Disabilities, Modalities, and Activity Adaptations

Disabilities, Modalities, and Activity

Adaptations
Multiple Sclerosis/ Cerebral Palsy
Kevin Sheldon (2724877)
4/17/15
LEI3703

Disabilities, Modalities, and Activity Adaptations

Multiple Sclerosis
Multiple Sclerosis can be defined as both a physical and neurological
impairment. According to Mayoclinic.org, Multiple Sclerosis, or MS, is a disease in
which your immune system attacks the protective sheath that covers your
nerves MS is a disease that affects the Central Nervous System (CNS) which
encompasses the brain, spinal cord, and optic nerves. As stated by Hersh C. and Fox
R. (2014), around 400,000 individuals in the US alone have been diagnosed with
multiple sclerosis and that number increases to around 2.5 million worldwide. This
disease can normally be seen under a wide range of ages, primarily around the age
group of 20-40 years of age (with a mean of 32 years of age), in which the disease
affects women at a higher rate than men (ratio 2:3 females). MS can even be seen
in children; however, it is very rare. It should also be noted that the origins, etiology,
and cure for MS are not yet known, although, a link towards some genetics and
environmental factors may possibly play a role in the prevalence of MS. For
example, an astonishing tie of geographical location and the prevalence of MS exist;
the likelihood and occurrence of MS increases the further a population is from the
equator (north or south). Some theories suggest that vitamin D may play a factor in
MS and MS exacerbations. To understand how this disease disables an individual, it
is important to dissect what occurs at the cellular level.
The nervous system is in charge of relaying messages from the brain, to the
body, and back. These relayed messages include both voluntary and involuntary
actions held within the body. For example, typing this research paper requires
voluntary action because it is an action that is controlled by the user, whereas, the

Disabilities, Modalities, and Activity Adaptations

heart of the user cannot be controlled (involuntary) by the user; it relies on the
brain to send impulses to the heart. In the case of Multiple Sclerosis, a block occurs
in the message relay process which brings about a variety of complications. At the
cellular level, inside the nervous system lie neuron (nerve) cells. These neuron cells
work together, constantly relaying and receiving messages throughout the body to
perform tasks. These neuron cells can be broken down into 6 individual parts, the
dendrites, soma, nucleus, myelin sheath, axon, and axon terminal button. In the
case of MS, the immune system attacks itself by corroding the myelin sheath
exposing the axon. The axon acts as a bridge or telephone landline that carries the
impulses to and fro so when the myelin sheath is damaged a number of things can
happen. In some cases, the exposed axon can lead to misfiring of impulse
communication or even miscarriage of the message being sent or received. Also, as
the cells restructure the broken-down sheath, it sometimes layers over the
damaged areas in which leads to the scarring over of the myelin sheath. This
scarring is not only irreversible, but it is also vital in the signal transmission of
impulses because the scarred tissue will block the neurons from effectively
communicating with one another. Depending on the severity of the damaged
sheath, the placement and amount of the scarring, and the neurons affected can
greatly dictate and influence the symptoms and side effects experienced in the
individual. After the attack on the myelin sheath, the body will react by causing
inflammation to the specific area. The point of inflammation is where most of the
individuals symptoms and relapses (flares or attacks) will occur.
The relapses occurred from MS are what causes the symptoms associated
with MS, such as, numbness, fatigue, dizziness, slurred speech, and many others.

