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Physical Agents II > Aquatics > Flashcards

Aquatics Flashcards

1
Q

What is aquatic physical therapy

A

Physical therapy interventions and treatment applications combined with hydrodynamic principles in the aquatic environment for the purse of improving the patient’s function

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2
Q

Accessibility of pool environment

A

Must assess all area from the building parking lot, the dressing room, to the pool itself for ease of access for all clients

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3
Q

Safety Issues/Precautions

A
  • Safety is the number one concern when performing any aquatic physical therapy
  • Keep you eyes on the patient at all times
  • Know your facilities safety regulations
  • Take advanced education courses on aquatic safety and update your aquatic safety skills on a regular basis
  • If facility does not have a safety policy be the first to help them establish one
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4
Q

prior to taking a patient into the pool…

A
  • Screen
  • Assess
  • Discuss
  • Review
  • Ensure
  • Explain
  • Discuss
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5
Q

Screen

A

for absolute and relative contraindications (open wounds, infection, recent cardiac events)

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6
Q

Assess

A

For fear and apprehension in the water
- Plan accordingly to ensure a safe experience

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7
Q

Discuss

A

safety issues or concerns with the patient

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8
Q

Communicate

A

and coordinate with other team members for any care or assistance required before or after pool (ie dressing)

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9
Q

Review

A

the entrance and exit strategy with the patient to be sure they are comfortable with this

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10
Q

Ensure

A

you know the emergency procedures to follow in the pool

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11
Q

Explain

A

what will occur during the session to the patient so they know what to expect

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12
Q

Discuss

A

the goal of aquatic therapy with the patient

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13
Q

Therapeutic Pool temperature range

A
  • 92-100 degrees F (typical pools rarely over 85)
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14
Q

Warm vs cold pools

A
  • Warmth creates relaxation, cool water invigorates and works better for endurance activities
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15
Q

Safety issues/precautions

A

 Review exit an entry plans and make
sure patient is comfortable with the plan
 Explain what the patient can expect during an aquatic treatment session

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16
Q

Precautions/Contraindications

A

a. Fever
b. Acute cardiac conditions
c. Respiratory capacity of <1.5 L
d. Extremely high/low blood pressure
e. Incontinence
f. Unprotected wounds
g. Urinary Tract Infections
h. Infectious diseases
i. Uncontrolled seizure activity
j. Severe hydrophobia
k. Severe peripheral artery disease
l. Acute cerebral hemorrhage
m. Active lung infection

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17
Q

Can a client who is properly catheterized participate in an aquatic program?

A

yes

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18
Q

Can a client with an open wound participate in aquatic therapy

A

only if the wound is properly covered with waterproof taep

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19
Q

Can a client with a G tube participate in aquatic therapy?

A

when the site is covered with a waterproof tape (after the initial wound heals)

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20
Q

What is Buoyancy

A

 The Archimedes’s principle states that when a
body is immersed in fluid, that body experiences a
buoyant force equal to the weight of the fluid
which the body has displaced.
 An upward thrust which acts in the opposite
direction of gravity

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21
Q

What is there an upward thrust that acts in the opposite direction of gravity?

A
  • The density of water is near that of the human
    body
  • The relative density of water is one, therefore any mass with a density less than one will float
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22
Q

The relative density of the human body varies with age:

A
  • Infants/younger children have a relative density of approximately 0.86, therefore flotation is assured
  • In adolescence/adulthood the
    body has a relative density of approximately 0.97, therefore the body will float, however to do so becomes more difficult
  • In the later years of life, with an increase in adipose tissue, the relative density of the
    body returns to approximately 0.86, and it again becomes easier to float
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23
Q

What does each individual body part and tissue have?

A
  • its own relative density
  • some body parts such as arms are less dense and float easier
  • other parts such as legs are more dense and tend to sink
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24
Q

water levels what part of the body are what percent weight bearing

A

C7 = 10% weight bearing
Xiphoid = 30% weight bearing
ASIS = 50% weight bearing

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25
Q

What is Hydrostatic Pressure (Pascal’s Law)

A

 Pascal’s Law states that fluid pressure is exerted
equally at any level in a horizontal direction;
that is pressure is at a constant at a given
depth –> However, pressure increases with depth and density of fluid

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26
Q

What 2 things contribute to the feeling of weightlessness

A

Buoyancy and hydrostatic pressure each
contribute to the feeling of weightlessness, and
this pressure increases with an increase in depth.

