Aquatic intervention in children with neuro-motor impairments

The present thesis addresses the influence of aquatic interventions on motor performance of children with neuro-motor deficiencies in a functional context. The theoretical framework is based on a functional approach in compliance to the International Classification of Function and Disability (ICF). Chapter 2 addresses the relationship between motor performance in the aquatic environment setting as measured by the Aquatic Independence Measure (AIM) to motor performance on land as measured by the Gross Motor Function Measure (GMFM) and the Pediatric Evaluation of Disability Inventory (PEDI) in a sample of 49 children with neuro-motor impairments. Significant relations were found between the total AIM and GMFM scores and PEDI self-care domains. Chapter 3 reviews aquatic intervention research in children with neuro-motor deficiencies aiming to evaluate research reported in relation to the ICF terminology (changes in body function, activity level and participation). Eleven of the 173 articles retrieved met the inclusion criteria. According to this review, there is a substantial lack of evidence - based research evaluating the specific effects of aquatic interventions in this population. Chapter 4 compares the effects of a four-month aquatic to land based intervention on energy expenditure and gross motor function in 17 children with spastic diplegia cerebral palsy (CP). Nine children (5.3 yr + 1.02) received aquatic and eight children (4.7 yr + .95) exercise intervention. Energy expenditure was measured by expired gas by means of Cosmed K4b2 metabolic system and the energy expenditure index based on heart rate measures. Self- paced and fast walking velocity were measured by the 10 meter walk. Gross motor performance was measured by the GMFM and PEDI. No differences were found between groups in energy expenditure measures. However, group effect sizes and mean trends suggested a more favorable decrease in energy expenditure in the aquatic intervention group in comparison to the exercise intervention group. Effect sizes of the ten meter walk were larger in the exercise group in comparison to the aquatic intervention group. Significant differences were found in the PEDI self care domain in favor of the aquatic intervention group. Based on this study it is recommended to combine both means of interventions to increase functional levels of motor performance in this population. Chapter 5 addresses the effects of a four-months aquatic compared to an exercise land based intervention on perceived competence and social acceptance in 22 children with spastic diplegia CP. Twelve children (5.4 yr + .95) received aquatic and ten children (5.4 yr + .95) exercise intervention. Perceived competence was measured by means of the physical and social sub-scales of the Pictorial scale for Perceived Competence and Social Acceptance (PSPCSA-CP). Social function was measured by means of the PEDI social function domain. Differences in social acceptance were found in favor of the aquatic intervention group and no differences were found in perceived physical competence. Significant differences between pre to post scores in the PEDI social function domain of the care givers were found in the aquatic intervention group. Aquatic intervention appears to have a positive effect on perceived social acceptance and social function as reported by caregivers