What is Aqua Therapy?

Called aquatic therapy, or aqua therapy, the use of water and water-induced resistance to improve physical functioning is accepted by the medical community as a method in which to rehabilitate, or re-educate, the human body. For children with cerebral palsy, water can be a healing force. All activities the child engages in takes place in a pool (heated or non-heated).

More than 50 percent of body weight is water. Gravity and body weight impacts the way the body moves. Aquatic therapy presents a near complete reversal of these. Water reduces a human’s body weight by 90 percent, allowing children and adults to ambulate freely in a way that doesn’t place undue stress on the musculoskeletal system from forces such as gravity and body weight.

Aqua therapy is one of the best environments for a child with cerebral palsy to improve physical functioning, especially if the child is not ambulatory. What sets aquatic therapy apart from traditional physical therapy is that the water – which in and of itself is known for restorative and detoxifying properties – provides buoyancy that makes aerobic and anaerobic exercises easy to perform effectively, and safely. Additionally, if the water is warm, it has a massage effect on muscles, joints and ligaments that often times are over-used and in pain.

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

What are the Benefits of Aquatic Therapy?

Aqua therapy benefits children with cerebral palsy in numerous ways.

Benefits of water therapy include:

  • 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

Although traditional physical therapy can be immensely effective in teaching children with cerebral palsy how to move, water has the added benefit of hydrating, oxygenating and revitalizing the body’s musculoskeletal system. Gravitational pull is released, and weightlessness qualities are achieved. Range of movement increases and repetition, stretching and balancing is more sustainable.

Additionally, the viscosity of the water provides an excellent source of resistance, which can be incorporated into and aquatic therapy program. For instance, walking in water provides more than 10 times more resistance than walking on land, which means an aquatic therapy patient receives the benefit of deep, intense exercises while in a soothing and comforting environment.

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.

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

Aquatic therapy can also improve a child’s disposition and self-esteem by providing a sense of accomplishment as they master the exercises that take place in the pool. Pools are usually perceived as a source of enjoyment for children.

Psychologically, aquatic therapy can:

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

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When is Aquatic Therapy Advised?

There is no specific age, or point in a child’s therapy, that dictates when or if a child would benefit from aquatic therapy.

A child does not have to know how to swim to take part in an aquatic therapy program, although some familiarity with the water can be helpful in terms of easing the anxiety a child may experience if he or she has never been in a pool. Specific exercises and provisions will be made for children based on their age, physical condition and cognitive abilities in an effort to ensure the environment is safe, and the therapy is effective. If the child is severely restricted in movement, such as having quadriplegia, lifts and assistive technology are deployed to safely provide for the child’s therapy session.

If a child has medical issues – such as allergies or asthma – aquatic therapy may not be advised. It is always recommended to seek the approval of your child’s primary care physician when considering therapy.

Aquatic therapy, while effective, is unlikely to be covered by typical health insurance plans.

What Happens During Aquatic Therapy?

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

Once the warm-up is complete, a child 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 exercise regimen is designed to maximize and expand a child’s capabilities. However, the regimen will begin slowly, with the length and frequency of exercises increasing gradually as a child’s strength, flexibility, coordination and stamina improves.

Most often, aquatic therapy makes use of Propioceptive Neuromuscular Facilitation, which focuses on rhythmic, cardiovascular and conditioning movements that assist children in moving their limbs.

The exercises include, but are not limited to:

  • 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

The water – with the assistance of a practitioner – will help a child achieve position that may not be possible in other therapeutic environments. Additionally, a practitioner will also help children transition what they learn in the water to land – greatly enhancing their capabilities. Practitioners will also work with patients to help them achieve measurable goals.

Where is Aquatic Therapy Performed?

Aquatic therapy can be performed in several settings. 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. Pools may be located indoors or outdoors.

Aquatic therapy may place take place at:

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

Who Provides Aquatic Therapy?

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.

Most physical therapy programs at universities do not provide instruction in aquatic therapy, but comprehensive training and certification is available through the Aquatic Exercise Association (AEA), which was formed several years ago to implement standards to study and advance the cause of aquatic therapy.

AEA Aquatic Fitness Professional Certification (AFPC) is an intermediate level certification which allows professionals to teach aquatic fitness. The certification is based on the Aquatic Fitness Professional Manual, published by Human Kinetics which provides industry standards and guidelines. The manual covers several topics, each of which the applicant must master before certification is granted.

The subjects include:

  • Movement mechanics
  • Aquatic principles
  • Aquatic therapy principles
  • Professional responsibility
  • Health and safety
  • Legal considerations

Before an applicant can sit for the certification exam, he or she must complete the equivalent of 15 credit hours in aquatic therapy training, either at a training center, or online.

The AEA examination adheres to Council on Licensure, Enforcement and Regulation guidelines.

Once a therapist is AEA-certified, he or she must re-certify every two years, and maintain a valid CPR certificate.

Certification is also available through Aquatic Therapy & Rehabilitation Institute (ATRIC).

Before an applicant can sit for the certification exam, he or she must complete the equivalent of 15 credit hours in aquatic therapy training, either at a training center, or online. Training is available at workshops that are offered in many different locations, and testing covers the same topics as the AEA certification examination.

Are There Special Considerations or Risks for Aquatic Therapy?

Under the supervision of a trained, certified professional therapist, aquatic therapy is considered safe for children with cerebral palsy.

However, parents should pay attention during therapy sessions to make sure a child is always attended to both in and out of the water by the practitioner. Not only should the practitioner instruct the child in proper techniques for performing exercises, they should also ensure the child’s safety by using floatation devices, body boards or float belts when necessary.

Because there is no blueprint for how cerebral palsy affects a child, it’s important that an aquatic therapy regimen takes into account a child’s challenges as well as capabilities.