Aquatic therapy is a form of physical therapy that is performed in a pool. The use of heat and warm water is preferable in association with aquatic therapy.
The goal of this particular form of therapy is to assist in restoring the person's strength and movement through the use of buoyancy, resistance, and heat.
Water may be used for use in both active exercise or for passive immersion. There are a couple of main categories of aquatic passive modalities. One of them is known as, 'balneology,' or spa therapy, and the other is known as, 'hydrotherapy.' The National Library of Medicine states that balneology is used in reference to bathing in, or even drinking, mineral water. Passive immersion in either warm or hot baths of natural mineral waters, cures, or spas is something that might be labeled as, 'balneology,' or spa therapy.
'Hydrotherapy,' on the other hand, is a term that is used in reference to the external application of natural, non-mineral water with the emphasis being placed on both the motion and temperature of the water use. In America, the word, 'hydrotherapy,' is commonly used to mean a whirlpool bath; something that is used mainly to describe wound care. Many people in the United States are of the opinion that the power of immersion is in the activity which occurs once a person is involved, such as therapeutic exercise, gait training, functional task simulation and so forth. The American Medical Association makes efforts to describe aquatic therapy as an effort by a therapist to improve a person's ability to function through the application of aquatic therapeutic exercises. There is something to be said for enjoyment of stillness and inactivity. Remaining open-minded in regards to both spa and aquatic forms of therapy can be very helpful.
There are a number of different forms of aquatic therapy. These forms of therapy have been developed by different people over time, and reflect various approaches. What follows are descriptions of forms of aquatic therapy.
Ai Chi: The, 'Ai Chi,' technique refers to a form of active aquatic therapy. It is modeled after the principles of T'ai Chi and yogic breathing techniques. Ai Chi is commonly provided in a manner that is, 'hands-on,' where the person providing it stands on the deck of the pool, allowing for visual imaging of complex patterns by the people who are practicing it. People who practice Ai Chi stand chest-deep in the water and are instructed, both visually and verbally, by the person providing therapy on how to perform a slow and rhythmic combination of therapeutic movements as they breath deeply.
Aquatic Proprioceptive Neuromuscular Facilitation: This form of aquatic therapy is active and is modeled after the movement patterns and principles of, 'Proprioceptive Neuromuscular Facilitation (PNF).' Aquatic PNF may be provided through either hands-off or hands-on means by the person providing it. The person receiving therapy is instructed visually, verbally, and/or through tactile methods in a series of functional, diagonal and spiral, mass-movement patterns as they are sitting, standing, lying or kneeling in the water. The patterns involved can be performed with assistance, actively, or with resistance that is provided by aquatic equipment or the therapist.
Aquatic Task-Type Training (TTTA): Aquatic Task-Type Training involves a set of guiding principles that assist people practicing it to create functional therapeutic activities to perform in the water. TTTA is considered to be a school of thought rather than a classic, specialty-technique with specific components and movement patterns. TTTA is something that has a suggested set of parameters for optimizing a person's treatment, particularly treatment of persons with neurological impairments. Aquatic TTTA is something that can be provided in either a hands-off or hands-on manner by a therapist. People who pursue this form of therapy are positioned in a functional task position and are visually, verbally, and/or tactilely instructed in the simulation of tasks that they currently do not execute well, or find themselves unable to achieve outside of water. The tasks themselves might be performed either on an active basis, or with assistance from either the therapist or aquatic equipment.
Bad Ragaz Ring Method: This form of aquatic therapy can be pursued on either an active or passive basis, and is modeled after the movement patterns and principles of Knupfer exercises and PNF. Bad Ragaz is always performed in a hands-on manner by the therapist. People practicing this form of aquatic therapy are instructed visually, verbally, and/or tactilely through a series of movement or relaxation patters as they are positioned horizontally and supported by floats or rings in the water. The patterns can be performed passively for either flexibility or relaxation, as well as actively with assistance or resistance from the therapist.
Fluid Moves: Fluid Moves is a form of passive or active aquatic therapy that is modeled after the, 'Feldenkrais Method.' Therapy can be provided in either a hands-on or hands-off manner by the therapist. People practicing fluid moves actively are guided in an exploratory process, following a sequence of movements that are based on the early developmental stages of the infant. The person stands in the water chest-deep, commonly with their back to the pool wall. They are instructed both visually and verbally by the therapist through slow and rhythmic combinations of therapeutic movements as they breathe deeply.
Halliwick Method: The Halliwick Method of adapted aquatic therapy can also be modified into active aquatic therapy. Halliwick is nearly always performed in a hands-on manner by the therapist and is commonly done through the use of games in groups of pairs. The person is commonly cradled or held as they are in the water by the person providing therapy as they systematically and progressively destabilize the person with the intention of teaching the person postural control and balance. The therapist progresses the person through a series of activities that require more sophisticated rotational control in order to teach the person how to swim, or to teach the person control over movement. The person is constantly required to react to and eventually predict, the demands of an unstable environment. The Halliwick Method combines both the unique qualities of the water itself, and the rotational control patterns involved, in an attempt to facilitate improvements in the person's musculoskeletal, neurologic, and psychosocial systems.
Watsu: Watsu is a form of passive aquatic therapy; it is modeled after the principles of Zen Siatsu. Watsu is always performed in a hands-on manner. The person is commonly cradled or held while they are in warm water as the therapist moves or stabilizes one segment of their body, resulting in a stretch of another segment caused by a drag effect. The person remains entirely passive as the therapist combines the qualities of the water with the flow patterns, which attempt to facilitate improvements in the person's musculoskeletal, cardio-respiratory, neurologic, psychosocial systems, and metabolic systems.
Aquatic Therapy Practitioners
Practitioners of aquatic therapy should have knowledge of movement mechanics and science, including knowledge of respiratory, cardiovascular, nervous, muscular and skeletal systems in and their collective interactions. They should have knowledge of basic anatomy, physiology and kinesiology concepts, as well as knowledge of basic health terminology and knowledge of body terms, positions and movements. These same practitioners should have knowledge of aquatic principles, to include variations to movement quality using aquatic and physics concepts. They should have knowledge of how to choose equipment based on the needs and goals of the people they are serving, and knowledge of practical skills in aquatic therapy and rehabilitation.
Aquatic therapy and rehabilitation practitioners should have knowledge of basic methods and principles used in aquatic therapy and rehabilitation, to include indications, contraindications, precautions and opportunities for aquatic therapy and rehabilitation. They should have knowledge of the evaluation process, as well as knowledge of treatment and prevention components. These same practitioners should exhibit professional responsibility, have the appropriate education, certification, licensing and training. They should have knowledge of legal and ethical practices as well.
Practitioners of aquatic therapy should demonstrate safety and health consciousness by maintaining current certifications and training. They should be familiar with supervisory guidelines and possible emergencies. They should also be able to maintain an overall risk management program and personal and client safety. Aquatic therapy practitioners should have knowledge of applicable regulations and legal considerations. They should comply with all of the applicable laws and codes related to aquatics, rehabilitation and therapy, and know and apply the limits of their practice as they relate to base competencies within the medical system.
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