Facilitation Technique Category: Aquatic Therapy

Activity Title: Aquatic PNF (Proprioceptive neuromuscular facilitation): classic movements

patterns.
Source: Broach, E. (n.d.). Aquatic Therapy.
Equipment: Aquatic bells, gloves, or paddles, boots, fins, specific aquatic resistance shoes,
flotation devices (for horizontal position to create floating platform).
Activity description: Aquatic therapy in general promotes functional enhancement in physical
and psychological aspects as well as leisure effective and quality of life. Regarding physical
implications/benefits include: circulation, weight bearing, balance, stability, strength, ROM,
ambulation etc. Also provides psychological benefits such as improving mood and self-esteem
while decreasing depression and anxiety. The purpose of this activity is to improve independence
through water exercises. First, the instructor will read the instructions and will perform physical
demonstration of the steps. Second, have a line formation along the water with a considerable
space between participants to prevent injuries/accidents. Third, the instructor will conduct the
first step by providing the following command: The starting position will be in standing and
participants will complete the traditional PNF patterns such as D1/D2 flexion by elevating one
upper extremity in diagonal movement across midline using aquatic bells, gloves or paddles on
bilateral wrists or therapist will provide external resistance, Fourth, processed to different
positions such as sitting and kneeling while performing same exercises 10 repetitions x 3 sets.
Fifth, continue with rhythmic initiation and the instructor will give the instruction such as
passive movement do not move yourself just let me move you, then processed to active
assistive participate with me during the movement and finally continue with slight resistance
move against therapists resistance 15 repetitions x 3 sets. Six, continue with rhythmic
stabilization and the instructor will conduct the step by asking the client to be relax during
isometric contraction (muscle contraction without muscle lengthening) of all muscles around the
articulation against advanced resistance applied by therapist, hold the contraction x 10 sec
against the resistance x 10 reps. Seven, clients will have aquatic resistance shoes, boots or fins
(on (B) LE) during the next step which is resisted progression that will include resistance applied
on pelvis, hips, or UE/LE extremities during gait training by a designated distance. Eight, the
session will be finish by having the instructor reviewing the steps and providing feedback.
Leadership considerations: CTRS will be the instructor in this activity with a minimum
requirement of comprehensive training and accreditation that is offered through the Aquatic
Exercise Association (AEA), which was formed a couple of years ago to standardize the study
and advancement of aquatic therapy. AEA Aquatic Fitness Professional Certification (AFPC) is a
transitional level authorization which allows specialists to teach aquatic therapy. The
endorsement is based on the Aquatic Fitness Professional Manual, published by Human Kinetics,
which offers industry principles and procedures. Also, staff /volunteers, recreational therapist

students can support/guide participants during the activities. The staff to participants ratio
should be1:1, 1:2, 1:3, and 1:4 depending on the clients level of assistance.
Instructions/education regarding all safety issues include: fall precautions during transfers excs
from W/C to pool, proper body mechanics, and energy conservation techniques (rest periods
between sets) and breathing excs to promote endurance, transfers techniques requiring
dependent transfers or assistive transfer. Some precautions/contraindications should be taken into
consideration including: water temperature, open wounds, uncontrolled bowel incontinence, skin
condition, hepatitis- A, uncontrolled seizure, etc.
Adaptations: Participants with Multiple Sclerosis: This condition is characterized by damage
to the myelin coating around the nerve fibers in the CNS and as a result the nerve fibers inhibit
the conduction of nerve signals between the brain, spinal cord and many others parts of the body.
Interrupted nerve signals cause the signs of multiple sclerosis, which vary depending the person,
time, and area of the damage (National Multiple Sclerosis Society). According to Giles, some
adaptations that could be very helpful will be modified the water temperature to (less that 85
degrees) since this population exhibits exacerbations by being exposed to heat mostly (2012).
Pool exercises should be performed in the morning time when the client is refreshed is advisable
to avoid tiredness. It is also recommended to give them rest periods between sets and to break a
task into reduced steps to prevent fatigue (Giles 2012). Ambulation and mobility training using
flotation devices in the pool will promote endurance and prevent disuse atrophy.
Adaptations: Participants with Osteoarthritis: This disease occurs when the cartilage that
cushions the ends of bones in your articulations gradually declines. Cartilage is a strong; slippery
tissue that allows nearly frictionless joint indication. In this condition, the slick exterior of the
cartilage becomes rough. Finally, if the cartilage wears down totally, the client will be left with
bone chafing on bone (Mayo clinic 2016). Some adaptations for clients with osteoarthritis will be
having them exercising in the pool to avoid overexertion and fatigue. According to Broach, the
pool will serve as a weight reduction due to water properties such as Archimedes principle that
relative density reduces weight bearing in water. The use of floating and balls will serve for
balance/stability.

Adaptations References
(n.d.). Retrieved from http://www.nationalmssociety.org/Living-Well-With-MS/HealthWellness/Heat-Temperature-Sensitivity
Andrea Salzman, P. (n.d.). Aquatics International. Retrieved from
http://www.aquaticsintl.com/facilities/pattern-treatments_o
Broach, E. (n.d.). Aquatic Therapy.

Mayo Clinic. (n.d.). Retrieved from http://www.mayoclinic.org/diseasesconditions/osteoarthritis/symptoms-causes/dxc-20198250

My child at cerebral palsy. (n.d.). Retrieved from http://www.cerebralpalsy.org/about-cerebralpalsy/treatment/therapy/aqua-therapy
National Multiple Sclerosis Society. (n.d.). Retrieved from
http://www.nationalmssociety.org/Symptoms-Diagnosis