More Related Content
Similar to tx_15_-_short.ppt
Similar to tx_15_-_short.ppt (20)
More from ssakher
More from ssakher (11)
Recently uploaded
Recently uploaded (20)
tx_15_-_short.ppt
- 2. Aquatic Therapy • Useful tool to facilitate training & fitness • Movement skill & strength can be enhanced • Effects • joint compression • Reduces muscular guarding • Useful in improving movement and fitness • Basic Concepts as Land-based Rehab • Warm-up • Strengthening/mobility activities • Endurance/cardiovascular • Cool down/stretch
- 3. Goals • Specific Goals: • Facilitate ROM • Initiate resistance training • Facilitate weight-bearing activities • Enhance delivery of manual techniques • Provide 3-dimensional access to patient • Facilitate cardiovascular fitness • Initiate functional activity • Minimize risk of injury/re-injury during rehab • Enhance patient relaxation
- 4. Precautions & Contraindications • Precautions • Fear of water • Neurologic disorders • Seizures • Cardiac dysfunction • Small open wounds & intravenous lines • Contraindications • Onset of cardiac failure & unstable angina • Respiratory dysfunction • Severe peripheral vascular disease • Danger of bleeding or hemorrhage • Severe kidney disease • Open wounds, skin infections • Uncontrollable bowel/bladder • Water & airborne infections or diseases • Uncontrolled seizures
- 5. Advantages & Benefits • Buoyancy allows active exercise while providing a sense of security and minimizing discomfort • Water provides environment in which more can be accomplished than on land • Useful in early stages of rehabilitation • Provides for earlier movement due to compressive forces • Supportive environment – allows for extra time to control movement – proprioception enhancement • Turbulence functions as a destabilizer & as a tactile sensory stimulus • Provides gradual transition from non-WB to full WB
- 6. • Psychologically – may allow for increased confidence due to increased ability of function allowed by water • Strengthening & muscle re-education • Strength gains are dependent on effort put forth by athlete • Energy expenditure may be • Must perform activity & maintain stability of body within the water • Cardiovascular maintenance
- 7. Disadvantages • Cost • Building & maintaining a rehabilitation pool • Space & personnel • Thermoregulation • Impact on core body temperature • May impact tolerance for participation in heat • Contraindications involved with injuries & potential of open wound • Additional contraindications • Fear of water, fever, urinary tract infection, allergies to pool chemicals, cardiac dysfunction or uncontrolled seizures • If lacking in ability to stabilize body, aquatic training can be challenging
- 9. Facilities & Equipment • Facility must have certain characteristics • Should be at least 10 ft. x12 ft. • Adequate access (either above or below ground pool) • Shallow & deep areas to perform various exercises • Flat pool bottom with marked gradients - optional • Adequate temperature (79°-82°) • Ancillaries • Prefabricated pools with treadmill or current producing device • Pool toys – limited by imagination (gloves, hand paddles, belts, kickboards) • Clothing & attire
- 10. Equipment • Safety equipment – • Exercise equipment – • Assistive Devices – flotation devices • Resistive devices – paddles, water shoes, webbed gloves
- 11. Water Properties • Specific Gravity • Buoyancy • Hydrostatic Pressure • Viscosity
- 12. Specific Gravity • Also known as “Relative Density: • The density of an objective relative to that of water • The density of a substance divided by density of H2O. • Specific gravity of water = 1 • If object’s s.g. is > 1, object will sink • If object’s s.g. is < 1, object will float • If object’s s.g. is = 1, object will float just below water surface • S.G. of fat = 0.8 • S.G. of bone = 1.5-2 • S.G. of lean muscle = 1.0 • Human Body = 0.95-0.97 (Less than 1 - enables the body to float)
- 13. • Buoyancy is partially dependent on body weight • Different body parts will vary • On average, human S.G. is less than water • Doesn’t mean body will float due to body part make-up • Factors that determine the specific gravity of the individual body part: • ratio of bone weight to muscle weight • the amount & distribution of fat • depth & expansion of chest • Air in lungs vs. extremities • Lungs filled with air can the specific gravity of the chest (allows head & chest to float higher in the water)
- 14. Buoyancy • Upward force that works opposite to gravity • Counterforce that supports submerged or partially submerged object against pull of gravity • Assists motion toward water’s surface • Sense of weight loss (equal to amount of water that is dissipated) • Changes relative to level of submersion • Differing levels in males & females due to relative CoG • Allows for ambulation & vigorous exercise with little impact & friction reduction between articular surfaces • Archimedes principle – an immersed body experiences upward thrust equal to the volume of liquid displaced
- 15. Center of Buoyancy • Center of buoyancy, rather than center of gravity, affects the body in water • Reference point of an immersed object upon which buoyant (vertical) forces of fluid predictably act • In the vertical position, the human center is located at the sternum • In the vertical position, posteriorly placed buoyancy devices will cause the patient to lean forward (anterior causes patient to lean back)
- 16. Hydrostatic Pressure • Pressure exerted on immersed objects • Pascal’s Law – pressure exerted by fluid on an immersed object is equal on all surfaces of the object • As density of water & depth of immersion so does hydrostatic pressure
- 17. • Friction occurring between molecules of liquid resulting in resistance to flow • A fluid’s “thickness” • Resistance is proportional to the velocity of movement through liquid • Increasing the surface area moving through water will resistance Viscosity
- 18. Hydromechanics • Physical properties & characteristics of fluid in motion • Components of Flow motion: • Laminar flow – movement where all molecules move parallel to each other (typically slow movement) • Turbulent flow (also known as “Wave Drag”) – movement where molecules do not move parallel to each other (typically faster movements) • Drag – cumulative effects of turbulence & fluid viscosity acting on an object in motion • As speed of movement through H20 , resistance to motion will . ( speed = drag; velocity2) • Moving H20 past the patient will require the patient to work harder to maintain position in pool. • Application of equipment will drag & resistance as the patient moves the extremity through H20.
