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:
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:
aerobic capacity/endurance conditioning
balance, coordination and agility
body mechanics and postural stabilization
gait and locomotion
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.
is the difference between "aquatic
physical therapy" and "aquatic
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.
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.
do I do if I am denied coverage for
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.
there particular patients that should or
should not have aquatic physical
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:
Centers for Disease Control and Prevention: CDC.gov
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
is the history of the Aquatic PT
Section? Focus of research and study in
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.
are the current trends in aquatic
Trends vary depending on what part of the country/world in which one lives.
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 sometime in 2013.
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.
do I become an aquatic physical
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.
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.
National Swimming Pool Foundation (NSPF): nspf.org
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)
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.
is the required ratio of patients to PTs/PTAs?
This is governed by the
individual State Practice Acts.
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
long should someone be/can
someone be required to be in the
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:
National Swimming Pool Foundation (NSPF) website: nspf.org
does one go about
reporting a bad
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".
agency (or agencies) regulate the
operation of the pool?
Operations for pools are
regulated by your State, County, and/or Local Health
is the range of pool temperatures for
specific kinds of therapy and certain
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
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:
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.
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.
many patients constitute a group for
Two to five and in order to be reimbursed through Medicare, all in the group must have the same diagnosis.
there a required ratio of land to
aquatic therapy required for
Often, land and aquatic therapy cannot be performed on the same day.
Medicaid reimburse for treatment at an
Medicaid is a State administered program with individual state