Aquatic Therapy 1 Flashcards
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
CPT code for aquatic?
YES!
97113
Aquatic therapy vs. exercise - THERAPY
Completed by a skilled/licensed PT/PTA
Focus on functional limitations/impairments
Most insurers will reimburse
Requires CDM
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
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
Buoyancy - longer lever arm
With longer lever arm - increases!
Buoyancy - Density/mass
More mass = you will sink (less buoyant)
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
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
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
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
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
Buoyancy - clinical relevance - order (after assisted is what)
Supported
Clinical relevance example with Buoyancy - want shoulder flexion - now supported, what position?
Sidelying
Water/Buoyancy is supported the arm
Clinical relevance example with Buoyancy - want shoulder flexion - now resist, what position?
Prone with 90 flex to ext
Buoyancy - clinical relevance - Body weight unloading - static - if up to C7 you are unweighted how much
90%
Buoyancy - clinical relevance - Body weight unloading - static - Xiphosternum
75 - 60%
Buoyancy - clinical relevance - Body weight unloading - static - ASIS/Umbilicus
50%
Buoyancy - clinical relevance - Body weight unloading - static - Symphysis pubis
40%
Buoyancy - clinical relevance - Body weight unloading - Slow walk - clavicular area
75%
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?
Buoyancy - clinical relevance - Body weight unloading - Slow walk - ASISs
25%
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
