotherapy treatment is the use of water as an exercise medium, often by people who have a learning disability. The ideal environment for hydrotherapy sessions is a pool that is large enough to enable walking and permit a foil range of movements when the client is supported supine. Air temperature and ventilation also play an important part in ensuring the comfort of all involved, and an average air temperature of 65 to 75 degrees Farenheit (19 to 24 degrees Centi grade) is recommended.
Safety matters The changing rooms should be large enough to enable disabled people to gain access, and should be equipped to ensure the comfort of those using them. A toilet, shower and footbath should be sited nearby so people can use them before and after using the pool. First aid equipment must be available, as well as a safe hoist to allow disabled people access to the pool. The pool should have a non-slip floor, smooth sides and a handrail around the inside. It is rec ommended that the water temperature is maintained at 92 to 98 degrees Farenheit (33 to 37 degrees Centigrade), and the standard of water purity mast be very high. Staff must also be aware of the Health and Safe ty at Work Act, policy statements and codes of safe practice in relation to hydrotherapy depart ments, which include guidelines for staff working
V.
in such areas. The areas these guidelines cover are shown in Table 1. Staffing No definitive rules are laid down for a therapist/client ratio, but all staff should be trained in resuscitation techniques and aware of the location of the necessary equipment. Hoists These should be available and regular safe ty checks should be made. Non-professional staff Helpers and support work ers may be employed to assist with hydrotherapy. The person in charge is responsible for ensuring that any helpers have received instruction in the lifting, handling, dressing and undressing of physically disabled clients, hygiene, the safe use of hoists and any other information related to health and safety. Staff should also know how to report any accident that may occur. Chlorination Regular checks must be made on the chlorine levels in the pool, and safe stan dards must be maintained. Equipment All equipment must be checked reg ularly and records should be kept. Pool areas must be checked by safety representatives during rou tine inspections. Body temperature The loss of heat from the skin and respiratory system depends upon the level of humidity and the temperature in the pool room. October H Volume 7/Number 4/1992 Nursing Standard 25
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CLINICAL LEARNING DISABILITIES If these are not maintained, the client may expe rience unpleasant and undesirable effects. Treatment times Treatment sessions lasting up to 20 minutes in the pool are quite safe. Most therapists can spend up to three hours in the pool, providing they take a break of at least 20 min utes halfway through. Pool environment This covers facilities in the |xxil room, the air temperature and ventilation. Contra-indications A frill assessment of any per son who is referred for hydrotherapy will reveal any reasons why he or she is not suitable for the treatment. Hubbard tank This is often used for people who have wounds and infected sores or are inconti nent. After any treatment, the tank must be washed down and scrubbed with a strong ster ilising solution. Cleaning A timetable for cleaning the pool area and all surrounding facilities must be drawn up, with tasks allocated to individual staff. Chemicals All chemicals used to maintain and clean the pool should be handled and stored with care as they are potentially dangerous if misused. Laboratory' tests Routine bacteriological investi gations are recommended for safe practice to be maintained. A thorough assessment of any person who wish es to participate in hydrotherapy must be completed. Those clients with obvious contra indications must be excluded, for example acute febrile illnesses, acute tubercular diseases, acute chest conditions, urinary infections, open wounds or uncontrolled epilepsy. Feet should be checked for tiny signs of verm-
Table 1: Areas which should be covered by staff guidelines Staffing Hoists Non-professional staff Chlorination Equipment Treatment times Pool environment Contra-indications Hubbard tank Cleaning Chemicals Laboratory tests Hygiene cae and a continence assessment undertaken. Peo ple who are incontinent of faeces should not be treated in the pool unless they have had a bowel movement beforehand. Suitable clothing must be worn in the pool and, before entering it, the client should have used the toilet and taken a shower. Initially, individuals may be afraid of the water. Staff should encourage them to set their own pace while giving them a clear explanation of what is happening. At no time should they be com pelled to get into the pool. Entry into the pool will depend on the pool design. Ambulant clients may enter the pool independently or with some help and support, via steps or a ramp. A hoist will be necessary for those who are physically disabled. Hydrotherapy has a number of benefits. Those
Hydrotherapy offers people a change from their normal environment, and allows for relationships and tmst to lie developed.
