pp 1-10 | Cite as

Integrated Thermal Rehabilitation: A New Therapeutic Approach for Disabilities

  • Giovanni BarassiEmail author
  • Esteban Obrero-Gaitan
  • Giuseppe Irace
  • Matteo Crudeli
  • Giovanni Campobasso
  • Francesco Palano
  • Leonardo Trivisano
  • Vito Piazzolla
Part of the Advances in Experimental Medicine and Biology book series


A mutual link between somatic and visceral neural pathways is known in medicine. This study addresses therapeutic effectiveness of an integrated rehabilitative approach of thermal aquatic environment, combined with neuromuscular manual stimulation, on activation of afferent sensory visceral and somatic efferent neuronal motor pathways in different pathologies of neuromuscular motor and respiratory systems. The study included 63 patients subjected to a protocol consisting of hydroponic treatment, hydrokinesitherapy associated with ozonized vascular pathway, and mud therapy associated with cardiorespiratory treatment performed in aquatic environment and aided by neuromuscular manual therapy. The therapeutic protocol consisted of rehabilitation sessions 5 days a week for 2 months. The outcome measures were spirometry tests and the following evaluation instruments: Tinetti Gait and Balance assessment scale, Functional Independence Measurement, visual analogue scale, and the EQ-5D-5 L instrument. The tests were applied before and after the protocol completion. The findings demonstrate a general increase in patients’ everyday living autonomy and quality of life, with a particular improvement in respiratory function tests. We conclude that the integrated thermal approach holds promise in therapeutic rehabilitation of disabilities.


Balneotherapy Disability Hydrokinesitherapy Neuromuscular manual therapy Physiotherapy Respiratory system Spirometry Thermal therapy 


Conflict of Interest

This research received no external grants or funding. The authors declare no conflicts of interest in relation to this article.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Written informed consent was obtained from all individual participants included in the study.


