1. Presented By:
Amanda McCune
Student of Physical Therapy class of 2017
Aquatic Fitness Instructor since 2007
& Member of APTA’s Aquatic Section
*
2. Goals of this presentation:
Provide information as a guide to rationalize, design, &
implement Aquatic Physical Therapy programming
Introduce & Demonstrate Aquatic PNF Techniques, &
Other Applicable Exercises
*
3. *
“Aquatic Physical Therapy is the evidence-based and skilled
practice of physical therapy in an aquatic environment by a
physical therapist, or a physical therapist assistant under the
supervision of a physical therapist. Aquatic Physical Therapy
includes but is not limited to treatment, rehabilitation,
prevention, health, wellness and fitness of patient/client
populations in an aquatic environment with or without the use of
assistive, adaptive, orthotic, protective, or supportive devices and
equipment.”
4. *
*Buoyancy: Upward force equal to weight of fluid an object
displaces, when immersed. Enables object to float.
*Resistance: A counter force to direction of movement. In water,
resistance is proportional to relative speed of body part and water
motion/turbulence (i.e. a jet) and to the frontal areas of body part
in contact with the water (assuming no resistive device used).
*Viscosity: Thickness (resistance) to flow of a liquid due to friction
between its molecules. Water, has a relatively low viscosity.
*Allow for Drag
*Hydrostatic pressure: Pressure that fluid exerts on an immersed
body. Increases proportional to immersion depth.
5. *Musculoskeletal Effects
Decreased weight bearing
Strengthening
Effects on bone density loss
Less fat loss than with other
forms of exercise
*Respiratory Effects
Decreased vital capacity
Increased work of breathing
Decreased exercise-induced
asthma
*Renal Effects
Diuresis
Increased Na+ & K+ excretion
Relaxing or invigorating,
depending on
temperature
*Cardiovascular Effects
Creased venous circulation
Increased cardiac volume
Increased cardiac output
Decreased heart rate, systolic
blood pressure, and
rate of
Oxygen uptake (VO2) response
to exercise
* *
8. *
*Every person, including those with special conditions, should
be assessed individually
Generally:
*Disorientation
*Medications
*Urinary incontinence
*Respiratory issues
For Very Warm or Hot water
*Impaired Thermal Regulation
*Pregnancy
*Multiple sclerosis (not above 88 degrees Celsius)
*This is not an exhaustive list*
9. *
* Effects of aquatic PNF lower extremity
patterns on balance and ADL of stroke
patients. Journal Of Physical Therapy
Science. 2015
* Rhythmic initiation in LE D1 & D2
30 mins/day, 5 days/wk for 6 wks
* Supine on Land Vs.
* Supine 110 cm below water surface
Wore ring between L5 & S1 + Neck collar
Temp: 90-92 degrees Fahrenheit
* Results indicated performing LE PNF in
the water improves balance & ADL
participation in stroke patients.
* Significant improvements in both groups
* Groups could not be compared
10. *
* Comparison of Effects of a Proprioceptive Exercise Program in Water and on Land the Balance of Chronic Stroke Patients.
Journal Of Physical Therapy Science. 2013
* Results indicated underwater exercise was more effective for increased sense of joint position & balance of stroke patients.
Underwater on Wonder Board Group (N=31) Vs. Land on Balance Mat Group (N=31) at Daejeon Korea hospital.
* Authors propose additional benefits may be due to increased symmetrical WB associated with:
* Decreased fear of falling
* Inherent feedback of buoyancy. Symmetrical WB must be maintained or apparatus would float away.
* Both Groups performed: One-legged Knee Flexion (lunge, 1-on-1-off), Toe Stand, One-Legged Stance (SLS for 30s), Two-legged
knee flexion (lateral,1-on-1-0ff), Weight Shift (lateral, 1-on-1-off),
* 10 reps x 3 sets each, 40 mins/day (incl. 5 min warm up & 5 min cool down)
* 3 days/wk for 6 wks
* Underwater Pool depth 1.1M, Temp: 92.5 Degrees Fahrenheit
12. *
*Resistance Progressions
* Orientation
* Depth (WB progressions)
* Devices (SA-can also assist, PROM, ECC)
* Speed/Velocity (Fast, Slow, Hold, Reverse
*UE Demo: Slice < Cup < Splay < Speed < Device
*Trunk & Core Stability
* Demo: Inherent Constant Challenge, Activation counts here too (TVA). Orientation: Whole Body
(i.e. plank) or Extremities (plane, reversals), Lever Lengths, Speed, Devices
* Supine: Otters, Aqua-crunch, Aqua-crunch + twist
* Prone/Plank (on wall or equip): Multifdus
*LE DEMO: Assistive Devices (PROM/AAROM/PRE), Speed
* BALANCE (on noodle/or balance board): One-legged knee flexion (lunge, 1-on-1-off), Toe Stand, One-
Legged Stance (SLS for 30s), Two-legged knee flexion (lateral,1-on-1-0ff), Weight Shift (lateral, 1-on-
1-off)
* FUNCTIONAL: Initiating Gait (Reversals-build momentum to go against it), Coordination/dual tasks
challenge (Lateral Cross-over).