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27
Q

Gravity is pushing down and…

A

buoyancy is pushing up and hydrostatic pressure is pushing laterally

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28
Q

What is viscosity

A

Type of friction between the molecules of a
liquid which causes a resistance to movement, because the molecules of a liquid tend to adhere to the surface of the body moving through it

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29
Q

what is surface tension

A
  • the force exerted between the surface molecules of a fluid
  • A certain amount of attraction occurs between each molecule, this creates a tension, therefore a force is needed to break them apart
30
Q

What happens to viscosity and surface tension as temperatures increase?

A

they decrease

31
Q

Surface friction is how much greater in the water than in the air

A

790 times greater

32
Q

Laminar or streamline flow

A

-The smooth motion when the thin layers of fluid molecules slide over one another
- Resistance is directly related to water flow velocity

33
Q

Turbulent flow

A
  • The irregular movement of fluid which is rampant and random
  • Turbulent resistance is greater than streamline
34
Q

What can an increase in water turbulence cause

A

an increase by even a small amount can significantly increase resistance depending on the activity

35
Q

Refraction

A

▪ The bending of light rays as from one medium (air) into another (water).
▪ A change in apparent position due to bending of light rays.

36
Q

Metacentre

A

 Bougier’s Theorem states that when a body
is immersed in the water, it is subject to two opposing forces - Buoyancy and gravity
- When these forces are equal, the result is a floating body
- When these forces are directionally opposite, no rotation will occur
- If the forces are not equal, rotation will occur until equilibrium/alignment between the two forces occurs
- Any movement of the limbs will interrupt these two forces and rotation will occur.

37
Q

Initial evaluation

A
  • based on referral source you may want to choose between aquatic eval or screening tool
  • No matter what, some form of aquatic assessment should be performed at initiation of aquatic treatment
38
Q

Aquatic treatment plan

A

Based on functional status in water but should have land based outcomes because you should be sequencing treatment toward land based outcomes

39
Q

What is the halliwick method

A
  • A method of water safety for independent mobility in the water (similar to adapted swimming)
  • Group sessions with one to one assist
  • Consists of 4 phases that contain 20 basic points to promote independence in the water
  • Assistive or supportive equipment is avoided as much as possible
40
Q

Objective of water safety in Halliwick Method

A

leading to independent movement in water

41
Q

What are participants taught to do in the halliwick method

A

maintain a safe breathing position with their airway clear regain a safe position if it is lost control of exhalation with the face immersed in the water

42
Q

Halliwick method phase 1

A
  • Mental adjustments to water
  • Entering the water may be a frightening experience for the patient need to adjust to the effect of gravity removed and the buoyancy begin in the vertical position prior to the massive effect of huoyancy on the body
43
Q

Halliwick Method Phase 2

A
  • Rotations
    A. Forward/vertical rotations –> Achieved by movement at he hips; supine to stand
    B. Lateral rotation: movement of the body around the spine, the client uses his head/or arm to initiate the movement
    C. Combined rotation: combination of forward and lateral rotation used with the independent entry; the client falls forward and would use a lateral rotation to supine first then a vetical/forward rotation to stand
44
Q

Halliwick Method Phase IV

A
  • Movement through the water
  • The client begins to move himself through the water
  • Begin with spilling or the UE’s rowing
  • Simplified back crawl
45
Q

Objective of Bad Ragaz or Ring Method

A
  • Buoyancy as support
  • client is completely supported by buoyancy and/or buoyant devices in the water
  • Resistance is provided through direction and speed through water
46
Q

What is Bad Ragaz

A
  • An evolving method of aquatic interventions that involves supporting the client with a series of “rings” or floatation devices
    *The therapist is the key stabilizing support
    *Very versatile
    *Frequently compared to PNF and incorporates muscle and tone influences similarly
    *Has some basic patterns to follow as a start for
    intervention
47
Q

Bad Ragaz General Concepts

A
  • Attempting to put patient in a state of equilibrium so with ring placement therapist must take into consideration each clients own muscles, tone, ROM limitations or asymmetries and adjust floats to accommodate
  • Client is not holding onto anything for stability to therapist must be ready at all times
  • Specific points or holds a therapist uses in order to perform various exercises or assist with movement pattern
48
Q

The more support or assurance a client requires…

A

the more proximal the hold

49
Q

The does the client perform the greatest amount of work

A

work when the therapist is using distal holds and the client moves at the fastest speed through the greatest available ROM

50
Q

In Bad Ragaz, how are almost all the exercises performed

A
  • with the pt in prone or supine position
  • rings are typically placed at cervical level (C5-T12???? who knows)
51
Q