Disabilities, Modalities, and Activity Adaptations

According to neurologist Christina Johnston, these attacks last from a variety of

ranges, from at least 24 hours and may extend to 3 days or in some cases it can
last pass several weeks. Following these attacks are periods of healing. This period
of healing is also known as remission or remitting. During the remitting stage, the
body will work to fix or regenerate any damaged areas affected by the auto-immune
systems attacks. At the remitting point, MS symptoms will subside and the
individual will experience limited to no signs of MS until flair up or relapse occurs
again. To better understand this concept, the process of relapsing-remitting can be
ber compared to a hurricane. At the wings (or arms) of the hurricane occurs a great
deal of turbulence and chaos, whereas, in the middle (or eye) of the hurricane is a
brief state of calmness and minimal signs or symptoms of the hurricane. These
back-and-forth periods of relapse and remission are very common in individuals with
MS. It must be noted that, over time, these relapses and remissions will eventually
have long term affects caused by the scleroses (scarring) left on the damaged
neuron cells; in many cases, this will eventually lead to a gradual loss in cognitive
and physical ability. Aside from the many primary conditions, including exhaustion,
overheating, numbness, slurred speech, blindness, and many more, there also lie
secondary conditions embedded that individuals may experience.
Some of these secondary conditions that can be found, as a byproduct of the
primary conditions in MS, may fall under many domains such as the emotional,
social, physical, and leisure domains. In the article Depression in multiple sclerosis
(Minden S., Orav J., & Reich P.), studies showed that an extremely high number of
patients with MS experienced some level of depression; in the study consisting of 50
patients, 54% fit criteria for major depression. Although this may be a small sample

Disabilities, Modalities, and Activity Adaptations

size, it has been documented that forms depression and anxiety follow as a
secondary condition of MS. Also, socially, some individuals may feel stress when
establishing new relationships, however, greater awareness of this disease is
helping to bond the MS community into both support groups and inclusive activities
in efforts to mend relationships and ultimately reach empowerment. As far as
secondary physical conditions that might occur in individuals with multiple sclerosis,
include osteoporosis, respiratory infections, and even UTIs. Last, in the leisure
domain, many individuals with MS should be careful to not overwork themselves or
their bodies. It is common to find individuals with MS to overheat their bodies due to
strenuous, physical activities. It is recommended for leisure activity to be modified
and/or limited to short spurts and in cooler areas if possible to prevent fatigue and
overheating.
It is important to note that individuals with MS have needs and limitations.
For example, activities that involve extraneous activity or hot temperatures are
prohibited as these factors can exacerbate relapses. It is imperative the close
monitoring is taken place on the individual with MS, such as, watching body
language signs, verbally communicating, and also having cold water, ice packs, or
water vests readily available (to prevent overheating or exhaustion).
Recreational Therapy Modalities
Therapeutic recreation specialists use the term treatment modality to
describe recreation or other activities used to help clients meet therapeutic goals.
(Robert T. 2008 p. 70)The primary job of a TRS is to create goals to benefit their
clients health and reaching those goals by constructing and conducting programs
through recreation and leisure activities. Since MS covers a range of people and

Disabilities, Modalities, and Activity Adaptations

contains a wide range of needs and limitations, there is a multitude of beneficial

leisure and recreational activities clients with MS may partake in. For example,
individuals with MS may find animal-assisted therapy, horticulture, exercise and
fitness, tandem cycling, and aquatic therapy modalities to be both fun and help the
individual reach their personal and therapeutic goals.
Animal-assisted therapy may be beneficial to people with MS emotionally
because the animals aid in motivating, adding a sense of ownership, and reliance on
their care giver. This companionship may also combat the levels of anxiety or
depression that may typically follow multiple sclerosis. Sometimes, depression is
replaced with a greater self-image that aids in more likelihood of social interaction
as well.
Horticulture is the caring of the plants exercises cognitive skills (such as focus
and endurance), motor skills (hand-eye coordination and balance), and sensorymotor skills. (Robert T. 2008 p. 123) Also, emotionally, horticulture may provide a
positive outlet on releasing anger or anxiety by caring for a plant and reaping the
rewards of watching their creation sprout to life. This complex of power may aid in
the individual grasping both higher self-esteem and empowerment. A higher selfesteem then rewards the individual in a social aspect as well.
Exercise and fitness serves multiple functions that are beneficial for people
with MS. First it aids the individual physically; it helps strengthen weakened areas
caused by MS, prevents spasticity, and conditions the individuals endurance in an
effort to prevent fatigue. Also, it has a residual effect of aiding people emotionally
and socially. Generally, a healthier body, many times, can boost a persons selfimage and self-esteem. This greater sense of self bleeds from emotion to social

