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An Introduction To • THERAPY CORNER An Introduction to hen I first heard of aquatic therapy, my muscles spasms, and cold water was used to reduce initial thought was, “You can do more than fevers.2 just swim in a pool?” Through my education During the late 1700s, cold water was used for the W 2 and experience, I have learned that there is much treatment and comfort of smallpox victims. In 1830, more than just swimming when it comes to pool a Silesian peasant, Vincent Priessntiz, combined cold use. I have also learned that there are many different water with a vigorous exercise program to strengthen techniques to use when providing aquatic therapy. patients who were ill.2 Priessntiz’s program created a The focus of this article will include a brief history stir in Europe which led to seminal research looking of aquatic therapy, an overview of aquatic principles, at water temperatures and their reaction times to the therapeutic benefits, as well as aquatic therapy various diseases. techniques including, Bad Ragaz Ring Method, Dr. Winterwitz of Vienna, Austria took part Watsu®, Ai Chi, and AquaStretchTM. in researching the effects of water at different temperatures on sick patients, which eventually THE HISTORY OF AQUATIC THERAPY established an accepted physiological basis for There is a long history of the use of water for hydrotherapy that still stands to this day.2 In the therapy. Over the course of that history, a great United States, hydrotherapy was developed as a number of terms have been generated to describe this treatment modality for neurologic rehabilitation, type of therapy such as hydrotherapy, balneotherapy, initially in response to the polio epidemic and then for hydrology, hydrogymnastics, water therapy, spa the treatment of amputees following World War I.2 therapy, water therapeutics and water exercise. As years and centuries have gone by, using water Today, it is most commonly referred to as aquatic for therapy spread throughout the world. Over time, rehabilitation or aquatic therapy. new names to describe water therapy were created, Aquatic Rehabilitation is a late-twentieth century new methods of treatment were discovered, and term that describes a scientific therapy, medical novel equipment was fashioned, but overall, aquatic rationale, and a set of clinical procedures using water principles have largely remained the same. Today, immersion for the restoration of physical mobility aquatic therapy is used to help individuals improve and physiologic activity, and, at times, for effecting balance, coordination, weight bearing, muscular 1 psychological transformation. endurance, muscular strength, cardiovascular and The long history of water therapy began as hot and pulmonary endurance, pain management, motor cold baths that were used to treat disease as far back skills, motor control, range of motion, and circulatory as 460 B.C. in Greece. Three hundred years ago, hot function.3 water was used with patients who were spastic or had By Kirk Howard, MS, ACSM-CEP Aquatic TherapyRainbow Rehabilitation Centers AQUATIC PRINCIPLES AND muscles working in opposition to buoyancy. For THERAPEUTIC BENEFITS therapists, it increases ease of handling. Immersion also increases oxygen delivery,3 providing numerous Buoyancy other health benefits. Archimedes’ Principle states that when a body is completely or partially immersed in a fluid at rest, it Hydrostatic Pressure experiences an upward thrust equal to the weight of Hydrostatic pressure is force exerted on an 3 the fluid displaced.4,5,6 In modern vernacular, this is immersed body by fluid molecules. As described termed “Bouyancy.” In essence, buoyancy decreases above, the pressure is proportional to the depth of 3 the effects of gravity on the individual’s body by the immersed body and is equal in all directions. allowing someone who cannot weight bear on land This pressure has different effects on a patient’s to be able to place weight on their limbs while in the cardiovascular system, renal system, respiratory water. The amount of weight bearing the individual system, and nervous system. may tolerate is dependent on the depth of water in From a cardiovascular perspective, when a person which they are immersed.2 An individual waist deep is immersed in water, hydrostatic pressure forces in water may experience only 50 percent of their blood from the legs into the chest. This results in the weight. A person chest deep in water experiences only heart pumping excess blood and the heart muscles 25 to 30 percent of their body weight, and neck deep stretching. When the heart muscles are stretched, it submersion equates to one experiencing only about produces an increased muscle contraction, causing 10 percent of their weight.2 it to empty more completely. This is called Starling’s Another buoyancy concept relates to body weight Law, which results in fewer heartbeats per minute to in relation to water displacement. If the body or body pump the same volume of blood thereby decreasing 2 part is more than the weight of the water displaced, a patient’s