Hydrotherapy for Children with Cerebral Palsy
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Hydrotherapy also known as 'Aquatic Therapy' involves therapeutically immersing the body in water where the physical properties of altered density and gravity, hydrostatic pressure, buoyancy, viscosity, and thermodynamics can be used to promote physiological change[1]. It differs from a normal swimming pool because it involves special exercises in a warm-water pool with a temperature between 33–36ºC. Hydrotherapy is beneficial in treating children with neurodevelopmental disorders like Cerebral Palsy by improving their physical and psychological well-being. [2]
The buoyancy and turbulence of water facilitate weight relief and ease of movement during rehabilitation to promote safe movement exploration, strengthening, and functional activity training[2]. It helps them with body movements, particularly those with difficulty moving on the ground. Therefore, hydrotherapy is suggested as a supportive and complementary therapy for children with cerebral palsy, even those with low Gross Motor Function Classification System (GMFCS) levels.
Benefits[edit | edit source]
Hydrotherapy is recommended for children with cerebral palsy. When used effectively, hydrotherapy has the potential to reduce joint load and friction between articular surfaces due to buoyancy. Additionally, it can improve endurance, aerobic capacity, and muscle strength, and reduce spasticity. Water also provides sensory information, improves lymphatic circulation, and offers postural support, a sense of independence, and the opportunity for rotational movements that some patients may not experience without hydrotherapy.[3]
Safety Considerations and Outcome Measures[edit | edit source]
Absolute Contra-indications.[4]
- Acute vomiting/diarrhoea.
- Medical instability
- Chlorine / Bromine allergy
- Resting angina
- Shortness of breath at rest
- Uncontrolled cardiac failure
- High BMI limiting exit from the 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 measured in dimensions outlined by the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY)[5].
Common motor function measures utilized in Aquatic Therapy research:[6]
- Gross Motor Function Measure (GMFM).
- Pediatric 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
- Pictorial scale of perceived competence
- Canadian Occupational Performance Measure
Key Evidence[edit | edit source]
Administered correctly, aquatic therapy can:
- Improve muscle tone
- Increase core strength
- Enhance circulation
- Improve cardiovascular functioning
- Improve flexibility and balance[7]
- 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
References[edit | edit source]
- ↑ Becker BE. Aquatic Therapy: Scientific Foundations and Clinical Rehabilitation Applications.PM&R; 2009,1;9:859-72
- ↑ 2.0 2.1 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.
- ↑ Chandolias K, Zarra E, Chalkia A, Hristara A. The effect of hydrotherapy according to Halliwick concept on children with cerebral palsy and the evaluation of their balance: a randomised clinical trial. Int J Clin Trials. 2022;9(4):234.
- ↑ 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
- ↑ World Health Organisation. The International Classification of Functioning, Disability and Health for Children and Youth (ICF–CY), 2007.
- ↑ 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.
- ↑ Chandolias K, Zarra E, Chalkia A, Hristara A. The effect of hydrotherapy according to Halliwick concept on children with cerebral palsy and the evaluation of their balance: a randomised clinical trial. Int J Clin Trials. 2022;9(4):234.
