Modalities - Hydrotherapy

Total body immersion in cool water produces all of the following physiological effects EXCEPT:

a. Increased central venous pressure
b. Increased cardiac output
c. Increased heart rate
d. Increased stroke volume

c. Increased heart rate

The physical properties of water include all of the following EXCEPT:

a. Lower density than human body
b. Resistance
c. Buoyancy
d. High specific heat

a. Lower density than human body

Water can transfer heat by:

a. Conduction only
b. Conversion only
c. Conduction and Convection
d. Conversion and Convection

c. Conduction and Convection

Consider the following for questions 4 and 5:
An adult patient with partial weight-bearing precautions is receiving hydrotherapy to allow for
lower extremity exercise while unloading weight-bearing joints.

Which property of water will allow for achieving this goal?

a. Increasing hydrostatic pressure with greater depths
b. Viscosity
c. Buoyancy
d. Specific heat

c. Buoyancy

Consider the following for questions 4 and 5:
An adult patient with partial weight-bearing precautions is receiving hydrotherapy to allow for
lower extremity exercise while unloading weight-bearing joints.

To decrease the amount of weight borne by the patient’s lower extremities, which of the following variables can be changed for the treatment session?

a. Ask the patient to move from a 2-foot to a 4-foot depth
b. Ask the patient to move briskly in the water
c. Ask the patient to raise his or her arms out of the water
d. Decrease the temperature of the water

a. Ask the patient to move from a 2-foot to a 4-foot depth

Which of the following treatments will be most effective in warming superficial tissues of the hand?

a. Immersion in a whirlpool at 104° F
b. Immersion in standing water at 104° F
c. Immersion in fluidotherapy at 104° F
d. Immersion in a contrast bath

a. Immersion in a whirlpool at 104° F

Which of the following treatments would be most beneficial in managing a patient with acute edema and pain in the hand and wrist?

a. Non-immersion hydrotherapy with an electric pulsatile irrigation device using water at
40° F with elbow resting on a table surface in a non-dependent position
b. Local immersion into a 40° F whirlpool, 1-foot depth
c. Local immersion into a neutral warmth whirlpool, 1-foot depth
d. Use of a standard hot tub at home to decrease pain and allow for greater mobility

b. Local immersion into a 40° F whirlpool, 1-foot depth

The safe and effective pressure range for cleansing or debriding wounds with water is:

a. 2 to 4 psi
b. 4 to 15 psi
c. 10 to 20 psi
d. 15 to 30 psi

b. 4 to 15 psi

Hydrotherapy is used in treating wounds for all of the following effects EXCEPT:

a. Soften and remove debris from the wound
b. Remove adherent dressings
c. To improve circulation
d. To expedite the closure of fully granulated wounds

d. To expedite the closure of fully granulated wounds

Exercise in water may be better than dry land training in some instances because of all the following effects EXCEPT:

a. The work of breathing is increased by 60%, thus increasing the challenge to the
respiratory system
b. There is less risk of exercise-induced asthma
c. There is greater potential for increasing heart rate
d. Increased muscle blood flow from water immersion

c. There is greater potential for increasing heart rate

Which of the following wound characteristics is LEAST likely to indicate a need for hydrotherapy?

a. A wound that has dehisced
b. Presence of debris in the wound
c. Presence of necrotic tissue in the wound
d. A red wound with surrounding intact skin that is macerated

d. A red wound with surrounding intact skin that is macerated

Which of the following is least cytotoxic?

a. Hibiclens
b. Betadine
c. Bard skin cleanser
d. Tap water

d. Tap water

All of the following statements regarding infection control for immersion hydrotherapy are true EXCEPT:

a. The whirlpool tank and turbine should always be washed and disinfected between uses
b. The type of antimicrobials used to clean a whirlpool may be determined by the infection control department of a facility
c. Antimicrobial additives should always be added to water when a patient with an open wound receives whirlpool treatment
d. Whirlpools are a potential source of infection for patients with open wounds

c. Antimicrobial additives should always be added to water when a patient with an open wound receives whirlpool treatment

