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Salem Y1,2, Liu H3, Elokda A2,4, Quiben M3, Ersen A3, Yavuz M3, El Negemy E2, Holmes C3
1University of North Texas Health Science Center, Physical Therapy, Fort Worth, United States, 2Cairo University, Faculty of Physical Therapy, Cairo, Egypt, 3University of North Texas Health Science Center, Fort Worth, United States, 4Florida Gulf Coast University, Fort Myer, United States
Background: Cerebral palsy, a commons neurodevelopmental disorder, is the most prevalent cause of persisting motor function impairment and childhood physical disability. Aquatic therapy has been recommended for children with cerebral palsy with several research studies reported positive outcomes following participation in aquatic exercise.
Purpose: The purpose of this systematic review was to examine evidence regarding the potential benefits of aquatic exercise for children with cerebral palsy. Safety, outcomes, and applications are addressed.
Methods: Electronic databases used werePubMed/MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Physiotherapy Evidence Database (PEDro), and Scopus.Date searched included all published works to date(May 2018). Additionally, we performed a hand search of the reference lists of relevant studies. Studies were included if they met the criteria of diagnosis (any form of cerebral palsy), population (aged 0-21), and intervention (aquatic exercise). Quality of the included studies was rated using the Centre of Evidence-Based Medicine: Levels of Evidence and the PEDro scale.
Results: Of the 17 studies, three were randomized controlled trials, three were cohort studies, seven were quasi-experimental design, one was a prospective time series group design, two were case reports, and one was a case study. The sample sizes for the included studies ranged from 1 to 46 subjects. The duration of treatment ranged from 6 weeks to 6 months, with frequency of sessions varying between 1 to 3 times a week, and length of sessions averaging between 30 to 60 minutes. A range of aquatic exercises and techniques were used to address multiple impairment areas, including upper and lower extremity strengthening and stretching, balance, aerobic capacity, water adjustment skills, and gait. Various outcome measures were used to assess effectiveness of aquatic exercises including gross motor function, ROM, balance, gait, energy expenditure, social acceptance, and self-esteem measures.
Conclusion(s): The evidence suggests that aquatic exercise programs may be effective in the short term for improving gross motor function, gait parameters, social function, and self-esteem in children with CP ages 0-21. The evidence also suggests that aquatic exercise is safe, and fun treatment option for this population, with no reports of adverse effects or decline in neurological status. The overall body of evidence is inconclusive due to a lack of high-quality evidence and small sample sizes. Also, there is significant variability between studies in intervention parameters (frequency, duration, intensity, etc.), disease severity of subjects, and outcome measures used to document changes.
Implications: Available literature on aquatic exercise in children with cerebral palsy suggests that there may be beneficial effects that facilitate improvement in motor and social function without adverse outcomes. More research should be conducted with larger sample sizes, higher quality study design, and more consistent outcome measures.
Keywords: Cerebral Palsy, Aquatic Therapy, Aquatic Exercises
Funding acknowledgements: None.
Purpose: The purpose of this systematic review was to examine evidence regarding the potential benefits of aquatic exercise for children with cerebral palsy. Safety, outcomes, and applications are addressed.
Methods: Electronic databases used werePubMed/MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Physiotherapy Evidence Database (PEDro), and Scopus.Date searched included all published works to date(May 2018). Additionally, we performed a hand search of the reference lists of relevant studies. Studies were included if they met the criteria of diagnosis (any form of cerebral palsy), population (aged 0-21), and intervention (aquatic exercise). Quality of the included studies was rated using the Centre of Evidence-Based Medicine: Levels of Evidence and the PEDro scale.
Results: Of the 17 studies, three were randomized controlled trials, three were cohort studies, seven were quasi-experimental design, one was a prospective time series group design, two were case reports, and one was a case study. The sample sizes for the included studies ranged from 1 to 46 subjects. The duration of treatment ranged from 6 weeks to 6 months, with frequency of sessions varying between 1 to 3 times a week, and length of sessions averaging between 30 to 60 minutes. A range of aquatic exercises and techniques were used to address multiple impairment areas, including upper and lower extremity strengthening and stretching, balance, aerobic capacity, water adjustment skills, and gait. Various outcome measures were used to assess effectiveness of aquatic exercises including gross motor function, ROM, balance, gait, energy expenditure, social acceptance, and self-esteem measures.
Conclusion(s): The evidence suggests that aquatic exercise programs may be effective in the short term for improving gross motor function, gait parameters, social function, and self-esteem in children with CP ages 0-21. The evidence also suggests that aquatic exercise is safe, and fun treatment option for this population, with no reports of adverse effects or decline in neurological status. The overall body of evidence is inconclusive due to a lack of high-quality evidence and small sample sizes. Also, there is significant variability between studies in intervention parameters (frequency, duration, intensity, etc.), disease severity of subjects, and outcome measures used to document changes.
Implications: Available literature on aquatic exercise in children with cerebral palsy suggests that there may be beneficial effects that facilitate improvement in motor and social function without adverse outcomes. More research should be conducted with larger sample sizes, higher quality study design, and more consistent outcome measures.
Keywords: Cerebral Palsy, Aquatic Therapy, Aquatic Exercises
Funding acknowledgements: None.
Topic: Paediatrics: cerebral palsy
Ethics approval required: No
Institution: University of North Texas Health Science Cente
Ethics committee: No ethics approval is required.
Reason not required: No ethics approval required, this is a systematic review of literature
All authors, affiliations and abstracts have been published as submitted.
