the aquatic therapist

Ask ARN: Must therapy pools supply lifeguards during aquatic therapy sessions?

The Aquatic Resources Network gets questions from clinicians each day. We think everyone should learn from the answers!

 

Question: What kind of policy should we have regarding posting a lifeguard on duty at the pool? Are therapeutic pools held to the “public pool” standard?

Answer: There are over 100 bathing codes in effect in the U.S. and no two of them have identical wording concerning lifeguards. In most states, therapy pools are considered "public" pools and are subject to all the same codes and regulations as any other public pool in the state.

Some states have a “semi-public" or "special pool" or “therapeutic pool supervised by a licensed medical practitioner" category. Since surveillance requirements vary from state to state depending on the categorization, each practitioner should make himself aware of the requirements which pertain to his state or locality.

Regardless of whether or not a state code requires that lifeguards be posted, the facility is still required to provide a safe environment, and to provide rescue assistance and necessary First Aid.

The prevailing standard that public pools must hold to includes the following requirements:

• The standard of care in the industry (in the U.S.) is the "10/20 Supervision Rule". Trained and qualified lifeguards must be posted in a way that they can observe and scan their entire area of responsibility once every 10 seconds, and respond to and manage an emergency situation within another 20 seconds.
• Lifeguards should be properly dressed in uniforms (provided and paid for by the employer) and readily identifiable to patrons.
• At least two certified or licensed lifeguards should be in attendance at all public pools at all times the pool is in operation.
• Lifeguards should have no duties to perform other than the close general supervision of participants in water contact activities.
• Lifeguards should be alert, rotate to a new position at least once every 40 minutes, and be given frequent relief breaks from surveillance duties.
• The number of lifeguards should be adequate for the activities being conducted, the size and shape of the facility, and environmental conditions which might limit the ability to provide supervision.
• Lifeguards should be at least 18 years old, medically fit, have good eyesight, be physically capable of meeting the demands of the job, possess current certifications or licenses (in lifeguarding, CPR, and First Aid) from a recognized training agency, have adequate specific training for the facility, and be qualified and practiced in emergency procedures and other job aspects including use of rescue equipment (a minimum of four hours/month inservice training).

Source: Osinski A. Aquatic Therapy Listserv. Aquatic Consulting Services: San Diego, CA; 2001. For more information: Aquatic Consulting Services, Phone (619) 224-3100, Hotline (900) 446-6075 x 820. Web: www.AlisonOsinski.com

A toddler slips out of the house and heads for the family swimming pool. The boy falls in the water, and sinks, but something amazing happens next. Instead of drowning, he flips on his back, floats to the top and cries for help.

Too good to be true? You decide! Watch the video making the rounds on the Internet.

An organization called Infant Swimming Resource is teaching baby aquatic survival skills and drowning prevention classes to infants as young as 6 months old.

Harvey Barnett Ph.D. and his wife JoAnn have developed Infant Swimming Resource (ISR) into a nationally recognized program with a specific mission: prevent childhood drowning through specialized survival training. According to their statistics, since ISR’s inception in 1967 there have been more than 1700 aquatic survivals witnessed and 783 survivals unwitnessed.

Read more on becoming an instructor.

Ask ARN: Should the tracheostomy patient be allowed to do aquatic therapy?

The Aquatic Resources Network gets questions from clinicians each day. We think everyone should learn from the answers!

Question: Is it contraindicated for a patient with a tracheostomy to get into the pool for aquatic therapy?

Answer: The answer is: It depends! Many clinics consider a trach a contraindication -- there is too big a risk for any benefit the client may receive. For those who decide to allow patients with an open trach into the water, here is one research article which may assist in that difficult decision. (more to come in future postings...)

Authors: Taylor,S.
Title: The ventilated patient undergoing hydrotherapy: a case study
Periodical, Full: Australian Critical Care
Pub Year: 2003
Pub Date Free Form: Aug
Volume: 16 Issue: 3
Start Page: 111-115
Descriptors: Neurological; Liability; Adverse Effects; Metabolic and Systemic; Tracheotomy; Best

Abstract: The ascending peripheral neuropathy and paralysis that result from Guillain-Barre Syndrome's (GBS) demyelination of peripheral nerves is a challenge to health professionals; the patient requires support during the acute disease process and during the remyelination recovery period, often lasting months to years. The staff of a major metropolitan teaching hospital's critical care unit (CCU) and physiotherapy departments developed a hydrotherapy treatment programme for a ventilated patient with GBS. Through careful planning and appropriate preparation, it was found that hydrotherapy could successfully and safely be incorporated into a patient's treatment regimen. The benefits included improved range of movement due to the supportive nature of water, anecdotal increased strength, size and movement of remyelinating muscles and a psychological improvement. Although this patient has not recovered from GBS to be independent, hydrotherapy was a valuable part of the treatment regimen and it could be suggested the increase muscle strength lead to improved respiratory function and enabled weaning from ventilation, reducing intensive care length of stay and cost.

