What is 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 treatment in a heated therapy pool.
When we found out we were going to have a hydrotherapy pool in our new build at Sandside lodge school, everyone from the staff, parents and pupils were extremely excited and thankful that we were going to be able to offer this facility to our amazing pupils.
A group of staff were trained to a high standard, including pool safety and hygiene, pool maintenance, as well as aquatic and rescue techniques which created our aquatic therapy team. We worked with various other professionals in order to get our pool up and running to become the fantastic facility it is today.
Since our new hydrotherapy pool has been open for use, the impact on our pupils and young people has been phenomenal. It has been a pleasure to be part of setting up this facility for our school. First and foremost, it’s enjoyable and fun! This has had an immediate positive impact on their psychological wellbeing, with all the pupils looking forward and excited for their sessions in the pool.
Some of our pupils have never been able to use a pool or had to stop sessions due to our local hospital hydrotherapy pool being closed and running out of funding to facilitate this. However, are now enjoying regular sessions and experiencing the freedom of movement in the pool – whereas on dry land their movements are extremely limited. Also being able to move in the water improves their general physical stamina and lung function, which has a massive positive impact on their health.
All pupils and young people who are using the Aquatic therapy pool have benefitted:
- Pupils who are normally in their seating systems in their wheelchair or various supportive equipment for a lot of the day can experience freedom of movement in the pool.
- Others who don’t move much on dry land become active and really enjoy moving round the pool and has improved their independence as well as developing their functional mobility.
- Pupils who have very limited movement and struggle to communicate when on dry land are able to vocalise or move their arms to indicate preferences whilst in the water. We use a number of symbols and sign language in the water to aid with their communication.
- Passive physiotherapy programmes can be difficult to tolerate on dry land but in the water the pupils with tight painful muscles and joints are much happier when their muscle stretches are incorporated into a fun or relaxing time in the pool.
- Pupils who access the water for multi-sensory use and sensory overload are now starting to see its calming effects on their well-being.
Aquatic Lead teacher
10 benefits to aquatic therapy
Warm water facilitates muscle relaxation and increases circulation.
Water buoyancy lessons the pressure on muscles and joints, assists with movement and reduces swelling caused by gravity.
Warm water stimulates body awareness, balance and trunk stability.
The reduction of gravitational forces in the pool allows the student to stand and start to weight bear to increase strength and mobility.
Warm water and buoyancy results in decreased pain sensitivity and helps to loosen tight joints and muscles and increase flexibility.
Improvement of student’s confidence and morale can be established by providing a positive medium in which to move and function.
The water provides a working environment of less pain and muscle stress, which reduces symptoms and increases the body’s ability to do exercise and functional activities, they would find difficult on land.
Multi-sensory environment helps stimulate the senses whilst calming children with sensory and learning difficulties.
Movement in the water and water pressure helps to reduce residual lung capacity for children and young people with chest problems. This enables more efficient lung function and reduces the risk of chest infections developing.
Creating turbulence around an arm or leg can increase awareness of a limb and improve mobility both in water and later on dry land.
The hydrotherapy pool is a great facility for many of the pupils at SSL. For those with limited movement abilities it provides the opportunity for stretching and relaxing in a warm environment. The effects of buoyancy enable pupils who struggle to move independently on land to experience how they can use their body movements to move around the pool. This active movement promotes development of fitness, improved circulation and overall well-being.
For those with more active movement we develop programmes to help increase their confidence and independence in the water so they can learn to be safe in this environment whilst exercising and having fun – a great skill for life! They are encouraged to take ownership of their programme and be responsible for their own routine.
The pool at SSL has great changing facilities and is accessible for all pupils. Sessions are planned carefully to ensure pupil’s needs are met on an individual level with specific goals to work towards and skills to develop. Pupils can work together in small groups in the pool, socialising and having fun whilst doing their exercises and activities.
Highly specialist children’s Physiotherapist
We have worked alongside the pupils, parents, and other professionals when assessing and establishing the pupils own unique aquatic therapy plan.
Each plan offers unique need to know information for that pupil, on access to the pool, medical information, equipment needed and a tailor made, step by step aquatic techniques to use in the pool. Their personal plan is taken to poolside and kept with them at all times and is a working document, that is frequently adapted as the pupil’s needs change.
If a pupil is on our MOVE program in school, their plan will incorporate their personal MOVE targets and feeds back to their personal progress.
