Aquatic Rehabilitation Matt McGraw MS, ATC, PES, CES March 2, 2019 Overview • History of Aquatic Rehabilitation • Principles of Water • Aquatic Therapy Techniques • Contraindications and Precautions • Indications and Advantages • Things to think about History of Aquatic Rehab • Early Civilizations - early 20th Century • Belief that hot springs/spas provided therapeutic and medicinal value • Social activity • Hot air/water and cold plunge • Limited use of submerged exercise History of Aquatic Rehab • 1830: Vincenz Priessnitz • Combined cold water with exercise to strengthen ill patients • Dr. Winternitz • Researched varying water temps on sick patients • U.S. treatment modality during smallpox outbreak for Neurological Rehab • 1913: Dr. Charles Leroy Lowman • 1924: Hubbard Tank History of Aquatic Rehab • 1930’s Underwater PT with Physical Exercise in Warm Water • 1937: Dr. Lowman • Technique of Underwater Gymnastics: A Study in Practical Application • Dr. Rebekah Wright: Mental Diseases • 1960’s and 70’s: Space Age • 1980’s: American Physical Therapy Association • Aquatic Therapy and Rehabilitation Institute Aquatic Therapy Today • Used to Improve • Balance • Coordination • Weight Bearing • Strength • Endurance • Pain management • ROM • Motor Control • Circulatory Function Principles of Water • Buoyancy • Archimedes' principle: • Buoyant force on an object submerged in a fluid is equal to the weight of the fluid that is displaced by the object • 50% Umbilicus • 60% Xiphoid process Principles of Water • Benefits include: • Increase: • Decrease: • Supports weak muscles • Joint compressive forces • Enhance flexibility while weight bearing • ROM • Stress on connective tissue • Easier to handle patient • Fear of falling • Changes the • Blood pooling Biomechanical Stress Principles of Water • Hydrostatic Pressure (HP): Water exerts a pressure of 22.4 mm Hg/ft of water depth equally in all directions. • 12” = 22.4 mm Hg/ft • 24” = 44.8 mm Hg/ft • 36” = 67.2 mm Hg/ft • 48” = 89.6 mm Hg/ft Principles of Water • Effects of Hydrostatic Pressure on systems of the body: • Cardiovascular system: • Forces blood from the legs into the chest • Heart pumps excess blood • Causing it to stretch • Increased heart muscle contraction • Causes heart to empty more completely • Starlings law: Heart requires fewer heart beats to pump the same volume of blood, decreasing the HR in the water. Principles of Water • Respiratory system • Increased blood flow, makes breathing harder • HP on the chest causes pressure on the diaphragm • pressure=resistance, forcing air out of the lungs • Improves inhalation and assist exhalation Principles of Water • Nervous system: • Interprets sensory information about the bodies position in space, temperature, pressure, and sensations • Receives sensory stimulation which aids in decreasing pain Principles of Water • Viscosity: Resistance of a fluid to change in shape or movement • Accommodating resistance: Resistance that matches the patients applied force of effort • Variable resistance: the ability to change the speed, velocity, &/or direction of the movement • Works opposing muscle groups equally, unlike the equivalent on land Principles of Water • Assist patients by dampening involuntary movements • Parkinson’s • Cerebral Palsy Principles of Water • Thermodynamics: More efficient at transferring heat than air. • Recommended Temp Therapy Pool • 33.5-35.5 C (92.3-95.9 F) • Recommended Temp Vigorous Exercise • 26-29.5 C (78.8-85.1 F) Aquatic Therapy Techniques • Aquatic Therapist use principles and interactions with patients to create progressive exercises that are: • Passive to active • Isometric • Isotonic • Isokinetic • Incorporate fundamental PNF Aquatic Therapy Techniques • Bad Ragaz Ring Method (BRRM): • 1957 Dr. Knupfer • 3 rings to keep client supported in horizontal supine or prone position • Watsu: • 1980’s • Gentle rhythmic moves • Viscera • Limbic system • Nervous system • Musculoskeletal system • Psyche Aquatic Therapy Techniques • Ai Chi • Benefits: • 1990 Jun Konno • Increased • Fluid movement • Flexibility • ROM • Long axis • Mobility • Posture • Improves • Breathing • Insomnia • Visualization • Depression • Imagery Aquatic Therapy Techniques • Other current therapy techniques • Backhab • Burdenko method • Feldenkrais • Halliwick • PNF • Unpredictable command technique Contraindications • Phobia of water • Trouble breathing • Pulmonary disease • Weak chest muscles • Unstable cardiac conditions • Unstable vital signs • Uncontrolled hypertension • Uncontrolled seizures • Uncontrolled diabetes Contraindications • Open wounds • Infected wounds • Active infections • ex: GI virus causing diarrhea, vomiting, or exposure to other bodily fluids • Fever • Kidney Failure Examples of Precautions • Severe or chronic ear infections • Chronic UTI • Yeast Infection • Chronic skin diseases • Dermatitis • Psoriasis • At risk of Hyper or Hypothermia Indications and Advantages • Patient needs can be addressed by principles of water • Patients that require the physical properties of water to increase function • Extreme pain against gravity, buoyancy may help (neurological disease or disorder) • Patients with edema in LE may benefit from hydrostatic pressure • Patients with Arthritis Indications and Advantages • Patient can practice in reduced load before land equivalent • Patient needs variety in rehabilitation • Respiratory strengthening and efficiency • Strengthens heart • Improves pain due to over sensory stimulation Things to think about • Align your Aquatic policies and procedures with local and state bathing codes, and federal regulations • Post appropriate signage in pool area • Therapist in the pool? • Assisting patient (safety) • Challenge patient • Calling for help in an emergency Things to think about • Patient safety • Slip resistance mats • Wear appropriate footwear out of the pool • Adequate overhead lighting • Handicap accessible • Appropriate changing room • Restroom easily accessible • Shower available Things to think about • Variety of aquatic exercise modalities • Appropriate storage References - Gianfaldoni, S., Tchernev, G., Wollina, U., Roccia, M. 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