Aquatic Therapy and Alzheimer’s

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The following is an edited transcript from the Aging Boomers podcast with Stacy Lynch, founder and owner of Inertia Therapy Services..

Frank: Welcome to the Aging Boomers. I’m your host, Frank Samson. On this show we discuss many of the issues facing boomers, their parents and what we know as an aging population. I’m very excited about today’s guest., Stacy Lynch who became one of the first credentialed aquaticists in America and one of the first five geriatric aquaticists in the world in 2013 through Aquatic Therapy University. He also has his Associate of Arts and an Associate of Applied Science in the Physical Therapist Assistant program, and is a certified personal trainer and certified lymphedema therapist.

Stacy is the founder and owner of Inertia Therapy Services in Surprise, Arizona, where he holds international continuing education services for therapists around the world. Stacy was integral to the first published case review on aquatic therapy and Alzheimer’s Disease and is its lead spokesperson. He continues to work with the development of aquatic programs for residents with dementia in the long-term community. Stacy is currently a national presenter on the benefits of aquatic therapy. Stacy, welcome to the show, welcome to the Aging Boomers.
Stacy: Thank you, Frank. It’s a pleasure to be here.
Frank: Great to have you. I’m going to just start out with a pretty basic question. A lot of people are probably thinking, what is aquatic therapy? Tell me a little bit about aquatic therapy, its history, et cetera.

Stacy: Aquatic therapy is really nothing new. It dates back to Hippocrates over 2,000 years ago. In fact, throughout history there were human water rituals that were a part of the Greek, Hebrew, Islamic, and Christian cultures. Watching almost any movie or television show involving the early Roman and Japanese empires you’ll see an emphasis on the bath as just part of their community, part of their health and wellbeing.

Today, however, at least in America, a pool is seen mostly as a recreational thing. Before the Civil War, there were American medical colleges that focused on what was called the water cure and this was mostly cold water bathing. In the early 1900s doctors were using therapeutic tubs for the treatment of patients with cerebral palsy and spastic conditions. If you can remember Franklin Roosevelt used to be known for traveling to Warm Springs, Georgia where he would perform aquatic exercise for his legs. In World War II aquatic therapy was so prevalent in America that the government commandeered many America pools and spas and turned them into military hospitals for physical therapy and aquatic programs.

It really took off in the 1950s when the American polio epidemic hit and there were many establishments and government programs for corrective swimming pools and therapeutic tubs. Then once the Salk vaccine was introduced and technology started to take off, the interest in aquatics seemed to disappear. There was a pretty big surge in interest in aquatic therapy and research in the 1960s and ‘70s because of the space race, but today aquatics tends to be a misunderstood and underutilized environment especially in our American geriatric population.

Frank: Talk to us about that, about the geriatric population. I know you’re a geriatric aquaticist, so it’s obviously a specialization with geriatrics, so tell us more about that.

Stacy: Yeah, an aquaticist is basically a credential that’s given to therapists who have completed a specific continuing education syllabus training. On top of that training I have additional specialization with the responses in the geriatric population. The reason this came about is … The truth is very few medical professionals are even aware of the benefits of aquatic exercise or immersion. There’re many times I’m talking with doctors and I’m educating them on some of these benefits that we’ll discuss.

A lot of times they actually get frustrated and they’ll ask me, “Why didn’t I learn any of this in med school?” and I have to laugh and say in all honestly why would med school have taught you the benefits of immersing somebody chest level in a pool. It’s our job to educate the public and the medical field about the benefits of aquatic therapy. What really frustrates me is that even most of the doctorate level physical therapist programs barely touch on aquatics. You basically have to take specialized training after you graduate.

That’s why I created Inertia Therapy Services and that’s where my credential came from. There’re several international certifications and credentials and the one that I received, this aquaticist, came from Aquatic Therapy University. They have a wide population of therapy classes in the United States, so I host a lot of their classes as well. The geriatric aquaticists, they started to find so much more information and research in the geriatric population that they had a field specific to that and so I was a part of that as well.

Frank: I was just amazed. I did watch a video that you had put together. Your patient, I think his name was Bill, I believe.

