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Aquatic Therapy: Intermediate
Assignment
Matt Rongstad
Case 1
• 49 year old female with R hip pain x 1 year
• Pt reports being born with dislocated hip
which need surgical correction…
• Current MRI - Dx labral tear and gluteus
medius insertion changes with mild chronic
changes
• Chief pathology – trochanteric bursitis
• Pain fairly constant, increased with prolonged
sitting or moving from sit-stand
Case 1 cont
• Hip strength an issue
– FL 4+/5, Ext 4/5, Abd 4+/5, Add 4+/5, IR 4+/5, ER
4/5
• ROM deficits as well (mentioned in note, no
measurements)
• Initial Tx: dry land therapy to increase
strength, ROM, DTM for ST mobility
• Failed – pt unable to tolerate treatments
Case 1 cont
• Aquatic therapy implemented to create
decreased WB environment
• Pt responded much better, significantly
decreased pain during Tx
• Major focus was on strength and flexibility
while in pool, using water for resistance as
well as assisting in stretching
• No pain with bicycle kicks, squats, SLR etc
Case 2
• 75 year old female s/p 3 R hip Sx to fix Fx
femoral head sustained during a fall. Most
recent Sx on 3/28/13
• ADLs very difficult due to pain/strength
• Pt unable to walk more than a few paces due
to pain and strength/coordination
Case 2 cont
• Aquatics implemented right away to create
decreased WB environment
• Main focus, regaining proper gait
mechanics/coordination and balance for land
based activity
• Pt was able to tolerate aquatics with no
significant complaints
Case 2 cont
• Therapy involves
– Gait training – forward, backward, side-
side, marching (needed lots of verbal cues early
on)
– Overall hip/LE strengthening exercises using water
for resistance (encouragement to increase speed
of movements)
– Recently started more aggressive
balance/coordination activities
Hip Aquatic therapy research
• NAJSPT – arthroscopic labral repair
– Rehabilitation to include aquatic therapy when
available
• Physical Therapy Journal – Aquatic PT for hip
and knee OA
– 71 volunteers
– Intervention resulted in less pain and joint
stiffness as well as increased physical
function, quality of life, and muscle strength
Aquatic Therapy Rehab Protocol:
Cerebral Palsy
• 18 year old male with Cerebral Palsy
• Reports to PT with desire to be able to walk
with assistive devices (ie Kaye walker) rather
than be in wheel chair
• (B) LE weakness and significant decrease in
ROM due to muscle contractures
• Aquatic therapy implemented to create
decreased WB environment for aggressive gait
training and LE strengthening
Kaye Walker
Aquatic Therapy Protocol
• Beginner:
– Improve ROM of (B) LE to allow for proper LE
function for normal gait
– Stretching – emphasis on HS and hip flexors (note
ankles fused)
– LE strengthening – bicycle kicks, scissors
kicks, skiers (using water as resistance in all
planes)
Aquatic Therapy Protocol
• Intermediate:
– Cont w/ LE strengthening/stretching
– Begin gait training
– Walking in pool - due to CP condition, focus mostly on
the ability to walk, not necessarily on detailed form of
walk. Use floatation devices or side of pool for
support PRN
– Start with forward walking, progress to backward
walking, side to side, marching, etc
– Consider land based therapy simultaneously for
additional strengthening and mobility improvements
Aquatic Therapy Protocol
• Advanced:
– Cont strengthening/stretching and walking
activities
– Core work for added stabilization (use of
floatation devices in water)
– Water games
– Begin transitioning period to land based gait
training.
Research
• Journal of Aquatic Therapy (2005)
– Purpose: assess outcome of a 10 week aquatic
therapy program in children w/ CP
– Conclusion: improvements were seen comparing
pre and post intervention
– More research needed – only 7 participants
– No control group or comparison group
Sources
• Garrison, J., Osler, M., & Singleton, S. (2007). Rehabilitation after
arthoroscopy of an acetabular labral tear. North American Journal of
Sports Physical Therapy, 2(4), 241-250. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953303/
• Hinman, R., Heywood, S., & Day, A. (2007). Aquatic physical therapy
for hip and knee osteoarthritis: results of a single blind randomized
controlled trial. Phyical Therapy Journal, 87(1), 32-43. Retrieved
from http://physicaltherapyjournal.com/content/87/1/32.short
• Thorpe DE, Reilly M, Case L. The effects of an aquatic resistive
exercise program on ambulatory children with cerebral palsy.
