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Balance training with a cognitive twist

Byline: Andrea Salzman, MS, PT

Why you should consider adding Alzheimer's patients to the list of aquatic therapy candidates. Read the research which supports this idea. Links located at end of post.

In the water, patients may be challenged beyond limits of stability without the fear of consequences of falling which are often present with land-based balance training. The environment leads to improvement in balance reactions which are translatable to land.

#1. Sensory and Motor Input. Movement through water is affected by turbulence and viscosity. Water is more viscous than air, and resistance to flow through water is greater than resistance to flow through air. Thus, it takes more force to push through water molecules than to push through air molecules. The faster an object is pushed through the water, the more turbulence is created and this creates additional resistance to movement. Additionally, the viscosity of water creates drag and this drag stimulates the sensory systems of the body.

#2. Reaction Time. A body immersed is surrounded by a viscous fluid which retards the speed of movement. This viscosity prevents rapid falling and elongates the period of time in which a patient can respond to a shift of his center of mass outside his base of support.

#3. Safety. In water, the natural end result of any loss of balance which is not corrected is a fall into a compliant fluid (water) and not a fall to a noncompliant solid (the ground). Thus, the patient may be challenged to move outside his base of support without fear of traumatic consequences. Which brings us to...

#4. Fear of Failure. This reduction in patient anxiety may encourage the patient to attempt tasks which he would not attempt on land. It becomes possible to elicit balance challenges which the patient has both time and mental confidence to combat. On land, without the assistance of such aquatic properties, the resultant balance responses may be incomplete or absent.

#5. Alertness and Arousal. A recent case report focused on how a nonambulatory patient with advanced Alzheimers made major gains in alertness and arousal after treatment with aquatic therapy using the Halliwick concept.

Want some ideas on how to aquatic balance train... with a cognitive kick?

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Read more about the effects of Ai Chi on balance and fall risk in community dwelling adults: Skinner, E. E. H., Dinh, T., Hewitt, M., Piper, R., & Thwaites, C. (2016). An Ai Chi-based aquatic group improves balance and reduces falls in community-dwelling adults: A pilot observational cohort study. Physiotherapy Theory and Practice, 32(8), 581–590.

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