1. Relative Density 2. Temperature 3. Buoyancy 4. Surface Tension 5. Turbulence /Streamlining 6. Hydrodynamic Resistance/Viscosity 7. Hydrostatic Pressure 8. Hydrostatic Stability 9. Refraction of light

Aquatic Physical Therapy PP and K&C Flashcards by natalie brown

Objectives  By the end of this course student will be able to

Identify the definition of aquatic physical therapy
Explain the properties of water
Recognize the precautions and contraindications
Compare and contrast therapeutic techniques
Select appropriate equipment for support and resistance
Select appropriate therapeutic exercises for stretching, strengthening, and conditioning.

fyi

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Aquatic Physical Therapy definition

evidence-based and skilled practice of physical therapy in an aquatic environment by a PT or by a PTA who is under the direction and supervision of a PT. Aquatic Physical Therapy includes but is not limited to:

treatment
rehabilitation
prevention
health
wellness
fitness
of patient/client populations in an aquatic environment with or without the use of assistive, adaptive, orthotic, protective, or supportive devices and equipment.

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The buoyancy, support, accommodating resistance and other unique properties of the aquatic environment enhance interventions for patients/clients across the age span with what kind of disorders or conditions?

musculoskeletal
neuromuscular
cardiovascular /pulmonary
integumentary diseases,

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Aquatic Physical Therapy interventions are designed to improve or maintain what?

function
aerobic capacity/endurance conditioning
balance, coordination and agility
body mechanics and postural stabilization
flexibility
gait and locomotion
relaxation
muscle strength, power and endurance

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Interventions used in Aquatic Physical Therapy include, but are not limited to what mechanical modalities using the properties of water and techniques to the aquatic environment.

therapeutic exercise
functional training
manual therapy
breathing strategies
electrotherapeutic modalities
physical agents

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Properties of Water

Relative Density
Temperature
Buoyancy
Surface Tension
Turbulence /Streamlining
Hydrodynamic Resistance/Viscosity
Hydrostatic Pressure
Hydrostatic Stability
Refraction of light

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Relative Density

Density is the mass of an object divided by what?

the volume

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Relative Density

The relative density of water is what?

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Relative Density

The relative density of the human body with the lungs inflated is between?

.95 and .974 with lungs fully inflated (will float)

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Relative Density

The relative density of the human body without lungs inflated is between ?

1.050 and 1.084 without lung inflated (will sink)

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Spastic muscles appear more dense

will they sink or float?

sink

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Flaccid muscles appear less dense. will they sink or float?

float

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Temperature of water
92-96 degrees desired for patients who are?

less active.

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Temperature of water 89-92 degrees desired for patients who are ?

moderately active.

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Temperature of water 84-89 degrees desired for patients who are?

athletic.

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Temperature of water Warmer temperatures help what 3 things?

decrease tone
promote relaxation
assist in decreasing fear

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Temperature of water Cooler temperatures help stimulate what 2 things?

tone and alertness

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a force that works in the opposite direction of gravity

Buoyancy

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what principle is this?

When a body is wholly or partially immersed in a fluid at rest it is acted upon by a buoyant or lifting force equal to the weight of the displaced fluid.

Archimedes’ Principle

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Buoyancy Allows for the adjustment in weight bearing activities. What art the percentages o body weight reductions?

Waist deep water
Chest deep water
Neck deep water

50% reduction in body weight-Waist deep water
70% reduction in body weight-Chest deep water
80-90% reduction in body weight-Neck deep water

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what are some general benefits using buoyancy of water?

Acts as a supportive, assistive or resistive tool
Helps of unload joints
Ease in increased functional skills
Ease of handling the client for the therapist.

