Aquatic Physical Therapy for Parkinson's Disease

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Aquatic Physical Therapy for Parkinson's Disease Vol.2, No.4, 102-107 (2013) Advances in Parkinson’s Disease http://dx.doi.org/10.4236/apd.2013.24019 Aquatic physical therapy for Parkinson’s disease Talita Gianello Gnoato Zotz1*, Eliani Arruda Souza2, Vera Lúcia Israel3, Ana Paula Cunha Loureiro4 1Physical Therapy Department, Federal University of Paraná, Matinhos, Brazil; *Corresponding Author: [email protected] 2Physical Therapy Clinic, Curitiba, Brazil 3Physical Therapy Department, Federal University of Paraná, Curitiba, Brazil 4Department of Physical Therapy, School of Health and Biosciences Pontifical Catholic, University of Paraná, Curitiba, Brazil Received 11 June 2013; revised 2 August 2013; accepted 13 August 2013 Copyright © 2013 Talita Gianello Gnoato Zotz et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT a chronic and progressive disturbance of the nervous system, more specifically the ganglions of the base and One of the predominant effects of PD is altera- eventually resulting in abnormal posture and involuntary tion of motor skills, which leads to compromised movements [2]. posture and physical balance. Aquatic physical The knowledge about the possible factors in the phy- therapy, performed in a heated pool, can serve siopathology of PD also demands an inevitable investi- as one of intervention alternatives for PD carri- gation of the pertinent questions about natural aging of ers. Aim: To analyze the effects of the Halliwick the human being. And these investigations can also lead Concept hydrotherapy in acquisition of motor to further development of a repertoire of preventive phy- skills in Parkinson’s disease (PD) patients. Meth- siotherapeutic methods by the intervention team for PD ods: A clinical, qualitative method was used to patients. evaluate 7 volunteers (59.85 ± 7.92 years of age, With the clinical diagnosis of PD, the individual may both male and female), who were in II and III show an alteration in postural reactions such as straight- stages of PD according to the Hoehn & Yar Scale. ening, balance, protective extension, difficulty in corpo- The participants were evaluated in the start and ral rotation and reduced muscular strength [3]. Such end of the interventions phase, and then the symptoms are accentuated when the patient is subjected evaluation was conducted interventions in a to situations of stress, fatigue or pressure, which can ex- heated pool (32˚C - 34˚C) twice a week, each session lasting approximately 30 minutes, to- acerbate the freezing phenomenon and postural compro- taling 10 sessions. The Halliwick Principles’ 3- mise, leading to a sudden loss of balance [4]. phase 10-point methods were used for acquisi- In order to slow down the progression of the disease, tion of aquatic motor skills. Results: They indi- one can try various physical therapy intervention proce- cate an improvement in their ability to float in dures such as exercising on a treadmill with partial sup- prone and supine positions (P = 0.04*) and lon- port weights [5], adaptive exercise programs with multi- gitudinal rotation in the bipedal position. Con- modalities [6], resistance training [7] and stimulus for clusion: The activation of motor control improv- motor skill learning [8]. In addition, aquatic physical ed the motor skills of the participants. therapy (APT) is currently used as a treatment for indi- viduals with PD in clinical practice [9]. Some authors Keywords: Parkinson’s Disease; Motor Skills; have suggested this kind of therapy as a means to im- Hydrotherapy; Halliwick Concept prove the quality of life, reduce postural instability and the risk of falling in the elderly, and to enhance treat- ments for different disorders [9,10]. 1. INTRODUCTION The approach of APT can be defined as a practice of The process of aging in the human includes psycho- methodologies and concepts in a heated pool [9] whose logical, emotional, social and biological alterations, which objective is the kinetic recovery of a physically debili- can be quite apparent and obvious throughout the body tated individual [11,12]. Being able to participate clini- [1]. Certain diseases can trigger and accelerate the aging cally in a pool is one of the requirements for aquatic process, as documented in Parkinson’s disease, which is therapy interventions. The liquid medium with the proper Copyright © 2013 SciRes. OPEN ACCESS T. G. G. Zotz et al. / Advances in Parkinson’s Disease 2 (2013) 102-107 103 hygiene and temperature enables the physiologic and Table 1. Aquatic Motor Skills. therapeutic benefits for neurological patients such as in Grades Description of skills the case of PD. Performs movement without help, with 5 In addition, APT uses the physical properties such as complete motor control resistance noted in Archimedes’ and Pascal’s Principle 4 Performs movement without help, with motor control [11]. These aquatic effects are versatile and can be ad- Performs movement without help, with partial motor 3 vantageous for the use of therapeutic intervention of PD control Performs movement with 1 or 2 supports patients. Buoyancy and hydrostatic pressure offered by 2 Performs movement with 1 or 2 supports water provide extra support for the participant to perform the proposed exercises and reduce the velocity of falls [9]. 