Aquatic Therapy for Children with Special Needs
What is Aquatic Therapy?
Who doesn’t love the weightless feeling of floating in a pool, letting the water carry you effortlessly? Now think of the countless hours that your child will splash about and play in the bath - the majority of children find true joy in being in water from an early age!
Whether you choose to relax and float about, or engage in more active play, water allows for a wide range of therapeutic activities and benefits that makes it an ideal setting for therapy to occur.
Don’t worry - it’s not necessary to have an Olympic-sized pool with expensive technology to obtain positive outcomes! Even in a small, basic pool, therapists can provide meaningful, personalized treatment that is based on each individual’s needs and/or interests.
Who can benefit from aquatic therapy?
The mutual goal of the therapists and parents/caregivers is to promote happiness, health and social interaction with loved ones. Aquatic therapy is a viable modality in the rehabilitation process for achieving optimal quality of life for children with conditions including, but not limited to: Cerebral Palsy, Juvenile Arthritis, Spina Bifida, Scoliosis, Down’s Syndrome, Muscular Dystrophy, Autism, Sensory Processing Disorder, Orthopedic or Musculoskeletal Pain Syndromes.
Who provides aquatic therapy?
Healthcare providers who may provide aquatic therapy include, but are not limited to: Occupational Therapists, Physical Therapists, Speech/Language Pathologists, Recreational Therapists, Massage Therapists, Adaptive Physical Education teachers and Athletic Trainers.
What are the benefits of aquatic therapy?
Exercising while the body is submerged in water can positively impact the overall health and wellness of people of all ages and abilities, including children with special needs.
Aquatic therapy techniques incorporate social interaction such as sharing and taking turns to develop emotional regulation skills. Exercise improves blood flow to the brain to enhance cognitive regulation; therefore, pool therapy games such as Simon Says and charades incorporate memory and problem solving.
Water provides unique benefits that are not possible with traditional, land-based methods due to the effects of gravity. Research shows that the unique, physiological benefits of water can help children who struggle with illness or injuries. These unique qualities include:
hydrostatic pressure, and
thermal sensory input.
Understanding the therapeutic benefits of buoyancy
Buoyancy forces the body upward and reduces gravitational force on the weight-bearing joints, such as a child’s spine and legs. If these areas are affected by weakness, pain, or other impairments, exercising in water helps to promote controlled movement with less abnormal compensation (Koury, 1996).
In an upright, standing position on land, the body’s center of gravity is found near hips (the second sacral vertebrae level). In the water, however, buoyancy shifts the center of gravity upward toward the level of the lungs; therefore weight bearing on the joints and muscles of the body will vary with the depth of the water in which one is working (Bates & Hanson, 1996). This allows aquatic therapists to modify the level of challenge of each therapeutic task based on the child’s performance. This helps a child stay interested and actively participating in therapy; therefore, helping them to make progress.
Aquatic therapists target the same skills that traditional land-based therapies do, such as head/neck stability, trunk strength, and righting reflexes, which are critical components of postural control/stability. This is necessary to successfully achieve developmental milestones to interact within their environment, like reach for toys, crawl, walk, run, climb, and other functional mobility. (AOTA, 1996). Since gravity is reduced in the water, what better place to work on postural control than a pool where the buoyancy reduces the child’s fear of falling?
Water & Hydrostatic Pressure
Another unique physiological benefit of water is hydrostatic pressure; this is defined as the pressure of water on the body and its blood vessels (Koury, 1996).
Hydrostatic pressure increases renal output by transferring body fluids from the arms and legs toward the abdominal organs for circulation in order to reduce edema and arterial blood pressure (Davis & Harrison, 1988, as cited in Koury, 1996). This is beneficial for those struggling with chronic pain, diabetes, post-surgical edema or lymphedema.
When a child is submerged to a chest deep level, hydrostatic pressure assists respiratory exhalation and resists inhalation (Adams, Norton, & Tilden, 2000). This improves vital lung capacity for improved endurance and strength which helps those with asthma or other breathing difficulties.
Exercising in neck-deep water promotes effective breath control, optimal expansion of the rib cage, and intercostal muscle retraining to control respirations (Ogden, 2003). Coordination of breath during aquatic exercise is beneficial for the same reasons as it is during yoga; it improves focus and attention; decreases stress/anxiety; and promotes self-regulation.
Self-Regulation and Thermal Sensory Input
A child’s ability to self-regulate directly impacts their overall mental health. Difficulties with self-regulation may be caused by Autism, Attention Deficit Disorder, Sensory Processing Disorder, or other medical conditions.
Water temperature influences the level of alertness by stimulating the nervous system; warm water typically relaxes the body which may decrease impulsivity, or actions made prior to thinking through the consequences. Alternatively, cooler water temperatures arouses a child who struggles with lethargy and fatigue to maintain attention. With repetition, these therapeutic benefits will become familiar for enhanced carryover to other environments (school, home, community).
