Download - McGraw Aquatic Rehab Presentation 2019 Final
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:
• Decrease:
• Joint compressive forces
while weight bearing
• Stress on connective tissue
• Fear of falling
• Blood pooling
• Increase:
• Supports weak muscles
• Enhance flexibility
• ROM
• Easier to handle patient
• Changes the
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
• 1990 Jun Konno
• Fluid movement
• Long axis
• Posture
• Breathing
• Visualization
• Imagery
• Benefits:
• Increased
• Flexibility
• ROM
• Mobility
• Improves
• Insomnia
• Depression
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. G., Floranelli, M., Gianfaldoni, R., & Lotti, T. (2017). History of Baths and Thermal Medicine. Journal of Medical Sciences, 5(4), 566-568. doi:10.3889/oamjms.2017.126
- Hydrotherapy. (2017, April 26). In Encyclopedia Britannica, Inc. Retrieved from https://www.britannica.com/science/hydrotherapy
- Becker, B. E. (2009). Aquatic Therapy: Scientific Foundations and Clinical Rehabilitation Applications. Pm&r, 1(9), 859-872. doi:10.1016/j.pmrj.2009.05.017
- Thein, J. M., & Brody, L. T. (1998). Aquatic-Based Rehabilitation and Training for Elite Athlete. The Journal of Orthopedic and Sports Physical Therapy, 27(1), 32-41. doi:https://doi.org/10.2519/jospt.1998.27.1.32
- Waller, B., Lambeck, J., & Daly, D. (2009). Therapeutic aquatic exercise in the treatment of low back pain: A systematic review. Clinical Rehabilitation, 23(1), 3-14. doi:10.1177/0269215508097856
- Prins, J., & Cutner, D. (1999). Aquatic Therapy in the rehabilitation of athletic injuries. Clinics of Sports Medicine, 18(2), 447-461.
- Marinho-Buzelli, A. R., Bonnyman, A. M., & Verrier, M. C. (2014). The effects of aquatic therapy on mobility of individuals with neurological diseases: A systematic review. Clinical Rehabilitation, 29(8), 741-751. doi:10.1177/0269215514556297
- Valtonen, A., Pöyhönen, T., Sipilä, S., & Heinonen, A. (2010). Effects of Aquatic Resistance Training on Mobility Limitation and Lower-Limb Impairments After Knee Replacement. Archives of Physical Medicine and Rehabilitation, 91(6), 833-839. doi:10.1016/j.apmr.2010.03.002
- Becker, Bruce E., and Andrew J. Cole. Comprehensive Aquatic Therapy. Washington State University, 2011.
References- Ultimate Guide to Aquatic Therapy & Water Therapy - HydroWorx®. (n.d.). Retrieved from https://www.hydroworx.com/research-education/additional-resources/aquatic-therapy-guide/
- An Introduction to Aquatic Therapy. (2016, June 15). Retrieved from http://www.rainbowrehab.com/introduction-aquatic-therapy/
- The History of Aquatic Therapy. (2015, September 12). Retrieved from https://www.physicalrehabstl.com/the-history-of-aquatic-therapy/
- Kauffman, B. E., & Kauffman, B. W. (2014). Aquatic Therapy. In A Comprehensive Guide to Geriatric Rehabilitation (pp. 517-519). Churchill Livingstone Elsevier.
- Aquatic Therapy: A Viable Therapeutic Recreation Intervention. (n.d.). Retrieved from https://www.researchgate.net/publication/234563482_Aquatic_Therapy_A_Viable_Therapeutic_Recreation_Intervention
- Wyatt, F. B., Milam, S., Manske, R. C., & Deere, R. (2001). The Effects of Aquatic and Traditional Exercise Programs on Persons With Knee Osteoarthritis. Journal of Strength and Conditioning Research, 15(3), 337-340. doi:10.1519/00124278-200108000-00013
- Levin, S. (1991). Aquatic Therapy. The Physician and Sportsmedicine, 19(10), 119-126. doi:10.1080/00913847.1991.11702274
- Choi, E. K. (2015). Aquatic Physical Therapy in the Rehabilitation of Athletic Injuries: A Systematic Review of the Literatures. Journal of Yoga & Physical Therapy, 05(03). doi:10.4172/2157-7595.1000195
- Meyler, J., Moss, R., & Skinner, B. (n.d.). Going with the flow: The use of aquatic therapy in sports injury rehabilitation. https://www.co-kinetic.com/content/going-with-the-flow-the-use-of-aquatic-therapy-in-sports-injury-rehabilitation
- Norton, Charlotte O., and Lynette Jamison. A Team Approach to the Aquatic Continuum of Care. Butterworth-Heinemann, 2000.