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An Introduction to Aquatic Therapy

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An Introduction to Aquatic Therapy ! THERAPY CORNER This article is reprinted with permission from Rainbow Rehabilitation Centers. View the entire RainbowVisions® magazine by visiting rainbowrehab.com/rainbow-visions-magazine By Kirk Howard, MS, ACSM-CEP Rainbow Rehabilitation Centers An Introduction to Aquatic Therapy hen I first heard of aquatic therapy, my muscles spasms, and cold water was used to reduce AQUATIC PRINCIPLES AND muscles working in opposition to buoyancy. For initial thought was, “You can do more than fevers.2 THERAPEUTIC BENEFITS therapists, it increases ease of handling. Immersion just swim in a pool?” Through my education During the late 1700s, cold water was used for the also increases oxygen delivery3 providing numerous W 2 Buoyancy and experience, I have learned that there is much treatment and comfort of smallpox victims. In 1830, other health benefits. Archimedes’ Principle states that when a body is more than just swimming when it comes to pool a Silesian peasant, Vincent Priessntiz, combined cold completely or partially immersed in a fluid at rest, it Hydrostatic Pressure use. I have also learned that there are many different water with a vigorous exercise program to strengthen Hydrostatic pressure is force exerted on an 2 experiences an upward thrust equal to the weight of techniques to use when providing aquatic therapy. patients who were ill. Priessntiz’s program created a 3 the fluid displaced.4,5,6 In modern vernacular, this is immersed body by fluid molecules. As described The focus of this article will include a brief history stir in Europe which led to seminal research looking termed “Bouyancy.” In essence, buoyancy decreases above the pressure is proportional to the depth of of aquatic therapy, an overview of aquatic principles, at water temperatures and their reaction times to 3 the effects of gravity on the individual’s body by the immersed body and is equal in all directions. the therapeutic benefits, as well as aquatic therapy various diseases. allowing someone who cannot weight bear on land This pressure has different effects on a patient’s techniques including, Bad Ragaz Ring Method, Dr. Winterwitz of Vienna, Austria took part to be able to place weight on their limbs while in the cardiovascular system, renal system, respiratory Watsu®, Ai Chi, and AquaStretchTM. in researching the effects of water at different water. The amount of weight bearing the individual system, and nervous system. temperatures on sick patients, which eventually may tolerate is dependent on the depth of water in From a cardiovascular perspective, when a person THE HISTORY OF AQUATIC THERAPY established an accepted physiological basis for which they are immersed.2 An individual waist deep is immersed in water, hydrostatic pressure forces There is a long history of the use of water for hydrotherapy that still stands to this day.2 In the in water may experience only 50 percent of their blood from the legs into the chest. The results in the therapy. Over the course of that history a great United States, hydrotherapy was developed as a weight. A person chest deep in water experiences only heart pumping excess blood, and the heart muscle number of terms have been generated to describe this treatment modality for neurologic rehabilitation, 25 to 30 percent of their body weight, and neck deep to stretch. When the heart muscles are stretched, it type of therapy such as hydrotherapy, balneotherapy, initially in response to the polio epidemic, and then submersion equates to one experiencing only about produces an increased muscle contraction, causing hydrology, hydrogymnastics, water therapy, spa for the treatment of amputees following World War I.2 10 percent of their weight.2 it to empty more completely. This is called Starling’s therapy, water therapeutics and water exercise. As years and centuries have gone by, using water Another buoyancy concept relates to body weight Law, which results in fewer heartbeats per minute to Today, it is most commonly referred to as aquatic for therapy spread throughout the world. Over time, rehabilitation or aquatic therapy. in relation to water displacement. If the body or body pump the same volume of blood thereby decreasing new names to describe water therapy were created, 2 part is more than the weight of the water displaced, a patient’s heart rate while in water. Routine water Aquatic Rehabilitation is a late-twentieth century new methods of treatment were discovered, and the person or body part will sink. If the weight of exercise, and the resulting hydrostatic pressure can term that describes a scientific therapy, medical novel equipment was fashioned, but overall, aquatic body or body part is less than the weight of the water increase breathing capacity outside of the water, and rationale, and a set of clinical procedures using water principles have largely remained the same. Today, displaced, the person or body part will float.4 allow the heart to function with greater efficiency. immersion for