“Why you never miss your aquatic therapy session in your therapeutic pool?” friend asked this question to his friend who is confined to a wheel chair. “I feel Independent; the day I entered into the water for the first time it was a blessing and literally I got tears in my eyes as my body felt better. I was able to hold the ball at a range which I never expected I could,and you will not believe, but first I started with assisted swimming and then independent swimming in the same pool. I feel like I have my wings which are helping me to float and move in the water.” This is the conversation overheard by me as a therapist and it was a dilemma for me whether to thank Aquatic Therapy and AquaCentric Therapy for providing such a great environment or to apologize for over hearing conversation.

Introduction:

Physical Activity is a nourishment for our “Body” and “Soul”. Movement is a key to our existence as it allows us to carry out our daily activitiesand to be a part of this modern fast world by keeping us on our feet. Kids perform physical activities by playingand adults perform their daily work life. However, many take this ability to perform physical activities for granted and are not able to understand the importance of movement.

Good movement is a foundation of good health and we shouldtruly  appreciating the importance of Movement as it provides us feeling of health, wellness and a high quality of life(Hall, 2005). When life gives us a sudden pause in the form of an injury, our existence is no longer as we have known it to be. Beingconfined to one placeoften brings with it a feeling of helplessness; that feeling is what a person, whether an adult or a child, feels when they are confined to a wheelchair.

Research indicates that

• physical activities impact teenagers’ social relations with their peers and parents (Faigenbaum, 2000).
• Further, studies suggest a negative correlation between physical activities and anxiety, depression and stress.

When physical activities are performed,

• The levels of anxiety, depression and stress decrease.
• There is a positive correlation between physical activities and self-respect and self-perception (Berger and Owen, 1983).

Owing to these  benefits, physical activities should be an integral part of the routine of our friends who are confined to wheel chair.

One of the important physical property of water is Buoyancy. A body or body part immersed in water will experience this buoyant force, which reduces the force of gravity on the body and, thus, decreases weight-bearing on the lower part of the body. Exercise of the extremities can be assisted by buoyancy. A person standing in water up to the neck can raise an extremity with the assistance of buoyancy.(Torres-Ronda L, Del Alcázar XS, 2014)

As aquatic therapists, we observed “Water as an environment providestremendous motivation to perform movement, it provides new avenues for movement which are less explored such asthere is an opportunity for overall postural correction, synchronization of breathing to perform various activities in water as well as integrating sensory system to provide rehabilitation. Children love being in the water and actively engage themselves which in turns increases their participation in Physical Activity and that is a huge advantage to achieve goals and function on land. There is always a sense of joy, fun and emotional security provided by water when you let go and surrender to it completely.

Here I would like to describe journey of two of our heroic friends because they changed my perspective ofAquatic Therapy.

Case 1: Miss A, our first case, is a 14 years old sweet, passionateand highly intelligent girl who has  a  very rare Merosin Deficient Muscular Dystrophy, Progressive disorder which affects muscles of the body and forces one to confine to a wheel chair. She has been with us for more than a year now and actively participates in the sessions. When the parents visited us at AquaCentric Therapy, they were concerned about how aquatic therapy will be useful for their child. They startedaquatic therapy immediately after the first consultation and their daughter was self-conscious about herself. Her journey with water started withher being able to sustain 15 mins of play time to being able to complete a full 45 minutessession in the pool.Owing to an environment in which she was comfortable,we had an immediateopportunity tobond.As a resultof persistence and continuous efforts,with assistance, she is now able to completes 4 to 5 laps of our 500 Square Feet heated therapeutic pool as a part of mobility training. She does not like to miss any session because with one neck float she becomes independent in the pool and enjoys the session. With our advance aqua treadmill, she is able to walk on itwith my assistance which is needed for maintaining her muscle strength without damaging it further. We have our therapy session in which 15 mins is specially specifically for play time in which we play various games to engage different body muscles. And then we close our session with respiratory muscle strengthening by various props and swim based movement with breath coordination. Thatjoy which she experiences because of sense of independence is very important not only for her physical needs but for her body image and overall confidence level.

Case 2: Our second case is a 94 years “Young”enthusiastic and confident person, Mr. G, who even at this age enthusiastically wanted to give a try to Aquatic Therapy with existing limited mobility andadditional agerelated visual impairment.He came with a concern of inability to stand and walk due to issues in his spine. We took him in to the pool by using a mechanical lift called “Hoist”,he was confident on his performance and we were confident on our skills due to which we were able to make him stand with minimal support in the second session itself. And then by third session onwards he was able to walk independently under supervision. It was fascinating to see his improvement after every sessionand as unbelievable as it may seem,after few more sessions he was able to walk on aqua treadmill as well on a slow speed.Moving forward we even raised platform of treadmill to balance forces of gravity and buoyancy to facilitate more muscle recruitment and bravo; he did manage to achieve 30% emersion and 70% body out of water which helped us to have standing transition on land.We moved further and were able to do various balance tasks further in the pool. The satisfaction to see him doing all physical activities which seems impossible to do on land at that time cannot be described in words.

Case 2 : Mr. G / 94 year old male

Aquatic Therapy AS A medium helped US immensely to achieve a better transition and functional carryover on landwhen combined with appropriate activities on land. Water is a beautiful medium and under guidance of experienced therapist we can achieve and explore the things that seems impossible for our patients. With that said let us all try to explore possibilities of using Aquatic Therapy as a tool. I would also like to thank all patients for trusting me and teaching me each and every day about newer unexplored dimensions of water. Let us enjoy and cherish our functional independence and help our friends to achieve and enjoy their independence. 

Dr. Manthan Gajjar MPT

Neuromuscular Disorders

Paediatric Physiotherapist and

Aquatic Therapist

References:

882. Atamturk H, Atamturk A. Therapeutic effects of aquatic exercises on a boy with Duchenne muscular dystrophy. J ExercRehabil. 2018;14(5):877-882. Published 2018 Oct 31. doi:10.12965/jer.1836408.204
883. Chapter 5: Hydrotherapy: The Use of Water as a Therapeutic Agent Elaine L. Bukowski; Thomas P. Nolan

• Archer S. Aquatic exercise and arthritis. AquatTher J. 2002;16:29–31. [Google Scholar]

15. The entangled geographies of social exclusion/inclusion for people with learning disabilities.Hall E Health Place. 2005 Jun; 11(2):107-15.
16. Strength training for children and adolescents.Faigenbaum ADClin Sports Med. 2000 Oct; 19(4):593-619.
17. Mood alteration with swimming–swimmers really do “feel better”.Berger BG, Owen DRPsychosom Med. 1983 Oct; 45(5):425-33.

• Torres-Ronda L, Del Alcázar XS. The Properties of Water and their Applications for Training. J Hum Kinet. 2014;44:237-248. Published 2014 Dec 30. doi:10.2478/hukin-2014-0129