Healing Waters

In our business, when we talk about people with disabilities, we always put people first: We speak of “people with brain injuries,” for instance, or “people with arthritis” or “people with spinal injuries.” That’s an important distinction, because the language informs the entire mindset needed to help them improve their situations in the most effective ways.

For starters, this “people-first” approach helps us avoid misleading generalizations: Often, we find that two people with nominally similar conditions or disabilities will have significantly different needs and that the methods used to treat each may prove to be significantly different as well. Everything we do at the Brown Center, in other words, must be based on the individual’s own

profile.

Situated at the heart of the campus of California State University, Northridge (CSUN), the center is able to provide precisely that sort of individualized attention and care, largely because we offer facilities for both land-based exercise programs and activities that take place in water. By providing both therapeutic mediums, we’re able to provide an unusually full set of opportunities to address and, we hope, improve a broad range of physical conditions.

Work on our newly expanded aquatic center was completed in the Spring of 2003, and the facility now includes four bodies of water in which a spectrum of activities take place to address everything from obesity and arthritis to severe brain injury and more. It’s a place where people can follow paths that suit their individual needs via an extraordinary array of exercise options.

WORKING SPACE

We at CSUN are proud of the university’s commitment to helping people with disabilities. The Brown Center (named for a local family that funded a large portion of the construction) is one significant component of a larger program known as the Center for Achievement Through Adapted Physical Activity. I currently serve as the director of aquatic programs and in that role have seen at first hand just how important adapted water exercise can be in improving a broad range of conditions.

Our programs provide both individual exercise as well as opportunities for work in groups. What we do is not “physical therapy.” It is adapted exercise, which is part of a greater category known as adaptive physical activity, which can be defined as any activity that has been modified for people with disabilities, whether it’s horseback riding, swimming or walking. Our program and facility are unique in the range of activities we provide – all of them outside the mainstream medical community.

Indeed, most people in our program have already worked their way through the medical community to the greatest extent possible and have found in the Brown Center a means of continuing their pursuit of better health. The program currently serves about 300 people (both land and water), many of whom would not otherwise have access to such a facility. And we work with people of all ages: there’s a program for children we offer twice a week.

‘Access by every conceivable means’ is what the pools at the Brown Center are all about. From mechanisms and ramps for those who need complete support to railed stairways and transfer wells for those able to maneuver themselves into the water, the design intent was to make it possible for those with a full range of capabilities to get into and enjoy the water.

The foremost issue for people with disabilities is simply having a place to go. The unfortunate fact is, there just aren’t many facilities like ours where such a wide variety of programs can be offered. Having both land-based programs and aquatic facilities under one roof (as in our case) is extremely unusual: For the most part, land-based clinics go no farther than offering a warm-water tank of some kind – and that’s about it.

Given our facility’s flexibility and scope, we’ve been able to establish programs in which university students in fields such as kinesiology, physical therapy or pre-medicine can volunteer to work with our users. So not only does this facility provide an opportunity for those with disabilities, it also provides a unique hands-on, highly personalized educational opportunity.

These students participate in “lab time” in which they’re paired with individuals who come from the surrounding community or from within our student population. This gives these young people the opportunity to gain real-world experience in the profound benefits of adapted therapeutic exercise. It also gives the Brown Center a role in building a cadre of future practitioners who have direct experience in caring for those with physical disabilities.

OPEN CONCEPT

In most adapted-physical-activity curricula, there’s unfortunately not much time spent on aquatic exercise – perhaps a lecture or two. Here, students can get up to a year of working directly with people in the water and as a result come away from the program with a far greater appreciation and understanding of how the theoretical ideas behind therapeutic exercise apply to real people. In essence, they gain practical experience that they might not otherwise have gathered until much later in their careers.

That’s important to us as part of a teaching institution, but we never lose sight of the fact that the presence of our extensive aquatic programs gives a large number of people a safe and enjoyable place to follow a path toward greater physical strength, endurance, flexibility and, most important, confidence in what they can do with their bodies.

