Aquatic exercise in rehabilitation of children and adolescents with cerebral palsy

Abstract

Introduction: Cerebral palsy is a condition that arises in pediatric age and implies rehabilitation needs along life. Exercise, in particular aquatic one, gained importance in the rehabilitation process of children and adolescents with cerebral palsy. Still, their real effects are yet to be proven.

Methods: The expression (“cerebral palsy” AND “aquatic”) OR (“children” AND “aquatic exercise”) was searched in PubMed, PEDro and Cochrane databases; and an analysis of data on population, therapeutic intervention, control and results was made within 13 studies.

Results: 102 children/adolescents with cerebral palsy engaged on an aquatic exercise program. Samples ranged between one and 46 elements aged between 5 and 21 years-old; all them had a pattern of spastic cerebral palsy with a variable form of presentation. All articles included a program of aquatic exercise to develop aerobic endurance and some of them also included muscle strengthening activities and/or other variants of physical fitness. Interventions lasted 30-60 minutes (1-3 times per week) for a period of 6 weeks to 8 months. None of the articles conducted sample randomization and only four compared groups with different interventions. The methodology used to evaluate the outcomes was diverse, but all included the effects of aquatic exercise program on functionality.

Discussion: The characteristics of the aquatic environment provide an advantage for the rehabilitation of children and adolescents with cerebral palsy taking into account the spectrum of disease presentation. Despite the limited evidences of efficacy and safety of aquatic exercise on rehabilitation of children and adolescents with cerebral palsy, this type of exercise is a good alternative to improve levels of fitness, a basic parameter in the rehabilitation process of this population. The diversity of studies architectures difficult the demonstration of the aquatic exercise effectiveness in the rehabilitation of children and adolescents with cerebral palsy, but gives suggestions to overcome this limitation.

Conclusions: Aquatic exercise reveals itself as a valid option for children and adolescents with cerebral palsy reach some benefits of active life style, optimize their functionality e improve their quality of life. Future studies about aquatic exercise programs on cerebral palsy rehabilitation should, among other aspects, recruit subjects by Gross Motor Function Classification System, use consensual evaluation scales e make considerations about participation barriers, rehabilitation program adequacy and aquatic environment safety.

Keywords: Exercise Therapy; Rehabilitation; Child; Adolescent; Cerebral Palsy.