Aqua therapy makes big splash in Nikiski

Making waves

Posted: Sunday, August 05, 2001

One morning in the winter of 2000, Debra Southwick heard her phone ringing. As she walked quickly through the house to answer it, Southwick fell abruptly to the floor.

"I was flat on my face," the 47-year-old Soldotna resident said. "All of a sudden, I couldn't feel my legs."

Southwick heard her friend's voice, leaving a message on the answering machine.

"It was like a strange dream," she said. "I just couldn't get up off the floor."

Rolling around and using her arms, Southwick managed to drag herself to the phone. She called the friend back and described her dilemma. Help was on the way.

Days, then weeks passed by. Southwick still had little sensation in her feet or legs. Doctors ran an array of tests. Her strange dream became more like a nightmare.

"I finally got a diagnosis," Southwick said. "I call it 'Central Nervous System Disorder,' but the medical term is Chronic Immune Demylenating Polyradiculopneu-ropathy."

Her doctors said the condition is caused by a virus that eats away at the protective covering of the nerve induction pathways.

"Their slang description of it is 'shorts in the nervous system,'" Southwick said.

At first they thought it was multiple sclerosis, because the condition tends to mimic that disease.

"The day they took my keys and my car away from me, I thought, 'There went my world,'" she said.

Although Southwick regained some use of her legs after a few months, she was confined to using a walker or wheelchair.

"Then, I found aquatic therapy," she said. "To me, walking in water feels almost as much like a miracle as walking on water."

Getting their feet wet

Every Friday, Southwick goes to the Nikiski pool for an aquatic therapy session with Kathy Gardner, an occupational therapist for Alaska Aquatic Therapy.

"I can walk back and forth in chest-deep water, without holding on to something," Southwick said. "The water holds me up. It's wonderful to be able to do it on your own."

"Patients like Debra have much more mobility in the water," Gardner said. "She can do things in the gravity-reduced environment that are very difficult for her to accomplish on land."

From the knees down, Southwick said she has no sensation, except for her feet, which have a numbing or tingling feeling at times.

"In the pool, they put weighted cuffs around my ankles before I start walking," she said. "That gives me more of an idea of where I'm at."

Since its launching in June 1995, Alaska Aquatic Therapy has served hundreds of patients at the Nikiski pool. Owners Gardner and Helga Lang, a physical therapist, saw an opportunity to bring the cutting edge techniques of aquatic therapy to the Kenai Peninsula.

"Earlier that year, Helga and I took a continuing education class," Gardner said.

"The topic was aquatic therapy, presented by the Mapleton Rehabilitation Center in Boulder, Colo. We got pretty excited about learning the techniques. We didn't want to compete with other clinics, but offer an adjunct modality, as well as start a private aquatic practice," she said.

"On the plane ride back to Alaska, we decided to see if we could develop aquatic therapy and offer it to local patients."

The timing was perfect.

"The Nikiski pool had just been remodeled and made handicapped accessible," Lang said. "I was getting burned out working in clinics, and I thought the pool would be an interesting change."

"Helga and I became partners, were incorporated, and the rest is history," Gardner said.

In addition to being co-owners of AAT, Lang and Gardner each have a private practice. Lang does physical therapy with children and sees adults in their own homes. Gardner has a practice called Occupational Rehabilitation Services.

"We provide occupational therapy to area clinics, the hospital, and home health patients, as well as our private practice," Gardner said. "We serve the hospital in Homer and provide consulting services statewide."

Alaska Aquatic Therapy is a rehabilitation agency, certified by Medicare, Lang said.

In the beginning, the business consisted of only Lang and Gardner. Now there are five others working with them at the pool: Laurie Cramer, Mark Newton, Pam Burlingame, Joy Hobart and Carol Tauriainen-Ernst.

 

Mark Newton, at center top, leads an ai chi class in the Nikiski pool. The exercise helps people stretch and move muscles that are more difficult to move on land.

Photo by M. SCOTT MOON

Aquatic exercise has been around for many years. Originally, it was used in rehabilitation for injured athletes.

More recently, physical therapists have been using aquatic therapy for all kinds of conditions, such as arthritis, strokes, hip and knee replacements, even multiple sclerosis and cerebral palsy.

"The water helps them relax and eases their pain," Lang said. "Water can be incredibly healing."

How it works

Igor Burdenko, whose aquatic program is used by AAT, began his career more than 30 years ago as a rehabilitation and training consultant for athletes.

"We use the Burdenko program primarily for back patients," Lang said. "Patients have been quite successful at reaching their goals with this program."

