Multiple Sclerosis (MS) and Aquatic Therapy

1. Multiple Sclerosis (MS) and Aquatic Therapy Tiffany Dean Temple University Therapeutic Recreation Major Tiffany.dean@temple.edu

2. Learning Outcomes • Define Multiple Sclerosis (MS) and describe the effects it causes. • Explain ways in which Aquatic Therapy is beneficial for individuals with Multiple Sclerosis • Identify Precautions that should be considered before an individual with MS participates in Aquatic Therapy.

3. Overview of Multiple Sclerosis • Multiple sclerosis (MS) is a chronic autoimmune disorder affecting movement, sensation, and bodily functions. It is caused by destruction of the myelin insulation covering nerve fibers (neurons) in the central nervous system (brain and spinal cord). • “Most common cause of neurological disability in young & middle aged adults affecting an estimated 400,000 people in the U.S.” (Salem, et al, 2011).

4. Types & Symptoms of MS Types • Relapsing-Remitting Pattern • Primary Progressive Pattern • Secondary Progressive Pattern • Progressive-Relapsing Pattern Symptoms • visual disturbances • sensation in extremities • weakness or clumsiness in leg or hand • Spasticity • Difficulty with bladder control • Vertigo • Gait disturbances • Stiffness • Fatigue of limbs

5. Overview of Aquatic Therapy • Aquatic therapy is a form of physical therapy that is performed in a pool. • The goal of this particular form of therapy is to assist in restoring the person's strength and movement through the use of buoyancy, resistance, and heat. •  It aims to rehabilitate patients after injury or those with chronic illness. http://www.youtube.com/watch?v=bZQUYaG0Zqc

6. Types of Aquatic Activity • Balance exercises • Ai Chi (Water Tai Chi) • Halliwick techniques • Relaxation and stretching • Stretching • Ai chi • Aquatic body work: Watsu, Jahara, or Healing Dance • Strengthening exercises • Deep or shallow water techniques • Bad Ragaz Ring Method • Use of drag or resistance equipment

7. Sample Aquatic Exercises • Marching—stand with your side to the pool wall. Hold onto the wall if needed for balance. Lift one leg up and down, then the other. Repeat 5 to 8 times. • Side leg lifts—stand facing the side of the pool. Hold onto the edge of the pool if needed for balance. Lift leg out to the side 5 to 8 times. Do the other leg. • Back leg lifts—stand facing the side of the pool. Hold onto the edge of the pool if needed for balance. Lift leg straight back 5 to 8 times. DO NOT arch the back. Do the other leg. • Runner's stretch—stand facing the side of the pool. Hold the edge of pool for balance. Step one leg back. Both feet flat on floor. Keep the heel of the back leg on the floor. Bend the knee of the forward leg. Lean forward from the ankles. You should feel a stretch in the lower leg or calf muscles. Hold for 20-30 seconds. Do 1 to 2 times. Switch legs.

8. Equipment for Aquatic Therapy • Flotation devices • Ankle weights • Water barbells • Kickboards • Water shoes • Therapy bars

9. Benefits for Individuals with MS

10. Other Benefits… • Decreases stress • Pain relief • Improved flexibility • Ease depression • Boost self-esteem • Improved posture • Increased circulation • Increased cardiovascular functioning

11. Research Study • Conducted by Physical Therapy Departments of Long Island University & Hunter College in 2011 • Purpose: to examine the effects of group aquatic exercise in individuals with MS. • Methods: 11 participants, 5-week program, 2/wk for 1hr • Results: Improved gait speed, grip strength, muscle strength, walking speed, balance, & mobility • Conclusion: Aquatic Therapy is beneficial in improvement in motor functioning of individuals with MS.

12. Precautions • Bowel incontinence with firm stools • Communicable diseases (cold flu, Hepatitis) • Autonomic dysreflexia • Sensitivity to disinfection chemicals • Sensitivity to heat/ humidity • Rashes, skin conditions with flaking or open areas • Hydrophobia • Controlled seizures, • Open wounds • Compromised immune system

13. Interested in Aquatic Therapy Certification? • Aquatic Therapy & Rehab Institute (ATRI) • How to get started http://www.atri.org/How%20to%20Get%20Started12.pdf • ATRI Certification • Membership $45

14. Resources Butler, C. (2002). Walking in Water. Inside MS, 20(3), 66. Chamberlayne, N. (2006). Come on in, the water's fine!. Inside MS, 24(4), 34-35. Merck Manual Staff (2013). Overview of Multiple Sclerosis. Accessed via www.merckmanuals.com/professional/neurologic_disorders/demyelinating_disorders/multiple_sclerosis_ms.html?qt=muliple%20sclerosis&alt=sh Salem, Y., Scott, A., Karpatkin, H., Concert, G., Haller, L., Kaminsky, E., & ... Spatz, E. (2011). Community-based group aquatic programme for individuals with multiple sclerosis: a pilot study. Disability & Rehabilitation, 33(9), 720-728. doi:10.3109/09638288.2010.507855 Weiss, Thomas C. (2010). Aquatic Therapy- Facts and Information. Accessed via http://www.disabled-world.com/medical/rehabilitation/therapy/aquatic-therapy.php

15. Using Aquatic Therapy to treat individuals with Multiple Sclerosis Tiffany Dean Temple University tiffany.dean@temple.edu “If I could live in the water, I would.” –Mary Ann Lee. • Overview of Aquatic Therapy • Aquatic therapy is a form of physical therapy that is performed in a pool. • The goal of this particular form of therapy is to assist in restoring the person's strength and movement through the use of buoyancy, resistance, and heat. • Types of Aquatic Therapy include: Ai Chi, Halliwick Method, Watsu, Bad Ragaz Ring Method, etc. • Benefits of Aquatic Therapy • Improved muscle strength • Improved walking speed • Enhanced balance & coordination • Decreases stress • Pain relief • Improved motion • Improved flexibility • Promotes muscle relaxation • Ease depression • Boost self esteem • Resources: • Americans w/ Disabilities Act www.ada.gov • The National MS Society • www.nationalmssociety.org/index.aspx • Moss Rehab www.mossrehab.com • ATI Physical Therapy www.atipt.com • Oxford Rehab Center www.oxfordrehab.com • ATRI Certification www.atri.org • ATRA's Aquatic Therapy Treatment Network www.atra-tr.org • Aquatic Resources Network www.aquaticnet.com • http://recreationtherapy.com/articles/aquaticstherapy.htm • Just so you know… • Aquatic Therapy Certification will look great on your resume! • Aquatic Therapy has the power to change someone’s life!