  1. Barassi G, Bellomo RG, Di Giulio C, Giannuzzo G, Irace G, Barbato C, Saggini R (2018a) Effects of manual somatic stimulation on the autonomic nervous system and posture. Adv Exp Med Biol 1070:97–109Google Scholar
  2. Barassi G, Bellomo RG, Porreca A, Di Felice PA, Prosperi L, Saggini R (2018b) Somato–visceral effects in the treatment of dysmenorrhea: neuromuscular manual therapy and standard pharmacological treatment. J Altern Complement Med 24(3):291–299Google Scholar
  3. Barassi G, Bellomo RG, Porreca A, Giannuzzo G, Irace G, Trivisano L, Saggini R (2019) Rehabilitation of neuromotor disabilities in aquatic microgravity environment. Adv Exp Med Biol 1113:61–73Google Scholar
  4. Batterham SI, Heywood S, Keating JL (2011) Systematic review and meta–analysis comparing land and aquatic exercise for people with hip or knee arthritis on function, mobility and other health outcomes. BMC Musculoskelet Disord 12:123Google Scholar
  5. Bellometti S, Cecchettin M, Galzigna L (1997) Mud pack therapy in osteoarthrosis: changes in serum levels of chondrocyte markers. Clin Chim Acta 268(1–2):101–106Google Scholar
  6. Bellomo RG, Barassi G, Di Iulio A, Giannuzzo G, Lococo A, Carmignano SM, Saggini R (2015) Rehabilitation of cancer pain in lung cancer: role of manual therapy. J Physiother Phys Rehabil 19(4)Google Scholar
  7. Bellomo RG, Barassi G, Verì N, Visciano C, Giannuzzo G, Pecoraro I, Saggini R (2016) Integrated rehabilitation approach for small children with damage to the central nervous system. Adv Sci Med 1(3):5–10Google Scholar
  8. Bocci V, Borrelli E, Zanardi I, Travagli V (2015) The usefulness of ozone treatment in spinal pain. Drug Des Devel Ther 9:2677Google Scholar
  9. Burton AC, Taylor RM (1940) A study of the adjustment of peripheral vascular tone to the requirements of the regulation of body temperature. Am J Physiol Renal Physiol 129(3):565–577Google Scholar
  10. Casaburi R, Kukafka D, Cooper CB, Witek TJ Jr, Kesten S (2005) Improvement in exercise tolerance with the combination of tiotropium and pulmonary rehabilitation in patients with COPD. Chest 127(3):809–817Google Scholar
  11. Constant F, Collin JF, Guillemin F, Boulange M (1995) Effectiveness of spa therapy in chronic low back pain: a randomized clinical trial. J Rheumatol 22(7):1315–1320Google Scholar
  12. Dogaru G, Ispas A, Bulboacă A, Motricală M, Stănescu I (2017) Influence of balneal therapy at Băile Tușnad on quality of life of post–stroke patients. Balneo Res J 8:201–205Google Scholar
  13. Fioravanti A, Giannitti C, Bellisai B, Iacoponi F, Galeazzi M (2012) Efficacy of balneotherapy on pain, function and quality of life in patients with osteoarthritis of the knee. Int J Biometeorol 56(4):583–590Google Scholar
  14. Grunke M, Schulze-Koops H (2006) Successful treatment of inflammatory knee osteoarthritis with tumour necrosis factor blockade. Ann Rheum Dis 65(4):555Google Scholar
  15. Herdman M, Gudex C, Lloyd A, Janssen MF, Kind P, Parkin D, Badia X (2011) Development and preliminary testing of the new five–level version of EQ–5D (EQ–5D–5L). Qual Life Res 20(10):1727–1736Google Scholar
  16. Holdcraft LC, Assefi N, Buchwald D (2003) Complementary and alternative medicine in fibromyalgia and related syndromes. Best Pract Res Clin Rheumatol 17(4):667–683Google Scholar
  17. Hurley MV, Walsh NE, Mitchell H, Nicholas J, Patel A (2012) Long-term outcomes and costs of an integrated rehabilitation program for chronic knee pain: a pragmatic, cluster randomized, controlled trial. Arthritis Care Res 64(2):238–247Google Scholar
  18. Hutzler Y, Chacham A, Bergman U, Szeinberg A (1998) Effects of a movement and swimming program on vital capacity and water orientation skills of children with cerebral palsy. Dev Med Child Neurol 40(3):176–181Google Scholar
  19. Jochheim KA (1990) Adapted physical activity – an interdisciplinary approach. Premises, methods, and procedures. In: Adapted physical activity. Springer, HeidelbergGoogle Scholar
  20. Konrad K, Tatrai T, Hunka A, Vereckei E, Korondi I (1992) Controlled trial of balneotherapy in treatment of low back pain. Ann Rheum Dis 51(6):820–822Google Scholar
  21. Langlais B, Reckhow DA, Brink DR, Ozone in Water Treatment. Application and Engineering (1991) Cooperative research report. American Water Works Association Research Foundation. Lewis Publishers, Boca Raton/London/New York/Washington, DCGoogle Scholar
  22. Lim HJ, Moon YI, Lee MS (2005) Effects of home–based daily exercise therapy on joint mobility, daily activity, pain, and depression in patients with ankylosing spondylitis. Rheumatol Int 25(3):225–229Google Scholar
  23. Lioy PJ, Spektor D, Thurston G, Citak K, Lippmann M, Bock N, Speizer FE, Hayes C (1987) The design considerations for ozone and acid aerosol exposure and health investigations: the Fairview Lake summer camp – photochemical smog case study. Environ Int 13(3):271–283Google Scholar
  24. Liu H, Zeng C, Gao SG, Yang T, Luo W, Li YS, Lei GH (2013) The effect of mud therapy on pain relief in patients with knee osteoarthritis: a meta–analysis of randomized controlled trials. J Int Med Res 41(5):1418–1425Google Scholar
