Aquatics – GLOBAL HEALTH AGING

What’s on the Minds of Top Aquatic Experts?

10/05/201802/06/2019Global

The excitement and the anticipation of attending the fifth International Conference on Evidence-Based Aquatic Therapies (ICEBAT) had been growing inside of me for months. Unsure who I’d meet, but, certain I needed to be there, my excitement multiplied when names like Bruce Becker and Johan Lambeck appeared in the “line-up” of keynote speakers.

For me, best possible outcomes for my patients/patrons meant I would have significant opportunity to learn empirical evidence from the some of the latest published studies and have face-to-face conversations with aquatic leaders like these two industry icons. Not only would I learn but, as in past professional aquatic conferences, I could reaffirm what I’d already put into practice with my patrons.

Keynote speakers from various countries presented their findings on such matters as end-stage dementia, neural plasticity, and motor learning, therapies for the end of life quality, appropriate applications for children with CP and cartilage health and repair. Oral presenters and poster presentations were intermingled with pool practicums and equipment demonstrations that, in some cases were new to many and in some cases familiar to me. What wasn’t familiar were vendors from other countries offering products and services like dolphin encounters as a therapy or in-water photography.

What I gleaned from all the presentations and research was simple: the industry requires unification and some concrete basis of “assumed competency” and “common knowledge” that bridges between the practitioner (me), the trainer like Mary Wykle and Kiki Dickinson and the researchers like Ben Waller and Johan Lambeck.

To start, Paula Geigle’s opening keynote address emphasized a need for recording the specific parameters of dosing: a consistent and comprehensive documentation of what is taught in the water and how. Specifically, each professional needs to record the following:

Cadence
Duration
Frequency
Intensity
Mode
Water Depth and temperature

At the top of this list, “cadence.” Is it a coincidence that Geigle referenced it first and I find it THE most prominent controllable parameter of consistency for the participant? Geigle’s leading bullet was an affirmation for me that I continue to “set the pace” for my participant(s) by establishing the rhythm or speed either by music or verbal counting cue and sometimes both when cueing half-speed or double time.

Other keynotes spoke about using a metronome, but as a practitioner, in a true natatorium like a YMCA or Community Center, a metronome would likely be inaudible…especially to older adults! The bass thump of 135 bpm Dynamix CD, however, would ultimately serve as my backdrop for tempo, half-tempo and double or even quadruple time, depending upon the moves.

As an Ai Chi instructor, I have grown so holistically through this practice of coordinating breath with a movement that I now incorporate it in ALL my teachings from personal training to boot camp or HIIT and deep water running or arthritis and mobility instruction.

Another practicum leader stated that he didn’t believe in stretching. It has been an integral part of my cool-down phase of instruction in virtually every class or personal training I have led in 27 years of practice. I have no clinical data to back up my experience in leading arthritis classes, but, I feel certain that a stretch is imperative in the older population. Where is the evidence to support such a belief that it isn’t important?

Bottom line: This conference will reconvene in two years in China. Start saving now. In a worldwide perspective, all can contribute, learn and be made stronger in the profession. The intimacy of the gathering makes it somewhat elitist but also empowering. In this setting, relationships can be established that foster progress for the industry in the world, not just in our country or region. For us in the U.S., it seems we need to ‘catch up’ with some other countries who are leading our industry. Also, I hope that 2020 vendors will include new players in the field like float therapy pools and AquaBase. With the advent of full face mask snorkels, how many non-swimmers could overcome their fear of water?

Felecia Fischell is a certified aquatic practitioner with 27 years experience in aquatic personal training and group exercise. She is passionate about water and it’s pain relief and healing properties. Fischell is currently in the process of relocating to the island of Ambergris Caye in Belize where she is setting up an aquatic practice. She continues to maintain an active interest and perhaps role in creating the 2020 ICEBAT Conference to be held in Beijing. Find her on Facebook at FunLife Aquatic Consulting, LLC.

Aquatic Wellness: Designing Functional Pools for A Personalized Experience

02/02/201605/09/2016GlobalLeave a Comment

“This design to the length, reach, and breadth parameters of the body human translates into the least amount of energy, water, and space for the most exercise and traction. Do more with less…then reuse it.” The Vertical Pool

Aquatic therapy is a process wherein the body is submerged in a pool of warm water and made to perform movements for physical rehabilitation and recovery after an illness or injury. Many populations including seniors and veterans with disabilities are subject to physical limitations that can be improved through aquatic therapy, including internal organ function like pulmonary and cardiovascular efficiency.

As a professional aquatic practitioner, I have always dreamed of patenting my own pool design on a small footprint to economize on space and expense. A pool does not need to be large; it needs to be deep. After studying up on all the in-home and sports medicine pools on the market, I grew frustrated that not one pool – even at the cost of more than $60,000 – could meet my three critical requirements of internal pool depth of more than 54 inches, small in size and a sloping ramp access. This was until just a few months ago when a prospective buyer sought out one of my professional association member bulletin boards for a recommendation about what kind of pool to choose for her home. It was then that I learned about the Vertical Pool (TVP).

