the aquatic therapist

New Shark Therapy for Kids Arousing Praise, Concern in Central FL

Surrounded by vigilant camp counselors, 7-yr old JJ Warner tries to relax as Big Ed, a Brazilian White-Tip, glides by to take a closer look.

Article posted by Stuart Smalley, Guest Blogger

Merritt Island, FLA. Parents from around the world are converging on this small coastal town in hopes that a controversial new therapy will help their children cope with conditions ranging from post-operative rehabilitation to hypersensitivities to touch.

The new program is an off-shoot of dolphin therapy which was popular until 2010, the year dolphins were put under the protection of the Federal Wildlife Agency. However, the need for alternative fish-based therapies never abated and to cope with the demand, dolphins have been replaced by specially-trained domesticated sharks which children as young as 3-yrs old can now touch, swim and even hitch a ride.

"The turn-around we are seeing in these kids is amazing," said Ellen Trumfounder, director of Swim For Your Life Aquatic Camps. "Sure, they start out crying when they see that big fin coming at them, but soon they are splashing and yelling and interacting with others with great fervor. I've actually seen it bring tears to some parent's eyes."

And the pediatric self-improvement industry is standing up and taking notice. "We are watching this development closely," said John Ferburr, president of the Skinner Foundation. "Studies have shown that violent video-games, giant 3D IMAX shoot-em-up movies and loud monster truck shows have hardened young people to the point where gentle, non-threatening dolphins no longer make an impact. Sharks, in the meantime, seem to be one of the only things left that can make the immediate type of impression we are looking for."

Naturally, the new movement has its detractors, some who say the dangers far outweigh the benefits. One of these groups, Citizens for Halting Underwater Mayhem, are particularly dismayed that parents would subject their children to such extreme ends.

"I don't think the government should allow this to happen," yelled Doris Rhydermacher, CHUM's spokesperson who was protesting outside the camp gate. "Just look at those precious babies bobbing in the water with those menacing things floating by. They must look like little Skittles to them."

"These sharks are well-fed and are bred to be non-threatening," answered the flustered Trumfounder. "I assure you they are no more dangerous than manatees."

"Manatees with very sharp teeth," mocked the protesters.

In fact, Swim For Your Life has been cited for numerous violations of child safety laws in the past. The last one being in December, 2012, when the Broward County Child Welfare agency fined the resort $350 for a shark attack on a 9-year old boy recovering from rotator cuff surgery.

"Yes, that case was an anomaly and has been fixed," said Trumfounder. "We forgot to feed Fat Nat that day but he has since been defanged and should no longer be a problem," she added. "Besides the stitches, the session was a success because during his emergency egress, the boy was finally able to demonstrate full range of motion."

If you would like to try your luck with shark therapy, enroll your children now by contacting the resort at info@swimforyourlife.com. Slots are filling fast for their next scheduled retreat this coming April 1st.

Clients at Risk for Falls? Aquatic Therapy Treatments and Supportive Research

Join us for the April 23, 2013 webinar: Evidence-Based Aquatic Therapy for Clients at Risk for Falls: Parkinson's, CVA, Ortho, Elderly & Beyond.

Ortho & Neuro balance disorders will be discussed.

For instance, here is some of the Parkinson's research we will be outlining. We will also be showing you great treatments, justifications (for payers), marketing materials and more.

Effects of Aquatic Exercise onPersons with Parkinson's disease: A preliminary study

Aquatic Therapy Versus Conventional Land-Based Therapy for Parkinson's Disease: An Open-Label Pilot Study

Feasibility of 2 Different Water-Based Exercise Training Programs in Patients With Parkinson's Disease: A Pilot Study

Long-Term Multimodal Exercise Program Enhances Mobility of Patients with Parkinson's Disease

Lastly, here is a downloadable book Aquatic Exercises for Parkinson's Disease.

 

 

The Holy Grail of Aquatic Therapy Literature: No Increased Risk of Infection after Surgery

You've heard every rationale in the book from payers who want to discontinue aquatic therapy.

• "It's not functional; people don't live in the water"
• "6-8 visits to teach the exercises, then an immediate transition to land"
• "You don't need a skilled therapist to teach water aerobics." (my personal favorite)

So, when the day comes when a gorgeous piece of literature comes out which makes the case for aquatic therapy -- and that case is not just (unequivocally) pro-aquatic therapy, but pro-starting-as-early-as-4-days-post-op, well, it's time to celebrate.

This systematic review/meta-analysis is equivalent to the Holy Grail... desired by all, long sought, yet always elusive.

