Research purpose – The purpose of this study
was to determine how aquatic exercise interventions effect gross motor function
and aquatic skills in children with cerebral palsy (CP).
Research background – CP is
the most common disability among children, it is a disorder that is caused by
damage/abnormal development of an infant’s brain. This results in a lack of
motor control and muscular coordination. Characteristics of CP include, but are
not limited to, abnormal muscle tone, spasticity, dyskinesia, dystonia,
athetoid movements, issues with balance and diminished selective (gross and
fine) motor control. Aquatic exercise is commonly used as a supplement to physical
therapy to manage the condition. Buoyancy has been found to relieve the weight
bearing effects on the joints by reducing the force of gravity experienced by
individuals with CP. Water based adapted exercises aids in the relief of pain,
muscle spasms, maintaining and increasing range of motion, strengthening weak
muscles, reeducating paralyzed muscles, improving circulation, lung function
and speech in addition to aiding in the maintain/improvement of balance,
coordination and posture. However, there is a lack of evidence-based studies
that document the effects of this form of treatment in children with CP.
Design – 6-week intervention study
Setting – swimming pool of the Sports Centre “?air” in
Participants – 29 children with CP ages
5-14 (27 completed the study but 2 had to stop because of illness). The
inclusion criteria consisted of five components – participants to be between
the age of 5-14 years, ability to understand instructions, no medical contra-indications
present, no botulinum toxin treatment or surgery within the past 3 months and
written parental approval.
Interventions – The children were split
into 2 groups; the aquatic intervention group which had 14 participants and the
control group which had 13 participants. The children within the aquatic
intervention group partook in a 55-minute swimming program which met 2 times
per week, for 6 weeks. The sessions consisted of one-on-one instruction, which
was broken down into 10 minutes of a light warm up, which included walking and
jumping in the pool, 40 minutes of exercise swimming techniques (i.e. free
style, back stroke, diving, etc.), and 5 minutes of free play/cool down (i.e.,
ball based or chase based games).
Dependent variables – gross
motor function, aquatic skills.
Outcome measures – The Gross Motor Function Measure (GMFM) for motor
function and the Water Orientation Test Alyn 2 (WOTA 2) for aquatic skills
Main results – There was a significant increase in gross
motor function (GMFM) in the aquatic intervention group, after 6 weeks. The
control group remained the same throughout the program.
weeks following the completion of the study, the subjects were asked to return
to complete a follow-up test. The children from the aquatic group did not
participate in any aquatic exercise, in the three weeks following the study, therefore
their results returned to their baselines.
significant improvement was observed in the secondary assessment of WOTA 2. With
respect to the aquatic exercise group, there was a significant increase in
aquatic skills acquirement, after six weeks. Unlike the GMFM, the aquatic skill
scores remained the same when retested 3 weeks after the completion of the
intervention. Thus, it was concluded that aquatic skills such as mental
adaptations and balance are more sustainable for children with CP than gross
Conclusions –The subjects were not a part of the healthy
population, rather a group of individuals effected by a severe neurological
disorder which in turn affects their motor capabilities, the study concluded
that a 6-week program is not a long enough intervention to produce lasting
effects. Whereas in a healthy population, it might be.
Clinical implications – Longer intervention studies must be performed
in order to assess permanent adaptations in gross motor function in children