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Professional specialists' perceptions of the benefits of water activity for children with disabilities

ProQuest Dissertations and Theses, 2011
Dissertation
Author: Patricia Lee Schellbach
Abstract:
This study presents the findings of 20 participants in two rounds of interview questions to determine their perceptions of the benefits of water activity for children with disabilities. Water activity (a) utilizes varying water temperatures, (b) utilizes specialists having a broad range of backgrounds, (c) provides in a way that land activity cannot provide, (d) accomplishes a fuller sense of physical and psychological health, and (f) includes a unique dimension of healing or wholeness. Current educational and financial policies, as well as contraindications or disadvantages, utilize but also constrain the full use of water activity for the disabled child. The current research data greatly informs how children with disabilities benefit from water activity. The findings, from carefully compiled and analyzed data, bring realistic promise about the benefits of water activity for children with disabilities.

TABLE OF CONTENTS Dedication m Acknowledgments iv Abstract v List of Tables xiv Chapter Page 1 Introduction 1 The Research Problem 1 The Purpose Statement 2 The Research Question and Sub-Questions 3 Significance of the Study 4 Definition of Terms 5 Definitions within a Water Environment 5 Definitions within Educational Policy 6 Related Laws Affecting Educational Policy 11 Summary 13 2 Literature Review 15 Documentation of the Literature Search 16 Background on Water Activity 19 A General Definition 19 VI

Chapter Page Historical Background 22 The Need for Evidence-based Research 23 The Physiological Benefits of Water 25 Beneficial Properties of Water 25 Beneficial Characteristics of Water Activity 29 Water Activity Precautions 38 The Psychological Benefits of Water 40 Weil-Being through Water Activity 40 Particular Disabilities Dealing with Water Activity 45 Weil-Known Disabilities 45 Lesser-Known Disabilities 48 A Systematic Approach of Care toward Several Disabilities 49 Formal Research Studies on Water Activity 50 Two Research Studies on Water Activity and Autism 50 Two Research Studies on Water Activity, Visual-Motor, and Emotional Difficulties 53 Two Research Studies on Water Activity Done by Physical Therapists 55 Two Research Articles on Water Activity and Children with Other Disabilities 57 Two Studies Evaluating School Programs for Disabled Students 59 Two Further Research Studies Involving Water Activity 61 Understanding the Role of Special Education and Water Activity 64 vn

er Page John's Story 65 The Dilemma of Cost 67 Summary 70 The Vacuum this Study Addresses 72 3 Methodology 73 Research Approach 74 Qualitative Interview 74 The Researcher's Background 75 Reasons for Interest and Relevant Background 75 Bias and Strategies to Counteract Their Influence 76 Participants 77 Selection Process 77 Data Sources 79 The Demographics of the Professional Specialists 79 Recruitment Procedures 79 Interview Protocol 80 Researcher's Log 80 Ethical Procedures 80 Real Names and Places Changed 80 Consent Form 81 Security Procedures Regarding Data 81 Data-Gathering Procedures 82 Vl l l

Chapter Page Settings 82 Time Line 83 Data Analysis 84 Qualitative Interview Approach 84 Summary 86 4 Findings 87 The Research Questions and the Interview Protocol 87 First Iteration of Codes and/or Surface Content Analysis 90 Second Iteration of Theme and Pattern Variables 91 Research Question One and Corresponding Codes 91 Code 1 Who the Participants Were 93 Code 2 A Variety of Needs are Met 99 Code 3 Physical Benefits 103 Code 4 The Physical and Psychological Together 113 Code 5 Water Activity Provides Normalization 115 Code 6 Water Activity Provides Lifetime Leisure and Recreation 117 Code 7 Water Activity as a Preferred Activity 120 Code 8 Water Activity Provides Bonding, Trust, and/or Rapport 121 Code 9 Water Activity Provides Play Benefits 123 Code 10 Water Activity Provides Persistence in Working with Fearful Children 126 Code 11 Water as a Different Medium of Engagement 130 IX