Attend March 26th webinar for a much more extensive look at the ramifications of this study and many others. We will be incorporating this study into a free brochure you can use to give to refering physicians after the webinar.

REVIEW ARTICLE (META-ANALYSIS): Early Aquatic Physical Therapy Improves Function and Does Not Increase Risk of Wound-Related Adverse Events for Adults After Orthopedic Surgery: A Systematic Review and Meta-Analysis.

Even the title makes me shiver. Let's look at the good news:

Interview with LeAnn Childress, PT, ATC/LAT, ATRIC

Aquatic therapy can be useful for just about anyone. LeAnn Childress, PT, ATC/LAT, ATRIC, and her staff at West Tennessee Healthcare rehabilitation facilities hope to make that fact known in their community. With four existing pools and two new pools coming to the LIFT Wellness Center in Jackson, Tenn., the Sports Plus, Work Plus and Aqua Therapies facilities are ready for everyone from the avid triathlete to the weekend gardener with sore knees.

“We can take care of any need. Aquatics can meet any need a person has,” Childress explained.

The new pool at the LIFT Wellness Center in Jackson, Tenn. has a deep well which will aid patients who are hindered by weight bearing. It also contains a four lane lap pool, a heated therapy pool and a large hot tub. The pool is equipped with UV lighting and an Evacuator pool system to make it comfortable for even the most sensitive of clients. The four other pools are located in Dyersburg, Humboldt, Milan and Jackson, Tenn.

While aquatic therapy can certainly help patients with fibromyalgia and arthritis, Childress hopes aquatic therapy can overcome the stigma that it is just for older patients.

“You don’t think about (aquatic therapy) with the well population,” she said. “It’s not just for the physically challenged.”

She hopes physicians and those in her community will understand benefits available so close to home. Although some clients may not know how to swim, this should not stop them from pursuing aquatic therapy for their needs.

“We’ve seen miracle after miracle of what aquatics can do, both personally and professionally,” Childress said.

Childress’ interest in aquatics started after attending a conference in 1999. “I just soaked it in after that,” she said of her passion, even if her day to day activities now primarily consist of management duties.

Childress and her staff currently work with student athletes in the West Tennessee area: 15 high schools and two community colleges. The staff trainers assist with athletic training, on-field assessments, taping and prevention. Each trainer is assigned to a clinic. If an injury is prescribed physical therapy, they often can utilize aquatic therapy at one of their four pools.

“I get the kids in there and afterwards they just look at me and say ‘Miss LeAnn, you kicked my butt!’”

Childress said because of the small town atmosphere in West Tennessee, the junior leagues will often contact the trainers as well, which she views as a positive. Besides organized sports athletes, she also wants others to know aquatic therapy may be beneficial for them, like the weekend rock climber or home gardener.

“Triathletes, runners and marathoners have really picked up here in Tennessee and we can help them get the help they need,” she said.

To further the staff’s knowledge as their customer base grows, Sports Plus AquaTherapies will host Aquatic Therapy University and their Aquatic Training for the Collegiate, Professional and Elite Athlete seminar March 1 and 2.

Childress said she is specifically excited about learning new sport specific techniques.

“A lot of the athletes are in the best shape of their life with their strength and endurance, but they can lose it so fast because they can’t do load-bearing exercises after an injury,” she said.

The Sports Plus AquaTherapies facility has worked with ATU in the past and was able to increase their staff’s knowledge base through their industry recognized aquatic expertise. Childress said they plan on hosting an ATU seminar every year to continue to learn new skills.

She encourages other facilities wanting to venture into aquatic therapy to not give up. Childress advises to start small if needed and to try working with pools in local hotels.

“It’s the best thing that’s happened to us in my opinion,” she said.

 

Read more about LeAnn here: http://www.westtnmedicalnews.com/news.php?viewStory=2023

Aquatic Therapy Continuing Education Seminars 2013

Aquatic Training Options for the Collegiate, Professional & Elite Athlete
Location: Jackson, TN (Memphis)
Dates: Mar 1-2, 2013
Instructor: Garry Killgore, PhD

 

Hands-On Aquatic Therapy Techniques for the Ortho & Neuro Client

Location: Knoxville, TN

Dates: April 12-13, 2013

Instructor: Andrea Salzman, MS, PT

 

Water-Based Intervention for the Musculoskeletal Client
Dates: April 20-21, 2013
Host: St. Judes Rehab
Location: Brea, CA
Instructor: Beth Scalone, PT, DPT, OCS

