Aquatic Therapy after a Stroke
By Walt Kilcullen
What is Aquatic Therapy?
Aquatic therapy (also called water therapy, hydrotherapy, and pool therapy) is using a warm water pool facility to perform physical therapy. It is designed to help the survivor using both the buoyancy of the water and the resistance of the water to improve balance, strength, and to reduce chronic pain. It has the additional benefit of reducing or eliminating the fear of falling during the therapy. Warm water therapy offers a safe and relaxing setting to improve physical skills.
Why Aquatic Therapy?
I had never heard of aquatic therapy until I visited the “Y” in Randolph, New Jersey where I saw a demonstration using a special treadmill in the therapy pool adjusted so that the water came up to the patient’s chest. I was told the water temperature was kept between 85 and 90 degrees.
Until recently, physical therapy applied to stroke survivors followed traditional physical therapy at a gym, in a physical therapy facility, or a rehabilitation hospital. Aquatic therapy will not replace traditional physical therapy but it is a wonderful therapeutic aid that can later be continued as traditional physical therapy in a gym or even at home.
Aquatic therapy gives the patient greater mobility because body weight is decreased significantly (up to 90%) and water buoyancy creates balance making movement easier. Since the water aids balance, the patient has an easier time with flexibility and stretching muscles. Because of the buoyancy that the pool water provides, the patient can stand up with far less physical strength. Some survivors, who cannot walk on land, find they are able to stand up and even walk in a pool.
Aquatic therapy results in strength improvement because the water provides resistance similar to the concept of isometrics. Resistance increases the survivor’s ability to regain muscle performance, motor skills, and flexibility.
Aquatic therapy has also been successful in reducing chronic pain. In a warm pool, spasticity or tone is reduced during exercise which is often the cause of upper and lower extremity pain. Even head pain may be reduced because the warm water calms the body releasing endorphins, which are natural pain killers. (Much of the information for this section on “Why Aquatic Therapy?” came from: “The Healing Benefits of Water,” Lisa Nagg, Stroke Smart Magazine, Winter, 2012.)
Aquatic therapy is often divided into two types: deep water exercises and shallow water exercises.
Deep water exercises use water buoyancy to balance the body in an upright position so that the patient can stretch, walk (sometimes on a treadmill when available), run in place, and perform bicycle movements while holding on to the side of the pool. All of these exercises are much easier in water than in the traditional physical therapy setting.
Shallow water exercises are designed to help the stroke survivor gain strength and balance as a transition to walking on land. Walking in shallow water is the primary exercise. The patient walks around in the pool avoiding obstacles placed randomly on the pool floor. Because the water is no more than knee deep, balance is more difficult, but once that skill is mastered, the patient can transition to land exercises. (Most of the information in “Specific Techniques” above came from “Pool Therapy as Stroke Rehab, “Linda Huey, Word Press published on-line, May 3, 2012).
In a case study concerning a patient who received aquatic therapy at Vital Energy Wellness and Rehab Center in Lexington, South Carolina, the following results were published: The patient suffered right side paralysis resulting from a stroke, and was unable to stand, walk or perform other normal functions. After aquatic therapy, she experienced decreased pain and has improved muscle strength and balance. She is now able to sit up in a chair, roll over in bed, and assist with transfer to and from her wheelchair. (“Stroke Patient Increases Mobility with Aquatic Therapy,” HydroWorx, July 12, 2013).
I found several other studies that showed there are significant benefits using aquatic therapy after a stroke. In a 2008 study comparing two groups of stroke survivors; one group received conventional physical therapy, the other aquatic therapy. The findings were that the aquatic group improved significantly more in strength, balance, and knee flexor strength than the conventional physical therapy group (study by Dong Koog Noh et. al., Seoul National University College of Medicine, 2008).
Christine Shidla, Director of Wellness, Summit Place Senior Campus, in Eden Prairie, Minnesota, states, “For stroke survivors, we see at our facility, exercise in the water has the power to change their lives. Often our clients have been discharged from the hospital or land-based therapy because they have ceased to make gains. Undaunted and determined, they turn to us to develop innovative exercise programs in our underwater treadmill therapy pool. The results normally lead them to accomplish goals they could not otherwise achieve.
Finding an Aquatic Therapy:
Finding a facility is easy. Finding a facility close to your home that your insurance will cover can be more difficult. My advice is to do your own research by using the following resources:
Editor’s Note: Many Stroke Network members are enthusiast about Aquatic Therapy. Here are links to some article we have published over the years sharing personal experiences.
Walt is a retired guidance counselor. He has been a mentor for stroke and traumatic brain injury survivors for the past 15 years.
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The Stroke Network, Inc.
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