User:2grovey2/Aquatic therapy

Applications and effectiveness

Applications of aquatic therapy include neurological disorders, spine pain, musculoskeletal pain, postoperative orthopedic rehabilitation, pediatric disabilities, and pressure ulcers.

A 2006 systematic review of effects of aquatic interventions in children with neuromotor impairments found "substantial lack of evidence-based research evaluating the specific effects of aquatic interventions in this population".

For musculoskeletal rehabilitation, aquatic therapy is typically used to treat acute injuries as well as subjective pain of chronic conditions, such as arthritis. Water immersion has compressive effects and reflexively regulates blood vessel tone. Muscle blood flow increases by about 225% during immersion, as increased cardiac output is distributed to skin and muscle tissue. Flotation is able to counteract the effects of gravitational force on joints, creating a low impact environment for joints to perform within. The temperature changes, increase in systolic blood pressure to extremities, and overall increase in ambulation are factors which help immersion to alleviate pain. Aquatic Therapy helps with pain and stiffness, but can also improve quality of life, tone the muscles in the body, and can help with movement in the knees and hips. Protocols using a combination of strengthening, flexibility, and balance exercises resulted in the greatest improvements in Childhood Health Assessment Questionnaire scores, whereas aerobic exercise did not result in greater improvements in CHAQ scores compared to a comparison group performing Qigong. Not only does aquatic therapy help with pain, but can benefit postural stability, meaning it can help to strengthen balance functions especially with people who have neurological disorders. For people diagnosed with Parkinson's disease, aquatic exercise has been proven to be more beneficial than land-based exercise for two important outcome measures. The Berg Balance Scale and Falls Efficacy Scale score were reported to have significant improvement when implementing aquatic exercise over land-based exercise. These results suggest that aquatic exercise can be extremely helpful for Parkinson's disease patients with specific balance disorders and fear of falling.

Aquatic therapy in warm water has been shown to have a positive effect on the aerobic capacity of people with fibromyalgia. It is still inconclusive whether land therapy is better than aquatic therapy however it has been demonstrated that aquatic therapy is as effective as land base therapy. There are advantageous outcomes for patients with fibromyalgia resulting from aquatic therapy such as decrease of articulate load regarding an individual's biomechanics.

Currently there is no standardized aquatic therapy protocol for people post stroke however it is safe to conclude that aquatic therapy can be more effective than land based therapy for improving balance and mobility. There is insufficient evidence regarding improvements in functional independence of people post stroke.

From a cardiopulmonary standpoint, aquatic therapy is often used because its effects mirror land-based effects but at lower speeds. During immersion, blood is displaced upwards into heart and there is an increase in pulse pressure due to increased cardiac filling. Cardiac volume increases 27-30%. Oxygen consumption is increased with exercise, and heart rate is increased at higher temperatures, and decreased at lower temperatures. However, immersion can worsen effects in cases of valvular insufficiency due to this cardiac and stroke volume increase. The aquatic environment is also not recommended for those who experience severe or uncontrolled heart failure.

Aquatic therapy can be used for younger populations or in a pediatric setting. Aquatic therapy improves the trunk structure involved in gross motor function. The role of physical therapists is early intervention to improve their physical, mental, and social recovery. There are different interventions or activity sequences that can be implemented using aquatic therapy to improve specific functions or address specific disabilities in children. In regards to children and aquatic therapy, studies show that aquatic therapy improves motor symptoms, increases physical activity levels (which can be maintained over a long period of time) in children with developmental or motor disabilities. It also has a positive influence on social interactions/behaviors, and participation in children with neurological disorders. Aquatic therapy is beneficial for people with spinal cord injury or disorder. Aquatic therapy promotes physical and psychosocial benefits for patients with spinal cord injury and disorders. In a study, underwater treadmill training improved lower extremity strength, balance and gait in people who suffer from partial damage to their spinal cord. Respiratory function also improved with underwater treadmill training in these individuals. Knowledge of how to use aquatic therapy in application to people with spinal cord injuries or disorders is important because access to aquatic therapy is limited in this population even though there is evidence of significant improvement of many systems/ overall function using aquatic therapy.

Multiple Sclerosis or MS, is a disabling disease that affects one's central nervous system. MS will target the protective sheath (myelin) that covers the nerves. Myelin allows for communication. The destruction of myelin would result in poor communication between the brain and the body. Those with MS will experience neurological damage that impacts physical, cognitive, and psychological and emotional functioning, as well as quality of life. Aquatic therapy offers benefits for this population. By utilizing the physical properties of water such as buoyancy, turbulence, hydrostatic pressure, and hydrostatic resistance, MS patients would be able to work on balance and coordination. This being something that had been compromised with the progression of the disease. The viscosity or thickness of water, allows for MS patients to take their time with their movements. The viscous environment would result in slower more careful movement. Aquatic therapy also offers the benefit of being able to actively use your muscle in order to maintain stabilization within the water itself. Finally, another potential benefit of aquatic therapy and patients with MS is the temperature of the water creating a comfortable environment. Patients with MS experience increased body temperature. Some authors have recommended that water temperature be below 85 °F (29.4 °C) for MS patients. In the exercise program, a temperature range of 83 °F to 85 °F (28.3 °C -29.4 °C) is recommended for low-repeat and low resistance exercises. The benefits of using aquatic therapy would result in a cool-down effect, that would essentially create a more optimal central temperature eventually increasing the ability to perform exercises effectively.