Novel Balance, Proprioception & Fall Prevention Strategies
Dates: Apr 27-28, 2013
Location: Sun City, AZ
Instructor: Kim Gordon, MPT

 

Aquatic Training Options for the Collegiate, Professional & Elite Athlete
Location: Beloit, WI
Dates: May 3-4, 2013
Instructor: Garry Kilgore, PhD

Aquatic Therapy for the Speech Therapist

Location: Hudson, WI (Minneapolis)
Dates: July 20-21, 2013
Instructor: Dickinson/SLP

 

Hands-On Aquatic Therapy for the Ortho & Neuro Client (Houston)
Location: Houston, TX
Dates: Aug 9-10, 2013
Instructor: PT TBA

 

Aquatic Therapy Options for the Low Back, Neck and Chronic Pain Client (Minneapolis)

Location: Minneapolis, MN
Dates: October 11-12, 2013
Instructor: Beth Scalone, PT, DPT, OCS

Aquatic Therapy Options for Cerebral Palsy, Developmental Disabilities & the Medically Fragile Patient (Minneapolis)
Location: Minneapolis, MN
Dates: Nov 8-9, 2013
Instructor: Kiki Dickinson, MPT

 

Aquatic Therapy Justification: Library Language for Computerized Documentation

Have you noticed the new push for justification?

Aquatic therapy is on the cusp of an explosion of popularity, but watch out! Because insurers pay more for aquatic therapy than almost any of therapeutic procedure, they are starting to demand clear and ongoing justification for continued aquatic treatment.

Well, you are in luck.

Thanks to the heavy lifting being done at Aquatic Therapy University, we have some library language that can be inserted directly into your computerized documentation system.

You have ATU's permission to incorporate this language for clinical uses!

Download entire document (PDF)

Send thank you email to ATU!

Industry News Delivered: Aquatic Therapy Case Study, Instructional Video and More...

Click on the links below and get open access to these resources:

• The Perceived Benefits of Aquatic Therapy as an Intervention Tool http://lightner.keuka.edu/files/2010/08/First_Final_paper_ch1-5.pdf

• The Science Behind the Soak: Health Benefits of Aquatic Therapy http://www.kenilworth.com/publications/psm/de/201206/files/32.html

• Risk Management Case Study: Failure to Properly Monitor or Supervise https://www.hpso.com/pdfs/db/PT_SLCS_x-8611-0812_August.pdf?fileName=PT_SLCS_x-8611-0812_August.pdf&folder=pdfs/db&isLiveStr=Y

• Introduction to Aquatic Osteopathy http://www.osteopathie-aquatique.com/documents/Introduction%20to%20Aqua%20Osteo.pdf

• Peggy Schoedinger's Instructional Video on Aquatic Therapy For Thoracic Extension  http://www.youtube.com/watch?v=QPgAZ92EOlY&feature=youtu.be

Ask Andrea: Starting an Aquatic Therapy Program: The good, bad and ugly

Question: How do I start an aquatic therapy program in my facility?

Answer: Yikes! Big Question. Let's look at the highlights.

Renting. Are you planning to rent space in an outside facility pool instead of building? Here is a link to an article that might be helpful. (It lists the scary things to watch out for, so don't panic when you read it, but it will open your eyes to what to consider.)

To read more about renting (what is the going rate, etc), go here.

Medicare: If you are going to treat Medicare patients in that community pool, you have to rent exclusive use of a portion of the pool. Your client can't intermingle with the public during your sessions.

Building in Rental Poperty: Considering building your pool in a strip mall or other leased property? Click here first.

Prefabs: Want to start up your start-up with a prefabricated pool. See the list here.

Books: Don't go it alone. Get the books that will guide you all the way.

For instance

Comprehensive Aquatic Therapy;

Aquatic Therapy Policies & Procedures Manual; and

How to Launch an Aquatic Therapy Practice.

Consulting: If you are looking for professional help, click here.

Misc: Read some other Aquatic Therapy start-up tips here.

Esplash: Or to read our aquatic therapy industry hotsheet, go to www.getresponse.com/archive/esplash

Leading the Aquaticist℠ movement: Stacy Lynch & Summit Therapy Group

Eight years ago Stacy Lynch of Summit Therapy Group, Phoenix, Ariz. was thrown into the aquatic therapy pool and since then, he hasn’t looked back.

“I went from having just four visits in the pool in three months to being in the pool every day for two to six hours, constantly learning,” Lynch said.

And that constant learning process is what stuck with him. He says the more education and knowledge he gained about aquatic therapy, the more he knew it was something he wanted to be doing.