The Vertical Pool (TVP) has an internal depth of 67 inches – a full 13 inches deeper than most other small pools on the market. This meets two of my three criteria: internal depth and small size. I found several other redeeming features which offset the lack of my third requirement of a ramp access. Some of these redeeming features include a cross-bar above the deep section of the pool to hang from, an easy way to disassemble and relocate the pool, and an unprecedented price – features I have never seen in any pool during my 25 years in the field of aquatic therapy.

Additionally, aspects like specially designed accessories to clean the pool, a shower massage hose, an adjustable floor, and even a rudimentary device known as a “swimhorse” – a support frame that enables people to swim in place and horizontally – coupled with an eye for conservation, make this pool more than amazing! The more I considered TVP and my personal needs, the less hesitant I became about the modest $12,000 investment. After all, I can break it down and take it with me when I move. Even the biggest name-brand on the in-home pool market cannot be broken down and re-assembled with a base purchase price of $12,000.

Being the daughter of a World War II Navy Commander, and a considerate “fish out of water” who is passionate about the limitless benefits of working out or relaxing in water, I was particularly impressed with the million-dollar investment of TVP inventor, Peter G. Hold. Hold designed and created a functional personal pool that many wounded members of the armed forces may afford.

While many of my professional peers can argue that these soldiers need to be in class and supervised, both for socialization and safety, I have come to realize that many veterans with disabilities may not be able to attend classes in a community pool for a multitude of reasons. And if they cannot attend classes, they will not gain improved functional goals attained by aquatic therapy. Therefore, it is sometimes easier to rely upon a caregiver for the occassional visit to a class or therapist, and then be able to have “homework” to do in one’s own Vertical Pool.

As industry icon Dr. Igor Burdenko, whom I interviewed for this article, said in response to my question about how the Vertical Pool will impact the industry of aquatic exercise and therapy, “I see that this pool has an opportunity to be used all over the world. Nothing comes even close!” For more information, please visit The Vertical Pool and Aquatic Therapy Foundation. Make sure to access the ATTRIBUTES tab on The Vertical Pool website and scroll down to Dr. Burdenko’s explanation of the value of vertical.

Felecia Fischell is an aquatic specialist with 25 years experience in aquatics. She leads aquatic classes and consults as an aquatic personal trainer and a swim instructor in and around Smith Mountain Lake, Virginia, USA. The Founder of FunLife Aquatics Consulting and Personal Training, Felecia presents at health fairs and has given aquatic presentations to high schools, Howard County Board of Education, Howard County General Hospital and Howard Community College.

HO-HO-H2O: Aquatic Therapy and Exercise Gifts

12/10/201502/20/2016GlobalLeave a Comment

For the Christmas season, Felecia Fischell, aquatic specialist, has written a personal piece on shopping for aquatic gifts.

The noodle is by far the most useful and versatile piece of aquatic equipment, and experientially speaking, HYDRO-FIT® sells the best product on the market. The HYDRO-FIT density foam has the longest shelf life I have ever seen. Several lasted more than 10 years, being used in a fresh water lake, saltwater cruise ship pool, chlorinated swimming pool, hot tub and the ocean. Currently referenced on their website, HYDRO-FIT sells the 54-inch long, 3.25-inch diameter solid noodles for $11.95 plus shipping. The shipping was considered “oversized” and therefore more expensive. However, I would rather purchase them again, as an eco-conscious consumer, because I have seen way too many of these equipment deteriorate and crumble in as little as one calendar year of indoor swimming pool use. Financially speaking, a $12 noodle, lasting 10+ years, is less expensive than buying $3 noodles every year or two. Because they are solid, not hollow, and made of superior foam, noodles retain their flotation properties well and do not become easily waterlogged. If you purchase a noodle, it can be straddled or wrapped around the back under the arms and may negate a need for the more expensive waist belt.

Photo Credit: Courtesy from HYDRO-FIT, Inc.

Waist belts are particularly useful when training in deep water. Low back support and aid in maintaining a vertical posture, when striding and pressing through the water with limbs can be important. This is so as not to compromise safest form through movement. There are many brands of belts and since this may truly be a personal comfort matter, it is difficult to recommend a specific one. Most belts should fit snugly around the midsection, almost as if the person cannot breathe when out of the water. The belt should not have dangling loose parts or get in the way of arm or leg movement through their fullest range of motion. Since waist belts are not often used in therapy as in exercise, this article provides tips to consider, rather than recommending a preferred brand. Please note, however, that belts which are straps with flotation “pillows” can be placed in different locations along the strap secured around the body. This may not only impede some movement but also increase the risk of losing the safest vertical form.

HYDRO-FIT still makes many of my most favorite products and during the Christmas season, their $100 cuff kit is being sold for $85. This kit includes a pair of webbed gloves (thin), a pair of hand buoys, a set of cuffs (which can be used not only on ankles or arms, but also buckled together to form a waist belt), and a very useful, sturdy mesh tote. I have enjoyed using other brand webbed gloves, as they do not need to be rolled down off the hand from the wrist, to prevent stretching that occurs if pulled off from the fingertips. Novice users do not require the added resistance and power of thicker, more robust gloves. Hence, the “wave mitts” included in this kit are perfect for beginner.

