Purpose: The purpose of this Special Interest Report is to present the 4 Walls Drill Concept used in and developed for the aquatic setting, and to determine its effectiveness in persons with Parkinson's disease specifically in its relationship to gait speed. There is no current research into the use of this concept, which is used specifically as a treatment intervention within the aquatic medium.
Description: The 4 Walls Drill Concept was developed by Andrea Salzman, PT, (Aquatic Therapy University), to address both the cognitive and physical impairments associated with Parkinsonism and other neurological disorders. During this drill, the participant is assigned 4 different tasks, with each task being performed facing one of 4 walls. The participant is asked to recall which task is assigned to each direction and then perform it, with cues given as needed depending upon the cognitive level of the individual. This drill can be advanced in multiple ways: increasing repetitions, timed drills, changing directions, adding a cognitive component, and moving to more shallow water to suggest a few. Individuals used a reverse pyramid approach, beginning with 6-8 reps of each exercise, decreasing to 1 rep of each per rotation. The total number of repetitions and time to complete were recorded.
Summary of Use: Data was obtained from a local aquatic PT practice for 4 individuals with Parkinson's disease. All 4 subjects received the 4 Walls Drill along with therapeutic exercise and gait training administered by a licensed PT skilled in the elements of aquatic PT. 4 Walls skills included: squats, step ups, cross country ski, and jumping jacks. Data collected included age, gender, number of visits, PT treatment, and outcome measures. A land based timed fourmeter walk was measured pre and post treatment. In the aquatic environment, timed forward walking, number of steps taken to walk backwards and sideways for 10.36 meters, and a 60 second sit to stand were used as pre and post intervention outcome measures.
Importance to Members: The hypothesis was not supported, as no statistically significant improvements were noted in gait speed. Although not significant, improvement was demonstrated in the land-based 4-meter walk test suggesting a potential carryover of AT to land based functional tasks. In addition, one individual continued to receive treatment for a total of 11 sessions and displayed improvement in all aquatic based outcomes. This may indicate that the limited number of treatment sessions contributed to the lack of statistically significant changes in all individuals. The results of this analysis can be used to help guide future research design to determine appropriate frequency and duration of a 4 Walls Drill as part of an aquatic therapy intervention in persons with Parkinson's disease.