Lynch has been a physical therapy assistant for 17 years and works mostly with geriatric patients in aquatic therapy. But he didn’t always concentrate on aquatics. In fact, he didn’t always want to be a physical therapy assistant. It was in a college bookstore at McLennan Community College in Waco, Texas where Lynch met a man who sparked his interest in physical therapy.

“I saw this man in a wheelchair and I discovered myself just staring at him. I was watching him put his books on the counter with his feet, write his check with his feet and hand it to the cashier with his feet. I felt compelled to talk to him.”

Ask Andrea: Does Medicare Require the Therapist to be in the Water for Aquatic Therapy Sessions?

Question: We recently received a request from our Medicare Contractor asking for documentation that verified that the therapist was in the water during aquatic therapy session. We have never had this request before.

Most of our sessions, the therapist is in the water, but sometimes she is not. Under neither circumstance do we specifically document the location of the therapist. Is this a valid restriction or reason for denial? Does the therapist have to be in the water for it to be considered skilled care. Help!

Answer: OK, let's tease out the two issues being discussed here. 

Skilled versus Unskilled Care.

First, is the care "skilled"? The answer is: it depends. Certainly, a therapist who remains on the deck for part of a session is not automatically providing "unskilled" care. In fact, here are some examples of situations that I would argue the therapist should position him or herself on the deck specifically in order to increase the caliber of care provided:

• A sports-medicine therapist stands on deck in order to throw a ball to wide-receiver client while the receiver runs against a progressively resistive current. The therapist needs to be on deck to position himself quickly in different locations to alter the angle and direction of throw and to alter the current speed rapidly.
  
  
• A pediatric therapist works with a child who is learning to get in/out of pool independently. The therapist positions a mat on the deck and assists the child in performing the pool exit by being positioned on deck.
  
  
• A geriatric therapist performs gait training with a patient with a total knee replacment. The patient has been vetted for safety, and the therapist hops out of pool and stands on deck to better visualize the patient's knee extension during the gait cycle.
  
  
• The therapist teaches a complicated exercise to a patient with spatial-relations problems. The therapist gets out of pool and stands on deck in order to demonstrate the exercise or activity better.

These are just samples. There are a hundred reasons to hop in and out of the pool each day. The question becomes more troubling when the therapist never gets in... and never has the capacity to.

I would argue that it's one thing if the therapist is wearing a bathing suit and making choices on a moment-by-moment basis. "Do I get in?" "Should I hop out?"

However, if the therapist is fully dressed, then the intention is clear. There will be no opportunity to get in the water, even if the occasion arises. Safety issues aside, I would challenge the readiness of any therapist to provide skilled care if there is zero ability to get in the pool during the session. Most therapists would -- at a minimum -- agree that there are times in almost every session that the care provided would be enhanced by being in the water. For that to happen, the therapist has to be in a bathing suit, ready to get in.

Billable Versus Non-Billable Care.

Let's assume for a minute that the care you are providing is skilled. There is a reason for you to be in the pool when you are in... and an equally compelling reason to be out of the pool when you are out. In both environments, you are serving a medically necessary function.

The care might still not be billable. WHY?

Documentation of medical necessity for aquatic therapy; A greater hurdle than for therapeutic exercise

Looking for tips to ensure your documentation supports the need for aquatic therapy?

Consider the following points outlined by National Government Services when providing aquatic therapy services.

(Editor's note: I don't agree with all of these points but I am listing them so you see what you are being asked to do)

• Does your patient require the skills as a therapist, or could the patient achieve functional improvement through a community-based aquatic exercise program?
• There are a limited number of therapeutic exercises generally performed in the water. These exercises become repetitive quickly. Once a patient can demonstrate an exercise safely, you may no longer bill Medicare for the time it takes the patient to perform this now independent exercise. If the same exercise is performed over a number of sessions, the documentation must describe the skilled nature of the qualified professional’s/auxiliary personnel’s intervention during the therapeutic exercise to support the ongoing medical necessity.
• Patients who will not be continuing their water-based program as a maintenance program should be transitioned to land-based exercises as soon as reasonably possible for the patient’s condition.
• The aquatic therapy treatment minutes counted toward the total timed code treatment minutes should only include actual skilled exercise time that required direct one-on-one patient contact by the qualified professional/auxiliary personnel. Do not include minutes for the patient to dress/undress, get into and out of the pool, etc.
• Do not bill for the water modality used to provide the aquatic environment, such as whirlpool (97022), in addition to 97113.
• See CPT 97150 Group Therapy for guidelines when treating more than one patient at the same time in the aquatic environment.

