S

Multiple Sclerosis (MS) and Aquatic

Therapy Tiffany Dean

Temple UniversityTherapeutic Recreation Major

Tiffany.dean@temple.edu

Learning Outcomes

Define Multiple Sclerosis (MS) and describe the effects it causes.

Explain ways in which Aquatic Therapy is beneficial for individuals with Multiple Sclerosis

Identify Precautions that should be considered before an individual with MS participates in Aquatic Therapy.

Overview of Multiple Sclerosis

Multiple sclerosis (MS) is a chronic autoimmune disorder affecting movement, sensation, and bodily functions. It is caused by destruction of the myelin insulation covering nerve fibers (neurons) in the central nervous system (brain and spinal cord).

“Most common cause of neurological disability in young & middle aged adults affecting an estimated 400,000 people in the U.S.” (Salem, et al, 2011).

Types & Symptoms of MS

Symptoms visual disturbances sensation in

extremities weakness or

clumsiness in leg or hand

Spasticity Difficulty with bladder

control Vertigo Gait disturbances Stiffness Fatigue of limbs

Types Relapsing-

Remitting Pattern

Primary Progressive Pattern

Secondary Progressive Pattern

Progressive-Relapsing Pattern

Overview of Aquatic Therapy

Aquatic therapy is a form of physical therapy that is performed in a pool.

The goal of this particular form of therapy is to assist in restoring the person's strength and movement through the use of buoyancy, resistance, and heat.

 It aims to rehabilitate patients after injury or those with chronic illness.

http://www.youtube.com/watch?v=bZQUYaG0Zqc

Types of Aquatic Activity

Balance exercises Ai Chi (Water Tai Chi) Halliwick techniques

Relaxation and stretching Stretching Ai chi Aquatic body work: Watsu, Jahara, or Healing Dance

Strengthening exercises Deep or shallow water techniques Bad Ragaz Ring Method Use of drag or resistance

equipment

Sample Aquatic Exercises

Marching—stand with your side to the pool wall. Hold onto the wall if needed for balance. Lift one leg up and down, then the other. Repeat 5 to 8 times.

Side leg lifts—stand facing the side of the pool. Hold onto the edge of the pool if needed for balance. Lift leg out to the side 5 to 8 times. Do the other leg.

Back leg lifts—stand facing the side of the pool. Hold onto the edge of the pool if needed for balance. Lift leg straight back 5 to 8 times. DO NOT arch the back. Do the other leg.

Runner's stretch—stand facing the side of the pool. Hold the edge of pool for balance. Step one leg back. Both feet flat on floor. Keep the heel of the back leg on the floor. Bend the knee of the forward leg. Lean forward from the ankles. You should feel a stretch in the lower leg or calf muscles. Hold for 20-30 seconds. Do 1 to 2 times. Switch legs.

Equipment for Aquatic Therapy

Flotation devices Ankle weights Water barbells Kickboards Water shoes Therapy bars

Benefits for Individuals with MS

Water Quality Benefit Buoyancy: The feeling of being lighter in the water; of floating.

• Provides support for weak limbs.• Movement takes less effort. A greater

range of motion can be achieved.• Promotes muscle relaxation.

Viscosity: The sensation that there is resistance to your movements; that you move slower through the water.

• The resistance of water can be used to improve muscle strength.

• Slower movement in water provides an opportunity to work on skills such as balance and coordination which may be harder to do on land.

Hydrostatic pressure: The sensation of compression while the body is in the water. Pressure increases with depth.

• Compression can provide support for standing activities, such as walking, with less effort than on land.

Temperature Control • Cooler water can help maintain lower core body temperature even during vigorous activity. This is especially helpful for people with heat sensitivity issues.

Other Benefits…

Decreases stress Pain relief Improved flexibility Ease depression Boost self-esteem Improved posture Increased circulation Increased cardiovascular

functioning

Research Study

Conducted by Physical Therapy Departments of Long Island University & Hunter College in 2011

Purpose: to examine the effects of group aquatic exercise in individuals with MS.

Methods: 11 participants, 5-week program, 2/wk for 1hr Results: Improved gait speed, grip strength, muscle

strength, walking speed, balance, & mobility Conclusion: Aquatic Therapy is beneficial in

improvement in motor functioning of individuals with MS.

Precautions

Bowel incontinence with firm stools

Communicable diseases (cold flu, Hepatitis)

Autonomic dysreflexia Sensitivity to disinfection

chemicals Sensitivity to heat/

humidity Rashes, skin conditions

with flaking or open areas Hydrophobia Controlled seizures, Open wounds Compromised immune

system

Interested in Aquatic Therapy Certification?

Aquatic Therapy & Rehab Institute (ATRI)

How to get started http://www.atri.org/How%20to%20Get%20Started12.pdf

ATRI Certification Membership $45

Resources

Butler, C. (2002). Walking in Water. Inside MS, 20(3), 66.

Chamberlayne, N. (2006). Come on in, the water's fine!. Inside MS, 24(4), 34-35.

Merck Manual Staff (2013). Overview of Multiple Sclerosis. Accessed via www.merckmanuals.com/professional/neurologic_disorders/demyelinating_disorders/multiple_sclerosis_ms.html?qt=muliple%20sclerosis&alt=sh

Salem, Y., Scott, A., Karpatkin, H., Concert, G., Haller, L., Kaminsky, E., & ... Spatz, E. (2011). Community-based group aquatic programme for individuals with multiple sclerosis: a pilot study. Disability & Rehabilitation, 33(9), 720-728. doi:10.3109/09638288.2010.507855

Weiss, Thomas C. (2010). Aquatic Therapy- Facts and Information. Accessed via http://www.disabled-world.com/medical/rehabilitation/therapy/aquatic-therapy.php

Using Aquatic Therapy to treat individuals with Multiple Sclerosis

“If I could live in the water, I would.” –Mary Ann Lee.

Resources: • Americans w/ Disabilities Act

www.ada.gov • The National MS Society

www.nationalmssociety.org/index.aspx

• Moss Rehab

www.mossrehab.com • ATI Physical Therapy

www.atipt.com • Oxford Rehab Center

www.oxfordrehab.com • ATRI Certification www.atri.org

• ATRA's Aquatic Therapy Treatment Network

www.atra-tr.org • Aquatic Resources Network

www.aquaticnet.com •http://recreationtherapy.com/articles/aquaticstherapy.htm

Overview of Aquatic Therapy • Aquatic therapy is a form of physical therapy

that is performed in a pool.

• The goal of this particular form of therapy

is to assist in restoring the person's strength and

movement through the use of buoyancy,

resistance, and heat.

•Types of Aquatic Therapy include: Ai Chi, Halliwick

Method, Watsu, Bad Ragaz Ring Method, etc.

Benefits of Aquatic

Therapy • Improved muscle strength• Improved

walking speed• Enhanced

balance & coordination

• Decreases stress

• Pain relief• Improved

motion • Improved

flexibility• Promotes

muscle relaxation

• Ease depression• Boost self

esteem

Just so you know…• Aquatic Therapy Certification will look great on your resume!• Aquatic Therapy has the power to change someone’s life!

Tiffany DeanTemple University

tiffany.dean@temple.edu