Have you struggled with a child with gross motor delays? Did they trip and fall often, could not hop, skip and jump as their peers did? There is certainly something you can do to help along while supporting their skill development in other areas.
Heard of Aquatic occupational therapy (Aquatic OT)? What is it?
It is a unique, yet evidence-based, type of therapy practice where water is used as a therapy tool. It is not common to see occupational therapy
for children in the aquatic environment. You will see kids in the sessions that look a lot like traditional therapy but in the water with toys and
games everywhere!
Aquatic OT is occupational therapy done in a water environment. Such a therapy addresses motor planning, core/trunk strength, upper extremity strength, fine motor skills, self-regulation, safety, social and play skills, coordination, dressing, sensory issues, self-care skills addressing difficulties with bathing and grooming and working toward the ability to participate in recreational water-based activities such as swim lessons or family outings.
Why water?
Here is how water specifically impacts our activities as per a study-
Water immersion to the shoulders increases cerebral blood flow (blood flow
to the brain) by 7% – you will often see therapists working on skills at the side while immersed in the water.
This increased blood flow to the brain further increases another 7% when
you introduce mild to moderate exercise (bringing the total up to 14%). This is why there is normally an active warm-up – moving back and forth across the pool kicking or moving arms and legs.
This heightened blood flow to the brain is thought to be the reason for
increased cognitive, language, engagement, and social skills are seen in the water environment.
Acetylcholine is a neurotransmitter that acts within the central nervous
system – it can speed up and slow down nerve signals. In the central nervous system, it mainly speeds up signals and assists in learning, memory, arousal, and neuroplasticity. Water immersion increases acetylcholine. This makes the water a prime environment for learning a variety of motor skills – even skills that kids have not been able to attain on land.
Water immersion promotes neural plasticity and motor learning – this effect
lasts for up to 4 hours after getting out of water. This means that working on skills such as dressing is enhanced in terms of motor learning when working on this after being in the water. This also means that your child’s brain is ultimately prepped for more motor learning for 4 hours after therapy so this is a good time to play games, toys, work on skills, etc.
Serotonin (a neurotransmitter that helps to regulate mood, social behavior,
memory, and more) and dopamine (a neurotransmitter that helps to regulate movement and emotional responses, and more) both increase during water immersion. That is why you often need a “warm-up” with getting rings or toys from the bottom of the pool. When combined with the increased blood flow to the brain, the pressure of the water prepares your child for the remainder of the session.
Reduction in proprioceptive feedback from the buoyancy of the water
creates a sensory conflict and stimulates the sensory systems involved in balance and contributes to sensory awareness.
Water immersion decreases blood pressure, decreases stress, increases
relaxation, and decreases the “fight or flight reaction” which makes the water a perfect place to work on stressful things. It is easier to talk about and plan for potential stressors (toilet, hand dryers, showers, dogs, etc) in the water and then tackle the stressor after. It also makes it the perfect place to work on social skills since everyone is more relaxed.
Aquatic occupational therapy may be effective in improving the social interactions and behaviors in children with ASD.
A mixed-methods intervention study was conducted among 6 children with ASD and their parents, with two research phases in a concurrent embedded design (an aquatic intervention as the quantitative design and a qualitative design in the second step). The intervention and qualitative design followed international guidelines and were integrated into the method and reporting subheadings. Significant improvement was observed in the physical competence (p = 0.026) and important improvements in school functioning and aquatic skills, with no adverse events. The objective of this study was to evaluate the effects of an AT program on social competence and quality of life and to understand participant’s experiences related to the intervention by obtaining qualitative data.
Stereotypy – often where you feel like you hit a wall!
Physical activity minimizes stereotypical behaviors of children with ASD. Many of these stereotypical behaviors increase in severity with developmental delays, frustrations, delays in social skills development, and immobility. It is challenging and important to incorporate activity into daily life to alleviate some of the challenges and difficulties described above and encourage more social and educational engagement.
One study investigated the relationship between the allocation of time and quality of physical activity and the socio-communal interaction in a football (soccer) team. The study aimed to explore the outcomes of a 10-week physical activity intervention in an integrated, twice-yearly program among children with ASD. The methodology consisted of a qualitative literature review, interview with the parent of each child, oral reports, and analysis of team photographs and accelerometer data. The second phase of data collection focused on qualitative data.
Observation: There was a significant increase in the number of sprints completed as well as the number of games won in the physical activity intervention compared with the control group (p < 0.001). There were also beneficial effects on the number of unsuccessful attempts and unsuccessful completions. Neither the parent nor the children reported any difficulties during the study. Physical activity may be an important intervention method that may have positive effects on the social aspects of children with autism.
Final thoughts: Most kids we see have a far better response, more fun, and learn more in the water than on land. Water is good for so many obvious reasons.
