is pending approval by the Arizona Board of Physical Therapy
Examiners for 8 CCUs for PTs and PTAs.

Human beings play; independent of age. Contents, intentions and goals change with age, but there are common features between young adults and elderly that play. These features are also important for the – neurologically – impaired person, which was underlined by Krakauer* in his 2018 article about high-dosed playful movements in stroke rehabilitation. Elements of playful moving are: challenging, problem solving, attention taking, enjoyment and fun, exertion, social interaction and experiencing success. Playful moving coincides with environmental enrichment, known to attenuate neuroinflammation and improve executive functions (Spielman 2016). Neuroinflammation is a chronic low grade inflammation of the nervous system that can occur in a variety of neurodegenerative – and metabolic diseases.  

Executive functions are important in (re)learning of skills and planning of tasks. They are cognitive processes, necessary for non-routine (movement) control in order to attain chosen goals. Various publications have shown the very positive effects of environmental enrichment and – intensive – movement in water on executive functions. Movement intensity e.g. is relevant as a basis for neuroplastic changes in the brain areas related to executive and motor control functions due to neurovascular and vasculo-neuronal coupling. Various authors found clinically relevant effects of playful moving with (an)aerobic components (Sato 2014, Albinet 2016, Kang 2015, Bressel 2018). 

Water is a great environment to combine all elements especially when possibilities to move on land are limited because e.g. of fall risk: playful movement, also focusing on agility and postural control in water is THE alternative.  

Underlying mechanisms might be neurophysiological, circulatory and immunological changes in the brain. These have been well documented, showing changes in cerebral blood flow during immersion (Parfitt 2017, Green 2021), effects on endothelial function (Tang 202)changes of corticospinal excitability (Sato 2015, Sato 2019), increases of growth factors like the Brain Derived Neurotropic Factor (Bansi 2013, Begum 2022) or modification of the expression of pro- and anti-inflammatory cytokines (Pochmann 2018): all aspects of neuroprotective mechanisms.

Case related contents provide students with a comprehensive picture of current research that supports decision making, clinical reasoning, problem-solving and goal-setting in aquatic therapy. This intensive postgraduate aquatic therapy course is based on “learning-by-reasoning-and-doing” or “think-pair-share”: pool practice encompasses 70% of the total contact hours.

Two aquatic treatment concepts form the practical implementation of evidence based, and competence guided approach to therapy. Both classes come with a (digital) course book.

References:

*Krakauer JW & Cortés JC. Non-task oriented approach based on high-dose playful movement exploration for the upper limb in stroke: a proposal. NeuroRehabilitation 43 (2018) 31–40. DOI:10.3233/NRE-172411 

*All other references will be discussed during the course 

Johan Lambeck, PT, owns an Aquatic Therapy Consultancy in the Netherlands, being a knowledge broker trying to implement the existing evidence in the daily practice of aquatic therapy.In 2020 he received the Award “Excellence in Aquatic Physical Therapy”, issued by the Academy of Aquatic Physical Therapy-APTA. He is a long time editorial board member of the Journal of Aquatic Physical Therapy. He was named the Aquatic Therapy Professional of the year in the United States by ATRI in 1998

From 1979 – 1998 he was in charge of the Department of Aquatic Therapy in the Rehabilitation Centre Sint Maartenskliniek (Nijmegen, NL) and was affiliated as Free Research Associate to the Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium, co-responsible the EU Erasmus Aquaevidence/Aquaoutcome project till 2017. Since 2017 he is Honorary Professor at the Zhongshan Vocational College, Nanjing, China.

He is co-founder of the International Halliwick Association (IHA) and the Association International Aquatic Therapy Faculty (IATF) in which he is Senior Lecturerand vice-chair.

Johan has taught over 1000 seminars in 53 countries on almost all topics in aquatic therapy. He is the author or co-author of 4 books / CDRom’s/websites, over 45 published articles and chapters in (peer reviewed) journals and books on aquatics and aquatic therapy.

In 2005, he joined the Cochrane Collaboration balneotherapy review group. Johan was co-founder of the aquatic network of the WCPT/World Physiotherapy and performed aquatic projects for WHO.

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