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More and more people are getting their news from their mobile devices. Now you can get your aquatic therapy fix on your iPhone or Android, too. Just go to to install the Flipboard app on your smartphone or tablet, then type eSplash into the magazine search box. Your device will now receive a live stream of our stories, as we build the next issue. All in beautiful living color. Just promise us not to get distracted with patients in the water.

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At the completion of her final 2-week Intensive class on Wednesday, Fezia Tyebally became the world's first Aquatic Therapy Professional℠. This credential was newly created by Aquatic Therapy University as a way to recogonize those non-therapists who complete 84 hours of aquatic therapy classes. Fezia is a massage and sacralcranial therapist from Malaysia and has been in Knoxville, TN for the last two weeks to sharpen her already extensive skill set in pediatric aquatic therapy. Fezia has a 16-year old special needs child whom she treats, along with others, in her own clinicin Kuala Lampur. In addition to broadening her client base, Fezia also plans to use her award to advance the state of aquatic therapy in her island nation.

ATU's next 2-week Intensive is meeting in Minneapolis in August. It is being attended by students from Hong Kong and Puerto Rico and is open for registration.

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b2ap3_thumbnail_6a00d83453c2c669e20192ab4f781b970d.jpgAs a former competitive swimmer and daughter of an Olympic swimmer, water has always been a part of Fezia Tyebally’s life. When her son Amir suffered a near drowning accident leaving him severely brain injured, she left her career in marketing behind and looked for any type of therapy to allow him to move and rehabilitate.

“We tried the water and he actually moved in it. So he actually likes the water,” explained Tyebally, who lives in Kuala Lumpur, Malaysia.

She now owns and operates Amir’s gym from her home, focusing on strength, stamina and wellness for differently abled children. One side contains a physiotherapy gym and the other a swimming pool and a spa pool.

“I work twice a week with kids in the water and the results are outstanding; they’re not even good, they’re outstanding!” Tyebally said.

When he was 13, her son became severely ill and was unable to move from his back. Scoliosis developed but before surgery was pursued, Tyebally worked with him for six months using CranioSacral therapy, myofascial release and water techniques. She made sure to get in the pool every day, even if it was just for 15 minutes.

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Surrounded by vigilant camp counselors, 7-yr old JJ Warner tries to relax as Big Ed, a Brazilian White-Tip, glides by to take a closer look.Article posted by Stuart Smalley, Guest Blogger

Merritt Island, FLA. Parents from around the world are converging on this small coastal town in hopes that a controversial new therapy will help their children cope with conditions ranging from post-operative rehabilitation to hypersensitivities to touch.

The new program is an off-shoot of dolphin therapy which was popular until 2010, the year dolphins were put under the protection of the Federal Wildlife Agency. However, the need for alternative fish-based therapies never abated and to cope with the demand, dolphins have been replaced by specially-trained domesticated sharks which children as young as 3-yrs old can now touch, swim and even hitch a ride.

"The turn-around we are seeing in these kids is amazing," said Ellen Trumfounder, director of Swim For Your Life Aquatic Camps. "Sure, they start out crying when they see that big fin coming at them, but soon they are splashing and yelling and interacting with others with great fervor. I've actually seen it bring tears to some parent's eyes."

And the pediatric self-improvement industry is standing up and taking notice. "We are watching this development closely," said John Ferburr, president of the Skinner Foundation. "Studies have shown that violent video-games, giant 3D IMAX shoot-em-up movies and loud monster truck shows have hardened young people to the point where gentle, non-threatening dolphins no longer make an impact. Sharks, in the meantime, seem to be one of the only things left that can make the immediate type of impression we are looking for."

Tagged in: News Pediatric Therapy
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Jb2ap3_thumbnail_6a00d83453c2c669e2017d42604cff970c-320wi.jpgoin us for the April 23, 2013 webinar: Evidence-Based Aquatic Therapy for Clients at Risk for Falls: Parkinson's, CVA, Ortho, Elderly & Beyond.

Ortho & Neuro balance disorders will be discussed.

For instance, here is some of the Parkinson's research we will be outlining. We will also be showing you great treatments, justifications (for payers), marketing materials and more.

Effects of Aquatic Exercise onPersons with Parkinson's disease: A preliminary study

Aquatic Therapy Versus Conventional Land-Based Therapy for Parkinson's Disease: An Open-Label Pilot Study

Feasibility of 2 Different Water-Based Exercise Training Programs in Patients With Parkinson's Disease: A Pilot Study

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b2ap3_thumbnail_6a00d83453c2c669e2017ee9963bc4970d-320wi.jpgYou've heard every rationale in the book from payers who want to discontinueaquatic therapy.

