Effectiveness of Aquatic Therapy Interventions in the Management of Children with Cerebral Palsy: A Systematic Review

Purpose The purpose of this systematic review was to analyze the current scope of literature regarding the effectiveness of aquatic therapy as an intervention for children with cerebral palsy (CP) and to assess the feasibility of incorporating aquatic therapy into the physical therapy management of this specific population. Methods A literature search in 3 electronic databases - PubMed, CINAHL, and Academic Search Complete - was performed, using the following search terms: “cerebral palsy,” “children with disabilities,” “aquatics,” “aquatic therapy,” and “hydrotherapy.” Articles published between 1984 and 2014 were selected. Inclusion criteria for study selection included publication in the English language (or publication in any other language with available English translation); recruitment of participants with CP ages 0-21; and the use of aquatic therapy as the main experimental intervention. Studies were excluded if they were not written in English or had no easily accessible translation or if they recruited subjects older than age 21. The initial search resulted in 280 potential articles, which were screened for the stated inclusion and exclusion criteria as well as for duplicates. Thirteen articles satisfied the inclusion criteria. There were two case reports, one case series, one pilot study, three cohort studies, five quasi-experimental studies, and one randomized controlled trial. A total of 280 children with cerebral palsy participated in these investigations. Sample size across the research studies varied from 1 to 46 children. The ages of the participants varied from 3 to 21 years old. Results The evidence suggests that aquatic therapy interventions are effective in the short term for improving gross movement and gait parameters as well as social function and self-esteem in children with CP ages 0-21, and that aquatic therapy is feasible, safe, and fun for this population. Conclusions The overall body of evidence is inconclusive due to a lack of high-quality evidence, small sample sizes, and variability in intervention parameters (frequency, duration, intensity, etc.), severity of disease, and outcome measures. More research must be conducted with larger sample sizes, higher quality study design, and more consistent outcome measures to determine effective exercise parameters and to further support the success of aquatic therapy as a physical therapy intervention for this population.