Beneficial Factors of Aquatic Therapy Interventions with Cerebral Palsy Adolescents

Living with Cerebral Palsy can come with many physical limitations leading to continuous rehabilitation sessions throughout the adolescent's lives, including physical therapy, speech therapy, hand therapy, occupational therapy, and more. Imagine if there was a source of rehabilitation that allowed children and adolescents to engage in fun strength and endurance-building activities in the water. Aquatic therapy is a new form of rehabilitation within the Cerebral Palsy community. It is a form of aquatic exercise that helps to improve the child's quality of life, improves their balance and sitting abilities, gross motor functions, and increases their endurance. Aquatic therapy also offers a fun and relaxing environment for cerebral palsy children to participate in strengthening exercises.  

Beneficial Properties of Water:

• The buoyancy of water: reduces the amount of stress on joints, relieving patients of pain and discomfort.
• The viscosity of water: puts resistance on the patients while walking and moving around in the water, increasing muscle control and muscle strength. 
• Antigravity positioning: decreases patients' weight by a large percentage allowing them to participate in active motions while feeling lighter.
• Decreased compression on joints: reduces pain and increases fluidity motion and flexibility while completing exercises.
• Water temperature: keeping water temperature between 33* C and 38* C helps increase the body's temperature. Increases in the body temperature reduce gamma fiber activity, allowing muscles to go into a relaxed state easier and reducing muscle spasticity, leading to an increased range of motion.

Cerebral Palsy Classifications: 

Cerebral Palsy is categorized into four types: Spastic, Dyskinetic, Ataxic, and Mixed. Patients are classified using the Gross Motor Function Classification System (GMFCS) to classify individuals from levels I-V. Due to the variety of classifications, some patients are higher functioning while others are lower functioning. Aquatic therapists work alongside rehabilitation professionals to create individualized aquatic therapy interventions that consider the patients' classification levels and gross motor functional abilities. Individualized plans include a variety of exercises and mobility movements and utilizing flotation devices and assistive equipment to aid in keeping the patients' heads above water to help reduce body weight while participating in exercises.

Exercises/Activities Used in Aquatic Therapy:

• Anaerobic and Aerobic exercises
• Aquatic yoga      
• Swimming
• Floating
• Underwater walking
• Resistance exercises
• Balance exercises
• Manual passive stretching 

Flotation Devices/Assistive Equipment:

• Vests
• Barbells
• Resistance bands
• Wrist weights
• Kickboards
• Noodles
• Treadmills
• Adjustable mechanical chair

Literary Findings:

• While underwater walking, decrease the water depth by 1-1.5 inches every 5 minutes, decreasing the waters support on bodyweight leading to increased endurance and muscle strength
• Implementing aquatic therapy interventions in schooling systems increases the quality of life, cognitive abilities, increases attention span and social interactions. 
• Intervention duration should be a minimum of 10 weeks, meeting 2-3 times per week lasting 1-1.5 hours 

How can we continue to utilize aquatic therapy?

Aquatic therapy is beneficial alone and works alongside more traditional rehabilitation resources. Suppose the field can find a way to bridge together aquatic therapy with PT, OT, speech, and hand therapy. In that case, the child's participation levels can improve and provide a more energetic and fun environment. Using the literary findings, clinicians can use this work to implement different elements into their interventions to make them more effective. These suggestions can create more opportunities for adolescents to participate in strength and endurance therapy outside of a traditional rehabilitation center. 

Active Resources: 

• https://www.hydroworx.com/research-education/additional-resources/cerebral-palsy0aquatic-therapy/
• https://www.youtube.com/watch?v=CJBvF6m6mIA
• https://www.flintrehab.com/aquatic-therapy-for-cerebral-palsy/

Carly Walsh is a senior at Westfield State University majoring in Movement Science with a concentration in Sports Medicine and a minor in Psychology. Her plans are to further her education by continuing on in a graduate program for Occupational Therapy. Carly can be reached at carlyg1213@icloud.com.

References 

Akinola, B. I., Gbiri, C. A., & Odebiyi, D. O. (2019). Effect of a 10-week aquatic exercise training program on gross motor function in children with spastic cerebral palsy. Global Pediatric Health, 6. https://doi.org/10.1177/2333794x19857378

Aquatic therapy for cerebral palsy patients. HydroWorx. (2020, December 11). Retrieved December 10, 2021, from https://www.hydroworx.com/research-education/additional-resources/cerebral-palsy-aquatic-therapy/

Dimitrijević, L., Aleksandrović, M., Madić, D., Okičić, T., Radovanović, D., & Daly, D. (2012). The Effect of Aquatic Intervention on the Gross Motor Function and Aquatic Skills in Children with Cerebral Palsy. Journal of Human Kinetics, 32(2012), 167–174. https://doi.org/10.2478/v10078-012-0033-5

Muñoz-Blanco, E., Merino-Andrés, J., Aguilar-Soto, B., García, Y. C., Puente-Villalba, M., Pérez-Corrales, J., & Güeita-Rodríguez, J. (2020). Influence of Aquatic Therapy in Children and Youth with Cerebral Palsy: A qualitative case study in a special education school. International Journal of Environmental Research and Public Health, 17(10), 3690. https://doi.org/10.3390/ijerph17103690

Rehab, F. (2021, June 1). Aquatic therapy for cerebral palsy: Techniques and benefits. Flint Rehab. Retrieved December 10, 2021, from https://www.flintrehab.com/aquatic-therapy-for-cerebral-palsy/