MULTIPLE SCLEROSIS

&
AQUATIC THERAPY
The benefits of aquatic therapy with patients suffering from multiple
sclerosis.

By: Katie Moskey

 INTRODUCTION

Throughout this presentation, I will discuss the research of the advantages of aquatic therapy and
multiple sclerosis. Not only will there be evidence from scholarly articles but a case study as well. This
case study will include the perspective of a patient diagnosed with MS and the pool exercises she
partakes in.
 WHAT IS MULTIPLE SCLEROSIS?

• Multiple sclerosis is a chronic progressive disease that affects the brain and spinal cord. This can lead to
loss of muscle control, vision, balance, and sensation.
• Affects 1 million people worldwide.
• Typically a patient can be diagnosed between 20 and 50 years of age.
• People are diagnosed due to genetic predisposition or environmental antigens.
• There is no cure for multiple sclerosis but there are treatments that can slow the progression of it and
improve its symptoms.
• One of the major limitations of MS is fatigue. Therefore, patients have a very low exercise tolerance.
This makes it difficult for them to strengthen their muscles and increase their range of motion.
 MS SYMPTOMS

• Patients could experience any of the following

symptoms…
• Fatigue* • Vision problems
• Difficulty walking • Tremors
• Stiffness/spams • Sexual problems
• Bladder problems • Difficulty moving arms
• Memory/cognitive problems • Swallowing problems
• Pain • Speech problems
• Mood problems • Seizures
 HOW DOES AQUATIC THERAPY BENEFIT PATIENTS
WITH MS?
• Aquatic therapy can help improve strength, endurance, cardiovascular ability, and balance.
• Studies have shown that there has been an increase in quality of life, mood, fatigue resistance,
strength and mobility among patients with MS.
• Pool Water Temperature
• The cooler water can reduce the body temperature and increase the exercise tolerance compared to on
land.
• According to NMSS, water temperature should be around 80-84 degrees Fahrenheit to keep core body
temperature low.
 HOW DOES AQUATIC THERAPY BENEFIT PATIENTS
WITH MS?
• Buoyancy
• Being in the pool can decrease weight-bearing and resistance which can endure longer durations of activity.
• The pool is a lot safer for the patient because they are no longer at fall risk. The uplift force while submerged
in water prevents falls.
• Hydrostatic Pressure
• Increases blood volume which can increase cardiac and respiratory function.
• Increases ability to stand, ambulate, and balance.
• Viscosity
• The pool water’s resistance can be used to increase/decrease difficulty of exercise.
• Slows the movement.
 EXAMPLES OF AQUATIC TECHNIQUES

• Hallwick Technique
• Emphasizes balance control in different planes.
• Sagittal: side to side movements
• Transverse: forward/backward movements
• Longitudinal: rotational movements

• Ai Chi Technique
• Increases mind-body awareness.
• Combines steady motions with breath patterns.
• Task Oriented Approach
• Focuses on functional tasks.
• Quick and reciprocal movement patterns.
 CASE STUDY: GRACE

• DIAGNOSIS: Grace is a 66 year old female. She was very active all of her life until one day she started to notice
how her left leg started to drag. Her balance was thrown off and she became a fall risk. She was then diagnosed
with multiple sclerosis in 2012.
• SYMPTOMS: The symptoms that affect her the most are fatigue and pain. When it comes to physical activity, she
can only perform in small increments. She experiences severe pain in her left hip which alters her gait pattern.
“When getting in and out of a car, I have to pick up my leg with my arms.” She has no neuromuscular control in her
left leg.”
• MEDICATIONS: The only medication Grace has been taking is Ampyra. This drug is meant to improve walking with
patients with MS. However, she doesn’t notice any change with her gait while taking it.
• DIET: Grace takes dietary supplements to get the nutrients she lacks. She also removed gluten, artificial sweeteners,
and preservatives from her diet.
 CASE STUDY: GRACE

• AQUATIC THERAPY: Grace started going to aquatic therapy and physical therapy Fall of 2017.
She loves how the buoyancy assists in her walking and exercises. When performing stair activities
in the pool, she noticed how her feet alternate steps. Compared to on land, she has to take the
stairs one foot at a time. Grace said “Not only does aquatic therapy help me physically but
psychologically as well!” Her exercise tolerance in the pool is about 30-45 minutes. On land, her
exercise tolerance is only 15-20 minutes. Even when Grace was on vacation for a few months, she
was able to use a local pool to continue her program.
 CASE STUDY: AQUATIC EXERCISE PROGRAM

• Gait training
• Walk in water at a slow and easy pace.
• Focus on hip flexion and toe up on the left leg*
• Avoid hip circumduction.
• In between sets, patient should increase the speed of their gait.
• Gait speed is an important determinant of fall risk.

• Stairs
• Reciprocal step pattern.
• Focus on hip flexion and toe up on the left leg*
• Hold railing for precaution.
 CASE STUDY: AQUATIC EXERCISE PROGRAM

• Leg Swings: 2 sets of 10 reps

• Patient holds wall on right side and swings left leg forward and back.
• Focus on keeping leg straight and improving range of motion of left hip.
• Increase the speed every set.

• Toe raises: 2 sets of 10 reps

• Patient is faced towards the wall and holds it with both arms.
• Patient shifts their weight from heel to toe to provide more momentum.

• Marching: 2 sets of 10 reps

• First, patient marches in place holding the wall.
• Focus on hip flexion*
• After a few sets, patient marches across the pool and holds the noodle out in front for balance.
 CONCLUSION

Multiple Sclerosis is a progressive disease that heavily affects muscle control, balance,
vision, and sensation. There is no cure to MS but there are many treatments that can improve an
individual’s symptoms. Aquatic therapy is an exceptional treatment technique. The pool provides
many benefits based off of its buoyancy, temperature, hydrostatic pressure, and viscosity. Many MS
patients are able to do so much more in the water than they can on land. Therefore, aquatic therapy
provides many advantages physically and psychologically as well.
LOCATIONS
85 Beach St. D Westerly, RI 02891
(401) 348-8112

14 Clara Dr. #3 Mystic, CT 06355

(860) 245-0851

95 High St. Westerly, RI 02891

(401) 596-2894
 BIBLIOGRAPHY

• “Effect of Aquatic Exercise Training on Fatigue and Health-Related Quality of Life in Patients
With Multiple Sclerosis” Mehdi Kargarfard, PhD, Masoud Etemadifar, MD, PhD, Peter Baker, PhD,
Maryam Mehrabi, MSc, Reza Hayatbakhsh, MD, PhD
• “Aquatic Exercise and Multiple Sclerosis: A Healthcare Professional’s Guide” Yasser Salem, PT,
PhD, MS, NCS, PCS, Linda Csiza, PT, DSc, NCS, Michelle Harrison, PT, ARTIC, ATP, Julie See, BS
• Google Images