Deiparine, Cyenel Nicole

BSPT 2A
Chapter 9 Outline

Aquatic Therapy – use of water for rehabilitation purposes o Lung expansion = inhibited d/t hydrostatic
pressure against the chest wall
➢ Provide treatment that impossible or difficult on
4. Cardiac Dysfunction – Pts with angina, abnormal bp,
land
heart disease or compromised pump mechanism
DEFINITION OF AQUATIC EXERCISE require close monitoring
Aquatic Exercise – use of water for therapeutic interventions
5. Small, Open Wounds and Lines
including:
➢ Small, open wounds and tracheotomy = waterproof

➢ Stretching dressing

➢ Strengthening ➢ Intravenous lines, Hickman lines, and other open

➢ Joint mobilization lines = proper clamping and fixation

➢ Balance and gait training ➢ G tube and suprapubic appliances

➢ Endurance training
Contraindications

GOALS AND INDICATIONS FOR AQUATIC EXERCISE

➢ Any situation creating potential effects to either pt
or water environment
➢ Purpose: facilitate functional recovery by providing
➢ Such factors include:
an environment that helps pt’s and/or PT’s ability to
o Incipient cardiac failure and unstable
perform interventions
angina
➢ Specific goals:
o Respiratory dysfunction, vital capacity of
o Facilitate range of motion (ROM) exercise
less than 1 liter
o Initiate resistance training
o Severe peripheral vascular disease
o Facilitate weight-bearing activities
o Danger of bleeding or hemorrhage
o Enhance delivery of manual techniques
o Severe kidney disease (patients are unable
o Provide three-dimensional access to the
to adjust to fluid loss during immersion)
patient
o Open wounds without occlusive dressings,
o Facilitate cardiovascular exercise
colostomy, and skin infections, such as
o initiate functional activity replication
tinea pedis and ringworm
o Minimize risk of injury or re-injury during
o Uncontrolled bowel or bladder (bowel
rehabilitation
accidents require pool evacuation, chemical
o Enhance patient relaxation
treatment, and possibly drainage)
PRECAUTIONS AND CONTRAINDICATIONS o Menstruation without internal protection
Precautions
o Water and airborne infections or diseases
1. Fear of Water – limit effectiveness (examples include influenza,
o Increased symptoms during and after gastrointestinal infections, typhoid, cholera,
immersion because of muscle guarding, and poliomyelitis)
stress response, and improper form with o Uncontrolled seizures during the last year
exercise (they create a safety issue for both clinician
2. Neurological Disorders – increased difficulty and patient if immediate removal from the
controlling movements pool is necessary)
o Pt’s w/ heat-intolerant multiple sclerosis –
fatigue w/ immersion in temp > 33 C
o Pt w/ controlled epilepsy – close monitoring
& drink meds before treatment

3. Respiratory Disorders – affect the breathing

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 PROPERTIES OF WATER o The proportionality of depth and pressure
allows patients to perform exercise more
➢ Have physiological implications
easily when closer to the surface

PHYSICAL PROPERTIES OF WATER

Viscosity – friction occurring between molecules of liquid
Buoyancy – upward force that works opposite to gravity
resulting in resistance to flow
• Properties – Archimedes’ Principle: an immersed
• Properties – resistance from viscosity is proportional
body experiences upward thrust equal to the
to the velocity of movement through liquid
volume of liquid displaced
• Clinical Significance – creates resistance with all
• Clinical Significance – effects include:
active movements
o provides the patient with relative
o Increasing the velocity of movement
weightlessness and joint unloading by
increases the resistance.
reducing the force of gravity on the body.
o Increasing the surface area moving
In turn, this allows the patient to perform
through water increases resistance
active motion with increased ease.
o provides resistance to movement when an Surface Tension – surface of a fluid acts as a membrane
extremity is moved against the force of under tension; measure as force per unit length
buoyancy.
• Properties – attraction of surface molecules is
▪ This technique can be used to
parallel to the surface
strengthen muscles.
o The resistive force of surface tension
o The amount of air in the lungs will affect
changes proportionally to the size of the
buoyancy of the body.
object moving through the fluid surface
▪ Buoyancy will be increased with
• Clinical significance - an extremity that moves
fully inflated lungs and decreased
through the surface performs more work than if
with deflated lungs.
kept under water
o Body composition will also affect buoyancy.
o Using equipment at the surface of the water
Obese patients will have increase buoyancy
increases the resistance
due to fat tissue having a lower specific
gravity. Hydromechanics - physical properties and characteristics of
▪ Patients with increased bone fluid in motion
density will have less buoyancy
• Components of flow motion - three factors affect
than those with decreased bone
flow
density.
o Laminar flow - Movement in which all
o allows the practitioner three-dimensional
molecules move parallel to each other,
access to the patient
typically slow movement
Hydrostatic Pressure – pressure exerted by the water on o Turbulent flow - Movement in which
immersed objects molecules do not move parallel to each
other, typically faster movements
• Properties – Pascal’s law: pressure exerted by fluid
o Drag -the cumulative effects of turbulence
on an immersed object is equal on all surfaces of
and fluid viscosity acting on an object in
the object
motion
o Density & depth of immersion increase =
▪ Clinical significance of drag
hydrostatic pressure increase
• As the speed of movement
• Clinical Significance
through water increases,
o Increased pressure reduces or limits
resistance to motion
effusion, assists venous return, induces
increases
bradycardia, and centralizes peripheral
• Moving water past the
blood flow
patient requires the patient

