Aquatic Therapy & Rehab

Aquatic Therapy & Rehab In This Issue I N S T I T U T E ATRI Newsletter WINTER 2014 Volume 7 Issue 4 ARTICLES Featured Program: The Warrior Program Results 2 Featured Topic: Rethink Core Stability Training 4-5 Business Feature: Medicare NEED TO KNOW Checklist 10-11 Featured Exercise: Hip Circles for Core, Balance and LE Strength 12 Featured Colleague: Donna Adler 13 True Health 14-15 EDUCATIONAL DATES & LOCATIONS 2014 National Conferences and Featured Courses 7-9 2015 National Conferences 10 2015 Professional Development Days 10 MISCELLANEOUS OnLine Ed News 3 Facebook 3 Certification Questions & Answers 6 2015 Promotional Opportunities 8 Event Volunteers Needed 16 2015 Volunteer Opportunities 17 ATRI 866-462-2874 www.atri.org atri@atri.org

Featured Program: The Warrior Program Results by Dr. Mary Wykle Leslie M. was already an extraordinary military wife and mother. She spent her days being very active and taught Zumba two hours a day along with being a student for another hour. She then spent the rest of her day as the primary caregiver to her seven year old son Keian and mother to her daughter. Keian was diagnosed with Cerebral Palsy at birth and is in a wheel chair. She took on the role of all his medical care. He weighs 60 lbs, but her little boy depended on her to do his bathing, diapering, and moving him on a consistent basis. Leslie suffered an injury that left her unable to walk or even stand without being in extreme pain. She has degenerative disc disease of the L-5 and S-1 disc. The pain continued to just get worse instead of better. She couldn t stand long enough to shower cook lift or carry more than 5lbs. drive clean her house (that used to be so organized and spotless) The worst thing for Leslie, was that she could no longer take care of her little boy and doctors suggested that she just put him in a home. Her husband was deployed to Korea and she had no help other than a few hours of nursing care a day for Keian. Her life felt like a complete disaster. She began to have blood pressure issues due to the pain and was even rushed to the hospital with chest pains narrowly missing a heart attack. Doctors told her that she needed to accept that she would never get better, but she refused to accept this kind of life for herself. She needed to get her pain under control and deal mentally with the challenges she was facing. Leslie began to search for her options. She tried chiropractic care, which made her pain worse, physically therapy which made her numb from the hips down, drugs for nerve pain, narcotics, muscle relaxers, NSAIDS, Tylenol, and had no results. Her life revolved around laying down 90% of the day flat on her back, not being able to sit or stand without everything going numb, and pain constantly at an 8 or 9. One day researching on the internet, she came across the Aquatic Program for Injured Warriors and Athletes. She was desperate to get her life back for herself, her family, and Keian. After starting the program, she had the beginning of relief after three sessions. She began to feel stronger and her numbness went away. Her pain has decreased to 4 and she no longer needed most of her medications. She went down to one or two pain pills a day compared to 2 every 4 hours around the clock. She still walks longer distances with a walker, but can walk around her house without be assisted in anyway. Leslie can now drive, cook, shower, and is able to help take care of her son. I know that I still have a ways to go before I am fully recovered, however I know I never could have gotten this far so fast without this program. I feel like I am getting my life back on track and for that I am extremely grateful for this Aquatic Program for Injured Warriors and Athletes. Compassion, caring, teaching, loving, and sharing your gifts, talents, and abilities are the gateways to power. ATRI Newsletter WINTER 2014 2 Volume 7 Issue 4

OnLine Ed News Winter 2014 I need my Continuing Education Credits. but I can t get to a Conference!! Online-Ed to the Rescue!!! ATRI has over 70 courses available Online for you to take. The courses range from easy one to two hours courses to fifteen-hour specialty courses. All of them can be viewed and studied at you leisure and in your PJs if you want! And you can go back several times to review the material prior to receiving your certificate! The NEW Courses below were videoed at the ATRI Symposium this year. Many will be available for our 12 Days Half-Price Special!! 1004 - Addressing Secondary Issues in Rehab - Anita Davis, PT, DPT, DAAPM 1021 - Amputee Options and Outcomes - Mary Essert, BA, ATRIC - Lecture Only 1214 - Aging Well - Steph Toogood, AS 1317 - Chronic Conditions - Donna Adler, BA, ATRIC - Land Workshop 2219 - Balance and Core Strength - Connie Jasinskas, MSc 2229 - Brazilian Athletic Interventions - Douglas Gil, MS, PT - Lecture Only 2234 - A New Approach to Abdominal Exercises - Eduardo Netto, MS - Land Workshop 2512 - Parkinson s Disease: Improving Functional Mobility - Mary Rosenberg, PT, DPT, ATRIC 2607 - Ai Chi for Scoliosis and Multi-Level Fusion - Mary Wykle, PhD, ATRIC 2633 - Intermediate AquaStretch for Lower Extremity - Donna Adler, BA, ATRIC 3601 - Clinical Wassertanzen - Luis Vargas, PhD, PT, ATRIC; Flavia Bayron, PT, MPA, ATRIC And Just a few Online Ed comments Believe it or not, I finally completed this course and gave an in-service on it at work, which was well received. I took pictures of all our aquatic exercise equipment and showed what can be done with it and for what purpose and then related it to transition to land based therapy. You have great instructors!! I enjoy learning new ideas. I also get frustrated because our pool at work is so small and is so limiting on what we can do for our patients. Very informative class. I really appreciated the overview of a variety of different treatment methods. The sampling gives me some ideas right off the bat, but also will help pique my interest in methods that I personally see potential in and want to pursue to greater competence. Wonderful course! Enjoyed and learned so much! Check us out on Facebook If you have been to our Facebook page, come back and if you haven t check us out. We have some great new photo albums posted and we will be adding more weekly. Find us at: http://www.facebook.com/pages/aquatic-therapy-rehab- Institute/179253248781779 https://www.facebook.com/pages/aquastretch/325327940865268 ATRI Newsletter WINTER 2014 3 Volume 7 Issue 4

