# Aquatic therapy and cerebral palsy with children

> Aquatic therapy (hydrotherapy) in general is any therapy based on use of water for the treatment of patients.

## Blended Intensive Program (BIP)
In October 2023, Savonia University of Applied Sciences (Finland) hosted a Blended Intensive Program (BIP) focused on Evidence-Based Physical Therapy (EBP). Over 40 students and 7 teachers from Savonia University of Applied Sciences (Finland), Universidade da Coruña (Spain), and Charles University (Prague) participated. Students collaborated on articles covering topics such as McKenzie methods, back pain, spinal cord injuries, aquatic therapy, ergonomics, Nordic walking, sports injuries, and children with disabilities.

## Aquatic Therapy Overview
Aquatic therapy (hydrotherapy) utilizes water to support functional ability and treat health conditions. By adjusting water form, duration, and temperature, therapists can influence various physiological systems. Literature suggests hydrotherapy can improve immunity, cardiovascular and respiratory function, and assist in managing pain, fatigue, obesity, stress, and anxiety. Because water reduces musculoskeletal load, it is particularly beneficial for individuals with joint pain or a high risk of falling.

## Cerebral Palsy (CP) and Rehabilitation
Cerebral palsy refers to a group of non-progressive motor conditions caused by disturbances in the developing fetal or infant brain. These conditions result in limitations in activity, movement, and posture, often characterized by abnormal muscle tone, impaired motor control, and reduced joint range of motion. These issues can impact daily activities such as walking, feeding, speech, and social participation.

While land-based exercises (e.g., stretching, balance training) are standard, they can sometimes cause pain. Research indicates that aquatic therapy is a feasible and effective alternative or supplement for children with CP.

## Research Findings on Aquatic Therapy for CP
*   **ICF Performance:** Studies show that water therapy combined with traditional rehabilitation produces positive effects across all areas of the International Classification of Functioning, Disability and Health (ICF).
*   **Gross Motor Function:** Research indicates that aquatic therapy significantly improves gross motor function scores. One study using a cross-over design found that 16 sessions of aquatic therapy (based on the Halliwick Concept) improved motor function compared to control groups.
*   **Head Control:** Hydrotherapy has been shown to be an effective way to improve head control in children aged 2–6 years, performing as effectively as land-based therapy in supporting functional movement.
*   **Systematic Reviews:** A review of children aged 2–18 found that 64% of studies showed improvement in motor function. Results are most effective for those with GMFCS levels I–III, while more severe cases may require longer intervention periods.

## The Halliwick Concept
The Halliwick Concept is a widely used aquatic therapy method based on hydrostatics, hydrodynamics, and body dynamics. It aims to teach swimming by encouraging independent movement through a ten-point program, progressing from mental adjustment to water and body rotations to basic swimming movements. Recent studies suggest that Halliwick-based interventions can be clinically more significant than conventional land-based exercises for improving sitting, standing, walking, running, and jumping.

## Authors
*   **Fulin Stepan**, Physiotherapy student, Charles University, Czech Republic
*   **Hasu Emma**, Physiotherapy student, Savonia University of Applied Sciences, Finland
*   **Pentti Jenni**, Physiotherapy student, Savonia University of Applied Sciences, Finland
*   **Syrjäniemi Kaisa**, Physiotherapy student, Savonia University of Applied Sciences, Finland
*   **Viitanen Sanni**, Physiotherapy student, Savonia University of Applied Sciences, Finland
*   **Marja Äijö**, PhD, Principal lecturer of gerontology and rehabilitation, Savonia University of Applied Sciences, Finland
*   **Mari Tuppurainen**, Physiotherapy lecturer, Savonia University of Applied Sciences, Finland
*   **Dagmar Pavlu**, Physiotherapist, Assoc. Prof. Charles University, Czech Republic
*   **Ivana Vláčilová**, Professor, Charles University, Czech Republic
*   **Jamile Vivas Costa**, PhD, MSc, PT, Lecturer, Universidade da Coruña, Spain
*   **Montserrat Fernández Pereira**, MSc, PT, Lecturer, Universidade da Coruña, Spain
*   **Verónica Robles García**, PhD, MSc, PT, OT, Lecturer, Universidade da Coruña, Spain

## Resources
*   Akinola, Bolarinwa Isaac, Gbiri, Caleb Ademola & Odebiyi, Daniel Oluwafemi 2019. Effect of a 10-Week Aquatic Exercise Training Program on Gross Motor Function in Children With Spastic Cerebral Palsy. Global Pediatric Health (6):1–7.
*   Bairaktaridou A, Lytras D, Kottaras A, Iakovidis P, Chatziprodromidou P, Moutaftsis K 2021. The effect of hydrotherapy on the functioning and quality of life of children and young adults with cerebral palsy. International Journal of Advanced Research in Medicine 3(2) 2-24.
*   Ballington, Samantha J. & Naidoo, Rowena 2018. The carry-over effect of an aquatic-based intervention in children with cerebral palsy. African Journal of Disability. 7 (0) a361.
*   Bax, Martin, et al. 2005. Proposed definition and classification of cerebral palsy. Development Medicine and Child Neurology 47 (8), 571-576.
*   Gresswell A, et al. 2010. THE HALLIWICK CONCEPT. International Halliwick Association (IHA) Education and Research Committee.
*   Hamed, Somaia A., ElMeligie, Mohamed Magdy & Kentiba, Efrem 2023. The effects of Halliwick aquatic exercises on gross motor function of children aged from 3 to 5 years with spastic cerebral palsy. Pedagogy of Physical Culture and Sports 27 (1): 24-31.
*   Khalaji, Masoud, Kalantari, Minoo, Shafiee, Zahra & Hosseini, Mohammad Ali 2017. The effect of hydrotherapy on health of cerebral palsy patients: an integrative review. Iranian Rehabilitation Journal 15(2), 173-180.
*   Mooventhan A, Nivethitha L 2014. Scientific evidence-based effects of hydrotherapy on various systems of the body. North American Journal of Medical Sciences, 6(5), 199-209.
*   Mostafa, Ahmed Mohamed Ahmed, et al. 2021. Effect of aquatic therapy on head control in cerebral palsy children. Curr Pediatr; 25 (11): 1142-114.
*   Mujawar, Muskaan Mahamadhanif 2022. A Systematic review of the effects of aquatic therapy on motor functions in children with cerebral palsy. Reabilitacijos mokslai: slauga, kineziterapija, ergoterapija 2 (27), 51–67.
*   Roostaei, Meysam, et al. 2016. Effects of Aquatic Intervention on Gross Motor Skills in Children with Cerebral Palsy: A Systematic Review. Physical & Occupational Therapy in Pediatrics 37 (5): 1-20.
*   Tapia C, Constanzo J, González V & Barría R. M. 2023. The Effectiveness of Aquatic Therapy Based on the Halliwick Concept in Children with Cerebral Palsy: A Systematic Review, Developmental Neurorehabilitation 1-6.