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| About Aquatic Physical Therapy |
This page provides the answers to more than 40 frequently asked questions related to Aquatic Physical Therapy. The questions are arranged below by category. Please click on the category and review questions and answers: |
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| General FAQs |
What
is "aquatic
physical therapy"
Aquatic Physical Therapy
Aquatic Physical Therapy is the evidence-based and skilled practice of physical therapy in an aquatic environment by a physical therapist or by a physical therapist assistant who is under the direction and supervision of a physical therapist. Aquatic Physical Therapy includes but is not limited to treatment, rehabilitation, prevention, health, wellness and fitness of patient/client populations in an aquatic environment with or without the use of assistive, adaptive, orthotic, protective, or supportive devices and equipment.
The buoyancy, support, accommodating resistance and other unique properties of the aquatic environment enhance interventions for patients/clients across the age span with musculoskeletal, neuromuscular, cardiovascular/pulmonary, and integumentary diseases, disorders, or conditions.
Aquatic Physical Therapy interventions are designed to improve or maintain:
- function
- aerobic capacity/endurance conditioning
- balance, coordination and agility
- body mechanics and postural stabilization
- flexibility
- gait and locomotion
- relaxation
- muscle strength, power, and endurance
Interventions
used in Aquatic Physical Therapy
include, but are not limited to,
therapeutic exercise, functional
training, manual therapy,
breathing strategies,
electrotherapeutic modalities,
physical agents and mechanical
modalities using the properties
of water and techniques unique
to the aquatic environment.
Abbreviated Definition of
Aquatic Physical Therapy:
Aquatic Physical Therapy is the scientific practice
of physical therapy in an
aquatic environment by physical
therapists and physical
therapists assistants. Aquatic
Physical Therapy includes but is
not limited to treatment,
rehabilitation, prevention,
health, wellness and fitness of
patient/client populations in an
aquatic environment. The unique
properties of the aquatic
environment enhance treatments
for patients/clients across the
age span with musculoskeletal,
neuromuscular,
cardiovascular/pulmonary, and
integumentary (skin) diseases,
disorders, or conditions.
Abbreviated Definition of
Aquatic Physical Therapists:
Aquatic Physical Therapists are
licensed physical therapists who
perform an examination and
evaluation to establish a
functional diagnosis, prognosis
for functional recovery, and
need for PT treatment with a
plan of care. Aquatic Physical
Therapists and Physical
Therapist Assistants provide PT
treatments in a safe aquatic
environment taking into
consideration transition to land
based functional activities and
communication with the
patient-care team.
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What
is the difference between "aquatic
physical therapy" and "aquatic
exercise"?
- The
difference is that aquatic physical therapy
requires the "skilled service" of a PT and/or
PTA which may include:
- the clinical reasoning and
decision making skills of a PT/PTA;
- the patient has impairments
and/or disabilities which can be minimized
or eliminated with
aquatic physical therapy; and
- the
patient has potential for reaching new functional
goals/outcomes to improve quality of
life and ease burden of care.
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Is
aquatic physical therapy effective?
This
is a rather broad "tell me
every thing you know"
question. Perhaps volumes could be
written on this topic. For
information on various topics, please refer to The Aquatic Physical Therapy Bibliography. (Click here to download order
form)
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What
do I do if I am denied coverage for
aquatic therapy?
First
of all, one needs to understand why the
denial occurred (i.e. Is documentation inadequate
to justify the need, or does the third party
payor globally deny aquatic physical therapy?).
If the denial occurs because the third party
payor denies this service, then one needs
to actively educate the payor about why
the physical therapist and/or doctor chose
the aquatic venue for treatment.
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Are
there particular patients that should or
should not have aquatic physical
therapy? Indications/contraindications?
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Is there an aquatic physical therapy day, week or month?
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What
is the history of the Aquatic PT
Section? Focus of research and study in
the Section?
Jean
Irion wrote a nice article in
the "Journal of Aquatic Physical
Therapy," Volume 10 Number 1,
Spring 2002, addressing the history. The focus of research and
study is the practice analysis currently being conducted.
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What
are the current trends in aquatic
physical therapy?
