Effects of water-based exercises on balance, functional status, fatigue and quality of life among patients with multiple sclerosis: case series.

Patients will participate in 6-week hydrotherapy programme 2 times a week. Each session will last for approximately 45 minutes. Hydrotherapy (warm-up, Ai-Chi exercises, cool down) will take place in a swimming pool which is 1.20 meters deep with a water temperature: 30-31 degrees Celsius. Each session will start with a 10 minute warm-up, which will include dynamic, active exercises, some with use of pool noodles, kickboards or balls. The main part, Ai-Chi exercises, will last for 25 minutes. Ai-Chi consists of 16 exercises performed in standing position, accompanied by deep breathing. The patient should be submersed to shoulder-depth level with a slight flexed knees. The Ai-Chi exercises will be performed with specified order and pace: upper limbs, upper limbs and torso, upper and lower limbs and torso. During exercise programme, the support plane for the lower extremities gradually decreases. There will be a progression of Ai-Chi exercises with each session (including more demanding exercises, increasing number of repetitions). Ai-Chi exercises will be performed by physiotherapist, experienced in neurophysiotherapy and water therapies. For better visibility the physiotherapist will stand outside the pool. There will be trained assistants inside to pool to support patients with poor balance. Each session will end with 10 minutes of cool down exercises, which will include stretching and free walking. There will be an attendance list to monitor patients adherence to intervention.