heart rate while in water. Routine water the person or body part will sink. If the weight of exercise and the resulting hydrostatic pressure can body or body part is less than the weight of the water increase breathing capacity outside of the water and displaced, the person or body part will float.4 allow the heart to function with greater efficiency. The benefits of buoyancy for patients are numerous, Hydrostatic pressure can improve kidney function including decreased joint compression forces, weight by increasing blood flow to the kidneys. Like the bearing, stress on connective tissues, fear of falling, cardiovascular system, the renal system is more and blood pooling. Buoyancy also supports weak efficient due to hydrostatic pressure. muscles, enhances flexibility and range of motion, The respiratory system is affected due to blood changes biomechanical stress, and strengthens being forced to the lungs. This makes it harder to • THERAPY CORNER AQUATIC THERAPY… breathe, and the weight of the water on the outside of the instantly when the forces of movement stops.2 Because of chest puts pressure on the diaphragm.2 The weight of the the resistance provided by viscosity, all muscle groups are water on the chest causes resistance to the diaphragm worked equally, unlike resistance training on land. and forces air out of the lungs, improving the inhalation The benefits of resistance to movement include muscles and assisting with exhalation.2,3 improved muscle strength and tone , better muscle The nervous system interprets information about the balance, decreased edema, and improved cardiac and body’s position in space, temperature, pressure, and pulmonary output.3 Resistance of water will especially sensation. When immersed in water, the body receives assist patients with Parkinson’s disease and cerebral sensory information about water pressure and temperature palsy due to dampening of involuntary movements. which decreases pain due to over-sensory stimulation and Contraindications include patients that have difficulty increased circulation to muscles.2 moving, tactile defensiveness or vestibular issues who may Benefits of hydrostatic pressure are decreased pain and be overstimulated by the water. edema, which will assist in increasing range of motion, and increased venous return and circulation, which decreases AQUATIC THERAPY TECHNIQUES heart rate, evens tactile inputs, turns down reticular Bad Ragaz Ring Method (BRRM) systems, strengthens muscles for inspiration and assists History with exhalation.3 This technique originated in Germany in 1957 and was Things to consider are patients with respiratory issues introduced by Dr. Knupfer to the therapeutic thermal and patients with unstable blood pressure. It is suggested pools of Bad Ragaz in Switzerland.3 Dr. Knupfer utilized for these patients to enter and exit water slowly, especially three floatation rings to help keep a client in a supportive during the first session, because of the increased sensation. horizontal supine position (or even prone) with floatation Hydrostatic pressure will assist patients, especially those devices at the neck, pelvis, and knees and or ankles. Since with cardiopulmonary disease, diabetes, development then, the technique has become more clearly defined as the delay, or intellectual disability.3 Bad Ragaz Ring Method.3 Resistance/Viscosity Concept/Description Viscosity is a measure of the frictional resistance caused BRRM is a method used for muscle re-education utilizing by cohesive or attractive forces between molecules of specific patterns of resistance, endurance, elongation of the liquid.3,4 Viscosity provides equal amounts of resistance spine, relaxation, range of motion, and tone reduction.3 throughout a movement in water. This makes water a Requirements of the pool environment are a warm water useful strength training medium because it resists more as temperature of 92 degrees Fahrenheit, at least an 8 feet by more force is exerted against it, and strengthens without 8 feet pool area 3 to 4 feet in depth, and the ideal position the need for weights. However, the resistance stops for the therapist is between thoracic vertebra 8 to thoracic Figure 1. Therapist is positioned at patient’s head. Figure 2. Therapist is positioned at patient’s legs. vertebra 11 of their thoracic spine.3 Floatation devices such moves though the water either toward, away, or around as neck collars to support neck, floatation belt for pelvis, the therapist, which allows the patient to determine the and floatation cuffs for ankles or knees and arm or wrist resistance by the speed of the movement.3 are utilized. The therapist can be located at the patient’s Outcomes and Contraindications head, sides or feet to perform swaying, rocking, rolling or The benefits of BRRM are tone reduction, trunk other movement. See Figure 1, Figure 2, and Figure 3 to alignment and stability, pre-weight bearing activation, and see therapist with floatation devices and variations of the improved range of motion. Patients that would benefit therapist’s locations.
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