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 is 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. Thus, if a ...

. The Halliwick Concept recognises the benefits that can be derived from activities in water, and sets out the fundamentals necessary for teaching and learning in this environment.THE HALLIWICK CONCEPT 2010, IHA Education and Research Committee - www.halliwick.org 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, such as saltwater or freshwater environments, usually for recreation, sport, exercise, or survival. Swimmers achieve locomotion by coordinating limb and body movements to achieve hydrody ...

, and

independence Independence is a condition of a 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 status of ...

. 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 tre ...

for application in rehabilitation of

injury Injury is physiological damage to the living tissue of any organism, whether in humans, in other animals, or in plants. Injuries can be caused in many ways, including mechanically with penetration by sharp objects such as teeth or with ...

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 disability, cognitive, Developmental disability, d ...

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 plasma (physics), plasmas) and the forces on them. Originally applied to water (hydromechanics), it found applications in a wide range of discipl ...

, 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 laminar flow, which occurs when a fluid flows in parallel layers with no disruption between ...

moving water provides resistance,; therefore

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

is lost slowly and there is time to react and learn

motor control Motor control is the regulation of movements in organisms that possess a nervous system. Motor control includes conscious voluntary movements, subconscious muscle memory and involuntary reflexes, as well as instinctual taxes. To control ...

. * Buoyancy:

Buoyancy Buoyancy (), or upthrust, is the force exerted by a fluid opposing the weight of a partially or fully immersed object (which may be also be a parcel of fluid). In a column of fluid, pressure increases with depth as a result of the weight of t ...

provides an easy way to change position, which influences the

vestibular system The vestibular system, in vertebrates, is a sensory system that creates the sense of balance and spatial orientation for the purpose of coordinating motor coordination, movement with balance. Together with the cochlea, a part of the auditory sys ...

in sensory integration. * Buoyancy, Gravity, and Rotational Torques:

forces counteract

gravity In physics, gravity (), also known as gravitation or a gravitational interaction, is a fundamental interaction, a mutual attraction between all massive particles. On Earth, gravity takes a slightly different meaning: the observed force b ...

forces and create rotational torques ( metacentric effects). These torques can be used to increase load on

connective tissue Connective tissue is one of the four primary types of animal tissue, a group of cells that are similar in structure, along with epithelial tissue, muscle tissue, and nervous tissue. It develops mostly from the mesenchyme, derived from the mesod ...

. 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: is an ongoing process throughout the learning process. Swimmer has to learn to respond appropriately to the water environment (adjusting turbulence and buoyancy, learning breath control, cultivating confidence and good attitude). # Disengagement: the swimmer becomes physically and mentally independent (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 (ex. picking up objects off the pool floor and feeling the upthrust bringing you back to the surface). # Balance in Stillness: learning to maintain a relaxed body while floating and with turbulence in different position. # Turbulent Gliding: learning to control the position of the body in a horizzontal float position 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 science, scientific study of function (biology), functions and mechanism (biology), mechanisms in a life, living system. As a branches of science, subdiscipline of biology, physiology focuses on how organisms, organ syst ...

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 and

pediatrics Pediatrics (American English) also spelled paediatrics (British English), is the branch of medicine that involves the medical care of infants, children, Adolescence, adolescents, and young adults. In the United Kingdom, pediatrics covers many o ...

. 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 moto ...

and

Conductive education Conductive Education 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 is bas ...

. In

neurological Neurology (from , "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 nervous system, which comprises the brain, the s ...

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