the restoration of physical mobility aquatic therapy is used to help individuals improve The benefits of buoyancy for patients are numerous, Hydrostatic pressure can improve kidney function and physiologic activity, and, at times, for effecting balance, coordination, weight bearing, muscular 1 including decreased joint compression forces, weight by increasing blood flow to the kidneys. Like the psychological transformation. endurance, muscular strength, cardiovascular and bearing, stress on connective tissues, fear of falling, cardiovascular system, the renal system is more The long history of water therapy began as hot and pulmonary endurance, pain management, motor and blood pooling. Buoyancy also supports weak efficient due to hydrostatic pressure. cold baths that were used to treat disease as far back skills, motor control, range of motion, and circulatory muscles, enhances flexibility and range of motion, The respiratory system is affected due to blood as 460 B.C. in Greece. Three hundred years ago, hot function.3 water was used with patients who were spastic or had changes biomechanical stress, and strengthens being forced to the lungs. This makes it harder to 20 | RAINBOWVISIONS • WINTER 2016 RAINBOWREHAB.COM WINTER 2016 • RAINBOWVISIONS | 21 ! 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 vertebra 11 of their thoracic spine.3 Floatation devices such moves though the water either toward, away, or around chest puts pressure on the diaphragm.2 The weight of the the resistance provided by viscosity, all muscle groups are as neck collars to support neck, floatation belt for pelvis, the therapist, which allows the patient to determine the water on the chest causes resistance to the diaphragm worked equally, unlike resistance training on land. and floatation cuffs for ankles or knees and arm or wrist resistance by the speed of the movement.3 and forces air out of the lungs, improving the inhalation The benefits of resistance to movement include are utilized. The therapist can be located at the patient’s Outcomes and Contraindications 2,3 muscles and assisting with exhalation. improved muscle strength and tone , better muscle head, sides or feet to perform swaying, rocking, rolling or The benefits of BRRM are tone reduction, trunk The nervous system interprets information about the balance, decreased edema, and improved cardiac and other movement. See Figure 1, Figure 2, and Figure 3 to alignment and stability, pre-weight bearing activation, and 3 body’s position in space, temperature, pressure, and pulmonary output. Resistance of water will especially see therapist with floatation devices and variations of the improved range of motion. Patients that would benefit sensation. When immersed in water, the body receives assist patients with Parkinson’s disease and cerebral therapist’s locations. from BRRM include those with pain with movement, sensory information about water pressure and temperature palsy due to dampening of involuntary movements. While the patient is in this position, the therapist will decreased range of motion, spasticity, decreased which decreases pain due to over-sensory stimulation and Contraindications include patients that have difficulty use aquatic principles to interact with the patient, creating coordination, proprioceptive or sensory deficits, weakness 2 increased circulation to muscles. moving, tactile defensiveness or vestibular issues who may progressive exercises that are passive to active, isometric, or low tone, and restricted weight bearing.3 Benefits of hydrostatic pressure are decreased pain and overstimulated by the water. isokinetic, and isotonic and incorporate fundamentals Precautions and contraindications of using BRRM would edema, which will assist in increasing range of motion, and of Proprioceptive Neuromuscular Facilitation (PNF) to be patients with ear problems and frequent ear infections. AQUATIC THERAPY TECHNIQUES 3 increased venous return and circulation, which decreases induce characteristics of normal motor patterns. Make sure to monitor the patient’s breathing to make sure heart rate, evens tactile inputs, turns down reticular Bad Ragaz Ring Method (BRRM) Passive BRRM is when the patient is slowly moved that they are breathing and not holding their breath.3 systems, strengthens muscles for inspiration and assists History through the water for passive trunk elongation, relaxation, with exhalation.3 This technique originated in Germany in 1957 and was and tone inhibition.3 Watsu® Things to consider are patients with respiratory issues introduced by Dr. Knupfer to the therapeutic thermal Isometric means same length when performing a muscle History and patients with unstable blood pressure. It is suggested pools of Bad Ragaz in Switzerland.3 Dr. Knupfer utilized contraction. Isometric BRRM is when a patient is holding Watzu has been referred to as a mixture of Bad Ragaz for these patients to enter and exit water slowly, especially three floatation rings to help keep a client in a supportive a fixed position while being moved through the water, and Ring Method and shiatsu massage.
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