Aquatic Exercise for Children with Cerebral Palsy
Abstract written by: Nekram Upadhyay
Kelly, M. & Darrah, J. (2005). Aquatic exercise for children with cerebral palsy. Dev Med Child Neuro. 47(12), 838-842.
This article reviews the research and developing theories that encourage therapists to consider water-based exercise rather than land-based exercise for children with cerebral palsy (CP). Over the years, much research has been conducted on improving overall health of children with CP. Most of this research has stressed developing land-based aerobic and progressive resistance exercise for non-ambulatory children with CP. The results achieved from these studies have shown significant increases in muscle strength as well as walking speed, wheelchair endurance, physical appearance, and gross motor functions.
The effects of land-based exercise for children with CP have often involved ambulatory children with little being reported about the effects on non-ambulatory children. In land-based environments, attaining sufficient intensity, safety, and control of aerobic and progressive resistance exercise for children with poor motor control, impaired balance, joint pathology, joint instability, and severe contractures often poses a challenge. This review describes how the buoyancy of water reduces joint loading and impact, and decreases the negative influences of poor balance and postural control. These characteristics may allow children with CP to exercise in water with more freedom than on land.
To monitor the aerobic intensity in aquatic environments, the researchers used telemetry heart-rate straps and ratings of perceived exertion, specifically the Children's OMNI Scale of Perceived Exertion.
Subjects performed a variety of exercises in water, including length swimming, shallow-water tuck jumps, stride jumps, jumping jacks (star jumps), on-the-spot and propulsive running, and wall-and-sit kicking (i.e., holding onto the ledge and kicking with the legs).
Participation in aquatic exercise was facilitated by support from the wall, a foam 'pool noodle' (a long flexible buoyancy aid), a floating kick board, a floating barbell, a life or neck jack, or another person (skilled in working in the water with individuals with physical disabilities).
Participants reported improvements in flexibility, respiratory function, muscle strength, gait, and gross motor functions. None of the studies evaluated showed negative effects of aquatic exercise on the level of fatigue in children with CP. The results were of particular benefit for the children who had significant movement limitations and who may, therefore, have had more difficulty performing land-based exercise.
Aquatic exercise is a creative and unique form of exercise for children with cerebral palsy to develop their endurance, muscular strength, motor skills functionality, and self-image. Further evidence is needed in order to fully assess the merit and safety of these programs; therefore, they should be planned and executed carefully. Factors that need to be considered when implementing aquatic exercise in children with CP are: ensuring adequate intensity, duration and frequency to promote the fitness effects; determining when a group environment may be more beneficial than individual interventions; and ensuring that the pool environment is suitable and safe for intervention.