Aquatic Therapy 1 Flashcards by Alex Stein

Aquatic PT is what

Active or passive techniques using water as main medium

AMA says - therapeutic procedure which attempts to improve function through the application of aquatic therapeutic exercises

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CPT code for aquatic?

YES!

97113

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Aquatic therapy vs. exercise - THERAPY

Completed by a skilled/licensed PT/PTA
Focus on functional limitations/impairments
Most insurers will reimburse
Requires CDM

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Aquatic therapy vs. exercise - EXERCISE

Performed by anyone
Maintain/improve general strength/conditioning
Self pay
Does not require CDM - is a progression from aquatic therapy

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Buoyancy - ___ principle and what is it

Archimedes!

When a body is wholly or partially immersed in a fluid, the body will experience an upward thrust equal to the weight of the fluid displaced

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Buoyancy - longer lever arm

With longer lever arm - increases!

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Buoyancy - Density/mass

More mass = you will sink (less buoyant)

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Buoyancy - Center of Buoyancy

COG - umbilicus

COB - more at T11 - so gives a little bit of a rotational force since they are not in alignment

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Buoyancy - Effect of breathing

Increase air in system - breathe in - COB shifts down

So the more air in your lungs, the more buoyant you are

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Buoyancy - ex of someone laying on their back and you want to get them standing - what do you do with breath

Breath out - decrease Buoyancy and they will stand

Other way (stand to supine) would have them breathe in to make them more Buoyancy

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Clinical relevance of Buoyancy

Strengthening a weak muscle

Buoyancy can be used to -

Support a movement
Assist a movement (EASIEST - START HERE)
Resist a movement

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Clinical relevance of Buoyancy - ASSIST IS THE EASIEST! - If working on shoulder flexion, how position to get the assist?

Standing (Buoyancy will help) - just think about Buoyancy and nothing else

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Buoyancy - clinical relevance - order (after assisted is what)

Supported

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Clinical relevance example with Buoyancy - want shoulder flexion - now supported, what position?

Sidelying

Water/Buoyancy is supported the arm

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Clinical relevance example with Buoyancy - want shoulder flexion - now resist, what position?

Prone with 90 flex to ext

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Buoyancy - clinical relevance - Body weight unloading - static - if up to C7 you are unweighted how much

90%

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Buoyancy - clinical relevance - Body weight unloading - static - Xiphosternum

75 - 60%

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Buoyancy - clinical relevance - Body weight unloading - static - ASIS/Umbilicus

50%

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Buoyancy - clinical relevance - Body weight unloading - static - Symphysis pubis

40%

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Buoyancy - clinical relevance - Body weight unloading - Slow walk - clavicular area

75%

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Buoyancy - clinical relevance - Body weight unloading - Fast walk to get 75% offloading - be at

About C7

(compared to slow walk which was clavicular area for 75% off loading)

So if walk fast have to be deeper to get more offloading?

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Buoyancy - clinical relevance - Body weight unloading - Slow walk - ASISs

25%

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Buoyancy - clinical relevance - Body weight unloading - Fast walk - 50% off loaded - be at

Xiphoid process

Buoyancy - clinical relevance - Pain - benefit?

Decrease splinting/guarding
Motor activity for postural muscles
Decreased compressive forces on joints

Buoyancy - clinical relevance - Post surgical - benefit?

Early gait training | Access to body parts

Buoyancy - clinical relevance - Balance/Strengthening - benefit?

Promote ease of handling patients Can work on eccentric control when use buoyant equipment (concentric without equipment)

Relative density is what

Ratio of the mass of an object to an equal volume of water

``` Relative density of water is what? Fat? Bone? Muscle? Human body avg? ```

``` Water = 1.0 Fat = 0.8 Bone = 1.5 Muscle = 1.5 Human body avg. = 0.95 - 0.97 ```

Relative density - person with more adipose will float or sink?

Float | More adipose - they are less dense than water, so they will float

Relative density - person with more muscle will float or sink?

