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PT Fosters Knowledge of Aquatic Therapy | NEWS-Line for Physical Therapists & PT Assistants

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FEATURE STORY 03/01/2002
Author: Carol DeVecka  
PT Fosters Knowledge of Aquatic Therapy
Salzman describes her business as "a one-stop clearinghouse for all things aquatic therapy. ARN serves the aquatic therapy community in four ways. First, it hosts a free network of aquatic therapy providers (and related businesses) which has grown to 10,000 persons strong. Secondly, ARN sponsors and hosts international seminars on the topic of aquatic therapy. Thirdly, ARN produces and sells educational resources on topics of interest to aquatic therapy providers such as bibliographies, justification papers, and training manuals. Lastly, ARN contracts with businesses around the globe to assist them in producing marketing kits, business plans, policy and procedure manuals and similar materials.

"Our mission is to foster appropriate use of the therapeutic procedure commonly known as aquatic therapy through communication, education, research and entrepreneurship," she continues, and goes on to describe the roots of her work. "The Aquatic Resources Network began as a volunteer cottage industry in 1995. At the time, I was serving as research advisor to the College of St. Catherine's Master's of Physical Therapy program in St. Paul, Minnesota. My students were interested in performing research on therapy done in an aquatic setting. A topic was selected: to develop means of comparing aquatic and land-based strength training. This topic had not been addressed in the literature, yet was of utmost importance to aquatic therapy providers.

"The search was on," Salzman says. "Traditional resources (Medline, journal searches, textbooks) yielded little results. Clinicians needed a national clearinghouse of information devoted solely to aquatic therapy, not to to swimming or whirlpool treatments. They needed someone to coordinate efforts between students and clinicians, companies and consumers. After searching for several months, I had made over 30 contacts with clinicians who knew nothing about this research question, but who had questions of their own to answer. Since that time, the Network has grown from that original 30 individuals to over 10,000 individuals, companies and organizations who all have questions of their own to answer."

Because ARN has grown to such a degree, it is impossible to manage as a side-venture, but Salzman says she still would give it all away if she could. "It maintains its volunteer roots by providing numerous free-of-charge services to clinicians, and especially, to students. It has also grown into a for-profit business to allow development and services requested by clinicians around the globe."

Salzman was studying Health and Sports Science when she first discovered her interest in Phsycal Therapy. She relates an experience that helped influence her career choice. "Children who aren't touched just curl up and die. We know that now. So do adults, it just takes a little longer. I saw a woman die once. It took about four months and I didn't realize she was dying until she was done.

"This lady was a feisty, sharp-tongued, wheelchair-bound, 60-year-old woman with an old hip fracture," Salzman recalls. "I met her when I started volunteer visiting at a convalescence home when I was 19. We got along great, predominately because we both thought very highly of our own humor. I visited her for two months, and then she commenced dying. I visited her for four more months and she was gone.

"I'm convinced she died of two things," she continues, "Lost hope and no touch. During the first two months I saw her, she was aggressively attempting to 'qualify' for physical therapy. Her insurance company considered her at high risk for falling and did not believe she had rehab potential. By month three, she realized that no one was going to work towards getting her out of that chair and into her home. That was the time she started to die. From that day on, she spent her days withdrawing, looking out the side window (a view of asphalt and electrical wires). She finally asked me to stop visiting. I did. She died. That year, I changed my major and applied to physical therapy school."

When Salzman began her career, she was not yet involved professionally with aquatic therapy, but worked in a more traditional hospital setting. "I graduated in 1991 from the University of Alabama at Birmingham, and at that time, the world was your oyster if you had a PT degree," she says. "I interviewed at 10 places, and all of them said 'please work for us'. In 1992, I chose to work in Winston-Salem, North Carolina, at a facility which was part of the Bowman-Grey School of Medicine.

"I worked in acute care primarily, but I also had three month rotations in other departments," Salzman says. "I worked in the Burn Unit, which I really enjoyed. In that unit, it was an occupational therapist and I who worked together. I also experienced working in outpatient, orthopedic and sports medicine. My least favorite department was Home Health, because it was so difficult to regulate the schedule. Basically," she says, "I was in every department but rehab."

Her start in aquatic therapy began after Salzman accepted a position at St. Paul-Ramsey Medical Center. "I moved up to White Bear Lake, a suburb of St. Paul Minnesota, and began working in 1994 for St. Paul-Ramsey Medical Center, now Regions Hospital," she explains. "They had a pool at the hospital which was being run by therapeutic recreation, and was used primarily for group classes.

