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No 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

Physiological 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.

Psychological Benefits

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.

Social Benefits

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 breathing rhythm.

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.