Community adapted aquatics programming: need and necessity.

In 1982 swimming was rated the number one recreation activity in the world (Nielsen Rating, 1982). And, certainly swimming is a favorite past time for young children who love to splash and play in the water. But what about children with disabling conditions? How can we enable them to participate with their non-disabled peers?

One of the most involved disabilties is cerebral palsy, a condition that affects the child's physical, social, cognitive, and emotional functioning and his or her leisure functions. Therapeutic recreation specialists, recreation professionals, and aquatic specialists use rehabilitation to restore levels of leisure functioning in their clients with disabilities. Once these levels are improved, children can participate with their non-disabled peers in a environment that is conducive to further stimulation and development of their functional leisure skill levels.

Bloomquist (1987) indicated that several of the rehabilitative needs of children with cerebral palsy and many other disabilities can be met through the use of adapted aquatics. A major part of functional leisure skills rehabilitation for children can be accomplished through the use of swimming and adapted aquatics. The water provides a combination of stimuli that help alleviate the disabling effects of cerebral palsy. And Chatard, Lavoie, Ottoz, Randaxhe, Cazorla, and Lacour (1992) say that a large portion of rehabilitation for children with cerebral palsy can occur in the water.

The physical functioning level is probably the most important aspect of the functional leisure skill levels that are effected by cerebral palsy. Physical functioning deficits severely limit the number and types of activities children with cerebral palsy can undertake. Meyer (1990) states, the water provides a place where physical inequities are minimized and persons with disabling conditions can participate" (p.12). This is the essence of the important role water plays in the increase of functional leisure skill level for children with cerebral palsy.

But what exactly does the water do for persons with disabilities? Water warmed to above 88 degrees F (this temperature may be cool for some clients) reduces the hypertonic effect of the disability, and the warmth of the water causes the muscles to relax to an almost normal level of muscle tone (Harris, 1978). Not only can the disability cause muscles to be hypertonic, but the effect of everyday living can create additional tension. I have noticed that even when a child has a correctly sized wheelchair and the proper body supports, he or she must be repositioned throughout the day. As he or she experiences things, his or her hypertonic level can go up, especially if the child becomes upset or agitated. In warm water, I have found that hypertonic muscle reduced significantly and elevated the client's mood. On more than one occasion, a client expressed either heightened pleasure or displeasure -- which adds to his or her hypertonicity -- when the swimming day came and the client could or could not swim. Swimming was a favorite recreation activity of the child in these cases, and he or she would get upset when our weekly session had to be cancelled.

One Example: A World of Difference

Take one specific example: a non-verbal person with severe spastic quadriplegia cerebral palsy and pulmonary and respiratory involvement. He is on supplemental oxygen at all times, except for when he is in the water. My experience working with him began when he was six years old: previously no one had worked with him in the water on a regular basis. During his third session with me he gripped a ball for the first time; and soon he was able to relax his arm and hand enough to control the extremity and was able to place the ball in an area under my instruction. I created a variety of stretching, reaching, and kicking exercises for him to practice for an hour once a week -- sometimes more if both our schedules permitted.

The physical benefits of these? activities were very apparent from the start; but his functional leisure skills levels were also increased through his experience in the water. As the other children in the pool got used to seeing us there on a regular schedule, they became more comfortable with my client and began to treat him as they would treat peers. My client enjoyed the break in structured physical skill learning and developed social skills appropriate to his age. He was able to play and share water toys and equipment with the other children. His comfort level with having other people around grew so much, he actually would show-off his newly acquired functional skills. For the first time in his life, he was allowed to participate fully in an activity. Not only did this affect his movement, but his self-image also improved. While he did not learn to completely express himself appropriately, he did improve socially most of the time. His caregivers began to use the pool as a motivational tool. If he behaved correctly during the week, he was taken to swimming class; bad behavior meant that he would miss his session that week. This was the first activity that be enjoyed well enough to allow his caregivers to have sufficient control over him and his behavior.

