Aquatic Therapy Programming for Individuals with Autism

Jennifer Knott, CTRS, discusses aquatic therapy programming for autistic individuals. She highlights the potential of such programs for removing barriers to involvement and expanding individual recreation repertoire to build memories and experiences together in a community-based setting. The speaker emphasizes the lifelong nature of aquatic therapy and presents various examples of individualized treatment techniques and goals. The speaker highlights the absolute need for teaching autistic people water safety skills and details how water’s essential qualities assist therapy techniques and individual skill-building. Knott asserts that we can promote lifelong health, wellness, and leisure development for autistic individuals by harnessing the power of the water and designing inclusive accessible programs. 

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Handouts are online at: Aquatic Therapy for Individuals with Autism

In this webinar: 

1:30 – About Jenn Knott
4:08 – Recreation therapy
6:15 – Aquatic therapy
8:25 – Properties of water
10:30 – Water safety skills
13:30 – Need for physical activity across the lifespan
15:55 – Barriers to community aquatic programming
18:40 – Aquatic therapy approach
20:20 – Aquatic therapy assessments
22:00 – Skills addressed in aquatic therapy
28:30 – Sensory stimulation in the water
33:20 – Case study: Donovan
38:00 – Swim skills are transferable
40:30 – Teaching swim safety skills
43:02 – Alleviating fear and anxiety
47:45 – Q & A

Introduction

Jennifer Knott introduces herself and explains how her intense passion for aquatic therapy was born. Her journey in aquatic therapy began while she was in college and volunteered at Hattie Laram, a group home for individuals with severe to profound disabilities. There she witnessed the transformative power of water on individuals’ physical functioning, behavior, and mood (1:30). Knott notes that this experience solidified her decision to dedicate her life’s work to eliminating barriers and providing meaningful recreation programs for individuals with special needs. She started Rec2Connect to provide communities with more accessibility to these life-changing therapies across an individual’s life (3:00). 

Recreation and aquatic therapy

Recreation therapy, although not widely known, is a lifelong therapy that uses recreational approaches to address the specific needs of individuals with chronic disabilities, syndromes, or diseases (4:08). Knott explains that treatment methods are highly individualized and can include any recreation (not just aquatic). Methods retain similar goals to physical, occupational, and speech therapy techniques. Skills taught in these programs aim to be transferable across opportunities and daily life. 

The speaker defines aquatic therapy as a form of recreation therapy that uses “water and specifically designed activity by qualified personnel to aid in the restoration, extension, maintenance, and quality of function for persons with acute, transient, or chronic disabilities, syndromes, or diseases” (6:40). Aquatic therapy includes goals that address skills which can be transferred to land and can be administered by a variety of professionals (7:35). Knott details properties of water like buoyancy, resistance, and hydrostatic pressure, which provide sensory-rich environments and help with focus and centering (8:30). For example, the hydrostatic pressure of water evenly distributed across the body offers a comforting “hug” and balanced sensory inputs. 

Aquatic therapy and autism

The speaker notes that many autistic individuals are often drawn to the water but lack the necessary safety awareness and skill sets. She discusses research suggesting a need for teaching swimming skills at a young age, highlighting that autistic children are 160 times more likely to die from drowning compared to the general pediatric population (10:30). Knott therefore asserts that swimming should be taught as an imperative survival skill before any behavioral, speech, or occupational therapies. She provides examples of safety measures such as specialized bracelets and watches and locks on doors and pools to ensure the well-being of autistic individuals in the water (12:35). Knott emphasizes the need for physical activity across the lifetime as a driver for mental and physical health (13:30). The presenter notes significant barriers to community aquatic programming and their effectiveness in skill-building for individuals with autism and other disabilities (15:50). 

Many autistic individuals exhibit hyperactivity, sensory-seeking behaviors, aversion to water, motor deficits, hypertonia, and balance issues. The speaker explains that participating in aquatic therapy can address these challenges and provide opportunities for lifelong leisure and skill development (19:00). She summarizes the aquatic therapy approach as individualized (based on patient assessments), goal-driven, and focused on lifelong skills, like motor movement. Personalized sessions are based on an individual’s interests and are often conducted weekly to track progress and guide future therapy sessions (21:15).

Skills addressed in aquatic therapy

Knott reiterates that skills addressed in aquatic therapy sessions extend beyond swimming and aim to be transferable. These can include gait, core strength, following directions, balance, gross motor skills, sensory regulation, and much more (22:00). She presents different examples of activities that address core strengthening, like pushing objects underwater or using fins for kicking (25:00). Motor skills and strength can be addressed with weighted medicine balls, squeezing sponges, and pool games that incorporate physical actions and hand-eye coordination. The speaker describes techniques used to build capacity for using one’s arms and legs simultaneously in water compared to on land (27:00). Knott reiterates the importance of incorporating sensory activities into therapy techniques, as well as allowing sensory breaks (32:34). She outlines a case study where therapeutic goals addressed sensory needs, core-strength, and coordination, as well as swim safety skills such as grasping the pool wall, swimming to the pool wall, and holding breath underwater (33:20). The presenter notes that many individuals experience water aversion and discusses techniques for building trust and alleviating fear and anxiety surrounding water (43:00). 

Knott reiterates the impact of aquatic therapy on lifelong health and wellness such as increased physical activity, decreased likelihood of drowning, increased strength, and opportunities for social activities (44:40). She provides thanks and references before the Q & A session where she covers accessibility to aquatic therapy programs, potentially toxic chemicals in pools, autism-friendly swimming environments, and more (47:45).