"I was always interested in aquatic therapy," she continues, "ever since having David Morris, MSPT, as a professor in graduate school. He is the President of the Aquatic section of the APTA. One thing that I began to learn was that if you don't have a dedicated aquatic team, no one wants to put a suit on in the middle of their day and jump in the pool. I spent a lot of time at the pool, and was asked if I would be interested in managing it for PT, which I was eager to do. The pool became used for more one-on-one physical therapy, and that is all I did during 1995 through 1997. Then I got married and moved to Wisconsin, a bit too far to commute regularly, but I still work there on call a couple of times a month."

Salzman noticed that she had been lucky to get aquatic therapy classes while she was a student, and was surprised to find out how little others were learning about it. "While I was working at the pool I observed that every time a student came through their rotations with me, no one seemed to know about aquatic therapy," she remembers. "One student from the Master's program at St. Catherine's asked if I would teach it there. I started teaching an elective aquatic course, which is now in its sixth year. Students can take it at any point in three years. It takes three Saturdays, half of the work is in the classroom and half of the work is hands-on."

While teaching, Salzman began the work which led to the beginnings of the Aquatic Resources Network. "The head of the program at St. Catherine's approached me to see if I would be willing to oversee students conducting research projects. The students wanted to quantify what was going on in the water during therapy. There are so many different forces at work - gravity, buoyancy, resistance to flow - that it is quite different from what happens on land.

"No one seemed to know how to do this," she continues, "and I spoke with many professionals in the field who were all interested in this as well. I started a database in my spare time, and began to collect all the information I could. It was something I did for love of aquatics, not for money. I am so fortunate that I could wrap a business around something that I love!"

Salzman still keeps her involvement in hands-on therapy and in teaching. "I still fill in at Regions Hospital, and I also do some private therapy," she says. "I am also still involved in the Master's program at St. Catherine's. Any time that I work with a patient I am reminded of how life-changing this work is for those we affect."

There is one experience Salzman relates that was a particularly dramatic example. "I worked with a woman I had known before she had the need for therapy," she says. This woman was a well-dressed, articulate person, and served on the Board of Directors for the hospital I was working for at the time. She went on a cruise to Greece, and while getting off the ship she fell on her wrist, breaking it. She went to a local doctor in Greece, where it was set using no painkiller with three men in white coats pulling and tugging on it to move the bones. She got a prescription which numbed her arm, and returned to the boat and finished the cruise.

"When she went home she saw an orthopedic surgeon, but five weeks had elapsed, during which time she had kept her arm in a sling 24 hours per day. The wrist and hand fused together, and her arm was purple and atrophied. It was so weakened that she could not move her shoulder. She became so depressed that she stopped going out and dressing nicely and her family was worried," Salzman continues.

"She would not even look at her arm. She taught herself to function as though she did not even have two arms. When I worked with her, one of the major tasks I had was to get her to recognize that this was still her arm, and she needed to take responsibility for it. It took some time," Salzman recalls, "but eventually she began touching it again, and regained range of motion and strength. It began to change back to a normal color, and she began to be able to have function again, and to return to her usual activities."

It is her love of helping people return to health that gives Salzman her biggest wish. "The single greatest challenge is the fact that we get many calls from patients looking for help," she says. "It's frustrating because it is not our mission to help the patients directly, but we always take the time to do it. We get over 1,000 hits on our ARN website daily - and many of those people are looking for personal help. I would love to expand our operation to help both provider and patient - to do that we'd need a financial angel to underwrite the effort. If we had a privately funded grant, we would start a non-profit and be able to help the patients directly. But, for now, we're a small operation, just two people strong, and we work hard to keep up with the requests for help we get."

Andrea Salzman graduated from the University of Richmond, VA with her Bachelor of Science degree in 1989. She went on from there to the University of Alabama at Birmingham to obtain her Master's degree in Physical Therapy, which she earned in 1991. She is also a Certified Watsu Practitioner. ARN's website, www.aquaticnet.com, has grown to over 40 information documents (free to all). ARN can also be reached by telephone at 715-248-7258.

Carol DeVecka is a writer from the Philadelphia area. She is on the editorial staff of NEWS-Line for Physical Therapists and PT Assistants.
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