Chapter 9 Aquatic Therapy 217to breathe more easily while swimming with
the object in the mouth. Patients that readily
destroy toys often enjoy a stick with the bark
removed, a plastic water‐ski tow rope handle,
or 12–18 inches of garden hose with wooden
plugs in the ends.
Food
Food is used only if toys and voice encourage-
ment are not sufficient to motivate swimming.
Treats such as oyster crackers are best as they
float and are readily eaten.
Therapeutic pool guidelines
Written guidelines should be reviewed annu-
ally with staff. Guidelines include emergency
policies and procedures, a protocol for safe pool
entry and exit, a guideline for assessment of
anxiety and fatigue, a policy for monitoring
vital signs while in the pool, a protocol for pool
treatment for vomit or feces, and a daily pool
chemical checklist.
Policies and procedures for pool emergencies
include the procedure for dealing with dog
and/or human injuries that are pool‐related.
Examples include: falls, bites, lacerations,
chemical spills/splashes, and cardiac arrest.
Emergency phone numbers should be posted
clearly in the treatment areas.
The protocol for pool entry and exit includes
safe techniques for using slings or lifts and
expectations of staff during pool transfers
(Prankel, 2008). Pools without stairs require a
mechanical lift. Knowledge of this equipment
and its proper use and maintenance is impera-
tive. Staff should be trained and periodically
reminded how to use proper body mechanics
during transfers. Staff should know that many
patients need encouragement before stepping
onto submerged stairs; colored markings on
stairs are helpful to increase visible contrast,
and some heavy‐coated patients need time to
shed the weight of coat water in the partial anti‐
gravity environment of stairs because the
weight of water (8 lb/gallon) adds to the effort
of exiting.
A guideline for the assessment of anxiety and
fatigue increases client assurance as well as
staff awareness that patient anxiety is reduced
by increased physical contact with the therapist.
It should explain that multiple short swim sets
decrease anxiety and quickly build confidence
and muscle. When fatigue is identified, the
therapist should alter the treatment session
by reducing the swim time per set, increasing
the rest time, and decreasing the intensity
(Figure 9.9).
A policy for monitoring vital signs while in
the pool should indicate the frequency at which
vital signs are taken, especially for high‐risk
patients. Respirations are monitored for quality
and rate.
A protocol for pool treatment for vomit or
feces is required (Centers for Disease Control
and Prevention, 2016) Vomiting rarely occurs if
food is withheld at least 3 hours prior to ther-
apy. Excessive drinking of pool water can cause
vomiting. When this occurs, the patient is
removed from the pool and assessed. Particulate
matter is quickly removed with the skimmer.
If the vomiting is copious, the pool is treated
with a quick‐acting oxidizing shock and vacu-
umed. No patient can return to the pool for at
least 20 minutes.Figure 9.9 When fatigue is identified, the therapist must
immediately alter the treatment session by reducing the
swim time per set, increasing the rest time, and
decreasing the intensity.