Physiotherapy & Hydrotherapy / Aquatic Physiotherapy in Cerebral Palsy

The clinical benefits of physiotherapy and hydrotherapy/aquatic physiotherapy in cerebral palsy vary as this is such an umbrella term. It covers a wide range of symptoms that affect all aspects of your baby, child’s or young person’s life at different times of their lives.

5 Key ways that physiotherapy can help

Physiotherapy improves motor development

As babies, most of our motor development occurs within the first 18 months of life. We spiral-learn through repetitive movements.

Physiotherapy teaches babies and their families to help them to move using developmental pathways. This continues throughout childhood and adolescence as we want to avoid unwanted postures and movement that put strain through the joints and muscles of the body, especially as we grow in height and gain weight with more of the body to move against gravity.

Physiotherapy aids postural alignment and prevents the development of contractures and deformities

Abnormal patterns of movement occur due to altered and variable muscle tone and muscle imbalance. The muscles on one side of the joint become overstretched and those on the other side shorten. Physiotherapists use facilitated handling techniques and exercises to influence muscle tone and movement. They can also advise on splints and postural management equipment.

Physiotherapy can ease stiffness and prevent or reduce pain

High muscle tone (spasticity), repetitive abnormal movement patterns, and postural malalignment can lead to pain and stiffness.

Physiotherapists can teach stretching, movement and strengthening exercises which can be integrated into a person’s daily routine, play and school.

Physiotherapy provides rehabilitation after surgery or botulinum toxin injections or when skills are being lost

Physiotherapy can help maintain skills for as long as possible, especially during adolescence when the muscle and bone do not always grow at the same rate. It can be hard to keep mobile when it is effortful to move and tiredness kicks in. A physiotherapist can help in pacing activities and keeping people as mobile and independent as is feasible.

Physiotherapy can help to educate everyone involved and promote a physically active lifestyle

A good physiotherapist will always empower a young person to take as much control over their life and physio as possible. A physiotherapist can help to find the best approach to suit the individual person.

 ————–

Physiotherapy is tailored to meet your baby, child or young person’s needs. Children with cerebral palsy are usually classified on the Gross Motor Function Classification Score (GMFCS I – V).

GMFCS Level I – Walks without limitations

Physiotherapy will focus on increasing strength, fitness, stamina and exercise tolerance on land and in the pool. Any issues with swimming, sports or highly physically challenging activities will be addressed.

GMFCS Level II – Walks with limitations

In addition, physiotherapy will focus on stairs, eccentric muscle control (needed for coming down stairs, getting down to the floor, squatting etc), walking and if able running on cambers, slopes, uneven surfaces, steps and curbs. Strenuous exercise is easier undertaken in the pool because you will be able to exercise for longer without becoming as tired as you would on land, and without putting strain through your joints as the water takes your weight. Any issues with sports, swimming or highly physically challenging activities will be addressed.

GMFCS Level III – Walks using a hand-held mobility device

In addition, physiotherapy will focus on stairs, eccentric muscle control (needed for coming down stairs, getting down to the floor, squatting etc), walking and if able running on cambers, slopes, uneven surfaces, steps and curbs. Strenuous exercise is easier undertaken in the pool because you will be able to exercise for longer without becoming as tired as you would on land, and without putting strain through your joints as the water takes your weight. Any issues with sports, swimming or highly physically challenging activities will be addressed.

GMFCS Level IV – Self mobility with limitations

Physiotherapy will focus on enabling maximum physical participation in all aspects of life by managing muscle tone, especially if dystonic and involuntary movements are limiting movement control. The pool may be one of the only places in which to gain independent movement out of equipment. The focus is on helping to maintain and develop head and trunk control and movement that enables sitting balance, stepping in a walker or stand transfers.

GMFCS Level V – Transported in a wheelchair

Physiotherapy will focus on ensuring postural alignment and comfort. The hydrotherapy pool is of particular benefit in helping to manage pain and maintain flexibility and working on head control. Maintaining and developing head control is important for assisting swallow, communication, visual field and breath control. The pool may be the only place in which to gain independent movement with floats.

Hydrotherapy/Aquatic Physiotherapy Benefits can include:

• Helps work towards and maintain sit to stand transfers. Aids balance in all positions with reduced risk of falling, using the drag and rotational effects of water. The density of water allows more time to respond and react in different positions with lots of sensory feedback.
• Able to work in standing and even step when not possible on land due to the buoyant reduced weightbearing effects.
• Developing head and trunk control and aiding communication.
• Improving the quality of movement because muscle tone and dystonic movements are reduced.
• Increasing fitness and stamina as less effort required to exercise in water and the heat and physiological effects reduce muscle tone and dystonic movements, which are usually increased with increased physical effort on land.
• Less demand on the heart and lungs when immersed upright or exercising in heated water.
• Work on respiratory function and breath control using Aquaepps® and Halliwick techniques, alongside trunk control and spinal mobility.
• Increasing functional activities using buoyancy, rotational effects and drag with specific PNF and Aquaepps® techniques.
• Gait (walking and stepping) re-education in a reduced weightbearing environment.
• Pain relief using Watsu®, mobilising, Aquastretch and Aquaepps® techniques, and due to the physiological effects of immersion in heated water inducing muscle relaxation, reducing dystonic spasms and releasing endorphins.
• Increased range of movement and reduced spasticity and dystonia due to the effects of heated immersion (suppresses sympathetic nervous system) and by using Aquaepps® tone influencing techniques.
• Freedom of movement as an unencumbered environment.
• Sensory stimulation and increased proprioception (awareness of where joints are in space) due to hydrostatic pressure of water against body and turbulent drag of water moving around body.
• Increased muscle strength and endurance using modified PNF, the properties of water reducing the strain through vulnerable joints and soft tissues and Aquaepps® techniques.
• You might be able to learn to swim.
• It’s fun!