Contrary to therapeutic mythology, all care which occurs in the water is not identical. Clinicians make use of as broad a spectrum of treatment options in water as they do on terra firma. On land, therapists offer patients the sum total of their knowledge as health care professionals. This knowledge manifests itself as specific interventions or (if you will) as specialty techniques.
Therapists don't describe the work they do on land as "land-based therapy"; instead, they describe it as McKenzie extension work, muscle energy techniques, mechanical traction, and spinal stabilization. In water, aquatic therapy practitioners use the buoyancy, viscosity, hydrostatic pressure and other unique properties of water to construct new techniques.
Since water provides a therapeutic environment much different than land, it is unusual for therapists to merely take land-based treatments and place them in toto in the pool. It is much more typical for therapists to either significantly modify existing land-based treatments or to perform techniques which were specifically created to be used in water.
The Need for Nomenclature
Operational definitions allow those of us who work in the water to communicate with others who are not as familiar (or as enamored) with aquatic terminology as we are.
The operational definitions provided here were drafted after conducting extensive interviews with leading authorities on each topic. When available, the interview was done with the creator of the technique (Ai Chi, Fluid Moves, Watsu). When the creator was deceased, an agent of the organization charged with managing the technique was interviewed (Halliwick). When the technique was developed over time by the contributions of many individuals, the interview was done with an aquatic physical or occupational therapist who has published work on the technique in either a professional journal or textbook (Bad Ragaz Ring Method, Swim Stroke Modification and Training, Task-Type Training Approach).
Individuals interested in more information about each specialty technique should contact the individuals or organizations identified in the References section provided.
Aquatic Specialty Techniques Glossary
Ai Chi A form of active aquatic therapy or fitness modeled after the principles of T'ai Chi and yogic breathing techniques. Ai Chi is typically provided in a hands-off manner (the provider stands on the pool deck to allow visual imaging of complex patterns by the client). The client stands in chest-deep water and is verbally and visually instructed by the provider to perform a slow, rhythmic combination of therapeutic movements and deep breathing.
Aquatic PNF A form of active aquatic therapy modeled after the principles and movement patterns of Proprioceptive Neuromuscular Facilitation (PNF). Aquatic PNF can be provided in either a hands-on or hands-off manner by the provider. The client is verbally, visually and/or tactilely instructed in a series of functional, spiral and diagonal, mass movement patterns while standing, sitting, kneeling or lying in the water. The patterns may be performed actively, or with assistance or resistance provided by specialized aquatic equipment or the provider.
Bad Ragaz Ring Method A form of active or passive aquatic therapy modeled after the principles and movement patterns of Knupfer exercises and Proprioceptive Neuromuscular Facilitation (PNF). Bad Ragaz is always performed in a hands-on manner by the provider. The client is verbally, visually and/or tactilely instructed in a series of movement or relaxation patterns while positioned horizontally and supported by rings or floats in the water. The patterns may be performed passively (for flexibility and relaxation), actively, or with assistance or resistance provided by a provider.
Fluid Moves® (Aquatic Feldenkrais®) A form of active or passive aquatic therapy modeled after the Feldenkrais Method. Fluid Moves may be provided in either a hands-on or hands-off manner by the provider. During active Fluid Moves, the student in a guided exploratory process, follows a sequence of movements based on the early developmental stages of the infant. The client stands in chest-deep water, typically with his back to the pool wall, and is verbally and visually instructed by the provider to perform a slow, rhythmic combination of therapeutic movements and deep breathing. The passive, hands-on component to Fluid Moves is modeled after the "Functional Integration" component of the Feldenkrais Method.
Halliwick Method A form of adapted aquatics which can be modified into active aquatic therapy. Halliwick is almost always performed in a hands-on manner by the provider and is typically done through the use of games within groups of client-provider pairs. The client is usually held or cradled in the water while the provider systematically and progressively destabilizes him in order to teach balance and postural control. The provider progresses the client through a series of activities which require more sophisticated rotational control in an attempt to teach the client to swim (for adapted aquatics clients) or in an attempt to teach control over movement (for aquatic therapy clients). The client is continuously required to react to, and eventually to predict, the demands of an unstable environment. The Halliwick Method combines the unique qualities of the water with rotational control patterns.
