Front Matter

Chapter 9 Aquatic Therapy 213

Program progression

Preoperative planning

Preoperative swimming allows the patient to
become familiar with the pool and aquatic envi-
ronment, reducing the incidence of postopera-
tive mishaps at pool entry or exit, thrashing
while swimming, and inability to rest quietly
between sessions. The preoperative visit allows
for client education and the opportunity to
observe the progress of other patients with
similar conditions (Lindley & Smith, 2010).

Factors to consider

Aquatic therapy is started conservatively, and
increased according to the patient’s comfort and
ability. Most patients initially need body contact
with the therapist in the pool. The amount of
physical contact and bonding depends on the
patient’s comfort level and can be gradually
reduced. Client’s can be poolside to offer
encouragement. Teaching pool commands such
as “Rest” enhances responsiveness.
Swimming for 1 minute in a therapeutic pool,
with current (resistance and turbulence) and a
warm water environment (88–90 °F) is strenu-
ous. A cool water pool with no resistance jets
will allow for longer swim sets while a warm
water therapeutic pool with varying current
requires shorter swim sets due to greater effort
and likely fatigue (Bates & Hanson, 1992). Vital
signs are monitored by checking pulse, tongue
color, size, and shape, ear temperature, and
facial expression as well as alterations in swim-
ming speed and emotional state (Table 9.1).

During a 30‐minute treatment, swim sets

include multiple swim/rest cycles. As confi-

dence and stamina increase, the swimming

duration is lengthened and intensified and rest

periods are shortened. During rest cycles the

therapist provides treatments such as massage,

standing exercises, joint mobilizations, body-

work, and PROM.

Program goals, principles, and exercises

Aquatic therapy programs use the same reha-

bilitation principles and goals as land‐based

programs. The pool becomes the gym so a

myriad of exercises is offered. The primary

goals for aquatic exercises are: flexibility,

strength, balance, coordination, postural

awareness, movement, speed, and endurance

(Bates & Hanson, 1992; Grosee, 2009).

Flexibility

Flexibility is improved with stretching and joint

mobilization provided during rest periods.

Traction is also effectively applied.

Massage to release paraspinal trigger points

and tail‐pulls in water improves spinal mobil-

ity. Active exercises that improve flexibility

include using food lures for lateral cervical and

thoracolumbar stretching while standing or

luring the dog to swim in tight circles, zigzags,

or serpentine patterns.

Strength

Strength is improved with exercises that ini-

tially consist of slow swimming sets with low or

no current. Circle swimming creates a differen-

tial workout for the legs on the outside and

inside of the circle. Resistance can be applied by

holding the harness or life vest while the dog

swims. Standing exercises such as rhythmic sta-

bilization, and cross‐leg or three‐leg standing

can be effectively done in water. Dancing is per-

formed with the patient standing on the pelvic

limbs while the thoracic limbs rest on the pool

edge or stair. This can be done safely in water

before attempting the same exercise on land.

As strength improves, games are added,

including multiple rapid ball‐chasing sprints.

Quick repetition of swimming into high current

is excellent for increasing the difficulty of

Table 9.1 Assessment of anxiety and fatigue when
swimming

Anxiety Fatigue

Anxious facial expression

Rapid breathing/pulse

Thrashing thoracic limbs

Inability to rest

Attempting to exit

the pool

Tired body posture

Deep or irregular

breathing

Slowed swim pace

Reluctance to swim

Change in tongue

color/shape