Featured Topic: Rethink Core Stability Training by Laurie Denomme We mindfully decide to perform a task such as reaching for something in the back seat of the car. However the turn and reach action is accomplished by a series of unconscious reactions. We don t cognitively think Okay deltoids I need you to lift the arm and while you are doing that, obliques you better engage so I can turn and laterally flex at the trunk. Thankfully we do not have to think about each step in the process. However, it is important for the body to have the necessary mobility and strength to safely and efficiently get the task done. Conclusions from a 2010 research review (1) give us the opportunity to rethink our approach to core training. Let s use these findings to determine how to effectively use aquatic exercise to enhance core stability. Conclusion: The control of the trunk (and body) is whole. There is no evidence that there are core muscles that work independently from other trunk muscles during normal functional movement. Movement is the outcome of sagittal, frontal, and transverse plane motions at each joint throughout the body. For example, during gait the trunk is repeatedly asked to flex/extend, laterally flex right and left, and rotate in both directions. To enhance stability when walking, use exercises that load the trunk using the same parts of the body that drive movement when stepping. Try a: Single Leg Balance Reach. Stand on one leg and reach the opposite anterior-posterior, right and left lateral, and right and left rotation. Add a bilateral hand reach, with emphasis on pulling the water, in opposition to the moving leg to add further overload. Conclusion: There is no evidence that individuals can effectively learn to specifically activate one muscle group independently of all other trunk muscles. Attempting to improve function by isolating a single muscle will limit outcomes. The interconnectedness of the body is demonstrated in everything we do. In an upright position, look over your right shoulder. This head movement should cause inversion of your left foot (bearing you are free from restrictions at any of the joints along the path between the head and foot). Understanding that body movement has this domino effect opens the possibility to target the core using movement of an entirely different body part. In a lunge stance, try a single arm, same side rotational reach (below water surface). With the left leg forward, reach the right hand around the right corner (load), then move the arm back to start position (to explode). Cue clients to: Move the water, while maintaining a steady rate for greater overload. Conclusion: The internal-focus approach on individual muscles in core stability is likely to degrade motor learning Continued ATRI Newsletter WINTER 2014 4 Volume 7 Issue 4

Rethink Core Stability Training Continued as well as skilled performance. In fact, there may be potential danger of damaging the spine with continuous tensing of the trunk muscles during daily and sports activities. Movement has a conscious intent but is the result of a series of unconscious reactions. Therefore, it s important to help clients execute good movement mechanics without having to think about it. To help facilitate improved movement try using an indirect cue rather than one directed at cognitively engaging the core. If a client is leaning forward when water walking, have them try an alternating overhead reach. This action will help to elongate the core muscles, helping the body to load more effectively while facilitating tissue hydration. Conclusion: Patients who have been trained to use complex abdominal hollowing and bracing manoeuvres should be discouraged from using them. Replace squeeze your abdominals with turbulence. Start with gentle movement of the water around the client while they are performing any basic exercise, progressing to use of a more disruptive flow. Further study of functional movement and the effects of buoyancy and resistance will enable you to see more effective ways to design core focused exercises. Attend an Integrated Core Training workshop with Laurie at upcoming ATRI National Conventions in Chicago November 2014 and Sanibel June 2015. Bibliography 1. Lederman, E. The myth of core stability. Journal of Bodywork & Movement Therapies (2010) 14, 84-98 Laurie Denomme, Kinesiologist and Gray Institute Fellow of Applied Functional Science, is a recognized international speaker and is the recipient of the 2013 AEA Global Aquatic Fitness Professional Award and 2014 ATRI Tsunami Spirit Award. Visit Laurie: www.exerciseelements.com ATRI Newsletter WINTER 2014 5 Volume 7 Issue 4

