Evaluation of the Effects of Aquatic Therapy on Activities of Daily Living, Walking, Balance, Posture, Pain, and Depression in Parkinson's Patients

Abstract / Project Description Parkinson's Disease (PD) is a progressive neurodegenerative disorder characterized by the degeneration of dopamine-producing cells in the substantia nigra, ranking as the second most common neurodegenerative disease after Alzheimer's. The prevalence of the disease in Turkey is approximately 2/1000. The primary symptoms of Parkinson's disease include bradykinesia, resting tremor, rigidity, and postural instability. Posture, balance, and gait disturbances are significant findings that emerge during the course of the disease, causing severe disability. The gait pattern in PD varies across different stages and affects patients to varying degrees. Typically, a shortening of step length, patients walk slowly with small steps. In advanced stages, difficulty in initiating gait, freezing of gait, and postural instability are frequently developing symptoms. In addition to classic motor findings, non-motor symptoms such as urinary incontinence, sexual dysfunction, orthostatic hypotension, sleep disorders, depression, anxiety, and pain may also be observed.

The Modified Hoehn & Yahr Staging is a scale used to stage Parkinson's disease, with proven validity and reliability in Turkish. Developed by Hoehn and Yahr in 1967, this system allows both the patient and the clinician to easily define the severity of the disease and evaluate its progression across five stages. In the literature, Stages 1 and 2 are classified as "mild," Stage 3 as "moderate," and Stages 4 and 5 as "severe".

As conventional rehabilitation therapy, Parkinson's patients are frequently prescribed land-based gait and mobilization, posture, relaxation exercises, occupational therapy, and respiratory and swallowing exercises. Whether combined with other therapies or not, aquatherapy improves balance and functional mobility in PD patients compared to conventional rehabilitation. Aquatherapy, developed to improve balance, make walking more functional, and minimize strength imbalances between muscles, is considered a viable method for PD .

Aquatherapy is a rehabilitation method based on exercises performed in water using the physical properties of water . It is beneficial in the treatment of musculoskeletal, neurological, and cardiopulmonary diseases, among other conditions. The therapeutic safety margin of aquatherapy is quite broad . During treatment, the physical properties of water are utilized: hydrostatic pressure increases lymphatic and venous return in the extremities, contributing to the reduction of edema. Due to the buoyancy of water, patients move more comfortably; body weight is reduced by 90% with immersion up to the cervical region and by 60% up to the xiphoid process . Because of water's viscosity, resistance to movement is higher than in air, allowing movements to be performed at a constant speed. This resistance makes water an effective environment for strengthening. Additionally, heat can be retained or transferred through the thermodynamic effect of water . Aquatherapy is recognized as an effective adjunctive treatment in PD, particularly for improving motor symptoms . It reduces pressure on the joints, alleviates pain, provides support during movement, and reduces the risk of falling, thereby helping patients improve their balance skills .

In this study, the aquatherapy exercise program will be conducted in a therapy pool with a depth of 120 cm. Patients will be recommended to wear aquatic shoes to prevent slipping. Access to the pool will be provided via a lift. The water temperature will be maintained at 30-32°C. The aim of this study is to investigate the effects of aquatherapy on gait, balance, posture, freezing, activities of daily living (ADL), pain, and depression in Parkinson's patients.