Importance of Peer Relations

According to the manual on adapted aquatics produced by the American National Red Cross (1977), rehabilitation for persons with disabilities is defined as "the restoration of disabled individuals to their fullest physical, mental, and social capabilities" (p.15). Peer-group interaction is important to all children, especially children with disabilities. Because of the way cerebral palsy physically affects children and adults, establishing and maintaining peer relationships is difficult (Kraus, and Shank, 1992).

Compton, Goode, Towns, and Motheral (1988) designed a study to encourage peer interaction between teenagers with cerebral palsy and teenagers from a high school physical education class. They found both populations willing to participate because all of the students obtained something they desired. The students from the physical education class got certified as Water Safety Instructors, received school credit, and learned aquatic instruction for adapted populations. The students with cerebral palsy received the benefits of being in the water and were able to interact with their non-disabled peers at an equal level (Compton, Goode, and Towns, et al, 1988).

One major purpose of adapted aquatics and functional leisure skills development is the bonding that takes place between the client and the recreation professional. This bond was taught to me by a seven-year-old girl with whom I worked at a Sunday school for children with disabifities run by the Chicago Board of Jewish Education. After months of promising her that I would take her swimming, the weather finally warmed up enough; and I was able to keep my promise. After our first and only outing, a kindred spirit -- a friendship -- developed. The water became our common denominator; it became the catalyst to transcend traditional roles: she was no longer the student or a child with cerebral palsy, and I was no longer the swimming teacher. Instead, we became two friends enjoying the aquatic environment and shared experience on totally equal levels.

The water is a world in which I have not only spent many hours teaching individuals to swim, but it is a place were I feel most comfortable. I was able to bring her into the world of the water -- one in which I have spent many hours as a teacher and one in which I feel most comfortable -- and expose her to a higher level of play. I knew there were things she would allow me to help her do -- like go off the water slide and underwater -- because we were in the water. I was able to adapt water play to her needs, which provided a complete recreational experience.

Doing What We Do Best

Human nature dictates that children will do things that they are good at over and over during their leisure. Why? Because the success of doing the activity makes them feel good; it improves their self-image. A child with a disabling condition who has conquered his or her fear of the water and feels comfortable in this environment will want to experience that feeling of comfort over and over again. Paganoff (1984), an occupational therapist, has used adapted aquatics not only to physically rehabilitate an adolescent with moderate cerebral palsy but -- with the assistance of a therapeutic recreation specialist -- to improve the child's self-image through positive reinforcement games in the water. The occupational therapist and therapeutic recreation specialist designed a swimming course for the client that focused on having an effect on the client as a whole person. Functional leisure skill needs of the client were identified, and the functional leisure skill levels increased as a unit during a series of water sessions. The water was used to meet all of the client's rehabilitation needs and gave the client a new lifelong recreation activity.

Emotionally, because of the ease of physical function, a person with a disability can achieve an improved self-image (Compton, Eisenman, and Henderson, 1989). This improved self-image can be related directly to improved quality of life, one of the main benefits of any recreational activity. Sonnenfeld (1989) found that a person with a disability gained self-confidence and a better self-image due to the freedom of independent movement acquired in the water, and he or she was able to feel the same sensations as any person without a disability. When people are emotionally well, their satisfaction is reflected in their attitude about becoming physically well. The water is a place where a person with a disability can forget his or her physical limitations and have fun. In the water, children with cerebral palsy can play and receive the same emotional benefits of recreation and play as any other child.

Emotional Well-Being Contributes to Health

When people are emotionally well, they will want to repeat the activity that provided the emotional well being (Compton, Eisenman, and Henderson, 1989). At a camp for people with disabilities where I volunteered for a weekend, I was paired with a 19-year-old adolescent who has spastic quadriplegia cerebral palsy, is wheelchair-abled, and has impaired verbal skills. This was his second time at this weekend camp, the first time being a month and one-half ago. Each cwnper got one-on-one volunteer assistance to take them to four scheduled activity periods on Saturday. My camper informed me that he only wanted to go swimming for all the activity periods. Consequently, that was all we did. After swimming, he felt so much better physically, emotionally, and socially, he could not stop smiling. Volunteers who had been in attendance during his previous visit told me that the difference was amazing. He wanted to be with people more and had a better attitude than the staff had ever seen before.