CERTIFICATION Questions & Answers The ATRI Certification Exam is offered on Sunday, November 16, 2014 in CHICAGO, IL (ROSEMONT, IL) The certification exam is ALSO available online and can be taken any time for your convenience. For more information go to our website www.atri.org and click on Certification Information. http://www.atri.org/atricertification.htm How do I know when my certification is due for renewal? Your certification renewal date is on the bottom right-hand corner of your certificate. Also, about six months prior to your renewal date you will receive a reminder email with instructions to renew your certification. If you have not received an email, check your spam folder. Also, if you change your email address, please notify the ATRI office. How do I know what fee to pay for renewal? The fee for recertification is as follows: $29 if continuing education credits are earned through ATRI; $49 if continuing education credits are not earned through ATRI, but with an ATRI Authorized Continuing Education Provider (see the list on the website or the link below); $69 if continuing education credits are not earned through ATRI or are not on the ATRI Authorized Continuing Education Provider list. http://www.atri.org/certification/continuing%20education%20providers.pdf What does the certification exam cover? The exam tests the Aquatic Therapy and Rehabilitation Industry Standards and includes knowledge regarding the following topics with the percentage of questions on the exam listed: Movement Mechanics and Science - 21% Aquatic Principles - 22% Aquatic Therapy Principles / Methods - 31% Professional Responsibility - 8% Safety and Risk Awareness - 14% Legal Considerations - 4% You can also download the complete Standards of the Industry from the website, or use the link below. http://www.atri.org/certification/standards.pdf ATRI Newsletter WINTER 2014 6 Volume 7 Issue 4

2014 National Aquatic Therapy Conference November 13-16 Chicago, IL See www.atri.org for detailed information. ATRI Certification Exam offered at all National Conferences. Offered Online Anytime! Featured Specialty Certificate Programs, plus PLENTY of General Education! Intro. to Aquatic Therapy and Rehab Aquatic Warrior Basic Course AquaStretch TM Specialty Certificate Program Hip and Back Specialty Certificate Program Ai Chi Certification Power Balance for Healthy Aging Complex Shoulder Solutions Innovative Exercises for the Hip AquaStretch TM in the Home Exercise and Group Setting Joint Replacement Rehab Improving Ai Chi Outcomes ATRI Certification QuickPrep Stop Seated Stress with Integrated Core Training Ortho and Neuro Applications for PNF Two Featured Courses: 2627 AquaStretch Active Aquatic Release Specialty Certificate Program Intermediate / Pool Workshop / 15-Hour Program Faculty: Donna Adler, BA, ATRIC / Terri Mitchell, BA, PTA, ATRIC Chicago, IL / Thursday-Friday, November 13-14, 2014 15.0 credit hours equal to 15.0 CECs/1.5 CEUs THURSDAY, NOVEMBER 13: FRIDAY, NOVEMBER 14: Pool: 7:30-9:30 am Pool: 7:30-9:30 am Classroom: 9:30 am-12:00 pm Classroom: 9:30-11:00 am Lunch on own: 12:00-1:00 pm Pool: 11:00-12:30 pm Classroom: 1:00-3:00 pm Lunch on own: 12:30-2:00 pm Pool: 3:00-5:00 pm Classroom: 2:00-4:00 pm COURSE DESCRIPTION: AquaStretch is considered a breakthrough in pain management and aquatic therapy. It helps to quickly restore flexibility lost due to accidents or surgeries; significantly and immediately reduces chronic pain or pain with movement; creates profound relaxation that helps to improve function, quality of life, and sleep and therefore, the overall ability to heal. Integrative exercise programs will be presented through case studies on how to maximize the benefits of the AquaStretch technique. The participant will be presented with the tools to apply appropriate documentation and application of this modality in their particular aquatic therapy setting. This course presents the foundations and applications of AquaStretch, a new form of individual and facilitated aquatic exercise that has been successful in treating various patient populations including those suffering from chronic pain to elite athletes. AquaStretch theoretically breaks down fascial adhesions utilizing a combination of Continued ATRI Newsletter WINTER 2014 7 Volume 7 Issue 4

