December 2018: Aquatics & Congenital Disorders

SPOTLIGHT ON AQUATICS & CONGENITAL DISORDERS

THE POOL IS CUSTOM-MADE FOR TREATING DISORDERS PRESENT AT BIRTH

Content courtesy of the National Swimming Pool Foundation

RECENT PUBLICATIONS WHICH SHOW HOW WATER WORKS FOR CONGENITAL DISORDERS

There are many compelling reasons for choosing to treat children with congenital disorders in the pool, not the least of which may be the child’s own preference. Children generally find the pool fun and often do not seem to notice that they are doing therapeutic activities, working hard and making progress in their functional skills. As anyone who works with children knows, play is a child’s work. Since they see aquatic activity as play, they’re motivated to participate. 

That said, there are excellent reasons to choose the pool for children with special needs. On land, children who cannot control their head or trunk often require the use of special seating systems for positioning. In water, the skilled therapist or instructor can position a patient in a vertical, upright position without the use of special floats or a second pair of hands. It can be extremely encouraging for kids to work in such a freeing environment. When working on head and trunk righting or control, the water allows more time for the body to give and receive feedback in order to make an appropriate physical response. 

What’s more, the pool often permits children to participate in activities that are unachievable on land. As just one example, the water is an excellent medium to elicit weight shifting. A weight shift can occur accidentally or be initiated by the child or treating therapist, but movement is always a result and it stimulates righting reactions. Practice shifting their weight without falling helps children improve overall postural control. Buoyancy aids in the child obtaining proper postural alignment with less handling and greater ease. Proper alignment increases the child’s ability to promote motor learning and recruit proper muscles for improved head and trunk righting and control.

Impeded head and trunk control often results in reduced movement control overall. The pool provides a “viscous” (think sticky) environment in which to work; this environment then slows any movements (including falling) and constantly provides feedback to falling. In other words, the pool helps the child take risks without catastrophic consequences, thus allowing freedom to play, explore, and act as all children act on occasion—without restraint!

RECENT ANNOTATED REFERENCES

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. http://doi.org/10.1016/j.apmr.2016.08.407

Adar, S., Dündar, Ü., Demirdal, Ü. S., Ulaşlı, A. M., Toktaş, H., & Solak, Ö. (2017). The effect of aquatic exercise on spasticity, quality of life, and motor function in cerebral palsy. Turkish Journal of Physical Medicine and Rehabilitation, 63(3), 239–248. http://doi.org/10.5606/tftrd.2017.280

Altenbach-brennan, A. (2010). Teaching Aquatic Skills to Children with Autism Spectrum Disorders.

Appel, J. (2016). Commentary on “Benefits and Enjoyment of a Swimming Intervention for Youth with Cerebral Palsy: An RCT Study”. Pediatric Physical Therapy, 28(2), 170. http://doi.org/10.1097/PEP.0000000000000253

Atamturk, H., & Atamturk, A. (2018). Therapeutic effects of aquatic exercises on a boy with Duchenne muscular dystrophy. Journal of Exercise Rehabilitation, 14(5), 877–882. http://doi.org/10.12965/jer.1836408.204

Badawy, W. W. M., Ibrahem, M. M. B., Ph, D., Ibrahem, M. M. B., & Ph, D. (2016). Comparing the Effects of Aquatic and Land-Based Exercises on Balance and Walking in Spastic Diplegic Cerebral Palsy Children. Medical Journal of Cairo, 84(1), 1–8. Retrieved from http://medicaljournalofcairouniversity.net/home2/images/pdf/2016/march/57.pdf

Ballaz, L., Plamondon, S., & Lemay, M. (2011). Group aquatic training improves gait efficiency in adolescents with cerebral palsy. Disability and Rehabilitation, 33(17–18), 1616–1624. http://doi.org/10.3109/09638288.2010.541544

Barassi G, Bellomo RG, Ancona E, Trivisano L, & Saggini R. (2017). The role of water environment rehabilitation in patients with neurological and cognitive disabilites. Biophilia, (1). Retrieved from https://www.jstage.jst.go.jp/article/ibra/2017/1/2017_28/_pdf

Barassi, G., Bellomo, R. G., Porreca, A., Giannuzzo, G., Irace, G., Trivisano, L., & Saggini, R. (2018). Rehabilitation of Neuromotor Disabilities in Aquatic Microgravity Environment (pp. 1–13). Springer, New York, NY. http://doi.org/10.1007/5584_2018_164

Barmatz, C., Lazitz-Dor, A., Casher, H., Mekadesh, K., Morag, I., Bar-Yosef, O., & Friedman, H. (2014). Influence of Infant Aquatics on the neural development of premature infants. Journal of Molecular Neuroscience, 53, S13. 

