Healing Waters — Aquatic Therapy for Cerebral Palsy

Aquatic Therapy for Cerebral PalsySandy Oeverman was working as a lifeguard at a community pool that was particularly popular among senior citizens. One repeat visitor to the “senior swim time” caught her particular attention for the way he changed from the beginning of the pool session to the end.

Sandy writes on brainline.org:

“His posture was bent and his slow, difficult movements told of his pain with each arthritic step. Once he made his descent into the warm water, his posture relaxed and his movements became visibly smoother and less painful. He spent the next half hour leisurely stretching, paddling about, and socializing with the other pool patrons. When the old man exited the pool, he looked like a younger, more limber version of himself. However, the most marked improvement in his appearance was his attitude. The man always smiled and bid me a fond farewell after each session in the pool.”

The transformative effect of water on people with impaired body movement and muscle control has been well-documented in the past several years. It is shown to be a particularly advantageous form of therapy not only for the elderly, but also for those with cerebral palsy. The unique properties of water offer not only a beneficial environment for improving a patient’s physical capability and decreasing spasticity, but also contribute to an improved state of mind.

‘Upward Thrust’

More than 50 percent of our body weight is water, and gravity and body weight impact the way the body moves. These are forces that we all must contend with every day, and it seems effortless to most of us.

People with cerebral palsy, however, have a very hard time negotiating their movements against these forces. Even some forms of therapy, while ultimately beneficial, can be very demoralizing for people with cerebral palsy, since the patient’s compromised muscular capability puts him or her in constant danger of falling.

However, these factors are effectively “washed away” when a patient undertakes the same activities in water.

Being immersed in water reduces a human’s body weight by 90 percent, allowing it to move freely in a way that doesn’t place undue stress on the musculoskeletal system from forces such as gravity and body weight.

The buoyancy of water causes the individual to feel an upward thrust when submerged. This force acts in the opposite direction of gravity. Buoyancy allows for a variety of exercises to be performed in the pool with minimal equipment. In addition, people with balance deficits may experience less fear of falling while walking and exercising in the pool.

This kind of therapy is known among professionals as aquatic therapy, aqua therapy or hydrotherapy. These terms refer to the use of water and water-induced resistance to improve physical functioning. Under the supervision of a trained and certified professional therapist, aquatic therapy provides deep, intense exercise within a soothing and comforting environment.

The Benefits of Buoyancy

Aquatic therapy aims to:

  • Improve physical function
  • Develop and maintaining physical control
  • Improve psychological outlook
  • Enhance self-concept and confidence
  • Increase independence and quality of life

The various forms of aquatic therapy are helpful because they have little or no side effects that can harm the person with cerebral palsy. It helps to tone the muscles and develop coordination without any risk of injury in falling on a hard surface. Instead, the water’s viscosity offers gentle resistance that can be up to 10 times more effective than engaging in similar activities on land. This means an aquatic therapy patient receives the benefit of deep, intense exercises while in a soothing and comforting environment.

Water’s buoyancy alleviates the stress on the body that gravity causes. This allows the muscles to enjoy have a gentler “learning curve” than in other forms of exercise. And by allowing an individual to ambulate freely, water gives the person with cerebral palsy a higher range of motion capabilities. A patient immersed in water can, with the help of a professional therapist, achieve positions that may not be possible in other therapeutic environments; with the therapist’s help, a patient can learn to transition what they accomplish in the water to land.

Being immersed in water can also help with blood and nervous system development. The heart pumps more rigorously when the body is submerged. Hydrostatic pressure – or the pressure in water at rest due to the weight of the water above that point – benefits patients by decreasing swelling, reducing blood pressure and improving joint position. This in turn improves a patient’s proprioception, or body awareness. If the pool is heated, it has extra benefits in soothing muscular stiffness or pain, as well as improving mobility and flexibility.

Finally, there is the healing, mood-uplifting property of the water itself. This may sound kooky, but it is actually backed by science. Hydrostatic pressure turns down the brain’s system of arousal and turns down the volume, so to speak, on sensory input to the brain. Individuals who normally have a negative response to touch are often able, once in the pool, to tune out their surroundings, achieve calm and enjoy the detoxifying effect of exercise in the water.

