The Halliwick Concept focuses on biophysical principles of motor control in water, in particular developing sense of balance (equilibrioception) and

core stability In kinesiology, core stability refers to a person's ability to stabilize their core (all parts of the body which are not limbs). Stability, in this context, should be considered as an ability to control the position and movement of the core. Thu ...

. The Halliwick Ten-Point-Programme implements the concept in a progressive programme of mental adjustment, disengagement, and development of motor control, with an emphasis on rotational control, and applies the programme to teach physically disabled people balance control,

swimming Swimming is the self-propulsion of a person through water, or other liquid, usually for recreation, sport, exercise, or survival. Locomotion is achieved through coordinated movement of the limbs and the body to achieve hydrodynamic thrust that r ...

, and

independence Independence is a condition of a person, nation, country, or state in which residents and population, or some portion thereof, exercise self-government, and usually sovereignty, over its territory. The opposite of independence is the statu ...

. Halliwick Aquatic Therapy (also known as Water Specific Therapy, WST), implements the concept in patient-specific

aquatic therapy Aquatic therapy refers to treatments and exercises performed in water for relaxation, fitness, physical rehabilitation, and other therapeutic benefit. Typically a qualified aquatic therapist gives constant attendance to a person receiving treat ...

for application in rehabilitation of injury and

disability Disability is the experience of any condition that makes it more difficult for a person to do certain activities or have equitable access within a given society. Disabilities may be cognitive, developmental, intellectual, mental, physical, ...

The Halliwick Concept

The Halliwick Concept was originally developed by fluid mechanics engineer James McMillan in the late 1940s and 1950s, at the Halliwick School for Girls with Disabilities in London, to teach

physically disabled A physical disability is a limitation on a person's physical functioning, mobility, dexterity or stamina. Other physical disabilities include impairments which limit other facets of daily living, such as respiratory disorders, blindness, epilepsy ...

people

in water. Based on

fluid mechanics Fluid mechanics is the branch of physics concerned with the mechanics of fluids ( liquids, gases, and plasmas) and the forces on them. It has applications in a wide range of disciplines, including mechanical, aerospace, civil, chemical and ...

, McMillan developed teaching and therapeutic approaches to enhance sense of balance (equilibrioception) and

.Dutton, M. 2011. Orthopaedics for the physical therapist assistant. p 187 Halliwick Concept. Jones & Bartlett Learning. .Ainslie, T. 2012. The concise guide to physiotherapy - 2-volume set: Assessment and Treatment. Elsevier Health Sciences. pp 1106-1116 (Halliwick Concept). .Lambeck, J and Gamper U. 2011. The Halliwick Concept. In: Becker, BE and Cole, AJ and (eds). 2011. Comprehensive aquatic therapy, 3rd edition. Washington State University Press. . According to the Halliwick Concept, physical properties of water form the basis for therapeutic intervention: *Turbulence, Flow, and Resistance:

Turbulent In fluid dynamics, turbulence or turbulent flow is fluid motion characterized by chaotic changes in pressure and flow velocity. It is in contrast to a laminar flow, which occurs when a fluid flows in parallel layers, with no disruption between ...

moving water provides resistance,; therefore

balance Balance or balancing may refer to: Common meanings * Balance (ability) in biomechanics * Balance (accounting) * Balance or weighing scale * Balance as in equality or equilibrium Arts and entertainment Film * ''Balance'' (1983 film), a Bulgaria ...

is lost slowly and there is time to react and learn motor control. *Buoyancy:

Buoyancy Buoyancy (), or upthrust, is an upward force exerted by a fluid that opposes the weight of a partially or fully immersed object. In a column of fluid, pressure increases with depth as a result of the weight of the overlying fluid. Thus the ...

provides an easy way to change position, which influences the vestibular system in sensory integration. *Buoyancy, Gravity, and Rotational Torques:

forces counteract

gravity In physics, gravity () is a fundamental interaction which causes mutual attraction between all things with mass or energy. Gravity is, by far, the weakest of the four fundamental interactions, approximately 1038 times weaker than the stro ...

forces and create rotational torques (

metacentric Metacentric may refer to: * Metacentric height The metacentric height (GM) is a measurement of the initial static stability of a floating body. It is calculated as the distance between the centre of gravity of a ship and its metacentre. A larger ...

