SWIMMING FOR THOSE WITH DISABILITIES

AST – aim to promote all aspects of swimming for those with a disability, and to teach water happiness, pool safety, swimming, and to have fun, so swimmers and helpers understand the enormous benefits that can result from the use of the Halliwick Method.

SAFETY SECURITY EMPATHY FUN COMMUNICATION

The Halliwick Method and the AST (Association of Swimming Therapy)

Halliwick Method (McMillan, J.) developed in 1949 at the Halliwick School, London – based on hydrostatics, hydrodynamics and body mechanics; to help understand what happens to the body in water; to have fun and enjoy socialising with others: learning to feel at home in the water, breath control, understand the effect of ‘turbulence’ and how to respond and develop breath control, balance, scull and use basic strokes. No flotation or buoyancy aids are used, so the swimmers learn to control own natural balance, and understand the effect of water on the body and how to respond.

Swimmers are accompanied by a helper/instructor, often working in groups. Flotation and buoyancy aids are not used, as the swimmer has to learn to develop his own control and balance. All instructors are volunteers.

You need to assess as you are being assessed by your swimmers: talk to them and help then relax: offer good support and keep them safe and warm (e.g. cold water can induce fits): do not leave them: teach by example. You need to be aware of self in water and its effects e.g. density; breathing control; entry and exit methods.

Encourage swimmer to reduce reliance on you: to become more independent: aim for physical and mental disengagement by progression from full, partial, minimal and finally no support if possible.

Talk to your swimmer - relieve tension, induce relaxation and better buoyancy, by word, expression e.g. smile, eye contact, singing (lord help the swimmer), physical contact. Aim to teach safety skills and ensure swimmer can trust the water support and you, and learn of the dangers. Gain the trust and confidence of the swimmer (e.g. panic attacks).

Breath control - an early lesson - teach swimmer to blow out under water when face comes into contact with it for safety reasons, prevent instinctive breathing in, to ensure it becomes automatic. Teach in stages: Blow a ball: Blow the water to make a hole; blow bubbles under water; hum when nose and mouth submerged.

Need to establish empathy, provide security and help swimmer gain confidence, so he feels happy and will return

Ensure it is safe for both self and swimmer, and aim is swimmers independence. Steps are not recommended as a slip can result in injury, or prevent swimmer feeling independent. Several methods of entry – chair, sit on side and support round shoulders or hand to hand. Rotate, roll or drop in. Need encouragement, support and eye contact. Ensure swimmer keeps head forward and blow on entry.

Wriggle or vertical exit hands on side, guiding hips, lift self up and forwards (I cannot do arthritis in shoulders can give way).

Horizontal lift – mat or towel on side 3 helpers – 1 at feet, 1 at waist, 1 at head, needs care and work together, to avoid banging e.g. head.

Chair lift – see demonstration at poolside.

Basic aim is to give minimum essential support, use the water as a support. Use flat hands under water to support trunk, leave head free, and avoid them gripping. Initially close and firm and gradually reduce. Practice control of head, adopt chair position – feet flat on floor comfortably apart, knees bent and arms forward.

Face to face use flat palms to support trunk, elbows or hand on hand or straddled.

From behind both chair position supporting trunk or from front between arms and body.

Swimmer in chair position supported from behind at the hips – ears in the water, let feet slowing move to float position. Keep support until swimmer confident.

Short arm – arms on palms and arms.

Long arm – palm to palm from extended arms.

Cross arm – cross back to hold opposite hip (2 helpers).

File formation – hands on round hips of person ahead (swimmer/instructor).

Need to be able to change from one to another method easily and safely.

A sudden abnormal discharge from brain cells (like an electric storm in the brain), and is an established tendency to recurrent fits. Some seizures are very dramatic and may involve falls and convulsions (grand mal) or more subtle fleeting moments of unconscious (absences) or automatic activity (complex or partial). In 75% seizures can be controlled by skilful treatment, the other 25% experience continuing attacks varying in severity and frequency. There are three main types:

Loss of consciousness, thrashing about, eyes or head rolling.

Generalised absences and/or confusion (petit mal)

e.g. my petit mal with some involuntary activity, e.g. left arm out of control waving about (I have warning of onset of attack – sensation of rushing water over left ear which runs down left side and "out" of foot.

