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Aquatics Lecture Flashcards

1
Q

what is the definition of aquatic PT?

A

purposeful ther ex in water that must be supervised and/or performed by a licensed PT, uses specific examination, evaluation, and intervention techniques, and includes a plan of care with specific goals and outcomes

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2
Q

what are the benefits of warm water in aquatic PT?

A

promotes ms relaxation

decreased ms spasms

pain reduction

ease of joint movt

improved peripheral circulation

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3
Q

what are the benefits of the aquatic environment in aquatic PT?

A

LE partial WBing

spinal unloading

gravity-lessened movt

ease of movt in all planes

full body movt control

resistance throughout ROM

cardiopulmonary fxn/aerobic exercises

earlier progression in phases of rehab

safe environment for fxnal skills progression

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4
Q

t/f: the deeper you are in the water, the less weight you bear

A

true

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5
Q

what are the MSK indications for aquatic PT?

A

post-op (as long as no infection risks)

post-fx (WB limitation)

AROM/PROM limitations

strength limitations

joint conservation (RA/OA)

ms guarding and splinting due to pain

joint mobility limitations

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6
Q

what are the neuromuscular indications for aquatic PT?

A

ROM, strength, flexibility

poor motor control

balance and coordination deficits

gait impairments

fxnal skills

cardiopulm endurance

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7
Q

what do we have to be cautious about in aquatic therapy for pts with MS?

A

avoid high temp pools bc it could trigger an exacerbation of symptoms (Uhthoff’s phenomenon)

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8
Q

what are the contraindications for aquatic PT?

A

uncovered open wounds (can use waterproof dressings)

skin fungal infections

chemically-based skin irritation or dyspnea

low pulmonary vital capacity

absence of a cough reflex

dysphagia/aspiration risk (post neuro lesion)

tracheostomy

fever

poor body temp regulation

excessively high/low BP

poorly controlled seizures

incontinence of B/B

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9
Q

why is fever a contraindication to aquatic PT?

A

bc of the risk of dehydration bc we still sweat in a pool but are less aware of it bc we are in water

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10
Q

what is involved in clinical decision making in aquatic PT?

A

appropriate pt selection

appropriate and specific exercise prescription

utilization of hydrodynamic principles

integration of aquatic-based and land-based exercises and fxnal skills

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11
Q

what are the hydrodynamic principles that play a role in aquatic PT?

A

relative density (specific gravity)

buoyancy

viscosity (fluid resistance)

hydrostatic pressure

specific heat

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12
Q

what is relative density (specific gravity)?

A

the ratio of the weight of an object to the weight of an equal volume of water

the property of an object which determines if the object will float

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13
Q

what is the specific gravity of water?

A

1.0

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14
Q

an object with a specific gravity of ____ will float in water

A

<1.0

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15
Q

what is the specific gravity of the human body?

A

0.93-1.1 (avg=0.974)

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16
Q

what is the specific gravity of fat?

A

0.9

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17
Q

what is the specific gravity of muscles, bone, and connective tissue?

A

1.1

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18
Q

t/f: spefiic gravity varies with the ratio of adipose tissue

A

true

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19
Q

often, “floaters” have a higher ratio of _____ tissue when compared to ______ tissue

A

adipose, muscle

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20
Q

what can someone’s body composition tell us about in terms of aquatic PT considerations?

A

if they will float or sink

how much assistance they will need

what kind of flotation device to use

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21
Q

what is Archimedes’ principle?

A

an immersed body will experience an upward thrust equal to the weight of the fluid dispersed

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22
Q

what hydrodynamic principle is Archimedes’ principle related to?

A

buoyancy

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23
Q

t/f: buoyancy tells us that a body with a relative density <1.0 will float bc the weight of the object is less than the weight of the water dispersed

A

true

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24
Q

t/f: normally the center of buoyancy (COB)=COG of the dispersed fluid or point at which the buoyant force acts

