HALLIWICK METHOD
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| With The Experts |
The Halliwick Concept was founded by James McMillan MBE (1913-1994). Halliwick is a concept, originally developed to teach clients with a physical disability to swim and to make them independent in water. Independence is an important prerequisite for participation in therapeutic, vocational or recreational activities, individually or in a group.
The willingness to lose balance and the ability to regain it are core elements of this independence.
A Ten-Point-Program is used to reach these goals. The Halliwick Concept has been extended to include Water Specific Therapy (WST). Water Specific Therapy is focused on treating impairments of body functions or body structure. Halliwick uses a problem solving approach. Possibilities and constraints of the client are analysed in order to use a systematic intervention (Ten-Point-Programme and/or WST) to help the client increase function and independence.
The fluid mechanical properties of water are the basis for the intervention techniques. For example:
• Moving water provides impedance; therefore the client will move or lose balance slowly and has time to react
• Buoyancy forces counteract gravity forces and create rotational torques (metacentric effects). These torques can be used to increase load on connective tissue.
• Buoyancy provides an easy way to change position, which influences the vestibular system as in sensory integration.
Halliwick is active and mostly dynamic in order to facilitate movement and sensory input.Halliwick also has a static component, in which selective activation of muscles and stabilization of specific joints is exercised.
Halliwick can be used to address objectives at all components of the International Classification of Functioning, Disability and Health (WHO 2001). The Halliwick Concept has vast applications.
In musculoskeletal, neurological and pediatric rehabilitation, clients can experience early mobility. The mechanical advantages of water support the abilities of the trunk in a mobilizing and stabilizing way. In this sense Halliwick is a constraint-induced movement therapy without the disadvantage of gravity compensation.
Many activities can be repeated and varied and clients can learn balance strategies which have carry-over effects to dry land.
Halliwick also enables a graded activity program with low mechanical impact and increasing physiological demand. For example, patients with chronic low back pain can increase their functional capacity in a gravity lessened environment. Halliwick has been focused traditionally on postural control, a basis for adequate swimming performance. This postural control can be translated as “core stabilization”.
BAD RAGAZ RING METHOD
The bad ragaz ring method is a collection of therapeutic techniques performed in the water that have been developed through years in the thermal waters of Bad Ragaz, Switzerland. Still evolving, the method is used internationally for muscle re-education, strengthening, spinal traction/elongation, relaxation, and tone inhibition in water. Water’s unique properties of buoyancy, turbulence, hydrostatic pressure, surface tension, and thermal capacity are used to facilitate rehabilitation in a program of relaxation, stabilization, & progressive resistive exercises.
Clients with paralysis and limitation of movement in the joints were treated by performing range of motion exercises while supported on fixed treatment boards in the water. Straps were used to hold the client firmly in place, or rails were attached to the side of pool to provide a hand hold for clients exercising in the water. In 1957, advances in techniques developed by Dr. Knupfer of wilbad, Germany were introduced to Bad Ragaz by Nele Ipsen.
Knupfers exercises refined the method into horizontal treatment technique in which the client was supported floating on his back by flotation rings around the neck and the pelvic region and under the knees & ankles. The modified technique was used for stabilization or active resistive exercises. Knupfer incorporated the concepts of the neurophysiology of training, and developed exercises that consisted of simple chains of movement passing from joint to joint, mainly a single plane of motion. He contended that active movements away from and back toward the fixed point of the therapists hands facilitated stabilizing reactions adapted to the task circumstances, naturally occurring movement synergies, and isotonically resisted exercises of agonist & antagonist muscle groups. It aided use of closed kinetic chain exercise in a safe, supportive environment while enjoying the physiologic benefits of warm water.
After Knupfer, the use of buoyancy, turbulence, surface tension, and the thermal capacity of 92 degree f water to reduce pain, increase soft tissue compliance, reduce muscle tone, and promote relaxation were understood as unique clinical strategies that differentiated water from land exercise.
With the rapid growth & acceptance of proprioceptive neuromuscular facilitation (pnf), Dr. Zinn, medical director at Bad Ragaz and his medical team refined and modified Knupfer’s exercises. Three dimensional diagonal movements were developed and added to knupfer’s original exercise pattern. In 1967, physiotherapists Bridget davis and Verena laggatt incorporated Margaret Knott’s PNF patterns, resulting in the technique known today as the Bad Ragaz Ring Method (BRRM). The method continues to evolve, and is becoming popular in Switzerland, Germany, England, Australia, South Africa, the United States, and elsewhere.