Ask ARN: Lightening storms and aquatic therapy pools

The Aquatic Resources Network gets questions from clinicians each day. We think everyone should learn from the answers!

Question: Should we close our therapy pool during lightning storms?

Answer: The first place you should look is at your state code for swimming pools. To get a copy for your state, click here for state pool codes.

If there is nothing there, your state probably does not regulate the issue. You can then look to outside authorities.

For instance, here is a site on lightning safety and indoor pools.

Be aware that six states have recommendations or regulations for suspending indoor pool activities when under lightning threat: Delaware, North Dakota, South Dakota, Maryland, Rhode Island, and Michigan. Delaware’s state code reads "during electrical storms the use of a pool (indoor or outdoor) shall be prohibited."

Several large national groups describe building interior pool hazards (*) or have recommended indoor pool activity suspension (**) when nearby thunderstorms threaten. See:

National Athletic Trainers Assn.** (NATA)
www.nata.org (type "lightning" in search box)

National Collegiate Athletic Assn.* (NCAA)
www.ncaa.org/library/sports_sciences/sports_med_handbook/2002-03/1d.pdf

American College of Emergency Physicians ** (ACEP)
www.acep.org (type "lightning" in search box)

US Swimming, Inc. **
www.usa-swimming.org (type "lightning" in search box)

YMCA Services Corporation**
www.yservicescorp.com/Docs/Guidelines/LightningPoolGuide.doc

All pool buildings should be equipped with lightning protection as specified in the most recent version of National Fire Protection Association NFPA-780 Standard for the Installation of Lightning Protection Systems. Special attention should be paid to surge protection and bonding issues. A comprehensive inspection should be conducted by a qualified electrician every five years.

CMS Issues New Directive on Community Pool Leasing

The Centers for Medicare and Medicaid Services (CMS) has issued a long-awaited new directive that allows aquatic therapists in private practice to rent or lease a specific portion of a community pool, rather than being required to rent the entire pool when providing services to Medicare patients.

CMS Transmittal 88 that was released on May 7th states:

When therapy services may be furnished appropriately in a community pool by a clinician in a physical therapist or occupational therapist private practice, physician office, outpatient hospital, or outpatient SNF, the practice/office or provider shall rent or lease the pool, or a specific portion of the pool.

The use of that part of the pool during specified times shall be restricted to the patients of that practice or provider. The written agreement to rent or lease the pool shall be available for review on request.

When part of the pool is rented or leased, the agreement shall describe the part of the pool that is used exclusively by the patients of that practice/office or provider and the times that exclusive use applies.

Other providers, including providers of outpatient physical therapy and speech-language pathology (OPTs or rehabilitation agencies) and CORFs, are subject to the requirements outlined in the respective State Operations Manual regarding rented or leased community pools.

 

Read the complete transmittal. (Pool rental section is on page 14):
220.1.2 - Plans of Care for Outpatient Physical Therapy

Goals for treating children in the water

At the ARN office, we are often asked about goals for treating children in the water so, we decided to give you some examples. Here are some goals for Speech, look for past postings for PT and OT goals.

 

Aquatic-based SLP goals

1. Attend to an aquatic activity for eight to 10 minutes or until completion twice per session. (Attending to a task is a foundation for building strong language skills).

2. Play with a novel aquatic toy for five minutes without upset once per session.

3. Produce "K," "G," "W," "F" and "T" in the initial position of words at phrase level with 80 percent accuracy.

4. Produce three-syllable words with 80 percent accuracy while being given multisensory aquatic cues.

5. Produce three- to four-word utterances with 80 percent accuracy with given cues.

6. Perform successful repetitions of shaker head raises (while lying supine in water) to promote strengthening of swallowing muscles.

7. Tolerate hydrostatic pressure against the rib cage while producing sounds and vocalizations without shortness of breath.