Benedita, M., Pardo, L., & Israel, V. L. (2014). Hydrotherapy: Application of an Aquatic Functional Assessment Scale (AFAS) in Aquatic Motor Skills Learning. American International Journal of Contemporary Research, 4(2), 42–52. 

Blohm, D. (2012). Effectiveness of aquatic therapy in children and adolescents with cerebral palsy (ICP): The potential for positive effects is large [German]. Zeitschrift Fur Physiotherapeuten, 64(8), 6–15. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=jlh&AN=108096512&site=ehost-live

Bosko, V. (2017). An influence of initial swimming training technology on technical preparedness indicators of children with consequences of cerebral palsy. Slobazans’kij Naukovo-Sportivnij Visnik, 5(61), 24–27.

Byoungook, K., & Hyojeong, L. (2015). Effects of Aquatic Rehabilitation Program on Gross Motor Function and Balance in Children with Cerebral Palsy. Journal of The Korean Society of Integrative Medicine, 3(3), 35–42. http://doi.org/10.15268/ksim.2015.3.3.035

Chau, P. Y. (2012). Swimwear: Needs Assessment and Prototype Development for Special Needs Children. Ryerson University.

ChiaLing Chen. (2015). Effects of Pediatric Aquatic Therapy in Children with Spastic Cerebral Palsy. Chang Gung Memorial Hospital. Retrieved from https://clinicaltrials.gov/ct2/show/record/NCT01049581

Children, C. (2011). Best Evidence Statement (BESt): Aquatic physical therapy combined with land-based physical therapy to improve functional independence. Early Education, 9(January), 1–6. http://doi.org/10.1002/pits.20620.

Conatser, P.; James, E.; Karabulut, U.; Conatser, P.; & James, E.; (2018). Adapted Aquatics for Children with Severe Motor Impairments. International Journal of Aquatic Research and Education, 10(3), 5. 

Connor, J. O. (2012). Effects of Aquatic Exercise on Balance in Children with Cerebral Palsy, (May).

Declerck, M., Feys, H., & Daly, D. (2013). Benefits of Swimming for Children with Cerebral Palsy: A Pilor Study. Serbian Journal of Sports Sciences, 7(2), 57–69. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=sph&AN=90844790&lang=es&site=ehost-live&scope=site

Declerck, M., Verheul, M., Daly, D., Sanders, R., & Declerck, M., Verheul, M., Daly, D., & Sanders, R. (2016). Benefits and Enjoyment of a Swimming Intervention for Youth with Cerebral Palsy: An RCT Study. Pediatric Physical Therapy, 28(2), 162–169. http://doi.org/10.1097/PEP.0000000000000235

Declerck, M. (2014). Swimming and the physical, social and emotional well-being of youth with cerebral palsy. Retrieved from http://www.era.lib.ed.ac.uk/handle/1842/9459

Derikvandi, A. N., & Goudarzi, B. (2017). The effect of swimming exercise on the correction of thoracic kyphosis in patients with muscle dystrophy. International Journal of Biology, Pharmacy and Allied Sciences, 6(67), 1332–1342. Retrieved from http://ijbpas.com/pdf/2017/July/1500186782MS IJBPAS 2017 4112.pdf

Derikvandi, A., & Kaviyaniniya, R. (2017). The Effect of in Water Selective Exercises on Muscle Strength in Patients with Muscle Dystrophy. Global Journal of Health Science, 9(8), Epub ahead of print. Retrieved from http://www.ccsenet.org/journal/index.php/gjhs/article/view/69173

Dibiasio, P., Primus, K. B., Drogos, J., Husted, C., Stephens, H., Thorpe, D., … Hospital, D. R. (2015). Case Report An Aquatic Exercise Program for an Adolescent With Limb Girdle Muscular Dystrophy. The Journal of Aquatic Physical Therapy, 23(1), 3–14.

