Aquatic Physical Therapy PP and K&C Flashcards
Objectives By the end of this course student will be able to
- Identify the definition of aquatic physical therapy
- Explain the properties of water
- Recognize the precautions and contraindications
- Compare and contrast therapeutic techniques
- Select appropriate equipment for support and resistance
- Select appropriate therapeutic exercises for stretching, strengthening, and conditioning.
fyi
Aquatic Physical Therapy definition
evidence-based and skilled practice of physical therapy in an aquatic environment by a PT or by a PTA who is under the direction and supervision of a PT. Aquatic Physical Therapy includes but is not limited to:
treatment
rehabilitation
prevention
health
wellness
fitness
of patient/client populations in an aquatic environment with or without the use of assistive, adaptive, orthotic, protective, or supportive devices and equipment.
The buoyancy, support, accommodating resistance and other unique properties of the aquatic environment enhance interventions for patients/clients across the age span with what kind of disorders or conditions?
- musculoskeletal
- neuromuscular
- cardiovascular /pulmonary
- integumentary diseases,
Aquatic Physical Therapy interventions are designed to improve or maintain what?
- function
- aerobic capacity/endurance conditioning
- balance, coordination and agility
- body mechanics and postural stabilization
- flexibility
- gait and locomotion
- relaxation
- muscle strength, power and endurance
Interventions used in Aquatic Physical Therapy include, but are not limited to what mechanical modalities using the properties of water and techniques to the aquatic environment.
- therapeutic exercise
- functional training
- manual therapy
- breathing strategies
- electrotherapeutic modalities
- physical agents
Properties of Water
- Relative Density
- Temperature
- Buoyancy
- Surface Tension
- Turbulence /Streamlining
- Hydrodynamic Resistance/Viscosity
- Hydrostatic Pressure
- Hydrostatic Stability
- Refraction of light
Relative Density
Density is the mass of an object divided by what?
the volume
Relative Density
The relative density of water is what?
1
Relative Density
The relative density of the human body with the lungs inflated is between?
.95 and .974 with lungs fully inflated (will float)
Relative Density
The relative density of the human body without lungs inflated is between ?
1.050 and 1.084 without lung inflated (will sink)
Spastic muscles appear more dense
will they sink or float?
sink
Flaccid muscles appear less dense. will they sink or float?
float
Temperature of water
92-96 degrees desired for patients who are?
- less active.
Temperature of water 89-92 degrees desired for patients who are ?
moderately active.
Temperature of water 84-89 degrees desired for patients who are?
athletic.
Temperature of water Warmer temperatures help what 3 things?
- decrease tone
- promote relaxation
- assist in decreasing fear
Temperature of water Cooler temperatures help stimulate what 2 things?
tone and alertness
a force that works in the opposite direction of gravity
Buoyancy
what principle is this?
When a body is wholly or partially immersed in a fluid at rest it is acted upon by a buoyant or lifting force equal to the weight of the displaced fluid.
Archimedes’ Principle
Buoyancy Allows for the adjustment in weight bearing activities. What art the percentages o body weight reductions?
if
Waist deep water
Chest deep water
Neck deep water
50% reduction in body weight-Waist deep water
70% reduction in body weight-Chest deep water
80-90% reduction in body weight-Neck deep water
what are some general benefits using buoyancy of water?
- Acts as a supportive, assistive or resistive tool
- Helps of unload joints
- Ease in increased functional skills
- Ease of handling the client for the therapist.
- Force exerted between the surface molecules of a fluid and manifesting itself as an elastic skin of a fluid
- it nacts as a resistive force when a limb is submerged a must break it to move
- Work weak muscles under the surface of the water
Surface Tension
- the flow resistance is proportional to velocity (easy to move)
- the flow resistance is proportional to velocity squared (hard to move)
- can be used as resistance to exercise in the pool.
- The quicker the movement the greater this is
- The more unstreamlined to movement the greater the resistance to movement.
- When gait training the therapist should stand in front of the patient.
Turbulence /Streamlining
Hydrodynamic Resistance/Viscosity
Viscosity is the friction that occurs between the __________of a ____________?and causes _________to the flow of liquid.
- molecules of a liquid
- resistance
Hydrodynamic Resistance/Viscosity
Viscosity acts as a resistance to what?
movement
Hydrodynamic Resistance/Viscosity
Water provides 12 times the resistance of what
air.
Hydrodynamic Resistance/Viscosity
Can be used to progress strengthening exercises how?
- increase the surface area
- lengthen the lever arm
- increase the speed of movement.