Stacy: Yes.

Frank: I actually watched it twice. The first time I was tearing up a little bit, honestly. We’re a podcast, so it was just audio. Do the best you can to talk about that case, the results and how people could go look at it because, I think, they absolutely should, so tell us about that.

Stacy: In 2012 I was working with a patient that had end-stage Alzheimer’s Disease and the descriptions of this patient’s basic state according to his caregivers and his family members were that he was unable to bear weight, he was relegated to a wheelchair, he was unable to follow any instructions. He had absolutely no safety awareness, he was non-conversive, non-responsive, non-initiative and pretty much he had no facial expression. Now it does need to be clarified that a lot of this is subjective and as medical professionals we like things to be objective and so clinicians will frequently use a test called a mini-mental state exam.

Frank: Right.

Stacy: Or the MMSE.

Frank: Right.

Stacy: This is designed to test different mental abilities including a person’s memory, attention, and language and they try to put a number to someone’s cognitive state. It has a scoring range of zero to 30 and 27 is considered normal. This patient had been scoring a zero, a zero out of 30, for around six months, that was his level. You have to understand moving forward he was already on maximum doses of the Alzheimer’s medications, memantine and donepezil.

I’m a therapist, so we actually tried land-based therapy and his cognitive status was just honestly not allowing for much response, so being an aquatic specialist I was able to convince the staff to let me get him in the pool. It wasn’t easy in the beginning, but with some work, within just the first week I was able to get significant reactions, physical reactions. I was also able to get him to smile, laugh, perform multiple-step commands and all of this while being unsupported, without me touching him. We retook the MMSE in the water and he scored an eight out of 30, so you have to understand he went from a zero to an eight out of 30 while in the water.

When his doctor saw this with his own eyes, he actually came in the pool and saw this, he immediately met with me afterwards and started discussing putting together a case review. The doctor wanted to see a score increase from zero to eight, but it was the fact that he saw the personhood that actually returned to this patient that was the most astonishing. He has before and after photographs of this patient. To be honest, the patient is basically unrecognizable from the shell that he was prior. The facial expressions, smiling, laughing, and his initiative, those things were now there and you really couldn’t believe it was the same person.

Since the [case review] has been published, things are really starting to take off. Like you said, I’m now giving presentations. There’s a group aquatic program at that facility now where they actually have their long-term care residents with dementia in a group program. They bring them in the pool and start to progress them cognitively with activities they just can’t get them to do on land. I just came from Florida where I’m starting to help a facility there develop a very similar program, so I’m hoping this is going to start becoming much more public over the next year or so.

Frank: Yeah, I hope so. I know that’s just one case, so have there been others that you’ve been doing that have similar results?

Stacy: Yeah, this is one of those things where therapists have been doing therapy on patients for the longest time and we see people patients with Alzheimer’s Disease. The biggest thing is we don’t treat Alzheimer’s Disease, we don’t treat dementia, but you have to understand on the same note we don’t treat arthritis either, we don’t treat total hip surgeries. We treat a patient that has other complications that have occurred because of those things.

When I was in school 20 years ago, Alzheimer’s was almost a reason not to see a patient because that was a trigger that therapy was not going to be long lasting or beneficial. I think now with a lot of the research that is coming out, and the physiological benefits they’re starting to ask if this is a viable part of the treatment process for dementia and Alzheimer’s process.

Frank: Now I ask this again, but if somebody wanted to look at this video, I know it’s on YouTube. How would they get to that?

Stacy: Because of the sensitive nature and the personal relationship I developed with this man, I’m limiting most footage [available] to the public. . . I am currently working on a series of short web-accessible clips for the public. I’m planning on having them released to the public by the end of the month, so if anybody wants to see them they can go to my website. It’s www.InertiaTherapy.com. And you can also call me at 602-733-6393.

