Aquatic Physical Therapy

  1. Define aquatic physical therapy.

-theraputic use of water

  1. Identify the: aquatic exercise

    1.  Goals

      1. Increase circulation

      2. Improve strength

      3. Increase ROM

      4. Improve ambulation 

      5. improve coordination

      6. Cardiovascular conditioning

      7. Reduce pain,

      8. Reduce stiffness

      9. Reduce muscle spasm

    2. Indications

      1. Edema control

        1. Hydrostatic pressure

          1. Alters circulation 

          2. Must be in deep water

      2. Water exercise

        1. Buoyancy

          1. Effect normal gait mechanics

          2. No normal gait 

        2. Resistance 

          1. Effect gait mechanics 

          2. More exaggerated movements 

        3. Free to move

        4. Tethered 

          1. Walking 

          2. Running 

        5. Open chain

        6. Closed chain

        7. Strengthening

        8. Improve circulation 

        9. ROM / stretch

        10. Gait train

        11. Balance 

        12. Condition cardiovascular system

      3. Superficial heating/cooling

        1. Edema 

          1. Cool water 

          2. No warm water

          3. Consider not puting limb in dependent position 

          4. Contract bath 

            1. Edema reduction

            2. Alternating warm water 100-111 2-10 min 

            3. Cool water 50-64 1-3 min

            4. Alternate 5-6 times

            5. Total time: 20-30 min

  1. Precautions 

    1. Local immersion

      1. Impaired thermal sensation

      2. Alcohol ingestion

      3. Limited ROM, strength, endurance

      4. Urinary inconitience

      5. Fear of water

    2. Full immersion/ very warm water (hot tub)

      1. Pregnant

      2. Multiple sclerosis

      3. Poor thermal regulation

    3. Respiratory issues

    4. Medications

  2. contraindications 

    1. Cardiac instability

    2. Impaired cognition

    3. Bowl incontinence

    4. Maceration

    5. Bleeding

    6. Infection

    7. Severe epilepsy 

      1. Increased risk of drowning

    8. Suicidal 

3. Explain theroperties/componentsclinical significances: 

  • Buoyancy

    • Ability to float

    • Upward thrust opposite direction of gravity

    • Humans less dense than water = float

    • Salt makes more float

  • Advantage 

    • Decreases stress on joints

    • Decreases compression on joints

    • More deep = less body weight

    • Weight bearing restrictions

    • pain

  • hydrostatic pressure

    • Pressure exerted by fluid on body emersed in fluid

    • Deeper = more pressure

    • Pascals law

    • Same effect as compression garments

  • Advantage 

    • Promote circulation

    • Decrease edema 

- Disadvantage 

- limbs in dependent position

  • Viscosity

    • Resistance

    • Speed = morer esistance

      • Turbulence in water

      • Pt. moving quicker 

- Paddles, finns

-increase frontal area = increase resistance 

                      - Limbs in front

- decrease frontal area + decrease resistance 

(unless swimming fast or water fast)

  • surface tension

  •  Hydromechanics

  • specific heat

    • Cool water

      • Dissipate pt. Body heat from exercise

  • temperature transfer

    • Conduction

    • Convection

    • Transferred quickly because wet 

    • Ex: moist heat pack instead of heat pad

4. Center of buoyancy related to:

  •  Immersion

  • movement in the aquatic environment

  • aquatic exercise.

5. Explain how changes in the cardiac system are related to depth of water and water temperature.

6. Outline the body’s response to varying water temperatures in the aquatic environment.

7. Identify the appropriate temperatures or range of temperatures of water for aquatic exercise for the following patient populations or aquatic activities: 

  •  multiple sclerosis patients

  • general aquatic exercise – flexibility, strengthening, gait training, relaxation

    • 79-97

    • Warmer for relaxation

  • acute musculoskeletal injuries

  • cardiovascular training and aerobic exercise

  • intense aerobic training – 80% or above maximum heart rate.

    • Cool water

    • Cool pt. Down

    • Prevent overheatinfg

8. Identify the benefits of and general guidelines for performing with varying amounts of resistance in the aquatic environmen: 

  • manual stretching

  • Self-stretching

  • manual resistance

  • independent strengthening exercises 

9. Describe for aerobic conditioning in the aquatic environment, 

  •  Interventions

  •  physiologic responses

  • proper form

  • exercise monitoring

  • equipment selection 

10.  identifying precautions and accommodations for specific patient populations, within the plan of care established by the physical therapist.

