1King Fahd University of Petroleum & Minerals, College of Applied Studies, Physical Education Department, Dammam, Saudi Arabia
2Qatar University, College of Arts and Sciences, Sport Science Program, Doha, Qatar
3Erzincan Binali Yıldırım University, Faculty of Education, Department of Physical Education and Sports, Erzincan, Turkey
4Youth and Sports Ministry, Istanbul, Turkey
5Marmara University, Faculty of Sport Sciences, Department of Physical Education and Sports, Istanbul, Turkey
6Dumlupinar University, Faculty of Sport Sciences, Department of Physical Education and Sports, Kutahya, Turkey
7King Fahd University of Petroleum & Minerals, College of Sciences, Department of Mathematics and Statistics, Dammam, Saudi Arabia
The Effects of Aquatic Watsu Therapy on Gross Motor Performance and Quality of Life for Children with Cerebral Palsy
The purpose of this study was to compare the effects of Immersion and Watsu® therapy protocols on children with cerebral palsy. Gross motor function (GMF), spasticity (MAS), and Quality of Life (QoL) parameters of twenty-three children (age: 7.5±2.8, BMI: 17±3.7) were measured. Subjects received Watsu® therapy and Immersion protocols in Watsu-Immersion (W-I, n=12) and Immersion-Watsu (I-W n=11) groups in different periods based on a crossover design. The subjects received sessions for 30 minutes twice a week during 10-week experimental periods. The results were investigated with independent sample t-test and Wilcoxon rank-sum tests, which showed that there was no evidence of carryover effects in GMFM 88 and QoL. In contrast, Watsu® improved GMFM 88 (p<0.05), Quality of Life (p<0.05), and MAS-Upper spasticity (p<0.05), scores significantly compared to immersion. The current results demonstrated the specific benefits of Watsu® therapy on children with CP, confirming the previous anecdotal reports. We recommend Watsu® as a safe and well-accepted complementary intervention for the management of CP.
Watsu®, cerebral palsy, immersion, motor function, quality of life
Al-Dababneh, K. A., & Al-Zboon, E. K. (2018). Parents’ attitudes towards their children with cerebral palsy. Early Child Development and Care, 188(6), 731-47. https://doi.org/10.1080/03004430.2016.1230737
Amichai, T., & Katz-Leurer M. (2014). Heart rate variability in children with cerebral palsy: Review of the literature and meta-analysis. Neurorehabilitation, 35(1), 113-122.
Arnaud, C., White-Koning, M., Michelsen, S. I., Parkes, J., Parkinson, K., Thyen, U., Beckung, E., Dickinson, H. O., Fauconnier, J., Marcelli, M., McManus, V., & Colver, A. (2008). Parent-reported quality of life of children with cerebral palsy in Europe. Pediatrics, 121(1), 54-64. https://doi.org/10.1542/peds.2007-0854.
Banky, M., Ryan, H. K., Clark, R., Olver, J., & Williams, G. (2017). Do clinical tests of spasticity accurately reflect muscle function during walking: A systematic review, Brain Injury, 31(4), 440-455. https://doi.org/10.1080/02699052.2016.1271455
Barassi, G., Bellomo, R. G., Porreca, A., Saggini, R., Irace, G., Giannuzzo, G., & Trivisano, L. (2018). Rehabilitation of neuromotor disabilities in aquatic microgravity environment. Advances in Experimental Medicine and Biology, 1113, 61-73. https://doi.org/10.1007/5584_2018_164
Blair, E., & Cans, C. (2018). The definition of cerebral palsy. In C. P. Panteliadis (Ed.), Cerebral Palsy: A Multidisciplinary Approach, Third Edition (pp. 13-17). Switzerland: Springer International Publishing AG. https://doi.org/10.1007/978-3-319-67858-0_2
Brody, L. T., & Geigle, P. R. (2009). Aquatic exercise for rehabilitation and training. Champaign. IL: Human Kinetics.
Carayannopoulos, A. G., Han, A., & Burdenko, I. N. (2020). The benefits of combining water and land-based therapy. Journal of Exercise Rehabilitation, 16(1), 20–26. https://doi.org/10.12965/jer.1938742.371
Centers for Disease Control and Prevention. (2018). Data and statistics of Cerebral Palsy. Retrieved from https://www.cdc.gov/ncbddd/cp/data.html
Choi, K., & Cho, S. (2019). The effect of underwater intervention in children with cerebral palsy on the range of motion, coordination and balance of motion: meta-analysis. Korean Journal of Integrated Medicine, 7(3), 71–83. https://doi.org/10.15268/KSIM.2019.7.3.071
Dull H. (2008). Watsu: basic and explorer paths. Watsu Publishing.
