the aquatic therapist

Looking for practical ideas for treating sensory integration in the pool? Sign-up for our webcast

Tired of attending a seminar and going home with no immediately practical ideas for treating your pediatric clientele on Monday morning?

Well, our Aquatic Sensory Integration webinar is chock-full of practical treatment ideas generated from working with OTs, COTAs, PTs, PTAs, SLPs, adapted aquatic instructors and even a few hydrotherapists from Israel!

We have created a budget-conscious method for learning how to transform your therapeutic pool into a sensory integration "room".

To watch our 90 minute webcast, you only need a high-speed internet connection. If you know how to log onto a webpage, you can attend our webinar. And for $199, your entire office can watch along with you.

Shoot. Project it on a wall, order subs, and make our webcast into your in-house inservice!

Our live-streamed seminar will show you how to create 16 sensory stations in your home pool -- so that no matter what area your patient gravitates, you will always have a treatment plan.

With a few inexpensive toys (a flow-through mat, a child's plastic slide, a canvas hammock) your pool will become a joy to work in.

<more info on "Get Dressed Relay" under photo...>

Masterton Recreation Centre. A glimpse of the indoor children's pool. There is also an outside complex with a large pool, plus a diving pool. Also a water slide, children's pools and picnic tables.

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Here's one idea we'll be discussing on Tuesday, December 2, 2008 (1PM Eastern/12 noon Central).

Problem: Difficulty with body awareness.

Scenario: Your 6-year old patient has trouble donning his clothing correctly in the mornings.

Practice the “Get Dressed Relay” in the pool. Put various articles of clothing in two opposing corners of the deck.

Have your patient either swim or gutter crawl (hand-cruise along the edge of the pool) from the first location to the second and then climb up onto the side of the pool. He will pick a clothing item from the pile, put it on, swim (or crawl) to the second location (usually 14-20’ away), climb out of the pool and put on another piece of clothing. He will repeat this until fully dressed.

To make it even more challenging, require your patient to put on the clothes in an appropriate order (for instance, boxer shorts and tshirt first, socks second, pants and shirt third, belt and shoes last). This drill provides extensive amounts of proprioceptive input and problem-solving and kids love it.

[Idea courtesy Karen Reckamp, OTR/L, ATP, Wolfson Children’s Rehabilitation, Jacksonville, FL]

ADA compliant pool lifts

(photo: Aquatic Access Lift)

Looking to comply with the Americans with Disabilities Act requirements for pool lifts? Here is the language from the Act you must follow. The text in red is directly from the Act. The text in black is explanation provided by Aquatic Access, a pool lift manufacturer which produces ADA compliant lifts.

The recommendations for public pools require that at least two means of entry and exit be provided for each public and common use swimming pool. A sloped entry or lift must be the primary means of access. The secondary means of access is not permitted to duplicate the primary means and also allows transfer walls, transfer systems, stairs, or moveable floors as a means of access. An exception permits swimming pools with less than 300 linear feet of swimming pool wall to have only one means of access, but that means of access must be either a lift or sloped entry. When more than one means of access is provided into the water, it is recommended that the means be different. Providing different means of access will better serve the varying needs of people with disabilities in getting into and out of a swimming pool. It is also recommended that where two or more means of access are provided, they not be provided in the same location in the pool. Different locations will provide increased options for entry and exit, especially in larger pools. Wave action pools, leisure rivers, sand bottom pools, and other pools where user access is limited to one area, shall provide at least one accessible means of entry that complies with 15.8.5 (Swimming Pool Lifts), 15.8.6 (Sloped Entries) or 15.8.8 (Transfer systems). Sections 15.8.2 and A15.8.2

The secondary means of access must be different than the primary means and could include a pool lift, sloped entry, transfer wall, transfer system, or pool stairs.

