the aquatic therapist

Aquatic lymphatic therapy

Ever wondered if aquatic therapy (specialized exercise during immersion) could reduce lymphedema?

We did!

So we were especially stoked to read this just-released research study on this very topic.

Tidhar D, Katz-Leurer M. Aqua lymphatic therapy in women who suffer from breast cancer treatment-related lymphedema: a randomized controlled study. Support Care Cancer. 2009 Jun 3. [Epub ahead of print]

Department of Physical Therapy, "Maccabi Healthcare Services", Netivot, Israel.

BACKGROUND: Lymphedema is an adverse effect of breast cancer surgery. Aqua lymphatic therapy (ALT) is a novel treatment for limb volume reduction.

OBJECTIVE: The aim of this study was to examine whether ALT is a safe method and whether there are differences in adherence, limb volume, and quality of life between women who perform only self-management treatment and women who participate as well in ALT.

DESIGN: Design of the study was single-blind randomized clinical trial.

SETTING: The setting was in a hydrotherapy pool, 1.2 m depth, and a temperature of 32-33 degrees capital ES, Cyrillic.

PATIENTS: Forty-eight women (56 +/- 10 years), with a 12.8% lymphedema relative volume, participated in the study.

INTERVENTION: The control group was instructed to perform the self-management treatment. The study group joined a weekly session of ALT for 3 months in addition to the self-management therapy.

MEASUREMENTS: Adherence was assessed by a self-reported diary, limb volume by a water displacement device, quality of life by the Upper Limb Lymphedema Questionnaire (ULL27), prior to, and after the intervention period.

RESULTS: There was no episode of arm infection or aggravation in limb volume during the study period. ALT had a positive, statistically and clinically significant immediate effect on limb volume but no long-term effect was noted. The adherence rate to ALT was significantly higher than the adherence to self-management therapy. QOL improved in the study group.

CONCLUSION: ALT was found to be a safe method, with high adherence, in treating women who suffer from mild to moderate lymphedema. A significant immediate and insignificant long-term effect on limb volume was noted.

Looking for an aquatic therapy employee? Check out our Aquatic Therapy Job Board

Aquatic therapists are a special breed. We're hard to find in any market... add the recent deficit of skilled, licensed therapists and we become somewhat of an endangered species.

So, where can you find your perfect aquatic therapy employee?

On the Aquaticnet Job Board.

For $100/month, your posting will be seen by hundreds of therapists who have one thing in common: water.

LINK to post your job.

LINK to view available jobs.

For example, check out this posting that appear for the first time today.
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Non-traditional Physical Therapist or Occupational Therapist

Elements of Wellness (Moscow, Idaho)

Posted:

June 3, 2009

Address:

872 Troy Road, Suite 170

Moscow, ID 83843

Type:

Full-time, Part-time, Permanent

Description:

Welcome,

Elements of Wellness is a non-traditional outpatient therapy clinic located in Moscow, ID. We are currently looking for another Occupational Therapist or Physical Therapist to join our wellness team.

Preferred Experience/Certification:
- Aquatic Bodywork: Aquatic Integration, Watsu, etc.
- CranioSacral Therapy
- Current Practitioner License

Please email our office at elementsofwellness@mac.com for more information.

Our office website (currently under construction): http://web.mac.com/elementsofwellness

For information about Moscow, ID: http://www.moscow.id.us

For information about Aquatic Integration: http://www.aquaticintegration.com

For information about CranioSacral Therapy: http://www.upledger.com

Occupation: OT or PT Aquatic Therapist/CranioSacral Therapist

Type: Half-Time, Full-Time, Permanent

Send Resumes to: elementsofwellness@mac.com

Elements of Wellness
Aquatic & Manual Therapy, Inc.
872 Troy Road, Suite 170
Moscow, ID 83843
208-892-8888
208-882-8890 fax
elementsofwellness@mac.com

Salary:Based on experience
Apply by Email:elementsofwellness@mac.com

Aquatic therapy has poor showing on Wikipedia... So make it better!

Wikipedia is supposed to be the fount of all collective knowledge on the web. So what does this virtual encyclopedia have to say about aquatic therapy? Here is the entire accumulated wisdom about the topic:

Aquatic therapy or pool therapy is physical therapy that is performed in the water. Aquatic therapy use the resistance of water instead of weights.^[1] It aims to rehabilitate patients after injury or those with chronic illness, avoiding the amount of weight placed on the joints by exercise outside the water.

References
[1] Musculoskeletal Interventions

Yikes! Let's see how many fronts that is wrong on.

1. Aquatic therapy is performed by many professionals, not just physical therapists. Although physical therapists and recreational therapists are the most common providers of aquatic therapy, aquatic therapy is also performed by occupational therapists, speech therapists, massage therapists, kinesiotherapists, exercise physiologists, athletic trainers and others. Most insurance companies will only reimburse for treatment provided by PTs and OTs, although some speech therapists have started to provide services in the water and been successful in receiving payment.