Backed By Studies

Aqua therapy is widely accepted by the medical community as a proven method for rehabilitating the human body. A 2005 study published in Developmental Medicine and Child Neurology reported that participants of aquatic therapy enjoyed improvements in flexibility, respiratory function, muscle strength, gait and gross motor functions. None of the studies evaluated showed negative effects of aquatic exercise on the level of fatigue in patients with cerebral palsy.

Perhaps even more importantly, aquatic therapy can also improve a patient’s disposition and self-esteem by providing a sense of accomplishment as they master the exercises that take place in the pool.

Psychologically, aquatic therapy has been shown to:

  • Improve self-esteem
  • Empower
  • Increase confidence
  • Enhance quality of life
  • Encourage relaxation
  • Provide comfort
  • Increase socialization

Aquatic therapy has been shown as particularly effective for children with cerebral palsy, but there is no specific age or point in a patient’s therapy that dictates against aquatic therapy. A patient does not even have to know how to swim. Specific exercises and provisions will be made for the patient based on their age, physical condition and cognitive abilities.

How Does It Work?

After an evaluation of the patient’s overall health and a discussion about their capabilities and challenges, an aquatic therapy session begins with a warm-up, which includes stretching, before a patient is immersed in either a conventional pool or a rehabilitation pool. Depending on the patient’s needs and the course of therapy, the pool may be heated.

Once the warm-up is complete, a patient will begin to perform a series of supervised exercises; often with a floatation device such as body boards, life jackets, pool noodle, floating barbell or safety belts. The regimen will begin slowly, with the length and frequency of exercises increasing gradually as a patient’s strength, flexibility, coordination and stamina improve.

The exercises include:

  • Shallow walking or running in knee- or ankle-deep water
  • Deep water walking or running with broad strides while standing in chest- or waist-deep water
  • Kicking against water while holding onto the side of the pool
  • Ai chi (water-based tai chi)
  • Swimming
  • Water-based yoga

Where to Find Therapists

Practitioners of aquatic therapy are most often physical or occupational therapists who meet certification requirements to provide therapeutic services. Certification in aquatic therapy is also open to medical professionals, as long as they are in good standing and properly licensed or certified within their chosen professions.

You’ll find therapists who practice aquatic therapy in several settings:

  • Rehabilitation hospitals
  • Spas
  • Private rehabilitation centers
  • Public pools scheduled for private use
  • Home-based therapeutic pools and spas

Most often, aquatic therapy will take place in a rehabilitative environment; it’s not typically a therapy that occurs in a medical office or in an educational setting because either a conventional pool or specially-designed rehabilitation pool must be available for use.

The AEA Aquatic Fitness Professional Certification (AFPC) is an organization that certifies therapists in safe and effective aquatic therapy. If you have interest in locating a certified aquatic therapist, contact them.

Because there is no blueprint for how cerebral palsy affects a patient, it’s important that an aquatic therapy regimen takes into account their challenges as well as capabilities. In addition, caregivers should pay attention during therapy sessions to make sure a patient is always attended to both in and out of the water by the practitioner.

‘The Unique Properties of Water’

Aquatic therapy fosters functionality, mobility, fitness, and independence, and goes a long way to restoring mental and emotional well-being…not only for the patient, but for the caregiver, as well. There’s nothing quite like seeing someone you love flourish under the healing power of water.

As Sandy Oeverman reports:

“People with disabilities are often caught in a cycle of pain, depression, and stress. Disability can lead to social isolation, an external locus of control (believing that one does not have choice or possess control of one’s destiny), and the belief that exercise and fitness is impossible for them. Aquatic therapy is able to break this chronic pain cycle largely because of the unique properties of water.”

Get the Help You Need

At The Oshman Firm, our attorneys are happy to offer resources and information to those suffering from cerebral palsy and their families. We are attorneys who represent families harmed by cerebral palsy and other conditions as a result of doctor error during birth. If this has happened to you, please contact us at (800) 400-8182 or contact us online.

Ted Oshman


Ted Oshman has been with The Oshman Firm since 1988 serving clients for over 25 years. Learn more about Ted's background and featured practice areas here.

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