1. ATHT 333 Aquatic Therapy

2. When to use Research shows it to be beneficial with  Spinal cord injury  Orthopedic injury  Chronic pain  Cerebral palsy  MS  Preventative CV maintenance tool Beneficial due to decreased joint pressure  Reduces spasm

3. Goal of Aquatic Therapy Primary goal is to teach patient how to use water as a modality for improving movement, strength, and fitness

4. Physical Properties & Principles of Water Several major physical properties of water, including specific gravity, buoyancy, center of buoyancy, & hydrodynamics, affect the way people can exercise in water. Buoyancy Specific Gravity Resistive forces

5. Buoyancy Gravity pulls down, buoyancy pushes up Archimedes’ Principle  any object floating or submerged in in water is buoyed upward by a counterforce that that helps support the submerged object against the downward pull of gravity

6. Buoyancy If 100 lb person gets into water almost completely submerged, they will displace a volume of water approx 95 lbs. Therefore, they feel like they weigh 5 lbs due to only bearing the weight of the body above the water.  Weight changes as % of submerged body changes Different for males and females  Males carry higher % of weight in upper body Each joint below water is decompressed allowing for ambulation and vigorous exercises

7. Buoyancy Progression Patient NWB in deep end of pool  Can use vest, kickboard to assist in floating

8. Specific Gravity Buoyancy on different body parts varies Determined by  Bone to muscle weight ratio  Amount & distribution of fat  Depth and expansion of chest Humans have specific gravity slightly less than water, that’s why we float  Since entire body not uniform, horz. Float difficult Athletes typically muscular

9. Resistive forces Cohesive- run parallel to water surface, water molecules bond to form surface tension

10. Resistive forces Bow Force- force generated at front of the object during movement  Causes increase in water pressure at front of object due to decreases pressure at the rear  Water goes from high pressure to low pressure. As it does, swirls and forms eddie which impede flow by creating a backward force or drag

11. Resistive Forces Drag force- along with bow force can be controlled by changing the shape of object or speed of motion  Friction decreased by making it more streamline  Working with a patient that is generally weak, increased activity around patient and turbulence will make walking more difficult  Conversely, turbulence can be generated when speed of movement increased (causes muscles to work harder)  May also change directions to increase drag  Needs to be considered post Sx or when joint needs to be protected

12. Form Drag

13. http://www.youtube.com/watch?v=BH42aiqHZSg

14. Weight Bearing In Water The deeper you are in water, the less weight on LE Males different than female  M= COG higher  Weight at different depths varies  Up to xyphoid process M= 35%weight, F= 28% Need to consider when Pt. is NWB vs PWB Faster walking in water = more WB

15. Advantages Buoyancy provides security and comfort Restoring ROM early Slow motion mvt in water provides extra time to control mvt  Can error w/o consequence Turbulence aids in proprioception and balance Transition from NWB to FWB Ability to work out hard with no fear of reinjury psychologically beneficial Warmth of water can relax muscles & relieve pain, helping to break down the pain-spasm injury cycle

16. Advantages Can relieve or reduce pain due to immobilization or edema Is a modality that can be used early in rehabilitation program, helping to prevent deconditioning Intensity of exercise can be controlled by manipulating flow of water (turbulence), body position, adding equipment

17. Disadvantages Cost of building and maintaining pool Need qualified pool attendants Thermoregulation issues Does not improve or maintain tolerance to heat while on land

18. Precautions Fear of the water Medications  CV & BP meds may alter CV function Ear infections Specific conditions need careful monitoring  Diabetes  Cardiovascular disease  Seizure disorders

19. Contraindications Untreated infectious disease ( fever) Open wound/ unhealed surgical incisions Contagious skin disease Serious cardiac conditions Seizure disorders Excessive fear of water Allergy to pool chemicals Uncontrolled high/low BP Uncontrolled bowel/bladder Menstration w/o internal protection

20. Safety Equipment Rescue equipment  Ring buoys  Shepherds crook  Rescue tubes  Spine board  Wood  Plastic  Fiberglass

21. Exercise Equipment Assistive devices  Equipment that helps to stabilize or support the patient in a desired position while in the water  Examples: flotation cuffs, pull buoys, vests & belts, kickboards, water dumbbells, other buoyancy equipment

22. Exercise Equipment Resistive devices  Devices that advance the difficulty of an exercise to increase muscle strength or endurance  Increase the body’s surface area  Examples  Lower extremity: water shoes, fins, boots  Upper extremity: webbed gloves, paddles, bells  Cardiovascular devices

23. Application of Aquatic Principles & Progression Aquatic exercise progression  Early-phase exercises  Middle-phase exercises  Advanced-phase exercises  End-phase exercises

24. Early-phase Exercises Gait training ROM Early strengthening

25. Middle-phase Exercises Restoration of strength & muscular endurance

26. Advanced-phase Exercises Normal restoration of agility, balance & coordination Increase stresses in water to increase stresses on land Increase the pace of exercise at a faster pace, plyometrics, changing of directions

27. End-phase Exercises Mimic skill demands of sport & position Include:  Aggressive coordination  Agility  Speed activities  Reinforce performance of specific skills w/ proper posture

28. Deep-water Exercise Benefits  No weight bearing & no impact forces  Can help maintain cardiovascular fitness & strength  Forces of gravity on a submersed body are minimal  Deep-water exercises are essentially concentric

29. Deep-water Exercise Recommendations for deep-water exercise  Alignment of body  Arm activity  Correct position for deep- water running

30. Exercises for the Spine

31. Neck Stretches, Shallow Water

32. Spine Flexion & Extension

33. Pelvic Roll

34. Trunk Rotation

35. Pull-Down

36. Double-Leg Lift

37. Trunk Rotations

38. Lateral Flexion & Added Resistance

39. Exercises for the Lower Extremities

40. Hopping, Shallow Water

41. Deep-Water Cross-Country Skiing

42. Jumping Jacks, Deep Water

43. Double-Knee Lift, Deep Water

44. Hip Flexion With External Rotation, Deep Water

45. Hip Abduction, Deep Water

46. Double-Knee Bend, Deep Water

47. Seated Knee Extension, Deep Water

48. Exercises for the Upper Extremities

49. Shoulder Capsule Stretches

52. External Rotator Stretch

53. Internal Rotator Stretch

54. Shoulder Press-Down

55. Bent-Arm Pull, Deep Water

56. Straight-Arm Pull, Deep Water

57. Elbow Press, Deep Water