A
r-
26 Nursing,Standard
October 14 Volume 7/Number u 1992
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CLINICAL LEARNING DISABILITIES
J«r :zr-\
with a physical disability may learn to float by themselves, accomplishing something indepen dently although they are perhaps unable to do much without assistance out of the pool. Mini-* mal handling is needed in the water although* much is often needed on dry land. They can stand* or may be helped to maintain an upright posi-* tion which is often impossible at other times. • Hydrotherapy involves certain physical prin-* ciples. These including Archimedes’ principle,* which states that when a body is wholly or par-* tially immersed in a fluid at rest it is acted upon* by a buoyant or lift force equal to the weight of* the displaced fluid. It is this buoyancy, applied to* exercise in water, that is of value in physical treat-* ment. Buoyancy may be used in three ways: as* assistance, as support or as resistance. Hydrotherapy is also an enjoyable therapy and can be used for fitness and fun, thereby promot ing relaxation, improving circulation and restoring mobility, and therefore strengthening muscles and improving co-ordination. It helps to introduce people with a learning disability to larger water areas, often for the first time, and can enable them to gain confidence and self-esteem.
Developing trust
Further reading Golland A. Basic hydrotherapy. Phys iotherapy. 1981.67, 9, 258-262. Atkinson G P, Harrison R A. Impli cations of The Health & Safety at Work Act in relation to hydrotherapy departments. Physiotherapy. 1981.67, 9, 263-265. Trevelyan J. Aquatots. Nursing Times. 1990. 86, 15,46-47. Martin J. The Halliwick Method. Physiotherapy. 1981.67, 10, 288-291.
For people with challenging behaviours, hydro therapy can be used as a method of releasing tension and energy. When participating in water games, staff can create a more passive and tran quil atmosphere by using soft music to produce a relaxing environment. It may also focus staff on a client’s ability instead of his or her disability. Hydrotherapy is a valuable social activity for those taking part. It offers clients a change from their normal environment, and one to one ther apy provides an opportunity for relationships to be formed and trust to be developed. Group activities offer a chance for individuals to socialise and make friends, and games encour age vocalisation as well as movement and interaction with others. 1 Iydrotherapy offers indi viduals an opportunity to participate in sport and recreation, and enables them to gain indepen dence which can enhance self-confidence and esteem. Many people with a learning disability can be taught to swim. One method of teaching is the Halliwick method. This was devised by James McMillan in 19-19 at the Halliwick School tor Girls in Southgate. Tire method is based upon the scientific prin ciples of hydrodynamics and body mechanics. It is safe for people of all ages with many types of disability, as well as for the able-bodied. Each per
son is taught on a one to one basis until they achieve complete independence. No artificial flotation aids are used, and the instructor’s hands balance the swimmer's body. The hands are kept flat and only support the swimmer’s body at its centre of gravity. The Hal liwick Method is made up of 10 stages, divided into four phases: Phase one: Mental adjustment and disengage ment. Here, the individual has to adjust to the power of water. • Phase two: Vertical rotation, lateral rotation, combined rotation. Rotations forward or vertical are achieved by a movement of the hips resulting in balance restoration. • Phase three: Upthrust, balance and turbulent gliding. In this phase, the individuals learn to control their bodies. Phase four: Simple progression and basic pro gression. The final stage facilitates movement, resulting in the individual swimming by his or her own efforts. Therapy in the pool can be tiring, and the time each individual should spend in the water may vary from five to 20 minutes. This may be extended, depending on the individual. Once taught to swim, the person can continue the activity alone, with a friend or with the family. When the session is over, the individual should take a cooling shower to remove chemicals from the skin and reduce the skin temperature. The temperature of the shower is important, start ing at 96 degrees Farenheit (35.5 degrees Centigrade) if the pool is at an average tempera ture of 97 degrees Farenheit (36 degrees Centigrade), and gradually cooling to about 86 to 88 degrees (30 to 31 degrees Centigrade). This is important because general capillary vasodilation occurs during treatment, causing the blood pressure to fall. The cooling shower will result in a constriction of the surface vessels and the blood pressure will return to normal. How ever, the water must not be allowed to run cold. There are obvious dangers and disadvantages that can be minimised if health and safety stan dards are adhered to. One obvious danger is drowning, and for this reason staffing levels for hydrotherapy sessions need to be planned on an individual basis. In some cases this may mean a three to one ratio, in others a one to one ratio. Staff must also remain aware of the possibili ty of cross-infection, and chlorine levels need to be checked regularly. There is no doubt that most people who par ticipate in this form of treatment find it physically and mentally stimulating, and will experience fun and enjoyment through it ; October li'Volume 7/Number 4/1992 Nursing Standard 27
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Using hydrotherapy: maximising benefits Philip Boulter RNMH, RMN, Ls Deputy Director of Nursing Services, Lifecare NHS Trust. Caterham.
People with a learning disability are increasingly using hydrotherapy for exercise, socialising, and the release of tension and energy. For those with a physical dis ability, it offers an opportunityfor independent activity from which tlxy may beprecluded outside the hydrotherapy pool. The author discusses guidelines for staff involved in hydrotherapy sessions before examining in detail the benefits this form of treatment has to offer.
