The Journal of Aquatic Physical Therapy - Vol 25 No.
2, Winter 2017
Meeting Abstracts
Aquatic Physical Therapy Section Platforms
Presented at APTA’s 2017 Combined Sections
Meeting in San Antonio, Texas
Body Mass, Metabolic and
Cardiovascular Impact of Aquatic
Aerobic Exercise and Nutritional
Guidance for Individuals with Chronic
Incomplete Spinal Cord Injury (CMISCI)
P.R. Geigle, W.H. Scott, P.H. Gorman
Rehabilitation Research, University Maryland, West Ches-
ter, PA
S. Joanne
Fruitful Elements, Ontario, Ontario, Canada
K. Jones
Korinutrition, Ontario, Ontario, Canada
Purpose/Hypothesis: Assess dosed group aquatic exercise
at 70-75% of heart rate reserve (HRR) and nutritional guid-
ance upon body mass, glucose, insulin, A1C, peak VO2,
and resting metabolic rate (RMR) for four individuals with
CMISCI and fasting glucose > 100 mg/dL.
Number of Subjects: 4 men diagnosed with CMISCI and
fasting glucose > 100 ml/dL.
Materials/Methods: Four men: 63 yo, AIS D, body mass
index (BMI) 31.9; 34 yo who is non ambulatory, AIS C, BMI
of 31.6; 58 yo, AIS D, BMI 27.4 and 45 yo, non ambulatory,
AIS C, BMI of 30.9. We prescribed a dosed aquatic exercise
program 3 times per week for 10 weeks, and a weekly phone
nutritional consult by phone. Nutritional guidance included
reducing refined carbohydrates and processed food, limit-
ing high glycemic fruits, and increasing vegetable, fluid and
lean protein intake. Outcome measures (pre/post) included:
3-day electronic food logs, weekly hard copy food logs, glu-
cose, insulin and A1C (via standard fasting venipuncture),
weight, peak VO2 and RMR.
Results: Body weight reduced in all 4 participants between
5-10%; peak VO2 increased in 2 individuals, 8 and 34%,
and decreased in 2 individuals, 12%; REE increased in 2
individuals, 2 and 24%, and decreased in 2 individuals, 12%;
A1C reduced in 3 men 5-11%; reduced daily intake: 624 cal-
ories; fat calories 290 grams; total fat 32.5 grams; saturated
fat 9.5; overall carbohydrate 70 grams; and sugar 17 grams;
increased water intake by 155.5 grams/day.
Conclusions: Moderate exercise with weekly nutritional
guidance appears to positively impact: body mass, glu-
cose, HbA1C and caloric balance. Adherence ability var-
ied due to reliance on others for grocery shopping and
meal preparation, and transportation issues interfered
with some nutrition sessions. One participant resided in
a facility with meal options limited. One individual ex-
perienced musculoskeletal pain form a non-study source
during testing which appeared to negatively impact per-
formance outcomes. Further examination of the effect of
a low cost intervention, combined aquatic exercise with
nutritional guidance, exerts upon body mass, metabolic
status, and cardiovascular fitness for individuals with
CMISCI is indicated.
Clinical Relevance: Persons living with chronic spinal cord
injury (SCI) demonstrate an increased risk of premature
coronary artery disease and other secondary complications
of limited motoric activity with cardiac disease representing
a leading cause of death for individuals experiencing SCI.
Heart disease risk factors specific to SCI include arthero-
genic metabolic alterations including low high density lipo-
proteins (HDLs), glucose intolerance, insulin resistance and
a reduction in metabolic rate. Total body fat in SCI patients
is 50% higher than matched individuals without SCI. Our
aquatic aerobic exercise group exercise and dietary guid-
ance program appears to be one low cost possible solution
to mediate secondary metabolic health conditions for indi-
viduals with CMISCI.
The Effects of an Aquatic
Intervention on Balance, Gait Speed,
and Core Strength in Children
with Neurological Deficits
K. L. Countryman, M. Hurst, M. Riney, A. Senn, E. Walker,
K. Young, E. Ennis, M. Danzl
Physical Therapy, Bellarmine University, Louisville, KY
Background and Purpose: Aquatic therapy is used to treat,
rehabilitate, prevent, and improve overall health in a variety
of patients, specifically the pediatric population. The pur-
pose of this study was to create an aquatic therapy program
for participants with Cerebral Palsy (GMFCS level 2&3)
and Spina Bifida (level L3 or below).
65
Case Description: The aquatic therapy program consisted
of individualized exercises to help improve balance, core
muscle strength, gait speed, and overall function. Six par-
ticipants, including five with CP and one with SB, were
involved in an eight-week aquatic therapy program, with
each individual receiving specific exercises tailored to their
needs. Each session was forty-five minutes.