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 to work harder to maintain AQUATIC TEMP AND THERAPEUTIC EXERCISE
his or her position in pool.
➢ Pt impairment & intervention goals = water temp
▪ Application of equipment
selection
(glove/paddle/boot) increases
o Cooler – high intensity exercise
drag and resistance as the patient
o Warmer – mobility, flexibility and muscle
moves the extremity through water
relaxation
Thermodynamics – water temp has an effect on the body ➢ Ambient air temp 3 C > water temp

1. Specific Heat – amount of heat (calories) required Temperature Regulation

to raise the temp of 1 gram of substance by 1 C
➢ Temperature regulation during immersed exercise
o Properties – rate of temp change depends
differs from that during land exercise because of
on the mass and specific heat
alterations in temperature conduction and the
o Clinical Significance - Water retains heat
body’s ability to dissipate
1,000 times more than air
o With immersion there is less skin exposed to
▪ Differences in temperature
air, resulting in less opportunity to dissipate
between an immerse object and
heat through normal sweating mechanisms.
water equilibrate with minimal
➢ Water conducts temperature 25 times faster than
change in the temperature of the
air more if the patient is moving through the water
water
and molecules are forced past the patient.
Center of Buoyancy – center of gravity; reference point ➢ Patients perceive small changes in water
where buoyant forces of fluid act temperature more profoundly than small changes in
air temperature.
• Properties - Vertical forces that do not intersect the
➢ Over time, water temperature may penetrate to
center of buoyancy create rotational motion
deeper tissues.
• Clinical Significance
o Internal temperature changes are known to
o Vertical position – sternum
be inversely proportional to subcutaneous
▪ posteriorly placed buoyancy
fat thickness
devices cause the patient to lean
➢ Patients are unable to maintain adequate core
forward
warmth during immersed exercise at temperatures
▪ anterior buoyancy - causes the
less than 25°C
patient to lean back.
➢ Conversely, exercise at temperatures greater than
o Unilateral manual resistance exercises - the
37°C may be harmful if prolonged or maintained at
patient revolves around the practitioner in a
high intensities.
circular motion.
o Hot water immersion may increase the
o Pt w/ unilateral lower extremity amputation
cardiovascular demands at rest and with
- leans toward the residual limb side when
exercise
in a vertical position
➢ In waist-deep water exercise at 37°C, the thermal
o Patients bearing weight on the floor of the
stimulus to increase the heart rate overcomes the
pool (i.e., sitting, kneeling, or standing)
centralization of peripheral blood flow due to
experience aspects of both the center of
hydrostatic pressure.
buoyancy and center of gravity
➢ At temperatures greater than or equal to 37°C,
cardiac output increases significantly at rest alone

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Mobility and Functional Control Exercise Gloves, Hand Paddles, and Hydro-tone Bells

➢ Flexibility, strengthening, gait training, and ➢ Resistance to upper extremity movements

relaxation - 26°C and 35°C ➢ are not buoyant = only resist motion in the direction
➢ Beneficial for pt’s with acute painful of movement
musculoskeletal injuries (effects of relaxation,
Fins and Hydro-tone Boots
elevated pain threshold, decreased muscle spasm)
➢ generates resistance by increasing the surface area
Aerobic Conditioning
moving through the water
➢ CV training aerobic exercise – temps between 26°C
Kickboards
and 28°C (bc it maximizes efficiency, increase
stroke volume) ➢ to provide buoyancy in the prone or supine
positions
POOLS FOR AQUATIC EXERCISE
➢ to create resistance to walking patterns in shallow
water when held vertically
➢ Adequately ventilated – to avoid accumulation of
➢ to challenge seated, kneeling, or standing balance
condensation on walls, windows, floors
in the deep water

