Treating Patients with Visual Impairments or Low Vision in the Aquatic Environment


To better serve our patients, the APTA has expanded into a variety of sections, including acute care, geriatrics, neurology, oncology, pediatrics, orthopedics, and sports medicine, to name a few. 

As aquatic physical therapists, we have the wonderful opportunity to expand our influence by providing care to such a wide variety of patient groups. We are "jacks of all trades" and often treat patients as if we were members of all PT sections.

So, let's talk about special populations within those spheres of diagnoses I listed above.

In my role as Director of Practice for the AAPT, I was recently asked for feedback on how to better treat patients with low vision or visual impairments in the aquatic environment.

Our AAPT President Michael Murray and I have come up with this list of suggestions to help you, our members, better treat this special population:
  • Call in advance to let the patient know what to expect (where to go, where to check in, what to bring, etc.).
  • If the patient has a caregiver who will accompany him or her to a community pool, discuss whether the caregiver can attend the aquatic physical therapy session.
  • Inquire about the patient's preferences when it comes to being introduced to a new environment. For example, using a cane during a preliminary walking tour of the facility before entering the water.
  • Discuss ahead of time with the patient the agreement to touch (directing hand movement or the PT touching the patient's body to indicate what muscles need to be contracted). 
  • Ask the patient whether they prefer tactile contact or voice commands during the PT session. 
  • Let the patient know what sounds are going to be around him or her and what they mean.
  • It is very important to maintain safety on the pool deck and in the locker room. Having a friend, family member, or facility staff assist the patient is helpful when navigating the entrance, locker room, and pool deck.
  • Assist the patient in locating obstacles on the pool deck and how to safely enter the pool.
  • Consider using rope to make boundaries around the pool so that the patient is protected from sudden changes in depth and a safe location for the patient. The boundaries also prevent other patients or pool patrons from entering the therapy area.
  • Talk to the patient about how to present an aquatic exercise program at home or a community aquatic exercise program in advance. If you use written instructions, you will need to find an alternative. A recording of the session can be played back at home by the PT, so he or she can continue practicing at home. A phone can also be equipped with apps that read texts aloud.
  • Offer suggestions to the patient about facilities for transitioning from skilled therapy to community exercise to better assist the patient to stick with their aquatic exercise program.
We hope these suggestions will provide some guidance on how to begin working with patients who have visual impairments or low vision. Please let us know if you have any other suggestions!

Shelly Muhlenkamp
AAPT Director of Practice



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