Aquatic Exercises and Stretches to Improve Strength, Balance, and Gait in the Neurologic Population

by Genevieve Monroe

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Background:

Growing up on an island, I feel in love with water and realized that water was physically and mentally healing. As I shadowed therapists before applying to physical therapy programs, I made it a point to shadow aquatic therapists. Since entering this program, I have taken it upon myself to learn even more about aquatic therapy and how this unique medium can be used with numerous patient populations. During my 3^rd clinical, I presented my In-Service Project on aquatic therapy with the stroke population. To grow my understanding further in this subject matter, my Critically Appraised Topic (CAT) Paper in our Evidence Based Practice II class focused of aquatic therapy. Similarly, this entire spring semester, I have been working with two different professors, one on land and one in the pool, for my Integrated Clinical Experience elective. Lastly, my 4^th clinical rotation will be at an outpatient facility that focuses on aquatic therapy.

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Capstone Project Overview:

I am excited to announce that from April 26^th through May 4^th, I will be traveling to Antigua, Guatemala with 13 other UNC DPT 3^rd year students and 4 faculty members for the annual UNC PT Outreach Service Learning Trip. During this 8-day service trip, we will host health fairs in rural villages and work alongside Guatemalan therapists at the local hospital, Las Obras Sociales del Santo Hermano Pedro, and at a local school for children with disabilities, Enseñame a Pescar. If you are able, I would recommend following our journey via the UNC PT Outreach blog: http://uncptoutreach2.blogspot.com/.

Once interested in the Guatemala Service Learning Trip, I wondered how I could incorporate my capstone project with this experience and with my love of aquatic therapy. Late in the fall semester, I was informed of an aquatic facility at the hospital where students have gone on previous trips. I was also informed that the only past aquatic presentation was on orthopedics, total hip and knee replacement rehabilitation, and Las Obras’ pool is most commonly used for relaxation and for decreasing tone. After numerous discussions with faculty that have attended the trip in previous years, I established my capstone project. This project was created to be an educational presentation and lab for the Guatemalan therapists at Las Obras who bring their patients in the pool. This project will incorporate information such as appropriate patients for aquatic therapy, aquatic stretches and strengthening exercises, and to relate aquatic interventions to land-based interventions.

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Products:

To prepare for my Capstone project, I first reviewed the available literature regarding the neurological population. I wrote a Literature Review Paper that sought to provide evidence for using aquatic therapy with this unique population. I then reviewed articles that discussed the most effective way to present new information.

Based on the available literature, these articles, and discussions with my Capstone Committee, I created a Presentation Outline. My presentation is intended to take place in the pool with the Guatemalan therapists and any students who would like to attend. I am planning on having the therapists try new techniques with other therapists to understand how the stretches/exercises feel and how to administer them effectively. This presentation outline will be available to my translator for the actual presentation in Antigua.

To assist with knowledge retention of both stretches and exercises, I have created a handout, both in English and Spanish to give to the Guatemalan therapists. Copies of each document will be available on a flash drive and a few copies of the Handout will be laminated.

Lastly, to assess the effectiveness of this presentation, I will handout a Presentation Evaluation Form to the therapists. Once these forms are collected and translated into English, I will be able to assess the success of my presentation and of the handouts given. I hope that this feedback will assist me for future presentations, during my next clinical rotation, and with patients I treat.

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Acknowledgments:

I am very grateful to my Capstone advisor, Lisa Johnston, for providing guidance and direction with this project. I would to thank Debbie Thorpe for allowing me to work with her in the pool this past semester for my ICE elective and for her advice throughout this project. I am thankful for both Debbie Thorpe and Katie Ollendick for being on my capstone committee and providing me with feedback along the way. I could not complete this project or have any translated documents/presentation without the help of Christa Gomez, and of Sarah van der Horst. Lastly, I would like to thank all those in my life who have encouraged me to pursue this career and who have supported me through this journey.

