Aquatic Therapy Presentation – Flashcards
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Aquatic therapy: Defined
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Aquatic therapy, defined as treatments and exercises performed in water for relaxation, fitness, physical rehabilitation, and other therapeutic value, is believed to better a person's life physically, socially, physiologically, and psychologically.
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Properties of H2O
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The aspects of aquatic therapy that land-based activity cannot provide are: density, hydrostatic pressure, buoyancy, and viscosity (Becker, 2009; Bintzler, 2006; Hurley & Turner, 1991; Lee). Hurley and Turner stated that individuals with disabilities discover that the buoyancy, increased resistance, and the overall weight of water generate an environment for exercise that is more conducive for reaching treatment goals than exercise conducted on land.
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Density
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Density causes water to support the body during submerged exercises. Therefore aquatic therapy is able to limit the participant's overall muscle stress and energy expenditure. The density of water also slows movement and serves as general support for the body. Participating in aquatic therapy can lead to overall functional improvement of major muscle groups while drastically reducing the impact that is inevitable in land-based exercise
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Hydrostatic Pressure
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Hydrostatic pressure is the weight of the water against an object; this serves as a natural compression agent for joints in addition to the reduction of edema in injured body parts. The effects of hydrostatic pressure begin immediately upon immersion, including reduction in joint and soft-tissue edema as well as reduction in overall swelling; allowing activities such as walking, squatting, and stepping to be more tolerable and performed with less pain.
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Viscosity
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While traditional approaches of strength training have been successful in clinical settings, the viscosity of water promotes strengthening in numerous ways. The advantages viscosity offers are indirect; resistance is felt when an individual moves through water. Water acts as an accommodating resistance, matching an individual's applied force or effort. Because of this, the likelihood of exacerbation or re-injury is reduced dramatically.
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Buoyancy
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Buoyancy is an extremely vital principle to consider when working with individuals who are mechanically unstable or are in the beginning stages of rehabilitation. The use of water immersion partially, if not completely, offsets gravitational forces leaving only muscle torque forces. This reduction of acting forces allows for active assisted range-of-motion activities, mild strength building, and gait training while not exceeding medical restrictions
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In summary (properties)
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Virtually all the biological effects of aquatic exercise are related to the fundamental principles of hydrodynamics.
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Diagnoses Served
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Individuals with wide ranging conditions are able to participate in individualized or group aquatic exercise programs. Individuals with acute and chronic injuries, illnesses, physiological, and physical disabilities can benefit from water-based interventions. Aquatic therapy is beneficial in the physical, social, physiological and psychological domains.
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Diagnoses Served cont.
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Numerous improvements attained through participation in aquatic therapy have been recognized in cases of individuals diagnosed with multiple sclerosis, cystic fibrosis, orthopedic conditions, cerebral palsy, and autism spectrum disorder. These individuals frequently are unable to exercise on land or require additional assistance/supervision, but through water exercise they can contribute to their own health and wellness.
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Aquatic Therapy Methodologies
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There are numerous techniques utilized for aquatic therapy practices and programs. Some prevalent interventions include: Bad Ragaz, Watsu, and the Halliwick Method.
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Bad Ragaz
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The Bad Ragaz method mostly utilizes active and passive flexibility exercises for overall bodily strengthening. This method is tailored for individuals diagnosed with various medical conditions that require the prevention of excessive fatigue
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Watsu
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The Watsu methodology utilizes philosophies from Zen Shiatsu to enable the decrease of tension and enhance psychological wellbeing. The main purpose for the Watsu method is to reduce spasticity and permit increased freedom of movement during balance and gait activities. This method of intervention is mostly employed in the beginning steps of rehabilitation, recovery, or introduction to aquatic therapy
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The Halliwick Method
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The Halliwick Method encompasses all aspects of the individual's development: physical, psychological and social. The Halliwick Method facilitates movement and posture through the combination of water ambulatory exercises and therapeutic swimming.
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Multidisciplinary Approach
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Multidisciplinary care is more prevalent today as practitioners attempt to improve the treatment of their patients. Disabling conditions, illnesses, and other conditions are often regarded as the result of interrelating physical, psychological, and social or occupational factors. To best treat these factors, patients require multidisciplinary intervention; which is a more collaborative approach.
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Multidisciplinary Approach cont.