All of the items mentioned (highlighted and underscored) so far, except the gloves, are buoyancy equipment. The webbed gloves are drag equipment, as are paddles, bells and blades. Drag equipment is useful in that it works “omnidirectionally.” When under water, the drag equipment can train muscle parity (balance between complementary muscle pairs) more smoothly as it is not buoyant and likely to pop up to the surface. Muscle parity is frequently a more desirable objective in the outcome of rehabilitation and developing proper function for daily activities.

Paddles have evolved in design and form such that there are now glove-like devices that can be worn. There are far more designs and manufacturers of these than the paddles I use and started using more than 20 years ago. Comments based upon experience allow me to reference a pair of paddles that are hand-held, about 17-inch long and have a disc at each end. There is a center dial, allowing for adjustment of the triangular openings around the inner diameter of each disc. Water flows through the adjusted openings, making the resistance minutely modifiable. They are inexpensive, at less than $20 per pair, and withstand the test of age and durability. Water Gear Aquaflex manufactures these paddles and they can be obtained from many online vendors, including Swim2000.com. Persons with gripping issues or especially compromised wrist joints should not necessarily use such paddles.

Blades and Bells by AquaLogix are inexplicably a new favorite. Purchased just a little over a year ago, their durable plastic polymer construction gives a sturdy appearance and I have found them easy to don, care for, carry and use. The bells come in three different sizes and the grip handles, inside the bells, make the equipment particularly comfortable to hold. The blades almost appear to be the innards of a turbine engine, and they are attached to a velcro strap that cinches around each ankle (or wrist/forearm). Using drag equipment is beneficial to those who prefer developing their strength by controlling the amount of force to move the equipment through water. Such folks do not want the feature of buoyancy to support their extremities when working out in the water.

From the Nekdoodle to the Wonderboard and Buoyancy Wrap by Sprint Aquatics, there is SO much product on the market today. Swim Outlet is one online clearinghouse for aquatic equipment of all sorts including suits, shoes, videos and electronics. Purchase choices are greatest through internet sources, where name brand sources can sometimes be found at small discounts. Store bought products are usually of lesser quality and cannot be supported for replacement, like many manufacturer websites. The choices are numerous, overwhelming and sometimes hard to decide. Visiting local aquatic and therapy facilities that use equipment is a great way to try out products before making the investment. There is no harm in asking if you may borrow or even test out the products in a pool facility during a non-busy time. Just make sure to bring your own towel and be prepared with a swimsuit worn under your clothes or kept in the car. Have fun helping yourself, a friend or loved one celebrate a positively Buoyant New Year!

Aquatic Therapy Facilities: Focusing on Water Quality, Air Temperature and Noise

11/27/201502/20/2016GlobalLeave a Comment

In October of 2015, Global Health Aging celebrated National Physical Therapy Month by publishing a weekly four-part series on aquatic therapy. Part 3 of the series touched on three major considerations when looking for aquatic facilities. Herein, the blog continues to examine other factors that may contribute to new participants’ decisions in selecting a facility, especially when there is more than one facility in close proximity to the patron. In December, be sure to look for suggestions on equipment for new patrons’ holiday wish list.

Air Temperature

It is very important for patrons to be comfortable and warm when exercising in the water. If a patron tends to get cold, he or she can purchase a partial wetsuit or wet vest. A less expensive option is to simply wear a snug-fitting long sleeve shirt (over the top of a swimsuit, if female). When air temperatures are significantly cooler than the water temperature, a swim cap or even a knit ski type cap can greatly reduce the amount of heat lost through the head. This will help insure that the participant remains comfortably warm in the pool.

Noise Level and Water Quality

These two considerations are rare options that patrons can control when selecting a facility, unless they are willing to pay or drive to destinations farther than what is locally available. Most often, if using a public facility like a YMCA or athletic club, there is little choice available to the participant. However, it is worth noting, just to be certain, that these conditions will not impede or hamper participation.

Regarding noise level, natatoriums tend to have a lot of extraneous noise. If multiple groups are working simultaneously in either different areas of the same pool or within the same room, noise interference between the groups may diminish a participant’s satisfaction and focus. In classes designed for senior citizens who generally may have more trouble hearing than children, classes for children, like swim lessons, should not be scheduled at the same time as classes for seniors. Children naturally want to scream, especially when splashed. Hence, it is fun for them and a good release of their anxieties, as they are not yet comfortable in the water. It is not fair to expect children to be quiet, nor is it fair to expect seniors to enjoy their classes when they cannot hear the instructor and focus on the work to be done.