2. Aquatic therapy is not only used for rehabilitation after injury or for treatment of chronic illness. It can be used as a preoperative method (prior to total joint replacement), a post-operative rehab tool, a sensory integration technique, a training tool for athletes and more.

3. Aquatic therapy deserves more than a 2 sentence statement on Wikipedia. Rise up therapists and add your knowledge! There are certain rules and need for citations when contributing to a Wiki, but what a great class project for a Physical Therapy or other class.

Go forth and post!

Study Finds Water Aerobics Beneficial to Kids, Too.

The effectiveness and safety of a group aquatic aerobic exercise program on cardiorespiratory endurance for children with disabilities was examined using an A-B study design. Sixteen children (11 males, five females) age range 6 to 11 years (mean age 9y 7mo [SD 1y 4mo]) participated in this twice-per-week program lasting 14 weeks. The children's diagnoses included autism spectrum disorder, myelomeningocele, cerebral palsy, or other developmental disability. More than half of the children ambulated independently without aids. Children swam laps and participated in relay races and games with a focus of maintaining a defined target heart rate zone. The strengthening component consisted of exercises using bar bells, aquatic noodles, and water resistance. The following outcomes were measured: half-mile walk/run, isometric muscle strength, timed floor to stand 3-meter test, and motor skills. Complaints of pain or injury were systematically collected. Significant improvements in the half-mile walk/run were observed, but not for secondary outcomes of strength or motor skills. The mean program attendance was 80%, and no injury was reported. Children with disabilities may improve their cardiorespiratory endurance after a group aquatic aerobic exercise program with a high adult:child ratio and specific goals to maintain training heart rates.

Fragala-Pinkham M, Haley SM, O'Neil ME.
Group aquatic aerobic exercise for children with disabilities.
Dev Med Child Neurol. 2008 Nov;50(11):822-7.

Research Center for Children with Special Health Care Needs, Franciscan Hospital for Children, Brighton, MA, USA.

Working with the Parkinson's patient in water -- Download the 2008 manual

Looking for new ideas for how to work with the Parkinson's client in the pool? Download this free 35 page Aquatic Exercise manual.

It is 100% aquatic advice... specific to this population. And it is published by the American Parkinson Disease Association so you know it's up to date.

Aquatic exercise statistics - how popular is non-swimming aquatic exercise?

Building an aquatic practice? Designing and patenting an exercise device for the pool? Or just writing that horrid research paper for PT school?

Well, you need up-to-date statistics. Here are a few arrows for your quiver:

Non-swimming aquatic exercise grew in popularity in the United States by almost 8% between 1998-2007. This is in stark contrast to other popular exercise options, including fitness swimming (which dropped 4.4%), aerobic dance (-17.3%), and fitness cycling (-23.2%)

In 2004, approximately 5.8 million people in the US participated in aquatic exercise. By 2007, this number had increased to over 7.2 million.

Aquatic exercise continues to appeal most to females in their middle or senior years, although that is mutating with the developing athletic programming focus. The average age of the quintessential aquatic exerciser is almost 47 years old.

When casual aquatic exercise participants are removed from the sample, the average age of the “frequent participant” (those who reported exercising in water over 100 days/year) ascends to 57+ years. Nearly 75% of aquatic exercisers are female.

Excerpted from Salzman, A. "Aquatic Aftercare and Wellness". In Becker, B, Cole A (eds). Comprehensive Aquatic Therapy. 3rd edition. Lippincott, Williams & Wilkins. Pending publication 2009. Statistics compiled in part from 2008 Superstudy of Sports Participation (Aquatic Exercise Slice).

The Navy brings water aboard... for therapy

Last year, the Navy was looking for a way to increase career longevity of its special warfare combatant-craft crewman (SWCC) and SEALS.

It turned to water for the answer.

The Navy recently added a therapy pool to its inventory of equipment used to prolong a special boat operator's career.

The program is modeled after similar programs used by professional sports organizations, such as the National Football League. Its primary goal is to prevent or heal the damage done to a SWCC or SEAL's body simply because of the nature of his or her daily duties.

The pool is 15 feet long by 7 feet wide and is 4 1/2 feet deep. It holds approximately 2,000 gallons of water and has two high-powered water jets that push water over a built-in treadmill to provide different degrees of resistance.

Source: "Navy Integrates Hydrotherapy into Physical Fitness Program". NavySeals.com

Additional support for treating patients in the water after a Total Hip Replacement

Patients who have just undergone a THA have all the "problems" we try and solve with water-based intervention. And yet, they are often prevented from entering the pool until they "fail" land-based therapy.

