Front Matter

Chapter 9 Aquatic Therapy 221

Patients with minimal to moderate degenera-
tive joint disease (DJD) are worked with the
water midway between the shoulder and
elbow, providing some buoyancy. As they
become stronger the level can be lowered for a
workout with resistance (controlled by speed)
and diminished buoyancy. More profoundly
arthritic patients initially start with water levels
just over shoulder height. As the patient
becomes stronger, the water may be lowered to
halfway between shoulder and elbow, the
speed and time can be increased, and jets or
surface area resistance can be added.

Speed

Calibration of speed in UWTMs is not consist-
ent. Two UWTMs from the same manufacturer
may move at different speeds, despite the
monitor reading “1.0 mph.” If more than
one UWTM will be used for the same patient,
the therapist should calibrate the belt laps per
minute. Patients with neurological disease are
started at the slowest available speeds (usually
0.1–0.4 mph) to give them time to place their
feet. For  all other patients, the belt should
start at a comfortable walk speed. If the belt
moves too slowly, it is confusing for the patient.
Short‐legged patients, such as Dachshunds,
require slow initial belt speeds (0.5–0.8 mph).
Average size patients start at approximately
1.2–1.5 mph, while giant breeds can start at
2.2–2.5 mph for a comfortable walk. Trot speeds
average as follows: small breeds 2.0–2.2 mph;
medium breeds 2.5–5.3 mph; large breeds
6.0–9.0 mph. Patients may avoid breaking into
a trot. If they attempt to pace, the therapist
should cause a brief perturbation, such as a
quick forward tug on the leash causing them to
break into a trot.

Duration

The authors use the following plan with all
patients. Patients are started at a walk with two
to three reps of set periods of time. An older
patient may start with two to three 45‐second
reps with 2‐minute breaks. An athlete can start
with three 3‐minute reps with 2‐minute breaks.

Progression involves gradually working up to

fewer, longer reps. Breaks are always 2 minutes.

Once the patient can do one solid interval of

25 minutes at a fast walk, short speed intervals

are added. This starts with the patient under-

taking two to three sets of trotting for 1 minute.

The fast walk speed is maintained for the first

and final 2 minutes to create a warm‐up and

cool‐down period, and the remaining minutes

are gradually moved up to a trot. The patient’s

perceived exertion during the exercise and

after  its completion is evaluated, and this

is  used to determine the level of work for the

next session.

Resistance techniques

Tread speed can be used to increase resistance

due to higher viscosity. Jets can also be used for

resistance through turbulence. The therapist

can adjust the velocity of water flow and the

amount of air moving through the jets. Some

treadmills allow the therapist to choose between

jets positioned at different heights. Manual

techniques can also be used to apply resistance,

targeting specific muscle actions.

Starting the new patient

Preparation

Patients with urinary incontinence must be

expressed prior to going into the UWTM.

Patients who are fecally incontinent, but with

anal tone, can be stimulated to defecate with a

cotton swab. Patients with poor anal tone and

those with diarrhea in the past 24 hours are not

allowed in the UWTM.

Motivation

Food such as peanut butter smeared inside a

cup or frozen yogurt in a small plastic cup

works well to motivate most patients. Treats

can be stacked in front of the patient where

they can see them, rewarding their effort every

30 to 60 seconds. Some patients like to bite

splashing water, so the assistant or client can