Good Practice Guide in the Balneal Prophylactic

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Good practice guide in the

balneal prophylactic,therapeutic and

rehabilitation treatment in

elderly

proposal draft

presentationAuthors: O. Surdu 1, 2, V. Marin1, T. V. Surdu2, V. Rusu 1, D.Profir 11. Balneal and Rehabilitation Sanatorium Techirghiol2. Ovidius University ConstantaLeonardo Proyect:Thermal Baths for Active Ageing

Termas de CuntisMay 4-7, 2012


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CONTENTS

1. Natural therapeutic factors:

climate (relief, hydrology and vegetation),including salty mines and caves micro climate

mineral/thermal waters (for bathing and drinkingcure)

mud/peat/clay

Gases

2. geronto-prophylactic balneal cure

3. Therapeutic balneal cure in eldery

4. Rehabilitation balneal cure in eldery


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CONTENTS

5. Indication and contraindication of balneal cure in

adults

6. Physiological features of aging process and

modulation of thermal parameters required byapplication of balneal factors in elderly

7. Contraindication of balneal cure in elderly and

protocol for the application of spa treatment in

the elderly

8. Balneal section facilities and enforcement rules


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Climate

Type of climate in Romania (Your country):

temperate continental with four distinct seasons

Some parameter of climate:

a. The average annual temperature: 11C (52F)in the south and 8C (46F) in the north.

b. Precipitation - over 750 mm/year, on the highestmountains - much of it falling as snow.

-In the south-central parts - around 600 mm/year.

-In the Danube Delta, rainfall levels are very low-around 370 mm/year .


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Climate/bioclimate

the temperatecontinental climateismodulated by the relief:

plain climate (exciting in the summer),

seaside climate (hot and humid in the

summer, dry and windy in the winter);

hillock and hill climate (sparing climate);

mountain climate (low and high mountain

with tonic/challenging properties);


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Microclimate (exemples)

Salt mines and caves microclimate

constant temperature: 10 - 12 C

air humidity 50-80%

presence of aerosols of NaCl absence of vegetal allergens and pathogen

microorganisms (like in a surgery room)


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Mineral waters-definition and conditions(Congress at Bad Nauheim in 1912)

Def. Are natural solutions of salt separate ionic or not, inbalance from its source/spring.

at least one of the following conditions:

to contain at least 1 g salt/l;

to contain chemical elements, solid or gaseous, withscientifically proven therapeutic action;

to have from its source at least 20 C;

to contain micro-elements;


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Mineral waters

Criteria for the classification

concentration in salts

the temperature of the water chemical composition and physical

properties

level of mineralization


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Mineral waterstypes of

mineral/thermal waters:

Saline, chloro-sodic waters,

alkaline, alkaline terouse,

sulfatate-sodic-magnesium,

carbogaseous,

oligometallics,

oligominerale

ferruginous,

arsenicale,

iodurate,

sulfurous,

radonics/radioactive waters


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Mineral waters

Ways of using:

drinking cure, bathing cure,

aerosols,

lavages and gynecological applications


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Exploitation and marketing ofnatural mineral waters

Mineral waters used/indicated in internal cure are drunkmost of the time directly to the source.

They can be bottled and can be marketed for foodconsumption, daily. By judgment nr.1.020 of September1, 2005 have been established

"Technical rules of operation and marketing of naturalmineral waters"

This document (including attachments) contains theelements necessary for proper management andutilization of mineral water.

The label of mineral waters must contain information onchemical composition, name and location of the source.

On the label can be written instructions like "stimulatesdigestion", "stimulate biliary secretion" or similarindications

E l i d k i f


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Explotation and marketing ofnatural mineral waters specific

rules the source must be marked with signs, it must be paved,

equipped with handrails and benches for rest. Patientsreceive the instuction for the balneal cure from the

medical doctor of the resort. On the recipise are listed: the source of mineral water,

the amount of mineral water, the rhythm and the momentof administration, depending on the type of diseases.

Some mineral waters can be administrated as inhalationor/and vaginal irrigation. For this type of applications areneeded adequate facilities, approved by the Ministry ofHealth


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Therapeutic lakes

Are areas of water which have taken birth throughone of the mechanisms, which can be used tobathing. Yours country?

Types of lake: the sea shore lakes appeared at a river flowing

into the sea;

plain lakes whose chemical composition is

determined by soil composition of theneighborhood;

Lakes form in massive salt.


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Mud/Peat

Mud is one of the five elements of nature havingimmense impact on the human body in health as well asin sickness.

