Aquatic Therapy as a Programmable Multisensory Environment for Arousal and Postural Control After Severe Acquired...

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Aquatic Therapy

Background:

• Severe acquired brain injury (sABI) presents challenges in early rehabilitation due to fluctuating arousal, fragile trunk control, and limited therapy tolerance.
• Land-based therapy is often restricted by fall risks and staffing shortages, necessitating alternative approaches.

Purpose of the Study:

• To reframe aquatic therapy as a programmable multisensory environment for early neurorehabilitation in sABI.
• To stabilize arousal and support axial alignment before conventional impairment targets are addressed.

Main Methods:

• Integration of neurobehavioral assessment, motor control, and immersion physiology principles.
• Proposal of the Arousal-Alignment-Action loop as a falsifiable model.
• Definition of manipulable aquatic inputs (water depth, turbulence, temperature, orientation, support) as dosing parameters.

Main Results:

• The framework links state regulation to alignment and goal-directed behavior, offering testable predictions.
• Identified boundary conditions for aquatic therapy application in sABI patients.
• Proposed a minimal outcome package for assessing arousal, trunk control, behavior, participation, and physiology.

Conclusions:

• Viewing aquatic therapy as a measurable, titratable medium can enhance early neurorehabilitation for medically stable sABI patients.
• This programmable approach may reduce intensity bottlenecks and improve research implementability and comparability.
• The model is hypothesis-generating and requires further clinical evidence.