Trends
vary depending on what part of
the country/world in which one lives.
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Is
there a certification program for
aquatic physical therapy?
No; however, the Section is in the process of conducting a practice
analysis to see if there is a need for a certification process.
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What
education requirements are needed to
specialize in Aquatic PT?
Water safety, risk management, and an understanding of hydrodynamic principles and
various techniques.
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How
do I become an aquatic physical
therapist?
PTs/PTAs can take continuing education courses to gain knowledge in the
area of aquatic physical therapy.
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Rules, Regulations & Operations FAQs |
Where
can I find information on starting my
own aquatic physical therapy practice?
The "Developing an Aquatic Physical
Therapy Program" and the associated continuing education course offered by the Section are
the best resources we offer. (Click here to download order form)
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Where
do I get a list of operation rules for a
new facility with a pool?
Check with your State or Local
Health Department for guidelines.
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What
are the rules regarding supervision in
the pool of PTAs?
This is governed by the
individual State Practice Acts. Supervision is not different between pool and land-based therapy.
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What
is the required ratio of patients to PTs/PTAs?
This is governed by the
individual State Practice Acts.
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What
kind of insurance should be considered
for pools in aquatic PT facilities?
You should consider the same type of insurance
as for
all clinics (liability), except that it is important to consider the different challenges with pools (i.e. potential for death due to drowning).
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How
long should someone be/can
someone be required to be in the
water? |
The Aquatic Therapy and Rehab
Institute (ATRI) published a
document called Safety Standards
for Aquatic
Therapy and Rehabilitation Practitioners
- http://www.atri.org/articles/Standards.pdf,
which recommends that a practitioner be in the
water for no longer than four
(4) continuous hours per day
dependant upon the situation and
individual (e.g. considering
water temperature, water and air
chemistry, and personal medical
factors).
Here's a link to an article on
the topic
of safety, much of which
seems to be taken from the ATRI
standards document - http://www.rehabpub.com/features/72003/4.asp
Other than the ATRI guidelines,
APTA staff was unable to locate
any specific laws or regulations
regarding the length of time
spent in the pool. However, it
is possible that such laws and
regulations may be established
in the future, so practitioners
are advised to stay abreast of
federal and state laws and
regulations as appropriate.
Note: All links are current
as of 10/26/06 |
| How
does one go about
reporting a bad
working environment
(e.g. poor
environmental
conditions and/or
poor pool
maintenance)? |
Per the Occupational
Safety and Health
Administration's (OSHA)
Compliance Guidance
Office, PT's and
PTA's practicing in
states that have
established their
own occupational
safety and health
plan would file
complaints through
the state. This
link will take you
to information about
State Occupational
Safety and Health
Plans - http://www.osha.gov/fso/osp/index.html.
This Web page
provides links
for the states that
have established
their own
occupational safety
and health
administration.
In states that have
not established
their own
occupational safety
and health plan,
PT's and PTA's would
file complaints
through the Federal
OSHA by going to www.osha.gov,
select the link for "Audiences" located
on the left side of
the page, then click
on "Workers", then
"Filing a
complaint".
Note: All links
are current as of
10/26/06
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| Does
the APTA endorse or support a
particular liability insurance
plan for Aquatic Physical
Therapists? |
APTA endorses
the professional
liability
insurance plan
administered by
Healthcare
Providers
Service
Organization (HPSO)
and underwritten
by American
Casualty Company
of Reading, PA,
a CNA Company.
The plan is
designed to meet
the unique needs
of today's PTs,
PTAs, and
students of
physical
therapy, as well
as PT group
practices. For
more
information, or
to apply for
coverage,
contact HPSO at
800-942-9491 for
individual
coverage or
888-288-3534 for
group practice
coverage, or
visit their web
site at www.HPSO.com.
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What
agency (or agencies) regulate the
operation of the pool?
Operations for pools are
regulated by your State, County, and/or Local Health
Department.
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What
is the range of pool temperatures for
specific kinds of therapy and certain
ailments?
