AQUATIC EXERCISE FOR CHILDREN WITH CEREBRAL PALSY: A SYSTEMATIC REVIEW

Purpose: Cerebral palsy (CP) is the most common cause of childhood physical disability. The purpose of this systematic review was to examine evidence regarding the potential benefits of aquatic exercise for children with CP. Safety, outcomes, and applications are addressed. Methods: Electronic databases used were PubMed/MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Physiotherapy Evidence Database (PEDro), and Scopus. Additionally, we performed a hand search of the reference lists of relevant studies. Studies were included if they met the criteria of diagnosis (any form of CP), population (aged 0-21), and intervention (aquatic exercise). Quality of the included studies was rated using the Centre of Evidence-Based Medicine: Levels of Evidence and the PEDro scale. Results: Of the 17 studies, three were randomized controlled trials, three were cohort studies, seven were quasi-experimental design, one was a prospective time series group design, two were case reports, and one was a case study. The sample sizes for the included studies ranged from 1 to 46 subjects. In total, 319 children with CP were analyzed. The duration of treatment ranged from 6 weeks to 6 months, with frequency of sessions varying between 1 to 3 times a week, and length of sessions averaging between 30 to 60 minutes. A range of aquatic exercises and techniques were used to address multiple impairment areas, including upper and lower extremity strengthening and stretching, balance, aerobic capacity, water adjustment skills, and gait. Various outcome measures were used to assess effectiveness of aquatic exercises including gross motor function, ROM, balance, gait, energy expenditure, social acceptance, and self-esteem measures. Conclusion: The evidence suggests that aquatic exercise programs may be effective in the short term for improving gross motor function, gait parameters, social function, and self-esteem in children with CP ages 0-21. The evidence also suggests that aquatic exercise is a safe and fun treatment option for this population, with no reports of adverse effects. The overall body of evidence is inconclusive due to a lack of high-quality evidence, small sample sizes. There is significant variability between studies in intervention parameters (frequency, duration, intensity, etc.), disease severity of subjects, and outcome measures used to document changes.