acuatic therapy - handout

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

acuatic therapy - handout

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