This Is Why

Pool Party

A story of wonder in the water.

• By Melissa Crocker, PTA
• February 2012

Podcast: Listen to 'This Is Why' 

In my 13 years as a physical therapist assistant (PTA), I've worked with patients of all age groups and diagnoses, in a variety of practice settings. Recently, however, I encountered the biggest challenge of my career.

I currently spend most of my time assisting patients in a therapeutic pool. We received a call from a patient with a C6-7 spinal cord injury who said he wanted to do aquatic rehabilitation. I thought to myself, "Wow, this is going to be interesting." I explained to him that we'd never before worked with a patient with quadriplegia, but that we were up for the challenge if he was.

When he arrived for his evaluation, I sat in, discussing with the physical therapist (PT) and the patient some things we could work on. There is minimal research on the mechanics and benefits of aquatic rehabilitation for people with quadriplegia, but we nevertheless were determined to do all we could with the information and resources we had.

The patient—I'll call him "Jim" to protect his privacy—had told us ours wasn't the first clinic he'd contacted, but that several others had declined to take him on because they didn't have a lift to get him into and out of the pool. Well, we didn't either, but we decided that wouldn't stop us. We ended up using a bath sling. Fortunately, there's a fantastic team spirit among the PTs, PTAs, and aides at my clinic, and it was easy to recruit 3 colleagues to help me lift him. We successfully transferred Jim out of his chair and into the pool (which I considered to be a big triumph, as I'd frankly wondered if we'd even get that far).

During Jim's first few visits in the pool we focused on core and trunk control. First we sat him on an underwater balance board. Then we stood him up 4-feet-deep water, using weights to anchor his legs and feet to the floor of the pool while he held onto the railing. From there, we worked on the movements of walking, with the weights on Jim's legs keeping them from floating up. Next, we went without upper extremity support as I held him up and pushed his feet and legs from behind in a walking pattern. (If that sounds like a lot of equipment and work for both of us, it was! I joked to him that wasn't sure whether he or I was getting a more strenuous workout.)

Jim's stamina, trunk control, and cardiovascular strength all slowly but steadily increased. After a few weeks I was able to briefly turn my back without worrying that he might fall face down in the water. We were doing exercises together that I'd never have thought possible on day 1. Today, with no upper extremity support and with me holding him mid-torso, Jim propels his legs through the water independently. It may not look pretty, but he's doing it. It's an incredible feeling to see the joy in his face as he does something that had looked so improbable, if not impossible, not so long ago.

When I watch Jim in the pool, I see the reason I became a PTA, and why I'm so proud to be a member of our profession. PTs and PTAs combine their skills, education, and training with the creativity and determination needed for breakthroughs to happen in even the unlikeliest of situations. My personal motto is "adapt, overcome, and conquer." It's an attitude that tends to be contagious, feeding patients' own confidence.

I'm thrilled that Jim now can walk in water. But I must say, his success gives me such a lift that I sometimes feel as if I'm walking on it.

Melissa Crocker, PTA, works at West Park Rehab in Franklin, Pennsylvania.