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Force exerted between the surface molecules of a fluid and manifesting itself as an elastic skin of a fluid
it nacts as a resistive force when a limb is submerged a must break it to move
Work weak muscles under the surface of the water

Surface Tension

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the flow resistance is proportional to velocity (easy to move)
the flow resistance is proportional to velocity squared (hard to move)
can be used as resistance to exercise in the pool.
The quicker the movement the greater this is
The more unstreamlined to movement the greater the resistance to movement.
When gait training the therapist should stand in front of the patient.

Turbulence /Streamlining

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Hydrodynamic Resistance/Viscosity
Viscosity is the friction that occurs between the __________of a ____________?and causes _________to the flow of liquid.

molecules of a liquid
resistance

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**Hydrodynamic Resistance/Viscosity** Viscosity acts as a resistance to what?

movement

**Hydrodynamic Resistance/Viscosity** Water provides 12 times the resistance of what

air.

**Hydrodynamic Resistance/Viscosity** Can be used to progress strengthening exercises how?

* increase the surface area * lengthen the lever arm * increase the speed of movement.

Hydrodynamic Resistance/Viscosity Allows more time to what?

correct for a loss

**Hydrodynamic Resistance/Viscosity** Increases what kind of feedback ?

proprioceptive

pressure of a fluid (the compressive pressures exerted by molecules of a fluid upon an immersed body)

Hydrostatic Pressure ## Footnote

**Hydrostatic Pressure** Pressure increases with what?

depth

Hydrostatic Pressure what law states :Fluid pressure is exerted equally on all surfaces of an immersed body at rest at a given depth.

Pascal’s law:

**Hydrostatic Pressure** Pressure increases 1mmHg/1.36 cm (.54”) or 88mmHg in how many feet of water?

4’ of water.

**Hydrostatic Pressure** **what are some benefits ?**

* Builds muscles of respiration * helps reduce edema * helps decrease blood pooling in lower extremities.

**Hydrostatic Pressure** you will Need to use caution with patients with?

1. weak intercostals 2. poor vital capacity

Balance is stillness in water is ?

Hydrostatic Stability

**Hydrostatic Stability** what law? An object will reach a stable equilibrium when the center of gravity and the center of buoyancy are aligned in the same vertical plane.

Bougier’s Theorem:

**Hydrostatic Stability** what law? An object/person will continue to rotate until the center of gravity and buoyancy are aligned.

Metacentric effect:

**Hydrostatic Stability** A person with spastic hemiplegia will roll to the what side?

the affected side

**Hydrostatic Stability** A person with edema will roll which way from the affected side ?

away

the bending of a ray as it moves from a more dense to a less dense medium (the ray bends away from normal at a right angle)

Refraction of light

**Refraction of light ** Body images are ___________ in the water ?

distorted

**Refraction of light ** Limbs may look 25% larger and closer to the water’s surface. What does this make difficult?

Monitoring joint position

**Body’s Response to Immersion** :Cardiovascular system Hydrostatic pressure produces a lesser or greater venous pressure?

greater

**Body’s Response to Immersion** Cardiovascular system Cardiac and stroke volume increases or decreases?

increase

**Body’s Response to Immersion** Cardiovascular system Blood volume increases or decreases?

increases

**Body’s Response to Immersion** Cardiovascular system Heart rate is influenced by many factors and is not a good indicator of what?

exertion

Pulmonary system 1. Hydrostatic pressure places resistive forces on ________ \_\_\_\_\_\_\_\_\_\_? 2. Vital capacity decreases about \_\_\_\_%with immersion to the neck 3. Total work of breathing increases \_\_\_% with immersion to the neck. 4. Respiratory rate increases or decreases?. 5. Increase or decrease in O2 consumption ?

1. inspiratory musculature 2. 10% 3. 60 4. increases Respiratory rate 5. Increase O2

**Body’s Response to Immersion** **Musculoskeletal system benefits?** 1. Ease of \_\_\_\_\_\_\_\_? 2. Lymph and extracellular fluids are \_\_\_\_\_\_\_? 3. Blood supply to muscles is increased or decreased? 4. Increased or Decreased joint compression? 5. Muscle relaxation may occur in warmer or cooler water?

