Hydrotherapy for adolescents and adults

Last update: 5 Sep 2016

Hydrotherapy is activity or exercise that is performed in warm water to help a person to achieve the goals set for their therapy.
Hydrotherapy may provide pain relief, and increase fitness, mobility, strength and function for adolescents and adults with cerebral palsy.
For someone with severely limited mobility, hydrotherapy can be liberating – enabling much greater movement than they are able to experience on land.

Who is it for?

Whilst hydrotherapy can benefit people of all ages, this page focuses on the benefits and uses for adolescents and adults who have these characteristics:
Type of cerebral palsy : Bilateral cerebral palsy, Diplegia, Hemiplegia, Quadriplegia, Triplegia, Unilateral cerebral palsy

More information about cerebral palsy is contained in the What is CP? section.


Gross Motor Function Classification System (GMFCS) – classifies severity of mobility difficulties of children and adolescents with CP.

Walks without limitations in the home and community, climbs stairs and can run and jump, difficulties with speed and coordination.

Walks with limitations, difficulties with long distances and uneven surfaces, uses a railing for climbing stairs, limited running and jumping.

Walks using a hand-held mobility device such as crutches or walking frame, may use wheeled mobility for long distances.

Usually relies on wheeled mobility with assistance, may use powered mobility, usually needs special seating and assistance with transfers.

Usually transported in a manual wheelchair, requires specialised seating and full assistance for transfers.


Manual Ability Classification System (MACS) – classifies severity of upper limb impairment: how children with cerebral palsy use their hands to handle objects in daily activities in the home, school, and community settings.

MACS Level I
Handles objects easily and successfully.

Handles most objects but with somewhat reduced quality and/or speed of achievement.

Handles objects with difficulty; needs help to prepare and/or modify activities.

Handles a limited selection of easily managed objects in adapted situations.

MACS Level V
Does not handle objects and has severely limited ability to perform even simple actions.

Communication ability : CFCS I, CFCS II, CFCS III, CFCS IV, CFCS V

Communication Function Classification System (CFCS) – classifies severity of everyday communication of people with cerebral palsy.

CFCS Level I
Effective Sender and Receiver with unfamiliar and familiar partners.

Effective but slower paced Sender and/or Receiver with unfamiliar and/or familiar partners.

Effective Sender and Receiver with familiar partners.

Inconsistent Sender and/or Receiver with familiar partners.

CFCS Level V
Seldom effective Sender and Receiver even with familiar partners.

Movement disorder : Ataxia, Athetosis, Dystonia, Hypotonia, Spasticity

More information about movement disorders can be found on our websites.

Intellectual ability : No intellectual disability, Mild intellectual disability, Moderate intellectual disability, Severe intellectual disability

A person’s thinking skills – ability to understand ideas, learn and solve problems. People with intellectual disability have difficulty with intellectual functioning which may influence learning, communication, social and daily living skills. Intellectual disability may be mild to very severe.

Hydrotherapy is usually provided by physiotherapists, exercise physiologists and other similarly qualified rehabilitation specialists or allied health professionals.

Physiotherapists and exercise physiologists at Cerebral Palsy Alliance can help people decide if this intervention is a good choice for themselves, or their family member, and will advise about the types of exercises that would be of benefit.

Find a Cerebral Palsy Alliance service

Therapy - Fees will apply for an assessment and the hydrotherapy sessions with a health professional such as a physiotherapist or exercise physiologist. Fees will depend on the health professional and the number of sessions needed. Check with the health professional if fees will apply to develop a home program, travel to the sessions and prepare reports.

Equipment – flotation aids may need to be purchased

Entry fees – to use a hydrotherapy pool may apply.

Ask the health professional if you are eligible for funding to assist with fees and flotation devices. People with a disability living in Australia may be eligible for a health care rebate through Medicare or funding from the National Disability Insurance Scheme.

The time it will take for a person to benefit from hydrotherapy will vary depending on their needs, goals and tolerance of the warm pool and prescribed activities. Pool sessions are usually 20 minutes up to one hour.

More about hydrotherapy

Hydrotherapy involves working, in a heated pool, with an exercise physiologist or physiotherapist on exercises tailored to individual’s unique needs. Along with improving strength and mobility, hydrotherapy is also frequently used as part of rehabilitation programs following surgery. While a person with cerebral palsy is recovering from their surgery, hydrotherapy can help to gradually increase movement and their ability to put weight through their feet.

Specialist hydrotherapy pools are heated to 32-34 degrees Celsius, as warm water can help increase a person’s circulation, reduce their muscle spasms and relieve pain.

For some people, the special flotation devices used in hydrotherapy may be essential for safety and independence in the pool. For others, exercise equipment is used instead to provide additional support or resistance in their program.

