AQUATIC EXERCISE THERAPY - Union of aquatic exercise and physical therapy - A comprehensive therapeutic approach that uses aquatic

exercises designed to aid in the rehabilitation of various conditions - An innovative approach to aquatic therapy that promotes: o Independence among patients o Maximize pool usage o Requires less staff time Principles & Properties of Water RELATIVE DENSITY - Determines weather the body will sink or float - Synonymous with Specific gravity (SG) is - Fat =.8; bone =1.5-2; muscle = 1 Pure water = 1; Salt water= 1.024 Significance? As to body built (Fat vs. Thin) Men vs. women Effects of aging (Geria vs. Pedia)

Bouyancy assisted (BA) Vertical movement directed parallel to vertical forces of buoyancy that assist motion (patient may use buoyant equipment to assist with motion). Bouyancy supported (BS) :Horizontal movement with vertical forces of buoyancy eliminating or minimizing the need to support an extremity against gravity (patient may use buoyant equipment to assist with motion). Bouyancy resisted (BR) Movement directed against or perpendicular to vertical forces of buoyancy, creating drag (performed without equipment). Bouyancy superresisted (BSR) Use of equipment generates resistance by increasing the total surface area moving through water by creating greater drag. Increasing the speed of motion through water generates further drag.

BOUYANCY - upward force that works opposite to gravity Viscosity - Buoyancy provides the patient with relative - friction occurring between molecules of liquid weightlessness and joint unloading, allowing resulting in resistance to flow. performance of active motion with increased ease. - Resistance from viscosity is proportional to the - allows the practitioner three-dimensional access to velocity of movement through liquid. the patient. Clinical significance: - Can be assistive, resistive or supportive - creates resistance with all active movements - Reduces weight bearing force - shorter lever arm results in increased resistance. Percentage supported by LE at various water depth During manual resistance exercises stabilizing an extremity proximally require the patient to perform more work. - Increasing the surface area moving through water increases resistance. Surface tension - Attraction between surface molecules neck level=10% Clinical significance: xiphoid level = 25-30% or 33% - An extremity that moves through the surface hips level/ASIS = 50% performs more work than if kept under water. - Using equipment at the surface of the water - COG varies with the level of the water increases the resistance. Center of Bouyancy - is the reference point of an immersed object on Cohesion which buoyant (vertical) forces of fluid predictably Adhesion act. - If floating body is equal to weight of displaced fluid, then COB and COG will be in vertical alignment MOVEMENT THROUGH WATER Streamline vs. Turbulence Streamline/ Laminar flow

Terms used for equipment-assisted exercise

Movement where all molecules move parallel to each other, typically slow movement.

o o o o

Floating Autogenic relaxation Breathing exercise Progressive relaxation

Turbulence/ Turbulent flow - Movement where molecules do not move parallel to each other, typically faster movements. Drag - cumulative effects of turbulence and fluid viscosity acting on an object in motion. Clinical significance: - As the speed of movement through water increases, resistance to motion increases. - Moving water past the patient requires the patient to work harder to maintain his/her position in pool. - Application of equipment (glove/paddle/boot) increases drag and resistance as the patient moves the extremity through water. Hydrostatic pressure - pressure is the pressure exerted on immersed objects. - pressure is directly proportional with depth and density Clinical Significance: - Increased pressure reduces or limits effusion, assists venous return, induces bradycardia, and centralizes peripheral blood flow. - The proportionality of depth and pressure allows patients to perform exercise more easily when closer to the surface. Components of each Exercise Program: WARM UP - 20-30 minutes of total treatment time - allows body to adjust to onset of activity - duration depends on temperature of water STRETCHING - should involve muscle/s that will be exercised MUSCLE STRENGTH & ENDURANCE - increase length of lever arm - move float from proximal to distal or toward the bottom of pool - increase size and number of floats - increase surface area of resistance - moving in less streamlined position - increase speed of movement - move weight toward surface of water RELAXATION - Local Relaxation Techniques o Heat, Massage, joint traction - General Relaxation Techniques

PHYSIOLOGIC CHANGES DURING WARM WATER EXERCISE: - respiratory rate - HR - BP - blood supply to mm - metabolic rate - amount of blood returned to heart - sensitivity of sensory nerve endings - edema of submerged body parts - superficial circulation - mm metabolism - general mm relaxation THERAPEUTIC BENEFITS OF WARM WATER EXERCISE - promotes mm relaxation - pain sensitivity - mm spasm - ease of joint movement - mm strength and endurance in cases of excessive weakness - gravitational forces (early ambulation) - peripheral circulation - improves respiratory mm - improves body awareness, balance & proximal trunk stability - improves pt morale and confidence (psychological) Aquatic Facility

Uncontrolled seizures: They create a safety issue for both clinician and patient if immediate removal from the pool is necessary. * Study the Protocols of Phase 1-4

GOOD L.U.C.K.!

GOALS AND INDICATIONS FOR AQUATIC EXERCISE - Facilitate range of motion (ROM) exercise - Initiate resistance training - Facilitate weight-bearing activities - Enhance delivery of manual techniques - Provide three-dimensional access to the patient - Facilitate cardiovascular exercise - Initiate functional activity replication - Minimize risk of injury or reinjury during rehabilitation - Enhance patient relaxation PRECAUTION - Fear of Water - Neurological Disorders - Seizures - Cardiac Dysfunction - Small Open Wounds and Lines CONTRAINDICATION - Incipient cardiac failure and unstable angina. - Respiratory dysfunction; vital capacity of less than 1 liter. - Severe peripheral vascular disease. - Danger of bleeding or hemorrhage. - Severe kidney disease: Patients are unable to adjust to fluid loss during immersion. - Open wounds, colostomy, and skin infections such as tinea pedis and ringworm. - Uncontrolled bowel or bladder: Bowel accidents require pool evacuation, chemical treatment, and possibly drainage. - Water and airborne infections or diseases: Examples include influenza, gastrointestinal infections, typhoid, cholera, and poliomyelitis.