1. movement 2. mobilized 3. increased blood supply 4. Decreased joint compression 5. warmer water

**Body’s Response to Immersion cont.:Renal system** 1. Increased urine output with ______ and _______ of water 2. Sodium and potassium loss or gain? 3. Suppression of what? 4. increased or Decreased antidiuretic hormone (ADH)

1. time and depth of water 2. loss 3. thirst 4. Decreased

**Body’s Response to Immersion .:Nervous system** what are the two benefits for the nervous system?

1. Relaxation 2. Increase in pain threshold

name 10 Benefits of Aquatic Physical Therapy ?

1. Relaxation/Pain management 2. Stretching/ROM 3. Strengthening 4. Balance 5. Sensory input/Body awareness 6. Arousal 7. Coordination 8. Respiratory strengthening 9. Endurance 10. Circulation

Precautions/Contraindications

* ^Fever * ^{Infectious disease} * ^{Open wounds} * ^{Skin infections} * ^UTI * ^{Uncontrolled cardiac issues} * ^{Uncontrolled seizures} * ^Incontinence * ^{Severely limited vital capacity} * ^{Behavioral problems} * ^{Uncontrolled diabetes} * ^{Aspiration/absence of cough reflex} * ^Tracheotomy * ^{Ear infections} * ^{Skin and respiratory sensitivity to pool chemicals} * ^{Hearing aids and contact lens} * ^{Fear of water}

what are the Appropriate Patients for the Aquatic Setting?

1. Orthopedic (pre and post surgical) 2. Neurological injuries (CVA, spinal cord, TBI) 3. Arthritic patients 4. Muscular dystrophy (46 types determined by the MDA) 5. Amputees 6. Multiple sclerosis (need to be in cooler temperature water, 88 degrees or cooler) 7. Fibromyalgia/pain management 8. COPD/Asthma/cystic fibrosis 9. Pediatric (down syndrome, cerebral palsy, autism, seizure disorders, developmental delays) 10. Geriatrics

What method of techniques is this ? Started in 1950 in London England at a School for Crippled Girls. Started with 12 girls ranging in age from 9 to 15 years with various disabilities. Using the properties of water and interrelating bodies of various shapes and sizes with water , with control skill and safety the 10 point program was developed.

The Halliwick Method

Techniques cont. Halliwick 10 point program: what is included?

1. Mental adjustment 2. Disengagement 3. Transversal rotational control 4. Sagittal rotation control 5. Longitudinal rotation control 6. Combined rotation control 7. Upthrust 8. Balance in stillness 9. Turbulent gliding 10. Simple progression and basic swimming movements

True or False: The Halliwick 10 points method uses flotation devices

false

What Technique was Developed in 1980 It is a passive form of aquatic physical therapy that supports and gently moves a person through warm water in graceful, fluid movements. It promotes a deep state of relaxation with changes in the automatic nervous system (quieting the sympathetic nervous system and enhancing the parasympathetic nervous system)

WATSU

What method of technique helps..... * decrease muscle tension and increases range of motion. The support of the water provides relief from compression forces in the joint. * The movements provide a gentle stretch into all ranges of motion for the spine and extremities, all while the joins are unloaded.

WATSU

TRUE OR FALSE: the WATSU technique uses floataion devices?

False

what method or technque? * Has a long refining history. The basic concept started in the waters of Switzerland starting in 1240. * In the 1930’s knowledge of the medical benefits of movement were identified on land. Shortly after this discovery patients were placed on plinths and placed in the water to provide resistance to their movements (one dimensional movements). * In 1950 the use of flotation rings were used and medical professionals directed the patients in their movements, focusing more on strengthening and stabilizing exercises.