Dimitrijevic, L., Bjelakovic, B., Lazovic, M., Stankovic, I., Colovic, H., Kocic, M., & Zlatanovic, D. (2012). Aquatic exercise in the treatment of children with cerebral palsy. Srpski Arhiv Za Celokupno Lekarstvo, 140(11–12), 746–750.

Dimitrijević, L., Aleksandrović, M., Madić, D., Okičić, T., Radovanović, D., & Daly, D. (2012). The Effect of Aquatic Intervention on the Gross Motor Function and Aquatic Skills in Children with Cerebral Palsy. Journal of Human Kinetics, 32(May), 167–174. http://doi.org/10.2478/v10078-012-0033-5

Dimitrijevic, L., Bjelakovic, B., Lazovic, M., Stankovic, I., Colovic, H., Kocic, M., … Zlatanović, D. (2012). Aquatic exercise in the treatment of children with cerebral palsy. Srpski Arhiv Za Celokupno Lekarstvo, 140(11–12), 746–750. http://doi.org/10.2298/SARH1212746D

Dubois, M. (2011). Aquatic Therapy for Children with an Autism Spectrum Disorder: Occupational Therapists’ Perspectives. Children. University of Puget Sound. Retrieved from http://soundideas.pugetsound.edu/ms_occ_therapy/22

Education, P., Naučni, O., Bojan Jorgić, R., Dimitrijević, L., Aleksandrović, M., Okičić, T., … Radovanović, D. (2012). The Swimming Program Effects on the Gross Motor Function, Mental Adjustment to the Aquatic Environment, and Swimming Skills in Children with Cerebral Palsy: A Pilot Study. Clinic of Physical Medicine and Rehabilitation, 11(1), 51–66. http://doi.org/10.5937/specedreh1201051J

Emmi-Sofia Kangas. (2016). The use of performance enhancing swimwear during aqua therapy for cerebral palsy - a case study. Satakunnan ammattikorkeakoulu, Satakunta University of Applied Sciences.

Fragala-Pinkham, M. A., Dumas, H. M., Barlow, C. A., & Pasternak, A. (2009). An Aquatic Physical Therapy Program at a Pediatric Rehabilitation Hospital: A Case Series. Pediatric Physical Therapy, 21(1), 68–78. http://doi.org/10.1097/PEP.0b013e318196eb37

Fragala-Pinkham, M. A., Smith, H. J., Lombard, K. A., Barlow, C., O’Neil, M. E., & O’Neil, M. E. (2014). Aquatic aerobic exercise for children with cerebral palsy: a pilot intervention study. Physiotherapy Theory & Practice, 30(2), 69–78. http://doi.org/10.3109/09593985.2013.825825

Franzen, K., & Tryniszewski, P. (2013). Effectiveness of Aquatic Therapy for Children with Neurodevelopmental Disorders: Systematic Review of Current Literature. The Sage Colleges. Retrieved from http://library2.sage.edu/archive/thesis/PT/2013franzen_tryniszewski.PDF

Gaab, E., & Steinhorn, D. (2014). Families’ Views of Pediatric Palliative Aquatics: A Qualitative Study. Pain Management Nursing. Retrieved from http://www.sciencedirect.com/science/article/pii/S1524904214001593

Gabriel, E. (2010). Land and Aquatic Based Physical Therapy Interventions to Improve Mobility and Independence on a Pediatric Patient After a Near-Drowning: a Case Report. Sage Graduate School.

