Title : Skilled aquatic interventions for improving upper extremity function in those with adult-onset neurological conditions—A scoping review
Abstract:
Evidence-based clinical interventions and outcomes are necessary to support skilled Aquatic Therapy (AT) for individuals with adult-onset neurological conditions, and there is a paucity of research supporting Upper Extremity (UE) performance. We conducted CINAHL, Medline, Embase, Scopus, SportDiscus, and Google Scholar searches without language or year limitations using the following terms: Occupational Therapy (OT) or rehab AND aquatic or water or pool therapies AND upper extremities (arm, elbow, hand, wrist, etc.) AND post neuro events (stroke, seizure, brain injuries, etc.). Steps to ensure trustworthiness included an agreed upon pilot screening process successfully trialled by three team members, independent screens conducted by two screeners, and all “tie” decisions determined by a third, objective team member. Our team conducted a scoping review following a multi-stage screening process. After removal of 3 duplicates, 106 records were screened, yielding 17 full-text articles assessed for eligibility. Four reports were excluded (1 duplicate; 3 lacking relevant upper extremity outcomes), and 1 additional reference was identified through secondary manual review, resulting in 13 studies included in the final scoping review. Across neurological populations including Multiple Sclerosis (MS), stroke, Acquired Brain Injury (ABI), and Parkinson’s Disease (PD), AT showed positive effects on UE performance as measured by upper extremity or grip strength, dexterity, hand function, or Activities of Daily Living (ADL) participation.
Interventions commonly incorporated Ai-Chi, Halliwick methods, aerobic and strengthening exercises, swimming, balance activities, and task-oriented movement in warm-water environments over 5–12 weeks. Several studies reported statistically significant improvements in grip strength, shoulder strength, dexterity (e.g., 9-Hole Peg Test), upper extremity power, and ADL performance following skilled aquatic intervention, even when interventions were not directly targeting fine motor skills. Evidence base was limited by small sample sizes, heterogeneous intervention protocols, short study durations, and a lack of high-quality randomized controlled trials focused specifically on upper extremity functional outcomes. This scoping review advances understanding of AT’s impact on UE functional recovery within physical rehabilitation. By examining AT approaches across neurological populations—including intervention types, intensity, duration, and functional outcomes—the review supports interprofessional collaboration in identifying evidence-informed strategies to promote UE participation and performance. The findings also highlight the limited availability of high-quality research focused on skilled AT for UE recovery, underscoring the need for further research in this area.