Bad Ragaz Ring Method

what method or technique? * With the introduction of proprioception neuromuscular facilitation (PNF) in 1968, three dimensional movements, the development of the this Method was formulated in 1975. * This method uses flotation devices on the wrist, ankles, waist and neck. * Very specific patterns have been established. * Three categories of techniques: passive, isometric stabilization, isotonic movement (assisted, supported, resisted)

Bad Ragaz Ring Method

TRUE OR FALSE: the Bad Ragaz Ring Method uses floatation devices?

TRUE

What Method? * This method is an active therapeutic approach using gravity and buoyancy to facilitate healing and minimize dysfunction for patients of all ages, levels and diagnosis. * “Exercise for life, for pleasure, not as something you have to do. Regular exercise that activates the 6 essential qualities is not medicine- it is a description of a positive necessary interaction between you and your surround. It will help you live and stay healthy in a stressful, challenging world”

The Burdenko method Developed by Igor Burdenko Ph.D.

name Burdenko Method Basic 9 Principles

1. Work in the vertical position 2. Incorporate deep water when possible 3. Incorporate whole body exercises 4. Work in multiple directions 5. Vary the speed 6. Exercise on land and water 7. Build up to 30 repetitions 8. Don’t hit a limit, Don’t go through pain 9. Develop & maintain the 6 essential qualities

Burdenko-6 Essential Qualities of Movement

Level 1 = Balance Level 2 = Coordination Level 3 = Flexibility Level 4 = Endurance Level 5 = Speed Level 6 = Strength

What method or technique? * Myofascial release technique performed in shallow water. * Theoretically breaks down fascial adhesions using therapist manual pressure and patient active movement. * Quickly restores flexibility, reduces pain, creates relaxation to improve function, quality of life, and sleep – all required to heal.

AquaStretch

AquaStretch 4 theories as to why it works

1. The body’s enhanced flexibility in the water 2. Intuitive movements 3. The use of variable “stretching resistance” 4. The fascial adhesion Theory

AquaStretch: 4 step procedure

1. Play 2. Freeze 3. Pressure 4. Move

what do you need to know about Equipment ?

* You need to understand how the equipment will **effect your patient and how it relates to the goals. ** 1. You need to know **how to place a flotation device** for the desired effect. 2. A variety of equipment is necessary for **different body types.**

* There are no standard aquatic therapy pool, each facility has a different setup. * There are a variety of types of pool (chlorine, salt, hydrogen peroxide). What do you need to know about the pool? * You need to understand how to operate the\_\_\_\_1\_\_\_ \_\_\_\_\_\_, if one is present, before you put the patient in it. * You need to know what water \_\_\_2\_\_\_ works best for your body type.

1. pool lift 2. height

Take care of yourself: 1. It is recommended that a therapist only spend \_\_consecutive hours in a pool. 2. It is recommended to have a ____ \_\_\_\_\_ present and that the treating therapist have training. 3. Wash off your _____ after exiting the pool with a mild soap. 4. If the pool is outdoors, wear sunglasses to protect your eyes from the sun ________ off the water. 5. If the pool is outside wear a _________ on exposed skin and a protective cover up. 6. See a ____________ yearly (moles and skin fungus). 7. Drink \_\_\_\_\_\_\_\_

1. 4 2. life guard 3. skin 4. refraction 5. sunscreen 6. dermatologist 7. water.

Documentation and Goals 1. Documentation is your best \_\_\_\_\_\_\_\_\_!! 2. The more \_\_\_\_\_\_\_&\_\_\_\_\_\_\_ you are in your documentation, the better covered you are legally. 3. _______________ with the PT is critical in order to progress the patient out of the aquatic setting. 4. Goals need to be ________ based, so the aquatic exercises need to promote them.

1. defense 2. precise and detailed 3. Communication 4. land

CPT Code/reimbursement: Most Aquatic physical therapist are PTA’s because… PTA’s are typically paid less then a PT Note - # codes below are the same code CPT code\_\_\_\_\_\_\_\_\_ (aquatic therapy with therapeutic exercise) pays a higher rate. (This equals more money for the facility) CPT code \_\_\_\_\_\_\_needs to be used for billing unless the code is not acceptable by that specific insurance company.

