Aquatic Therapy Flashcards
What is the oldest date we have for aquatic therapy?
2400 to 1500 BC: Ancient Greece, Rome, Egypt
What are the main principles/properties of water therapy to keep in mind
- Buoyancy
- Hydrostatic Pressure
- Viscosity
- Surface Tension
- Hydromechanics
- Thermodynamics
- Density
- Center of Buoyancy
Define aquatic therapy
aquatic therapy defined as use of water for rehabilitation purposes
Discuss the properties of buoyancy
upward force that works opposite to gravity
- Archimedes’ principle (an immersed body experiences an upward thrust equal to the volume of liquid displaced)
- The amount of offloading is proportional to the depth of immersion and is easily modified by changing the depth of immersion.
- Resistance to movement occurs when an extremity is moved against the force of buoyancy. (can be used to strengthen muscles)
- The amount of air in the lungs will affect the buoyancy of the body.
- Body composition (fat tissue, bone density) affects buoyancy.
buoyancy reduces joint loading which can allow early participation in exercise after injury or surgery that may be too difficult to perform on land?
for pts with restricted weight bearing, buoyancy provides rleative weightlessness, postural support, and joint unloading by reducing the force of gravity on the body, allowing them to perform therapeutic exercises or activities
Describe the amount of offloading that occurs with buoyancy and reasons for different numbers
C7-reduces weightbearing to
5.9-10% body weight
Sternum-reduces weight-bearing to 25-37% body weight
asis-reduces weight-bearing to 40-56% body weight
think about trying to push a large floating object under water ; you had? to use force to submerge the object because of buoyancy
part of the reason there’s a large range of numbers for the amount of body weight offloaded is because of the amount of air in the lungs that will affect buoyancy of the body
fully inflated lungs cause increased buoyancy and deflated lungs cause decreased buoyancy
pts with increased fat tissue which has a lower specific gravity than muscle will have increased buoyancy
pts with increased bone density will have less buoyancy than those with decreased bone density
list properties of hydrostatic pressure
- Pascal’s law (states that pressure exerted by? fluid on an immersed object is equal on all surfaces of that object )
- Pressure is exerted in all directions. (and on all surfaces of the submerged body )
*Reduces effusion, assists venous return, induces bradycardia, and centralizes peripheral blood flow.(due to the fact that hydrostatic pressure is more peripheral when immersed in water?; therefore immersion can assist cardiac and respiratory function due to increased venous return and centralized blood flow ) - Increases blood volume in the chest, may make breathing more difficult. ( when the body is immersed to the chest or higher?)
- Resistance to chest expansion and can help train respiratory muscles. (hydrostatic pressure over the chest area when immersed )
- Exercise is easier when closer to the surface. (since pressure increases as depth increases)
- May provide a form of sensory input.
when our body’s immersed in water, we’re exposed to considerable higher pressure bc water has greater mass than air ; this pressure increases as the depth of immersion increases; so if you’re standing in water up to your neck, you’ll experience approximately 2x the hydrostatic pressure on your calf muscles than your chest
what’s hydrostatic pressure
pressure exerted by the water on immersed objects
describe the principles of viscosity
- Water viscosity provides a means to resist movement.
- Increasing speed of movement will increase the resistance to movements.
- Increasing the surface area moving through water increases resistance.
moving on to viscosity, its the magnitude of internal friction of a fluid during motion ; the cohesive or attractive forces between water molecules results in viscosity
this affects the body by providing resistive drag forces opposite to the direction of movement when moving in water ; so this means that water’s viscosity creates resistance with all active movements
imagine trying to run in waist deep water versus running on land
the viscosity is the principle that resists you as you try to move forward ; the amount of resistance is proportional to the speed of the movements
so as you attempt to run faster, you will experience more resistance
viscosity is also proportional to the surface area of the body moving in the water meaning a larger object will experience more resitance than a smaller object as it moves through water becasue it has more surface area ; lets look at some of the clinical signficance of viscosity - water viscosity provides a means to resist movement which means this principle is key when our goal is to improve a patients strength ; increasing speed of movement will increase the resistance to movements; increasing the surface area moving thorugh water increases resistance
moving an extended arm with an open hand will have more resistance than moving a flexed arm with a closed hand ; use of equipment such as a paddle to increase the surface area will increase the amojnt of resistance to mvoement ?
describe surface tension
- The force of the resistance changes proportionally to the size of the object moving through the fluid’s surface.