Chapter Page Code 12 Water Activity and Safety Concerns 134 Code 13 Disadvantages and Contraindications of Water Activity 137 Research Question Two and Corresponding Codes 140 Code 14 Water Activity and the Children's Affect 141 Code 15 Water Activity and the Children's Behavior 143 Code 16 Water Activity and the Children's Activity Level 146 Code 17 Water Activity and the Children's Compliance with Adults 148 Code 18 Water Activity and the Children's Focus on Academic Learning 150 Code 19 Water Activity and Students' Communication Efforts 153 Code 20 Water Activity and the Children's Social Interactions 156 Research Question Three and Corresponding Codes 159 Code 21 Water Activity and Educational Policy 159 Code 22 Water Activity and Financial Policy 163 Second Iteration of Theme and Pattern Variables 167 5 Discussion of Findings 169 Introduction 169 First Theme Water Activity Provided by Professionals and Para-Professionals with a Variety of Training Benefit Children with Disabilities 169 Discussion of First Theme 170 Implications of the First Theme 173 Comparison with the Literature Review 174

Page Second Theme Water Activity Provides a Variety of Physical Benefits for Children with Disabilities 175 Discussion of the Second Theme 175 Implications of the Second Theme 179 Comparison with the Literature Review 182 Third Theme Water Activity Provides a Variety of Psychological Benefits for Children with Disabilities 183 Discussion of the Third Theme 183 Enhanced Intra-personal Relationships from Water Activity 189 Discussion of Enhanced Intra-Personal Relationships 189 Implications of the Third Theme 190 Comparison with the Literature Review 194 Fourth Theme Water Activity Provides a Different Medium of Engagement than Land Activity for Children with Disabilities 196 Discussion of Fourth Theme 196 Implications of the Fourth Theme 199 Comparison of the Literature Review 200 Fifth Theme Water Activity May Not Necessarily Benefit All Children with Disabilities 201 Discussion of the Fifth Theme 201 Comparison with the Literature Review 203 Implications of the Fifth Theme 205 XI

Chapter Page Sixth Theme Water Activity Provides Administrative and Financial Hurdles for Children with Disabilities 206 Discussion of the Sixth Theme 206 Implications of the Sixth Theme 208 Comparison with the Literature Review 209 Unexpected Findings 210 The Participants Persevered with Fearful Children 210 The Participants Were Wary of Drowning 211 Water Properties Provide Healing 211 The Participants Often Used Play 211 Water Provided Another Avenue of Communication 212 The Participants Worked around Educational and Financial Policies 212 Third Iteration as Application to Data Set 213 6 Conclusions, Implications, and Recommendations 214 Significance of the Study 214 Limitations of this Study 215 Overall Implications of this Study 216 The Qualitative Research Yielded Three Informed Motifs 216 Recommendations 221 Final Thoughts 222 References 224 xn

Appendix Page A Professional Specialist's Interview Protocol 231 B Professional Specialist's Informed Consent 242 xm

LIST OF TABLES Table 1 Research Questions in Relation to Interview Questions 89 Table 2 The First Iteration of Codes Corresponding to Each Research Question 92 Table 3 Demographics of the Participants 101 Table 4 Each Theme and its Corresponding Codes 168 xiv

CHAPTER 1 INTRODUCTION This study used a qualitative interview approach to investigate the perceptions of 20 professional specialists who work with disabled children in the water about the intended benefits or outcomes of various water activities for these children This study also explored these specialists' perceptions about the intended benefits or outcomes of various water activities on these children's affect, behavior, activity level, compliance with adults, focus on academic learning, communication efforts, and social interactions Finally, this study explored the opinions of these professional specialists about the role of external forces, such as educational policy and finances on the implementation of water activities for disabled children The Research Problem The research problem was three-fold (a) Little formal research was available about the perceptions of professional specialists, a category that includes the educator, the water therapist, the adaptive physical education teacher, the occupational therapist, physical therapist, recreational therapist, or other such qualified personnel, on the intended benefits or outcomes of various water activities for disabled children (b) A second problem was that little formal research had been done to find out about these professional specialists' perceptions about the intended outcomes or benefits of water activities on these children's affect, behavior, activity level, compliance with adults, 1