Journal of Aquatic Physical Therapy. 2005;13:21-34.
http://pt.unlv.edu/ebpt/cats/Pediatrics/Effects%20of%20an%20aqu
atic%20resistive%20exercises%20program%20on%20ambulatory%2
0children%20with%20Cerebral%20Palsy.pdf

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Aquatic therapy interesting cases

  • 2. Case 1 • 49 year old female with R hip pain x 1 year • Pt reports being born with dislocated hip which need surgical correction… • Current MRI - Dx labral tear and gluteus medius insertion changes with mild chronic changes • Chief pathology – trochanteric bursitis • Pain fairly constant, increased with prolonged sitting or moving from sit-stand
  • 3. Case 1 cont • Hip strength an issue – FL 4+/5, Ext 4/5, Abd 4+/5, Add 4+/5, IR 4+/5, ER 4/5 • ROM deficits as well (mentioned in note, no measurements) • Initial Tx: dry land therapy to increase strength, ROM, DTM for ST mobility • Failed – pt unable to tolerate treatments
  • 4. Case 1 cont • Aquatic therapy implemented to create decreased WB environment • Pt responded much better, significantly decreased pain during Tx • Major focus was on strength and flexibility while in pool, using water for resistance as well as assisting in stretching • No pain with bicycle kicks, squats, SLR etc
  • 5. Case 2 • 75 year old female s/p 3 R hip Sx to fix Fx femoral head sustained during a fall. Most recent Sx on 3/28/13 • ADLs very difficult due to pain/strength • Pt unable to walk more than a few paces due to pain and strength/coordination
  • 6. Case 2 cont • Aquatics implemented right away to create decreased WB environment • Main focus, regaining proper gait mechanics/coordination and balance for land based activity • Pt was able to tolerate aquatics with no significant complaints
  • 7. Case 2 cont • Therapy involves – Gait training – forward, backward, side- side, marching (needed lots of verbal cues early on) – Overall hip/LE strengthening exercises using water for resistance (encouragement to increase speed of movements) – Recently started more aggressive balance/coordination activities
  • 8. Hip Aquatic therapy research • NAJSPT – arthroscopic labral repair – Rehabilitation to include aquatic therapy when available • Physical Therapy Journal – Aquatic PT for hip and knee OA – 71 volunteers – Intervention resulted in less pain and joint stiffness as well as increased physical function, quality of life, and muscle strength
  • 9. Aquatic Therapy Rehab Protocol: Cerebral Palsy • 18 year old male with Cerebral Palsy • Reports to PT with desire to be able to walk with assistive devices (ie Kaye walker) rather than be in wheel chair • (B) LE weakness and significant decrease in ROM due to muscle contractures • Aquatic therapy implemented to create decreased WB environment for aggressive gait training and LE strengthening
  • 11. Aquatic Therapy Protocol • Beginner: – Improve ROM of (B) LE to allow for proper LE function for normal gait – Stretching – emphasis on HS and hip flexors (note ankles fused) – LE strengthening – bicycle kicks, scissors kicks, skiers (using water as resistance in all planes)
  • 12. Aquatic Therapy Protocol • Intermediate: – Cont w/ LE strengthening/stretching – Begin gait training – Walking in pool - due to CP condition, focus mostly on the ability to walk, not necessarily on detailed form of walk. Use floatation devices or side of pool for support PRN – Start with forward walking, progress to backward walking, side to side, marching, etc – Consider land based therapy simultaneously for additional strengthening and mobility improvements
  • 13. Aquatic Therapy Protocol • Advanced: – Cont strengthening/stretching and walking activities – Core work for added stabilization (use of floatation devices in water) – Water games – Begin transitioning period to land based gait training.
  • 14. Research • Journal of Aquatic Therapy (2005) – Purpose: assess outcome of a 10 week aquatic therapy program in children w/ CP – Conclusion: improvements were seen comparing pre and post intervention – More research needed – only 7 participants – No control group or comparison group
  • 15. Sources • Garrison, J., Osler, M., & Singleton, S. (2007). Rehabilitation after arthoroscopy of an acetabular labral tear. North American Journal of Sports Physical Therapy, 2(4), 241-250. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953303/ • Hinman, R., Heywood, S., & Day, A. (2007). Aquatic physical therapy for hip and knee osteoarthritis: results of a single blind randomized controlled trial. Phyical Therapy Journal, 87(1), 32-43. Retrieved from http://physicaltherapyjournal.com/content/87/1/32.short • Thorpe DE, Reilly M, Case L. The effects of an aquatic resistive exercise program on ambulatory children with cerebral palsy. Journal of Aquatic Physical Therapy. 2005;13:21-34. http://pt.unlv.edu/ebpt/cats/Pediatrics/Effects%20of%20an%20aqu atic%20resistive%20exercises%20program%20on%20ambulatory%2 0children%20with%20Cerebral%20Palsy.pdf