When selecting a facility, water quality is another consideration that may be of concern Most pools today still use either a chlorine or bromine system to kill off harmful contaminants like bacteria. While salt pools and ion filters are more prevalent in smaller pools, they may also pose challenges to patrons with skin sensitivities. Water quality is not controlled by patrons in public facilities, therefore participants are better able to tolerate the harshness of the chemicals used in pools, by showering, prior to entering the pool. Most patrons consider showering an important responsibility to rid the body of oils, lotions, deodorants and perfumes that may add to the cloudiness of water. But few do not understand that they are doing themselves a disservice by not rinsing off before entering the pool. When a patron is already soaking wet, including their swimsuit and hair, he or she has saturated the oils etc., reducing the potential for chemicals to adhere to their skin, hair and swimsuit. By showering before entering the pool, a patron protects him or herself as well as the quality of the pool water.

Sound Systems

Sound systems deserve some brief mention as they can often be helpful when overcoming noise interference or hearing deficits. Sound systems are also good for playing music which not only adds to the enjoyment of many class programs, but the music sets the tempo and cadence for movement. There are some sound systems that play music over speakers outside the pool and the instructor may be either on the pool deck, leading the class or in the water. An instructor may wear a microphone headset that transmits a wireless voice signal to be broadcast through the speakers, if the sound system is waterproof. The choice of music can also induce relaxation in some cases.

If a patron of aquatic therapy returns to the pool to practice or perform assigned exercises without an instructor present, waterproof personal systems can add enjoyment and motivation to a patron’s aquatic therapy session. One of the most ingenious products on the market today is called a SwiMP3. The aquatic patron downloads a song list to a waterproof MP3 player and listens to the music through headphones that are actually placed adjacent to the ears on the jawbone, and the sound is perceived through bone conduction. Amazing!

Since touring an aquatic facility is exhaustive, it may be worth choosing to contract for a “trial” membership. If the patron chooses to no longer participate, the expense of a long-term membership commitment is not lost. Aquatic therapy and exercise are not only good for physical well-being, the socialization and relationships that are created in the water tend to last for years. As with most things in life, change is difficult. Choosing to begin an aquatic program is a huge investment of time and energy. Establishing a regular routine can be challenging, but when that commitment becomes routine, the benefits become SO evident that few will stop coming. Aquatics are good for life!

Aquatics Programming

10/23/201504/19/2016North AmericaLeave a Comment

In honor of National Physical Therapy Month, Global Health Aging is presenting a weekly four-part article series on aquatic therapy. This is Part 4 in this series. Part 1 focused on the aquatic therapy marketplace, Part 2 focused on selecting an aquatic practitioner and Part 3 focused on selecting an aquatic facility. Thank you for reading!

Aquatics Programming may be found in a class format or individual, one-on-one, personal training. Variances occur when the instructor is in the water or on the pool deck; the instructor can be demonstrating moves or simply observing. In one-on-one training, a physical therapist may demonstrate on the pool deck and then oversee land-based exercises to be performed in water. This article will present an overview of just aquatic therapy programming–oftentimes misconstrued by physicians and other healthcare providers as water aerobics, as they have not learned to differentiate between aquatic exercises and therapies.

Within aquatic therapies, class formats are usually considered “active” therapies, meaning the therapist is demonstrating moves to be performed by the participants using visualization or verbal cueing to effect the desired movement(s). “Passive” therapies require the therapist to be in the water with the participant, physically manipulating the participant in a one-on-one mode of care.

Active therapies are by far the more commonly observed practices in either class or personal format. In active therapies, the practitioner can be demonstrating the moves whether on the pool deck or in the water. Many participants prefer a practitioner on deck where moves can be easily seen and more closely modeled by the participant. However, there are unknown advantages to having the practitioner in the water with the participant(s). The practitioner can more concisely cue the participant to specific considerations that may be experienced in water, not commonly observed or experienced when the move is performed out of the water. For instance, a leg lift to the side, when performed on deck, is more easily aligned when the buoyancy and resistance of the water is not altering the form of a truly lateral abduction. When a practitioner instructs from the water, he or she may lift the leg sideways but it may be forward of the midline of the hip joint. By cueing the participant to turn the toes inward, the outside of the ankle leads the abduction, effecting a more true lateral abduction. The slight turn inward of the toes strengthens the leg muscles needed to perform the movement, which then translates to a more stable leg lift on land. This is because the muscles have been trained more strongly against the added resistance of the water.

Physical therapists who do not have aquatic training may never come to understand this variance in experience between land and water. Therefore, they can not ever use the water to its fullest multi-planar or “omni-directional” benefit. To be fair, even people trained in aquatic therapy may not become fully aware of this omni-directional efficacy unless they have spent a lot of time in the water, performing the movements they instruct the participants to carry out.

In class formats, there are many kinds of therapies that can be conducted: Yoga, Aqua Stretch, Aqua Pilates, Ai Chi and Watsu are some examples. While Watsu is a “passive” therapy, meaning the practitioner is usually the one to move the extremities of the participant, a therapist can lead a class of paired participants and cue and observe each pair in their therapy. Likewise, Ai-Chi-Ne is a paired participant therapy class. For the purpose of example, a brief explanation for Ai Chi will be included in this article.