Hydrodynamic Resistance/Viscosity
Allows more time to what?
correct for a loss
Hydrodynamic Resistance/Viscosity
Increases what kind of feedback ?
proprioceptive
pressure of a fluid (the compressive pressures exerted by molecules of a fluid upon an immersed body)
Hydrostatic Pressure
Hydrostatic Pressure
Pressure increases with what?
depth
Hydrostatic Pressure
what law states :Fluid pressure is exerted equally on all surfaces of an immersed body at rest at a given depth.
Pascal’s law:
Hydrostatic Pressure
Pressure increases 1mmHg/1.36 cm (.54”) or 88mmHg in how many feet of water?
4’ of water.
Hydrostatic Pressure
what are some benefits ?
- Builds muscles of respiration
- helps reduce edema
- helps decrease blood pooling in lower extremities.
Hydrostatic Pressure
you will Need to use caution with patients with?
- weak intercostals
- poor vital capacity
Balance is stillness in water is ?
Hydrostatic Stability
Hydrostatic Stability
what law? An object will reach a stable equilibrium when the center of gravity and the center of buoyancy are aligned in the same vertical plane.
Bougier’s Theorem:
Hydrostatic Stability
what law? An object/person will continue to rotate until the center of gravity and buoyancy are aligned.
Metacentric effect:
Hydrostatic Stability
A person with spastic hemiplegia will roll to the what side?
the affected side
Hydrostatic Stability
A person with edema will roll which way from the affected side ?
away
the bending of a ray as it moves from a more dense to a less dense medium (the ray bends away from normal at a right angle)
Refraction of light
**Refraction of light **
Body images are ___________ in the water ?
distorted
**Refraction of light **
Limbs may look 25% larger and closer to the water’s surface.
What does this make difficult?
Monitoring joint position
Body’s Response to Immersion :Cardiovascular system
Hydrostatic pressure produces a lesser or greater venous pressure?
greater
Body’s Response to Immersion Cardiovascular system
Cardiac and stroke volume increases or decreases?
increase
Body’s Response to Immersion Cardiovascular system
Blood volume increases or decreases?
increases
Body’s Response to Immersion Cardiovascular system
Heart rate is influenced by many factors and is not a good indicator of what?
exertion
Pulmonary system
- Hydrostatic pressure places resistive forces on ________ __________?
- Vital capacity decreases about ____%with immersion to the neck
- Total work of breathing increases ___% with immersion to the neck.
- Respiratory rate increases or decreases?.
- Increase or decrease in O2 consumption ?
- inspiratory musculature
- 10%
- 60
- increases Respiratory rate
- Increase O2
Body’s Response to Immersion Musculoskeletal system benefits?
- Ease of ________?
- Lymph and extracellular fluids are _______?
- Blood supply to muscles is increased or decreased?
- Increased or Decreased joint compression?
- Muscle relaxation may occur in warmer or cooler water?
- movement
- mobilized
- increased blood supply
- Decreased joint compression
- warmer water
Body’s Response to Immersion cont.:Renal system
- Increased urine output with ______ and _______ of water
- Sodium and potassium loss or gain?
- Suppression of what?
- increased or Decreased antidiuretic hormone (ADH)
- time and depth of water
- loss
- thirst
- Decreased
Body’s Response to Immersion .:Nervous system
what are the two benefits for the nervous system?
- Relaxation
- Increase in pain threshold
name 10 Benefits of Aquatic Physical Therapy ?
- Relaxation/Pain management
- Stretching/ROM
- Strengthening
- Balance
- Sensory input/Body awareness
- Arousal
- Coordination
- Respiratory strengthening
- Endurance
- Circulation
Precautions/Contraindications
- Fever
- Infectious disease
- Open wounds
- Skin infections
- UTI
- Uncontrolled cardiac issues
- Uncontrolled seizures
- Incontinence
- Severely limited vital capacity
- Behavioral problems
- Uncontrolled diabetes
- Aspiration/absence of cough reflex
- Tracheotomy
- Ear infections
- Skin and respiratory sensitivity to pool chemicals
- Hearing aids and contact lens
- Fear of water
what are the Appropriate Patients for the Aquatic Setting?
- Orthopedic (pre and post surgical)
- Neurological injuries (CVA, spinal cord, TBI)
- Arthritic patients
- Muscular dystrophy (46 types determined by the MDA)
- Amputees
- Multiple sclerosis (need to be in cooler temperature water, 88 degrees or cooler)
- Fibromyalgia/pain management
- COPD/Asthma/cystic fibrosis
- Pediatric (down syndrome, cerebral palsy, autism, seizure disorders, developmental delays)
- Geriatrics
What method of techniques is this ?
