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7/31/2019 Acuatic Therapy - Handout
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AQUATICTHERAPY
HYDROTHERAPY
or
DefinitionAquatic therapy refers to the use of multi-depthimmersion pools or tanks that facilitate the applicationof various established therapeutic interventionsincluding stretching, strengthening, joint mobilisation,balance, gait, endurance.
According to the American Physical TherapyAssociations Aquatic Therapy Section, aquatic therapy isdefined as: The practice of physical therapy by a trainedand licensed physical therapist (PT) or physical therapyassistant (PTA) within a pool environment.
The bouyancy, support, and accomodating resistance ofwater enhance exercise and create a safe environment forprogressive rehabilitation.
The temperature of the water prompts musclerelaxation, facilitates stretching and generally reducesthe sensation of pain
PROPERTIES OF WATER
Specific Gravity and RELATIVE Density
Hydrostatic Pressure
Buoyancy
Viscosity
Properties of WaterRelative Density
1. Definition: Property of an object that determineswhether object will float.
2. Ratio of weight of an object to the weight of an equalvolume of water. If the value is greater than one, theobject will sink and if less than one, the object willfloat.
3. If a persons relative density is .96, then 4% of theirbody will be above water.
Physical Properties Cont. Buoyancy
Counteracts downward pull of gravity
Upward force that supports submerged or partially submergedobject
Assists motion toward waters surface
Sense of weight loss
Changes relative to level of submersion
Differs in males and females due to relative CoG
Allows for ambulation and vigorous exercise
Reduces joint impact
Reduces friction between articular surfaces
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BUOYANCYArchimedes Principle
a. When a body is fully or partially submerged in a fluidat rest, it experiences an upward thrust equal to the
weight of the fluid displaced.
b. Influenced by volume and density influenced byhydrostatic pressure.
c. Relative Density (how well objects float) =density/volume.
Position/Size of an object influences how well itfloats.
Physical Properties cont. Buoyancy is partially dependent on body weight
Weight of different body parts will vary
Determined by:
Ratio of bone weight to muscle weight
Amount and distribution of fat
Depth and expansion of chest
Buoyancy can be used to assist, support or resist movement.
a. Depends on patients position standing, supine, sitting,etc.
- When immersed to pubic symphysis=60% weightbearing (WB)
- To umbilicus = 50% WB
- To xiphoid = 40% WB
- To shoulders = 20-30% WB
b. Depends on patient characteristics spasticity/tone increased tends to sink, decreased tends to float;innervation; body composition; fear of water; height.
Specific Gravity
Specific gravity of humans is slightly less than water
Enables the body to float
Does not mean that body will float horizontally
Different segments have different specific gravities
Air in lungs vs. extremities
Resistive Forces Resistance to movement in water. Bernoulli's principle:
A. Increased speed of flow; decreased pressure; object moves into an areaof decreased pressure.
B. Resistance altered by: Speed, Shape, Length
Cohesive force
Runs parallel to the direction of the water surface
Due to surface tension of water molecules
Bow force
Force generated at the front of an object during movement Increased water pressure at the front
Decreased water pressure in the rear
Creates a pressure gradient
Low pressure zones swirl = eddies (turbulence)
Creates a drag force
Resistive Forces cont. Drag force
Modified by shape and speed of object Increase streamline of object = decrease drag
Increase speed of object = increase drag
Must be considered carefully when attempting toprotect a limb during rehabilitation Drag forces = increased torque at a given joint
If move in the direction of the turbulence, you willdecrease the amount of work needed to move;therefore facilitating movement; if move againstturbulence will provide resistance.
Hydrostatic Pressure
1. Pressure is exerted equally around an object at any
given depth if pressure is exerted unequally, theobject will move in that direction.
2. When you enter a pool, there is a slight increase inpressure exerted to the skin covering the body andtherefore blood pressure increases slightly bymomentary constriction of cutaneous blood vessels.