The first technical requirement states that pool lifts need to be located where the water level does not exceed 48 inches. There are two exceptions to this rule. One states that it can be placed where the water level is greater in pools where all depths exceed 48 inches. The other exception states that if multiple lifts are used in one pool, only one must be located where the water depth does not exceed 48". Section 15.8.5.1

The centerline of the seat, when in the raised position, must be located over the deck and a minimum of 16" from the edge of the pool and not on a slope any greater than 1:48. There are a variety of seats available on pool lifts ranging from sling seats to those that are preformed or molded. Pool lift seats with backs will enable a larger population of persons with disabilities to use the lift. Pool lift seats that consist of materials that resist corrosion and provide a firm base to transfer will be usable by a wider range of people with disabilities. Sections 15.8.2 and A15.8.5

In order for an individual to move safely from wheelchair to lift and lift to wheelchair, there needs to be a comfortable distance from the edge of the pool to the place where the transfer will occur. A significant slope would increase the danger of the wheelchair rolling away.

There must be at least 36" of clear deck space on the side of the seat opposite the water. That clear deck space is not to be on a slope any greater than 1:48. Section 15.8.5.3

In order for an individual to bring a wheelchair alongside the lift and slide safely onto the lift seat (and return to the wheelchair after a swim), there must be enough space for positioning the chair. Again, a significant slope would increase the danger of the wheelchair's rolling.

The height of a lift seat needs to be designed to allow a stop between 16" and 19" from the surface of the deck to the top of the seat surface when the seat is in the raised position. Additional stops at other heights are acceptable as long as one stop falls between 16" and 19". Section 15.8.5.4

The height of the seat was determined as a compromise to accommodate the needs of an adult or a child in a standard wheelchair.

The width of the lift seat is to be 16" wide minimum. Section 15.8.5.5

Footrests that move in conjunction with the seat are required to be provided except for pool lifts that provide access to some spas. Footrests are encouraged on lifts used in larger spas, where the foot well water depth is 34 inches or greater. Additional options such as armrests, head rests, seat belts, and leg support will enhance accessibility and better accommodate people with a wide range of disabilities. Sections 15.8.5.6 and A15.8.5

If provided, the armrest opposite the water needs to be either removable or fold clear of the seat when the seat is in the raised position. This provision is included to guarantee an easy side-to-side transfer from wheelchair to lift seat. Sections 15.8.5.6 and A15.8.5

It is required that a pool lift be capable of unassisted operation from both the deck and water levels. The controls and operating mechanisms must be unobstructed when a lift is in use and not require tight grasping, pinching or twisting of the wrist to operate. Further, pressure to the operating mechanism cannot exceed 5 lbs. Pool lifts must be capable of unassisted operation from both the deck and water levels. This will permit a person to call the pool lift when the pool lift is in the opposite position. It is extremely important for a person who is swimming alone to be able to call the pool lift when it is in the up position so he or she will not be stranded in the water for extended periods of time awaiting assistance. The requirement for a pool lift to be independently operable does not preclude assistance from being provided. This section stipulates that the lift must have controls at the deck level and at water level all of the time. This guarantees that a person in the water does not become stranded in the water, and allows multiple individuals to utilize the lift within a swimming session. It is important that a lift buyer consider carefully whether or not this requirement is met. The regulation also implies in its final sentence that, while total independence is desirable, prudence must be exercised in any potentially dangerous situations. Sections 15.8.5.7 and A15.8.5.7

Another requirement is that the lift be designed so that the seat will submerge to a water depth of 18" minimum. This depth is deemed necessary to ensure that natural buoyancy assists the individual in moving from the lift into the pool. The standard models of the IGAT-180, IGAT-180/135, and IGAT-180AD fulfill this requirement. Section 15.8.5.8

Single person pool lifts shall have a minimum weight capacity of 300 lbs. (136 kg) and be capable of sustaining a static load of at least one and a half times the rated load. Pool lifts should be provided to meet the needs of the population it is serving. Providing a pool lift with a weight capacity greater than 300 pounds may be advisable. This requirement serves to guarantee that the lift can provide access to the majority of the population and has been tested with weights exceeding the rated load by 50%. Sections 15.8.5.9 and A15.8.5.9

Why your indoor therapy pool needs a pool blanket (which just might pay for itself in less than a year)

 

Why do most therapy pools close?

Is it lack of patient interest? Pool water quality? Need for space for other offices?

No. It's because pools can hemorrhage money. Or -- more precisely -- pools evaporate money. Your therapy pool will never make you one red cent until you get your evaporation problem under control.