- An extremity that moves through the surface of the water performs more work than if kept under water.
- Using equipment at the surface of the water increases the resistance.
let’s look at clinical signficance of surface tension - an extremity that moves through the surface of the water performs more work than if its kept underwater
early in rehabilitation, you may want to consider avoiding moving surface of the water and introducing it later as a progression
using equipment at the surface of water increases the resistance
define/describe surface tension
surface tension- the attractive force exerted upon the surface molecules of a liquid by the molecules underneath
surface tension is caused by cohesiveness and attraction between liquid molecules which acts as a membrane under tension
the force of the resistance changes proportionately? to size of object moving through the fluid surface , so larger objects will exhibit more surface tension resistance
differentiate between laminar flow, turbulent flow, and drag flow
- Laminar flow =steady, continuous in one direction
- Turbulent flow =chaotic changes in pressure and flow
velocity - Drag flow=cumulative effects of turbulence and viscosity acting on an object in motion
hydromechanics refers to movement through water
as an object moves through water, the water moves and we call this movement flow, which includes laminar flow , turbulent flow, and drag flow
laminar flow also called streamline flow?
besides the three different types of flow, list some other properties/considerations for hydromechanics
- As the speed of movement through water increases, resistance to motion increases.
- Moving water (past? a person? ) requires a person to work harder to maintain their position.
- Equipment can increase drag and resistance as a person moves through water.
- Resistance to movements increases as the velocity of water movement increases.
one way to decrease drag initially would be for the therapist to walk with the patient in the water and the therapist’s in the front to decrease the resistance felt by the pt ?
gait training can be progressed by the therapist walking beside or behind the pt
application of equipment such as a glove , paddle, or boot, increases the drag resistance as pt moves an extremity through water
resistance to movements increases as the velocity of water movement? increases
describe properties of thermodynamics as they relate to water
- Water can rapidly heat or cool the body.
- Water can retain heat or cold while
delivering it to an immersed body part. - Exercising in a water temperature that is cooler than body temperature will result in significant heat loss.
- Heat transfer increases with velocity.
water’s heat capcity is 1000x greater than heat capacity of air and higher than that of human body tissues ; water’s also an efficient conductor and transfers heat 25x faster than air
this means that if air temp and the water temp are same, there’lll be more heat loss in water than in air
clinically- water can rapidly heat or cool the body , becasue water can retain heat or cold while delivering it to immersed body or body part , it can be a good choice for tx modality
exerciscing in water temp that’s cooler than the body temp will result in signifcant heat loss ; heat transfer increases with velocity ?
so a pt moving through water loses body temp faster than an immersed pt at rest
another thing to consider- exercising in warm water will help transfer heat to superficial tissue and increase blood flow which can be used to decrease pain , decrease muscle spasms and increase superficial muscle?? tissue extesnsiblity
exercising in? cooler water may transfer body heat and during exercises and can allow a person to exercise more without causing eleveated body temp and exhaustion
keep this in mind- if goal is to increase intesntiy and duration of an exercise , some pts, such as those with multiple sclerosis, have heat sensitivity, and an elevation in body temperature that occurs during exercise can be dangerous
a cool water temperature can facilitate greater success with exercise in these pts with less core body temperature elevation
on the flip side, inappropriate water temperature may interfere with capacity to exercise, so for example exercising in water that’s too warm may result in increased body temp and fatigue,
describe water density
- Mass per unit of volume
- Water has a density of 1.0 grams per
milliliter - Muscle has a higher density than fat
- Bodies with high density tend to sink more than bodies with less density
density defined as mass per unit of volume
water has density of 1.0g/ml
anything less than 1.0 will float in water and anything greater than 1.0 will sink
human body tends to have density thats slightly less than that of water at about 0.974 which allows most people to float in water but variation exists between people based on their body composition because muscle has higher density than fat
main clinical significance- bodies with high desntiy tend to sink more than bodies with less density
describe center of buoyancy
- Posteriorly placed buoyancy devices cause forward lean; anteriorly placed buoyancy devices cause backward lean.