Information to help everyone feel confident and calm when helping someone having a seizure -

Danger is minimal if in controlled conditions, e.g. swim with a responsible companion such as a strong and capable swimmer (preferably a qualified life-saver), someone who is able to recognise an attack immediately and able to support the person in any depth of water: then fatal or serious accidents such are extremely rare.

There is less tendency to fall and hurt self.

Watch for loss of coordinated movements, involuntary movements or failure to respond or reply when spoken to.

Keep the face above water, preferable approach person from behind and if possible take to shallow water and hold the head until the attack passes. Less harm to person is likely in water. Once the seizures are over remove person from the water and if breathing has stopped use normal resuscitation measures. Keep under close watch those liable to attacks. Those who have absences which are usually brief, but the swimmer may suddenly sink. Nil by mouth until completely recovered (projective vomit?).

Series of attacks – where one follows another, must seek medical attention.

Swimmer must be accompanied by a responsible adult preferably a qualified life-saver who can support person and take to place of safety in event of attack – person must not swim unaccompanied. Also essential to ensure that pool side attendant is aware of situation. Swimmer needs someone able to recognise onset of an attack immediately, and who can ensure person does not go under and swallow water. It is helpful to ensure swimmer is feeling well before entering water. Also better when pool is not crowded, at quiet times.

Such as dazzling lights (e.g. Tesco – you?), stress, excitement, noise, cold water, e.g. need temperature over 26 degrees centigrade.

Loss of response to questions, lack of movement or involuntary movement, eyes vacant, sometimes head jerks, lack of co-ordination, thrashing about, eyes rolling, rigidity of body, foaming at mouth, chomping.

Person has injured self.

If seizure does not stop after five minutes.

If one seizure follows another without them regaining consciousness.

If you feel they need medical attention.

Chair lift one each side

Through arm lift

Stand and pivot - block feet

3 main lifts and roll

towel hoist/hammock

chair lift

one to one lift - 3 stages of progression

ribs/elbows/palms

vertical steps - stand behind

one man assisted exit

Individual mushroom - hand on shoulder, straddle legs

straddle

walking

horizontal - supine/prone

Groups - circle

line

Always have a firm wide base and always bend knees

3 areas

1. Psychological advantages of swim programme

success and achievement from low achievers

negative /positive environment

achievement at end

enhance self image

good at something

"normal" - not different

positive emotional outlook - firm

2. Sociological advantages

peer group interaction

less isolated

encourages to join in

encourages communication skills

reinforces school learning

safety skills

learn for family involvement

family activity to participate in

educate parents too

integrate into mainstream activities with peers

3. Physiological advantages

improve physical condition

get out of breath

improve fitness

improve agility

use every part of the body

move all parts as far as possible

increase mobility

strength

relaxation

flexibility

improve body awareness

body tension lacking

what it does

encourage to understand body and what swimmer can do with it

develop coordination and motor skills

help understand coordination and its importance

dog paddle

simplify

make it fun

put 3 advantages above into being

enjoyment and fun

encourage them to want to do it

improve fitness and mobility

help gain independence and safety in water

teach to move on own

teach to swim

teach safety - knowledge of how to get out of difficulty

1. Dry aids

transport

access - steps/doors

poolside - changing

lifting

spotters - e.g. epileptics

registers and records

cash

refreshments

drying

2. Wet aids

entry to pool

supports in water

activities - helpers

exits

Independents do as much as possible for selves

Information on disabilities

epileptics need 1 to 1

support head

ride fit out in water

hold from behind across chest

emergency

clear pool

poles

fishing nets - e.g. faecal incontinence

phone

whistle

helpers know what to do

all out

practice emergencies and handling

in dressing room

non-slip

bubbles take skin off bare feet

verruca socks

keep own shoes on

wet-smooth

crutches/sticks - slip

hot pipes

paraplegics

wheelchairs

brakes on

parallel to pool

belts undone

epilepsy

hold head, face side

then recovery position

hygiene

cerebral palsy - runny nose

tissues on side

clear nose

cystic fibrosis - mucuous (cough)

rubber pants under costume

incontinence - note correct time of regularity

physical - spinal break

pathway to brain interrupted

mental - pathway to brain inefficient

locomotive - arthritic, physically unable

overcome by nappies - remove

black bin bag on side

express - push hard on bladder

children

penile bag

catheter

let them cope with appliance

ensure appliance empty

profound handicap

use music

Disabilities of CNS