Empowering Patients with Aqua Therapy

MossRehab’s multifaceted aqua therapy program aims to heal chronic pain, promote function and boost confidence

Aqua therapy has been on the rise for several years now. The physical therapy community continues to recognize its potential and the benefits it can offer for both therapist and patient. ADVANCE took a closer look at the aqua therapy program at MossRehab in Norristown, Pa. to find out how the physical therapy department there is using aquatic therapy for a variety of patients.

“The aquatic therapy program at MossRehab consists of focused, prescribed exercise and functional mobility training in a heated therapeutic pool,” said Carolyn Kibelstis, PT, MPT, clinical manager of MossRehab Outpatient Center. “We provide multidisciplinary care to a diverse patient population; diverse in regards to demographics, socioeconomic status and diagnosis.”

Who are the Patients?

Anyone with certain injuries or conditions can benefit from aquatic therapy that is complementary to their existing regimen. “Our program is for patients who are limited by pain and decreased mobility. They have difficulty tolerating land physical therapy 1-2 times per week,” said Lakisha Murray, staff PTA at MossRehab. “When starting patients in aquatic therapy, they are able to perform gait activities and therapeutic exercises easier, and with reports of decreased pain levels. This facilitates increased strength and comfort levels for the patient, so transitioning back to land and performing their daily activities is easier.”

The types of patients that would have use for aquatic therapy may be present with some of the following:

  • Neurological diagnoses such as stroke, TBI, cerebral palsy and other progressive diseases;
  • Spinal cord injury;
  • Nerve injury;
  • Arthritis (osteoarthritis and rheumatoid);
  • Joint surgery;
  • Osteoporosis/osteopenia;
  • Orthopedic injuries of the spine and/or joints;
  • Pain due to pregnancy; and
  • Chronic pain/fibromyalgia.

According to Murray, aquatic therapy is a form of rehab that offloads the joints, making it easier for patients to walk and perform exercises that they would normally have trouble doing on land – which is why it’s a successful form for the aforementioned patient population.

Two Complementary Elements

As relaxing and approachable as aquatics are to patients reluctant to perform land exercise due to pain, the necessity to apply the progress they’ve learned in the pool on land is prevalent. “We take into consideration that while a patient can make significant progress in the pool, they still live on land; we need to ensure that whatever gains they are making in the pool is translating into gains on land,” said Kibelstis. “So at MossRehab, our therapists’ plans of care reflect a mix of aquatic and land therapy for each patient found appropriate for aquatic therapy.” She added that it’s very rare that a patient will receive solely aquatic treatments.

So how do therapists determine the ratio of aquatic to land therapy on any given patient? Kibelstis says it simply depends on the situation. “We look to previous and current research to assist us in making decisions regarding what frequency of aquatic to land therapy is optimal; and we find there is not a set answer,” she revealed. “We make our determination based on information from research, patient presentation and evaluation results.”

Moreover, Murray believes aquatic therapy has been an important stepping stone in easing patients’ fears of movement on land. “I feel that aquatic therapy is important because most of my patients who had solely land-based PT in the past had less than satisfactory results. Aquatic therapy allows the patients to realize that they can perform exercises that they have done on land in the past; which makes them less reluctant to return to land-based PT,” she said. “Patients feel more comfortable walking and performing balance activities in the pool, especially those patients who use an assistive device.”

“As a therapist, when a patient with pain who is so afraid of movement enters the clinic, I recognize how lucky I am to be able to offer them the option of aquatic therapy,” Kibelstis reflected. “Once they learn not to fear movement and learn more about how their body reacts to movement and how to stabilize, they can bridge to the land and progress further toward achieving their goals.”

Power to the Patient

A unique part of the aquatic program at MossRehab is the M-Power Aquatic Classes offered by the therapists. According to MossRehab, this program is specifically designed for participants limited by chronic pain. The goals are to educate and show patients exercises that will assist with reducing chronic pain and stress. This can help improve sleep and aid in the healing of the body and mind.

“Our M-Power program was created when a need was recognized for continuation of care options and support for those patients of ours dealing with chronic pain,” explained Kibelstis. “Our overall goal was to create an affordable and comprehensive pool program with a focus on exercise, education and community to empower people to take control of their pain.”

Kibelstis provided three main objectives for the outcome of the M-Power program:

  • To provide a community of support while increasing the activity level of participants. People who share a commonality, such as chronic pain, will support each other and hold each other accountable to attend class. M-Power participants who come in and state they just did not feel like coming to class usually leave stating how glad they are they came and that their pain is less.
  • To empower participants through pain-theory-specific education to decrease anxiety, fear or feelings of helplessness. Participants receive one-on-one pain theory education, during which they are provided with the book Why Do I Hurt? by Adriaan Louw, PT, PhD, CSMT, which assists in educating participants about the neuroscience of pain at a level everyone can relate to and understand.
  • To assist in breaking the cycle of patients’ repeated return to courses of therapy because they feel it is their only available resource to address their pain. To date, the program has had three participants who were previously physical therapy patients. They have not felt the need to return to therapy over the last eight months since the program initiated.

“I have seen positive results with the M-Power aquatic exercise class,” added Murray. “A handful of my former patients with chronic pain have joined the class. I’ve noticed in them a more positive attitude and increased motivation to exercise.”

Empowering the Patient

The biggest benefit of the aquatic program at MossRehab seems to be the self-assurance patients gain when they are able to do their exercises with limited pain. “I have seen [aqua therapy] change people’s lives. When patients enter the water, I’ve seen the relief on their faces,” said Kibelstis. “I’ve seen someone move past their fear of movement and learn more about what their capabilities are in a bodyweight-supported environment.”

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