This is a passion of mine, and as things develop I’m going to be releasing more and more things, especially as we start getting more facilities onboard. I’m having big expectations for this facility in Florida, where we’re working with long-term care nursing home patients that nothing else works for. I even had a patient on a case review who was on hospice and I even had it out with the hospice people, saying, “I’m getting this guy in the pool,” and they said no, you’re not. Then the family said if you don’t let him get in the pool we’re not going to go in a hospice. This is the reaction that we’re getting, and until the medical professionals actually saw the results with their own eyes they just didn’t understand.

Then when they saw it themselves they said oh, I guess, we’re going to let him continue to get in the pool. Things are going to start taking off, I believe, and that’s why I’m big on field footage. I can say a zero to an eight on the mini-mental state and that’s great, that means a lot clinically, but when you look at family members and loved ones and friends that look at their friends and have no visual recognition or response when they say hi and touch them and then they’re able to get in the pool with them and they smile and joke with them and actually start to converse with them, you can’t put a number on that, so that’s where I hope to go in the future.

Frank: I’m in this business in the long-term care industry and I know that pools as a whole are looked at negatively where . . . people with Alzheimer’s are concerned. What do we do about that or what’s being done about that?

Stacy: That’s what I do. I’m training other people to do what I’ve been doing. My big outreach at the moment is going to these continuing care retirement communities where they already have a pool and it’s more thought of that they’re independent living residents and nobody else gets in.

It’s easy to get them with a little education to start encouraging their assisted living residents to get in and then if we have some trained therapists that have had actual training in specialization in this environment they’re able to start getting their long-term care residents in. That’s where my passion is trying to change this misunderstanding about who gets in the pool. You start looking at these photographs in the 1950s, they were getting post-polio patients in the pool. We get patients with tracheostomies in the pool. All these people that you would look at and say no way can we get that person in the pool.

Those are the people that we get the most unbelievable responses. You look at autistic children, you look at … I understand where the fear comes from, but that’s why I think the video is so important because until your family member can see what takes place with these people we’re not going to really start making changes. I encourage all the time, yeah, get the family members to bring in their swimsuits, put on a pair of shorts and a shirt and hop in the pool with them and then they’re just basically in tears saying how can we do this more often.

Frank: I guess, people that are listening and are going, “oh, I’m just going to go do this with my dad or with my mom.” I guess you have to be careful, you have to have somebody trained. Do you want to comment on that?

Stacy: Yeah, and again that’s why it’s important to find someone that does this for a living. I am a therapist, so I’d recommend anyone to seek medical counsel before attempting anything new, but my favorite thing about this aquatic environment is the versatility. I can take a severely de-conditioned individual and work with them for an hour in the water and get some amazing results.

I have connections with some of the top trained aquaticists… Whether they’re fitness instructors, community aquatic instructors or especially aquatic specializing therapists for each individual disease, I have connections across the country. Feel free to have any of your listeners contact me and I can direct them to a place where they could at least get an evaluation and then if it’s appropriate maybe they could sit in with a group class.

Frank: I’m curious whether with this case or other cases … when they get out of the pool and go back to their everyday environment, do they revert back, or …

Stacy: Was there any carryover?

One of the side effects was that for about two hours after he would get out of the pool, he actually became an increased fall risk. That sounds like a bad thing, but that’s actually positive. You understand this is a person that would never initiate scooting in his chair, so he wasn’t a fall risk, he would just sit there and nothing would phase him. After the pool he would actually be cognizant enough to make communication with people and wheel himself in his chair across the room and actually grab onto the wall and try to stand up and start walking. That’s kind of a bad thing, but that’s a very, very impressive thing as well. That’s one of the aspects that would happen afterwards.

As far as what his carryover was, I have testimonials with the medical staff; they would watch him for up to two, three hours, four hours after he would get out of the pool. Remember, this patient had no responsiveness on land, so we had to keep in mind that this was an end-stage Alzheimer’s resident. After about two hours this would basically fade and so the next morning he would joke with the staff, joke with other residents, but after about two to three hours he would pretty much revert to where he was before. The next day when I would go and see him I was dealing with the same problem.

What I did notice was session after session after session I would get him in the pool and he started to get better and better. Every session I got him in the pool he almost started where he left off. That’s when you see these things I was getting him to do, these multiple step commands, floating on his back and even trying to do the dog paddle and things like that and following multiple commands.

