AQUATIC REHABILITATION

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AQUATIC REHABILITATION

• Veronica Southard PT MS GCS

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PHYSICAL Properties of Water

• Buoyancy, Provides an upward force. Opposite
  gravity. Opposite body wt..
• Archimedes Principle an immersed body at rest
  experiences an upward thrust equal to the amt. Of
  H2O it displaces.
• Effects of buoyancy are related to water depth
  and specific gravity.

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Specific gravity

• Specific gravity gt 1 g/cm3 will sink, anything
  less will float
• Determined by the relationship between lean m
  mass and body fat
• gt lean mass the more likely to sink
• Compensate by altering waters depth, floatation
  equipment and waterproof wt. Equipment.

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Center of Buoyancy

• Defined as the center of gravity of the displaced
  water
• If the body wt. And the displaced water wts. Are
  unequal, a rotation about the center of buoyancy
  occurs until equilibrium is reached
• Moment of buoyancy

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Altering the assistance provided by buoyancy

• 1. Position or direction of movement is changed
• 2. Water depth
• 3. Lever arm length
• 4. Floatation or weighted equipment

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Position and Direction of Movement

• Water activities
• buoyancy assisted
• buoyancy supported
• buoyancy resisted

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Water depth

• At deeper depths unloading occurs
• Shallow depths there is less buoyancy
• CV disease or M weakness may find deeper depths
  more difficult

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Lever arm length

• Adjusting the lever will increase or decrease the
  difficulty

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Buoyant equipment

• May increase the lever arm
• Cuff can be added to adjust the quantity and
  location of assistance or resistance
• Support the client in supine or prone

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Hydrostatic Pressure

• Pressure exerted by water to the body that
  increases as the depth of immersion increases.
• Makes deeper aquatic activities desirable.
  Relieves effusion and edema
• Greatest at the bottom of the pool secondary to
  the weight of the water overhead

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Viscosity

• Def- waters resistance to adjacent fluid layers
  sliding freely by one another. Creates a
  resistance to flow when moving through a liquid
• Inconsequential in static positions
• Resistance is created because a turbulent flow is
  produced when the speed of movement reaches a
  critical velocity

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Turbulent flow

• The resistance is proportional to the velocity
  squared. Therefore with Increased velocity there
  is Increased resistance.
• Moving forward in the water creates a frontal
  resistance proportional to the presenting surface

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Velocity of movement

• At the critical velocity, turbulence and
  resultant drag are created
• Slow movement there is little drag, minimal
  resistance

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Physiologic responses to immersion only

• Hydrostatic Pressure
• Water temperature

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Effects of Hydrostatic Pressure

• Immersion to the neck
• Centralization of peripheral blood flow
• Intrapulmonary bl vol increases 33-60
• VC decreases 8
• Central venous press at R atrium level from 2.5
  to 12.8 mmHg
• increased
• R atrium press, left vent end distolic vol
• , stroke vol 35, CO32

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Effects of Hydrostatic Pressure Cont

• HR will not change or may slightly decrease
  because HRSV / CO
• Any changes noted in centralization of bl fl are
  graded and occur with immersion even before
  exercise

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Water Temperature

• Too warm or too cold will add a thermal load to
  CV system.
• CO unchanged bet. 25-34C sign inc at 40C
• O2 consumption inc. at 25C
• Dec. HR in cold water
• Inc. HR warm water
• Thermoneutral is 34C
• Most pools are 27-35C

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Physiologic Responses to Exercise and Immersion

• Used to inc.or maintain CV conditioning
• Deep water running can be used to maintain O2
  consumption during injury
• Alternative training medium during recovery
• Inc Cardiac Load due to HP occurs even with
  exercise
• HR has been shown to be lower or unchanged when
  compared to land based

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Examination for aquatic rehab

• Full land based exam
• Consideration of Contraindications
• Excessive fear of water.
• Open wounds, Rashes
• Active infections
• Incontinence
• Tracheostomy

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Precautions in Aquatics

• CV changes
• Pulmonary impairments
• Over exercise- reduced gravity environment,
  support of buoyancy, m relaxation with immersion,
  HP and water temperature

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Treating Impairments with Aquatics

• Mobility impairments Progress activities to
  enhance function and reduce disability ASAP.
• Considerations
• Force of buoyancy
• Position and available ROM at the jt.
• Direction of desired movement
• Need for floatation or weighted equipment

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Mobility impairments Cont

• Buoyancy will facilitate ROM. Change the lever
  length and equipment as pt. improves
• Static stretches can be done using steps, pool
  sides and bars
• Observe the exercise on land first. Observe
  closely once in the water secondary to refraction

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Balance impairment

• Supportive medium with destabilizing forces make
  this approach ideal
• Falls are dramatically slowed, inc. pt.s time
  for response
• SLS activities
• SLS with arm mvt.
• Single toe raises
• Step ups

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Aquatic Rehab to treat Functional Limitations

• Functional limitations are restrictions in
  performance affecting the whole person.
• Good situation for working on posture or
  position.
• Chairs can be submerged, buoyancy sitting
  equipment. As sitting tolerance improves, water
  depth is decreased.
• Forward reach

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Coordinating Land and Water

• Land based activity should begin as soon as
  tolerated
• It is difficult to produce eccentric m
  contractions in the pool
• With pain, aquatics may be most of the program
• Sometimes alternating the pool with land based
  interventions works best

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Patient education

• Before entering the pool, explain the fundamental
  properties of H2O to the pt.
• Make sure the pt. is aware of the entrances and
  exits from the pool, drop offs, gutters, and
  bars.
• Show the pt. the exercises on land first.

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Indications for Aquatic Therapy

• Everything that is not contraindicated.

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Indications for Aquatic therapy
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Specific Approaches in the Water

• WATSU
• Halliwick Method
• Bad Ragaz Ring Method

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Resources for Aquatic Therapy

• Richard Ruoti, Aquatic Rehabilitation
• Lippincott 1997.
• Hall Carrie, Therapeutic Exercise Moving Toward
  Function, Lippincott Williams Wilkins
• 1999 Chapter 17.
• Bill Schuss !