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Ultimate Guide to Aquatic Therapy

For Students with Disabilities

Children of all ages and abilities usually enjoy being in water.


This can be especially true for children and students with disabilities or those who have Autism Spectrum Disorder.


Aquatic therapy provides a number of wonderful benefits for these children with special needs.

Michael is a twelve-year old boy with Autism, who struggled especially with sensory integration and often feels agitated, uncomfortable and restless.

The pressure that is exerted by the water during aquatic therapy allows Michael to relax and feel much calmer. He loves being in the water and his regular therapy sessions have resulted in better behavior, moods and impulse control even outside of the pool.

In this article, we will provide the ultimate guide to aquatic therapy for students with all kinds of disabilities.

We will talk about the benefits of this kind of therapy, important safety precautions that should be followed during therapy, how to make the aquatic therapy more effective and fun, and the various ways to use aquatic therapy to enhance other developmental and educational needs of our students.

Aquatic Therapy


Water is a unique environment that provides gentle pressure, buoyancy, and soothing support that has many benefits for students with disabilities.

Aquatic Therapy Benefits

Sensory Processing

Many children with disabilities and particularly those who have Autism Spectrum Disorder, also experience sensory integration disorder—meaning that they have difficulty interpreting, processing and responding to sensory input.

These sensory processing challenges can lead to anti-social, self-harming, or other inappropriate behaviors and outbursts.

Sensory Processing

Aquatic therapy is a unique way to help students with sensory disorders strengthen their sensory processing skills in three ways: hydrostatic pressure, vestibular stimulation, and proprioceptive feedback. We will explain and talk about each of these in turn.

Hydrostatic Pressure:

Children with sensory difficulties often love deep pressure. Similar to a weighted blanket, water provides heavy pressure on the body, 30 times more pressure than air. But even better than a blanket, water can surround the student’s entire body and puts equal pressure on all submerged parts.

This feels incredibly calming to students who have sensory processing deficits. The pressure the water puts on their body allows them to concentrate and organize other sensory input, giving them confidence to move physically and try new movements.

Vestibular Stimulation:

The human vestibular system includes the parts of the inner ear and brain that help control balance and eye movements. Aquatic therapy has been shown to have many benefits including helping to improve balance because of the pressure of the water against the body, which many children with disabilities struggle with.

Many students with Autism Spectrum Disorder and other disabilities also exhibit repetitive behaviors like rocking or twirling that may be caused by an underdeveloped vestibular system.

The rocking activities are an external way for these students to develop a sense of balance and also gain more sensory input. Sometimes these repetitive, obsessive behaviors can be distracting and can cause self-harm but when these students are able to move around in the water, they are able to receive increase sensory input throughout proprioception which helps to reduce repetitive movements.

Students are also able to more easily change positions while in the water, such as going from standing to floating, which activates their vestibular system allowing them to experience increased vestibular input. This increase in vestibular input allows for a reduction in the dizziness, vertigo, or spatial imbalance that results from vestibular disorders.

Proprioceptive Feedback:

Proprioception sometimes called our sixth-sense, is how a person understands where they are in space. This ability is developed throughout childhood, but this sense is underdeveloped for many students who have Autism.

Without proprioceptive development, their movements can be clumsy or erratic. The pressure and weight of the water and the resistance it provides when students move in it, combine to give students with disabilities better proprioceptive feedback.

Because of the way aquatic therapy improves sensory processing skills, therapists report that their students often have more ability to focus and experience better moods. In the water children with disabilities can have enhanced body awareness, improved touch tolerance, and a better ability to organize all of the various sensory inputs to focus on the correct one.

Physical Benefits

Aquatic therapy not only helps improve sensory processing for students with disabilities, but it also helps them develop physically and become stronger.

Because of the weight of the water, moving while submerged works more muscles at the same time than any other activity.

Aquatic Therapy Physical Benefits

Water exercise has been shown to strengthen muscles in the entire body, including the heart. Also, underwater, students have better coordination, a larger range of motion, improved balance, and increased physical endurance.

Students with Autism Spectrum Disorder often have physical deficits in many or all of these areas and so aquatic therapy can have significant health benefits.