Which statement is true regarding hydrotherapy in the treatment of burns?

a. Hydrotherapy for debridement of burn wounds is typically less painful than for patients
requiring debridement of non-thermal wounds

c. Hydrotherapy is only used in the early treatment of burns to remove eschar
d. Patients with burns should not be given analgesics before hydrotherapy

b. Non-immersion hydrotherapy can be used with a patient with burns over large areas of the body, including the trunk

Consider the following for questions 15 and 16:
Jane, a soccer player, has been treated in physical therapy (PT) for two weeks. She fractured her right tibia and has been instructed not to bear weight on her right lower extremity. She has been exercising in a pool to maintain her quadriceps strength.

How can the therapist modify her water exercises to increase the force of quadriceps contraction required?

a. Have her kick faster, have her use fins, provide jets of water in the direction of knee
extension
b. Have her kick slower, have her use fins, provide jets of water in the direction of knee
extension
c. Have her kick slower, have her use fins, provide jets of water in the direction of knee
flexion
d. Have her kick faster, have her use fins, provide jets of water in the direction of knee
flexion

d. Have her kick faster, have her use fins, provide jets of water in the direction of knee
flexion

Consider the following for questions 15 and 16:
Jane, a soccer player, has been treated in physical therapy (PT) for two weeks. She fractured her right tibia and has been instructed not to bear weight on her right lower extremity. She has been exercising in a pool to maintain her quadriceps strength.

What temperature range should be used for the pool?

a. 26° to 36° C (79° to 97° F)
b. 38° to 44° C (80° to 104° F)
c. 10° to 18° C (55 to 67° F)
d. 35.5° to 37° C (96° to 98° F)

Which of the following exercises in water is an example of an open-chain exercise?

a. Standing in shallow water performing knee bends (waist level)
b. Holding on to the side of the pool and allowing the body to float away from the side of
the pool, while still holding on, to increase shoulder flexion
c. Running in deep water (greater than height of patient)
d. Pushing off the side of the pool with feet

c. Running in deep water (greater than height of patient)

Which population would LEAST benefit from hydrotherapy for the stated goal?

a. Patients with central processing problems, to provide proprioceptive input
b. Patients with osteoporosis, to slow bone mineral density loss
c. Patients who are obese, to decrease load on weight-bearing joints
d. Patients who are obese, to accelerate weight and fat loss

d. Patients who are obese, to accelerate weight and fat loss

Consider the following for questions 19 and 20: A 22-year-old woman who is pregnant is
referred to physical therapy for hydrotherapy. She reports right hip pain, decreased ability to
bear weight on the right lower extremity, lower extremity edema, and general decreased
endurance.

Which of the following hydrotherapy treatments would be MOST helpful to this patient to
address these problems?

a. “Running in place” with her body immersed in water to the neck, wearing a flotation vest.
b. Kicking with a kickboard
c. Performing deep knee bends in waist-level water
d. Swimming freestyle at a pace that would increase her heart rate to at least 150 beats per
minute, to decrease fatigue

a. “Running in place” with her body immersed in water to the neck, wearing a flotation vest.

Consider the following for questions 19 and 20: A 22-year-old woman who is pregnant is
referred to physical therapy for hydrotherapy. She reports right hip pain, decreased ability to
bear weight on the right lower extremity, lower extremity edema, and general decreased
endurance.

The therapist should be aware that when a pregnant woman exercises, she:

a. May be able to exert more in water than on land while maintaining a safe heart rate
b. May be able to exert more on land than in water while maintaining a safe heart rate
c. Should exercise in water warmer than 99° F
d. Should exercise in water cooler than 50° F

a. May be able to exert more in water than on land while maintaining a safe heart rate

Water is a recommended environment for exercise because of all of the following EXCEPT:

a. It unloads weight-bearing anatomic structures
b. It provides resistance that increases with increased speed of motion
c. Cool water can help to cool an individual performing high- intensity exercise
d. It provides cardiac conditioning more effectively than dry-land training of similar intensity while allowing the patient to perceive less exertion

d. It provides cardiac conditioning more effectively than dry-land training of similar intensity while allowing the patient to perceive less exertion