Those were a progressive format with him, so basically he had quality of life when he was in the pool and he had carryover onto land for about two hours after. After about three to four hours he would revert back, but even in on-land therapy sessions, if we would get any progress there would be no carryover to the next session. It was just maybe we’d manipulate him to do something and he’d respond, but the next day there would be nothing. In the water, every time we got him in that pool he remembered … he even remembered his previous sessions in the pool. There was none of that happening on land.

Frank: That’s amazing.

Stacy: I don’t know if that really answers your question . . .

Frank: Absolutely. You know what, to me, if the person gets … However long they’re in the pool, if they’re in there for 15 minutes and they get enjoyment it’s worth it.

Stacy: When Dr. Meyers, he’s the one that wrote the case study. When Dr. Meyers … That was the funniest thing was he was in, I call it the insurance meeting, with the nurse who had been coming down and seeing him in the pool and their discussion was have you seen Bill in the pool. He says no, but I’ve heard he’s doing well and she said but you haven’t seen him and he said no, but I heard he’s doing well and she said you’ve got to go see him.

In all due respect, in his mind he’s thinking yeah, I’m sure he’s doing well, but you’re probably exaggerating a little bit. It’s good to know he’s doing better and she says no, she stopped the meeting. She brought him down while I had him in the pool and he opened the door and when he did I was walking with Bill, he was walking by himself in the middle of the pool. I saw the director of nurses and the doctor come out and I said, “Hey, Bill, turn around, somebody wants to see you.” He turned around and he smiled, he pointed his finger and he put his hands in the air and he goes, “Hey, hey, hey, hey, how are you doing?” Doctor Meyers just froze.

Frank: Wow.

Stacy: Dr. Meyers came and knelt down and he said, “Bill, repeat after me, apple, penny, table.” Bill said, “Apple, penny.” Then he froze and then he said, “Do this.” He did a movement and he partially did the movement and then he said, “Repeat after me.” He did a couple of things and he stood up and I didn’t want to think he was being rude, but he stood up and started to walk off.

I felt really compelled to tell him, “Dr. Meyers, come back. Understand, this is a bad day for him. He’s doing really bad, he can do better. You need to come back another day.” He knelt down and looked at me and he said, “You have no idea what just happened.” And he walked off. I thought I was in trouble, right. Then after that meeting he met with me and he says, “No, this is what I want you to do, we’ve got to get this recorded. None of this was even possible on land. You would say repeat after me and he would just stare at you.”

Frank: Stacy, I could talk to you all day about this, but I want you to go out and get people trained. This is tremendous, this is tremendous. Again let everybody know how they could get more information on what you’re doing, on training, on future videos and go ahead and repeat your website and contact information.

Stacy: Yeah, I’d give two sources. The first one would, of course, be me. My website is InertiaTherapy.com and that’s just www.InertiaTherapy.com. My phone number is probably the next best way to just leave a message, 602-733-6393. I have an email address from the website and if you wanted to write it down, it’s info@InertiaTherapyServices.com, but that’s a mouthful, so it’s easier to just go to the website and click on that. I would also recommend, if you contact me I’ll give whatever information I can and connect your listeners to other people in their areas, but if somebody wants to go out and start reading this research and start doing this, we might even have another show to give you these details.

When you understand why this stuff is happening and the research that’s now coming out, it should motivate everybody, even doctors, to start telling other people to start doing more of this.

One of my favorite go-to’s is a book by Dr. Bruce Becker and Dr. Andrew Cole, that book is Comprehensive Aquatic Therapy. His website is http://www.aquaticdoc.com and he’s just a great resource for a lot more of the research.

Frank: Thank so much for joining us on the show, Stacy, and we’d love to have you back. Please reach out to us as things develop and you want to share with our listeners; I know they’d be excited to hear more. So thank you so much for joining us and I want to thank everybody out there for joining us as well. Be safe out there. Please share this information with friends and family and we’ll talk to you all soon.

Stacy: Thank you.

 Thank you.