Swim Stroke Training and Modification A form of active aquatic therapy which makes use of swim stroke training and modification with the intent to rehabilitate, not to teach swimming skills or to promote swim stroke efficiency. Swim Stroke Training and Modification may be provided in either a hands-on or hands-off manner by the provider. The client is positioned horizontally and is verbally, visually and/or tactilely instructed in order to modify and execute various swim strokes.
Task-Type Training Approach A set of principles that guide clinicians as they design treatment programs for reducing clients' disabilities. Task Type Training Approach (TTTA) was first described as a way to teach functional activities to clients who had sustained a stroke. The principles can be extended to include treatment of all patient disorders, particularly those involving neurologic dysfunction. The TTTA is best described as a task-oriented approach because it emphasizes functional skills performed in functional positions. Clients are encouraged to be active participants in their skill development, an important characteristic of task-oriented rehabilitation.
Watsu® A form of passive aquatic therapy modeled after the principles of Zen Shiatsu (massage). Watsu is always performed in a hands-on manner by the provider. The client is usually held or cradled in warm water while the provider stabilizes or moves one segment of the body, resulting in a stretch of another segment due to the drag effect. The client remains completely passive while the provider combines the unique qualities of the water with rhythmic flow patterns.
Learn More on this Topic
For more on aquatic specialty techniques, order the Consumers' Guide to Aquatic Therapy, an 8-page educational mini-magazine that provides aquatic definitions and other helpful promotional material (this can be purchased in bulk for mass mailings to physicians and other referral sources). The Guide can be customized to profile your aquatic therapy practice and then ordered in bulk. Obtain order form by e-mail request.
1. Ai Chi Personal interview: Konno J., Sova R. (1999). Aquatic Therapy and Rehabilitation Institute, Route 1, Box 218, Chassell, MI 49916 USA. Ph: (906) 482-9500. Fax: (906) 482-4388. Web: www.atri.org.
2. Aquatic PNF Personal interview: Ogden D., Jamison L. (1999). Thunderbird Samaritan Medical Center, 5555 West Thunderbird Boulevard, Glendale, AZ 85306 USA. Ph: (602) 588-5830. Fax: (602) 588-5857.
3. Bad Ragaz Ring Method Personal interview: Garrett G. (1999). Aquatic Rehabilitation Consultants, 22 East Main Street, Smithfield, VA 23430 USA. Ph/Fax: (757) 357-0342.
4. Fluid Moves Personal interview: Ashton D. (1999). The Well Being, 9113 Cedar Park Lane #C, Knoxville, TN 37923 USA. Ph: (888) 935-6287 or (865) 690-9548. Fax: (865) 690-0517.
5. Halliwick Method Personal interview: Lambeck J. (1999). International Halliwick Association. c/o Akkersleep 32, NL - 6581 VM Malden, Netherlands. Ph: (011) 31-24-358-2092. Website: www.halliwick.net.
6. Swim Stroke Training and Modification Personal interview: Dunlap E. (1999). 1062 Happy Valley Avenue, San Jose, CA 95129 USA. Ph: (408) 252-9983.
7. Task-Type Training Approach Personal interview: Morris D.M. (1999). University of Alabama - Division of Physical Therapy, 1333 17th Avenue South, Birmingham, AL 35205 USA. Ph: (205) 934-0418. Fax: (205) 975-7787.
8. Watsu Personal interview: Dull H. (1999). Worldwide Aquatic Bodywork Association (WABA), Post Office Box 889, Middletown, CA 95461 USA. Ph: (707) 987-3801. Fax (707) 987-9638. Website: www.waba.edu.
Andrea Poteat Salzman, MS, PT is the owner of two businesses, the Aquatic Resources Network and Concepts in Physical Therapy. She has received both the prestiguous Aquatic Therapy Professional of the Year Award (Aquatic Therapy and Rehabilitation Institute) and the Tsunami Aquatic Therapy Award.
Salzman is well-regarded within the industry as:
- Editor-in-Chief of an aquatic therapy trade journal and newsletter;
- Author of over a dozen publications, including the soon-to-be-released Evidence-Based Aquatic Therapy textbook;
- Freelance author and columnist;
- Aquatic therapy seminar instructor;
- Adjunct faculty and research advisor, St. Catherine Physical Therapy Program, Minneapolis, MN;
- Immediate past manager of therapeutic aquatics, St. Paul Ramsey Medical Center, St. Paul, MN;
- Researcher and grant recipient examining aquatic exercise vs. land-based exercise.
She may be reached via e-mail at firstname.lastname@example.org