Hydrotherapy for Children with Cerebral Palsy: Difference between revisions

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== Description   ==
== Description<br>  ==


'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 <ref>Becker BE. Aquatic Therapy: Scientific Foundations and Clinical Rehabilitation Applications.PM&amp;amp;amp;amp;amp;amp;R; 2009,1;9:859-72</ref>. 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&nbsp;<ref>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.</ref>.&nbsp;<br>  
Hydrotherapy also known as '[https://www.physio-pedia.com/Aquatherapy 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<ref>Becker BE. Aquatic Therapy: Scientific Foundations and Clinical Rehabilitation Applications.PM&amp;R; 2009,1;9:859-72</ref>. 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. <ref name=":0" />


== Indication<br> ==
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<ref name=":0">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.</ref>. 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 Introduction|cerebral palsy]], even those with low  Gross Motor Function Classification System (GMFCS) levels.<br>
== Benefits    ==


Hydrotherapy is indicated in children with cererbal palsy. The main aim of aquatic therapy is:&nbsp;
Hydrotherapy is recommended for children with [[Cerebral Palsy Introduction|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.<ref>Chandolias K, Zarra E, Chalkia A, Hristara A. [https://www.researchgate.net/profile/Konstantinos-Chandolias/publication/364621412_The_effect_of_hydrotherapy_according_to_Halliwick_concept_on_children_with_cerebral_palsy_and_the_evaluation_of_their_balance_a_randomised_clinical_trial/links/63538b1a6e0d367d91b4516b/The-effect-of-hydrotherapy-according-to-Halliwick-concept-on-children-with-cerebral-palsy-and-the-evaluation-of-their-balance-a-randomised-clinical-trial.pdf 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. </ref>
 
*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  ==
== Safety Considerations and Outcome Measures  ==


Absolute Contra-indications&nbsp;<ref>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</ref>  
Absolute Contra-indications.<ref>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</ref>  


*Acute vomiting / diarrhoea  
*Acute vomiting/diarrhoea.
*Medical instability  
*Medical instability  
*Chlorine / Bromine allergy  
*Chlorine / Bromine allergy  
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*Shortness of breath at rest  
*Shortness of breath at rest  
*Uncontrolled cardiac failure  
*Uncontrolled cardiac failure  
*High BMI limiting exit from pool
*High BMI limiting exit from the pool
 
<br>
 
Relative Contra-indications  
Relative Contra-indications  


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*Poorly controlled epilepsy  
*Poorly controlled epilepsy  
*Unstable diabetes  
*Unstable diabetes  
*Exercise dependent O2 demand increases
*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)<ref>World Health Organisation. The International Classification of Functioning, Disability and Health for Children and Youth (ICF–CY), 2007.</ref>.  
<br>
 
Outcomes should be meaured in dimensions outlined by the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY)&nbsp;<ref>World Health Organisation. The International Classification of Functioning, Disability and Health for Children and Youth (ICF–CY), 2007.</ref>.  
 
<br>


Common motor function meaures utilised in Aquatic Therapy research:&nbsp;<ref>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.</ref>  
Common motor function measures utilized in Aquatic Therapy research:<ref>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.</ref>  


*Gross Motor Function Measure (GMFM)&nbsp;
*Gross Motor Function Measure (GMFM).
*Paediatric Evaluation of Disability Inventory - functional skills  
*Pediatric Evaluation of Disability Inventory - functional skills
*Dynamometer - muscle strength  
*Dynamometer - muscle strength  
*Energy Expenditure Index (EEI) - energy efficiency  
*Energy Expenditure Index (EEI) - energy efficiency  
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*Vital Capacity  
*Vital Capacity  
*Goniometry - range of movement  
*Goniometry - range of movement  
*Ashworth Scale - spasticity
*[[Modified Ashworth Scale|Ashworth Scale]] - [[spasticity]]
 
<br>
 
Swimming based measures:  
Swimming based measures:  


*Aquatics Independence Measure  
*Aquatics Independence Measure  
*Water Orientation Test-Alyn 2 (WOTA)
*Water Orientation Test-Alyn 2 (WOTA)
<br>
Social function measures:  
Social function measures:  


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


== Key Evidence ==
== Conclusion ==


Administered correctly, aquatic therapy can:  
Administered correctly, aquatic therapy can:  
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*Enhance circulation  
*Enhance circulation  
*Improve cardiovascular functioning  
*Improve cardiovascular functioning  
*Improve flexibility  
*Improve flexibility and balance<ref>Chandolias K, Zarra E, Chalkia A, Hristara A. [https://www.researchgate.net/profile/Konstantinos-Chandolias/publication/364621412_The_effect_of_hydrotherapy_according_to_Halliwick_concept_on_children_with_cerebral_palsy_and_the_evaluation_of_their_balance_a_randomised_clinical_trial/links/63538b1a6e0d367d91b4516b/The-effect-of-hydrotherapy-according-to-Halliwick-concept-on-children-with-cerebral-palsy-and-the-evaluation-of-their-balance-a-randomised-clinical-trial.pdf 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. </ref>
*Increase endurance  
*Increase endurance  
*Extend range of motion  
*Extend range of motion  
*Reduce muscle spasticity  
*Reduce muscle [[spasticity]]
*Elevate metabolism  
*Elevate metabolism  
*Reduce sleep disturbances  
*Reduce sleep disturbances  
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*Increase stability  
*Increase stability  
*Decrease pain and discomfort
*Decrease pain and discomfort
== Resources  ==
<br>&lt;img class="FCK__MWTemplate" src="http://www.physio-pedia.com/extensions/FCKeditor/fckeditor/editor/images/spacer.gif" _fckfakelement="true" _fckrealelement="0" _fck_mw_template="true"&gt;
== Case Studies  ==
add links to case studies here (case studies should be added on new pages using the &lt;a href="Template:Case Study"&gt;case study template&lt;/a&gt;)<br>
==  ==
<div class="researchbox"><rss>https://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1P5hUf9EVi7DANk4JXRqG5VfmzggAukOPUREM057eulao1egH0|charset=UTF-8|short|max=10</rss></div>


== References  ==
== References  ==
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&nbsp;<br>
&nbsp;<br>
[[Category:Cerebral Palsy]]
[[Category:Paediatrics]]
[[Category:Paediatrics - Interventions]]

Latest revision as of 12:26, 27 June 2024

Description[edit | edit source]

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

Conclusion[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]

  1. Becker BE. Aquatic Therapy: Scientific Foundations and Clinical Rehabilitation Applications.PM&R; 2009,1;9:859-72
  2. 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.
  3. 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.
  4. 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
  5. World Health Organisation. The International Classification of Functioning, Disability and Health for Children and Youth (ICF–CY), 2007.
  6. 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.
  7. 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.