hydrotherapy according to Halliwick concept #
Halliwick is a hydrotherapy concept developed in 1950 as a swimming method for people with special needs. It uses the buoyancy of the water to support the mobility and stability of the trunk. Thereby the Halliwick concept is a constraint-induced movement therapy. The Halliwick concept consist of water specific therapy (WST) and a ten point pragramme, which focuses on the control over rotations around various axis of the body, to create a core stability. By using the Halliwick concept you’re using an problem solving method. The possibilities and constraints of the patient are analysed to help the clients functions and independence.
If you are interested in learning more about hydrotherapy, you can read the following books:
Study Overview #
the following study ” The effect of hydrotherapy according to Halliwick concept on childre with cerebral palsy and the evaluation of their balance: a randomised clinical trial ” that conducted by Konstantinos Chandolias, Evangelia Zarra, Anna Chalkia and Alexandra Hristara l between September 2021 and November 2021
Hydrotherapy according to Halliwick concept is a physiotherapeutic intervention technique for disabled
patients and for children with neurodevelopmental disorders. Assessing the balance in children with cerebral palsy
(CP) is an extremely complex process and more difficult to evaluate the results of some therapeutic interventions in
these patients. The purpose of this study is to investigate the effect of Halliwick based Hydrotherapy on the support
base in children with CP. Several studies have proven the beneficial effects of hydrotherapy in the respiratory system
of children, but few are studies that report the effect on the balance of children with CP.
The study type was a randomized clinical trial between September 2021 and November 2021. The study involved 16 children diagnosed with cerebral palsy (GMFCS 1-2). Selection criteria were diagnosed children with CP, GMFCS level 1-2, without accompanying seizures, without recent surgery or alantic toxin injection, and able to understand basic instructions. The 16 children randomly were divided into 2 intervention groups. The 10 children attended a Hydrotherapy program according to the Halliwick philosophy by specially trained method therapists. The 6 children attended treatment with the methods of classical physiotherapy. Their balance was assessed with the Berg, GMFM, and footprint plate. The assessment was performed at the start of the program (pre-test) and after 3 months (post-test).
Assessment tools #
The Berg balance scale (BBS) includes fourteen (14) tests that correspond to the child’s daily activities. Balancing ability is a prerequisite for performing individual tests of the test. Each test is scored on a five-point scale, with values starting at 0 (inability to perform and up to 4 (full capacity). Then, the scores of all individual tests are added up and the total score of the test is calculated.
The gross motor function measure (GMFM) test was designed to quantify changes in gross mobility in children with CP at different times.30 No age limits are stated but the test can be performed with 100% success by a fiveyear-old child with normal motor ability. and movement to knees, standing posture and finally walking, running,
and jumping. Effort to shorten the time required to perform this test, as well as to prioritize its subtests based on the difficulty of performing them by children with CP, led Russel and her colleagues to select 66 subtests, which were arranged in order of their degree of difficulty and not grouped in 5 areas of gross mobility control. This new test was named GMFM-66 and its authors claim that
it better detects changes in gross mobility in children with very severe/ very mild motor impairment.
Footprint pate (Pelmatografima-elite) was also used. The footprint plate is a test that analyzes the distribution of pressures during posture and gait, digitally capturing the morphology of the sole. It is a device with thousands of sensors, which record the pressures exerted on each point of the foot when it is in contact with its surface. A computer is connected to the device, which collects, processes, and analyzes specific information.
There are a few limitations to this study. First, the sample size is relatively small, which may have limited the power to detect some significant differences. Second, the study did not include a control group, so it is impossible to determine whether the observed improvements were due to the hydrotherapy program or other factors such as natural recovery or maturation. Third, the study did not assess long-term outcomes, so it is not known whether the improvements seen at follow-up were maintained over time. Finally, the study did not assess the impact of the hydrotherapy program on functional outcomes, so it is not known whether the observed improvements in motor and cognitive skills translated into improvements in daily functioning.
Τhere is a statistically significant change between the 1st and 2nd measurement with the BERG and GMFM
tools and better for the water intervention group. The change in the support base between the 1st and 2nd
measurement was better in the water intervention group but not statistically significant.
Hydrotherapy according to Halliwick concept is one of the most important physiotherapy practices. The results obtained from this research were remarkable. In the second group, the control group, which included children who followed a classical physiotherapy program, there was no statistically significant change in support base and balance. In the first group, the intervention group
according to the Halliwick philosophy, there was an improvement in balance.
More specifically, the evaluation of the Berg scale and the GMFM showed a change in the support base and an improvement in the balance in the intervention group according to the Halliwick philosophy. As for the pedometer, there was a change in the support base in the intervention group, it was just not statistically large.
- It is proposed for the scientific community more research with a larger sample population and for a longer period of time.
- It is emphasized that hydrotherapy should be done by properly trained therapists and the whole scientific team should work together for the best treatment.
- The present research comes to fill an absence in the databases related to the effect of hydrotherapy on the support base of children with CP.
Future research #
should focus researchers’ attention on the complex evaluation of the parameters of the individual factors of functional balance evaluation by investigating their variation by gender, age, GMFCS level, in the short and long term.
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