Additionally, water has buoyancy characteristics that make the body lighter and students can experience a sense of weightlessness. This buoyancy can alleviate fears of injury and help students with disabilities feel more confident trying movements that they would not attempt on land. This confidence has obvious psychological benefits as well as physical ones. The feeling of accomplishment and mastery cannot be underestimated.

Other physical benefits of aquatic therapy for students with special needs include reduced pain and stress for joints and muscles, a strengthened core, improved motor planning and fine motor skills, enhanced breathing control and even increased oral motor skills.

Some children with disabilities, including Autism, have reduced oral motor skills, which means they can have difficulty using a straw or blowing out candles or sticking out their tongue. Aquatic therapy allows students to improve their oral motorskills and respiratory control as they learn to blow bubbles or blow small items, like a ping pong ball across the surface of the water.

Social and Communication Benefits

Aquatic therapy not only provides important physical and sensory benefits for students with special needs, but it is also lots of fun. Students enjoy the activities in the water and the socialization effects are important.

Many occupational therapists have reported that children with disabilities are more talkative, communicative, cooperative and social after an aquatic therapy session.

Social And Communication Benefits

Aquatic therapy reduces stress and anxiety, improves the ability to concentrate, and gives students a feeling of confidence. These results are not just anecdotal either, as studies have shown that aquatic therapy reduces reluctance in imaginative and group play.

The relaxing and comforting effects of hydrotherapy last well past the sessions, as well. Psychologists have noted a decrease in anxiety and problem behaviors after people with ASD have been in the water, for example, as well as improved moods, self-esteem and body image along with a tendency towards better impulse control and improvements in self-regulation.

Additionally, the pool environment can be uniquely normalizing and allow students a freedom they might not have on land or in a wheelchair. In the water, they can move and play just like anyone else. For many students with special needs, this is an added psychological benefit.


There are obviously many safety precautions that are important to follow while exposing students with special needs to aquatic therapy.

First, classroom staff participation is a must. Safety assessments must be performed in order to ensure the safety of every student while they are in the water.

Staffing must be provided according to these safety assessments and based on the swim skills of the students, either in a 1:1 ratio or 2:1 when swim skills are high.

Safety For Aquatic Therapy

All staff that participate in aquatic therapy should be certified in life-saving techniques and CPR. Water safety skills need to be taught and expected at all times from all the participants of aquatic therapy.

Additionally, the pools or swimming environment must be carefully maintained with proper chemical balance in the water, regular equipment checks, and care in grounds maintenance. This includes providing and maintain alternative access points into the water, either with a ramp or a mechanical lift for students who require dependent assistance into the pool.

If the pool is outside, special precautions must be taken for sun safety as well, with proper application of sunscreen and maintenance of shade apparatus.

It’s important to realize that giving students with special needs the opportunity to participate in aquatic therapy is in itself a valuable safety precaution. In a U.S. National Library of Medicine study, the majority of occupational therapists who participated, reported that the therapy improved the children’s swim skills.

While this may seem obvious, its value cannot be overstated. Water can be especially dangerous for children with disabilities, including Autism, and being familiar with the water and developing basic swim skills are essential means of self-protection. This is especially true in Arizona where access to pools is common.


One of the most important things to remember about aquatic therapy for children with disabilities is that the experience should be fun and engaging.

The water itself provides entertainment and the weightlessness the students experience contributes to their ability to move and have fun without as much restriction or pain.

For students who have orthopedic impairments or who may be medically fragile, this weightless environment can be profoundly freeing and enjoyable.


Aquatic Therapy Engaging And Fun

Additionally, staff members and therapists can help their students find additional joy and fun in the water by creating structured water games and using appropriate equipment like a basketball hoop, pool noodles, and other floating tools.

It can be helpful to use a variety of differently textured pool noodles or flotation equipment. Skin is the largest organ in the body and many students with special needs are particularly sensitive to tactile stimulation and input. The more variation you have in texture, the more experiences your students can have with equipment.

For example, pool noodles come in a variety of textures—with varying degrees of smoothness or bumpiness, made out of a variety of products from foam to plastic. Letting your students experiment with a variety of types and textures can enhance their experience in the water.

