The Effectiveness of the Bobath Neurodevelopmental Treatment and Halliwick Concept Hydrotherapy in the Treatment of Children With Cerebral Palsy.
Phase: NA
Conditions: Cerebral Palsy
Sponsor: University of Thessaly

The Effectiveness Of The Bobath Neurodevelopmental Treatment 
And Halliwick Concept Hydrotherapy In The Treatment Of 
Children With Cerebral Palsy. 
 
 
 
 
Study Protocol 
 
Dr. Konstantinos Chandolias 
Physical Therapist Phd 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
 
                  A first group of 40 children was the main intervention team for both Bobath 
neurodevelopmental treatment on land, and the Halliwick concept – hydrotherapy in 
water, a session from each approach, weekly. This specific group is the one which 
was also used for the control of validity and reliability the water assessment test 
translations in Greek (WOTA 1, WOTA 2, SWIM, HAAR). A second group of 35 
children, a control - intervention group 1 with the Bobath neurodevelopmental 
treatment on land, two sessions a week, was the standard of comparison and support 
of “reasonable” assumptions, in order to assess the hypothesis that Halliwick concept 
hydrotherapy, combined with the intervention on land leads to better therapeutic 
results. A third group, a control group 2 – without an intervention, consisting of 5 
children, also with cerebral palsy, upon which we could additionally affirm some of 
our assumptions about children who do not receive any intervention. This group was 
small, because it is extremely difficult to have children with cerebral palsy who do not 
receive any intervention, either privately or in an institution, or in their special school. 
              In the process of implementation of the WOTA 1, WOTA 2, SWIM, HAAR, 
GMFM, PEDI, PBS, TUG in the groups of children, one of the authors - pediatric 
physiotherapist, hydrotherapist and two pediatric physiotherapists - hydrotherapists of 
the Center for Developmental Physiotherapy “Laboratory of Movement” have 
participated, distinguished for their many years of experience in the motor skill 
disorders of children with cerebral palsy. All application procedures and follow-up 
tests performed in the group of participants were recorded by one of the three 
examiners who did not participate in the test grading. The grading was performed by 
the other two examiners, separately, through the watching of the video footage tests, 
in order to eliminate the possibility of affecting the judgment of one examiner from 
the other. 
             All tests were performed at around the same morning hour and before the 
little patient’s participation in any rehabilitation program, for example, physiotherapy 
session, occupational therapy, speech therapy, hydrotherapy. 
             All tests were performed in the same site, in the same room of the 
“Laboratory of Movement” Developmental Physiotherapy Center, where the required 
equipment (mattresses, staircase, appropriate seat height, rods, toys, balls) was 
available. The equipment was arranged by the examiners, in order for the arrangement 
of the area to be the same during all measurements. Particular emphasis was placed on 
keeping the test area constantly at such a level, so that the child being tested is dressed 
with the least amount of clothing, so as not to make it difficult for it to perform the 
skills, and to be able to videotape the effort in the best possible way . 
           The assessment of the water intervention group took place in the same indoor 
heated swimming pool for all children, with a length of 8 meters, and a width of 4 
meters and gradually increasing from 0.80 meters of the minimum depth to 1.50 
meters of a greater depth. The water temperature was 32 ° C - 33 ° C during all 
measurements. The pool lighting was only external and the same for all the tests and 

all children. No flotation aid was used. The children were dressed in their swimsuits, 
except for those that did not have a sphincter muscle control, who also used a special 
water diaper or a special swimsuit. 
          An attempt has been made to perform the tests without the presence of any 
other person (relatives, observers or other children) so as not to distract the children 
undergoing the tests. In order to perform all the tests, one of the two parents needed to 
be present, to ensure a sense of security, while at the same time, it was more 
attainable to achieve the best possible cooperation and performance of the child. 
         During the implementation of each evaluation test and during the grading, the 
instructions given by the authors in their manuals were closely followed by both 
evaluators. Oral explanations were given, but, in some cases, where the child’s 
cognitive level required it, a representation was made of how the test was meant to be 
performed, by the examiner, toward the child. This was noted in the observations of 
the first examiner for each child, in order for the second examiner to follow the same 
instructions. Each child was given three chances to perform each test.