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AQUATIC REHABILITATION

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May increase the lever arm ... Inc Cardiac Load due to HP occurs even with exercise ... the exercises on land first. Indications for Aquatic Therapy ... – PowerPoint PPT presentation

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Title: AQUATIC REHABILITATION


1
AQUATIC REHABILITATION
  • Veronica Southard PT MS GCS

2
PHYSICAL Properties of Water
  • Buoyancy, Provides an upward force. Opposite
    gravity. Opposite body wt..
  • Archimedes Principle an immersed body at rest
    experiences an upward thrust equal to the amt. Of
    H2O it displaces.
  • Effects of buoyancy are related to water depth
    and specific gravity.

3
Specific gravity
  • Specific gravity gt 1 g/cm3 will sink, anything
    less will float
  • Determined by the relationship between lean m
    mass and body fat
  • gt lean mass the more likely to sink
  • Compensate by altering waters depth, floatation
    equipment and waterproof wt. Equipment.

4
Center of Buoyancy
  • Defined as the center of gravity of the displaced
    water
  • If the body wt. And the displaced water wts. Are
    unequal, a rotation about the center of buoyancy
    occurs until equilibrium is reached
  • Moment of buoyancy

5
Altering the assistance provided by buoyancy
  • 1. Position or direction of movement is changed
  • 2. Water depth
  • 3. Lever arm length
  • 4. Floatation or weighted equipment

6
Position and Direction of Movement
  • Water activities
  • buoyancy assisted
  • buoyancy supported
  • buoyancy resisted

7
Water depth
  • At deeper depths unloading occurs
  • Shallow depths there is less buoyancy
  • CV disease or M weakness may find deeper depths
    more difficult

8
Lever arm length
  • Adjusting the lever will increase or decrease the
    difficulty

9
Buoyant equipment
  • May increase the lever arm
  • Cuff can be added to adjust the quantity and
    location of assistance or resistance
  • Support the client in supine or prone

10
Hydrostatic Pressure
  • Pressure exerted by water to the body that
    increases as the depth of immersion increases.
  • Makes deeper aquatic activities desirable.
    Relieves effusion and edema
  • Greatest at the bottom of the pool secondary to
    the weight of the water overhead

11
Viscosity
  • Def- waters resistance to adjacent fluid layers
    sliding freely by one another. Creates a
    resistance to flow when moving through a liquid
  • Inconsequential in static positions
  • Resistance is created because a turbulent flow is
    produced when the speed of movement reaches a
    critical velocity

12
Turbulent flow
  • The resistance is proportional to the velocity
    squared. Therefore with Increased velocity there
    is Increased resistance.
  • Moving forward in the water creates a frontal
    resistance proportional to the presenting surface

13
Velocity of movement
  • At the critical velocity, turbulence and
    resultant drag are created
  • Slow movement there is little drag, minimal
    resistance

14
Physiologic responses to immersion only
  • Hydrostatic Pressure
  • Water temperature

15
Effects of Hydrostatic Pressure
  • Immersion to the neck
  • Centralization of peripheral blood flow
  • Intrapulmonary bl vol increases 33-60
  • VC decreases 8
  • Central venous press at R atrium level from 2.5
    to 12.8 mmHg
  • increased
  • R atrium press, left vent end distolic vol
  • , stroke vol 35, CO32

16
Effects of Hydrostatic Pressure Cont
  • HR will not change or may slightly decrease
    because HRSV / CO
  • Any changes noted in centralization of bl fl are
    graded and occur with immersion even before
    exercise

17
Water Temperature
  • Too warm or too cold will add a thermal load to
    CV system.
  • CO unchanged bet. 25-34C sign inc at 40C
  • O2 consumption inc. at 25C
  • Dec. HR in cold water
  • Inc. HR warm water
  • Thermoneutral is 34C
  • Most pools are 27-35C

18
Physiologic Responses to Exercise and Immersion
  • Used to inc.or maintain CV conditioning
  • Deep water running can be used to maintain O2
    consumption during injury
  • Alternative training medium during recovery
  • Inc Cardiac Load due to HP occurs even with
    exercise
  • HR has been shown to be lower or unchanged when
    compared to land based

19
Examination for aquatic rehab
  • Full land based exam
  • Consideration of Contraindications
  • Excessive fear of water.
  • Open wounds, Rashes
  • Active infections
  • Incontinence
  • Tracheostomy

20
Precautions in Aquatics
  • CV changes
  • Pulmonary impairments
  • Over exercise- reduced gravity environment,
    support of buoyancy, m relaxation with immersion,
    HP and water temperature

21
Treating Impairments with Aquatics
  • Mobility impairments Progress activities to
    enhance function and reduce disability ASAP.
  • Considerations
  • Force of buoyancy
  • Position and available ROM at the jt.
  • Direction of desired movement
  • Need for floatation or weighted equipment

22
Mobility impairments Cont
  • Buoyancy will facilitate ROM. Change the lever
    length and equipment as pt. improves
  • Static stretches can be done using steps, pool
    sides and bars
  • Observe the exercise on land first. Observe
    closely once in the water secondary to refraction

23
Balance impairment
  • Supportive medium with destabilizing forces make
    this approach ideal
  • Falls are dramatically slowed, inc. pt.s time
    for response
  • SLS activities
  • SLS with arm mvt.
  • Single toe raises
  • Step ups

24
Aquatic Rehab to treat Functional Limitations
  • Functional limitations are restrictions in
    performance affecting the whole person.
  • Good situation for working on posture or
    position.
  • Chairs can be submerged, buoyancy sitting
    equipment. As sitting tolerance improves, water
    depth is decreased.
  • Forward reach

25
Coordinating Land and Water
  • Land based activity should begin as soon as
    tolerated
  • It is difficult to produce eccentric m
    contractions in the pool
  • With pain, aquatics may be most of the program
  • Sometimes alternating the pool with land based
    interventions works best

26
Patient education
  • Before entering the pool, explain the fundamental
    properties of H2O to the pt.
  • Make sure the pt. is aware of the entrances and
    exits from the pool, drop offs, gutters, and
    bars.
  • Show the pt. the exercises on land first.

27
Indications for Aquatic Therapy
  • Everything that is not contraindicated.

28
Indications for Aquatic therapy
29
Specific Approaches in the Water
  • WATSU
  • Halliwick Method
  • Bad Ragaz Ring Method

30
Resources for Aquatic Therapy
  • Richard Ruoti, Aquatic Rehabilitation
  • Lippincott 1997.
  • Hall Carrie, Therapeutic Exercise Moving Toward
    Function, Lippincott Williams Wilkins
  • 1999 Chapter 17.
  • Bill Schuss !
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