An in-depth look at the benefits of aquatherapy for neurorehabilitation.
by Kaila M. Morin, PT. DPT. CBIS
The pool has been proven to be a healing environment for many clients in neurorehabilitation. Due to its inherent benefits, aquatic therapy is becoming a popular alternative or adjunct to land-based therapies.
Aquatic therapy can be a powerful tool in a patient’s treatment plan. It may help them achieve milestones such as standing on their own for the first time, taking their first steps without assistance, climbing stairs or achieving other goals.
Aquatic therapy can help clients gain confidence both in and outside of the water. Due to the buoyancy of water and low risk of falling, people are more willing to try increasingly difficult activities in a swimming pool than on land.
This population may also benefit from adding aquatic therapy to their plan of care. It can be an exciting and motivating way to encourage clients and help them achieve faster recovery. This article explores the benefits of aquatic therapy for such clients.
Aquatic Therapy: A Basic Introduction
At Gaylord Specialty Healthcare, a nonprofit rehabilitation-focused healthcare system headquartered in Wallingford, Conn, physical therapists and occupational therapists perform inpatient and outpatient aquatic therapy in a large therapeutic pool to assist patients in their recoveries from neurological and medically complex conditions.
Gaylord’s aquatic center has a 75-foot-by-25-foot pool, which is kept at a therapeutic 90-92-degree temperature. The pool has stairs with handrails and is equipped with a mechanical lift chair as well as a Hoyer Lift to make it accessible to clients at all levels of fitness. The pool also has a submerged seat, a deep water station for push-ups and pull-ups, as well as warm water jets on all sides. The depth of the pool is between three and nine feet.
Gaylord’s therapists use a variety of pool equipment, including step benches, buoyancy belts and cuffs, webbed gloves for wrists and ankles as well as cervical collars. They also use paddles, barbells and dumbbells in varying difficulties, noodle flotation devices, and paddles.
The pool’s design, as well as the aquatic equipment available, allows therapists to target many different mobility issues, including gait, balance and strength, endurance and pain management. They can also address muscle relaxation and perform functional tasks.
A physical therapist who specializes in aquatic therapy will train and customize a program of aquatic exercises that are appropriate for the client’s level of mobility. Clients may choose to participate exclusively in aquatic therapy up until they feel strong enough to move on to land-based treatment, or they can combine both land-based and aquatic-based therapy.
When they are released from therapy, and it is deemed safe for them to do so, clients can move to Gaylord’s community-based aqua program. A family member or caregiver is often trained in the aquatics program to safely assist clients with their independent exercise programs after therapy discharge.
The Goal-Oriented Treatment of Neurological Conditions with Aquatic Therapy
The effects of neurological conditions are varied and include impairments in mobility, coordination, gait, balance, fatigue, or even loss of endurance.
Aquatic therapy can be beneficial for a variety of neurological conditions, including but not limited to stroke, traumatic brain injuries, multiple sclerosis (ALS), Parkinson’s, spinal cord injury and Guillain Barre syndrome.
Physical therapists provide their clients with methods to improve their independence, including their functional mobility. They can address different aspects of mobility, including gait, strength, balance, transfers and endurance.
The rehabilitation process involves a comprehensive clinical evaluation, the creation of a care plan that includes client-centered goals as well as functional goals, followed by the implementation of interventions to help the client reach those goals.
The process requires that the client and therapist have a collaborative relationship that is centered on reaching meaningful and purposeful objectives. Although the goals of each client may be the same, the exercises and interventions used to achieve them will vary depending on the individual needs and interests. One client may find it important to be able to play golf again, while another might want to walk with their grandchildren.
Pressure + Warmth + Buoyancy = Better Results
Inherently, water has many unique and beneficial qualities that can improve joint flexibility and strength, improve balance and gait, while simultaneously decreasing pain and abnormal tone.
Water, for example, is much more resistant than air. This unique property allows you to strengthen weak muscles. You can use dumbbells and paddles to increase resistance. Warm water helps increase blood flow to relax tight and painful muscles.
Water’s natural buoyancy is a great advantage, as it allows joints to move more freely and reduces the effect of gravity. The affected limbs of a person will float and make it easier to move. The buoyancy of the client can provide additional comfort.
Pressure and buoyancy work together to provide a substantial amount of support for a client, allowing them to react with greater confidence without fear of injury. Clients often feel more confident in challenging themselves to do new exercises because they are less afraid of falling and have a better sense of safety. It can also boost a client’s self-confidence and keep them motivated during their recovery.
Water allows clients to perform physical activities they might not be able to do on the land. In the water, a client who is unable to walk or stand on their own may be able do it.
Exercise Methods
In a pool, the therapist can provide hands-on help to facilitate desired movements or muscle activation when a client is in a relaxed condition. A client could, for example, float in the water on their back with buoyancy floats and noodles around their neck and waist. A therapist in this position can use the Bad Ragaz Ring Method to facilitate neck and trunk rotating and to perform passive and active assisted movements of the upper- and lower-extremities.
The activities in aquatic programs are based on the individual needs and level of mobility. Warming up for an individual who is ambulatory usually involves walking forward, backward and sideways to work different muscle groups. Exercises can be done for both upper and lower extremities. They can also be made more challenging with ankle weights and dumbbells.
Swimming and other exercises performed in deep water can be used to improve cardiovascular fitness and strength. Flotation devices such as noodles and buoyancy vests are available. The client can also do modified pull-ups and push-ups in a deep water exercise station.
A great tool for promoting neuroplasticity
Aquatic therapy promotes neuroplasticity, just like all other forms of rehabilitation for neurological conditions.
The brain’s ability to form new connections and reorganize them in response to a learning experience is called neuroplasticity. The brain can be stimulated by repetitive stimulation to improve movement patterns. Neuroplasticity promotes the ability to learn, strengthens areas where function has been lost or declined, and helps recovery from brain injuries such as stroke and traumatic injury.
A client undergoing aquatic rehabilitation will face a new challenge when walking in water. Walking on land stimulates the same neural pathways as walking in water. This population is best served by a combination of land-based and aquatic therapy, if they can tolerate it. Repetition is the key. The more a client performs a certain action, the stronger their neural pathways become. This will accelerate their neurological recovery.
Get Your Feet Wet
Aquatic physical therapy’s main objective is to improve a client’s functional mobility and independence, which can in turn enhance their quality of living. A client who has completed aquatic therapy has demonstrated measurable improvements in gait quality, strength and endurance, as well as balance and stability, during their physical therapy discharge or re-evaluation. These improvements have allowed the client to walk without an aid in the home, community, and uneven terrains without fear of losing balance or tiring easily. The client can now stand in the kitchen for long enough to prepare a meal, dress themselves, and take a shower without fear of falling. The client is now able to do their daily tasks independently and with greater confidence.
Aquatic therapy is a wonderful adjunct to or alternative for land-based rehab. It can benefit clients at all levels of function. Aquatic therapy can be a fun, creative way for clients to reach their rehab goals and maximize their function in an unique environment. It is also a great tool to motivate and engage them throughout the recovery process.
Original Blog: https://rehabpub.com/conditions/neurological/defying-gravity-with-aquatic-therapy/
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