97113

What IS A MUST!!? Visit the APTA Aquatic Section website for audio conferences, CSM and Summit programming. www.aquaticpt.com ATRI has classes for beginners. Classes are expensive! If you volunteer to moderate the classes the tuition is reduced, but you may not be in the class that you wanted. www.atri.org Aquatic Therapy University. www.aquaticnet.com World Aquatic Health Conference. www.WAHC.com

Continuing Education

Conclusion of Aquatics fyi * Be safe * Remember and use the basic properties of water * Remember the effects of immersion on the body * Take continuing education * Join and be active in the APTA * Have FUN!!

marco

k&c Goals and idications for aquatic exercise

1. facilitate range of motion 2. initiate resistance training 3. facilitate weight-bearing activities 4. enhance delivery of manual tech 5. provid three-dimensional access to the pt 6. facilitate cardio exercise 7. initiate fuctional activity replication 8. minimize risk of injury or reinjury during rehab 9. enhance pt relaxation

k&c precautions

**fear of water**- be mindful **neurological disorders**- ataxic pt, controlled epilepsypt must RX, heat intolerance pt **respiratory disorders**- may adversely effect breathing, lung expansion tends to be inhibited. **cardiac dysfunction**- angina pts, abnormal BP, heart disease, or compromised pump mechanisms closely monitor **small, open wounds and line**s- open wounds and tracheotomies may be covered by waterproof dressings. Lines required proper clamping. Watch g-tubes and suprapubic appliances adverse reactions

K& C contraindications for aquatics

1. incipient cardiac failure and unstable angina 2. respiratory dysfunction, vital capacity of less than 1 liter 3. sever peripheral vascualr disease 4. danger of bleeding or hemorrhage 5. sever kindney disease 6. open wounds 7. uncontrolled bowel or bladder 8. menstruation without internal protection 9. water and airborne infections or diseases(ex:flu,gastro infections, typhoid, cholera , and polio) 10. uncontrolled seizures during the last year

Name some aquatic devices

* collars, rings, belts, and vests * swim bars ( dumbbells) * gloves, hand paddles, and hydro-tone balls * fins and hydro-tone boots * kickboards

name some stretching exercises

1. manual stretching techniques 2. spine stretching techniques 3. shoulder stretching techniques 4. hip stretching techniques 5. knee stretching techniqes 6. self-stretching with aquatic equipment

Spine stretching techniques: What motions?

cervical spine flexion cervical spin lateral flexion thoracic and lumbar spine lateral flexion

shoulder stretching techniques what motions?

* shoulder flexion * shoulder abduction * shoulder external rotation * shoulder internal rotation

hip stretching techniques. what motions?

hip ext hip external rotation hip internal rotation

knee stretching techniques what motions are being stretched

* knee ext w/ pt on steps * knee flexion w/ pt on steps * knee flexion w/ pt supine * hamstings stretch

self-stretching w/ aquatic equipment

* shoulder flex-dumbell or wrist strap * shoulder abd-dumbell or wrist strap * hip flex-dumbbell or ankle strap * knee ext-dumbbell or ankle strap * knee flexion-dumbbell or ankle strap

manual resistance exercises typically occurs in a 1. concentric or eccentric 2. closed or open chain fashion?

1. concentric 2. closed

deep water equipment most common device for deep water running is ?

the flotation belt positioned posteriorly

deep water devices Pts presenting w/ injuries or sensitivity of the runk may require tan alternative buoyant deve such as...?

* vest * flotation dumbbells * noodles

deep water equipment providing the pt with smaller buoyant equipment requires the pt to ?

work harder to maintain adequate buoyancy, thereby increasing the intensity of the activity.

Aquatic Physical Therapy PP and K&C Flashcards

(91 cards)