The utilization of aquatic protocols with neurological patients is very different from orthopedic protocol development. Each patient with a neurological diagnosis requires an initial identification of the neurological progression and a determination of the patient’s ability to progress. It is also important for the therapist to understand what the patient can control mentally and physically.
Although diagnoses and progressions may be unique, the advantages of hydrotherapy for neurological conditions are typically the same. The advantages include improving balance, strength, flexibility, and range of motion while in the safe environment of water. Hydrotherapy exercises for neurological conditions may be similar for most patients but must be developed in relation to the mechanisms of each diagnosis and the patient’s body challenges. For example, exercises for patients diagnosed with Parkinson’s disease that stretch the patient’s comfort level can slow progression and ease symptoms. Alzheimer’s patients, however, will likely find multitasking frustrating and a detriment to the rehab experience. And while maintaining active musculature is important for achieving long-term quality of life for multiple sclerosis patients, activities in warm water environments can be destructive. The following hydrotherapy exercises and videos offer guidance for working with patients with neurological conditions.
Always consult a medical health care professional before performing any of the following interventions.
1. Balance training in a hydrotherapy pool
Water provides a safe environment for balance training as patients will not fear falling. Always start with a basic position as shown in the photo above. Remember that buoyancy, water movement, water resistance, and therapist involvement make all exercises in the pool dynamic. There are no true static exercises even without the resistant current. Using the current at low levels will compel the patient to use trunk stability.
Hydrotherapy exercise progression: To improve balance, the video below highlights a suggested progression. The video shows several exercises, including standing on both feet, standing on one leg, standing with a body rotation, using the resistant current, walking forward and backwards, taking steps, marching, and cross patterning with varying current.
2. Strength training in a hydrotherapy pool
For strength training, the therapist should identify weakened areas and begin with the patient performing exercises without any current. Exercises might include squats, lunges, ball movements, lumbar flexion exercises, and other protocols. Add current and repeat exercises.
Therapist tip: Concentrate on specific areas that need strength, but keep it simple and consistent. Repetition is important. Therapists should always check that the exercise is done correctly without any substitutions.
3. Functional movement training in a hydrotherapy pool
Throwing the ball to a patient and throwing it from different directions and different levels will help with functional movement. Another fun exercise involves playing the children’s game, “I Spy”. In this exercise, the therapist describes an item in the room and asks the patient to look around the room to find the item. This activity encourages the patient to change eye focus and eye level. See the video below:
Hydrotherapy provides a safe, supportive environment to initiate therapy for neurological issues. It can also be the initial step in rehabilitation toward a land-based program that would allow independence for the patient in their own environment. Neurological diagnoses are complicated in presentation, origin of issue, and potential progression. Start with basics until the patient is comfortable in the water and is ready to handle more challenging protocols.
~ Authored by Roger Meade, DPT, Masters Public Health Administration, BS in Business Administration, BS in Physical Therapy