Effects of Aquatic Intervention on Gross Motor Skills in Children with Cerebral Palsy: A Systematic Review

ABSTRACT

Aims: To review the literature on the effects of aquatic intervention on gross motor skills for children with cerebral palsy (CP). Data sources: Six databases were searched from inception to January 2016. Review methods: Aquatic studies for children aged 1–21 years with any type or CP classification and at least one outcome measuring gross motor skills were included. Information was extracted on study design, outcomes, and aquatic program type, frequency, duration, and intensity. Quality was rated using the Centre of Evidence-Based Medicine: Levels of Evidence and the PEDro scale. Results: Of the 11 studies which met inclusion criteria, only two used randomized control trial design, and the results were mixed. Quality of evidence was rated as moderate to high for only one study. Most studies used quasi-experimental designs and reported improvements in gross motor skills for within group analyses after aquatic programs were held for two to three times per week and lasting for 6–16 weeks. Participants were classified according to the Gross Motor Function Classification System (GMFCS) levels I–V, and were aged 3–21 years. Mild to no adverse reactions were reported. Conclusions: Evidence on aquatic interventions for ambulatory children with CP is limited. Aquatic exercise is feasible and adverse effects are minimal; however, dosing parameters are unclear. Further research is needed to determine aquatic intervention effectiveness and exercise dosing across age categories and GMFCS levels.

KEYWORDS:

• Aquatic exercise
• aquatic intervention
• aquatic therapy
• hydrotherapy
• swimming

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Notes on contributors

Meysam Roostaei

Meysam Roostaei, OT, BSc, is affiliated with the Department of Occupational Therapy and the Musculoskeletal Center at Isfahan University in Isfahan, Iran.

Hamzeh Baharlouei

Hamzeh Barharlouei, PT, PhD student, is affiliated with Ahvaz Jundishapur University of Medical Sciences in Ahvaz, Iran.

Hamidreza Azadi

Hamidreza Azadi, OT, MSc, is affiliated with the Department of Occupational Therapy in the School of Rehabilitation at Isfahan University in Isfahan, Iran.

Maria A. Fragala-Pinkham

Maria A. Fragala-Pinkham, PT, DPT, MS, is affiliated with Franciscan Hospital for Children in Boston, MA.