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References:

Literature Review Paper References

1. Medicare Part B – Billing Scenarios for PTs and OTs. Aquatic Therapist Website. Published at http://www.aquatictherapist.com/index/2009/11/medicare-part-b-billing-scenarios-for-pts-and-ots-11-pages-of-them-straight-from-the-cms.html. Accessed on February 27, 2016.
2. Plecash AR, Leavitt BR. Aquatherapy for neurodegenerative disorders. J Huntingtons Dis. 2014; 3(1):5- doi:10.3233/JHD-140010.
3. Kanitz AC, Delevatti RS, Reichert T, et al. Effects of two deep water training programs on cardiorespiratory and muscular strength responses in older adults. Exp Gerontol. 2015;64:55-61. doi:10.1016/j.exger.2015.02.013.
4. Noh DK, Lim J-Y, Shin H-I, Paik N-J. The effect of aquatic therapy on postural balance and muscle strength in stroke survivors–a randomized controlled pilot trial. Clin Rehabil. 2008;22(10-11):966-976. doi:10.1177/0269215508091434.
5. Kesiktas N. The Use of Hydrotherapy for the Management of Spasticity. Neurorehabil Neural Repair. 2004;18(4):268-273. doi:10.1177/1545968304270002.
6. Driver S, John O, Lox C, Rees K. Evaluation of an aquatics programme on fitness parameters of individuals with a brain injury. 2016;9052(February). doi:10.1080/02699050410001671856.
7. Vivas J, Arias P, Cudeiro J. Aquatic therapy versus conventional land-based therapy for parkinson’s disease: An open-label pilot study. Arch Phys Med Rehabil. 2011;92(8):1202-1210. doi:10.1016/j.apmr.2011.03.017.
8. Volpe D, Giantin MG, Maestri R, Frazzitta G. Comparing the effects of hydrotherapy and land-based therapy on balance in patients with Parkinson’s disease: a randomized controlled pilot study. Clin Rehabil. 2014;28(12):1210-1217. doi:10.1177/0269215514536060.
9. Avelar NCP, Bastone AC, Alcântara M a, Gomes WF. Effectiveness of aquatic and non-aquatic lower limb muscle endurance training in the static and dynamic balance of elderly people. Rev Bras Fisioter São Carlos São Paulo Brazil. 2010;14(3):229-236. http://www.scielo.br/pdf/rbfis/v14n3/en_07.pdf.
10. Marinho-buzelli AR, Bonnyman AM, Verrier MC. The effects of aquatic therapy on mobility of individuals with neurological diseases : a systematic review. 2015. doi:10.1177/0269215514556297.
11. Bergamin M, Ermolao A. Water-versus land-based exercise in elderly subjects: effects on physical performance and body composition. …  Interv Aging. 2013:1109-1117. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762608/.
12. Neville C, Henwood T, Beattie E, Fielding E. Exploring the effect of aquatic exercise on behaviour and psychological well-being in people with moderate to severe dementia: A pilot study of the Watermemories Swimming Club. Australas J Ageing. 2014;33(2):124-127. doi:10.1111/ajag.12076.
13. Declerck M, Verheul M, Daly D, Sanders R. Benefits and Enjoyment of a Swimming Intervention for Youth With Cerebral Palsy : An RCT Study. 2016:1-8. doi:10.1097/PEP.0000000000000235.
14. Brody, L. T., & Geigle, P. R. (2009). Aquatic exercise for rehabilitation and training. Champaign, IL: Human Kinetics.
15. Aquatic Therapy Precautions and Contraindications. Aquatic Therapist Website. Published at http://www.aquatictherapist.com/index/2008/03/aquatic-thera-2.html. Accessed on February 27, 2016.
16. Henley, C. and Wollam, K. Benefits and Techniques of Aquatic Therapy. Post-Polio Health International Website. Published at http://www.post-polio.org/net/10thconfbeneftsaquatic.pdf. Accessed on February 27, 2016.
17. Physical Therapists Guide to CPT Codes. WebPT Website. Published at https://www.webpt.com/cpt-codes. Accessed on February 27, 2016.
18. Physical Activity for Persons with Mental Retardation. American Academy of Orthopedic Surgeons Website. Published at http://orthoinfo.aaos.org/topic.cfm?topic=A00049. Accessed on February 27, 2016.
19. Oeverman, S. Why aquatic therapy? Brainline Website. Published at http://www.brainline.org/content/2009/05/creative-therapy-why-aquatic-therapy_pageall.html. Accessed on February 27, 2016.
20. Ayan C, Cancela J. Feasibility of 2 differentwater-based exercise training programs in patients with Parkinson’s Disease:A pilot study. Arch Phys Med Rehabil. 2012;93:1709-14.
21. Giladi N. Mobility and exercise in movement disorders. Parkinsonism Relat Disord. 2009;15S3:S46-8.
22. Crizzle AM, Newhouse IJ. Themes associated with exercise adherence in persons with Parkinson’s Disease: A qualitative study. Occup Ther Health Care. 2012;26(2–3):174-86.
23. Mori F, Ljoka C, Magni E, Codeca C, Kusayanagi H, Monteleone F, Sancesario A, Bernardi G, Koch G, Foti C,Centonze D. Transcranial magnetic stimulation primes the effects of exercise therapy in multiple sclerosis. J Neurol. 2011;258:1281-7.
24. Castro-Sanchez AM, Mataran-Penarrocha GA, Lara-Palomo I, Saavedra-Hernandez M, Arroyo-Morales M, Moreno-
25. Lorenzo C. Hydrotherapy for the treatment of pain in people with Multiple Sclerosis: A randomized controlled trial. Evid Based Complement Alternat Med. 2012;2012:473963.
26. Kargarfard M, Etemadifar M, Baker P, Mehrabi M, Hayatbakhsh R. Effect of aquatic exercise training on fatigue and health-related quality of life in patients with Multiple Sclerosis. Arch Phys Med Rehabil. 2012;93:1701-8.
27. Bansi J, Bloch W, Gamper U, Kesselring J. Training in MS: Influence of two different endurance training protocols (aquatic versus overland) on cytokine and neurotrophin concentrations during three week randomized controlled trial. Mult Scler J. 2012;19(5):613-21.
28. The EFNS Task Force on Diagnosis and Management of Amyotrophic Lateral Sclerosis: Andersen PM, Abrahams S, Borasio GD, de Carvalho M, Chio A, Van Damme P, Hardiman O, Kollewe K, Morrison KE, Petri S, Pradat P-F, Silani V, Tomik B, Wasner M, Weber M. EFNS guidelines on the Clinical management of Amyotrophic Lateral Sclerosis (MALS) – revised report of an EFNS task force. Eur J Neurol. 2012;19:360-75.
29. Bedlack RS, Aggarwal S. ALS update: Signs of progress, reasons for hope. Continuum Lifelong Learning Neurol. 2009;15:83-110.
30. Johnson CR. Aquatic therapy for an ALS patient.AmJ Occup Ther. 1988;42:115-20.
31. Sheaff F. Hydrotherapy in Huntington’s disease. Nursing Times. 1990;86:46-9.