Truly, the problems post-op total hip patients have are tailor-made for the pool:

• They have lower extremity swelling (Solution: hydrostatic pressure)
  
• They have difficulty weight bearing (Solution: buoyancy)
• They have need of assistive device to ambulation (Solution: buoyancy)
• They have pain and muscle spasm (Solution: thermal shifts and buoyancy)
• They have balance deficits (Solution: viscosity and flow to challenge; buoyancy to protect in case of fall)
• They have proprioceptive deficits (Solution viscosity and flow)
• They have ROM restrictions (Solution: hydrostatic pressure to reduce swelling and buoyancy to ease motion)
• They have weakness (Solution: buoyancy and viscosity)

The pool is the perfect place to be for the first month after surgery. But many MDs are gun-shy about infection and/or dislocation potential and don't think pool. So they restrict one of the best options for rehab immediately post-op.

See what researchers found can be done when you allow these patients to get in the water and go!
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Giaquinto S, Ciotola E, Dall'armi V, Margutti F. Hydrotherapy after total hip arthroplasty: A follow-up study. Arch Gerontol Geriatr. 2009 Mar 10. [Epub ahead of print}

IRCCS San Raffaele Pisana, Via della Pisana 235, I-00163 Rome, Italy.

The aim of the study was to evaluate the subjective functional outcome of total hip arthroplasty (THA) in patients who underwent hydrotherapy (HT) 6 months after discharge.

A prospective randomized study was performed on 70 elderly inpatients with recent THA, who completed a rehabilitation program.

After randomization, 33 of them were treated in conventional gyms (no-hydrotherapy group=NHTG) and 31 received HT (hydrotherapy group=HTG).

Interviews with the Western-Ontario MacMasters Universities Osteoarthritis Index (WOMAC) were performed at admission, at discharge and 6 months later. Kruskal-Wallis, Mann-Whitney and Wilcoxon tests were applied for statistical analysis.

Both groups improved. Pain, stiffness and function were all positively affected.

Statistical analysis indicated that WOMAC sub-scales were significantly lower for all patients treated with HT. The benefits at discharge still remained after 6 months. We conclude that HT is recommended after THA in a geriatric population.

Taking theater into the therapy pool: Disabled children as lead roles

So good it makes you want to cry!

Last summer, a British theatrical company Oily Cart enacted a "multi-sensory theater" production called Pool Piece with physically and mentally challenged children.

Where did this play take place? In a therapy pool.

The company transforms a special school hydrotherapy pool into somewhere that feels enchanted. Smoke billows from a golden chest and light falls across the surface of the water, catching the vivid fantasy costumes of the performers.

Song and gamelan instruments create a soundscape and the lapping of warm water against skin is matched by other sensory diversions: simple splashing; waterfalls falling from huge colanders.

Most importantly in these unique performances it is the audience that leads the way; the performers interact intensively with each child on a one-to-one basis, but always take their cue from the child.

Read a review of Pool Piece here...

Read more about Oily Cart productions here...

Read rehearsal notes on the production here...

Blue Cross Blue Shield defines medical appropriateness for aquatic therapy

Insurance companies are starting to establish limits on what they consider appropriate use of interventions such as aquatic therapy.

And although not all insurances treat CPT 97113 (aquatic therapy) the same, it is helpful to see what kinds of restrictions are working their way down the pike.

Here is an example of what Blue Cross Blue Shield of Tennessee considers appropriate use of aquatic therapy, including some "samples" of clinically-appropriate patients.

MEDICAL APPROPRIATENESS

• Aquatic therapy is considered medically appropriate for ALL of the following criteria:

  • The service is performed under the direct supervision of a licensed physical therapist with a physician's order
    

  • The therapeutic interventions rendered are directly related to a written treatment regimen that includes goals approved and signed by the physician
    

  • The individual must have impairments, functional limitations or disabilities that can be minimized or eliminated with aquatic therapy
    

  • The individual must be able to benefit from the unique properties of water (i.e., buoyancy, hydrodynamics, and hydrostatic pressure)
    

  • An individual selected for aquatic therapy must be unable to safely participate in a physical therapy program that is totally land based due to weight bearing restrictions, severe weakness or other considerations
    

  • The documentation must support the necessity of this intervention
    

  • The aquatic therapy rendered must require the skills of a physical therapist
    

  • A qualified therapist is physically present and actively involved in the treatment (Note: Refer to the medical policy Staff Supervision Requirements for Delegated Services for further information regarding BCBST's supervision requirements.)
    

  • The aquatic therapy services rendered are considered acceptable standards of medical practice for the individual's condition.

ADDITIONAL INFORMATION

An individual may receive aquatic therapy on the same date of service as land based therapy. However, there should be an evident trend away from aquatic therapy and towards a fully implemented land based program.

Clinical Examples of Skilled Aquatic Therapy:

• An individual with arthritis who cannot ambulate on land because of the inability to use an assistive device, but who can begin walking in the pool.

• An individual who recently had a total hip replacement with weight bearing restrictions who has difficulty following these precautions on land and who needs to begin progressive strengthening of the leg.

• An individual with Guillain Barré or multiple sclerosis who is too weak to exercise on land but who can move in the pool with a buoyancy assist device.