The unique properties of water mean that hydrotherapy has the potential to benefit people with cerebral palsy right across the severity spectrum. Exercising in water may provide greater physical activity opportunities for people with more significant movement limitations when compared with land-based activities.
  • Many hydrotherapy and other community pools have hoists or ramps to help people get in and out
  • If access to a hydrotherapy pool is difficult, speak to a health professional who can advise on appropriate alternatives
  • Hydrotherapy may not be suitable for everybody. Approval from a medical practitioner (medical clearance) and a discussion with a physiotherapist or exercise physiologist about any medical conditions or concerns are recommended before undertaking hydrotherapy
  • Hydrotherapy can also be referred to as aquatic therapy, aquatic physical therapy, aquatic exercise and water exercise


Two types of assessment are necessary when undertaking hydrotherapy:
Before starting hydrotherapy, an assessment with a physiotherapist or exercise physiologist will be completed to help set goals for the intervention and to carefully plan a program that is suitable for the person’s ability level.

The second type of assessment is to measure the outcome of hydrotherapy to ensure it has been effective for meeting the individual’s needs and goals. The physiotherapist or exercise physiologist, together with the person with cerebral palsy, will decide on the most suitable measures. Some typical outcome measures for this intervention are:

  • Canadian Occupational Performance Measure (COPM) – measures change in everyday activities that people have identified as a problem
  • Goal Attainment Scaling (GAS goals) – measures the extent to which individuals’ goals are achieved
  • Timed Up and Go Test – tests a person’s mobility and balance by measuring their time taken to stand up, walk three metres, turn around and sit down again
  • 6 Minute Walk Test – measures mobility and endurance by the distance a person can walk in six minutes
  • Functional strength testing – measures the strength required to complete daily tasks
  • Range of motion – measures the amount of movement around someone’s joints, such as the knee or hip

Best available research evidence

We searched the allied health and medical literature to find research evaluating the effects of hydrotherapy for adolescents and adults with cerebral palsy.
The search aimed to find the best available research to identify whether this intervention improved physical fitness, mobility, functional ability and strength.
There has been little research evaluating the outcomes of hydrotherapy for adolescents and adults with cerebral palsy. While it is not yet clear whether this therapy is effective for improving mobility and function in this population, the available research into other neurological conditions supports the positive outcomes of hydrotherapy.

The best available evidence for adolescents was from two small, low level, studies that measured outcomes before and after hydrotherapy in a total of 30 adolescents with cerebral palsy1, 2. The quality of research is considered to be very low as there is only one, low level (level 4) study informing each outcome. The two studies measured different outcomes of interest.

In the study by Ballaz and colleagues1, 10 adolescents with cerebral palsy across GMFCS Levels I to IV participated in 20 weeks of aquatic therapy. They attended two sessions per week that consisted of mainly swimming but also aquatic activities and games. The adolescents experienced small gains in walking efficiency which were more pronounced in those at GMFCS Levels III and IV. There was no improvement in gross motor function, walking speed or distance, or leg strength. No adverse effects from the intervention such as injury or pain were experienced. The authors concluded that such a program was feasible for adolescents at different levels of severity.

The second study2 included 20 adolescents, who had mainly quadriplegic or diplegic cerebral palsy. They all participated in 10 sessions of hydrotherapy consisting of swimming, exercises and games. On average the adolescents increased in functional independence on a scale which included a range of domains such as mobility, self-care and transfers.

Overall, there is insufficient research completed to determine whether hydrotherapy improves physical fitness, mobility, functional ability and strength in adolescents with cerebral palsy.

There was no research for adults with cerebral palsy, so we extended the search to include high level studies (randomised controlled trials and systematic reviews) of adults with other neurological conditions. We found one systematic review of the effects of hydrotherapy for adults with neurological conditions3.

This review by Marinho-Buzelli and colleagues3 included 20 studies of more than 250 adults with neurological conditions such as Parkinson’s disease, multiple sclerosis and stroke. They concluded that dynamic balance increased significantly in adults with neurological conditions participating in hydrotherapy. The majority of studies included in the review reported improvements in walking speed. The authors concluded that the effects of hydrotherapy are likely to be similar to land-based interventions for improving gait.

It is important to note that research evidence is just one aspect of the decision-making process about whether to pursue an intervention. Adolescents and adults with cerebral palsy and their families, who are interested in pursuing hydrotherapy, are advised to speak with a physiotherapist or exercise physiologist to discuss how this intervention might meet their needs.

Date of literature searches: March 2016

  1. Ballaz, L., Plamondon, S and Martin, L. (2011). Group aquatic training improves gait efficiency in adolescents with cerebral palsy, Disability and Rehabilitation, 33 (17-18), 1616-1624. See abstract
  2. Dorval, G., Tetreault, S and Caron, C. (1996). Impact of aquatic programmes on adolescents with cerebral palsy, Occupational Therapy International, 3(4), 241-261. See abstract
  3. Marinho-Buzelli, A. R., Bonnymean, A. M and Verrier, M. C. (2015). The effects of aquatic therapy on mobility of individuals with neurological diseases: a systematic review [with consumer summary], Clinical Rehabilitation, 29 (8), 741-751. See abstract