the aquatic therapist

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

Aquatic exercise programme for children with autism spectrum disorders

Fragala-Pinkham MA, Haley SM, O'Neil ME. Group swimming and aquatic exercise programme for children with autism spectrum disorders: A pilot study. Dev Neurorehabil. 2011;14(4):230-41.

Source

Research Center for Children with Special Health Care Needs, Franciscan Hospital for Children , Boston, MA , USA.

Abstract

Objective: To evaluate the effectiveness of a 14-week aquatic exercise programme for children with autism spectrum disorders (ASD). Design: Non-randomized control trial. Methods: Twelve children participated in this pilot study with seven participants in the aquatic exercise group and five in the control group. The programme was held twice per week for 40 minutes per session. Swimming skills, cardiorespiratory endurance, muscular endurance, mobility skills and participant and parent satisfaction were measured before and after the intervention. Results: No significant between-group changes were found. Within-group improvements for swimming skills were found for the intervention group. Programme attendance was high. Parents and children were very satisfied with the programme activities and instructors. Conclusions: This pilot programme was feasible and showed potential for improving swimming ability in children with ASD. Exercise intensity was low for some participants, most likely contributing to a lack of significant findings on fitness outcomes.

Comparing land and aquatic exercise for people with hip or knee arthritis on function, mobility and other health outcomes.

Batterham SI, Heywood S, Keating JL. Systematic review and meta-analysis comparing land and aquatic exercise for people with hip or knee arthritis on function, mobility and other health outcomes. BMC Musculoskelet Disord. 2011 Jun 2;12(1):123. [Epub ahead of print]

Abstract

BACKGROUND:

Aquatic and land based exercise are frequently prescribed to maintain function for people with arthritis. The relative efficacy of these rehabilitation strategies for this population has not been established. This review investigated the effects of aquatic compared to land based exercise on function, mobility or participants' perception of programs for people with arthritis.

METHODS:

Medline, CINAHL, AMED and the Cochrane Central Register of Controlled Clinical Trials were searched up to July 2010. Ten randomised, controlled clinical trials that compared land to aquatic exercise for adults with arthritis were included. Study quality was assessed with the PEDro scale. Data relevant to the review question were systematically extracted by two independent reviewers. Standardised mean differences between groups for key outcomes were calculated. Meta-analyses were performed for function, mobility and indices that pooled health outcomes across multiple domains.

RESULTS:

No differences in outcomes were observed for the two rehabilitation strategies in meta-analysis. There was considerable variability between trials in key program characteristics including prescribed exercises and design quality. Components of exercise programs were poorly reported by the majority of trials. No research was found that examined participant preferences for aquatic compared to land based exercise, identifying this as an area for further research.

CONCLUSION:

Outcomes following aquatic exercise for adults with arthritis appear comparable to land based exercise. When people are unable to exercise on land, or find land based exercise difficult, aquatic programs provide an enabling alternative strategy.

Is aquatic therapy useful for post CVA patients? Should water-based intervention be a part of neuro rehab?

Mehrholz J, Kugler J, Pohl M. Water-based exercises for improving activities of daily living after stroke. Cochrane Database Syst Rev. 2011 Jan 19;(1):CD008186.

Source

(a) Wissenschaftliches Institut, Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbH, Kreischa, Germany, (b) Sektion Therapiewissenschaften, SRH Fachhochschule für Gesundheit Gera gGmbH, Gera, Thueringen, Germany, 07548.

Abstract

BACKGROUND:

Water-based exercises are used in rehabilitation and might help to reduce disability after stroke.

OBJECTIVES:

To investigate the effect of water-based exercises for reducing disability after stroke.

SEARCH STRATEGY:

We searched the Cochrane Stroke Group Trials Register (last searched August 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE (1966 to April 2010), EMBASE (1980 to April 2010), CINAHL (1982 to April 2010), AMED (1985 to April 2010), SPORTDiscus (1949 to April 2010), the Physiotherapy Evidence Database (PEDro, April 2010) and OT Seeker (1969 to April 2010). In an effort to identify further published, unpublished and ongoing trials we handsearched relevant journals and conference proceedings, searched trials and research registers, checked reference lists and contacted authors.

SELECTION CRITERIA:

We included studies using random assignment.

DATA COLLECTION AND ANALYSIS:

Two review authors independently selected trials for inclusion, assessed trial quality and extracted the data. The primary outcome was activities of daily living.