Source: Blue Cross Blue Shield of Tennessee Medical Policy Manual

Aquatic vestibular rehab? New application for old problem of dizziness

We are all conditioned to think of the pool for motor complaints. Aquatic therapy has become an obvious choice for ROM, strength, weight-bearing, balance and tone issues. But, until now, very few people used the properties of water for a different kind of rehab... vestibular rehab.

It makes sense, though, doesn't it?

Think of all the minor adjustments in head and body position which can be achieved in a buoyant, turbulent, refractive environment like the pool.

10 sessions in the pool can do a lot for this miserable complaint. Read on...

Gabilan YP, Perracini MR, Munhoz MS, Gananç FF. Aquatic physiotherapy for vestibular rehabilitation in patients with unilateral vestibular hypofunction: exploratory prospective study. J Vestib Res. 2008;18(2-3):139-46.

Neurotology Division, Department of Otorhynolaryngology, Head and Neck, Federal University of São Paulo, São Paulo, Brazil. ygabilan@uol.com.br

PURPOSE: To explore the effects of aquatic physiotherapy on individuals with unilateral vestibular hypofunction and examine the association of therapeutic effects with age, time since symptom onset and use of antivertigo medication. STUDY

DESIGN: Exploratory study.

SETTING: Tertiary referral center.

PATIENTS: Twenty-one patients presenting chronic dizziness with uncompensated unilateral vestibular loss.

INTERVENTION: All patients underwent a regimen of 10 sessions of aquatic physiotherapy for vestibular rehabilitation.

MAIN OUTCOME MEASURES: Patient evaluation prior to and following rehabilitation involved the application of the Brazilian version of the Dizziness Handicap Inventory (DHI), dynamic computerized posturography and the self-perception scale of dizziness intensity. Statistical analysis compared average variables prior to and following rehabilitation using the Student t test.

RESULTS: Brazilian DHI total scores were lower following rehabilitation (p = 0.001). Posturography revealed a reduction in the variation of body displacement following rehabilitation in the average stability and anterior/posterior stability indexes (p = 0.001) and in the average medial/lateral stability index (p = 0.003). Self-perception of dizziness intensity was lower following rehabilitation (p = 0.001). No association between age, time since symptom onset and use of antivertigo medication and rehabilitation therapeutic effects were found.

CONCLUSION: Unilateral vestibular hypofunction patients undergoing aquatic physiotherapy for vestibular rehabilitation achieved an improvement in quality of life, body balance and self-perception of dizziness intensity, regardless of age, time since symptom onset, and use of antivertigo medication.

Comparison of maximal and spontaneous speeds during walking on dry land and water

Ever wondered how walking in water compared to walking on land? Read on...

Chevutschi A, Alberty M, Lensel G, Pardessus V, Thevenon A. Comparison of maximal and spontaneous speeds during walking on dry land and water. Gait Posture. 2009 Apr;29(3):403-7. Epub 2008 Dec 10.

LEMH, Université de Lille, Ronchin, France. achevutschi@univ-lille2.fr

The aim of this study was to quantify spontaneous and maximal speeds on dry land and in water, in four modalities of walking [forward (F), backward (B) and lateral walking (L)], with chest immersion level.

Lateral walking was studied with the upper limbs of the subject alongside the body with hands placed on the lateral face of the thighs (L1) and upper limbs tightened behind the back with the hands joined (L2). 16 males (age 22.8+/-1.8 years, height 178.1+/-6.1cm, body mass 73.5+/-6.6 kg) and 15 females (age 22.8+/-2.1 years, height 171.5+/-5.8 cm, body mass 69.2+/-9.3 kg) were evaluated using the four modalities of walking on dry land and in water.

The speed increments between spontaneous and maximal speeds on dry land for F, B and L1 and L2 were 60.2%, 60.9%, 64.3% and 65.3% for males and 47.3%, 48.3%, 44.5% and 53.1% for females.

In the water, these variation values for F, B, L1 and L2 for males were 44.6%, 26.1%, 48.8%, and 42.1%. The values for females were 31.7%, 21.6%, 32.8%, and 34.6%.

Spontaneous and maximal speeds of walking were substantially reduced in water with the chest immersed, compared to speeds on dry land for the four modalities and the two genders.

These findings may be used by therapists who utilize the various modalities of walking in aquatherapy.

Aquatic therapy (including Ai Chi and Halliwick) improves balance and fitness in CVA patients

So, you learned Ai Chi flows and Halliwick techniques at a recent aquatic therapy seminar. But do these aquatic "specialty techniques" really work in the therapy world? Or are they all hype?

A research team out of Korea wanted to compare the results of therapy (land versus water) on chronic stroke patients. They chose to provide Ai Chi and Halliwick as their water-based intervention. How did these techniques fare? Read on to find out...
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Noh DK, Lim JY, Shin HI, Paik NJ. The effect of aquatic therapy on postural balance and muscle strength in stroke survivors--a randomized controlled pilot trial. Clin Rehabil. 2008;   Oct-Nov;22(10-11):966-76.

