what are some Goals or indications of aquatic exercise?
- facilitate ROM
- initiate resistance
- facilitate WB activities
- enhance delivery of manual techniques
Precautions for aquatic ex
- fear of water
- neurological disorders
- seizures
- cardiac dysfunction
- small open wounds and lines
Contraindications of aquatic ex
- incipient cardiac failure or unstable angina
- respiratory dysfunction VC< 1L
- severe PVD
- danger of bleeding
- severe kidney disease
- open wounds, colostomy or skin infections
- uncontrolled bowel and bladder
- water and airborne infections
- uncontrolled seizures
WHat are the properties of water?
- Buoyancy
- Hydrostatic pressure
- viscosity
- surface tension
buoyancy
- upward force that works against gravity
- clinical significance: unloads joint, allows 3D access to patient
hydrostatic pressure
- pressure exerted on immersed object
- clinical significance:
- limits effusion
- -assists with venous return
- -induces bradycardia
- centralizes peripheral blood flow
- -easier to do ex near surface where pressure is less
viscosity
- FRiction occurring between molecules of liquid resulting in resistance to flow
- Clinical significance:
- extremity moved through the surface more work than under water only
- using equipment at surface requires more work
Hydromechanics
- physical properties and characteristics of fluid in motion
1. Laminar flow
2. turbulent flow
3. drag
Laminar flow
- all molecules move parallel to one another
- usually during slow movement
Turbulent Flow
- movement where molecules do not move parallel to each other
- faster movements
Drag
-Cumulative effects of turbulence and viscosity acting on an object in motion
Clinical significance of drag
-as the speed increases, resistance to motion increases (in water)
- moving water past patient requires patient to work harder
- application of equipment can increase resistance
thermodynamics: Specific heat
- amount of energy needed to raise 1g of substance by 1 deg Celsius
Clinical significance of specific heat thermodynamics
- water retains heat 1000 times more than air
- water can maintain its temp with minimal change even when different objects are immersed
- water conducts temperature faster
- heat transfer increases with velocity
Center of buoyancy
- the reference point of an immersed object on which buoyant forces of fluid act
- –Ex the sternum in a vertical patient
clinical significance: Unilateral manual resistance
- patient revolves around the PT in circular motion
- Unilateral lower extremity amputation, patient will lean toward side of residual limb in vertical position
- Patients bearing weight on floor of pool experience both center of buoyancy and center of gravity
Aquatic temp Rule of thumb
- Cooler temp for high intensity
- warmer temps for mobility and flexibility ex and muscle relaxation
- ambient air temp should be 3 deg C higher than water
Temperature regulation
- Patient has harder time regulating due to immersion
- water conducts heat 25 times faster to or from the patient
- patient perceives small changes in water temp more than in air
- water temp can penetrate deep into patient, inversely can penetrate deep into patient, inversely proportional to subcutaneous fat thickness
- Patients unable to maintain core temp if water is <25 deg C
- > 37 deg C may be too hot for intense activity
- Hot water increases cardiovascular demand
- In waist deep water @37 deg C, heart rate stimulated to incr and overcomes centralization of peripheral blood flow
- @37 deg C cardiac output incr even at rest
Mobility and Fucntional Control Exercise Temp
- 26-33 deg C
- use warmer water for acute painfuk patient
- incr relaxation
- elevate pain threshold
- decr muscle spasm
Aerobic Conditioning temp
- 26-28 deg C
- maximizes ex efficiency
- incr stroke volume
- decr heart rate
- if exercising at >80% target heart rate use 22-26 deg C
stretching in water
-Patient is supine in waist deep water or sitting on step
-buoyancy devices at neclm waist, feet
-
strengthening in water
- usually in waist deep water/ deeper water depending on device
- manual or mechanical resistance
Manual: usually distal segment of extremity os fixated. Body moves when muscle contract. drag of body creates resistance
Buoyancy assisted independent strengthening
(BA)
- vertical movement directed parallel to vertical forces of buoyancy that assist motion
Buoyancy supported (BS) independent strengthening
-Horizontal movement with vertical buoyancy forces eliminating or minimizing need to support extremity against gravity