MAIN RESULTS:

We included four trials involving 94 participants in this review. There was a significant improvement in activity of daily living (mean difference (MD) 13.20 points on the 'Capacidad funcional' (functional capacity) subscale of the Brazilian-Portuguese version of the SF-36; 95% confidence interval (CI) 8.36 to 18.04; P < 0.00001) and on muscle strength (MD 1.01 Nm/kg; 95% CI 0.19 to 1.83; P = 0.02) but these results should be interpreted with caution because population numbers were small and the results are based on single studies. There was no significant improvement in ability to walk (MD 0.14 m/s; 95% CI -0.32 to 0.606; P = 0.55), postural balance (MD 3.05 points; 95% CI -3.41 to 9.52; P = 0.35) or fitness (MD 3.6 (VO(2max); 95% CI -0.53 to 7.73; P = 0.09) after water-based exercises treatment compared to control. Adverse effects were not reported.

AUTHORS' CONCLUSIONS:

The evidence from randomised controlled trials so far does not confirm or refute that water-based exercises after stroke might help to reduce disability after stroke. There is a lack of hard evidence for water-based exercises after stroke. Better and larger studies are therefore required.

Does Aquatic Vertical Traction Change Spinal Height and Back Pain?

 

 

Simmerman SM, Sizer PS, Dedrick GS, Apte GG, Brismée JM. Immediate changes in spinal height and pain after aquatic vertical traction in patients with persistent low back symptoms: a crossover clinical trial.PM&R. 2011 May;3(5):447-57.

Source

Cleburne Physical Therapy, Cleburne, TX(⁎).

Abstract

OBJECTIVE:

To investigate the effect of aquatic vertical traction on spinal height, pain intensity, and centralization response compared with a land-based supine flexion position for patients with low back pain and signs of nerve root compression.

DESIGN:

Single-blind, repeated-measures crossover design.

SETTING:

Outpatient physical therapy clinic.

SUBJECTS:

Ninety-eight subjects were recruited using consecutive sampling, with 28 men and 32 women of a mean ± standard deviation (SD) age of 59.6 ± 11.6 years completing testing.

INTERVENTION:

Each subject participated in 2 sessions that consisted of loaded walking for 15 minutes, followed by either 15 minutes of land-based supine position or 15 minutes of aquatic vertical traction.

MEASUREMENTS:

Spinal height change, measured using a commercial stadiometer, was determined after completing loaded walking and after each intervention.

RESULTS:

The mean ± SD height change of 4.99 ± 2.88 mm after aquatic vertical traction was similar to that of 4.21 ± 2.53 mm after the land-based supine flexion (P = .0969). Paired t-test indicated that both interventions resulted in significant increased height (P < .0001). Decreases in pain after aquatic intervention (2.7 ± 2.1 cm) were significantly greater than decreases after land intervention (1.7 ± 1.7 cm; P = .0034), and centralization of symptoms was more pronounced after aquatic vertical suspension compared with the supine land-based flexion condition (P < .0001). A significant correlation between height change and both pain reduction (r = 0.39; P = .001) and centralization (r = 0.29; P = .013) was observed for the aquatic intervention only.

CONCLUSION:

Although both the aquatic and land interventions produced significant increases in overall spinal height, the aquatic intervention produced greater pain relief and centralization response in subjects with low back pain and signs of nerve root compression.

Comprehensive Aquatic Therapy, 3rd edition (May 2011 release)

 

Hot off the presses!

 

Comprehensive Aquatic Therapy (CAT) authors just got their first-eyes copies of this 3rd edition. 

 

Over 8 years in the making.... It's HUGE.

 

At 560 pages and 1.5" thick, it's 140 pages bigger than the 2nd edition. It's truly the quintessential guide to aquatic therapy. 

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Comprehensive Aquatic Therapy remains the acknowledged reference text for aquatic therapists the world over. Featuring extensive updates from the 2nd edition, in this edition the editors have included extensive case studies, with multiple choice questions and answers as didactic content.New chapters have been added, covering the entire scope of aquatic therapy practice, including innovative new techniques with material for program development, including staff training and marketing.

1.5 Million to Investigate Aquatic Therapy for Patients with SCIs: Way to Go, Paula & Peter!

Christopher Reeve made us aware of what was possible with aquatic rehab. Before his death, he had experienced some ground-breaking moments in the pool.

So, where do we go from here?

Well, Paula Richley Geigle PT, PhD and Peter Gorman MD (Kernan Rehabilitation Hospital, Baltimore, MD) are leading the way.

The Department of Defense has granted 1.5 million dollars to investigate aquatic therapy vs. land-based rehab for SCI.

Their study will compare the effects of 3 months of 3x/week aquatic therapy to a robotically assisted aerobic locomotor training exercise (Lokomat).

The study will focus on functional ambulatory ability and cardiovascular fitness in individuals with chronic motor incomplete spinal cord injury (MISCI).

Outcome measures include: gait parameters, speed, distance; V02; Walking Index for Spinal Cord Injury (WISCI II); Spinal Cord Independence Measure (SCIM); and glucose tolerance.

A second site is Shepherd Center (Atlanta, GA) with Leslie VanHiel BME, MSPT, CCRC, and Keith Tansey MD, PhD as collaborators.