A little girl with moderate to severe athetoid CP first found freedom of movement using a Wet Vest to jog in the water.
This is what her mother said about the experience after one summer. “…the most amazing thing that came out of the water program was independence for my daughter. She is so physically limited, that before the summer, she was never without an adult to hold or support her. Now, in the water she had unrestricted movement. She could swim on her own. We could swim together as a family for fitness or fun. It was the perfect way to enjoy the hot, summer weather. She began to wake up every morning asking to go swimming or saying that she had a wonderful dream that she swam to one place or another with one of her friends. I will never forget the look on her face the first time she jogged from one end of the pool to the other on her own.”
Current guidelines suggest a minimum of 60 minutes of vigorous exercise per day to ensure healthy development in able-bodied children. How does a child with an early neurological injury exercise? It is tough. Children with mild to moderate severity cerebral palsy are able to move under their own steam, but they frequently use up the majority of their energy stores just getting from place to place. The work of walking is higher for them. Yet we all know, that if you do cardiovascular exercise, both body strength and endurance increase. The physiology of deep water running has been studied for over 25 years.
The technique works and all you need to do it is some deep water and a buoyancy vest. I recommend the Wet Vest for children with a neurological problem. It holds the trunk firmly and provides improved proprioceptive awareness just where it is needed. It is not a life jacket and supervision is still needed, but most children quickly learn to move independently in the water.
In my experience, it is possible to change the cardiovascular fitness level and improve mobility in 6 to 8 weeks of regular use 3 to 4 times a week. I have written a simple gait training protocol that is available without charge. The Wet Vest sells new for $135.95 for small children and up to $195.95 for adults. The vests are very durable so used ones may be found on any of the popular lists like eBay. Able-bodied children and adults can use the less expensive flotation belts if needed. These belts do NOT provide sufficient upright support for children with a neurological problem.
Children with Hemiplegia have asymmetric movement in the water, as there is less movement of the affected side. In most children, the leg will spontaneously start to move reciprocally with the unaffected leg within a relatively short time. If they have trouble keeping the leg down, put an old running shoe on the affected leg. Jogging in this manner, out of gravity, trains the child’s brain to produce a normal reciprocal movement. If they do not start using their affected arm, they will jog around in circles. In the mildly affected child, they quickly learn how to start using their arm more effectively. Novel, challenging tasks stimulate brain neuroplasticity. If the arm does not start to move spontaneously in a reciprocal pattern, add a small size floatie to the affected arm over the elbow.
This will hold the arm straight out from the body, encouraging whole arm movements and strengthening the shoulder muscles. As the child’s strength improves, move the floatie down to just above the wrist… increasing the lever arm. As better reciprocal movement develops, gradually take the air out of the floatie until they are able to do a four-point reciprocal jog on their own.
Children with a Brachial Plexus Injury can use the same technique to gradually strengthen the shoulder and arm. Check with your therapist to ensure that there is not too much strain on the shoulder at the start. The therapist may adjust the position of the floatie to get the best effect. For most, starting the floatie high on the upper arm positions the shoulder in a neutral position.
Children with Diplegia or Quadriplegia can use all of the above modifications as needed. In more severely involved children with poor head control, a neck flotation collar is also available.
Simple, effective and fun. Enjoy the water this summer.
Water Exercise Results in an Adult with Cerebral Palsy
Moving from Deep Water Jogging to Land
Karen – thank you for the great post. It’s very clear and logical with practical information that families can implement straight away. Thank you for continuing to being a voice of innovation and progress for people with Cerebral Palsy. We are very glad we “discovered” your website, TEDx talk and Facebook page!
Karen, at what age would you recommend this? My son has hemiplegia and is 12 months old. He is commando crawling (pulling himself along with his good side). His physio says there is no benefit to anti gravity work at this early age. Your thoughts?