focus on academic learning, communication efforts, and social interactions (c) A third problem was that little research existed about the opinions of these water professionals about how external forces, such as educational policy and finances, impact the implementation of water activities The lack of research in all three of these areas of formal inquiry was a problem because the perceptions and opinions of these professional specialists can be valuable in therapy decisions and future research endeavors Research has shown that various water activities appear to be a valuable way to assist disabled children Research on actual outcomes of water activities have been published, but also appear to be limited The actual administering of water activities by professional specialists who work with disabled children also seems to be a scattered event and not widely practiced The Purpose Statement The purpose of this study was to better understand the perceptions and opinions of professional specialists in terms of the intended benefits and outcomes of various water activities to disabled children These specialists included educators, water therapists, adaptive physical education teachers, occupational therapists, physical therapists, recreational therapists, or other such qualified personnel who work with disabled children in a water environment Within these 20 interviews, I hoped to also gain more information about these professional specialists' opinions about the intended outcomes or benefits of various water activities on these children's affect, behavior, activity level, compliance with adults, focus on academic learning, communication efforts, and social interactions I also hoped to gather their opinions of how external forces, such as educational policy and finances, impact the implementation of water activities 2

These three closely related purposes remain relevant to both regular and special education venues because little research appears to have been conducted on understanding the perceptions and opinions of these professional specialists on the intended benefits or outcomes of water activities for the disabled population In researching these areas, I hoped that a better understanding of how various water activities as administered by professional specialists serve disabled children's needs I also hoped that this study would benefit disabled children by providing research-based findings to better guide professionals and parents in their therapy decisions The Research Question and Sub-Questions Three research questions were put forward in this qualitative study (a) What are the intended benefits or outcomes of water activity as perceived by professional specialists, including the water therapist, adaptive physical education teacher, occupational therapist, physical therapist, recreational therapist, or other such qualified personnel, as administered by these professionals to disabled children9 (b) What are these same professionals' opinions about the intended outcomes or benefits on these children's affect, behavior, activity level, compliance with adults, focus on academic learning, communication efforts, and social interactions in receiving various water activities7 (c) What are the opinions of these professional specialists on how external forces, such as educational policy and finances, Impact the implementation of water activity9 3

Significance of the Study An important aspect of this proposed research was to discover if outcomes and benefits of water activity were limited to the physical aspects of development, or if they extended to the psychological and social development of a child as well Thus, it was hoped that the proposed research provided an additional avenue in explonng the intended benefits and outcomes of water activity as seen from the vantage point of professional specialists who had some type of experience and background in working with disabled children in the water in various ways The research design of interviewing professional specialists about the intended benefits or outcomes of various water activities does not appear to have been adequately researched or discussed in the literature In terms of the perceptions of professionals about the outcomes or benefits of various water activities for disabled children, one example may be that an adaptive physical education therapist's outcome for a disabled child receiving water activity may be for a child "to have fun " A recreational therapist's goal may be for the child "to participate in games and sports " A water therapist's goal for that child may be "increased range of motion or increased strength " The same water activity may have various outcomes for various professional therapists Finding out the various outcomes of the same and various water activities from different professionals should have proven to be informative Not only understanding concrete goals but understanding nuances of these professional specialists about water activity should also have been informative Perhaps an intended benefit or outcome of water activity for a disabled child may have been the building of greater trust, further nurturing, or greater bonding which helps the child not 4

only the in the pool but also in the classroom as well as the home Perhaps the professional specialist believes that an outcome or benefit of water activity for the disabled child is to expenence greater laughter and joy or further calm and quiet Perhaps a professional specialist may also question the benefits or outcomes of continuing the use of a certain water activity, or the water environment altogether, and may discontinue the activity or change it, or discontinue the water environment altogether, for a child, for example, who has become increasingly fearful after receiving water activity Generally, physical education philosophy includes those activities which provide development in cognition, physical or psych-motor development, as well as affective development within children's lives The more we know about the perceptions and opinions of professional specialists about the intended benefits or outcomes of various water activities for disabled children, the more informed the public and future researchers should be Thus, this research study should have given greater direction in further research possibilities Definition of Terms Definitions within a Water Environment Professional specialists This included those educators, water therapists, adaptive physical education teachers, occupational therapists, physical therapists, recreational therapists, and other such qualified personnel who worked with disabled children in the water with various water activities Water activity This included the spectrum of various types of water activities that a professional specialist may have utilized in the water, including any water activities, water exercise, water therapy, swimming, floating, water games and sports, and 5

