AQUATIC

                          THERAPY       

                                AND

                   REHABILITATION

                                                           

                                   

                                   

                                                     

                        STANDARDS

                                FOR

                                THE

                          INDUSTRY

                                   

                                   

 

 

 

 

 

 

AQUATIC THERAPY & REHAB INSTITUTE, INC.

www.atri.org

 

 

 

 

 

 

 

 

Copyright 1996 by Aquatic Therapy & Rehab Institute, Inc.

 

Revised 2004 by the Aquatic Therapy & Rehab Institute, Inc

 

 

 

 

All rights reserved.  No part of the material protected by this copyright notice may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner.

 

 

 

 

 

Production Editor:  Ellen Dybdahl

 

Copy editor:  Gina Taucher

 

Design and Production:  Aquatic Therapy & Rehab Institute, Inc.

 

Cover Design:  InterSection Design

 

Printing and Binding:  Heritage Publishing Company, Inc.

 

 

Printed in the United States of America

                                                                       

                                                                                               

 

 

STANDARDS FOR THE AQUATIC THERAPY AND REHABILITATION  INDUSTRY

 

 

 

I.  Aquatic therapy and rehabilitation practitioners should have knowledge of Movement Mechanics and Science (anatomy, physiology, kinesiology and biomechanics) including knowledge of the cardiovascular, respiratory, circulatory,  nervous, muscular and skeletal systems and their collective interactions; knowledge of  basic anatomy, physiology and kinesiology concepts; knowledge of  basic health care terminology; and knowledge of body terms, positions and movements.

 

 

II.  Aquatic therapy and rehabilitation practitioners should have knowledge of aquatic principles including variations to movement quality using aquatic and physics concepts correctly, knowledge of how to choose equipment based on client need and goals, and knowledge of  practical skills in aquatic therapy and rehabilitation. 

 

 

III.  Aquatic therapy and rehabilitation practitioners should have knowledge of  basic principles and methods used in aquatic therapy and rehabilitation including  indications, contraindications, precautions and opportunities for aquatic therapy and/or rehabilitation; knowledge of the client evaluation process; and knowledge of the treatment and prevention components.

 

 

IV.  Aquatic therapy and rehabilitation practitioners should exhibit professional responsibility, including the proper education, certification, and/or license and training or their equivalent; knowledge of the allied health field; and knowledge of legal, ethical practices.

 

 

V.  Aquatic therapy and rehabilitation practitioners should demonstrate health and safety consciousness by maintaining current certifications and training; they should be familiar with supervisory guidelines and possible emergencies; they should be able to maintain an overall risk management program, and personal and client safety.

 

 

VI.  Aquatic therapy and rehabilitation practitioners should have knowledge of applicable regulations and legal considerations; comply with all applicable codes and laws relating to aquatics, therapy and rehabilitation; know and apply the limits of practice as they relate to base competencies within the medical system; and  generally know basic reimbursement factors.

 


 

 

I.  Aquatic therapy and rehabilitation practitioners should have knowledge of Movement Mechanics and Science (anatomy, physiology, kinesiology and biomechanics) including the cardiovascular, respiratory, circulatory, nervous, muscular and skeletal systems and their collective interactions .  .  .

 

they should be able to apply basic anatomy, physiology and kinesiology concepts including but not limited to

 

Cardiorespiratory/circulatory                        

venous return                                                                       central venous pressure                                                         pulmonary blood flow physiology                                        maximal myocardial oxygen consumption

cardiac output                                                                      oxygen consumption                                                              stroke volume  

 

Neuromuscular/skeletal                                                                                                                                                                      planes/axes                                        levers                                                     articulations

muscle balance                                     physiological principles                      physical fitness components                principles of training                             joint range                                             muscular contractions                                         central and peripheral nervous systems changes                                             

major postural deviations (including consideration of general landmarks) and potential injury           

proper body alignment (static and with movement in and out of the water)

 

 

they should be able to use basic health care terminology including but not limited to

