Aquatic Therapy In Speech Pathology

“Aquatic therapy and children…is a medium… (in which) great things... (may) happen in the physical, cognitive and psycho-social realms...while providing a natural environment in which to practice ADL skills, communication skills, problem solving skills and motor skills...”

—(from APT Newsletter, October, 1995, “Aquatic Therapy and Children—Welcome to the Water”, by Dori Maxon, PT, specializing in pediatric physical therapy for children with a variety of limitations including gross motor involvement).

Aquatic Therapy for physical therapy has been a standard of practice for many years. Now aquatic therapy is also a standard of practice for massage therapists with Watsu, Jahara, Water Dance, Healing Dance and other strategies available for therapist training and patient treatment. Birthing babies in water has been evident in the United States since information about Dr. Frederick LeBoyer became available in the late 1960’s and early 1970’s (Birth Without Violence, Frederick LeBoyer).

Buoyancy provides a medium in which working with a variety of people with physical limitations is possible in order to facilitate increased movement patterns. While being supported in water at body temperature the patient is consistently comfortable and out of the challenge of gravity pull. This reduced stress environment facilitates more normalized patterns that may then be brought into focus for better land function.

One’s memory of successful integration of sensory awareness, upper and lower extremity movement, vocalizing, oral-motor function, etc., may serve to facilitate successful function on land.

Aquatic therapy techniques have been incorporated into my private practice in speech pathology with children with a variety of speech related limitations since 1987.

A client, an adorable, but frustrated 2-year old boy with cerebral palsy with spastic quadriplegia seemed unhappy and had a great deal of difficulty moving his body and using his mouth for efficient eating and speaking. His voice blocked with every attempt to vocalize yielding dramatic vocal restrictions occurring at the laryngeal level of initiation.

In a frustrated attempt, I asked his mom if her boy enjoyed water. Her response yielded relief and joy when she told me how happy he was in his bath.

I set up an appointment at a local pool for people with disabilities—a fantastic olympic sized pool with double wheelchair ramps and 95-98º temperature and no deeper than 4' anywhere. We started off on the ramp so this child would be able to have independent function in the water while I observed him.

Very quickly he showed his delight and crawled into deeper water. Mom told me she knew nothing about how to swim or act in water, in general, and she would follow my lead. She held her boy as we, slowly, moved into deeper water. He was exuberant and used his voice by squealing with delight with no vocal blocking—just happy little kid squeals—no effort.

Since my speech goals included increasing respiration for phonation, I wanted to test his ability to control inhalation and exhalation by using the water. I played with him in up and down movement, while modeling putting my own mouth into the water by saying, “Ahhh”—“/mmm/, and closing my mouth while going under while blowing bubbles. He caught on immediately and pushed his head under before I was ready and came up quickly laughing and repeating again and again.

My role was simply to support him so he wouldn’t go under unexpectedly. Then I asked mom to get ready to catch him. We were facing each other and just about touching. The boy loved doing this and I asked him if he wanted to go under the water, which he did, immediately. So, mom moved backward a step, I released him, and he independently dove under with his whole body, reached mom who pulled him out while he laughed, squealed, breathed in and turned towards me for more.

Before swim time was over, this little frustrated, unhappy 2-year old child, was swimming efficiently underwater using all 4 extremities and managing inhalation and exhalation with no sputtering with good, clear vocalizing expressing his utter joy at independent function.

Since then, I have had many different experiences with infants, children, adolescents and adults with varying disabilities who had secondary feeding, oral-motor, speech and language limitations needing to be addressed as therapy goals. My practice has incorporated using water as a medium to decrease oral hypersensitivity when it is a major factor for children with feeding and/or developmental apraxia of speech (DAS) issues. I have seen increased function across the board. It is also important to provide traditional land therapy to teach how to use the mouth and articulators for producing motor-speech, with supportive computer voice programs to enhance the newly learned patterns.

The path that guided me towards using aquatic therapy consists of my desire to help a gentleman with post-brainstem CVA with severe oral apraxia and disorganized respiration for both general breathing and speech. It appeared that he would benefit from learning inhalation and exhalation strategies for general relaxation in order to acquire enough control for breath support for speaking.

I referred him to a massage therapist who shared my office explaining that this man would benefit from relaxation and easy breath release work. The ensuing appointment was a total disaster because neither patient nor therapist could communicate with each other regardless of my shared information about this person with the massage therapist.

This inspired me to attend massage school and become a California Certified Massage Therapist (CMT, 1981) so I would be able to provide the hands on treatment that I believed would benefit this patient. Soon after, in the same year, I received my first infant referral for a boy with cerebral palsy/spastic quadriplegia. His mother asked if I were a Neurodevelopmental Treatment (NDT) Speech Pathologist and if I knew what that was. My response was negative to both, but I was willing to learn.

This parent had a relative who was a pediatric physical therapist who used the approach that is the Bobath (NDT) method and recommended an SLP who understood that strategy. I followed the path into my current work that began with my learning about the NDT concept with that referral, followed by the 8 week pediatric NDT course completed in 1987 while, simultaneously, studying Radiance Breathwork and Radiance Prenatal Therapy, taught by Gay and Kathlyn Hendricks, Ph.D’s in Transpersonal Psychology.

I focused on issues relating to breathing, vocalizing and self-expression utilizing a hands-on approach. Following participation in the NDT course, I learned that my strengths were in kinesthetic approaches to therapy strategies. It was through massage therapy, NDT, Radiance Breathwork (in and out of water), and aquatic therapy approaches, that I have developed a clear hands-on therapeutic approach.

Many children with DAS (Developmental Apraxia of Speech) are strong kinesthetic learners and yield well to being shown what to do with their mouths, as many colleagues are teaching (Suzanne Evans Morris, Pamela Marshalla, Sara Johnson). I have found that these same children also learn the coordination of inhalation, exhalation and voicing in water in the least restrictive sense: through play, movement and developing trust in their own abilities.

Recently, I became a Watsu practitioner with emphasis on adaptive techniques. There are few pediatric aquatic therapists and those are mostly physical therapists. I have been asked to prove that aquatic therapy is a standard of practice for SLPs. So, I invite those who are interested to take my course so that we may establish this standard of practice and receive conventional funding while providing another strong approach to support our clients’ best outcome for independent function for feeding, speech and language competence.

“It was said in Egypt that water is given the soul as compensation for taking on a bodily form. In water our bodies find the freedom the soul has lost. Watsu is the continuing exploration of that freedom.” From WATSU Freeing the Body in Water, by Harold Dull.

References:
“Aquatic Therapy and Children—Welcome to the Water!”, excerpt from APT aquatic therapy workshop by Dori Maxon, PT; APT Newsletter, 10/1995

Note: APT= Association of Pediatric Therapists; based in San Francisco Bay Area
For membership: APT, 1193 Clear Lake Court, Milpitas, CA 95035

WATSU Freeing the Body in Water, Second Edition, by Harold Dull, 1997; Harbin Springs Publishing