OBJECTIVE: To evaluate the effect of an aquatic therapy programme designed to increase balance in stroke survivors.

DESIGN: A randomized, controlled pilot trial.

SETTING: Rehabilitation department of a university hospital.

SUBJECTS: Ambulatory chronic stroke patients (n = 25):13 in an aquatic therapy group and 12 in a conventional therapy group.

INTERVENTIONS: The aquatic therapy group participated in a programme consisting of Ai Chi and Halliwick methods, which focused on balance and weight-bearing exercises. The conventional therapy group performed gym exercises. In both groups, the interventions occurred for 1 hour, three times per week, for eight weeks.

MAIN MEASURES: The primary outcome measures were Berg Balance Scale score and weight-bearing ability, as measured by vertical ground reaction force during four standing tasks (rising from a chair and weight-shifting forward, backward and laterally). Secondary measures were muscle strength and gait.

RESULTS: Compared with the conventional therapy group, the aquatic therapy group attained significant improvements in Berg Balance Scale scores, forward and backward weight-bearing abilities of the affected limbs, and knee flexor strength (P < 0.05), with effect sizes of 1.03, 1.14, 0.72 and 1.13 standard deviation units and powers of 75, 81, 70 and 26%, respectively. There were no significant changes in the other measures between the two groups.

CONCLUSIONS: Postural balance and knee flexor strength were improved after aquatic therapy based on the Halliwick and Ai Chi methods in stroke survivors. Because of limited power and a small population base, further studies with larger sample sizes are required.

Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.

Aquatic exercise vs. Elastic bands for fitness. And the winner is...

 

Photos: HydroWorx and Thera-band

So which do you think would make for a better workout? Using elastic band, such as Thera-band, to work-out or jumping into the nearest pool? Inquiring minds wanted to know... so a team in Spain published their research findings last month.
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Colado JC, Triplett NT, Tella V, Saucedo P, Abellán J. Effects of aquatic resistance training on health and fitness in postmenopausal women. Eur J Appl Physiol. 2009 Feb 10.

To investigate effects of 24 weeks of resistance training with aquatic resistance devices or elastic bands (EB) on markers of cardiovascular health and physical capacity. Forty-six healthy, sedentary postmenopausal women participated.

The groups were aquatic exercise (AE; n = 15), EB (n = 21), and control (n = 10).

Venous blood chemistry included cholesterol, triglycerides, glucose, and apolipoprotein B. Physical capacity was assessed by the sit-and-reach, knee push-up, 60-s squat, and abdominal crunch tests.

Both AE and EB, respectively, showed a significant (P </= 0.05) decrease in body fat (14.56, 11.97%) and diastolic blood pressure (8.03, 5.88%), and a significant increase in fat-free mass (2.88, 1.22%), sit-and-reach (27.94, 44.2%), knee push-ups (84.74, 51.59%), and 60-s squats (65.76, 46.04%). AE also showed a significant increase in abdominal crunches (28.11%).

CONCLUSION: Aquatic resistance training can offer significant physiological benefits in health and performance that are comparable to those obtained from EB in this population.

Questions: juan.colado@uv.es.

Finally, a pediatric aquatic therapy seminar in Toronto!

Paediatric Aquatic Therapy Course
Date: March 6-7, 2009
Host: Southlake Regional Health Centre
Location: Newmarket, Ontario (right outside Toronto)
Instructor: Jennifer Tvrdy, OTDR/L
Cost: $500.00
Contact Name:  Carrie Anne McQuaid 
To request brochure or register: (905) 895-4521 ext. 2389

Request your own information on custom seminars (PDF version/ doc version)

Cost of hosting a custom seminar versus traveling.

Economic downtime putting a crunch on traveling to seminars? Bring the seminar home instead!

Money too tight to travel? Seminars never come close to your home town? Or maybe you've been burned by sloppy instructors or too crowded courses?

Read below about one facility's decision to pass on travel for aquatic therapy training in 2009.

INTERVIEW with Aili Pare, PT, Southlake Regional Health Centre, New Market, Ontario

ARN: Why did you first decide to bring continuing education to your facility instead of sending your people out for training? 

PARE: It was a more practical option for us as there is little to no aquatic training offered for therapists in Ontario.  It enabled us to train our staff and with outside registrants it helped to offset the cost.

ARN: With the economy problems looming, do you see custom seminars as an up-and-coming trend for 2009? 

PARE: For our facility it makes sense.  I think it would work well for facilities that don't have the funds to send all of their staff to a course or perhaps two or more facilities in the same area that don't have easy access to courses offered in major city centres.

ARN: Why did you pick ARN for training? 

PARE: We were very impressed with the resources available online, Andrea Salzman (ARN Founder) seemed very knowledgeable and friendly and they offered a great hands-on course that could be tailored to fit our specific needs.