  25. Ness TJ, Gebhart GF (1990) Visceral pain: a review of experimental studies. Pain 41(2):167–234Google Scholar
  26. Pappas S, Perlman A (2002) Complementary and alternative medicine: the importance of doctor–patient communication. Med Clin 86(1):1–10Google Scholar
  27. Pecyna MB, Pokorski M (2013) Near–infrared hemoencephalography for monitoring blood oxygenation in prefrontal cortical areas in diagnosis and therapy of developmental dyslexia. Adv Exp Med Biol 788:175–180Google Scholar
  28. Pokorski M, Barassi G, Bellomo RG, Prosperi L, Crudeli M, Saggini R (2018) Bioprogressive paradigm in physiotherapeutic and antiaging strategies: a review. Adv Exp Med Biol 1116:1–9Google Scholar
  29. Pospíšil P, Konečný L, Zmeškalová M, Srovnalova H, Rektorova I, Nosavcovová E, Siegelova J (2007) Balneotherapy in patients with Parkinson’s. Scr Med 80(5):233–238Google Scholar
  30. Ravaud JF, Delcey M, Yelnik A (1999) Construct validity of the functional independence measure (FIM): questioning the unidimensionality of the scale and the value of FIM scores. Scand J Rehabil Med 31(1):31–42Google Scholar
  31. Restaino L, Frampton EW, Hemphill JB, Palnikar P (1995) Efficacy of ozonated water against various food–related microorganisms. J Appl Environ Microbiol 61(9):3471–3475Google Scholar
  32. Saggini R, Ancona E, Carmignano SM, Supplizi M, Barassi G, Bellomo RG (2017) Effect of combined treatment with focused mechano–acoustic vibration and pharmacological therapy on bone mineral density and muscle strength in post–menopausal women. Clin Cases Miner Bone Metab 14(3):305–311Google Scholar
  33. Sauvage JL, Myklebust BM, Crow-Pan J, Novak S, Millington P, Hoffman MD, Rudman D (1992) A clinical trial of strengthening and aerobic exercise to improve gait and balance in elderly male nursing home residents. Am J Phys Med Rehabil 71(6):333–342Google Scholar
  34. Saxena S, Carlson D, Billington R, Orley J (2001) The WHO quality of life assessment instrument (WHOQOL–Bref): the importance of its items for cross–cultural research. Qual Life Res 10(8):711–721Google Scholar
  35. Seymour JM, Moore L, Jolley CJ, Ward K, Creasey J, Steier JS, Moxham J (2010) Outpatient pulmonary rehabilitation following acute exacerbations of COPD. Thorax 65(5):423–428Google Scholar
  36. Staffieri A, Abramo (2007) A sulphurous–arsenical–ferruginous (thermal) water inhalations reduce nasal respiratory resistance and improve mucociliary clearance in patients with chronic sinonasal disease: preliminary outcomes. Acta Otolaryngol 127(6):613–617Google Scholar
  37. Stein SW, Thiel CG (2017) The history of therapeutic aerosols: a chronological review. J Aerosol Med Pulm Drug Deliv 30(1):20–41Google Scholar
  38. Travagli V, Zanardi I, Valacchi G, Bocci V (2010) Ozone and ozonated oils in skin diseases: a review. Mediat Inflamm 2010:610418Google Scholar
  39. Travell JG, Simons DG (1983) Myofascial pain and dysfunction: the trigger point manual. Lippincott Williams Wilkins, PhiladelphiaGoogle Scholar
  40. Tsujii T, Komatsu K, Sakatani K (2013) Acute effects of physical exercise on prefrontal cortex activity in older adults: a functional near–infrared spectroscopy study. In: Oxygen transport to tissue XXXIV. Springer, Berlin/Heidelberg, pp 293–298Google Scholar
  41. Verhagen AP, Bierma-Zeinstra SM, Boers M, Cardoso JR, Lambeck J, de Bie RA, de Vet HC (2007) Balneotherapy for osteoarthritis. Cochrane Database Syst Rev (4):CD006864Google Scholar
  42. Walsh WM, Gerley PP (1985) Thermal biofeedback and the treatment of tinnitus. Laryngoscope 95(8):987–988Google Scholar
  43. Wilkinson DJ, Baikie G, Berkowitz RG, Reddihough DS (2006) Awake upper airway obstruction in children with spastic quadriplegic cerebral palsy. J Paediatr Child Health 42(1–2):44–48Google Scholar
  44. Yurtkuran M, Yurtkuran MA, Dilek K, Güllülü M, Karakoc Y, Özbek L, Bingöl Ü (1999) A randomized, controlled study of balneotherapy in patients with rheumatoid arthritis. Phys Med Rehab Kuror 9(03):92–96Google Scholar
  45. Zamparo P, Pagliaro P (1998) The energy cost of level walking before and after hydro-kinesi therapy in patients with spastic paresis. Scand J Med Sci Sports 8(4):222–228Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Giovanni Barassi
    • 1
    Email author
  • Esteban Obrero-Gaitan
    • 2
  • Giuseppe Irace
    • 3
  • Matteo Crudeli
    • 3
  • Giovanni Campobasso
    • 4
  • Francesco Palano
    • 3
  • Leonardo Trivisano
    • 5
  • Vito Piazzolla
    • 6
  1. 1.Department of Medical and Oral Sciences and Biotechnologies“Gabriele d’ Annunzio” University Chieti-PescaraChietiItaly
  2. 2.Faculty of Health SciencesJaen UniversityJaenSpain
  3. 3.Thermal Medicine Center of Castelnuovo della DauniaFoggiaItaly
  4. 4.Department of Health, Social Wellness and Sport PromotionPuglia RegionBariItaly
  5. 5.Rehabilitation DepartmentLocal Health Unit of FoggiaFoggiaItaly
  6. 6.Local Health Unit of FoggiaFoggiaItaly

Personalised recommendations