 

basic references and standards                                                                                                                                            basic structure (prefixes, suffixes, abbreviations and acronyms) of medical terminology

terminology pertinent to disease conditions encountered in the Aquatic Therapy and Rehabilitation setting

 

and they should be able to describe body terms, positions and movements including but not limited to

 

anterior                                                  posterior                                                superior

ventral                                                    dorsal                                                     lateral                                                         medial                                                  supine                                                    prone

sagittal                                                   frontal (coronal)                                   transverse                                                 multiplanar                                         anatomical position                             flexion                                                                    horizontal flexion                     extension                                             horizontal extension                                            hyperextension                                     agonist                                   antagonist

abduction                                              adduction                                              horizontal abduction                               horizontal adduction                             circumduction                                       rotation                                                                  opposition                                dorsiflexion                                             plantar flexion

supination                                             pronation                                               inversion                                                   eversion                                              elevation                                                depression

concentric                                             eccentric                                                inferior

proximal                                 distal

 

 

 

 

II.  Aquatic therapy and rehabilitation practitioners should have knowledge of aquatic principles .  .  .

 

they should be able to apply variations to movement quality using aquatic and physics concepts correctly including but not limited to      

 

resistance

drag forces                                 frontal area/bow wave              surface tension

turbulent (resistant) flow  laminar (streamlined) flow                     viscosity          

eddy drag                                   skin friction                                           tail suction

Bernoulli's principle

 

buoyancy

specific gravity                            Archimedes principle                buoyancy resisted        

force absorption              buoyancy assisted                     buoyancy supported    

center of gravity              center of buoyancy                   relative density 

suspended moves                        rebound moves

 

acceleration

mass                                           speed                                       force

 

fluid properties

hydrostatic pressure                    specific heat                              thermal conductivity     

refraction                                    Pascal's law

 

physics concepts relating to water

action vs. reaction                       leverage                                    range of motion

traction                                       inertia                                       momentum

 

 

they should be able to choose equipment based on client need and goals by

 

knowing the indications and contraindications of general aquatic equipment

being familiar with the principle underlying selected equipment

being familiar with equipment rationale and protocols

 

they should know practical skills in aquatic therapy and rehabilitation such as

 

role of positioning

specific functional biomechanics

body alignment

      breath control

 

 

 

 

 

 

 

 

 

III.  Aquatic therapy and rehabilitation practitioners should have knowledge of  basic principles and methods used in aquatic therapy and rehabilitation .  .  .

 

 

they should know the indications, contraindications, precautions and opportunities for aquatic therapy and/or rehabilitation through but not limited to

 

the basic pathologies and conditions and their response to immersion  

the effects of hydrophysics on bone density; circulation; muscle tone and balance; the visual,    auditory and tactile senses; urine output and spasticity

the application of hydrophysics for treatment       

the utilization of patient position changes to vary treatment effects       

the positive lifestyle change enhancement (recreational, social, fitness) and appropriate                           community based referrals

 

 

they should be able to describe the client evaluation process, including but not limited to

 

clinical and aquatic assessment of client situation

functional improvement goals for both water and land

program development

treatment and intervention prioritization related to functional activity needs of the client

 

 

they should be aware of treatment and prevention components including but not limited to

 

the purpose of each activity

the quantification of short term and long term goals

the procedures, equipment, frequency, duration and intensity of treatment       

the referral to other professionals in treatment program as appropriate

listing examples of suggested protocols and/or treatment techniques for the identified                            dysfunction

 

 

 

 

 

 

 

 


 

 

 

 

 

IV.  Aquatic therapy and rehabilitation practitioners should exhibit professional responsibility .  .  .

 

 

they should have the proper education, certification, and/or license and training or their equivalent including one of the following

 

undergraduate degree in exercise science, biology, pre-med, physical education, recreation, or       a related field

license or certification registration in physical therapy, or physical therapy assistant, or athletic         training, or kinesiotherapy, or occupational therapy, or occupational therapy assistant, or            recreation therapy, or massage therapy, or exercise physiology

