B.Sc PT year 2 Exercise Science Aquatic Therapy /Hydrotherapy

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B.Sc PT year 2 Exercise Science Aquatic Therapy
/Hydrotherapy

• Raija Kuisma
• September 2001

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Specific gravity of human body is?

• 1. 8.97
• 2. 9.97
• 3. 0.97
• 4. 1.01
• 5. 1.97

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Buoyancy of water is the force?

• 1. Equal to the weight of water spilling over
  the full container when you put your leg in it
• 2. Equal to the weight of the leg under water
• 3. Equal to the force of gravity affecting the
  leg on land
• 4. Equal to the sum of weight of the leg in
  water and land

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Hydrostatic pressure is the force

• 1. Per the total area of the body
• 2. Is greater upwards than
• 3. Directly proportional to both liquid density
  and the depth of immersion
• 4. Equal to the diastolic pressure when
  standing up in the water

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Properties of Water

• Density and specific gravity
• Specific gravity of human body 0.97
• density of body vs density of water
• density mass divided by volume
• Buoyancy
• the force is equal to the weight of water
  displaced by the volume of the object

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• Hydrostatic pressure
• Force of the water per unit area of the body
• Fluids exert pressure in all directions equally
• Directly proportional to both liquid density and
  the depth of immersion
• (1mm Hg/1.36cm)
• 120cm depth88.9 mm Hggt diastolic BP

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• Metacentre
• balance in water centre of gravity and centre
  of buoyancy in the same vertical line
• metacenter is the point where line of gravity and
  line of buoyancy meet
• not the same as CB
• if MC is above the CG the CG will move under CB
• if MC is below the CG the CG will move above CB

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Turbulent flow is

• 1. In laminar form
• 2. Related to velocity,density and viscosity of
  the liquid
• 3. Wake formation in front of the object moving
  in water
• 4. Increases when movement is stopped when
  movement stops

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Water and Motion

• Laminar /streamline flow
• Turbulent flow related to velocity,density and
  viscosity
• Drag force, wake behind the object
• Resistance in front of the object due to
  friction, viscosity and density of water
• These drop immediately when movement stops

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Movement of Water (agitation)

• Mechanical stimulation to skin receptors
• ? sedative
• ? counter-irritant
• Stimulus to large afferents
• ? pain block

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Physiologic Effects of Immersion

• Vascular system
• Dive reflex constriction of blood vessels
• Compression of all body tissues
• Immersion to neck level 700cm3 of blood from
  extremities and abdominal vessels to veins in
  thorax and heart
• Causes increase in right atrial pressure, SV and
  CO

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• Soft tissue effects
• Soft tissues compressed
• Lymphatic return enhanced
• Oedema resolution
• Joint effects
• Offloads pressure on joints
• Immersion to neck level 7kg compressive force on
  spine, hips and knees
• In floating buoyancy counterbalances the effect
  of gravity force

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Progress Weight Bearing Walking

• Static standing at
• C7 level lt 25 BW
• Xiphoid 25-50 BW
• ASIS 50-75 BW
• Fast walking increases weight bearing up to 76
  of the static stance

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• Muscle tone
• heat reduces tone
• buoyancy reduces tone
• tone influenced by proprioceptive input
  stimulated by gravitational force
• after 15 minutes immersion tone automatically
  decreasesgtgtgt relaxation

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• Renal Effects of Immersion
• Increased urine output with loss of plasma
  volume, sodium, potassium and suppression of some
  related hormones
• Homeostatic compensatory mechanism to counter
  distended cardiac receptors
• Clinical application
• Toilet before immersion
• Drink water before and after
• Check deficiencies in sodium and potassium
• Cold water increases diuresis, exercise reduces

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Thermodynamics

• Specific heat
• Waters specific heat capacity 1
• Airs specific heat capacity 0.001
• Water retains heat 1000 x same volume of air
• Heat transfer
• Increases as a function of velocity
• Swimmer loses more heat in cold water than a
  stationary person convection
• Water releases heat (cold) more easily to the
  body than air

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Physiologic Responses to Exercise in Water

• Aerobic energy expenditure
• May be greater, the same or less than on land
  depending on depth, temperature, speed, position
  in water and type of activity
• VO2 max
• Often lower due to lower maximal HR
• Max HR lt20 than land
• SV and CO
• Greater than on land

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Aims of Exercise Increase mobility