Goals of treatment
BRRM provides infinite possibilities for variation of exercise for the neurologic, orthopedic, & rheumatologic client.
1. Tone reduction
2. Relaxation
3. Increasing range of motion
4. Muscle re-education
5. Strengthening
6. Spinal traction/elongation
7. Improving alignment & stability of the trunk
8. Preparation of the lower extremities for weight bearing.
9. Restoration of normal patterns of upper & lower extremity movements.
10. Improving general endurance
11. Training functional capacity of the body as a whole.
Stressing the need for the therapist to provide stability for the client and still be flexible with application, there are three ways in which the therapist acts in relation to the client.
• Isokinetically : Therapist provides fixation while the client moves through the water either toward, away from, or around the therapist. The client determines the resistance encountered by the setting the speed of movement through the water.
• Isotonically: The therapist acts as a “movable” fixation point. Ex: the client can be pushed or swung into the direction of his or her active movement. This action leads to an increase in resistance to that movement. Conversely movement can be assisted by a therapist pushing in the direction opposite to the client’s intended motion.
• Isometrically: The client holds a fixed position while being pushed through the water by the therapist. Promotes stabilizing contractions.
Bad Ragaz Ring method exercises can be divided into patterns for the trunk, arms, and legs. They can also be categorized as unilateral or bilateral. Bilateral patterns are further defined as symmetric or asymmetric. Most patterns emphasize reciprocal movement patterns. Reciprocal movements are not always emphasized with certain client conditions and circumstances. In general, the patterns are performed in supine floating, yet a few arm patterns are performed in prone and a few trunk patterns in side lying. Because of the flexibility of the patterns and the adaptability of the technique, an almost infinite variety of exercises can be developed by the therapist to maximize client outcomes.
AI CHI
Ai Chi is a water-based total body strengthening and relaxation progression that bridges East and West philosophies, and integrates mental, physical, and spiritual energy. It combines Tai-Chi concepts with Shiatsu and Watsu techniques, and is performed standing in shoulder-depth water using a combination of deep breathing and slow, broad movements of the arms, legs, and torso. The Ai Chi progression moves from simple breathing, to the incorporation of upper-extremity, trunk, lower-extremity, and finally total body involvement.
Ai Chi was created to help aquatic practitioners (including aquatic exercise instructors, personal trainers, and aquatic therapy and rehabilitation practitioners) and students enjoy the water in a flowing yet powerful progression. It is an efficient exercise program that increases oxygen and caloric consumption through correct form and positioning in the water, a perfect relaxation technique for highly stressed, over-challenged clients, and is ideal for creating improved range of motion and mobility.
Jun Konno, ATRIC, creator of Ai Chi, is one of Japan’s foremost swimming and fitness consultants and the President of Aqua Dynamics Institute (Japanese chapter of AEA). Since 1986, he has worked to promote aquatics in Japan and is Chairman of the Executive Committee for Japan’s National Aquatic Conference.
Benefits of Ai Chi
Flexibility and core (abdominal) strength are the benefits most mentioned by aquatic exercise instructors. The trunk stabilization/balance and pain management benefits of the program are the two most frequently cited by aquatic therapists. Clients’ comments include: "a soothing experience," "mind and body relaxation," and "a symphony for my body." Such benefits increase with practice. As a person becomes more familiar with the program, relaxation will be improved, with a focus on the smallest movement of the hand, wrist, or eyes, and improved mental alertness.
Water lessens edema in the joints, which allows clients to improve range of motion and mobility. The soft, round flowing motions strengthen core muscles while providing a soothing experience, and the circular movements create harmony, based on a principle of yielding to, rather than resisting the natural flow.
The flowing movements of Ai Chi can increase metabolism and blood circulation. Studies show that simply breathing while submersed to the shoulder in water can increase oxygen consumption from 7 to 25 percent. This, in turn, increases caloric consumption.
