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.
Adjustment to water
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.
Entry, exits and helping in water
Need to establish empathy, provide security and help swimmer gain confidence, so he feels happy and will return
Entering the pool
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.
Support in the water
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.
EPILEPSY (notes from British Epilepsy Association)
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:
Generalised tonic/clonic seizures (grand mal)
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.
People with epilepsy are encouraged to get G.P. approval to swim.
First Aid for Tonic-Clonic Seizures
Information to help everyone feel confident and calm when helping someone having a seizure -
Avoid preventing them from falling if this would put you at risk of injury.
Cushion head with something soft, your arms/legs if nothing else available.
Do not attempt to restrict their jerking movements.
Do not put anything in their mouth.
Leave them where they have fallen, unless they are in danger.
Allow the seizure(s) to run its natural course there is nothing you can do to stop it.
Once the jerking is over, lie them down turn on side and place them in the recovery position, it will help them to breath.
Do not leave them until they have recovered fully. The time for this varies from person to person.
When to call for emergency help
Call for an ambulance if:
Injury has occurred.
If the seizure does not stop after five minutes.
If one seizure follows another without them regaining consciousness (status epilepticus).
If you feel they need medical attention.
If resuscitation is necessary.
Fits in water - Safety
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.
How to recognise a fit
Watch for loss of coordinated movements, involuntary movements or failure to respond or reply when spoken to.
How to deal with a fit
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.
Swimming with epilepsy
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.
Signs of onset
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.
Prevent them from falling, but do not put yourself at risk.
Use something soft to support head, e.g. hands, arms if nothing else available.
Do not attempt to restrict jerking movements. Let the seizure run its natural course as there is nothing you can do to stop it.
Do not put anything in mouth to prevent biting tongure (the original first aid lecturers told us to do this). A bitten tongue heals, broken teeth could be dangerous if swallowed.
If they have fallen leave them there unless they are in danger.
Move out of water when seizure stops, and place in recovery position, use of resuss. if necessary.
Imperative person is not left unattended, ensure safety, e.g. on carpeted floor or rubber mat rather than chair (danger of falling off).
Allow to rest until recovered and fully conscious, e.g. responds appropriately to questions.
Do not give anything by mouth, e.g. food or drink.
Avoid swimmer eating and drinking immediately after attack, e.g. nil by mouth, until recovery is complete.
Call for ambulance if:
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.
TEACHING HANDICAPPED TO SWIM (ASA COURSE)
Lifting and Handling
Chair lift one each side
Through arm lift
Stand and pivot - block feet
Into/out of water
3 main lifts and roll
one to one lift - 3 stages of progression
vertical steps - stand behind
one man assisted exit
Supports in water
Individual mushroom - hand on shoulder, straddle legs
horizontal - supine/prone
Groups - circle
Always have a firm wide base and always bend knees
AIMS OF PROGRAMME
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
encourages to join in
encourages communication skills
reinforces school learning
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
use every part of the body
move all parts as far as possible
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
make it fun
Aims of swim programme
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
Help needed in swim programme
1. Dry aids
access - steps/doors
poolside - changing
spotters - e.g. epileptics
registers and records
2. Wet aids
entry to pool
supports in water
activities - helpers
Independents do as much as possible for selves
Information on disabilities
epileptics need 1 to 1
ride fit out in water
hold from behind across chest
fishing nets - e.g. faecal incontinence
helpers know what to do
practice emergencies and handling
in dressing room
bubbles take skin off bare feet
keep own shoes on
crutches/sticks - slip
parallel to pool
hold head, face side
then recovery position
cerebral palsy - runny nose
tissues on side
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
let them cope with appliance
ensure appliance empty
Disabilities of CNS