11. Outline important principles to remember in patient education, as delegated by the physical therapist, concerning exercise in the aquatic environment.

Properties of water 

How they affect exercise

How to use water as modality


Affects on different body systems

Musculoskeletal system

  • Use hydrotherapy for most in rehab

  • Buoyancy 

    • Depth of immersion effect on weight bearing

    • Rescue weight bearing on muscle skel system

    • Pain with WB

    • WB restriction, difficulty maintaining on land

  • Viscosity

    • Strengthening thru resistance 

Cardiovascular system

  • Hydrostatic pressure improves:

  • Circulation more efficient 

  • Enhanced venous return from extremties

Imersed up to neck

  • Hydrostatic pressure greatest = central blood volume = stroke volume = cardiac output increased

Heart rate response decreased

  • Pt. perceives exercise as easier

Healthy adult

  • Helps condition cardiovascular system 

Heart failure

  • Heart cannot pump efficeinty 

  • Increased cardiac demands in water overwlms heart = decreased pumping ability more\


Respiratory system

  • Decreased vital capacity 

    • Total amount of air under volition control 

    • Air breathed in and out

    • Decreased because hydrostatic pressure compresses chest 

    • Decreased = work harder to breath

  • Increased work of breathing

    • Work of breathing increased because lungs don’t expand as much

    • Due to decreased vital capacity 

Asmatic patients 

  • Humid environments 

  • Do well in humid environment 

  • Mucus membrane moist = decrease asma attacks from exercise

  • Increased circulation


Renal system

  • Diabetic pt.s 

  • Kidney issues 

  • Hydrostatic pressure

    • Increase urine production

    • Increase urine Exrete sodium and potassium 

    • Increase renal blood flow = increased urine 

    • Increase blood volume 

    • Hormone production 

Advantage 

  • Decreases edma 

Good for 

  • High blood pressure

  •  Hypertension

  • Hyperbolemia

  • peripheral edema 


Physiological system 

  • Relaxing 

    • Warm water 

    • No fear of water 

    • Confidence 

  • Stressful 

    • Cant swim

    • Afraid of water 

    • Being immersed in water is scary 

      • Negative experiences 

      • Weakness

      • Stroke 

      • Spinal chord injury and cant use legs

  • Temperature 

    • Warm

      • Relaxing

    • Cool

      • Invigorating


Aquatic therapy is temporary until can do land based.  

Aquatic used as a bridge to transition back to land

Downside 

  • Reduce  weight bearing

    • No impact on bone density 

Osteoporosis 

  • Weight bearing needed for osteoblast activity 

  • Improve bone density 

Less likely to contribute to weight loss

  • Land promote weight loss more than pool 

NO NEGATIVE PRESSURE WOUND THERAPY


Solvent

  • Dissolving chemical compounds

  • Wound care


 History 

  • Many cultures 

  • Therapeutic effects

  • 1940-50s for polio

  • Transitioned for rehab 



Adverse effects of hydrotherapy

  • Hyponatremia 

    • Open wound pt.s

    • Whirlpools

    • Debridement 

    • Risk of cross contamination

  • Drowning

  • Burns

  • Fainting 

  • Bleeding

  • Exacerbation of edema 

    • Adverse effects of hot water specifically and apply to heat modalities 

  • Asthma 

    • Chemicals in pool can trigger an attack 



Exercise things 

  • Underwater treadmill

    • Instead of tethering

  • Adjustable flow rates

    • Resistance 


Safety issues

  • Infection control

  • Safety

  • Pool maintenance 

    • Maintenance log

    • Draining 

    • Inspection

  • PT.s MUST BE SUPERVISED AT ALL TIMES


Documentation 

  • Type of hydrotherapy

  • Water temperature 

  • Pt.position

  • Pt. activities 

  • Tx time 

  • Fluid pressure

  • Water additives 

  • Response to intervention 

Why having limb in dependent position is not good.

  • hydrostatic pressure less effective when the limb is not elevated

  • gravity will contribute to fluid accumulation.