Disabilities, Modalities, and Activity Adaptations

because the confidence can carry over into conversation and a more-willingness to
effectively communicate with others. Since proper nutrition is a vital component in
fighting MS, with a great exercise plan that fits well with the patient, proper diet and
knowledge can be tremendous in the overall prognosis and health for people with
MS. It must be noted that the level and type of exercise should be greatly monitored
to prevent overworking or overheating a patient.
Another great modality to use for people with MS can be tandem cycling.
Tandem cycling works on physical, social, and emotional areas. A great aspect in
tandem cycling is that it incorporates team building and cooperation to achieve a
common goal. These aspects key in on positive social wellbeing. Of course, the
physical aspect of pedaling and balancing work on coordination and endurance but
what is great about tandem cycling is that if the patient with MS may start to get
fatigued, they can simply rest while the other cyclist takes over. The ability to briefly
rest while still on the cycle allows the individual with MS to constantly be involved
with the group, versus being secluded. This inclusive and group-based atmosphere
provides a platform or foundation to open the floor for many social possibilities. In
turn, a greater sense of community directly affects internal feelings toward self
which turns into higher self-esteem.
In the case of aquatic therapy, this modality not only exercises the body but
the water acts as a cooling effect on the client. The use of water as a medical
treatment, and as an alternative supplementary means of rehabilitation, is as old as
mankind (Bender et al., 2004). In aquatic therapy, not only does an individual work
out the body physically but also hones in on balance, coordination, and focus.
Aquatics therapy helps to combat any loss of strength because the patient becomes

Disabilities, Modalities, and Activity Adaptations

virtually weightless when in the water. Also, in aquatic therapy, it is easy for the
therapist to target specific areas of the body or ranges of motion that the individual
with MS may need to focus on. Goals may include achieving better flexibility to fight
spasticity, endurance to fight fatigue, better circulation and blood flow throughout
the body, and even the goal to achieve the practice of swimming.
Many activities make up the whole known as aquatic therapy. Between
bubbles/ breathing exercises, stretching, diving, mainstream swim strokes, and
floating/ treading water. In bubble drills, the participant works on getting
comfortable with putting their faces and head under water as well as breathing
rhythm and technique. Stretching is a big part of aquatic therapy and is very useful
because the buoyancy allows for easily flexibility while the water is used as a means
of restriction. The amount of motion can be modified to easily suit how vigorous the
instructor or participant desires. Diving is another step in being comfortable in the
water and exercises coordination, cardio, and breathing techniques. Mainstream
strokes consist of 4 swimming strokes, front crawl, back crawl, breast stroke, and
butterfly stroke (some consider scissor kicks as the 5 th stroke). These strokes require
proper body and breathing technique and take great coordination and endurance to
complete. Practicing these strokes workout the entire body, as well, as the mind.
Floating and treading water, like swimming strokes, focuses on breathing,
concentration, coordination, and endurance, alongside the physical and social
aspects that go with it.
Activity Description
Within aquatic therapy, a great activity to implement with participants is to
practice on floating and treading water. The purpose of this activity is to drill

