Barmatz, Caroline, Crowe, Melissa, Biros, Erik, Mendez, Diana, Dudkiewicz, Israel, and Reznik, Jacqueline (2026) Safety and Feasibility of Early Aquatic Physical Therapy for Military Survivors of Gunshot Wounds and Blast Injuries: A Case Series. Archives of Rehabilitation Research and Clinical Translation. (In Press)

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Abstract

This study evaluated the safety and feasibility of early aquatic physical therapy (APT) for gunshot wounds (GSWs) and/or blast injuries (BIs). Early aquatic physical therapy (eAPT) is defined as “therapy conducted within the first month after injury, considering the injury type, setting, and environment.” APT facilitates the restoration of mobility and function after illness or injury. Although APT is helpful for patients with mobility issues, muscle weakness, and pain, its early use in high-functioning adults recovering from ballistic trauma remains underexplored. Usually, multidisciplinary rehabilitation occurs on land in sterile settings because of infection risks from GSWs and BIs. Water exercise offers a controlled, low-impact environment for recovery; however, precautions, particularly for infection prevention and control, are essential. Three case studies are described, all of whom received mobilization in water within their first month after injury. Two patients sustained only GSW, and a third experienced a combined GSW and BI. Participants also received conventional multidisciplinary treatment and were followed up for almost 7 months. Adverse events, feasibility, and functional improvements were assessed. Range of motion assessment, the manual muscle test, and the FIM instrument were used to evaluate progress. The eAPT program was feasible for all 3 patients who completed it. Noninfected open wounds were covered with waterproof dressings before eAPT, and assistance was provided and at the poolside, on steps, and during pool entry and exit using hoists. Exercises were performed at a safe water depth. No adverse events occurred, and patients showed clear functional improvements in and out of the water. eAPT appears to be a safe, feasible adjunct to early rehabilitation after complex ballistic or blast trauma, supporting further investigation into its broader clinical application.

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