Supportive Documentation Recommendations for 97113

• Justification for use of a water environment
• Objective loss of ADLs, mobility, ROM, strength, balance, coordination, posture and effect on function
• If used for pain include pain rating, location of pain, effect of pain on function
• Specific exercises/activities performed (including progression of the activity), purpose of exercises as related to function, instructions given, and/or assistance needed to perform exercises to demonstrate that the skills and of a therapist were required.

Source: http://apps.ngsmedicare.com/lcd/LCD_L26884.htm

Aquatic therapy and aquatic exercise statistics

Looking for statistics and fast facts about aquatic exercise and therapy? Look no further...

• The HyDATTool: UK Aquatic Physiotherapy Standardised Data Collection Project
  www.csp.org.uk/publications/hydat-project-uk-aquatic-physiotherapy-data-collection
  

• Aquatic Resources Network statistics page
  www.aquaticnet.com/media-statistics.htm
  
  
• eSPLASH archives
  http://app.getresponse.com/click.html?x=a62b&lc=BMtvx&mc=Bm&s=C02yy&y=O&

Open access to evidence supporting aquatic therapy: Click and download

Looking to support aquatic therapy? Frustrated at abstracts that don't give the whole picture? Click on the links here and get open access to these evidence-based guides and clinical studies.

Evidence-Based Links

• Aquatic Physiotherapy Evidence-Based Guide
  www.physiotherapy.asn.au/images/Groups/aquatic/ap_ebguide.pdf
  
  
• Effectiveness of Aquatic Exercise and Balneotherapy: A Summary of Systematic Reviews Based on Randomized Controlled Trials of Water Immersion Therapies
  http://aquaest.typepad.com/files/review-of-aquatic-therapies-h.karnioka-et-al.pdf

• Evidence-Based Systemic Review of the Effectiveness of Hydrotherapy
  www.evidencebased.net/files/EBDMReviewofHydrotherapy2008.pdf
  
  
• Bruce Becker's Aquatic Therapy: Scientific Foundations
  www.ewac.nl/files/341017vcan.pdf
  
  

Recent Clinical Trials (free dowloads)

• Comparison of the Effects of Exercise by Chronic Stroke Patients in Aquatic and Land Environments
  https://www.jstage.jst.go.jp/article/jpts/23/5/23_5_821/_pdf
  
  
• The Effects on Muscle Strength and Visual Analog Scale Pain of Aquatic Therapy for individuals with Low Back Pain
  https://www.jstage.jst.go.jp/article/jpts/23/1/23_1_57/_pdf
  
  
• Effects of Aquatic Exercise Training Using New Water-resistance Equipment on Trunk Muscles, Abdominal Circumference, and Activities of Daily Living in Elderly Women
  https://www.jstage.jst.go.jp/article/ijshs/advpub/0/advpub_201112/_pdf
  
  
• Postural Balance of Stroke Survivors in Aquatic and Land Environments
  https://www.jstage.jst.go.jp/article/jpts/23/6/23_6_905/_pdf
  
  
• The Effect of Aquatic Exercise on the Peak Torque and Stability of Knee Joints of Elderly Women
  https://www.jstage.jst.go.jp/article/jpts/23/6/23_6_871/_pdf
  
  
• Simulation Analysis of Optimal Form and Orthosis during Walking in Water for Elderly People
  https://www.jstage.jst.go.jp/article/jbse/7/2/7_2_211/_pdf

Poolmageddon to be rescinded?

A Senate bill has been introduced to prevent the Americans with Disabilities Act from being enforced on commercial pools and spas. “[The ADA for pools and spas] is another one-size-fits-all, big-government mandate that could have a negative impact on Americans,” Senator DeMint said in a statement.

Read more --

http://www.poolspanews.com/2012/041/041n_ada.html

Advice regarding the correct water temperatures for swimming pool and therapeutic pools

Question: I am writing to you today for advice regarding the correct water temperatures for swimming pool and therapeutic pools and  room temperatures. Our pool water is being kept from 87-88F in the swimming pool where most of the clients having therapy are immobile; it's uncomfortable for most of us. Thank you in advance for your help. Patricia C.

Answer: Although the term therapeutic pool is used quite often, there is really no one temperature for all diagnoses. While 94F might be perfect for the acutely painful patient who is unable to exercise aerobically, it would be stiffling for the athlete. Check out the resources below to find the perfect temperature for your setting.

