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Aquatic Therapy

What is aquatic therapy?


The Aquatic Therapy Association of Chartered Physiotherapists (ATACP) defines aquatic therapy as "A physiotherapy programme utilising the properties of water, designed by a suitably qualified Physiotherapist. The programme should be specific for an individual to maximise function, which can be physical, physiological, or psychological. Treatments should be carried out by appropriately trained personnel, ideally in a purpose built, and suitably heated Aquatic Physiotherapy Pool" [1].

Basically aquatic therapy, sometimes known as hydrotherapy, although this refers to a broader practice, takes advantage of the properties of water, such as buoyancy, to achieve certain therapeutic goals, such as:

  • Alleviate symptoms of certain diseases and injuries [2];

  • Improve motor skills, coordination and speech [3];

  • Improve muscle tone and strength [4];

  • Recovery from fractures, trauma and surgery [2];

  • Preparation for surgery [2];

  • Etc.

It is a personalized treatment carried out by a qualified physiotherapist [1] and when combined with other forms of therapy it is possible to have a more focused approach on the patient's specific problems. It may involve small group classes, if it benefits the patient. With children, it is usually "disguised" as play and, although it is not as effective in some aspects as land based exercise, they usually prefer it [5].

As explained above, it should be performed in a purposely built pool, with easy access through a flight of stairs, a floor designed for easy grip and variable depth for different weight bearing loads [6].

What properties of water may be used for therapeutic purposes and what benefits do they provide?

 

  • Buoyancy, which helps unload the joints by supporting the body, reducing pain and providing freedom of movement, and can be used to create resistance, to improve mobility;

  • Drag and friction create resistance when the body moves, which can be used to improve strengthening and mobility;

  • Turbulence can be used for strengthening, by creating resistance, and for balance and stability by creating an unstable environment;

  • Hydrostatic pressure promotes circulation, reduces swelling and increases the work of breathing;

  • Temperature can be modulated, affecting circulation (hot water causes vasodilation while cold water causes vasoconstriction) and controlling edema and inflammation associated with lesions [6, 7];

Aquatic Therapy in achondroplasia


There is a clear lack of published literature about the effects of aquatic therapy in people with achondroplasia.

However, ALPE Foundation has published resources on this subject, namely a poster explaining the benefits of aquatic therapy in this population, a case study of the treatment of a child with aquatic therapy and a swimming exercise guide for babies, both developed by Dr. Carmen Barreal.

Aquatic therapy in achondroplasia aims to improve motor skill development, muscle tone (children with achondroplasia have low muscle tone) and joint mobility, with special care to improve elbow extension and rotation, head control, rotational movements and respiratory control.

It provides a number of benefits, beside the ones listed before, including:

  • Elongation and strengthening of the back muscles;
  • Strengthening of the abdominal muscles;
  • Improvements in balance and coordination;
  • Improvements in lung capacity.


The full poster can be seen here.


The case study focuses on the treatment of a 20 month old girl with combined aquatic and land-based therapy, in order to improve her motor skills and independence, with improvements on muscle tone, movement range and dexterity as secondary objectives.

This treatment improved this infant's motor skill delay, reducing it by 1 month (at the end of the study, at 25 months, she was achieving a 21 month old's motor achievements, while at 20 months she was achieving a 15 month old's motor achievements).

The full case study can be seen here.


Dr. Carmen Barreal also shared swimming exercises for babies with achondroplasia, which can be performed by the parents. It starts with exercises for 3-12 month old babies to develop several aspects of swimming:

  • Water habituation exercises;
  • Posture control;
  • Respiratory control;
  • Stimulation of alternative leg movements;
  • Crawling and manipulative exercises
  • Flotation.


The second part of this short guide describes exercises for 12-24 month old babies to improve:

  • Balance;
  • Basic motricity;
  • Motor expressiveness.

The whole guide can be seen here.

Sources:


  1. Aquatic Therapy Association of Chartered Physiotherapists. About ATACP. [cited 2018 14/03].
  2. AquaPhysio. Conditions we treat at AquaPhysio. [cited 2018 14/03].
  3. The Aquatic Therapist. The Benefits of Aquatic Therapy for Special Needs Children. 2011 [cited 2018 14/03].
  4. Partners in Learning. Aquatic therapy. [cited 2018 14/03].
  5. Maillard, S., Chapter 25 - Physiotherapy Management of Pediatric Rheumatology Conditions, in Handbook of Systemic Autoimmune Diseases, R. Cimaz and T. Lehman, Editors. 2016, Elsevier. p. 527-555.
  6. Lauren Robinson and A. Turner. Aquatic Therapy / Hydrotherapy. Rehabilitation [cited 2018 14/03].
  7. Torres-Ronda, L. and X.S.i. del Alcázar, The Properties of Water and their Applications for Training. Journal of Human Kinetics, 2014. 44: p. 237-248.
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