Potential Benefits of Ai Chi
1. Improved flexibility, range of motion, and general mobility
2. Improved metabolism and caloric consumption
3. Better blood circulation
4. Re-vitalized energy circulation along important accupoint meridians
5. Renewal of vital organs
6. Improved liver efficiency
7. Decreased stress, insomnia, depression, anger, fatigue, anxiety, and confusion: the water and music can help to free the body of stress and to encourage a state of relaxed awareness
8. Increased mental alertness
9. Creates "design sense" (a feeling that you’re doing what the body was designed to do) and therefore, improves kinesthetic sense (our perception of how we move)
Ai Chi Can Assist with the Following Health Conditions
1. Chronic disorders and other diseases such as pain management, fibromyalgia, arthritis, cancer (especially mastectomy), multiple sclerosis, cerebral palsy, immunodeficiency disorders, and medical self-care .
2. Respiratory disorders such as asthma, chronic obstructive pulmonary disease, and pulmonary rehabilitation.
3. Cardiovascular problems including congestive heart failure, angina, stress-related cardiac arrhythmias, mitral valve prolapse, and cardiac rehabilitation.
4. Circulatory disorders such as hypertension and migraine headaches.
5. Metabolic disorders including eating behaviors, weight control, type II diabetes, type I diabetes, and obesity.
6. Psychological problems such as chronic fatigue syndrome, anxiety and depressive disorders, anger management, stress-related dysthrthmias, and violence.
7. Musculoskeletal or orthopedic disturbances including low back pain, scoliosis, carpal tunnel syndrome (or any repetitive stress syndrome), musculoskeletal injuries and surgeries, balance deficits, prenatal, sports injuries, and accident and fall prevention.
8. Neurological disturbances including cerebral vascular accidents (strokes) and traumatic brain injury.
9. Endocrine disorders such as immunodeficiency disorders, fatigue, menopause therapy, and hormonal management.
WATSU
Watsu
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| Harold Dull |
Watsu is a passive form of aquatic bodywork/therapy that supports and gently moves a person through warm water in graceful, fluid movements. Watsu promotes a deep state of relaxation with dramatic changes in the autonomic nervous system. Through quieting the sympathetic and enhancing the parasympathetic nervous systems, Watsu has profound effects on the neuromuscular system. These changes benefit clients with a wide variety of special needs.
Physiological changes then occur throughout the body. These changes may include:
• Decreased heart rate
• Decreased rate of respiration
• Increased depth of respiration
• Increased peripheral vasodilatation
• Increased smooth muscle activity (digestion)
• Decreased activation of striated muscles (skeletal)
• Decreased muscle spasm
• Enhanced immune system response
Benefits of Watsu
Therapists utilizing Watsu as part of their aquatic therapy treatment programs report the following improvements in their clients:
1. Immediate Benefits with First Session
• Increased range of motion
• Increased muscle relaxation
• Decreased muscle spasm
• Decreased spasticity
• Decreased pain
2. Long-term Benefits After Multiple Sessions
• Improved sleep patterns
• Improved digestion
• Improved healing and immune system response
• Greater decreases in pain
• Decreased anxiety
• Many clients report a decrease in their emotional pain
Before a Session
• You need to allow a 'good hour' for a session, generally 45-60 minutes of this is spent in the water.
• You will need a swimsuit and towel (and sunscreen, if sessions are outdoors).
• Your practitioner will outline the course of the session and answer any questions you might have.
• At the first session a health history questionnaire will be completed, and range of movement tests may be undertaken in cases of restricted mobility.
• In the water your practitioner may wrap small 'floats' around your legs to prevent them from sinking during the session.
• Your practitioner will support under your head and either low back or knees. You will be gently moved through the water in a continuous flowing motion, with the practitioner adding stretches, point work and massage as appropriate.
• Your ears will be mostly under the water, nose and mouth above. Earplugs may be an option for some.
• Some drift off to sleep, others will remain aware of everything during a session, both are fine. There is no right or wrong way to receive Watsu.
At any stage you have had enough for what-ever reason, you can ask to stop. (Although usually the opposite happens and people want a session to go on and on)
Completion
• At the end of a session your practitioner will bring you to an upright stable position and stay with you until you are ready to support yourself. Some people like to sit quietly at the wall, or float in the pool on their own. Others like to talk a little about their experience of the session. Either is fine.
• Make sure you have planned time to rest quietly after your session (rather than rushing off to work!) and drink a little extra water. Also make sure you have a contact number for your practitioner in case you have questions later on...or would like another session!
Note: The above is an outline of a Watsu session. After receiving a number of Watsu sessions, some people choose to experience underwater session.
