Vo A.1, Valle M.1, Salem Y.1, Liu H.1
1University of North Texas Health Science Center, Physical Therapy, Fort Worth, United States
Background: Cerebral palsy is the most common childhood physical disability resulting in motor impairments such as abnormal muscle tone, weakness or paralysis, abnormal postural alignment and weight bearing, and delayed postural reactions and motor development. These impairments can lead to decreased participation in daily activities, respiratory difficulties, and the inability to ambulate. Aquatic therapy is useful for individuals with motor impairment because the effects of poor balance, lack of postural control, and joint compression associated with this population are decreased in the aquatic environment. Currently, the body of evidence concerning aquatic therapy for this population is lacking. While the studies that have been published are mostly supportive of aquatic therapy for children with cerebral palsy, there is no single study that determines a consensus of how effective this intervention is for this population.
Purpose: The purpose of this systematic review was to analyze the current scope of literature regarding the effectiveness of aquatic therapy as an intervention for children with cerebral palsy (CP) and to assess the feasibility of incorporating aquatic therapy into the physical therapy management of this specific population.
Methods: A literature search in PubMed, CINAHL, and Academic Search Complete was performed, using the following search terms: cerebral palsy, children with disabilities, aquatics, aquatic therapy, and hydrotherapy. Articles published between 1984 and 2014 were selected. Inclusion criteria for study selection included publication in English, recruitment of participants with CP ages 0-21, and the use of aquatic therapy as the main experimental intervention. Studies were excluded if they were not written in English or had no easily accessible translation or if they recruited subjects older than age 21. The initial search resulted in 280 potential articles, which were screened for inclusion and exclusion criteria and for duplicates. Thirteen articles satisfied the inclusion criteria. There were two case reports, one case series, one pilot study, three cohort studies, five quasi-experimental studies, and one randomized controlled trial. A total of 280 children with CP were included in these investigations. Sample size across the research studies varied from 1 to 46 children. The ages of the participants varied from 3 to 21 years old.
Results: The evidence suggests that aquatic therapy interventions are effective in the short term for improving gross movement and gait parameters as well as social function and self-esteem in children with CP ages 0-21.
Conclusion(s): The overall body of evidence is inconclusive due to a lack of high-quality evidence, small sample sizes, and variability in intervention parameters (frequency, duration, intensity, etc.), severity of disease, and outcome measures. More research must be conducted with larger sample sizes, higher quality study design, and more consistent outcome measures to determine effective exercise parameters and to further support the success of aquatic therapy as a physical therapy intervention for this population.
Implications: Aquatic therapy is feasible, safe, and fun for children with CP, according to the current body of evidence. Once more defined intervention guidelines are determined, there is the potential for increased resources to be allotted to funding, executing, and further developing this treatment option.
Funding acknowledgements: This work was unfunded.
Topic: Paediatrics
Ethics approval: Ethics approval was not required.
All authors, affiliations and abstracts have been published as submitted.