Two Featured Courses: 2627 AquaStretch Active Aquatic Release Specialty Certificate Program Continued the facilitator/therapist s manual pressure and the client/ patient s active movement. AquaStretch method can be utilized as a wellness program or specifically applied as a skilled aquatic therapy technique. This certificate course will cover the basic wellness applications and progressions and provide an introduction to the advanced therapy concepts through case study presentations. Topics include starting positions and grips, how to safely apply stretch resistance using 5-15 pound weights to the body in 3-5 foot depth water and understanding intuitive movement. This is a manual, one-on-one technique not intended for group classes. Skills check and verbal exam will be given as part of the certificate course. COURSE OBJECTIVES: Upon completion of this course the participant will be able to: 1) Explain the basic AquaStretch theories including, restoration of movement, stretch resistance, fascial adhesions and intuitive movement. 2) Safely progress a client through the eleven basic starting positions and grips within the AquaStretch wellness program. 3) Effectively cue and perform the basic AquaStretch procedure. 4) Determine appropriate water depth and equipment usage including safe application and removal of weights. 5) Describe appropriate level of documentation for various aquatic therapy settings 6) Describe the benefits of the AquaStretch techniques for various patient populations FACULTY: Donna Adler, BA, ATRIC, owns and operates Liquid Assets for Fitness in Phoenix, AZ. She is an Arthritis Foundation Online Educator/Trainer and works with geriatrics, pediatrics and clients with health challenges. Donna is an AquaStretch Facilitator and ATRI AquaStretch Trainer. She is co-author of the ACSM Exercise is Medicine Aquatic Solutions for Chronic Conditions Manual. She is a consultant at the Virginia G. Piper Sports and Fitness Facility for Persons with Disabilities and also studies at the Center for Applied Energy Medicine. She is the 2012 recipient of the ATRI Tsunami Spirit Award. FACULTY: Terri Mitchell, BA, PTA, ATRIC, has been involved with aquatic fitness since 1982. She is a Training Specialist with the Aquatic Exercise Association, a Licensed Physical Therapist Assistant (PTA) specializing in aquatic therapy, and instructor of a variety of aquatic fitness classes to persons of all ages and abilities. Terri is on staff at the University of Texas at Austin and enjoys working with young adults in the water. She holds certifications from AEA, ATRI, and IAR. Terri is a Certified Personal Trainer for both land and water. She is co-author of Applications of PNF Techniques in the Aquatic Setting manual and co-producer of PNF in the Pool video. She is the 2001 recipient of ATRI s Dolphin Award and the 2010 recipient of the ATRI Professional Award. Continued 2015 Promotional Opportunities Do you have a product or service you want to promote? Consider partnering with ATRI as an equipment supplier or sponsor. We have varied opportunities for all budgets. Contact Monica at mgunn@atri.org for more information. ATRI Newsletter WINTER 2014 8 Volume 7 Issue 4

Two Featured Courses: Continued 2313 Hip and Back Specialty Certificate Program Intermediate / Pool Workshop / 15-Hour Program Faculty: Beth Scalone, PT, DPT, OCS, ATRIC Chicago, IL / Friday-Sunday, November 14-16, 2014 15.0 credit hours equal to 15.0 CECs/1.5 CEUs FRIDAY, NOVEMBER 14: SATURDAY, NOVEMBER 15: SUNDAY, NOVEMBER 16: Classroom 12:00-3:30 pm Classroom: 7:30-9:00 am Pool: 8:30-10:15 am Pool: 3:30-5:00 pm Pool: 9:00-11:00 am Classroom: 10:15-11:30 am Sit-down Luncheon: 11:15 am-1:00 pm Classroom: 1:30-3:00 pm Pool: 3:00-5:30 pm COURSE DESCRIPTION: The hip, pelvis and low back are the foundation of our spine. Balanced and strong muscles in this region are required for getting out of a chair, walking and running, negotiating stairs and lifting. With injury or disuse, compensatory patterns emerge leading to pain and dysfunction. In order to effectively reestablish normal movement, specific sequencing of therapeutic interventions and client education is recommended. This course will review the anatomical connections as they relate to function and linked to discussions on how these muscles influence on distal regions with the importance of core control. Aquatic spine stabilization progressions in all three planes are performed and linked to land-based exercise. Evidence-based research is presented in conjunction with clinical pearls to provide the aquatic therapist with best practice applications for a variety of patient populations. Precautions and considerations for variety of spine and hip diagnoses will be reviewed. The focus will be on providing treatment strategies including manual techniques and exercise progressions with the goal restoring balance in flexibility, strength and endurance of hip and lower back musculature. COURSE OBJECTIVES: Upon completion of this course the participant will be able to: 1) Explore anatomical connections between the hip, pelvis and lower back as they relate to function. 2) List contraindications, precautions and considerations for common hip and lower back diagnoses. 3) Incorporate relevant research into clinical decisions when treating individuals with hip or lower back dysfunction. 4) Systematically progress aquatic treatment strategies to restore flexibility, strength and endurance of hip, pelvis and lower back region. 5) Perform 4-5 manual techniques to improve flexibility of the illiotibial band, hip flexor muscles, quadratus lumborum and lumbar paraspinals. 6) FACULTY: Beth Scalone, PT, DPT, OCS, ATRIC, is a licensed physical therapist with over 18 years of experience in orthopedic and aquatic therapy. As the owner of North County Water and Sports Therapy Center in San Diego (www. waterpt.com), she continues with hands-on clinical care in addition to her role as educator. Since graduating from the University of Connecticut in 1991, Beth has belonged to the American Physical Therapy Association and has achieved certification as a Clinical Specialist in Orthopedic Physical Therapy. In January 2006, she graduated from Boston University with a Doctor of Physical Therapy degree. Additional certifications include Certified STOTT Pilates instructor and Master Instructor for the Burdenko Method. Beth not only provides continuing education for health care professionals, she is an adjunct faculty in the San Diego Mesa College PTA program, teaching Orthopedic Rehabilitation and Introduction to Pathology courses. She also provides the learning module/instruction on aquatic therapy to the University of St. Augustine San Diego Campus DPT program. ATRI Newsletter WINTER 2014 9 Volume 7 Issue 4

