Exercise in the Aquatic Environment for Patients with Chronic Spinal Cord Injury and Invasive Appliances: Successful Integration and Therapeutic Interventions

Objective Our primary objectives of this initial "proof-of-principle" trial were to evaluate the interventions used in skilled aquatic therapy and to identify any clinical benefits for individuals with spinal cord injuries who use invasive appliances including pressure injury dressings, suprapubic catheters, indwelling catheters, colostomy bags, and tracheostomy tubes. Design This is a retrospective chart review of patients with chronic spinal cord injuries using invasive appliances who had also undergone skilled aquatic therapy. Results Forty-nine patients with traumatic spinal cord injuries demonstrated scores showing statistically significant improvement using their total mobility and self-care of the Spinal Cord Independence Measure III (P ≤ 0.021, 0.039, 0.021) scores. Forty-five patients with traumatic spinal cord injuries demonstrated significant improvement of ASIA Impairment Scale motor scores (P ≤ 0.002) and nine patients with traumatic spinal cord injuries walked longer distances in 6-min walk test (P ≤ 0.011). The Spinal Cord Independence Measure III efficiency was 0.26 per hour (95% confidence interval = 0.037-0.475). There was one reported unplanned bowel evacuation that occurred but did not prevent future therapy. All patients successfully completed a sequence of aquatic therapy. Conclusions Spinal cord injury patients with various invasive appliances can safely participate in specialized aquatic therapy without complications and seem to achieve clinically significant benefits. We recommend that spinal cord injury rehabilitation centers seek out and connect with opportunities for aquatic therapy within their institutions and communities.