Aquatic Therapy for Neurological Conditions

Neurologic patients often have problems with functioning “on land”, due to problems with e.g. strength, muscle stiffness, information processing, pain or fear of falling. The properties of water give the opportunity to progress fast towards the functional land based skills that a neurologic patient needs to (re)gain and (re)learn.

The pool offers the possibility to experience early movement and to prevent the negative effects of sedentary non-use. Activities can be varied easily and repeated frequently, which is important for the nervous system as well as the musculoskeletal, cardiovascular and metabolic systems. Patients can learn stumble-strategies with carry-over effects to dry land and are also able to learn without gravity induced compensation (thus related to dry land constraint induced movement programs).

The focus will be on brain health, based on moderate aerobic conditioning and environmental enrichment in a distributed practice framework of neuroprotective exercise, with contemporary ideas of serious gaming

A recent systematic review by Veldema & Jansen (2021) states that aquatic therapy is highly effective – and superior to land therapy -  in supporting gait and balance; established concepts (including water specific therapy) are the most effective.

Underlying mechanisms are neurophysiological, circulatory and immunological changes in the brain, which have been well documented, showing increases in cerebral blood flow during immersion, with a cascade of effects in brain networks that are used like e.g. the attentional network (for executive functions).

The course aims at implementing the present body of knowledge and will propose the elements of a valid aquatic therapy approach. Treatment goals are very practical at the same time: increase sitting balance, prevent falls, normalize gait, increase reaching distance, train agility, but also address self-efficacy and participation. 

This course is focussed on an integrated approach of treatment concepts within the framework of evidence based aquatic therapy and modern motor relearning knowledge. Patient groups for whom these contents are important are: CVA, TBI, Parkinson, MS and SCI

Topics

• Evidence Based Practice with cases
• Dynamics Systems Model and motor learning
• Serious gaming / motor-cognitive therapy
• Assessment in water and on land
• Applications in:
  • Gait training and fall prevention
  • Core stabilization
  • Strengthening 
  • Aerobic conditioning
  • Reduction of connective tissue / fascia stiffness
  • Environmental Enrichment
  • Distributed practice principles

Teaching and learning activities:

Tutorials 

Observation of patients and group discussion

Psychomotor activities: guided experience with exercises, activities

Demonstration of exercises and activities

Observation of patient demo’s and cases 

Peer guided learning

Learning objectives

Upon completion of this course, participants will be able to

- demonstrate various techniques of intervention tactics, e.g. WST and CAC

- describe the evidence for neurological aquatic therapy

- follow a clinical reasoning procedure a patient with MS, PD or stroke

- construct exercises for fall prevention

- apply serious gaming during aquatic motor-cognitive therapy

- use Water Specific Therapy to increase power, agility and (an)aerobic endurance