It depends on the usage, but most therapy pools run 88-95 degrees F with an air temperature near 87 degrees. Typically, you want the air temperature warmer than the water temperature until you hit 87 degrees Fahrenheit (water temperature).

Once you get that warm, the air temperature stays around 87 unless you work with your HVA technicians to ensure that you are not going to create artificial dew points inside the building.

Here are 4 sources to examine.

www.aeawave.com/PublicPages/Education/StandardsGuidelines.aspx

The AEA has a Standards and Guidelines document (click on link) which outlines their suggestions for selecting water temperatures for various activities.

www.ewac.nl/files/341017vcan.pdf

Bruce Becker's articles (available as PDF online; use link above) discusses the changes that occur in the body with immersion in different temperatures.

www.atri.org/Aq%20Therapy%20Temps.pdf

The ATRI listserv (click on link) does a nice job of discussing the pro's and con's of temperature. These are anecdotal references, from a clinician's standpoint.

www.usaswimming.org

USA Swimming has an article online (click link) that discusses ideal water temperature and depth for different types of pools -- including lap swim pools, recreational pools and therapy pools.

www.aquatictherapist.com/index/2007/03/choosing_the_ri.html

And finally, this is a link to a previous posting about air temperature. It has some additional links you might find helpful.

 

 

 

Poolmageddon: As seen on Drudge Report

All 300,000 public pools in the United States must install a permanent fixed lift. The deadline for compliance is tomorrow, March 15. Call it "Poolmageddon."

There is no way all 300,000 pools can install permanent lifts by Thursday. So what happens tomorrow when a disabled individual checks into a Holiday Inn and finds no lift at the pool? The Obama DOJ has said it will not be enforcing the new guidelines right away. That means no fines from the government, for now.

But the ADA also empowered citizens to sue businesses that are not in compliance with DOJ guidelines. The result will be a huge payday for enterprising trial lawyers everywhere.

Read original article (as posted on Drudge Report on 3/14/2012)

 

 

Pool Lifts and the March 15, 2012 Deadline: Answers for the Confusion for ADA Compliance

Starting March 15, 2012, all public swimming pools and spas will be required to install pool lift chairs and/or sloped entry points to enable people with handicaps and disabilities to access the facility. Whaaa? Does that mean you?

When the Americans with Disabilities Act standards compliance deadline of March 15 was originally announced, some professionals likened it to the Virginia Graeme Baker Act.

But unlike that federal law, the ADA deadline lacks sense of urgency. Well, here are the facts (from the horse's mouth)....

NEWLY RELEASED, 2012 REVISED ADA REQUIREMENTS This Department of Justice documents clarifies the rules that apply to pool lifts and answer many of the questions pool owners have.

ADA Ruling: No Sharing Portable Lifts: Ahead of the upcoming March 15 compliance deadline, the Department of Justice has issued an interpretation of the Americans with Disabilities Act revised 2010 standards that shoots down many facilities’ compliance plans involving portable lifts.

 

Are colostomy bags contraindicated for aquatic therapy?

QUESTION: Are than any contraindications to allowing a patient with a colostomy bag in the pool?  We have an order form one of our doctors to include the pool along with land PT.

 

ANSWER: We would say there is a precaution but not a contraindication. In other words, it is a concern, but not always a prohibited behavior. Many people with colostomies swim and exercise in water.

Below is an excerpt of text from our Aquatic Therapy Boot Camp training.

You can also read an article on aquatic therapy and stomas, ostomies and appliances from the Aquatic Therapy Journal. Finally, here are some discussions from the ATRI listserv on waterproof bandages.

A colostomy, urostomy, or ileostomy bag
Patients with any –ostomy bag (bags which collect waste from the intestinal tract) present a special risk with immersion, especially if their bags do not seal properly or the skin around the bag is macerated.  Because these bags collect waste, a punctured or leaky bag can result in fecal matter being deposited into the pool. Equally troubling perhaps, is the potential for additional contaminants from poorly disinfected pool water from entering the system of a patient who is already at high risk due to the underlying medical condition which required the bag. 
 
Patients with long-standing and well-managed –ostomies are not typically barred from swimming or therapy pools. One method of preparation for aquatic activities is for the patient to empty his collection bag, place a clean gauze dressing over the bag, place a bio-occlusive dressing (such as Tegaderm) over the entire bag, and then place a pair of compression or “bikers” shorts over the site. Some patients will take the additional step of wrapping a compression bandage like an Ace wrap around their abdomen prior to pulling on the shorts.
 
