the aquatic therapist

Introducing Open Meme Fridays

What is a meme? A meme is a concept, thought or idea that is meditated and improved upon as it is spread, usually via the web. Do aquatic therapists have memes? We can't help but think that you do.

To that end, every weekend, we at Aquatic Resources Network will be handing over our blog to all you hydro-geeks out there who have got it all figured out.

You know who you are. You who have made your pools effervescent, your patients giddy and your practices prosperous.

Every Friday, we will stir the pot by introducing a new topic, concern or problem. Then, once we have planted the seed, we will get out of the way and let you (along with our 19,999 other visitors) publish your insights and expertise with the rest of the aquatic sociosphere by letting you comment on the post all weekend.

So, how do you get heard on our blog? Click the word "Comments" at the bottom of the posting. NOTE: You do not need to be a Typepad member to post a comment. Just enter your name and then your comments.

This weekend our meme will be on:

REFERRALS. How are you getting the word out to your community?

So, this Friday take a moment to log back onto www.aquatictherapist.com and click "Comments" to tell us what works for you!

Employer picks land-based PT to provide care in Worker's Compensation claim

Very interesting Iowa Worker's Compensation case from a few years back.

Michael Dameris was injured on the job and underwent surgery. His physician recommended he receive therapy from a physical therapist at the YMCA so he could get both aquatic and land-based therapy.

He received a medical membership to the YMCA where there was a PT who worked in the pool and on land.

Midway through the therapy, Dameris's employer requested that the location of physical therapy be switched from the YMCA to a place called the Work Center (which offered only land-based PT).

Even though Dameris had already been switched from water to land therapy and was receiving land therapy at the Y, the referring physician complied with the request and wrote a new referral for the Work Center.

Dameris did not want to go. He felt that his therapy at the Y was going well. He was done with water-based therapy (which is what the employer insisted on), but was able to receive land therapy at the Y. The employer still demanded the right to switch his care over to a new place.

Here is the rub. Because the worker was unable to argue that there was something deficient about the care he would receive at the Work Center, he was unable to prevent the transfer.

In Iowa, employers have the right to direct the provider of care and they did not want this "water-based provider". They argued that it was because the PT at the Y only had a bachelor's degree, whereas the PT at the Work Center had a Master's -- but as everyone knows, that is a distinction without a difference as far as licensure goes. Both PTs had licenses in good standing.

It reads like the employer felt that therapist who worked in the water was not competent or would not progress the employee appropriately. What do you think?

Read the case...

Fun read: 1899 report of MD's use of hydrotherapy

Fun to know that hydrotherapy was the treatment of choice... even in 1899. Read this 1899 report...

Recent diarrhea? Don't get in the therapy pool.... for 2 weeks! (says the CDC)

From the CDC...

Pools should post signs alerting patrons to any diarrhea outbreaks and urging patrons with current or recent diarrhea to stay out of the water.

The CDC says swimmers also need to help by following these tips:

• If you've got diarrhea, don't get in the water until two weeks after the diarrhea ends.
• Avoid swallowing pool water.
• Practice good hygiene. Wash your hands after using a restroom or changing diapers.
• Shower before getting into the water.
• Report fecal contamination to pool operators.

The report appears in the CDC's Morbidity and Mortality Weekly Report.

SOURCES: CDC, Morbidity and Mortality Weekly Report, July 27, 2007; vol 56: pp 729-732. News release, CDC.

Watsu® for CVA patients: Water shiatsu comes into its own in the world of aquatic therapy research

(photo: aquatichealing.com)

It wasn't too many years ago when Watsu® was little known in the world of western medicine.

Well, 28 years after its inception, therapists across the globe can now read about using Watsu for their most disabled clientele.

It's validating for those of us who first learned Watsu back in the 80's and 90's to watch it make such a mark on westernized medicine. We always knew the beauty, the power and the effectiveness of Watsu. It's just that now it's been published.

Watsu® is a registered trademark of the Worldwide Aquatic Bodywork Association.

*****************************

Well, Chon SC, Oh DW, Shim JH. Watsu approach for improving spasticity and ambulatory function in hemiparetic patients with stroke. Physiother Res Int. 2008 Sep 30.  [Epub ahead of print]

ABSTRACT
Background and Purpose. This study reports the effect of Watsu as rehabilitation method for hemiparetic patients with stroke.

Method. Watsu consisted of 40 treatment sessions for 8 weeks, delivered underwater or at water surface level, it applied in three patients. Outcome measures included tools for assessing spasticity and ambulatory function.

Results. All patients showed decreased scores in the TAS and RVGA after Watsu application. Conclusions. Watsu was helpful in controlling spasticity and improving ambulatory function of the patients with hemiparesis. Copyright (c) 2008 John Wiley & Sons, Ltd.

AUTHOR AFFILIATIONS: Physiotherapy Section, Department of Rehabilitation Medicine, Hanyang University Hospital, Seoul, Korea.

What to do if you are not getting the weekly eSplash (aquatic therapy industry newsletter)

Aquatic therapy gurus,

Many of you who signed up for our Aquatic Resources Network weekly eSplash have told us you are still not getting it. This may be because the email has photos/graphics which can tend to plop it into your spam folder.

