Aquatic Health Benefits Bulletin

NSPF provides a monthly Aquatic Health Benefits Bulletin (AHBB), each focusing on a different topic area: athletes and non-impaired, cardiopulmonary & systemic, neurological & cognitive musculoskeletal, pediatric, and women's health. The monthly posts include 300-500 vignettes written in laymen's terms and the corresponding scientific references. The bibliography is organized by a certain topic area with links to publications that are available online. The AHBB is a great resource for the pool and spa industry influencers who want to help build demand for pools, spas, and aquatic facilities by promoting the benefits of water immersion and activity. It is also a perfect way for aquatic leaders to help promote healthier living and reduce drownings.


July 2018: Aquatics & Traumatic Brain Injury



Content courtesy of the National Swimming Pool Foundation


Significant brain injury can be a world-stopping disorder which changes everything. Even minor incidences of concussion can produce long-lasting effects that are not realized for weeks, months or even years after the incident. Over 5 million Americans currently live out their daily lives with the shadow of long-term disabilities from brain injury lingering upon them. Each year, another 2.5 million people are affected in the US alone. Unlike progressive neurological conditions like Parkinson’s, dementia or multiple sclerosis, the effects of trauma are typically “once and done.” Unfortunately, the precipitating event (usually a fall, blunt trauma or car accident) often produces a dramatic and irreversible condition.

So what does the therapy pool offer these patients? First, immersion in water facilitates treatment of multiple sites simultaneously/ in rapid succession; it allows ease of positioning and access to patient’s body; and/or facilitates ease of handling of patient by therapist. This is quite useful when working with patients with significant mobility restrictions, spasticity and (in some circumstances) unpredictable actions. In the water, patients’ balance may be challenged beyond limits of stability in the water without the fear of consequences of falling often present with land-based balance training. The environment leads to improvement in balance reactions without the dangers associated with the alternative. It is possible to grade both weight bearing and resistance in water by altering depth of immersion and speed of movement, respectively. This allows patients with weakness the opportunity to gradually expand the work they perform in a self-selected pace. 

As is obvious to anyone who has ever stepped foot in a pool, exercise in water promotes more movement freedom and thus promotes improved motion, reduced stiffness and increased functional strength and mobility while diminishing the negative consequences of lack of movement. Finally, exercise in a therapeutic pool promotes normal socialization and promotes psychological well-being. Pool time is a fun experience and it does not feel like work or therapy. For all these reasons and more, aquatic therapy should be seen as the treatment of choice for the patient with a traumatic brain injury.


Bland, D. C., Zampieri-Gallagher, C., & Damiano, D. L. (2011). Effectiveness of physical therapy for improving gait and balance in ambulatory individuals with traumatic brain injury: a systematic review of the literature. Brain Injury : [BI], 25((7-8)), 664–679.

Driver, S., & Ede, A. (2009). Impact of physical activity on mood after TBI. Brain Injury, 23(3), 203–212.

Driver, S., O’connor, J., Lox, C., & Rees, K. (2004). Evaluation of an aquatics programme on fitness parameters of individuals with a brain injury. Brain Injury, 18(9), 847–859.

Driver, S., Rees, K., O’Connor, J., & Lox, C. (2006). Aquatics, health-promoting self-care behaviours and adults with brain injuries. Brain Injury, 20(2), 133–141.

Fenech, A. (2012). Aquatic Leisure satisfaction and engagement in Neuropalliative Disability Management. Scandinavian Journal of Caring Sciences, 26(3), 519–527. article.

Lambeck, J. (2017). Hydrotherapy in adult neurology. EWAC Medical Accessed, 10.

Lee, I. H., Seo, E. J., & Lim, I. S. (2014). Effects of aquatic exercise and CES treatment on the changes of cognitive function, BDNF, IGF-1, and VEGF of persons with intellectual disabilities. Journal of exercise nutrition & biochemistry, 18(1), 19.

Lourenco, M., Bueno, L., Baccaro, V., Batista, B., Kanashiro, M., Anjos, C., & Braga, D. (2015). Electromyographic analysis of tibialis anterior and soleus muscles in hemiparetic patients on aquatic environment in comparison to land environment. Physiotherapy (United Kingdom), 101(1), eS903

Lynch, J. (2016). AquaJogging the brain: An early intervention to concussion management? Current Res Concussion, Epub ahead of print. 

Marinho-Buzelli, A. R., Bonnyman, A. M., & Verrier, M. C. (2015). The effects of aquatic therapy on mobility of individuals with neurological diseases: a systematic review. Clinical rehabilitation, 29(8), 741-751.

McCain, K., & Shearin, S. (2017). A Clinical Framework for Functional Recovery in a Person With Chronic Traumatic Brain Injury: A Case Study. Journal of Neurologic Physical Therapy, 41(3), 173-181.

Murrey, G. J., & Sell, M. (2017). Recreational therapy program for patients with traumatic brain injury. In Alternate Therapies in the Treatment of Brain Injury and Neurobehavioral Disorders (pp. 89-105). Routledge.

Perry, S. A., Coetzer, R., & Saville, C. W. (2018). The effectiveness of physical exercise as an intervention to reduce depressive symptoms following traumatic brain injury: A meta-analysis and systematic review. Neuropsychological rehabilitation, 1-15.

Wheeler, S., Acord-Vira, A., Arbesman, M., & Lieberman, D. (2017). Occupational therapy interventions for adults with traumatic brain injury. American journal of occupational therapy, 71(3), 7103395010p1-7103395010p3.

Wheeler, S., Acord-Vira, A., & Davis, D. (2016). Effectiveness of interventions to improve occupational performance for people with psychosocial, behavioral, and emotional impairments after brain injury: A systematic review. American journal of occupational therapy, 70(3), 7003180060p1-7003180060p9.

Wykle, M. O. (2010). Easing the Trauma. Aquatics International, 22(8), 46–48. Retrieved from

Xu, G.-Z., Li, Y.-F., Wang, M.-D., & Cao, D.-Y. (2017). Complementary and alternative interventions for fatigue management after traumatic brain injury: a systematic review. Therapeutic Advances in Neurological Disorders, 10(5), 229–239.