Over the course of the past several months, we have explored many cool ideas to use in your pool. We have looked at Ai Chi, Watsu, Halliwick, the Bad Ragaz Ring Method and other impressive ?aquatic specialty techniques.?

However, when a therapist chooses to use some of these techniques (for instance, Halliwick or the Bad Ragaz Ring Method), that therapist must take functional activities and break that activity down into a series of movement patterns. As a result, the resulting improvements in movement are predominantly therapist-generated.

But at the end of the day, your patient has to be able to get out of the pool and function on his own. Some therapists argue that many aquatic neurotherapeutic facilitation approaches lack carry-over to functional skills and are not easily adaptable by patients.

These therapists increasingly support the use of a task-oriented approach that engages patients to perform a functional task instead of a therapist-directed skill.

The Task Type Training Approach (TTTA) was first described as a way to teach functional activities to patients who had sustained strokes. The principles then were extended to include treatment of all patient disorders, particularly those involving neurologic dysfunction. In the 1990s, David Morris, president of the American Physical Therapy Association?s Aquatic PT Section, took these ideas into the pool.

If you want to incorporate functional tasks into your aquatic bag of tricks, it is best to have many different depths in your pool. Shallow depths of 3 feet or less are optimal for the later stages of skill development in the pool. The idea, after all, is to move people out of the pool and onto normal land-based activities. Steps, ramps and ladders can be incorporated into the drills.

Certain tasks easily lend themselves to simulation in the pool. These include occupational activities such as lifting, pushing, pulling, carrying and bending, or recreational activities like playing tennis, performing ballet leaps or pitching a softball.

In the water, therapists can use regular land-based equipment, which is old or discarded for pool-based tasks. For instance, an old tennis racket or baseball bat can make the transition into the pool as long as it is not intended for future land-based athletic glory. Grab bars on the pool walls or similar structures are helpful for providing external stabilization; however, flotation devices or therapist support can be substituted.

Comfortable water temperatures (approximately 90 degrees to 94 degrees Fahrenheit) are helpful because many patients with neurologic dysfunction have hypertonicity, which initially can be aggravated by cool water. The environment should allow patients to hear the therapist without difficulty.

All health-care providers who perform task simulation as part of their scope of practice may integrate aquatic TTTA techniques as they are learned. Practitioners using the aquatic TTTA should have a thorough understanding of neurologic dysfunction, functional skill analysis and motor learning principles. Such a background is common with physical and occupational therapy professionals.

There are no certifications or special classes teaching this technique. Therapists who want to incorporate Task Type Training Approach into their repertoire should look to common sense and creativity to bring new functions into the water.