2015 National Aquatic Therapy Conferences March 12-15 Washington, DC April 30-May 3 Chicago, IL June 23-26 Sanibel, FL September Dates TBA Cities TBA November 12-15 Chicago, IL 2015 Professional Development Days March 21-22 Dallas, TX February 28/March 1 Omaha, NE April 18-19 Morgantown, WV April 11-12 Seattle, WA September 26-27 Tucson, AZ October 3-4 Boston (Canton), MA October 10-11 Birmingham, AL October 17-18 Allentown, PA Other cities and dates coming... Business Feature: Medicare NEED TO KNOW Checklist by Beth Scalone PT, DPT, OCS, ATRIC Medicare rules and regulations vary from region to region and will change intermittently based on how congress votes. The following is a list of what every aquatic therapist should understand when treating Medicare patients. For detailed policy information see www.medcare.gov 1. Who is your clinic/facility s fiscal intermediary? Fiscal Intermediaries In processing claims for Medicare the Center of Medicare and Medicaid Services (CMS) utilizes region fiscal intermediaries. Each intermediary has their own set of rules therefore, it is important to communicate directly with the company from which your clinic receives payment. When a therapist performs an initial evaluation, they chose an ICD-9 or diagnosis code for that patient. These ICD-9 codes are directly linked to accepted CPT codes. CPT codes are the billing codes used to indicate the therapeutic intervention provided on that date of service. Meaning if the diagnosis code does not include 97113 as an accepted treatment code then denial of payment occurs. The CPT code for aquatic therapy is 97113. As a side note some fiscal intermediaries limit number of aquatic therapy sessions so know the rules before you start! For a list of fiscal intermediaries and links to individual websites go to: https://www.cms.gov/medicare/provider- Enrollment-and Certification/MedicareProviderSupEnroll/downloads/contact_list.pdf Or https://www.cms.gov/medicareprovidersupenroll/downloads/contact_list.pdf Continued ATRI Newsletter WINTER 2014 10 Volume 7 Issue 4

Medicare NEED TO KNOW Checklist Continued 2. What are the rules when sharing a pool with other programs and the community? When renting or leasing the pool or a specific portion of a community pool, be sure to have in your agreement a clause that specifically states, The use of that part of the pool during specified times shall be restricted to the patients of that practice or provider. CMS transmittal 88 released on May 7, 2008 3. Can I use the group code? The group code is 97150. outpatient physical therapy services provided simultaneously to two or more individuals by a practitioner constitutes group therapy services and should be billed as such, the individuals can be, but need not be performing the same activity. The therapist involved in group therapy services must be in constant attendance and must provide skilled services to the group www.apta.org/payment?coding?on eononegroup/ It is an untimed code meaning the payment is based occurrence not time. If you perform skilled one on one aquatic therapy in the same session you will need to apply the 59 CPT code modifier. Warning some Medicare contracted payers do not recognize this code or will not pay for it with one-on one procedures billed on the same date. Always check with your fiscal intermediary 4. About how many sessions can a patient complete before reaching the Medicare Therapy Cap? Medicare Therapy Cap 2014 It is important to educate patients early so they understand the Medicare benefits are not limitless. PT and speech has a combined $1920 with exceptions process OT $1920 with exceptions process Automatic denial with manual review process at $3700 (process varies depending on region) ABN (Advanced Beneficiary Notice) forms are required to be signed by patients before a clinic that is a Medicare participating provider can bill a patient for services that go beyond the cap. Medicare links on therapy cap and ABN form: http://www.medicare.gov/what-medicare-covers/part-b/more-information-about-therapy-limits.html http://www.medicare.gov/claims-and-appeals/medicare-rights/abn/advance-notice-of-noncoverage.html To download an ABN form: http://www.cms.gov/medicare/medicare-general-information/bni/abn.html 5. What are the key documentation requirements? Therapists should be familiar with: 1. Required elements to a patient plan of care including functional G code reporting. 2. Re-evaluation, progress note and g-code reporting on or before the 10 th visit. 3. Do not use check marks with flow sheets 4. Documenting medical necessity for the use of aquatic therapy over land based exercise. ATRI Newsletter WINTER 2014 11 Volume 7 Issue 4