  • "It's not functional; people don't live in the water"
  • "6-8 visits to teach the exercises, then an immediate transition to land"
  • "You don't need a skilled therapist to teach water aerobics." (my personal favorite)

So, when the day comes when a gorgeous piece of literature comes out which makes the case for aquatic therapy -- and that case is not just (unequivocally) pro-aquatic therapy, but pro-starting-as-early-as-4-days-post-op, well, it's time to celebrate.

This systematic review/meta-analysis is equivalent to the Holy Grail... desired by all, long sought, yet always elusive.

Attend March 26th webinar for a much more extensive look at the ramifications of this study and many others. We will be incorporating this study into a free brochure you can use to give to refering physicians after the webinar.

REVIEW ARTICLE (META-ANALYSIS): Early Aquatic Physical Therapy Improves Function and Does Not Increase Risk of Wound-Related Adverse Events for Adults After Orthopedic Surgery: A Systematic Review and Meta-Analysis.

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b2ap3_thumbnail_6a00d83453c2c669e2017d410ffed8970c-320wi.jpgAquatic therapy can be useful for just about anyone. LeAnn Childress, PT, ATC/LAT, ATRIC, and her staff at West Tennessee Healthcare rehabilitation facilities hope to make that fact known in their community. With four existing pools and two new pools coming to the LIFT Wellness Center in Jackson, Tenn., the Sports Plus, Work Plus and Aqua Therapies facilities are ready for everyone from the avid triathlete to the weekend gardener with sore knees.

“We can take care of any need. Aquatics can meet any need a person has,” Childress explained.

The new pool at the LIFT Wellness Center in Jackson, Tenn. has a deep well which will aid patients who are hindered by weight bearing. It also contains a four lane lap pool, a heated therapy pool and a large hot tub. The pool is equipped with UV lighting and an Evacuator pool system to make it comfortable for even the most sensitive of clients. The four other pools are located in Dyersburg, Humboldt, Milan and Jackson, Tenn.

While aquatic therapy can certainly help patients with fibromyalgia and arthritis, Childress hopes aquatic therapy can overcome the stigma that it is just for older patients.

“You don’t think about (aquatic therapy) with the well population,” she said. “It’s not just for the physically challenged.”

Tagged in: atu Seminars Sports Therapy
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aquatic therapy elite athlete sport training
Aquatic Training Options for the Collegiate, Professional & Elite Athlete
: Jackson, TN (Memphis)
: Mar 1-2, 2013
: Garry Killgore, PhD


aquatic therapy for the orthopedic and neurologic patient
Location: Knoxville, TN
Dates: April 12-13, 2013
Instructor: Andrea Salzman, MS, PT


ortho musculoskeletal aquatic therapy
Water-Based Intervention for the Musculoskeletal Client
Dates: April 20-21, 2013
Host: St. Judes Rehab
Location: Brea, CA
Instructor: Beth Scalone, PT, DPT, OCS

aquatic therapy novel balance
Novel Balance, Proprioception & Fall Prevention Strategies
Dates: Apr 27-28, 2013
Location: Sun City, AZ
Instructor: Kim Gordon, MPT


aquatic therapy elite athlete sport training
Aquatic Training Options for the Collegiate, Professional & Elite Athlete
Location: Beloit, WI
Dates: May 3-4, 2013
Instructor: Garry Kilgore, PhD

Location: Hudson, WI (Minneapolis)
July 20-21, 2013
Instructor: Dickinson/SLP


aquatic therapy for the orthopedic and neurologic patient
Hands-On Aquatic Therapy for the Ortho & Neuro Client (Houston)
Location: Houston, TX
Dates: Aug 9-10, 2013
Instructor: PT TBA


hydrotherapy back neck pain cover
Location: Minneapolis, MN
Dates: October 11-12, 2013
Instructor: Beth Scalone, PT, DPT, OCS

Aquatic Therapy Options for Cerebral Palsy, Developmental Disabilities & the Medically Fragile Patient (Minneapolis)
Location: Minneapolis, MN
Dates: Nov 8-9, 2013
Instructor: Kiki Dickinson, MPT
Tagged in: atu Seminars Therapy
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Have you noticed the new push for justification?

Aquatic therapy is on the cusp of an explosion of popularity, but watch out! Because insurers pay more for aquatic therapy than almost any of therapeutic procedure, they are starting to demand clear and ongoing justification for continued aquatic treatment.

Well, you are in luck.

