Aquatic excs

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Copyright 2005 Lippincott Williams & Wilkins

Chapter 17

Aquatic Physical Therapy


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Physical Properties of Water Buoyancy

Main Controlling Variables:

1. Position or direction of movement inwater2. Water depth3. Lever arm length4. Flotation or weighted equipment use


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Position and Direction of Movement

Movements toward the surface Buoyancy assisted.Movements parallel to the bottom ofthe pool Buoyancy supported(gravity minimized).Movements toward the bottom of

pool Buoyancy resisted.


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Depth, Lever Arm Length, or BuoyantEquipment Can Alter Resistance

or Assistance

Shallower water Less support.

Deeper water More support, but increasedfrontal resistance.

Modifications can be made through use ofbuoyant equipment.


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Buoyancy and Lever Arm


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Buoyancy and Flotation


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Resistance Is Influenced By:

1. Velocity of movement (mean muscleactivity alters when velocity reaches

a threshold (See Table 17-1)2. Surface area3. Water depth

4. Direction of movement


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Physiologic Changes with Immersion(Changes vary with immersion depth)

1. Decreased peripheral blood flow, vitalcapacity.

2. Increased heart volume, intrapulmonary

blood volume, right atrial pressure, leftventricular end-diastolic volume, strokevolume, cardiac output.

3. Decreased or unchanged heart rate.


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Physiologic Response to Exerciseand Immersion

Physiologic adaptations aresimilar to land training.

Increased cardiac loading due tohydrostatic pressure.

Depth of immersion affectsdegree of cardiac changes.


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Examination and Evaluation for AquaticRehabilitation

Full land-based examination must be performed.

Also consider:Basic safety (ability to enter water, comfort, etc.)Precautions (cardiac history, etc.)Contraindications to aquatic environment (fever,infections, rashes, etc.)


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Therapeutic Exercise Intervention Mobility Impairment

Progress simple ROM exercises towardfunctional limitations.Use lever arm length and buoyant equipment to

alter resistance.Observe land mechanics before pool exercise toensure proper technique.


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ROM(Hamstrings and Shoulder Extensors)


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Balance Impairment

Ideal environment for balance training.Variety of activities can be performed.

Loss of balance is slowed dramatically. Allows for increased reaction time.


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Aquatic Therapy to Improve Balance


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Aquatic Rehab to Treat FunctionalLimitations

As patient improves, modify activities toaddress functional limitations.

E.g., decrease level of water as sittingactivities improve. As normal mechanics improve, decreasewater levels to replicate land-basedenvironments.


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Land-Based Functional Activities inWater


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Contraindications/Precautions

Individuals withexcessive fearOpen wounds

Rashes Active infectionsIncontinence

Tracheostomy

CV changesDiuresisOverexercise


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Summary

Pool provides a unique environment forrehabilitation.The properties aquatic therapy provides

can be used in many ways to achievetherapeutic goals.Physiologic responses, temperature, andhydrostatic pressure must be considered forsafety.


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Summary (cont.)

Aquatic therapy can accommodate activities andprogress from early-functional stages.

Balance is challenged with most movementsand stabilizing muscles must be considered.

Pool program should include a land-based

program for a well-balanced transition to theland environment.

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Aquatic excs