the aquatic therapist

Aquatic exercise statistics - how popular is non-swimming aquatic exercise?

Building an aquatic practice? Designing and patenting an exercise device for the pool? Or just writing that horrid research paper for PT school?

Well, you need up-to-date statistics. Here are a few arrows for your quiver:

Non-swimming aquatic exercise grew in popularity in the United States by almost 8% between 1998-2007. This is in stark contrast to other popular exercise options, including fitness swimming (which dropped 4.4%), aerobic dance (-17.3%), and fitness cycling (-23.2%)

In 2004, approximately 5.8 million people in the US participated in aquatic exercise. By 2007, this number had increased to over 7.2 million.

Aquatic exercise continues to appeal most to females in their middle or senior years, although that is mutating with the developing athletic programming focus. The average age of the quintessential aquatic exerciser is almost 47 years old.

When casual aquatic exercise participants are removed from the sample, the average age of the “frequent participant” (those who reported exercising in water over 100 days/year) ascends to 57+ years. Nearly 75% of aquatic exercisers are female.

Excerpted from Salzman, A. "Aquatic Aftercare and Wellness". In Becker, B, Cole A (eds). Comprehensive Aquatic Therapy. 3rd edition. Lippincott, Williams & Wilkins. Pending publication 2009. Statistics compiled in part from 2008 Superstudy of Sports Participation (Aquatic Exercise Slice).

The Navy brings water aboard... for therapy

Last year, the Navy was looking for a way to increase career longevity of its special warfare combatant-craft crewman (SWCC) and SEALS.

It turned to water for the answer.

The Navy recently added a therapy pool to its inventory of equipment used to prolong a special boat operator's career.

The program is modeled after similar programs used by professional sports organizations, such as the National Football League. Its primary goal is to prevent or heal the damage done to a SWCC or SEAL's body simply because of the nature of his or her daily duties.

The pool is 15 feet long by 7 feet wide and is 4 1/2 feet deep. It holds approximately 2,000 gallons of water and has two high-powered water jets that push water over a built-in treadmill to provide different degrees of resistance.

Source: "Navy Integrates Hydrotherapy into Physical Fitness Program". NavySeals.com

Additional support for treating patients in the water after a Total Hip Replacement

Patients who have just undergone a THA have all the "problems" we try and solve with water-based intervention. And yet, they are often prevented from entering the pool until they "fail" land-based therapy.

Truly, the problems post-op total hip patients have are tailor-made for the pool:

• They have lower extremity swelling (Solution: hydrostatic pressure)
  
• They have difficulty weight bearing (Solution: buoyancy)
• They have need of assistive device to ambulation (Solution: buoyancy)
• They have pain and muscle spasm (Solution: thermal shifts and buoyancy)
• They have balance deficits (Solution: viscosity and flow to challenge; buoyancy to protect in case of fall)
• They have proprioceptive deficits (Solution viscosity and flow)
• They have ROM restrictions (Solution: hydrostatic pressure to reduce swelling and buoyancy to ease motion)
• They have weakness (Solution: buoyancy and viscosity)

The pool is the perfect place to be for the first month after surgery. But many MDs are gun-shy about infection and/or dislocation potential and don't think pool. So they restrict one of the best options for rehab immediately post-op.

See what researchers found can be done when you allow these patients to get in the water and go!
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Giaquinto S, Ciotola E, Dall'armi V, Margutti F. Hydrotherapy after total hip arthroplasty: A follow-up study. Arch Gerontol Geriatr. 2009 Mar 10. [Epub ahead of print}

IRCCS San Raffaele Pisana, Via della Pisana 235, I-00163 Rome, Italy.

The aim of the study was to evaluate the subjective functional outcome of total hip arthroplasty (THA) in patients who underwent hydrotherapy (HT) 6 months after discharge.

A prospective randomized study was performed on 70 elderly inpatients with recent THA, who completed a rehabilitation program.

After randomization, 33 of them were treated in conventional gyms (no-hydrotherapy group=NHTG) and 31 received HT (hydrotherapy group=HTG).

Interviews with the Western-Ontario MacMasters Universities Osteoarthritis Index (WOMAC) were performed at admission, at discharge and 6 months later. Kruskal-Wallis, Mann-Whitney and Wilcoxon tests were applied for statistical analysis.

Both groups improved. Pain, stiffness and function were all positively affected.

Statistical analysis indicated that WOMAC sub-scales were significantly lower for all patients treated with HT. The benefits at discharge still remained after 6 months. We conclude that HT is recommended after THA in a geriatric population.

Taking theater into the therapy pool: Disabled children as lead roles

So good it makes you want to cry!

Last summer, a British theatrical company Oily Cart enacted a "multi-sensory theater" production called Pool Piece with physically and mentally challenged children.

Where did this play take place? In a therapy pool.

The company transforms a special school hydrotherapy pool into somewhere that feels enchanted. Smoke billows from a golden chest and light falls across the surface of the water, catching the vivid fantasy costumes of the performers.

Song and gamelan instruments create a soundscape and the lapping of warm water against skin is matched by other sensory diversions: simple splashing; waterfalls falling from huge colanders.

