Η υδροθεραπεία εστιάζει κυρίως στις hands-on τεχνικές και στην θεραπευτική άσκηση στο νερό Παράλληλα περιλαμβάνει τεχνικές κινητοποίησης, διάτασης και άλλες τεχνικές παθητικής χαλάρωσης στο νερό. Το κεφάλαιο επίσης της επανεκπαίδευσης της βάδισης και της στάσης απασχολούν τηω υδροθεραπεία.
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 in a group: the willingness to loose balance and knowing how to stand up again are core elements.A Ten-Point- Programme is used to reach these goals. The most important part of this programme is rotational control, also basis for a second part of the Halliwick Concept: Water Specific Therapy (WST). This part is focused on eg postural control, normalising muscle stiffness and facilitation of movement.Halliwick is 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 gain functional increases.Mostly Halliwick is dynamic to facilitate movement and sensory input. Halliwick also has a static part, in which e.g. selectiveactivation of muscles and stabilisation of specific joints is exercised.Halliwick can be used to address objectives at all levels of the International Classification of Functioning, Disability and Health (ICF).The Halliwick Concept has vast possibilities. In neurological and paediatric rehabilitation, clients can experience early mobility. The mechanical advantages of water support the abilities of the trunk in a mobilising and stabilising way. In this sense Halliwickis a constraint-induced movement therapy without the disadvantage of gravity compensation.Many activities easily can be repeated and varied and clients can learn balance- and stumble- strategies, which have carry-over effects to dry land.Halliwick enables also a graded activity programme: with low mechanical impact and increasing physiological demand, chronic low back pain patients and others can increase their functional capacity in a mostly joyful way.The amount of moderate to even high quality clinical trials has increased enormously in the past decade, giving Halliwick a stable evidence base.
Water Specific Therapy
Water Specific Therapy (WST), which is defined as a motor (re)learning program in water, using it's mechanical constraints , which includes elements of the Halliwick 10 Point Programme. WST is focused on objectives at the ICF levels of function and structure, activity and also participation to achieve an increase in quality of life. WST is evidence based and uses all elements of clinical reasoning and fits in the allied health competence profiles. We have followed the structure of the International Classification of Functioning, Disability and Health (ICF), but also highlighted the special topics in WST: the Ten Points and fluid mechanics.
Bad Ragaz Ring Method
The Bad Ragaz Ring Method (BRRM) is an active technique in which the therapist provides manual resistance to a client, supported by flotation aids. The patient is facilitated, mainly proprioceptively to activate weak muscles. BRRM follows the principles of Proprioceptive Neuromuscular Facilitation (PNF), but is adapted to the possibilities and difficulties of moving in an aquatic environment. BRRM exists of some 23 patterns of arms, trunk and legs. In various patterns, PNF techniques like e.g. combination of isotonics or reversalof antagonists can be used. Apart from that, muscle strengthening physiology has been included the last decade. The main objectives of BRRM are activating weak muscles through the principles of segmental irradiation, increasing muscle power and muscular stabilization of joints. The BRRM therefore is limited to the function level of ICF and has no direct task- or goal oriented objectives. The evidence is limited, showing only about 4 research articles. Expert opinion still is the base of this method.
Ai Chi is often described as a simple aquatic form of T’aiChi in combination with Qi Gong. There are resemblances, but the basis is Zen-Shaitsu. It is an active technique in which balance, breathing and relaxation come together.The evidence base still is small, but clinical trials have shown large effect sizes on balance scales (Berg Balance Scale and POMA). Because of this, it is hypothesised that it can be used well in falls prevention, especially in populations that have difficulty to enter in land falls prevention programmes. The repetitive slow movements are thought to positively affect visco-elasticity of connective tissue while at the same time increase coordination.