An area of open, macerated or non-intact skin, especially non- or poorly healing wounds
Open wounds and macerated, unhealthy skin present a risk during immersion — both to the public and to the patient. Any significant area of non-intact skin presents an open port for infection in poorly disinfected water. And immersion in water can further degrade the integrity of macerated, unhealthy skin, especially that present around wound beds or open -otomies. Even immersion in properly disinfected water can cause additional skin irritation in patients with chlorine or other halogen sensitivities. And while clean surgical wounds (such as those present after a knee surgery) present little risk to the public, persistent open sores or wounds can be colonized with infections such as MRSA which theoretically can be spread to others.

 

You can watch a 10 minute clip of the Aquatic Therapy Boot Camp DVD online; just tab down to bottom of page. It's not on precautions, but it gives you the flavor of the class. The ATBC series does have a whole section devoted to precautions and contraindications and the 4 hour DVD is an amazing way to train your entire staff on aquatic therapy.

How to Prevent Hospitalization in Senior Living Settings: The Role of Exercise

Question: The president of our Senior Living complex spoke with me last night about conducting a survey or a study within our properties that will show the importance of a fitness/wellness program and facility in senior housing. 

They would like to look at decreased falls, decreased days in the hospital/TCU, decreased medical cost, etc.  Are you aware of anything out there like this or a contact?  I do not have a lot of experience in research, so any pointers would be appreciated.

Answer: Here are some tools that will help you assess function and determine improvement. They are not aquatic-specific.

• An Evaluation of Functional Fitness in Assisted Living and Independent Living Residents (Master's Thesis)
  
  
• The "Try This" series has some tools you could use.
  
  
  • Here is one specific tool in the series that might be helpful
    
    
• Early evaluation of the risk of functional decline following hospitalization
  

 

Here are a few aquatic-specific investigations:

• The influence of Ai Chi on balance
• An aquatic-based training program that includes pertubation
  
• Effectiveness of aquatic and non-aquatic lower limb muscle endurance training
  
• The effect of land and aquatic exercise on balance scores in older adults

 

 

 

Ask Andrea: Chemo Chemicals

Dear Andrea: I'm a registered massage therapist, specializing in aquatic therapy and am seeing a new patient who has some lumbar issues and a knee that might need replacing down the road. She is also presently receiving chemotherapy for ovarian cancer. While there needs to be no discussion about the positive effects of immersion for her back and knee, my concern is with the effects of the chlorine in the pool while she's undergoing chemo. My pool is chlorinated while her pool in her hometown is salt-water. What advice can you share about the effects of chlorine in conjunction with chemotherapy?

Questioning in Seattle

Dear Questioning: Thank you for your question. Salt water pools are still chlorinated pools. State statute requires that all public pools have a halogen (e.g. chlorine/bromine) in them for sanitation. A "salt water" pool is just a pool that brings chlorine in a solid (NaCl or salt) and the uses electricity to split the Na from the Cl (thus rendering Chlorine). It's really not necessarily any easier on your skin. For more info on salt water generation, see Alison Osinski's info here

http://www.alisonosinski.com/?p=419  (tab down to inline generator);

and here:

http://www.carefreeclearwater.com/saltwaterpools.html

A better choice may be a pool that doesn't just rely on a stand-alone halogen for disinfection. Look for a pool that uses a supplemental system like ozone or ultraviolet light. These systems have dual options for disinfecting the water so that a lower level of halogen can be used. More info here:

http://www.alisonosinski.com/?p=432

I hope this helps!

Andrea

I'm a registered massage therapist, specializing in aquatic

therapy and also operating a breast health clinic. I've attended several workshops with experts in

the cancer field in Seattle and Toronto.

Just Added: Endless Pools Workshop in Philly

We just added a new class for our East Coast members. On April 27-28, 2012 we will be teaching our Ortho/Neuro Survey class at the Endless Pools facility in Aston, PA. While the workshop is being held primarily for the benefit of Endless Pools customers and potential customers, it is also open to outside registrants. Price is $595 and pre-approval through the Pennsylvania PT Board is being applied for.

Aquatic Therapist Alert: You don't even know you're thirsty...You spend too much time in the pool.

DRINK. DRINK. DRINK. Everyone tells you to drink water when you work in the pool. But, dang it, you are never thirsty. So the day rolls on with nary a sip.

Well guys, your body is tricking you into a low grade, long term dehydrated state with serious consequences.

Why? Well, we all understand the effects of hydrostatic pressure on edema control in the legs.We even get the fact that this volume shift creates an extra pre-load on the heart ... in effect making each contraction more powerful.