Did you know?

• Raising your pool's water temperature just 1°F can cost an additional 10-30%
  
  
• It's much more efficient to keep as much of the water you've already heated (and paid to heat) in the pool than to keep replacing that heat when lost.
• The Department of Energy has found that water evaporation is overwhelming the single largest source of energy over consumption, accounting for 70% of total energy lost in both outdoor and indoor pools.
  
  

Take a look at this concrete example of the waste that comes with evaporation:

Take your typical 1,000 square foot pool (let's say 20 x 50 dimension)

A typical indoor pool loses 1-1.5" of water each week to evaporation

One inch of water lost = 625 gallons of water lost (assuming 1000 sq foot pool)

One gallon of water needs 10 BTU to raise it one degree

It took 62.5 therms of natural gas to heat those 625 gallons

Although it differs state to state and season to season, each therm costs between $1.00-$2.00

You just lost between $62.50-$125 per week (assuming you only lost 1" of water)

That's can be a loss of $500/month

If your pool is larger -- or if you lost 1.5" instead of 1" of water -- you lost even more.

So what's the answer?

Since evaporation is the chief culprit of both indoor and outdoor pool heat loss, the best way to reduce the effects would be the addition of a thermal blanket.

On an outdoor pool, the use of a thermal blanket translates into an energy savings of 60 - 80 percent.

On an indoor pool, the use of a thermal blanket translates into an energy savings in upwards of 85 percent.

How long would it take for a thermal blanket to "pay for itself"?

Glad you asked! Generally, the payback time is 9 - 18 months.

Need more specifics?

Energy Smart Pools is a program that was written by the U.S. Department of Energy to determine the annual cost savings generated by the use of pool blanket systems.

The software takes into account the surface area of the water, the flow of air across the surface, whether shading is present, the water and room temperature, the size of the pump and ventilation motors, the activity level, the relative humidity and fuel costs to derive the approximate operating cost of the facility.

The system will calculate monthly energy costs and also yields comparison costs for the same pool with a cover. This information is invaluable as it relates to budgeting for a pool blanket system. [Download the DOE software]

Below are some actual examples of the energy savings calculated from actual examples when using pool covers and solar heating options. The assumptions of pool size, water temperature, air temperature, humidity etc. are also provided below.

Projected Pool Heating Costs / Savings

(Keep in mind that the Annual Heating Costs provided in the below chart are for 82 degree pools. Your therapy pool (89-94 degrees) will cost much more to heat -- and subsequently you will save much more with the use of a pool blanket. Also, natural gas costs have more than doubled since this chart was created, from 50 cents/therm to over 1.00/therm. Thus, you will need to more than double the annual heating cost estimate. Better yet, download the DOE software and do the number crunching yourself!).

City	Pool Type	Annual Heating Costs	Pool Cover Savings	Solar System Savings
Atlanta	Indoor	$4,598	$1,919	$1,314
	Outdoor	$490	$421	$417
Boston	Indoor	$4,695	$2,028	$906
	Outdoor	$1,389	$790	$565
Chicago	Indoor	$4,698	$1,996	$978
	Outdoor	$1,042	$693	$648
Dallas	Indoor	$4,468	$1,881	$1,641
	Outdoor	$250	$191	$176
Denver	Indoor	$4,097	$1,819	$1,302
	Outdoor	$1,408	$858	$730
Kansas City	Indoor	$4,584	$1,992	$1,251
	Outdoor	$483	$393	$369
Los Angeles	Indoor	$4,739	$2,087	$1,517
	Outdoor	$5,827	$2,615	$1,512
Miami	Indoor	$4,038	$1,549	$2,023
	Outdoor	$2,615	$1,452	$1,174
New York	Indoor	$4,567	$1,966	$1,021
	Outdoor	$951	$627	$582
Philadelphia	Indoor	$4,567	$1,966	$1,021
	Outdoor	$951	$627	$582
Phoenix	Indoor	$3,630	$1,669	$2,208
	Outdoor	$4,094	$2,011	$1,402
Sana Francisco	Indoor	$4,869	$2,091	$1,315
	Outdoor	$1,826	$924	$518
Seattle	Indoor	$4,743	$2,034	$639
	Outdoor	$1,756	$818	$395

