Advantages

• Movement with more freedom and less pain is possible
• Exercises can be more enjoyable and free of the fear of falling
• Spasticity can be reduced by the warmth and buoyancy of the water, and the slow, rhythmic motions possible in water
• Strengthening can be enhanced by the buoyancy and viscosity of the water
• Range of motion can be increased with greater ease and comfort
• Pain can be reduced by the warmth, stimulation, pleasure, relaxation, and weight relief of being in the water
• Vital capacity can be significantly increased
• Pulse rate can be significantly decreased
• Peripheral circulation can be improved
• Cardiac output, stroke volume, general metabolism, and high-density lipoprotein can be increased
• Aerobic endurance can be increased, particularly with swimming exercises
• Balance and coordination can be more easily restored
• Tension, depression, anger, and confusion can be reduced

Contraindications

• Fever and infectious diseases
• Skin rashes and wounds that cannot be protected with waterproof dressing
• High or low blood pressure
• Vital capacity of <1L
• Seizure, or recent seizure activity
• Tracheostomy
• Bowel or bladder incontinence; unclamped drain tubes; unattached catheter bags
• Unprotected menstruation
• Inability to tolerate at least ½ hour of activity in the gym
• Unavailability of special handling needed for people with ostomies, cardiac involvement, orthostatic hypotension, autonomic dysreflexia, hypothermia, and halo traction

Transfers Into and Out of Pool

• Hydraulic stretchers or chair lifts can be used
• Ramps and a shower chair can be used
• A wheelchair-stool-floor transfer can be used for patients with C7 and below injuries
• Park the patient facing the pool
• Place a stool, about ½ the height between the floor and wheelchair, in front of the chair, and place the patient's legs over the stool
• After the patient eases onto the stool, extend the patient's legs and let the patient ease onto the floor to a sitting position at the edge of the pool
• Assist the patient into the pool and to the desired area of the pool