Bruce E. Becker

The aquatic environment has broad rehabilitative potential, extending from the treatment of acute injuries through health maintenance in the face of chronic diseases, yet it remains an underused modality. There is an extensive research base supporting aquatic therapy, both within the basic science literature and clinical literature. This article describes the many physiologic changes that occur during immersion as applied to a range of common rehabilitative issues and problems. Because of its wide margin of therapeutic safety and clinical adaptability, aquatic therapy is a very useful tool in the rehabilitative toolbox. Through a better understanding of the applied physiology, the practitioner may structure appropriate therapeutic programs for a diverse patient population.

1. Aquatic Rehabilitation: A Historical Perspective 2. The Biophysiology of Aquatic Therapy 3. Facility Design and Water Management 4. Halliwick and Bad Ragaz Techniques 5. Watsu and Related Tecniques Uses and Modifications of Watsu in Rehabilitation 6. Aquatic Therapy Tools, Toys and Equipment 7. Aqua-Running: Applications and Technique 8. Aquatic Rehabilitation for Neurologic Disorders 9. Spine Pain: Aquatic Rehabilitation 10. Aquatic Therapy in Rheumatologic Disease 11. Aquatic Strategies in Musculoskeletal Pain 12. Pediatric Aquatic Therapy 13. Community Transitioning in Aquatic Therapy 14. Burn and Wound Therapy 15. Staff Training in Aquatic Therapy 16. Interdisciplinary Models of Care 17. Legal Aspects of Aquatic Therapy

Physiologic change associated with aquatic activity has been found to profoundly affect human function and health-related biologic alterations. Similar to sleep research, aquatics has emerged as an area ripe with human health and performance implications. Aquatic activity impacts the cardiovascular, musculoskeletal, autonomic nervious system (ANS) and endocrine systems in ways that have positive public health implications for issues confronting the nation, including obesity, diabetes and arthritis Aquatic activity has tremendous application in the area of sports medicine and has great potential value to student athletes in both training and rehabilitation. The aquatic environment is a research area just emerging as a focus of physiologic importance with many health benefits that apply across the age span and could be widely accessed by the American public if both research support and understanding by the health professionals were to increase.

OBJECTIVE: There is a need for interventions that assist in managing the multiple adjustments of persons with spinal cord and brain injuries and their families. The purpose of the present field-initiated development project was to adapt a family psychoeducation model, multiple-family group treatment (MFGT), for persons with brain and spinal cord injury and their families. DESIGN: The experiences of survivors and caregivers in MFGT were evaluated using quantitative and qualitative methods. Twenty-seven survivors and 28 caregivers participated in MFGT for 12-18 mos. Reliable and valid quantitative measures were used to assess a variety of target outcomes. Additionally, semistructured interviews and focus groups were conducted with participants. RESULTS: Survivors reported a decrease in depressive symptoms and anger expression toward others as well as an increase in life satisfaction. Caregivers reported a significant reduction in burden. The themes derived from the qualitative analysis addressed the normalization of the caregiving experience, importance of socialization, improvement in a variety of coping skills, and education about the injuries. CONCLUSIONS: The findings support the adaptation of MFGT for brain and spinal cord injuries.