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swimming and hemiplegia

The information provided on each sport is based on direct personal experience. As every child with cerebral palsy is different, your child’s experience and success in a particular sport may vary. However, the following should provide useful insights on how to proceed and what to expect.

Swimming and water play are excellent forms of exercise for children with cerebral palsy. As warm water loosens tight muscles and supports full body weight, many children with cp have more freedom of movement in the water than anywhere. Freer movement combined with the gentle water resistance provides an optimal environment for these children to build muscles and bones. The various swimming exercises build strength, range of motion, coordination, lung capacity, and breath control. In addition, the sensations of water and waves support neurological development.

Because we live in Florida, we felt it was imperative for our daughter to learn to swim at a very young age. There were just too many instances of children accidentally drowning in pools every year. We started her in private lesson at about the age of 12 months. The lessons were 15 minutes per day, 5 days per week for 4 weeks. Their objective was to teach the child to float and swim to the edge of the pool, in the event the child fell in. Though the instructor was a pillar of patience, our daughter absolutely hated these lessons. She would start to cry the minute we drove into the parking lot of the pool and would continue to cry through the entire lesson. Though I felt horrible and feared that she would be so traumatized that she would be afraid of water, I was determined as 9 babies had accidentally drowned that year in our area. Despite crying the entire time, our daughter actually did quite well and learned to swim by the end of two month long sessions. By the time she was 3, she could swim like a fish and dive off the edge. And, I am happy to say that she is not afraid of water in the least. Though the crying was difficult emotionally, I am glad we persisted with the lessons.

Though our daughter kicked with both legs, through favoring her right leg; she stroked with only her right arm for many years, keeping her left affected arm tucked into her side like a closed wing. Though she sometimes tried to use it, her affected arm was simply too stiff and moved too slowly that it would cause her to sink before she could get it out of the water. However, over time, as she became stronger and her kicks more powerful, she gained the ability to stay afloat long enough to begin to stoke with her affected left arm. It took a great deal of persistence, but eventually she was able to do the freestyle stroke with both arms—first only a few strokes, then across the width of the pool, and finally the full length of the pool. Last summer, she completed 30 lengths without stopping at our local Olympic size pool. More recently, she was able to back stroke with both arms for the first time. Though she swims very well, her affected left arm does not have the same extension, amplitude, speed, or power as her unaffected right arm and her strokes are a bit uneven in cadence. Despite her impairment, she swims as well as most able-bodied children.

Swimming Hints:

If your child progresses to the point where they are actually doing the different strokes, be sure to experiment with breathing on different sides. Some hemi kids have had greater success with the freestyle stoke if they turn their head to their affected side to take a breath. By turning the head, it is easier to lift the affected arm lift up and out of the water.

Some children with cerebral palsy have had great success using flippers as they can increase speed and improve body position, allowing the child to focus on stroke production. Use of flippers during group swimming lessons can help the child keep up with the rest of the class. However, proper fit is essential as it can be difficult to keep the flipper on the affected foot if the size is even slightly too big. We also found it helpful to start out with shorter flippers, rather than full size versions. (Another added benefit was to have the child try and walk around in flippers as a fun exercise. The child really has to pick their knees up and put their foot down flat to be able to walk with flippers on.)

Keep in mind that progress will likely be slow compared to able-bodied children. Be patient. Children with cerebral palsy need to build range of motion, strength, coordination, and confidence before stroke patterns can attempted with success.

Swimming Cautions:

Never leave a child with cerebral palsy unattended in a pool even if they know how to swim. Many children with cerebral palsy are at risk for seizures, which can be deadly in water. In addition, if a child should panic or cramp for any reason, their spasticity can quickly become very severe, impairing their ability to stay afloat.

Be very wary of cold water. We have found that if the water is too cold, our daughter’s entire spastic side quickly becomes completely immobilized, as if it is frozen. Such severe spasticity makes swimming near impossible.

Those Slippery Water Shoes

Many times, children with hemiplegia may have problems keeping on water shoes in the summer.  Here are some ideas about alternatives....

From Diane:
I didn't have any luck with those water shoes either, as you said, they kept falling off her right foot. Annie has a pair of those character sandals that you can by at K-mart, etc. for water play. They have a strap around the back of the foot and velcro on the top so you can get it on tight.

From Sara:
I found the plastic jellies (Gap, Children's Place, Kids R Us) worked the best so far...it sort of "sticks" to the back of the foot... the ones that are closed all around.

Disability Swimming, British Amateur Swimming Association

Aquatic Sports and Recreation Equipment

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The information contained in this Children's Hemiplegia and Stroke Association (CHASA) Web site is not a substitute for medical advice or treatment, and CHASA recommends consultation with your doctor or health care professional.