1 Can not perform movement The Halliwick Concept, created by James McMillan in England, is based on scientific principles of hydrody- of the vascular response to exercise. namics and body mechanics [13] and encourages the b) Hydrotherapeutic Intervention independence of the person in water. The method [8] The intervention was preceded by an introductory developed with recreational activities in three-stage and demonstration and orientation of the exercises with each ten-point teaches aquatic motor skills in a subtle way. patient. Ten therapeutic interventions in total, twice a The application of APT depends on two assessments: week, were performed in a heated swimming pool (av- wet and dry. The wet evaluation [15] should assess the erage temperature between 32˚C and 34˚C). They were following skills: entry into and exit out of the pool, res- conducted lasting 30 minutes each and covered the three piratory control and control of basic movements inside phases and 10 points of the Halliwick Concept. the water. The exercises were developed and implemented with This study was conducted with the objective of ana- objectivity to minimize any biases and partiality between lyzing the efficacy of the Halliwick aquatic therapy in the two groups of patients. the acquisition of motor skills of PD patients. b.1) Aquatic Intervention Program The exercises were aimed at the functional motor skill 2. METHODS potential in an aquatic assessment. The intervention pro- gram also sought repeatibility [14] of the procedures in This research’s clinical and qualitative evaluation in- any follow-up studies and is described below [18]. tentions [16] were approved by the ethics committee of Type: Front Entry from the pool edge with support in the Pontifical Catholic University of Parana (PUCPR No the Armpits. 1995/07). The study sample consisted of seven subjects Phase I—Mental Adaptation (mean age 59.85 ± 7.92 years of male and female) in Step 1—Mental Adjustment Stage II and III on the Hoehn and Yahr Scale of PD [17] Phase II—Control of Balance (time since diagnosis 7.85 ± 3.80 years). Stept 2—Control of Sagittal Rotation The following criteria were considered to inclusion: Step 3—Control of Transversal Rotation clinically diagnosed as Parkinson’s disease, ages between Step 4—Control of Longitudinal Rotation 40 and 70 years and participants personally read and Step 5—Control of Combined Rotation signed the Terms of Agreement. And to exclusion: inabil- Step 6—Buoyancy ity to walk, blindness, clinically diagnosed dementia, Step 7—Balance in Stillness severe interference with oral communication, fear of wa- Step 8—Turbulent Gliding ter or any signs and symptoms that may put their health Step 9—Simple Progression at risk while performing aquatic therapeutic exercises. Phase III—Control of Movements Step 10—Basic Movements of the Halliwick Procedures Exiting the Pool: The exit entails the participant walk- a) Collection of Data ing up the stairs or ladder to get out of the pool. In the data collection, an initial interview was carried c) Statistic Analysis out to collect volunteers’ age, sex, duration of illness, use The sample was characterized as non-parametric due of assistive devices and medications. Subsequently, an to the heterogeneity of the group (time since onset of aquatic evaluation [13] was made at the start and end to illness, age, weight, sex, medication, blood pressure). the intervention phase. Participants received a score The software Statistic 7.0 was used to perform a Wil- coxon test on the data, with a reference value p ≤ 0.05. based on performance in executing the aquatic motor skills of various levels of difficulty [11] (Table 1). Their 3. RESULTS blood pressure was monitored at the start and end of each intervention with the purpose of observing the evolution The obtained results show that after the aquatic inter- Copyright © 2013 SciRes. OPEN ACCESS 104 T. G. G. Zotz et al. / Advances in Parkinson’s Disease 2 (2013) 102-107 vention the PD participants improved significantly some to practice center-of-gravity shifts beyond the limits of motor abilities, the end was compared to he same. their base of support [22]. Even though aquatic exercise Among the analyzed functional aquatic motor skills re- has been shown to be an effective strategy for reducing lated to balance, we highlight the buoyancy in the prone postural instability, to our knowledge, very few interven- position (P= 0.04*) and supine (P = 0.04*) (Figure 1) to tions have been performed in this environment with pa- rotations: sagittal (P = 0.133), combined (P = 0.073), tients suffering from PD.
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