Featured Exercise: Hip Circles for Core, Balance and LE Strength by Dylan Palmer PTA Physical Therapy Associates, Spokane, Washington When working with patients who require improvements with balance, core control, and lower extremity strength my favorite exercise is standing hip circles. This exercise requires patients to isoloate upper body movements from lower body movements utilizing core control. Why: We rarely move in straight plane motions in our day to day routines, which is why I love this exercise because it teaches patients what it feels like to utilize or set their core before moving outside of their base of support with loaded twisting and lifting activities which are commonly the most dangerous activities for the spine. Teaching patients initially what it means to bolster their spine with their core muscles is frequently a difficult concept to convey. The other component of this exercise that benefits patients is the multi-joint disassociation, control, and coordination, which I have found to correspond to improved quality of exercises with both aquatic and land activities. Plus it feels really good to the hip joint! How To: This exercise is best introduced in shallow water about naval depth and should be performed while standing perpendicular to a solid support structure to lightly assist balance intially, the patient will then stand on one leg and with the other leg make submaximal circles from the hip keeping the knee straight and making sure that hip extension is included in the circle. For the first attempt at this exercise perform about ten hip circles clockwise then ten counterclockwise. Cue the patient to keep their trunk upright and motionless as the leg moves around. There needs to be enough leg speed to create some controllable torque for this exercise to be successful. When the patient is able to complete 10-15 circles clockwise and counterclockwise with no balance aides, and maintain a quite trunk in standing, the pt has mastered this exercise. Ideal Population: This exercise is appropriate for patients of all levels from the general weakness patients to your high level athletes. I love this exercises for all populations because it teaches and improves core control with functional use of extremities better than any other exercise I have seen. --Honestly, while I most commonly use this with the balance impaired patient population I have used this on professional football players who were challenged just as much. When To Use: I have found that this exercise is best used as the first exercise after a light warm up because it helps facilitate the feeling of the core control that you are trying to teach and it is unlikely that fatigue will limit the success of this exercise. It is a good place to allow the patient to feel how they should be supporting themselves with other exercises performed later in the treatment. Precautions: Progress this exercises slowly as patients tend to want to move their leg faster against the water resistance and with the leg acting as such a long lever arm this can place a fair amount of torque through the spine. The patient should be able to perform approximately 15 clockwise and counterclockwise circles without losing form before increasing resistance or speed of the leg. Always emphasize quality over quantity. Patients tend to cheat with this exercise by white knuckle gripping the support structure to gain more stability through the trunk or to gain power through the stance leg. The other method is that they will over utilize the big dumb strong lumbar and quadratus lumborum muscles. Advancing: The intensity of this exercise can be controlled based on speed or size of the circles and it can be advance by adding resistance to the leg at the ankle or you can perform it in deeper water utilizing a floatation belt or noodle for the upper body. This is very advanced to perform with any amount of speed. ATRI Newsletter WINTER 2014 12 Volume 7 Issue 4

Featured Colleague: Donna Adler Donna Adler is on Faculty at the Aquatic Therapy & Rehab Institute, and in a training program at the Center for Applied Energy Medicine. She is our featured speaker and is offering some new courses at ATRI. In 2014, she introduced Intentional Sequencing at the Sanibel Symposium. It involves using myofascial lines to integrate accentuated and intentional myofascial stretching to manual therapies. AquaStretch for the Home and Group Exercise Program was also introduced in 2014, along with an Ai Chi course that will be offered for the first time this November in Chicago, titled Improving Ai Chi Outcomes. Next year she will be teaching a new class in 2015 - AquaStretch for the Hand & Wrist. In Sanibel, also look for a new Ai Chi course she s teaching with other Ai Chi master trainers called Ai Chi Bodymind in Sanibel in June, 2015. She combines a natural approach to wellness, implementing both land and water programming. Her specialty is relieving chronic pain. When asked why she chose this path, Donna said; I just loved the water and was drawn to it. The opportunity of a career kind of fell into my lap. About 25 years ago the club I was attending asked me to teach water exercise as they thought I would be good at it. Back in the day, no certifications were needed - just a quick training from the local club. I had many participants come to me asking specifics regarding exercise and their disease, so I sought out avenues to get that education. First, I attended IAFC, became certified by AEA, and then the Arthritis Foundation, followed by ATRI. The Arthritis Foundation asked me to become a trainer soon after I attended the first certification, and I was a trainer for over 18 years for the Arthritis Foundation. I then started attending ATRI events, and presented for the first time in 2000, and have continued to do so ever since. I tend to add in a very holistic approach, as I continue my education at the Center for Applied Energy Medicine, among other holistic practices. Donna Adler is the recent recipient of the Tsunami Spirit Award 2012 from the Aquatic Therapy & Rehab Institute, and the Regional Public Service Award - University of Pittsburgh Community Service Award (2013) from the Arthritis Foundation. It s a National Award for Volunteer Work. She has worked with clients from sports and fitness enthusiasts to those with chronic disease and disabilities, and is a co-author with Terri Mitchell, of Aquatic Solutions for Chronic Conditions Manual. Terri and Donna are in the middle of creating three new Aquatic DVD s - one on Chronic Conditions, another on Advanced AquaStretch Techniques for the Lower and Upper Extremity, and a Water Exercise Made Easy DVD available for public use. She travels nationally and is a speaker and Continuing Education Provider for the Aquatic Exercise Association and the Aquatic Therapy & Rehab Institute. Beyond her active aquatic business, she also facilitates workshops on spiritual self-mastery. Over the years, she has created scholarship funds for those who cannot afford to attend aquatic therapy classes, as well as provide programs for veterans to attend aquatic training, and land training as well, at no cost. Donna has been able to touch many lives through these community programs. Donna ended our conversation, by saying I simply feel blessed to have my skills continue to develop over the years, and evolve into helping others accomplish healing for their clients and patients. It gives me personal joy when I am able to help someone feel better, and lead a better life. I love sharing and teaching, and it s a great avenue to help a host of others when I can teach other therapists methods I use with my clients. ATRI Newsletter WINTER 2014 13 Volume 7 Issue 4