 

and 30 hours of training specific to aquatic therapy and rehabilitation

 

and a six month aquatic therapy and rehabilitation internship with a knowledgeable           professional in aquatics of at least 2 hours per week or a total of 50 hours

 

and continually expanding knowledge

 

 

they should understand the allied health field including

 

the treatment role of various allied health professionals in the care of the client

the ability to make effective and timely referrals as defined by each discipline's professional                 organization

 

 

they should follow legal, ethical practices including

 

respecting confidentiality

complying with laws and regulations

practicing informed consent, non-discrimination, beneficence ("do no harm"), and fiduciary                 responsibility to the consumer

acknowledging patient concerns, rights, and responsibilities

reasonable and appropriate consumption of resources

appropriate documentation

 

 

 

 

 

 

 

 

 

 

 

V.  Aquatic therapy and rehabilitation practitioners should demonstrate health and safety consciousness .  .  .

 

they should have current certifications and training to demonstrate professionalism with certification by a national organization recognized in their discipline, in the field of aquatic therapy and an emergency certification.

 

 

they should have the ability to maintain personal safety and client safety including awareness of immersion time, thermoregulatory issues, transfers, entry and exit, equipment and body positioning, and communication avenues.

 

 

they should have knowledge of supervisory guidelines including surveillance issues and requirements, precautions and contraindications, infection control policies, and understanding of bioethics.

 

 

they have responsibility to recognize emergencies and precursors to emergency situations including the knowledge to perform facility evaluations and daily inspections with regards to safety, water chemistry, air and water temperatures, humidity, and pool closure factors.

 

 

they should understand and implement an overall risk management program including legal issues, rescue plan, extrication options, ADA and OSHA requirements, state/local codes, and an Emergency Action Plan (EAP) written in compliance with guidelines.

 

 

 

 

 

 

 

 

 

VI.  Aquatic therapy and rehabilitation practitioners should have knowledge of applicable regulations and legal considerations .  .  .

 

 

they should comply with all applicable codes and laws relating to aquatics, therapy and rehabilitation by

 

meeting the standards of care from both the aquatic and therapy/rehabilitation professions

being covered by corporate, facility and/or individual personal liability insurance

knowing the plan of facility operation including outlined policies and procedures with                              defined structure, process and outcome criteria

citing the department of health regulations (city, county, state) regarding pool and therapy pool      facility requirements

following state practice guidelines regarding activity restricted to a specific profession

having medical information forms for physician referral

 

 

they should know and apply the limits of practice as they relate to base competencies within the medical system

 

with a plan for continuity of care through collaboration with other professionals

       stating limits of professional qualifications

in knowing legal limits, operating within those limits, and referring to other professionals              when necessary

regarding "best practice" treatment plan within a health care continuum

 

 

they should know basic reimbursement factors including but not limited to

 

which services are generally private pay and which are reimbursable

how to document outcomes

terminology for Managed Care, PPO's, HMO's, medicare, workman's compensation and per      diem  reimbursements

how to determine competitive and reasonable rates for private pay clients

 

 

 

 

 

 

 

 

 

                                                                                             

 

STANDARDS AND STEERING COMMITTEES MEMBERS

                                                                                                 


 

Barbara Banwell, M.A., P.T.

Rehabilitation Consultant

S. Yangouian & Associates; Oak Park YMCA

Lansing, MI

 

Sheralee Beebe, HBOB, M.E.S.,CALA AEA

Pool Manager & Aquatic Therapist

Smithers, B.C.  CANADA

 

Sonnie Blocki, M.S. P.T

St. Margaret's Hospital

Spring Valley, IL

 

Paula Briggs, M.S. Exercise Physiologist

Aquatic Coordinator

HealthSouth Mountain View Regional Rehab Hospital

Morgantown, WV

 

Annie Clement, Ph.D., J.D.

Cleveland State University

Cleveland, OH

 

Heidi Ernst, P.T.

Toledo Rehab Clinic

Toledo, IA

 

Ron Fuller, P.T.A., A.T.C.

Concord Orthopaedic/Center for Sports Medicine

Concord, NH