the aquatic therapist

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.

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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.

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.

Why balance train in water & how to convert the Berg Balance Assessment into an aquatic challenge

Why balance train in water? Read the 2008 full text research which supports this idea (article is in Portuguese and English).

In the water, patients may be challenged beyond limits of stability without the fear of consequences of falling which are often present with land-based balance training. The environment leads to improvement in balance reactions which are translatable to land.

(Read Andrea Salzman's Converting the Berg Balance Test into an aquatic challenge)

 

Movement through water is affected by turbulence and viscosity. Water is more viscous than air, and resistance to flow through water is greater than resistance to flow through air. Thus, it takes more force to push through water molecules than to push through air molecules.

Additionally, the faster an object is pushed through the water, the more turbulence is created and this creates additional resistance to movement.

A body immersed is surrounded by a viscous fluid which retards the speed of movement. This viscosity prevents rapid falling and elongates the period of time in which a patient can respond to a shift of his center of mass outside his base of support.

Additionally, the natural end result of a loss of balance which is not corrected is a fall into a compliant fluid (water) and not a fall to a noncompliant solid (the ground). Thus, the patient may be challenged to move outside his base of support without fear of traumatic consequences.

This reduction in patient anxiety may encourage the patient to attempt tasks which he would not attempt on land. It becomes possible to elicit balance challenges which the patient has both time and mental confidence to combat. On land, without the assistance of such aquatic properties, the resultant balance responses may be incomplete or absent.

So, it makes sense that aquatic based balance training could lead to an improvement in balance on land.

Link to Andrea Salzman's adaptation of the Berg Balance Assessment into a 30 minute aquatic treatment for your balance patients.

2008 research source: Resende SM, Rassi CM, Viana FP. Effects of hydrotherapy in balance and prevention of falls among elderly women. Rev Bras Fisioter. 2008;12(1):57-63.

The effectiveness of hydrotherapy in the management of fibromyalgia syndrome: a systematic review

Don't you just love to be right? Who knew aquatic therapy was good for the patient with fibromyalgia? YOU KNEW! (Do the end-zone dance now).

 

ABSTRACT: Hydrotherapy is often used in the treatment of fibromyalgia syndrom (FMS), however there has been limited evaluation of its effectiveness.

The aim of this systematic review was therefore to examine the effectiveness of hydrotherapy in the management of FMS. AMED, BNI, CINAHL, The Cochrane Library, EMBASE, MEDLINE, ProQuest, PubMed, Science Direct and Web of Science were searched (1990-July 2006).

Key words used 'fibromyalgia' and 'hydrotherapy', 'balneotherapy', 'aqua therapy', 'pool therapy', 'water therapy', 'swimming', 'hydrogalvanic', 'spa therapy', 'physiotherapy', 'physical therapy' and 'rehabilitation'.

Searches were supplemented with hand searches of selected journals. Randomised controlled trials (RCTs) were assessed for methodological quality using the van Tulder scale.Ten RCTs met the inclusion criteria. Mean methodological quality was 4.5/9 on the van Tulder scale.

Positive outcomes were reported for pain, health-status and tender point count. There is strong evidence for the use of hydrotherapy in the management of FMS.

SOURCE:

McVeigh JG, McGaughey H, Hall M, Kane P. The effectiveness of hydrotherapy in the management of fibromyalgia syndrome: a systematic review. Rheumatol Int. 2008 Aug 27. [Epub ahead of print]

School of Health Sciences, Health and Rehabilitation Sciences Research Institute, University of Ulster, Newtownabbey, BT37 0QB, Northern Ireland, UK, j.mcveigh@ulster.ac.uk.

National Aquatics Journal available online: A blast from the past

To those interested in research - a blast from the past. The National Aquatics Journal
was published from 1983 through 1995. NSPF has scanned all those journals and posted them for free at http://www.nspf.org/Aquatics_Journal.html. 

Sample Table of Contents for one issue:

• Aquastep Your Way To Fitness
• Full Inclusion Or Least Restrictive Environment?
• Psychological Aspects Of College Age Entry Level Scuba Divers
• Emergency Care And Bloodborne Pathogen Training For Lifeguards

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.

Ask ARN: Should the tracheostomy patient be allowed to do aquatic therapy?

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

Question: Is it contraindicated for a patient with a tracheostomy to get into the pool for aquatic therapy?

Answer: The answer is: It depends! Many clinics consider a trach a contraindication -- there is too big a risk for any benefit the client may receive. For those who decide to allow patients with an open trach into the water, here is one research article which may assist in that difficult decision. (more to come in future postings...)

Authors: Taylor,S.
Title: The ventilated patient undergoing hydrotherapy: a case study
Periodical, Full: Australian Critical Care
Pub Year: 2003
Pub Date Free Form: Aug
Volume: 16 Issue: 3
Start Page: 111-115
Descriptors: Neurological; Liability; Adverse Effects; Metabolic and Systemic; Tracheotomy; Best

Abstract: The ascending peripheral neuropathy and paralysis that result from Guillain-Barre Syndrome's (GBS) demyelination of peripheral nerves is a challenge to health professionals; the patient requires support during the acute disease process and during the remyelination recovery period, often lasting months to years. The staff of a major metropolitan teaching hospital's critical care unit (CCU) and physiotherapy departments developed a hydrotherapy treatment programme for a ventilated patient with GBS. Through careful planning and appropriate preparation, it was found that hydrotherapy could successfully and safely be incorporated into a patient's treatment regimen. The benefits included improved range of movement due to the supportive nature of water, anecdotal increased strength, size and movement of remyelinating muscles and a psychological improvement. Although this patient has not recovered from GBS to be independent, hydrotherapy was a valuable part of the treatment regimen and it could be suggested the increase muscle strength lead to improved respiratory function and enabled weaning from ventilation, reducing intensive care length of stay and cost.

