Front Matter

Chapter 9 Aquatic Therapy 219

Pool versus underwater treadmill
(UWTM)

There are advantages for both the UWTM and
swimming as aquatic treatment modalities
(Table  9.2).  Whenever possible, the therapist
selects the best modality or combines these
modalities based on the client’s needs. The
remainder of this chapter will focus on the
UWTM.
The UWTM can help to eliminate the fear that
some dogs show in being totally immersed in a
swimming pool. Wolf’s law suggests that weight
bearing on the treadmill encourages increased
bone strength over swimming alone. (Teichthal
et al., 2015) When working with canine athletes,

the therapist can change the level of the workout

by increasing or decreasing the water height,

and by altering the level of incline and/or tread

speed. Small to medium patients can be cross‐

trained as both swimming and treadmill work

can be accomplished in one unit.

Use of the UWTM assists or speeds gait

retraining and sequencing, especially in neuro-

logically impaired patients. A large percentage

of one author’s (L.M.) neurologically impaired

patients will walk in water before they will on

land. Work on the UWTM improves active

ROM because of increased step height (Jackson

et al., 2002). It also allows for careful exercise of

overweight patients with respiratory issues as

the water is cooling, the buoyancy diminishes

Case Study 9.1 Hydrotherapy for fibrocartilaginous embolism (FCE) with complications

Signalment: 7 y.o. M/N retired racing Greyhound.

History: Diagnosed with cervical FCE. Family unable

to provide physical care as patient tetraparetic and

incontinent. Requested in‐patient rehabilitation with

aquatic therapy.

Examination: Left lateralizing tetraparetic, laterally

recumbent, unable to independently turn or change/

hold positions. CP deficits all limbs. Evidence of

neurogenic atrophy and decreased superficial pain

sensation all four limbs, worse on left. Mild urine

scald and stage two decubitus left shoulder.

Primary goals: Improve limb muscle strength, espe-

cially left; improve trunk and core strength; improve

proprioception and enhance position awareness;

assure skin integrity with turning schedules and

pressure‐relief mattress; add diaper system to wick

urine from skin; provide decubitus care.

Aquatic treatment and outcome: Initially treated in

pool four times per week for 20–30 minutes

(Figure  9.10). Sessions included six 45‐second

to  1‐minute swim sets interspersed with four

3–5‐minute rest periods. Therapy during rest periods

included whirlpool, PROM, spinal mobilizations,

traction, massage with trigger point release, PNF

patterns, and assisted sit‐to‐stand. Patient moved all

four limbs in water, although left thoracic limb and

pelvic  limbs weaker than right, and sequencing of

pelvic limbs to thoracic limbs poor. Sequencing and

strength steadily improved.

Over 4 weeks, swimming reduced to three times per

week with increased duration and intensity. Sessions

included four 5‐minute swim sets interspersed with

four 2‐minute rest periods. Rest periods included

more advanced exercises including independent

position transitions from sit‐to‐stand and sphinx lie to

stand on pool stairs or backing up on pool bench. The

decubiti healed completely within 14 days. Ability

to participate with land exercises was expedited due

to early swimming and aquatic therapy. For example,

patient could perform sit‐to‐stand 3 weeks sooner in

water than on land.

Figure 9.10 Early pool work consisted of six

45‐second to 1‐minute swim sets interspersed with

four 3‐ to 5‐minute rest periods.