13. *
Demo: SLS Series
*Between Muscle Groups
*Between Types of Contractions
*Concentric:
* Primary, with no device (moving in frontal plane)
* Multi-Directional with drag (increased SA)
*Eccentric:
* Can be primary with buoyant device (control ascension)
*Isometric:
* Wall
14. *
*Proprioceptive: Sensory Receptors
*Neuromuscular: Involve Nerves & Muscles
*Facilitation: Make Easy
*Uses typical patterns of movement to increase
flexibility, strength, & balance needed for everyday
activities.
15. *
*Stretch Reflex (noodle)
* Initiate contraction in direction opposite to max stretch
*Agonist Reversals (gloves, DB)
* Natural occurrence in water
* Hold/Contract Relax (noodle)
* PROM, pt. presses back into noodle, holds, then relaxes
*Trunk Stability, Lift & Chop
*UE D1, Flexion & Extension
*UE D2, Flexion & Extension
*LE D1, Flexion & Extension
*LE D2, Flexion & Extension
16. *
*Flexion
*Shoulder (FADER)
*Flex, Add, ER
*Elbow
*Flex OR Ext
*Forearm
*Supination
*Wrist
*Flex, RD
*Fingers
*Flex, Add
*Elbow
*Flex OR Ext
*Forearm
*Pronation
*Wrist
*Ext, UD
*Fingers
*Ext, Abd
17. *
*Flexion
*Shoulder (FABER)
*Flex, Abd, ER
*Elbow
*Flex OR Ext
*Forearm
*Supination
*Wrist
*Ext, RD
*Fingers
*Flex, Abd
*Elbow
*Flex OR Ext
*Forearm
*Pronation
*Wrist
*Flex, UD
*Fingers
*Ext, Add
18. *
*Flexion
*Hip (FADER)
*Flex, Add, ER
*Knee
*Flex OR Ext
*Ankle
*DF, Inversion
*Toes
*Ext
*Extension
*Hip
*Ext, Abd, IR
*Knee
*Flex OR Ext
*Ankle
*PF, Eversion
*Toes
*Flex
19. *
*Flexion
*Hip (FABIR)
*Flex, Abd, IR
*Knee
*Flex OR Ext
*Ankle
*DF, Eversion
*Toes
*Ext
*Extension
*Hip
*Ext, Add, ER
*Knee
*Flex OR Ext
*Ankle
*PF, Inversion
*Toes
*Flex
20. *
Rarely do we treat a patient with an isolated musculoskeletal condition. For this reason,
the presenter urges you to consider the whole person (by ICF revised standards).
Consider the various possibilities of carry-over effects associated with:
* Systemic effects of the aquatic environment
* Patient Motivation (adherence & reduced depression)
* Fatigue (Mixed Results – Look to patient response)
* Impact on prolonging QOL for patients with life-altering or terminal conditions
*See additional resources for evidence regarding these topics*
Additional Research regarding specific applications of aquatic therapy needed.
In the meantime, the utilization of validated outcome measures may play a
significant role in the empowerment of healthcare providers in rationalizing,
designing, & implementing an individualized & integrative plan of care.
21. *
* Aquatic Physical Therapy Section. American Physical Therapy Association. Journal Of
Aquatic Physical Therapy.
* Cameron M, ed. Physical Agents in Rehabilitation: From Research to Practice. St. Louis,
MO: Saunders/Elsevier; 2009.
* Kim E, Lee D, Kim Y. Effects of aquatic PNF lower extremity patterns on balance and ADL
of stroke patients. Journal Of Physical Therapy Science [serial online]. January
2015;27(1):213-215. Available from: MEDLINE, Ipswich, MA.
* Seul Ki H, Myung Chul K, Chang Sik A. Comparison of Effects of a Proprioceptive Exercise
Program in Water and on Land the Balance of Chronic Stroke Patients. Journal Of Physical
Therapy Science [serial online]. October 2013;25(10):1219-1222. Available from: CINAHL
Plus with Full Text, Ipswich, MA.
22. *
Pulmonary System
* Jaehyun J, Eunjung C, Kyoung K, Byoung-Hee L, Jiyeun L. The Effects of Aquatic Exercise on
Pulmonary Function in Patients with Spinal Cord Injury. Journal Of Physical Therapy Science
[serial online]. May 2014;26(5):707-709. Available from: CINAHL Plus with Full Text, Ipswich,
MA.
Neurological disease
* Marinho-Buzelli A, Bonnyman A, Verrier M. The effects of aquatic therapy on mobility of
individuals with neurological diseases: a systematic review. Clinical Rehabilitation [serial
online]. August 2015;29(8):741-751. Available from: CINAHL Plus with Full Text, Ipswich, MA.
* Fair evidence that aquatic therapy is beneficial, but not enough to say it is superior to land
Spasticity
* Chon S, Oh D, Shim J. Watsu approach for improving spasticity and ambulatory function in
hemiparetic patients with stroke. Physiotherapy Research International [serial online]. June
2009;14(2):128-136. Available from: CINAHL Plus with Full Text, Ipswich, MA.
* Watsu was found to be effective at reducing spasticity & improving ambulation ability of
patient with hemiparesis
Rehab Applications
* Becker B. Aquatic therapy: scientific foundations and clinical rehabilitation applications. PM &
R: The Journal Of Injury, Function, And Rehabilitation [serial online]. September
2009;1(9):859-872. Available from: MEDLINE, Ipswich, MA.