Mark Newton works as an aide with the aquatic therapy team.

"I work a lot with the Burdenko program at the pool, because I've most recently been trained in that program," he said.

He helps patients get acclimated to the deep water, while using devices that keep them afloat as they exercise.

"After I walk in the shallow side for a while, I go in the deep end," Southwick said. "It's cool to have a flotation belt on and move like you're walking, when your legs are hanging in the deep water."

Southwick does exercises like scissors, bicycling and jumping jacks in the deep end.

"I swing my arms and sometimes take long strides with my legs," she said.

Water walking, splits, hip rotation and "jumping over boulders" are some of the many other movements in the Burdenko back rehab program.

"We work most often with orthopedic patients -- people with injuries," Lang said. "They are usually with us for about four to six weeks. Some of them may have had an injury years ago, and as they get older, it begins to show up."

Kenai resident Loveda Hobbs, 83, is an orthopedic patient at the pool. A few years ago she was diagnosed with a ruptured lumbar disc, but Hobbs cannot recall any specific injuries that would have caused a problem in her spine.

 

Loveda Hobbs laughs while exercising with foam barbells in the deep end of the pool.

Photo by M. SCOTT MOON

"I think it may have started way back in the '50s and '60s," she said. "My (then) teen-age son and I were building a cabin near Homer. We worked really hard, and I remember straining to carry some heavy loads.

"Three years ago, when I started aquatic therapy, the exercises seemed hard to me," Hobbs said. "I stuck with it, even though I was in some pain. Some people give up when they find exercise to be uncomfortable, but you have to get past that part.

"Now that I've been doing it a while, I can walk around pretty good, with my walker," she said. "People often comment on how much better I can walk these days."

Some people who come for therapy have a fear of the water -- especially the deep end, Lang said.

"But our patients don't have to know how to swim. With the flotation devices, they can concentrate on exercising, not floating. We go in water with people who are fearful -- they're usually able to quickly become more comfortable."

Many of them soon end up going in the deep end by themselves.

"They put that float around my waist, give me the floating barbells and turn me loose," Hobbs said and laughed. "I know all the exercises by now. They just keep an eye on me."

Nikiski pool has a wide ramp going into the water, a "stairway ladder" and a mechanical chair that lowers people into the water.

"It takes some work, but I can climb in and out by the stairway now," Hobbs said. "I feel pretty good about that. The only part I dread is coming back out of the water. You can feel your weight coming back as you gradually walk back out of the pool."

Why it works

Water's natural properties of buoyancy and resistance provide a good environment for patients to improve their flexibility and muscle tone.

"Often we place flotation cuffs around a patient's ankles." Lang said. "They have a flotation belt around their waist, and perhaps use the barbells. Then they go in the deep end and work at remaining vertical in the water. The patient develops more strength, by using trunk control to stay in that vertical position."

"Each patient works on a specific program, with documented goals," Gardner said. "The programs are designed according to the patient's needs and current level of functioning.

The aquatic therapists use a variety of programs with their patients, including Watsu, Halliwick, Bad Ragaz and Burdenko.

Kenai resident Jim Glendening was referred to AAT by an orthopedic surgeon and sports medicine physician. He suffered an injury at his job in Prudhoe Bay, resulting in a ruptured biceps tendon.

"I had a previous injury to that same arm and rather than having surgery right away, I'm working on strengthening the arm, and stabilizing it," he said. "If it turns out I still have to have surgery, my arm will be stronger."

Aquatic therapy can be more effective than land-based exercise, Glendening said.

"You're moving against the resistance of the water and getting uniform resistance throughout your full range of motion. It's different than being tied to a weight machine or bike. I think it's a wonderful variance or addition to a normal physical therapy program."

As part of his exercise program, Glendening sits on a "barbell" in the deep end of the pool.

"You propel yourself around with your arms. It's a good workout for arms, shoulders and back," he said.

He uses foam dumbbells and swings his legs back and forth to do "the pendulum."

"After the workout, you feel tired, but not beat up," he said. "You can function for the rest of the day -- that's what's good about it."

Southwick said her goal in therapy is to be able to spend more time using her walker and less time in the wheelchair.

"The doctors have given me only a 5 percent chance of doing that," she said. "But I'm hoping to make liars out of them."

She said she has more feeling now between her hips and knees, and less stress when she's using the walker.

"Now, when I do my regular therapy (on land), I can make more sense of what they want," she said.

Kids in therapy

"Baby Violet" Turner is a special patient at the pool. Violet has cerebral palsy. She's 3 and has been coming to aquatic therapy since she was 4 months old.