The inclusion criteria for the research study included:
• Be between the ages 3-10 years old
• GMFCS Level 2 or GMFCS Level 3 for children with CP
• Participants with Spina Bifida involving level L3 or below
• Must present with a diagnosis of either Spina Bifida or
Cerebral Palsy
• Obtain physician’s consent from primary care physician
Outcomes: Pre-test data was collected on each participant
for core strength, gait speed, PediBerg for balance, and the
PedsQL Neuromuscular module. Each participant then
received seven forty-five minute aquatic therapy sessions.
Post-test measures were taken three days after the comple-
tion of the aquatic intervention. All six participants im-
proved in core strength. Four of the six subjects improved in
gait speed, with the other two participants being unable to
complete the 10-meter walk test. Five of the six participants
improved on the PediBerg balance outcome measure, with
one participant being unable to complete any tasks on the
PediBerg. Three of the participants PedsQL Neuromuscu-
lar Module overall scores improved, while the other three
scores decreased. The PedsQL Neuromuscular Module has
three subcategories, which include neuromuscular disease,
communication, and family resources. The changes in these
subcategories varied for each participant.
Discussion: Based on our results, improvements in each
participant were seen in different areas. Several factors con-
tributed to a changes in the scores, including attendance,
concurrent therapy, reinforcement and feedback. While
it cannot be said that there was a significant change in the
participants in this study, improvements were noted in each
participant. Future research should include more focus on
SB, more specific inclusion criteria, larger sample size, differ-
ent outcome measures, and a longer time frame for the study.
Miller Fisher Syndrome and Guillain
Barré Syndrome: Rehabilitation
of a Complex Patient Case
J. E. Mayer, C. A. McNamara, N. O’Brien, J. Bello, T. Ferrante,
N. LeClair, M. Koval, B. Kraus
Physical Therapy, Ithaca College, Ithaca, NY
J. Mayer
Outpatient Physical Therapy, Cayuga Medical Center,
Ithaca, NY
66
Background and Purpose: Guillain-Barré Syndrome
(GBS) presents with acute peripheral neuropathy leading
to a rapid progression of ascending motor and sensory
deficits, with occasionally associated autonomic dysfunc-
tion, cranial nerve involvement and respiratory failure.
Miller Fisher syndrome (MFS), a rare variant of GBS af-
fecting one in 1 million people, is characterized by oph-
thalmoplegia, ataxia and areflexia. In unusual cases, MFS
and GBS may overlap, indicated by paresis of the extremi-
ties or definite limb weakness and reported as 5%-28% of
MFS diagnosed cases. This case report describes the physi-
cal therapy examination, a novel treatment intervention,
and outcomes for a patient with a complex diagnosis of
overlapping MFS-GBS.
Case Description: The patient, a 57-year-old male phy-
sician, was diagnosed with complex regional pain syn-
drome (CRPS) following a quadriceps muscle tear. Over
the course of one month, the patient experienced evolv-
ing motor, sensory, autonomic and cranial nerve dys-
function including diplopia, ataxia, areflexia, weakness,
multiple falls and respiratory distress. He was diagnosed
with MFS-GBS. Further complications included repeated
traumatic brain injury secondary to falls. Following
acute care and short inpatient rehabilitation stay, inad-
equate medical coverage delayed further treatment by
3-months, despite persistent impairments and functional
limitations. At five months post-onset of symptoms, a
7-week treatment program was initiated consisting of
four 60-minute intensive sessions per week, 2 aquatic and
2 land based.
Outcomes: Pre-intervention functional mobility, endur-
ance, gait velocity, balance and quality of life were measured
using the Timed Up and Go (TUG), 6 minute walk test
(6MWT), 10 meter walk test (10MWT), Berg Balance Scale
(BBS), and Short form-36 (SF-36), respectively. Following
completion of the 7-week therapeutic program, improve-
ments were demonstrated on the 6MWT (47.9m change),
TUG (26.8sec change), 10MWT (fast velocity .21m/s
change) and SF-36 (all sub-scales excluding general health).
BBS scores did not change. Short term goals were achieved,
however long term goals were not. Initiation of treatment
was attempted again 6 weeks later, but was discontinued due
to a relapse.
Discussion: This case serves as a means for clinicians to
better identify signs and symptoms that may present in
patients along the GBS continuum. The preceding medi-
cal complication leading up to the diagnosis of MFS-GBS
was CRPS, an atypical prior event. The novel treatment
approach including aquatic and land-based therapy dem-
onstrated favorable short term outcomes. Although most
cases of GBS and MFS have a good prognosis and relapse
is rare, symptom recurrence is possible and complex pa-
tients may require longer recovery time with continued
rehabilitation.
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