Thanks to the heavy lifting being done at Aquatic Therapy University, we have some library language that can be inserted directly into your computerized documentation system.

You have ATU's permission to incorporate this language for clinical uses!

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Click on the links below and get open access to these resources:


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b2ap3_thumbnail_6a00d83453c2c669e201761789b11b970c-320wi.jpgQuestion:How do I start an aquatic therapy program in my facility?

Answer: Yikes! Big Question. Let's look at the highlights.

Renting. Are you planning to rent space in an outside facility pool instead of building? Here is a link to an article that might be helpful. (It lists the scary things to watch out for, so don't panic when you read it, but it will open your eyes to what to consider.)

To read more about renting (what is the going rate, etc), go here.

Medicare: If you are going to treat Medicare patients in that community pool, you have to rent exclusive use of a portion of the pool. Your client can't intermingle with the public during your sessions.

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b2ap3_thumbnail_6a00d83453c2c669e20177443fed89970d-500wi.jpgEight years ago Stacy Lynch of Summit Therapy Group, Phoenix, Ariz. was thrown into the aquatic therapypool and since then, he hasn’t looked back.

“I went from having just four visits in the pool in three months to being in the pool every day for two to six hours, constantly learning,” Lynch said.

And that constant learning process is what stuck with him. He says the more education and knowledge he gained about aquatic therapy, the more he knew it was something he wanted to be doing.

Lynch has been a physical therapy assistant for 17 years and works mostly with geriatric patients in aquatic therapy. But he didn’t always concentrate on aquatics. In fact, he didn’t always want to be a physical therapy assistant. It was in a college bookstore at McLennan Community College in Waco, Texas where Lynch met a man who sparked his interest in physical therapy.

“I saw this man in a wheelchair and I discovered myself just staring at him. I was watching him put his books on the counter with his feet, write his check with his feet and hand it to the cashier with his feet. I felt compelled to talk to him.”

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b2ap3_thumbnail_6a00d83453c2c669e201774400c0bf970d-320wi.jpgQuestion: We recently received a request from our Medicare Contractor asking for documentation that verified that the therapist was in the water during aquatic therapy session. We have never had this request before.

Most of our sessions, the therapist is in the water, but sometimes she is not. Under neither circumstance do we specifically document the location of the therapist. Is this a valid restriction or reason for denial? Does the therapist have to be in the water for it to be considered skilled care. Help!

Answer: OK, let's tease out the two issues being discussed here. 

Skilled versus Unskilled Care.

First, is the care "skilled"? The answer is: it depends. Certainly, a therapist who remains on the deck for part of a session is not automatically providing "unskilled" care. In fact, here are some examples of situations that I would argue the therapist should position him or herself on the deck specifically in order to increase the caliber of care provided:

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b2ap3_thumbnail_6a00d83453c2c669e2016769270bcd970b-320wi.jpgLooking for tips to ensure your documentation supports the need for aquatic therapy?

Consider the following points outlined by National Government Services when providing aquatic therapy services.

(Editor's note: I don't agree with all of these points but I am listing them so you see what you are being asked to do)

  • Does your patient require the skills as a therapist, or could the patient achieve functional improvement through a community-based aquatic exercise program?
  • There are a limited number of therapeutic exercises generally performed in the water. These exercises become repetitive quickly. Once a patient can demonstrate an exercise safely, you may no longer bill Medicare for the time it takes the patient to perform this now independent exercise. If the same exercise is performed over a number of sessions, the documentation must describe the skilled nature of the qualified professional’s/auxiliary personnel’s intervention during the therapeutic exercise to support the ongoing medical necessity.
  • Patients who will not be continuing their water-based program as a maintenance program should be transitioned to land-based exercises as soon as reasonably possible for the patient’s condition.
  • The aquatic therapy treatment minutes counted toward the total timed code treatment minutes should only include actual skilled exercise time that required direct one-on-one patient contact by the qualified professional/auxiliary personnel. Do not include minutes for the patient to dress/undress, get into and out of the pool, etc.
  • Do not bill for the water modality used to provide the aquatic environment, such as whirlpool (97022), in addition to 97113.
  • See CPT 97150 Group Therapy for guidelines when treating more than one patient at the same time in the aquatic environment.

Supportive Documentation Recommendations for 97113

  • Justification for use of a water environment
  • Objective loss of ADLs, mobility, ROM, strength, balance, coordination, posture and effect on function
  • If used for pain include pain rating, location of pain, effect of pain on function


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b2ap3_thumbnail_6a00d83453c2c669e2017744023af5970d-320wi.jpgLooking for statistics and fast facts about aquatic exercise and therapy? Look no further...

