Hydrotherapy for Children with Cerebral Palsy

 

Original Editor - Eoin McNamee

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Description

'Hydrotherapy' also known as 'Aquatic Therapy' involves therapeutically immersing the body in water where the physical properties of altered density and gravity, hydorstatic pressure, buoyancy, viscosity and thermodynamics can be used to promote physiological change [1]. The bouyancy and turbulence of water facilitates weight relief and ease of movement during rehabilitation to promote safe movement exploration, strengthening, and functional activity training [2]

Indication

Hydrotherapy is indicated in children with cererbal palsy. The main aim of aquatic therapy is: 

  • Provides resistance
  • Encourages a wider range of movement and opposition
  • Alleviates stress and tension
  • Reduces pain and tension in muscles and joints
  • Protects against injury
  • Improves cardiovascular conditioning since the heart pumps more blood per beat when body is submerged in water
  • Decreases post exercise discomfort

Safety Considerations and Outcome Measures

Absolute Contra-indications [3]

  • Acute vomiting / diarrhoea
  • Medical instability
  • Chlorine / Bromine allergy
  • Resting angina
  • Shortness of breath at rest
  • Uncontrolled cardiac failure
  • High BMI limiting exit from pool


Relative Contra-indications

  • Acute illness
  • Irradiated skin
  • Known aneurysm
  • Open infected wounds
  • Poorly controlled epilepsy
  • Unstable diabetes
  • Exercise dependent O2 demand increases


Outcomes should be meaured in dimensions outlined by the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) [4].


Common motor function meaures utilised in Aquatic Therapy research: [5]

  • Gross Motor Function Measure (GMFM) 
  • Paediatric Evaluation of Disability Inventory - functional skills
  • Dynamometer - muscle strength
  • Energy Expenditure Index (EEI) - energy efficiency
  • 3/5/6 minute walk tests
  • Timed up and Go (TUG)
  • Vital Capacity
  • Goniometry - range of movement
  • Ashworth Scale - spasticity


Swimming based measures:

  • Aquatics Independence Measure
  • Water Orientation Test-Alyn 2 (WOTA)


Social function measures:

  • PEDI - social function domain
  • Pictoral scale of perceived competence
  • Canadian Occupational Performance Measure

Key Evidence

Administered correctly, aquatic therapy can:

  • Improve muscle tone
  • Increase core strength
  • Enhance circulation
  • Improve cardiovascular functioning
  • Improve flexibility
  • Increase endurance
  • Extend range of motion
  • Reduce muscle spasticity
  • Elevate metabolism
  • Reduce sleep disturbances
  • Relieve joint stress
  • Improve muscle tone
  • Increase stability
  • Decrease pain and discomfort

Resources


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Recent Related Research (from Pubmed)

References

  1. Becker BE. Aquatic Therapy: Scientific Foundations and Clinical Rehabilitation Applications.PM&R; 2009,1;9:859-72
  2. Morris DM, Aquatic Rehabilitation for the Treatment of Neurologic Disorders .In: Cole AJ and Becker BE. Comprehensive Aquatic Therapy. 2nd edition. Philadephia: Butterworth Heinemann, 2004. p151-175.
  3. Aquatic Therapy Association of Chartered Physiotherapists. Guidance on Good Practice in Aquatic Physiotherapy. United Kingdom: Aquatic Therapy Association of Chartered Physiotherapists; 2015. Available from: http://atacp.csp.org.uk/guidance-good-practice-aquatic-physiotherapy-2015
  4. World Health Organisation. The International Classification of Functioning, Disability and Health for Children and Youth (ICF–CY), 2007.
  5. Jorgić B, Dimitrijević L, Lambeck J, Aleksandrović M, Okičić T, Madić D. EFFECTS OF AQUATIC PROGRAMS IN CHILDREN AND ADOLESCENTS WITH CEREBRAL PALSY: SYSTEMATIC REVIEW. Sports Science. 2013 [cited 2016 Oct 21];5(2):49–56. Available from: http://www.sposci.com/PDFS/BR0502/SVEE/04%20CL%2009%20BJ.pdf.