ARN: Did/will you open up the seminar to outsiders? Did this completely/partially cover your costs? Did you make a profit? 

PARE: We did open the course to outsiders which offset the cost of the course for our staff and we did have a little money left over to purchase some pool equipment. We are holding a paediatric aquatic therapy course March 6-7, 2009 which will also be open to the public, so people can call Carrie Anne at (905) 895-4521 ext. 2389 for information.

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Considering Bringing a Custom Seminar to Your Home Pool?

Custom Seminar Request Form (doc)

Cost -- and other reasons -- to consider a custom seminar

Underwater treadmill: Want it to be harder? "Walk backwards!" say researchers

Masumoto K, Hamada A, Tomonaga HO, Kodama K, Amamoto Y, Nishizaki Y, Hotta N. Physiological and perceptual responses to backward and forward treadmill walking in water. Gait Posture. 2009 Feb;29(2):199-203. Epub 2008 Sep 30.

Institute of Health Science, Kyushu University, 6-1 Kasuga-koen, Kasuga, Fukuoka 816-8580, Japan. masumoto@ihs.kyushu-u.ac.jp

We compared physiological and perceptual responses, and stride characteristics while walking backward in water with those of walking forward in water.

Eight males walked on an underwater treadmill, immersed to their xiphoid process level. Oxygen uptake ((.)V(O2)), respiratory exchange ratio (R), heart rate (HR), minute ventilation ((.)V(E)), blood lactate concentration (BLa), ratings of perceived exertion (RPE: for breathing and legs, RPE-Br and RPE-Legs, respectively), blood pressure (for systolic and diastolic pressures, SBP and DBP, respectively), and step frequency (SF) were measured.

In addition, step length (SL) was calculated. (.)V(O2), R, HR, V (E), BLa, RPE-Br, RPE-Legs, and SBP were significantly higher while walking backward in water than when walking forward in water (P<0.05).

Furthermore, SF was significantly higher (P<0.001) and SL was significantly lower (P<0.001) while walking backward in water, compared to walking forward in water.

These results indicate that walking backward in water elicits higher physiological and perceptual responses than those produced when walking forward in water at the same speed.

Treadmill walking versus deep water running in overweight women: Which is harder?

Phillips VK, Legge M, Jones LM. Maximal physiological responses between aquatic and land exercise in overweight women. Med Sci Sports Exerc. 2008 May;40(5):959-64.

School of Physical Education, University of Otago, Dunedin, New Zealand. vicky.phillips@otago.ac.nz

PURPOSE: To investigate the maximal physiological responses between aquatic and land-based graded exercise tests in overweight women.

METHODS: Twenty healthy, overweight (body mass index (BMI) > or = 25 kg.m(-2)), Caucasian women (mean +/- SD; age 48 +/- 7 yr, BMI 30 +/- 4 kg.m(-2)) completed a deep water running (DWR) and treadmill walking (TMW) graded exercise test.

Maximal responses during the DWR and TMW graded exercise tests were compared using paired t-tests.

Comparisons were made in the incidence of achievement of maximal oxygen consumption (VO2max) criteria between DWR and TMW protocols.

Criteria were a plateau in VO2 (change < 2.1 mL.kg.min(-1)), heart rate (HR) equal to or above the age-adjusted maximum, and respiratory exchange ratio (RER) > or = 1.15.

RESULTS: Maximal responses for VO2max (22.5 +/- 4.86 vs 27.7 +/- 4.73 mL.kg.min(-1)), HRmax (159 +/- 16 vs 170 +/- 12 bpm), and RER (1.03 +/- 0.06 vs 1.10 +/- 0.06) were significantly lower (P < 0.01) for the DWR test compared with the TMW test, respectively.

Achievement of various VO2max criteria was demonstrated more consistently during the TMW test than the DWR test.

CONCLUSION: Maximal physiological responses of overweight women to DWR and TMW are significantly different but are comparable with other populations. As the maximal responses for DWR compared with TMW differ, the use of land-based criteria for VO2max is not recommended for a graded DWR exercise test.

Low back pain and aquatic therapy: Helpful combination say researchers

 

Waller B, Lambeck J, Daly D. Therapeutic aquatic exercise in the treatment of low back pain: a systematic review. Clin Rehabil. 2009 Jan;23(1):3-14.

University of Jyväskylä, Finland.

Objective: To examine the effectiveness of therapeutic aquatic exercise in the treatment of low back pain.

Design: A systematic review.Methods: A search was performed of PEDro, CINAHL (ovid), PUBMED, Cochrane Controlled Trials Register and SPORTDiscus databases to identify relevant studies published between 1990 and 2007.

Population: Adults suffering from low back pain. Intervention: All types of therapeutic aquatic exercise. Comparison: All clinical trials using a control group. Outcomes: Oswestry Disability Index, McGill Pain Questionnaire, subjective assessment scale for pain (e.g. visual analogue scale) and number of work days lost as a direct result of low back pain. Methodological quality was assessed using the PEDro scale and the SIGN 50 assessment forms.

