Knowledge preface summary:
Aquatic therapy has been used intermittently for many years. It remains the main stay for various conditions: OA, LBP and other degenerative disease processes. Common benefits from this form of exercise are:
- decreased weight bearing on joints-- caused by buoyance varied based on water depth
- increased ROM
- thermoregulation
- external hydrostatic pressure causes decreased peripheral joint swelling --> decreased post activity pain
- increased pulmonary function
- increased activity tolerance --> decreased energy demands while walking
- increased cardio output--> central blood supply increased. 30% end diastolic pressure, noted a decreased HR. (frank-starling law)
-increased safety by decreased risk of falls
Some common concerns with this form of exercise:
- accessibility
- infection control
- cost associated
- limited protocols
- social pressure
-lack of weight bearing
This article reviews the impact of aquatic therapy on various common neuro-conditions.
POST CVA
Older or more ill population seen after loss of blood flow (ischemic or hemorrhagic) to a specific area, impairments vary based on area of ischemia.
Hypothesis:
Increased blood flow to vital organs may increase cerebral blood flow-- will this help increase rates of healing and recovery?
Findings:
Blood velocity in MCA of swimmers: 20% increased
Clinical implications:
increased activity tolerance: it is suggested that with the decreased energy demands with aqua therapy makes the energy demands equivalent to a non-CVA survivor there for there is improved distance and tolerance
increased sensory input (Rood's Sensory Motor Training)
increased parasympathetic output (temperature based)
Results
Same results as with land based treatment
CEREBRAL PALSY
non-progressive brain injury seen with 4 subtypes. seen in the past in pediatrics, however, improvements in medicine have allowed increased life expectancy to adulthood.
hypothesis
increased activity tolerance and motion, increased opportunity for activity because of decreased physical demand on caregivers(parents)
Findings:
increased vital capacity y 65% at 4 weeks, increased timed 0.5 mile, and floor to stand; however, no impact on walking, running and jumping (land based activities)
Clinical implications
noticeable benefits are seen, however, are not appreciated by caregivers, causing limited buy-in and thus decreased utilization.
PARKINSONS DISEASE
younger population, noted with progressive bradykinesia, altered posture and rigidity increased the risk of falls, depression and sleep alterations.
Pathogenesis: associated with altered heat shock proteins, decreased dopamine in the substantia nigra may worsen with elevated temperatures.
Hypothesis:
Temperature regulation in aqua therapy may result in longer lasting effects.
Findings:
decreased risk of falls and improved balance
Clinical implications:
limited protocols limit results. The same benefits are noted with land-based however the use of halliwick (aqua) and Balance and posture training(land) had better lasting results at 6 months.
MULTIPLE SCLERORIS
autoimmune disorder affecting the CNS resulting in scattered and random CNS lesions. various presentations: progressive, relapsing-remitting, primary progressive, relapsing-progressive. increased incidence in warmer areas.
Hypothesis
Temperature regulation may improve temperature regulation and decreased relapses and recurrence due to reported low tolerance to heat seen in 50-66% or affected population
findings:
sensory and motor effects -- limited benefits to either
more cytokines and neurotropnis are seen with aquatherapy--significance unknown at this time.
Clinical Implications:
Aqua is the same as land, due to limited understanding of etiology
Common interventions
Halliwick
https://www.physio-pedia.com/The_Halliwick_Concept?utm_source=physiopedia&utm_medium=related_articles&utm_campaign=ongoing_internal
https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcTnfwA3H192Ewbasvj5b7T4-wnRMFQHm2DcSA&usqp=CAU
Ai chi
https://en.wikipedia.org/wiki/Ai_Chi
https://i0.wp.com/aichiplus.com/wp-content/uploads/2016/10/AiChi6to9-300x232.jpg?resize=606%2C469
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