Disabilities, Modalities, and Activity Adaptations

coordination, balance, concentration, and are essential in the preparation of

achieving the ultimate goal of swimming effectively. During the floating process, the
instructor reviews key aspects to swimming, such as, rhythm, balance, and
breathing. The instructor then asks the participant to rest their head over the chest
or shoulder of the instructor while facing the sky. At this time, the instructor will
gently bring both arms up under the participants back to align them horizontally
towards the surface of the water. With elbows locked, the instructor then guides the
participant on proper resting technique, such as, keeping the chin up, body
relaxed, hands and arms stretched out in the shape of a starfish, and proper
rhythmic breathing. If the instructors feels that the participant is ready to advance,
the instructor will then slowly pull back their arms and let the participant try floating
on their own. With some practice, the participant should be able to effectively float,
demonstrating proper posture and breathing.
The next step after floating is followed by treading water. Treading water is
the ability to stay in one spot while staying afloat at the same time, without making
contact with the ground. Treading water can be extraneous and drills on physical
movement, coordination, endurance, and breathing. It is important to learn floating
first because the buoyancy, balance, and controlled breathing aspects are learned.
These aspects segue into some of the key components of treading water. To tread
water, the instructor will bring the participant into deeper water to discourage
touching/ standing on the floor. If necessary, the instructor will distribute a pool
noodle or floatation device to the participant if they do not feel comfortable in open,
deep water. Next, the instructor will demonstrate proper technique and key points of
treading water, such as, keeping head up, alternating leg kicks, rhythmic breathing,

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and figure 8 arm patterns. When the participant is ready, the instructor will then
walk the swimmer through each technique verbally to ensure the swimmer
understands what to do. Last, the swimmer will then be asked to perform the task of
treading water while the instructor supervises and makes any required corrections.
After analyzing the activity, it can be noted that this activity provides many
beneficial physical movements. Effective swimming requires total body movement.
This specific activity (floating/ treading water) exercises everything from the legs,
core (abdomen), upper body, heart, and lungs. It is also an effective way to stretch
the joints and overall body. Proper swimming increases endurance and condition
which leads to better health and even positively affects the immune system.
Socially, the activity leans more towards intra-individual. Although an
instructor is common, it is not always necessary which makes it intra-individual. The
activity requires at least one person but is not limited in maximum number of
participants. Because there is no set maximum, this opens the door to greater
opportunity for social interaction. When an instructor is present, effective, honest
communication between swimmer and instructor is vital in achieving proper
technique. In a public aquatic class, spacing is very important. If the swimmers are
too close, the risk of hitting, injury, or even drowning can occur. However, if
swimmers are too spread out, the risk of drowning can occur as well due to the
inability to supervise every participant at once. Spacing should be in an area that
avoids participants from overlapping, while at the same time, close enough for the
instructor to supervise and approach everyone in a quick manner.
In the affective domain, aquatic therapy allows great freedom for expressing
emotion or feelings. Because swimming is not instinctual, some people may find

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difficulty learning certain aspects of it. Because of these possible hardships in

learning, it is common for participants to express frustration, fear, anxiety, or even
anger. These emotions are acceptable and the possibility of having these emotions
occur should be anticipated. Also, after the completion of these activities, it is
common that the individual feels a sense of pride and joy which is also greatly
welcomed.
Administratively, it is typical that the aquatic therapy is instructed by a
certified aquatic therapist or physical therapist. The activities do not require any
equipment; however, it is not uncommon that some classes use equipment, such
as, pool noodles, weights, bars, floatation devices, or other equipment. Aquatic
therapy typically occurs over a set time, in sessions or class setting. Again, the
number of required people is but not limited to at least one participant.
Activity Adaptation
Aquatic therapy is viewed as the best means of recreational therapy amongst
many individuals with MS. With MS comes the challenge of keeping a healthy
balance between exercise and rest. This can be a challenge because it is vital to
exercise and keep the body strong in efforts to prolong any of the individuals
strengths while reducing weakness that the individual may encounter. Also, a
healthier body, diet, and lifestyle strengthen the participants immune system.
However, too much exercise is dangerous because it can overwork, overheat, and
exacerbate relapses in individuals with MS causing the bodys immune system to
attack itself and experience symptoms previously discussed. With aquatic therapy,
people with MS get to not just workout their bodies and minds, but they do it in a
safe environment and security knowing that they will be surrounded by qualified

