B.E. Becker FACSM

University of Washington School of Medicine, Seattle, WA

PURPOSE: Despite the value of exercise in dementia, severe dementia patients are often non-compliant and incapable of following directions. This case report describes evaluation of a therapeutic trial of aquatic therapy requested by a patient’s family as she had previously been an exercise swimmer. METHODS: The patient was a 54-year-old former physical therapist, retired due to progressive cognitive decline 4 years prior to referral. She was diagnosed with early-onset Alzheimer’s dementia. Conventional therapy for dementia had proven futile. Initial evaluation revealed a nonverbal female seated in a wheelchair, dependent on 2-person assist for all transfers and activities of daily living. She had been either nonresponsive or actively resistive for both activities of daily living and had neither stood, taken steps, or assisted with transfers in the 6 months before assessment. The patient received a total of 17 1-hour therapy sessions in a warm water therapy pool consisting of Clinical Watsu and a modification of basic Halliwick Method called Water Specific Therapy. She was monitored for transfer skills, ambulation, in-pool activity, responsiveness and communication skills. RESULTS: Over the treatment course she achieved ability to tread water for 15 minutes, transfers improved to moderate-to-maximum assist from seated, and ambulation improved to 1000 feet with minimum-to-moderate assist of 2 persons. Communication increased to “yes,” “no,” and “okay” appropriate responses, and an occasional “thank you” and “very nice.” Treatment results demonstrated clinical effects currently unobtainable by existing medications. CONCLUSIONS: Recent research has demonstrated aquatic immersion to significantly increase cerebral circulation, both at rest and during aquatic exercise when compared to land based data. A warm water aquatic environment produces a calming and relaxing effect on humans across the age span. This effect is therapeutic, increasing cardiac efficiency, lowering blood pressure, improving sleep patterns, and having downregulating effects on the autonomic system.1Since there were neither medication changes nor alterations in other aspects of her daily care, the authors propose that her clinical progress may be related to her aquatic therapy intervention.

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