Hydrotherapy for stroke recovery leverages the therapeutic properties of water as a valuable tool in stroke rehabilitation programs. The unique properties of water provide an effective environment for exercise and healing, making it particularly beneficial for this population.
In this blog, we’ll explore the barriers to exercise after stroke, the healing properties of water, the specific benefits of hydrotherapy for stroke recovery and the various exercises that can aid in rehabilitation. We will also discuss special safety consideration for hydrotherapy specifically, as well as beginning any exercise program in general.
Table of Contents
- Overcoming barriers to exercise after stroke
- Healing properties of water
- Benefits of hydrotherapy for stroke recovery
- Hydrotherapy exercises for stroke rehabilitation
- Safety considerations for hydrotherapy for stroke recovery
- Conclusion
Barriers to Exercise After Stroke
After a stroke, multiple factors can make it difficult for individuals to practice their physical therapy exercises at home. Individuals often experience the following, which can lead to a fear of falling:
- strength deficits, either in their upper extremities and/or their lower extremities,
- reduction in balance,
- reduced independence with transfers (such as moving from their wheelchair to their bed),
- and reduced independence with walking.
These factors along with limited equipment or physical support when doing the exercise at home can create barriers to completing their recommended program.
Participating in aquatherapy reduces many of these barriers. Patients are often more confident moving in the water and the fear of falling is removed. This makes them more active participants in their rehab and ultimately improves their outcomes.
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Healing Properties of Water
Hydrotherapy, also often referred to as aquatherapy, involves the use of water for therapeutic treatment. While some individuals choose to do an aquatherapy class at their local gym as part of their workout routines, many physiotherapists will also include it as part of a patient’s rehabilitation plan.
These properties of water help provide patients with an effective environment for exercise and healing.
- Buoyancy: Hydrotherapy is especially helpful for individuals who have limited mobility or pain that impacts their ability to do exercises. Water reduces the effects of gravity, putting less pressure on the joints and other parts of the body, allowing individuals to potentially move more without pain. In other words, it makes it easier to do exercises that might be difficult to do on land.
- Resistance: In addition to mobility, hydrotherapy is also a way for individuals to work on strengthening. The water provides natural resistance with movement to allow strengthening of the muscles. Foam weights and pool noodles can be used to increase the resistance for more of a challenge. Even with the use of these additional weights, it is often less taxing compared to doing higher-intensity exercises or using dumbbells to obtain similar benefits, and often safer for individuals as well.
- Temperature: Hydrotherapy often occurs in warm-water pools. The warm water helps relax the muscles, improves blood circulation and reduces pain. In turn, this allows participants to be more comfortable when exercising.
Benefits of Hydrotherapy for Stroke Recovery
Hydrotherapy offers numerous benefits for people recovering from stroke, making it an excellent addition to rehabilitation programs. Here are some key advantages of hydrotherapy:
- Reduced weight-bearing: The buoyancy of the water allows body weight to be supported making it easier for stroke survivors to practice movements without fear of falling.
- Increased mobility: Hydrotherapy allows for less load to be on the joints allowing individuals to move through a great range of motion which can help improve flexibility.
- Resistance training: Water resistance can help build muscle effectively and safely.
- Cardiovascular conditioning: Hydrotherapy can also improve cardiovascular fitness which is important for recovery as often stroke survivors experience fatigue and reductions in exercise tolerance. In addition, improving cardiovascular health is important for prevention of future strokes
- Pain management: Warm water can help reduce muscle spasms, reduce pain and enhance relaxation.
- Balance and proprioceptive training: Hydrotherapy provides a safe environment to practice balance exercises reducing the risk of falls. It also improves proprioception which is often impaired following a stroke.
- Transition to land: In addition to enhancing confidence with movement, hydrotherapy also serves to help transition exercise to land exercises. For example, for those with a fear of falling, practicing balance exercises in the water first will be helpful before transitioning to practicing them on land. In addition, hydrotherapy may allow clients to explore positions they may not otherwise be able to on land, including prone (on the stomach) or kneeling.
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Hydrotherapy Exercises for Stroke Rehabilitation
As a physiotherapist there are a range of exercises that I recommend for stroke rehabilitation clients to either complete independently or with the assistance of another person. It is important to note that the program is individualized so patients are targeting specific impairments they are dealing with following a stroke.
Exercises for stroke recovery are often prescribed based on an individual’s abilities and limitations, as well as their goals.
- Stretching: Stretching is often helpful for those dealing with spasticity, pain and/or reduction in mobility and flexibility. Often individuals can work through a greater range and work on different muscles/joint than they can on land.
- Lower extremity strengthening: Some exercises I often recommend are leg swings and squatting. These mimic functional tasks such as walking and going from sitting to standing. If the resistance of the water is too easy for individuals, I recommend them use a pool noodle as they are swinging their leg forward and back to increase the resistance the muscles must work through. Even individuals who cannot stand on land would be able to stand and work on these exercises in the water.
- Upper extremity strengthening: Just as with lower body strengthening exercises, individuals can enhance upper body strength with water resistance alone or and or foam dumbbells to increase the resistance. I often recommend exercises like shoulder raises, rows and chest presses to specifically target and strengthen then upper body.
- Balance training: Often times following a stroke, patients have a significant fear of falling. This can make practicing balancing tasks in a clinic setting challenging. To address this, I have patients perform balance exercises in the water, where they feel more comfortable and no fear of falling. These balance exercises include standing with eyes closed, standing with a narrow stance, walking with one foot in front of the other and even standing on one foot.
The supportive environment of the water helps patients overcome their fear and engage more willingly in these activities.
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Safety Considerations for Hydrotherapy for Stroke Recovery
Ensuring safety during hydrotherapy for stroke recovery is crucial for maximizing its benefits and preventing any potential risks. Here are some key considerations to keep in mind:
- Professional supervision: There are many ways hydrotherapy is delivered. Sometimes it is delivered one-on-one and other times in group setting. Both delivery methods can work for stroke rehabilitation. However, even in a group class setting, it is important to ensure there is a trained therapist or instructor who can guide the motions and ensure the exercises are performed safely and correctly by the person recovering from stroke.
- Individualized programs: Each stroke presents differently and so programs and exercises should be tailored to each individual based on their abilities and recovery goals to ensure the program is most effective.
- Safety: Most suburban areas have many different community centres, gyms and clinics that have hydrotherapy pools. It is important to make sure the pools are accessible where there is a ramp or a lift to help individuals get in/out of the pool safely and flotation devices.
- Medical clearance: If there are any health conditions, it is always important to discuss with your primary care doctor to determine if it is safe for you to begin hydrotherapy.
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Conclusion
Hydrotherapy can play a vital role in stroke recovery and rehabilitation. A trained therapist or instructor can help create and guide you through a personalized program that can help you achieve your goals. By leveraging the benefits of the water, stroke survivors may be able to experience improved mobility, strength, balance and less pain.
If you, or someone you care about, could benefit from hydrotherapy contact us at the clinic to discuss with one of our experienced physiotherapists on how it can optimize outcomes and enhance your quality of life.
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