Thermal sensory input also promotes muscle relaxation and restful sleep. Tilden (2005) stated that the physiological function of sleep is to eliminate waste products, restore energy, and repair the body; therefore we can see how impaired sleep can negatively affect our children’s success with learning and information retention.
More information about aquatic therapy services
Most medical insurances require a physician’s order to initiate a child’s participation in aquatic therapy. This provides justification for medical necessity so that insurance will pay for it successfully. As with any medical cost, be sure to check your health plan’s explanation of benefits to know what you are going to be responsible for out-of-pocket.
Initially, a therapist will complete a traditional land-based evaluation to identify areas of difficulty in order to develop personalized treatment plans and goals. Each therapist bases these on their own discipline’s scope of practice. These may include, but are not limited to:
sequencing, eye-hand coordination, sensory exploration, and dressing success by Occupational Therapists;
muscle strength, joint flexibility, balance and endurance by Physical Therapists;
speech, communication, and understanding by Speech/Language Pathologists.
Aquatic therapy programs are found in variety of settings such as outpatient clinics, hospitals, skilled nursing facilities, assisted living facilities, and community organizations such as a YMCA.
Some facilities allow the parent or caregiver to participate alongside the child and therapist in order to learn exercise and handling techniques in a hands-on manner; this will encourage ongoing aquatic participation after formal therapy is completed.
Parents or caregivers who are interested in furthering their knowledge on aquatic therapy strategies may also find workshops and courses beneficial through organizations such as the International Council for Aquatic Therapy and Rehabilitation Industry Certification (ICATRIC) and Aquatic Resources Network.
Aquatic therapy may be nontraditional, but it has successfully helped children with special needs in a variety of ways. As a parent myself in addition to an occupational therapist, I share the same desire as parents/caregivers to provide the highest quality care and support for each and every child. Compassion, dedication, innovation, and parental collaboration are critical components to incorporate into the therapeutic intervention process; these will directly influence the success of meeting the complex developmental needs, and ultimately, achieving an optimal quality of life.
About the Author
Stacy Yagow, MS, OTR/L, obtained an Associate’s Degree in Occupational Therapy from the North Dakota State College of Science in 1994, as well as a Master’s Degree in Occupational Therapy from Belmont University in 2010. She has received specialty certification in aquatic rehabilitation from the International Council for Aquatic Therapy and Rehabilitation Industry Certifications; aquatic personal training and group fitness by the Aquatic Exercise Association and Arthritis Foundation. She has presented continuing education courses titled, “Introduction to Aquatic Therapy” to occupational and physical therapy practitioners throughout Nebraska and Iowa, including a NOTA state conference. She has guest lectured on aquatic therapy to college students at the College of Saint Mary and Clarkson College. She was elected and served a 5-year term on the Nebraska Board of OT Practice, and volunteered as OTA Committee Chairperson of the Nebraska Occupational Therapy Association. Stacy may be reached by email at email@example.com, or Spier Physical Therapy, 3200 Raasch Drive, Norfolk, Nebraska 68701, phone (402)371-2722.
Adams, H. P., Norton, C. O., & Tilden, H. M. (2000). Aquatic exercise toolbox. Champaign, IL: Human Kinetics. American Occupational Therapy Association. (2002).
Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy, 56, 620–621. Bates, A., & Hanson, N. (1996).
The mighty power of breath. Physical Therapy Products. Retrieved September 18, 2006, from http://www.ptproductsonline.com/article.php?s=PTP/2005/04&p=4 Health Insurance and Portability and Accountability Act. (1996). Pub. L. 104-191, 42 U.S.C. § 1301 et seq. Kinnaird, D. W. (1999, June).
Board games. Aquatic Therapy Journal, 1, 15–17. Koury, J. (1996).
Aquatic therapy programming: Guidelines for orthopedic rehabilitation. Champaign, IL: Human Kinetics. Ogden, D. (2003, January). Activities and cues for clients with osteoporosis. Aquatic Therapy Journal, 5, 17–24. Schoedinger, P. (2005, February).
Aquatic physical therapy for patients with neurologic disorders. Paper presented at the Combined Sections Meeting, New Orleans, LA. Simmons, V., & Hansen, P. D. (1996).
Effectiveness of water exercise on postural mobility in the well elderly: An experimental study on balance and enhancement. Journal of Gerontology, 51A(5), M233–M238. Tilden, H. M. (2004).
Posture, balance, and coordination. AKWA, 18(1), 32–33. Tilden, H. M. (2005). The ABCs of ZZZs. AKWA, 18(6), 49–52.
Yagow, S. (2006, December). Aquatic therapy: An innovative approach to practice with older adults. Gerontology Special Interest Section Quarterly, 29(4), 1–3.