Answer from Karen Pape
Thank you for a good question. Your PT is right in saying there’s no benefit to antigravity works such as the LokoMat or Lite Gait at this young age, but I strongly disagree that there’s no reason to put him in the water. He won’t need a Wet Vest. You can get the same benefit for your child with just about any of the child size swimming vests that allow him to keep his head out of the water and freely move his arms and legs. If he is commando crawling and only using his good side, the thing to look at is what’s happening to his “bad” side. If during his activities, he is fisting his affected hand, retracting his shoulder and stiffening his leg, then he needs more support to inhibit the spasticity. Look at my post on Crawling: Normal, But Not Necessary. Crawling accentuates the unbalance and tone in children with hemiplegia. If he’s properly supported in his trunk and his feet are stable in some form of orthotic, he may well not need anything on his hand as yet. However, if the hand tightens up, he needs a split there too. See Minimize Maladaptive Motor Habits
It is important to realize that there is a new paradigm – preventing maladaptive movement patterns rather than allowing them to occur and then treat. It’s easier to prevent a maladaptive habit than it is to change it. I hope this is of help.
Karen, thank you for this information. my 5-year old son has mild cerebral palsy. he goes for physiotherapy two times in a week, and swimming (each session is for 40 mins.) twice a week. he has been swimming for the last one month now. Do you think we should go for swimming more often?
he walks with a limp on his right leg. he will always walk with his toe up in the air because of muscle tightness. plus, there is a slight swinging motion in his waist. when he was young, he used to fall down very frequently, because of balance issues. but now he does not fall down anymore. otherwise he is very active. he loves to play and jump around all the time.
i must also say that he seems to lack confidence in everything. he will always need validation on everything. suppose he is writing alphabets… he will keep asking us what comes after C, and so on, though he knows all of them very well. he will keep saying something like this… D comes after C… right. and that’s not just with alphabets. it is with almost everything.
Do you think we should meet a child psychiatrist or psychologist?
Dear Niladri, thanks for your comment. It sounds as if you have a great program for your son. You might add 15 minutes of jogging in a Wet Vest to his swimming class.It will help him build his endurance. I would suggest that you talk to his physician about an AFO and or Botox for the right leg…sometimes they put them on both legs to balance the walk. It is important to correct this while he is young as toe-walking will affect the growth and function of his leg and hip.
For the confidence issue, I would also talk to your paediatrician first. He or she would be the one to give advice on managing this and/or a referral to someone else.Good luck, Karen
Dear Karen, I have a six year old son who has dystonic cerebral palsy with poor head control unable to sit-Wsitting he can by himself- but able to walk assisted in his walker or having me holding his pelvis.Would you recommend both neck collar and the vest for him or the vest is not helpful in severe cases.? Thank you in advance
Thank you for your question. The fact that he can w-sit on his own shows what he can do with a better base of support. I would start with a TheraTogs. http://theratogs.com/ They can let you know if there are any trained therapists near to you.Regardless, I would start with just the long vest type of compression garment and add a neck collar if needed. You may find that with trunk support his head control increases.
My daughter has dystonia. She is 17 months with no mobility as of now. She is not even sitting yet. Do you suggest swimming would help her in any way?
At this point,I would work with your neurologist and therapists to decide what is best for your daughter. Swimming would not be advised at this time.
My daughter is 1 with mild cerebral palsy. How do I go about getting into this
For an overview of brain injury in children that leads to CP, start with reading my book,The Boy Who Could Run But Not Walk.
I believe early therapy is important and now that you have a diagnosis, push for referral to a physical therapist as a great starting point. Talk to your doctor to get a more specific diagnosis. That will help you by giving you a more accurate idea of what your child’s needs will be. Hope this helps,Karen
Dear Karen, My nephew is a CP child. He is 9 years old. He cannot speak, hear and walk. He walks with the help of a walker and with the help of someone behind. Can you please suggest some exercise for strengthening his walking. Hearing I guess nothing can be done. Please advise if swimming is ok for him
I would ask his doctor and therapist is their is any contraindication to him swimming with a floatation device. If he can use it, it may help strengthen him. Best of luck with it.