the addition and use of selected flotation, assistive, or water devices that would lead to intended benefits or outcomes for disabled children Water exercise This included any exercises done in the water with usually a certain regimented routine, frequency, duration, and length of time involved that lead to intended benefits or outcomes for disabled children Water therapy Skinner and Thomson (2008) defined water therapy as "the use of properties of water for the therapeutic benefit of people of all ages and abilities" (p 76), and for this current research was meant to include any water therapy event that lead to intended benefits or outcomes for disabled children These authors did not define what therapeutic meant, and thus, the exact nature of what is meant by water therapy is part of the exploration of this current research project Swimming Dictionary com defined the term swim as the ability "to move m water by movements of the limbs, fins, tail, etc " (retrieved 8/12/08) Swimming is the ability of children to move from point A to B in a body of water which leads to intended benefits or outcomes for disabled children Water games and sports Those events in the water that follow certain prescribed routines or rules that lead to intended benefits or outcomes for disabled children Definitions within Educational Policy Disabled children Those children who are mildly to severely disabled and who may or may not have an Individual Education Plan (IEP) or specialized service plan, and who are able to receive various water activities from a professional specialist who works with these children in the water 6

Inclusion Generally speaking, inclusion allows special needs children to remain in the general education population with special education services being brought to them The Wisconsin Education Association Council (2007) defined inclusion as "bringing support services to the child and requires only that the child will benefit from being in the class" (p 1) Full Inclusion The Wisconsin Education Association Council (2007) also defined full inclusion as all students being located in a regular education classroom "regardless of handicapping condition or severity" and that "services must be taken to the child "(p 2) Mainstreaming Mainstreaming allows special education children to be brought into the regular education population to be able to participate in the regular education curriculum The Wisconsin Education Association Council (2007) defined mainstreaming as students brought in the regular education classroom "demonstrating an ability to 'keep up' with the work for the regular classroom teacher" (p 1-2) PL 94-142 Several laws protect the rights of disabled children and a major one is the federal Education for All-Handicapped Children Act of 1975, or Public Law (PL) 94- 142 Reliable sources (e g , Lepore, Gayle, & Stevens, 2007) summed up this law this way It "ensures a free and appropriate public education in the least restrictive environment, including special education and related services, for all handicapped children aged 3 to 21 years" (p 330) IDEA. PL 94-142 is now commonly known as IDEA, or the Individuals with Disabilities Education Act Lepore et al (2007) described IDEA as PL 101-476, which was an amendment to the original PL 94-142, so that transition plans would be put into 7

place for those children 14 years and older to help transition them into life after public school It also added other disabilities to be served under special education (p 331) FAPE. Free and Appropriate Public Education (FAPE) is the right of every student, whether in regular education or special education, and this concept is intertwined within the policies and concepts of IDEA, Least Restrictive Environment (LRE), mainstreaming, and inclusion LRE Students assigned to special education services should be assigned to their Least Restrictive Environment, or LRE LRE is a very important theory and concept It is a theory which is supposed to protect and meet the needs of the child in the least restrictive environment, which usually means as close to a regular education environment as possible (Lepore et al 2007, p 331) However, LRE becomes easily contested and debated because the needs of special education children - which can be varied, complicated, or unclear - may collide with how LRE is interpreted To hold a child's particular needs in balance with LRE appears to not always be an easy task The federal special education laws contained within PL 94-142 along with IDEA and all of its cumulative amendments make provision to serve a child in his or her Least Restrictive Environment (LRE) The concept of LRE is supposed to allow the child to be in as close a regular education environment as possible, while at the same time meets the particular needs of the special education student Several sources (e g Constable, Massat, McDonald, and Flynn, 2006), provided the federal definition of LRE To the maximum extent appropriate, children with disabilities are educated with children who are nondisabled, and that special classes, separate schooling, or other removal of children with disabilities from the regular education environment occurs only if the nature or severity of the disability is such that education in regular classes with the use of supplementary aids and services cannot be achieved satisfactorily (20 U S S 1412 [a] [5] [A]) (p 182) 8