Getz, M., Hutzler, Y., Vermeer, A., Yarom, Y., & Unnithan, V. (2012). The Effect of Aquatic and Land-Based Training on the Metabolic Cost of Walking and Motor Performance in Children with Cerebral Palsy: A Pilot Study. ISRN Rehabilitation, 2012, 1–8. http://doi.org/10.5402/2012/657979

Gorter, J. W., & Currie, S. J. (2011). Aquatic Exercise Programs for Children and Adolescents with Cerebral Palsy: What Do We Know and Where Do We Go? International Journal of Pediatrics, 2011(2), 1–7. http://doi.org/10.1155/2011/712165

Grosse, S. J. (2009). Aquatics for Individuals with Disabilities: Research Implications. International Journal of Aquatic Research & Education, 3(4), 356–367. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=45306136&site=ehost-live

Güeita-Rodríguez, J., García-Muro, F., Rodríguez-Fernández, Á. L., Lambeck, J., Fernández-de-las-Peñas, C., & Palacios-Ceña, D. (2017). What areas of functioning are influenced by aquatic physiotherapy? Experiences of parents of children with cerebral palsy. Developmental Neurorehabilitation, 21(8), Epub ahead of print. http://doi.org/10.1080/17518423.2017.1368728

Guille, S. (2016). Aquatic Physiotherapy in the Inpatient Setting. Aquatic Physical Therapy Group. http://doi.org/10.1017/CBO9781107415324.004

Hernandez, A. A. (2016). The Benefits of Aquatic Therapy on Individuals with Cerebral Palsy. University Presentation Showcase Event. Eastern Kentucky University. Retrieved from http://encompass.eku.edu/swps/2016/undergraduate/54/

Hill, M., McAuliffe, K., Watkins, P., Wheeler, A., Raynes, E., M., H., … Raynes, E. (2015). The Underwater Treadmill as a Physical Therapy Intervention for Children with Cerebral Palsy. The Federation of American Societies for Experimental Biology Journal (FASEB), 29(1), 983.10. http://doi.org/10.1096/fj.1530-6860

Hind, D., Parkin, J., Whitworth, V., Rex, S., Young, T., Hampson, L., Sheehan, J., Maguire, C., Cantrill, H., Scott, E. and Epps, H., Hind, D., Parkin, J., Whitworth, V., Rex, S., Young, T., … Baxter, P. (2017). Aquatic therapy for boys with Duchenne muscular dystrophy (DMD): an external pilot randomised controlled trial. Pilot and Feasibility Studies, 3(1), 16. http://doi.org/10.1186/s40814-017-0132-0

Hind, D., Parkin, J., Whitworth, V., Rex, S., Young, T., Hampson, L., … Baxter, P. (2017). Aquatic therapy for children with Duchenne muscular dystrophy: a pilot feasibility randomised controlled trial and mixed-methods process evaluation. Health Technology Assessment, 21(27), 1–120. http://doi.org/10.3310/hta21270

Israel, V. (2015). Aquatic assessment of motor skills in muscular dystrophy: a case study. Physiotherapy. Retrieved from https://scholar.google.com/scholar?start=100&q=%2522aquatic+therapy%2522+OR+%2522aquatic+exercises%2522&hl=en&as_sdt=0,10&as_ylo=2014#4

Jackson, J., Cosbey, J., & Meyer, W. (2015). Influence of Adaptive Water Sports Programs on Quality of Life Perceptions for People with Disabilities: A Feasibility Study. University of New Mexico. Retrieved from http://dspace.unm.edu/handle/1928/26753

Jarad, N. A., Powell, T., & Smith, E. (2010). Evaluation of a novel sputum clearance technique--hydro-acoustic therapy (HAT) in adult patients with cystic fibrosis: a feasibility study. Chronic Respiratory Disease, 7(4), 217–227. http://doi.org/10.1177/1479972310376082

Jens, B., Wilhelm, B., Jürg, K., Urs, G., Fabio, J., Daniel Dos Santos, G., … Sanders, R. (2013). 1st EUROPEAN CONFERENCE ON EVIDENCE BASED AQUATIC THERAPY (ECEBAT) ABSTRACTS OF PRESENTATIONS. TURKISH JOURNAL OF PHYSIOTHERAPY AND REHABILITATION (Vol. 24). Retrieved from https://pdfs.semanticscholar.org/3adb/9ab6b7c96ea3902bfcf45632fdcc7b11060d.pdf

Jorgic, B. (2014). The Effects of a Program of Swimming and Aquatic Exercise on Flexibility in Children with Cerebral Palsy. Facta Universitatis, {…}. Retrieved from http://casopisi.junis.ni.ac.rs/index.php/FUPhysEdSport/article/view/289

Jorgić, B., Dimitrijević, L., Lambeck, J., Aleksandrović, M., Okičić, T., & Madić, D. (2012). Effects of aquatic programs in children and adolescents with cerebral palsy: Systematic review. Sport Science, 5(2), 49–56.