 

Handout Picture References

1. Adams HP, Norton CO & Tilden HM. Aquatic Exercise Toolbox. [CD-ROM] 1^st ed. Champaign, IL: Human Kinetics; 2000.
2. Movement Disorders In Spinal Cord Injury: Range Of Motion (Rom) Exercises: Passive Stretching (Upper Extremity). Rehab Team Site Website. Published at http://calder.med.miami.edu/pointis/upper.html. Accessed April 2016.
3. Proper way to stretch pectorals. Physical Fitness Beta Website. Published at http://fitness.stackexchange.com/questions/11837/proper-way-to-stretch-the-pectoral-muscles. Accessed April 2016.
4. Shoulder strength and conditioning. CargoCollective Website. Published at http://cargocollective.com/holisticathlete/Shoulder-Strength-Conditioning. Accessed April 2016.
5. Norma, S. Water is a workout. Dry is not an option website. Published at http://dryisnotanoption.blogspot.com/2010/09/whats-in-water-workout.html. Accessed April 2016.
6. Water Exercises. UW Medicine Website. Published at http://www.orthop.washington.edu/?q=patient-care/articles/arthritis/water-exercises.html. Accessed April 2016.
7. APFT Calisthenics Exercises. Army Real Website. Published at http://www.armyreal.com/apft/item/5293. Accessed April 2016.
8. Fitness Challenge Day. Ficus Fitness Website. Published at http://www.fiscusfitness.com/post/425/Fitness-Challenge-Day-53. Accessed April 2016.

Picture reference for this page: http://www.dreamstime.com/stock-photos-equipment-aqua-aerobics-image2649393