Hadders-Algra, M. (2014). Early diagnosis and early intervention in cerebral palsy. Frontiers in Neurology, 5, 185. https://doi.org/10.3389/fneur.2014.00185
Josenby, A.L., Jarnlo, G. B., Gummesson, C., & Nordmark, E. (2009). Longitudinal construct validity of the GMFM-88 total score and goal total score and the GMFM-66 score in a 5-year follow-up study, Physical Therapy, 89(4) 342–350. https://doi.org/10.2522/ptj.20080037
Kinner, V. L., Het, S., & Wolf, O. T. (2014). Emotion regulation: exploring the impact of stress and sex. Frontiers in Behavioral Neuroscience, 8, 397. https://doi.org/10.3389/fnbeh.2014.00397
Ko, J., & Kim, M. (2013). Reliability and responsiveness of the Gross Motor Function Measure-88 in children with cerebral palsy. Physical Therapy, 93(3). 393-400. https://doi.org/10.2522/ptj.20110374.
Kokorelias, K. M., Gignac, M. A. M., Naglie, G., & Cameron, J. I. (2019).Towards a universal model of family centered care: A scoping review. BMC Health Service Research, 19, 564. https://doi.org/10.1186/s12913-019-4394-5
Lai, C., Liu, W. Y., Yang, T. F., Chen, C., Wu, C. Y., & Chan, R. C. (2014). Pediatric aquatic therapy on motor function and enjoyment in children diagnosed with cerebral palsy of various motor severities. Journal of Child Neurology, 30(2), 200-8. https://doi.org/10.1177/0883073814535491
Li, S., & Francisco, G. E. (2019) Spasticity. In: Handbook of Experimental Pharmacology. Springer, Berlin, Heidelberg.
Meireles, A. L., Marques, M. R., Segabinazi, E., Spindler, C., Piazza, F. V., Salvalaggio, G. S., Augustin, O. A., Achaval, M., & Marcuzzo, S. (2017). Association of environmental enrichment and locomotor stimulation in a rodent model of cerebral palsy: Insights of biological mechanisms. Brain Research Bulletin, 128, 58-67. https://doi.org/10.1016/j.brainresbull
Muñoz-Blanco, E., Merino-Andrés, J., Aguilar-Soto, B., García, Y. C., Puente-Villalba, M., Pérez-Corrales, J., & Güeita-Rodríguez, J. (2020). Influence of aquatic therapy in children and youth with cerebral palsy: A qualitative case study in a special education school. International Journal of Environmental Research and Public Health, 17, 3690.
Noor, R., Gul, S., Saleem, T., & Shahzad, N. (2105). Relationship of Stress, Anxiety and Psychological Adjustment among Parents of Intellectually Disabled and Cerebral Palsy Children. International Journal of Rehabilitation Science, 4(2), 32.
Novak, I. (2014). Evidence-based diagnosis, health Care, and rehabilitation for children with cerebral palsy. Journal of Child Neurology. 29(8), 1141-56. https://doi.org/10.1177/0883073814535503
Roostaei, M., Baharlouei, H., Azadi, H., & Fragala-Pinkham, M. A. (2017). Effects of aquatic intervention on Gross Motor Skills in children with cerebral palsy: A systematic review. Physical Occupational Therapy Pediatric, 37(5), 496‐515. https://doi.org/10.1080/01942638.2016.1247938
Russell, D. J., Avery, L. M., Rosenbaum, P. L., P. S. Raina, S. D. Walter., & R. J. Palisano. (2000). Improved scaling of the Gross Motor Function measure for children with cerebral palsy: Evidence of reliability and validity. Physical Therapy, 80, 873-875.
Schitter, A. M., & Fleckenstein, J. (2018). Passive hydrotherapy WATSU® for rehabilitation of an accident survivor: A prospective case report. Complementary Medicine Research, 25(4), 263-268. https://doi.org/10.1159/000487768
Schitter, A. M., Fleckenstein, J., Frei, P., Taeymans, J., Kurpiers, N., & Radlinger, L. (2020). Applications, indications, and effects of passive hydrotherapy WATSU (WaterShiatsu)—A systematic review and meta-analysis. PLoS ONE, 15(3): e0229705
Scott, J., Wozencroft, A., Nocera, V., Webb, K., Anderson, J., Blankenburg, A., Watson, D., & Lowe, S. (2020). "Aquatic Therapy Interventions and Disability: A recreational therapy perspective." International Journal of Aquatic Research and Education, 12(3), 5. https://doi.org/10.25035/ijare.12.03.05
Ward, R., Reynolds, J. E., Bear, N., Elliott, C., & Valentine, J. (2016). What is the evidence for managing tone in young children with, or at risk of developing cerebral palsy: a systematic review. Disability, and Rehabilitation, 58(5), 492–501. https://doi.org/10.3109/09638288.2016.1153162
Waters, E., Davis, E., Boyd, R., Reddihough, D., Mackinnon, A., Graham, H. K., Lo, S. K., Wolfe, R., Stevenson, R., Bjornson, K., Blair, E., & Ravens-Sieberer, U. (2013). Cerebral Palsy Quality of Life Questionnaire for Children (CP QOL-Child) Manual. Melbourne: University of Melbourne.