Course Description:

From a broad perspective Halliwick-Aquatic Therapy (HAT) is an intervention tactic that uses the specific constraints of the aquatic environment to therapeutically influence human functioning for those that have impairments in function or structure of organ systems, limitations in their activities and/or restrictions in their participation.

The first module covers the state-of-science in HAT – Ten-Point-Program, which is focused on teaching independence in water. Independence is an important prerequisite for participation in therapeutic, vocational or recreational activities in a group: the willingness to loose balance and knowing how to stand up again are core elements.

The second module of this course develops into the certification into Water Specific Therapy (WST). WST is an aquatic therapy with elements of the Halliwick 10 point-programme swimming method. Halliwick is used as pretraining for exercises that use the fluidmechanical properties of water. The Halliwick ten-point-programme was developed by the engineer James McMillan. The first 6 points were also described by him as pretraining, i.e. teaching a patient to dare to fall and be able to stand up. These points are related to aquatic self-efficacy as basis for compliance to exercises and activities that address a patient specific problem, using the constraints of the aquatic environment. Some of these constraints are related to fluidmechanics: use of flow conditions (turbulence), waves of transmission and metacentric effects (using the change of gravity and buoyancy induced torques).

The choice for WST (exercises and activities) is the result of a clinical reasoning process in which, partly based on external evidence, aquatic therapy is chosen as the best intervention for a certain patient with (mostly) a certain neuromusculoskeletal problem.

When the intervention requires activity of the patients and the goals are at the level of function of ICF: WST has proven to have clinical relevant results in e.g. neurological patients (Scarano 2012, Tripp 2013, Fumari 2014). A clinical question in WST could be : “can metacentric effects be used to train central stability in an ataxic patient”?

Perhaps more important is that the combined approach of WST and original Halliwick group activities fit perfectly in the contemporary framework of neuroprotective exercises: a combination of sustained physical activities and environmental enrichment.

Water Specific Therapy (WST) is THE aquatic therapy concept worldwide, included in more than 50 published articles. WST covers the entire CIF-spectrum including one of the most important topics in rehabilitation: fall prevention. Other examples are:
•   neuroprotective training: environmental enrichment and aerobic training
•   influencing neuroinflammation
•   gait training
•   handling techniques for unsecure or severely impaired persons
•   using published evidence in clinical reasoning:

The choice for WST (exercises and activities) is the result of a clinical reasoning process in which, partly based on external evidence, aquatic therapy is chosen as the best intervention for a certain patient with (mostly) a certain neuromusculoskeletal problem.

When the intervention requires activity of the patients and the goals are at the level of function of ICF: WST has proven to have clinical relevant results in e.g. neurological patients (Belmonte 2011, Vivas 2011, Scarano 2012, Tripp 2013, Zotz 2013, Fumari 2014). A clinical question in WST could be: “can metacentric effects be used to train central stability in an ataxic patient”?

Noh (2008) used the pre-training to continue with Ai Chi and Kwon (2010) to continue with an obstacle course. Where swimming mostly is a continuation of the 10 point programme in paediatrics, in aquatic therapy for adults a focus on postural control (in fall prevention) is more logic. This is what the quoted literature shows.

WST has been described in-depth in the book Comprehensive Aquatic Therapy by Lambeck & Gamper (2011) and this chapter, together with the publication by Noh in 2008 were the reason to include WST in the Dutch guidelines on stroke treatment.

In 2018, the German book “Wasserspezifische Therapie” was published by Katharina Kastner. This book covers in-depth descriptions of all elements that belong to WST and Halliwick. See: https://buecher.pflaum.de/buecher/physiotherapie/wasserspezifische-therapie/

Case related contents provide students with a comprehensive picture of current research that supports hypothesis-oriented algorithmic decision making, clinical reasoning, problem-solving and goal-setting using the HAT methodological approach.

Module 2 will mainly be related to the analysis of patient constraints at the ICF function/structure level and design exercises accordingly, based on appropriate physiological training rules.