Aquatic Therapy: A Viable Therapeutic Recreation Intervention Ellen Broach and John Dattilo This paper presents a review of the literature concerning the effects of aquatic therapy utilizing swimming and exercise activity to improve function. Based on the literature, aquatic therapy appears to have numerous psychological and physical benefits. Research studies support the belief that participation in an aquatic therapy program can provide individuals with a realistic solution for maintaining physical fitness and continuing to achieve rehabilita- tion goals while engaging in enjoyable leisure pursuits. Implications of aquatic therapy to leisure generally and therapeutic recreation more specifically are highlighted. KEY WORDS: Aquatic Therapy, Swimming, Water Exercise, Therapeutic Recreation Aquatic therapy, utilizing swimming and improve functioning of all major muscle exercise activity to improve function, is be- groups without the impact that is unavoid- lieved to have beneficial consequences for able in land based physical exercise (Cam- physiological and psychological well-being pion, 1985). (Campion, 1990; Davis & Harrison, 1988; Physiological improvements achieved Hurley & Turner, 1991; Skinner & Thom- through involvement with aquatic therapy son, 1989). Hurley and Turner (1991) sug- have been documented in studies of individ- gested that for many individuals with disabil- uals who have multiple sclerosis (Gehlsen, ities the buoyancy as well as the increased Grigsby, & Winant, 1984), cystic fibrosis resistance and warmth of water creates an (Edlund, 1980), arthritis (Danneskiold- environment for exercise which is more con- Samsoe, Lyngberg, Risum, & Telling, 1987), ducive to achieving treatment goals than ex- orthopedic impairments (Skinner & Thom- ercise conducted on land. In addition, exer- son, 1989), cerebral palsy (Harris, 1978; cise achieved through aquatic therapy may Smith, 1985) and asthma (Haung, Veiga, Ellen Broach is a doctoral student and John Dattilo is a Professor in the Department of Recreation and Leisure Studies at the University of Georgia. Third Quarter 1996 213 Sila, Reed, & Hines, 1989). Furthermore, the restorative properties of spas, warm baths psychological benefits of participants in and the sea since the 5th century BC. Greeks aquatic therapy have been identified to in- and Romans recognized the value of the clude improved mood (Berger & Owen, warm water as an adjunct to their sporting 1992; Berger, Owen, & Man, 1993), en- activities and aquatic activity for rehabilita- hanced self-esteem and body image (Bene- tion of individuals with paralysis (Campion, dict & Freeman, 1993; Wright & Cowden, 1990). More recently, aquatic therapy has 1986), and decreased anxiety and depression been provided in the United States in swim- (Stein & Motta, 1992; Weiss & Jamieson, ming pools and therapeutic pools since 1989). In addition to physiological and psy- World War I (Reynolds, 1976). Aquatic ther- chological benefits, aquatic therapy may apy has been described as activity in the wa- promote the development of swimming as a ter based on hydrodynamic principles for lifetime leisure skill which helps maintain therapeutic purposes (Campion, 1990). The health and contributes to happiness (Beau- literature concerning use of water as a me- douin & Keller, 1994; Johnson, 1988; Pega- dium for therapy has been written by various noff, 1984; Smith, 1992; Tsukahara, Toda, individuals practicing in aquatics, including Goto, & Ezawa, 1994). therapeutic recreation specialists, physical Although various issues abound in the therapists, occupational therapists, massage general area of aquatics, from concerns re- therapists, physiotherapists, medical doctors, garding water temperature (Campion, 1990; sport psychologists and exercise physiolo- Franchimont, Juchmes, & Leccomte, 1983) gists. to qualifications of practitioners using the Aquatic therapy (Johnson, 1988), hydro- aquatic medium in therapy (Campion, 1990; therapy (Campion, 1990), water therapy Smith, 1992), the general consensus reported (Smith, 1992), swimming therapy (Campion, in the literature is that aquatics is a viable 1990), water exercise (Danneskiold-Samsoe, medium that has potential to enhance quality Lyngberg, Risum, & Telling, 1987) and wa- of life for people with disabilities. Based on ter physiotherapy (Smith, 1992) are some of the findings reported in the literature, aquatic the phrases used in the literature describing therapy appears to be an intervention that the use of the water for therapeutic benefits. can be used by therapeutic recreation spe- The term "hydrotherapy" is presented pri- cialists to promote psychological and physi- marily in literature published in Great Britain ological improvement while facilitating in- and ' 'aquatic