Danielle D.

Solon, PTRP
Definition
Use of multidepth immersion
pools or tanks that facilitate the
application of interventions
Stretching, strengthening, PJM,
balance and gait training and
endurance training
Goals and Indications
Facilitate ROM exercises
Initiate Resistance training
Facilitate weight-bearing activities
Enhance delivery of manual
techniques
Goals and Indications
Provide three-dimensional access
to patient
Facilitate cardiovascular exercise
Initiate functional activity
replication
Goals and Indications
Minimize risk of injury/ reinjury
Enhance patient relaxation
Precautions
Fear of water
Can often lead to increased
symptoms during and after
immersion
Orientation period is required
Precautions
Neurological disorders
Ataxic patients may have increased
difficulty
Heat intolerant MS may fatigue at
temperatures >33deg C
Precautions
Seizures
Require close monitoring
Medication prior to treatment
Precautions
Cardiac dysfunction
Angina and abnormal BP require
close monitoring
Low-intensity aquatic exercise may
result in lower cardiac demand than
similar land exercise
Precautions
Small open wounds and lines
Small open wounds and tracheotomies
may be covered with waterproof
dressings
IV lines and other open lines require
proper clamping and fixation
Contraindications
Cardiac failure and unstable
angina
Respiratory dysfunction
Severe peripheral vascular disease
Danger of bleeding/ hemorrhage
Contraindications
Severe kidney disease (unable to
adjust fluid loss during immersion)
Open wounds, skin infections
Uncontrolled bladder and bowel
(require pool evacuation, chemical
treatment and possibly drainage)
Contraindications
Water and airborne infections
Uncontrolled seizures
Physical Properties of Water
BUOYANCY
Upward force that works opposite to
gravity
Archimedes’ principle: immersed body
experiences upward thrust equal to
the volume of liquid displaced
Physical Properties of Water
BUOYANCY
Provides patient with relative
weightlessness and joint unloading
Allows performance of active
motion with increased ease
Physical Properties of Water
Hydrostatic Pressure
Pressure exerted on immersed
objects
Pascal’s law: pressure exerted by
fluid on immersed object is equal
on all surfaces of the object
Physical Properties of Water
Hydrostatic Pressure
As density of water and depth of
immersion increase, hydrostatic
pressure also increase
Physical Properties of Water
Hydrostatic Pressure
Reduces/limits effusion
Assists venous return
Induces bradycardia and centralizes
peripheral blood flow
Physical Properties of Water
Viscosity
Friction occurring between
molecules of liquid resulting in
resistance to flow
Water’s viscosity creates resistance
with all active movements
Physical Properties of Water
Viscosity
Shorter lever arm results in
increased resistance
During manual resistance exercise,
stabilizing an extremity proximally
require more work from the patient
Physical Properties of Water
Viscosity
Stabilizing an extremity distally
requires less work from patient
Increasing surface area moving
through water increases resistance
Physical Properties of Water
Surface tension
Surface of a fluid acts as a
membrane under tension
Measured as force per unit length
Physical Properties of Water
Surface tension
Resistive force of surface tension
changes proportionally to the size
of the object moving through the
fluid surface
Physical Properties of Water
Surface tension
An extremity that moves through
the surface performs more work
than if kept under water
Using equipment at the surface
increases resistance
Hydromechanics
Comprise the physical properties
and characteristics of fluid motion
Hydromechanics
Components of Flow Motion
Laminar flow – molecules move
parallel to each other; slow
movement
Hydromechanics
Components of Flow Motion
Turbulent flow – molecules do not
move parallel to each other;
typically faster movement
Hydromechanics
Components of Flow Motion
Drag – cumulative effect of
turbulence and fluid viscosity acting
on an object in motion
Hydromechanics
Clinical significance of drag
As speed of movement through water
increases, resistance to motion
increases
Moving water past the patient requires
patient to work harder to maintain
position in pool
Hydromechanics
Clinical significance of drag
Application of equipment
(glove/paddle/boot) increases drag
and resistance as patient moves
extremity through water
Thermodynamics
Specific heat
Amount of heat required to raise
the temperature of 1 gram of
substance by 1 deg C
Thermodynamics
Specific heat
Rate of temperature change is
dependent on the mass and specific
heat of the object
Thermodynamics
Specific heat
Water retains heat 1000 times more
than air
Water conducts temperature 25
times faster than air
Thermodynamics
Specific heat
Heat transfer increases with
velocity. A patient moving through
water loses body temperature
faster than immersed at rest
Center of Buoyancy
Affects the body in an aquatic
environment
Reference point of an immersed
object on which buoyant (vertical)
forces of fluid predictably act
Center of Buoyancy
Vertical forces that do not
intersect the center of buoyancy
create rotational motion
Vertical position: at the sternum
Center of Buoyancy
Posteriorly placed buoyancy
devices cause patient to lean
forward
Anterior buoyancy devices cause
patient to lean back
Center of Buoyancy
During unilateral manual resistance
exercise, the patient revolves around
the practitioner in a circular motion
Unilateral lower extremity
amputation: patient leans toward
residual limb
Temperature Regulation
In general, utilize cooler
temperatures for higher-intensity
exercise and warmer
temperatures for mobility and
flexibility exercise and for muscle
relaxation
Temperature Regulation
Ambient air temperatures should
be 3 deg C higher than the water
temperature for patient comfort
Mobility and Functional Control
Exercise
Exercises my be performed in
temperatures between 26deg and
33deg C
Aerobic conditioning
Should be performed in water
temperatures between 26deg and
28deg C
Intense training should take place
in temperatures between 22deg
and 26deg C
Collars, Rings, Belts and Vests
Assist patient positioning by
providing buoyancy assistance
Ex. Cervical collars are used for
supine patient to support neck
and maintain head out of water
Swim Bars
Aka buoyant dumbells
Available in short and long lengths
Patients can balance on long swim
bars in deep water to challenge
balance, proprioception and trunk
strength
Gloves, Hand Paddles, Hydro-tone
Balls
Resistance to upper extremity
movements
Not buoyant
Can increase drag
Fins and Hydro-tone Boots
Lower extremity resistance
exercise
Fins: challenging to hip, knee and
ankle strength
Boots: deep water walking and
running
Kickboards
Provide buoyancy in prone or
supine positions
Create resistance to walking
patterns in shallow water
Challenge seated, kneeling or
standing balance in deep water
1. Stretching
2. Strengthening
3. Aerobic
4. Geriatric