A

true

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25
____pushes down on a swimmer, while ____ pushes up on a swimmer
gravity buoyancy
26
if the forces acting on the body (gravity and buoyancy) are not in equilibrium, what will happen?
the body will tilt bc the COB and COG are not lined up well
27
what is buoyancy torque?
the rotation of the body that occurs when the forces are not equilibrium
28
what is happening when we naturally tilt in water in relation to buoyancy and gravity?
the force of gravity and the force of buoyancy are unequal and not aligned
29
do flotation devices increase or decrease buoyancy forces?
increased buoyancy forces
30
moment of buoyancy is altered by what factors?
the size of the flotation device the location of the flotation device the length of the lever arm
31
how can we use buoyancy assist?
by bring the arms out the sides with a flotation device, the forces will assist pushing the arms out
32
how can we use buoyancy resist?
by bringing the arms in with flotation devices the forces will resist the motion and make it more challenging
33
the larger the flotation device, the _____ the buoyancy
greater
34
how can we use buoyancy supported?
bringing the arms straight up in front on top of the water will allow the arms to just float at that angle
35
with the water level at the ASIS, what is the reduction in WBing?
~50% only WB about ~50%
36
with the water level at the xiphoid process, what is the reduction in WBing?
~70-75% only WB about 25-30%
37
with the water level at the C7 spinal level, what is the reduction in WBing?
~90% WBing ~10%
38
t/f: the % of body weight supported by distal LEs changed at various depths
true
39
what is viscosity (fluid resistance)?
resistance to movt throughout a fluid caused by friction bw molecules of the fluid
40
what are the 4 forces involved in viscosity?
cohesion adhesion surface tension force of resistance/"drag"
41
what is cohesion?
the force of attraction bw molecules of the same type of matter (ie. cohesion of water molecules)
42
what is adhesion?
the force of attraction bw molecules of different types of matter (ie adhesion of water molecules with the person's skin or clothes)
43
what is surface tension?
the force of attraction bw the surface molecules of the fluid
44
what is "drag"?
the force of resistance as a body moves through a fluid
45
the amount of resistance is proportional to what?
the effort exerted
46
"drag" increases with what factors?
increased velocity of movt increased lever arm length increased surface area
47
t/f: turbulence creates drag
true
48
what is hydrostatic pressure?
the amount of fluid pressure exerted against the body's surface is directly related to the depth of immersion (the deeper we go, the more pressure their is against the body)
49
what are the benefits of hydrostatic pressure in aquatic PT?
opposes LE pooling of fluids/edema supports unstable joints supports the body in an upright position (increased postural control/balance)
50
how does hydrostatic pressure help oppose LE pooling?
bc the pressure is the greatest at the feet and creates and decreasing gradient up the body
51
what pts would benefit from the LE edema reduction effects of hydrostatic pressure in aquatic PT?
pts s/p trauma or arthroplasties pts with lymphedema
52
what is a potential downside of the hydrostatic pressure of water in aquatic PT?
it can cause breathing difficulties in pts with low vital capacity due to COPD
53
what is specific heat?
the amount of energy required to raise the temp of 1 gram of water by 1 deg celcius
54
at a given temp, the amount of heat loss into water is ____x the amount of heat loss into air
25
55
heat loss occurs with _____ and/or _____
conduction, convection
56
why would a pt feel cold in aquatic PT?
if there is a greater amount of heat loss than the amount of heat produced during exercise
57
what is the water temp of a therapeutic pool?
92-96 deg F
58
what is the water temp of a aerobics pools (ideal temp)?
82-86 deg F
59
what is the water temp of a lap swimming pool?
80-85 deg F
60
t/f: vigorous exercise in high temps is safe and appropriate in aquatic PT
false, it may lead to rapid overheating, fatigue, dehydration, and possible syncope
61
what is refraction?
the bending of a light ray as it moves from one medium to another medium of different density create visual distortions
62
visual distortions in water from refraction may cause difficulties with what?
visual feedback/visual learning monitoring joint position exercise instruction postural education some pts may report nausea/dizziness
63
t/f: state public health laws do not apply to aquatic PT?
false, they must be followed for safety, lifeguard to swimmer ratios, and sanitation of the pool/locker rooms
64
what is negligence of omission?
when the professional fails to do what another reasonable practitioner WOULD have done under the same circumstances (not doing what you should)
65
what is negligence of commission?
when the professional does something that another reasonable practitioner WOULD NOT have done under the same circumstances (doing something you shouldn't)
66
negligence lawsuits most commonly involve what?
faulty equipment and facilities failure to supervise faulty instruction failure to provide emergency care faulty emergency care
67
what is involved in risk management?
IDing all risks evaluating the risk for their probability, severity, and magnitude establishing controls to eliminate/reduce risk being proactive by implementing the appropriate policies/procedures
68
if policies/procedures are in place and something goes wrong and you didn't follow them, are you more or less liable?
more liable
69
if policies/procedures are in place and something goes wrong and you followed them, are you more or less liable?
less liable
70
what are the safety concerns of aquatic PT?
pool deck and locker room (fall risks) water safety (lifeguard, CPR staff, emergency action plan)
71
