Multiple Sclerosis (MS) and Aquatic Therapy Tiffany Dean Temple University Therapeutic Recreation Major [email protected] S Learning Outcomes S Define Multiple Sclerosis (MS) and describe the effects it causes. S Explain ways in which Aquatic Therapy is beneficial for individuals with Multiple Sclerosis S Identify Precautions that should be considered before an individual with MS participates in Aquatic Therapy. Overview of Multiple Sclerosis S 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). S “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 Types S S S S RelapsingRemitting Pattern Primary Progressive Pattern Secondary Progressive Pattern ProgressiveRelapsing Pattern Symptoms S visual disturbances S sensation in extremities S weakness or clumsiness in leg or hand S Spasticity S Difficulty with bladder control S Vertigo S Gait disturbances S Stiffness S Fatigue of limbs Overview of Aquatic Therapy S Aquatic therapy is a form of physical therapy that is performed in a pool. S 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. S It aims to rehabilitate patients after injury or those with chronic illness. http://www.youtube.com/watch?v =bZQUYaG0Zqc Types of Aquatic Activity S Balance exercises S S S Relaxation and stretching S S S S Ai Chi (Water Tai Chi) Halliwick techniques Stretching Ai chi Aquatic body work: Watsu, Jahara, or Healing Dance Strengthening exercises S S S Deep or shallow water techniques Bad Ragaz Ring Method Use of drag or resistance equipment Sample Aquatic Exercises S 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. S 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. S 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. S 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 S Flotation devices S Ankle weights S Water barbells S Kickboards S Water shoes S Therapy bars Benefits for Individuals with MS Water Quality Benefit Buoyancy: The feeling of being lighter in the water; of floating. • • S • 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… S Decreases stress S Pain relief S Improved flexibility S Ease depression S Boost self-esteem S Improved posture S Increased circulation S Increased cardiovascular functioning Research Study S Conducted by Physical Therapy Departments of Long Island University & Hunter College in 2011 S Purpose: to examine the effects of group aquatic exercise in individuals with MS. S Methods: 11 participants, 5-week program, 2/wk for 1hr S Results: Improved gait speed, grip strength, muscle strength, walking speed, balance, & mobility S Conclusion: Aquatic Therapy is beneficial in improvement in motor functioning of individuals with MS. Precautions S Bowel incontinence with firm stools S Communicable diseases (cold flu, Hepatitis) S Autonomic dysreflexia S Sensitivity to disinfection chemicals S Sensitivity to heat/ humidity S Rashes, skin conditions with flaking or open areas S Hydrophobia S Controlled seizures, S Open wounds S Compromised immune system Interested in Aquatic Therapy Certification? S Aquatic Therapy & Rehab Institute (ATRI) S How to get started http://www.atri.org/How%20to%20Get %20Started12.pdf S ATRI Certification S 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/mult iple_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. Tiffany Dean Temple University [email protected] Overview of Aquatic Therapy •Aquatic therapy is a form of physical therapy that is performed in a pool. Benefits of Aquatic Therapy •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. 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 •Types of Aquatic Therapy include: Ai Chi, Halliwick Method, Watsu, Bad Ragaz Ring Method, etc. • 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/article s/aquaticstherapy.htm Just so you know… • Aquatic Therapy Certification will look great on your resume! • Aquatic Therapy has the power to change someone’s life!