However, body regulates quickly and blood pressureactually becomes slightly lower than when on land..
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Pressure in a liquid increases with increasing depth.This is relevant to the practice of aquatic therapybecause this increases blood flow from feet to thorax ifstanding in a pool.
This helps to decrease edema in the lower extremities.
Renal output is also increased during aquatic therapywhich attributes to the shift in body fluids from theextremities to the thorax
INDICATIONS Muscle weakness Loss of joint mobility Poor co-ordination or balance Pain or lack of confidence Pre-gait training
patient populations that benefit from Aquatic Therapyinclude:
Ankylosingspondylitis Osteoarthritis Rheumatoid Arthritis Juvenile chronic polyarthritis Spondylosis Capsulitis Mechanical spinal disorders
INDICATIONS cont
Polymyalgia rheumatica (PMR) Fibromyalgia Syndrome (FMS) Major fractures especially of the lower limbs or
spine Orthopedic surgery Neurological disorders such as hemiplegia,
paraplegia, tetraplegia, polyneuropathy. PregnancyAthletic conditioning during recovery. Children
CONTRAINDICATIONS
Uncontrolled seizures, unstable angina or uncontrolleddiabetes
Bowel incontinence with diarrhea, and no stool program
Open wounds or bleeding without bio-occulsive dressing(including menstruation without internal protection)
Tracheotomies until healed
Acute flare-up active joint inflammation (rheumatoidarthritis, hemophilia)
Orders for NPO (nothing by mouth)
Presence of DVT (deep vein thrombosis) withoutanticoagulation therapy or filter
PRECAUTIONS & DANGERS
Bowel incontinence with firm stools (pt should be
on stool program and wear plastic pants into pool) Communicable diseases (cold flu, Hepatitis)
Autonomic dysreflexia
Sensitivity to disinfection chemicals
Sensitivity to heat/ humidity (e.g MultipleSclerosis)
Rashes, skin conditions with flaking or open areas(psoriasis)
Orthostatic hypotension
Hydrophobia
Cont
Combative or difficult to control population Poor cognition Dependence in ambulation Controlled seizures, exercise-induced angina,
controlled diabetes Exercise induced asthma Open wounds with bio-occulsive dressing Compromised immune system (e.g. low T-cell
count) On chemotherapy for cancer On dialysis for renal/kidney dysfunction
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Equipment Flotation vest Pool noodles Flotation rings Dumbbells Paddles Gloves Fins Ankle weights/cuffs Resistive boots Kickboards Steps Resistive bands
EQUIPMENTS
Therapeutic Pool
Environment 1. Need to decide what type of program you are
implementing to decide on the design andtemperature of the water.
a. Pediatrics requires shallow depth and specif ic entryrequirements lifts, zero entry.
2. Bad Ragaz and Halliwick require chest height waterfor the therapists.
3. Aerobic conditioning and sports med programsrequire cooler temperatures and varying depths (80 to85 degrees).
POOL DESIGN Type: Pools can be below ground, below ground deck level,
semi-raised, or raised.
But below ground with or without deck construction isrecommended
Shape:more room than square Rectangular, square, or kidneyshaped pools are available.
But rectangular is best because it has less turbulence thansquare shaped and kidney shaped pools.
The larger the pool, the more you can do. Minimum spaceper person is 2.5 x 2.25 meters
Floor:Asloped floor is recommended because it offers less risk ofpatients slipping.
Material on Level throughout, stepped, or sloping. the floorneeds to be non-abrasive and non-slippery.
POOL DESIGN cont Depth:
A maximum depth of 5 feet is recommended. Entry:
Steps, ramps, and hoists are available and which is useddepends on the status of the patient.
Ventilation:Maintain humidity at 50% and have dehumidifying airconditioning to control condensation and allow body heatto evaporate.