• Unloading of joint forces, muscular relaxation
  due to heat
• Buoyancy, quantity and direction
• Position and available range of the joint motion
  in relation to the direction of buoyancy
• The direction of movement
• Use of floatation aids

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Maximise muscle function

• Resistance provided by
• Buoyancy
• volume of the body part, floatation aids, lever
  arm
• assisted, supported, resisted
• Turbulence
• surface area, speed of motion, drag effect
• streamline, turbulent flow
• slow, fast, change of direction

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Facilitate posture and balance reactions

• Density and hydrostatic pressure
• slows down movement
• Turbulence
• challenges balance reactions
• Metacentre and moment of inertia
• small movement causes rotation round the Centre
  of Buoyancy (CB)
• longer radius more stable

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Reduce pain and spasticity

• Heat
• Tone reduction due to buoyancy
• Tactile sensory input by pressure, buoyancy,
  turbulence and heat
• weight reduction on joints due to buoyancy

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Problems most likely to benefit from aquatic
rehabilitation

• Orhtopaedic conditions OA, RA, AS, replacements,
  fractures, spinal operations, chronic LBP and
  instability
• Neurological conditions SCI, Polio, CP
• Miscellaneous Obesity, burns

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AssessmentOn land

• Swimmer/non
• Body shape
• Body density
• Precautions and relative contraindications

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Precautions and relative contraindications

• Infectious or contagious conditions
• Uncontrolled Hyper- or hypotension
• Severe kidney, cardiac or respiratory disease,
  acute TB
• Uncontrolled epilepsy
• Uncontrolled movements, behaviour or cognitive
  problems
• Infectious skin condition or sensitivity to pool
  chemicals, large open wounds

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Assessment in Water

• Pain
• ROM
• Mmtone
• MM strength
• Vital capacity
• Balnance
• Weight bearing
• gait

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Recording Rx

• Rx time
• Water Temp C
• Depth of water
• Exs FITT, position, size of floats, equips.
• Progression
• C/O in and out of water
• Outcomes

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Conventional method

• buoyancy and turbulence assist, support or resist
  the movement
• isotonic concentric and eccentric, isometric
• with and without floatation and resistance
  equipment

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Modified Oxford Scale

• 1 Buoyancy assisted (B.A)
• 2 B. Counteracted/neutral (B.N)
• 2 Slowly against B.
• 3 Against B. at speed
• 4 Against B. with a small float
• 5 Against B. with a large float
• Turbulence

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Badragaz method

• buoyancy supports the body with floatation aids
• turbulence assists or resists the movement
• therapist is the fixing point
• isometric, isotonic concentric and eccentric,
  isokinetic
• Modified PNF using 3-D movements and special
  techniques

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Halliwick method

• Goal total independence
• Mental adjustment
• Balance restoration
• Posture control
• Facilitation of controlled movement
• disengagement
• swimmer/patient performs activities and therapist
  guides, supports

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Watsu Water Shiatsu

• passive stretching with rhythmic rotational
  movements through water

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Practicum I

• Experience the effects of water properties in
  human body
• Positioning
• Use of floatation aids
• Examples of conventional exercises for
  musculo-skeletal problems

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Practicum II

• Badragz method
• Halliwick method
• Applications to patients with neurologic problems

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How would you progress your exercise using
buoyancy or turbulence

• 1. After a fracture or joint replacement?
• 2. To improve ROM?
• 3. To Improve muscle strength from
• grade 1-5

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Reference

• Ruoti R G, Morris D M and Cole A J. 1997
• Aquatic Rehabilitation, Lippincott
• http//www.halliwick.net/

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Answers to quiz on terminology

• 1 - F
• 2 - D
• 3 - J
• 4 - C
• 5 - H
• 6 - I

• 7 - K
• 8 - E
• 9 - A
• 10 - B
• 11 - G

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Answers to questions on Halliwick video

• 1. Amputation, cerebral palsy, poliomylitis,
  blindness, spasticity
• 2. Sit on side or in wheelchair, forward roll
• 3 a) with instructor facing the swimmer
• hands on shoulders, hands in hands
• b) without instructor

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• 4. Face the edge, pull with arms, prone crawl,
  then turn to sitting on the edge
• 56. Horizontal-safe position
• Vertical - to stand up from floating
• Combined- safety
• 7. Head control
• 89.Breathing control
• 10. Instructors palm under scapulae or hips
• 11. For support and floating
• 12. For drag effect to follow the instructor
• 13. Swimming races, undressing in water, survival
  skills