GOALS AND INDICATIONS FOR AQUATIC EXERCISE
The specific purpose of aquatic exercise is to facilitate
functional recovery by providing an environment that augments a patient’s
and/or practitioner’s ability to perform various therapeutic interventions. The
specific goals include:
Facilitate range of motion (ROM) exercise* Initiate resistance
training
Facilitate weight-bearing activities
Enhance delivery of manual techniques
Provide three-dimensional access to the patient
Facilitate cardiovascular exercise
Initiate functional activity replication
Minimize risk of injury or reinjury during rehabilitation
Enhance patient relaxation
PRECAUTIONS AND CONTRAINDICATIONS TO
AQUATIC EXERCISE
Although most patients easily tolerate aquatic exercise, the
practitioner must consider several physiological and psychological aspects of immersion
that affect selection of an aquatic environment.
Precautions
Fear of Water
Fear of water can limit the effectiveness of any immersed activity. Fearful patients often experience increased symptoms during and after immersion because of muscle guarding, stress response, and improper form with exercise. Often patients require an orientation period designed to provide instruction regarding the effects of immersion on balance, control of the immersed body, and proper use of flotation devices.
Neurological Disorders
Ataxic patients may experience increased difficulty controlling purposeful movements. Patients with heatintolerant multiple sclerosis may fatigue with immersion in temperatures greater than 33_C.
Patients with controlled epilepsy require close monitoring during
immersed treatment and must be compliant with medication prior to treatment.
Cardiac Dysfunction
Patients with angina and abnormal blood pressure also require
close monitoring. For patients with cardiac disease, low-intensity aquatic
exercise may result in lower cardiac demand than similar land exercise.
Small Open Wounds and Lines
Small, open wounds and tracheotomies may be covered by
waterproof dressings. Patients with intravenous lines, Hickman lines, and other
open lines require proper clamping and fixation.
Contraindications
Incipient cardiac failure and unstable angina.
Respiratory dysfunction; vital capacity of less than
1 liter. Severe peripheral vascular disease.
Danger of bleeding or hemorrhage.
Severe kidney disease: Patients are unable to adjust to fluid
loss during immersion.
Open wounds, colostomy, and skin infections such as tinea pedis
and ringworm.
Uncontrolled bowel or bladder: Bowel accidents require pool
evacuation, chemical treatment, and possibly drainage.
Water and airborne infections or diseases: Examples include
influenza, gastrointestinal infections, typhoid, cholera, and poliomyelitis.
Uncontrolled seizures: They create a safety issue for both
clinician and patient if immediate removal from the pool is necessary.
PROPERTIES OF WATER
The unique properties of water and immersion have profound physiological implications in the delivery of therapeutic exercise. To utilize aquatics efficiently, practitioners must have a basic understanding of the clinical significance of the static and dynamic properties of water as they affect human immersion and exercise.
Physical Properties of Water
The properties provided by buoyancy, hydrostatic pressure, viscosity, and surface tension have a direct effect on the body in the aquatic environment.
Buoyancy
Definition. Buoyancy is the upward force that works
opposite to gravity.
Properties. Archimedes’ principle states that an immersed body
experiences upward thrust equal to the volume of liquid displaced
Clinical Significance
Buoyancy provides the patient with relative weightlessness and
joint unloading, allowing performance of active motion with increased ease.
Buoyancy allows the practitioner three-dimensional access to the
patient.
Hydrostatic Pressure
Definition. Hydrostatic pressure is the pressure exerted
on immersed objects.
Properties
Pascal’s law states that the pressure exerted by fluid on an
immersed object is equal on all surfaces of the object.
As the density of water and depth of immersion increase, so does
hydrostatic pressure.
Clinical Significance
Increased pressure reduces or limits effusion, assists venous
return, induces bradycardia, and centralizes
peripheral blood flow. The proportionality of depth and pressure
allows patients to perform exercise more easily when closer to the surface.
Viscosity
Definition. Viscosity is friction occurring between
molecules liquid resulting in resistance to flow.
Properties. Resistance from viscosity is proportional to
the velocity of movement through liquid.
Clinical Significance
Water’s viscosity creates resistance with all active movements. A
shorter lever arm results in increased resistance. During manual resistance exercises
stabilizing an extremity proximally require the patient to perform more work Stabilizing
an extremity distally requires the patient to perform less work.
Increasing the surface area moving through water increases
resistance.
Surface Tension
Definition. The surface of a fluid acts as a membrane under
tension. Surface tension is measured as force perunit length.
Properties
The attraction of surface molecules is parallel to the
surface. The resistive force of surface tension changes
proportionally
to the size of the object moving through the fluid surface.
Clinical Significance
An extremity that moves through the surface performs more work
than if kept under water.
Using equipment at the surface of the water increases the
resistance.
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