Aquatic therapy 2 Flashcards
Surface tension =
Forces exerted between the surface molecules
Clinical relevance of surface tension
Strengthening - can break the surface
- Weak muscles
- Progressions
Sensory - Increase sensory input - can work under water initially and then work towards breaking the water - gives sensory input
Refraction =
bending of a ray as it moves from a less dense to a more dense medium
Refraction clinical relevance
Visual feedback - putting them in water stops them from being able to look at their feet when walking for example
Evaluation - you have to do an eval OUT of water for this reason - distorted views in water
Water temperature
Thermoneutral water for most people is 93 F
Water temperature - special populations More active pts and pts with MS Less active pts Ther ex/arthritic conditions Pregnancy
More active pts and pts with MS - 82 to 88 F
Less active pts - 88 to 92 F
Ther ex/arthritic conditions - 92 to 96 F **
Pregnancy - 88 to 90 F
** Most pools are between 92 and 96 F
Water temp - clinical relevance
Cooler pool = if you want to get someone to be more alert
Warmer pool = relaxation
Physiological effects of immersion
Inc superficial circulation
Enhanced oxygen delivery and blood glucose to mm tissue
Increase diuresis (pt need to drink water)
Generalized mm relaxation
Dec pain and joint loading
Dec SNS activity
Dec edema
Greater potential change in core body temp
Effects of exercise and immersion
Decreased WB and impact stresses in the water
Less mm is recruited and a lower rate of work as compared to same activity as on land
Inc mobility often occurs due to dec WB stresses, relaxation
Provides a comprehensive challenge to balance, coordination, and kinesthetic mechanism
Cont effects of exercise and immersion
Provides ample opportunity for trunk and postural training
The buoyancy offers inc support of ROM and flexibility exercises
Equal resistance in all planes of motion, so that several mm groups can be worked simultaneously
CV systems effects
External water pressure exceeds venous system pressure at a relatively small depth
60% inc central volume (27-30% dentral volume)
Inc R atrial pressure
CV system effects cont.
Dec VC of blood vessels due to change in central volume
Inc pulmonary blood flow of large vessels
Inc blood volume of 33-60%
Dec in vital capacity and total lung capacity
CV system effects - Immersion to neck
35% inc in SV
32% inc in CO
CV system effects - HR dependent on
Dec HR dependent on water temp
77 F = drops 12-15 bpm
Thermoneutral = drop less than 15% HR
Warm temp = inc HR
Pulmonary system effects - submersion to neck
Pressure on rib cage dec circumference - 10%
Vital capacity dec 6-10%
Influenced by water temp
Total work of breathing inc about 60%
Pulmonary system effects - submersion to xiphoid
Expiratory reserve volume decreased by 75%
Pulmonary system effects - diaphragm
will be elevated because of the pressure - so more work to get it down
Pulmonary system effects - Diffusion capacity
is reduced
Psychological benefits
Overall physical benefits of exercise Interesting Relaxing Greater accountability with the program Fun to do Less chance of re-injury
Economical/Social benefits
40-50% reduction in rehab time
Rehab begins earlier
Pt is able to return to functional activities sooner
Indications for aquatic therapy
Poor tolerance to exercise on land WB difficulties - post op, fx/sprain Arthritis Chronic pain Multiple injuries Elite athletes MSK injuries Back pain Weakness Dec ROM EVERYTHING!
Precautions/Contraindications
* Usually contra
Absence of cough reflex or mouth closure Trach tube or open stoma* IV lines, NG tubes, external collection devices Any -ostomy Open, macerated skin, open wounds* Rash.skin condition Chemical sensitivity Environmentally communicable conditions * B/B incontinence * Infectious resp disease * Immuno compromised pt * Seizure disorder * Renal disease * Active joint inflammation - RA, Hemophilia * Fear of water *
Precautions/Contraindications - Numbers
Ejection Fraction
Vital Capacity
Fever
EF less than 25%
Vital capacity less than 1.5 L
Fever over 101
Purpose of equipment
To offer needed support/balance
To decrease the support needed by staff
To increase the intensity of the exercise
To add variety to an exercise program
To make exercise more challenging or enjoyable
To make an exercise easier
Two classifications of aquatic equipment
Equipment that uses buoyancy’s effect
Equipment that increases resistance by increasing the surface area
Aquatic equipment - the amount of resistance is determined by
Size of equipment
Shape
Speed of movement of equipment
Aquatic equipment - buoyancy
Cervical pillow Noodle Ankle or wrist cuffs Aquabelt Kickboard Styrofoam dumbbells Swimbar Inflatable ring Vests
Aquatic equipment - resistance
Swimmers paddle Aqaufins Kickboard Styrofoam Dumbbells Swimbar Ankle weights Webbed gloves Aquapaddles Hydrotone blades
Documentation
Function, disabilities, and health that may be positively affected
Pt requires skilled intervention
Water offers a therapeutic environment for interventions which is not achievable on land
Improvements made in water carry over to land
Evaluation -
Land based eval first
Give pt tour of clinic and pool
Perform eval with shoes off to analyze gait
Common pitfalls for denials
Did not demonstrate skilled intervention
Billed for 2 eval codes for same diagnosis
Duration of therapy exceeded reasonable time frame
Repetitive nature of tx
Failure to document why land alone was not adequate
Failure to demonstrate carry over