Sink | Muscle is more dense than water

Relative density - people typically tend to

Float | Human = 0.95 to 0.97 so less than 1.0, so float!

Relative density - clinical relevance ``` mm vs adipose OP kyphosis/scoliosis spastic flaccid resp status pt comfort ```

Body size/composition - Inc mm bulk vs. adipose - OP = FLOAT (losing mass of bone) - Kyphosis/scoliosis SINK (bony mass in one area, won't take in as much air) - scoliosis - tend to rotate - Amputation (rotate to amp side) Spasticity vs. Flaccid (spastic = SINK - short lever arm and tight, flaccid = FLOAT) Respiratory status (INC air in lungs = FLOAT more) Pt comfort in water (sink if fearful)

Hydrostatic pressure =

Pascals law! | When a body is immersed in water, there is a pressure exerted by the fluid upon the tissues at rest and at a given depth

Hydrostatic pressure - TWO things affect the pressure - what are they

Density of the fluid - Denser the fluid, the more pressure Depth of the immersion - the deeper you go, the more pressure

Hydrostatic pressure - salt water pool vs. regular

More hydrostatic in salt water pool

Hydrostatic pressure = greatest external pressure

4 feet at the deepest point (so at feet) - 88 mm of pressure Increase in venous return Hydrostatic pressure is greater than venous return - this is good for decreasing edema

Hydrostatic pressure - clinical relevance - resp implications

Will make it harder to breathe! Harder for them to take deep breath because of pressure on the wall Facilitates exhalation!

Hydrostatic pressure - clinical relevance - resp implications - Vital capacity

If they have vital capacity lower than 1500 ml they will have trouble breathing in pool - so either float them, or don't go as deep

Hydrostatic pressure - clinical relevance - resp implications - edema

Beenfit for those with venous insufficiency - will help with return up to core

Hydrostatic pressure - clinical relevance - resp implications - cardiac

``` Results in increased preload to heart increased SV (same CO though - so HR goes down) ```

Hydrostatic pressure - clinical relevance - resp implications - sensory system

Effect with desensitization - getting pressure in that area

Good to do if want to increase return to core from LEs

Exercise in deep water

Viscosity is what

Friction that occurs between the molecules of a liquid and causes resistance to the flow of a liquid

Viscosity - moledules adhere to

surface of body moving through the liquid

Viscosity - water vs. air

Water is 12 x more viscous than air So harder to move in water than air But easier in water than air because of buoyancy

Hydrostatic pressure - Pt on dialysis or lasix - with the venous return to the core

Need to watch for them becoming hypotensive

Viscosity - if you have more movement in the water - you add

more turbulence which creates more drag

Change viscosity by changing what

Medium - more viscous in salt water | Temp - inc temp, dec viscosity

Viscosity - clinical relevance

Strengthening Weight bearing Balance

Viscosity - clinical relevance - Strengthening

Progressive resistance exercise program Resistance = force exerted (isokinetic) Exercise resistance in 3 dimensions

Viscosity - clinical relevance - Weight bearing

Drag - stimulates skin receptors, GTOs and mm spindles | Rapid mvmnt with resistive devices = quasi WB moment

Viscosity - clinical relevance - Balance

Movement is slowed down | Slows down the movement

Hydromechanics is what

Properties and characteristics of fluid in motion Laminar flow Turbulent flow Drag

Hydromechanics - Laminar flow =

Fluid molecules slide over one another, move parallel | EASIER than turbulent

Hydromechanics - Turbulent flow =

Fluid molecules do not move parallel | HARDER than laminar

Hydromechanics - Drag =

Effect of turbulence and fluid viscosity acting on object in motion Superman cape = walking against drag

Hydromechanics - clinical relevance - you can increase of dec resistance by changing what

Change frontal SA (streamline/laminar vs turbulent) Change velocity (double velocity, takes 8x the power) Change lever arm (longer is harder) Oppose momentum (quick reversals) Use slipstream effect (drafting - easy to walk behind someone than be the person in front) Use rebound effect Work against jets