Many of the goals of aquatic therapy can be reached while the child is busy “playing” in the water. In this way the child engages in treatment and strengthens areas of weakness without even knowing it—it feels simply like play. Children, no matter their age or ability, learn best through play and aquatic therapy provides a perfect opportunity to engage in this kind of purposeful, playful learning.

For example, a student can build upper body strength by pulling up on the side of the pool. The weightless, buoyant nature of the water makes this task easier than it would be on land and the student is developing strength without even realizing it.

Depending on the students’ abilities as well as their swim skills there are a number of games you can play in the water that allow them to build strength, gross and fine motor skills, coordination, and body awareness–all while playing in the pool.

Here are some activities that look and feel like a play that can simultaneously accomplish therapeutic objectives:

Pool Pull

Hold one end of a noodle and have the child hold onto the other end. Carefully pull him or her through the water in a variety of ways. You can adjust your speed or the student can change their position from front to back to side as you work. They will be building muscles in their arms and core without even realizing it.

Noodle Balance

Have the student sit on the noodle in a u-shape, like they are sitting on a swing. This is will help with balance and core strength. Another way to work on balance is to have the student sit on the noodle like a horse and ride the horse from one side of the pool to another.

Kick Board Obstacle Course

You can set up an obstacle course with different activities around the pool. The student can use a kickboard to move from one area to the next, building their legs, arm and core strength as they go. At the stations, you can work on other skills, like blowing a ping pong ball across the water or filling a bucket on the side of the pool with a cup. Whatever skills you want to strengthen in your student can be incorporated into the obstacle course.

Resistance Builders

Depending on your students’ ages and abilities you can add flippers or have them pick up weighted items from the to increase resistance in the water and gain even more strength.


One of the most beneficial aspects of aquatic therapy programs is the way that this discipline can collaborate with other therapeutic disciplines to better meet all the needs of a student with special needs.

For example, aquatic therapy can easily be coordinated and combined with occupational therapy by working on gross motor and fine motor skills in the pool.

Aquatic Therapy For Autism

Movement that is difficult or challenging on land, can often be more easily accommodated in the water. There is much less chance of injury from falls or strains in a water environment. With the decrease in gravity that the water provides, many physically disabled students have more freedom to move.

Additionally, speech pathologists can collaborate to create communication opportunities for students and provide waterproof communication support for use in the pool. Communication happens everywhere and speech therapy exercises can easily be integrated into aquatic therapy programs. As we have already mentioned, oral motor skills are easily translated to work in the water.

In one case, a student named Kayla with cerebral palsy has been doing aquatic therapy to improve her strength so that she can have more breath and stability when she speaks, allowing her to communicate better.

“It has been amazing,” said Nicole Thelen, Kayla’s mother. “She’s worked on her core muscles, and we’ve noticed that she’s learned stability and is able to talk more.” Not only that, but Kayla’s mother reports that Kayla can concentrate better and focus on what she is saying because she has more breath and control.

Since starting aquatic therapy Kayla has doubled the amount of words she can say without stopping and can sometimes speak in complete sentences. This has been a huge gift for Kayla and her family.

Aquatic therapy can also play a key role in supporting academic objectives. For many students with sensory processing issues, the water gives them an opportunity to minimize sensory distractions and allow them better focus and concentration, both in and out of the pool. Studies have shown increases in concentration, decreases in distracting behaviors, and improved moods, all of which allow students with special needs to have more academic success.


At ACCEL we believe in helping our students by giving them access to every opportunity that will improve their strengths, skills, and quality of life.

Aquatic therapy is just one way that we do this. As we have shown, this valuable and beneficial therapy can make an enormous difference in the life of many students.


We want the very best for our students with special needs and we provide the very best aquatic therapy program as part of our multi-faceted approach to learning.

At ACCEL we integrate therapeutic work with our curriculum and programs so that our students receive the care and instruction they need in ways that serve them best.

If you are interested in learning more about ACCEL’s aquatic therapy program and taking a tour of our unique campus, please click here for more information.

Contact us today or come visit our ACCEL Adult Services program.

We have been successful because of our deep commitment to each individual and finding the exact right opportunity for them.