Precautions & Contraindications

PRECAUTIONS:

Take action and have a plan in place in order to avoid unwanted or adverse outcomes. Always be sure to monitor the client's response to treatment.

• Unstable Blood Pressure

  • If your client has unstable BP, it is important to have a sphygmomanometer poolside. The hydrostatic pressure in the pool can lower BP. Watch for signs of hypotension.

• HIV

  • If your client has a diagnosis of HIV, it is important to know that their lungs and skin are compromised due to a weaker immune system. Your client should not get into the pool if they have any open wounds or skin infections. Watch for signs of overexertion, especially if your client has a lower vital capacity.

• IV Site

  • It is important to properly cover any IV site prior to entering the pool. Tegaderm is commonly used for this. You do not want any blood borne pathogens in the pool.

• Ostomy/Central Line Catheters

  • Be cautious of ostomy bags and catheters; they can pull away if you are not careful. Ensure the pouch or line is properly sealed and secured to the client. Have your client empty their ostomy pouch/drainage bag prior to entering the pool. Tegaderm can be placed over the catheter exit site and a catheter valve can also be used.

• Bowel Incontinence

  • If your client experiences bowel incontinence, they are still able to get into the pool, but it is important that they have a toileting schedule set in place. Using clinical judgment, decide whether or not they are appropriate for aquatic therapy.

• Epilepsy

  • Any glare in the pool could cause a client with epilepsy to have a seizure. Be cautious of the lighting in the area and ensure proper positioning.

• Low Vital Capacity

  • The hydrostatic pressure in the pool can make inspiration harder. Watch for signs of overexertion and lower the intensity of the treatment, if necessary.

• Fear

  • If your client is scared of the water or is uneasy, take rest breaks as needed and slowly progress them through treatment.

• Swallowing Disorders/Absent Cough Reflex

  • Ensure your client is not swallowing the water- this could cause aspiration. Be sure to closely monitor your client.

• Vertigo/Vestibular Disorders

  • The movement of the water or moving too fast could create increased dizziness or an unwanted response. Avoid quick/rotational movements.

• Kidney Disease

  • Be cautious of fluid loss. Treatment sessions may need to be shorter in duration for these clients.

• Multiple Sclerosis

  • This patient population can easily overheat while in the pool. Be cautious of the intensity of the treatment session and the water temperature, as overheating could lead to a temporary loss of function.

• Hearing Aids

  • Clients who wear hearing aids should remove them prior to entering the pool in order to keep water out.

• Ear Infections

  • Clients with ear infections should keep their ears above the water at all times.

• Prosthetic Limbs

  • Clients with prosthetic limbs should not wear them in the pool, unless they are specifically made for swimming.

• Skin Breakdown

  • Clients prone to skin breakdown should wear water shoes while in the pool.

CONTRAINDICATIONS:

Do NOT get your client into the pool for therapy if they are experiencing any of the following:

• • Infections

    • Anyone with an infection of some sort should not participate in aquatic therapy. This includes:

      • Open wounds or skin infections

      • Throat infections

      • UTI

      • GI infections

      • Water-borne infections

      • Influenza

  • Vomiting

  • Diarrhea

  • Conditions that cause issues with thermoregulation

  • Cardiac Failure

  • Limited Vital Capacity

  • Uncontrolled Epilepsy

  • Severe Cognitive Deficits

  • Cerebral Hemorrhage

    • Your client should not be participating in aquatic therapy until they are at least 3 weeks post-stroke.

*If you have any questions or doubts about getting your client into the pool, always ask an appropriate authority!*