Most importantly in these unique performances it is the audience that leads the way; the performers interact intensively with each child on a one-to-one basis, but always take their cue from the child.

Read a review of Pool Piece here...

Read more about Oily Cart productions here...

Read rehearsal notes on the production here...

Blue Cross Blue Shield defines medical appropriateness for aquatic therapy

Insurance companies are starting to establish limits on what they consider appropriate use of interventions such as aquatic therapy.

And although not all insurances treat CPT 97113 (aquatic therapy) the same, it is helpful to see what kinds of restrictions are working their way down the pike.

Here is an example of what Blue Cross Blue Shield of Tennessee considers appropriate use of aquatic therapy, including some "samples" of clinically-appropriate patients.

MEDICAL APPROPRIATENESS

• Aquatic therapy is considered medically appropriate for ALL of the following criteria:

  • The service is performed under the direct supervision of a licensed physical therapist with a physician's order
    

  • The therapeutic interventions rendered are directly related to a written treatment regimen that includes goals approved and signed by the physician
    

  • The individual must have impairments, functional limitations or disabilities that can be minimized or eliminated with aquatic therapy
    

  • The individual must be able to benefit from the unique properties of water (i.e., buoyancy, hydrodynamics, and hydrostatic pressure)
    

  • An individual selected for aquatic therapy must be unable to safely participate in a physical therapy program that is totally land based due to weight bearing restrictions, severe weakness or other considerations
    

  • The documentation must support the necessity of this intervention
    

  • The aquatic therapy rendered must require the skills of a physical therapist
    

  • A qualified therapist is physically present and actively involved in the treatment (Note: Refer to the medical policy Staff Supervision Requirements for Delegated Services for further information regarding BCBST's supervision requirements.)
    

  • The aquatic therapy services rendered are considered acceptable standards of medical practice for the individual's condition.

ADDITIONAL INFORMATION

An individual may receive aquatic therapy on the same date of service as land based therapy. However, there should be an evident trend away from aquatic therapy and towards a fully implemented land based program.

Clinical Examples of Skilled Aquatic Therapy:

• An individual with arthritis who cannot ambulate on land because of the inability to use an assistive device, but who can begin walking in the pool.

• An individual who recently had a total hip replacement with weight bearing restrictions who has difficulty following these precautions on land and who needs to begin progressive strengthening of the leg.

• An individual with Guillain Barré or multiple sclerosis who is too weak to exercise on land but who can move in the pool with a buoyancy assist device.

Source: Blue Cross Blue Shield of Tennessee Medical Policy Manual

Aquatic vestibular rehab? New application for old problem of dizziness

We are all conditioned to think of the pool for motor complaints. Aquatic therapy has become an obvious choice for ROM, strength, weight-bearing, balance and tone issues. But, until now, very few people used the properties of water for a different kind of rehab... vestibular rehab.

It makes sense, though, doesn't it?

Think of all the minor adjustments in head and body position which can be achieved in a buoyant, turbulent, refractive environment like the pool.

10 sessions in the pool can do a lot for this miserable complaint. Read on...

Gabilan YP, Perracini MR, Munhoz MS, Gananç FF. Aquatic physiotherapy for vestibular rehabilitation in patients with unilateral vestibular hypofunction: exploratory prospective study. J Vestib Res. 2008;18(2-3):139-46.

Neurotology Division, Department of Otorhynolaryngology, Head and Neck, Federal University of São Paulo, São Paulo, Brazil. ygabilan@uol.com.br

PURPOSE: To explore the effects of aquatic physiotherapy on individuals with unilateral vestibular hypofunction and examine the association of therapeutic effects with age, time since symptom onset and use of antivertigo medication. STUDY

DESIGN: Exploratory study.

SETTING: Tertiary referral center.

PATIENTS: Twenty-one patients presenting chronic dizziness with uncompensated unilateral vestibular loss.

INTERVENTION: All patients underwent a regimen of 10 sessions of aquatic physiotherapy for vestibular rehabilitation.

MAIN OUTCOME MEASURES: Patient evaluation prior to and following rehabilitation involved the application of the Brazilian version of the Dizziness Handicap Inventory (DHI), dynamic computerized posturography and the self-perception scale of dizziness intensity. Statistical analysis compared average variables prior to and following rehabilitation using the Student t test.

RESULTS: Brazilian DHI total scores were lower following rehabilitation (p = 0.001). Posturography revealed a reduction in the variation of body displacement following rehabilitation in the average stability and anterior/posterior stability indexes (p = 0.001) and in the average medial/lateral stability index (p = 0.003). Self-perception of dizziness intensity was lower following rehabilitation (p = 0.001). No association between age, time since symptom onset and use of antivertigo medication and rehabilitation therapeutic effects were found.

CONCLUSION: Unilateral vestibular hypofunction patients undergoing aquatic physiotherapy for vestibular rehabilitation achieved an improvement in quality of life, body balance and self-perception of dizziness intensity, regardless of age, time since symptom onset, and use of antivertigo medication.