Our synthesis showed "fair" evidence supporting the use of aquatic therapy to improve dynamic balance and gait speed in adults with certain neurological conditions.

Balance training in the aquatic environment is often used in rehabilitation practice to improve static and dynamic balance. Although aquatic therapy is widely used in clinical practice, we still lack evidence on how immersion in water actually impacts postural control. We examined how postural sway measured using centre of pressure and trunk acceleration parameters are influenced by the aquatic environment along with the effects of visual information. Our results suggest that the aquatic environment increases postural instability, measured by the centre of pressure parameters in the time-domain. The mean velocity and area were more significantly affected when individuals stood with eyes closed in the aquatic environment. In addition, a more forward posture was assumed in water with eyes closed in comparison to standing on land. In water, the low frequencies of sway were more dominant compared to standing on dry land. Trunk acceleration differed in water and dry land only for the larger upper trunk acceleration in mediolateral direction during standing in water. This finding shows that the study participants potentially resorted to using their upper trunk to compensate for postural instability in mediolateral direction. Only the lower trunk seemed to change acceleration pattern in anteroposterior and mediolateral directions when the eyes were closed, and it did so depending on the environment conditions. The increased postural instability and the change in postural control strategies that the aquatic environment offers may be a beneficial stimulus for improving balance control.

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Study design This work is a case series. Objectives We assessed the influence of the aquatic environment on quasi-static posture by measuring center of pressure (COP) sway and trunk acceleration parameters after incomplete spinal cord injury (iSCI) in water and on land. Setting Tertiary Rehabilitation Hospital, Ontario, Canada. Methods Six adult participants with iSCI (4 cervical/2 thoracic injuries, AIS D) were enrolled. Baseline balance was assessed by the Berg Balance Scale and Mini-Balance Evaluation System Test. Participants stood on a waterproof force plate for one minute per trial on land and in water; participants completed testing with their eyes open or closed in random order over 10 trials. Individuals' perceptions of their standing balance were obtained. COP and trunk acceleration parameters were analyzed in the time-domain.

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Aquatic therapies are used to restore step initiation in people with locomotor disabilities. However, there is lack of evidence of underlining mechanisms of gait initiation in water. We investigated center of pressure (CoP), vertical and anterior-posterior impulse forces, and kinematics of the first step performed in water in comparison with overground walking. The peaks of anticipatory postural adjustment (APA) and the sections of CoP trajectories were longer in water than on land. Impulse forces were increased in water compared with land. Range of motion (ROM) of ankle joint increased in water while knee joint ROM did not change. We suggest that the aquatic environment may facilitate gait initiation training by allowing a longer step execution with greater stimuli and imposed resistance for the phases of gait initiation.

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