Started in 1950 in London England at a School for Crippled Girls. Started with 12 girls ranging in age from 9 to 15 years with various disabilities. Using the properties of water and interrelating bodies of various shapes and sizes with water , with control skill and safety the 10 point program was developed.
The Halliwick Method
Techniques cont. Halliwick
10 point program: what is included?
- Mental adjustment
- Disengagement
- Transversal rotational control
- Sagittal rotation control
- Longitudinal rotation control
- Combined rotation control
- Upthrust
- Balance in stillness
- Turbulent gliding
- Simple progression and basic swimming movements
True or False: The Halliwick 10 points method uses flotation devices
false
What Technique was Developed in 1980
It is a passive form of aquatic physical therapy that supports and gently moves a person through warm water in graceful, fluid movements. It promotes a deep state of relaxation with changes in the automatic nervous system (quieting the sympathetic nervous system and enhancing the parasympathetic nervous system)
WATSU
What method of technique helps…..
- decrease muscle tension and increases range of motion. The support of the water provides relief from compression forces in the joint.
- The movements provide a gentle stretch into all ranges of motion for the spine and extremities, all while the joins are unloaded.
WATSU
TRUE OR FALSE: the WATSU technique uses floataion devices?
False
what method or technque?
- Has a long refining history. The basic concept started in the waters of Switzerland starting in 1240.
- In the 1930’s knowledge of the medical benefits of movement were identified on land. Shortly after this discovery patients were placed on plinths and placed in the water to provide resistance to their movements (one dimensional movements).
- In 1950 the use of flotation rings were used and medical professionals directed the patients in their movements, focusing more on strengthening and stabilizing exercises.
Bad Ragaz Ring Method
what method or technique?
- With the introduction of proprioception neuromuscular facilitation (PNF) in 1968, three dimensional movements, the development of the this Method was formulated in 1975.
- This method uses flotation devices on the wrist, ankles, waist and neck.
- Very specific patterns have been established.
- Three categories of techniques: passive, isometric stabilization, isotonic movement (assisted, supported, resisted)
Bad Ragaz Ring Method
TRUE OR FALSE: the Bad Ragaz Ring Method uses floatation devices?
TRUE
What Method?
- This method is an active therapeutic approach using gravity and buoyancy to facilitate healing and minimize dysfunction for patients of all ages, levels and diagnosis.
- “Exercise for life, for pleasure, not as something you have to do. Regular exercise that activates the 6 essential qualities is not medicine- it is a description of a positive necessary interaction between you and your surround. It will help you live and stay healthy in a stressful, challenging world”
The Burdenko method
Developed by Igor Burdenko Ph.D.
name Burdenko Method Basic 9 Principles
- Work in the vertical position
- Incorporate deep water when possible
- Incorporate whole body exercises
- Work in multiple directions
- Vary the speed
- Exercise on land and water
- Build up to 30 repetitions
- Don’t hit a limit, Don’t go through pain
- Develop & maintain the 6 essential qualities
Burdenko-6 Essential Qualities of Movement
Level 1 = Balance
Level 2 = Coordination
Level 3 = Flexibility
Level 4 = Endurance
Level 5 = Speed
Level 6 = Strength
What method or technique?
- Myofascial release technique performed in shallow water.
- Theoretically breaks down fascial adhesions using therapist manual pressure and patient active movement.
- Quickly restores flexibility, reduces pain, creates relaxation to improve function, quality of life, and sleep – all required to heal.
AquaStretch
AquaStretch
4 theories
as to why it works
- The body’s enhanced flexibility in the water
- Intuitive movements
- The use of variable “stretching resistance”
- The fascial adhesion Theory
AquaStretch: 4 step procedure
- Play
- Freeze
- Pressure
- Move
what do you need to know about Equipment ?
- You need to understand how the equipment will **effect your patient and how it relates to the goals. **
1. You need to know how to place a flotation device for the desired effect.
2. A variety of equipment is necessary for different body types.
- There are no standard aquatic therapy pool, each facility has a different setup.
- There are a variety of types of pool (chlorine, salt, hydrogen peroxide).
What do you need to know about the pool?
- You need to understand how to operate the____1___ ______, if one is present, before you put the patient in it.
- You need to know what water ___2___ works best for your body type.
- pool lift
- height
Take care of yourself:
- It is recommended that a therapist only spend __consecutive hours in a pool.
- It is recommended to have a ____ _____ present and that the treating therapist have training.
- Wash off your _____ after exiting the pool with a mild soap.
- If the pool is outdoors, wear sunglasses to protect your eyes from the sun ________ off the water.