It’s common for program participants to start out with individual exercise, working in the water with an assigned helper before moving on to group sessions in shallow water and, in some cases, into deep-water workouts as they become better able to move independently in the water.

Ultimately, we want to place participants in a combination of land and aquatic exercises, but it’s common to see participants start out in the water because that’s the best place for them – especially in the early stages of exercise. Often, they will stick to water as the primary focus of their exercise regimens.

Once our clients are in the water, we offer them a full range of available activities, including a pair of underwater treadmills and swim jets in the main pool as well as comfortable lounges in the spa. Along with access to activities and various forms of individual and group exercise, we also offer them the personal attention of the center’s experts as well as the support of talented students.

In entering the program, each participant is evaluated to determine levels of strength, endurance and flexibility. We then design their routines with all the components of a workout that someone without any disability would pursue, including a warm up, cardio-vascular exercise, strength training, flexibility work, relaxation and a cool down.

For people with disabilities, the levels of fitness they attain in these workouts can make a huge difference in their ability to move through daily routines – things as simple as brushing hair, going to the grocery store or getting in and out of a car. Thus empowered, they might be able to do more with greater ease and speed and with less pain. It’s a realm in which the importance of fitness simply cannot be overstated.

What’s so fantastic about water exercise is the range of conditions it can benefit. We see people who are extremely limited in what their bodies allow them to do, but because of the safety and comfort of water and the buoyancy it provides, they can pursue a variety of activities, find their limits and continue to reach new goals – even if they started out with extreme limitations. By the same token, more independent users can challenge themselves and make progress toward even greater physical freedom, all in a very secure environment.

FREEDOM OF MOVEMENT

There’s an emotional component to these activities that can be extremely important, especially when it comes to aquatic exercise. As an example, we’re working with a woman who incurred severe injuries in an automobile accident some 16 years ago: She’s been in a wheelchair ever since and, until she came to the Brown Center, had never tried working in water.

When we did the aquatic evaluation, she was able to rise out of the wheelchair and move with relative freedom in the water. It wasn’t long before tears of joy began flowing, and I’ll never forget how she explained that her wheelchair had become a “cage.” Only in the water did she make much initial progress, and, no matter how difficult it was, she was encouraged to keep going because of the incredible sense of freedom she experienced in our pools.

As is often the case with people who haven’t been in water for long periods of time, she had to go through a period of adjustment in which the water went from feeling like a foreign environment to becoming a place in which relative ease of motion and comfort were possible.

The deep-water pool is the most specialized of our four pools. Before sessions begin, its floor stands at deck level to provide easy access, then gradually lowers until everyone is immersed, buoyant and ready to exercise. We have a portable treadmill and various other equipment we can move onto the floor as well, giving our clients the full range of opportunities to benefit from the healing power of water.

She’s not alone. In fact, getting participants to develop a comfort level in water can be a big part of the early stages of our work with them. Often, these initial activities amount to baby steps, and we’re always alert to the fact that sometimes just moving beyond an initial fear of water is a significant and extremely important accomplishment.

In the case of the woman who was in a wheelchair, she now wears a mask and snorkel and moves around our pools with tremendous confidence and mobility. She doesn’t have use of her lower extremities, so it’s unlikely she’ll achieve anywhere close to that mobility on land. From the standpoint of someone who doesn’t face that kind of challenge, it’s hard to fathom just how important the opportunity to move freely must be to her and others in similar situations.

When looking at water exercise as a therapeutic activity, you can never underestimate the importance of the psychological effects it can have. Certainly, that’s true about all forms of therapy, but with water we find that we’re able to work with many people who have no other options: In many cases, the first, best and only real progress they can make is when their bodies are freed from gravity.