Benefits of warm water and aquatic therapy include the ability to address water safety concerns in a natural environment. It is an ideal setting to address sensory issues related to bathing, dressing, play, and aversion to water impacting self-help and participation in recreational activities. Increased buoyancy enhances the ability to develop motor skills. Moreover, it gives a child extra time to react to and experiment with movement, increased range of motion, hydrostatic pressure to increase body awareness, as well as a fun way to make progress on therapy goals in a new environment. It is definitely worth a try, look out for aquatic therapies in and around you!
References:- https://pubmed.ncbi.nlm.nih.gov/24977699/ https://pubmed.ncbi.nlm.nih.gov/31637867/ 1. Huberman G. Organized sports activities with cerebral palsy adolescents. Rehabil Lit. 1976;37:103–106, 128. Cited Here |PubMed 2. Dulcy F. Aquatic programs for disabled children: an overview and analysis of the problem. In: Dulcy F, ed. Aquatics: A Revived Approach to Pediatric Management. New York, NY: Hawthorne Press; 1983: 59–74.Cited Here 3. Dumas H, Francesconi S. Aquatic therapy in pediatrics: annotated bibliography. Phys Occup Ther Pediatr. 2001;20:63–78.Cited Here |PubMed | CrossRef 4. Kelly M, Darrah J. Aquatic exercise for children with cerebral palsy. Dev Med Child Neurol. 2005;47:838–842.Cited Here |PubMed | CrossRef 5. Peganoff SA. The use of aquatics with cerebral palsied adolescents. Am J Occup Ther. 1984;38:469–473.Cited Here |PubMed | CrossRef 6. Figuers C. Aquatic therapy intervention for a child diagnosed with spinal muscular atrophy. Phys Ther Case Rep. 1999;2:109–112.Cited Here 7. Baldwin J. Pool therapy compared with individual home exercise therapy for juvenile rheumatoid arthritic patients. Physiotherapy. 1972;58:230–231.Cited Here |PubMed 8. Hutzler Y, Bergman U, Szeinberg A. Effects of a movement and swimming program on vital capacity and water orientation skills of children with cerebral palsy. Dev Med Child Neurol. 1988;40:176–181.Cited Here |PubMed 9. Takken T, van der net J, Kuis W, et al. Aquatic fitness training for children with juvenile idiopathic arthritis. Rheumatology. 2003;42:1408–1414.Cited Here |View Full Text | PubMed | CrossRef 10. Rosenbaum P, King S, Law M, et al. Family-centered service: a conceptual framework and research review. Phys Occup Ther Pediatr. 2000;20:59–79.Cited Here 11. Widerstorm A. Newborns and infants at risk for or with disabilities. In: Widerstrom A, Mowder B, Sandall S, eds. Infant Development and Risk: An Introduction. 2nd ed. Baltimore, MD: Paul H. Brooks; 1999:3–20.Cited Here 12. Rothman K. Types of epidemiologic study. In: Epidemiology: An Introduction. New York, NY: Oxford University Press; 2002:57–93. Cited Here 13. Campbell S. The child’s development of functional mobility. In: Campbell S, ed. Physical Therapy for Children. Philadelphia, PA: WB Saunders; 1999:3–38.Cited Here 14. Mullen E. Mullen Scales of Early Learning: AGS Edition. Circle Pines, MN: American Guidance Service; 1995.Cited Here 15. Schraeder B. Assessment of measures to detect preschool academic risk in very-low-birth-weight children. Nurs Res. 1993;42:17–21.Cited Here | View Full Text | PubMed | CrossRef 16. Landa R, Garrett-Mayer E. Development in infants with autism spectrum disorders: a prospective study. J Child Psychol Psychiatry. 2006;47:629–638.Cited Here |View Full Text | PubMed | CrossRef 17. Selva K, Harper A, Downs A, et al. Neurodevelopmental outcomes in congenital hypothyroidism: comparison of initial T4 dose and time to reach target T4 and TSH. J Pediatr. 2005:775–780.Cited Here |View Full Text | PubMed | CrossRef 18. Humphrey A, Williams J, Pinto E, et al. A prospective longitudinal study of early cognitive development in tuberous sclerosis. Eur Child Adolesc Psychiatry. 2004;13:159–165.Cited Here |View Full Text | PubMed 19. Kornhauser M, Baumgart S, Desai S, et al. Adverse neurodevelopmental outcome after extracorporeal membrane oxygention among neonates with brochopulmonary dysplasia. J Pediatr. 1998;132:307–311.Cited Here |View Full Text | PubMed | CrossRef 20. Vohr BR, Garcia-Coll C, Oh W. Language and neurodevelopmental outcome of low birth weight infants at three years. Dev Med Child Neurol. 1989;31:582–590.Cited Here |PubMed