AQUATHERAPY - THE ULTIMATE STEP
longer are the children with disabilities left on hillside to perish like
the days of Sparta, nor do they spend their lives in beds, hospitals,
or sanatoria like the era right until World War II. A great deal has changed
not only in rehabilitation science but also the social climate has improved.
New frontiers in realising optimal health, wellness, and fitness are being
accomplished through research, public policy, advocacy, technological
advances, and training and programme development. There have been changes
in attitude, system, facilities, educational programmes, and school curriculum
for the disabled people. The Governments and Non-Government Organisation
world over are making endless efforts in this direction. The socalled
“disabled people” are rather considered “differently
abled persons”. In fact, it is the society, which handicap them
by depriving them form the opportunities that they require to lead their
lives actively. They do not want any pity but need encouragement in their
efforts to overcome the handicaps. The society should see what these people
are left with and not what they have lost.
The most obvious impact of disability is the limitation of one’s
ability to engage in physical activity. It leads to deconditioning and
reduced capacities for daily living requirements. It ultimately results
into further deterioration of activities, which is termed as disabilitative
cycle. Bring the disabled persons into mainstream of life requires offerisng
them all possible opportunities, especially physical therapy, to improve
their motor capacities. In this regard exercising inside water permits
them, irrespective of the handicap, to moove quite freely without calipers,
sticks, cruches, or wheelchairs. Such an independent exercise programme
through unhurting active routines in water is called Aquatherapy. It is
the most valuable and latest thereapy that is considered as the ultimates
step towards the rehabilitation of disability. It leads to immeasurable
benefits and aims for ABILITY IN WATER as opposed to DISABILITY ON LAND.
Aquathreapy emphasises the prevention and treatment of neuro-muscular
complications. It is also useful for those with back problems, joint reconstructions,
arthritis, stress related injuries and sports injuries.
Benefits of Aquatherapy
and Physical Benefits of Aquathreapy
The dynamic exercises inside water and its buoyant nature created a
phperaemic response in body, which opens up circulation to the ischemic
regions of the spinal cord and brain. Aqua therapy helps in the release
of endorphins, which reduce pain and give a feeling of well-being. Swimming
helps in deeper and rhythmical breathing which increases the metabolic
rate and cardiovascular fitness rapidly.
Water imparts a soft flexible resistance and allows greater and free movements
with less strain, which is quite soothing and relaxing. It frees the patient
from jolting factor of gravity on dry land. Swimming involves most of
muscle groups in their healthy flexing and stretching. The affected body
parts are treated and the unaffected muscles toned and conditioned leading
to increased strength, stamina, flexibility and coordination. Swimming
improves the concept of space, time, form, force application, rhythm,
balance, reaction time and concentration. Water stimulates skin, eyes
and ears and tends to activate the mentally retarded and spastic person.
Aqua therapy is a great psychotherapeutic means. The disabled persons
experience complete independence of movements. They try out unfamiliar
moves in water, which is friendly and gives feeling of freedom from aids.
Water itself acts as an apparatus, which most handicapped need. They get
an opportunity to work at their own level. It prevents the disabled people
from resigning themselves to their disabilities. Accomplishments of simple
aquatic skills boost their morale. It provides a feeling of success, self-satisfaction
and an increased confidence, self-image and pride.
Water workouts provide the disabled persons an opportunity to discover
their personal hidden abilities. Swimming is regarded as “Mother
Sport” for the disabled. In fact, water is the playground for disabled
persons. It provides them a sport, lots of fun and recreation. Participation
in such activities and by meeting, working, and playing with others offer
them an opportunity for communication, friendship, feeling of equality,
social adjustment, and integration into community life. They learn to
live again as respectable citizens and equal partners in social, economical,
political and sports life.
The Remedial Pool
The swimming pool in an Aqua therapy Rehabilitation Centre must have
a ramp. The pool size may be in the region of 10 m x 8 m with a depth
ranging from 75 cm to l m. The water temperature should be kept slightly
higher than the normal (29-30 0C) because exercise in luke warm water
facilitates smooth and relaxed movement in water in contrast to jerky
spasmodic movements outside water. Fittings like rails or splasher edges
can enhance the programme by providing support and fixed exercise stations.