Ai Chi, a Japanese aquatic therapy, is oftentimes confused with the land-based Chinese Martial Art, Tai Chi. In a lot of ways, the practices are similar and the newer Ai Chi is based upon the martial art. However, when done in water, Ai Chi accomplishes different objectives of wellness and mind/body self-care. It has a very restorative, if not healing effect when practiced regularly. Moreover, Ai Chi coordinates controlled fluid movements with deep, diaphragmatic breathing in through the nose, but out through the mouth. Its relaxation effects are bridging the mind’s control of the body through the control of breath. It is said that, “the breath is the bridge between the mind and the body.” When practiced regularly, the healing effects of the therapy can be profound. Ai Chi is a cultivation of the energies in and around the body, drawing in healing energy and expelling toxic or harmful stressors.

In a one-on-one aquatic therapy session, a powerful bond is created between the practitioner and participant when both are in the water. Inexplicably, the shared common experience endears the participant to the practitioner, establishing a stronger trust and respect than when a practitioner stays dressed in street clothes, sits on a chair on the pool deck and perhaps keys entries on their computer, while the participant completes the instructed movement(s) or repetitions of a move.

In sports therapy pools, the trainer is like the therapist on the pool deck, but expensive underwater video and monitor equipment enables the trainer to observe the form and kinesiology of the participant. This insures proper form and alignment therefore maximum potential for improvement. The trainer is also acutely focused on the athlete whose sole objective is to increase maximal performance. Non-professional athletes do not have the luxury of such intensive observation and performance monitoring…unless, of course, the therapist puts on a dive mask or goggles and watches closely with their head under water. Granted, some observations can be made by either the trainer or therapist from above the water’s surface. However, the added benefit of underwater observation can improve the outcomes. If not, sidewall windows in therapy pools would not be created with outside video cameras transmitting or recording the movements within.

Finding an aquatic therapist who is willing to get into the water and observe under the surface can be one’s best investment in personal aquatic programming as well as possibly insure the best possible outcomes for the participant. In many cases of aquatic therapy, it is not reasonable or justified to have a physical therapist treat patients on the same day he or she works as an aquatic practitioner. After all, their time is billable hours and transitioning from land to pool and back again is valuable billable hours lost. Aquatic therapy associations can do more to benefit participants and promote best possible outcomes by lobbying for changes in both insurance coverage and licensing for their members.

Another consideration for programming is music. In many therapy settings, a background accompaniment of soothing music can enhance the experience, aiding in relaxing the participant and helping to center and focus the mind. Quiet times in natatoriums are a rare occurrence in some facilities hence the use of soothing music necessitates the quiet environment.

Physical therapy practices that have therapy or warm water pools are far more likely to have opportunities for quiet times as well as access to sound systems and music that fit the therapeutic objective. Community pools, YMCAs and other athletic clubs are not likely to provide such experiences, except at some limited or designated times. However, many physical therapy practices do not have pools, largely because of the expense. They may only offer aquatic therapy using other facilities where the noise must be tolerated, and therefore cannot offer therapies in quiet classroom formats.

When considering aquatic therapy, programming is one component of the total experience that needs consideration. The skills and credentials of the practitioner, along with the features of a facility, make aquatic programming play a significant role in the participant’s decision to pursue one of the most effective means of self-care currently available in 21st century America.

Felecia Fischell is an Aquatic Specialist with twenty-three years experience in aquatics. She leads aquatic classes and consults as an aquatic personal trainer and a swim instructor at the Franklin County Family YMCA in Virginia. Formerly the Founder of FunLife Aquatics Consulting in Maryland, Felecia presents at health fairs and has given aquatic presentations to high schools, Howard County Board of Education, Howard County General Hospital and Howard County Community College.

Selecting an Aquatic Facility

10/16/201504/19/2016North AmericaLeave a Comment

In honor of National Physical Therapy Month, Global Health Aging is presenting a weekly four-part article series on aquatic therapy. This is Part 3 in this series. Part 1 focused on the aquatic therapy marketplace and Part 2 focused on selecting an aquatic practitioner. Click here to read Part 4.

Selecting an aquatic facility may be one of the most personal considerations for a prospective aquatic patron. Depending upon an individual’s circumstances, the choice of which facility is best for each patron may vary. At one extreme, there are classes in a resort location, on the shore of a beach or off the dock of a lake home. However, the most common facility is the community pool.

Different health considerations and performance or functional objectives may be central to any patron’s focus. Therefore, an aquatic consultant may be helpful in isolating a patron’s specific requirements. This article focuses on natatoriums (indoor swimming pools) that are open year round as well as some of the many important features of an indoor facility including Access and Water Temperature/Depth.

Access

Zero Depth Entry
Wide Stairs with Handrail(s)
Chair Lift
Pool Ladder

Getting into and out of a pool can be a problem for a large number of people who will benefit from aquatic therapy and exercise. In the bullet list above, Zero Depth Entry is the most desirable way to enter the water gradually. Consider wave pools designed with a wide cement slope into deeper and deeper waters of the pool.