The mud is made of ground/rocks of pasty consistency

Substances formed in natural conditions under the

influence of geological processes and which in smoothlydivided state and in mixture with water are used inmedical practice as mud bath or local procedures.(ISMH)


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Mud/Peat

Types of mud: exemples and clasification

Sapropelic mud - black, sulfurous deposits, very

unctuous with very good plasticity

Peat - brown organic deposits

Mineral mud are formed by salts sedimentation

of carbon dioxide, calcium, iron or soulphourous

springs

Ways of using:

cold ointment, mud bath, mud wrapping/pack


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Gases

Emanation ofdry CO2 named mofeta (pluralmofete) therapeutic used for their vasculoactive

properties

Emanation ofSH2 named sulphatarium used fortheir condroprotectiv activity ex?

Emanation of both: dry CO2 and SH2 used forboth: vasculoactive and condroprotectiv

properties ex?


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Fields of pathology/prophylaxis potentialbeneficiaries of balneal cure

1. Neurological pathology (central/periphery)

2. Rheumatologycal diseases: osteoarthritis; inflammatory arthritis;

acute, sub-acute, sub chronic or chronic steady; 3. Post traumatic pathology: shoemaker, orthopedic-surgical, sports;

4. Cardiovascular pathology (cardiac diseases; peripheral-arterial/venous/lymphatic);

5. Respiratory pathology (type restrictive / obstructive/ mix);

6. Pathology of civilization (sedentariness; stress/breakdown - withimportant prophylactic connotations);

7. Geriatric pathology, geriatric-prophylaxis, geriatric-rehabilitation;

8. Pediatric pathology


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Fields of pathology/prophylaxis potentialbeneficiaries of balneal cure

9. Psychiatric pathology (stress/breakdown,syndromes neurotic syndrome);

10. Digestive pathology (gastro-intestinal, biliary,hepatic);

11. Kidney and urinary pathology; 12. Metabolic pathology;

13. Gynecological pathology

14. Dermatological pathology and cosmetology

15. Pathology ORL

16. Professional-occupational pathology


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General contraindications forbalneal cures in adults:

Acute and chronic fever during the flare

Infectious diseases - including the venereal diseases(syphilis, clap, AIDS, hepatitis acute type B, C, etc.);tuberculosis - except in cases with healing confirmed by

the specialist physician; healthy carriers of pathogens -including parasitic agents

Cachectic states, regardless of causes;

Cancer of any type, in every location or stage;

Bleeding from any cause; Hematological diseases

Epilepsy, psychopaths - including elitism chronic and otherdrug addiction;


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General contraindications forbalneal cures in adults:

Diseases to the limit organ failure (cardiac insufficiency, renal, hepaticand/or metabolism status unbalanced or difficult to control withtherapeutic means; swinging HTA and/or with high values withouttherapeutically control;

Disturbances of sensitivity (hypersensitivity to specific current links itwas perhaps psychogenic/hypo - anesthesia emanating on the

areas relatively taut) Lesions and/or skin diseases, with risk of aggravation by F. F. T. N.

and/or lesions large, unsightly; areas with skin irritation, solutions ofcontinuity;

Patients who can not care for themselves;

Patients recovering from serious and recent illness

Pathological pregnancy in any month and normal pregnancy afterthree months


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General rules for applyingbalneal treatment

Inspection of the patient before immersion in the tub.

General warm procedures must not be appliedsecondary abundant meals (lunch), stress, physicalexercises, tensed situations. It is preferred that

application takes place in the morning. If the patient has two major procedures the same

morning, its mandatory to have a 2 hours breakbetween them. The physician must avoid too manyprocedures on medical prescription for one patient.

Menstrual bleeding contraindicates any balnealprocedure first 2-3 days, the following days allowingonly partial applications to upper limbs.


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Draining of kidney and digestive residues.

The application of cold thermotherapy will be doneonly on warm skin or heated before areas and beginsalways with the warm factor.

Hot or warm applications will always be followed by acold procedure, in order to avoid consecutivevasoplegia.

When the patient finish the bath, he goes out of the tuband must be dried with a sheet, intensity of thisprocess being correlated with the intended aim: withvigorous movements (for toning the patient) or softly(to reduce response).


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Precise application of the prescription: temperature,duration, level of immersion or application area. Theassistant/therapist may add minor procedures - friction orbrushing, in order to rush appearance of dermo-vascular

reactions. The therapist must provide psychological support to the

patient by explaining him the applied procedure andavoiding unpleasant discussion or arguing.

The assistant/therapist must supervise the patient

carefully meanwhile the application, in order to preventincidents or accidents which can happen.