Water-based exercise:

a. Increases the work of breathing and increases exercise-induced asthma
b. Increases the work of breathing and decreases exercise-induced asthma
c. Decreases the work of breathing and increases exercise-induced asthma
d. Decreases the work of breathing and decreases exercise-induced asthma

b. Increases the work of breathing and decreases exercise-induced asthma

When applying hydrotherapy to a wound:

a. The water should be clean and warm. The wound should be clean and granulating
b. The water should be sterile and warm. The wound should have necrotic tissue or exogenous debris
c. The water should be clean and warm. The wound should have necrotic tissue or exogenous debris
d. The water should be sterile and warm. The wound should be clean and granulating

c. The water should be clean and warm. The wound should have necrotic tissue or exogenous debris

Immersion in water will:

a. Increase peripheral edema due to the effects of hydrostatic pressure on cardiovascular
and renal function
b. Increase peripheral edema due to the effects of buoyancy on cardiovascular and renal function
c. Reduce peripheral edema due to the effects of buoyancy on cardiovascular and renal function
d. Reduce peripheral edema due to the effects of hydrostatic pressure on cardiovascular and renal function

d. Reduce peripheral edema due to the effects of hydrostatic pressure on cardiovascular and renal function

To reduce the risk of hyponatremia from whirlpool immersion of patients with extensive burns:

a. Use warm water
b. Use cold water
c. Add salt to the water
d. Thoroughly clean the whirlpool

c. Add salt to the water

Whirlpool water temperature should never exceed:

a. 40° C (104° F)
b. 43° C (110° F)
c. 45° C (113° F)
d. 52° C (126° F

b. 43° C (110° F)

The water in an exercise pool should be kept at a temperature of:

a. 20° to 30° C (68° to 86° F)
b. 26° to 36° C (79° to 97° F)
c. 37° to 40° C (99° to 104° F)
d. 40° to 43° C (104° to 110° F)

b. 26° to 36° C (79° to 97° F)

A whirlpool safety program should include:

a. Regular electrical checks and cleaning of the whirlpool with a detergent AND a disinfectant
b. Regular electrical checks and cleaning of the whirlpool with a detergent OR a disinfectant
c. Consistent use of disinfectants in the water and cleaning with a detergent AND a disinfectant
d. Consistent use of disinfectants in the water and cleaning of the whirlpool with a detergent OR a disinfectant

a. Regular electrical checks and cleaning of the whirlpool with a detergent AND a disinfectant

Michael, age 13, has cerebral palsy with left hemiparesis. He is ambulatory, highly verbal,
and is a good reporter regarding his status. He has had tendon lengthening to allow for
increased wrist extension. Upon removal of the cast, the surgical wound is found to be well-
healed with a minimally raised scar. He complains of wrist pain and stiffness. Which of the
following hydrotherapy treatments would be most appropriate?

a. Whirlpool with cool or cold water
b. Whirlpool with warm or hot water
c. Non-immersion hydrotherapy to clean the wound
d. Contrast baths
e. No hydrotherapy is indicated

b. Whirlpool with warm or hot water

Jenny, age 3, sustained a superficial, partial-thickness burn to her hand when she placed it on
an electric stove burner. She presents with blistering. She is seen in the emergency department on the day of injury approximately 5 hours later. What is the appropriate hydrotherapy treatment?

a. Immersion whirlpool with cold water
b. Immersion whirlpool with hot water
c. Non-immersion technique
d. Contrast bath
e. No hydrotherapy is indicated

e. No hydrotherapy is indicated

Millie, age 55 and diabetic, has an open wound with a yellow base on her foot. She sustained injuries to her foot when she dropped a brick on it in her yard 2 months ago. She was referred to PT by her physician for wound care. What is the most appropriate hydrotherapy treatment?

a. Whirlpool with cool water
b. Whirlpool with hot water
c. Non-immersion technique
d. Contrast bath
e. No hydrotherapy is indicated

c. Non-immersion technique