True Health by Ruth Sova While I was a very fit 40-year-old I was no match for the high school boys in my SCUBA class. I wasn t teaching this class I was taking it. There were about 15 of us taking the course the high school boys, a couple 20-somethings and me. I knew all the others mothers! I was fine in the classroom, slow in the required swim skills at the local pool and worried about the upcoming open water dive. We live on Lake Michigan that sometimes gets up to 60 degrees on the surface near the shore in the summer. We were going away from shore and to the bottom of the lake. Naturally we would be fully suited with the thick wetsuits, hoods, mittens, booties, etc. but I m a chilly-willy. Here s another issue: I have vestibular problems which means I vomited a lot when we took our boat out on the lake (the things we do for family togetherness!). What does any of this have to do with health and fitness? I want you to know what I discovered that windy, turbulent day at 35 feet beneath the surface in 37 degree waters: Strength, health and fitness accomplishments are more about your mind than your physical being. I was one of only 6 who were able to jump in the water, put on my BC, go to the bottom, take out my regulator, throw it over my back, retrieve it and go through the rest of the testing. I didn t vomit and I didn t quit. I passed. Most of the kids didn t. On the boat ride back to shore I thought about what happened and I realized I used my mind more than my body. I knew I had the skills to finish and was determined to certify that day. My body wanted to quit. My mind wouldn t let it. Others panicked when they hit the cold water, others from the rough seas, and others from having to give up their oxygen supply while sitting on the bottom of the lake. The strength of my mind kept me focused, calm and moving forward. Our minds really are stronger than our bodies but we traditionally ignore them and work only the body. Why? Western society views the mind and body as separate entities, even adversaries. Westerners tend to think of the body as a slave that can be pushed at will. In contrast, Eastern philosophers stress the unity of mind and body, stating that body and mind are a team, communicating and working toward the same goal. How much of your client s recovery ability is about the body and mind working together? A lot. We ve all seen it in action. The muscle and mental fatigue from your session can be terrible but if the mind is driving the client to follow through, the client has success. We ve also seen it go the other way where the mind sabotages the body. I d like to give you ideas on how to teach your clients to strengthen the mind and body but I think we each need to practice using the power of the mind ourselves first. Without firsthand knowledge our teaching would only be words. I think we all know we can change our body/health (often called our biology ) through our thoughts, feelings, and intentions. Our cells are constantly eavesdropping on our thoughts and being changed by them. When we fall in Continued ATRI Newsletter WINTER 2014 14 Volume 7 Issue 4

True Health Continued love, positive thoughts and emotions course through our body and strengthen our immune system. On the other hand, the dark thoughts and feelings of depression can leave us vulnerable to illness. So thought is creative it creates things. I was determined to finish my SCUBA certification. I knew I could do it. My mind (thoughts) carried the day in spite of my body. We all have moments of strength (positive) and moments of fear (negative). We have to catch ourselves in the negative thoughts and change them. If you know you never perform well at interviews you will make yourself very anxious each time you have one. If you believe you don t deserve more money for your aquatic work you make it hard for others to think otherwise. If you keep telling yourself that they don t return because I did something wrong, you will lose confidence. If you keep judging the one mistake you made today as unforgivable, you will be more afraid of failure in the future. I am capable and confident or I am unable and a failure reflect your thought and that thought creates your future. Whatever vision you have about yourself (and the world around you) will become reality. As soon as you use the mind power you have you can strengthen the mind muscles. Then you can dream bravely: letting go of your limiting beliefs and pushing past your fears. As John Milton said, The mind is its own place, and in itself can make a heaven of hell, a hell of heaven. When our body is healthy and strong, it is a reflection of the choices our minds have made. In contrast, many illnesses stem from negative thoughts and emotions. In fact, Deepak Chopra says, Approximately 90 percent of our physical toxicity is emotionally derived which means that unresolved emotional issues such as a lack of self-love and an inability to forgive can wreak havoc on our physical selves through stress and anxiety. Insomnia, fibromyalgia, chronic fatigue, high blood pressure, gastrointestinal issues, etc. can be created or modified by our mind s perceptions, interpretations, and attitude. Science supports the essential connection between mind and body. A study from Britain found that people in conflicted close relationships (which resulted in negative thoughts) had a 34 percent increase in coronary heart problems. A report from Ohio State University showed that one heated argument can delay wound healing by 24 hours! I don t think any of this surprises you. You already know how important positive thoughts are. The question is: how do we get into the positive practice more regularly? On a personal level, I set my watch to beep every hour. When it beeps I think Here I am in exactly the situation my past thoughts created. What should I think now to start creating a different future? It forces me to review my positive vs. negative thoughts and helps with my overall health in many ways. Something like that might help you. If you have other ways that help I d (ruthsova@ruthsova.com) be thrilled to hear about them so we can share them with everyone. Our minds are incredibly powerful. Let s start to use them to create true health! You are more important than any of your problems. ATRI Newsletter WINTER 2014 15 Volume 7 Issue 4

