What is hydrotherapy?

Hydrotherapy, also known as Aquatic therapy, is the use of water for therapeutic purposes. It has been gaining recognition as an effective adjunct to traditional land-based therapies, particularly for children with neurological conditions. This blog post explores the multifaceted benefits of hydrotherapy and why it can be a valuable addition to conventional treatment methods.

Hydrotherapy involves exercises and movements performed in water, in a specially designed and adapted pool with controlled temperatures. Therapy within an aquatic environment utilises properties of water, such as buoyancy, hydrostatic pressures and resistance, to provide therapeutic benefits for children with neurological conditions. Here we delve deeper into how these properties contribute.

Buoyancy reduces the effects of gravity on the body, effectively decreasing the weight that the muscles and joints need to support. This is beneficial for children with limited strength or mobility as it allows them to perform movements that may be difficult on land. With less gravitational pull, children can move more freely and explore a greater range of motion.

Resistance in the water can be applied by changing the speed or direction of movement, engaging and strengthening multiple muscle groups which in turn can lead to better motor control and functional movements on land. An example of this may be encouraging the child to walk in different directions on the standing platform i.e. forwards, backwards or sideways. By altering the direction of movement, specific and targeted muscles can be strengthened.

Hydrostatic effects is the pressure exerted by molecules of a fluid on an immersed body. This particular property can improve lung capacity and help strengthen the respiratory muscles through gentle resistance, particularly when the child is immersed up to chest level. In addition, the even pressure of the water against the skin provides constant sensory feedback, enhancing body awareness (through proprioception) and aiding in learning and refining movements.

Temperature plays a pivotal role in understanding what makes a hydrotherapy pool different from a regular swimming pool. The warm water, which is typically maintained at between 33-35 degrees Celsius helps in relaxing muscles, reducing spasms and alleviating pain. It also has a calming effect on the nervous system, which is said to influence increased muscle tone and spasticity. There is evidence to suggest that nociceptive impulses (nerve cells that cause pain when stimulated) are linked to heat stimulatory receptors. By introducing heat, it can override the sensation of pain making it easier to move uninhibited. This is like introducing a heat pack if we have back pain and the feeling of muscle relaxation once applied.

What does the research say?

When considering the physical benefits of hydrotherapy, a recent study¹ was able to compare the effects of land-based and hydrotherapy on balance for children with cerebral palsy. Despite the absence of long term follow up, the research showed that the unique properties of the water had the potential to reduce risks associated with joint loading and fear of falling. Children were also able to engage more easily in intensified therapy in the water compared to just land-based exercise.

Further studies have also correlated with this theory stating that there can be significantly greater gains in vital capacity (respiratory function) and motor control/orientation in the water if land-based is combined with hydrotherapy, for children with cerebral palsy ⁴.

Moreover, pilot studies have also examined the impact of hydrotherapy on balance and equilibrium in children with Down syndrome. The results were positive despite the small sample size⁹.

What are the benefits of hydrotherapy?

Based on a review of literature, the benefits of hydrotherapy are as follows:

• Improvement in functional mobility^{1, 3}
• Reduction in fear of falls ¹
• Improved postural control and balance reactions ^{5, 1}
• Increased active and passive range of motion (mainly in upper extremities) ⁵
• Improved self-image and emotional well-being ⁵
• Improved sensory regulation, particularly within tactile and proprioceptive systems ¹
• Increased water orientation skills and motor control ⁵
• Improved vital capacity due to strengthening of respiratory muscles ⁵
• Reduced pain ⁸
• Decreased spasticity of muscles ⁸

Who can benefit?

The following conditions have been known to benefit from hydrotherapy:

• Cerebral Palsy ^1,2,4,6,8
• Autism spectrum disorder ¹⁰
• Developmental co-ordination Disorder ( DCD) ¹¹
• Down Syndrome ⁹
• Muscular Dystrophy ¹²
• Spina Bifida ¹³

In summary, hydrotherapy offers a unique and effective adjunct to land-based therapy for children with neurological conditions. Its benefits, ranging from improved mobility and strength to enhanced emotional well-being, make it a valuable component of a holistic therapeutic approach. By harnessing the healing properties of water, hydrotherapy can help children with neurological conditions achieve their full potential in a fun and engaging environment.

We offer hydrotherapy service at High Hopes, so if this is a treatment approach you are interested in, you can request to speak to one of our team members who can share more information.

Sources:

1. Badawy, W., & IIbraheim, M., 2016. Comparing the Effects of Aquatic and Land-Based Exercises on Balance and Walking in Spastic Diplegic Cerebral Palsy Children. Med. J. Cairo Univ., Vol. 84, No. 1, March: 1-8.
2. Shelev, N., 2001. The Effects of Partial Immersion Aquatic Intervention on Perceived Physical Competence and Quality of Life in Children With Severe Cerebral Palsy. The Journal of Aquatic Physical Therapy 29(2):p 40-48.
3. McManus, B. M., & Kotelchuck, M. (2007). The Effect of Aquatic Therapy on Functional Mobility of Infants and Toddlers in Early Intervention. Pediatric Physical Therapy, 19(4), 275–282.
4. Hutzler Y, Bergman U, Szeinberg A ( 1988). Effects of a movement and swimming program on vital capacity and water orientation skills of children with cerebral palsy. Dev Med Child Neurol. 40:176 –181.
5. Peganoff SA. The use of aquatics with cerebral palsied adolescents. Am J Occup Ther. 1984;38:469 – 473.
6. Kelly M, Darrah J. 2005. Aquatic exercise for children with cerebral palsy. Dev Med Child Neurol. 47:838 – 842.
7. Dumas H, Francesconi S., 2001. Aquatic therapy in pediatrics: annotated bibliography. Phys Occup Ther Pediatr. 20:63–78.
8. Lai, C.-J., Liu, W.-Y., Yang, T.-F., Chen, C.-L., Wu, C.-Y., & Chan, R.-C.,2015. Pediatric Aquatic Therapy on Motor Function and Enjoyment in Children Diagnosed With Cerebral Palsy of Various Motor Severities. Journal of Child Neurology, 30(2), 200–208.
9. Michaels. N and Youngblood.M., 2023. The Effect of Aquatic Exercise on Balance in Ambulatory Individuals With Down Syndrome: An Interventional Feasibility Study.The Journal of Aquatic Physical Therapy 31(2):p 41-49.
10. Pan, C. Y., 2010. Effects of water exercise swimming program on aquatic skills and social behaviors in children with autism spectrum disorders. Autism, 14(1), 9-28.
11. Green, D., Chambers, M. E., & Sugden, D. A., 2008. Does subtype of developmental coordination disorder count: Is there a differential effect on outcome following intervention? Human Movement Science, 27(4), 363-382.
12. Eagle, M., 2002. Report on the use of hydrotherapy in muscular dystrophy. Neuromuscular Disorders, 12(3), 205-210.
13. Franks, C., 2003. Aquatic therapy in the rehabilitation of a child with myelomeningocele. Journal of Aquatic Physical Therapy, 11(1), 14-20.