Water Therapy: Water therapy is a kind of CBT that has
adjustable levels and can be applied with help of special mechanism. Loyd,
Vargas (2004) describes the commonly used method of giving water therapy by
placing the human patient in a water basin that is custom made for this
purpose. Pump driven water circulation (the intensity of which can be adjusted)
is applied by streams of water that come from various openings in the basin.
The motor is attached to a controller that patient has access to and can
control the intensity of circulation without having to exit the water basin. Water
therapy is usually administered
at a spa facility, physical therapy unit (that is equipped with water therapy
machine) or even at home in bath tubs that are also known as ‘Jacuzzis’
(Elkayam et al., 1991)
Effectiveness of Water Therapy: Danneskiold-Samsøe et al. (1986) explain
that it is well known that patients suffering from rheumatoid arthritis have a reduced muscular function. In their
study, they observed the effects of exercise therapy in a heated pool for eight
RA patients and after two months found increase in strength of patient. They
conclude that use of water therapy as a CBT for RA patients can be an effective
method to increase physical capacity of patients. The use of water therapy has
been understood by some researchers in comparison to same physical activity on
dry ground. According to Melton-Rogers,
Hunter, Walter, Harrison (1996) exercising in the water gives the RA patients a
chance to get the physical activity levels that they are comfortable for a long
term. Their study was with eight RA patients by monitoring their pain, rate of
perceived exertion (RPE), heart rate, oxygen intake during biking on the ground
and then doing similar activity in the water. Results showed lower RPE during
ground biking and mixed results for other monitored body functions as well. It
was noted that both kind of activities would provide necessary activity as
suggested by the American college of sports medicine, but water exercise has a
higher chance of patients continuing it in the long run.
Method to use Water Therapy: McIlwain, Bruce (2003) suggest to get into a heated pool three times
a week at least and participate in water aerobics, also known as aquatics
exercise two to three times a week for a pain free arthritis. Their article is
quiet clear in explaining that exercise may seem like a challenge as a thought
for RA patients, but when practiced in the water as part of water therapy, it
can relief almost all of the pain from RA. Like any kind of treatment, it is
important to know how often a CBT is used to show results.
The method explained above by McIlwain, Bruce (2003) sound
similar to the kind of mechanisms found in simple Jacuzzi bath tubs. Most
modern houses are constructed with these kinds of bathtubs built in and
installation is not too expensive either if weighed in reference of the benefit
they may provide as water therapy. In an effort to encourage RA patients to use
water therapy as a CBT we would aim to schedule a consult with the patients to
educate them on the benefits of water therapy and highlight the simplicity of
using the method in their own homes.
The
challenge is when you approach RA patients from lower socioeconomic status
(SES) as they may not have enough financial health coverage or a house facility
equipped with a hot tub or Jacuzzi bath. In that case we could suggest joining a
local pool like the YMCA, which allows membership at nominal cost and use the
facility to exercise water exercise.
Tai Chi: Tai Chi is a form of martial arts that originated
in ancient China and is today a strong part of the health care system in China.
Many people in China and other South Asian countries practice Tai Chi religiously
every morning with the belief that it prevents as well as cure lot of chronic
diseases (Chi, 2009). Today Tai Chi is
thought to benefit hypertension, asthma, knee problems, stress and RA in China
as well as in the Western world. Chi in
Chinese medicine means free flowing energy and its believed that it must flow
freely for good health; block chi can
cause health problems (Chi, 2009). Chang, the founder of Tai Chi created specific
postures (a version of martial arts) that facilitate a free flow of energy
throughout the body.
Effectiveness of Tai Chi: Peterson
(2014) writes that Tai Chi like yoga and weight bearing activities has shown to
improve flexibility in RA patients. Some recent studies by NIH have revealed
that Tai Chi helps patients recover from chronic diseases that involve inflammation
like RA (Chi, 2009). Uhlig et al. (2010) conducted a study aimed at
understanding in which ways Tai Chi impacts disease activity, health and physical
function in RA patients. The study used qualitative and quantitative methods
with 15 patients (ages 33-74) who practiced Tai Chi twice a week for 12 weeks.
Results showed that after 12 weeks there was reduction in stress, better
understanding of handling RA pain and improved lower limp function. Tai Chi is
a great CBT for RA patients that has shown to improve health in many ways and
is a cost effective technique.
Methods to use Tai Chi: The primary technique to practice Tai
Chi is to learn slow, controlled postures that are mostly named for animals or nature
(Chi, 2009). Each posture is designed to help flow of energy and correct any
blockage of energy flow. Tai Chi can be practiced in a group, but for its
effectiveness it is crucial that it is practiced daily, and therefore, encouraged
to do solo as well (Chi, 2009). It is reported that unlike other rigorous exercises,
Tai Chi practice of gentle, flowing movements is comparatively less intense and
more long lasting. It is usually taught by a master and has been observed to be
easy to teach to the elderly with limited movement easily.
Since Tai
Chi is relatively a newer concept in some parts of the world, we can assume that
some RA patients maybe not familiar with the practice. We have established that
Tai Chi originates from China and popular in South Asia to promote health. It
is still gaining familiarity in the Western, Middle Eastern cultures and this
may be due to health care access, religious or cultural beliefs. RA patients
who are not familiar with the Chinese culture, practices and use of Tai Chi as
a CBT would need to educated properly about the practice. It should be noted
that Tai Chi is a form of exercise that needs be learnt and practiced, so it is
crucial that this population be familiarized the background of Tai Chi. If we
are able to find a common ground in the practice of Tai Chi and the CBT used in
other cultures, then that may bridge the barrier of being unfamiliar. It is
then also important to follow up that RA patients understand the importance of regularity
and every day practice to see results.
References
Chi, W. T. (2009). Tai Chi for Health.
Danneskiold-Samsøe, B., Lyngberg, K., Risum,
T., & Telling, M. (1986). The effect of water exercise therapy given to
patients with rheumatoid arthritis.Scandinavian journal of rehabilitation
medicine, 19(1),
31-35.
Elkayam, O., Wigler, I., Tishler, M.,
Rosenblum, I., Caspi, D., Segal, R. & Yaron, M. (1991). Effect of spa
therapy in Tiberias on patients with rheumatoid arthritis and osteoarthritis. The Journal of rheumatology, 18(12), 1799-1803.
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