What we fail to realize is that this same shift in volume creates a sustained stimulation of the cardiopulmonary baroreceptors and reduction of a dipsogenic (ahem... fancy term for thirst) stimulus.

This volume-induced stimuli of  fluid receptors sends a message to your brain saying

Control of an Exoskeleton for Realization of Aquatic Therapy Effects

Kyoungchul Kong;   Hyosang Moon;   Doyoung Jeon;   Tomizuka, M.; Dept. of Mech. Eng., Univ. of California at Berkeley, Berkeley, CA, USA. Control of an Exoskeleton for Realization of Aquatic Therapy Effects. Mechatronics, IEEE/ASME Transactions on. 2010; 15(2): 191-200.

Exoskeletons are attracting great attention as a new means of rehabilitation devices. In such applications, control algorithms of exoskeletons are often inspired by nature for natural and effective assistance for patients. In this paper, a control algorithm inspired by aquatic therapy is introduced.

Aquatic therapy provides various beneficial effects for rehabilitation based on useful properties of water, e.g., buoyancy and drag. The proposed controller calculates joint torques equivalent to the buoyant and drag forces.

Then, an exoskeleton-type assistive device generates the calculated joint torques to provide the similar effects as aquatic therapy.

In this paper, the Sogang University biomedical assist robot is utilized as a testbed. This paper also discusses the mechanical impedance of actuators, which obstructs implementation of controllers in practice. The resistive forces generated by actuators are precisely modeled and compensated to realize the control algorithm inspired by aquatic therapy correctly and effectively.

Aquatic Therapy Versus Conventional Land-Based Therapy for Parkinson's Disease: An Open-Label Pilot Study

Jamile Vivas PhD, PT, Pablo Arias PhD and Javier Cudeiro PhD, MD. Aquatic Therapy Versus Conventional Land-Based Therapy for Parkinson's Disease: An Open-Label Pilot Study. Archives of Physical Medicine and Rehabilitation. August 2011, 2(8): 1202-1210

Abstract

Objectives

To assess and compare 2 different protocols of physiotherapy (land or water therapy) for people with Parkinson's disease (PD) focused on postural stability and self-movement, and to provide methodological information regarding progression within the program for a future larger trial.

Design

Randomized, controlled, open-label pilot trial.

Setting

Outpatients, Parkinson's disease Center of Ferrol - Galicia (Spain).

Participants

Individuals (N=11) with idiopathic PD in stages 2 or 3 according to the Hoehn and Yahr Scale completed the investigation (intervention period plus follow-up).

Interventions

After baseline evaluations, participants were randomly assigned to a land-based therapy (active control group) or a water-based therapy (experimental group). Participants underwent individual sessions for 4 weeks, twice a week, for 45 minutes per session. Both interventions were matched in terms of exercise features, which were structured in stages with clear objectives and progression criteria to pass to the next phase.

Main Outcome Measures

Participants underwent a first baseline assessment, a posttest immediately after 4 weeks of intervention, and a follow-up assessment after 17 days. Evaluations were performed OFF-dose after withholding medication for 12 hours. Functional assessments included the Functional Reach Test (FRT), the Berg Balance Scale (BBS), the UPDRS, the 5-m walk test, and the Timed Up and Go test.

Results

A main effect of both therapies was seen for the FRT. Only the aquatic therapy group improved in the BBS and the UPDRS.

Conclusions

In this pilot study, physiotherapy protocols produced improvement in postural stability in PD that was significantly larger after aquatic therapy. The intervention protocols are shown to be feasible and seem to be of value in amelioration of postural stability–related impairments in PD. Some of the methodological aspects detailed here can be used to design larger controlled trials.

Key Words: Hydrotherapy; Parkinson disease; Physical therapy modalities; Rehabilitation

Abbreviations: BBS, Berg Balance Scale; FRT, Functional Reach Test; PD, Parkinson's disease; TUG, Timed Up and Go; UPDRS, Unified Parkinson's Disease Rating Scale

Aquatic Therapy University (ATU) classes, trainings & continuing education (2012)

Pool Therapy for the Female Client Feb 4-5, 2012

Aquatic Therapy for Total Hip/ Knee Feb 10-11, 2012

Hands-On Aquatic Therapy Techniques March 9-10, 2012

Water-Based Interventions for the Neuro Client April 13-14, 2012

Marketing Strategies for the Aquatic Therapy Manager Sept 7-8, 2012

Function in Water: Closed-Chain Progressions Oct 12-13, 2012

More details at: www.swimatu.com