therapy'' seems to be the domi- dependence in swimming and water exer- nant phrase used in the United States. For the cise. purpose of this paper, the phrase "aquatic This paper begins with a definition of therapy" is used to include water exercise "aquatic therapy" and the issue of swim- and swimming as modes of prescribed activ- ming as therapy as discussed in the literature. ity used as rehabilitation/habitation to Subsequently, physiological, psychological, achieve goals of improved physiological, and leisure activity implications are ad- psychological, psychosocial and/or life ac- dressed. Implications for aquatic therapy de- tivity function under the supervision of indi- livered in community settings by therapeutic viduals qualified and competent in its tech- recreation specialists are presented as well. niques and utilization. Therapeutic recre- The paper concludes with recommendations ation specialists should be familiar with for the practice of therapeutic recreation. intervention strategies and benefits of aquatic therapy. An understanding of the po- Description of Aquatic Therapy tential of aquatic therapy to enhance an indi- Aquatic therapy has a long-established vidual's leisure lifestyle may be useful in and documented history. People have sought justifying treatment programs. 214 Therapeutic Recreation Journal The techniques of aquatic therapy vary. Physiological Implications Some popular interventions include Bad Ra- Although techniques such as Watzu, and gaz (Boyle, 1981) (employing the principles Bad Ragaz are discussed in the literature, of proprioceptive neuromuscular facilitation swimming and non-swimming water exer- using active and passive techniques for cise were the only mediums found to be ex- strengthening, muscle re-education and amined in the research literature. The physi- trunk elongation); Watsu (Dull, 1993) cal benefits of activity performed in the wa- (applying the moves of Zen Schiatsu to facil- ter may include relief of pain (Guillemin, itate decreased tension and improved psy- Constant, Collin & Boulange, 1994; Lan- chological well being); deep and shallow wa- gridge & Phillips, 1988; Woods, 1989), de- ter ambulatory exercise and therapeutic creased spasticity and increased relaxation swimming commonly implemented using (Davis & Harrison, 1988), improved bone the Halliwick Method (Campion, 1985) or density (Benedict & Freeman, 1993; Tsuka- Sequential Swim Techniques (Carter, LeCo- hara et al., 1994), improved pulmonary func- ney, & Dolan, 1994) which inherently facili- tion (Haung et al., 1989; Whitley & Schoene, tates normal patterns of movement and pos- 1987), strengthened muscles (Gehlsen, Grig- ture (Neurodevelopmental Treatment). The sby, & Winant, 1984), improved endurance use of passive or active water exercise and (Burke & Kennan, 1984; Danneskiold- swimming as therapeutic media are technical Samsoe, Lyngberg, Risum, & Telling, 1987; processes that require the ability to teach Edlund, 1980; Edlund et al., 1986; Routi, swimming as well as understand the hydro- Troup, & Berger, 1994; Wright & Cowden, dynamics of the water and the implications 1986), and improved range of motion and and contraindications associated with use of increased circulation (Peganoff, 1984). The the water for therapy (Association of Swim- following is a review of articles describing ming Therapy, 1992). the physical benefits of aquatic therapy. Although swimming is considered to be a component of aquatic therapy in this paper, Decrease Pain for some individuals it is seen as a recreation Although water exercise and swimming activity not in the realm of aquatic therapy are commonly mentioned as recommended (Davis & Harrison, 1988). Some prac- forms of treatment for lower back pain titioners consider aquatic therapy as limited (Campion, 1990; Johnson, 1989; J^evin, to passive or active exercise techniques in 1991; Meyer, 1990; Siracusano, 1984; Skin- the water, while Campion (1985) and others ner & Thomson, 1989), it is a treatment mo- believe that swimming is an integral part of dality which has limited scientific research aquatic therapy, and is essential to the over- basis and reports in the back pain literature. all rehabilitation of some individuals. Nu- One study conducted by Guillemin, Con- merous examples of the benefits of swim- stant, Collin, and Boulange (1994), assessed ming when used in aquatic therapy are pre- the effects of spring water treatment on sented in the literature (Bar-Or & Inbar, chronic low-back pain by comparing a ran- 1992; Benedict & Freeman, 1993; Edlund, domly selected group of 50 people undergo- 1980; Haung et al., 1989; Johnson, 1988; ing an aquatic therapy program to 52 ran- Langridge & Phillips, 1988; Peganoff, domly selected people not receiving aquatic 1984).