the aquatic therapist

Recent diarrhea? Don't get in the therapy pool.... for 2 weeks! (says the CDC)

From the CDC...

Pools should post signs alerting patrons to any diarrhea outbreaks and urging patrons with current or recent diarrhea to stay out of the water.

The CDC says swimmers also need to help by following these tips:

• If you've got diarrhea, don't get in the water until two weeks after the diarrhea ends.
• Avoid swallowing pool water.
• Practice good hygiene. Wash your hands after using a restroom or changing diapers.
• Shower before getting into the water.
• Report fecal contamination to pool operators.

The report appears in the CDC's Morbidity and Mortality Weekly Report.

SOURCES: CDC, Morbidity and Mortality Weekly Report, July 27, 2007; vol 56: pp 729-732. News release, CDC.

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.

What to do if you are not getting the weekly eSplash (aquatic therapy industry newsletter)

Aquatic therapy gurus,

Many of you who signed up for our Aquatic Resources Network weekly eSplash have told us you are still not getting it. This may be because the email has photos/graphics which can tend to plop it into your spam folder.

To make it even easier, we took all the back issues and put them on the web.

For archived copies, go to:

http://archive.constantcontact.com/fs054/1102184430637/archive/1102261598185.html

Here are a few topics we've covered recently:

• 2 second test to determine if you are suffering from low-grade chronic dehydration
• Why Medicare changed their mind about community pool rental exclusivity
• What to do if your payers don't recognize aquatic therapy
• Sensory integration tips for pediatric therapists... and much more

Andrea Salzman, MS, PT
Aquatic Resources Network
www.aquaticnet.com

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.

Feeling poorly? It just might be a chronic, low-grade case of dehydration

Unfortunately, thirst isn't always a reliable gauge of the aquatic therapist's need for water.

Instead, take the runner's test. Long distance runners have learned that a quick look back into the toilet bowl after peeing can give them a heads-up as to their hydration status.

Clear or light-colored urine? You're well hydrated.

But if you're seeing dark yellow or amber colored urine (see photo above!), you're simply not getting enough to drink.

Immersion causes the body to excrete more fluids. The more time you spend in the water, the more fluid you lose.

You've got to drink more. A lot more. Or you're going to develop a chronic case of "feeling old" before your time.

Mild to moderate dehydration is likely to cause:

• Dry, sticky mouth
• Sleepiness or tiredness
• Thirst
• Decreased urine output
• Few or no tears when crying
• Muscle weakness
• Headache
• Dizziness or lightheadedness

Source: Mayo.com

Other reasons for dark urine...

Questions about the Pool and Spa Safety Act? Here are your answers

Did you miss the Aquatics International webcast on implementing the Pool and Spa Safety Act?

Experts from CPSC, APSP and other industry pros discussed the Act in a roundtable discussion. Here is the Q&A session from registered participants to some of the questions asked and answered.

Note: We have not received any response from the CPSC to our questions about whether therapy pools must comply with this act. We will keep you posted, but for now, assume that you must even though therapy pools are not always considered "public pools" by the states.

It's a "best practice" issue even if it isn't the law.

Cool download: Sample appeal letter for aquatic therapy denial

Aquatic therapy treatment can be denied for many reasons. Many have nothing to do with the pool, but some do. And you can do something about those things!

Here is a quick list of many of the reasons Medicare and other payers will deny aquatic therapy.

See also this sample letter of appeal to use if aquatic therapy has been denied.

Reasons aquatic therapy sessions can be denied:

Are you a licensed provider?

Did you provide 1:1 contact?

Was the care skilled, not maintenance, with the intent to restore function?

Did you exceed the standard treatment duration and progression?

Did you provide an appropriate rationale for use of water?

Did you provide more than one type of water therapy per session? (for instance, contrast bath and aquatic therapy)

Now take a minute to join the Aquaticnet Social Network to get gems like this all the time. It's free!

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]

Guest blog: Staying afloat - Tips for aquatic therapists

by Kelly Kilpatrick

It’s no longer an emerging trend, but aquatic therapy continues to struggle to find its niche in the realms of mainstream medicine.

There’s no doubting the fact that aquatic therapy is beneficial in recovering from surgeries, illnesses and injuries with the least amount of pain. Why? In water, the body is supported while allows for a low-stress environment during the healing process unlike on dry land where gravity tends to affect weight bearing activities.

But the tricky part for aquatic therapists may have nothing to do with the pool itself. Rather, therapists who choose to work in the water often must jump through additional hoops in order to get paid. Here are a few tips for aquatic therapists to help them stay afloat:

• You’re bound to have trouble with the reimbursement from some insurance companies and some local intermediares of Medicare. There are certain rules to be followed before the payment comes through, and if you’re not familiar with these, you can kiss the money goodbye. For instance, your documentation must support medical necessity and show that you worked 1:1 with the client in the pool.

• Think once, twice and many more times before you invest in your own pool and other treatment facilities. While it’s nice to have your own place, if your practice is not continuously lucrative, you’re going to be stuck with a white elephant and maintenance costs are going to hit the roof. And those energy costs are certainly not coming down anytime soon.
  
  
• Consider cash-based therapy if your patient caseload is not covered by insurance. Cash-based practices do best in states with direct access. Keep in mind that some states do not allow direct referrals while others do, so check if you need an evaluation by a physician. Keep a list of the insurance companies that do allow direct referrals.
  
  
• Diagnosis codes vary according to insurers, so make sure you use the right ones in your documentation. Some payers do not recognize the code 97113 although they do not have a problem with water-based treatment.
  
  
• Set goals for your clients and work on reaching those goals within the time limits. Find out early on if your clients want to continue with aquatic exercise even after they are discharged. If so, teach them a little more independence each visit rather than just telling them what to do.  

By-line:

This post was contributed by Kelly Kilpatrick, who writes on the subject of nursing schools online. She invites your feedback. Or checkout her website at www.nursingdegree.net. 

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.