- If the pool is outside wear a _________ on exposed skin and a protective cover up.
- See a ____________ yearly (moles and skin fungus).
- Drink ________
- 4
- life guard
- skin
- refraction
- sunscreen
- dermatologist
- water.
Documentation and Goals
- Documentation is your best _________!!
- The more _______&_______ you are in your documentation, the better covered you are legally.
- _______________ with the PT is critical in order to progress the patient out of the aquatic setting.
- Goals need to be ________ based, so the aquatic exercises need to promote them.
- defense
- precise and detailed
- Communication
- land
CPT Code/reimbursement:
Most Aquatic physical therapist are PTA’s because…
PTA’s are typically paid less then a PT
Note - # codes below are the same code
CPT code_________ (aquatic therapy with therapeutic exercise) pays a higher rate.
(This equals more money for the facility)
CPT code _______needs to be used for billing unless the code is not acceptable by that specific insurance company.
97113
What IS A MUST!!?
Visit the APTA Aquatic Section website for audio conferences, CSM and Summit programming. www.aquaticpt.com
ATRI has classes for beginners. Classes are expensive! If you volunteer to moderate the classes the tuition is reduced, but you may not be in the class that you wanted. www.atri.org
Aquatic Therapy University. www.aquaticnet.com
World Aquatic Health Conference. www.WAHC.com
Continuing Education
Conclusion of Aquatics fyi
- Be safe
- Remember and use the basic properties of water
- Remember the effects of immersion on the body
- Take continuing education
- Join and be active in the APTA
- Have FUN!!
marco
k&c
Goals and idications for aquatic exercise
- facilitate range of motion
- initiate resistance training
- facilitate weight-bearing activities
- enhance delivery of manual tech
- provid three-dimensional access to the pt
- facilitate cardio exercise
- initiate fuctional activity replication
- minimize risk of injury or reinjury during rehab
- enhance pt relaxation
k&c
precautions
fear of water- be mindful
neurological disorders- ataxic pt, controlled epilepsypt must RX, heat intolerance pt
respiratory disorders- may adversely effect breathing, lung expansion tends to be inhibited.
cardiac dysfunction- angina pts, abnormal BP, heart disease, or compromised pump mechanisms closely monitor
small, open wounds and lines- open wounds and tracheotomies may be covered by waterproof dressings. Lines required proper clamping. Watch g-tubes and suprapubic appliances adverse reactions
K& C
contraindications for aquatics
- incipient cardiac failure and unstable angina
- respiratory dysfunction, vital capacity of less than 1 liter
- sever peripheral vascualr disease
- danger of bleeding or hemorrhage
- sever kindney disease
- open wounds
- uncontrolled bowel or bladder
- menstruation without internal protection
- water and airborne infections or diseases(ex:flu,gastro infections, typhoid, cholera , and polio)
- uncontrolled seizures during the last year
Name some aquatic devices
- collars, rings, belts, and vests
- swim bars ( dumbbells)
- gloves, hand paddles, and hydro-tone balls
- fins and hydro-tone boots
- kickboards
name some stretching exercises
- manual stretching techniques
- spine stretching techniques
- shoulder stretching techniques
- hip stretching techniques
- knee stretching techniqes
- self-stretching with aquatic equipment
Spine stretching techniques:
What motions?
cervical spine flexion
cervical spin lateral flexion
thoracic and lumbar spine lateral flexion
shoulder stretching techniques
what motions?
- shoulder flexion
- shoulder abduction
- shoulder external rotation
- shoulder internal rotation
hip stretching techniques.
what motions?
hip ext
hip external rotation
hip internal rotation
knee stretching techniques
what motions are being stretched
- knee ext w/ pt on steps
- knee flexion w/ pt on steps
- knee flexion w/ pt supine
- hamstings stretch
self-stretching w/ aquatic equipment
- shoulder flex-dumbell or wrist strap
- shoulder abd-dumbell or wrist strap
- hip flex-dumbbell or ankle strap
- knee ext-dumbbell or ankle strap
- knee flexion-dumbbell or ankle strap
manual resistance exercises typically occurs in a
- concentric or eccentric
- closed or open chain
fashion?
- concentric
- closed
deep water equipment
most common device for deep water running is ?
the flotation belt positioned posteriorly
deep water devices
Pts presenting w/ injuries or sensitivity of the runk may require tan alternative buoyant deve such as…?
- vest
- flotation dumbbells
- noodles
deep water equipment
providing the pt with smaller buoyant equipment requires the pt to ?
work harder to maintain adequate buoyancy, thereby increasing the intensity of the activity.
