Aquatic Therapy Intervention, Including the 4-Walls Drill, for Persons With Hoehn and Yahr Stage IV Parkinson's Disease: A Retrospective Data Analysis

Abstract

Background and Purpose: Individuals with Parkinson's disease (PD) experience a decline in functional mobility secondary to the associated motor symptoms of festinating gait, rigidity, bradykinesia, and postural instability. The objectives of this study were to determine the feasibility of the 4-walls drill for individuals with Hoehn and Yahr stage IV (H&Y IV) PD and evaluate the effect of an aquatic therapy (AT) intervention on land-based gait speed. Methods: A retrospective data analysis was performed after 4 individuals completed an AT program incorporating the 4-walls drill. Primary outcome of gait speed was measured via land-based 4-m walk test (4MWT). Secondary outcome measures in the aquatic environment included 60-second sit-to-stand (STS) test, forward walking speed, and number of steps for backward and sideways walking. A Wilcoxon signed rank test was used to determine significance, with significance set at .05. Results: No adverse events were reported. Analysis of pre- and posttreatment scores revealed no significant difference in the 4MWT (P = .068), 60-second STS test (P = 1.0), and forward (P = .144), backward (P = .93), and sideways (P = .144) walking. Conclusion: The 4-walls drill is a safe and feasible intervention for persons with H&Y IV PD. The results did not show a statistically significant improvement in land-based gait speed or aquatic outcome measures. One subject continued to receive AT for an additional 5 visits and demonstrated continued improvement across all aquatic outcome measures. Future research with a larger sample size and longer intervention duration is needed.