Hydrotherapy or Aqua therapy is therapy which is performed with use of water and water induced ressitance by a trained and certified professional therapist. The therapy provides deep, intense exercise within a soothing and comforting environment thus promoting physical functioning for children or individuals with acute, transient, or chronic disabilities, syndromes or diseases with the help of water’s restorative and detoxifying properties. Water buoyancy makes aerobic and anaerobic exercises safe and effective by allowing the child to move freely.In simple terms aquatic therapy means making use of different properties of water to facilitate functional recovery and independence of children with CP.
Water can be a healing force for children with Cerebral Palsy. All activities the child engages in takes place in a pool (heated or non-heated). Our bodies weight is more than 50 % water weight thus gravity and body weights impact the way we move.
Hydro therapy facilitates a near complete reversal of these. Water immersion reduces a body weight by 90 percent, allowing children and adults to ambulate freely in a way that doesn’t place undue stress on the musculoskeletal system from forces such as gravity and body weight. The environment in the pool is the best for a child with cerebral palsy to improve physical movements and functions for both ambulatory and non ambulatory children. The best part of exercising in water versus land is due to its restorative and detoxifying properties it provided buoyancy which makes anaerobic and aerobic exercises easy to perform .Additionally, warm water used during therapeutic sessions provide massage effect on overused joints, muscles and ligaments.
Properties of Water:
Buoyancy is the upward push exerted by water on immersed body of the childThus providing weightlessness experience in water. In Therapeutic enviornment It is used to relieve the compressive forces on the joints. If the child is immersed till waist level then the effective weight on the legs is reduced by 50%. For therapeutic benefit weightlessness is a very important phenomenon. It also helps to reduce the stiffness of the muscles of Weight bearing joints like ankle, knee and hip joints as they are offloaded in water .
2. Hydrostatic Pressure
It Is the pressure exerted by forces of water and depends upon the depth of immersion and density. The deeper we immerse the child the greater will be the force. This is very helpful in reducing the swelling and provides passive relaxation through deep pressure. Hydrostatic pressure is also important to push the blood from the legs and thighs up, thus increasing the blood returning to the heart. It also helps in increasing blood supply to the brain and thus helps in improving cognitive functions of the child.
Water is thicker or dense than the air. The density of water is more than the air and almost similar to the human body. The density of water is important therapeutically because of this quality of water that will support the child once immersed in water and also exerts an upward force. Due to this difference in the densities of various tissues in the body, a leaner child with less fat tissue will tend to sink more in the water whereas children with more fat tissue will tend to float.
The amount of friction generated with a movement in water is known as Viscosity of water is. Water is an excellent strengthening pool as friction forces are significantly higher in water than on land. However the speed of the movement and direction of the movements define the resistance experienced in the pool. The strengthening exercises are performed within the limits of childs tolerance .
These unique properties of water provide a desirable environment for the children with cerebral palsy. Immersion in water brings about beneficial effects in various body systems of a child with cerebral palsy.
Benefits Of Aquatic Therapy In Cerebral Palsy :
• Improves muscle and movement coordination
• Improves oral motor control
• Improves respiratory capacity
• Better flexibility of the muscles
• Improves vestibular stimulation
•Improves sensorimotor stimulation
•Helps to improve balance
• Improves walking patterns
• Improves muscle strength
• Improves cardiovascular endurance
• Regularization of the sleep patterns
• Reduces abnormal involuntary movements
• Inhibition of sudden spasms of the muscles
• Sustained reduction in spasticity
• Improve eye – hand coordination
Hydro therapy is not the same as swimming. It includes purposeful therapeutic movements or exercises performed in order to reduce the symptoms of CP. There are various techniques in hydro therapy such as a combination of these techniques and approaches like Halliwick technique, Bad-Ragaz Technique, Clinical Aai-Chi, Aquatic exercises, Aqua aerobics and Passive relaxation. In the beginning of the session the exercise will emphasize to adaptate to the water environment and being comfortable in water. Therapists will choose various activities to engage the patient in various play activities on the surface of the water. Therapy session will also focus to improve respiratory and oromotor control in water where the child will slowly be introduced to the underwater environment facilitating better breath control. Once the child gets comfortable in water and has achieved good breathing control, various goal oriented activities will be performed during subsequent exercise sessions.
Hydrotherapy is not an alternative to land therapy but a conjunct to it. Land based rehabilitation and hydrotherapy rehabilitation needs to be performed together. Neither is an alternative to the other. Although there are some advantages of hydrotherapy as compared to the land based rehabilitation both are essential for optimum recovery.
Benefits Of Hydrotherapy Over Land Based Therapy
- Hydrotherapy helps to achieve benefits of land based therapy as there is less weight on the joints , and the child is well supported and joints are not under stress.
- It is observed children are able to perform the tasks much easier in water which aids their activity participation as well.
- Children tend to be more active and engaged in water as activities in water are fun and interesting.
- As there is no effect of gravity in water , children with severe motor deficits and motor restriction tend to achieve more freedom of movement .
- The risk of fall is significantly less .
Thus we can say hydro therapy can be preferred in some children or preferred over a certain period in a child’s development. It provides an excellent tool to train the child and improve their motor and sensory impairments. It is also fun and enjoyable. It is safe and effective in improving the quality of life as well as functions of the children with cerebral palsy. However hydro therapy alone is not sufficient and must not be a replacement to land therapy.