An acute stroke in April left the entire right side of 60-year-old physician Anant Shirke's body paralysed. Besides the lack of sensation and weakness in his limbs, Dr. Shirke could not balance himself. At the time of discharge, Dr. Shirke was referred for aquatic rehabilitation at Jupiter Hospital, Thane, where he exercised in a temperature-controlled pool on specialised gym equipment in water. Four sessions later, his balance improved considerably.
A fairly underutilised form of physical rehabilitation, aquatic therapy is gaining strength with many doctors prescribing exercises in water for patients suffering from muscle weakness, arthritis, back pain etc. Patients like Mr. Shirke who have severe debilitations or those suffering from other neurological disorders are also finding such exercises beneficial.
“Water provides an overall therapeutic environment and its properties like buoyancy and hydrostatic pressure support the body while exercising. This helps decrease the pain while performing the exercises,” said Dr. Amit Ramesh Dhumale, director of the neuro-rehabilitation centre at Jupiter Hospital. Dr. Dhumale also heads the hospital’s aquatic rehabilitation centre: a first-of-its kind aquatic gymnasium, a pool with five state-of-the-art equipment including an aqua back for core abdominal strengthening, aqua pullpress for chest and shoulder muscles, aqua bike for lower body, aqua rotation for spine mobilisation and aqua dip for shoulder and trunk muscles.
In an aqua gym, the equipment is submerged and one can see only the top of the machines. So the patient’s body, except for his head and neck, are on the surface. The pool’s depth is 4 feet, 2 inches. For regular water therapy exercises too, the movement is under water while the rest of the body is on the surface.
The therapies are customised for each patient. “Dr. Shirke’s sessions would include him exercising on all the equipment under water. We chart our programmes depending on what the patients need the most. It could be balance or even muscle strength,” said Dr. Dhumale, adding the half-hour sessions are conducted three times a week and cost Rs. 1,500 each.
Dr. Shirke’s improvement reflected on the Berg Balance Scale, which from zero to 54 helps determine a patient’s ability to balance on his own. “When he started with us, his scale was merely 28. After his fourth session, it has improved to 38,” said Dr Dhumale.
Another patient, Thane resident Kuldeep Thakur who suffered a stroke in 2014, has seen improvement after physical rehabilitation in water. Mr. Thakur had spasticity in his upper and lower limbs. His improvement was measured on the Modified Ashworth Scale that helps in documenting spasticity. At first, Mr. Thakur’s spasticity was at level 3, which dropped to level 2. The reduced spasticity also improved his speed in the 10-metre walk test. “I can feel the difference in my body. My walking pattern is better and there is improved movement in my fingers,” Mr. Thakur told The Hindu . Besides exercising on the equipment, Mr. Thakur also had an water-based stretching programme designed for him.
While aqua therapy is a broadly-used term for exercising in water, Dr. Dhumale says what he offers is a pure form of aqua rehabilitation, which is a doctor-driven programme. “Since we opened in May, we have enrolled nearly 25 patients including those suffering from stroke, Parkinson’s disease, cerebral palsy, joint stiffness etc.”
While Jupiter Hospital has the first rehabilitation-based aqua gym, general aqua therapies are offered by fitness trainers in residential pools and clubs.
Mumbai-based fitness instructor Shivani Patel, who offers aqua aerobics training, says many of those who come to her suffer from frozen shoulder, knee problems, spine ailments and back injuries. “Exercising in water is slow-paced. To improve the movements, I use water loops and water dumbbells,” said Ms. Patel, adding there is poor awareness of water therapy. “People come only when they have an injury or a disease and their doctor suggests it,” she said.
Physiotherapist Dr. Ali Irani, who has been treating several celebrities including actor Shah Rukh Khan, said aqua therapy reduces the rehabilitation period and prepares the patient for movements he/she cannot do otherwise. However, he said, it cannot be a blanket therapy for all. “Movements that cannot happen against gravity, happen under water. Hence, a patient with severe difficulty in rehabilitation on the ground can do ‘underwater rehabilitation’ and prepare himself for the continuous exercising that will follow,” said Dr. Irani, who has referred many of his patients for aqua therapy.