Using water as therapy can promote relaxation, improve circulation and restore mobility, as well as being an enjoyable activity.
Hydrotherapy is a commonly used term, but its specialised nature is rarely understood. The use of water as a therapy includes several different types of treatment, such as packs, baths and douches. The most important and widely used hydrotherapy treatment is the use of water as an exercise medium, often by people who have a learning disability. The ideal environment for hydrotherapy sessions is a pool that is large enough to enable walking and permit a foil range of movements when the client is supported supine. Air temperature and ventilation also play an important part in ensuring the comfort of all involved, and an average air temperature of 65 to 75 degrees Farenheit (19 to 24 degrees Centi grade) is recommended.
Safety matters The changing rooms should be large enough to enable disabled people to gain access, and should be equipped to ensure the comfort of those using them. A toilet, shower and footbath should be sited nearby so people can use them before and after using the pool. First aid equipment must be available, as well as a safe hoist to allow disabled people access to the pool. The pool should have a non-slip floor, smooth sides and a handrail around the inside. It is rec ommended that the water temperature is maintained at 92 to 98 degrees Farenheit (33 to 37 degrees Centigrade), and the standard of water purity mast be very high. Staff must also be aware of the Health and Safe ty at Work Act, policy statements and codes of safe practice in relation to hydrotherapy depart ments, which include guidelines for staff working
V.
in such areas. The areas these guidelines cover are shown in Table 1. Staffing No definitive rules are laid down for a therapist/client ratio, but all staff should be trained in resuscitation techniques and aware of the location of the necessary equipment. Hoists These should be available and regular safe ty checks should be made. Non-professional staff Helpers and support work ers may be employed to assist with hydrotherapy. The person in charge is responsible for ensuring that any helpers have received instruction in the lifting, handling, dressing and undressing of physically disabled clients, hygiene, the safe use of hoists and any other information related to health and safety. Staff should also know how to report any accident that may occur. Chlorination Regular checks must be made on the chlorine levels in the pool, and safe stan dards must be maintained. Equipment All equipment must be checked reg ularly and records should be kept. Pool areas must be checked by safety representatives during rou tine inspections. Body temperature The loss of heat from the skin and respiratory system depends upon the level of humidity and the temperature in the pool room. October H Volume 7/Number 4/1992 Nursing Standard 25
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CLINICAL LEARNING DISABILITIES If these are not maintained, the client may expe rience unpleasant and undesirable effects. Treatment times Treatment sessions lasting up to 20 minutes in the pool are quite safe. Most therapists can spend up to three hours in the pool, providing they take a break of at least 20 min utes halfway through. Pool environment This covers facilities in the |xxil room, the air temperature and ventilation. Contra-indications A frill assessment of any per son who is referred for hydrotherapy will reveal any reasons why he or she is not suitable for the treatment. Hubbard tank This is often used for people who have wounds and infected sores or are inconti nent. After any treatment, the tank must be washed down and scrubbed with a strong ster ilising solution. Cleaning A timetable for cleaning the pool area and all surrounding facilities must be drawn up, with tasks allocated to individual staff. Chemicals All chemicals used to maintain and clean the pool should be handled and stored with care as they are potentially dangerous if misused. Laboratory' tests Routine bacteriological investi gations are recommended for safe practice to be maintained. A thorough assessment of any person who wish es to participate in hydrotherapy must be completed. Those clients with obvious contra indications must be excluded, for example acute febrile illnesses, acute tubercular diseases, acute chest conditions, urinary infections, open wounds or uncontrolled epilepsy. Feet should be checked for tiny signs of verm-
Table 1: Areas which should be covered by staff guidelines Staffing Hoists Non-professional staff Chlorination Equipment Treatment times Pool environment Contra-indications Hubbard tank Cleaning Chemicals Laboratory tests Hygiene cae and a continence assessment undertaken. Peo ple who are incontinent of faeces should not be treated in the pool unless they have had a bowel movement beforehand. Suitable clothing must be worn in the pool and, before entering it, the client should have used the toilet and taken a shower. Initially, individuals may be afraid of the water. Staff should encourage them to set their own pace while giving them a clear explanation of what is happening. At no time should they be com pelled to get into the pool. Entry into the pool will depend on the pool design. Ambulant clients may enter the pool independently or with some help and support, via steps or a ramp. A hoist will be necessary for those who are physically disabled. Hydrotherapy has a number of benefits. Those
Hydrotherapy offers people a change from their normal environment, and allows for relationships and tmst to lie developed.
A
r-
26 Nursing,Standard
October 14 Volume 7/Number u 1992
Downloaded from RCNi.com by ${individualUser.displayName} on Oct 21, 2016. For personal use only. No other uses without permission. Copyright © 2016 RCNi Ltd. All rights reserved.
