Impact of Aquatic Interventions

8/8/2019 Impact of Aquatic Interventions

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Impact of aquatic interventionsImpact of aquatic interventionson treatment of spasticityon treatment of spasticity

Submitted toSubmitted to

Prof.Dr. Ebtsam KhattabProf.Dr. Ebtsam Khattab

Prepared byPrepared by

Khaled Hussein YusufKhaled Hussein Yusuf


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Introduction to spasticityIntroduction to spasticity

Spasticity (meaning to draw or tug) is involuntary,velocity-dependent, increased muscle tone that results inresistance to movement.

The condition may occur secondary to a disorder ortrauma, such as a spinal cord injury (SCI), a brain injury,a tumor, a stroke, multiple sclerosis (MS), or a peripheralnerve injury.

A lag time may exist between injury and spasticity onset,and severity may wax and wane over time. Spasticitymay be static or dynamic in nature. Although manytherapeutic and medical interventions can attenuate itseffects, spasticity can be severely debilitating.


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Morbidity/disadvantages ofMorbidity/disadvantages of

spasticityspasticity Orthopedic deformity, such as hip dislocation,

contractures, or scoliosis

Impairment of activities of daily living (e.g., dressing,bathing, toileting)

Impairment of mobility (e.g., inability to walk, roll, sit) Skin breakdown secondary to positioning difficulties and

shearing pressure

Pain or abnormal sensory feedback

Poor weight gain secondary to high caloric expenditure

Sleep disturbance Depression secondary to lack of functional

independence


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Aquatic TherapyAquatic Therapy

The Standards and Steering Committees of the AquaticTherapy and Rehabilitation Industry Certification defineaquatic therapy and rehabilitation as:

"The use of water and specifically designed activity byqualified personnel to aid in the restoration, extension,maintenance and quality of function for persons withacute, transient, or chronic disabilities, syndromes ordiseases


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Definition of HydrotherapyDefinition of Hydrotherapy

Hydrotherapy is the use of water by external

applications, either for its pressure effect or as a means

of applying physical energy to a tissue. The term often

refers to the use of water in wound management, suchas whirlpool baths, but can be used interchangeably with

the term, "aquatic therapy."


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Indications for Aquatic TherapyIndications for Aquatic Therapy

Sensory Disorders

Limited Range of Motion

Weakness

Poor Motor Coordination

Pain Spasticity

Perceptual/Spatial Problems

Balance Deficits

Respiratory Problems

Circulatory Problems

Depression/Poor Self-Esteem

Cardiac Diseases

Joint Replacement

Motor Learning

Orthopedic Injuries / Trauma Obesity

Prenatal

Neurological (MS)

Osteoporosis

Rheumatology (Arthritis /Fibromyalgia)


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Benefits of Aquatic therapy:Benefits of Aquatic therapy:

1-Buoyancy

One benefit of aquatic therapy is the provided by the

water. While submerged in water, buoyancy assists in

supporting the weight of the patient. This decreasesthe amount of weight bearing which reduces the force

of stress placed on the joints. This aspect of aquatic

therapy is especially useful for patients with arthritis,

healing fractured bones, or who are overweight. By

decreasing the amount of joint stress it is easier and

less painful to perform exercises.


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22--ViscosityViscosity

Provides an excellent source of resistance that canbe easily incorporated into an aquatic therapy exerciseprogram. This resistance allows for musclestrengthening without the need of weights. Using

resistance coupled with the waters buoyancy allows aperson to strengthen muscle groups with decreased

joint stress that can not be experienced on land.


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44--Warmth of the waterWarmth of the water

Lastly, the experience during aquatic

therapy assists in relaxing muscles and

vasodilates vessels, increasing blood flow

to injured areas. Patients with muscle

spasms, back pain, and fibromyalgia find

this aspect of aquatic therapy especially

therapeutic.


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Contraindications of aquatic therapyContraindications of aquatic therapy

It is important to know however, that aquatictherapy is not for everyone.

People with cardiac disease should not participate

in aquatic therapy. Those who have fevers,infections, or bowel/bladder incontinence are alsonot candidates for aquatic therapy. Always discussthis with your physician before beginning an

aquatic therapy program.


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Examples for aquatic training linesExamples for aquatic training lines

Ai Chi

Created by Jun Konno of Japan, ai chi is

a combination of deep breathing andslow broad movements of the arms, legs,

and torso, using concepts of T'ai Chi,

Shiatsu, and Qigong. Ai Chi is performed

standing in shoulder-depth water with anideal pool temperature of 88F to 96F.


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Ai Chi NeAi Chi Ne

Ai Chi Ne (pronounced Eye Chee Knee) is

a partner stretching program. "Ne" is the

Japanese word for "two". Ai Chi Ne

involves breathing techniques to increase

relaxation and therefore enhance the

stretch abilities. Using the breathing

techniques decreases stress, joint tension,muscular tension, and the stretch reflex

response.


