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Aquatic Therapy

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Shayla Hall

on 12 December 2012

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Transcript of Aquatic Therapy

Aquatic Therapy & Rehab Institute (2004). Aquatic Therapy & Rehabilitation Standards for the Industry. http://www.atri.org/Standards.htm
Bates, Andrea (1996). Aquatic Exercise Therapy, Saunders.
Becker, Bruce (2009). Aquatic Therapy: Scientific Foundations and Clinical Rehabilitaiton Applications. American Academy of Physical Medicine and Rehabilitation. Vol 1: Issue 9.
Campion, Margaret R. (1997). Hydrotherapy Principles and Practice, Oxford: Bumerworth – Heinemann.
Davis, Bridget C. and Harrison, Ronald A(1988). Hydrotherapy in Practice, Edinburgh: Churchill Livingston.
Robinson S & Buono M. Effect of Continuous-Wave Ultrasound on Blood Flow in Skeletal Muscles. Journal of the American Physical Therapy Association (1995; 75: 145-149).
RSPT 544 Class Notes (September 24, 2012). Matt Furlot (Sungod Sports & Orthopaedic Physiotherapy Clinic)
@ the joint Aquatic Therapy what you might learn: thanks 1. Hydrodynamic Principles & Newton’s Laws of Motion

2. Guidelines for Exercise Progression

3. Physiological Effects of Immersion

4. Therapeutic Benefits of Aquatic Therapy

5. Precautions, Contraindications, Safety Who cares? Physiological Effects of Immersion Hydrodynamic Principles Archimedes’ Principle: the upward thrust (buoyancy) on an object submerged in the water which is equal to the weight of the dispersed fluid. Floating: 0% weight bearing
Neck deep water: 10% weight bearing
Chest deep: 25% weight bearing
Waist deep water: 50% weight bearing BUOYANCY: upward force that acts in the opposite direction to gravity Buoyancy Assisted - move up towards surface
Buoyancy Supported - move on surface
Buoyancy Resisted - move down towards pool bottom Relative density (RD) is the ratio of density (mass/volume) of an object compared to the mass of an equal volume of water. Average Body Density: 0.974 Increase RD:
- deflated lungs (1.05 – 1.08)
- lean body mass (1.1)
- spastic limbs, tense clients
- kyphotic trunk Decrease RD:
- Amount of body fat (0.9)
- flaccid limbs
- relaxed clients Metacentric Principle states that the opposing effects of gravity and buoyancy act as a force couple to create rotation. A body seeking stable equilibrium will rotate until the COG and COB are vertically aligned. dead man's float COG: anterior to S2 COB: posterior thorax Viscosity describes describes the friction of molecules in a liquid that causes them to adhere to each other (cohesion) or to a submerged body (adhesion). double the speed = quadruple the resistance RD water = 1
RD > 1 will sink
RD < 1 will float Drag is created by differences in water pressure between front and back of an object as it moves through the water. Pressure builds up at the front of an object and decrease at the rear (the wake). Surface Tension - strongly coherent molecules Beware of movements that continually break the surface tension Newton's Laws of Motion 1) Inertia 2) Acceleration 3) Action / Reaction an object remains at rest or in uniform motion unless acted on by a force. proportional to the force applied, and inversely proportional to its mass the greater the body mass, the more force it takes to move that mass for every action there is an equal and opposite reaction. Remind clients not to “bear walk”. modify this squat easier harder - deeper water
- move slower
- hold onto pool noodles
- wear buoyancy belt
- wide base of support
- empty pool - shallower water
- increase speed
- no arms in water
- narrow BOS
- wave pool CARDIOVASCULAR effects of immersion increased venous return
increased stroke volume (35%)
decreased heart rate (25%)
decreased blood pressure
HR unreliable - use RPE Pulmonary System With immersion to the neck, vital capacity decreases by approximately 10% and the work of breathing increases by 60%
Accessory breathing muscles engage and diaphragm must work harder Musculoskeletal System: Blood flow is over 200% that on land
Blood supply to the muscles increases
increased oxygen delivery
increased removal of metabolic wastes

pain & edema management
reduced joint compression
muscle relaxation
inhibition of spastic tone (viscosity, temperature, pressure) Effect of 200% increase in blood flow on wound and tissue healing?! Renal System Immersion causes increased blood flow to kidneys
increased urine output
increased sodium and potassium loss
suppression of thirst. Renal responses are greater and faster in the elderly
Watch dehydration patients won’t feel thirsty Therapeutic Benefits of Aquatic Therapy Increase ROM
Decrease stiffness
Normalize muscle tone (i.e. restore post THR; decrease tonicity post stroke)
Improve balance and coordination
Gait training
Improve sensory and perceptual function
Pain relief
Improve muscle strength
Improved cardiovascular, respiratory function
Increase ease of handling
Decrease swelling and edema
Increase peripheral blood flow
Maintain bone density
Increase sense of independence and self esteem
Re-integration into community Hydrostatic Pressure: increases with depth by 0.43 PSI / foot. Precautions Incontinence of Bowel / bladder
Skin conditions / infections
Infectious respiratory disease
CVD or respiratory compromise
Nasogastric / gastrostomy tubes
Drainage bags
Open wounds
Acute orthopaedic injury with resultant instability
Special populations (i.e. post-polio, MS)
Controlled seizures, diabetes Exercise induced angina
Chemical sensitivity (chlorine, bromine etc)
Difficult to control populations
Poor cognition or nonverbal clients
Dependence in ambulation
Severe peripheral artery disease
Perforated eardrums
Kidney disease Contraindications Uncontrolled seizures
Unstable angina, cardiac failure
Uncontrolled diabetes
Bowel incontinence w/ no bowel routine
Open wounds or bleeding
Rashes, skin conditions with flaking or open areas Uncapped tracheotomy
Active joint inflammation (RA, haemophilia)
Severely compromised cardiovascular system Client / staff ratio based on client abilities
Emergency procedures and equipment
Client screening and assessment pre-immersion
Hygiene / infection control
Personal management re: effects of immersion (i.e. dehydration)
Design: non slip surface, pool temp, access, flotation equipment Safety Considerations Buoyancy assisted -> supported -> resisted
Slow -> fast
Deep water -> Shallow water
Stable position -> dynamic position
Supported position -> unsupported position
Isolated motion -> complex movement patterns
Streamlined -> turbulent flow -
Short lever arm -> Long lever arm
Wide base -> narrow base (buoyancy)
(Archimedes’ Principle)
(Action / reaction)
(Metacentric Principle)
(Frontal resistance, inertia)
(Metacentric Principle) Exercise Progression 2x inspiratory muscle training - chronic disease sufferers to elite athletes
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