An online course available through the Aquatic Therapy & Rehab Institute (ATRI) highlights the cervical and thoracic spine’s influence on the shoulder girdle, noting that often injuries and symptoms at the elbow and wrist can be linked to proximal impairments.

The ATRI website states that the Upper Quarter Connections and Aquatic Therapy Progressions course will present evidence-based medicine regarding upper quarter connections with exercise, focusing on progressions from increasing mobility to improving stability and strength, ending in functional integration. While orthopedic diagnoses are the primary concentration for case examples and clinical pearls presented, the exercises can be applied to neurologically impaired and general conditioning clients.

The site notes that course objectives include describing biomechanical relationships of the upper quarter; performing manual stretching and techniques in the water to improve flexibility of the upper quarter; design, cue and progress upper quadrant strengthening aquatic exercise; incorporate purposeful integration-type activities in the aquatic exercise program to maximize functional recovery; and state precautions of specific orthopedic upper limb diagnoses especially as they relate to aquatic exercise.

Course faculty Beth Scalone, PT, DPT, OCS, ATRIC, is a licensed physical therapist with more than 18 years of experience in orthopedic and aquatic therapy. The site notes that Scalone is the owner of North County Water and Sports Therapy Center in San Diego ( and continues to provide hands-on clinical care in addition to her role as educator. Since graduating from the University of Connecticut in 1991, she has belonged to the American Physical Therapy Association and has achieved certification as a clinical specialist in Orthopedic Physical Therapy. In January 2006, Scalone graduated from Boston University with a Doctor of Physical Therapy degree. Additional certifications include Certified STOTT Pilates instructor and Master Instructor for the Burdenko Method.

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[Source: Aquatic Therapy & Rehabilitation Institute]