what is involved in pool sanitation/safety?
maintaining disinfectant levels (chlorine, bromine), pH levels, and clarity according to the State Public Health Law requirements
72
the guidelines for sanitation standards are published by who?
the CDC
73
the safe chemical storage and handling guidelines are regulated under who?
OSHA
74
what is the risk of dry chlorine?
toxic chlorine gas forms when dry chlorine products become moist/wet
75
a public swimming pool needs to maintain chlorine levels bw what range?
1.5-3.0 ppm
76
a therapeutic pool needs to maintain chlorine levels bw what range?
3.5-5.0 ppm
77
warm water temps of pools can cause what infection risks bc of the temp?
hot tube folliculitis (caused by pseudomas aeruginosa)
78
what pH level does the pool need to be maintained at?
7.5-8.0
79
what clarity level does the pool need to be maintained at?
visibility to the bottom of the pool
80
t/f: the state/city public health laws require that there be an emergency action plan/rescue plan in place
true
81
what rescue equipment must be easily accessible and in good condition?
rescue ring and line spine stabilization board hook and "Shepard's crook"
82
the emergency action plan must include what 3 categories of emergency actions?
life-threatening emergencies non-life-threatening emergencies environmental emergencies
83
what are life-threatening emergencies that we need a plan for?
drowning cardiac arrest
84
what are non-life-threatening emergencies that we need a plan for?
falls
85
what are environmental emergencies that we need a plan for?
electrical storms fire chemical spills/air quality emergencies
86
our pt selection should be guided by what?
the initial PT exam/eval and medical records
87
what are the considerations for aquatic PT?
indications/contraindictions swimmer vs non-swimmer fear of water pt's motivation/goals/preference
88
what techniques can we use in aquatic PT?
PROM/AAROM/AROM PNF patterns of UEs and LEs resistance exercises spine stabilization exercises aerobics joint mobs gait training balance training/midline control coordination training fxnal mobility skills
89
what fxnal mobility skills can we do in aquatic PT?
rolling.bed mobility skills sit to stands/stand to sits swimming skills as full body fxnal exercise
90
what is included in the subjective data/CC in aquatic PT?
Current/prev medical condition(s) Meds Pain level/description Prev PT intervention Comfort level in the water (swimmer vs non-swimmer vs hydrophobic)
91
what is included in the objective data in aquatic PT?
Skin condition/integrity (open wounds? rashes?) Respiratory status PROM/AROM Strength Mobility and fxnal abilities/limitations
92
what is included in the evaluation in aquatic PT?
Prioritization problem list Indications/contraindications Pt's potential for rehab Justification for aquatic PT
93
what should we relate our aquatic PT goals and outcomes to?
LAND-BASED fxnal tasks
94
what should we link all improvement in impairments in aquatic PT to?
LAND-BASED fxnal skills
95
t/f: we should only integrate land-based exercises and/or fxnal skills later on in aquatic PT
false, we should integrate land-based exercises and fxnal skills as early as possible
96
to bill for aquatic PT, the therapist must have _____ and ______ pt contact
DIRECT, INDIVIDUAL
97
pt contact can include _____, _____, or _____ contact when both the pt and PT are in the water or when the pt is in the water and the PT is poolside ready to jump in if needed
visual, verbal, manual
98
what is the basic exercise format of aquatic PT?
warm up stretching strengthening aerobics cool down/relaxation
99
what can we do for strengthening in aquatic PT?
AROM to specific joints PREs (surface area resistance, buoyancy resistance, increased lever arm, increased velocity of movt, weights) precautions for safety
100
what are some things are can do as a cool down/relaxation in aquatic PT?
jogging/marching walking gentle kicking/UE stroking relaxation in supine deep breathing exercises
101
what can we do in aquatic PT for spine rehab?
lumbar stabilization program spinal traction Bad-Ragaz techniques for spine mobility
102
what are the benefits of sport-specific training in water?
gradual return to full capacity motor learning with reduced stresses opportunity to practice skills with reduced WBing/stress on bones/joints
103
what are some sport-specific exercises we can use in aquatic PT?
agility exercises (grapevine, lateral slides, hops) vertical jumps running/jogging, pivots
104
what are fxnal training skills we can practice in aquatic PT?
chair position or cube position as a base for STS transfer training dynamic balance training balance training/midline control gait training bed mobility/rolling skills
105
t/f: in chest deep water, pts can often ambulate w/o AD due to hydrostatic pressure
true
106
what are some specialized aquatic PT techniques?
Ai-Chi (aquatic Tai Chi) Watsu (water Shiatsu) Bad Ragaz ring method Halliwick method (10 step program)
107
what is the Bad Ragaz ring method?
a aquatic PT technique that uses PNF techniques and supine floating with ring shaped flotation devices to allow free floating
108
what exercises are involved in Bad-Ragaz?
PROM (lateral and snake movts) Isometrics Isokinetics/AAROM/AROM resistive exercises
109
what is the purpose of PROM in Bad-Ragaz?
to promote relaxation and mobility
110
what is the purpose of isometrics in Bad-Ragaz?
stabilization and stengthening
111
what is the purpose of isokinetics/AAROM/AROM in Bad-Ragaz?
strengthening
112
what is the purpose of resistive exercises in Bad-Ragaz?
progressive strengthening
113
what is the underlying philosophy of the Halliwick method?
balance and control of movt in water w/o flotation devices based on principles of hydrodynamics and body mechanics (ie sick out ur bottom to sit)
114
what is the ultimate goal of the Halliwick method?
to use swimming as a means to independent movt

DPT 617 (14 decks)

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