Thus, it appears that the legal definition of LRE allows flexibility of placement, particularly for children with severe disabilities Constable et al (2006) continued to report that "the term inclusion is not to be found anywhere in the IDEA legal mandate" (p 183) Constable et al continued to emphasize that LRE "merely requires that to the maximum extent appropriate, children with disabilities should be educated with children without disabilities" (p 183) IEP. Lepore et al (2007) also discussed the Individualized Education Program, known as the IEP, which all special education children are required to have if they are in special education programs However, a pre-school-aged disabled child may alternately have an Individual Family Service Plan (IFSP) due to his or her young age and dependence on the family, rather than an IEP, which is for school-aged children They also stated that infants and children with disabilities "may seek community aquatics programs as appropriate motor activities for young children" (p 11) Individualized Transition Plan Lepore et al (2007) stated that as a student under an IEP transitions between programs from infancy or into high school, he or she must also be provided with an Individualized Transition Plan (ITP), Water therapy or other water activities, such as swimming, may turn into a recreational activity for the rest of one's life for some disabled persons and the ITP can prepare a disabled person for such activities Lepore et al observed that water instructors may be very helpful in forming a transition plan that includes aquatics for those disabled persons who are transitioning, particularly as they end high school Lepore et al commented "After all, what better lifetime pursuit is there than aquatics9" (p 11) 9

Definition of special education Lepore et al (2007) discussed how IDEA under PL-101-476 defines special education "Instruction that is specially designed, at no cost to the parent, to meet the unique needs of a child with disability, including classroom instruction, instruction in physical education, home instruction, and instruction in hospitals" (p 263) The Special Olympics Swimming and Diving Sports Skills Instructional Program (1981) observed that in Section 121 24 of PL 94-142 for Special Olympics that "the term 'special education' means specifically designed instruction, at no cost to the parent, to meet the unique needs of a handicapped child, including classroom instruction, instruction in physical education, home instruction, and instruction in hospitals and institutions" (p 3) Special Olympics also noted that the exclusive course which was listed to serve the disabled was "physical education," which suggests its importance for the handicapped to receive (p 3) Definition of physical education Interestingly, the only specific subject presented m the definition of special education was physical education The U S Federal Register (as cited in Lepore et al 2007) defines physical education as "(1) the development of (A) physical and motor fitness, (B) fundamental motor skills and patterns, and (C) instruction in aquatics, dance, individual and group games, and sports (including intramural and lifetime sports)" (p 11) The definition of physical education was also supported by such sources as PL 94-142 It's the Law (1978) Lepore et al discussed how "aquatics programming should be a priority in formal education and thus in special education" (p 263) Shernll (as cited in Martinez, 2006) indicated that IDEA supports aquatic exercise for children with disabilities 10

The Special Olympics Swimming and Diving Sports Skills Instructional Program (1981) also made a very interesting observation that water, or aquatic activities have been considered important enough to be contained in the definition of "physical education," particularly for those special education students who may benefit from its presence within their physical education program (p 3) It is very salient that the appearance of water activities was important enough to be considered in the definition of "physical education " This implies that disabled students may benefit from water activities within their physical education program Related Laws Affecting Educational Policy Current laws appear to also cover a persons' right to access water activities in one way or another, such as being able to get into the water, and being able to enjoy the benefits of water within different facilities, such as a school setting There are many federal laws also protecting the rights of disabled persons to water activity and disabled children Architectural Barriers Act (ABA). Lepore et al (2007) discussed the Architectural Barriers Act (ABA) passed by Congress in 1968 This law directed federal structures "to be accessible if they were designed, built, or altered with certain federal funds or if they were leased for occupancy by federal agencies" (p 10) Many schools and community agencies receive funding from the federal government and one can appreciate the impact this law may have through the placement of elevators, wheelchair ramps, and handicapped accessible bathrooms in many public facilities Section 504 of the 1973 Rehabilitation Act. Another law which has protected the rights of the disabled is Section 504 of the Rehabilitation Act of 1973 Lepore et al 11