Ka, B., Declerck, M., Daly, D. J., Karklina, B., Declerck, M., Daly, D. J., … Daly, D. J. (2013). Quantification of Aquatic Interventions in Children with Disabilities: A Systematic Literature Review. International Journal of Aquatic Research & Education, 7(4), 344–379. 

Khalaji, M., Kalantari, M., Shafiee, Z., & Hosseini, M. A. (2017). The Effect of Hydrotherapy on Health of Cerebral Palsy Patients: An Integrative Review. Iranian Rehabilitation Journal, 15(152), 173–180. http://doi.org/10.18869/nrip.irj.15.2.173

Labianca, L., Calderaro, C., Rota, P., Vulpiani, M. C., Turturro, F., Montanaro, A., … Ferretti, A. (2013). Evaluation by gross motor function measure of a pilot aquatic exercise program for children with cerebral palsy. Journal of Orthopaedics and Traumatology, 14(1), S84–S85. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L71249575%5Cnhttp://dx.doi.org/10.1007/s10195-013-0264-9%5Cnhttp://rd8hp6du2b.search.serialssolutions.com?sid=EMBASE&issn=15909921&id=doi:10.1007%2Fs10195-013-0264-9&atitle=Evaluation+by

Lai, C.-J. J. C., Liu, W. Y. W. W.-Y., Yang, T.-F. F. T., Chen, C.-L. C. C.-L. L., Wu, C.-Y. Y., & Chan, R.-C. C. (2015). Pediatric Aquatic Therapy on Motor Function and Enjoyment in Children Diagnosed with Cerebral Palsy of Various Motor Severities. Journal of Child Neurology, 30(2), 200–8. http://doi.org/10.1177/0883073814535491

Lambeck, J. (2015). Clinical Spotlight: A reaction to the Clinical Spotlight on Pediatric Aquatic Therapy. International Organization of Physical Therapists in Pediatrcs, pp. 16–20.

Łubkowska, W., Paczyńska-jędrycka, D. M., Eider, D. J., & Lubkowska, W. (2014). The significance of swimming and corrective exercises in water in treatment of postural deficits and scoliosis. The European Journal of Sports Science and Medicine, 6(2), 93–101. Retrieved from http://agro.icm.edu.pl/agro/element/bwmeta1.element.agro-7b31168e-0005-49ee-afbd-40913a296161/c/THE_SIGNIFICANCE_OF_SWIMMING_AND_CORRECTIVE....pdf

Maniu, D. A., Maniu, E. A., & Benga, I. (2013). Effects of an aquatic therapy program on vital capacity, quality of life and physical activity index in children with cerebral palsy. Human & Veterinary Medicine, 5(3), 117–124. 

Maniu, D., Maniu, E. A., & Benga, I. (2013). Influencing the Gross Motor Function, Spasticity and Range of Motion in Children with Cerebral Palsy by an Aquatic Therapy Intervention Program. Studia Universitatis Babes-Bolyai, Educatio Artis Gymnasticae. 

Meyer, E., Vanheuverzwijn, A., Remacle, M., & Lambeck, J. (2016). Comparison of the passive range of motion of the upper (UE) and lower extremities (LE) after a session of classical hydrotherapy versus «Halliwick» in children with cerebral palsy (CP): Randomized Clinical Trial (RCT). In AQUA Leuven. 

Nelson, L., Early, D., & Iannaccone, S. (2013). P.7.14 Effects of a regular aquatic therapy program on one individual with Duchenne Muscular Dystrophy (DMD): A case study. Neuromuscular Disorders, 23(9–10), 777–778. http://doi.org/10.1016/j.nmd.2013.06.495

Not, I., Publica, C., Reuni, E. S., Cursos, E. S., Links, E., & Contato, G. (n.d.). Effects of an aquatic therapy approach ( Halliwick-Therapy ) on functional mobility in subacute stroke patients : a randomized controlled trial Abstract AddThis Sharing, 45–47.