Equipment we use
We use a wide range of specialized equipment in the pool, recommended by physiotherapists to support the pupils to be as independent as they can. Sometimes the pupils will be able to work towards floating on their own for the first time without being held. This is an amazing feeling and achievement for them.
Our Swimming including Aquatic Therapy Policy
The guidance contained in this policy is based on the HSE document Managing Health and Safety in Swimming Pools. It also takes into account as a pool operator The Management of Health and Safety at Work Regulations 1999, which articulates that an assessment of the risks which may affect employees, and others, as a result of the activity, must be carried out. Everyone involved in the provision of swimming is made aware of all guidelines and procedures to ensure the safe and effective use of pool facilities at all times. It is a requirement that all staff and service users in the school who take students swimming must read a copy of this policy and adhere to its content.
Students use this facility for access to shallow pool areas which meet the needs of our younger learners. A lifeguard is in attendance, as is a qualified swimming teacher, who provides advice and guidance. Sessions are managed by the Group Leader with the focus on water awareness and confidence.
Students use this facility to meet the needs of our older students. A lifeguard is in attendance, as is a qualified swimming teacher, who provides advice and guidance. Sessions are staff led with the focus on teaching students to swim.
Sandside Lodge Aquatic Therapy Pool
Our pool is used to meet students’ therapeutic needs and maintain their wellbeing. We aim to provide:
- opportunities for students to explore their environment and develop confidence in the water;
- opportunities for freedom of movement, balance, weight-bearing and coordination;
- physiotherapy routines, circulation exercises and toleration of touch;
- the development of communication skills and a safe environment for fun and relaxation;
- access to learning through sensory programmes in the pool.
Pools visited during residential or day visits.
Students may access swimming pools and hydrotherapy pools during a residential stay. These sessions will be led by the group leader in conjunction with the centre staff and will be accessed for enjoyment purposes.
Swim Safe is delivered in Lake Windermere by RNLI lifeguards, qualified instructors and volunteers. Students learn where is safe to swim, how to float, what to do if something goes wrong and how to call for help if someone else is in trouble. Swim safe sessions, organised by Swim England and the RNLI teach important open water safety skills that students won’t learn in a swimming pool. Our students access these hour-long sessions in the summer term.
It is the responsibility of the group leader to carry out a thorough risk assessment prior to any swimming activities. This risk assessment should follow the procedures adopted by Sandside Lodge School that are overseen by the Education Visits Coordinator (EVC). The risk assessment must consider, in addition to the risk associated with a water based activity, the risks posed by medical, behavioural and physical needs of the students involved in the activity.
The risk assessment must detail how staffing ensures that this policy is followed and include detailing of staffing.
Any changes to the risk assessment that are required at short notice must be documented on the Evolve form and signed off by the EVC or a member of the senior management team.
Sessions will not take place if appropriate staffing levels are not in place.
Male, female and gender-neutral students will be given privacy and appropriate places in which to change and shower.
Staff of the same sex may not always be available to support and help students to shower and change. Permissions will be sought from parents and carers if this is the case.
If costumes are modified for religious or cultural reasons, eg. Covering arms and legs, they must be tight fitting to prevent becoming waterlogged.
Staff supporting students during swimming activities should always wear a t-shirt.
Roles, Responsibilities and Ratios
All staff have a duty of care that operates for any activity in which students are involved; staff cannot transfer that duty of care to anyone else.
All staff members and volunteers are required to have an enhanced DBS certificate.
There must be a minimum of one member of staff on the premises trained in basic life support.
No-one is permitted to use the pool on their own.
Senior Manager – Provides staff direction about the conduct of aquatic therapy and ensures guidelines are followed, staff are trained appropriately, pool plans are in place, H&S and maintenance plans are followed and risk assessments are in place.
Lead Teaching Staff – Produce pool plans in conjunction with physiotherapist and other related professionals, timetabling, equipment, completing risk assessments.
Maintenance – trained to National Pool Plant Operators Certificate standard. Carry out pool tests prior to the pool being used and periodically throughout the day, as per Pool Water Treatment Advisory Group (PWTAG) recommended guidelines. Check the environment for defects and faults. Pool cleaning. Authority to close down the pool if not satisfied with the operation of the plant, quality of water and climatic control.
