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

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

3. 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

4. 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

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

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

7. 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

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

9. 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

10. 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

11. 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.

13. 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

14. 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)

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

16. Specialty Certifications
Intervention specific
Halliwick, Bad Ragaz, Watsu…
Aquatic Therapy and Rehab Institute (ATRI)
Aquatic Fitness Certification
Adapted Aquatics Instructor
Arthritis foundation
Lifesaving/Lifeguard

17. 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.

18. 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.