- Unilateral manual resistance exercises will cause the patient to revolve around the practitioner in a circular motion.
- A patient with a unilateral lower extremity amputation leans toward the residual limb side when in a vertical position.
- When upright in water, the center of buoyancy is aligned with the center of gravity and a person is stable. Small perturbations may cause loss of balance.
center of buoyancy - reference point of an immersed object on which buoyant or vertical forces of fluid predictably act
in water, body is affected more by center of buyoancy, not center of gravity
for a person standing in neck deep water, their center of buoyancy is at level of sternum
clinically - bc center of buoyancy is higher in vertical position, , posteirorly placed buoyancy devices ? will cause a person to lean forward , and anteriorly placed buoyancy devices will cause pt to lean backward?
during unilateral manual resistance exercises , pt revolves around practioner in a circular motion
pt with unilateral lower extemity amputation leans toward residual limb side when in vertical position?
in vertical position wehn center of buoyancy’s aligned with center of gravity , pt’ll be stable, however small amount of perturbation may cause pt to lose balance
s unilateral perturbater results in body rotation and may result in loss of balance?
list goals and indications of aquatic therapy
- Facilitate range of motion exercises
- Facilitate resistance training and improve strength
- Facilitate weight-bearing activities
- Enhance the delivery of manual
techniques - Facilitate cardiovascular exercise
- Minimize risk of injury or reinjury
during rehabilitation - Enhance patient relaxation
- Decrease anxiety or fear of falling (by allowing movement against gravity?)
- Facilitate balance, walking, and
functional activity training - Relieve pain and muscle spasm
purpose of aquatic exercise- facilitate functional recovery through an environment that augments therapeutic interventions
still needs more research regarding temrpature, depth of immersion and care settings
list precautions for aquatic therapy
- Fear of water (for these pts education’s key) (fear can cuase muscle guarding, stress response, and improper form while exercising which can exacerbate a pts sx)
- Neurologic disorders
- Seizure disorders
- Respiratory disorders
- Cardiac dysfunction
- Small open wounds
- G-tubes
- Colostomy
- Bladder or bowel disorders
- Menstration
if you do proceed in light of these precautions , still need to closely monitor and be ready to stop if necessary
many pts with neurologic disorders present with balance and mobiltiy deficits and could benefit from the aquatic environemnt; however, consider the pts ability to safely enter and exit pool
pts with multiple sclerosis are heat intolerant and may fatigue when immersed in warm water temp
when working with individuals who experience seizures , have a plan in place so you can get the pt out of the pool safely in case there’s a seizure
water immersion may adversely affect breathing for a pt with a respiratory disorder
maximal oxygen uptake is lower during most forms of water exercise than during land exercise
there’s several physiologic reponses involving the respiratory system in response to immersion
lung expansion tends to be reduced due to hydrostatic pressure against chest wall and centralization of blood flow in chest cavity may further inhibit lung expansion
pts with angina , abnormal bp, heart disease, or compromsied pump mechanisms require very close monitoring
small open wounds and tracheotomies may be covered by water proof dressings
intravenous lines and other oepn lines require proper clamping and fixation
precautions should also be exercised with patients who have g tubes and colonostomies can be covered with occlusive dressings but pts should be closely monitored
pts with uncontrolled bladder or bowel disorders can exercise by emptying bladder before entering pool and use of swimming diapers or proper protection
pts with menstruation or vaginal bleeding can participate with use of swimming diapers and proper internal protection
list contraindications for aquatic therapy
- Incipient cardiac failure and unstable angina
- Severe respiratory dysfunction,vital capacity of
less than 1 liter - Severe peripheral vascular disease
- Danger of bleeding or hemorrhage
- Severe kidney disease
- Water and airborne infections or diseases
- Some dermatological conditions and skin infections
- Contagious diseases
include any situation creating high risk of potential for adverse effects to either the pt or the water environment
some factors listed here but may be more - always use your clinical judgment as to whether water immersion will be safe and effective for pt
describe water temperature regulation
Cold water
* Decreases heart rate and cardiac output
* Increases peripheral resistance
* Increases oxygen consumption
and metabolism
* If <25°C = unable to maintain core warmth
Hot water
* Increases cardiac output
* Increases blood flow
* Decreases peripheral resistance
* Increases oxygen consumption and metabolism
* If >37°C = exercise is harmful
describe how water temperature needs change depending on exercise type
Mobility and Functional Control Exercise
* Flexibility, strengthening, gait training, and relaxation: between 26°C and 35°C.