To make it even easier, we took all the back issues and put them on the web.

For archived copies, go to:

http://archive.constantcontact.com/fs054/1102184430637/archive/1102261598185.html

Here are a few topics we've covered recently:

• 2 second test to determine if you are suffering from low-grade chronic dehydration
• Why Medicare changed their mind about community pool rental exclusivity
• What to do if your payers don't recognize aquatic therapy
• Sensory integration tips for pediatric therapists... and much more

Andrea Salzman, MS, PT
Aquatic Resources Network
www.aquaticnet.com

The shoulder isn't getting the cold shoulder anymore. Aquatic therapy works for the upper extremity, too

Finally! Some research that looks at aquatic therapy for the shoulder. And the conclusion is a nice verification of what we have always thought to be true... that aquatic therapy is a viable alternative to traditional land-only therapy.

Isn't it sweet to be validated?

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SOURCE: Brady B, Redfern J, MacDougal G, Williams J. The addition of aquatic therapy to rehabilitation following surgical rotator cuff repair: a feasibility study. Physiother Res Int. 2008: Sep;13(3):153-61

ABSTRACT:

BACKGROUND AND PURPOSE: Rotator cuff tears are frequently encountered in medical outpatient settings and often require surgical repair to achieve desirable functional outcomes. However, the optimal form of post-operative rehabilitation of rotator cuff repairs remains unidentified by the research literature. The aim of this study was to determine the feasibility of implementing and investigating the effect of a combined aquatic and land-based rehabilitation programme in the post-operative rehabilitation of rotator cuff tears.

METHODS: A cohort of 18 subjects undergoing rotator cuff repair were examined over a treatment period of 12 weeks. Twelve subjects participated in a combined aquatic and land-based programme, while six subjects received a standard land-based protocol. Passive range of motion and the Western Ontario Rotator Cuff Index outcomes were measured pre-operatively and at three, six and 12 weeks, post-operatively. Subjective responses on patient's assurance and confidence in the value of the exercises (questionnaire using an 11-point Visual Analogue Scale (VAS)) were collected at 12 weeks for both groups.

RESULTS: There was a significant improvement in both range of motion and Western Ontario Rotator Cuff scores in all subjects with treatment (p < 0.001). Furthermore, participation in aquatic therapy significantly improved passive flexion range of motion measures at three weeks (mean 46 degrees , 95% CI 17-75, p = 0.005) and six weeks (30 degrees , 95% CI 8-51, p = 0.01). There was no significant difference in the attendance rates (80% in both groups) or patients perceptions of the programmes (100% confidence and assurance in both groups).

CONCLUSION: The implementation of a combined aquatic and land-based physiotherapy programme following surgical repair of the rotator cuff is feasible and presents a potential viable alternative to conventional land-based exercise with comparable outcomes.

Copyright (c) 2008 John Wiley & Sons, Ltd.

Feeling poorly? It just might be a chronic, low-grade case of dehydration

Unfortunately, thirst isn't always a reliable gauge of the aquatic therapist's need for water.

Instead, take the runner's test. Long distance runners have learned that a quick look back into the toilet bowl after peeing can give them a heads-up as to their hydration status.

Clear or light-colored urine? You're well hydrated.

But if you're seeing dark yellow or amber colored urine (see photo above!), you're simply not getting enough to drink.

Immersion causes the body to excrete more fluids. The more time you spend in the water, the more fluid you lose.

You've got to drink more. A lot more. Or you're going to develop a chronic case of "feeling old" before your time.

Mild to moderate dehydration is likely to cause:

• Dry, sticky mouth
• Sleepiness or tiredness
• Thirst
• Decreased urine output
• Few or no tears when crying
• Muscle weakness
• Headache
• Dizziness or lightheadedness

Source: Mayo.com

Other reasons for dark urine...

Questions about the Pool and Spa Safety Act? Here are your answers

Did you miss the Aquatics International webcast on implementing the Pool and Spa Safety Act?

Experts from CPSC, APSP and other industry pros discussed the Act in a roundtable discussion. Here is the Q&A session from registered participants to some of the questions asked and answered.

Note: We have not received any response from the CPSC to our questions about whether therapy pools must comply with this act. We will keep you posted, but for now, assume that you must even though therapy pools are not always considered "public pools" by the states.

It's a "best practice" issue even if it isn't the law.

Cool download: Sample appeal letter for aquatic therapy denial

Aquatic therapy treatment can be denied for many reasons. Many have nothing to do with the pool, but some do. And you can do something about those things!

Here is a quick list of many of the reasons Medicare and other payers will deny aquatic therapy.

See also this sample letter of appeal to use if aquatic therapy has been denied.

Reasons aquatic therapy sessions can be denied:

Are you a licensed provider?

Did you provide 1:1 contact?

Was the care skilled, not maintenance, with the intent to restore function?

Did you exceed the standard treatment duration and progression?

Did you provide an appropriate rationale for use of water?

Did you provide more than one type of water therapy per session? (for instance, contrast bath and aquatic therapy)

Now take a minute to join the Aquaticnet Social Network to get gems like this all the time. It's free!