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b2ap3_thumbnail_6a00d83453c2c669e20176171c20b9970c-320wi.jpgLooking to support aquatic therapy? Frustrated at abstracts that don't give the whole picture? Click on the links here and get open access to these evidence-based guides and clinical studies.

Evidence-Based Links

Recent Clinical Trials (free dowloads)

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A Senate bill has been introduced to prevent the Americans with Disabilities Act from being enforced on commercial pools and spas. “[The ADA for pools and spas] is another one-size-fits-all, big-government mandate that could have a negative impact on Americans,” Senator DeMint said in a statement.


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b2ap3_thumbnail_6a00d83453c2c669e20168e9093aca970c-320wi.jpgQuestion:I am writing to you today for advice regarding the correct water temperatures for swimming pool and therapeutic pools and  room temperatures. Our pool water is being kept from 87-88F in the swimming pool where most of the clients having therapy are immobile; it's uncomfortable for most of us. Thank you in advance for your help. Patricia C.

Answer: Although the term therapeutic pool is used quite often, there is really no one temperature for all diagnoses. While 94F might be perfect for the acutely painful patient who is unable to exercise aerobically, it would be stiffling for the athlete. Check out the resources below to find the perfect temperature for your setting.

It depends on the usage, but most therapy pools run 88-95 degrees F with an air temperature near 87 degrees. Typically, you want the air temperature warmer than the water temperature until you hit 87 degrees Fahrenheit (water temperature).

Once you get that warm, the air temperature stays around 87 unless you work with your HVA technicians to ensure that you are not going to create artificial dew points inside the building.

Here are 4 sources to examine.

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All 300,000 public pools in the United States must install a permanent fixed lift. The deadline for compliance is tomorrow, March 15. Call it "Poolmageddon."

There is no way all 300,000 pools can install permanent lifts by Thursday. So what happens tomorrow when a disabled individual checks into a Holiday Inn and finds no lift at the pool? The Obama DOJ has said it will not be enforcing the new guidelines right away. That means no fines from the government, for now.

But the ADA also empowered citizens to sue businesses that are not in compliance with DOJ guidelines. The result will be a huge payday for enterprising trial lawyers everywhere.

Read original article (as posted on Drudge Report on 3/14/2012)

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QUESTION: Are than any contraindications to allowing a patient with a colostomy bag in the pool?  We have an order form one of our doctors to include the pool along with land PT.


b2ap3_thumbnail_6a00d83453c2c669e20168e8ca565d970c-320wi.jpgANSWER: We would say there is a precaution but not a contraindication. In other words, it is a concern, but not always a prohibited behavior. Many people with colostomies swim and exercise in water.

Below is an excerpt of text from our Aquatic Therapy Boot Camp training.

You can also read an article on aquatic therapy and stomas, ostomies and appliances from the Aquatic Therapy Journal. Finally, here are some discussions from the ATRI listserv on waterproof bandages.

A colostomy, urostomy, or ileostomy bag
Patients with any –ostomy bag (bags which collect waste from the intestinal tract) present a special risk with immersion, especially if their bags do not seal properly or the skin around the bag is macerated.  Because these bags collect waste, a punctured or leaky bag can result in fecal matter being deposited into the pool. Equally troubling perhaps, is the potential for additional contaminants from poorly disinfected pool water from entering the system of a patient who is already at high risk due to the underlying medical condition which required the bag. 
Patients with long-standing and well-managed –ostomies are not typically barred from swimming or therapy pools. One method of preparation for aquatic activities is for the patient to empty his collection bag, place a clean gauze dressing over the bag, place a bio-occlusive dressing (such as Tegaderm) over the entire bag, and then place a pair of compression or “bikers” shorts over the site. Some patients will take the additional step of wrapping a compression bandage like an Ace wrap around their abdomen prior to pulling on the shorts.
An area of open, macerated or non-intact skin, especially non- or poorly healing wounds
Open wounds and macerated, unhealthy skin present a risk during immersion — both to the public and to the patient. Any significant area of non-intact skin presents an open port for infection in poorly disinfected water. And immersion in water can further degrade the integrity of macerated, unhealthy skin, especially that present around wound beds or open -otomies. Even immersion in properly disinfected water can cause additional skin irritation in patients with chlorine or other halogen sensitivities. And while clean surgical wounds (such as those present after a knee surgery) present little risk to the public, persistent open sores or wounds can be colonized with infections such as MRSA which theoretically can be spread to others.

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