December 2022 / January 2023 / February 2023 | Akwa | 19 imperative. In the water, individuals can confidently prac- tice activities of daily living and transfer those learned skills outside of the water. Aquatic exercise is a significant first step in increasing quality of life while also providing an oppor- tunity to build strength, stability, and flexibility with a low risk of injury or falls. Not only can the pool provide the saf- est means for confident exercise but including a fun and/ or social aspect to an exercise program can further increase the quality of life. Studies show that functional mobility and timed up-and-go performance directly correlate to depres- sion scores in geriatric individuals (Chang 2014). Training should be progressively increased over time to con- tinue achieving results. Once stability and confidence have increased from aquatic treatment, the training program can be gradually transferred to the land, practicing real-life sce- narios that may pose problems for fall-risk patients. Exercise Examples While many exercises can be completed in the water to include balance and gait training simultaneously, specific exercises can be implemented to focus on one or the other, depending on the needs of the participant. Aquatic Balance Exercise • Romberg Stance with Variations Alter difficulty by changing the foot position, opening/ closing the eyes, adding head movement, changing the surface the participant is standing on, or changing the turbulence of the water. • Heel-Toe Raise This exercise focuses primarily on weight shifting through the ankles. Alter it by changing upper extremity assis- tance or through turbulence to make it more challenging to establish equilibrium. • Rocking Horse As the participant gains stabilization in the planted lower extremity, they are forced to maintain dynamic balance as their weight shifts from front to back, coordinating upper extremity movement with lower extremity movement. • Single Leg Lateral jumps Although this exercise includes higher impact, it is very effective in training lateral stabilization, which is a sig- nificant cause of falls. As the participant completes a lateral jump to land on one foot, they must establish a solid base with the ground while also fighting the aquatic turbulence to maintain stationary. Aquatic Gait Exercises • Forward/Backward/Lateral Walking As simple as it may seem, walking in the water has largely been used to train gait efficiency, using the water’s prop- erties to elicit a positive response in dynamic posture. • Hip ROM (ab/adduction, flexion/extension) The hip is the root of many gait issues, especially in cases of Trendelenburg gait, a common disorder resulting from a defective hip abductor mechanism. • Marching The simple march can be a great exercise for people expe- riencing gait issues and altering it can make it even more impactful. This exercise can improve hip and knee ROM; adding movements, such as ankle circles, or emphasizing knee flexion at the top of the march will further increase efficiency. To conclude, the aquatic environment works in many ways to help train individuals with balance and/or gait issues and provide an excellent opportunity for preventative care. There is a potential to change lives by eliminating one of the lead- ing causes of injury in people over 65. Participants will expe- rience a safe and fun environment in the pool to address fall prevention, and they will also leave the pool more confident to get up and get moving! n Resources Azevedo Y, et al. Aquatic physiotherapy: a vestibular rehabilitation option. Brazilian Journal of Otorhinolaryngology. 2021;87(6): 649-654. Bergen G, Burns E, Stevens M. Falls and Fall Injuries Among Adults Aged > 65 Years – United States. CDC. 2014;65(37):993-998. Bordner R. Sensory Processing Pediatrics and Beyond. Aquatic Therapy & Rehab Institute. 2011;1(1):1-4. Bulstrode S, Harrison RA, Hillman M. Loading of the lower limb when walking partially immersed: implications for clinical practice. Physiotherapy. 1992;78(1):164-166. CDC. Facts about falls. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. 2017;1(1):1. Change K, Lee H, Lin S, Tsauo J, Yang Y. Problems and fall risk determinants of quality of life in older adults with increased risk of falling. Geriatrics and Gerontology International. 2015; 15(5):579-587. Kim E, Kim Y, Lee D. Effects of aquatic PNF lower extremity patterns on balance and ADL of stroke patients. Journal of Physical Therapy Science. 2015;27(1):213-215. Author Ryan Dean is a graduate from West Virginia University with a BS in Exercise Physiology with an emphasis in Aquatic Therapy, and plans to attend graduate school in physical therapy. He currently works as a Physical Ther- apy Technician at Fyzical Therapy and Balance Center in Morgantown, WV and recently completed an intern- ship at HealthWorks Rehab & Fitness where he worked patients through their aquatic therapy treatment plans. Ryan believes in the utilization of the aquatic environment and plans to fully implement into future clinical practice. In the aquatic setting, the fear of falling tends to diminish, allowing one to confidently perform balance, strengthening, and range-of-motion exercises to offer greater stability and confidence out of the water.