Aquatic PT Section Calls for SwimEx Research Grant Award Applications

Attention Members of the Aquatic PT Section of the APTA.

Aquatic PT Section members are invited to apply for the Section's 2008 SwimEx Sports and Orthopedic Research Grant Award. Applications are due by the extended deadline of June 1, 2008.

The $5,000 grant is designed to assist with a one-year research study that investigates a question or questions of importance to aquatic physical therapy in patients with sports or orthopedic related injuries, according to Mitzi Wiggins, the Section's director of research.

The purpose of the grant is to provide funding to assist physical therapist investigators and to encourage research that will add to the body of knowledge related to the improvement of patients requiring rehabilitation for a sports related or orthopedic injury utilizing aquatic physical therapy, Wiggin said. The grant can support post-professional thesis or dissertation research.

The grant is made possible by a gift from SwimEx, a leading designer and manufacturer of residential swim spas and commercial aquatic therapy and sports conditioning pools with headquarters in Fall River, Mass.

Apply here. (Note: the application has the wrong deadline on it. The correct deadline is June 1, 2008 and the grant will be awarded by July 1st if a qualified applicant is identified.

Research award in aquatic PT

Luis Vargas, PT, PhD, Chair of the Dept. of Physical Therapy for Wheeling Jesuit University . . .

. . . is awarded the prestigious Richard Ruoti Award for Scholarship during the Aquatic PT Section's Membership Meeting at CSM in Nashville.

In making the nomination, PT Marty Biondi wrote in part:

"Having worked with Dr. Vargas on various aquatic endeavors including a research project and certification process, I believe I can attest to his vast knowledge of physical therapy, his passion for aquatic therapy as a practitioner and as an instructor, his integrity and willingness to share his vast experience in the field of aquatics.

"As the Chair of the Department of Physical Therapy for Wheeling Jesuit University, he encourages the DPT students to utilize aquatic therapy as the treatment medium for their research and has facilitated this process by making his contacts in the field available to assist those who are interested.  Currently, he has two research teams involved in this much needed endeavor for the entire field of aquatics.  While having been Chair only since July 2006, Dr. Vargas has begun the process of establishing an Aquatics Residency/Fellowship Program for post graduate individuals interested in pursuing such a specialty.  This shall ultimately undergo the accreditation process of APTA, and will mark the first of it kind for the PT professional.  His long-term plan is to provide an academic specialty in Aquatic Therapy; to this end he is diligently working to satisfy the university criteria for such a program.

Read more...

Upcoming Aquatic Therapy Education - Andrea Salzman, Instructor

Looking for kick-tail aquatic therapy continuing education?

This course has tons of pool time. Tons of research backing up what you have always suspected to be true… that aquatic therapy works.

We look at what insurance companies are saying, what the AMA is saying, and what YOU should be saying about aquatic therapy.

And then we plop our butts in the pool and practice it until our toes turn pruney.

Andrea Salzman's Evidence-Based Aquatic Therapy
Oct 16-18, 2008: Minneapolis, MN (Thurs PM, Fri, Sat)

For more information, call the Aquatic Resources Network at (715) 248-7258 or go online here.

SCHEDULE
Day 1 (FRIDAY EVENING) 

3:30-4:00 ~ Registration and box supper

4:00-6:00 ~ Making the case for aquatics in general; Making the case for aquatic therapy for the shoulder and neck patient

6:00-6:15 ~ Change for pool

6:15-8:15 ~ Pool Lab - Shoulder and neck patient practicum

8:15-8:30 ~ Wrap up and dismissal

Day 2 (SATURDAY)

7:30-8:00 ~ Check in and continental breakfast

8:00-10:00 ~ Making the case for aquatic therapy for the back, hip and knee patient

10:00-11:30 ~ Making the case for aquatic therapy for the cardiopulmonary-compromised and neuro patient

11:30-12:30 ~ Lunch (provided)

12:30-2:45 ~ Pool Lab - Thoracic, lumbar and pelvic patient practicum

2:45-3:00 ~ Energy break

3:00-5:00 ~ Pool Lab - Hip, knee and ankle patient practicum

5:00 ~ Dismissal

Day 3 (SUNDAY)

7:30-8:00 ~ Check in and continental breakfast

8:00-10:00 ~ Pool Lab - Cardiopulmonary-compromised patient practicum

10:00 ~ Energy break

10:15-12:00 ~ Pool Lab - Neuro patient practicum

12:00-1:00 ~ Lunch (provided)

1:00-2:00 ~ Billing and reimbursement forum

2:00-3:30 ~ Creating exciting aquatic therapy programming

3:30-4:30 ~ Marketing to physicians and the public

4:30-5:00 ~ Wrap up and dismissal

(Schedule subject to change without notice)