Applications in Therapeutic Recreation Aquatic Therapy Applications in Therapeutic Recreation Broach & Dattilo, 2011

Defined… Passive or active exercise and swimming as modalities for habilitation or rehabilitation.

Considerations Various settings Participation in enjoyable activity -> increased functional ability Utilize techniques to increase comfort in water Some interventions require ability to mentally adjust to the water Assessment Land vs. Water Groups Technique Varying ability

Therapeutic Qualities of Water Warm Temperature (92-94) Relaxation Improved circulation Reduced spasticity/tone Increased metabolism Resistance/Viscosity Improves strength & conditioning Buoyancy Improved mobility Less weight bearing Hydrostatic Pressure Increased vital capacity

Common Populations Served Multiple sclerosis Cerebral palsy Cystic fibrosis Arthritis Orthopedics & Mobility Impairments Asthma Bariatric

Aquatic Therapy Interventions Adapted Swimming Methods Sensory Integration Activities Bad Ragaz Watsu Ai Chi                       

Adaptive Swimming Methods Halliwick Method Developed by James McMillan for CP in 1930’s Outcomes: balance, motor control, hyper/hypotonicity, fear of water, Highlighted by 10 step process No floatation devices 1:1 participant to instructor Neurodevelopment treatment Dolan Method Developed by Mary Dolan to teach individuals with autism to swim Highlighted by Patterned motor skills Verbal praise Gradual removal of flotation devices

Sensory Integration Activities and exercises that promote integration of: Vestibular Tactile Visual Auditory Bilateral integration Proprioceptive

Bad Ragaz Comes from Bad Ragaz, Switzerland Resistive exercises, apply Proprioceptive Neuromuscular Facilitation (PNF) principals Spiral and diagonal aquatic movements used to enhance movement Isometric (hold), isotonic (specialist, push/pull), isokinetic (participant resistance), and passive (slow stretching) patterns

Watsu Mandala Spa Water Shiatsu Utilizes general rhythmical rotational stretching, rocking, and pressure point techniques found in Zen Shiatsu for therapeutic gain. Advanced Certifications available (WATSU I & WATSU II) Designed to treat: Muscle tension, Pain, Spasticity/tone, Stress & anxiety, ROM, Body awareness, Chronic fatigue, Depression Mandala Spa

Ai Chi Modified Tai Chi in water Excellent technique for range of motion, mobility, centering, and relaxation. Useful as an independent program for patients to follow up their treatment regimen. Advanced training available in Ai Chi.

Contraindications of AT Osteoporosis Sensitivity (Hyper/hypo) Pain Fibromyalgia SCI Joint ROM precautions Hip replacement No internal rotation or adduction past neutral; no flexion past 90º Skin precautions Open wound Frequent Ear Infections Excessive vertigo Fatigue (MS) Incontinence Inappropriate Behavior

Efficacy of Aquatic Therapy (AT) Physical Implications Decrease pain (Guillemin et al., 1994) Prevent bone loss (Tsukagars et al, 1994) Increase strength (Broach et al., 1997) Increase endurance (Wright & Cowden, 1986) Improve pulmonary function (Haung et al., 1989)

Efficacy of AT Psychological Effects Improved body image (Benedict & Freeman, 1993) Decreased depression symptomology (Stein & Motta, 1989) Positive Mood (Berger & Owen, 1993)

Specialty Certifications Intervention specific Halliwick, Bad Ragaz, Watsu… Aquatic Therapy and Rehab Institute (ATRI) http://www.atri.org/ATRICertification.htm Aquatic Fitness Certification Adapted Aquatics Instructor Arthritis foundation http://www.arthritis.org/aquatics.php Lifesaving/Lifeguard

Case Study 47 year old female with fibromyalgia. Diagnosed 4 years ago. Reports pain throughout most areas of her body. Has headaches 3-5 days per week. Fatigues easily. Rests 3-4 times per day. Has difficulty sleeping. Works part time as a secretary but frequently misses work secondary to pain and fatigue. Her job consistently increases pain in her arms, shoulder and neck. She currently receives a massage once a week, which provides her with pain relief for several hours. No current exercise program. Has tried exercise in the past, but has always quit secondary to pain. She admits she has a tendency to “over do” and then “pay for it” for several days.

Case Study 45 year old male left side CVA (right side affected). Working as an assistant manager at local grocery chain when stroke occurred. Has no family near by, but girlfriend of 7 months is local. Right arm is spastic and right leg is flaccid. Patient is not terribly motivated. Patient has a mild fear of water, but is willing to give aquatic therapy a try. Patient enjoys dancing with girlfriend at local taverns and beach clubs.