Then, of course, there’s the inescapable fact that being in water is pleasant for almost all of us and that it’s human nature that anyone who enjoys an activity is far more likely to stick with it over a longer period of time.

WATER BODIES

As I mentioned above, this level of program flexibility is possible because of the variety of aquatic environments we have under one roof here. As designed by the team at Rowley International (Palos Verdes Estates, Calif.), each of our four bodies of water serves a different set of purposes, all of which are critical in designing regimens for a wide range of issues.

[ ] Main pool: The main pool is our largest body of water and is where a majority of group activities take place – not to mention the broadest overall range of activities. In almost constant use by individuals and groups, it offers access in various ways, including several lifts, a wheelchair ramp and steps with broad treads. There’s also a bench that runs the length of the pool – easily accessible by anyone who needs to sit and take a break – as well as handrails around the full perimeter. In addition, this vessel is equipped with two underwater treadmills and swim jets.

[ ] Cool Pool: This vessel is kept at a moderate 82 to 84 degrees F. and is used primarily by people who cannot tolerate warmer water. (That includes a large percentage of those who have multiple sclerosis and are therefore extremely sensitive to temperature.) This small pool is equipped with a swim jet and a “flume” system for more vigorous workouts.

[ ] Spa: This large, inground spa is similar to vessels found at health clubs or resorts and is a primary location for our work with people who have arthritis and a range of other motion-limiting conditions. In addition, many people enjoy relaxing in the spa after working out in our other vessels or in our land-based programs.

[ ] Deep-water pool: This pool has remarkable features, including a moveable floor that can be raised until it is flush with the deck. This allows people in wheelchairs to roll onto the floor and be lowered into the water, which can be set at any depth we choose down to seven feet. All of our deep-water classes take place in this pool.

The deep-water pool has proved to be particularly useful. In some cases, people use it simply to be suspended in water: When they’re lowered into the pool, they experience a decompression of the spine that gives them a sense of physical articulation and relief of pressure they can’t experience on land. This pool is also very helpful in acclimating those who might be apprehensive or even fearful of the water at first due to its ability to be set at any depth.

EASY ACCESS

It’s very important to us that we keep our program both affordable and readily available. These days, there’s much controversy about costs of health care, and we’re more than aware that medically based physical therapy can be expensive.

As mentioned above, we have the advantage that we’re outside the mainstream medical community, and that certainly is a factor in our fee structures. Students participating in the program, for example, pay nominal fees through their tuition, while members outside the university pay the program directly – but not much. While those with helpers pay a bit more, the typical cost is just $200 per school semester – any way you look at it, just a fraction of the cost of traditional, medical-system programs.

We can do things this way because of our affiliation with the university and the fact that students in kinesiology and related health and wellness fields use the Brown Center as part of their learning experience. Moreover, this facility is proving to be a fantastic place for academic research: We’re currently engaged in studies looking at underwater walking gaits compared to land-based gaits as well as studies of various psychological techniques for reducing fear of water-based work.

But again, all the attention eventually flows back to those who use the facility as part of their therapeutic routines. We’re proud of the fact that our center is large and flexible enough that we can serve a diverse range of needs and different disabilities. We’re also humbled by the opportunity we have to make a difference in our members’ lives. It’s an important mission, and the four pools of the Brown Center make it all possible.

Belinda Stillwell is an assistant professor at California State University, Northridge, and director of aquatics at the university’s Brown Center, a facility devoted to adaptive therapy for people with disabilities. She holds Ph.D. in physical education/curriculum and instruction from Arizona State University in Tempe and a masters degree in physical education from California State University, Dominguez Hills as well as a range of professional credentials and aquatics certifications, including lifeguard training from the American Red Cross and an Adapted Aquatic Master Teacher Credential from the American Association for Physical Activity and Recreation, among others. Her background in aquatics encompasses lifeguard and disaster training, multiple sclerosis aquatic specialization, U.S. Coast Guard boating and seamanship certification and credentials in water aerobics.