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therapists. According to Ann Pietrangelo (2014), the the buoyancy of water helps
support weak limbs, making them feel lighter. Water also provides resistance, which
helps strengthen muscles. People with MS may find it easier to stand in the water
than on dry land, and theres a lower risk of injury due to a fall. The main adaptions
with floating and treading water include having an instructor knowledgeable on MS,
constant communication regarding the participants feelings, cold drinking water,
shorter workout sessions, and, if possible, swimming in cooler water or at times
when the sun or heat is not at its peak of the day. It is important to have constant
communication with the participant because an individual with MS can easily and
quickly begin to overwork themselves. In the case of a participant with MS begins to
overheat, it is important to pause the session and rest the individual while providing
cold drinking water upon request. Because treading water can be very taxing on
anybody, it is important to keep these workout sessions to short terms. While
treading, water the entire body is being used; everything from muscles, to the
lungs, and the mind. These shorter sessions will go a long way in the prevention of
having the person from overworking themselves. Also, if possible, the participant
with MS should carry out the activity in colder waters. Warm water can only act as a
catalyst in triggering exhaustion and relapses. To achieve cooler water, the
instructor might want to adapt the class by setting the time of the activity earlier in
the morning or later in the afternoon. This is done to avoid the hotter times of the
day (midday) as a combination of the sun and warmer waters create a difficult
environment for the participants body.
Physically, these adaptions help to provide a more suitable environment for
the participants. The ready drinking water, cooler pool temperatures, and shorter

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swim sessions reduce the strain the body might experience. In short, these
adaptions allow the entire body to physically work but in respects to the conditions
of multiple sclerosis. For cognitive and emotional domains, these adaptions make it
possible to not just participate in the therapeutic activity but also expand on
important health factors. As stated earlier, this aquatic therapy activity aids in
coordination and endurance. Focus on coordination is important because many
times people with MS struggle with it due to weakness in limbs, numbness, or even
from the scarring over the myelin sheath. The conditioning and endurance aspect
contests the fatigue that might occur and help to prevent future fatigue or at least
slow the degenerative process down. Emotionally, these adaptions may reassure
the participant that changes have been made to accommodate the individual. This
higher comfort level may reciprocate into less anxiety and will allow the person to
enjoy the activity. The more enjoyment the participant encounters the higher the
chance of reaching empowerment which bridges the individual to feel a multitude of
positive feelings, such as, higher self-esteem and confidence and less chance of
depression. These positive emotions in turn blend into a greater probability of the
individual to have healthier social communication. Also, these adaptations and
accommodations may entice other participants with MS. If the participant is
surrounded by more individuals who have MS, the greater sense of community,
belonging, and togetherness that individual might feel. Even if the participant does
not manage to share the activity with other MS participants, the activity can still be
carried out by the general population. This then turns into an opportunity of
inclusion. The participant would then be included with a wide variety of people and
in turn can provide the foundation for healthy socialization for the swimmers.

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Cerebral Palsy
Cerebral Palsy (CP) refers to a group of disorders characterized by an
inability to control muscular and postural movements. CP results from damage to
the brain before age 12. (Robert T. 2008 p.138) Like MS, cerebral palsy covers a
multitude of groups, symptoms, and conditions; however, CP may be a broader
diagnosis making it cover a larger group of people. This is evident in the numbers
presented by WebMD.com (2015), about 10,000 infants are diagnosed with CP and
up to 1,500 preschoolers in the U.S. are recognized as having it each year. The
United Cerebral Palsy Association estimates that more than 764,000 Americans
have CP. CP is a result of many factors of the childs early development. These
factors may include hereditary or genetic conditions, trauma to the head, infections,
and many more.
There are four types of CP including spastic CP, athetiod CP, ataxic CP, and mixed
CP. The differences found in these types are based on the areas of the body affected
and the severity of restriction in movements and control found under the CP
umbrella.
Some areas to consider or take note of for individuals with CP might
include difficulty controlling appendages, difficulty in flexing and/ or resting muscles
upon request, spasticity that may cause pain or discomfort in muscles and joints,
possible inability to walk or grasp objects, lack of balance, and strong muscle and
motor reflexes.
Floating and treading water in aquatic therapy would be considered a
great modality for people with CP. Aquatic programs are especially useful because
buoyancy in the water makes movement and manipulation much easier (Robert

