May 29th, 2017

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The Evergreen Hamlets at Fleetwood assisted living community is located in Surrey, just outside of Vancouver BC.  This 66 bed residential care community provides specialized care for people whose primary reason for assisted living care is related to factors other than their age. This includes cares for those with acquired brain injury, providing 24-hour nursing care as required by our residents. The Residential Care Hamlets will provide the best in professional support and medical intervention, while maintaining an optimum lifestyle for residents who require 24-hour nursing care. Each resident will have a individualized care plan that recognizes his or her unique interests, history and family situation.

Amenities and recreation at the Evergreen Hamlets at Fleetwood include private or semi private rooms, aqua therapy with a pool on site, hairdressing services, church services in our chapel, 24 hr in-house electronic security, intimate dinning rooms, regular outings, clubs, daily exercise and more.  The Hamlets works with various funding partners, including the Interior Health Authority, Community Living BC, Ministry of Housing and Social Development, WorkSafeBC, ICBC and Private Insurers to meet the varied needs of persons.

We’ve been participating in research with aqua therapy to help cure Huntington’s Disease.

The progressive motor dysfunction and cognitive impairment associated with mid- to late-stage Huntington Disease (HD) renders few exercise programs amenable for use in this population. Exercise may slow the symptomatic progression of HD, therefore appropriate programs should be available to those with advanced disease.

The pool, with a low risk of falling, boasts an appropriate environment to support choreic limbs. The purpose of this qualitative questionnaire-based study was to assess the feasibility and safety of aquatherapy in mid- to late-stage HD, and program perception by participants/caregivers.

Six participants with manifest HD completed a six-week aquatherapy program comprised of twice weekly sessions. Participant-tailored aquatherapy sessions involved a warm-up, exercise-set, and a cool-down. Study notes regarding injury and compliance were recorded to track measures of safety and feasibility.

Participants were offered twice-weekly pool sessions for a 6 week period, amounting to a total of 12 possible pool sessions. Pool sessions were conducted by a trained aquatherapist (also a certified lifeguard) and assisted by a care-aid for entry and exit. All participants wore some type of floatation aid (i.e. a lifejacket or aqua jog belt) for safety, and pool noodles were used for additional support for some participants. Sessions were conducted one-on-one with each participant and the aquatherapist. Each program involved a series of exercises (based on previously discussed recommendations) sandwiched between a brief warm-up and a cool-down. Some examples of the types of exercises involved include: sit-to-stands, walking drills, squats, kicking, band exercises, ball tosses, and stretching.

Participants (and caregivers where available) gave an interview following the program. Conversations were audio recorded and fully transcribed. Interviews were analyzed to extract themes.

Another important finding in this study was the positive impact the aquatherapy program had on participants’ general physical conditioning as observed by companions of participants. This is quite encouraging, given the short assessment period of the study (maximum 12 sessions over six weeks).

Participant 1’s companion said:

“I did notice that she (P1) is sitting up a lot more upright in her wheelchair and that can be because her core muscles were getting weaker and I think they (are) strengthened into the pool. …She is keeping her head up, you may have noticed today, even.”

Participant 3’s companion said:

“Yes, there is that feeling (that) she (P3) can walk. (The therapist) was saying she is walking again. I haven’t seen her do that … on her own in the pool. It just has to feel good all over to be able to stand up, so I think that would be the best part of it …”

This finding may suggest that aquatherapy might have a beneficial impact on motor symptoms of HD, but firm conclusions cannot be drawn from this small pilot study.

Results of this study, confirm that all participants adhered to the study (as assessed by an adherence rate of greater than or equal to 50%). Only one of six participants ever refused to attend aquatherapy sessions when they were offered, often based on psychological feelings of apathy, anxiety, and/or irritability. Otherwise reasons for missed sessions by all five other participants include illness, being away from the facility on outings, and mechanical failure of the pool lift. It was noted that compliance was positively affected by the presence of a familiar caregiver at the aquatherapy sessions. This may mitigate some of the psychological stress participants may experience when confronted with new experiences or environments.

Generally, participants reported the aquatherapy to be enjoyable, feasible, and safe, as well described improved mood, sleep, and quality of life. Anecdotal evidence suggests that many participants experienced improved physical conditioning.

As such, what was found was twice-weekly aquatherapy is feasible in mid- to late-stage HD, and was perceived to be safe and enjoyable.