In a cost-effective simulation to the wave pool design, a sloping ramp that may actually contain a turnaround or two is ideal. It is much like wading into the ocean, but without the risk of shells underfoot, jellyfish stings, or waves that knock one off balance. In essence, a patron may walk or move their wheelchair into the water using a gently sloping ramp.

Wide Stairs: Ideally, handrails on both sides are sufficient for at least 90 percent of patrons accessing the pool waters. These standard rise pool steps are very helpful in performing some types of therapeutic exercises; a definite plus for most patrons.

Chair Lift: This is very important to consider as land-based ambulation requires canes, walkers and especially wheelchairs. One note of caution to wheelchair-bound patrons: transition between wheel chair and chair lift can be challenging. In addition to a lifeguard on duty, a patron needs a caregiver to assist and perhaps even accompany the patron into the pool. Skill set, including licensing and certification requirements for practitioners and instructors, is undefined in this circumstance. In other words, the patron’s aided entrance into the pool cannot be assumed to come from the aquatic practitioner.

Pool Ladder: Despite being the most difficult to use, pool ladders affixed to the poolside and deck can be quick and accessible for patrons with sufficient upper body strength and balance. Safe entry into the pool from a ladder attached to the pool deck requires backwards entry. Patrons should consider placing one foot on each subsequent rung although it is more important to focus on the distance between the bottom last rung and pool floor, especially if the patron is not “water safe” (able to float, swim or otherwise not panic when not grounded to the pool floor).

Emphasis must be restated on the requisite upper-body strength to hoist oneself up each rung of the ladder if no easier exit is available.

Water Temperature/Depth

Temperature
Depth

Temperature: In most circumstances, temperature and depth are equally important. Patrons can generally tolerate aquatic aerobic exercise at 78 degrees F and up to about 84 degrees F or perhaps 85 degrees F. Therapeutic water temperatures are best between 88 degrees F and 92+ degrees F. However, some medical conditions like multiple sclerosis need cooler temperatures even though temperature considerations can also affect certain people with diabetes and some neurologic or degenerative conditions. Arthritis patients have their own specific condition guidelines: 84-88 degrees F for exercise and 92-100 degrees F for therapy.
Note: Facilities that come close to the temperatures necessary for a patron’s specific use can still be considered when the patron invests in warm-water apparel such as a wet vest or aquatic wetsuit.

Depth: Manufacturers in the personal and therapy pool industry tend to hover around a 4-foot-8 to 5-foot-2 inches maximum depth for vertical exercise applications. These parameters seem to target patrons at or below 6-foot in height, which means that a waist belt or noodle is employed to support patrons adequately to achieve full range of motion (ROM) of extremities when suspended (not touching the pool floor) in water.

Depth, of course, is a specifically personal consideration, especially when a patron may not be “water safe.” Comfort in the water, where a patron is able to relax and not panic, is the ultimate consideration in patrons who are self-described as “afraid of the water.”

The choice of water depth is sometimes also a personal consideration. In therapy, if the focus is rehabilitating a joint on a lower extremity, the patron will begin in deeper water, somewhere between shoulder and chest or sternum depth, and progress to more weight-bearing, shallower water when the muscles and joints are stronger. However, depending upon an individual’s center of buoyancy or COB (as it relates to lean muscle mass), it may be difficult for some patrons to stay grounded on the pool floor. If the patron is not water safe, staying grounded will be necessary for the participant to remain relaxed. Fear induces muscular tension which can be counter-productive in aquatic therapies and exercise. Involuntary or unintentional rigidity of muscles may increase the chance of injury and it will make the patron more likely to sink. At a minimum, the tension may inhibit the participant’s ability to perform the exercises with proper form and control; thus making the time spent working not as effective as it can be.

Deep water exercise tends to encourage the use of flotation devices like noodles, hand buoys, and waist belts. By far, the waist belt is the most effective equipment to use in water when performing vertical workouts like cross-country skiing, deep water running, leaping, jumping jacks and other moves where all limbs may be working concurrently. A noodle may be straddled between the legs or wrapped around the back either at the waist or under the arms. Hence, deep water can be a very rigorous form of aerobic work, targeting not only muscle strength but also endurance. Deep water exercise can also enhance range of motion when performed slowly or with a hold between changes of direction of the limbs. One of the most important considerations about deep water work is that postural alignment is maintained with shoulders back (and down) over the hips. This alignment is critical in maintaining core strength and minimizing back strain.

The task of selecting a facility has so very many different considerations to review in making a choice. Often, an aquatic patron does not have the luxury of a large selection of facilities available to them. When visiting a facility and observing the staff and instructors, all these ideas will prepare the new patron to be watchful of conditions, which can make it necessary to plan and prepare ahead of their first aquatic therapy or exercise experience. A good question to always ask on a site inspection is whether towels are provided.

Water is, for most people, a therapeutic medium when comfort of the patron is properly addressed. Plan to heal, grow stronger and enjoy!