Results: Thirty-seven trials were found and seven were accepted into the review. Therapeutic aquatic exercise appeared to have a beneficial effect, however, no better than other interventions. Methodological quality was considered low in all included studies. The heterogeneity among studies, in numbers of subjects, symptoms durations, interventions and reporting of outcomes, precluded any extensive meta-analysis of the results.

Conclusion: There was sufficient evidence to suggest that therapeutic aquatic exercise is potentially beneficial to patients suffering from chronic low back pain and pregnancy-related low back pain. There is further need for high-quality trials to substantiate the use of therapeutic aquatic exercise in a clinical setting.

Open Meme Friday: The Economy and Your Practice

First there was the mortgage bubble. Then there was the credit crunch. Now there are layoffs. While the experts are waiting for "the bottom", the rest of us are keeping a tight reign on our spending. Ordinarily, this should not effect the healthcare industry because consumers of HC services don't normally pay out-of-pocket for their care but we are starting to hear rumblings; rumblings of hospital cutbacks and rumblings of facility closures.

Taking in what the pundits think is one thing but we want to hear it from the aquatic street so we are turning on the comments this weekend to hear from you.  How has your aquatic therapy practice been trending the last few months? How does the economic downturn look in regard to your census? Have your referrals dried up? Have you had to let staff go? Or have your profits tracked even with last year or actually gone up? Contribute to this meme by clicking on the comments link below. The stories you tell may dictate how we all do business in the next 12-18 months.

Another nail in the coffin of the only-weight-bearing-exercises-will-improve-bone-density theory

You've heard the conventional wisdom. Aquatic exercise is nice, but what about bone loss? Only weight-bearing activities can retard (and even reverse) bone loss. Right?

Hmmm. Well someone better tell these guys, soon.

Rotstein A, Harush M, Vaisman N. The effect of a water exercise program on bone density of postmenopausal women. J Sports Med Phys Fitness. 2008 Sep;48(3):352-9.

Department of Life Sciences, Zinman College, Wingate Institute, Netanya, Israel. rotstein@wincol.ac.il

AIM: The aim of the present study was to examine the effect of a seven months program of water exercise, on bone mineral density (BMD) in postmenopausal women.

METHODS: Thirty-five postmenopausal women trained for seven months for three one-hour sessions per week. DEXA test findings for vertebrae L2-L4 showed that although the time factor had a significant effect only on the bone mineral content (BMC), (4.61 P < 0.05), the interaction of time group was found to be significant for each of the variables: BMD (9.25 P < 0.01), BMC (7.99 P < 0.01), z-score (5.35 P < 0.05) and t-score (9.41 P < 0.01).

RESULTS: These interactions indicate a general trend towards maintenance or improvement of bone status in the experimental group and a trend towards declining bone status for the control group. DEXA test findings for femoral neck density indicated no significant differences between the groups pre and post treatment. However a significant interaction was found for BMC (8.08 P < 0.01) in the right leg indicating an increase trend in BMC in the experimental group and a trend towards decrease for the control group.

CONCLUSION: The findings of the present study support the hypothesis that it is possible to plan and execute a water exercise program that has a positive effect on bone status of post-menopausal women.

Add deep water running to your therapy sessions ... To improve balance???

 

For many years, therapists have been advised that aerobic training (like deep water running) may not be billable unless tied to a client's specific cardiopulmonary deficit. We knew the benefits of deep water work for cardiovascular health, mood, pain control and healing rates. But, balance?

This study, just published in the Journal of Aging and Physical Activity helps make the case for spending time in the deep end... to improve the balance and reaction time of our clients.

Kaneda K, Sato D, Wakabayashi H, Hanai A, Nomura T. A comparison of the effects of different water exercise programs on balance ability in elderly people. J Aging Phys Act. 2008 Oct;16(4):381-92.

Graduate School of Comprehensive Human Science, University of Tsukuba, Japan.

This study compared the effects of 2 types of water exercise programs on balance ability in the elderly. Thirty healthy elderly persons (60.7 +/- 4.1 yr) were randomly assigned to a deep-water-running exercise (DWRE, n = 15) group or a normal water exercise (NWE, n = 15) group.

The participants completed a twice-weekly water exercise intervention for 12 wk. Exercise sessions comprised a 10-min warm-up on land, 20 min of water-walking exercise, 30 min of water exercise while separated into NWE and DWRE, a 10-min rest on land, and 10 min of recreation and relaxation in water.

Postural-sway distance and tandem-walking time were decreased significantly in DWRE. Postural-sway area was decreased significantly in NWE. In both groups, simple reaction times were significantly decreased.

The findings of this study show that a water exercise program including deep-water running is much better than normal water exercise for improving dynamic balance ability in the elderly.