Olama, K., Kassem, H., & Aboelazm, S. (2015). Impact of Aquatic Exercise Program on Muscle Tone in Spastic Hemiplegic Children with Cerebral Palsy. Clinical Medicine, 1(4), 138–144. Retrieved from http://www.aiscience.org/journal/cmj

Oliveira, L. C., Trócoli, T. O., Kanashiro, M. S., Braga, D., & Cyrillo, F. N. (2014). Electromyographic analysis of rectus femoris activity during seated to standing position and walking in water and on dry land in healthy children and children with cerebral palsy. Journal of Electromyography and Kinesiology: Official Journal of the International Society of Electrophysiological Kinesiology, 24(6), 855–9. http://doi.org/10.1016/j.jelekin.2014.08.008

Park, J. H., & Chung, Y. J. (2018). Comparison of Aquatic Treadmill and Anti-Gravity Treadmill Gait Training to Improve Balance and Gait Abilities in Stroke Patients. The Journal of Korean Physical Therapy, 30(2), 67–72. http://doi.org/10.18857/jkpt.2018.30.2.67

Passmore, EdD, CTRS/L, FDRT, T., Gbur, BS, MS, T., Lindenmeier, PhD, D., Price, PhD, ATC, T., & Passmore, BS, CTRS/L, ATRIC, J. (2018). Warm-water—A recreational therapy intervention: A case report. American Journal of Recreation Therapy, 17(1), 21. http://doi.org/10.5055/ajrt.2018.0151

Patterson, C., & Grosse, S. (2013). Swimming for Individuals with Severe Multiple Impairments: A Fitness Imperative. Palaestra, 27(1), 30–35. 

Pattman, J., Hall, J., & Record, E. (2013). Effectiveness of Aquatic Physiotherapy in Clinical Practice. International Journal of Aquatic Research and Education, 7(4). http://doi.org/10.25035/ijare.07.04.09

Quick, E. (2015). Aquatic Therapy Strength Training Benefits for the Leg Strength of Children with Cerebral Palsy. 

Roostaei, M., Baharlouei, H., Azadi, H., & Fragala-Pinkham, M. A. (2016). Effects of Aquatic Intervention on Gross Motor Skills in Children with Cerebral Palsy: A Systematic Review. Physical & Occupational Therapy In Pediatrics, 37(5), 1–20. http://doi.org/10.1080/01942638.2016.1247938

Ryu, K., Ali, A., Kwon, M., Lee, C., Kim, Y., Lee, G., … Jingu Kim. (2016). Effects of assisted aquatic movement and horseback riding therapies on emotion and brain activation in patients with cerebral palsy. Journal of Physical Therapy Science, 28(12), 3283–3287. Retrieved from https://www.jstage.jst.go.jp/article/jpts/28/12/28_jpts-2016-570/_article/-char/ja/

Salem, Y., Jaffee Gropack, S., Gropack, S. J., & Jaffee Gropack, S. (2010). Aquatic therapy for a child with type III spinal muscular atrophy: a case report. Phys Occup Ther Pediatr, 30(4), 313–24. http://doi.org/10.3109/01942638.2010.493097

Sanders, M. E., & Torres, L. E. (2010). Aquatic exercise for muscular dystrophy: The story of Laura Sos, Castell??n, Spain. ACSM’s Health and Fitness Journal, 14(6), 35–41. http://doi.org/10.1249/FIT.0b013e3181f8a332

Sands, P., Hoff, L., & Voigt, A. (2014). Team Joseph: Adaptive Aquatic Device. Retrieved from http://digitalcommons.calpoly.edu/mesp/213/

Sato, T., Hodge, S. R., Casebolt, K., & Samalot-Rivera, A. (2015). Physical education teacher candidates’ beliefs about instructing students with disabilities in adapted aquatics. International Journal of Aquatic Research and Education, 9(3), 308–328. 

Scenario, C., & Question, F. C. (2012). The effectiveness of sensory integration to enhance occupational engagement in children with sensory processing difficulties. (June).