Temperature:The range in an exercise pool should be between 79 and 97degrees F.Air temperatures depend on the populationbetween 68 and 72 degrees for aerobic and 80 to 100degrees for therapeutic
POOL DESIGN
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S
WhirlpoolsExtremities
Whirlpools Ferno Jr.Whirlpools Full
Body (HubbardTank)
Whirlpools MobileWhirlpools PodiatryWhirlpools SportsWhirlpools
Stationary
APPLICATIONS in WATER BAD RAGAZ patterns Holdrelax Breathing exercisesJoint mobilisation exercises Strengthening exercises Stretching exercises PNF techniquesAerobic exercises NDTs Stability exercises Gait training Under water massage
EXERCISES
Group therapy
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Aquatic Techniques Must consider
Type of injury/surgery
Treatment protocols if appropriate
Results/muscle imbalances found in evaluation
Goals/expected return to activity
Program designWarm-up
Strengthening/mobility activities
Endurance/cardiovascular
Cool down/stretch
EXERCISES
Upper Body Shoulder Horizontal Abduction /
Adduction, Elbows Straight Shoulder Lateral Abduction /
Adduction, Elbows Straight Shoulder Internal / External
Rotation, Elbows Straight Shoulder Internal / External
Rotation: Combined Motion Shoulder Forward Flexion to 90 Shoulder Forward Flexion to 180 Shoulder Extension from 0 Shoulder Extension from 90 Shoulder / Elbow Forward Press Shoulder / Elbow Pull-Back Shoulder Horizontal Fly, Elbows
Bent Shoulder (Scapula) Retraction Shoulder External / Internal
Rotation,
Elbows BentShoulder / Elbow Vertical Press
Shoulder: Pendulum (Clockwise /Counterclockwise)Shoulder: Pendulum (Side-to-
Side)Straight Arm CirclesElbow Flexion / Extension
Elbow / Wrist Supination /PronationWrist Flexion / Extension
Wrist CirclesWrist / Hand Radial / UlnarDeviation
Finger Flexion / Extension
Thumb to FingertipsFinger Abduction / Adduction
Thumb Circles
Shoulder StabilizationPushaway
Lower Body General Tips Hip Flexion, Knee Bent Hip Extension, Knee Bent Hip Flexion, Knee Straight Hip Extension, Knee Straight Hip Horizontal Abduction / Adduction,
Knee Bent Hip Horizontal Abduction / Adduction,
Knee Straight Hip Lateral Abduction / Adduction To
Midline Hip Lateral Abduction / Adduction Past
Midline Hip Flexion / Abduction, Knee Straight
Combined Motion Hip Internal / External Rotation, Hip /
Knee Bent
Hip Internal / External Rotation, Hip /Knee Straight Hip / Knee Extension, Resisted Using
Buoyant Object Hip Flexion / Extension High Kick Knee Flexion / Extension Knee Extension / Flexion, Hip Flexed Squat Leg Circle
Ankle Circle
Ankle Dorsiflexion / Plantar
FlexionAnkle / Toe Writing
Ankle Inversion
Ankle EversionToe / Heel Raise
Trunk
Pelvic Posterior TiltPelvic Anterior / Posterior Tilt /
Pelvic Rock
Neutral Pelvis Sequence, StandingSpine Stabilization, Standing inPlace
Spine Stabilization, DynamicStandingNeutral Pelvis Sequence, Sitting
Spine Stabilization, Sitting, Feeton Pool FloorSpine Stabilization, Sitting
Suspended
Effects
Physiological effects
Psychological impact
Increased confidence due to increased function allowedby water
Strengthening and muscle re-education
Dependent on effort put forth by athlete
Energy expenditure
Aerobic workout possible to maintain CV fitness
ADVANTAGES DISADVANTAGE Free movement with less
risk of injury
Decreases weight bearingon joints
Buoyancy may assist weakmuscles to allow increasedperformance of activeexercise
Has the ability to affect allmajor body systems.
Slippery environment withincreased risk of fallsoutside pool
Risk of infection
Difficulty stabilizing orisolating body parts duringexercise
Risk of drowning