// Interactive aquatic therapy
by Jennifer Schembri-Portelli
The three case studies presented in this article demonstrate how aqua therapy can act as a stepping stone between hydrotherapy sessions and mainstream aqua classes. Hydrotherapy sessions are traditionally conducted by a physiotherapist, whereas aqua therapy can be delivered by suitably qualified aquatic specialists.
Target audience and specific goalsParticipants of an aqua therapy program may include clients rehabilitating from an injury or surgery, or those with medical, physical,
intellectual or mental health conditions.
The ultimate goal for all aqua therapy participants is to exercise in a safe, enjoyable and effective environment, but each population group will also seek outcomes particular to their condition. The injured athlete, for example, aims to make rapid yet safe progress to return to competition, while the sedentary or new-to-exercise participant looks for an activity with a degree of comfort and satisfaction, which can then be the catalyst to bring about increased confidence to partake in other physical activities.
Setting the sceneIn each of the cases below, the diagnosis, necessary treatment and review was conducted by a medical and or allied health professional (AHP) who then referred, communicated and worked in collaboration with the aqua therapy provider.
All clients received a one-on-one aquatic and land assessment from the aqua therapy instructor who used a criteria sheet to document details and establish measurable outcomes.
Body type, water familiarisation, buoyancy and resistant aids were integral components of the therapy sessions, while personal information, hydrodynamic principles and the properties of water were the basis for the checklist and assessment criteria.
For the best results the instructor was in the water for the individual and small group sessions. This enabled efficient communication in addition to creating a supportive environment for the often hesitant aqua therapy participant.
While the beneficial and healing properties of the water have been well documented, there are some disadvantages that should be acknowledged, such as;
• Acute fear of water
• The physiological effect of immersion which may result in limited therapy time
• A possibility of infection in clients with low immune system
• The facility and pool accessibility
• High costs of pool hire and appropriate water temperature
Case study 1Brian, an elite athlete with polio, competed in numerous World Championship and Paralympic Games.
As a Paralympian, Brian won gold medals in weightlifting at the 1985, 1991 and 1994 World Championships and in the 1992 Paralympic Games in Barcelona. He went on to win a silver medal at the 1996 Paralympic games inAtlanta, but unfortunately had to retire eight months prior to the Sydney 2000 games. While Brian had previously used the therapeutic advantages of the aquatic environment, he had not included swimming or aqua fitness as part of his training regime.
Brian required aqua therapy as part of his rehabilitation from a workplace injury to his elbow and left hip (unrelated to his polio). He swam 15 metres of freestyle during the assessment session which also included experimenting with finding the most effective flotation aids. People with polio are inclined to have strong upper body, which causes the hips and legs to sway and drag. Twelve months after his initial assessment, Brian was able to swim 200 to 300 metres with brief intervals after each 50 metres, a result which he is continuing to improve upon.
All workplace cases (compensation claim-related) require detailed documentation and, where necessary, Brian provided reports from the physiotherapist, acupuncturist and orthopaedic surgeon. Limitations included accessibility to various pools; although some facilities ranked themselves as wheelchair friendly, the change rooms were not always suitable. During initial aqua therapy sessions, Brian displayed early fatigue due to a lack of sleep caused by discomfort in his hip and elbow.
Measurable outcomes included improved range of movement (ROM) in the hip, increased cardiovascular and endurance fitness and improved posture and core stability.
Case study 2Aged 19, Darren is passionate about extreme sports. He is a member of the National Water Sports Club and participates in many events including barefoot skiing, wake boarding and complex slalom courses. During a ski jump requiring a complicated twisting manoeuvre, his anterior cruciate ligament (ACL) and medial collateral ligament (MCL) were severely torn. Surgery was necessary to reconstruct the damaged ligaments which in turn improved the stability of the knee.
The long recovery and rehabilitation period for this injury can result in boredom and a loss of motivation. The aqua therapy instructor therefore had to be aware that setbacks could occur for Darren if his boredom led to his returning to skiing too soon. Compliance from the participant is imperative during the early stages of rehabilitation – and so is encouragement and support from the aqua therapy instructor!
Following surgery on the knee, contraindications included eliminating any leg crossover exercises. The sequential aqua therapy program consisted of exercises that addressed ROM, strength, balance, coordination and endurance, sport-specific stretching and joint maintenance. Darren had clear aqua therapy outcomes and was therefore easily guided through the sessions.
Photo 7: In the initial sessions, Darren firmly places his foot in the middle of one kickboard. He is required to resist the buoyant effect of the kickboard. The knee should not raise beyond a 90 degree angle. Progressive resistance is introduced by using two kickboards. This move is also effective if the foot is placed into a small ‘arm floatie’. An adduction movement is then included into the routine.
Photo 8: Exercise prescription should be effective and enjoyable. Darren works in intervals of deep water running followed by a stationary move.
Photo 9: Lean participants can benefit from a buoyancy aid beneath their trunk as hyperextension may occur during fast and slow long lever kicking.
Photo 10: Sport-specific exercise should be included in each program. Balancing on the belt replicates Darren’s slalom ski starting position. This exercise can also be performed on a noodle.
Case study 3Pip, a 21-year old young adult with an intellectual disability, was described as being like a mermaid in her early years such was her love of water. However, she had an intense fear of full immersion before she participated in aqua therapy.
Her involvement commenced when she started to accompany her mother to the gym. As a regular gym member Pip would complete her workout and relax her joints during a post-session swim. On one occasion Pip was in the pool during a scheduled aqua class and demonstrated great pleasure in listening to the music and making up her own moves.
She made it known that she was interested in joining the mainstream aqua class, so in consultation with her family and allied health professionals, Pip joined aqua therapy. It took only three individual sessions before Pip achieved full immersion and felt ready to successfully join the mainstream aqua class (see photo 11 above) – the aqua therapy outcome was achieved!
Regular participation in the aqua fitness class has resulted in Pip achieving obvious muscle toning, weight loss, improved coordination and concentration and in her making many new friends. In addition to its role in the intensity of the exercise, the music also has a calming effect on Pip’s emotional state.
FITT – Frequency, Intensity, Time and Type of aquatic activityThe progression, frequency, duration, intensity and exercises varied in each case study, but the one thing that every participant shared was the fact that they experienced real change. Their comments or facial expressions often reflected a new sense of realisation about themselves and the condition that they bring to the aqua therapy. The water is a very forgiving and gentle environment providing the opportunity to perform movements not necessarily possible on land. Sometimes the client may be inclined to rush the therapy, but the experienced and skilled instructor, in consultation with the AHP, can monitor and evaluate when they deem it necessary to change exercise intensity and the progression to mainstream aqua fitness. The success of these case studies is not uncommon, and all fitness professionals can benefit from gaining an awareness that aquatics can assist clients in maintaining and regaining a healthy and physical lifestyle.
JSP has specialised in water-based training for over two decades and is one of Network’s stalwart aquatic presenters. An aqua entrepreneur, she designs and delivers marketable and user-friendly aquatic initiatives through her business, WETS (Water Exercise Training Service). JSP has significantly influenced the development and profile of exercising in water within the fitness industry.
NETWORK MAGAZINE • AUTUMN 2008 • PP41-46