November 2017: Specialty Techniques



Content courtesy of the National Swimming Pool Foundation


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. 

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. 

Below is a list of the definition of the most well-established specialty techniques currently being performed in the aquatic therapy setting. 

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.

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.[3]

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 Concept  – 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 Concept combines the unique qualities of the water with rotational control patterns.

Salzman Blanket Drills – A form of active aquatic therapy which makes use of towels, blanket or weight-weight scarves or wraps to create resistance and a visual effect in water. Created by physical therapist Andrea Salzman, these activities are designed to mimic functional movements and are named accordingly (Matador, Cursive writing, Spaghetti wrap, Parachute Bounce, Balance ball, etc). These activities are not a closed system; rather, the Blanket Drills are taught as an open system, encouraging new ideas and extrapolation from existing 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.


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