Aquatic Therapy 3 Flashcards
Ai Chi
Flowing aquatic energy
Creator = Jun Konno (1993)
Molded after Tai Chi, Qi gong, and yogic breathing
Consists of 19 movements with increasing difficulty
Key elements to Ai Chi
Listening to inward feeling
Breath modulation
Relax (increase chi)
Ai Chi - progression
WBOS to narrow
Symmetrical to asymmetrical UE mvmnt
Small hand to large hang mvmnt
Visual control to non visual (fixate on something outside of water - progress to moving gaze)
Symmetrical trunk to rotatory trunk mvmnt
Static to dynamic COG
Ai Chi progression - positions
19 of them
Ai Chi - populations of patients
Balance or prop deficits (CVA, head injury)
Cardiorespiratory disorders (COPD, asthma)
MSK stiffness/Dec ROM (RA, OA, Fibro)
Pain (back, HA, chronic fatigue)
Stress related disorders (anxiety, depression)
Ai Chi - populations of patients - with cardiprespiratory disorders -
Need to be at mid chest level with Ai Chi
AquaStretch
Assisted stretching and myofascial release technique Performed in 3 to 5 ft of water Uses properties of water 10 step process from toe to head May use weights
AquaStretch - basic procedure (ex shoulder pain and restriction)
PLAY - in water just moving shoulder around until find painful place - then freeze!
FREEZE - they do not move! have them explain where the pain is - they direct you to the spot
PRESSURE - you apply pressure to this point that acts as the fulcrum
MOVE - you want them to move freely - not directed by PT on how to move
AquaStretch - appropriate patient populations
Fibromyalgia Joint of mm pain (arthritis, HA, fibro) Post injury/accident Post surgical patients (TKA) Psychological Spinal deformities, degenerative or herniated discs
Bad Ragaz Ring Method
Modeled after principles of PNF
Developed in Switzerland in 1950s
Horizontal tx technique - pt must be comfortable in supine position
Neck and hips supported by rings
Resistance from PT hands and drag due to mvmnt through water
Bad Ragaz ring method - explain
Slow mvmnts OR rapid mvmnts - streamline and turbulent flow are used
Unilateral and B mvmnts
Sym and Asym mvmnts
With unilateral - one limb is often isometric and the other is isotonically working
Bad Ragaz - PT position
You do not want to be too deep
Probably to about T9 area
Bad Ragaz progression
Inc ROM Hand holds proximal to distal Inc speed Lengthen lever Use combination of techniques Inc resistance Dec air in flotation devices Change SA
Pt populations for Bad Ragaz
Chronic spine problems/poor spinal stabilization
General weakness or motor control deficit
Peripheral joint problems
post surgery
Relaxation or tone reduction
Good for CHF and COPD too because get good effects but they are in supine and not have to be vertical in water
Halliwick concept
Mostly concentrated on neurological facilitation; can be task oriented
Developed by James McMillan in the 50s
Techniques based on fluid mechanics
Teaches how to maintain balance control in water
4 phases
10 stages
Halliwick concept - phases
Phase 1 = adjustment to water
Phase 2 = rotation control
Phase 3 = control of movement
Phase 4 = movement in water
Halliwick concept - phase 1
Adjustment to water
Mental adjustment - pt feel comfortable in water
Breath control
Halliwick concept - phase 2
Rotation control
Ability to maintain a position
Ability to change a position in a controlled way
Halliwick concept - phase 3
Control of movement
Balance and control
Halliwick concept - phase 4
Movement in water
Effective, efficient and directed skilled activity
Halliwick concept - patient populations
Balance deficits Gait pattern dysfunctions Dec control of voluntary mvmnt Dec mm endurance Developmental disorders (CP) mm tone dysfunctions Stabilization deficits
Watsu
Developed by harold dull in 1980s
Based on Zen shiatsu, stretching body’s meridians (energy pathways)
Very beneficial when promoting relaxation and tone reduction
Pt is cradled by the PT throughout movements
Watsu - provides what
Soft tissue stretch Vestibular stimulation Relaxation Deep tissue massage Decrease in SNS and increase in PNS
People who get watsu tx have better
Sleep
Immune system function
Digestive motility
Pt population - watsu
Restricted ROM of spine/extremities
High tone or spasticity
Pain
Stress or difficulty relaxing
NOT WITH OP patients - rotation and flexion motion = contra
Chronic LBP
Watsu - need to be careful since 100% passive
Ai Chi - can work on inc ROM and breathing
Bad Ragaz - stabilization
CVA
Ai Chi - start with unilateral
Bad Ragaz - if poor trunk control
Halliwick - can work on rotation
Spastic CVA - could do Watsu
Incomplete spinal cord
Halliick - work on trunk stability
Bad Ragaz
Mild heart failure and general weakness
Bad Ragaz - help with weakness
Ai Chi
TKA 6 months post op
Ai Chi
Halliwick
AquaStretch
OP
Bad Ragaz
NOT WATSU
Neuro population - general guidelines - Deep vs. Shallow
Deep if working on weakness deficit
Spasticity - would want to deep to get relaxation and warmth properties
Balance - progress from deeper to more shallow
Neuro population - general guidelines - Unilateral vs. B
Coordination - B
Balance - Unilateral is easier with UE support - then progress to B
Coordination B then U
Balance U then B
Neuro population - general guidelines - Distal stabilization
Have them stabilize on something that is connected and then progress to less support
Neuro population - general guidelines - Speed and excursion
Small excursions first and then progress to bigger
Start slow and progress to fast
Neuro population - considerations
Access - to the pool (stairs, zero access)
Varying depths
Temp
Pt position (cube, triangle, stick)
Neuro population - things to work on
Inc or dec tone (rotational will dec = watsu will help with dec tone) Trunk control Balance restrictions Incoordination Weakness Deconditioned Dec ROM Gait dysfunction
MSK population - Acute injury
Phase 1 - acute
Phase 2 - recovery
Phase 3 - functional phase (plyometrics)
MSK population - Post operative
Phase 1 - acute or early rehab
Phase 2 - Intermediate rehab
Phase 3 - Advanced rehab
Phase 4 - Return to sport participation
MSK considerations
Need to follow protocol if indicated by surgeon/need to follow the phase of healing
Try to add in new activities often in the supportive and controlled environment of water
MSK precautions
Monitor exertion, symptoms, pain
Can easily underestimate the effects of buoyancy, turbulence, and work
MSK - spine population
Postural alignment Core stabilization Pelvic stabilization Water walking Traction Aerobics
CP population - target HR zone…etc
12 to 17 beats below 220-age
Use Borg scale (13 is highest)
Low vital capacity
Be aware of body heat build up (esp with obese)
Encourage breaks
Check vitals
Swimming (hardest CV exercise you could have pt do)
CV population - benefits
Inc cardiac efficiency and myocardial perfusion
Improve preload, SV, CO during execise
Strengthen resp mm
Promote clearing of excretions
Promote complete exhalation and larger inhalation
Reduce LE edema
Obese population
Protective effects against heavy joint loading
Aerobic exercise sufficient for conditioning effect
Aids circulation
Dec possibility of stress fractures or overuse injuries
High risk for heat exhaustion
Pediatric population
Tend to be more chest breathers so requires more energy to breathe
Not good at determining if they are overworked
Won’t notice signs of intolerance
Need to keep things functional