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Bad RagazBad Ragaz

This technique originated in Germany in 1957

and was introduced by a German therapist to the

therapeutic thermal pools of Bad Ragaz in

Switzerland. The technique has since becomemore clearly defined as the Bad Ragaz Ring

Method. Bad Ragaz is a method of muscle re-

education utilizing specific patterns of

resistance, endurance, elongation, relaxation,range of motion, and tonal reduction.


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Proprioceptive Neuromuscular FacilitationProprioceptive Neuromuscular Facilitation

(PNF(PNF))

PNF is an approach to therapeuticexercise which aims to improve motor skillthrough positive motor transfer, using the

principles of facilitation/inhibition,irradiation/reinforcement, and reciprocalinnervation. Exercises consist of spiral anddiagonal patterns and must incorporatethree components of motion: flexion orextension, adduction or abduction, androtation.


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reatment GoalsTreatment Goals

(vary depending on the individual& level ofinvolvement)

Increase ROM

Improve mobility and strength Decrease Pain

Increase Endurance & Cardio Fitness

Improve Proprioception

Improve Gait & Fall Prevention Decrease Energy Expenditure

Decrease Spasm Frequency

Improve Self Esteem


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Aquatic Factors to Consider for Safety forAquatic Factors to Consider for Safety for

Individuals with SpasticityIndividuals with Spasticity

(Reduce all internal and external factors that can exasperate spasticity)

Extreme changes in temperature

Loud noises

Irritants

Tight fitting suit or aqua shoes

Introduction to hydrostatic pressure

Quick movements during transfers

Placement and use of aquatic equipment

Contact with pool floor and walls, benches, jets, stairs, ladders,railings

Velocity of movements Turbulence

Fatigue


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PrePre--Aquatic Therapy AssessmentAquatic Therapy Assessment

(Re-evaluate client following set # of aquatic treatments)

Proprioceptive skills- sensory, balance, coordination

Motor skills- functional mobility assessment

ROM & Posture specific musculoskeletal assessment

Spasmodic Activity- muscle involvement, focal or diffuse, frequency,degree, chronic vs. acute

Reflexes deep tendon response, primitive, developmental

Cognition- comprehension of activity/environment, decision-making,etc.

Communication skills- must have established communication plan

Pharmacology medications that could interact adversely with waterbased activity

Assistive Care and/or Services/Equipment


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Manual Treatments for Spasticity that areManual Treatments for Spasticity that are

utilized in Aquatic Therapy Applicationsutilized in Aquatic Therapy Applications

Soft Tissue

Mobilization

Joint Mobilization

Deep Tissue

Massage Fascia's Release

Trigger Point Therapy

Joint Approximation

Joint Distraction

Cardiovascular

Training

Compression

Vibration

Stretching

Breath Awareness

Positional Cuing

Exercises, active-assist,

active, resisted

Strengthening

isometric, isotonic,

isokinetic

PNF proprioceptive

neuromuscular

facilitation patterns


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Spasticity Specific Aquatic TherapySpasticity Specific Aquatic Therapy

AccommodationsAccommodations

Slow rhythmical movement with rotational components.

Slow sustained stretch, minimize frictional resistance and

turbulence.

Stop stretch movement 5 degrees before spasm initiation,

gently repeat. Gradual release of agonist - antagonist using slow

reversals and rhythmic

initiation PNF patterns.

Passive figure 8 patterns to reduce muscle tone and inhibit

co-contractions.

Utilize water assistive and supported activities for active

stabilization and functional

use activities.


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Aquatic equipment selection to: maximize

relaxation, for stabilization, or to facilitate a

neuromuscular response.

Easy reciprocal active/ assisted open chainmovements.

Applications of tactile cuing and movement

assistance using: compression, stroking,

tapping, jamming, vibration, turbulence into or from

body segment


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Exercise Session FormatExercise Session Format

Start with 10 to 15 minutes and increase in 5-

minute intervals.

Use deep breathing to increase vital capacity.

Use GRADUAL progressive overload.

Work on balance.

Work on strength.

Work on flexibility. Longer cool down.


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Program ModificationsProgram Modifications

Use fewer reps of the same muscle group when beginning.

Center the body between transitions.

Reach across the midline and overhead across.

Use hands behind head and body.

Move backwards as well as forward.

Exercise to improve posture.

Use slow, controlled movement.

Begin weight-bearing issues in deeper water and progress toshallower.

Enter water slowly so all systems have an opportunity to graduallyaccommodate the environment.

Keep medications at pool edge.


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Impact of Aquatic Interventions