Hydrotherapy Manual for Upper Extremity Stroke Rehabilitation: Flow Forward Pool Program

Abstract

The Hydrotherapy Manual for Upper Extremity Stroke Rehabilitation serves as a tool guide to support the delivery of occupational therapy (OT) led hydrotherapy sessions for outpatient stroke rehabilitation. The program, “Flow Forward Pool Program," was developed by a team of OT students from Queen’s University under the supervision of Dr. Dorothy Kessler, Dr. Olivia Manning and Zanna Farmer. The manual was influenced and supported by Olivia Manning's (2024) dissertation which looked at water-based therapeutic exercises in stroke recovery and community use. A literature review was conducted by E.C., H.G., and K.F. and a grey literature search was completed by J.L., V.L., and C.R. The manual is intended to assist in the implementation of an upper extremity hydrotherapy program as part of the Outpatient Stroke Rehabilitation Program at Providence Care Hospital (PCH) in Kingston, Ontario. Currently, the hospital's therapy pool is used by physiotherapists, focusing on primarily lower extremity exercises, as well as use by the community through pay-per-use and private programs such as Aching Joints. This manual aims to address a current gap in OT service delivery and the limited evidence-based literature on upper extremity hydrotherapy interventions for stroke rehabilitation. It is also intended to provide guidance for graded water-based exercises focusing on shoulder, trunk, wrist, fingers and hand, balance and coordination, which is informed through stroke best practices and supporting literature.