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Therapists work "interdependently," sharing common treatment philosophies and goals fostered by ongoing communication between disciplines. This method of collaboration leads to more effective monitoring of program progress and adjustment of patient goals.
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Multidisciplinary Approach cont. 2
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A randomized controlled study by Guzmán (2001) examined the effectiveness of multidisciplinary treatments. There was strong evidence supporting the use of intensive multidisciplinary treatments with benefits such as functional restoration, improved function, and decreased pain when compared with inpatient or outpatient non-multidisciplinary treatment.
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Description of Context
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I examined the best practices in aquatic therapy at three hospitals located in the United States: Via Christi Health, Catholic Health Services, and Spaulding Rehabilitation Network. I selected the clinical programs and each website was evaluated individually. I chose the programs based on their philosophies, client base, programs offered, and overall website accessibility.
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Description of Instrument
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The instrument utilized in this study was a best practice checklist developed by the me. I utilized an Excel spreadsheet to document the examination process of the individual hospital's best practices, as determined by each item on the checklist. The checklist consisted of 10 open-ended qualitative questions that related to the background of the hospitals as well as the facilities use of aquatic therapy for patient treatment.
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Description of Procedures
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I conducted an analysis of each of the three hospital websites during May of 2014. The process of analysis was conducted utilizing the checklist for each hospital's website assessing the facilities use of aquatic therapy. I documented outcomes on my developed checklist.
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Via Christi Background
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Via Christi Health Care has offered programing and medical services to the people of Kansas and the surrounding region for over 100 years and is the largest provider of health care services in the state of Kansas. Based in Wichita, the facilities serve Kansas, as well as northeast Oklahoma through their doctors, hospitals, and health services; all offering aquatic therapy programs.
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Catholic Health Services Background
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Catholic Health Services (CHS) is a ministry of the Archdiocese of Miami and the largest post-acute provider in the southeast United States. CHS operates 30 facilities in Broward and Miami-Dade counties, three of which are rehabilitation hospitals offering aquatic therapy.
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Spaulding Rehabilitation Network Background
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The Spaulding Rehabilitation Network provides a full continuum of rehabilitative care for patients recovering from injury, illness, or surgery. The facility offers world-class care delivered at six inpatient facilities and 23 conveniently located outpatient centers stretching from Cape Ann to Cape Cod, and to Framingham in the state of Massachusetts.
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Via Christi (Program)
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Via Christi Health (VCH) program offers a comprehensive evaluation and treatment by professional staff with a one to one therapist-client ratio. The facility does not integrate a multidisciplinary approach into to their rehabilitation programs. Patients are evaluated initially on land to establish baseline functional information, as well as to determine the suitability of aquatic therapy. Aquatic therapy goals at the facility are developed to correlate with land based functional goals. No specialized aquatic therapy programs, such as Ai Chi, Bag Ragaz or Back Hab, were offered or listed on the facility's webpage.
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Catholic Health Services (Program)
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Catholic Health Services (CHS) provides a broad range of services for patients suffering from any number of acute or chronic illnesses that cause temporary or permanent disability. Therapeutic interventions are conducted, utilizing a unimodal approach, by physical and occupational therapists with specialty training in aquatic therapy. Specialized Aquatic Therapy treatment techniques offered by the facility included: Ai Chi, Aquatic Therapeutic Exercises, Aquatic PNF, Bad Ragaz Ring Method, and Back Hab.
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Spaulding Rehabilitation Network (Program)
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Clinicians evaluate patients in the Aquatic Therapy Program at Spaulding Rehabilitation Network (SRN). The patients are then provided with a customized plan of care consisting of land-based exercise and pool exercises in a one to one ratio format, utilizing a multidisciplinary approach. Specialized Aquatic Therapy treatment techniques offered include: Bad Ragaz, Ai Chi, Burdenko, Pilates, and BackHab
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Via Christi (benefits)
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VCH is offered to patients as an alternative therapy program. Benefits of Aquatic Therapy described are: painful or limited motion on land can be limited and increased ease of movement when patients are submerged in water.
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Catholic Health Services (benefits)
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At CHS, the goal of aquatic therapy is to promote overall rehabilitation and personal fitness of an individual. Basic aquatic principles of buoyancy, resistance and hydrostatic pressure are applied to the biomechanics of movement patterns; thus, minimizing pain, overall swelling, increased range-of-motion, strength, and balance.