Disabilities, Modalities, and Activity Adaptations

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T., 2008 p. 138) To make proper adaptions for participants with cerebral palsy, it is
ideal to carry out these activity sessions at times when it is generally warmer (if
possible). To achieve this, it may be ideal to schedule these activities midday and
near the end of the aquatic therapy session so that the water is already warm and
the individuals body has already warmed up to relieve contractures. The reasoning
behind this is that warmer water temperature will help to open up joints and relax
muscles, making it easier and more enjoyable to rest and reflex the body. Because
standing, grasping, and balance can be disabling factors, one adaption that should
be made is the ratio between qualified instructors and swimmers. An instructor
should have a small number of participants with CP in the event that a participant
slips off a ledge and into the water, loses balance and falls in the water, or has a
muscle contraction making it difficult to float or stand. It may become a dangerous
environment if there is a high number of swimmers with CP and a low number of
instructors (an ideal ratio is a 1:3 ratio; 1 instructor for 3 participants with CP- based
on severity). Another adaption that may prove to be beneficial is the inclusion of
floatation devices (life vests, pool noodles, body boards, water belts, etc.). These
devices will help to reinsure the safety of the participants of drowning; acts as a
safety net, however these devices should not be heavily trusted (Aquatic Therapy,
2015).
The adapted domains affected by this activity include physical, social,
emotional, and administrative aspects. Physically, the added floatation devices help
to prevent drowning and in a result provide security not only for the instructor but
the participant as well. Also, the warmer water helps to make the activity more
enjoyable. The less spastic and stiff the participant becomes, the less possible pain

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and frustration may be encountered by the individual with CP. Because the activity
is generally a universal activity, it opens the door for the activity to easily be
modified into an inclusive program. This inclusion would help all participants
socially. Not only does the participant with CP get involved with the general
population but the general population gains awareness and necessary knowledge
on people with disabilities, specifically people with cerebral palsy. This increased
social aspect ties directly into better outcomes emotionally. With the feeling of
being included and respected comes a greater sense of self-image, confidence, and
higher self-esteem. Administratively, the adaptation of higher certified instructor
ratios help to ensure the individual attention required for people with CP. This
decreases the chance of dangerous environments and increases involvement and
necessary instruction.

Reference Page

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Aquatic Therapy. (2015, January 1). Retrieved April 16, 2015, from
http://cerebralpalsy.org/about- cerebral-palsy/treatment/therapy/aqua-therapy/
Bender, T., Balint, P.V., & Balint, G.P. (2002). A brief history of spa therapy.
Annals of the Rheumatic Diseases, 61, 949-950.
doi:10.1136/ard.61.10.949
Cerebral Palsy Types and Causes. (2015, March 1). Retrieved April 17, 2015, from
http://www.webmd.com/brain/understanding-cerebral-palsy-basicinformation
Hersh, C., & Fox, R. (2014, September 1). Multiple Sclerosis. Retrieved April 13, 2015, from
http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/neurology/multiple_
sclerosis/Default.htm
Minden, S., Orav, J., & Reich, P. (1987). November 1987. Depression in Multiple Sclerosis, 9(6),
426-434. Retrieved April 13, 2015, from
http://www.sciencedirect.com/science/article/pii/0163834387900521

