1. Copyright 2005 Lippincott Williams & Wilkins Chapter 17 Aquatic Physical Therapy

2. Copyright 2005 Lippincott Williams & Wilkins Physical Properties of Water – Buoyancy Main Controlling Variables: 1.Position or direction of movement in water 2.Water depth 3.Lever arm length 4.Flotation or weighted equipment use

3. Copyright 2005 Lippincott Williams & Wilkins Position and Direction of Movement  Movements toward the surface – Buoyancy assisted.  Movements parallel to the bottom of the pool – Buoyancy supported (gravity minimized).  Movements toward the bottom of pool – Buoyancy resisted.

4. Copyright 2005 Lippincott Williams & Wilkins Depth, Lever Arm Length, or Buoyant Equipment Can Alter Resistance or Assistance  Shallower water – Less support.  Deeper water – More support, but increased frontal resistance.  Modifications can be made through use of buoyant equipment.

5. Copyright 2005 Lippincott Williams & Wilkins Buoyancy and Lever Arm

6. Copyright 2005 Lippincott Williams & Wilkins Buoyancy and Flotation

7. Copyright 2005 Lippincott Williams & Wilkins Resistance Is Influenced By: 1.Velocity of movement (mean muscle activity alters when velocity reaches a threshold (See Table 17-1) 2.Surface area 3.Water depth 4.Direction of movement

8. Copyright 2005 Lippincott Williams & Wilkins Physiologic Changes with Immersion (Changes vary with immersion depth) 1.Decreased peripheral blood flow, vital capacity. 2.Increased heart volume, intrapulmonary blood volume, right atrial pressure, left ventricular end-diastolic volume, stroke volume, cardiac output. 3.Decreased or unchanged heart rate.

9. Copyright 2005 Lippincott Williams & Wilkins Physiologic Response to Exercise and Immersion  Physiologic adaptations are similar to land training.  Increased cardiac loading due to hydrostatic pressure.  Depth of immersion affects degree of cardiac changes.

10. Copyright 2005 Lippincott Williams & Wilkins Examination and Evaluation for Aquatic Rehabilitation Full land-based examination must be performed. Also consider:  Basic safety (ability to enter water, comfort, etc.)  Precautions (cardiac history, etc.)  Contraindications to aquatic environment (fever, infections, rashes, etc.)

11. Copyright 2005 Lippincott Williams & Wilkins Therapeutic Exercise Intervention Mobility Impairment  Progress simple ROM exercises toward functional limitations.  Use lever arm length and buoyant equipment to alter resistance.  Observe land mechanics before pool exercise to ensure proper technique.

12. Copyright 2005 Lippincott Williams & Wilkins ROM (Hamstrings and Shoulder Extensors)

13. Copyright 2005 Lippincott Williams & Wilkins Muscle Strength/Power/ Endurance Impairment  Principles and progressions are the same as on land.  Resistance is influenced by surface area (SA) and direction. Consider gloves, etc. to increase SA.  Be aware of groups providing stability.  Leg and trunk stabilizers are necessary to counter many upper extremity movements.

14. Copyright 2005 Lippincott Williams & Wilkins Balance Impairment  Ideal environment for balance training.  Variety of activities can be performed.  Loss of balance is slowed dramatically.  Allows for increased reaction time.

15. Copyright 2005 Lippincott Williams & Wilkins Aquatic Therapy to Improve Balance

16. Copyright 2005 Lippincott Williams & Wilkins Aquatic Rehab to Treat Functional Limitations  As patient improves, modify activities to address functional limitations.  E.g., decrease level of water as sitting activities improve.  As normal mechanics improve, decrease water levels to replicate land-based environments.

17. Copyright 2005 Lippincott Williams & Wilkins Land-Based Functional Activities in Water

18. Copyright 2005 Lippincott Williams & Wilkins Contraindications/Precautions  Individuals with excessive fear  Open wounds  Rashes  Active infections  Incontinence  Tracheostomy  CV changes  Diuresis  Overexercise

19. Copyright 2005 Lippincott Williams & Wilkins Summary Pool provides a unique environment for rehabilitation. The properties aquatic therapy provides can be used in many ways to achieve therapeutic goals. Physiologic responses, temperature, and hydrostatic pressure must be considered for safety.

20. Copyright 2005 Lippincott Williams & Wilkins Summary (cont.) Aquatic therapy can accommodate activities and progress from early-functional stages. Balance is challenged with most movements and stabilizing muscles must be considered. Pool program should include a land-based program for a well-balanced transition to the land environment.