Input Variables for Above Examples

Variable	Outdoor	Indoor
Pool Surface Area	1000	1000
Pool Temperature	82°	82°
Pool Activity Level	low	low
Air Temperature	site specific	82°
Relative Humidity	site specific	50%
Wind Speed at Pool Surface	site specific	still air
Annual Operating Dates	May 20-Sep 5*	year around
Daily Operating Hours	9:00am-9:00pm	9:00am-9:00pm
Heating System Efficiency	75%	75%
Heating Fuel and Cost	Gas $.50/therm	Gas $.50/therm
Solar Collector Area	750 sqft	750 sqft

* Except for Los Angeles, Phoenix and Miami which were year around.

Describing what you do in the therapy pool: Aquatic specialty techniques

 

(Illustrations by Nick Orabovic; ©2008, Aquatics International)

Constantly searching for a quick and dirty way to describe exactly what you do in the therapy pool? Payers, doctors and patients may not have heard of terms like "Ai Chi" or "Watsu®" -- so how do you explain them in an easy-to-understand and completely accessible way?

Well, once again, the Aquatic Resources Network has done it for you.

Check-out the 2008 series we published in Aquatics International.

In each monthly column of WaterFitness, Andrea Salzman describes (and Nick Orabovic illustrates) the most popular aquatic specialty techniques.

Click the links to access each short, informative article:

• Aquatic PRE
• Aquatic PNF
• Aquatic spinal stabilization
• Ai Chi
• Bad Ragaz Ring Method
• Cardiorespiratory conditioning
• Watsu

Watsu® for orphans: What better way to celebrate aquatic therapy worldwide?

What better way to celebrate World Watsu® Week (April 20-26, 2009) than to donate water therapy sessions for children living in orphanages and childcare institutions?

Watsu providers from all over the world (Brazil, Haiti, France, Great Britain, USA, Lithuania, Poland, Hungary, Thailand and Africa) are joining in.

Watsu for Orphans was initiated by Basia Szpak Borst, a Watsu practitioner and instructor from the Netherlands, and is supported by an Endowment Fund.

This project is an opportunity for orphanages to learn about this ground-breaking water therapy (Watsu) and to benefit from the installation of mobile pools donated by the Endowment Fund wherever technical possibilities allow their installation.

The long-term objective of the donation is to ensure continuous presence of Watsu practitioners and therefore enable participating institutions to integrate Watsu into their existing therapeutic and pedagogical programs.

But why water for these children?

As just one example, look to Bulgaria where the Ministry of Health is monitoring a 10-year follow-up of babies from an orphanage. They found that these children had a greater chance to be adopted because of a 20-minute a day medical water training.

Quick links for more info:

Watsu for Orphans newsletter update (newsletter is in English)

Website - Watsu for Orphans

Videoclips - Watsu sessions

Watsu for Children book chapter

The design matrix: Calculating the costs and benefits of putting in a therapeutic pool for aquatic therapy

Hot dog. Your administrator is finally on board and the new facility is going to include a therapy pool. Or you have finally decided to stop using the pool at the local Y or hotel. Unfortunately, you’ve been assigned the task of determining how much to budget for
the construction and yearly operations of the pool. Gulp.

Getting the ball rolling The first smart decision you can make is to attend a conference and/or hire a consultant to help you with the project. This is too big a potential money-pit to have a novice making decisions.

Here are the best resources available to help you design your pool right the first time.

QUICK LINK:  Design Matrix Article: Designing Therapy Pools for Aquatic Therapy

MANUALS & BOOKS:
How to Successfully Launch an Aquatic Therapy Practice (manual)
To order: info@aquaticnet.com
Nearly 300 pages. Comprehensive guide to designing, building and/or buying a therapy pool. Also includes practice information on billing, programming, documentation, etc.

How to Successfully Launch an Aquatic Therapy Practice (DVD of 3 day seminar)
To order: info@aquaticnet.com
3 days of programming from annual conference of the same name. Comprehensive guide to designing, building and/or buying a therapy pool. Also includes practice information on billing, programming, documentation, etc.

