the aquatic therapist

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