(2007) observed that this law expanded the ABA law to require that all projects accepting federal funds must provide access for the handicapped person This meant that the U S Architectural and Transportation Barriers Compliance Board had to form rules of access Lepore et al observed Many services became available for the first time to people with disabilities For example, federally funded organizations made parking spaces, bathrooms, university classrooms, government offices, and recreational facilities accessible Specific to aquatics all federally funded facilities had to make their pools accessible through such means as hydraulic lifts or sloped entries (p 10) Section 504 of the 1973 Rehabilitation Act also affects federally funded schools If a child has a disability which is severely impacting a life function, often defined through a medical diagnosis, whether short-term or long-term, that child then has rights to those accommodations or modifications which allow him or her access to education so that child is not discriminated against For instance, if a child has a short-term medical condition such as a broken leg and needs to use a wheelchair, the classroom must be wheelchair-accessible for that student, through provision of a ramp or other device for accessibility The child must also be given the time to get to class without penalty If a child has a long-term condition of ADHD, asthma, diabetes, or another type of condition that is severely impacting the life or educational functioning of that child, this child can be protected under a 504 Plan so he or she is not discriminated against in receiving his or her rights to a free and appropriate public education (FAPE) Potentially, there may be cases of students who may need to be protected by a 504 Plan if they have been accessing water services, or need to access water services as part of their routine or treatment ADA. Lepore et al (2007) also discussed the Americans with Disabilities Act, or ADA, or PL 101-336 as passed back in 1990 (p 12) This federal law attempts to outlaw 12

any inequities for those who may be handicapped Complimenting the Rehabilitation Act of 1973, Lepore et al observed that this law "covers employment, public services, transportation, public accommodations, services of private entities, telecommunications, and activities of the state and local governments" (p 12) It is within ADA's Title III that impacts water activity the most Cohen (2001) discussed the rules and regulations of the ADA when it comes to making water environments accessible to the handicapped, such as those in wheelchairs In terms of water he reported Where should you start in order to comply with the ADA9 The minimum requirement for a swimming pool includes the availability of at least one accessible means of getting in and out of the pool, either by ramp, stairs or lifts If only one means of water entry and exit is available, a lift, ramp, or zero-depth entry point is required Stairs and ramps should feature appropriate width and riser height, be covered with a non-slip surface and be set at an appropriate depth (P 84) A comprehensive and complex system of federal laws appears to thoroughly protect disabled children, and has allowed them to access and to thus better appreciate the benefits of water activity Particular state and local laws or codes also combine with federal laws to ensure the enforcement of rights for the disabled However, in appreciation of the vanous disabilities which may benefit from water activity in the K through 12 school system, my discussion below is presented to better understand how cost may complicate yet also broaden the issue of fulfilling all the federal laws and concepts just discussed Summary The opinions of professional specialists who work with disabled children in the water were not well known and needed to be further explored and analyzed in a formal study This chapter presented the research questions, the problem they addressed, the 13

Full document contains 261 pages
Abstract: This study presents the findings of 20 participants in two rounds of interview questions to determine their perceptions of the benefits of water activity for children with disabilities. Water activity (a) utilizes varying water temperatures, (b) utilizes specialists having a broad range of backgrounds, (c) provides in a way that land activity cannot provide, (d) accomplishes a fuller sense of physical and psychological health, and (f) includes a unique dimension of healing or wholeness. Current educational and financial policies, as well as contraindications or disadvantages, utilize but also constrain the full use of water activity for the disabled child. The current research data greatly informs how children with disabilities benefit from water activity. The findings, from carefully compiled and analyzed data, bring realistic promise about the benefits of water activity for children with disabilities.