Aquatic Therapy 3 Flashcards by Alex Stein

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

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Key elements to Ai Chi

Listening to inward feeling
Breath modulation
Relax (increase chi)

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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

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Ai Chi progression - positions

19 of them

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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)

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Ai Chi - populations of patients - with cardiprespiratory disorders -

Need to be at mid chest level with Ai Chi

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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

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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

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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

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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

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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

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Bad Ragaz - PT position

You do not want to be too deep

Probably to about T9 area

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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

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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

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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

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Halliwick concept - phases

Phase 1 = adjustment to water
Phase 2 = rotation control
Phase 3 = control of movement
Phase 4 = movement in water

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Halliwick concept - phase 1

Adjustment to water
Mental adjustment - pt feel comfortable in water
Breath control

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Halliwick concept - phase 2

Rotation control
Ability to maintain a position
Ability to change a position in a controlled way

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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

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