effects). These torques can be used to increase load on connective tissue. The first part of the concept, the Halliwick Ten-Point-Programme, incorporates these biophysical principles and focuses on mental adjustment, disengagement, and development of motor control, with an emphasis on rotational control, and is applied to teach participation in water activities, moving independently in water, and swimming. McMillan emphasized participation and independence: the willingness to lose balance and knowing how to stand up again. The second part of the concept, Halliwick Aquatic Therapy (also known as Water Specific Therapy, WST), applies the fundamental biophysical principles and the underlying principles of the Ten-Point-Programme for planning and implementing patient-specific

Technique

The Halliwick Ten-Point-Programme

The first part of the Halliwick Concept implements the Halliwick Ten-Point-Programme to develop balance control, swimming skills, and

: #Mental Adjustment: adjusting turbulence and buoyancy, learning breath control, cultivating confidence and good attitude. #Disengagement: reducing reliance on instructor, changing instructors, practicing independently. #Transversal Rotation Control: learning movement in the sagittal plane around a transverse axis, in particular, regaining the upright position from the horizontal position, and the horizontal position from the upright position; eventually learning somersaulting. #Sagittal Rotation Control: learning movement in the transverse plane around a sagittal axis, controlling activities that involve trunk side flexion, such as side stepping. #Longitudinal Rotation Control: learning movement around a longitudinal axis, controlling activities that involve rolling over. #Combined Rotation Control: learning to control any combination of rotations executed in a single movement; once learned a swimmer can control position in pool and is safe. #Upthrust or Mental Inversion: learning about buoyancy, in particular that water always pushes up. #Balance in Stillness: learning to maintain a relaxed body while floating and with turbulence. #Turbulent Gliding: learning to control the position of the body while being moved by the instructor. #Simple Progression and Basic Swimming Movement: progressing from simple propulsive movements to coordinated arm, leg, head, and torso movements required for swimming.

Halliwick Aquatic Therapy

The second part of the Halliwick Concept, known as Halliwick Aquatic Therapy (also called Water Specific Therapy, WST) is an

approach developed in Bad Ragaz, Switzerland since 1974. Halliwick Aquatic Therapy is a system-oriented aquatic motor (re)learning approach, which includes elements of the Ten-Point-Programme. It uses a holistic task-directed approach within the context of the International Classification of Functioning, Disability and Health (ICF), in particular postural control, normalizing muscle stiffness, and facilitation of movement to attain functional goals on land. It also follows training guidelines of

physiology Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemical ...

and its clinical reasoning in various patient populations. Most Halliwick therapy is active (dynamic) to facilitate movement and sensory input. Halliwick also has a passive (static) component, in which, for example involving selective activation of muscles and stabilization of specific joints by the therapist. Halliwick Aquatic Therapy is a problem-solving approach, in that specific possibilities and constraints of the client are analyzed in order to plan a systematic intervention to help the client gain functional increases.

Applications

The Halliwick Ten-Point-Programme has been applied for teaching swimming to people with disability, as well as more broadly as a general approach to teaching swimming and working with disability. Halliwick Aquatic Therapy has mainly used in

neurorehabilitation Neurorehabilitation is a complex medical process which aims to aid recovery from a nervous system injury, and to minimize and/or compensate for any functional alterations resulting from it. Features In case of a serious disability, such as caused ...

and pediatrics. It has resemblances to

Bobath The Bobath concept is an approach to neurological rehabilitation that is applied in patient assessment and treatment (such as with adults after stroke or children with cerebral palsy). The goal of applying the Bobath concept is to promote motor ...

and

Conductive education Conductive Education (CE) is an educational system, based on the work of Hungarian Professor András Pető, that has been specifically developed for children and adults who have motor disorders of neurological origin such as cerebral palsy. CE i ...

. In

neurological Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal c ...

and paediatric rehabilitation, clients can experience early mobility. The mechanical advantages of water support the abilities of the trunk in a mobilising and stabilising way. In this sense Halliwick is a constraint-induced movement therapy without the disadvantage of gravity compensation. Many activities easily can be repeated and varied and clients can learn balance- and stumble- strategies, which have carry-over effects to dry land. This application in fall prevention is extended by using obstacle courses or Ai Chi.Noh DG, Lim JY, Shin HI, Paik NJ. 2008. The effect of aquatic therapy on postural balance and muscular strength in stroke survivors - a randomized controlled trial. Clinical Rehabilitation 22: 966-976. Halliwick also enables a graded activity programme: with low mechanical impact and increasing physiological demand, chronic low back pain patients and others can increase their functional capacity in a mostly joyful way.

References

External links

*History of Halliwick development in the UK (1949 – 1970)
The Halliwick Story part one
*Historical Films of McMillan
Video
{{Aquatic therapy Aquatic therapy Swimming Physical therapy Rehabilitation medicine Hydrotherapy