CLINICAL LEARNING DISABILITIES
J«r :zr-\
with a physical disability may learn to float by themselves, accomplishing something indepen dently although they are perhaps unable to do much without assistance out of the pool. Mini-* mal handling is needed in the water although* much is often needed on dry land. They can stand* or may be helped to maintain an upright posi-* tion which is often impossible at other times. • Hydrotherapy involves certain physical prin-* ciples. These including Archimedes’ principle,* which states that when a body is wholly or par-* tially immersed in a fluid at rest it is acted upon* by a buoyant or lift force equal to the weight of* the displaced fluid. It is this buoyancy, applied to* exercise in water, that is of value in physical treat-* ment. Buoyancy may be used in three ways: as* assistance, as support or as resistance. Hydrotherapy is also an enjoyable therapy and can be used for fitness and fun, thereby promot ing relaxation, improving circulation and restoring mobility, and therefore strengthening muscles and improving co-ordination. It helps to introduce people with a learning disability to larger water areas, often for the first time, and can enable them to gain confidence and self-esteem.
Developing trust
Further reading Golland A. Basic hydrotherapy. Phys iotherapy. 1981.67, 9, 258-262. Atkinson G P, Harrison R A. Impli cations of The Health & Safety at Work Act in relation to hydrotherapy departments. Physiotherapy. 1981.67, 9, 263-265. Trevelyan J. Aquatots. Nursing Times. 1990. 86, 15,46-47. Martin J. The Halliwick Method. Physiotherapy. 1981.67, 10, 288-291.
For people with challenging behaviours, hydro therapy can be used as a method of releasing tension and energy. When participating in water games, staff can create a more passive and tran quil atmosphere by using soft music to produce a relaxing environment. It may also focus staff on a client’s ability instead of his or her disability. Hydrotherapy is a valuable social activity for those taking part. It offers clients a change from their normal environment, and one to one ther apy provides an opportunity for relationships to be formed and trust to be developed. Group activities offer a chance for individuals to socialise and make friends, and games encour age vocalisation as well as movement and interaction with others. 1 Iydrotherapy offers indi viduals an opportunity to participate in sport and recreation, and enables them to gain indepen dence which can enhance self-confidence and esteem. Many people with a learning disability can be taught to swim. One method of teaching is the Halliwick method. This was devised by James McMillan in 19-19 at the Halliwick School tor Girls in Southgate. Tire method is based upon the scientific prin ciples of hydrodynamics and body mechanics. It is safe for people of all ages with many types of disability, as well as for the able-bodied. Each per
son is taught on a one to one basis until they achieve complete independence. No artificial flotation aids are used, and the instructor’s hands balance the swimmer's body. The hands are kept flat and only support the swimmer’s body at its centre of gravity. The Hal liwick Method is made up of 10 stages, divided into four phases: Phase one: Mental adjustment and disengage ment. Here, the individual has to adjust to the power of water. • Phase two: Vertical rotation, lateral rotation, combined rotation. Rotations forward or vertical are achieved by a movement of the hips resulting in balance restoration. • Phase three: Upthrust, balance and turbulent gliding. In this phase, the individuals learn to control their bodies. Phase four: Simple progression and basic pro gression. The final stage facilitates movement, resulting in the individual swimming by his or her own efforts. Therapy in the pool can be tiring, and the time each individual should spend in the water may vary from five to 20 minutes. This may be extended, depending on the individual. Once taught to swim, the person can continue the activity alone, with a friend or with the family. When the session is over, the individual should take a cooling shower to remove chemicals from the skin and reduce the skin temperature. The temperature of the shower is important, start ing at 96 degrees Farenheit (35.5 degrees Centigrade) if the pool is at an average tempera ture of 97 degrees Farenheit (36 degrees Centigrade), and gradually cooling to about 86 to 88 degrees (30 to 31 degrees Centigrade). This is important because general capillary vasodilation occurs during treatment, causing the blood pressure to fall. The cooling shower will result in a constriction of the surface vessels and the blood pressure will return to normal. How ever, the water must not be allowed to run cold. There are obvious dangers and disadvantages that can be minimised if health and safety stan dards are adhered to. One obvious danger is drowning, and for this reason staffing levels for hydrotherapy sessions need to be planned on an individual basis. In some cases this may mean a three to one ratio, in others a one to one ratio. Staff must also remain aware of the possibili ty of cross-infection, and chlorine levels need to be checked regularly. There is no doubt that most people who par ticipate in this form of treatment find it physically and mentally stimulating, and will experience fun and enjoyment through it ; October li'Volume 7/Number 4/1992 Nursing Standard 27
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