Description of Intervention
Fluidized therapy—or fluidotherapy—is a multipurpose therapeutic modality that transfers heat by convection to an injured or painful area.1 It circulates dry air through a special thermostat-controlled container that is filled with cellulose particles, and the heated air moves and separates these particles to create a fluid-like medium. This allows for uniform heat transfer across the surface area while also providing tactile stimulation.1,2
Through this process, fluidotherapy simultaneously performs the functions of applied heat, massage, sensory stimulation, desensitization for hypersensitive dermatomes, levitation, and pressure oscillations. It is used to increase range of motion (ROM) and reduce pain, edema, muscle spasm, and stiffness in conditions involving the hands, wrists, and elbows. Fluidotherapy is a dry thermal physical agent that exerts its therapeutic effect by transferring heat to soft tissues by forced convection, which is the process of heat transfer through the forced movements of the heated air and cellulose particles in the chamber. As with other forms of heat treatment, this leads to several physiologic changes, including vasodilatation, increased cellular metabolism, and the induction of phagocytosis.2,3
A typical temperature range for fluidotherapy is 115–120°F, and both the temperature and the amount of particle agitation can be adjusted by the clinician.1 Research has shown that the effectiveness of fluidotherapy is similar to that of paraffin baths and whirlpool, two other frequently used heat transfer modalities. Another benefit of fluidotherapy compared to some other modalities is that it allows the patient to perform active ROM exercises while undergoing treatment.
Indications for Intervention3
Certified Hand Therapists, both Occupational Therapists and Physical Therapists, may use fluidotherapy for patients presenting with pain, swelling, stiffness, inflammation, and/or reduced ROM caused by a traumatic injury or musculoskeletal condition involving the hand, wrist, or elbow. Post-surgical patients may also be candidates for fluidotherapy.
Diagnosis
- Ask the patient to describe their medical history, including any recent injuries to the hand/fingers, wrist, or elbow, and any recent surgeries performed in those regions.
- Ask if the patient has any comorbidities, including smoking, diabetes, or osteopenia.
- Perform a physical examination of the area of interest. If ROM is impaired, measure the active and passive ROM of any involved joint(s) and compare these measurements to the contralateral side.
- Ask the patient to rate their pain on the visual analogue scale (VAS) or a similar outcome measure.
- If edema is present, assess and document its severity. The water displacement method with a volumeter, which accurately measures the composite volume of the hand and lower arm, is the gold standard for evaluating edema.
- If muscle spasms are reported, ask the patient to describe their frequency and intensity.
- If the patient presents with pain, swelling, inflammation, and/or impaired ROM in the upper extremity, consider utilizing fluidotherapy.
Intervention Options1,3-5
Fluidotherapy should be integrated into a comprehensive and individualized treatment program designed by a physical therapist or hand therapist. Depending on the patient’s diagnosis, the program is also likely to include strengthening exercises, stretching exercises, manual therapy, functional training, and/or other therapeutic modalities.
The fluidotherapy machine should be set to a temperature in the range of 115–120°F and the patient should be instructed to wash the affected area and remove any jewelery. While seated, the patient then inserts the affected extremity into the sleeve of the fluidotherapy machine, which is closed snugly around the proximal arm. Additional highlights of fluidotherapy treatment are below:
- Each session should last for 15–20 minutes
- Ask the patient about their comfort level throughout the session and adjust the heat and/or agitation level if necessary
- Patients should be told to do active ROM exercises with the wrist, metacarpophalangeal, and interphalangeal joints frequently throughout each session
- After the session, check the patient’s skin and temperature; while some redness is normal, signs of significant inflammation or irritation may suggest that fluidotherapy is not appropriate
- Patients should undergo fluidotherapy several days per week for 3–4 weeks
After completing treatment, consider assessing pain, ROM, edema, stiffness, or any other parameters to determine if any immediate improvements have occurred.
