Chapter 3 E-materials

Acknowledgements

Stephanie Taylor, Aquatic Physiotherapist, Nuffield Orthopaedic Centre, NHS Trust.

Mr Alan Hazlett

Author profiles

Dr Anne Jackson PhD MSc BA(Hons) MCSP

Anne Jackson has been a specialist in aquatic physiotherapy for much of her career, working clinically in the South of England. Her PhD thesis focused on outcomes and patient experience of aquatic physiotherapy. She was editor of Aqualines, the Journal of the Aquatic Therapy Association of Chartered Physiotherapists, from 2003 – 2010 and has been a frequent author of a range of papers in this journal. She has been involved with establishing the international group Aquatic Physical Therapy International. Anne currently works for the Chartered Society of Physiotherapy.

Cathy Stringer BSc(Hons) BEd MCSP

Cathy qualified as a physiotherapist in 2004 after a career change and has been employed by Good Hope Hospital, Heart of England Foundation Trust ever since. She completed my junior rotations and chose to specialise in musculoskeletal out-patients, where she divides her time between working in the hydrotherapy pool and working in the out-patient department treating patients with chronic pain problems. Cathy has been instrumental in developing the pool services to include classes for hip and knee arthroplasties, Bad Ragaz for shoulder rehabilitation and ante-natal classes and has plans for further initiatives to be developed in the future.

Alison Skinner

Alison Skinner has worked in physiotherapy education at the Middlesex Hospital School of Physiotherapy and later at University College London specialising in Aquatic Therapy. She has taught Aquatic Therapy both in the UK and internationally for many years. Her qualifications include certificates in hydrotherapy following a 6 month course from the Chartered Society of Physiotherapy and a senior lecturer’s certificate from the International Halliwick Association. She has written articles for a variety of publications and co-edited Duffields Exercise in Water. Currently she is Treasurer of the Aquatic Therapy Association of Chartered Physiotherapists.

Susie Grady MSc BSc(Hons) MCSP

I work as the Aquatic Therapy Team leader at The Gardens and Jacob Neuro-rehabilitation centres in Hertfordshire, UK. These centres are part of the Ramsey Healthcare group. I am responsible for delivering the Aquatic Therapy service to our clients who all have neurological conditions.

I have served on the ATACP committee for 6 years and have held the position of Research Officer and CPD Co-ordinator.

I have also gained a Masters Qualification in Veterinary Physiotherapy, and work as a self-employed Veterinary physiotherapist with both horses and dogs. I am a category A member of ACPAT and my research project investigated the use of canine hydrotherapy in the UK and abroad.

www.4legsphysio.co.uk.

Ankie Postma GradDipPhys

Ankie Postma is a physiotherapist working part time at Basildon Hospital, Essex, UK. She has responsibility for the Aquatic Physiotherapy service in her district, but her caseload includes amputees and patients with ankylosing spondylitis as well. She undertook the ‘Bath Hydrotherapy Course’ in 1994, after which she joined the ATACP committee, where she has been the minute secretary for many years. Apart from her NHS work, she is involved in the local NASS group and ‘WADERS’ (Water Assisted Disability Exercise and Rehabilitation Scheme), an exercise group for people with mobility problems, in local leisure pools.

Mike Maynard GradDipPhys HT

Mike Maynard qualified from Bath School of Physiotherapy in 1980, and this training kindled his interest in aquatic physiotherapy. He joined the Royal Air Force on qualifying, and over 20 years served at various military hospitals both home and abroad. He is now Site Lead Physiotherapist at Pilgrim Hospital, in Boston, UK and is Clinical Lead for Aquatic Physiotherapy for United Lincolnshire Hospitals.

He has carried out aquatic physiotherapy treatments in situations as diverse as a 6-foot-square pool in Germany, to a full-size outdoor swimming pool in Cyprus and served 2 periods at the Medical Rehabilitation Unit Headley Court in Surrey. During the first period he was responsible for all the individual (rather than class-based) patients, and the second period involved responsibility for a complete pool rebuild plus setting policy for the running and use of the aquatic physiotherapy facility.

He successfully passed the Bath Hydrotherapy Course in 1996, and commenced national and international teaching on a variety of courses in 1998. He is on the committee of the Aquatic Therapy Association of Chartered Physiotherapists (ATACP); and took over the chair in April 2000.

He has presented at many aquatic physiotherapy study days and at the PCT conference at the NEC Birmingham in 2008. He also leads the Education subgroup of the ATACP. He was awarded a Chartered Society of Physiotherapy Distinguished Service Award for his services in aquatic physiotherapy in 2009.

Case Study 1: Post traumatic back pain

Background

• The patient fell from a ladder and sustained a crush fracture of L3 with no associated spinal cord injury.

• He was immobilised for 6 weeks in a rigid brace and was taken out of the support for exercise.

• He demonstrated fear avoidance behaviour and was reluctant to move at all.

• He agreed to aquatic physiotherapy after it was explained to him what this would entail.

• There were no contraindications to hydrotherapy, however excessive flexion was to be avoided.

Treatment outline

• Early sessions

– A basic home regime of exercises was commenced, including pelvis setting and control.

– The patient commenced aquatic therapy standing in water to a depth of T11 performing slow head movements of flexion and extension.

– He was immersed to this depth in order to challenge his balance and core stability.

– Therapist turbulence (created by the therapist with their hands) was applied at waist level to further challenge core stability.

– The patient progressed to standing at the rail and performing alternate hip flexion/extension to encourage spinal movement, and trunk rotations (free movement).

– Anxiety was reduced sufficiently to enable the patient to be put into supine float lying.

– Rhythmical stabilisations for trunk flexors, extensors and rotators were added to transversus abdominis setting and were performed by the physiotherapist applying pressure at the shoulders and pelvis while the patient resisted the pressure.

– As the patient improved in mobility and strength, work at the rail was introduced to increase trunk extension and flexion (the patient held the rail with elbows extended and walked their feet back to stretch the spine into extension, this was followed by walking the feet forwards to increase flexion).

– In supine lying, buoyancy counterbalanced side flexion movements were added, along with transversal rotations into flexion and extension. For this exercise the patient held a float in each hand and flexed and extended their neck rolling it backwards and forwards.

– The exercise was started with small pendular movements and gradually progressed to a fuller swing.

– Longitudinal rotations, with the patient lying supine and turning the head from side to side were added to assist trunk rotation.

• Later sessions

– Posterior to anterior mobilisations were applied to the lumbar spine with the patient supported in supine lying.

– Supine lying was used to induce buoyancy resisted trunk flexion and extension exercises.

– Aerobic conditioning work was commenced using exercises such as “spotty dogs” (alternate leg and arm movements in the water), full transversal and Saggital (side to side) rotations holding dumbbells, pushing and pulling, lunges with a kickboard and rotations using the elbows in the water to create resistance to movement “Helicopters”.

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