Multiple sclerosis. (2014, July 10). Retrieved April 11, 2015, from
http://www.mayoclinic.org/diseases-conditions/multiplesclerosis/basics/definition/con- 20026689
Pietrangelo, A. (2014, April 18). Open Swim: Multiple Sclerosis Water Therapy.
Retrieved April 14, 2015, from http://www.healthline.com/health/multiple-watertherapy
Robertson, T. (2008). Places, Models, and Modalities. In Foundations of therapeutic
recreation (p. 70). Champaign, IL., IL: Human Kinetics.
Robertson, T. (2008). Orthopedic and Neurological Impairment. In Foundations of
therapeutic recreation
(p. 123). Champaign, IL., IL: Human Kinetics.
Robertson, T. (2008). Therapeutic Recreation and Developmental Disabilities. In
Foundations of
therapeutic recreation (pp. 138-139). Champaign, IL., IL: Human
Kinetics.

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---------------------------------------------------------DISCUSSION!-----------------------------------------------------

1. Multiple Sclerosis (MS) is a neurological disease were the immune system

attacks and damages the neuron cells. Because these nerve cells are
damaged, it may bring a wide plethora of symptoms including restricted
movement, fatigue, difficulty in speech, blindness, and many, many more.
Physically, individuals may find trouble with movements between both
voluntary and in voluntary motion, over exhaustion, sexual performance,
among other conditions. Through research it has been strongly suggested
that depression is one of the most common secondary symptoms
experienced after MS. This depression and these limitations like overexhaustion/ fatigue may make it hard for individuals to experience healthy
social lives.
Cerebral Palsy (CP) is classified as a developmental and cognitive disability
that refers to a group of disorders characterized by an inability to control
muscular and postural movements. Since this impairment covers a wide
spectrum as well, many difficulties may follow. An example of these
difficulties is physically; CP restricts movement and may affect the
individuals ability to walk or even grasp objects. Emotionally, depression and
low self-esteem are a commonly found within people with CP. Since CP is a
developmental impairment, many times CP will block proper development in
functions physically and cognitively as well.

2. The modality I chose to practice was aquatic therapy, more specifically,

floating and treading water. Aquatic therapy is a great way to not only have
fun but to also work out the entire body, whether it is the joints, muscles, or
even the mind. Aquatic therapy helps to provide a door for inclusion because
the waters buoyancy makes it easy for many individuals with impairments to
enjoy alongside others. Also, accessing a pool or body of water is easy. As a
therapist, it must be noted that attention to detail on class sizes and times
are very important. If the class to teacher ratio is too big, it may make it
difficult to supervise every individual and create a dangerous environment in
the event of an accident or emergency. Also, attention to times of classes
may provide windows of opportunities for some people with specific needs to
be involved in. For example, someone with CP may find it to better to be in a
class during midday so that the warm water can sooth the muscles and
diminish the likelihood of being more spastic than if the water was colder.

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3. Adaptations in the activity may include time of classes (including length of

the class), floatation devices, water temperature, higher instructor/
participant ratio, available drinking water, and increased communication
between therapist and participant. As stated in number 2, class time can
affect the person because it creates a more suitable environment for the
participant. For example, earlier times in the day may make it easier for
individuals with MS because the colder water will help to prevent overheating
the person, whereas, midday might benefit a participant with CP because
warmer water relaxes the muscles resulting in less spasticity. Also, floatation
devices may aid both the instructor and participants because they may help
in the prevention of a drowning accident and can give the participant peace
of mind knowing that they have extra security. Emotionally and socially, these
adaptations provide a positive, leveled platform for people to interact with
one another and increase inclusion. This increase in inclusion may carry over
into healthier social opportunities with the general population or even their
own population, they go hand and hand.
4. It is vital to be able to adapt this activity. Not only does this activity provide
fun for everyone but the knowledge gained in this activity could be the
difference between life and death in the case of a pool accident/ drowning.
Adapting aquatic therapy provides a leveled platform for inclusion and
creates a positive environment for all parties. It works on all domains might
be the activity that someone can greatly benefit from.

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