Selecting an Aquatic Practitioner

10/09/201504/19/2016North AmericaLeave a Comment

In honor of National Physical Therapy Month, Global Health Aging is presenting a weekly four-part article series on aquatic therapy. This is Part 2 in this series. Part 1 focused on the aquatic therapy marketplace. Click here to read Part 3.

Over the last thirty years, the field of aquatic therapy has steadily grown in US allied healthcare. Insurance companies that reimburse for aquatic therapy ONLY reimburse for a licensed physical therapist or maybe a physical therapy assistant. Depending on the state, there are some workarounds like a certified instructor being employed by a physical therapy practice or hospital. All too often, though, the employers err on the side of legal caution, fearful of liabilities which may be inherent in land-based physical therapy but seem almost non-existent in aquatic therapy.

Out of respect for those licensed in physical therapy, Aquatic Therapy Rehab Institute (ATRI) certified instructors, who do not have a degree and license in physical therapy, are discouraged from calling themselves “aquatic therapists”. Physical therapists, however, are not required to have aquatic certification to bill for aquatic therapy. So, if you are in need of aquatic therapy, perhaps as pre-operative conditioning or after your insurance allowable coverage for physical therapy has been exhausted, what can you look for in an aquatic professional?

Many reputable organizations either post or offer access to staff biographies. Like they do in the physician offices, those practicing aquatic therapy should specifically display their credentials. A certificate, license or degree from a bona fide organization can be a first tier requirement. Certifications usually require professionals to obtain continuing education hours to maintain credentials. This must be done every two years or less, and professionals should display the one that is relatively current.

Certifications from organizations like ATRI, Aquatic Exercise Association (AEA) and Aquatic Therapy University (ATU) may give an indication that your practitioner has met certain stringent requirements to authenticate their expertise. ATU has more recently been established specifically to target degreed professionals in both physical and occupational therapy. In some instances, even speech pathologists are obtaining certifications as evidence is now emerging on warm water activities. The soothing effects of such activities can advance progress in remediating stroke, traumatic brain injury (TBI) deficits or other speech pathologies, including some oral cancers.

Across all three certifying organizations, a broad and sometimes intensive proficiency needs to be demonstrated. This includes sufficiently answering test questions governing anatomy, physiology, kinetics and some physics as it pertains to water properties, as well as skill demonstration, especially when performing physical manipulations in the water.

Even when a licensed physical therapist is practicing aquatic therapy, it is important to know what additional training and credentials the aquatic professional may have by a certifying organization. All the knowledge of anatomy, physiology and kinesiology may not be as helpful if the practitioner has not spent a significant amount of time in water experiencing how the body works differently on land and in waist or shoulder deep water. It is more important that the aquatic practitioner have a deep understanding of how the properties of the water can be used to best achieve the functional goals or milestones of the participant.

Thus, beyond finding credentials, seeing is believing. Take time to observe your aquatic practitioner and ask permission to observe – perhaps make a video with your cell phone or take notes. Compare one practitioner to another or better yet several others! Look to find many of the following qualities:

Clearly defined milestones and functional goals/expectations of outcome;
Workload progression that supports goals: meaning variances in
- time to accomplish an exercise;
- range of motion;
- effort or exertion;
- depth of water used;
- length of extremity in activating a particular joint;
- exercises performed where extremities are operating in different depths;
- exercises performed where extremities are operating in different planes;
- use of equipment such as drag and buoyancy equipment;
- cadence/rhythm/speed;
- breath cueing and control (when to inhale and exhale; diaphragmatic breath);
Attentive observation of and note-taking about the patient (some PTs bring their laptops poolside and pay more attention to their computer than their client);
Apparent knowledge of how to make modifications of exercises to insure progress without pain or injury;
Cheerful disposition and encouragement based upon progress toward goals.

With all or most of these objectives meeting your approval, ask to speak with the professional and ask for referrals. In some cases, aquatic practitioners are award winners in their fields. They may have published research articles or been written up in a local paper or support group newsletter. Be sure to contact references and add their comments to your observation notes. It is best to have a conversation with a prospective aquatic specialist to make sure you communicate easily and understand their instructions. Sometimes, communication disconnects can derail the most qualified professional’s efforts to guide you toward your functional goals.

This kind of upfront investment in your self care may prove the best return for not just your dollar, but more importantly your well-being. After all, your health is your greatest wealth!

Aquatic Therapy Marketplace

10/06/201504/19/2016North AmericaLeave a Comment

In honor of National Physical Therapy Month, Global Health Aging is presenting a weekly four-part article series on water aerobics. This is Part 1 in this series. Click here to read Part 2.

Welcome to the 21st century and a new American Healthcare System. The advent of the Affordable Care Act (ACA) and its gaining foothold of functional acceptance in America presents an interesting opportunity for citizens who are making a paradigm shift: movement from managed health care to managed self care. Who will be making this shift? Citizens are moving into a realm of do-it-yourself healthcare management through many fields of allied health.

