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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:

 
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 a physical therapist assistant under the 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 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.

 

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 to maximize functional goals/outcomes to improve quality of life and ease burden of care.
    • the implementation of such therapy must comply with all standards of care which impact all other treatment services.
  • Aquatic Exercise is the utilization of water for the implementation of quality of life, fitness-related or general health-related goals; can be delivered in a group setting that includes multiple clients and diagnoses; can be delivered by an individual other than a licensed physical therapist or physical therapy assistant; and usually has little or no accompanying paperwork, insurance involvement or written follow-up information required.

 

Is aquatic physical therapy effective?

While there is considerable research effectively documenting the value of water therapy in various setting and for multiple diagnoses, it comes down to both the therapist's skills and the patient's diagnosis as to the exact benefit of this intervention for a specific patient. To delve more into specific diagnoses and the effectiveness of water therapy, one is encouraged to refer to the APTA website under research and follow the prompts to utilize various search engines to custom your search. Additionally, on this web page, one can, if an Aquatic Section member, retrieve previous Journal of aquatic Therapy articles that may help. Lastly, one might be encouraged to directly contact the Director of Research if adequate information regarding a specific topic cannot be found.

What do I do if I am denied coverage for aquatic therapy?

First of all, one must understand the exact reason for the denial, and that is stipulated on the insurance document usually, but it may also require a call to the insurance company. Additionally, one might refer to the APTA website under reimbursement to assist with the process. If this particular third party payor globally denies aquatic physical therapy, one can attempt to educate this insurance regarding the benefits of aquatic therapy, and specifically for the diagnosis in question. It would behoove the therapist to have research to substantiate this statement of aquatic therapy benefits. Such information might be initiated using the APTA website and going to the education tab to the research selection and following the prompts to various searches, directly emailing the Aquatic Section or discussion of this denial with therapists involved in aquatic therapy AND in your geographic area of practice regarding the denial and what they have done to rectify the situation to date. Additionally, one might consider contacting the reimbursement chair either in your state, as they may already be involved with education of insurance regarding this matter, or contact the APTA reimbursement office directly for assistance in how to proceed.

Are there particular patients that should or should not have aquatic physical therapy? Indications/contraindications?

This is an area with potentially deleterious ramifications for both patient and therapist, so it would behoove one to become familiar with specific contraindications as well as relative contraindications. This information is included in various aquatic therapy texts and is also covered directly in the Aquatic Section's "Developing an Aquatic Physical Therapy Program." (Click here to download order form)

Are there any potential risks to therapists who are involved with prolonged exposure to water?

While this is absolutely dependent on water quality and one's person medical history, the has been documented evidence regarding both respiratory and dermatological conditions that one who is immersed in water for prolonged periods, seem to be susceptible to. At this time, there is no specific disease attributed to the water. For more information regarding this topic, you are encouraged to seek information on the following websites:

  • National Swimming Pool Foundation: NSPF.org
  • Centers for Disease Control and Prevention: CDC.gov

 

What is lifeguard lung?

Here is link to a citation for an article on the topic of lifeguard lung: Click Here

And, here is a link for another article that provides further background information on the topic - Click Here

 

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.

 

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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Education FAQs

Is there a certification program for aquatic physical therapy?

No; however, the Section has a Certificate in Aquatic Physical Therapy Clinical Competency for PTs and PTAs.  To find out more information, go to the APTA Learning Center.


Is there a certification program for aquatic physical therapy?

No; however, the Section is in the process of putting together of certificate for Aquatic physical therapists which should be available in the Spring of 2014.

What education requirements are needed to specialize in Aquatic PT?

Water safety, risk management, and an understanding of hydrodynamic principles and various aquatic therapy techniques. Prior to embarking on providing aquatic therapy, one is strongly encouraged to take continuing education classes, and if possible, to actually observe aquatic therapy sessions.

How do I become an aquatic physical therapist?

PTs/PTAs should take continuing education courses to gain knowledge in the area of aquatic physical therapy; should have an understanding of the effects of water on the human body during immersion, should be familiar with water chemistry and should have an understanding of the inherent risks in and around swimming pools.

 

 
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 courses offered by the Section should assist you in getting started. (Click here to download order form) Additionally, list below are several great sources of information regarding design, construction, and risk awareness for pools.

These include:

 

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. Additionally, if you order "Developing an Aquatic Physical Therapy Program", you can get the management package that INCLUDES STATE-SPECIFIC information and how to utilize the various state/local health department services. This can be ordered directly from this website or use the attached order form. (Click here to download order form)

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.

What is the required ratio of patients to PTs/PTAs?

This is governed by the individual State Practice Acts.

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). Additionally, one may want to engage risk management specialists to determine the exact risks inherent at a specific pool location. Initial information can be derived from the National Swimming Pool Foundation (NSPF) website: nspf.org

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 dependent upon the situation and individual (e.g. considering water temperature, water and air chemistry, and personal medical factors).

Additional sites with respect to water safety are the following:

  • Centers for Disease Control (CDC) cdc.gov
  • National Swimming Pool Foundation (NSPF) website: nspf.org

 

How does one go about reporting a bad working environment (e.g. poor environmental conditions and/or poor pool maintenance)?

There are several means to report poor working environments, and it may behoove one to solicit the help of local health department officials with such environmental concerns. State health officials, likewise, are mandated to enforce swimming pool standards, and while not all states have adequate swimming codes, this is an option. 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".

 

What agency (or agencies) regulate the operation of the pool?

Operations for pools are regulated by your State, County, and/or Local Health Department.

 

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

What is the required level of chlorine for aquatic therapy pools?

This is usually regulated locally by the city/county and/or state Health Department. While there are specific standards for acceptable chemical levels, one must first be aware of those enforced by your region's health governing body. Additional information regarding this can also be found in the following locations:

 

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.

 

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

Do aquatic PT pools need lifeguards?

This is dependent upon local codes.

 

Are aquatic PTs required to be certified in life saving?

No; however, the Section recommends some type of water safety training and risk management.

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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