Another study telling us what we already knew... that aquatic therapy works for the fibromyalgia patient

Fun, fun, fun! More fibro research!
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OBJECTIVES: To evaluate the effects of a 16-week exercise therapy in a chest-high pool of warm water through applicable tests in the clinical practice on the global symptomatology of women with fibromyalgia (FM) and to determine exercise adherence levels.

DESIGN: A randomized controlled trial.

SETTING: Testing and were completed at the university.

PARTICIPANTS: Middle-aged women with FM (n=60) and healthy women (n=25).

INTERVENTION: A 16-week aquatic training program, including strength training, aerobic training, and relaxation exercises.

MAIN OUTCOME MEASURES: Tender point count (syringe calibrated), health status (Fibromyalgia Impact Questionnaire); sleep quality (Pittsburgh Sleep Quality Index); physical (endurance strength to low loads tests), psychologic (State Anxiety Inventory), and cognitive function (Paced Auditory Serial Addition Task); and adherence 12 months after the completion of the study.

RESULTS: For all the measurements, the patients showed significant deficiencies compared with the healthy subjects. Efficacy analysis (n=29) and intent-to-treat analysis (n=34) of the exercise therapy was effective in decreasing the tender point count and improving sleep quality, cognitive function, and physical function. Anxiety remained unchanged during the follow-up. The exercise group had a significant improvement of health status, not associated exclusively with the exercise intervention. There were no changes in the control group. Twenty-three patients in the exercise group were exercising regularly 12 months after completing the program.

CONCLUSIONS: An exercise therapy 3 times a week for 16 weeks in a warm pool could improve most of the symptoms of FM and cause a high adherence to exercise in unfit women with heightened FM symptomatology. The therapeutic intervention's effects can be assessed through applicable tests in the clinical practice.

SOURCE: Munguía-Izquierdo D, Legaz-Arrese A. Assessment of the effects of aquatic therapy on global symptomatology in patients with fibromyalgia syndrome: a randomized controlled trial. Arch Phys Med Rehabil. 2008 Dec;89(12):2250-7.

Section of Physical Education and Sports, University Pablo de Olavide, Seville, Spain. dmunizq@upo.es

Aquatic therapy billing questions answered...

Advance Magazine columnist Rick Gawenda, PT answers tough aquatic therapy questions like these for breakfast.

Question #1: We're an outpatient hospital billing on a UB92. A patient is attending one of our satellites for land physical therapy 3 days a week and requested to come to another satellite facility the other 2 days for aquatic therapy. Even though both satellite facilities show 1 tax identification number and the UB92 reflects the same HCPC codes, the charges are from two different services lines. Will Medicare pay to treat this patient 3 times a week on land at one satellite and 2 times at another for aquatic therapy?

Question #2: Are land and pool services that are delivered on the same day billable to Medicare? The ICD-9 codes are the same for both therapies.

Read his answers here (tab down to find question):

Rick Gawenda, PT, is president of the American Physical Therapy Association section on health policy and administration. He's also the director of physical medicine and rehabilitation at Detroit Receiving Hospital in Michigan. He conducts national seminars on coding and reimbursement, along with other topics. If you have a tough coding issue you can't crack, e-mail shuelskamp@merion.com. To read more coding suggestions, go to www.advanceweb.com/rehab and click on the Coding Clues tool bar.

Aquatic respiratory exercises improves inspiratory muscle strength in healthy persons

Does immersion plus exercise improve your respiratory capacity? Read more here.

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PURPOSE: To assess the effect of a program of aquatic versus non-aquatic respiratory exercises on respiratory muscle strength in healthy aged persons.

METHODS: The respiratory muscle strength was measured in 81 subjects between 60 and 65 years, 59 of which completed the program. Subjects were randomized into 3 groups. Gaquatic undertook a program of respiratory exercise in an aquatic environment. Gnon-aquatic undertook the same program in a non-aquatic environment. Gcontrol acted as the negative control. Programs were applied three times a week for 10 consecutive weeks. Subsequently, subjects were reevaluated, and results compared to each individual’s pre-treatment own result and between the groups. The data were statistically analyzed using the paired t test and the Sign test. Comparisons between the groups were performed through parametric and nonparametric variance. A comparison of Gaquatic and Gnon-aquatic versus Gcontrol was performed using the Dunnett test.

RESULTS: A significant improvement in the inspiratory muscle strength in the Gaquatic group compared to the Gcontrol, group was found, suggesting beneficial effects mediated by the aquatic exercise. The expiratory muscles did not show significant alterations.

CONCLUSION: Aquatic respiratory exercise improves the inspiratory muscle strength of healthy aged persons. However, neither aquatic nor non-aquatic respiratory exercise influences the expiratory muscle strength.

SOURCE: IDE MR et al. Effects of an aquatic versus non-aquatic respiratory exercise program on the respiratory muscle strength in healthy aged persons. CLINICS. 60(2):151-158, 2005.