Traditional Therapeutic Pools

POOL CARE AND SAFETY

➢ Measure at least 100 ft (L) 25 ft (W) 3-4 ft (depth,

➢ Require regular care and cleaning to avoid
w/a sloping bottom, progressing to 9-10 ft)
Pseudomonas aeruginosa (infection causing
o This larger type pool may be used for
folliculitis)
groups of patients and the therapists
➢ Cleaning should occur at least twice weekly, and
conducting the session while in the pool
chlorine and pH level tests should be done twice
o Entrance to larger therapeutic pools
daily
includes ramps, stairs, ladders, or
➢ All walking surfaces near and around the pool
mechanical overhead lifts.
should be slip-resistant and free of barriers. Water
o These pools have built-in chlorination and
splashes should be dried immediately to prevent
filtration systems
slips and falls.
Individual Patient Pools ➢ Safety rules and regulations are a must, as are
emergency procedures, and should be posted and
➢ These self-contained pools are entered via a door or
observed by all involved in therapeutic pool use
one to two steps on the side of the unit.
➢ Life preservers should be readily available, and at
➢ The therapist provides instructions or cueing from
least one staff member who is CPR certified should
outside the unit
be present at all times
➢ In addition to built-in filtration systems, these units
may include treadmills, adjustable currents, and Stretching Exercises
Manual Stretching Techniques
varying water depths

Spine Stretching Techniques

SPECIAL EQUIPMENT FOR AQUATIC EXERCISE
Collars, Rings, Belts, and Vests
a. Cervical Spine: Flexion
➢ assist with patient positioning by providing b. Cervical Spine: Lateral Flexion
buoyancy assistance can be applied to the neck, c. Thoracic and Lumbar Spine: Lateral Flexion/Side
extremities, or trunk Bending

Swim Bars Shoulder Stretching Techniques

➢ supporting the upper body or trunk in upright a. Shoulder Flexion

positions b. Shoulder Abduction
o the LE in the supine or prone positions c. Shoulder External Rotation

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 d. Shoulder Internal Rotation f. Ankle Motions
g. Ankle Dorsiflexion and Plantarflexion
Hip Stretching Techniques
h. Ankle Inversion and Eversion
a. Hip Extension
Dynamic Trunk Stabilization
b. Hip External Rotation
c. Hip Internal Rotation a. Dynamic Trunk Stabilization: Frontal Plane
b. Dynamic Trunk Stabilization: Multidirectional
Knee Stretching Techniques
Independent Strengthening Exercises
a. Knee Extension With Patient on Steps
b. Knee Flexion With Patient on Steps Extremity Strengthening Exercises
c. Knee Flexion With Patient Supine
Lumbar Spine Strengthening
d. Hamstrings Stretch
Trunk-Strengthening Exercises: Standing
Self-Stretching With Aquatic Equipment
Trunk-Strengthening Exercises: Semi-Reclined
• Patient position. Includes BA (seated/upright), BS
(supine), or vertical. Trunk-Strengthening Exercises: Supine
o Buoyancy-assisted - Using the natural
Trunk-Strengthening Exercises: Prone
buoyancy of water to “float” the extremity
toward the surface. Trunk-Strengthening Exercises in Deep Water

o Equipment-assisted - Includes use of

AEROBIC CONDITIONING
buoyancy devices attached or held distally Treatment Interventions
on an extremity.
Deep-water walking/running
Shoulder Flexion and Abduction
Mid-water jogging/running (immersed treadmill running)
Hip Flexion
Immersed equipment
Knee Extension
Swimming strokes
Knee Flexion
Physiological Response to Deep-Water Walking/Running
Strengthening Exercises
Manual Resistance Exercises Cardiovascular response

Upper Extremity Manual Resistance Techniques Training effect

a. Shoulder Flexion/Extension Proper Form for Deep-Water Running

b. Shoulder Abduction
Instruction for beginners
c. Shoulder Internal/External Rotation
d. Unilateral Diagonal Pattern: D1Flexion/Extension of Accommodating specific patient populations

the Upper Extremity Exercise Monitoring

e. Unilateral Diagonal Pattern: D2Flexion/Extension of
the Upper Extremity Monitoring intensity of exercise

f. Bilateral Diagonal Pattern: D2Flexion/Extension a. Rate of perceived exertion

g. of the Upper Extremities b. Heart rate

Lower Extremity Manual Resistance Techniques Monitoring beginners

a. Hip Adduction Equipment Selection

b. Hip Abduction
Deep water equipment
c. Hip Flexion With Knee Flexion
d. Hip Internal/External Rotation Midwater equipment
e. Knee Extension

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