Effects of an aquatic therapy program on vital capacity, quality of life and physical activity index in children with cerebral palsy.

Introduction Swimming and aquatic exercises are often recommended for children with disabilities, since they are recognized as part of paramedical treatment programs (Huberman 1976, Ruoti et al 1997). The specific advantageous features of aquatic activities for children with disabilities include: (a) water buoyancy, which favors the initiation of movement even if the neuromuscular system is unable to move against gravity, (b) increased viscosity of water, which provides gradual resistance (braking force) and together with the amplitude of movement makes very demanding exercises almost impossible, (c) heat transfer in the water is much faster than in the air, water reaching 32oC or more decreases spasticity and leads to the lack of involuntary movement, (d) hydrostatic pressure provides extensive stimulation of exteroceptors and proprioceptors, increased pressure on the lungs and other internal organs, as well as pressure on the respiratory muscles. These are assumed to improve coordination, breathing and associated functions such as feeding and speech (Harris 1978; Peganoff 1984; Broach & Dattilo 1996). Despite the enthusiasm for the therapeutic effects of aquatic exercises, very little information has been published in this field (Hutzler et al 1998). Rothman (1978) observed a significant decrease of respiratory functions in children with cerebral palsy compared to children without disabilities (37-38% below normal values). The respiratory system is deeply affected when the body is immersed in water to the chest. An effect is chest compression by water, as well as the change in lung function, increased respiratory muscle effort and the change in respiratory dynamics. Vital capacity decreases by 7-9% when the body is immersed in water up to the neck as compared to when it is immersed to the xiphoid process. Part of this decrease is due to increased blood volume in the thoracic cavity, part is due to the hydrostatic force of water which resists inspiratory muscles (Hong et al 1996; Agostoni et al 1996). Inspiratory muscle weakness is an important component of many chronic diseases. Given the accommodation of respiratory functions in an environment that causes significant changes Abstract. The aim of this paper is to track the aspects and results of applying an aquatic therapy intervention program adapted and integrated in the treatment of neuromotor reeducation of children with cerebral palsy on gross motor function, spasticity and range of motion. Material and methods: The aquatic therapy program had a duration of 6 months, 2 weekly sessions. The average duration of a session was 45 minutes. The water temperature was 36°C. Besides the aquatic therapy sessions the children participate in 2 physical therapy sessions which were included in the rehabilitation program of the institutions they belonged to. Twenty-four children diagnosed with cerebral palsy have participated in this study. The average age was 12.5±2.7 years.The assessment methods used were: Physical Activity Index is calculated by multiplying physical activity frequency, intensity and duration. Spirometry: The following device was used in order to assess vital capacity: MIR Spirobank II Spirometer, S/N 000912. Results: After the use of the aquatic therapy program, results have been statistically significant for physical activity index scores p<0.001. Baseline percentage of the maximum physical activity index score was 16.8% and the final percentage of the maximum physical activity index score was 68%. KINDLR Questionnaire for measuring quality of life in children and adolescents. The scores of the questionnaire assessing quality of life in children and adolescents, KINDLR, show statistically significant increases (p<0.001), where we can observe a significant increase from a mean score of 67.3 ± 6.9 to a mean score of 96±4.1. At the end of the 6-month aquatic therapy program, the values for vital capacity have shown a statistically significant increase, p<0.001. The mean value of baseline vital capacity was of 2.2±0.7, the mean value of final vital capacity was of 3.4±1.1. The values for vital capacity increased by 56.7% when compared to baseline values. Conclusion: The aquatic therapy program along with the classic rehabilitation program is a factor which influences these parameters.