General guidelines might include:
82-88 degrees for more active patients and patients with MS
88-92 degrees for less active patients such as those with arthritis or women
92-96 degrees for less active patients with
hypertonicity/spasticity issues |
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What
is the required level of chlorine for
aquatic therapy pools?
This
is addressed in the "Developing an Aquatic Physical Therapy
Program." on pages 54-55. (Click
here to download order form) Generally, a level of 1.0 to 3.0 parts per
million is required. This may also be regulated
locally by the Health Department.
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Can
patients with HepatitisB and other water
borne illnesses participate in aquatic
therapy?
There should not be a problem with a patient who has Hepatitis B if they
do not have any open wounds, are continent of bowel and bladder and if the pool chemistry is properly maintained.
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What
type of design is recommended for an
aquatic therapy pool?
The type of design depends on the business plan and the type of
patients/clients to be served. The "Developing an Aquatic Physical Therapy Program." outlines a planning process on pages 1-17.(Click here to download order form)
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Can
PTs treat patients in their private
pools in their homes?
Things to consider
include:
(a) State Practice Act
(b) Liability insurance
(c) Local regulations |
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Do
aquatic PT pools need lifeguards?
This is dependent upon local codes.
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Are
aquatic PTs required to be certified in life saving?
No; however, the Section recommends some type of water safety training
and risk management.
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| What
is the new federal pool and
safety act? |
The
Virginia Graeme Baker Pool and
Spa Safety Act was passed by
Congress
in 2007. It sets new standards for pool and
spa drains and drain covers.
(CLICK
HERE TO READ THE ACT)
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Reimbursement Issues FAQs |
Does
Medicare have a requirement regarding
exclusive use of the pool by therapist
and Medicare patients? |
On May 7, 2008, the
Centers for Medicare and Medicaid
Services (CMS) issued a long-awaited new
directive that allows aquatic physical
therapists in private practice to rent
or lease a specific portion of a
community pool, rather than being
required to rent the entire pool when
providing services to Medicare patients.
CMS Transmittal 88 that
was released on May 7, 2008, states on
page 14:
"When therapy services may be furnished
appropriately in a community pool by a
clinician in a physical therapist or
occupational therapist private practice,
physician office, outpatient hospital,
or outpatient SNF, the practice/office
or provider shall rent or lease the
pool, or a specific portion of the
pool. The use of that part of the pool
during specified times shall be
restricted to the patients of that
practice or provider. The written
agreement to rent or lease the pool
shall be available for review on
request. When part of the pool is rented
or leased, the agreement shall describe
the part of the pool that is used
exclusively by the patients of that
practice/office or provider and the
times that exclusive use applies. Other
providers, including providers of
outpatient physical therapy and
speech-language pathology (OPTs or
rehabilitation agencies) and CORFs, are
subject to the requirements outlined in
the respective State Operations Manual
regarding rented or leased community
pools."
The former CMS
requirement to rent the entire pool has
long been a serious problem for the
aquatic physical therapy sector. Click
below to read the complete transmittal.
(Pool rental section is on page 14). 220.1.2
- Plans of Care for Outpatient Physical
Therapy
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I need
information on Medicare reimbursement of aquatic
therapy services in my state.
First, you need to check with
your Medicare carrier. The
states are divided into sections
and each section has a carrier.
This is the company that is
responsible for reimbursement.
If you do not know who your
carrier is, please contact the
reimbursement division of APTA
or your state chapter
for further
instructions. They can tell you
who your Medicare carrier is.
For most of us, aquatic therapy
is reimbursed at a greater
amount than other services, but
sometimes the secondary carrier
does not recognize and pay for
Aquatics. .
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Will
Medicare reimburse for group therapy or does the treatment
need to be one-on-one?
Medicare will generally not reimburse for group therapy; therefore,
treatment needs to be one-on-one.
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| How
many patients constitute a group for
group therapy?
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Is
there a required ratio of land to
aquatic therapy required for
reimbursement?
Often, land and aquatic therapy cannot be performed on the same day.
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Will
Medicaid reimburse for treatment at an
off-site pool?
Medicaid is a State administered program with individual state
guidelines.
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©
Aquatic Physical Therapy Section, All Rights Reserved
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