Aquatic Therapy Deanna M. Errico, PT, DPT, ATC Clarkson University - - PowerPoint PPT Presentation
Aquatic Therapy Deanna M. Errico, PT, DPT, ATC Clarkson University January 10, 2009 EATA Workshop Objectives Relate the principles of physics to aquatic therapy Identify the physiological benefits of exercising in water Identify
Deanna M. Errico, PT, DPT, ATC Clarkson University January 10, 2009 EATA Workshop
Relate the principles of physics to
aquatic therapy
Identify the physiological benefits of
exercising in water
Identify the precautions and
contraindications to aquatic therapy
Apply the therapeutic effects of aquatic
exercise
Aquatic Physics
Density/Specific Gravity Hydrostatic Pressure Buoyancy Refraction
Thermodynamics
Density
Mass per unit volume (kg/m3)
Specific Gravity/relative density
Ratio of the density of a particular
substance to the density of water.
Pressure = force per unit area (N/m2) Fluid pressure exerted on all surface
areas of an immersed object
Directly proportional to depth of body
part below surface of water.
Upward force generated by the volume
Immersed objects have less apparent
weight than the same object on land.
Buoyancy increases with volume
Gravity is not eliminated in water but
the impact of gravity is reduced.
Simply adjust the amount of human
body immersed to therapeutically alter the Buoyancy Factor.
= Center of gravity of a fluid T2-T4 = center of buoyancy for human
standing in neck-deep water.
Effects are greatest as the limb approaches
the surface of the water
Upward force of buoyancy decreases the
effect of body weight and the weight bearing forces on the muscles and joints of the body.
Increasing depth of water decreases
weight-bearing stresses up to C7.
Generally:
Immersion to neck = 10% WB Immersion to chest = 25-35% WB Immersion to waist = 50% WB
When light passes from one medium to
another it encounters a boundary layer and undergoes a transformation at this interface
Part of the incident light is reflected at the
boundary and the portion passing into the new medium may change direction
Specific Heat/Thermal Energy
Transfer
Keep in mind the transfer of heat:
water or body transfers heat in dynamic
system.
Conduction, convection, radiation
Water in Motion
Flow Viscosity Laminar Flow Turbulent Flow Drag Contribution Resistance Effects
= Magnitude of internal friction specific
to a fluid
Friction Resistance to movement Energy must be exerted to create
movement
Surface tension
force exerted among surface molecules of
water
Frontal tension
the more surface area facing the water,
the greater the resistance
Drag
Inertia
Tendency of masses to resist changes in motion
Acceleration
Depends on object’s mass and on the applied
forces
Faster movements require greater force
Apply these properties to increase exercise
intensity
Shorter objects vs. longer objects when
moved the same amount of distance through same resistance
To increase work load, lengthen the
resistance arm
Cardiorespiratory System Musculoskeletal System Center of Buoyancy/Center of Balance Joint Effects
Aerobic Energy Metabolism Water Temperature Effect Maximal Oxygen Uptake Anaerobic Energy Metabolism Circulation Ventilation Thermoregulation Endocrine
Benefits Precautions Contraindications Treatment Other
Increases circulation (superficial and
peripheral)
Increases blood supply in muscles Muscle relaxation Promotes inhibition of spastic muscles by
decreasing gamma fiber activity
Prepares connective tissues for stretching Improves flexibility as muscles are able to
work through a greater ROM when supported by water
Decreases joint compression forces Hydrostatic pressure improves lung capacity Hydrostatic pressure decreases pooling of
blood in LE’s
Improved strength of agonist/antagonist Decreased osteoporotic effects secondary to
muscle contraction
Decreased sensitivity of sensory nerve
endings (and usually less pain)
Risk of overexertion and dehydration Prone swimming decreases O2 intake by 20% HR is 10-15 bpm lower with water exercise
than land exercise, when exercising at same MET level (use RPE)
Chlorine/Bromine can cause skin and
respiratory problems
Causes a 10% decrease in pulmonary function
when submerged to neck level
Easy to over stimulate vestibular system
Fever over 100 Uncontrolled epilepsy Incontinence Respiratory disease with vital capacity below
1L
Infectious disease Open wounds Skin infections Uncontrolled blood pressure
Severe cardiac complications Acute cerebral hemorrhage MS (in warm water) Chlorine sensitivity Repeated syncope Absent cough reflex UTI’s Isolation precautions
Land versus Pool based treatment
inconvenience of pool and increased liability
Applicable to wide range of diagnoses and
patient populations
Can be used at several points in rehabilitation
process
Entering and Exiting pool issues
ladder vs steps vs lift
Benefits of decreased weight bearing
Gait training while still under precautions Decreased pain in arthritic joints while
performing cardiovascular exercise
Proprioceptive awareness in early recovery
stages
Benefits of buoyancy
Decreased need for assistance Assistance with hip flexion and knee flexion
in gait
Provides supportive environment
Water mobility tasks (similar to land
based)
Parallel bars Steps Assistive devices Dumbbells Weights Buoyancy belts
Increase challenge:
Increase speed Add resistance Increase surface area Quick reversals Add drags and turbulence Decrease depth
Constant use of abdominal/trunk
musculature for stabilization
Sitting, kneeling, standing on noodle,
dumbbell (with or without a belt)
Ball activities, standing with narrow base of
support/one leg
Maintain pelvic tilt and good posture during
UE/LE exercises and with ambulation activities
Noodle activities in sitting or kneeling (bicycle
with arm and leg movement)
Side bend and trunk rotation stretches Golf swing, kickboard presses, scapular
retraction,
Deep end activities of scissoring, thrusts, and
pendulums
Calf Quad Hamstring LB/upper back Buttocks Upper extremity (triceps/post
shoulder/ant)
Remember physical properties of water
when designing program (buoyancy supported, assisted, or eliminated)
Increase difficulty by increasing speed,
reps, resistance, and position in water, and depth of water.
Aqua jogging walking Swimming Bicycling Aerobics Remember
pulmonary and cardiac impacts of water
THR is 10-15 BPM
lower
Dehydration Warm-up and Cool-
down
Bad Ragaz Watsu Mechanical traction Manual techniques Plyometrics Sports Pregnant patients
(benefits)
Other specific
populations
Warm vs cool pool CPT codes
97110: ther-ex 97113: Aquatic ex
Lifeguard Consent form/waiver Pool costs/
maintenance
High risk
environment
Ruoti RG, Morris DM, Cole AJ. Aquatic Rehabilitation.
Lippincott Williams & Wilkins Publishers: Philadelphia
Sova R. Aquatics: the Complete Reference Guide for
Aquatic Fitness Professionals. DSL, Ltd.: Port Washington, WI. 2000
Marocco S. Aquatic Therapy Inquiry Seminar,
Clarkson University 2005.
McNamara C. Aquatic PT for LE Injuries. CE Course. Whisher D, Lebel C. Aquatic PT: An Orthopedic Approach.
CE course