AQUATIC

THERAPY

AND

REHABILITATION

STANDARDS

FOR

THE

INDUSTRY

AQUATIC THERAPY & REHAB INSTITUTE, INC.

www.atri.org

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

Pamela L. George, J. D.

Owner, Aquatic Specialist

Aquatic Care Programs, Inc.

Humble, TX

Susan Grosse, M.S.

AAHPERD Aquatic Council, Past Chair

Milwaukee High School of the Arts

Milwaukee, WI

Gina S. Harvey

Director Aquatic Therapy

Health South

Fort Collins, CO

Inga Hunt

Rehabilitation Counseling

Carbondale, IL

Lynette Jamison, M.O.T., O.T.R./L.

Clinical Supervisor Aquatic Services

Maryvale Samaritan Health Inst

Phoenix, AZ

Carol Knight, M.Ed, O.T.R.

Assistant Professor Occupational Therapy

Nova Southeastern University

Davie, FL

Lynda Kuhne, P.T., A.T.C.

Exeter Hospital - Rehabilitation Department

Exeter, NH

Marcia Kulick

Courage Center

Rockford, MN

June Lindle, M.A., Exercise Physiology

Cincinatti, OH

A. Roxanne Lloyd, C.T.R.S., B.S. Rec & Leisure Admin.

Director of Aquatic Therapy

Brethren Village

Ephrata, PA

Ruth Meyer, M.Ed. , R.K.T.

Consultant, Aquatic Therapist

Kinesiotherapy of NH

Concord, NH

Wendy S. Morford, M.Ed Educational Psychology

Department Head Special Education-ACMS

Arkansas City Middle School

Arkansas City, KS

Marilou Moschetti, Bsc, P.T.A.

Aqua Technics Consulting Group and

The Wellness and Rehabilitation Center of Watsonville Community Hospital

Aptos, CA

Sue M. Nelson, ASCA Level 4,Water Specialist

Nelson's School of Swimming & Fitness Facility WaterWay Therapy Inc.

Danville, IL

Julie Ann O'Connor, B.S., R.M.T.

Aquatic Therapy Specialist

Georgetown, TX

Alison Osinski, Ph.D.

Aquatic Consulting Services

San Diego, CA

Ron Otte, B.A.

Cincinnati, OH

Leana Rasmussen, B.A.,A.T.

The Lifestyle Center

Visalia, CA

Paula Ray, O.T.R.

Rehab Focus, Inc.

Owosso, MI

Paul Ricker, P.E.

Guadalupe Medical Center

Carlsbad, NM

Peggy Schoedinger, P.T.

Mapleton Center

Boulder, CO

Trace Sears, M.S., P.T.

Aquatic Program Director

Florida Hospital Rehabilitation Center

Orlando, FL

D. Laree Shanda, C.T.R.S.

Recreation Therapist/Consultant

Port Orchard, WA

Kevin Sharpe, M.S.

Director of Fitness Aquatics and Cardiac Rehab

Columbia Davis Medical Center

Statesville, NC

Kristen Simms, W.S.I. , L.G.I., C.P.R.P.R.

The Rehabilitation Center

Evansville, IN

Kelly Skelton, M.S. Biology, Human A & P

Aquatic Director

Shelbyville Recreation Center

Shelbyville, TN

Joanne Suomi, Adapted Aquatics

University of Wisconsin

Stevens Point, WI

Dale Theberge, M.S., Exercise Physiology

Owner, President

Aquatic Therapy of New England

Danver, MA

Jill White, Director

Jeff Ellis & Associates, Inc.

Fort Collins, CO

Ruth Ann Hood Wieser, Ph. D.

Co-ordinator of Aquatics Instruction

University of North Carolina at Greensboro

Greensboro, NC

Special Recognition:

Ruth Sova, M.S.

Standards and Steering Committees Facilitator

Port Washington, WI

Walter C. Johnson, Executive Secretary

National Aquatic Section

National Recreation and Park Association

Hoffman Estates, IL

Grace Reynolds, President/CEO

Disability International Foundation

Longview, WA

John Williams, Chairman

Adapted Aquatics Committee

International Swimming Hall of Fame

San Diego, CA

John Lancaster, Executive Director

President's Council on Employment of People with Disabilities

Washington, DC

Karen Hensley, M.A.

Director of Recreation and Camping

Easter Seal Society of TN, Inc.

Nashville, TN

Karl Knopf, Ed.D., Executive Director

Fitness Educators of Older Adults Association

Sunnyvale, CA

Vicki Chossek, Executive Director

Aquatic Therapy & Rehab Institute, Inc.

Port Washington, WI

Steven Lynch, Education Development

American Red Cross

Falls Church, VA

William Most, M.S., R.K.T.

American Kinesiotherapy Association

Hines, IL

The Standards and Steering Committees utilized the following as their definition of Aquatic Therapy and Rehabilitation:

The use of water and specifically designed activity by qualified personnel to aid in the restoration, extension, maintenance and quality of function for persons with acute, transient, or chronic disabilities, syndromes or diseases.

These standards are designed to separate the aquatic therapy practitioner from land-based therapists and from aquatic fitness professionals.

These standards should allow all practitioners in the field to bring themselves to a base level of knowledge in all six categories. Practitioners with different backgrounds will find themselves above or below standards in different categories. For instance, a Physical Therapist practicing in a clinic may fall short in the "Aquatic Principles" or "Health and Safety" categories where an Adapted Aquatics instructor practicing in the schools may fall short in "Principles and Methods Used in Aquatic Therapy."

Practitioners in some disciplines will have more extensive knowledge in specific categories. Each discipline will continue to specialize and have specific discipline standards, licenses, credentialing, and certifications.

Conforming to Standards does not make a practitioner an aquatic therapist.

The Standards and Steering Committees members are listed on the previous pages.

THE AQUATIC THERAPY & REHAB INSTITUTE, INC.

The Aquatic Therapy & Rehab Institute, Inc., is a nonprofit educational organization dedicated to the professional development of health care professionals involved with aquatic therapy. ATRI offers continuing education courses at conferences and workshops that will advance the knowledge and skills of the aquatic therapist.

ATRI provides information to the public on aquatic therapy topics.

ATRI works with organizations whose members are health care professionals to serve them in the area of aquatic therapy.