One such allied healthcare service is becoming more commonly prescribed and sought after: Aquatic Therapy. National collegiate teams and professional franchises have led the way as it is most commonly used in sports medicine. Patrons in private and public clubs, especially non-profits like YMCAs, are blazing new trails in aquatic practices, catching up with other countries around the world.

Whether it is prescribed or not, many patrons now choose to seek services outside the coverage of their insurance. In the 21st century, aquatic exercise and therapies are steadily growing with the aging of the baby boomer population. The trend is growing more rapidly in younger populations where an overuse injury from a favorite sport may occur. The younger “weekend warriors” are aware of the conditioning and rehabilitative outcomes from employing aquatic exercise and therapies in support of their favorite sport.

In today’s aquatic marketplace, how can new patrons, of any generation or experience, determine what is desirable in an aquatic program, facility or instructor? The industry is so new that standardization in practice is far from being established and even farther from being commonly known or accepted. Insurance regulations governing those who may be reimbursed for services are sorely misaligned. This means that many aquatic therapy participants can get insurance coverage for “aquatic therapy” but it may not be the best available instruction and care.

Knowing this about the industry now, three questions come to mind: What do you look for in an aquatic facility or program? And thirdly, who or what kind of person with what skill-set or credentials is most important when becoming a patron of aquatic therapy?

Since university degree programs and licensing in physical therapy do not instruct or test students in this aquatic modality, aquatic patrons need be guarded in their pursuit of care. Water exercise can be performed anywhere between high impact and totally suspended, meaning no contact with the pool floor. This variance assures that there is some effective form of aquatic therapy for all ages, most types of injuries, and almost any physical condition a person may need to address. Even speech pathologists are gaining advancements through aquatic environments.

Water therapies can be passive or active. An active therapy is something the patron does in response to the therapist’s instruction and it may ultimately become an exercise. A passive therapy is a physical maneuver or manipulation that the therapist does to the patron’s trunk, limb or extremity. More often than not, passive therapies are practiced only by those aquatic professionals specifically trained in aquatic therapies. They may or may not hold a degree or license in physical therapy.

As the aquatic industry continues to evolve, it can very well become its own discipline in colleges. Presently, there needs to be a lot more work put toward the effort of standardizing practices, quantifying outcomes and modifying insurance coverages. This will allow certified professionals even without degrees in physical therapy to be compensated or reimbursed for their services.

When practitioners universally understand and consistently use the properties of water to their fullest potential, then best outcomes for patrons will emerge. Aquatic therapies will then become a first line application for preventative and restorative allied healthcare. For instance, physicians will prescribe pre-operative aquatic conditioning to keep the muscles, ligaments and tendons surrounding a surgical site as strong and healthy as possible. Doctors will also place post-op patients in water before commencing land- or weight-bearing exercises so that the supporting muscles, tendons and ligaments can begin moving sooner and speed the healing and recovery process from the surgery performed. The efficacy of aquatic therapy is growing exponentially, thanks to the wisdom of experience; once relegated to senior citizens. The positive experiences of seniors may now be shared by all ages with varying abilities and health constraints.

Aquatics for Life

02/22/201502/24/2016North AmericaLeave a Comment

Inactivity in the elderly has become an ever increasing epidemic in the United States. Politicians as well as insurance and health care providers need to band together to reverse this trend to insure the longevity and quality of life. The elderly are not only at risk for lifetime diseases such as diabetes and heart disease; they are at risk for greater loss in bone density which translates into greater probability of falling and breaking bones.

Land-based physical activity is important for the elderly as it increases muscle and strength development, bone density and endurance which are both respiratory and cardiovascular. On the other hand, aquatic exercise benefits EXCEED land-based activities since it trains muscle parity and balance. Land-based exercise in the elderly is fraught with potential for injury. Likewise, unsupervised weight training can lead to torn muscle fibers, strained or torn ligaments, and unbalanced overtraining of some muscles while not sufficiently training the complementary muscles equally. Water exercise in a class format allows for participants to work at their own comfort level of perceived exertion. Good water instructors will always cue participants to work below the threshold of pain. In other words, participants can work to tension and ask for modifications of moves when in pain.

For the elderly, a good rule of aquatic exercise is to be mindful of aches and pains in advance of a water workout. If two hours later, the pain is greater than before training, then the participant has done too much. At this point, they can notify the instructor for modifications of moves that may affect their pain experienced. Because aquatic exercise trains complementary muscle pairs like biceps and triceps, the potential for injury in land-based exercise or activities of daily living (ADL) is reduced. Moreover, aquatic activities not only balance muscle pairs, they inherently strengthen the core muscles which provide for better over-all balance and strength. Core strength can show some correlation to immunity and overall health.

All seniors, especially those who are overweight, need to exercise in a muscle-balancing, core strengthening and reduced-risk-of-injury environment. Aquatic exercise is perhaps the ultimate life-time sport!

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Air Temperature

Noise Level and Water Quality

Sound Systems

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Water Temperature/Depth

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