"She can't float yet, but she's learning to swim," said her mother, Raelynne Turner. "If you hold her lightly, she can push herself through the water with her arms and hands. She kicks her legs some, too."

Therapists work with Violet on stretching and range of motion, as well as learning to swim.

"Going under the water is one of her favorite things," Turner said.

Violet is usually smiling and laughing while she's in the pool, and other patients get a kick out of her, Turner said.

"I think she's therapeutic for them. One man said he works harder when Violet's around. Her attitude helps to get him motivated."

On land, Violet doesn't get up on her hands and knees yet, but she can roll herself over. She's always happy when it's time for a dip in the pool, her mother said.

"By the time we're done, she's exhausted and ready for a nap. She's at it for an hour and a half," Turner said.

Eight-year-old Annie Street of Nikiski has fetal alcohol syndrome. She's been a patient at AAT since she was 3.

"Annie has problems with sensory integration," said her mother, Sandy Street. "The resistance of the water helps her know where her body is in space. It has taught her a lot of coordination."

Aquatic therapy also has helped Annie with social issues.

"Now she is more able to tolerate being in a large group of people, with lots of noise around," Street said.

A busy pool

Aquatic therapy sessions are on Wednesday and Friday mornings, and usually last from an hour to an hour and a half. Most patients come twice a week, Lang said.

"We see anywhere from 10 to 25 patients in a day. The average is 16 to 18," Gardner said.

The aquatic therapy activities have had an impact on the staff and facilities at the pool.

"In recent years, therapy attendance has grown, and so has our need for more staff people during that Wednesday-Friday time slot," said Karen Kester, director of the North Peninsula Recreation Service Area.

"The normal pool temperature is 84.5," Kester said. "For therapy, many people say they'd like it to be warmer, but it beats the 80 degrees at the high school pools."

Kester said some patients return during nontherapy hours to use the equipment or practice their exercises.

"People can use our equipment, which we've always had for exercise and swimming lessons. We have jogger belts for people who like to water walk and not hit bottom so hard, or jog in the deep end. Some people come in and use our equipment, or some buy and bring their own," she said.

Many people in the senior-age group enjoy coming for the exercise and camaraderie, Kester said.

"You're not labeled as a senior here. They can associate with people of all ages in the pool."

Jack Hickey started out as a patient 3 1/2 years ago, and now you can't keep him away.

"These guys are like part of my family," he said. "The atmosphere is supportive and therapeutic, even though I'm not an active patient right now."

Hickey, 69, had a spinal injury from an accident when he was in the U.S. Air Force. He was diagnosed with scoliosis and osteoporosis.

"I was in a plastic cast when I first started therapy. I even had to sleep in it," he said. "Coming to aquatic therapy was the first time I could take it off. Boy, that felt good. The water is definitely therapeutic -- just that it's there."

"I like the fact that some patients keep coming back," Kester said. "The exercise has become a routine for them."

Donna Wilcox is one of those who keeps coming back. She and five other women ride together to the pool twice a week. While her husband was in therapy a few years ago, Wilcox discovered she enjoyed water walking in the deep end of the pool and doing laps on the shallow side. Her husband has died, but she is still a regular patron at the pool.

Wilcox lives out Funny River Road and makes the trip to Nikiski, even in winter, unless the roads are especially bad.

"We go for the exercise and the socializing," she said. "We usually go out for lunch after our swim.

"Pam Hansen is the driver for our ladies' swim group," Wilcox said. "She loves the pool, too. Pam's dedication helps us all stay healthy and happy."

Coming back for more

"When patients have completed their therapy, we discharge them with a written home exercise program and encourage them to come back and do it on their own," Lang said.

About 35 percent come back and exercise or just walk in the pool, Gardner said.

Despite the serious nature of the injuries that bring patients to them, aqua therapy does have a lighter side, too, Gardner said.

"It's fun to run into patients in town or at the store, and once we recognize each other the famous line is, 'Oh, that's what you look like with your clothes on!' That always brings laughs, and sometimes funny looks from people around us."

Lang and Gardner said their work can get quite busy, but there aren't many stressful moments at the pool.

"During summer, the pool has swim lessons for children," Gardner said. "Sometimes the new little swimmers in training jump in the wrong spot and dive bomb the therapy patients."

But it's a challenge they are will to take.

"I really enjoy this work," said Newton of his job at AAT. "I grew up on a resort lake in Michigan, so I've always been comfortable in the water. On those dark winter days, there's no better place on the peninsula to be than the Nikiski pool."



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