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Spaulding Rehabilitation Network (benefits)
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Spaulding Rehabilitation Network (SRN) physical or occupational therapists work with patients to develop a program that reduce pain, increase strength, enhance balance and stability, increase range of motion, loosen stiff joints, and reduce spasticity while improving overall conditioning.
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Via Christi (diagnoses served)
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VCH serves diagnoses such as: arthritis, low back, shoulder or knee pain, sports injuries, neuromuscular disorders, and post-operative orthopedics. The facility also offers treatment programs for children diagnosed with Cerebral Palsy, Muscular Dystrophy, Myelomeningocele, Arthrogryposis, low muscle tone, and muscle weakness.
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Catholic Health Services (diagnoses served)
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CHS offers treatments that are beneficial to orthopedic conditions, which include fractures, joint replacement, amputations and soft tissue injuries can benefit from the facility's aquatic program. Treatments are also available that assist in the rehabilitation and treatment of neurological conditions, brain injury, and Parkinson's disease. Pain conditions and back injuries are offered aquatic programming at CHS.
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Spaulding Rehabilitation Network (diagnoses served)
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SRN offers aquatic therapy for adult, as well as pediatric patients. The facilities treatment programs benefit patients with conditions including, but not limited to: arthritis, back and neck pain, sprains, strains, or fractures, and for individuals recovering from surgery or seeking a preventative fitness program.
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Discussion (Multidisciplinary Approach)
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Though aquatic therapy can serve as a multidisciplinary rehabilitation technique, the facilities that the researcher selected primarily utilized unimodal treatment approaches, staffed either by certified physical therapists or occupational therapists exclusively. By implementing a multidisciplinary rehabilitation approach to treatment, patients overall function would be improved by 75% compared to patients receiving unimodal care.
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Discussion (Utilization of Properties of H2O)
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The three facilities excluded other properties and their benefits from their webpages and programs. Combined, the properties of water are effective; one does not operate without the other. In order to be accurate, facilities need to acknowledge all properties of water.
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Discussion (Diagnoses Served)
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The results of the study also concluded that the hospitals focused primarily on developmental, neurological, neuromuscular, and physical diagnoses. Previous literature has stated that aquatic therapy is beneficial in the physical, social, physiological, and psychological domains. The selected facilities did not offer programming for wide ranges of developmental conditions and psychological disabilities.
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Discussion (Diagnoses Served) cont.
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The use of aquatic therapy for recreational pursuits and overall wellness was not promoted by these hospitals; therefore were not addressing leisure implications such as satisfaction, enjoyment, intrinsic motivation and self-determination. By excluding various conditions and disabilities from the facility's offered treatments, the facilities are not offering well-rounded programs that are beneficial to the community at large.
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Discussion (Benefits)
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The hospitals examined by the researcher were found to effectively provide and describe the benefits patients participating in aquatic therapy could expect. Benefits such as an increase in joint flexibility and muscle strength, decrease in pain, decrease in abnormal tone, spasticity, and rigidity, and improved balance was described.
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Discussion (Benefits)
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The general public is typically uneducated about the field of aquatic therapy. By providing the benefits, the public would become better educated on aquatic therapy as an alternative therapy program. Aquatic therapy can offer many of the same benefits as land-based exercise with less overall impact on the body, including improvements in the following areas: cardiovascular fitness, strength, endurance, flexibility, and balance.
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Limitations
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Lack of quality peer reviewed articles pertaining to aquatic therapy in recreational contexts. There is limited documentation on the implications of aquatic therapy to therapeutic recreation. This affected the study in that it limited the results to fields such as physical therapy, occupational therapy, and medical settings.
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Limitations
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Quality of Websites
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Conclusions
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Selected hospitals in the United States are utilizing a variety of aquatic therapy techniques such as Bad Ragaz, Ai Chi, Burdenko, Pilates, BackHab, Aquatic Therapeutic Exercises, and Aquatic PNF. Selected hospitals are not utilizing multidisciplinary approaches to treatment at their facilities. The properties of water that aquatic therapy utilizes are density, hydrostatic pressure, buoyancy, and viscosity.
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Conclusions
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Diagnoses that benefit from aquatic therapy are developmental, neurological, neuromuscular, physical, and psychological diagnoses. The benefits of aquatic therapy are: the reduction of painful/limited motion, increased range-of-motion and ease of movement, relaxation of muscles, bodily support during exercise, overall swelling reduction, improved strength, and overall balance improvement.
