What is aquatic therapy?
The Aquatic Therapy and Rehabilitation Institute defines Aquatic Therapy as "The use of water and specifically designed activity by qualified personnel to aid in the restoration, extension, maintenance and quality of function for persons with acute, transient, or chronic disabilities, syndromes or diseases".
Simply put, aquatic therapy means making use of various physical and chemical properties of water for the treatment of various disorders.
The most common question that arises in the mind is when we live on land how can being in water help us. That is also the answer to the question because water provides us an alternative environment where the body is more supported and can experience a larger degree of freedom otherwise unavailable on land. Aquatic therapy is always used in conjunction with land based rehabilitation.
Aquatic therapy is usually conducted in swimming pools and therefore there is a risk of accidents, especially with children who have limited cognitive capabilities. Hence the children should always be accompanied by professionals who are trained and qualified in identifying and preventing these risks.
There are different ways of conducting aquatic therapy it could in the form of one on one session with child and therapist, sometimes family members can be involved in one on one session or group of therapists with family members can conduct group therapy.
Various techniques are used in aquatic therapy. Some of the most commonly used techniques are Halliwick, Bad Ragaz ring method, Watsu, Aai Chi and aquatic exercises.
Why aquatic therapy?
- Benefits to the heart and blood circulation: Compressibility of water is poor, therefore it exerts a pressure on the immersed body from all the directions. This compressive force helps pump the blood from blood vessels back to the heart, increasing the amount of blood that enters the heart. Due to this increase in the volume of received blood heart is able to pump out more blood with every heart beat; increasing the cardiac output.
- Benefits for the brain and learning: Shoulder or Neck deep immersion increases the cardiac output and also created a larger pressure gradient in the blood pumped out and the blood vessels of brain, thereby increasing the blood supply to the brain. Increased blood supply means that brain receives nutrients much more efficiently and the toxic waste is taken away quickly. Water immersion therefore has a beneficial effect for memory and cognitive tasks.
- Psychological and behavioral benefits: Inappropriate or exaggerated responses of anxiety to any unpleasant stimuli in children with Autism spectrum disorders are thought to be due to autonomic nervous system dysfunction causing over arousal of sympathetic nervous system and depression of parasympathetic nervous system. Altered autonomic nervous system function is thought to be one of causal factors in Autism Spectrum disorders. Increased blood supply to brain and cardiac systems also leads to activation of the parasympathetic nervous system and suppression of the sympathetic nervous system; after immersion in water. Mere immersion in water therefore helps reduce anxiety, hyperactivity, repetitive motor mannerisms, stereotypical behavioral and inappropriate emotional responses. Water immersion results in calming of the children on spectrum.
- Beneficial effects on joint position sense and muscle co-ordination: Buoyancy and up thrust experienced in water provides freedom of movement, which is lacking on land due to poor motor planning and co-ordination and increased risk of fall. Water supports the child but at the same time creates a relatively unstable environment providing vestibular inputs. Viscosity of water combined with hydrostatic pressure provides proprioceptive inputs. These are crucial in addressing the low tone and in-coordination in these children.
Benefits of aquatic therapy in Autism
- Improve Posture, Coordination, and Body Control
- Reduces Sensory Issues
- Improves Social Skills
- Improves Cognitive Functions like memory and learning
- Improves attention and concentration
- Improves tolerance for performing a task
- Improves oromotor control and stimulates speech
- Improves sleep patterns
- Reduces hyperactivity
- Reduces the vestibular seeking behaviour
Reduces stimulatory behaviour
What to expect in a session of aquatic therapy?
An aquatic therapy session can be conducted as an individual session or group therapy session. Group therapy sessions are particularly beneficial for improving the social skills and behavioural abnormalities in these children.
A detailed assessment should be duly undertaken before the session. Building a rapport with the child on land before entering into the alien water environment is essential. There are various techniques that a therapist may utilize during these sessions. Some of the common concepts in aquatic therapy are Halliwick therapy which uses a 10 point program to increase the water adaptability, breath control and movement of the body when immersed in water. Bad Ragaz ring method is essentially used for motor system deficits like low tone, muscle weakness and in-coordination. Aai chi uses various postures and movements in water which provide active relaxation where as Watsu is a technique used for passive relaxation while in water. Various aquatic exercises can be used for building the aerobic endurance. Aquatic therapist will make use of all of these techniques in combination for optimum results.
The time duration for the aquatic program is pre-determined. Ideally an aquatic therapy program for ASD should be for about 2-6 months with a frequency of 1-3 times per week.
What does research suggest about aquatic therapy?
The current evidence for benefits of aquatic therapy in Autism is preliminary and limited. The early evidence comes from a case report of a 9 year old child suffering from Autism treated with a 10 week long aquatic therapy program primarily based on Halliwick concept which showed improvement in physical fitness parameters like balance, speed, agility, cardiorespiratory endurance and muscle strength, endurance and power. It also showed reduction of repeated stereotype motor mannerisms. This was followed by a survey of the perception of Occupational therapists about the benefits of aquatic therapy in Autism. Eighteen therapists participated in this study and unanimously agreed that there is significant improvement in tolerating touch and maintaining eye contact post therapy. When further tested with non randomized controlled trials they too showed similar results. Four non randomized controlled trials unanimously showed beneficial effects of aquatic exercises over normal treatment methods in aquatic skills and safety, cardiovascular endurance (Ability to perform activities in the target heart rate zone for a longer time), muscular strength and endurance and social skills. One of the trials showed reduction in antisocial behavior and repeated motor mannerisms; the other showed increased functional mobility of children and greater satisfaction of the parents with use of aquatic exercises.
The available evidence is therefore clinically significant in identifying the benefits of aquatic therapy in autism to improve motor skills, social and behavioral skills and physical fitness. The strong point of all these trials was use of relevant and standardized outcome measures. However, the results cannot be generalized over the spectrum as participants in all of the above mentioned trials were small in numbers, categorized as high functioning autism or asperger’s syndrome between the age group of 4 to 12. The long term carry over effect of the therapy has not been tested. The exercise programs lasted for a maximum of 14 weeks and a carryover effect was also measured for the same duration.