Event Volunteers Needed We would like to send a huge thank you to all our volunteers. We appreciate the valuable support they provide at our National Conferences and our International Symposium. We rely on their involvement to make our events successful. We have several volunteers that have been assisting us for years and hope they will continue to volunteer in the future. We are also looking for new volunteers to join the ATRI Team. We have volunteer opportunities available for all our upcoming fall events. Join us as a volunteer for a great experience at a substantially discounted rate. Volunteer rates are listed below: Regular Complete Conference Rate (Tue - Fri) $795-$925 Volunteer discounted rate $575 Regular Specialty Certificate Program Rate $565-$655 Volunteer discounted rate $350 Regular Full-day rate $325 Volunteer discounted rate $225 Volunteer positions are filled on a first come basis. Volunteers receive the same educational opportunity as a regular attendee. Volunteers select the courses they wish to attend. They are present for both the classroom and pool sessions of those courses and they receive full CEC/CEU credit. Volunteers serve as liaisons between the classroom and the staff. They pick up the necessary materials for each course from the registration office. They check itineraries to ensure attendees are in the right place, collect signatures for the course rosters and make the necessary announcements at the start of each course. Volunteers distribute and collect course evaluations which we rely on for future planning of conferences. They assist in monitoring the time to ensure timely transitions from the classroom to pool. If interested in volunteering, do not register online. For more information on volunteer opportunities, visit our website www.atri.org or email Monica at mgunn@atri.org. Here are quotes from a few of our volunteers: As someone new to aquatic therapy, volunteering gave me the opportunity to more quickly connect with others in the field. ATRI conferences are the most organized and friendly I ve ever attended; and I attend a LOT of conferences. I couldn t feel more welcome or part of a Team. The volunteer discount made it possible for me to attend and now I am hooked. Thank you to all our exhibitors at the International Aquatic Therapy Symposium in Sanibel. You helped to make our 20 year celebration quite special. What a great event and what exciting new products they brought for us to experience. Visit their websites for information on their products and services. ATRI Newsletter WINTER 2014 16 Volume 7 Issue 4

2015 Volunteer Opportunities We have a great line up of events for next year, and we will need help to make those events a success. Consider attending one of the conferences as a volunteer and receive a greatly reduced rate on the registration fee. Regular Complete Conference Rate (Thu - Sun) $795-$925 Volunteer Discounted Rate $575 Regular Specialty Certificate Program Rate $565-$655 Volunteer Discounted Rate $350 Regular Full-Day Rate $325 Volunteer Discounted Rate $225 Volunteer positions are filled on a first come basis. Volunteers receive the same educational opportunity as a regular attendee. Volunteers select the courses they wish to attend. They are present for both the classroom and pool sessions of those courses and they receive full CEC/CEU credit. Volunteers serve as liaisons between the classroom and the staff. They pick up the necessary materials for each course from the registration office. They check itineraries to ensure attendees are in the right place, collect signatures for the course rosters and make the necessary announcements at the start of each course. Volunteers distribute and collect course evaluations which we rely on for future planning of conferences. They assist in monitoring the time to ensure timely transitions from classroom to pool. Contact us immediately to be put on the list to notify you early for volunteer registration. You will still need to complete the volunteer application and registration for the event you are interested in, but you will receive advanced notice for registration. You can contact us directly by email at mgunn@atri.org or call 712-480-0050. Here are a few quotes from our volunteers: ATRI conferences are the most organized & friendly I ve ever attended; and I attend a LOT of conferences. I couldn t feel more welcome or part of a Team. The volunteer discount made it possible for me to attend and now I am hooked. Our next issue will deal with Autism / Social Behavior Obesity / Diabetes Business Referrals Contributions are welcome... Send your thoughts and comments to Ruth Sova at ruthsova@ruthsova.com ATRI Newsletter WINTER 2014 17 Volume 7 Issue 4