Welcome to our Two Takes series! 

We’re taking on hot topics and commonly asked questions from parents with a unique team approach. We’re putting our PT (Kendall) and OT (Sarah) brains together to bring you two perspectives on topics relevant to your child.

Today, we’re sharing two takes on: aquatic therapy! See how we use our different professional lenses to answer frequently asked questions about aquatic therapy below:

 Why provide therapy in the water?

Water has some unique properties that have different effects on the environment, the body, and its systems. 

 Buoyancy: “float” factor, reduces weight bearing/load placed on joints based on how much of body is submerged

  • Exercises:
    • Floating on back or tummy
    • Pushing kickboard underwater

Hydrostatic pressure: increased pressure on the body that changes based on how much of the body is covered (water submersion at level of hips vs. at neck) and the depth of water (bottom of pool vs. shallow end of pool)

  • Exercises best performed at chest level:
    • Diving for toys in deeper water
    • Breathing exercises (blowing through tube, rubber straw, noodle)

Viscosity: provides resistance with movement in all directions, and changes based on size and speed (ex: faster speed of kicking = increased resistance), allowing increased reaction time to address balance challenges

  • Exercises:
    • Running back and forth in water
    • Kicking upright in water

Surface tension: the barrier between the water and the air provides intense tactile input and resistance while pushing through it

  • Exercises:
    • To increase arousal level: going in and out of water 
    • To decrease arousal level: encourage breathing under water (blowing big bubbles, watching self in mirror) 

Turbulence and flow: the drag from the flow of the water in the pool provides resistance for strengthening and helps children find their body in space, which can be generalized to moving their body on land

  • Exercises:
    • Skipping in water
    • Pulling mat around the pool (like a horse & carriage) 

 These properties and their effects allow for a unique opportunity to perform a wider variety of treatment activities in different capacities and positions than on land. 


Who can benefit from aquatic therapy?

Aquatic therapy has a wide array of benefits for children of all ages (even babies!) and ability levels, including, but not limited to, children with:

  • Impaired fine motor skills
  • Impaired gross motor skills 
  • Neuro-motor disorders (Cerebral Palsy, Down Syndrome, Duchenne’s Muscular Dystrophy)
  • Autism Spectrum Disorder
  • Sensory processing disorder (auditory, tactile, visual, or vestibular processing issues)
  • Medically fragile diagnoses
  • Poor body awareness
  • Poor attention/focus

 OT Perspective

  • Self-regulation: the vestibular input from the buoyancy of the water allows for a calm and relaxed state.
  • Tactile sensitivities: constant stimulation of tactile receptors throughout the whole body becomes desensitized by the water, allowing increased tolerance to touch. Many children may be able to tolerate increased tactile input for several hours after a pool session!
  • Focus and attention: the resistance (viscosity) of the water provides your child with heavy work, helping them organize and attend to their body movements and tasks at hand. This focus and attention has been shown to carry over for several hours after the pool session! 
  • Breath control and awareness: resisted inhalation and assisted exhalation encourages efficient breathing patterns and increased lung capacity, which helps improve focus/attention and self-regulation skills!
  • Body awareness and motor planning: resistance and drag of water allows your child to feel their body in space (proprioceptive feedback) to more accurately complete each movement in a more slow and controlled manner than on land. Additionally, visual information is distorted underwater, encouraging your child to focus more heavily on their proprioceptive system to navigate.
  • Gravitational insecurity: the pressure and increased tactile and vestibular input from the water provide your child with enough stimulation to feel more organized with their body inverted than when on land.
  • Auditory processing impairments: going underwater provides a break from auditory stimulation in the child’s environment.
  • Visual processing impairments: visual tracking above and below the water to find toys, see where the body is in the pool in relation to other bodies, the wall, etc. can help support visual processing difficulties.

 PT Perspective 

  • Posture and head control: buoyancy allows for better postural alignment and positioning in a variety of developmental positions with less handling, and allows for facilitation of weight shifting and performing transitional movements without compensations.
  • Strength: water reduces the load placed on joints, which allows for increased repetitions and a variety of muscle groups to be targeted. The viscosity and drag provide resistance during movements, and can be adjusted by performing water-assisted or water-resisted activities, breaking through the surface tension, and changing speed and direction of activity affecting the turbulence and flow of water. 
  • Endurance: performing activities in water helps improve aerobic capacity and improve breathing function due to the effects of hydrostatic pressure on cardiac output (efficiency of heart pumping blood to the body) and breathing against resistance.
  • Flexibility: the temperature and rhythmic movements that can be performed in water allow muscles to relax, which can be particularly beneficial for children with high muscle tone or spasticity. Buoyancy takes out the effects of gravity, which provides an optimal environment for stretching muscles throughout the body.
  • Gait: buoyancy reduces the amount of load placed through the joints and provides postural support to practice walking that cannot be replicated on land.
  • Balance and coordination: the properties of water allow for increased reaction time, in addition to providing proprioceptive feedback to help the body know where it is in space.

 If you would like to learn more about aquatic therapy, or think your child would benefit from therapy services, please contact our office for additional information or to set up a consultation with a therapist!