- 19. • 3 Resistive forces at work in H20: • Cohesive force - Runs parallel to the direction of the H20 surface • Result of H20 molecule surface tension • Bow force - Force generated at front end of object during movement • When object moves, in H20 pressure at the front and pressure in the rear • Creates a pressure gradient, resulting in low pressure zones swirling = eddies (turbulence) create a drag force • Drag force – water’s resistance to movement within a fluid that is caused by the friction of the fluid’s molecules • Form Drag – resistance that an object encounters in a fluid and is determined by the object’s shape & size • Wave Drag – water’s resistance as a result of turbulence • Frictional Drag – result of water’s surface tension • Can be changed by shape and speed of object • streamline = drag • Must be considered carefully when attempting to protect a limb during rehabilitation • Drag forces can torque at a given joint which may be contraindicated
- 20. Thermodynamics • Water temp. will have an effect on the body & performance • Specific Heat – amount of heat (calories) required to raise the temp of 1 gram of substance by 1°C. • Rate of temp change is dependent upon mass & specific heat of object • Water retains heat 1000 times more than air • Temperature transfer – water conducts temp 25 times faster than air • Heat transfer increases with velocity (patient moving will lose body temp faster than patient at rest)
- 21. Aquatic Techniques • Program can be designed to have active assistive movements & progress to strengthening • Can perform exercises in various positions including: • Supine, prone, side-lying, seated, vertical • Things to consider when performing aquatic techniques: • Type of injury/surgery • Treatment protocols if appropriate • Results/muscle imbalances found in evaluation • Goals/expected return to activity • Program design (similar to land-based programs) • Warm-up • Strengthening/mobility activities • Endurance/cardiovascular • Cool down/stretch
- 22. Spine Dysfunction • Initial Level • Instruct athlete on neutral position in partial squat with back against wall • Wall will provide feedback to monitor ability to maintain position • Progression of upper/lower extremity activity can be incorporated with stabilization exercises • If dealing with sciatica-type symptoms, deep water traction may be beneficial • Work on normalization of gait pattern and increasing ability to bear weight (performed in deep end) • Increasing pelvic mobility through stretching
- 23. • Intermediate Level • Move athlete away from wall • Incorporate equipment to simulate pulling/pushing motions • Can also perform activities that incorporate single leg stance and lunging while challenging dynamic stabilization of core • Supine and prone activity can also be utilized to train core
- 24. • Advanced Level • Must be sure to incorporate activities that mirror challenges of sport and provide higher level of trunk stabilization • Train bilateral activity – integrate opposite movement patterns • Athlete should be integrated back to training on land • Water does not allow for normal speeds and forces during sports specific activities
- 25. Lower Extremity Injuries • Initial Level • Goal - restore normal motion & early strengthening • Restore normal gait patterns • Can work on active joint motion (hip, knee, ankle) • Utilize cuffs, noodles, or kickboards under foot will assist with increasing motion • Incorporate conditioning & balance activities • Utilize good postural mechanics while challenging balance/neuromuscular control • Deep-water activities allows for conditioning & cross-training • It also provides an opportunity for non-weight bearing secondary to injury • Incorporate of supine activities • Resistance against uninvolved leg will also allow for strengthening of injured extremity
- 26. • Intermediate Level • Challenge athlete with weights & flotation devices • Be aware if you need to use proximal or distal resistance • Utilize straight & diagonal plane activities • Balance training • Standing on cuff, noodle, uneven surfaces • Deep water tethering for running/sprinting • Continue integrating supine & prone exercises as athlete’s strength & ability • Integrate sports specific activity & jumping progression
- 27. • Final Level • Athlete should be engaged in high level strengthening & conditioning • Program should compliment land-based program • Decrease use of floatation devices, alter use of buoyancy cuffs (minus floatation belt) • Endurance training in aquatic environment is a good alternative for athlete’s conditioning program • May be useful in preventing recurrence of injury
- 28. Conclusions • Should not be exclusive treatment option for athlete • Many physical & psychological benefits during early stages of rehabilitation • Sports specific training – utilize land & water based training to achieve goals • Must be sure to engage in activity at “normal” speeds and force levels prior to return to play