Group leader – Ensure students are appropriately supervised and current aquatic therapy and M&H plans are followed. Knowledge of emergency procedures. Ensure a spotter is in place whist using the pool. Ensure correct ratio of staff to students. Ensure students are under control at all times. Has set or is aware of the intent, implementation and impact of the pool session for each student. Check equipment before use, record temperature before use, ensure floor and steps are free of water, report any H&S hazards and defects in the pool, visual check of emergency equipment, trained in Aquatic Therapy. Overall responsibility for the session.
Staff users – Knowledge of emergency procedures. Knowledge of students plans. Have read and are familiar with the Swimming including Aquatic Therapy policy. Supervise students appropriately. Manage student behaviour.
Spotter – one spotter per session is required. The spotter is required to observe the session from the pool side and be aware of any situation which might compromise the session or cause any risk. This then needs to be reported to the group leader. They should be there as the first student enters the water and remain poolside until the last student leaves. The spotter needs to be able to move around the poolside to view from every angle. If an emergency occurs the spotter needs to be vigilant and alert the session lead. The spotter follows instructions from the lead. The spotter is aware of all risk assessments and behaviour plans.
- It is the responsibility of the group leader to have read and adhere to the Sandside Lodge Aquatic Therapy Risk Assessment (Appendix 1). All staff and students are covered within this document.
- All users with a M&H plan will have considerations listed on it.
- All sessions will have a completed Aquatic Session Plan including intent, implementation and outcomes, to include risks specific to the user.
- Individual user risks may include medical conditions eg. gastrostomy, tracheostomy or behavioural eg. Behaviour Support.
- All sessions will complete the pool session sheet (Appendix 2) clearly outlining the group leader, number of pool users and ensuring pool checks are complete prior to entering the pool.
- Volunteers should not be left alone in the pool with a student or in the changing room.
- Any pregnant staff should have a risk assessment to take into account their changed circumstances. A pool temperature of 31C and above is to be avoided during pregnancy.
- Shoes must be either removed or covered with plastic overshoes before entering the pool area, except in an emergency.
- Anyone using the pool must leave the area in a clean and tidy state.
- Wheelchairs and buggies should be left in the large assisted change.
- Any pool user must shower in water before use.
- Pool users must shower after use. Shower gels and soap are permitted at this time only.
- Faeces (solid) or vomit must be removed immediately, if possible, using the fine mesh net or scoop, and flushed down a nearby toilet. Staff must protect themselves with the appropriate protective clothing. The group leader will evacuate the pool and inform the site manager. The pool will be closed until appropriately treated. The net or scoop must be disinfected. Incidents must be recorded on the pool session sheet.
- Diarrhoea – bathers must leave the pool immediately and the pool closed for at least six complete turnovers (at least the remainder of the day). Incidents must be recorded on the pool session sheet.
- All incontinent users of the pool must wear appropriate protective clothing to prevent pollution of the water.
- Any user with an open wound should have the wound covered and sealed. In the case of a student parental permission must be sought.
- Nobody with a known infection or disease should enter the pool area. Obvious reasons include, Impetigo, Ringworm, Lice, Scabies, unidentified skin rash, conjunctivitis, ear infections and urinary/bladder infections. This list is not exhaustive and medical advice should be sought if there are any concerns.
- Females who are menstruating should not go in the pool; this is dependent upon the hygiene products being used.
- If a student or staff has shown signs of being unwell beforehand, eg. Raised temperature, abnormally loose stools, vomiting, headaches or a streaming cold, they should not participate in a pool session.
- Students and staff should not wear jewellery when using the pool, with the exception of wedding bands.
- Students should be discouraged from deliberately drinking the pool water.
- Daily storage and laundering of student swim wear and towels belonging to school is the responsibility of class staff. Other personal swimwear will be sent home with the student at the end of the day.
- Where possible students should bring their own swimming kit from home, including specialist swim pants.
- Students and staff are encouraged to use the toilet before entering the pool.
- Any pool user with verruca’s and or athletes foot may not enter the pool or pool area without suitable foot cover/protection.
- Used slings must be dunked in the pool for 60 seconds and rinsed with cold shower water at the end of a session before being hung up to dry.
Security and safety
- The pool is kept locked when not in use, the key will be stored in the key safe.
- When in use the assisted change door leading out onto the corridor will be locked as well as the inner pool entrance door.
- The pool has capacity to hold up to 6 people (including students and staff) in one session.
- There will always be a minimum of one adult who has attended pool training pertinent to working within the pool and one adult who is qualified in first aid on the premises.