Schram, B. (2018). Relationship between disability orientation and participation of children with disabilities in aquatic programs. Oregon State. Retrieved from https://ir.library.oregonstate.edu/concern/graduate_thesis_or_dissertations/9k41zm08s

Shams-Elden, M., & Mohamed, S.-E. (2017). Effect of aquatic exercises approach (Halliwick Therapy) on motor skills for children with austism spectrum disorders. Ovidius University Annals, Series Physical Education and Sport, 17(2), 490–496. 

Sharan, D., & Rajkumar, J. S. (2018). A comparative study on the effectiveness of standing balance training in a temperature-controlled pool versus land for children with cerebral palsy. Annals of Physical and Rehabilitation Medicine, 61, e315. http://doi.org/10.1016/J.REHAB.2018.05.734

Shelef, N. (2016). The effectiveness of aquatic therapy environment on upper limb function performance with specifically advanced modification instrument for children with severe cerebral palsy. Serbian Journal of Sports Sciences, 10(11), 6–15. Retrieved from https://www.researchgate.net/profile/Niv_Shelef/publication/320755802_THE_EFFECTIVENESS_OF_AQUATIC_THERAPY_ENVIRONMENT_ON_UPPER_LIMB_FUNCTION_PERFORMANCE_WITH_SPECIFICALLY_ADVANCED_SITTING_MODIFICATION_INSTRUMENT_FOR_CHILDREN_WITH_SEVERE_CEREBRAL_PALSY/li

Sigmundsson, H., & Hopkins, B. (2010). Baby swimming: exploring the effects of early intervention on subsequent motor abilities. Child: Care, Health and Development, 36(3), 428–430. http://doi.org/10.1111/j.1365-2214.2009.00990.x

Sršen, L, Vidmar, G, Pikl, M, Irena, V, Burja, C, Krisec, K. (n.d.). Content Validity and Inter-rater Reliability of the Halliwick-Concept-Based Instrument “Swimming With Independent Measure.” 1University Rehabilitation Institute.

Statement, P. (2012). Sensory Integration Therapies for Children With Developmental and Behavioral Disorders. Pediatrics, 129(6), 1186–1189. http://doi.org/10.1542/peds.2012-0876

Sutthibuta, U. (n.d.). Systematic Review of Aquatic Exercise Programming for Children and Adolescents with Cerebral Palsy. Rajanagarindra Institute of Child Development.

Tirosh, R., Katz-leurer, M., & Getz, M. D. (2008). Halliwick-Based Aquatic Assessments : Reliability and Validity Halliwick-Based Aquatic Assessments. International Journal of Aquatic Research and Education, 2(3), 224–236.

Vaščáková, T., Kudláček, M., & Barrett, U. (2015). Halliwick Concept of Swimming and its Influence on Motoric Competencies of Children with Severe Disabilities. European Journal of Adapted Physical Activity, 8(2), 44–49. 

Vo, S., Becnel, S., Salem, P., Liu, P., Vo, A., Becnel, M., … Liu, H. (2016). Effectiveness of Aquatic Therapy Interventions in the Management of Children with Cerebral Palsy: A Systematic Review. Research Appreciation Day. University of North Texas. Retrieved from http://digitalcommons.hsc.unt.edu/rad/RAD16/Other/3

Yamaguchi, B., Souza, F., Villegas, I., Gluszewicz, I., & Israel, V. (2015). Postural Acute Effect of an Aquatic Physical Therapy on Chronic Non Progressive Encephalopathy of Infancy. Revista Neurociências, 23(01), 130–135. http://doi.org/10.4181/RNC.2015.23.01.979.6p

Zamunér, A. R., Andrade, C. P., Forti, M., Marchi, A., Milan, J., Avila, M. A., … Silva, E. (2015). Effects of a hydrotherapy programme on symbolic and complexity dynamics of heart rate variability and aerobic capacity in fibromyalgia patients. Clinical and Experimental Rheumatology, 33(1 Suppl 88), 73–81. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25786047

Zverev, Y., & Kurnikova, M. (2016). Adapted Community-Based Group Aquatic Program for Developing Balance: A Pilot Intervention Study Involving Children and Adolescents with Cerebral Palsy. Journal of Physical Education and Sport, 16(4), 1258.