Sensory integration

A
  • All sensory systems are involved in aquatic treatment: tactile, proprioceptive, kinesthetic, vestibular, visual, auditory
  • excellent environment to work on bilateral integration and motor planning
  • thought must be given to the environment and how to use it to the patients advantage
52
Q

What is watsu

A
  • water shiatsu
  • incorporates zen shiatsu and aquatic elements
  • stretching and mobilizations combined with breathing patterns in warm water
53
Q

Traditional Exercises

A
  • definite as exercise in the water with a point of stabilization on the pool or a piece of equipment
  • hydrodynamic principles are used to apply assistive, supportive, and resistive elements
  • equipment and water depths are varied to grade the exercise
54
Q

Functional Task Sequencing

A
  • Allowing the client to accommodate to the water allowing the client to move all body parts, increase kinesthetic sense and postural/sensory control and awareness, increase sensory input
  • Perform the task
  • Increase ROM and strength together
55
Q

Prepare the environment

A

Prepare the environment
Bring out equipment - floats Chair in water, dock Shallow vs. deep water
Resistance – turbulence, buoyancy, length of lever arm

56
Q

Developmental sequence activities

A

a. Patient in most functional position
b. Provide support directly to start
c. Use floats with intermittent contact
d. Work toward complete patient independence
e. In more challenging positions - max buoyancy and more to shallower less supportive depths.
f. Once control in one position, work towards active transition into another
g. While working on maintenance and transition of
positions - incorporate active and passive ROM
through stretching and weight hearing

57
Q

How to do gait training

A
  • Use facilitation techniques as in clinic, but vary
    depth of water as resistance or assistance is needed,
  • Water allows freedom of movement (especially
    backwards or sideways)
  • Speed can be decreased to work on components of gait
58
Q

The increased independence most have in the water is beneficial BUT…

A

sometimes gait deviations can be increased so try and balance quality with independence

59
Q

Postural control/spinal stabilization

A

can work on maintaining trunk control in various depths of water
- work first with the feet or pelvis in a WBing position and move extremities on stable trunk
- Then work on maintaining stable trunk on a float device or while suspended in the deep well
- Add extremity movement to controlled trunk in deep well as highest level of stabilization activity

60
Q

Functional Status in Water

A

◼ Learning to control your body as safely
& independently as possible in the
aquatic environment is a universal goal
that must be refined for each individual.
◼ Functional means measurable: use
amount of assistance, speed, distance,
time, number of repetitions, depth of
water as measures of change in
function.

61
Q

Sequencing Treatment with land based goals in mind

A

◼ Knowing where you are starting and where you hope to go is the first order of proper sequencing
◼ Continually breaking down each treatment session using a task analysis approach will help prioritize treatment approaches
◼ In water, proper breath control and head position are critical to full independence and therefore a sequencing priority

62
Q

Respiratory Exercises

A

▪ the water provides a very functional place to work on breath control and on oral motor control
▪ Ribcage and trunk work are often more easily focused on in the pool
▪ even if prone swim or underneath activity is not ultimately your focus breathing activities can and should be performed in the pool

63
Q

What should you focus on for breath control

A
  • learning to treat OUT under the water, not just tolerating their face near the water or holding their breath - very important for proper breathing patterns
64
Q

What should you do if mouth closure is a problem

A

work on midline positioning and just trying to get mouth closure for blowing bubbles

65
Q

why is blowing out the nose also important to do in the water

A

it has implications for breath control in a variety of situations

66
Q

Why should you practice breath control in a variety of positions

A

to see how tone or positioning influences breathing patterns

67
Q

Groups/community programming

A
  • There are ways to justify pool groups that third party payors will reimburse for
  • Consider running a self-pay class running for a limited number of weeks led by a clinician as a transitional pool exercise option.
68
Q

Utilization of the pool

A
  • Be aware of cost effectiveness operating a pool is expensive
  • Renting from a local pool may be more efficient
  • Be creative about keeping the pool in use and staffing patterns
69
Q

Prepare different documentation formats for the pool

A

 Screening tools/assesments
 Poolside exercise programs
 Home Exercise programs that are laminated to be used pool side
 Referral forms for in–house staff and for physicians

70
Q

Recommendations for frequency and implementation

A
  • what is the priority?
  • How many sessions with it take an aquatic therapist to help meet this need?
  • Think in terms of “episodes of care”
  • Prepare for D/C at the start

Physical Agents II (8 decks)

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