Ancient Egyptians knew it, Greek philosopher and writer Hippocrates was talking about it over 2,400 years ago and physicians of the Roman Empire recommended it. The amazing effect of water therapy, or aquatic therapy, is working to improve the lives of children with a wide range of disabilities. The only side effect appears to be smiles.
Immersing the body in water causes an increase in blood flow, which positively affects the musculo-skeletal system. According to United Cerebral Palsy, benefits of aquatic therapy include improved muscle tone and strength, elevated endurance and cardiovascular efficiency, improved self-esteem, improved healing after injury and recovery from intense exercise, enhanced mood, improved quality of life, increased circulation, improved flexibility and range of motion and increased balance and coordination.
In a recent study of young children with autism, clinicians saw substantial increases in attention, muscle strength and balance, as well as the ability to tolerate touch and to initiate and maintain eye contact. An article in the Journal of Physical Education, Recreation and Dance reported some of the benefits for children with autism who had received aquatic therapy for a period of 10 years, included an improvement in movement skills and family bonding, as well as the advantages of providing sensory input.
Aquatic therapy has many attributes that make it an ideal therapeutic low-impact activity for either an indoor or outdoor pool. "For children with physical disabilities, the indoor pool provides a gravity-reduced environment that allows them to work on motor skills that may be difficult on land," explains Lisa Koo, OTR/L at Bergen Pediatric Therapy Center in Westwood. "The center's aquatic therapists help children with a variety of special needs, including abnormal muscle tone, coordination difficulties and sensory processing disorders."
The benefits of therapy in a water environment are in water’s unique ability to create an atmosphere of buoyancy, acting as a support for the spine or a weakened limb, and allowing for more comfortable movement than would otherwise be possible on land. "Water provides buoyancy," Koo notes, "making the patient feel lighter, move easier and allow less weight on weight-bearing joints. The resistance of the water provides a safe surrounding for strength and balance training."
It is a unique and motivating experience for children to be able to address their therapeutic goals in water, says Koo. "The aquatic environment provides tactile, deep pressure." Because of salt water’s ability to support more weight, the heated salt water pool offers even more buoyancy. Koo says this "assists in relaxing muscles and decreasing abnormal tone in children with motor impairments."
Another benefit of performing therapeutic exercises in water is the reduced force on joints and a reduction in levels of spasticity. When the water is heated, it relaxes the body and increases circulation. "The warmth of the water," Koo says, "helps decrease abnormal tone by relaxing spastic muscles and gently stretching soft tissue."
In terms of sensory issues, because the hydrostatic pressure of the water increases with the depth of the pool, it is very organizing for the child. "Aquatic therapy requires less physical handling of the child as opposed to land therapy," Koo says. "Sensory stimulation of water increases body awareness which facilitates kinesthesia and motor planning." In other words, there is an increased sense of the body, which results in better movement and control. There is also improved sensory integration which Koo says results from the water’s ability to facilitate an optimal level of arousal. "Fluid pressure is exerted equally on all surface areas of an immersed body at rest."
Another difference between land and aquatic therapy is the ability water has to provide turbulence that offers resistance. "Resistance also occurs when moving away from the surface of the water," Koo explains. "Assistance occurs with movement toward the water surface and support occurs at the surface."
In addition to those with cerebral palsy and autism, Koo notes that aquatic therapy helps with a wide range of other disabilities. Anyone with sensory processing delays, low muscle tone, neurodevelopmental delays, muscular dystrophy or spina bifida or spinal cord injuries can benefit.
One of Koo’s patients at the center is a 4-year-old boy who suffered a spinal cord injury due to a car accident. "S.A. loves aquatic therapy," his mother says. "He looks forward to being in the pool because the water allows him to freely move his upper extremities." While the boy has difficulty with certain activities on land, she says he is finding more success in the water. "It also allows him to stand freely without the confinement of an adaptive equipment."
Because many therapeutic activities are more achievable in a water environment, there is a greater chance for increased motivation and success. This can translate into more effort. Since more movement is possible, the therapeutic benefits are greater. As the mother of S.A. points out, "Aquatic therapy assists with providing the postural control he needs and I find that more muscles groups are being treated simultaneously."
Another patient is 16-month-old Leo, who suffered a stroke in utero. He has mild cerebral palsy. "I believe aquatic therapy has been very beneficial for Leo," says his mother. "His father and I are Pilates instructors… so we understand the physical aspects of strengthening, flexibility and control of the body as it relates to our son." She says Leo loves being in the water, and engages in more therapeutic activities. "The water teaches him to know where his body is in space, which is difficult to teach on land. The heated environment helps decrease his spasticity and keep his muscles limber. The water also provides constant resistance which has helped him become stronger and achieve functional use of his right side."
In addition to the physical advantages, aquatic therapy offers other benefits, including opportunities to incorporate and enhance recreation and socialization. The increased experience of success in the water environment also boosts confidence and self esteem. For parents who have watched their special needs child struggling to reach his/her therapeutic goals, the difference can be dramatic. "For S.A.," says his mom, "I believe aquatic therapy is one step above land PT/OT and I highly recommend it for any child with special needs."
Kathryn Davis is a New Jersey special education teacher and mother of three.
Bergen Pediatric Therapy Center, www.bergenpediatrictherapy.com