Rett syndrome is a progressive neurodegenerative disorder that severely affects movement, coordination, communication, behavior, speech, language, and thinking ability. There is currently no specific cure for Rett syndrome, but functional abilities can be improved by various interventions such as physiotherapy, occupational therapy, hippotherapy, hydrotherapy, speech therapy, and music therapy.

Hydrotherapy uses activities in water as a clinical intervention method to improve or restore functional abilities in Rett syndrome patients. These activities are generally done in swimming pools, bathtubs, showers, or full body immersion tanks. Hydrotherapy is aimed at promoting relaxation, improving circulation, restoring mobility, strengthening muscles, improving walking and coordination, and providing recreation.

How hydrotherapy works

Hydrotherapy uses multiple sensory stimuli through principles of hydrodynamics such as buoyancy, density, viscosity, hydrostatic pressure, turbulence, and flow.

Water assists active movement, provides postural support, promotes relaxation, strengthens muscles, and improves circulation. Aquatic activities also provide opportunities for social interaction and play, which can facilitate language development and improve self-esteem, self-awareness, and a sense of accomplishment.

In people with Rett syndrome, hydrotherapy can be used to learn:

  • correct breathing
  • proper head control
  • stability and balance
  • relaxation
  • effective hand use
  • body movements including walking
  • social interactions

Different methods of hydrotherapy have been developed for patients with disabilities that can be used to serve different purposes.

  • The Halliwick method focuses on biophysical principles of motor control in water, in particular developing the sense of balance (equilibrioception) and core. It is made up of four phases: adjustment to water, rotations, control of movement in the water, and movement in the water.
  • The Watsu method involves muscle stretching, joint mobilization, and massages in water.
  • The Bad Ragaz Ring method is used to improve neuromuscular functions using patterns of movements under the direction and assistance of a therapist wherein the patient lies horizontally in the water supported by rings or floats around the neck, arms, pelvis, and legs.
  • The Ai Chi method involves gentle exercises in warm water to improve mobility and strengthen muscles and joints.
  • Bath therapy involves using hot and cold or even icy water in a shower, a bathtub, or a Jacuzzi to relieve discomfort and pain, and aid in relaxation and regulating blood circulation.

Hydrotherapy research in Rett syndrome

A case study of an 11-year-old girl with stage 3 Rett syndrome was published in the Journal of Rehabilitative Medicine. The patient was treated with the Hallwick method of hydrotherapy in a swimming pool twice a week for eight weeks. The study showed that stereotypical movements decreased immediately after hydrotherapy, an improvement that was maintained for eight weeks. There were improvements in feeding activities, hand skills, balance, and interactions with the environment. After eight weeks of hydrotherapy, hyperactive behavior and anxiety also decreased.


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