The Aqua therapist
The Aqua therapist should be an experienced person having Swimming Teacher’s
Certificate, which will ensure that together with his medical knowledge
he has a through understanding of swimming methodology. A basic knowledge
of the principles of Swimming to the disabled, principles of hydrodynamics
and body mechanics will be very useful. He must be flexible in his teaching
approach that should very from one person to another because different
disabilities and the patients’ condition will present different
challenges to him. He should give individual attention to each patient
and keep anecdotal records.
Use of Floatation Aids
The Halliwick Method does not approve the use of artificial floatation
aids for disabled persons because they are already burdened enough by
the aids on land. It suggests a one-to-one teaching approach until complete
independence is achieved. Moreover, the Aqua therapist uses his hands
and arms to facilitate balance. The author, however, experienced an absolute
necessity to floatation aids in some instances even if he constantly accompanied
the patient. He suggests the use of Arm bands, Swim rings, Swim suits
with pockets of floats, Horse-shoe-shaped collars etc. in early stages.
They should be discarded as the patients gain confidence and ability to
float. But, never use them as a measure to limit personal supervision
of the patient.
Progression in Water
The patient should first be introduced to the water because further
progress can be made only after gaining some water confidence and after
he starts putting his head into water. The Aqua therapist should accompany
him for his first entry into the pool. He is then assessed for specific
problems likely to be faced by him in maintaining balance.
Floating is the first technique to be taught and this is generally acquired
by majority of people, however disabled they are. Through Aqua drills,
suitable to their age and ability, the patients are made aware of the
behaviour of water and how to control their own specific balance problems.
After the initial mental and balance adjustments the patients may reach
a stage where they can disengage from the Aqua therapist’s contact.
Correct handling by the Aqua therapist will enable the patient to experience
mobility, which is unknown on land. Now, perhaps for the first time in
their lives, they will experience complete independence of movement. In
the mean time they are taught how to maintain a safe breathing position
with face out of the water, how to regain balance if lost and how to exhale
with face immersed in water. Controlled breathing is of paramount importance
and all success stems from this. Encourage them to maintain a regular
The disabled people acquire swimming techniques in variety of ways depending
on their disability. Some will find it easy on backs using hands for propelling
on sides while others may find the prone or side positions more appropriate.
Some will have no power to move their lower limbs; others will be without
lower limbs. But, they all will learn to move in water and to achieve
varying degrees of confidence.
For teaching the strokes, it should be broken down into different parts
like leg kick, arm pull, breathing, and the combination. Each part is
taught separately, i.e., an upper limb amputee could be taught the leg
part of backstroke to be joined later by arms pull. The position of the
other arms in this case should be changed, while the legs only are working,
so that a suitable position is found in order to keep the body evenly
balanced. It may often be necessary to teach the leg movement of one stroke
and the arm movement of another, for example, dog paddle with the arms
and front crawl with the legs, or sculling with the arms and life-saving
leg kick. It does not matter how the swimmer get about in the water, as
long as he can swim, his style can be corrected as he becomes proficient.
Remember that the strokes learnt by a disabled swimmer will always be
far from orthodox even after years of practice.
The Competitive Swimming
In competitive swimming for disabled adjustments should be made in starts,
turns and strokes. A Breast or Butterfly stroke swimmer may not be able
to touch with both hands simultaneously but this should not bar him from
entry into that event. A vision-impaired swimmer when approaching the
wall may be alerted by the official using a padded pole. The events should
be swum to a system where points awarded for disability, determined prior
to the event, are multiplied with the points awarded for speed, so that
each swimmer has an equal opportunity of wining.
A Word of Warning
The Aqua therapist should be a trained and well-experienced person who
can handle the disabled people with great care and patience. Their bodies
can so easily slip through the hands. If artificial aids are used, they
should be applied before entry into the pool and such patients need constant
supervision. The severe spastic and tetraphelagic must be guarded against
inhaling water with breath, which could cause increased spasm. Never over
work the swimmer with Multiple Sclerosis and Muscular Dystrophy. Since
these are progressive conditions, it is advisable to check with the doctor
at regular intervals.