Chapter 17 Aquatic Physical Therapy

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Physical Properties of Water Buoyancy

Main Controlling Variables:
1. Position or direction of movement in water 2. Water depth 3. Lever arm length 4. Flotation or weighted equipment use

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Position and Direction of Movement

Movements toward the surface Buoyancy assisted. Movements parallel to the bottom of the pool Buoyancy supported (gravity minimized). Movements toward the bottom of pool Buoyancy resisted.

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Depth, Lever Arm Length, or Buoyant Equipment Can Alter Resistance or Assistance
Shallower water Less support. Deeper water More support, but increased frontal resistance. Modifications can be made through use of buoyant equipment.
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Buoyancy and Lever Arm

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Buoyancy and Flotation

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Resistance Is Influenced By:

1. Velocity of movement (mean muscle activity alters when velocity reaches a threshold (See Table 17-1) 2. Surface area 3. Water depth 4. Direction of movement

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Physiologic Changes with Immersion

(Changes vary with immersion depth)
1. Decreased peripheral blood flow, vital capacity. 2. Increased heart volume, intrapulmonary blood volume, right atrial pressure, left ventricular end-diastolic volume, stroke volume, cardiac output. 3. Decreased or unchanged heart rate.

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Physiologic Response to Exercise and Immersion

Physiologic adaptations are similar to land training. Increased cardiac loading due to hydrostatic pressure. Depth of immersion affects degree of cardiac changes.

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Examination and Evaluation for Aquatic Rehabilitation

Full land-based examination must be performed. Also consider:
Basic safety (ability to enter water, comfort, etc.) Precautions (cardiac history, etc.) Contraindications to aquatic environment (fever, infections, rashes, etc.)

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Therapeutic Exercise Intervention

Mobility Impairment
Progress simple ROM exercises toward functional limitations. Use lever arm length and buoyant equipment to alter resistance. Observe land mechanics before pool exercise to ensure proper technique.

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ROM (Hamstrings and Shoulder Extensors)

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Muscle Strength/Power/ Endurance Impairment

Principles and progressions are the same as on land. Resistance is influenced by surface area (SA) and direction. Consider gloves, etc. to increase SA. Be aware of groups providing stability. Leg and trunk stabilizers are necessary to counter many upper extremity movements.

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Balance Impairment
Ideal environment for balance training. Variety of activities can be performed. Loss of balance is slowed dramatically. Allows for increased reaction time.

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Aquatic Therapy to Improve Balance

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Aquatic Rehab to Treat Functional Limitations

As patient improves, modify activities to address functional limitations. E.g., decrease level of water as sitting activities improve. As normal mechanics improve, decrease water levels to replicate land-based environments.

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Land-Based Functional Activities in Water

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Contraindications/Precautions
Individuals with excessive fear Open wounds Rashes Active infections Incontinence Tracheostomy CV changes Diuresis Overexercise

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Summary
Pool provides a unique environment for rehabilitation. The properties aquatic therapy provides can be used in many ways to achieve therapeutic goals. Physiologic responses, temperature, and hydrostatic pressure must be considered for safety.

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Summary (cont.)
Aquatic therapy can accommodate activities and progress from early-functional stages. Balance is challenged with most movements and stabilizing muscles must be considered. Pool program should include a land-based program for a well-balanced transition to the land environment.

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