8. Perform lip and mouth closure and hold breath to perform immersion for 10 seconds without aspiration.

9. Share an aquatic task with a peer (expanding descriptive language by teaching a game to the peer).

10. Perform forced expiration necessary to project voice over loud atmospheric noises.

11. Perform sustained exhalation necessary to blow pool toy across surface of water for 10 seconds.

12. Articulate names of pool toys without sputtering.

13. Decrease facial sensitivity enough to allow splashing of water around face and neck without avoidance.

Goals for treating children in the water

At the ARN office, we are often asked about goals for treating children in the water so, we decided to give you some examples. Here are some goals for OT, look for other postings for PT and Speech goals.
 

Aquatic-based OT goals

 

1. Improve eye-hand coordination by throwing and catching a medium-sized ball with less than 30 degrees deviation to the target while standing in water up to the waist, for three out of four throws.

2. Improve bilateral coordination by paddling in a kayak position on a raft for 10 feet, two out of three times.

3. Independently propel through the water 10 feet without support or assistance from therapist, three out of four attempts.  

4. Maintain balance while seated on an unstable bolster in the water for one minute with minimal challenge, three out of four trials.  

5. Play fishing game which requires casting, reeling, and unhooking “fish” with fine motor skills.  

6. Cross midline while sitting on aquatic mat to retrieve aquatic toy  

7. Sustain interactive play with peer for 3 minutes while sitting on aquatic mat.  

8. Perform head-righting while “kneeling” on therapist’s thighs while immersed in water.

 

 

Goals for treating children in the water

At the ARN office, we are often asked about goals for treating children in the water so, we decided to give you some examples. Here are some goals for PT, look for future postings for OT and Speech goals.

 

 Aquatic-based PT goals

1. Perform unilateral stance on right and left leg for five seconds without trunk compensation and without assistance in 1 to 2 feet of water.

2. Successfully walk up and down one step in 1 to 2 feet of water without trunk compensation and without assistance two out of three times.

3. Successfully jump off a step or ledge 6 inches high into water with only standby assistance for safety two out of three tries.

4. Perform developmental transitions on floating mat (sit, kneel, supine, prone, quadruped, bridge, crawl, stand, etc.)

6. Perform symmetrical kicking motion to propel across water.

7. Crawl down ramp to enter pool independently.

8. Perform sit to stand in gravity-offset environment

9. Perform 5 minutes of sustained exercise at appropriate level of exertion.

10. Sustain scullying motion to keep body afloat for 10 seconds 

 

Congressional Passage of Pool and Spa Safety Legislation Increases Need for Higher Education

The recent passing of the first federal pool and spa safety law amplifies the need for higher education of Pool and Spa Operators.

There are many things that can go wrong if the water is not properly cared for and the facility is not properly maintained.

"The key to assuring a safe and enjoyable experience when people are swimming is directly connected to the higher education of those who maintain the pools and spas. It is critical now, more than ever," says Connie Sue Centrella, Program Director of the Keiser University online Aquatic Engineering Technology degree program.

The protection and safety of guests at hotels, condominiums, and aquatic facilities, as well as private pools has gained recent public attention with the passing of the Virginia Graeme Baker Pool and Spa Safety Act of 2007.

Keiser University is the first and only accredited university providing a higher education degree program in the pool and spa field.

Read  more about the degree...

 

Finding out why your local Medicare office might deny aquatic therapy

Even though Medicare is a federal program, CMS leaves many reimbursement decisions up to local contractors.

This means that although "aquatic therapy" (CPT code 97113) is considered a covered service under Medicare, your local contractor may restrict its use or deny coverage unless you meet certain standards.

This is frustrating as heck -- and many practitioners get caught with their pants down (financially speaking) when billing for aquatic therapy.

But, there is a single "go to" source to find out exactly what your local Medicare contractor has to say about "aquatic therapy" in its LCDs (Local Coverage Documents).

Here's how to find the LCDs for your Medicare contractor:

1. Do you already know the name of your local carrier or intermediary? Then skip this step. Otherwise, find out the name of your local Medicare A or B contractor here.

2. Once you know who your local contractor is (for Medicare Part A or B), you will want to read their LCDs about aquatic therapy. Log onto this page to start. A search page will pop up.

Step 1: Click "Local Coverage" and some drop-down presets will load. Change the Articles preset to "Key Articles Only".

Step 2: Enter your state or geographic area -- or, if you already know it, enter the name of your contractor (carrier or intermediary).  Then, select the box under "Pick one or more" which says CPT/HCPCS. Enter "97113" in the search box. Click "Search now".

Articles specific to your state or your local contractor will come up. Click on each article's hyperlink to open the article. Once the article is open, perform a search for the term "97113" inside the article and read what your contractor has to say about aquatic therapy.