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Why Water Can Bring Children Hope

A blast from the past. Here is one of the 300+ aquatic articles our team has written for Advance magazine over the last 10 years. The Advance magazine archives are no longer available online, so we are preserving them here.

Byline: Andrea Salzman, MS, PT

Pediatrics and aquatic therapy are often a natural mix. I don't think it takes the place of land-based therapy — nor should it — but it can be the turning point for many kids.—Kiki Mayer, PT

Ask Kiki Mayer, PT, what she thinks about putting children with disabilities in the pool and you'll hear an earful.

"Everyone here works in the pool — PTs, OTs, even speech therapists. It's a critical part to some kids' therapy because it's incredibly motivating. The children don't even know they are working," Mayer said.

According to Mayer, who works at Special Children Center, a privately owned therapy center in Hudson, WI, kids who can't even stand on one foot on land are thrilled because they can in the pool.

"I don't think it takes the place of land-based therapy—nor should it—but it can be the turning point for many kids," she said. "I think therapists who don't have training in aquatics sometimes think, 'What a hassle.' They look at the child and say to themselves, 'I've got to get him into a bathing suit? It's not happening.' But once therapists learn how awesome the water can be, how soothing for the therapist and engaging for the child, they change their minds. They see the value in struggling over the little things."

Terry M. Petersen, MS, PT, owner of Aquatic Physical Therapy, L.L.C., Leawood, KS, agree. Since 1993, Petersen has devoted 100 percent of her pediatric practice to aquatics, so she's in a perfect position to judge. She believes that aquatic PT is valuable for children for whom land-based treatment fails to provide adequate motivation, or for children who require a more "gravity-friendly" environment. Irrespective of the child, however, she warned that aquatic PT goals must be closely related to land-based needs.

Petersen said that both the Halliwick method and NDT principles are foundations for effective handling in water, but she does not incorporate many of the latest techniques, such as Watsu ®.

"I use very little of the adult-based aquatic interventions, such as Watsu and Bad Ragaz," said Petersen. "I fail to see the relationship between the achievement of pediatric outcomes and adult interventions, which are developed primarily to manage painful symptoms." Petersen also said she does not often use passive techniques; instead, she relies on engaging children in meaningful activities to improve functional skills that clearly relate to land-based outcomes.

A Sample Treatment Session At Special Children Center (SCC), an aquatics session typically runs between 30 and 60 minutes. Since SCC's pool does not have an entry ramp (an item on Mayer's "wish list" for the pediatric pool), therapists often lift their patients into the pool. A session with "Lisa," a 3-year-old with triplegia cerebral palsy, begins this way.

Since Lisa only uses a walker to walk very short distances and is gravitationally insecure, Mayer holds her initially without an flotation device in the water. She then progresses to using a float ring, where Mayer can distance herself from Lisa, allowing the child a sense of accomplishment while still providing contact-guard assistance.

"A huge portion of the session is spent working on elongating trunk and pelvis musculature," said Mayer. After gaining range, Lisa is better able to perform bilateral kicking as a precursor for reciprocal gait and other loaded activities. "Mostly, she's motivated by cooking—she pretends she's making something for me. So we sit on the steps in the 90/90 position (90 degrees hip flexion, 90 degrees knee flexion, like sitting on a chair) and cook up a feast."

At the end of the session, Lisa climbs out (a new skill; she just recently has been able to flex enough at the hip) and lowers herself into the hot tub.

"She loves the hot tub—she would be in there the whole time, but we limit it to 5 to 10 minutes because of thermoregulation issues with children," Mayer said. She said some children (such as those with a history of seizures) are not allowed in the warmer tub. The 101-degree water is warmer than thermoneutral (the temperature at which the water and the skin are equal, so no thermal shift occurs from one to the other—typically considered about 94 degrees), so Mayer can work on manual stretching with the added bonus of superficial heat. Since most hot tubs are the right depth for three-quarter support, therapists often use them for weight-bearing tasks and then translate the work to land-based functional tasks.

The Future for Pediatric Aquatic Therapy Although many clinics find aquatic therapy to be a popular choice among their pediatric clientele, there is not an overwhelming amount of scientific support for the procedure. Matthew Schaeffer, PT, who works with the Easter Seals Society in Stockton, CA, first became interested in aquatics after graduation.

"It was an area I never learned about in PT school," he said. "And then, once I started working in the water, I couldn't find much in the journals to support aquatic therapy." This prompted Schaeffer to propose a research study that would examine the effect of aquatic therapy on children's ability to maintain head and neck control.

"Aquatics is such a relatively unexplored environment," he concluded. "It deserves our attention. I'd like to see more PTs work to expand the evidence-base that supports it."


  1. Campion, M.R. (Ed.) (1997). Hydrotherapy: Principles and Practice. Oxford, England: Butterworth.

  2. Langendorfer, S.J., & Bryuya, L.D. (1995). Aquatic readiness: developing water competence in young children. Champaign, IL: Human Kinetics.

  3. Lepore, M., Gayle, G.M., & Stevens, S.F. (1998). Adapted aquatics programming: A professional guide. Champaign, IL: Human Kinetics.

  4. Ure, C., & Kilpatrick, J. (2000). Teaching infant and preschool aquatics. Champaign, IL: Human Kinetics.

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Want to learn more about pediatric or adolescent aquatic therapy? Read more research here: Adams, S., Hutton, S., Janszen, A., Rawson, R., Sisk, C., Stenger, S., … Adams, S., Hutton, S., Janszen, A., Rawson, R., Sisk, C., Stenger, S., & Ennis, B. (2016). Effects of an Individualized Aquatic Therapy Program on Respiratory Muscle Function in Adolescents with Muscular Dystrophy. Archives of Physical Medicine and Rehabilitation, 97(10), e130–e131.

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