Unsure of her career direction after graduating from college, Harriet Adams, PTA, BA, bought a copy of "What Color Is Your Parachute?" The guide told her to follow her talents and passions to find a satisfying career. It proved to be good advice.

"Everything came back to swimming, which I have always loved, so I started working for the YMCA and began the first multiple sclerosis water exercise class there," she said. "It was amazing for me to see people who had come in on walkers and in wheelchairs be able to ambulate independently once they were in the water." Her class was videotaped and used nationally to help train instructors.

That led to a job in the multiple sclerosis program at Shepherd Center in Atlanta and a return to school to become a physical therapy assistant. She continued learning about water therapy in Warm Springs (where President Franklin D. Roosevelt was treated with other polio patients) and Switzerland.

Once the American Medical Association recognized aquatic therapy procedures, Adams and several other therapists discussed opening their own business to offer a broad spectrum of physical therapy and rehabilitation services, including aquatic physical therapy.

"When the time came to quit full-time jobs, everyone got cold feet, but I believed so much in these services that I started Integrated Therapy LLC in 1997," Adams said.

Today, she operates three clinics in Atlanta, teaches continuing education courses for therapists and serves on the board of the aquatic section of the American Physical Therapy Association.

Adams' patients range in age from 2 to 102, with conditions that include accident-related injuries, chronic pain, arthritis, herniated disks, joint replacements, multiple sclerosis, neurological disorders, fibromyalgia and Parkinson's disease.

"Water therapy has been around since the Greeks and Romans, but ongoing medical research continues to prove its beneficial effects," Adams said. "There's just something magical about water. In therapy, we can use its physical properties to resist or assist the patient." Water exercise can improve a patient's cardiovascular, circulatory and respiratory systems; increase �exibility, muscle strength and endurance; and enhance balance and coordination. Plus, it's relaxing and reduces stress. New patients are referred by physicians, and Adams or one of her staff therapists meets with them to evaluate their range of motion, strength, flexibility and balance on land. They tour the pool, watch other patients and learn what to expect from water therapy. The therapist establishes a program with short-term and long-term goals, and pool sessions begin.

"Seeing patients one-on-one allows us to establish a relationship and level of trust," Adams said. "Someone who can't raise his leg on land may be surprised to find that he can in the pool, thanks to buoyancy. They may be fearful at first, but once they accomplish one goal, they're ready to move on to the next one."

Therapists work closely with the physicians and patients to achieve rehabilitation goals. Exercising in the water is something patient can do for the rest of their lives, giving them more confidence and control over their bodies, Adams said.

In 2001, with the help of two experts, Adams published an "Aquatic Exercise Toolbox" for patients and trainers that includes 197 water-resistant exercise cards and a CD-ROM manual.

Because the physiological effects of immersion can result in big rehabilitation gains, aquatics is one of the fastest-growing types of physical therapy. Demand is growing, but not every health care facility can afford it.

"The cost of putting in a pool and training therapists is one challenge that we face to expanding programs," Adams said. "Another challenge is insurance reimbursement."

There's a cap that can restrict Medicare patients to just a few visits. "It's hard to rehab anyone after a stroke or fractured hip in eight visits. We'd like to see the cap lifted," she said.

Besides running the business and training therapists nationally, Adams works with patients two days a week. "I need to keep my skills up, and I love it," she said. "This may sound corny, but the biggest satisfaction in this job is seeing someone in a lot of pain get in a warm body of water and watching her face relax. It's a good feeling to be able to help somebody."