Which of the following may pose an aspiration risk during aquatic therapy?

Cognitive impairments are critical factors to consider when assessing the safety of a patient during aquatic therapy. Individuals with cognitive impairments may have diminished awareness of their surroundings, reduced ability to follow instructions, or impaired judgment, which can significantly increase the risk of aspiration. These impairments may lead to difficulty in managing water intake, swallowing properly, or reacting appropriately in an aquatic environment, thereby raising the possibility of inhaling water into the lungs.

Other options, while they may present their own specific risks in an aquatic setting, do not directly relate to the aspiration risk as dynamically as cognitive impairments. For example, open wounds can pose an infection risk; catheters have potential for infection or displacement; and tracheostomy may indicate a need for special care but is not as directly tied to the risk of aspiration as cognitive factors. Thus, cognitive impairments stand out as a significant concern when considering patient safety in aquatic therapy.