Compton, Eisenman, and Henderson (1989) found that to improve psychological variables it is important to establish, retain, and repeat an enjoyable physical activity. This camper may not have learned any new physical skills, but aquatics is something he thoroughly enjoys; so the overall benefits physically, socially, emotionally, and cognitively were high. He achieved rehabilitation through the recreational experience, as did all of the children I have worked with in the water. The water gives children with cerebral palsy -- and many other disabilities -- relief from the stress of day-to-day living and provides them with a place they can play.

Establishing Adapted Aquatics Programs

Establishing an adapted aquatics program in your community is relatively easy. You only need people with access to a pool who also have an interest in serving persons with disabilities in an aquatic capacity. For staff, contact your local American Red Cross office and ask if they can provide aquatic instructors with experience in teaching persons with disabilities to train your own staff. The Red Cross should be able to find at least one person with prior experience who is willing to help you get a program started.

Or you can contact a local college that has students who would be very willing to get involved with a new adapted aquatics program.

Young people with cerebral palsy can enjoy fun and recreation as much as anyone. They just need an activity that meets their special needs, qualified instructors, and some extra attention and encouragement. The result is healthier, happier kids who -- if even only for a few hours a week -- are just like other kids, playing, laughing, and splashing in the pool.

KEY TERMS

Adapted Aquatics: A swimming activity modified for persons with various disabilities. The disability can be physical, cognitive, social, or emotional.

Cerebral Palsy: A congenital nouromuscular condition.

Functional Leisure Skills: The physical, cognitive, social, and emotional skills any individual possesses to participate in a recreation or leisure activity.

Humanics: The study of human nature. This is the overall educational philosophy and mission at Springfield College, Springfield Massachusetts. This philosophy states a belief in educating students in Spirit, Mind, and Body, to excel in humanitarian service to others.

Hypertanic/hypertonicity: Excessive tension or tone in the muscles.

Quadriplegia: The torso and all four limbs affected by the type of cerebral palsy. The neck and head can also be affected.

Spastic: A type of cerebral palsy usually marked by inability to control muscle movement. Muscles are hypertonic and can be in constant spasm.

References

American Red Cross. (1977). Adapted Aquatics. Garden City, New York: Doubleday and Company, Inc..

Bloomquist, L.C.. (1987). Adapted Aquatics Program Manual (2nd ed,). (Report No. SP-028-949). Kingston, R.I.: University of Rhode Island-department of Physical Education, Health, and Recreation. (ERIC Document Reproduction Service No. ED 238-788).

Chatard, J.C., Lavoie, J.M., Ottoz, H., Randaxhe, R, Cazoria, G., & Lacour, J.R. (1992). Physiological aspects of swimming performance for persons with disabilities. Medicine and Science in Sports and Exercise, 24(11),1276-1282.

Compton, D.M., Eisenman, P.A., & Henderson, H.L. (1989). Exercise and fitness for persons with disabilities. Sports Medicine, 7, 150-162.

Compton, D., Goode, P., Towns, B.S., Motheral, L. (1988). Project PAIRS: a peer-assisted swimming program for the severely handicapped. Children Today, 1(1), 28-30.

Harris, S.R. (1978). Neurodevelopmental treatment approach: teaching swimming to cerebral palsied children. Physical Therapy. 58,(8), 979-983.

Kraus, R. & Shank, J. (1992). Therapeutic Recreation Service (4th ed.). Dubuque, IA.: Wm. C. Brown.

Meyer, R.I. (1990). Practice settings for kinesiotherapy-aquatics. Clinical Kinesiology, 44(1), 12-13.

Nielsen, A.C., (1982). Nielsen Survey: Swimming is nation's #1 leisure activity. Swimming Poolage, 58(10),33.

Paganoff, S.A. (1984). The use of aquatics with cerebral paisied adolescents. The American Journal of Occupational Therapy 38(7), 469-473.

Sonnenfeld, M. (1989). Rehabilitation of people with various levels of disabilities with the aid of swimming. Coach Education, 1(1), 123-130.