I love providing occupational therapy in the pool because it is an exceptionally motivating and therapeutic environment. Water offers an abundance of therapeutic properties that I can utilize to create engaging and effective interventions. Here is a brief description of the most common therapeutic properties of water that I integrate into interventions. You will learn how they impact the body during a therapy session and how they can be tailored to suit individual needs.

Buoyancy: low impact and less gravity

Buoyancy provides an upward force that gives us that extra “bounce” in the water. Because of the density of our body compared to the density of water, the amount of gravity acting on the body is reduced, which results in a low impact environment for movement. With buoyancy, we can do more complex movements with a reduced risk of falling. This is exactly why many people can comfortably perform backflips under water, but may not attempt them in the grass!

Buoyancy is strongest at the water’s surface, which means we will have the least resistance against gravity (and will feel the bounciest) moving upwards towards the waterline. By changing the plane and direction of movement, we can either perform buoyancy-assisted or buoyancy-resisted movement.

Here is a simplified example:

Let’s say we want to work on building strength in the shoulders. A great place to start would be holding the arms up and out at the water’s surface. This would be a buoyancy-assisted movement, because the force of buoyancy will help to support the arms up. Once, that is mastered, we can practice pushing the arms from the surface down towards their sides, which will be a buoyancy-resisted movement. This requires much more strength because we have to push against the force of buoyancy. By altering the plane and direction of movement, I can use buoyancy as a means for either reduced or increased resistance.

Viscosity: extra time for movements

Viscosity gives us a “drag” that slows our movements down when we are submerged. With viscosity, there is extra time to correct a movement. For example, let’s say a kiddo is working to strengthen their postural muscles and is practicing sitting upright while submerged chest-deep. They may lose their equilibrium and start to tip over to one side. However, they will have extra time (and buoyancy!) to help correct the movement, so they are more likely to right themselves and return to equilibrium.

Hydrostatic Pressure: calming input

Hydrostatic pressure acts as a phenomenal source of calming input for the body for two reasons: it forces increased breathing and it provides deep proprioceptive input. When we are submerged, the hydrostatic pressure pushes on the lungs ever so slightly, which causes a natural increase in deep breathing. This can help to put the nervous system in parasympathetic, “relaxation mode”. Furthermore, if we are submerging, we are forced to practice some breath control, which further amplifies our sense of relaxation.

Additional, as we submerge and dive deeper, hydrostatic pressure intensifies. So, we will experience an increasing sense of compression on the organs and skin. This provides a wonderful “deep pressure” sensation to our proprioceptive system (our sense of body awareness) which also calms the body.

Oftentimes, kiddos who are “sensory seekers” will develop a natural affinity for diving and submersion. This is because the experience provides such a powerful, heavy work sensation that cannot be replicated outside of the pool.

Surface Tension: tactile input and resistance

Surface tension results from water molecules bonding tightly at the water’s surface, which creates a stronger force between the water and the atmosphere. This means that it takes more resistance to move from the air to the water or vice versa. The tense bonds must be broken to do so.

If we do movements that involve breaking the surface tension, there will be additional resistance required, which increases the strengthening component of a movement. Furthermore, the act of breaking the water’s surface provides an intense tactile sensation. For kiddos who enjoy tactile input, this can be a highly regulating activity. Conversely, for kiddos who have a tactile sensitivity, activities that break the surface tension may allow for additional exposure to tactile input in a fun and motivating way. Two of the most common activities I do to break the surface tension are splashing and jumping in-both tend to be exhilarating for kiddos!

Refraction: body awareness

Refraction involves the way the light reflects off of the water’s surface. Due to the fluid motion of water, the light refracts when it is reflected, which causes a slightly distorted visual image. This can be mildly disorienting for kiddos who do not yet have experience in the water. While it can initially feel disadvantageous, it quickly forces reliance on other sensory systems to build an awareness of the surrounding environment. The brain receives heightened input from proprioceptive, tactile, and vestibular systems, which counteract the confusing visual feedback. Therefore, it allows our body to lean on those other sensations to get oriented to the water. OTs often aim to draw awareness to new sensory systems and this allows us to do just that!

During your child’s therapy session, you will see a beautiful combination of all of these therapeutic properties at play. Find out which properties will best support your child’s therapy goals!

References:

Agostoni, E. , Gurtner, G. , Torri, G. , & Rahn, H. (1966). Respiratory mechanics during submersion and negative‐pressure breathing. Journal of Applied Physiology, 21, 251–258. doi: 10.14814/phy2.15475

Aquatic Therapy University (2012). Aquatic Sensory and Motor Integration for the Pediatric Therapist. [Continuing Education lecture and manual]. https://www.atuseminars.com/product-page/aquatic-sensory-motor-integration-forpediatric-3-hr-w-manual 

California Physical Therapy Association (n.d.) Aquatic physical therapy key messages. https://med.stanford.edu/content/dam/sm/pain/documents/AquaticTherapyKeyMessages.pdf

Tisser, A. & Freedman, C. (2021). Totally treatment-pediatric aquatic therapy course. [Continuing Education PowerPoint slides]. Swim Angelfish. https://swimangelfish.com/therapist-training/