Developing an Aquatic Physical Therapy Program (manual)
To order: aquaticpt@assnoffice.com

Aquatic Therapy Policy and Procedure Manual (manual and CD)
To order: h2obabies@cox.net (Lynette Jamison)

CONSULTANTS:
Andrea Salzman, MS, PT
Aquatic Resources Network
Plymouth, Minnesota
Email: asalzman@aquaticnet.com

Alison Osinski. PhD
Aquatic Consulting Services
San Diego, California
Email: alisonh2o@aol.com

Doug Cook, PE
Counsilman/Hunsaker & Associates
St. Louis, Missouri
Email: dougcook@chah2o.com

Mick Nelson, Director Club Facilities Development
USA Swimming
Colorado Springs, Colorado
E-mail: mnelson@usaswimming.org

Sometimes it's the air, not the water, that makes you sick in the therapy pool

Many aquatics professionals are hearing reports about swim meets where athletes have to queue up in the hallway because the natatorium air is too polluted to breathe.

Similarly, therapists are beginning to complain about the air quality in their therapeutic pools. After all, its the therapists who are breathing the stuff 4-8 hours a day. Worse, what if you have asthma? Or are pregnant? Are you at risk?

In the past, we've been focused on ensuring the cleanliness of our pool water; we have been worried about RWI (recreational water illnesses). Unfortunately, no one was thinking about the offgasing of chemicals and byproducts that tend to hover about 18 inches above the water's surface (right where your intake valve is!)

According to Robert Kappel, Siemens Water Technologies, the health issues relating to disinfection byproducts (DBPs) and indoor air contamination may soon overtake the concerns about recreational waterborne illnesses (RWIs).

Read more...

How to keep your therapy pool clean and RWI free: a monthly newsletter from the NSPF

Aquatic professionals now have a respected source for the most current information about pool and spa accident and illness prevention with the Prevention Advisor™.

This free monthly e-newsletter is published by the National Swimming Pool Foundation® (NSPF®) as a service to pool and spa operators, service technicians, health officials, and other professionals committed to staying abreast of key prevention topics. The Prevention Advisor allows NSPF to keep pool professionals up-to-date on the latest improvements until they are ready to re-certify.

Each month, the Prevention Advisor contains information which focuses on a specific subject such as health and safety information, regulations and legal topics, training opportunities, preventive maintenance tips, research findings, and other important subject matter.

Sign up to receive newsletter

Ask ARN: Does aquatic therapy effect bone density in patients with osteoporosis or osteopenia?

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

Question: How does aquatic exercise or therapy effect bone density? It would seem that the reduction in weight-bearing which occurs with water-based exercise would diminish the benefits for bone retention.

Answer: The answer is two-fold. Yes, exercising in the pool will reduce the amount of joint compression and weight-bearing performed during a given task (isn't that what we love about aquatic exercise?).

Thus, a given gravity-based task "should" result in greater bone preservation (and perhaps even growth) than its water-based cousin.

However, weight bearing is not the only way to lay-down (or preserve) bone. Strength training exercises, which cause the muscles of the body to pull on their respective bones, can also effect bone density. And aquatic exercise has been shown to create enough pull to have a positive effect on bone.

Bibliography on bone density, body composition and aquatic exercise...

Here is the conclusion of one study addressing this very issue:

Ay et al (2005): Although weight-bearing physical activity is known to be superior to non-weight-bearing activity to increase the bone mass, our present evidence shows that aquatic and weight-bearing exercises both can increase calcaneal BUA.

More studies are listed in the bibliography provided above.

ACL rehabilitation through aquatic therapy: A good idea or dangerous for the knee?

Are you taking your anterior cruciate ligament (ACL) patients in the water? If you are treating a partially torn ACL — or a reconstructed ACL — you will want to follow some restrictions. For instance, you will need to avoid some elements of open chain terminal knee extension. In other words, you need to avoid resisted knee extension for the last 30 degrees of extension.

So, what does this mean for treatment?

Do not put your patient in a resistance boot (or a flipper or fin) and then have the person rapidly flex and
extend against the resistance of the water.

Why would this be a concern? What benefits would water therapy add to the mix?

Find out more (PDF)...