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Necessary equipment for section/departmentof balneotherapy and surveillance measures

(microbiological and biochemical) of

therapeutic resource

Tub dimension must be between 80x175 cm and100x190 cm and the volume of used water is between180 - 220 l.

Minimal area allocated for a tub is 8 m2 , and for theshower is 2-3 m2.

Drainage system and filling valves must be dimensionedin order to allow filling, respectively drainage of the tub in3-5 minutes.

Scottish shower, massage shower, etc) is minimum 3-4m2 by room , and for Scottish shower is necessary adistance of 3-3.5 m between the nozzle and the patient.


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therapeutic resource

The mud packing room must has an optimum surface of4 m2, height of 2.5 to 3.5 m, must contain beds withdimensions between 80x175 cm and 100x190 cm, with aheight of 70 to 80 cm.

Balneotherapic rooms must have the floor coated withnon-slippery materials, be provided with adequatedrainage system, wooden grills and naturally illuminated.

Fluorescent lamps provide most proper artificial light,which allow the therapist to see dermo-vascular reaction.

The walls must be covered by tiles up to the ceiling or atleast up to a height of 2 m from the floor.


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(microbiological and biochemical) oftherapeutic resource

Ventilation of the rooms must ensure vapor removalduring application, so that humidity in the air doesnt

exceed 75%. Optimum temperature in the baths rooms/chambers is

22C to 24C, and in the corridors and waiting rooms20C to 22C.

It is appropriate to have ambient thermometers in every

room, for better monitoring of thermal comfort necessaryduring the procedures.

Duration of a warm bath is 20-30 minutes, after thisresting is necessary for 1-2 hours.

For time monitoring every room must have a signalizing

clock or an hourglass with sand.


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therapeutic resource Sweating and resting shall be carried out in the hotel room and

when hydrothermotherapy is applied in specialized outpatient mustexist specially designed spaces: rooms for resting and/or sweating,where the patient get fluids for hydration: mineral water, tea.

Special attention must be paid to surveillance of surface/source ofmineral water, to protection of perimeter in accordance with theexisting laws, checking periodically microbiological and biochemicalparameters.

Personnel involved in this activity will carry out periodically amedical exam, according to valid epidemiological and workingprotection normative.

Special attention will be paid to self control rhythmically realised bythe owner of the base.


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Physiological features of aging processand modulation of thermal parameters

required by application of balneal

factors in elderly

Th h i ll bj i i ld


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The therapeutically objectives in elderlocomotors rehabilitation in balneal

resort are:

The maintaining / regaining of articular mobility;

The maintaining / regaining of muscular force

and resistance;

The maintaining / correction of body posture

and alignment;

The maintaining / correction of motorcoordination and control and equilibrium.

Th h i ll bj i i ld


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The therapeutically objectives in elderrehabilitation in balneal resort in

pathology of:

Respiratory tract

Cardiovascular aparat

Digestive tract

Kidney and urinary tract

Neurological periphery and central

Posttraumatic sequels


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Therapeutic objectives followed in

balneal treatment in elderly are:

The decrease/control of pain;

Prevention of loss/recover of joint mobility;

Prevention of loss/recover of muscular force and resistance;

In case of neurological squeals, the kinetic program aims are:

recover of the muscular tonus decrease in muscular hypertoniaand increase in muscular hypotonia;

prevention of axial deviations;

recover the balance between agonist / antagonists, synergistic /stabilizers, and also between the physiological alternationcontraction / relaxation;

the re-establishment of body equilibrium, voluntary motor control,walking and abilities.


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Contraindications and/or limits for

balneal cures in elderly

Painful ischemic heart disease (especially

angina at rest), myocardial infarct, cardiac

arrhythmia (except possibly chronic atrial

fibrillation with average rate, well tolerated), Severe high blood pressure, uncontrolled /

difficult to control treatment

Clinical cerebral atherosclerosis, dementia

syndromes

Sphincter disorders (bladder and / or anal)


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Conclusions

Parameter modulation of kinetics andhydrokinetotherapy clinically motivated prescriptions,may allow 3-rd age and even 4-th age patients to doefficient balneal and physical treatments,

not only with the purpose of training/stimulating the

organisms adaptability, with the delay of global decrease of performance /

maladjustment phenomena characteristic forsenescence - thus gerontoprophilaxis -

but also with the purpose of treating ailments and/or

chronic dysfunctions gerontorehabilitation, both aspects leading finally to the same objective the

improvement of life quality.

Good Practice Guide in the Balneal Prophylactic

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