* Acute painful musculoskeletal injuries: performed in warm water (33°C)
Aerobic Conditioning
* Cardiovascular training and aerobic exercise: between 26°C and 28°C.
* Intense aerobic training (performed above 80% of a patient’s max HR): between 22°C and 26°C.
pool temps between 28 degrees and 31 degress celcius usually comfortable for most types of water exercise
you should choose the water temp based on your pts impairments , diagnosis, type of exercise and intervnetion goals
in general, cooler temps should be used for higher intensity exercsie with warmer temps for relaxation , mobility, or flexibility exercise
cooler water temps also used for athletic training and recovery to minimize effects of overheating
young children and aging adults typically perform a warmer water temp
describe aquatic pools themselves
pools used for aquatic therapy vary in shape, size, design, some equipped with features such as movable pool floor?, water flow system for resistance, or built in water treatdmill system
other pools designed for safe entry and exit with ramps or gradual steps or handrails
external equipment such as a mehcanical lift can also be used to safely get pts in and out of pool
traditional therapeutic pools like image on left measure at least 100 ft in legnth and 25 ft in width with depth of 3 to 4 ft sloping down to 9 or 10 ft ?
there’s also smaller self-contained pools for individual use as seen in image on right
describe equipment for aquatic therapy
Equipment for Aquatic Exercise
* Buoyancy equipment
* Collars, rings, belts, vests
* Buoyant dumbbells
* Resistance equipment
* UE: Gloves,hand paddles,
Hydro-Tone® bells
* LE:Fins,Hydro-Tone®boots
* Kickboards * Weights
* Under water treadmill
* Parallel bars
list of some of the available aquatic equipment which your book details
aquatic equipment can be used to increase buoyancy , assist with balance, or generate resistance to movmenet
may include ressitive paddles , floats, paddle boards, or weighted chairs,
when you understand the properties of water you can progress exercise intensity simply by adding or removing euqipemnt
as with interventions on land, type of euiqpemnt used is determined by the current functional level of the pt and specific therapy session goals
textbook details specific therex interventions using an aquatic environement and she encourages us to read about these techqnieus
describe the studies she talked about for aquatic therapy
- Orthopedicsurgery(Villaltaet.al., 2013)
orthopedic pts- villata? et al sr of controlled trials evaluating effects of aquatic physical therapy on adverse events for adults less than three months after orthopedic surgery ; for this study, they included any ortho surgeries, ? found that after ortho surgery, aquatic physical tehrapy improves fucntion and doesn’t increase risk of wound related adverse events and is effective as land-based thearpy in terms of pain, edema, strength, and rom ? in the early post-op period ?
*Childrenwithcerebralpalsy(Roostaei et. al., 2017; Lai et. al., 2015)
did sr to examine effects of aquatic intervention on gross motor skills in children with cerebral palsy
found that the evidence on aquatic interventions for ambulatory children with cp is limited but aquatic exercsise is feasible and advesre effects minimal
another study used a controlled trial to investigate aquatic therapy for children with spastic cerebral palsy finding a signficant improvement in gross motor function for those who participated in aquatic teharpy versus control group?
- Stroke(Nohet.al.,2008)
in randomized control study, known colleagues? noh and colleagues? evaluated effect of aquatic tehrapy on balance for pts with stroke ; they found signficiant imrpvoements in measures of balance such as berg balance scale for aquatic thearpy group ?
*Coronaryarterydisease(Volakliset.al., 2007)
for pts with coronary artery disease, volkalkis et all examined effects of combined resistance and aeoribc training on land versus same treatment in water, found that exercsie programs that combine resistance and aerobic exercise performed either on land or in water can both improve exercsie tolerance and muscle strength in pts with coronary artery disease ?