- All staff users must have read the swimming including Aquatic Therapy policy.
- The hoists must be used appropriately, manual handling plans should be adhered to at all times. Specialist slings should be used for all students; and after use they should be hung to dry ready for the next group. Staff must be M&H trained.
- Judgements on the length of time students and staff spend in the pool should be made taking into account the water temperature, air temperature, students medical condition and the effects of increased temperature on the circulatory system. No student should be in the water longer than 30 minutes during any session.
- No staff should be in the pool areas for longer than 1.5 hours without a 15 minute break.
- No one should spend more than 3 hours (in total) in the water on any one day.
- On very hot days staff should make the decision as to whether it is safe to use the pool, bearing in mind the temperature within the pool area.
- An adult will remain in the pool until all the students have left the water.
- If the water begins to become cloudy and the floor of the pool cannot be seen clearly, the site supervisor should be contacted immediately. A water test will be carried out and remedial action should be taken. Do not enter the pool and evacuate the pool immediately.
Service user assessment and screening
- Referrals for Aquatic Therapy will be made through the Senior Manager, Lead Teaching Staff and/or designated physiotherapist.
- All pool users will complete an Aquatic Therapy Screening Form prior to pool use.
- Screening forms should be returned by parents of all students accessing aquatic therapy to ensure consent is gained.
- Any staff using the pool are required to complete a screening form.
- Information should be requested from the appropriate medical agency e.g. consultant, where there is a change in the pool user’s heath status.
Emergency Procedures including evacuation
The pool is fitted with an emergency call button.
A mobile phone is situated in the assisted changing room.
Students medication will be stored securely in school and accessed from the pool if needed.
On hearing the fire alarm or flashing light:
- The spotter will use the pool phone to confirm the location of the fire.
- All bathers will remain in the pool unless told by staff to start the evacuation process.
- If informed of a fire drill by the senior leadership team, swimmers may remain in the pool.
- If confirmed as a fire and pool users are asked to evacuate they will do so using the fastest and safest method e.g. using the steps, hoist or doing an assisted lift onto the pool side.
- Depending on the location of the fire take steps to dry and clothe vulnerable students before going out to the muster point. Alternatively wrap pool users in a towel, space blanket or bathrobe.
- Make your way through the nearest fire exit.
- The spotter will sweep the pool and assisted changing areas before exiting the building.
This type of incident can be safely managed and is not life threatening, however, it may result in an amendment of a risk assessment. All such incidents should be reported via the appropriate accident/incident form and informing a member of the SMT.
Students may remain in the pool until advice from staff is sought. If the hoist is not fixed within 30 minutes from when the student first entered the pool an manual evacuation will take place. The pool phone will be used to call assistance from within school for additional staff to attend to support with this.
- If a student or staff in the water requires medical attention a member of staff in the water will ensure the safety of that person.
- The spotter will use the emergency call button and be responsible for calling the emergency services on the pool phone.
- Remove the casualty from the pool by the safest method, a minimum of two staff would need to be in the water and staff available on the side. The group leader will give instructions.
- If a student is having a seizure they must be monitored carefully and medication obtained immediately. Once over removed from the pool by the safest method. The students Health Care Plan should be followed.
- Carry out first aid procedures until help arrives.
- Towel dry the casualty and ensure they are kept warm.
- Ensure all other pool users are reassured and removed from the pool area.
- As a result of a serious incident a report must be submitted under Reporting of Incidents, Diseases and Dangerous occurrences Regulations 1009 (RIDDOR).
- During term time the site manager will carry out checks 3 times a day 5 days a week. In his absence, he will delegate this to the assistant site manager or staff lead.
- The group user will carry out water temperature checks each time the pool is used by a group.
- The premises cleaning team will be responsible for cleaning the pool at the end of the day (green mop and bucket stored in small assisted change).
- The site manager (or assistant site manager or staff lead teaching staff in his absence) will be responsible for disinfecting the scoop or net used for the removal for faeces or vomit.
- The pool water temperature is maintained within the ranges as directed in the pool operating guidelines.
- The ambient temperature in the pool is maintained within the ranges as directed in the pool operating guidelines.
- The pool water is treated with a disinfectant agent maintained at a level which protects bathers form pathogens.
- Disinfectant levels are maintained within the ranges as directed in the pool operating guidelines.
- The pool is disinfected with choline and ultraviolet.